Research Proposal on "Inconsistency of Evidence-Based Practice at the Bed Side"

Research Proposal 12 pages (3435 words) Sources: 6

[EXCERPT] . . . .

Nursing

Evidence-based practice is a crucial component of quality of care. Nursing is a holistic profession that depends on caring and compassion but also on research and science. As both art and science, nursing must not neglect the role of evidence when making decisions related to patient care. The proposed research outlines the importance of evidence-based practice on quality of care as well as cutting costs in a health care institution. Evidence-based practice has been shown experimentally to increase quality of care and to reduce costs. Therefore, employing more evidence-based practice at the bedside should be a primary concern of nurse leaders. To encourage greater reliance on evidence-based practice, nurses need time, mentors, and access to avenues of professional advancement. When these elements are in place, nurses are more likely to consult scientific journals for recent best practices in areas such as catheter treatment, anesthesia, and other routine health care services. The research therefore works with the hypothesis that evidence-based practice is directly dependent on an organizational culture that supports it.

Chapter One: Nature of Project and Problem Identification

a. Introductory materials with an abbreviated literature review to substantiate the choice of this problem

As Staffileno & Carlson (2009) point out, many nurses have difficulty incorporating research into daily practice because of insufficient time, lack of quality nursing leadership, and a lack of education on what the research process entails. Yet "using evidence-based research to drive practice is suggested to both improve the quality of health care as well as contain costs," (Artinian, West & Conger 2011). Research also shows a disconcerting pattern in health care: few nurses are actually using evidence-based research to guide their daily practice. This research elucidates the problem and proposes a comprehensive solution for transforming nursing care into the middle of the 21st century.

b. Identify significance of problem.

Ironically, the efficacy and practical results of evidence-based practice must itself be rooted in empirical research. This research will show that incorporating evidence-based practice into the daily practice of all nurses will be qualitatively and quantitatively beneficial for the health care industry. The problem of insufficient evidence-based practice in daily nursing care is an extensive one, cutting straight to the core of what it means to be an effective nurse and an effective health care organization. Delivering quality of care to patients within time and budgetary constraints are among the primary objectives of health care institutions. If evidence-based practice is shown to "both improve the quality of health care as well as contain costs," as Artinian, West & Conger (2011) point out, then it only makes sense to bolster evidence-based practice. To bolster evidence-based practice, nurses must learn to embrace research by incorporating empiricism into their daily practice. As Staffileno & Carlson (2009) show, three factors are shown to be the most important to increasing evidence-based practice in health care: time, leadership, and education.

The Problem: Evidence-based practice is necessary to improving quality of care and lowering health care costs overall. However, evidence-based practice is not being sufficiently used by current nursing staff at Mary Martha Hoffman Healthcare Center (MMH) in rural northern Mississippi. As a result, quality of care is diminishing, and in some cases patient health is being seriously compromised. The health care institution risks not only moral dilemmas but also financial ones, as malpractice suits will be inevitable.

c. Hypotheses or list of research questions that further expand the problem

How can evidence-based practice become an integral part of the nursing care repertoire at MMH?

What factors are empirically shown to increase the prevalence of evidence-based practice in the health care industry in general? These factors will be used as independent variables in the current research with MMH.

How can empirical research enhance nursing leadership practices, so that nurses (a) have more time to devote toward reading journals, attending seminars, and boosting knowledge of their areas of specialization; (b) trust nurse leaders and use mentoring as a means of improving evidence-based practice methods; (c) receive nursing education that promotes evidence-based practice as normative? The answers to these research questions will also impact the selection of independent variables in the proposed research.

Hypothesis: An organizational commitment to evidence-based practice will lead to patient care that is safe, cost-effective, and consistent with empirical research, without sacrificing a culture of caring and compassion.

Chapter 2: Review of Literature and Theoretical Framework

The following review of literature includes definitions of terms and overview of prior research on the importance of evidence-based practice. A theoretical framework within which the research will be conducted follows.

