Evidence-Based Practice in Nursing

This assignment examines the concept of evidence-based practice (EBP) in nursing. It investigates nurses' attitudes, understanding, and perceived obstacles to integrating EBP into clinical decision-making. Drawing upon a selection of academic sources, students will analyze various factors influencing the adoption of EBP, including knowledge gaps, organizational support, and individual beliefs. The assignment aims to provide a comprehensive overview of the current state of EBP implementation within the nursing profession.

Running head: NURSING ASSIGNMENT
Nursing assignment
Name of the student:
Name of the University:
Author’s note

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Introduction:
Evidence based practice (EBP) is the critical use of best practice based evidence to
influence decision making and plan patient care. The integration of EBP in clinical practice is
done by systematic search and critical appraisal of relevant evidence according the clinical
question or issues. It involves integrating clinical expertise and patient’s preference and values in
the decision making process (DiCenso, Guyatt, & Ciliska, 2014). According to the standard 1 of
the Registered nurse standards for nursing practice, registered have the responsibility to use
critical thinking skill and use best available evidences in decision making and providing safe,
quality nursing care (Registered nurse standards for practice, 2016). Although nurses face several
challenges in integrating and implementing EBP in nursing practice, my individual position
statement is that ‘nurses must be actively involved in implementing EBP during decision making
and care delivery process’. The report provides a proper rational and discussion for taking this
stand on the topic and also defends the individual position statement by refuting argument to
finally make it clear why nurses should remain at the forefront of EBP implementation.
Discussion on the final position statement
Health and medical care is a dynamic discipline where new medicines, medical
equipments and clinical procedures are regularly invented. The main motive for new and
advanced health care procedures and equipment is to support clinicians and nurses to provide the
best standards of care to patients. Due to this perspective, there is great emphasis on using EBP
in clinical decision making (Majid et al., 2013). Apart from clinicians, nurses are also expected
to implemented research findings into their practice. This is a professional obligation for nurses
too as the Standard 1.1 of the Registered Nurse Standards for Practice states that nurses must

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access, analyze and apply the best available evidence for providing safe and quality practice
(Registered nurse standards for practice, 2016). The importance of EBP in nursing practice is
also seen due to its positive impact on clinical outcome of patient. Stevens (2013) has shown that
EBP has great promise in achieving intended health outcome and nurse must employ EBP to
deliver optimal care. The main rational for favoring EBP for nurses in daily practice is that it is
the most appropriate method to cover gaps in patient care and achieve best outcome for patient
by combining clinical experience and best evidence. It also has the advantage of enhancing
patient’s experience in care as EBP considers patient values in care too (Steven, 2013). Hence,
considering positive clinical outcome and patient’s experience associated with EBP, it is
necessary that nurse use this opportunity to expand their skills in clinical practice and transform
the delivery of care.
In the current health care environment, special emphasis has been placed on EBP to
promote excellence in health care. However, the use of EBP as a routine patient care is very
inconsistent among nurses because of the several barriers in integrating EBP in daily practice
(Adamu & Naidoo, 2015). This points out to opposing arguments against the individual position
statement. For instance, a study done to investigate the readiness of nurses in implementing EBP
has revealed that although nurses had a positive perception about EBP, however they did use it in
daily in clinical practice due to poor skills in using EBP. The common barrier expressed by
nurses in implementing EBP was the challenges in finding and reviewing the research related to
any clinical question. The research also showed that positive attitudes and required skills in
identifying the best research was higher in experienced nurses compared to newly placed nurse
(Ammouri et al., 2014). Based on the relevant barriers experienced by nurse in implementing
EBP, it can be a relevant opposition argument to disapprove the individual position statement.

