Developing a Culture of Evidence-Based Practice
Changing clinical practice is complicated and demanding for the nursing profession because it requires administrative support (Melnyk & Fineout-Overholt, 2018). For example, a change of policy or new purchase of equipment for an inmate in the correctional setting needs administrative approval from the Department of Corrections. Hisham et al. (2016) related that physicians seldom practiced evidence-based medicine (EBM) in their routine clinical practice despite the awareness of the positive benefit of EBM. It implies that there are barriers for not implementing change. The purpose of this discussion is to analyze dissemination strategies and identify possible obstacles during the dissemination phase of the EBP.
To communicate EBP, a strategy that a leader can utilize is the Kick-off meeting in the organization using a PowerPoint presentation and handout packets containing the agenda (Gallagher-Ford et al.,2011). It is essential to do this strategy because the presenter can also access and reply to the different feedback and reactions from the stakeholders. Another key strategy in achieving high reliability in health care organizations is by utilizing the Advancing Research and Clinical practice through close Collaboration (ARCC) model that consists of a 12-month mentorship program (Melnyk, 2012). It is a vital strategy because it has a series of educational, skill-building sessions that focus on the seven-step EBP process and the necessary strategies for building an EBP culture (Melnyk, 2012).
Both the ARCC Model and the Kick-off meeting are most likely favorable to use in communicating EBP. A least strategy is the Journal Club Format. It is effective in the clinical setting in assisting clinicians who want to improve the translation of research into practice (Melnyk & Fineout-Overholt, 2018). However, time constraints and daily commitment to patient care needs are few of the barriers for this strategy to become successful (Melnyk & Fineout-Overholt, 2018).It implies that if a staff is not interested, it can be a grave experience attending the club.
Part of the accountability of a physician is to identify current, high-quality research evidence to inform clinical decisions (Melnyk & Fineout-Overholt, 2018). However, a barrier of EBP is the lack of interest, motivation, vision, strategy, and direction among leaders (Melnyk & Fineout-Overholt, 2018). Seeking synergistic opportunities to collaborate EBP, such as leadership support/mentorship, and the need to have tools available on hand is a win-win outcome (Newhouse et al., 2007). Another barrier is the high volume of research evidence coupled with the integration of expertise and patient preference into best practice (Melnyk & Fineout-Overholt, 2018). The Steven Star Model establishes several ways to overcome the obstacle. Knowledge transformation according to this model consist of 5 steps: discovery research, evidence summary, translation to guidelines, practice integration, and process outcome evaluation (Melnyk & Fineout-Overholt, 2018).
Indeed, EBP must become a way of thinking rather than an obligated course that requires an end (Melnyk & Fineout-Overholt, 2018). Models such as the ARCC and a Kick-off meeting through PowerPoint presentation are indeed vital for a systematic approach to practice change. Also, the implementation of the ARCC Model can improve patient outcomes (Melnyk et al., 2017). Furthermore, recognizing the challenges inherent in changing practice, both at the individual or organizational level, is essential for the success of the dissemination (Melnyk & Fineout-Overholt, 2018).
Hisham, R., Ng, C. J., Liew, S. M., Hamzah, N., & Ho, G. J. (2016). Why is there variation in the practice of evidence-based medicine in primary care? A qualitative study. BMJ open, 6(3), e010565. https://doi.org/10.1136/bmjopen-2015-010565
Melnyk, B. M., Fineout-Overholt, E., Giggleman, M., & Choy, K. (2017). (2017). A Test of the ARCC© Model Improves Implementation of Evidence‐Based Practice, Healthcare Culture, and Patient Outcomes. Worldviews on Evidence‐Based Nursing, 14(1), 5–9. https://doi-org.ezp.waldenulibrary.org/10.1111/wvn.12188
Melnyk, B. M. (2012). Achieving a high-reliability organization through implementation of the ARCC model for systemwide sustainability of evidence-based practice. Nursing Administration Quarterly, 2, 127.
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Newhouse, R. P., Dearholt, S., Poe, S., Pugh, L. C., & White, K. M. (2007). Organizational change strategies for evidence-based practice. The Journal of Nursing Administration, 3