Evidence-Based Practices and Applied Nursing Research

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nIntroduction

nPractices that have proved to be effective in enhancing the lives of several people should be used in health care settings. The demand to use evidence-based practices in nursing care has led to the rise of many practice guidelines. Aarons, Cafri, Lugo, & Sawitzky, (2012) note that professional organizations and government develop guidelines in order to transform research literature into succinct statements aimed to facilitate change. Nonetheless, research indicates that the attempts have limited impacts because nurses have not changed their practices. In mental health hospitals, many treatment algorithms, consensus statements, guidelines and recommendations describe effective practices of care for patients with severe mental illnesses (Aarons, Cafri, Lugo & Sawitzky, 2012). According to research, specific medications should be used as well as use of psychosocial strategies such as case management, family psychoeducation, and self-management depending on community treatment strategies. Moreover, the treatment of substance abuse should be combined with mental health treatments (Aarons, Cafri, Lugo & Sawitzky, 2012).

nBarriers facing EBP

nHowever, one of the common challenge facing nursing practices is the fact that evidence-based practices are not used in routine care. Patients suffering from mental illnesses such as schizophrenia do not receive effective services. In addition, many patients do not benefit from psychosocial interventions, which are supported by research. Therefore, the routine intervention in mental health is not effective in changing the lives of patients.

nResearch show that large number of mental patients do not receive family psychoeducation in mental health settings (Torrey, Drake, Dixon, Burns, Flynn, Rush & Klatzker, 2014). Furthermore, only less than 2 percent of the total patients with mental health illness reported to have benefited from employment services. Therefore, research indicates that evidence-based practices are rarely practiced in mental health hospitals for patients with severe mental illnesses. In this regard, mental health facilities have a critical challenge of ensuring higher utilization of research-based practices in daily mental health practices in all facilities (Aarons, Cafri, Lugo & Sawitzky, 2012). Consequently, the adoption of research-based practices in mental health care settings will help patients with mental illnesses.

nKnowledge base

nThe project considered a wide range of reports from crucial stakeholders such as administrators of Mental Health facilities, advocacy groups, nurses, and family groups as well as research literature. The main aim of project is to establish implementation toolkits that help to promote effective practices among nurses. The literature research helps to change routine practices in medical care. On the hand, administrators facilitate implementation of evidence-based practices. Nurses also provided insights that can play a crucial role in development of appropriate approaches (Dixon, McFarlane, Lefley, Lucksted, Cohen, Falloon, & Sondheimer, 2014).

nLiterature research

nA change in behavior can be enhanced through implementation of a special practice in of nurses in mental health care. According to research, a behavior can be changed when appropriate skills are combined with desire to change. However, research points out that a change in behavior can be facilitated when environment constraints are absent (Torrey, Drake, Dixon, Burns, Flynn, Rush & Klatzker, 2014). Furthermore, based on Greens model of behavior change, three elements promote change. They include disseminating or influencing strategies such as written materials and educational events; enabling strategies such as through supporting decisions and practice guidelines; and reinforcing strategies such as establishing efficient feedback mechanisms (Aarons, Cafri, Lugo & Sawitzky, 2012).

nJacobs, Jones, Gabella, Spring & Brownson, (2012) argue that education alone has no capacity to robustly affect the practices behaviors of nurses in mental health facility. However, other efforts are able to promote change of behaviors in their practice. These efforts included higher consumer demand for better services, provision of financial penalties and incentives, and introduction of administrative regulations and rules. In addition, change and practice behaviors of nurses can be supported through provision of continuous feedbacks on activities under these practices (Jacobs, Jones, Gabella, Spring & Brownson, 2012). Furthermore, supervision on practice should be implemented in order to help the nurses. A system of care, which is implemented, should minimize resistance and support change and ultimately it will lead to practice involvement. Therefore, better systems are directly associated with success in practice change (Sandström, Borglin, Nilsson, & Willman, 2011).

nMoreover, research identified that when complicated changes are implemented such as adjusting the practice of nurses, high intensity of changes are required to make a simple change. Guidelines cannot be executed to a single group of stakeholders in the facility. Therefore, all the stakeholders must join hands in order to implement the guidelines. Most importantly, Huffman, Niazi, Rundell, Sharpe, & Katon, (2014) argue that a sustained change can be developed through rearrangement of the daily workflow. Consequently, it will help the nurse to provide care in a supporting way.

