International collaborations, improvement science networks, and efforts by professional organizations are all potential mechanisms to bring staff leaders and EBP mentors into sustained contact in relation to the development, implementation, evaluation and dissemination of EBP initiatives. Melnyk and Fineout-Overholt have further developed the model, which now serves as a guide to advance system-wide implementation and sustainability of EBP See Figure 1.
Capacity-building for EBP in under-resourced environments requires that organizational leaders use creativity to identify mentors and engage nursing staff in the process and uptake of evidence to improve practice. These include models that focus on the process of individual practitioner incorporation of Melnyk et al 2014 principles of EBP as well as system-wide strategies for implementation.
Although healthcare leaders, government agencies and professional organizations have emphasized that an evidence-based approach to healthcare should be the standard of practice, the majority of clinicians in healthcare systems do not consistently implement evidence-based care Institute of Medicine U.
It also is proposed as a critical strategy to speed the application of research in clinical practice and to optimize care delivery Goode et al. Therefore, in the future, healthcare funders are likely to only reimburse care that is based on the best evidence Melnyk The translation of basic research discoveries into real-world applications presents complex and multifaceted challenges AaronsChen and WorrallMelnyk and Fineout-Overholt EBP mentors are then developed and placed within the healthcare system to work directly with point-of-care staff to foster their EBP knowledge, beliefs and skills in evidence-based care.
Findings also indicate that individuals who rate themselves higher on knowledge and beliefs about the value of EBP and their ability to implement it are more likely to teach it to others Melnyk et al.
There is a role for organizations such as Sigma Theta Tau International, specialty organizations and academic centers of excellence to create initiatives that offer programming and partnership support for EBP mentors and staff leaders.
Multiple barriers have contributed to the slow uptake of EBP across healthcare systems, including a inadequate knowledge and EBP skills by healthcare professionals, b misperceptions about EBP, c lack of informatics competencies, d insufficient administrative support and resources at the point of care, e lack of EBP mentors in healthcare systems, and f traditional approaches to teaching healthcare students the rigorous process of how to do research rather than how to use research to guide best practice Fineout-Overholt et al.
Online questionnaires included measures of organizational readiness, evidence-based practice beliefs, evidence-based practice implementation, job satisfaction, group cohesion and intent to leave nursing and the current job.
When delivered Melnyk et al 2014 a context of caring and an organizational culture that promotes best practices, EBP is associated with higher quality care and better patient outcomes than care that is steeped in tradition Melnyk and Fineout-Overholt Results Participants in the evidence-based practice mentorship programme had a larger increase in perceived organizational culture and readiness for evidence-based practice and in evidence-based practice belief scores than those who did not participate.
As a result, there is an urgent need to test strategies to advance EBP throughout international healthcare systems.
However, the integration of evidence-based practice implementation into daily clinical practice remains inconsistent, and the chasm between research and bedside practice remains substantial. From an administrative standpoint, improved cost-effectiveness Winch et al.
Findings from studies have indicated that EBP improves patient outcomes, care quality and practitioners skills and reduces practice variation and healthcare costs MadiganMelnykRoberts and Yeager Committee on the Health Professions Education Summit et al. Although EBP conceptual models are important and useful in guiding general implementation strategies to advance EBP in individuals and in organizations, few studies have generated empirical evidence to support the proposed relationships in the majority of these models.
Other outcomes that can be derived from the EBP process include clinical practice guidelines, protocols, and standards Swinkels et al. The effect of EBP on patient outcomes and cost has been extensively discussed in the literature.
Background Barriers to implementing evidence-based practice are well-documented in the literature. Specifically, it is largely unknown what strategies within the proposed models contribute to system-wide adoption, implementation and sustainability of EBP.
The first step in the ARCC model is an organizational assessment of the culture and readiness for EBP so that EBP facilitators and barriers can be identified, toghether with a plan to overcome them. Despite very many educational endeavours, consumer pressure, and multiple government reports, the integration of EBP implementation into daily clinical practice remains inconsistent, and the chasm between research and practice remains substantial.
Abstract Aim This paper is a report of the effectiveness of a structured multifaceted mentorship programme designed to implement evidence-based practice in a clinical research intensive environment.An Evidence-Based Practice (EBP) Pilot Project: Taking EBP to the Bedside.
Funded by Inova Research Center Seed Grant West et al., ; Davidson & Brown, ; Melnyk, Gallagher - Ford, Troseth, & Wyngarden, ; Mitchell, ) Program design strategy.
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