Creating and Sustaining a Cultural Environment for Evidence Based Practice in a Healthcare Setting

Creating and Sustaining a Culture and Environment for Evidence-Based Practice

Part 1

Using critically appraised and scientifically proven data, nurses can utilize evidence-based practice (EBP) to give high-quality health care to a specific population. In the current case of keeping women NPO during labor, EBP provides the best approach to address the conflict between the professional recommendations and the available scientific evidence (Tucker et al., 2021). An EBP institutional culture must be developed within the labor and delivery floor in the urban hospital to facilitate effective change in practice.

In the current case, the EBP process has advanced to a research report that does not support keeping women NPO during labor. The next phase of the process, thus, is the incorporation of the research results to practice, thus EBP. The first step in this phase is to choose a decision-making framework (Chiwaula et al., 2021). Implementation science has shifted to a more systematic approach, with theoretical frameworks guiding the process of translating research into practice.

The next step is a critical appraisal of the evidence. The validity, reliability, and applicability of research to answer the clinical question must be assessed. During the literature search, the team members must determine how much high-quality evidence was discovered. The strength of clinical evidence can be measured by assigning an evidence level to each study (). RCTs, meta-analyses, and systematic reviews are usually the highest level of evidence for making clinical decisions in most level hierarchies.

The next stage is to provide a grade that will help guide recommendations for putting the results into reality. The team's assessment of the strength of evidence for implementing a therapy or intervention determines the recommendation grade. Grades are frequently expressed as A, B, C, or plus signs. The strength of the suggestion based on the evidence is determined by grading the evidence. Although grading is a crucial element of the process, it is not uniform among health professions. 1) SORT (Strength of Recommendation Taxonomy), 2) Grade Working Group (Grading of Recommendations Assessment Development, and Evaluation), and 3) AGREE II (Appraisal of Guidelines for Research and Evaluation 2) are some of the existing grading systems (Sims et al., 2019).

The next crucial step is to put the evidence into practice. Following a rigorous review of the literature, the team must decide whether to proceed with placing the evidence into practice. A plan and robust methodology are required to incorporate the best evidence into patient care.

The next step after implementing an EBP methodology is to assess the results. Some of the questions to be determined at this stage are; Is it true that it made a difference? Is it true that it answered the clinical question? The labor and delivery floor nurses must assess the anticipated outcomes of implementing the techniques. In the current case, the nurses must determine the effects of allowing women to eat or/and drink during labor. A QI process may be required as part of the project's evaluation to discover gaps in procedure and process. The nurse will be able to adjust the process based on the discovered gaps to attain the intended output.

The results must then be disseminated. In the current case, these findings will be shared at professional conferences after being shared in a report and a presentation to the professional organizations.

Part 2

EBP mentors are key to integrating EBP into the culture and achieving implementation and sustainability of EBP in practice settings. To successfully do this, three characteristics are considered vital;

i. Knowledge and skill in EBP

This trait pertains to personal, hands-on participation in real-time EBP activities. It also has to do with being visible and indicates that you are directly and operationally supportive of EBP. This characteristic required the following core intervening/involving behaviors: (a) leading organized EBP-related activities; (b) participating as an active member in others' EBP-related activities; and (c) responsively providing concrete and tangible support to others in terms of observed or requested EBP needs (Melnyk et al., 2021). An EBP mentor with this character will "walk the talk" by leading and participating in EBP activities at any leadership level. All, except informal staff nurse leaders who have neither authority nor resources at hand, will assist in response to barriers and requests from others who are so engaged. Multiple leaders who originate, enact and involve others in evidence-based journal clubs and formal EBP initiatives reflect the high level of intervening behaviors in the EBP Role Model site.

ii. Credibility with frontline staff

Because EBP mentors must excite their team, generate consensus, and persuade doubters, the ability to influence others is critical to their success. It takes more than just being a good speaker or writer. It also necessitates what Aristotle considered the most important aspect of persuasion: believability. According to Aristotle, a communicator must be perceived as a person of good character to influence an audience. Credibility is a judgment made by the mentee about how trustworthy the communicator is, and it's significant since people often respond to a persuasive message based on their perception of the communicator rather than the content (Melnyk et al., 2021; Wang, Zhang & Guo, 2021). This EBP mentor's personality is focused on motivating, encouraging, and engaging people in EBP. This can take the shape of a carrot or a stick, including both administrative and relational activities. They aid in operationalizing basic expectations that could otherwise be left as jargon or pronouncements in documents. EBP mentors, for example, use discretionary monies to facilitate participation in external EBP-related activities and overtly acknowledge and promote expected EBP behaviors (or absence thereof) in performance assessments. Relational behaviors are more informal; interpersonal gestures motivate an EBP mentee to participate or "give them a spark."

iii. Leadership ability

This EBP mentor trait is mostly focused on project monitoring and implementation. In terms of EBP monitoring, related critical leadership behaviors include routine and EBP project-focused measuring, with considerable attention to auditing; a general seeking out of information on targeted EBP progress and issues; and the routine provision of aggregate observations and data regarding general indicators and progress on EBP to groups of staff/mentee (Melnyk et al., 2021). In the EBP program, effective leaders can communicate effectively, encourage their team, manage and assign duties, listen to feedback, and solve problems with flexibility. Leadership ability is a widespread, fundamental characteristic of an EBP mentor that may be seen in two ways: strategic and functional. In terms of strategy, leadership demonstrates a desire to influence the EBP standard and change. As a result, leaders used specific EBP language, introduced and consistently discussed the EBP vision, and made frequent references to new EBP requirements. Task- or operational-oriented behaviors for more immediate aims are reflected in functionally leading. For example, talks or presentations about a new evidence-based aim focus on raising others' awareness, knowledge, attitudes, and behavior.