Integration of Evidence Based Practice in Nursing

This position statement discusses the integration of evidence based practice (EBP) in nursing. It highlights the importance of EBP in improving patient outcomes and enhancing nursing practice. The paper also explores the challenges and limitations of implementing EBP in the nursing profession.

Running head: POSITION STATEMENT
Position paper on Integration of evidence based practice
Name of the Student
Name of the University
Author Note

1POSITION STATEMENT
Introduction- The authority for the nursing profession is based on a social contract
that delineates responsibilities and professional rights, in addition to the mechanism of
remaining accountable to the people who are being provided care. The primary aim of the
nursing community is to ensure that quality care services are provided to all people, while the
professionals maintain their code of ethics, credentials, competencies, standards, and continue
their education (Hoeve, Jansen & Roodbol, 2014). The profession makes the nursing staff
place a due focus on caring for families, individuals, and communities, in order to help them
maintain, attain, and recover quality of life and optimal health. In addition, nurses are also
differentiated from other providers based on their scope of practice and the training that they
receive. Furthermore, nurses also improve the plan of care that they deliver to the patients,
while working in collaboration with the therapists, physicians, patients, their relatives and
other team members (Smolowitz et al., 2015).
Nurses also play an important role in preventing chronic illness, and are expected to
be particularly well-informed about the places where they can seek necessary health
information, and are often involved in doing research on different interventions. As the
profession of nursing endures to progress and develop, so does the existing healthcare
situation. Affected by a plethora of factors, the profession of nursing will incessantly be in a
continuous state of fluctuation and instability. One such trend is the integration of evidences
in present-day practice, while delivering any kind of care plan to patients, who suffer from
acute or chronic diseases.
Background- The profession of nursing has profoundly rooted traditions. It can be
traced back to the 19th century when Florence Nightingale brought about several
advancements in the profession. This was followed by the participation of nurses in
promoting patient advocacy, understanding the importance of infection control, prior to the
germ theory (Bostridge, 2015). Nurses also started placing a due focus on taking physical

2POSITION STATEMENT
care of the human body, and did not merely restrict their professional attention on
management of signs and symptoms related to a disease.
Evidence-based practice (EBP) has gained attention refers to an interdisciplinary
approach that is utilised and implemented by clinical practitioners, all across the world. In
addition, the domain of EBP involves making judgments about how to uphold and enhance
health of the patients, who are being provided care, by integrating the contemporary and
pertinent evidence with the expertise of the clinical practitioner, and other resources.
According to Straus et al. (2018) EBP also takes into account the state, characteristics, values,
needs, and preferences of the patients, who will be affected by the caregiving process. In
other words, integration of evidence is typically done in a manner that is attuned to the
organisational and environmental context of delivering care services. Evidence of research
findings are generally obtained from the systematic assortment of factual or numeral data,
through experiment and observation, followed by the formulation of research questions and
the testing of theories. The field of evidence-based nursing (EBN) is relatively new and refers
to the approach that is adopted by nursing professional, in order to making quality decisions
related to caring for patients, with the ultimate objective of delivering care in a manner that is
based on a combination of clinical expertise and relevant research that have been conducted
in that domain (Laska, Gurman & Wampold, 2014).
In other words, EBN focuses on the application of most up to date approaches of
delivering care that have been confirmed and established through assessment and evaluation
of high quality investigations, and statistically substantial research conclusions. The objective
of EBN is to expand and enhance the safety and health of patients, while also treating them in
a cost-effective method to develop the health consequences for both the clients, and the
entire healthcare system. Thus, it can be stated that EBN is a procedure instituted on the
collection, clarification, judgement, and incorporation of effective, clinically substantial, and

3POSITION STATEMENT
appropriate research (Harvey & Kitson, 2015). The evidences are typically used by nursing
professionals for changing their scope of practice, and/or participating in the process of
clinical decision making. Essential decisions related to the intervention that is most
appropriate for a patient is often made based on the seven existing levels of evidence, which
diverge in the quality and type of research that is being evaluated. With the aim of properly
implementing the EBN, the awareness and familiarity of the nurse with the disease that is
being treated, the preferences and demands of the patient, and manifold scholarly pieces of
evidence are all assembled and made use of, in order to deliver a suitable solution to the
illness. These skills of EBN are usually taught in contemporary nursing edification, and form
an integral part of professional nursing training.
Asserting the thesis- It is imperative for nursing staff to follow EBN since it will
allow them to incorporate the best available exploration evidence, medical proficiency, the
patient's discrete morals and situations, and the features of nursing practice, where the
nursing professionals work. Thus, the importance of this trend can be accredited to the fact
that EBN will not only facilitate applying evidences that are pertinent to the clinical
phenomenon under investigation, and will facilitate the nurses in their decision making
process, it will also help them use their skills and experiences, which have been acquired
during the course of their nursing training and practice (Hoffmann, Montori & Del Mar,
2014). Furthermore, the importance of adopting this trend in nursing practice can be
associated to the fact that the procedure will also help the nurses to take into consideration the
values and situations of the patient such as, financial situation, and social support, thus
facilitating the process of selecting an intervention, based on contemporary evidences.
According to Brown (2014) EBN is also important in the profession owing to the fact that it
targets to deliver the greatest operative care that is obtainable and accessible, with the
objective of enhancing the health outcomes of the patient. Furthermore, the patients also

