In this approach nursing practices assignment we will be looking into the strategies which can be used for the implementation of an evidence based approach for nursing practices apart from the challenge which can be faced during the implementation of the same. Before we look into these two factors it will be important for us to know the exact nature of the topic which we are discussing here as well as the value which this brings to the practice of nursing on an overall level.
As has been defined by previous researchers and industry practitioners, evidence based nursing practices for the nursing is an approach which tries to solve the health related problems of the patients through a process which assimilates the best evidence from studies and patient care data with clinician expertise as well as preferences and values of the patients. (Fineout-Overholt E, 2010)
The approach of evidence based nursing, which can be achieved through validating as well as refining the present knowledge in addition to generating new knowledge which can indirectly or directly influence the various practices of nursing, has the following aims:
- Providing the nursing care which is of best possible quality.
- Providing this high quality nursing care in a cost efficient way.
- Developing the quality of care which are provided by the nurses.
- Increase the level of patient satisfaction.
- Providing nursing practices on the basis of evidence and research instead of habits and traditions.
In view of the fact that we can establish from the previous discussion that there are various positive effects of using an evidence based approach as far as nursing practices are concerned, it is also important for us to understand why it is not being able to be implemented in all the medical sectors of all the nations. For understanding this we will be looking into some of the difficulties which the individuals face at the time of implementation of the same as well as a strategy will be prescribed through which it may be possible to successfully implement this. We will first look into the challenges of implementing this approach (Fineout-Overholt E, 2010).
Challenges of Implementation of an Evidence Based Approach for Nursing Practices
As we can understand from a number of previous researches there are various difficulties which the medical staffs face while the process of implementation of an evidence based approach for nursing practices is carried out.
The most important factor which is required for an effective and efficient implementation of evidence based approach in the health care infrastructure is the resources which are available for the institutions that can be used for the implementation of the same. Similar to any other investment made by the organizations, the implementation of this can only be successful if an only if the variety of resources are made available for this. The process of implementation of evidence based practice also necessitates the commitment of support at the time of initiation of the process as well as for the duration of the same. Without the institutional acknowledgment of the effort, time, as well as resources which are necessary for sustainability of the process, the evidence based approach will fail to deliver (Maljanian, 2002).
Some of the resources which are require for this process are as following:
- Readiness of the organization
- Sufficient support from the leadership of the organization
- Various resources which can be used for development of the staff
- Various real time resources
- Resources for searching for evidence, etc.
It may not be possible for the healthcare providing organizations to have sufficient amount of all of these resources for a longer period of time for developing the culture of the evidence based nursing. Also given the nature of the medical industry and the short time frame in which it works it can be very difficult for the companies to build sufficient readiness for the organization.
Also one very necessary factor for the successful development and sustenance of evidence based approach is the education and knowledge level of the nurses. The success of this approach depends heavily on the proficiency of the nurses as well as the nursing students for comprehending in addition to critiquing the research articles apart from the various literatures on the same or similar topic which will be used for their education in the medical setting. As has been stated by Nancy Dickenson-Hazard,
“Nurses have the capacity to serve as caregivers and change agents in creating and implementing community and population-focused health care service systems.”
A survey on the topic has been carried out by the Honor Society of Nursing in the year 2009.
Through this it has been established that the amongst the registered nurses of the industry in which the study was carried out only 69% have low to moderate knowledge of evidence based practice. Amongst these 69% only 35% are confident of the steps which are required to be taken in the process of the same. A lot of participants in this survey confirmed that, “lack of time during their shift is the primary challenge to researching and applying EBP.” The psychological preparedness of the nurses and the doctors is also an important factor for implementing the evidence based approach which helps them in dealing with the modern inventions to enhance the health care services provided to the patients. Apart from these the ability of the nurses to appraise the researches critically also act as a hindrance for he implementation of this in view of the fact that this calls for significant skills for evaluation of the research which may not be always present in all the individuals. Also the support of the clinic or the hospital for spending time on evidence based nursing can also be scarce due to the usual factors including workload pressures and competing priorities. The lack of knowledge of the nurses as well as other professional practitioners on the research methods in addict to the lack of support from professional colleagues and organizations, and lack of confidence and authority in the research arena also add to the same.
Strategies for Implementation of an Evidence Based Approach for Nursing Practices
There are various leadership strategies which can be used with the intention of successfully implementing. However amongst them a handful has been identified by a number of past researchers and industry practitioners as the most practical strategies for the implementation of evidence based nursing (Greiner, 2003). These are:
- EBP (Evidence based practice) rounds,
- Critically appraised topics, and
- Educational prescriptions.
