Challenges Faced by Nurses in Implementing Evidence-Based Methods

Running head: CLINICAL QUESTION 1
Challenges faced by nurses in the implementation of evidence-based methods Clinical situations
Student’s Name
University

CLINICAL QUESTION 2
Table of Contents
Outline of Clinical Issue..................................................................................................................3
Clinical question..............................................................................................................................3
Evidence search...............................................................................................................................4
Literature Synthesis of Best Evidence.............................................................................................5
Recommendations for practice change and research.......................................................................7
Conclusion.......................................................................................................................................9
References......................................................................................................................................10
APPENDIX A: 1PRISMA diagram...............................................................................................11
Appendix B: summary table..........................................................................................................12
Appendix c: Links to five best evidence sources...........................................................................17
Appendix D: Critical appraisal of highest level of evidence.........................................................18

CLINICAL QUESTION 3
Challenges faced by nurses in the implementation of evidence-based methods Clinical
situations
Outline of the clinical issue
Evidence-based methods entail the use of scientific evidence for decision making within
clinical settings. This means that nurses have to be guided by these sets of evidence that have
been adequately researched and proposed for use within clinical settings. This implies that
nursing practitioners must gather evidence, synthesis it and pick the one that reflects the patient
situations (Farley, et al., 2019). This means that the use of this approach works well when nurses
adopt a patient-centered approach that deals with the meeting the specific needs of the patient.
Titler (2018) adds that in this process the nurse combines personal clinical expertise in
combination with the most current and relevant research that exists on the topic. The goal is to
improve the health and safety of the patients while at the same time provide care that is cost-
effective and meets the needs of both the patient and the healthcare system. However, most
nurses are facing challenges in implementing this practice due to professional and system
difficulties
The rationale for selecting this topic is the fact that despite the existence of evidence-
based guidelines for nursing practice, there are cases of nursing malpractices, ethical issues and
even the failure to follow the required standards when dealing with patient-related issues. This
means that most clinical situations and nurses are not practicing the use of evidence based
methods in clinical situations because of different factors that shape their views. This implies
that most nurses are ignoring the evidence-based approach and only using their clinical expertise
which compromises the quality of life of the patient and at the same time increases the likelihood
of nursing errors. This study explores these challenges from different research studies to propose

CLINICAL QUESTION 4
ways of addressing them to improve clinical outcomes. This will reduce medical errors and the
challenges faced in the implementation of evidence-based approaches and lead to better
outcomes that arise from increased accountability of clinical professionals.
Clinical question
Burns & Chung, (2010) argues that when developing a clinical question for searching on the
databases, the PICO format is important in breaking down the question into searchable
components. .Clinical question: Challenges faced by nurses in the implementation of evidence-
based methods
Problem: Implementation of evidence-based practice
Intervention: Identify barriers/challenges for implementation
Comparison: none
Outcome: recommend ways of addressing barriers
The domain for this question is the need to identify challenges that nurses face in implementation
of evidence-based approaches so that ways of improving can be developed. This shows that the
challenge is evident in clinical nursing situations based from the fact that moist of them are
failing to implement the method due to challenges within clinical settings and thus pose
recommendations that can be used to improve clinical outcomes.
Evidence search
The search strategy will be based on searching for articles from relevant databases like
CINAHL, Cochrane databases, and the Medline and British Journal of Nursing. The focus for the
search strategy is research articles on the topic which have mainly been done using systematic
reviews of randomized control trials. Systematic reviews offer evidence based on a summary of
evidence about the research question which is synthesized to highlight implications for practice.

CLINICAL QUESTION 5
The nature of the selection of articles is justified allowing the reader to understand which studies
were selected and which ones were not. Since the selection focusses on high-quality studies
especially randomized controlled trials, systematic reviews have been regarded as offering the
highest level of evidence in research. On the other hand, randomized controlled trials entail the
use of two groups, one is the general group and the other one is the control group which allows
the researcher to compare the findings from the two groups to develop implications for practice.
The search terms were based on the use of the following terms, evidence-based practices, nurses,
challenges. To refine the search well the following order was used, challenges and nurses and
evidence-based methods. The search was for purely research articles from 2010-2019. The
exclusion in inclusion criteria was based on nurses in clinical situations. The initial search led to
300 papers and when the year of publication was sued to refine, 212 papers were found. The
refinement was further based on full-text English articles leading to 69 articles. When the studies
were further analyzed from their abstracts to determine their design whether they were relevant
to the research topic 21 articles were found. Lastly, the review of the design method led to eight
articles that were based on either systematic review of the randomized control trial, six articles
were found to be relevant to the study.
Literature Synthesis of Best Evidence
The biggest challenge in the implementation of evidence-based approaches is the
management of illness beliefs which lead to resistance of the medical interventions. Peters, et al.
(2011) study reported that some patients especially those with the log-term illness have
developed unquestionable authority that has developed due to their long-term experience in the
management of symptoms. This creates challenges for the nurse since it becomes difficult to
manage the needs of such patients by applying the evidence-based approach.

CLINICAL QUESTION 6
The environment within which nurses practice provides challenges that create tension in
the application of evidence-based approaches. This is because as the clinical environments
succumb to the challenges of limited resources, nurses are forced to manage heterogeneous
patient situations which makes it difficult to apply evidence-based approaches. This means that
there is a lack of organizational support for the nurses in the use of evidence-based approaches.
According to Shayan, Kiwanuka, & Nakaye (2019) study reported that even though the nurse
may be applying the evidence-based practice, some healthcare professionals are unsupportive
which creates the difficulty of implementing the approach. This can also be seen I organizational
barriers that create the inability of the nurse to implement the approach. This means that in an
organizational setting where the evidence-based approach is not applied, it becomes difficult to
implement this approach since it is seen as time-consuming.
Shayan, Kiwanuka, & Nakaye (2019) study also reported that nurse-led barriers existence
from the level of knowledge that nurses have in the implementation of the evidence-based
method. In most cases, there is a lack of translation of the evidence-based practices in care
delivery. This is due to the lack of implementation strategies that nurses can be used to promote
the practice. Studies have reported that there is a knowledge gap in the implementation of
various domains of EBP. In some situations, nurses had difficulties due to the lack of clear
guidelines for researching since in most cases nurses are not involved. Most nurses have quoted
the difficulty based on the lack of understanding of some terms that are used in research. This
knowledge gap exists due to the inability of those involved in the design in developing studies
that reflect the needs of practitioners. Ubbink, Guyatt, & Vermeulen (2013) study reported that
most nurses viewed themselves as lacking adequate EBP knowledge which compromised their
ability to implement evidence-based methods. This is because most studies do not use similar