Evidence-Based Practice in Nursing: Implementation and Challenges

This essay delves into the critical process of transforming evidence into nursing practice, emphasizing the importance of evidence-based practices (EBP) in healthcare settings. The essay begins with a rationale and background, highlighting the need for quality improvement and effective decision-making in the nursing profession. It then outlines a literature search strategy, followed by a comprehensive literature review that critically evaluates the wider perspectives informing the rationale. The review covers key components of EBP, including research, clinical guidelines, and patient preferences, while also addressing ethical, legal, and political aspects. The essay examines specific applications of EBP, such as blood pressure measurement techniques, and discusses ethical considerations. It also explores the impact of EBP on patient outcomes and healthcare organization. The essay concludes by summarizing the implementation strategies and the importance of EBP in healthcare. References are provided to support the arguments and findings. The essay showcases how healthcare professionals can utilize evidence-based practices to enhance quality and improve patient care.

Transforming Evidence into
Nursing Practice

TABLE OF CONTENTS
INTRODUCTION .................................................................................................................3
Rationale and Background...............................................................................................3
Literature search strategy.................................................................................................4
Literature review...............................................................................................................4
Lewin's Change Management model...............................................................................8
Implementation of the
change............................................................................................................................ 9
CONCLUSION................................................................................................................... 10
REFERENCES................................................................................................................... 11

INTRODUCTION
Healthcare environment has been constantly changing in today's world; hence, it is
important for all healthcare professionals to ensure that the practices which are implemented in all
health settings are providing the best practices and services (Zimmerman, Shier & Saliba, 2014).
Evidence practices have been recognised to a wider extent in nursing profession. The
implementation and services which are provided to all the service users is considered as one of the
most important drivers in nursing and clinical services. With the help of evidence based practices,
all nurses gets an opportunity to analyse that each and every clinical intervention which is provided
to patients is safe and suitable (Makic & et.al, 2013). The process of EBP should not be considered
as a work load and all the nurses should feel comfortable and competent enough to handle all the
clinical forms of EBP in a proper manner.
In this part of essay, transforming evidence into nursing practice will mainly focus on
managing quality within the healthcare settings so that better health services are provided to all the
care users. It will also help in decision making process by considering patient's values and
opinions. Different models will be applied which will help in determining wider perspectives for the
chosen rationale.
Rationale and Background
For enabling effective decision making process in the nursing profession, it is very
important to implement evidence based practices so that decisions can be taken in proper manner
(Hamric & et.al, 2013). Although many studies have been conducted on nursing profession and
evidence based practices but no studies have ever focussed collectively on transforming evidence
into nursing practices. When theoretical perspectives change into practices it is very important to
consider certain evidences which can improve and manage quality in a better way (Melnyk & et.al,
2012). Studies which have been conducted earlier and results drawn from them can be
significantly used in nursing profession so that evidence is produced. The models which are used
in evidence based practices helps nursing process to accomplish assessment, diagnosis, proper
planning and integration of practice and evaluation of problem. For implementing evidence based
practices it is necessary to consider following points which can improve the quality of patient's care
in healthcare settings (Goldberg & et.al, 2013). On the initial level, it is necessary to identify

problem that is existing in the profession. For justifying the problem, it is important that empirical
evidence and appraisal is collected. Summarising all the empirical and non empirical evidence will
help in developing strategies that can integrate evidences into practices (What is Evidence-Based
Practice (EBP)?, 2016). Rationale of the study has been formed because there is a need to
change various practices so that quality of services can be enhanced and improved.
Literature search strategy
There are various sources which help in selecting articles for the given topic. Database
sources such as CINAHL, PubMed, Science direct, Google scholar, emerald insight and British
library index are some of the common database sources that help in choosing articles that are
relevant to the study (Burman, Robinson & Hart, 2013). For the completion of the ongoing study,
the articles and research papers were also selected from the same sources.
Literature review
Critically evaluate the wider perspectives informing the rationale
There are three basic components of evidence based practices which should be
implemented to improve the quality of services and practices in nursing and healthcare profession
(Linton & Prasun, 2013). The three components can be research, clinical guidelines and expertise
and patience preference. Different ethical, legal and political aspects are also very necessary to be
considered when implementing evidence based practice because it helps in justifying the change
that is brought in the working of staff nurses and profession. Mitchell, 2013 has stated that
evidence base practices cannot be justified only by using a single research paper it is very
important to critically analyse all the research papers associated with the study so that study and
findings can be linked together. It is also very necessary to add perspectives and judgements of
different clinical personnels because it is imperative to true evidence based practices in nursing
practices. In recent times evidence based practices have gained an impulse which is very helpful in
implementing changes in nursing field (Pelletier & Stichler, 2013). Basic research findings, clinical
knowledge and opinions from clinical expertise are all considered among evidence which can be
used in nursing. There are many aspects in healthcare where evidence practice is very necessary.
There are many methods which can be adopted with the help of evidence based practice in
the field of nursing like maintaining fluid balance, measuring blood pressure in ill children,