nFor instance, research conducted by Sandström, Borglin, Nilsson, & Willman, (2011) showed that improvement of primary care for depression treatment can be achieved using multifaceted and intensive program, which involved physician training and services restructuring. However, the researcher observed that the interventions did not lead to improved care to patients outside the intervention program although same nurses provided services to them (Sandström, Borglin, Nilsson, & Willman, 2011). Similarly, nurses who participated in the restructured intervention did not change their behavior after reverting to their normal work (LoBiondo-Wood, Haber, Berry, & Yost, 2013).

nAnother study-conducted by Dixon, McFarlane, Lefley, Lucksted, Cohen, Falloon, & Sondheimer, (2014) revealed that programs on mental health executing evidence-based practices had better outcome when they featured higher quality implementation. In this respect, when two programs provide effective practices of care, the program with higher fidelity leads to superior nursing outcomes. Therefore, the findings of this research suggest that attempts to enhance evidence-based practice should have higher fidelity and automatic feedback system (Dixon, McFarlane, Lefley, Lucksted, Cohen, Falloon, & Sondheimer, 2014).

nTorrey, Drake, Dixon, Burns, Flynn, Rush & Klatzker, (2014) argued that implementation attempts have higher effectiveness when they focus on specific concerns, values and needs of the individual or group they intends to change behavior. In particular, nursing training elements should be designed to mental health nurses, administrative elements to administrators and family and consumer education to relevant groups (Torrey, Drake, Dixon, Burns, Flynn, Rush & Klatzker, 2014).

nPerspectives of administrators

nAdministrators of mental health facilities play a crucial role in enhancing change of practice of the nurses and other staff. In this respect, they make important decisions in financial administration and implementation of rules and regulations in mental health facility (Jacobs, Jones, Gabella, Spring & Brownson, 2012). Most importantly, they affect the execution of evidence-based practices in the facility by prioritizing care and arranging the operational practice details. Administrators also emphasize for establishment of structured resources in order to enable provision of evidence-based practices. Therefore, implementation of precisely defined evidence-based practices, play an essential role in assisting the administrators to deliver on their mandate (Aarons, Cafri, Lugo & Sawitzky, 2012).

nResearch argues that adjustment of administrative regulations and rules and financial incentives must be carried out in order to support evidence-based practices implementation. The attempts to implement these programs in the health facility must be supported through stable financial structure. Moreover, sustainable evidence-based practices require continuous funding (Torrey, Drake, Dixon, Burns, Flynn, Rush & Klatzker, 2014). In addition, the funding should be viable with potential income from other activities performed by nurses. Administrators also need funding on training cost and data collection costs over time. Similarly, the implementation of evidence-based practices should be streamlined because the process of data collection and fidelity practice require a lot of time and energy. In this regard, it helps to prevent direct interruption of the nursing service (Dixon, McFarlane, Lefley, Lucksted, Cohen, Falloon, & Sondheimer, 2014).

nPerspectives of nurses

nIt is important to understand the views of nurses who provide care to patients before implementation of evidence-based practice. In this respect, it helps to establish different factors that motivate nurses to change their behaviors of practice. In addition, it ascertains how a new practice can be learnt and their perceptions on barriers of change (Huffman, Niazi, Rundell, Sharpe, & Katon, 2014).

nResearch indicates that nurses are convinced that evidence-based practices are important to learn. Additionally, they should learn the practices through reading, training and observations. On the other hand, the attempts to support the practices such as feedback and supervision over a period are beneficial to nurses. However, studies revealed out that most of the nurses lack motivation to change. Therefore, they should be motivated to embrace new practices (Jacobs, Jones, Gabella, Spring & Brownson, 2012). Various factors influence nurses to adopt new practices, which include practice ideology, imitations of practice seen in other places, and persuasive vignettes. These factors help to improve their experiences and values as providers. Most notably, nurses are willing to learn practices that are easily learned and practical rather that those that need dramatic change in system and intensive learning (Sandström, Borglin, Nilsson, & Willman, 2011).

nA study by Huffman, Niazi, Rundell, Sharpe, & Katon, (2014) shows that nurses are encouraged to adapt new EBP if they know that there will be high demand of these practices from their patients. They are also inspired to adopt new practices if they feel that they will assist them in a nursing area where they have in adequate knowledge (Huffman, Niazi, Rundell, Sharpe, & Katon, 2014).

