Challenges and Strategies for Evidence Based Nursing Practice

This essay delves into the crucial role of evidence-based practice (EBP) in nursing, emphasizing its significance for optimal patient outcomes and high-quality healthcare. It defines EBP, highlighting its principles, including the integration of research evidence, clinical expertise, and patient values. The essay outlines the structured seven-step process of EBP, from cultivating an inquiry spirit to circulating findings. It then addresses the challenges nurses face when implementing EBP, such as time constraints, lack of research knowledge, and organizational support. Focusing on a kidney transplant unit, the essay explores specific difficulties and provides strategies to overcome them, including promoting an EBP culture, providing training, and improving access to research. Ultimately, the essay underscores the importance of EBP for enhancing patient care and professional satisfaction, advocating for supportive organizational structures and educational programs to facilitate its effective implementation.

Running head: EVIDENCE BASED NURSING PRACTICE
EVIDENCE BASED NURSING PRACTICE
Name of Student
Name of University
Author’s Note

1EVIDENCE BASED NURSING PRACTICE
To ensure the evidence based practice (EBP) of the nurses, an increased amount of
pressure is put on the nurses in the 21st century. In order to achieve the excellent outcomes of the
patient and delivering high quality of health care, the evidence based practicing of nurse is
widely recognized (Babcock & Thonus, 2018). According to different studies, the evidence
based practicing have many benefits like improved safety, cost effective results, enhanced health
and patient has reduced rates of morbidity and mortality (Holmqvist, Philips & Barkham, 2015).
The optimal healthcare outcomes are only achieved when the nurses have the adequate
knowledge to find, utilize and critically appraise the evidence which is best suited for the clinical
practice, along with the behavior and confidence of patients towards their healthcare
professionals, which boost the efficiency of the treatment (Cameron, 2017). With the availability
of various scientific based practices, the evidence based practicing of nurses is still facing some
challenges and difficulties. The main objective of this essay is to understand the importance of
evidence based practicing by nurses by defining it and by analyzing the principles of the practice,
including its procedure and discussing about the various challenges and difficulties faced by the
healthcare professionals, nurses while implementing the practice in a unit of kidney transplant.
The term evidence based practicing implies the utilization of prevailing scientific
evidences during the process of making decisions in order to provide efficient patient care (Cook
& Odom, 2013). This is an area of approach to make clinical decisions with the influence of
research evidences. The abilities of the healthcare providers like their expertise and critical
thinking, is combined with the research evidence and is then involved in the practice (DiCenso,
Guyatt & Ciliska, 2014). By defining EBP, one will be able to understand that the agenda behind
the practice is not the research related journals or publications but it also involves the integrated
judgments and clinical expertise of the healthcare providers (Harvey & Kitson, 2015). However,

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the presence of certain factors like cultural and clinical also helps in the decision-making
procedure. In a non-English speaking society, the resources have limited access and for using,
the blood products, the associated cultural beliefs, are the example, how these factors impact.
This is the reason why, the patient’s requirements are prioritized in the evidence based practicing
(Hauck, Winsett & Kuric, 2013).
Almost all the disciplines of the health like medical intervention, allied health, public
health and nursing, are researched proactively, in order to find an effective way of evidence
based practicing (LoBiondo-Wood & Haber, 2017). The different ways like keeping tracks of the
team, effective learning from research studies, which are relevant, utilizing the knowledge of
clinical practice, are immensely time consuming. For this reason, the different tools are used to
help efficient evidence based practicing (Melnyk et al., 2014). The EBP is quietly a structured
process, involving seven steps:
 Inquiry’s spirit cultivation
 Assessing the required information into questions, which will help them find the evidence
which is relevant
 In order to answer the question, look for the finest evidence
 The clinical usefulness, reliability and validity of the found evidence is appraised
efficiently
 Prioritizing the patient’s needs, values, beliefs and requirements and infusing it with the
healthcare provider’s area of expertise, thereby implementing the final results in the
clinical practice
 Assessment of the clinical practice’s outcomes

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 Circulating the changes or decisions of the evidence based practicing (Schwartz et al.,
2013)
Besides the critical behavior of the inquiry’s, spirit cultivation in the culture of the
healthcare, the step results in comforting the healthcare providers, in order to ask questions
regarding the treatment of their patients along with the ability to challenge the current practices
like the attitude towards consistent questioning (Boswell et al., 2015). With the adoption of the
culture in the evidence based practicing, the spirit of inquiry is extensively enhanced and
promoted by embedding in the hospital’s mission and philosophy (Stokke et al., 2014). The
minute the nurses start questioning their patients, the evidence based practicing starts like
clarifying about the way the patient in a kidney transplant with BK infections will be given
intravenous immunoglobulin and enquiring about the patient weight for immunosuppressed
patients or the standard guidelines (Straus et al., 2018).
Conversion of the acquired information into the relevant formatted questions is the next
step. PICOT is the most common format used in the principles of the health care. The format is
designed in way to account the interests of patient population (P), by defining the area of interest
or interventions (I) and lastly generating the comparisons group or interventions (C), outcome of
states (O) and time (T) (Elias et al., 2015). For patients of kidney transplant with BK infections,
the best way to enquire about the rate of intravenous immunoglobulin based on the patient’s
weight is “In kidney transplant patient with BK infection (population), giving IVIG at patient
weight (intervention) compared with standard guidelines (comparison) affect the chances of
thromboembolic events (outcome) during a six-month period (time)?”

