Evidence-Based Nursing Practice: Standards, Barriers, and Solutions

This essay examines evidence-based nursing practice (EBP) and its critical role in modern healthcare. It defines EBP as the integration of research evidence, clinical expertise, and patient preferences to enhance patient-centered care. The essay outlines the steps involved in EBP, including patient assessment, clinical question formulation, research, evidence appraisal, and application to practice. It highlights the benefits of EBP, such as improved patient outcomes, enhanced patient safety, and support for patient values. Furthermore, the essay explores the impact of EBP on nurses' roles, emphasizing the need for higher education and research integration. It also discusses the misconceptions among nursing students regarding research and the importance of dynamic nursing education. The essay delves into the NMBA standards, which align with EBP, and the ethical frameworks nurses must adhere to. It also addresses barriers to EBP implementation, such as organizational support, time constraints, limited access to IT resources, and resistance to change. The essay concludes by emphasizing the need for increased awareness and training to facilitate successful EBP implementation across clinical settings.

Running head: EVIDENCE BASED NURSING PRACTICE
EVIDENCE BASED NURSING PRACTICE
Name of the Student
Name of the university
Author’s note

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EVIDENCE BASED NURSING PRACTICE
My position statement: Evidence based practice links research evidence with clinical expertise to
support a patient centered care through the inclusion of preference of the patients.
According to Fleiszer et al., 2016, Evidence based research may be defined as the
explicit, judicious and conscientious use of the current evidences in taking decisions regarding
the care of individual patients. The effect of the evidence based nursing has been felt in all the
aspects of clinical practice. The concept of evidence based practice in nursing has gained
momentum for the past few years. With the increasing demands of heath care over the world, the
nurses now act in frontline with the doctors to give a patient centered care (Mitchell et al., 2015).
In a simplified form it can be said that evidence based practice in nursing requires scientific
reseaches, remaining updated with the current research techniques, efficient learning of the
medical journals, application of the formal rules of the evidence, which can be useful in
extending the conventional limits of the nurses (Hall & Roussel, 2016).
The steps in the evidence based nursing research includes-
Assessing the patient, to determine the questions or the doubts that may arise from the
case study of the patient, construction of a well built clinical question acquired from the case,
conducting extensive research in relation to the case, Appraising the validity of the evidence
found, Linking the evidence with the clinical practice and apply necessary interventions to the
patient, obtained from the evidence based practice (Mitchell et al., 2015). EBP fills the gaps in
patient care and brings about better outcomes in patients by collaborating clinical practice with
research evidences. It supports the values of the patients to promote a better experience in

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patients. EBP assists the nurse to expand their horizon and modify patient care (Williams et al.,
2015).
According to Boltz et al., 2016, EBP involve better outcomes in patients, enhancing patient
safety by providing a culturally safer background to the patient. In today's world patients are
health care consumers and demand safer and skilled healthcare practice. The basis of EBP lies in
research that would help in providing information regarding the treatment of the health care
condition (Stevens, 2013).
With the increasing demands of the health care needs, healthcare organizations are now
involving the nurses in the decision making process, due to which a large portion of nurses are
proceeding their higher education in nursing. Higher education related to nursing, requires lot
researches. It should be noted, that incorporation of evidence based practice by the nurses is also
required for the growth of the organization (Stevens, 2013). As the hospitals are asking the
nurses to become more innovative and improve the operations related to healthcare (Williams et
al., 2015). In addition to that, the nursing students pursuing masters or researches are provided
with opportunities to continue their research based work under the aid of the organization.
Practice of evidence based research work helps the nurses to step into leadership roles. EBP also
helps the nurses to reach the underserved population and implement strategies to reach them.
Nowadays advanced education is required to enhance the skills, incorporate information
technology, and greater care coordination across the care continuum (Stevens, 2013).
Throughout the 21st century the roles of the nurses have evolved drastically. The
profession of nursing has become dynamic. They have to work in a variety of settings, which
includes the hospitals, schools, businesses sector, and health department of the community,

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laboratory, home and health care. Each of these nurses has various responsibilities, but the
primary concern of the nurses will remain the same (Stevens, 2013).
There are misconceptions in the nursing students regarding the nursing researches and do
not have the ideas how to proceed with the research. Evidence based practice demands changes
in the nursing education to be more dynamic, such that there is a closer working relationship
between the clinicians and the caregivers (Williams et al., 2015). EBP helps the nursing practice
to become more focused, individualized, streamlined and also helps in increasing the active
judgment capability. The other effects of the EBP are cost containment, increasing availability of
information's and increasing customer savvy for the care and treatment options (Stevens, 2013).
There are different NMBA standards proposed by the nursing midwifery practice of
Australia, which aligns with the evidence based research practices. All the registered nurses have
to maintain certain codes of conduct and certain codes of ethics in nursing practice (Williams et
al., 2015). The purpose of this framework is to provide them with professional guidance and
support on matters related to their clinical practice. This works as a framework to under pin the
decision making in nurses (Stevens, 2013). It helps to understand the needs for professional
development. It also promotes reflective practices to enhance self learning for providing a safer
and quality care to the patient (Hall et al., 2016). The standards help the nurses to make decisions
regarding their roles and responsibilities which is an empowering determinant for the
practitioners. There are seven NMBA standards of nursing that is required to be followed by the
registered nurses.
Critical thinking and analysis in nursing practice is required by an RN to make the best
possible use of the evidences available (Stevens, 2013). As a nurse it is required to practice a

