The low utilisation of evidences in the healthcare settings.
The low utilization of evidences in the healthcare settings were related to the interval of undergraduate education and the preparation for the students to be able to provide the effective health care through the making of decision, safety and enhance the quality of care (Doumit et al. 2010). The difficulties of transition the evidences from the educational filed into the practice in the healthcare settings that required directing the nurses to use the best support of evidence based practice EBP. The development of evidence based practice through decades which help to change and support the unique practice made by nurses and other workers in the healthcare settings. Additionally, evidence based practice required to explore the clinical settings and nursing theories that emphasized the placement of procedural tasks by the professional healthcare workers when there is a lack of formal knowledge about the nurses’ roles in implementing the EBP (Benner et al. 2009). The nurses’ perception to use the EBP and the search for information may combine with the contributing to positive and negative attitudes, stressors and anxiety. These attitudes ended with many barriers that affected the improvement of healthcare, safety and quality. Evidence based practice is effective on improving the practice, education and research developed by the nurses. This assignment will discuss the meaning of healthcare effect, what need to know about the practical that crossed to inform practice, EBP and its impacts on intended health outcomes, the using of standardize all scientific care based on EBP to reduce the variation in care, identify the nurses attitudes and barriers related to EBP and the comment on the current educational program that focused on the quality of EBP.
Using the evidence based practice in the clinical healthcare practice is based on the amount of researches and studies that existed on the daily practiced perform by the nurses. McGlynn  shown that many 10–40% of patients did not receive evidence based care and 20% of nurses and doctors seen that they provided the care without evidences is not necessary and may not end with a harmful result on the patients’ health. The National Board of Health and Welfare in Sweden (2008) mentioned that 8.6% of hospitalized patients were experienced injuries during the hospital care due to the poor implementing of evidence based practice. They assured that the reducing of injuries was caused by the improving of knowledge and implementing the evidence-based practice. Evidence-based practice EBP is originated from the evidence-based medicine that described as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients”. The practice of evidence-based medicines referred to the integrating of individual clinical expertise that required for the available internal and external clinical evidences that taken from the systematic research that included of the using of evidence-based clinical guidelines  (Heiwe et al. 2011). Evidence-based practice is defined by Thyer (2006) as “the receiving of considerable attention within the general field of human attention with conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients”. It is one of the effective a methodical approach to assimilating the objectives and observational evidences with the clinical expertise and the requirements and expectations of the patients as individual (Sackett et al. 2010). These mean that EBP is a key to improve the care, have a positive quality improvement, and develop the level of safety and care and reduce the errors. The recently announced “decade of health information technology” offers unparalleled opportunities to develop and implement strategies that bring evidence-based information to the point of decision making on an unprecedented scale.22 Previous studies, conducted largely at a small number of institutions with sophisticated clinical information systems, have produced substantial evidence that electronic pathways—from evidence-based reminders to clinical decision support systems—can improve quality and efficiency and reduce medical errors. Cooperation between the public and private sectors is required to learn from and build on these results and implement incentives for the adoption of inter-operable electronic medical records (EMRs). Because patients often receive care, even within a single episode, from multiple clinicians in different settings, secure, confidential exchange of health care information from interoperable EMRs across health care settings is critical to providing evidence-based care. To date, the organizational, financial, legal, technical, and operational challenges of creating and sustaining health information exchange have been highly variable and technically idiosyncratic and have yet to produce sustainable business models that could be used in other communities. To accelerate the growth of regional health information exchange, a more uniform and cost-effective approach is needed. HHS is supporting grants and contracts to facilitate health information exchange and advance the adoption of EMRs. The proliferation of these regional collaborations will reflect local health care priorities and provide a trusted resource for physicians and patients to achieve quality and safety goals in the community. As they evolve, these entities, or regional health information organizations (RHIOs), could develop new data sources to accelerate the conduct of health research. If done successfully, these databases could, over time, reduce the reliance on administrative data sets. While legal and operational policies are needed to oversee the use of these databases, RHIOs—with guidance from the state or federal government—could work together to determine appropriate requirements for confidentiality, informed consent, approved uses, and access fees. New methods, including appropriate study designs and analytic techniques, to make effective use of these new, rich data sources for public health surveillance and clinical and health services research will be needed. Using real-time detailed clinical data from large cohorts will bring about a whole new concept of a representative “sample.” Enrollment in prospective studies, including randomized controlled trials, could be expedited, as could data collection and management. These types of developments can greatly reduce the time necessary to fill gaps in the evidence base and reduce the uncertainty in the decision-making process. The HIT Strategic Framework for Action prioritizes efforts to support market institutions to ensure that reliable and interoperable EMRs will be adopted successfully with features to customize the use of (global) evidence. Clinical decision support must be implemented in a way that balances transparency about the source and strength of evidence with legitimate private-sector interests in deploying workable electronic solutions for clinicians and consumers. Rely on well-articulated case formulations, knowledge of relevant research, and the organization provided by theoretical conceptualizations and clinical experience to craft interventions were designed to attain