4POSITION STATEMENT
anticipate to accept the most operative care grounded on pertinent evidence. This approach
will also promote presence of an attitude of inquiry among the nursing professionals, and will
also help them start thinking about the strategy that is being employed while providing care,
and will also assist in exploring for evidence that that guide them in their practice.
Counter argument- Although EBN has started receiving support from a range of
biological and psychological research bases in recent years, this growing trend also has some
potential limitations. Limiting the action of care delivery by nurses only on evidences often
result in a failure of the nursing staff to integrate different theoretical models that are
reinforced by the patient advocates, or individuals having lived experience. Often it might
happen that the nurses demonstrate a failure in identifying these nursing models as a core
component of EBN, owing to the absence of empirical exploration, and not due to the lack of
efficiency amid them (Townsend & Morgan, 2017). Furthermore, most EBN have not yet
been formulated, developed and verified for patients belonging to particular cultural groups.
Methodical approaches for employing EBNs to target culture-specific concerns among
patients are imperative. In addition, issues related to satisfactory funding and reliability of
particular treatment model has the probability of creating an impact on the generalizability of
the research findings.
Moreover, funding and subsidy for the treatment modalities that have been identified
appropriate from scholarly pieces of evidences are time and again insufficient, thereby
making complete application of EBN problematic, which in turn could compromise
dependability to a specific EBP prototype (Boltz et al., 2016). In addition, while there are
numerous health insurance businesses that demonstrate a willingness to offer coverage,
predominantly if the treatment identified by the nurse, for the disease being treated has been
presented to be beneficial, they might often refute coverage if the nursing professionals. This
might also put the patients in a difficult condition.

5POSITION STATEMENT
Counterclaims- There are several counterclaims to the integration of EBN in the
nursing profession. One such counterclaim was first postulated by Mitchell, a pioneer nurse
author, who elucidated the fact that integration of EBP in the nursing domain was too
constricted, and that it was excessively attentive towards a study of practical and methodical
nursing activities. It was stated that the heavy dependence of this method on research
procedures that associate and draw a comparison between interventions, often make the
nurses demonstrate a failure in asking essential questions, which primarily focuses on the
percentage of patients demanding either intervention (Melnyk et al., 2014). While the
investigation supporting the worth of integrative remedy and all-inclusive nursing practice
has developed meaningfully in the past years, the enormous bulk of EBM fails to provide
adequate emphasis on primary prevention. In addition, it has also been proposed that EBN is
committed towards discovering non-pharmacological and less invasive methods that provide
certain counterweight to big commerce and for-profit health corporations. Several public
health specialists have also put forth queries concerning the limitations of EBN, in relation to
presence of diseases that affect the health of wider populations and communities.
It is often considered difficult in the domain of public health, if not unmanageable, to
explore and gather satisfactorily comparable communities, in order to use them as a
comparison group and/or control, with the aim of implementing state-of-the-art community
health programs (Maki et al., 2014). EBN has also been criticised for being too profoundly
based on one-dimensional linear fundamental models of knowledge. Time and again it has
been proposed that the discipline of health promotion needs to place a due emphasis on
narrative description of available evidences. It has consistently been argued by public health
professionals that in the era of computers and the World Wide Web, it is imperative for
nursing professionals to acquire and demonstrate necessary skills and expertise that will
provide assistance in the process of synthesising pertinent information from an assortment of

