The Most Challenging Step to Implement and Why
The research step along the way that I feel is the most challenging to implement is applying evidence into practice. The step requires making clinical decisions based on new evidence obtained through research. In my clinical experience, translating new evidence into clinical practice has always been a challenge. I believe this step is the most challenging since it cannot be conducted in isolation, as individual and organizational factors significantly impact it. Studies show that the implementation or application phase is considered the most complex and slow process and is influenced by different factors at multiple levels (Pitsillidou et al., 2021). Barriers to applying evidence into practice relate to either nurses or the readiness of the health organization in question to implement new practices. Major barriers include limited awareness regarding the need for new evidence, limited knowledge, unsupportive organizational culture, and access to resources (Pitsillidou et al., 2021). Based on personal experiences, even with adequate knowledge, applying evidence into practice has always been challenging due to a lack of support from other professionals or organizational leadership. Most organizations lack a supportive framework to support nurses in integrating evidence gained into clinical practice. Applying evidence into practice requires resources, especially financial resources, which are usually not readily available and may take longer periods to acquire, resulting in discouragement.
I feel applying evidence into practice is the most challenging of the steps in general, as supported by evidence. Studies show that the application of evidence into practice is limited, with a recent survey unveiling that 72.1% of nurses had not previously attempted to apply evidence into practice (Pitsillidou et al., 2021). Applying evidence into practice is widely recognized as an essential element in addressing healthcare challenges and improving health and patient outcomes, but its value is yet to be reflected by nursing trends in health facilities. Despite the APN being called on to propose solutions for clinical problems and the existence of strong evidence supporting the use of different procedures or processes, practice change still occurs slowly or does not occur at all (Pitsillidou et al., 2021). Various practices that continue to be in existence show that the selected step is the most challenging in general. For example, a practice like instilling normal saline into endotracheal tubes before suctioning is continuously used despite evidence strongly suggesting that the clinical practice is ineffective and potentially harmful to the patients (Joel, 2022). Despite evidence-based practice being considered the gold standard of care and abundant research being conducted to inform clinical practice, many patients still need to receive evidence-based care (Duff et al., 2020). The evidence shows that the challenge affects many advanced practice nurses and remains a challenge in many health facilities.
Plan to Overcome the Barrier
I plan to overcome the barrier by utilizing the leadership competencies I gained throughout my DNP course to act as a change agent and an EBP facilitator. Evidence indicates that leadership plays a significant role in EBP implementation as the practice can be most effectively influenced by people with the greatest authority over EBP pillars such as education, nursing practice, resources, and leadership (Ylimäki et al., 2022). As a DNP-prepared nurse, I intend to utilize my knowledge, skills, and influence to champion the application of evidence into practice. Advanced practice nurses are identified as critical stakeholders with distinct roles in applying evidence in practice. Such roles include evidence transfer and implementation to the immediate patient care, development and support, harmonization of practices, mentoring, teaching, and consulting (Ylimäki et al., 2022). As a leader, I can support the application of evidence into practice through communication and networking, feedback, monitoring and evaluation, and promoting an open organizational culture that provides the necessary support, including financial and human resources. As a leader, I can influence the organization and the nursing staff towards applying evidence in practice. Leaders can influence at individual and organizational levels.
I will utilize my leadership skills to establish a supportive organizational culture and work environment that is friendly to the application of evidence in practice. Studies show that despite nurses having high levels of EBP-related knowledge, skills, self-efficacy, and positive attitudes, their levels of EBP behavior are still low (Ylimäki et al., 2022). The trend is linked to organizational-related barriers such as work overload, robbing nurses of adequate time to prepare for the implementation process, weak collaboration among the necessary stakeholders, and lack of appreciation (Mathieson et al., 2019). An organizational culture that champions and values collaboration promotes proper nurse-to-patient ratios and offers supportive frameworks that can promote the application of evidence in nursing practice. A supportive organizational culture will motivate the nursing team to integrate new evidence into practice. I also intend to utilize my leadership skills to rally for financial support from other stakeholders, including government agencies. Financial support plays a significant role in implementing new evidence, and the cost may overwhelm a health facility, hence the need for external support. I intend to network with the relevant stakeholders for financial support. Using my leadership skills and competencies will help me address the challenge at an individual and organizational level, benefiting other people.
References
Duff, J., Cullen, L., Hanrahan, K., & Steelman, V. (2020). Determinants of an evidence-based practice environment: an interpretive description. Implementation Science Communications, 1(1), 1-9. https://implementationsciencecomms.biomedcentral.com/articles/10.1186/s43058-020-00070-0
Joel, L. A. (2022). Advanced practice nursing: Essentials for role development 5th ed.) Philadelphia: F.A. Davis Company.
Mathieson, A., Grande, G., & Luker, K. (2019). Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: a systematic mixed-studies review and qualitative synthesis. Primary Health Care Research & Development, 20, E6.
https://www.cambridge.org/core/journals/primary-health-care-research-and-development/article/strategies-facilitators-and-barriers-to-implementation-of-evidencebased-practice-in-community-nursing-a-systematic-mixedstudies-review-and-qualitative-synthesis/74D8FB3E7561129C8CBBF01207837BCC
Pitsillidou, M., Roupa, Z., Farmakas, A., & Noula, M. (2021). Factors affecting the application and implementation of evidence-based practice in nursing. Acta Informatica Medica, 29(4), 281.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8800576/
Ylimäki, S., Oikarinen, A., Kääriäinen, M., Holopainen, A., Oikarainen, A., Pölkki, T., … & Tuomikoski, A. M. (2022). Advanced practice nurses’ experiences of evidence-based practice: A qualitative study. Nordic Journal of Nursing Research, 42(4), 227-235. https://journals.sagepub.com/doi/abs/10.1177/20571585221097658
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