Running head: FINAL PAPER: PUTTING EVIDENCE-BASED PRACTICE INTO

Final Paper: Putting Evidence-Based Practice into Action

Jessica Foster
University of Saint Mary

FINAL PAPER: PUTTING EVIDENCE-BASED PRACTICE INTO

Final Paper: Putting Evidence-Based Practice into Action

Evidence-based practice (EBP) is the cornerstone of the nursing profession. EBP is
developing scholarly statistical data to help deliver high quality health care (American Nurses
Association [ANA], 2010). Even with numerous databases and national guideline organizations
studies show that up to 40% of patients are not receiving care according to statistical data (Grol
& Grimshaw, 2003). Literature throughout the years identify different barriers impeding on
nurses ability to implement EBP. Identifying barriers then implementing strategic organizational
infrastructures will increase nurses' time, knowledge, motivation and skill into putting evidencebased practice into action.
During a literature review of barriers to implementing EBP the data began to intertwine.
Fifteen studies were analyzed and reviewed. The top barriers identified were lack of time,
organizational support and autonomy. Allowing increased time away from bedside care,
knowledge and organizational support will motivate nurses to explore evidence-based practice
guidelines and investigate research databases to gain confidence in their practice. The Scope and
Standards of Practice states that nurses will "integrate evidence and research findings into
practice" (ANA, 2010, p. 51). When nurses integrate evidence into practice they are helping the
patient, the nursing community and the organization. Education is a powerful tool that can create
leaders within the profession and future nurses to take example for implementing EBP.
One of the most crucial findings throughout literature was the lack of evidence to support
the success and failures of programs for implementing EBP. Solomons & Spross, (2011)
established that most nurses obtain their information from other nurses even if this knowledge is
or is not EBP. This was also established in a study designed by Newman, Papadopoulos, &
Sigsworth, (1998) concluded only focusing on individual knowledge improvement and skill

FINAL PAPER: PUTTING EVIDENCE-BASED PRACTICE INTO

would not be sufficient because without utilizing this knowledge at work they would be
unsuccessful. Nurses also must have autonomy to address practice issues, review the literature
for the problem then identify where changes could be made. This empowers nurses with
knowledge and moral to participate in quality improvement and patient safety initiatives. Direct
and indirect patient care is based on scientific research that is then created into policies that
improve patient outcomes.
In order for change to occur more research is needed to identify the success of
educational programs as clinical ladder programs. Although the literature is useful in identifying
common barriers to practice each organization will have their own barriers due to cultural
differences. Collecting data to identify the barriers and facilitators becomes the first step to
implementing EBP. Next would be to create a program that would decrease or delete the barriers
identified. Most organizations stop here and do not bother to investigate the effectiveness of the
program. Researching the success or failure of the program becomes the crucial last step. If the
program designed does not make a change then there is no effect for anyone from the patient to
the organization. This is where the research is lacking. The literature review was extensive on
identifying barriers but minimal evidence to guide changes and the effects of these changes.
Sherriff, Wallis, & Chaboyer, (2007) state that further research needs to be done to evaluate the
effectiveness of educational programs and the incorporation of EBP in patient care.
More organizations have begun to develop clinical ladder programs to encourage and
support educational advancements. These clinical ladder programs encourage nurses to utilize
critical thinking skills to research and analysis data to incorporate into practice. These programs
will help nurses gain knowledge into the latest EBP guidelines then educate the staff on research
found. This also motivates nurses by including financial incentives. Not only does this show

FINAL PAPER: PUTTING EVIDENCE-BASED PRACTICE INTO

great educational support by the organization but it improves the quality of care for patients
when the evidence is implemented. The limitations on some of these programs still hold to some
of the same barrier; no extra time away from bedside care to work on the project, no autonomy to
implement new evidence due to the need for policy changes and non-congratulatory
organizational support.
Every stakeholder has their own ethical considerations that need to be addressed to avoid
a potential harmful domino effect. Without nurses implementing EBP at the bedside the patient
is the greatest effected. When the patient does not receive the best quality of care this reflects
poorly on the organization which then goes into possible financial and policy changes. These
changes may not be in tune with best nursing practice and according to the Guide to the Code of
Ethics for Nurses, nurses are to mandate the profession and the standards that support patient
care (American Nurses Association [ANA], 2010). The number one objective for implementing
EBP is to mitigate risk and improve outcomes. When the nurse and organization work in a
collaborative manner to implement EBP the Hospital Quality Institute (HQI) standards will be
met.
While numerous data supports that barriers exist to implementing EBP there is little
research to support changes can make a statistical difference in the health-care setting. Evidencebased practice is the standard nurses' oath to patients and their organizations. When this is not
implemented then all key stakeholders are at risk. Making changes to organizational
infrastructures and empowering nurses with knowledge will put evidence-based practice into
action.

FINAL PAPER: PUTTING EVIDENCE-BASED PRACTICE INTO

References
American Nurses Association. (2010). Guide to the code of ethics for nurses: Interpretation and
Application [reissue of 2008 with new cover]. Silver Spring, MD: Nursebooks.org.
American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.).
Silver Spring, MD: Nursebooks.org.
Grol, R., & Grimshaw, J. (2003). From best evidence to best practice: effective implementation
of change in patients care. The Lancet, 362, 1225-1230. Retrieved from
http://web.b.ebscohost.com/ehost/detail/detail?vid=6&sid=ac0b4988-849a-4f15-b78e95856ec17501%40sessionmgr111&hid=107&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d
%3d#db=ccm&AN=2005026921
Newman, M., Papadopoulos, I., & Sigsworth, J. (1998). Barriers to evidence-based practice.
Intensive & Critical Care Nursing, 14, 231-238. Retrieved from
http://share.worldcat.org/ILL/articleexchange/FileDownload/JHtpeJuo8;jsessionid=AC19
F9D6A7AEEBCE9A13625B86F5CBE2
Sherriff, K. L., Wallis, M., & Chaboyer, W. (2007). Nurses attitudes to and perceptions of
knowledge and skills regarding evidence-based practice. International Journal of Nursing
Practice, 13, 363-369. http://dx.doi.org/10.1111/j.1440-172X.2007.00651.x
Solomons, N. M., & Spross, J. A. (2011). Evidence-based practice barriers and facilitators from a
continuous quality improvement perspective: an integrative review. Journal of Nursing
Management, 19, 109-120. http://dx.doi.org/10.1111/j.1365-2834.2010.01144.x