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culturally safe nursing, with special reference to the aboriginal population of Australia. It is the
duty of the nurses to meet up to the legislations, guidelines and the policies associated to the
nursing standards. Ethical frame woks should be maintained while taking any decisions. Melnyk
et al., (2014) has argued that ethical frame work in nursing refers to beneficence and non
malefiecience, which cannot be always used for the sake of the patients health.
Standard 2 refers to the engagement of the nurse in therapeutic relationship with the
patient. Nurse can use the concept of EBP in providing a collaborative care to the patient. As per
the conditions of the evidence based practice, it is necessary to advocate confidentiality of the
patient’s condition. A nurse should be able to maintain the patient’s dignity (LoBiondo-Wood &
Haber, 2017).
Evidence based practice involves professional development, which again aligns with the
NMBA standard 3. EBP requires conduction of patient's assessment that is holistic and
culturally safe to the patient, which is same as the standard 4 of NMBA. The standard 5 of the
NMBA framework refers to the use of the assessment data to develop a plan for the patient.
Harvey & Kitson (2015) have argued that planning is always not possible due to the resistances
from the nurse managers and the doctor in charge. The standard 6 of the NMBA framework
encourages the nurse to provide a timely and safe nursing care to the patient (Masters, 2015). It
is the duty of a nurse to point out the potential risks and flaws related to the system. It often
becomes very difficult to point out the flaws being in the same system. Thus, from this
perspective it often becomes very difficult in implementing evidence based practice (Ossenberg
et al., 2016). The standard 7 of the NMBA framework, it is the duty of a nurse to measure the
progress and the deterioration in a clinical setting to proceed more towards the expected goals.

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Ackley et al (2016) has argued that it is not possible to implement evidence based
practice in all the aspects of healthcare without a proper training. Researchers have shown that
only 34.5% of the nurses in a clinical setting use EBP in their nursing practice (Stevens, 2013).
Majority of the nurses feel that it is required to have enhanced knowledge and skills in EBP,
which is due the lack of proper educational scopes. According to Levin & Feldman (2012), the
two most important factors that can act as barriers to evidence based practice are organizational
support and time. Sometimes it becomes very difficult to incorporate any change in the old
setting and getting past the workplace resistance as that is the way the nurses have been doing so
far. In most of the cases the nurse students gets resistance from the nurse leaders and the nurse
managers (Melnyk et al., 2014). Furthermore, it cannot be expected that nurse would sit and look
after articles instead of taking care of the patients. Even if they are self motivated to the
necessary researches, time will not allow them to do that.
Education is the biggest barrier as people educated many years ago have no idea about
the EBP approach of care. While many organization are supporting the EBP method of practice,
there are few that still that follows the conventional methods of nursing (Masters, 2015).
Some of the organizations who are in support of the evidence based practice needs to
understand that a one or two days workshops will not be able to bring about any sustainable
change in clinical settings (Melnyk et al., 2014). In order to make things feasible it is necessary
to appoint enough EBP mentors, who will be able to work beside the clinicians to have in-hand
experiences. Another important factor may act as a barrier to the EBP implementation is the
limited access to information technologies and computer systems (Melnyk et al., 2014). It cannot
be expected from the nurse to perform EBP without proper availability of the IT resources, as it
is required to remain updated regarding the various scientific journals and articles. (Flodgren et

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al., 2014) have argued that there are lots of loops and holes to jump through for making a thing
implemented in a clinical setting.
According to author Brownson et al., 2017, many nurse practitioners have felt that the
patients have often refused the new evidence based treatment plans and wanted to stick to the old
methods. In case of older or mental patient, it becomes very difficult to get them convinced
regarding the change (Melnyk et al., 2014). It is evident that EBP can lessen the burden on the
doctors and reduce their invested time over individual patients. However, Jacob et al., 2012, have
argued that there are certain doctors who feel that their treatment methods are evidence based,
even if they are outdated. Hence that becomes a challenge for practicing EBP.
Hence it can be rightly said that it is not feasible to expect the registered nurses to
implement evidence based practice in all aspects of clinical setting. Lot of researches is yet to be
done and awareness regarding EBP is still needed to be disseminated to make it successful
throughout the clinical setting.

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