Introduction
Even though the use of an evidence-based approach is actively promoted by healthcare providers, the application of this approach in clinical settings faces a range of obstacles. As a result, researchers and practitioners are interested in developing strategies and techniques that can be used in evidence-based practice (Friesen-Storms, Beurskens, & Bours, 2017; Jackson, 2016). In this context, evidence-based practice is an approach associated with applying research findings and the best clinical practices in healthcare settings to maximize the likelihood of positive outcomes for patients (Christensen, Carroll, & Josephson, 2014; Warren et al., 2016). The following discussion will focus on the specifics of using evidence-based practice in the context of an intensive care unit. The purpose of this paper is to identify challenges that are associated with the implementation of an evidence-based approach in a clinical environment and describe strategies that can be used for implementing this approach.
Challenges in Implementing an Evidence-Based Approach
Although the evidence-based practice is important in intensive care units as well as in other settings, there are certain challenges or barriers to the use of this approach by clinicians. It is possible to divide these challenges and barriers into individual and organizational obstacles. Individual challenges are connected with nurses’ inability to apply evidence to practice because of a lack of knowledge regarding relevant facts and data (Christensen et al., 2014). The problem is that nurses and other healthcare providers working in different clinical settings, including intensive care units, are often unaware of the latest findings relating to different problems and disease treatment.
Moreover, healthcare providers may lack the necessary skills that are required to identify the essential information in published research to guide their practice and implement the most effective problem-solving approach. Evidence-based practice is associated with making patient-oriented decisions concerning scientific evidence and the most effective findings in the clinical field (Hoffmann, Montori, & Del Mar 2014). However, nurses’ inability to review studies and propose decisions limits them in providing the most appropriate care. Furthermore, there may also be psychological barriers if nurses do not believe that their actions or decisions can change practice and improve patient outcomes.
Organizational challenges include a lack of support and resources from authorities in healthcare organizations, a lack of time, and a lack of training about evidence-based practice. Thus the problem is that the application of an evidence-based approach in clinical settings is often not supported by actual changes in the work of clinical units to provide nurses and other healthcare practitioners with opportunities to learn more about the available findings on various questions (Grant & Coyer, 2018; Hallum-Montes, Middleton, Schlanger, & Romero, 2016). Nurses are often not provided with training and time for searching for research studies and evidence to resolve a clinical problem. As a result, the lack of access to a clinician’s expertise negatively affects the quality of provided care as more efficient solutions could be proposed and applied. Therefore the principles of applying an evidence-based approach to different clinical settings should be taught to nurses and other healthcare providers at an organizational level (Tacia, Biskupski, Pheley, & Lehto, 2015). The reason is that practitioners need to know how to search for material, evaluate research results, and conclude concerning data.
Strategies for Implementing an Evidence-Based Approach
To guarantee the implementation of an evidence-based approach in a clinical setting, it is necessary to implement changes at an organizational level. The associated strategies include providing training and education for nurses to help them learn how to work with research and evidence, and how to apply them to practice (Melnyk, Gallagher‐Ford, Long, & Fineout‐Overholt, 2014). For this purpose, healthcare authorities often use online and interactive courses, as well as consultations with professionals in the field. After completing a training course, nurses and physicians can conduct searches of available databases and analyze findings most efficiently (Kristensen, Nymann, & Konradsen, 2015; Hallum-Montes et al., 2016; Grant & Coyer, 2018). Moreover, nurses should also be trained regarding the correlation between patients’ individual preferences and the latest research in the field to choose the most appropriate treatment in a specific case (Grant & Coyer, 2018; Friesen-Storms et al., 2017). As a result of these activities, it is reasonable to expect that evidence will begin to be applied to daily practice.
Other strategies are motivational, and they are associated with involving nurses in regular meetings and discussions of patient cases and searching for solutions to clinical problems. Leaders in healthcare settings are expected to stimulate nurses’ interest in learning more and finding the most efficient solutions to problems. Therefore, they need to provide access to the Internet, databases, and online libraries so that they do not limit nurses and other clinicians in their search for resources and discussions of the latest innovations in different medical spheres (Underhill, Roper, Siefert, Boucher, & Berry, 2015). In this context, the promotion of cooperation between nurses in finding solutions to clinical problems also should be one of the strategies that are used in healthcare facilities, including intensive care units, to improve patient safety and the quality of care (Black, Balneaves, Garossino, Puyat, & Qian, 2015; Melnyk et al., 2016; Underhill et al., 2015). From this perspective, the use of an evidence-based approach is possible when healthcare providers know how to implement it, and they have the required resources, including time and the support of leaders.
Conclusion
The application of an evidence-based approach is a requirement in a modern clinical setting, especially in an intensive care unit where the focus is on using the most effective methods that can provide immediate results. However, despite the obvious interest of researchers and practitioners in evidence-based practice and associated research, there are still challenges. The problem is that nurses often lack the knowledge and critical skills to effectively analyze studies or data about effective practices or to apply this information to their work, and they often lack resources to complete these tasks daily. Thus in many healthcare facilities and units, there are no opportunities provided for nurses and other healthcare workers to practice collecting data on diagnosis and treatment concerning recent trends in the field. However, it is possible to apply certain strategies to implement an evidence-based approach to practice. In a clinical setting, these are usually educational and motivational strategies at an organizational level. These strategies usually lead to positive changes in shifting nurses’ practice toward an evidence-based approach.
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