desired outcomes. Cultural values and beliefs and social factors (e.g., implicit racial biases) also influence patterns of seeking, using, and receiving help; presentation and reporting of symptoms, fears, and expectations about treatment; and desired outcomes. t and desired outcomes, and these preferences are influenced by both their cultural context and individual factors. One role of the psychologist is to ensure that patients understand the costs and benefits of different practices and choices (Haynes et al. 2002). EBP seeks to maximize patient and nurses choice among effective alternative interventions. Effective practice requires balancing patient preferences and the judgment based on available evidence and clinical expertise to determine the most appropriate treatment. Evidence-based practice reduces variation in patient care and promotes the highest quality, most cost-effective care.7Nurses can support medical practice in the use of appropriate practice guidelines while also leading efforts to comply with current evidence-based nursing practice. Reducing and managing variation are essential approaches to reducing delays in services. There are two reasons: waiting lists build up because sometimes demand for work exceeds our capacity to do deal with our work. The mismatch is due to variation in both demand for work and variation in our capacity to deal with work. There’s a lot of evidence that suggests that our capacity to deal with work varies more than our demand. Variation in the way we work and do work, such as the way we deal with paperwork, the timing of decision making along a clinical pathway, the decisions we make, how we organise and manage work, all impact the pace that patients progress and the number and length of unnecessary delays patients experience. Protocol based care enables NHS staff to put evidence into practice by addressing the key questions of what should be done, when, where and by whom at a local level. It provides a framework for working in multi-disciplinary teams. This standardisation of practice reduces variation in the treatment of patients and improves the quality of care. The standardisation of practice reduces variation in the treatment of patients on the same pathways. Working to stipulated protocols also provides the opportunity for redesigning and extending roles, for example nurse led discharge which can improve patient experience, reduce length of stay and releases some of the doctors’ capacity.
Using the EBP in the field of healthcare settings has different views and attitudes among the nurses. Heiwe et al. (2011) conducted a cross-sectional survey among the professional healthcare workers in the Swedish University hospital to explore their attitudes, knowledge and beliefs and behaviors about the evidence-based practice to make an effective healthcare. The results showed that the attitudes towards the using of EBP and the using of evidence to support the workers to make decisions were positive among them and all of them seen it was necessary to guide their practices. The majority of professional healthcare workers indicated that workers need for skills to understand and interpret the evidences and make a guideline for the clinical practice. 5,6 showed that there are many factors contributed to the positive attitudes among the nurses to influence the effective using of EBP such as social, organizational, economic and political and individual levels that enhanced the play for an active role. Ploeg et al.  confirmed that health professional workers as nurses have positive views to enhance a learning process that depended on the implementation of evidence-based guidelines, leadership support, included of recommendations at the organizational level, determine the health care providers’ attitudes and beliefs, available resources, constraint and collaboration and establish a network that affected the implementation process. Hakkennes and Dodd  stated that EBP is critical to understand the causes of barriers and facilitate the using of a theoretical framework to be able to enhance the development of effective strategies. Additionally, in a systematic review taken by 11 investigated that nurses can determine the research utilization and attitudes related to evidence-based practice when their level of education is often used to affect the nurses’ attitudes, skills and knowledge might also have an impact on the integration of research into practice. Nurses were held positive attitudes towards evidence-based practice to support decisions that concerned with the patients in their provided care. Overall, nurses’ attitudes can be affected by the barriers that be either personal or related to the healthcare settings.
The majority of nurses’ barriers to implement the EBP in the decisions making and practices were as a result of individual aspects due to the impacts of educational level. Khammarnia et al. (2015) had taken a study to determine the barriers to implement the EBP among 280 nurses in a cross-sectional study in Zahedan City. The results reported that more than half of nurses agreed that the EBP barriers were related to the organizational and individual aspects, respectively. They identified that the barriers on the organizational level were included of lack of human resources, lack of internet access at work and heavy workload while the individual barriers were included of lack of time to search or read any literature or article, lack of ability to work on computer and insufficient proficiency in English language. This study assured that factors related to age, educational levels, job experiences, and employment conditions were associated with organizational barriers to EBP while for the individual level; the educational statue was associated with barriers to apply the EBP. In addition, knowledge of barriers helped the health care system and policy makers to provide a culture of EBP. 19-21 indicated that 57% of barriers were due to individual aspects such as lack of time, poor computer skills and the present of English language. It had been highlighted by 15 that the most common barrier among the individual nurse is lack of time. Other barriers are the lack of human resources as nursing shortage, lack of Internet access, heavy workload and lack of time to go to rich the library 5. Accordingly, organizational support can be a reason to change the process in implementing the EBP. Schoonover  supported that organizational strategies are required to influence the awareness and utilization of research while there is an increase problems of clinical nurse to perform the appraisal system related to the organizational context. 13,28 explained that the variables as educational level and year of experiences are significantly associated to implementation of EBP. Education level is a main factor to implementation of EBP as mentioned by Weng et al.  who revealed that educational training and academic degree are important factors for EBP when the nurses have to increase their knowledge and attitude about EBP. For the year of experiences less than 5 and more than 16 years agree are linked with the organizational aspects that contributed to be a barrier to implement of EBP.
