Challenges and Strategies for Implementing Evidence Based Practice in an Emergency Department

Running head: EVIDENCE BASED PRACTICE
Evidence based practice
Name of the student:
Name of the University:
Author’s note

1EVIDENCE BASED PRACTICE
Part A: Essay
Evidence based practice (EBP) is the strategy to provide most effective care by looking at
the best available research studies related to the clinical issue and integrate them with patient
values and clinical decision making. In today’s health care environment, great emphasis is given
to EBP as it has been found to increase patient safety, enhance clinical outcome, decrease
variations in practice and reduce medical cost (Mackey & Bassendowski, 2017). In case of health
care staffs working in emergency department, emergency nurses and practitioners have to deal
with life and death situations. However, like other health care professionals, emergency
department staffs are expected to work in alignment with latest research advancement and follow
the steps of EBP (Lehane et al., 2019). Despite this, emergency staffs struggle to engage in EBP
because of various barriers and challenges in implementing EBP. This essay aims to explore the
challenges and barriers to implementing EBP in an emergency department and find out the
strategies to overcome barriers in such settings.
EBP is the integration of best research evidence with clinical expertise and patient value
to engage in effective clinical decision making and improve patient outcome. As it unifies
patient’s preference with clinical expertise, it promotes individualization of care. It involves
taking stepwise steps to formulate a clinical question and engaging in rigorous method of
searching best available evidence and implementing it in clinical practice (). Hence, systematic
and rigorous inquiry help health care professionals to produce the required knowledge and use
their clinical judgment and expertise to provide high quality care. As all clinical staffs have the
professional responsibility to provide high quality services, it highlights the necessity to
incorporate research evidence in decision making (Stevens, 2013). However, evidence of barrier
to widespread use of updated research studies remain in clinical setting and this is mainly

2EVIDENCE BASED PRACTICE
because of presence of various individual and organization barriers to research utilization (Black
et al., 2015). The following paragraphs of the essay will explore in details about the barriers and
challenges in implement EBP in emergency department.
The emergency department is a clinical setting or place of high activity where work flows
at a high pace. With the increase in the number of patients in need of emergency care, such
setting are often overcrowded because of high demand of care. Like all practitioners, health care
professionals working in ED are expected to apply EBP during care delivery (Dang & Dearholt,
2017). However, research evidence reveals many challenges in implementing EBP in ED.
Firstly, overcrowding is a major issue that acts as a barrier in adhering to guidelines and
implementing EBP process. The problem associated with overcrowding is that it results in longer
waiting time and provides little opportunities for staffs to utilize current research evidence (Kirk
& Nilsen, 2016). There are many evidences where nurses report organizational factor as a major
barrier to EBP implementation. For instance, the study by Shifaza, Evans and Bradley (2014)
reporting about nurse’s perspective related to EBP revealed insufficient time during clinical
practice to implement new ideas as a major barrier for them along with lack of organization
support. In addition, the study by Khammarnia et al. (2015) reported about the organizational
level barrier such as high workload, lack of internet access and lack of resource for EBP. Hence,
as staffs working in ED are more focused on meeting appropriate and stable patient flow, the
need to implement the steps of EBP becomes challenging for them.
The review of evidence regarding the barrier to EBP implementation and following best
practice recommendation shows physical layout of the ED to be an important factor influencing
staff’s ability to meet EBP guidelines. For example, Burgess, Kynoch and Hines (2019)
conducted a clinical audit in an ED in a large metropolitan hospital and compared current

3EVIDENCE BASED PRACTICE
practice in the hospital with triage guidelines and best practice. It aimed to identify barriers to
adherence to EBP in the area of triage. The triage is a service where the urgency of a patient
condition is decided. Therefore, triage is an area of high risk where emergency nurse must act
upon limited data under time pressured condition. The clinical audit revealed that physical layout
or the physical environment of the triage is a major barrier to achieving EBP. This is because this
often leads to long waiting time and overcrowding and staffs are left with little time to engage in
EBP.
Apart from organizational barrier, individual barrier to EBP implementation in ED
cannot be ignored too. Kirk and Nilsen (2016)revealed that lack of knowledge, skills and self-
efficacy of health care practitioners as a major barrier for health care staffs in ED as it affects
their ability to use research in clinical practice. The study by DeVon et al. (2013) investigating
about barrier to implementing EBP in ED revealed lack of staff engagement, variability in
training, nurse’s opinion of lack of time and perception of interference as a major barrier to EBP.
Jordan, Bowers and Morton (2016) reported individual level barriers too which included lack of
confidence in EBP, poor skills in synthesizing literature, poor sources to access evidence and
poor motivation to implement EBP. However, such kind of limitation also emerges because of
the relevance of the organizational culture for EBP implementation. There might be numerous
EDs where there is no process to encourage staffs to engage in EBP. The key benefit of having
any organizational culture for EBP implementation is that it enables sharing assumptions, beliefs
and norms among members of the organization and this will exert greatest influence of
individual staffs ability to think and behave in a manner to use research evidence (Ryan, 2016).
Jordan, Bowers and Morton (2016) opines barriers related to EBP occur because of poor
organizational support and change too. Therefore, fostering an EBP culture is most crucial to