6POSITION STATEMENT
scientific and scholarly sources, and will also help the remain focused on the issue that is
being investigated (Pérez-Campos, Sánchez-García & Pancorbo-Hidalgo, 2014).
EBN has also been criticised for failing to elucidate and make obvious its
fundamental expectations and frameworks, thus making the coalescing or contrasting of
different research studies as challenging. Part of the explanation for this statement can be
accredited to the fact that with the loads of nursing practice being enunciated in the public
media, there remains an earnestness to uncritically convert facts into evidence. The accretion
of scientific material does not essentially progress the discipline of science. In other words,
the advance of science necessitates deliberation of cultural and historical contexts of
investigation and examination findings, such as, those that are conducted in hermeneutic
investigations (Straus et al., 2018). Inadequate or unreliable use of hypothetical agendas
makes the clarification of the connotation of the research findings less convenient and
advantageous to the development of science. While there is a substantial quantity of EBN
literature, in relation to nursing enquiry and practice, tools established for, and/or
incorporated to the nursing profession, it is still undecided that in what course, and how fat
will the identified efforts help in progressing the nursing discipline (Kirk & Nilsen, 2016). It
therefore remains uncertain how the obscuring of limitations between nursing and medicine
has created an impact on the profession, and eventually on the health of the wider population.
Refuting the counterclaims- Since the initial days of the contemporary nursing drive,
it has been found that nursing professionals have taken huge efforts in establishing
correlation between methodical evidences and their clinical expertise, with the aim of
delivering patient health and safety, and enhancing their outcomes. Thus, EBN is now
measured important for delivering quality nursing modalities, and is typically utilized in
different domains of the caregiving process, such as dress code to hand hygiene. The concept
of care giving is no longer founded in tradition, nonetheless in substantiation that supports

7POSITION STATEMENT
generation of morals and values in health and social care (Brownson et al., 2017). Both the
nurses and the patients greatly benefit from constancy and steadiness in the types of
interventions that are implemented upon the patients. Furthermore, best practice nursing
guidelines are also accessible, with the aim of guiding healthcare professionals and
institutions, in the development of healthcare policies and individual nursing practice.
Furthermore, it also makes the patients and their family members also feel more protected in
having a clear conception of what they will likely receive in the caregiving process.
Claim 1- EBN is directly associated with better patient outcomes. Patient outcomes
have been found to greatly improve, following the implementation of evidence based nursing
interventions. Research evidences have suggested that implementing evidences that are based
on Chlorhexidine washcloths have proved effective in decreasing the rates of infection and
complication to infection control guidelines, as proposed by different clinical guidelines
(Edmiston et al., 2015). It has also been found the incorporating evidences have often helped
nurses in enhancing their knowledge and expertise on hand hygiene procedures. In addition,
it has also helped nurses in gaining a sound understanding on the importance of preventing
transmission of microorganisms, thereby enhancing patient health and safety, and preventing
the onset of nosocomial infections (Neo et al., 2016). Likewise, making the patients show
adherence to exercise based regimen also helps the nurses in enhancing health outcomes, by
keeping a control on their glycemic index (Colberg et al., 2016).
Claim 2- EBN is an advancing career field. Another potential benefit of delivering
nursing care based on available evidences is that it helps the nursing filed to gain an increased
autonomy. The nursing practitioners are permitted to obtain more independence, and are
progressively being allowed to care for their patients, based on the complete extent of their
learning (DeBruyn, Ochoa-Marín & Semenic, 2014). Hence, nurses have to no longer depend

8POSITION STATEMENT
on the orders from clinical practitioners or physicians, in relation to administering any
intervention that has been proved beneficial in scholarly pieces of work.
Claim 3- EBN also influences dress code. It has often been found that there exists a
positive association between the identification of nursing staff, their standardised attire, and
appearance of competence and know-how (Schmidt & Brown, 2017). Hence, it has been
recommended that nursing professionals must put on discipline-specific scrubs, such as, solid
white, solid blue, or a combination of attire by RNs, and solid white or solid teal attire by
nurse practitioners. Evidences from scholarly articles have also resulted in the issue of black
and gold tags for nursing staff that facilitated the recognition of their professional
designations.
Conclusion- To conclude, incorporation of current evidences in practice play a major
role in creating opportunities for the entire domain of nursing care to be more customised,
more operative, rationalised, and vibrant, and to make the most of the impacts of clinical
decision. Under circumstances when scientific evidences are used for crucial best practices,
in place of supporting the already prevailing practices, nursing care retains pace with the up-
to-date technological improvements and takes benefit of new information expansions.
Restating the argument- Thus, it can be stated that the increasing trend of EBN is
imperative in delivery of quality care services to all patients, and must be adequately
incorporated in real time settings, in order to eliminate variations in the care modalities that
are administered, and for standardising the concept of health and social care.
Action plan- The action plan would involve six steps that are namely, (i) asking
correct questions about the problem that has been identified in a clinical situation, (ii)
gathering evidence from personal, empirical, ethical or aesthetic sources, (iiii) appraising the
evidences that have been collected, (iv) using an appropriate research methodology for

9POSITION STATEMENT
implementing the change, (v) comparing the project with the health outcomes, and (vi)
disseminating the information that has been collected.

10POSITION STATEMENT
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