Evidence-Based Practice in Nursing: Policy Analysis

Introduction and Problem Identification

Despite many efforts to promote evidence-based practice (EBP), many patients are not receiving appropriate care. Evidence-based practice implies that decisions about treatment options will depend largely on evidence of their clinical effectiveness. The major purpose of EBP is the elimination of expensive, ineffective, or dangerous medical decision-making. However, developing and using this evidence is not always straightforward. Making use of evidence in clinical practice is a major challenge for nurses, who face numerous gaps and barriers to EBP. The major barriers include a lack of time, poor access to literature, and a lack of ability to judge the quality of research.

The goal of policy implementation is to facilitate EBP in ways that ensure patients receive the most cost-effective and efficacious care. To support this goal, the following objectives were formulated: to determine the level of nurses' understanding of EBP and provide necessary education; to identify barriers and ways to integrate EBP effectively into clinical practice; to establish evidence-based guidelines and make them accessible; and to implement strategies to enhance the utilization of and adherence to evidence-based practice.

Many patients today are not seeing the quality of care that they actually need, despite the fact that evidence-based practice has been evolving (Claxton et al., 2005). Patients are too often receiving inconsistent, wasteful, and even harmful interventions (Helfand, 2005). There has been an increasing emphasis on the outcomes of patient care, shifting the focus from tradition- and opinion-driven decisions toward practices guided by evidence (Helfand, 2005). Problems that remain unresolved include the gap between evidence and practice, unnecessary variations in practice, and the rising cost of healthcare (Claxton et al., 2005). Evidence-based practice attempts to eliminate wasteful and harmful practices by improving standards of care, which could also help provide more cost-effective healthcare for many patients (Claxton et al., 2005).

The establishment of EBP is not an easy process. Nurses are confronted every day with challenges in providing both safe and effective care. According to Haines et al. (2004), barriers may exist in the healthcare system such as a lack of financial resources, a lack of access to care, poor practice organization, failure of curricula to reflect research evidence, inappropriate continuing education, and patient demand for care that is not effective in the long run.

Barriers to the proper use of research in nursing practice exist at both the institutional and individual levels. The lack of time is generally seen as the most significant barrier (Claxton et al., 2005). Very few nurses today have either the skills or the time to search for relevant evidence and appraise it properly (Claxton et al., 2005). Quite often, nurses rely mostly on experiential knowledge gained through interactions with colleagues, medical staff, and patients (Pravikoff et al., 2005). Unfortunately, they receive little to no education or training in information retrieval, do not often understand or value research, and are therefore generally unprepared for a practice built on evidence rather than experimentation and common knowledge that may be seriously out of date (Helfand, 2005).

Some of the problems nurses face in this area can be attributed to rapid and significant technological change (Garber, 2005). However, some must also be attributed to nursing education programs and their failure to prepare students at all levels of practice, so that future nurses could understand the importance of maintaining a practice based on something more than tradition, experience, and intuition (Garber, 2005).

Evidence-based practice is crucial for care directed toward the improvement of patient outcomes (Helfand, 2005). This kind of practice provides the basis for reducing inappropriate variability in practice patterns and increasing patient compliance. Measurements of patient outcomes in organizations using EBP can help further validate the importance of this practice and help close the gap between practice and research (Helfand, 2005). It is likely that EBP will become much more common as the cost of healthcare increases. The contribution that nurses make in advanced practice roles — such as clinical nurse specialists and nurse consultants — can greatly assist the EBP process (Helfand, 2005). These specialists and consultants can act as a valuable resource for collecting evidence-based information and for supporting an environment more receptive to change (Helfand, 2005).