Managing Barriers to Change in Nursing Practice
This paper examines the barriers nurses and nurse educators encounter when implementing changes in clinical practice, drawing on a capstone project experience. It identifies key categories of barriers—including staff resistance, lack of leadership, insufficient resources, and communication challenges—using Funk, Tornquist, and Champagne's (1991) four-factor barrier scale as a framework. The paper further addresses ethical concerns relevant to nursing practice, such as informed consent, IRB compliance, patient advocacy, and professional codes of ethics, alongside legal issues including the Nurse Practice Act, licensure, negligence, and malpractice. Together, these dimensions illustrate the complex landscape nurses must navigate to deliver responsible, patient-centered care.
- Introduction to Barriers in Practice Change: Capstone project barriers and leadership responses
- Categories of Barriers to Research Utilization: Funk et al. four-category barrier scale explained
- Ethical Issues in Nursing Practice: Consent, IRB, patient advocacy, and professional ethics
- Legal Issues and Accountability in Nursing: Nurse Practice Act, licensure, negligence, and malpractice
- References: APA citations for all sources used
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What makes this paper effective
- Grounds abstract concepts in a real capstone project experience, making the discussion of barriers concrete and relatable.
- Moves logically from organizational barriers to ethical and then legal dimensions, showing how each layer compounds the challenge of practice change.
- Integrates authoritative sources—including the ANA Code of Ethics and the Funk et al. barrier scale—to support each category of concern.
Key academic technique demonstrated
The paper demonstrates applied synthesis: it connects a named theoretical framework (Funk, Tornquist, and Champagne's four-category barrier scale) to practical nursing scenarios, then extends the analysis into ethical and legal territory. This move—theory to practice to professional obligation—is a hallmark of graduate-level nursing capstone writing.
Structure breakdown
The paper opens with a brief narrative from a capstone project to contextualize barriers, then broadens to enumerate general barrier types with a supporting citation. Subsequent paragraphs address the research-utilization barrier scale, ethical dilemmas (access, consent, IRB, advocacy), and legal accountability (Nurse Practice Act, malpractice). A short concluding statement ties these threads back to the nurse educator/executive role. The reference list follows APA format.
Introduction to Barriers in Practice Change
Barriers encountered in a capstone project revolved around the perception among staff that reading rhythm strips was not part of their job, and that continuing education was not worth leaving the floor to attend. Good leadership can help eliminate these kinds of problems, as they must be addressed by those who insist that everyone fulfill their responsibilities and make time for professional development such as continuing education. As this example illustrates, there are generally a number of barriers encountered when trying to implement a change in practice. Even when that change would resolve a problem or address a legitimate concern, many people will still resist it. The main barriers can include resistance to change from staff, lack of leadership, insufficient resources (both financial and material), environmental factors, communication breakdowns, and stakeholder opposition, among others (Pexton, 2005). Recognizing a barrier represents an opportunity to take action and remove it.
Categories of Barriers to Research Utilization
Evidence-based nursing practice depends on the ability to overcome barriers to research utilization. Funk, Tornquist, and Champagne (1991) developed a scale based on four categories of barriers to research use by nurses in practice. These factors were: characteristics of the potential adopter, characteristics of the organization, characteristics of the research itself, and characteristics of the communication of the research. Each category captures a distinct dimension of why well-supported evidence may fail to reach the bedside.
Ethical Issues in Nursing Practice
There are also a number of ethical and legal dilemmas that must be addressed, and that can affect the barriers nurses face. Nurses must take appropriate action on issues such as professionalism, health policy, reimbursement, and the organizations that provide care. Professional ethics are part of the nurse's routine, and professional organizations have developed codes to guide practice. The American Nurses Association (ANA) Code of Ethics for Nurses with Interpretive Statements (2001) is one such resource nurses rely on when ethical issues arise. Nurses also have a responsibility to report any unethical, incompetent, or illegal practices they encounter.
Other ethical issues facing nurses include who receives access to healthcare, resource allocation, staffing and delegation, fraud and abuse, end-of-life concerns, informed consent, and ethics in research (Finkelman & Kenner, 2010). Unfortunately, there has been a long history of ethical problems in research, which led to significant reform and legal guidelines in the 1970s. Since that time, greater attention has been paid to ethics in the conduct and reporting of research. Informed consent and Institutional Review Board (IRB) approval are both requirements. Nurses should be aware of IRB requirements because they must follow the same rules as any other researcher when working with human or animal subjects. Nurses also need to remain patient advocates while collecting data for ongoing research — a role that requires a delicate balance. The rights of the patient must be upheld above any research concerns, and nurses are charged with ensuring this is true for every patient in their care.
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