injections, prescribing medications, hand washing and discharge system. Generally, Oscillimetric
technique is used to measure the level of blood pressure in ill children (Myrick & et.al, 2012). From
past 20 years, this method is considered to be one of the best methods despite of its inaccuracy
and precision. According to NIBP measurements, auscultatory method is one of the most
appropriate methods which should be used by all the nurses to measure the blood pressure levels
in adults as well as children. When nurses apply any new techniques based on evidence then they
should justify those methods on the basis of guidelines and frameworks of nursing practice
(Williams & et.al, 2012). All nurses should measure blood pressure of adults with the help of
auscultatory technique and should compare the results with measurements that are obtained
through oscillimetric methods so that new methods and treatment can be evolved. There are
related beliefs and evidence based on measuring blood pressure which should be taken into
consideration while transforming evidence into practice. There are four methods of measuring non
invasive blood pressure in children who are less than 1 year. They are auscultation, oscillimetry,
palpitation and Doppler imaging (Christie, Hamill & Power, 2012). Korotkoff sound is hardly audible
in children who are less than a year. Hence, Doppler imaging is one of the best methods in
measuring the blood pressure of children accurately.
It can be for bringing change in education of the students and for working in a team for all
the clinicians and researchers. It provides a wide opportunity for all the nurses to practice their
work on individual basis (Stanhope & Lancaster, 2015). It is important to consider ethical principles
in health and medical field so that they are able to provide treatment to all the patients in proper
manner. For implementing various practices it is necessary to ensure that particular outcome will
be obtained. When certain modifications are made in nursing it should be made after considering
ethical framework because there are equal chances that both positive as well as negative results
can be obtained (Paterson & Chapman, 2013). If ethical considerations are not taken into account
then it becomes very difficult to justify the changes that have been brought in the nursing
profession. Changes can be at nursing level, healthcare organization level and patient’s level.
Changes at nursing level can be improvement in the way a particular treatment is provided to a
patient. It can also be used to improve the quality of services furnished to them (Tomoaia-Cotisel &
et.al, 2013). On the other hand, it can also be at organization level by identifying and managing risk

in various conditions. If risk is identified it will help in resolving various types of issues which exists
in healthcare organization. Evidence based practice in nursing practice has been consistently
growing these days. However, study results are of less consistency because research questions in
all the evidence based practices is different (Finotto & et.al, 2013). The measurements in blood
pressure levels are also inconsistent because they are measured with the help of techniques that
are not accurate and precise in providing results. Use of different arms, limbs and body position to
measure systolic and diastolic mean may vary. Due to this reason, it is difficult to provide any
clinical recommendations in an acute care nursing practice.
Huang, Chen & Chiang, 2016 have stated that if nurses at various levels are not able to
identify risk and danger in the profession then with the help of evidence based practices they can
identify them effectively. Providing best and effective quality care services to all the patients is one
of the main duties and responsibilities of nurses in nursing profession (Myrick & et.al, 2012). With
the help of evidence based practice nurses can incorporate all the practices which have been
included in randomised control trials, care studies related to the patients and data of patient
derived from compilation of different interventions. If evidence based practices are considered then
patients will not suffer from any major health problems and healthy outcomes of nursing profession
will be developed. Evidence based practice should not be confused with any primary or secondary
research because it does not aim at conducting new research in order to implement new findings
and sources, rather it utilises latest evidence from research which can act as a guidelines in
deriving possible outcomes of evidence based practice (Williams & et.al, 2012). Importance of
evidence based practice has been increased in recent years. One of the major advantage of EBP
is that it helps in improving the quality of services which are provided to patient. It can also result in
improved outcomes of the patient due to the incorporation of new evidence based practices.
(Christie, Hamill & Power, 2012) In nursing profession all the nurses should inform patients about
the treatment and medical interventions so that they are able to make their own choices based on
law and ethical considerations. The code of ethics also states that all the patients in healthcare
settings are liable to be treated equally which can eliminate the factor of discrimination and
inequality (Finotto & et.al, 2013). In a healthcare firm, there are certain decisions that should be
taken collectively with the help of doctors and family members of the patients. In such cases

