BARRIERS TO EVIDENCE BASED

PRACTICE

By
P.Karthikeyaprasath
 LEARNING OUTCOMES
• Discuss Barriers to EBP
• Explain Barriers categorization According to
cabana &colleagues(1999)
• Recognize steps to overcome Barriers to EBP
• Identify requirements of change to EBP with
in an organization or practice.
 INTRODUCTION
The past century has witnessed
spectacular changes in the way we like and
think. Human brilliance and technology have
come together to propose solutions we dared
not imagine fifty years ago. Like most
disciplines, nursing consists of both scientific
knowledge and conventional wisdom.
 EBP is the integration of best research
evidence with clinical experience and patient
values to facilitate clinical decision making. It
is a problem solving approach to clinical
practice that integrates
A systematic search for a clinical appraisal of
the most relevant evidence to answer a burning
clinical question
One’s own clinical expertise
Patient preference and values
 THEMES

• Dominant themes for the decades of 1970-1980

were “Doing this cheaper” (efficiency) and
“Doing things better” (Quality improvement )

• During 1980-1990 “ Doing the right things”

• During 21st century “ Doing right things is

right”
 DEFINITION
Research:
A systematic inquiry that uses disciplined
methods to answer questions or solve
problems. The ultimate goal of research is to
develop, refine, and expand a body of
knowledge.
 WHAT IS EVIDENCE

Evidence is the available facts,

circumstances etc., indicating whether or
not a thing is true or valid
Evidence Based Practice:

EBP is the integration of best research

evidence with clinical expertise and patient
values to facilitate clinical decision making.
(Sackett et.al.,2000).
 WHAT IS EVIDENCE BASED NURSING
PRACTICE

EBNP is using the best available evidence

from research, along with patient preferences
and clinical experiences, when making nursing
care decisions.(Dicenso, 2005.)
 IMPORTANCE OF EBNP

 Helps to improve quality of nursing care and is

best service to patient care.
 Promotes practices that have better outcomes
and are scientifically proven to be effective.
 It aims to eliminate unsound or risky nursing
practices, thus promoting patient safety
 Helps to keep nurses knowledge up to date
 FEATURES OF EBP
 It is a clinical problem solving strategy, it
deemphasizes decisions based on custom,
authority, opinion or ritual.
 It emphasizes on identifying best available
research evidence and integrating with other
factors.
 Key ingredient is the effort to fit the evidence
to a specific patient need and particular clinical
situation.
 OVERVIEW OF EBP MOVEMENT

 In 1970 the corner stone was laid down by

Archie cochrane, British epidemiologist in UK
who made the initiative for cochrane
collaboration.
Cont..
 In 1983 cochrane collaboration center in
oxford was established with the aim to help
providers to make good decisions about health
care by preparing, maintaining and
disseminating system reviews of health care
interventions.
 At the same time a group from Mc.Master
school in Canada developed a learning strategy
called evidence based medicine under dr.
David Sackett a pioneer of this movement.
 Cont..

 Journal on EBM began publication in 1970.

 Later EBM shifted to other health care

practitioners in a multidisciplinary team.
EBP IN NURSING
 IMPLEMENTATION OF EVIDENCE
BASED NURSING CARE

QUESTION:

What is the effective route or method of

administering bronchodilators in children?
 Asking question /Assessment
Problem: Children experiencing dyspnea and wheezing
Present need: Bronchodilators

Searching for evidence

Search strategies: English text only, article search for
research –based studies.
Key search terms: MDI, Nebulizer, Bronchodilator and
children.
Data bases used: PUBMED, MEDLINE, MEDLINK.

Summarizes the evidence

30 research based articles were listed(2004-2009)
 ANALYZING THE EVIDENCE
 10 research based articles showed that
administration of bronchodilators using
metered-dose inhaler with spacer is an
effective alternative to nebulizers for the
treatment of children with acute asthma.
 5 studies showed that Aerosol treatment by
MDI (with a valved holding chamber) proved
to be superior to nebulizer treatment.
 15 studies showed that MDI with spacer device is
equally effective as nebulization in treatment of
children with asthma.

Applying the evidence into practice

MDI method is an effective alternative to
nebulizer for the treatment of children with
acute asthma.

Evaluation of evidence
 WHAT IS A BARRIER?

• An obstacle or circumstance that keeps

people or things apart, or prevents
communication.
( or)
• Anything that prevents progress or success
BARRIERS TO EBP
CATEGORIZATION OF BARRIERS
Cabana & colleagues (1999)

• Knowledge and lack of awareness

• Attitude
• Behavior
INDIVIDUAL BARRIERS
ORGANIZATIONAL
BARRIERS
ENVIRONMENTAL
BARRIERS
EDUCATIONAL SYSTEM
BARRIERS
 INDIVIDUAL BARRIERS
Nursing professionals still view Nursing as a
practical ability rather than a cognitive ability.
Nursing tends to be situation driven rather
than research driven and actions have become
rituals.
Nurses lack time to actively participate in
conducting and implementing research.
Nurses do not understand the importance of
research.
 Cont..

