Evidence-Based Practice Models and Their Barriers
Nursing is a field that is highly built on translating research into practice. Evidence-based practice (EBP) is the application or translation of research findings in daily patient care practices and clinical decision-making (Tucker et al., 2021). Considering the complexity of translating research into practice, several EBP models have been developed over time to assist nurses and other clinicians in incorporating evidence into practice. However, these models vary in criteria, and different models fit different nursing organizations and situations differently. This essay identifies and explores different Evidence-Based Practice models I have seen implemented in my institution and their barriers, how they can be overcome, and identifies the model I think would work well in my current institution and the rationale. Evidence-Based Practice Models and Their Barriers
EBP Models and Barriers
One widely used EBP model in healthcare is the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model. The model aims to guide nurses in translating research into practice through a three-step process: Practice Question, Evidence, and Translation. Additionally, the model requires the care providers to identify a clinical problem, review available evidence associated with the problem, and implement changes to address the problem based on the evidence findings. Tucker et al. (2021) note that the JHNEBP model requires forming an EBP team that nurses mainly lead.
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The primary barriers to applying the JHNEBP model in translating research that we have encountered are time and research skills constraints. The model requires forming an EBP team, and the team should have excellent research skills to review and appraise literature evidence. These barriers can be overcome by training nurses on research skills and the essence of EBP and allocating adequate time for EBP and related reforms.
The other EBP model is the Promoting Action on Research Implementation in Health Services (PARIHS). According to Harvey and Kitson (2020), the PARIHS model stipulates that the three key elements of a successful implementation of evidence into practice are evidence, context, and facilitation while emphasizing the need to customize interventions to a specific healthcare environment. The team gathers and evaluates research, clinical, and patient preference evidence in the evidence phase. They thereafter assess the setting where the EBP will be implemented. Facilitation entails identifying and training a skilled team to drive the EBP process, address barriers, and guide implementation based on context.
The potential barriers to using the PARIHS model include resource constraints for training skilled facilitators and inadequate readiness for EBP in a particular healthcare setting. These barriers can be overcome by ensuring the institution evaluates the setting’s readiness for EBP and tailors the interventions to the context based on readiness. Additionally, the institution should allocate adequate resources to develop facilitation skills among staff to enable effective EBP implementation across diverse units. Evidence-Based Practice Models and Their Barriers
The other EBP model is Advancing Research and Clinical Practice Through Close Collaboration (ARCC). The ARCC Model builds on a mentoring framework, where EBP mentors guide clinical staff through implementing evidence-based changes (Migliore et al., 2020). It includes assessing organizational readiness and fostering an EBP culture. Additionally, the model aims to empower individual practitioners to incorporate evidence into their clinical practice. The ARCC model has five steps: Assessment of Organizational Culture and Readiness, Identification and Training of EBP Mentors, Mentorship, Measurement of EBP implementation, and Feedback and Sustainability.
The barriers we have encountered while implementing this EBP model include the unavailability of mentors within the organization and having an organizational culture that does not prioritize EBP. These barriers can be overcome by creating structured mentorship and training programs for potential EBP champions and fostering an organizational culture that prioritizes and incorporates EBP values while emphasizing EBP importance.
Suitable EBP Model for My Institution
The EBP model that can be implemented in my institution is the PARIHS. The PARIHS model is an effective choice for implementing EBP in healthcare settings due to its focus on three essential elements: context, facilitation, and evidence. Being a complex environment with diverse departments, each possessing unique workflows, staff dynamics, and resources, the model would fit the institution. It also emphasizes adapting EBP to fit each unit’s specific culture and needs, which increases the likelihood of successful implementation. By incorporating trained facilitators, the model also provides staff with the necessary support to overcome resistance, address challenges, and ensure that EBP initiatives are adopted consistently across departments. Evidence-Based Practice Models and Their Barriers
Furthermore, the model’s approach to integrating various evidence types, such as clinical experience and patient preferences, aligns well with the multidisciplinary nature of patient care. The PARIHS model’s iterative process allows for continuous refinement based on feedback, helping maintain EBP effectiveness over time. This adaptability makes it suitable and sustainable for fostering EBP in healthcare institutions.
Conclusion
Evidence-Based Practice (EBP) faces barriers, such as limited time, restricted access to resources, and inadequate EBP training. Overcoming these challenges requires leadership support, expanded research access, and targeted EBP education and training to cultivate a culture that values evidence-based care. The PARIHS model aligns well with our institution’s needs by emphasizing context, facilitation, and diverse evidence sources tailored to each department. The model, with the guidance of skilled facilitators, can enable smoother, sustainable EBP integration, ultimately enhancing patient outcomes and strengthening our organization’s commitment to quality care, as seen above. Evidence-Based Practice Models and Their Barriers
References
Harvey, G., & Kitson, A. (2020). Promoting action on research implementation in health services: the integrated-PARIHS framework. In Handbook on Implementation Science (pp. 114–143). Edward Elgar Publishing. https://doi.org/10.4337/9781788975995.00012
Migliore, L., Chouinard, H., & Woodlee, R. (2020). Clinical research and practice collaborative: An evidence-based nursing clinical inquiry expansion. Military Medicine, 185(Suppl 2), 35–42. https://doi.org/10.1093/milmed/usz447
Tucker, S., McNett, M., Mazurek Melnyk, B., Hanrahan, K., Hunter, S. C., Kim, B., Cullen, L., & Kitson, A. (2021). Implementation science: Application of evidence-based practice models to improve healthcare quality. Worldviews on Evidence-Based Nursing, 18(2), 76–84. https://doi.org/10.1111/wvn.12495 Evidence-Based Practice Models and Their Barriers
