Challenges Faced by Nurses in Implementing Evidence Based Practice in the Clinical Setting

Elaboration, 2018

7 Pages, Grade: 1




Key Aspects of Evidence Based Practice

Barriers to the Implementation of Evidence Based Practice




Over the past few decades, approaches towards healthcare reforms have been framed within the scope of clinical evidence leading to the emergence of what is commonly referred to as evidence based practice (EBP). EBP is conceptualized as a new clinical decision making approach that is based on diverse aspects of clinical practice including clinical experience, emerging research findings, patient preferences, and expert opinion (Melnyk, 2011; Melnyk & Fineout-Overholt, 2015). This new approach is considered as a transformative perspective through which patient outcomes and quality of care can be improved. From a critical perspective, evidence based practice underpins the advancement and development across the continuum of clinical practice. In the Australian context, healthcare professionals are involved in the assessment and implementation of EBP. However, nurses are expected to play integral roles in implementing EBP in the clinical setting. The Nursing and Midwifery Board of Australia [NMBA] 2016 standards of nursing practice require nurses to adopt evidence based interventions, in order to improve the safety and quality of practice. According to NMBA (2016) standard 1.1; a registered nurses “accesses, analyses, and uses the best available evidence, that includes research findings, for safe, quality practice” (p. 3). Based on this standard of practice, it is expected that nurses are at the forefront of EBP implementation in the clinical setting, yet they do not have relevant training or support. Therefore, this essay argues that it is not feasible to expect RNs to implement EBP in the clinical setting without training/support.

Key Aspects of Evidence Based Practice

In this context, a focused argument of this kind requires an overview of the key aspects related to the issue. Therefore, this essay provides a comprehensive discussion of two principal aspects of EBP; how EBP improves patient outcomes, and how it is applied theoretically and clinically. Foremost, there is consensus in the clinical field that EBP improves patient outcomes. This is why it is most policy, as well as practice guidelines emphasize on transforming evidence from research findings into practice. One of the ways through which EBP improves patient outcomes is the enhancement of safe, effective and efficient care. Over the past decades, patient safety, autonomy and quality of healthcare have been the key areas of concern. This has led to the development of evidence based interventions which solve most barriers associated with the traditional treatment and management interventions for different diseases. Second, EBP improves patient outcomes through ensuring appropriate utilization of healthcare resources. Under the NMBA (2016) standards of nursing practice, a nurse “assesses the resources available to inform planning” (p. 4). Therefore, EBP aims at providing cost-effective interventions to reduce the cost of healthcare which has been one of the most challenging issues in delivering quality healthcare services in Australia, as well as other countries. An outstanding example of how EBP improves the quality of care and reduces cost can be provided by the use of probiotics in the prevention, treatment and management of antibiotic-associated diarrhea (AAD). Over the decades, AAD has been a significant challenge to patient outcomes, primarily in patients on antibiotic therapy. AAD has also been a challenge to patients in hospital settings due to the effects of Clostridium difficile infections which cause Clostridium difficile -associated diarrhea (CDAD) (Elseviers et al., 2015). Hickson (2011) reports the prevalence of AAD among the global population to be 5%-39% of all patients receiving antibiotic therapies. Evidence indicates that probiotics are effective in treating AAD through several biochemical mechanisms of action, including enhancing intestinal mucosa barrier, production of antimicrobial substances and modulation of the host’s immune responses (Bermudez-Brito et al., 2012). Overall, probiotics confer beneficial effects to the host’s health leading to efficient management of gastrointestinal symptoms (Gibson & Shepherd, 2010; Ciorba, 2012; Ford et al., 2014).

Another significant aspect of EBP is its application in clinical setting. In theory, EBP is applied through education and learning. For instance, the incorporation of probiotics use in addressing gastrointestinal symptoms into the nursing curricula may enhance the use of probiotics in nursing practice. On the other side, EBP is usually implemented clinically through the use of evidence based interventions in preventing, treating and managing different diseases. In this case, the use of probiotics to treat AAD in a pediatric or adult experiencing crampy abdominal pain and watery bowel movements is a clinical application of EBP.

Barriers to the Implementation of Evidence Based Practice

Despite the relevance of nurses in the implementation of EBP in the clinical setting, there is evidence that there are several barriers to the implementation of EBP. From a critical perspective, the success of EBP in clinical setting can be achieved if nurses are involved in its implementation. The rationale for this observation is based on the fact that nurses constitute the largest proportion of healthcare workforce (Australian Institute of Health and Welfare, 2016). This implies that change management within the clinical setting depends on the response of the nurses. On the other hand, nurses are closely involved in the patients’ care throughout the continuum of care, unlike the other healthcare personnel who experience minimal contact with patients (Kieft, Brouwer, Francke & Delnoij, 2014). Therefore, it is quite surprising that Australian nurses are not adequately trained, nor are they given support to implement EBP in the clinical setting. In this context, this essay discusses three main reasons why nurses should not be expected to be in the forefront in the implementation of EBP in the clinical setting.

The first reason why it is not feasible to expect nurses to implement EBP in the clinical setting is the culture of nursing practice that represent a nurse as a care-giver, but not a researcher. Over the decades, nurses are trained to provide care to patients. Therefore, emphasis lies on how nurses can provide safe, efficient and quality care. As such, a nurse is perceived as a care provider, but not necessarily as a researcher. In reality, a care provider, as it is the case of a contemporary nurse, apply the available interventions to address health problems. In most cases, nurses the knowledge and skills they acquire during their education and training in their practice. This implies that they only apply what they learn at college. As a result, most nurses prefer using single interventions which they are familiar to them. In contrast, a nurse researcher could focus on finding advanced interventions which solve the challenges associated with existing interventions. As such, a nurse researcher may incorporate multifaceted interventions to address a common problem, as it is the approach with EBP (Beck et al., 2010). This is why NMBA (2016) view a nurse as a care-giver and a researcher based on standard 1.7 which states that a registered nurse “contributes to quality improvement and relevant research” (p. 3). This implies that practice and research in the clinical setting are faces of the same coin. However, the Australian context portrays research and nursing practice as different entities, creating a challenge in transforming research into practice. Research is usually done outside the clinical setting; thus excluding nurses, only to introduce research findings in the clinical setting through nurses. The fact that the current Australian standards of nursing practice require nurses to practise within their scope of practice provides justification why nurses have not taken up research roles. This way, nurses require relevant training in order to conceptualize the new evidence into practical approaches. Unfortunately, adequate training of nurses on research evidence remains a challenge within the Australian healthcare system.


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Challenges Faced by Nurses in Implementing Evidence Based Practice in the Clinical Setting
Egerton University
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challenges, faced, nurses, implementing, evidence, based, practice, clinical, setting
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Patrick Kimuyu (Author), 2018, Challenges Faced by Nurses in Implementing Evidence Based Practice in the Clinical Setting, Munich, GRIN Verlag,


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