Lack of knowledge and skills to implement

research in practice.
Fears about practicing differently than peers.
Lack of time and heavy workload.
Researchers not being involved directly in
patient care.
Nurses resist changes to work practices.
 ORGANIZATIONAL BARRIERS
Lack of administrative support.
Lack of incentives.
Difficulty in accessing evidence.
Resource constraints.
Lack of funds for ongoing skill development.
Failure to include evidence based nursing
practice or management priorities.
 ENVIRONMENTAL BARRIERS
• Government policy- Government fails to
support for research finding utilization
through development of clinical practice
guidelines.
• A culture of change that leaves Nurses too
over whelmed to cope with further changes
that might enhance their practice.
• A shift in managerial responsibilities that
leaves Nurse Manager and Nurses with
different agenda.
• Patient expectation- Demand from patients
for a certain type of treatment.
• Failure to directly involve practicing Nurses
in research projects.
 EDUCATIONAL SYSTEM
BARRIERS
• Viewing research as a difficult component of
undergraduate nursing programme.
• Lack of training and information seeking
• Lack of critical appraisal skills.
• Lack of availability of resources.
 OTHERS :
• Misconceptions or views about research
and evidence based care.
• Lack of belief that evidence based practice
will result in more positive outcome than
traditional care.
• Voluminous amounts of information in
professional journals.
• Failure of researchers to communicate their
research findings in to practice
HOW TO OVERCOME BARRIERS
 1.PROMOTING ACCEPTANCE

Barriers to EBP must be assessed

within particular system.

Assess baseline knowledge, attitude,

beliefs and behaviors regarding EBP.
Encourage that EBP will produce better
outcomes in order for change in their
practices.
Health care providers who do not believe
that EBP results in improved patient care
and client outcomes need to be exposed to
real case scenarios in which evidence based
care resulted better outcomes than care in
traditional practice
 2. CORRECTING MISPERCEPTIONS
 Clarifying these perceptions about advancing
evidenced care.
 Clinicians may have the misperception that the
EBP process is not practicable in the context of
their current practice environment.
 Create baseline knowledge and skills through
providing basics regarding EBP e.g.
 how to formulate a searchable question
 how to search for and appraise relevant
studies
CONTINUING

Education conferences
Interaction workshops, and
Distribution of educational material
such as journal articles, textbooks
and information handouts.
 3. Questioning clinical practices:
developing guidelines
• Ask question about their current clinical
practice
• Prioritize practice problems with in practice
setting
• Identify colleagues who have an interest in the
same clinical question
• Collaboration can be formed to search for and
critically appraise the evidence found.
• The results of the search and appraisal can be
shared with colleagues through ( journal clubs,
practice round, or informational handouts).
• Develop and implement clinical practice
guidelines
• Guideline development should be accurate.
• Evaluation of the outcome of guideline
implementation is essential to determine its
effect on the process and outcome of care.
 4. Change to EBP with in an
organization
• Have clear vision
• A written strategic plan
• A culture in which EBP is valued and repected
• Administrative support, encouragement
• Start with a small change and elevated levels
of complacency with in a system.
• Advancing evidenced based care must be
made by both individuals and organizations.
• Basic and graduate professional programs
must teach the value and process of EBP
• Doctoral programs must create researchers
who advance EBP through:
• The generation of new knowledge from
research to support the most effective practice.
• Testing EBP implementation, determine which
models are most effective on both staff and
client outcomes.
 ESSENTIAL QUALITIES OF NURSES IN
THE USE OF EBP
• Critical thinker
• Culturally competent.
• Knowledgeable coordinator.
• Politically aware.
• Ethically and legally grounded.
• Effective communicator.
• Competent provider of health care.
• Responsible manager.
 CONCLUSION:
Change is the universal law of life. As the new
good things are available we should adopt it.
Similarly evidence based nursing practice is the
new trend in the nursing profession in which we
have to implement the practice which is proven
very effective through research.
So, it is the responsibility of nursing
professionals to overcome these Barriers and
practice evidence based practice for the betterment
of nursing practice in caring the clients.
“ What you want are facts, not opinions………..
The most important practical lesson that can be
given to nurses is to teach them what to observe-
how to observe- what symptoms indicate
improvement- which are of none – which are
evidence of neglect – and what kind of neglect
This is Evidence Based Nursing”
-Florence Nightingale