Barriers to Implementing Evidence-Based Practice

Although practitioners are expected to utilize evidence-based practice in their daily clinical work, a majority of practitioners fail to base their practice on research findings. Based on research studies conducted in the United States and the Netherlands, approximately 30-40% of patients fail to receive care in compliance with current evidence-based research and 20-25% of the care administered is not necessary and may be harmful (Golden-Biddle & Scott-Findley, 2005, p. 359). In a dire effort to make health care organizations clinical practices based on evidence-based research, an understanding of how organizational culture shapes research is of grave significance (Golden-Biddle & Scott-Findley, 2005, p. 359). As a result, research is now centrally focused on identifying and understanding the major facilitators of research utilization in conjunction with the barriers involved in creating a paradigm shift toward implementing evidence-based practice in current clinical practice. 

Since a majority of healthcare personnel work within a complex healthcare organization that requires the development of a better understanding of research use as practitioners, organizational culture definitely shapes research use in clinical work. The top 3 facilitators include acute care nurses, practitioners, and nurse managers. According to an organizational scholar, Edgar Schein, the application of a cultural framework is utilized in research use and acute care nursing practice (Golden-Biddle & Scott-Findley, 2005, p. 360). Schein’s theory as applied to acute care nurses and the provision of medical services to patients help to guide the structuring of work within healthcare organizations; however, barriers exist in implementing evidence-based practice. An organizational approach to work is based on Schein’s cultural assumptions which entails the nature of activity of how work is construed and valued. Organizations are geared toward doing or toward being. An organization which focuses on doing “implicitly values working hard to achieve an outcome, and is therefore consistent with an efficiency value set” while “an orientation toward being focuses on the here and now, with an acceptance of an inability to change an outcome” (Golden-Biddle & Scott-Findley, 2005, p. 361). Secondly, the varying types of knowledge that are utilized in acute care settings are influenced by “the nature of the nurses’ work” (Golden-Biddle & Scott-Findley, 2005, p. 362). For instance, practical knowledge is correlated with a doing approach to work as compared to knowledge acquired from research studies in nursing journals. At times a highly skilled veteran nurse may decide to not rely on research findings from scholarly journals as it does not support her practical experience within the nursing profession and instead, rely on following principles in the Nurses Code of Ethics,  while other nurses may very well so choose to follow published research findings. It is imperative that nurses and other healthcare professionals comprehend the notion that culture shapes what type of knowledge is viewed as significant or relevant. Lastly, the structure of work signifies how practitioners use or fail to use research (Golden-Biddle & Scott-Findley, 2005, p. 362). For example, an organizational structure focused on doing will have less space and time for procedures involving interacting and collaborating.

My PICOT question is as follows: In patients age 65 and older, what is the effect of scheduled nursing interventions such as assisted trip to the bathroom, hospital orientation, and monitor medication versus patient restraints on the number of in-patient hospital falls and fall-related injuries during a hospital stay? Implementation of evidence-based practice for the aforementioned project will present a major barrier due to a lack of awareness of the root of the problem which stems from a nurses excessive workload (Paramonczyk, 2005, p. 12). One approach is to heighten recruitment, hiring, and retention of dedicated and highly experienced nurses (Bernadette, 2002, p. 160). The nurse-patient ratio must always be followed if a floor is short on staff then a nurse from another floor may have to be pulled to the floor which needs to comply with the appropriate nurse-staff ratios. 

Reference

Bernadette, M. M. (2002). Strategies for overcoming barriers in implementing evidence-based practice. Pediatric Nursing, 28(2), 159-61. Retrieved from http://search.proquest.com/docview/199488379?accountid=32521 

Golden-Biddle, K., & Scott-Findlay, S. (2005). Understanding how organizational culture shapes research use. Journal of Nursing Administration, 35(7/8), 359-365.

Paramonczyk, A. (2005). Barriers to implementing research in clinical practice. The Canadian Nurse, 101(3), 12-15. Retrieved from http://search.proquest.com/docview/232041691? accountid=32521