AS far as addressing EBP for a larger group is concerned, this method can be very effective. In view of the fact that this technique is able to engage with practitioners from various levels in addition to allowing all of them to be engaged in the discussion related to EBP to their desired extent, the buy in which is gathered through this method of implementation from these practitioners is immense. Through the discussion on the patient progress by the healthcare team, various supporting evidences can be included for the decisions on the treatment which have been taken. This process also involved having an EBP mentor, who helps during the initial stages. With the growing knowledge of the nurses regarding the EBP principles, the mentor can be discontinued and the nurses will be taking more important organisational leadership positions (Fineout-Overholt E, 2010).
Critically appraised topics
As far as this technique is concerned, this can be done with less group participation than the strategy discussed previously. This process can be a one-page summary of the evidence with end proposals for practice backed by data. In this the topics which are medically relevant are of supreme importance, apart from the applicability of the studies. For this approach, an ideal system can be poster on the unit of the patient care, which can allow all the staffs to take part in this apart from reaping benefits from having knowledge on the entire process.
This process deals with prescriptions which are self-initiated and which help in reflecting on the process of EBP as well as determining if any learning gaps exist in the process. Then the learners mention their prescriptions of what should be done for bridging the gaps. The culmination of this activity is presentation of the process to a group, increasing accountability for the learner (Greiner, 2003).
One of the rising problem and challenge in Australian population is increasing childhood obesity in age range of 5 year to 14 years old kids. It has very strong clinical implications too because obesity act as a precursor to many diseases like diabetes, Hypertension, high cholesterol levels, hormonal imbalance etc. Both type 1 and type 2 diabetes patients are on a rise in Australia and it is expected that by the end of year 2020 this would take course of a epidemic in Australia. Real concern here is to identify the root causes of such diseases and their development and stop it at a grass root level itself. Clinical question developed here is:- how to control the rising number of children with obesity in age range of 5-14 years in Australia.
PICO standards for population, intervention, comparison and Outcome of a evidence based nursing approach towards a problem.
Population:- population consist of both male and female child of age range 5 years to 14 years in Australia. This population is scattered over urban and rural population and both are showing signs of increase in numbers. Population which is of concern here are children close to puberty from toddler age (Dubois, 2006).
Intervention:- in this age range intervention can be made through vehicles like school. Playgroups, parents, teachers and peer group. Through education and awareness target group can be informed about the benefits of balanced diet, exercises and creating a diet plan for self. A nursing intervention would start with assessing the calories which are consumed by the child on a daily basis and then it is compared with the daily consumption. There would be extra intake of calories which will be corrected by balancing the diet and then exercise regime would be started which will help in consuming the extra calories which is deposited in form of fat. Low quantity of carbohydrates and fats and higher fibrous diet would be initial nursing intervention (Janssen et al, 2004).
Comparison would be done with other age group of children or with other countries’ same age group population. This comparison would help in understanding how rapidly population of Australia’s age group is growing in numbers in comparison with others. Through this analysis gap in the current health care system and intervention approaches can also be identified and developed. Nursing goals and objectives would also be developed on the basis of comparative evaluation.
Comparison would help in understanding the prevalence of the problem and also guide developing of nursing goals and objectives. Outcome would also include creating standards of health care plans and intervention would definitely increase awareness level among families and parents. A change in life style can be observed with the help of such interventions in young age population.
Key Search Words
Key words of search includes obesity, life style disorder, child hood obesity, type 1 diabetes and type 2 diabetes, population of obesity, community health care etc. According to Australian Bureau of Statistics, obesity in children in Australia is progressing at an average rate 10 percent in year 2007 (ABS, 2010).
- ABS, (2010) FEATURE ARTICLE 1: CHILDREN WHO ARE OVERWEIGHT OR OBESE (online) available on http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/1301.0Chapter11062009%E2%80%9310 last accessed on 21/08/2014
- Dubois, L,. Et al 2006) “Breakfast eating and overweight in a pre-school population: is there a link?”. Public Health Nutr 9 (4): 436–42.
- Janssen, I. Et al. (2004) Associations between overweight and obesity with bullying behaviors in school-aged children”. Pediatrics 113 (5): 1187–94.
- Fineout-Overholt E, Melnyk BM, Stillwell SB, Williamson KM. Evidence-based practice step by step: Critical appraisal of the evidence: part I. Am J Nurs. 2010 Jul;110(7):47-52
- Greiner, A., & Knebel, E. (Eds.) (2003). Health professions education: A bridge to quality. Washington, DC: National Academy Press. Institute of Medicine (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.
- Kajermo, K.N., Nordstrom, G., Krusebrant, A., & Bjorvell, H. (1998). Barriers and facilitators of research utilization, as perceived by a group of registered nurses in Sweden. Journal of Advanced Nursing, 27, 798-807.
- Kitson, A. (2000). Toward evidence-based quality improvement: Perspectives from nursing practice. International Journal for Quality in Health Care, 12(6), 459-464.