Factors Impeding in Nursing Practice

This research article explores the factors that impede the application of evidence-based research to nursing practice. It discusses the challenges and issues faced by nurses in implementing evidence-based practice and provides insights into the importance of evidence-based nursing.

Running head: FACTORS IMPEDING IN NURSING PRACTICE
FACTORS IMPEDING IN NURSING PRACTICE
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1FACTORS IMPEDING IN NURSING PRACTICE
Introduction:
According to the Academy for Medical-Surgical Nurses, the evidence-based practice
(EBP) is a beneficial technique for effective patient care with a positive approach. Nurses are
usually classifies under two major categories including Registered nurses (RN) with a degree
of nursing practice and Enrolled nurse (EN) with a certificate or diploma of nursing practice.
Nurses falling under RN or BSN take up the evidence-based practice approach for effective
patient care (Arora, Hashmi & Thokchom, 2019). Evidence based practice is considered as an
amalgamation of significant research confirmation with best clinical proficiency and patient
standards. This approach will help nurses to improve the nursing practice for effective
outcome (Hills et al., 2019). The three major pillars of EBP consists of three different factors,
which are essential to carry out this approach namely Clinical expertise, patient values and
significant research collectively termed as “Pillars of Evidence-based practice”. Using the
approach of EBP, an Evidence-based nursing method is set-up and used (Kaiser, Cmar &
Anderson, 2019). This will allow the nurses to stay updated and advance in their respective
field to offer best effective care to the patient such as evidence literacy proficiency, which
will assist the nurses to practice information in more effective and efficient way in order to
develop their individual conclusions. High quality of care is provided to the patient using
Evidence-based practice hence; allowing the nurses to take an independent decision regarding
effective patient care decisions centred on the research of evidence based practices and need
of the patient. In this research work, an insight will be provided on the factors that impede or
hinder the application of evidence-based research to nursing practice (Callahan & Nichols,
2019). Different set of factors or issues will be highlighted, which will impede the use of EBP
in nursing.

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Agbedia, C., Okoronkwo, I., Onokayeigho, E., & Agbo, M. A. (2014). Nurses’ perspective of
the research-practice gap in nursing. Open Journal of Nursing, 4(02), 95.
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Alaloul, F., Williams, K., Myers, J., Jones, K. D., Sullivan, K., & Logsdon, M. C. (2017).
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Arora, S., Hashmi, S., & Thokchom, S. (2019). Effectiveness of An Awareness Program
Related to Evidence-based Practices in Nursing on Knowledge and Attitude Among
Staff Nurses in a Selected Hospital of Delhi: A Quasi-Experimental Study. Journal of
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Callahan, K., & Nichols, S. M. (2019). 23 Evidence-Based Practices. Systemically Treating
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Carriere, S. A. L. (2019). How Nurses Balance Risk with Patient Autonomy When Making
Decisions about Physical Restraint Use with Older Patients in Acute Care. (Doctoral
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(R01). Retrieved from https://grants.nih.gov/grants/guide/pa-files/PAR-10-038.html
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nursing: A mixed-methods study. Collegian, 25(2), 171-179.
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Maniya, C. (2018). Workflow Interruptions: Risk Factors and Outcomes in Nursing.
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practice. Nursing Outlook, 63(5), 601 -606.
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work patterns and workflow disruptions. Applied ergonomics.
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Learning Experiences (pp. 235-258). Springer, Cham.
Palese, A., Cadorin, L., Testa, M., Geri, T., Colloca, L., & Rossettini, G. (2019). Contextual
factors triggering placebo and nocebo effects in nursing practice: Findings from a
national cross‐sectional study. Journal of clinical nursing.
https://doi.org/10.1111/jocn.14809
Stevens, K. (2013). The impact of evidence-based practice in nursing and the next big ideas.
OJIN: The Online Journal of Issues in Nursing, 18(2), 4. DOI:
10.3912/OJIN.Vol18No02Man04

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Carriere, S. A. L. (2019). How Nurses Balance Risk with Patient Autonomy When
Making Decisions about Physical Restraint Use with Older Patients in Acute Care
(Doctoral dissertation, University of Saskatchewan).
The author used explanatory descriptive study to comprehend and recognise the way
in which a nurse balance the risk with patient independence while making a decision
regarding physical restraint (Carriere, 2019). Physical restraint was used to decrease falls
within the elder population of patients in hospital setting of acute care, which is considered as
the vital portion of risk assessment and anticipation of patient impairment (Abraham et al.,
2015). The decision-making process of the nurses in this study was influenced by various
contextual factors such as heuristics, lack of staff, and lack of organizational culture. In this
study, the author focused to provide a better understanding of patient autonomy and risk,
which are appropriate for regular nursing practice (Hallett et al., 2016). However, in this
study the author lacked in providing evidences, which links the physical restraint interference
to injury prevention as the application of physical restraint in respect to prevent injury from
fall, was explained with proper evidence. The lack of evidence for patient’s understanding of
risk and the experiences faced by the nurses while making any decision was considered as a
major gap or drawback in this literature study. Hence, in this study the author used
explanatory descriptive methodology to explore the concept of risk management with balance
of patient autonomy regarding physical restraint application (Hung et al., 2016). The author
developed a profound understanding on any variation in the process of decision-making and
commonalities that nurses might have to face to balance patient autonomy and risk.
Maniya, C. (2018). Workflow Interruptions: Risk Factors and Outcomes in Nursing.
The author described workflow interruptions in this study. In nursing research,
workflow interruptions is considered as the interference and interference of any nursing duty.
Workflow interruption is a communal stress in a nursing work, which leads to the focus