evidence based practices is very beneficial. Through evidence one can support that following
clinical or medical intervention will result in proposed outcome rather than relying on different types
of assumptions. Different ethics and codes can be considered in four categories (Wong, Cummings
& Ducharme, 2013).
The four categories can be use of drugs in different forms, management strategies,
provision of services and various intervention that are incorporated to treat diseases and illness
(Pearson, Jordan & Munn, 2012). In a research based evidence a study was conducted and it was
revealed that before prescribing drugs to any patient, their body weight, diet and lifestyle should be
known. By developing evidences, the population can be prescribed of various medications so that
they are treated for their diseases (Cowen & Moorhead, 2014). Based on ethical considerations
there are evidence for management strategies that justify the importance of adequate nutrition and
immune system required to sustain any type of medication in the body. Evidence from randomised
control trial has been obtained where more than 81 subjects were selected above the age of 65
years. They suffered from chest infection and (Zimmerman, Shier & Saliba, 2014). As it was a
randomised study they received 500 mL of supplement ensure during the treatment and no
supplement at the time of discharge. Based on research evidence it was stated that the group
which received supplements showed significant health improvement with increased functional
ability as compared to the group which did not receive any treatment (Burman, Robinson & Hart,
2013). Service provision was also based on evidence-based practice which was obtained from
retrospective cohort study analysis. It was reported that individuals who received structured care
for diabetes presented low body weight mean arterial pressure of blood, fasting of blood glucose
and increased use of ACE inhibitors (Wong, Cummings & Ducharme, 2013).
It is very important to know that ethical considerations and evidence based practices have
influenced the clinical and nursing practices in many ways (Tomoaia-Cotisel & et.al, 2013). Due to
the presence of evidence it is ensured that all the patients receive equal treatment for same
condition. Efforts are incorporated so that equal quality of care is incorporated so that there are no
limitations but there are certain aspects were limitations have been reported. The use of therapy in
cardiovascular diseases, replacement therapy and therapy for chronic heart failures are some of

the rationing occurs as limitation of resources (Burman, Robinson & Hart, 2013).
Utilise national and local policies and guidelines and current literature
At national and local level there are different set of policies which are adopted in order to
improve the quality of the services which provided to patients (Zimmerman, Shier & Saliba, 2014).
In this context, there are several policies so as to shape the care policies. Main focus is to
disentangle policies in order to make sense at different roles which are played by organizations to
develop them (Makic & et.al, 2013). However, following are the frame work which are followed in
national and local level:
National policy framework:
In resourcing health and social care, National policies have high impact. However, they also
set up different types of evaluation and indicator criteria. For instance: if for every patient is one
criterion for evaluation (Burman, Robinson & Hart, 2013). Then they should be named nurse. This
highly affects to manage or to organize work or it may also affect the way one welcomes a patient.
On the other hand, if performance indicators which are developed or set by national government
which aims at measuring patients throughput, then one would find it difficult or under pressure to
discharge patient them others (Linton & Prasun, 2013).
National service framework: It was in the year 1998 since government of England started
to develop NSFs (National Service Framworks) (Stanhope & Lancaster, 2015). They aimed at
providing proper care to all the people within the country and it also included elderly people. In this
context, they aimed at understanding different types of researches which has been done in order to
make the practice more effective. They conduced evidence based practice which enabled to
develop trust and confidence with the help of which proper policies has been developed or created.
However, they fine it difficulty in developing it into a policy (Paterson & Chapman, 2013).
Policies at organizational level: All the organizations have their own policies which they
must be following. Regarding procedures and practices, they are very specific policies (Christie,
Hamill & Power, 2012). These policies can be compared to as guidelines which are very helpful for
the organization and the employees in it. It is not easy to trace their origins as they may not be
local. There are many cases in which they get lost in the mists of time. In this context, there may
be no records regarding the committees and groups who developed these policies (Pearson,

Jordan & Munn, 2012). However, the evidence which is related with the policies is very helpful and
they enable to improve the policies in an effective manner.
Dissemination policies: There are many systems which are adopted by organizations and
agencies in developing dissemination policies (Huang, Chen & Chiang, 2016). Some of the policies
many is structure and formal. In formal committees the policies which are developed can be read
as they are made available in many sources. On the other hand, there are organizations in which
the process is not that free or not easily accessible (Goldberg & et.al, 2013). In this context, the
first type of policy has the advantage of transparency. Any of the people who want to access it can
do it and could also get the outcomes. However, there are cases in which it takes time to respond
do it. Second set of policies are more flexible but people within the organization are not clear about
it.
Dignity on the ward campaign: This enables to understand the way in which campaign
helps in making the policies change (Tomoaia-Cotisel & et.al, 2013). There are many cases in
which elderly people are not provided proper care without respect and dignity. Sometimes, it
causes due to lack of resources, effective communication process and negative behaviour of staff
members and caring roles. In addition to this, health care experts and caring roles requires to
respect the culture of service users without doing any type of discrimination with them (Myrick &
et.al, 2012). The caring roles of care organization require maintaining the privacy of service users
in respect to their personal information, identification and medical reports.
Lewin’s Change Management model
In order to adopt change, there are different types of models which can be adopted. Among
these models Lewin’s Change Management model is very effective (Zimmerman, Shier & Saliba,
2014). There are three stages which are involved in this model which are Unfreezing, changing
and refreezing. Following are the different stages involved in Lewin’s Change Management:
1. Unfreezing
2. Changing
3. Refreezing
This model is generally known as change management model which identifies different
areas which needs change and improvement. At initial level it identifies the area which needs a

