Lack of a comprehensive education and lack of knowledge in EBP could lead many of the nurses that work in hospitals around the country to make errors, which would negatively affect the patient care and predispose them to increased chances of litigation. This issue also has the potential to undermine the support for evidence-based practice among many health care providers (Gerrish & Clayton, 2004).
Evidence-based practice is also not restricted to the context of the individual patient, but is extended to all areas of healthcare systems and healthcare policy-making. Evidence-based practice is therefore seen to be not only an important means to the improvement of the quality of medical care in this country, but also as an instrument to control the costs (Gerrish & Clayton, 2004).
In view of the scarcity of health care resources that are seen in this country, the decisions on allocation of care will need to be made much more explicitly, and these should also be more transparent and accountable (Gerrish & Clayton, 2004). Evidence-based practice deals with a combined approach to both improving the quality of clinical care and controlling the costs of care through the use of the best available evidence. Changing the medical practice so that it is better for the patients and more cost effective for everyone requires the development of not only of political institutions, but of legal and medical institutions that can oversee medical care properly (Gerrish & Clayton, 2004). Promoting medical practices based on evidence will therefore necessitate more politics, not less, and some people will find this unfortunate, but it is necessary to ensure that patients are taken care of properly (Gerrish & Clayton, 2004).
There are three important and key elements in ethics that also apply to EBP. The first of these elements is veracity, which is the ability of the nurses to be able to comprehensively explain to their patients the EBP diagnostic and treatment modalities (Holmes-Rovner & Rovner, 2000). The second one of these elements is autonomy, which is the ability of the nurses to use the EBP to the best of their ability, in order to ensure that patient care will benefit from it (Holmes-Rovner & Rovner, 2000). The third of these elements is the utilitarian perspective, which is seen to be the best way to comprehensively educate the largest number of nurses in order to ensure that they therapeutically implement EBP properly to affect the greatest number of patients (Holmes-Rovner & Rovner, 2000).
It is important to address the main statement of the issue here, and to look at the question that is being asked so that the reader has a complete and clear understanding of what is being addressed. For the purposes of this discussion, the main question is: what are the most effective ways to implement evidence-based practice in order to provide appropriate and quality care to patients?
The Stakeholders Involved
There are many different stakeholders that are involved with this type of issue. The stakeholders of EBP can include the health care organizations (both public and for-profit), the insurers (both tax-based and for-profit), the health professions, the research community (both funding agencies and researchers), the regulators, the legal system, and the consumers (both health plan purchasers and the public) (Holmes-Rovner & Rovner, 2000). Multiple stakeholders, therefore, shape the evidenced-based decision making in many ways (Fox, 2005).
Policy-makers play a very important role in the influencing of whether (and to what degree) research findings have an influence on health services. These research findings actually use evidence in order to help justify some decisions that have already been made (Fox, 2005). Then, clinicians use these same guidelines in order to help them take even better care of their patients.
Both insurers and administrators use these guidelines in order to help set the policies on both quality of care and reimbursement for care. Lawyers can also use these guidelines in their malpractice litigation, if they are arguing that the physicians have not followed these guidelines without having a good rationale, and the opinion is that they might be negligent (Fox, 2005). There are also key stakeholders in the delivery and payment of care, and these can include employers, consumers, plan providers, and regulators (Fox, 2005). These individuals need a full and complete understanding of EBP, its appropriate application, and the ways that it can be optimally integrated into the care of the patient.
Policy Goal and Objectives
There are always objectives and policy goals that also must be addressed when it comes to these kinds of issues (Clancy & Cronin, 2005). The policy goal that is addressed here is to implement the evidence-based practices effectively, and this will ensure that appropriate patient care can be provided. Policy objectives are also significant, and these objectives are as follows:
To determine the level of understanding of EBP that nurses have and to provide necessary education to fill in any knowledge gaps that may be seen.
To identify the barriers that are in evidence and the ways to integrate EBP effectively into the clinical practice for the benefit of the patients.
To establish important evidence-based guidelines and ensure that they are made accessible.
To implement important strategies that will enhance the utilization and the adherence to evidence-based practices and therefore help ensure the safety and recovery of the patients.
Evaluation criteria is also highly important, and there are three specific areas that will be addressed here to show what will be evaluated. These three areas are:
An emphasis on EBP education and training.
An enhancement of the access to evidence-based resources.
The impact on the cost of health care.
Policy alternatives must now be addressed, because there are many areas that must be discussed, and there are several different ways that these policies can be dealt with and various alternatives that can be utilized in order to help implement EBP and provide the best care for the patients (Atkins, et al., 2005). These alternatives will be discussed below.
1. The first policy objective would be to mandate EBP curricula so that both college and university nursing programs would all be accredited.
Emphasis on EBP education and training
PRO: Having a comprehensive education in EBP is very strongly emphasized. Standards would also be set for RN education. Graduated nurses would be able to educate more senior staff nurses regarding EBP, and these same senior nurses would be able to educate the graduated nurses regarding clinical skills (Deaton, 2001). This would improve the future outlook for evidence-based practice and therefore assist with cost-efficiency and patient care for many nurses.
CON: This policy implementation may actually scare away some new nursing students because of more rigorous requirements. An additional EBP curricula may also not be feasible in many of the diploma programs. Another downside to this is the concern of who will develop these EBP/RN curricula standards.
Enhancement of access to evidence-based resources
PRO: With an EBP course, the students can learn not only how and where they can obtain these important evidence-based resources, but also how they can interpret the data that they find in these resources (Deaton, 2001).
CON: Despite the idea that there will be a better understanding when it comes to EPB, many healthcare institutions do not have the means or the technology for the nurses to access many of the evidence-based resources that would be helpful to them in the future (Deaton, 2001).
Impact on the cost of health care
PRO: Strengthening the process of education, the application of evidence-based practice, and the intensification of research. Involving agencies that work to provide the accreditation, and involving institutions that help to educate the future health care providers. Creating practices that are designed for EBP that can be both mandated and also enforced. These ideas will result in more efficiency regarding the use of more evidence-based resources, and therefore alleviate some of the increasing cost where healthcare is concerned (Deaton, 2001).
CON: The proposal for mandating EBP curricula will improve the success of these efforts when faced with gaps and barriers (Deaton, 2001). However, the cost that is involved with such a proposal will be the largest hindrance when it comes to its implementation (Hewitt-Taylor, 2003).
2. The second policy is to concentrate more on the improving of education within various healthcare institutions.
Emphasis on EBP education and training
PRO: Both education and training within the healthcare facility are convenient and save time for nurses (Hewitt-Taylor, 2003). Nurse EBP committees can therefore facilitate the integration of this information into the hospital's standards of practice. They can also train the immediate staff, treat emergency patients, and acquire new data. Existing staff will then be possibly phased out by some of the better trained RNs if the staff chooses not to learn…