EB005 Discussion Board. For your Competency Discussion, respond to the following prompts within the Discussion area to engage with your faculty and prepare to begin this Competency.
From your perspective as a nurse, what are the biggest challenges in applying evidence-based decision making?
From your perspective, what are the biggest opportunities or advantages in evidence-based decision making?
Challenges and Opportunities in Evidence-Based Nursing Practice
Introduction
As frontline healthcare providers, nurses play a pivotal role in delivering high-quality, compassionate care to patients. At the same time, the nursing profession faces immense pressures to continually improve outcomes while containing costs. In this environment, evidence-based practice (EBP) has emerged as a promising approach to ensure care is optimized based on the latest scientific evidence. However, integrating research findings into daily clinical decision-making presents both obstacles and opportunities for nurses. This paper will explore some of the biggest challenges and advantages of adopting an evidence-based approach from the perspective of a bedside nurse.
Challenges of Evidence-Based Practice
One of the primary challenges nurses face in implementing EBP is a lack of time. With demanding patient caseloads and documentation requirements, frontline nurses often struggle to find time to search for relevant research studies, appraise their quality and applicability, and determine how to translate findings into practice (Melnyk et al., 2016). A lack of protected time to engage in EBP activities was cited as a barrier in a meta-synthesis of 27 qualitative studies exploring nurses’ perceptions (Stokke et al., 2014). With competing priorities and time constraints, taking the time to ensure decisions are grounded in research can seem like an unaffordable luxury in the clinical setting.
Another challenge is that research evidence may not always provide clear or definitive answers, particularly for complex patients with multiple comorbidities. While clinical practice guidelines aim to synthesize evidence into recommendations, individual patient circumstances may fall outside of guideline parameters. This can leave nurses questioning how to apply population-level evidence to unique individuals (Melnyk et al., 2016). There is also often a lag between when research is published and when findings are incorporated into guidelines or practice tools, so the available evidence may not address the precise clinical questions nurses face on a daily basis (Stokke et al., 2014).
A lack of EBP knowledge and skills represents another obstacle. While EBP training is increasingly incorporated into nursing education, many practicing nurses did not receive formal training on how to search, appraise and apply research findings to patient care (Melnyk et al., 2016). A survey of over 1,000 nurses across the United States found that less than half felt confident in their ability to implement EBP (Pravikoff et al., 2005). Without a solid foundation of EBP competencies, it can be difficult for nurses to independently lead the shift towards a more evidence-based model of care delivery.
Opportunities of Evidence-Based Practice
While the challenges of EBP implementation should not be understated, there are also significant opportunities that come with adopting an evidence-based approach to nursing care. First and foremost, EBP helps ensure patients receive the highest quality of care based on the best available research evidence. Rather than relying on tradition, clinical intuition or anecdotal experience alone, EBP provides an objective means to evaluate which interventions are most likely to benefit patients (Melnyk et al., 2016). This enhances patient outcomes and safety.
From a nursing perspective, EBP also presents opportunities for professional growth and career advancement. Nurses who develop expertise in searching, appraising and applying research are well-positioned to become clinical leaders and champions of practice change initiatives (Stokke et al., 2014). EBP competencies are increasingly valued by Magnet hospitals and other prestigious healthcare organizations, opening doors for nurses interested in clinical ladder programs, advanced practice roles, management positions or transitioning into academia (Pravikoff et al., 2005). Engaging in EBP also enhances critical thinking skills that are transferable to any nursing role.
On an organizational level, EBP supports healthcare cost-containment by ensuring limited resources are directed towards the most effective, efficient interventions supported by scientific evidence (Melnyk et al., 2016). Widespread EBP adoption could help curb the estimated $300 billion in annual wasteful or unnecessary healthcare spending in the United States alone (IOM, 2013). By standardizing care around evidence-based guidelines and order sets, EBP also promotes practice consistency which supports quality improvement efforts (Stokke et al., 2014).
Conclusion
Incorporating research evidence into daily clinical decision-making presents both obstacles and opportunities for bedside nurses. While a lack of time, applicability of evidence to complex patients, and EBP skill deficits pose challenges, the advantages of improving outcomes, enhancing the nursing profession, and supporting healthcare system priorities through EBP are compelling. With organizational support and a commitment to lifelong learning, nurses are well-positioned to help lead the shift towards a more evidence-based model of care that benefits both individual patients and the broader healthcare system.