4EVIDENCE BASED NURSING PRACTICE
Looking for the finest evidence to provide the question with an answer is the third step.
When the questions are asked in the format of PICOT, it is highly advisable to explore the
evidence in order to update the clinical practice (Townsend & Morgan, 2017). In order to find
the solution to the kidney transplant question using the PICOT format, the phrase patient of
kidney transplant with BK infection would be the first to enter; this will give an outcome of huge
amount of citations and abstracts of the board subject (Weist et al., 2014). The infusion rate of
intravenous immunoglobulin would be the second thing to enter followed by the patient’s weight
or the PICOT question’s standards and guidelines. Lastly, joining the results of the searches for
every section, in order to limit the results based on the relevant articles is the last step.
Critical appraisal of the evidence is the fourth step. After finding the list of relevant
articles, the next step nurses perform is the rapid determination of the relevant articles, which are
reliable, valid and most importantly applicable to the clinical practice. During the stage of
evidence appraisal, the healthcare providers should question three factors, validity of the results,
and importance of the results and assistance of the results (Straus et al., 2018).
Combination of the patient’s requirements, values and preferences with the clinical
expertise of the health care provider is the next step, because to validate a clinical decision, only
the research evidence is not sufficient in the practicing. The important role of EBP is the
expertise of the healthcare providers based on the laboratory report, patient assessment and their
earlier experiences including the values and beliefs of the patients. The implementation of the
evidence based practicing is further enhanced by the impact of the hospital and clinical variables
(Babcock & Thonus, 2018).

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For practice decisions or evidence-based changes, efficient evaluation of the results is
necessary and this comprises the last second step. The monitoring and evaluating the changes in
the results, after the successful implementation of the EBP is necessary, in order to resolve the
negative effects and support the positive effects (Weist et al., 2014).
Lastly, the circulation of the evidence based results. By the useful ways like presentations
at local, national and regional conferences and different reports in various journals, publications
and professional newsletters, the evidence based practicing can be efficiently circulated (Cook &
Odom, 2013).
However, even after the application of structured evidence based care and treatment
involving seven steps and the awareness of the nurses that the engagement of evidence based
practice results in extreme professional satisfaction, there are healthcare providers are still not
utilizing its benefits, creating the difficulties and challenges of the evidence based practicing of
nurses. The most common challenges are implementation of research in practice because of lack
of time, lack of statistical knowledge, to change the care of patient, the support is very low and
lack of literature knowledge due to insufficient time (Wike et al., 2014). These challenges are
organized into several factors like organizational factors, individual factors, communicational
factors and research quality.
The setting where the research will be utilized perceives the organizational factors as
challenges. Lack of time to read, time constraints, lack of time to analyze, evaluate, implement
and circulate the researched evidence is another challenge faced by the hospitals and are reported
by the healthcare providers. Lack of support to nurses in terms of insufficient organizational
culture is one of the biggest and major challenges (LoBiondo-Wood & Haber, 2017). For

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example, the unpredictable kidney transplantations resulted in the shortage of staffs leading to
limitation of the EBP adoption due to the huge amount of patient loads.
Insufficient knowledge and skills regarding the methods of research and lack of
awareness in terms of findings of research including the negative attitude towards the evidence
based treatment are other common challenges (Hauck, Winsett & Kuric, 2013). According to a
study conducted in China, found that the nursing individuals are faced by the top three
challenges, which are based on their attitudes about the research value, not trusting the results of
evidence based practice and insufficient skills to research. There are nurses in the transplantation
units who do not have the knowledge or they are not trained efficiently to evaluate a research
finding or to implement unfamiliarity or change with the literature of the research. The
accessibility of the nurses to research findings is another challenge. The nurses are not bothered
about the importance and effectiveness of the outcomes of the EBP and thus they are not
interested in performing EBP, this is another challenge.
The accessibility of the research is one of the challenges faced by the organization, along
with the availability of the insufficient awareness and evidence of the research, which are
published (Wike et al., 2014). In addition, the inability of the nurses to interpret the results from
the statistical analysis is a regular challenge faced by the organizations. In the case of the patient
in kidney transplant with BK infection, the lack of knowledge of the nurses in regarding with the
IVIG because of insufficient research sources and literature, which leads to the transference of
the queries to the educators or other hospital officials. Lack of utilization of methods, proper
explanations and procedures are one of the few problems faced by the beginners. The slow
process of the publishment of the uncertain results or research and articles also influences ghastly
to the quality of the research.

7EVIDENCE BASED NURSING PRACTICE
In order to facilitate enhance program planning and reduced elimination rates, the
identification of the challenges and different strategies will assist in the growth of organization
and enhancing the healthcare providers to provide quality healthcare treatment. The conditions
which facilitate the EBP should be practiced including the support from organization that
prioritize the culture for EBP, like providing incentives to the nurses and giving them in-service
teachings to monitor them in between the shift timings. In addition, elements related to
communication, quality and individual practitioner also play a vital role in the efficient
implementation of the evidence research based practicing. In transplant units, the nurses are
asked to discuss the ideas with their seniors, mentors educators and managers, so that they can
generate new protocols by educating themselves by reading articles and successfully
implementing those ideas. Without the use of computer and internet skills by the nurses, the
different aspects of EBP for its misconceptions as it is excessively time consuming will
constantly flourish (Huey et al., 2018). In conclusion, the support from the managers, physicians
and other members for efficient EBP should be motivated and encouraged, and the education
programs for the nurses should be arranged to enhance their awareness regarding EBP, so that
they can provide patients with high quality care.

8EVIDENCE BASED NURSING PRACTICE
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