7FACTORS IMPEDING IN NURSING PRACTICE
deviation of the nurses resulting in prescription error and care (Neyens et al., 2018). This
deviation mainly result in compromise of a patient safety and health leading to reduced
satisfaction. The primary purpose or aim of this research article was to categorize the grounds
of these interludes, the effect of this cause on nurses and patients, and strategies to prevent
these interruptions between registered nurses. A qualitative approach of survey was
conducted to identify the interruptions and evidence-based intervention for the problem
(Baryramzadeh et al., 2018). The result analysed by the author exhibited that interruption
could be classified as internal and external interruptions. The outcomes in respect to flow
disruption was also acknowledged as positive outcome and negative outcome. Methods were
identified to reduce interruptions such as embracing positive work faith and executing no
interruption region (Cohen et al., 2016). The major limitation of this study was that a certain
limited articles were only accessed through goggle scholar and NIU library database, which
might possibly, had excluded some valuable studies due to publication restriction. Hence, in
this study the author concluded that evidence-based practice could be used to significantly
reduce workflow interruptions (Maniya, 2018). Detail knowledge and education should be
provided to the nurses reading positive beliefs of reducing stress.
Leach, M. J., & Tucker, B. (2018). Current understandings of the research-practice gap
in nursing: A mixed-methods study. Collegian, 25(2), 171-179.
The author had described the existing research nursing practice gap, which may result in
serious consequences of bad patient outcome and reduced quality care to the patient (Newton
& Butler, 2019). The author had focused on this gap to understand the factors, which may
lead to sub-standard care to patients. The primary aim of this literature study was to
understand the break in between nursing practice and nursing research from the viewpoint of
Global nurse academics (Agbedia et al., 2014). A descriptive mixed-method approach was
used in this study, which included question-answer round and interview. The analysis of the

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participants were completed after post-interview were the participants agreed that nurse
engagement in research was important for positive and effective patient outcome
(Emparanza, Cabello & Burls, 2015). The primary factors, which was noticed in the nursing
research gap, were associated to the problem of “change” and “translation”. Hence, in order
to fill the necessary gap a shared responsibility towards the improvement of research access
was required. The findings in this study did not gave a clarity on the magnitude of the
research gap. The extent to which this problem has affected the population of patients and
nurses (Leach & Tucker, 2018). The author in the study concluded that improved nurse
academics was necessary to support nursing practice linked with research. The author in this
study highlighted the area of attention as primary factors, which required a development and
change to overcome the bridge of nursing practice and nursing research.
Stevens, K. (2013). The impact of evidence-based practice in nursing and the next big
ideas. OJIN: The Online Journal of Issues in Nursing, 18(2), 4.
The author has described the effect of evidence-based practice (EBP) through various
nursing learning, science and practice. The primary purpose of evidence-based practice is to
redesign the primary effective care design, which is much more effective, efficient and safe.
In respect to multiple course-site commendations from nation-wide experts, the nurses have
positively responded to inaugurate the initiatives, which capitalize on the respected assistance
that nurses can make, have made, and will make, in order to convey the assurance of EBP
efficiently (Grants.nih.gov, 2019). In this study, a brief description regarding the evidence-
based practice movement was done and the impact of evidence-based practice on nursing
education, practice, research and models and frameworks were discussed. The discussion
highlighted selected initiatives and responses of those who are in the occupation of nursing,
in order to exploit the valued offerings of the nurses (Ahrq.gov, 2019). The variation of
influences or quantity of nominated influences in evidence-based practice (EBP) inclinations

9FACTORS IMPEDING IN NURSING PRACTICE
relating to nursing and care quality were discovered and the thought regarding the “next big
concepts” was focused to take healthcare and nursing forward to an entire new approach and
level. Hence, the author in this research article concluded relating to the discussion of “next
big philosophies” in evidence-based practice (EBP) (Stevens, 2013). The discussion was
based on two major centralised initiatives namely National Institute of Health’s development
of the platform on Dissemination and Implementation (D&I) science and the expansion in
research system under the Improvement Science Research Network (ISRN) (Isrn.net, 2019).
Palese, A et al., (2019). Contextual factors triggering placebo and nocebo effects in
nursing practice: Findings from a national cross‐sectional study. Journal of
clinical nursing.
The author had described the concept of placebo effect in nursing discipline, whereas
the nocebo effect is still unexplored (Feo, Kiton & Conroy, 2018). The contextual factors,
which triggers these effects were described and the use of placebo/nocebo effect in daily life
or activities of daily life (ADL) was has been documented in this study. The chief objective
of this research study was to define the contextual factors (CFs) utilized by nurses in order to
upsurge placebo effect and avoid nocebo effect (Alaloul et al., 2017). A cross-sectional
investigation was performed in accordance to the checklist of the guidelines of internet E-
surveys and strengthening the reporting of observational studies in epidemiology (STROBE).
The methodology in this survey convoluted a questionnaire-based approach on CFs exploring
the definition of contextual factor, beliefs, conditions of applications, ethical implications,
and the frequency of use according to the case, clinical conditions and communication
problems surrounding the patient (Hall et al., 2018). The author stated that contextual factors
were effective in maintaining the core superiority of the nurses and the relationship of the
patient and nurses. The author also focused that this quality would demand a huge personal
investment, which require the nurses to upgrade their knowledge respectively during nursing

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graduation (Miller & Miller, 2015). Hence, the this study stated that nurses were aware of the
contextual factor as an element to enhance the placebo effect and to avoid the nocebo effect
in conjunction with the evidence-based practice (EBP) nursing intrusion (Palese, 2019).