Challenges of incorporating evidence within clinical practice

I am passionate about developing nurses skills in relation to accessing and using the best available evidence to inform clinical decisions. Consequently, joining the editorial team at Evidence-Based Nursing was an exciting start to the year. New roles are often associated with a mix of emotions, from excitement to apprehension and having the skills to meet expectations. The focus of EBN twitter club Session 4 (https://blogs.bmj.com/ebn/), nursing graduates’ ability to incorporate evidence into practice and influence clinical change (Wallin et al 2012), certainly struck a chord. Undertaking a new role coupled with some unpredicted events that resulted in competing time pressures, left me feeling rather overwhelmed.  In many ways it not surprising that competing demands and the many contextual factors that influence nursing practice results in wide variability in the way nurses use and promote evidence to underpin practice.

Nurses increasingly face many dilemmas in providing safe and quality care in an environment ever more dominated by cost containment which has implications for patient care. Healthcare systems in around the world, whether private or publicly funded, are facing unprecedented change and having to respond to the current global economic downturn (Adams 2012). A recent report by the European Federation of Nurses Associations (2012) refers to a ‘crisis in care’; suggesting the twin imperatives of quality care and efficiency are not attainable. Yet it is precisely at times of crisis with nurses facing many competing demands that nursing care is based on the best available evidence. Although I am not suggesting evidence-based practice (EBP) is a panacea for solving all of the challenges of current healthcare delivery, it is a starting point.  Clear organisational strategic plans in relation to EBP coupled with strong leadership have been identified as central to developing a critical mass of nurses that evaluate evidence and apply findings to their practice (Hauck et al 2013).  It seems logical that nurses will be more likely to develop the skills and attitudes required to incorporate EBP into care delivery, with the potential to improve patient care, in organisation that value and encourage the contribution of nursing in developing a culture that values EBP. The challenge for the nursing profession is to ensure that the provision of healthcare is not dominated by financial issues, but on meeting patient’s health needs using the best available evidence.

References

Adams, E. (2012) Delivering and securing health care in challenging times. International Nursing Review 58, 401–2;

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

Wallin, L., Gustavsson P., Ehrenberg, A., et al (2012) A modest start, but a steady rise in research use: a longitudinal study of nurses during the first five years in professional life. Implement Science 7, 19;

European Federation of Nurses Associations (2012) Caring in Crisis: the Impact of the Financial Crisis on Nurses and Nursing. A Comparative Overview of 34 European Countries.  http://www.efnweb.be/wp-content/uploads/2012/05/EFN-Report-on-the-Impact-of-the-Financial-Crisis-on-Nurses-and-Nursing-January-20122.pdf

 

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