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However, the refuting argument against this evidence is that barrier to implementing evidence is
found among nurse due to poor trainings and exposure to evidenced based information during the
nurse education period. Hence, lack of resource and training to prepare the nurse in using
evidence during their diploma programmes affects their ability to use EBP confidently. (Grant,
Stuhlmacher & Bonte-Eley, (2012) also showed that nurses with masters degree can promote
EBP use among other nurse colleagues as knowledge of research process promotes interpretation
of scientific evidence. Therefore, if health management creates an environment that trains and
educate nurse in analyzing and applying evidence, they can be at the forefront of EBP
implementation and optimize positive outcomes for patient too.
Another study that defends the individual position statement of nurse’s responsibility to
implement EBP in nursing care is that despite having skills related to EBP, lack of time act as a
barrier for nurses in utilizing and applying research in clinical practice. A study done to explore
barrier to EBP experienced by nurses revealed that nurses had insufficient time on the job to
implement new research evidence and hospital administration did not support implementation of
EBP in routine clinical care (Shifaza, Evans, & Bradley, 2014). In addition, the system level
limitation is that many hospitals lacks adequate human and fiscal resource to promote a culture
of EBP. This means that lack of leadership support and lack of inclusion in decision making
contributes to poor EBP implementation among nurses (Warren et al., 2016). Hence, lack of
appropriate work culture to support and identify the importance of EBP has an impact on nurse’s
perception of research importance too. The above evidences goes against the individual position
statement because nurse alone are not responsible for implementing EBP, they also require the
support of organization and adequate resource to increases the utilization of best evidence in
practice.

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Despite the above argument of not expecting nurses to implement EBP, the rebuttal
against the argument is that nurses must use EBP in clinical care only when they get the training
and support from health care organization in implementing EBP. A system of support and
recognition for EBP along with reward system can act as facilitator to research utilization and
address inconsistencies in the use of EBP among nurses. The leaders and management of health
care organization need to play a role in creating a strategic climate for EBP implementation and
sustaining the new practice in the health care system (Aarons et al., 2014). Apart from standard
1.1 of registered nurse standards for practice that directs nurse to use the best available evidence,
the standard 5.1 also emphasize that nurses must use best available evidence to develop a plan of
nursing practice. The professional obligation of using EBP among nurse is also necessary
because it will support the nurse to fulfill other obligations in nursing practice such as providing
safe and responsive quality nursing care and achieving improved health outcome for patient
(Registered nurse standards for practice, 2016).
Many nurses also excuse themselves from using EBP by stating that they do not have the
skills or they have not got the required education in their nursing education programme to
implement EBP. However, nurses cannot escape from this responsibility because it is also a
professional obligation of nurses to maintain their capability for practice and engage in
professional development (Registered nurse standards for practice, 2016). The above argument
strengthens the fact that EBP is essential for nurse to facilitate professional development. Hence,
it will be important for nurses to attend training programs to develop their skills in asking the
clinical question and searching and critically appraising best available evidence. Winters &
Echeverri, (2012) explains that nursing faculty or the nursing preceptor are the important person
who can train the nurse in step-by-step implementation of EBP. There training programs should

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focus on addressing the common barrier faced by nurse in using research in practice such as
challenges in interpreting research evidence and lack of confidence in evaluating the evidence.
Therefore, this means nurses need to be taught about the all steps in EBP implementation such
asking clinical question, searching for best evidence, integrating the evidence into practice and
evaluating the outcomes.
Based on the individual position statement, the first step towards implementation of EBP
in nursing practice is to develop spirit of inquiry and intellectual curiosity among all nursing
students. Teaching nursing students to frame a clinical question in PICOT format can also help
them to use appropriate search term and find empirical evidence (Nielsen, Lasater & Stock,
2016). Many nurses are competent in framing the clinical questions, however they fail to
critically appraise the evidence. In this case, nurse preceptor’s guidance is critical in teaching the
nurses the method to analyse the validity and the applicability of the study (Ryan, 2016). In
addition, collaboration with clinical managers can also support nurse in determining the
applicability of the evidenced based practice in real setting (Aasekjær et al., 2016). A study also
revealed that undergraduate education program should focus on building the attitude, skills and
uptake of EBP among nursing students to increase their confidence in adapting evidence (Leach,
Hofmeyer, & Bobridge, 2016).
Conclusion
The report summarized and supported the use of EBP in nursing considering better
clinical outcome, patient satisfaction with care, lesser complication and improving patient safety
and quality of life. Several studies also gave opposing argument regarding the use of EBP by
discussing about individual and organizational barrier in implementing EBP. Despite the barrier,

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the final position statement is also again the same which is to promote implementing EBP in
nursing practice. This is mainly because of professional obligation to promote patient safety as
well as professionally develop in nursing practice. Currently EBP is used inconsistently by
nurses and role of hospital management or clinical managers is important in providing the right
resource and knowledge in using EBP confidently.

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Reference
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