Evidence-Based Practice in Nursing: Leadership and EBP

Purpose of the Appraisal

The article chosen is Hauck, Winsett, and Kuric (2013), "Leadership facilitation strategies to establish evidence-based practice in an acute care hospital," because it addresses a vital aspect of nursing practice. Evidence-based practice is critical for nursing in order to ensure that preventable complications are avoided. Improving patient care is one of the primary obligations placed upon hospitals, and this is only achievable if they implement evidence-based practice. This is a research article focusing on the effects of leadership in establishing evidence-based practice strategies within a hospital. The researchers intended to analyze the beliefs of nurses regarding the importance of using evidence-based practice to improve patient care (Hauck et al., 2013). The researchers also investigated the readiness of the organization to use evidence in daily nursing practice.

The research article focuses on an area that has been neglected by many researchers (Hauck et al., 2013), which makes this article particularly effective for improving and expanding knowledge in the field of nursing. The researchers chose an area vital for maintaining nursing knowledge, which in turn is essential for improving patient care. By increasing the use of evidence-based practice, a nurse gains critical information for addressing specific clinical situations. Evidence-based practice gives nurses the opportunity to use research studies when making practical decisions, supporting informed and defensible choices. The researchers were attempting to solve the clinical problem of failing to use evidence-based practice in the performance of nursing duties. Hauck et al. (2013) demonstrated that implementing evidence-based practice within a hospital requires backing from all stakeholders, not just direct care nurses. By incorporating evidence alongside clinical expertise, nurses can make better decisions and improve patient care.

There is a persistent challenge in changing the mindsets of people, which has made it difficult to implement evidence-based practice successfully within a hospital. Nursing leaders were assumed to be supportive of evidence-based practice, but they are often at fault when it comes to strategy implementation (Hauck et al., 2013). Nursing leaders should be at the forefront of implementing evidence-based practice within the hospital. The researchers sought to establish how effective three distinct groups of nurses were when it came to evidence-based practice, and to demonstrate that using EBP within a facility would improve patient care and increase nurse satisfaction with their decisions. The article makes clear that there is significant room for improvement if EBP is to be fully implemented within the hospital, and that leaders should be more encouraging and supportive of EBP.

The problem addressed in the article is compounded by a lack of support from leaders and indirect care RNs (Hauck et al., 2013). There has been limited training on how to best implement an EBP culture within an organization, and the support offered by leaders is not demonstrated in practice. This makes it difficult to create such a culture within a hospital. According to Hauck et al. (2013), the failure to rely on evidence-based practice forces nurses to fall back on their clinical experience when making decisions. Decision-making supported by evidence is less likely to be questioned and tends to produce more favorable results than decisions based on experience alone. The reliance on experience is preferred by many nurses because it allows them to handle situations in familiar ways. Using evidence-based practice, however, means a nurse may need to try something new, and fear of unknown outcomes can be a significant obstacle.

Appraisal of the Article

The level of evidence presented by the research article is 2c. This is because the research uses a prospective descriptive comparative design, which attempts to analyze nurses' beliefs about the importance of EBP, the frequency of EBP use in their daily practice, and the organization's readiness for EBP after implementing a strategic plan (Hauck et al., 2013). The study describes what is happening rather than examining the effects of various independent and dependent variables. Being prospective means the data to be used is not available at the outset; it is generated only after the study has begun. Since the strategy had not yet been implemented at the start, the researchers could not draw on pre-existing data.

The research was conducted in a single hospital and incorporated nurses who had already been working within the facility for at least three months (Hauck et al., 2013). The study was located in a non-teaching hospital, which was a limitation, as the evidence discovered could not be assumed to apply to teaching hospitals. The researchers critically appraised relevant studies and demonstrated the importance of using EBP in nursing care (Hauck et al., 2013). The article is well formulated and incorporates information from diverse sources, presenting that information in a discussion format and linking the literature to the research question. The research design does support the research question, though it is limited in that the researchers can only observe the strategy's implementation without manipulating any variables. The research question is vital for advancing EBP in hospitals, and the study should be expanded to include additional hospital settings. Conducting the research in two separate locations would help determine effective methodologies for implementing the strategy.

Hauck et al. (2013) state that the instruments used for measuring results were the Evidence-Based Practice Belief Scale, the Evidence-Based Practice Implementation Scale, and the Organizational Culture and Readiness for System-Wide Integration Survey. These instruments were used to measure change before and after strategy implementation, and their validity and reliability were supported by the evidence they generated. The baseline measurement was vital, as it revealed who most strongly supported EBP and at what level. The researchers demonstrated a measurable increment between baseline and final results. According to Hauck et al. (2013), the impact of the strategic EBP plan on nurses' beliefs increased by 7%, indicating that the strategic plan's target was achieved. The Practice Belief Scale used 16 items scored on a Likert-type scale, and Cronbach's alpha was also employed as a reliability measure.

The impact of the strategic plan on frequency of EBP use showed low scores, with no statistically significant difference between baseline and final scores; however, the hospital still achieved a 14% increment from the baseline. The organizational culture was positively impacted, with the hospital achieving a 19% increase against a target of 10%. Organizational readiness achieved the highest percentage increase — a 26% improvement against a target of 10% (Hauck et al., 2013).

Study Results and Key Findings

The study results demonstrate that among the three categories — direct care, indirect care, and director/leader — the direct care group was the most supportive of incorporating EBP into their daily nursing duties. Leaders, whom the baseline results had initially indicated were supportive of EBP, were found to be a hindrance to strategy implementation in practice (Hauck et al., 2013). Direct care nurses reported that leaders and indirect care nurses were obstructing their progress. The reliance on baseline scores prevented the researchers from anticipating problems during strategy implementation, which could be considered a flaw in the study's methodology. The lack of support revealed that leaders were assumed supportive but were, in reality, unwilling to adopt the strategy. While the study could potentially be replicated in another setting, the results from this study cannot be broadly generalized, as it centered on one non-teaching, faith-based hospital.

References

Hauck, S., Winsett, R. P., & Kuric, J. (2013). Leadership facilitation strategies to establish evidence-based practice in an acute care hospital. Journal of Advanced Nursing, 69(3), 664–674.