Nursing research and evidence-based practice

Nurse Barriers

Nursing Care and Barriers to Evidence-Based Practice

In a recent and rather typical nursing setting, I was tasked with delivering care -- including the provision of advice -- to a patient with Type II diabetes. The care provided was very standard and straightforward, as the patient was present in the medical office for a check-up/monitoring of her condition and not due to any new or recently aggravated symptoms or other complaints or concerns. Insulin and fasting glucose were tested and assessed in accordance with established guidelines, dietary records were taken as reported by the patient, and dietary choices were discussed in light of the patient's reported eating habits and history of insulin needs as well as other parameters of her condition. All of this was accomplished in keeping with evidence-based practice, as far as this nurse is aware, and yet this really is the crux of the issue (Polit & Beck, 2012). The degree of standardization and established practice guidelines for such check-ups is assumed by the nurse to be in keeping with research and thus to constitute evidence-based practice, and yet the regularity of the interpretation of results and of the advice given does not appear to be individually customizable nor has this nurse been able to independently verify the recommendations made for practice and care delivery.

The primary barrier to delivering, or more correctly to confirming the delivery of, evidence-based care, is a lack of time available to the nurse to engage in reading the relevant research (Zeitz & McCutcheon, 2003). Especially in a general practice setting where no real specialization exists, nursing staff are not only expected but required (due to a variety of ethical, medical, personal, and legal constraints) to provide care along established guidelines and to make significant adjustments to care only after lengthy discussions with nursing leaders and/or physicians, and must be able to do so for a variety of patients in many different situations and with different ailments. While it would have been unquestionably beneficial to the patient and indeed to this nurse to be able to engage in a more meaningful, enlightened, and research-based discussion of her condition and methods for addressing it, this nurse simply did not have the time to devote to reading the latest research on diabetes care in addition to remaining prepared for all patients. The policies of the organization in which the nurse was functioning do not support the use of at-work time for engaging in reading, nor is there a substantial knowledge-sharing apparatus at work: the published and long-accepted guidelines for care remain largely unchanged not only from day-to-day but from year to year, as well.