To be able to improve the nurses’ behaviors to integrate the evidences based practice in the daily activity foe the patients, there is a need to change the education course for the nursing and other scientific fields. Nurses and doctors were poorly being prepared for the competencies to reduce the patients’ errors and improve the quality of care. Nurses were being educated to know the theoretical and practical parts in the hospital without taking into consideration how to be effective in improving the healthcare system through the working with others. To solve this problem and change the educational system, the Institute of Medicine competencies, QSEN faculty and National Advisory Board were provided different component that focused on the quality and safety for nursing and proposed many targets for the skills, attitudes and knowledge to be developed in nursing for a pre-licensure program for each competency. The first competences were provided by the IOM (2003) that included from: health informatics, quality improvement, Patient-centered care, interdisciplinary team and evidence-based practice. Safdari et al. (2011) stated that health informatics is depended on health informatics model and Shortlliffe model that included the consumer health informatics, medical informatics, public health informatics, Bioinformatics, nursing informatics and dental informatics. Nursing informatics is a subset of health informatics that seems that the cognitive science is related to the decision-making and problem-solving processes taken by the nurses and focused on the presented data and information as well as the processing and storing (Mastrian 2008). Nursing informatics helps nurses in various positions including the administrator, educator, researcher, or even the nurse who cares for the patient in doing their tasks using the main principles of informatics (Hersh 2009). Health informatics is one component of quality improvement in the healthcare setting that used to use data to monitor the outcomes of care and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems (Cronenwett et al. 2011). It described the strategies for learning about the outcomes of care in the setting in which one is engaged in clinical practice. It also recognized that nursing and other health professions students are parts of systems of care and care processes that affect outcomes for patients and families and explain the importance of variation and measurement in assessing quality of care and the importance of variation and measurement in assessing quality of care (IOM 2011). Moreover, it described the processes used in understanding causes of error and allocation of responsibility and accountability (such as, root cause analysis and failure mode effects analysis and discuss potential and actual impact of national patient safety resources, initiatives and regulations (Smith et al. 2007). Additionally, patient-centered care is effective component to help the nurses to improve the quality and safety which is defined as “a care provision that is consistent with the values, needs, and desires of patients and is achieved when clinicians involve patients in healthcare discussions and decisions” (Cooper et al. 2008). It used to identify the patient centeredness to achieve by understanding patients experiences about their illness and disease (van der Eijk et al. ). Patient-centered care is focused on have many benefits and proposed as a means of achieving better health outcomes, greater patient satisfaction and reduced health costs (Ford et al. 2015). The previous elements are provided through the effective of interdisciplinary team that worked as a complex process to provide different types of staff to work together to share expertise, knowledge, and skills to impact on patient care. Despite increasing emphasis on interdisciplinary team work over the past decade, in particular the growth of interdisciplinary education and using the evidence-based practice to integrate the best research with clinical expertise and patient values for the care and participate in the process of learning and research activities.
To sum up, Evidence-based practice lead to improve the higher quality of care that reflected on the patients outcomes, increased the greater satisfactions among the nurses and reduced the hospital cost that are different from the traditional way to provide the care. Until now, nurses remained unpredictable the using of evidence-based into the daily care. Some nurses during their education predated the inclusion of EBP in the nursing education curriculum due to the lack of skills and numbers of computer and Internet access that necessary to know how to implement the evidences into the practice. As a result of that, many institutions provided supportive components to enhance the ability of nurses to implement the EBP into the practice to improve the safety and quality. Nurses who used evidence based practice seen it was essential and they had hold a positive attitude toward the using of EBP as they observed the positive outcomes on patients health and quality of care. They have believed that the quality of patient care is improved based on the using of evidences that used in the practices and the nursing faculties were increasingly have an interest on improving the research skills that are necessary to integrate the EBP into practice. Although there are many barriers such as low level of knowledge and skills in EBP, lack of time, lack of resources and difficulty to understand the evidences and how to apply into the their daily practice. Moreover, nurses’ positive attitude on EB is faculties are required for knowledge, experiences and skills toward EBP. In my view, educational system should be increased to focus more on the ability of students to graduate with the ability to provide the best quality of care with a higher level of safety for the hospitalized patients.