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Evidence-Based Practice
Although studies have supported that patient outcomes are substantially improved when health care is based on evidence from well designed studies versus tradition or clinical expertise alone (Melnyk, Fineout-Overholt, Stone, & Ackerman, 2000), many nurses are struggling or lack the knowledge and skills to implement evidence-based care. Numerous reasons for the failure to implement evidence-based practice (EBP) have been cited, including: (a) lack of knowledge regarding evidence-based strategies, (b) misperceptions of or negative attitudes about research and evidence-based care, (c) lack of knowledge regarding how to search for and appraise evidence, (d) demanding patient workloads, (e) organizational constraints (e.g., lack of administrative support or incentives), (f) patient expectations (e.g., parents who demand antibiotics for their child's upper respiratory infection when they are not indicated), (g) fears about practicing differently than peers, and (h) overwhelming amounts of information in medical and nursing journals as well as textbooks (McKibbon, 1999; Melnyk et al., 2000; Silagy & Haines, 1998).
Strategies to Overcome These Barriers
Despite these challenges, a number of strategies can be implemented to promote the implementation of evidencebased nursing care.
Identify barriers to evidence-based care. The first step to overcoming barriers to EBP is assessing and identifying the obstacles to evidence-based care. Insight into the obstacles that exist in delivering evidence-based care will frequently pave the way for an action plan that yields success. For example, surveys or focus groups (i.e., group discussions that facilitate open communication) can be held in an organization to determine nurses' knowledge, attitudes, and beliefs about EBP as well as challenges in implementing evidence-based care.
Strengthen beliefs about the benefits of evidence-based care. Nurses must first believe that evidence-based care will result in improved patient outcomes in order for changes in their practice to occur. It is well-known that information alone generally does not result in behavior change. Therefore, providing sufficient evidence and assisting nurses in understanding the benefits of evidence-based care is a critical first step in instituting changes in practice.
Initial thought-provoking questions to ask of colleagues when attempting to facilitate a change to EBP might include: (a) "If your child was in a motor vehicle accident and sustained a severe head injury, would you not want his neurologist to use the most effective, empirically-supported treatment...