EBP Use Evaluation
End-of-life care is a complicated area of healthcare as it is full of challenges for working nurses. The process of caring for the dying is often charged with practices that are more connected to emotional support than to medical treatment (Ingebretsen & Sagbakken, 2016). However, as many patients in these facilities may have health-related issues, nurses engage in both communicational and therapeutic practices. The use of evidence-based practice (EBP) in hospice nursing is often complicated by the nature of care, as nurses rely on their personal experience and interactions with their coworkers (Klein-Fedyshin, 2015).
For example, the process of pain assessment in patients with such conditions as cancer may not be supported by EBP and based on previously used procedures and scales. According to Herr et al. (2010), this problem is reoccurring in hospice care, where the use of specific guidelines for pain assessment may be infrequent. In one of my recent clinical experiences, I encountered a similar situation when my coworker based the examination on his previous knowledge of cancer pain rather than adhering to any type of official recommendations.
Care Based on EBP
In the discussed case, the process of pain assessment was not based on EBP. However, some nurses used a valid scale for pain evaluation during patients’ admission to the hospital. In many situations, workers are able to recognize the usefulness of strict guidelines, but it may seem as though their decisions are not based on recent and reliable research but on practices that were implemented some years ago. Thus, while some nurses used numeric rating scales, others chose to rely on their professional experience and neglected some questions from the scale (Herr et al., 2010). As a result, the use of EBP was not consistent.
Questions
Research Questions
- Which practices do hospice nurses in the discussed clinical setting prefer?
- Which existing pain assessment scales can be used for end-of-life patients with cancer pain?
- Why do hospice nurses use specific recommendations periodically and not consistently?
- What is the current state of research on EBP in hospice care?
PICOT Question
In end-of-life care, what is the effect of nurses following specific guidelines for pain assessment compared to the sporadic use of evaluation recommendations for patients with cancer over 6 months?
Barriers to Implementation
The culture in the discussed clinical setting is not based on following EBP practices. Many nurses do not possess the necessary knowledge to research information effectively during work. Furthermore, most of them do not have enough time to devote to learning. Thus, many of the activities in the organization are based on previous experiences as nurses share their thoughts with each other. It is a common problem in end-of-life care, as many hospice nurses cannot or do not want to engage in research at their place of work. It can happen because of poor information and computer literacy skills, access to EBP resources, time, and organization’s training plans (Klein-Fedyshin, 2015).
In the current setting, nurses’ lack of time may be the main barrier to implementing an EBP solution. According to Majid et al. (2011), this issue is among the main possible barriers to using EBP in nursing practice. Nevertheless, as any barrier, this problem can be overcome with planning (Polit & Beck, 2017). The organization’s management can be consulted about this problem to suggest some scheduling changes for nurses working on implementing the researched EBP. More nurses’ time can be devoted to research. It is vital to highlight the significant impact that these changes may bring.
References
Herr, K., Titler, M., Fine, P., Sanders, S., Cavanaugh, J., Swegle, J.,… Tang, X. (2010). Assessing and treating pain in hospices: Current state of evidence-based practices. Journal of Pain and Symptom Management, 39(5), 803-819.
Ingebretsen, L. P., & Sagbakken, M. (2016). Hospice nurses’ emotional challenges in their encounters with the dying. International Journal of Qualitative Studies on Health and Well-Being, 11(1), 31170.
Klein-Fedyshin, M. (2015). Translating evidence into practice at the end-of-life: Information needs, access and usage by hospice and palliative nurses. Journal of Hospice and Palliative Nursing: JHPN, 17(1), 24-30.
Majid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y. L., Chang, Y. K., & Mokhtar, I. A. (2011). Adopting evidence-based practice in clinical decision making: nurses’ perceptions, knowledge, and barriers. Journal of the Medical Library Association: JMLA, 99(3), 229-236.
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.