Implementation of Evidence-Based Practice
Sheila Wright

Submitted to Sharon Mooney, RN, MSN in partial fulfillment of
NR 460R Evidence-Based Practice in Nursing
Regis University
April 9, 2010 Implementation of Evidence-Based Practice Throughout history, nursing practice has experienced change. Florence Nightingale initiated the greatest change in nursing in the mid-1800’s when she gathered data regarding the morbidity and mortality of soldiers (Chitty & Black, 2007). Nightingale recognized there was a need for change to improve patient outcomes. Her determination to provide the best possible care, based on the evidence she gathered, has inspired a profession. Today, the process of using research to care for patients is referred to as evidence-based practice. The purpose of this paper is to define and explain the importance of evidence-based practice, discuss qualitative and quantitative research studies which affect medical-surgical areas, and barriers preventing research utilization and how they may be overcome.
Definition of Evidence-Based Practice There are numerous definitions of evidence-based practice (EBP). EBP is defined by Boswell and Cannon (2007) as, “A research-based, decision-making process used to guide the delivery of holistic patient care by nurses” (p. 340). Cope (as cited in Chitty & Black, 2007), defines EBP as “using the best available research findings to make clinical decisions that are most effective and beneficial for patients” (p. 275). It is clear throughout the spectrum of definitions that research is important for making the best possible clinical decisions for patient care.
The Importance of Evidence-Based Research Evidence-based research and EBP are important to nursing for many reasons. The most important reason for evidence-based research is that it provides a scientific basis for nursing care, which is one criteria of a profession. Knowledgeable nurses who use research in practice provide better care and have improved patient outcomes. Research can also help nurses and facilities to provide holistic, efficient, cost-effective care, and better patient teaching. Many nursing studies prompt further research, increasing awareness of a particular subject, and stimulating change (Chitty & Black, 2007).
Research Examples Which Affect Medical-Surgical Nursing
Qualitative Research Study The article, The cultural-ecological orientation of graduate nurses (novice) in medical-surgical nursing, by Mary Oliver, RN, PhD, examines the journey of 10 novice nurses from the start of their careers as they progress into clinical experience regarding psychosocial issues involving patients and how problems were managed. This was an ethnographic interpretive paradigmatic study, using purposeful sampling, which employed the use of observation of the nurses throughout each shift and in-depth interviews following observation. Nurses were observed on the floors on which they worked for more accurate observation. Two themes were drawn from this study: experience is a process and that nurses go through a cultural-ecological orientation. Gaining experience is described as a process in that nurses’ experiences are influenced by the floor on which they work, as well as their personal experience in working with patients. Cultural-ecological orientation is recognition of the importance of how a patient relates to his/her environment and the effects this has on healing. The focus is on therapeutic environment and includes the awareness of the patient’s relationships with his or her family and friends, cultural and spiritual concerns, socioeconomic status and personal beliefs. In conclusion, Oliver found that the novice nurses in this study had concerns about their lack of procedural skill, but were empowered by their increasing cultural-ecological awareness regarding patients (Oliver, 2008). This study is important to medical-surgical nurses in that experienced nurses can nurture the ability of novice nurses to expand their clinical expertise and benefit patients with better outcomes. Given that novice nurses are affected by the particular floor on which they are assigned, creating a positive and caring atmosphere with active department managers and mentors will also aid in creating better experienced nurses.
Quantitative Research Study A quantitative research study that may prove useful on medical-surgical floors evaluates the administration of intravenous continuous infusion medications and dosage calculations by nurses. In the article, Evidence-based practice, clinical simulations workshop, and intravenous medications: moving toward safer practice, Crimlisk, Johnstone and Sanchez (2009), discuss a descriptive performance improvement study. Data, including medication error reports in adults for 6 months prior to a workshop, demographics, workshop evaluations, participant comments and clinical data from three time periods, was collected. A total of 26 workshops, teaching critical thinking skills and best practice for IV medication safety, to 232 nurses, were given. Data was collected for 2 years after the workshops. The nurses used a toolkit with cards identifying common medications used on the medical-surgical unit, math formulas and conversions, and weight conversions. A 4-step approach was used: the nurse calculated dosages, with a second nurse to calculate and verify the dosage, an IV medication drip chart and the use of infusion pump guidelines. The 5 rights of medication were reviewed and an additional 4 rights were identified for a total of 9 rights of IV medication administration. The study showed a decrease in medication errors within the category C and higher medications over a 2 year period (Crimlisk, Johnstone & Sanchez, 2009). This evidence suggests that evidence-based practice workshops may be beneficial to medical-surgical units across the country. Educating nurses of all experience levels, using evidence based research, in an informal, comfortable manner, may decrease medication errors and provide better outcomes for all patients.
Barriers Preventing Research Utilization Despite the current push to implement evidence-based research and practice into the daily routines of all nurses, there are barriers which prevent the use of research. Boswell and Cannon (2007) identify education, beliefs and attitudes, and support and resources as three obstacles preventing research utilization. The authors stress that many nurses working in the field now are educated at the associate degree or diploma level, where little or no research utilization is taught. They go on to explain that even nurses with bachelor’s degrees or baccalaureate level education may be intimidated by research and that the link between research and practice is not emphasized or understood. The value an organization places on research is directly affects the way its nurses view research. Cost and time allowances for nurses to do research or attend continuing education are also deterrents to the use of nursing research. Lack of access to research, including lack of access to the World Wide Web on facility computers, as well as a lack of computer skills, are prohibitive factors (Boswell & Cannon, 2007). Nurses also argue that there is a lag time between when research was performed and when it is available to be put into practice. Some of these obstacles are more easily overcome than others. The education issue has been discussed in depth, with many nurses believing that new graduates should obtain a minimum of a Bachelor of Science degree. This obstacle may remain until the nursing shortage is under control. As a whole, nursing facilities and individual nurses can promote and encourage nursing research. Nurses with experience in research and computer skills can mentor those nurses who are overwhelmed by the idea of research or using computers. Having learning laboratories within facilities where nurses can practice skills and have access to at least one computer with research capability may provide an atmosphere more conducive to evidence-based research and practice.

Conclusion Evidence-based practice is a holistic approach to patient care, which uses current research, to better patient outcomes. Nurses with research knowledge provide care with a scientific basis, and perform care in a holistic, safe, efficient and cost effective manner. Using both qualitative and quantitative research studies gives nurses a base of information to apply to practice. Although there are many benefits of evidence-based practice and research, there are still barriers which prohibit nurses from using research. Access to research and the feeling of intimidation regarding research may be overcome by providing computer access and support to nurses in facilities. Evidence-based practice ensures that patients receive the most current treatment by knowledgeable staff.

References
Boswell, C. & Cannon, S. (2007). Nursing Research: Incorporating evidence-based practice. Sudbury, MA: Jones and Bartlett Publishers.
Chitty, K. K. & Black, B. P. (2007). Professional Nursing: Concepts & Challenges. St. Louis, MO: Saunders.
Crimlisk, J. T., Johnstone, D. J., & Sanchez, G. M. (2009). Evidence-based practice, clinical simulations workshop, and intravenous medications: moving toward safer practice. Medsurg Nursing, 18(3), 153-160.
Oliver, M. (2008). The cultural-ecological orientation of graduate nurses (novice) in medical- surgical nursing. International Journal of Nursing Practice, 14, 342-346. doi: 10.1111/j.1440-172X.2008.00711.x