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It is however also important to consider the importance of internal individual factors such as the self-confidence levels of nurses. According to Hockenberry, Wilson and Barrera (2006), for example, note that nurses could feel considerably intimidated by the demands of EBP in nursing practice. Their limited knowledge of the research process thus serves as a barrier to its effective implementation.
Furthermore, the authors also raise the management problem, with nurses feeling a lack of power within their environment even if they do believe that they are able to handle the requirements of effective evidence-based practice. This brings the issue of research back to the leadership issue. In addition, nurses often experience a lack of autonomy, authority, and a basic lack of adequate resources to offer excellent patient care. The authors however suggest that overcoming the barriers to effective EBP could lead to increased job satisfaction for nurses.
In this way, improved nursing practice will complement satisfaction from the work and will have a cumulatively positive effect upon the nursing profession as a whole. Many authors make suggestions on overcoming the barriers to evidence-based practice.
III. OVERCOMING BARRIERS to EBP
According to Drury and several other authors, leadership has manifested itself as one of the primary problems creating barriers to the effective implementation of EBP. It therefore makes good sense to make nursing leadership the target as an instrument of overcoming such barriers. According to Drury, a good leader should master three basic skills, all of which relate to change: the leader should initiate change, promote the acceptance of change, and ensure a safe environment for other initiaters of change.
One of the elements that make nurses reluctant to implement evidence-based practice in their nursing is the fact that they experience a basic uncertainty about how to accomplish this. Attempting to force them to do so makes matters worse. Nurses who are treated like this feel not only victimized, but also intimidated. A good leader should avoid this at all costs.
Udod & Care (2006) provide some practical examples about how such leadership can be accomplished. The most important factor is that leaders must promote the cause of evidence-based practice by themselves believing in and championing it. On an individual level, for example, leaders can demonstrate commitment to EBP by role modeling it. In other words, leaders must themselves become instruments of evidence-based practice to show nurses on a very practical level how beneficial it is for practice.
Once nurses become more confident and show a tendency towards acceptance of the new mode of practice, the next step for leaders would be to create a network of opportunities for nurses themselves to practice EBP. This can be done in a variety of ways, where each individual nurse is provided with an information outlet for research, such as a computer, the findings of which she will then later share in a collaborative environment. Collaboration is an important concept. While no profession can be said to ever occur in isolation, nursing is particularly a manifestation of collaborative practice. In this way, EBP becomes not only a more effective way of serving patients, but also of supporting other nursing staff.
This is also important in terms of time constraints. Nurses can take turns to do research and share this with others, along with suggestions on how to implement theory practically. This will both diversify and lighten the workload, decrease unhealthy stress for nurses, and also provide a basis for greater job satisfaction.
Most importantly, Udod & Care (2006) also note that leaders are to provide psycho-social support to nurses who are in the learning process when implementing the new mode of nursing, where research, evidence, and practice converge.
Being at the heart of the barrier matter, research is another important element that should enjoy focus when implementing evidence-based practice. Drury (1998) suggests that research teams should be developed within the nursing profession, which will further the solution to several of the problems mentioned above. In addition to considerably lightening the collective workload, as mentioned above, such research teams should be composed in a very specific way in order to ensure the greatest effect rather than acting as only a further barrier to effective evidence-based research.
The composition of research teams should be such that its leaders are those who are educated in the art of carrying out and evaluating research. These group leaders can then act as coaches to the rest of the group, who can then "graduate" to become future researchers and teachers. Furthermore, group members should also comprise those registered nurses who work directly with patient care and leaders. Such teams can then collectively act to bring the strength of each individual group member to a team that is ultimately able to implement evidence-based practice in a much more effective way than individuals can.
Such research teams, according to Drury's findings, can then also demonstrate the importance and usefulness of research to those who are not aware of this, they can continue to develop the research prowess of graduate nurses, encourage critical thinking, share research, promote research acceptance, and initiate change while developing researchers.
Research teams then have the potential to implement the necessary elements of evidence-based practice to the hospital setting in a very practical way without significantly adding to the workload of any individual nurse or leader. Indeed, teams can provide the solutions to most of the individual, organizational and environmental barriers to EBP mentioned above.
IV. ADVANTAGES of EBP in NURSING
As seen above, there are many and divergent advantages to the implementation of EBP in nursing. In addition to more effective leadership, teamwork and patient care, Udod & Care (2006) also note that evidence-based nursing practice integrates research and practice in a way that promotes the science base. In other words, nursing practice will not only be improved, it will also develop in terms of future research, practice, and as a science in itself.
What this means in a practical sense is that research results are applied to practice. The practice of the evidence reveals the effectiveness or lack thereof of the evidence implemented, which is then retained or discarded as a result. Soon, the entire institution will be based not only upon research or practice, but upon a combination of the two in a culmination of solid scientific fact. This in itself provides a basis for further scientific research that can be implemented as practice on an experimental basis. Indeed, existing research can be enhanced by new research generated by hospital staff themselves.
This is much more effective and beneficial to nursing practice as a whole than to overload individual nurses with duties that they can barely perform adequately within a single working day. Research teams empower both nursing research and practice by providing the opportunity for both management and nursing practitioners to work together, combine the strengths of group members, and become a solid scientific entity.
This effect has a further effect upon the perception of patients regarding their care. Being more consistent and based upon recent research, nursing practice itself will improve. Patients will receive a higher quality of care from personnel members who enjoy their work and find meaning in its practice. In addition, nurses will also be concerned about providing client satisfaction to patients who are recognized as caring and being knowledgeable about their own health. In this way, nurses become more knowledgeable as well as being recognized for their knowledge. Furthermore, nurses will come to a position where they will be eligible for leadership positions themselves.
In general, the main advantage of implementing evidence-based nursing in this way is its beneficial effect upon the well-being not only of nursing professionals and their leaders, but also upon those who make use of their services.
In conclusion, the best practice when coping with the challenges of implementing evidence-based practice in the nursing profession is to follow a number of logical steps. The first is to determine the nature of the challenge. In general, these challenges tend to revolve around a combination of work and research volume. These challenges can be addressed effectively by the implementation of research teams, which combine the expertise of a number of individuals rather than expecting each individual to handle both patient workloads and theoretical research.
Finally, the issue of evidence-based practice is obviously a very current one in nursing. It is commonly recognized that this practice should be implemented in order to optimize patient care. However, it should also be recognized that the needs of nursing practitioners and their leaders are to be taken into account. Fulfilled, happy nursing and research practitioners can provide much better services than those who feel insecure, victimized, and afraid of change. Hence, leadership should be the starting point in implementing effective change that would ultimately lead to better hospital practice and health care. In this way, not only the satisfaction of clients, but also of those who serve them, will be recognized.
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