According to Burns and Grove, (2009) "evidence-based practice is the conscientious integration of best research evidence with clinical expertise, patient needs and values in the delivery of quality cost-effective care," (p. 699). Evidence-based practice is the application of science to the daily job of nursing: from washing hands to safely maintaining catheters. Evidence-based practice is "explores the empiric way of knowing, focusing on methods of critically appraising and applying available data and research to understand and inform clinical decision-making better," (Pipe, Wellik, Hansen & Martyn 2005, section 2). Moreover, evidence-based practice is a "problem-based learning approach" that "synthesizes clinical expertise, with the best evidence available from systematic research, and the values and preferences of patients," (Bennett & Bennett 2000, p. 172). The concept of evidence-based practice "emerged from evidence-based medicine (EBM), which has been defined as the conscientious and judicious use of current best evidence from clinical care research in the management of individual patients," (Egerod & Hansen, 2005, p. 466).

Evidence-based practice is not, and need not be, the only factor impacting decision-making in health care. In fact, evidence-based practice is only one component of health care delivery and in some cases is insufficient for providing for the total needs of patients. Pipe, et al. (2005) outlines at least four different ways of knowing that impact health care decisions, including empiricism, ethics, personal inclinations, and aesthetic patterns. Being a fundamentally empirical pursuit, evidence-based practice is an important but not singular part of health care. As Bennett & Bennett (2000) put it, "research evidence is just one factor informing clinical decision making." Ultimately nurses need to integrate empirical with other ways of knowing, in order to deliver the best quality of care. Because evidence-based practice is the implementation of scientific literature into the daily decision-making and praxis of nurses, "it has been debated whether EBP represents a new paradigm, or whether it is a neologism for known phenomena, such as research utilization or quality improvement," (Egerod & Hansen, 2005, p. 466).

Evidence-based practice is crucial in all aspects of health care and is not limited to one specific type of nursing. Bennett & Bennett (2000) define evidence-based practice in terms of its application to the field of occupational therapy. Chwalisz (2003) provides a framework for evidence-based practice in the psychological counseling field. The type of evidence might change depending on the specific health care field, but the relevance and role of evidence-based practice remains the same.

Evidence-based practice in health care has come to light "because of troubling gaps between available knowledge and what is used by professionals" in their actual daily practice (Gambrill, 2005, p. 254). This problem is evident in health care centers such as Mary Martha Hoffman Healthcare Center (MMH) in rural northern Mississippi. Moreover, research reveals several problems related to designing and implementing a comprehensive means by which to encourage evidence-based practice. For one, "the relevant research-based databases are not comprehensive in many areas," (Pipe et al. 2005, section 2). This means most nurses do not have access to credible scientific data regarding best practices. Another problem revealed in the research is that many nurses underestimate the raw importance of scientific data. Scott & Pollock (2008) found that the hierarchical organizational structure inhibited nurse initiative during the decision-making process because "nurses perceived that the behaviors expected of them were arbitrarily determined by physicians and managers in charge," (p. 298). This means that changing the very organizational structure of a health care institution can be one of the best ways of increasing evidence-based practice.

Other important barriers to implementing evidence-based practice are related to time constraints, leadership weaknesses, and failings in the nursing education sector. As Gambrill (2005) points out, some health care workers view research as a "waste of time" and even believe that research" will diminish the quality of service because it interferes with the creative, spontaneous flow that is the heart of effective helping," (p. 24). Yet combining the art of caring with the science that underlies best practices is the only way to deliver quality care to patients (Gambrill 2005).

The possible consequences of not using evidence-based practice in a health care institution are grave. Gambrill (2005) outlines some of the potential risks that health care institutions take when they deny the relevance of research in daily practice. First, the health care administrators might adopt policies or intervention methods that are unproven, or even those that have "proven ineffectiveness," (Gambrill, 2005, p. 254). Second, administrators and nurses… READ MORE

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