change (Goldberg & et.al, 2013). After identification of change the rectification should be
incorporated so that functioning and structure of the organization is changed. At last after the
change has been incorporated the change is refreeze so that the change is not reverted back to its
original position.
Implementation of the change
Before adopting any change, it is important that the change which has to be adopted should
be clearly defined. Proper steps should be prepared so that they will be able to achieve the desired
goals and objectives. Further, the organization should be able to analyse the situation and
understand positive as well as negative impact when the change is been adopted (Lewin's 3-Stage
Model of Change, 2016). In this essay, measurement of blood pressure through different
techniques has been considered. Earlier, the method of oscillimetry was used in the measurement
of pressure levels but it was reported that this technique is inconsistent in providing accurate
results (Cowen & Moorhead, 2014). In addition to this, it is important that the changes which have
to be made should be conveyed to employees so that they may not find issues related to it. This
way the policy can be implemented effectively and efficiently.
Second stage is adopting the policy which has to be adopted. It is important that the
organization take proper step or precaution through which they will be able to implement the
change effectively (Wong, Cummings & Ducharme, 2013). After the inconsistency in results
obtained through oscillimetric technique new technique of auscultatory measurement was adopted
because it was reported to produce more accurate and precise results of systolic and diastolic
rates in children who were less than 1 year (Zimmerman, Shier & Saliba, 2014). This method of
non invasive blood pressure measurement was based on evidence based practice in nursing.
Further, monitoring should be done so that they will be able to identify the whether the change
which has been made is helping the firm to grow or not. In this way, firm can also make changes in
the policy which they are willing to adopt. In addition to this, suggestions should be taken from
employees as they will be able to provide better ideas they will be practically adopt the change
(Cowen & Moorhead, 2014).
It is the final stage of freezing because this leads to implementation and reinforcement of
practices after the change (Pelletier & Stichler, 2013). The norms, practices and all the changes

that are made in nursing profession are accepted but there are many cases where all the nurses
and other medical staff do not comply with the changes readily. In the refreezing process it is very
necessary to ensure that all the nurses and other staff nurses do not revert back to old ideas and
changes that were implemented earlier (Tomoaia-Cotisel & et.al, 2013). Refreezing should not
show a revert back mechanism because if it is not accepted by all the nurses in evidence based
practices then the change will be lost from the organization framework. After the implementation of
auscultation technique for measurement of blood pressure, it is necessary to maintain the same
technique throughout nursing so that inaccuracy in results will not be produced (Pelletier & Stichler,
2013). When the results of auscultation method were compared with oscillimetric technique, it was
found that auscultatory method accurately measured the systolic and diastolic rate of blood
pressure in children less than 1 year.
CONCLUSION
The overall report is based on transforming evidence into nursing practice. In this report it
has been discussed that how different types of researches help in developing strategies and
evidence for the implementation of practices in nursing profession. In the first part of the report a
critical analysis was done by considering all the ethical, legal and political aspects of evidence
based practice in nursing. It is important to consider all the ethical and legal considerations in
nursing because when different practices are innovated in health and care organization it is very
necessary to justify them with the help of evidence so that it is not proved wrong. Without ethical
and legal consideration it cannot be implemented in nursing or any other medical profession. In
another part of the report various national and local policies were discussed which further helps in
implementation of various evidence based practices. A model was also designed which could help
in providing a better understanding of different types of research studies in nursing profession.
That model has helped in comparing the change that has been brought in nursing profession
before and after evidence based practices.
Through evidence based practice, I have learned the way in which studies from different
research such as randomised controlled trials and prospective cohort studies can be used to
understand the concept of EBP in nursing profession. It is very important to justify all the practices

in healthcare to ensure that proper practice is conducted in nursing. Through this report, I have
learned that it is very necessary to bring about changes in working of nurse in order to improve the
quality of work and practices in nursing.