The low utilization 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 [2] 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 [5] (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.

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