Accreditation

Accreditation :
? Provision of necessary funding to support nursing research and its dissemination
? Development of health information systems that support evidence based practice.
? Data about nursing practice must be collected, stored, maintained and retrieved in broader health information system.
? Ensure a consistent data collection system and use of standardized languages to aggregate and compare data across the country and out.
? Inclusion of nursing data in HIS is essential to EBP and to be effective HIS should be designed to be comprehensive, integrated and relational.

What are the competencies required for Evidence based practice?

Essential skills for EBP are Intellectual skills, critical thinking, analytical skills, problem solving, empowering, communication, Interviewing, observational, linguistic (articulating skills), computer and documenting skills.

Nurses can develop these skills through basic and continuing education programs or self-initiated learning and reinforced in the practice environments.

What are the barriers to Evidence Based practice?

A study by Voda et al. found the following facts

? Practicing nurses lack time to actively participate in conducting and implementing research.
? Practicing Nurses failing to read current research findings
? Practicing nurses perceive that nurses who are involved in conducting and implementing research must be removed from the clinical setting.
? Practicing nurses do not understand the importance of research,
? Research is a minute and difficult component of undergraduate program
? Failure to directly involve clinical nurses in research projects
? Researchers not directly involved in patient care.
? Majority of the research disseminated in journals are not read by the practitioners
? Practitioners consider nursing tend to be in situation driven or intuitive rather than research driven hence actions have become rituals.
? Practitioners also felt that application of research findings in nursing practice is the greatest challenge facing the nursing profession.
? Lack of concern with the education of nurses in the process of research during initial training.
? Lack of Scientific tools to obtain data and lack of Know how amongst practitioners to develop such scientifically sound instruments.
? Inadequately informed nurse practitioners with lack of empathic perception of the nursing situation and inability to transform information into a sense of significant relationships and wholes through inductive and deductive processes.

STRATEGIES FOR ENCOURAGING EBP

? Development of leadership skills amongst nurses to have leaders who are comfortable, with influencing, directing and initiating change.
? Development of research team: These team would include- members with the education required to carry out research and teach future researchers, registered nurses directly involved in patient care, and leaders who support research and have the ability to initiate change.
Such a team would have potential to:
? Reduce individual workload
? Demonstrate to clinical nurses the importance and usefulness of research
? Continue to develop research awareness
? Encourage critical thinking and questioning of each other
? Share the highs and lows of research
? Promote research acceptance

? Increase in research components in undergraduate and post graduate courses
? In-service training of those practicing nurses who did not have the course taken in their basic programs.
? Improvement of nursing research skills amongst nursing teachers.
? Promote use of informatics to support EBP and quality monitoring
? Incorporate standardized nursing language and examine the link between nursing language and documentation and evidence-based practice.
? Appreciate the role of nursing management, nursing informatics research and enabling technologies.

A framework illustrated here is an example of a nurse working primarily in practice domain. The focus is on client health; the four domains such as practice, education, leadership and research greatly influence the clinical nursing. Activities in these four domains contribute to achieving the goal of client health. In the practice domain the nurse simultaneously function as an educator, leader, and a researcher. Furthermore, the domains interact with one another. Activities or changes in one domain can have an impact on the activities in the other. These activities create the building blocks for the continuing development of the specific body of knowledge that defines nursing standards and competencies in the specified area of practice. The beliefs and guiding principles underlie the standards in all four domains. Adherences to the standards enhance the effectiveness of client care. Superimposed on all aspects of the framework is the reflective process. Through critical reflection the practioners continuously seek a new understanding and gain insight into the health care practices thereby link theory to practice in the pursuit of excellence in clinical decision-making.
The model illustrated here implies the practice of an orthopedic nurse whose standard of care is influenced by believes, guiding principles, values of the client, organization and her own self as a professional.
The four domains of role are integrated to achieve the ultimate goal of care the ‘client health’ through ongoing reflective practice.

Conclusion
To practice nursing based on evidence requires the use of a standardized Language and appropriate documentation system, Use of information and communication technology. Nurses must accept and be committed to change and incorporate research findings in their practice to enhance high standards of patient care. Fostering of a critical and questioning approach makes research possible to improve quality of care. Planned targeted strategies are required to disseminate research findings, evaluation, and synthesis of the results of research and quality improvement findings to those who will utilize this information. Ongoing research is needed to explore the concepts of evidence and its dissemination and utilization in nursing practice. Outcome of EBP must be regularly evaluated and disseminated. EBP can facilitate the identification of knowledge gaps and thereby establish research priorities.

I firmly believe that “the clinical nurse is a critical component of nursing research who is capable of identifying the constraints contributing to research –practice gap and identifying strategies to ensure evidence based practice”.

What do we need as professionals?
“Intuitive practice Vs Evidence based practice”?

Are we ready to change?
Form “Practice Knowledge to Knowledge based practice”?

References
1.Canadian Nurses association. Policy statement on Evidence Based
Nursing Practice. November 1998.
2. Saba V.K Evidence Based Nursing Practice, Language, and
Documentation. Central Queens land University, Australia.November
2000
3. Peta Drury. Barriers to Evidence Based Nursing Care: Listen to the
clinicians. St.Vincent hospital