nAfter they adopt a new practice, nurses require practical assistance. In this case, they need to see a certain EBP in action instead of just reading about it. Nurses can achieve this through observations, demonstration and watching educational videotapes. It is important to reinforce and support the new practices through supervision (Dixon, McFarlane, Lefley, Lucksted, Cohen, Falloon, & Sondheimer, 2014). The benefit of supervision is that it enables nurses to transform theory work into action. Furthermore, they should use feedbacks and follow-up training, which reinforces their learning. Provisions such as additional readings, advanced seminars and the Internet increase their skills and understanding (Torrey, Drake, Dixon, Burns, Flynn, Rush & Klatzker, 2014). Advocacy events such as Web Conferences and media events help to emphasize evidence-based practices in health care settings.

nSteps in Implementation of Evidence-Based Practices

nA model that would produce change is important is important in mental health settings. According to Sandström, Borglin, Nilsson, & Willman, (2011) implementation toolkits help to promote evidence-based practices. They were developed through Web-based resources, consultation opportunities, experiences for training and integrated written materials (Sandström, Borglin, Nilsson, & Willman, 2011). The implementation toolkits had an essential role at promotion of effective services to mentally ill patients. The implementation of toolkits involved three major steps (LoBiondo-Wood, Haber, Berry, & Yost, 2013).

nIn the first step, services in a mental health facility were restructured with the help of their stakeholders. Individuals who participated in the interventions utilized a video that provided details of evidence-based practices. The video also showed testimony from nurses and clients as well as scientific support that would help nurses in their interventions (Torrey, Drake, Dixon, Burns, Flynn, Rush & Klatzker, 2014). Moreover, written materials in the toolkits provided the reasons and benefits for adopting effective practices since they are research based.

nThe second step involved application of toolkits to make appropriate changes in health care facility. For instance, information in the toolkits explained how administrators could obtain funding for the evidence-based practices. They also had administrative regulations and rules in mental health facility (Torrey, Drake, Dixon, Burns, Flynn, Rush & Klatzker, 2014). The implementation toolkits also provided financial incentives and sources of consultations for specific evidence-based practices. In addition, they provided recommendations for enhancing change in the mental health facility. Training of the nurses was also provided in the implementation toolkits. Furthermore, supervision program for the nurses was also provided for in the implementation toolkits. Besides, advocacy materials such as booklets were included in the toolkits for the families and consumers who demand for better services (LoBiondo-Wood, Haber, Berry, & Yost, 2013).

nThirdly, the implementation toolkits provided for organized feedback systems for stakeholders. In this respect, they provided fidelity scales that enabled self-assessments. The implementation toolkits had simple tracking methods and follow-up training, which facilitated implementation by the stakeholders (Torrey, Drake, Dixon, Burns, Flynn, Rush & Klatzker, 2014). The toolkits helped to improve the change of behavior of practice of nurses in provision of effective services to patients with severe mental illnesses.

nApplication of EBP in the Health Facility

nInformation of evidence-based practices is very important in solving problems in mental health facility. The facility does not use EBP in routine nursing practices. Therefore, patients with severe mental illnesses such as schizophrenia do not benefit from effective services. Moreover, most of the psychosocial interventions in nursing are not evidence-based. On the other hand, majority of nurses lack adequate knowledge on how to practice EBP (Jacobs, Jones, Gabella, Spring & Brownson, 2012). Furthermore, they are not motivated to adopt evidence-based practices because they feel ineffective to provide better services. Nurses do not practice evidence-based practices because their patients do not demand them. Administrative rules and regulations also act as a barrier in provision of services (Sandström, Borglin, Nilsson, & Willman, 2011).

nApplication of evidence-based practices in health facility will help nurses to improve efficiency and effectiveness of care. Trainings on EBP will help nurses to change their practices when delivering services to patients with severe mental illnesses (Torrey, Drake, Dixon, Burns, Flynn, Rush & Klatzker, 2014). Evidence based practices will also provide financial incentives to facility administrators hence they will be able to execute their program. It will also provide better administrative regulations and rules, which will enable their stakeholders to implement EBP.

nConclusion

nResearch indicates that many psychosocial interventions play a major role in enhancing the lives of patients suffering from severe mental illnesses. Although a lot of knowledge exists on psychosocial interventions, only few nurses use evidence-based practices in their health facilities. Nurses lack motivation to change their current practices to those supported by research. On the other hand, administrative rules and regulations acts as a barrier to implement evidence based practices. In this paper, implementation of evidence-based practices has been recommended (Jacobs, Jones, Gabella, Spring & Brownson, 2012). Implementation toolkits were developed after collecting various perspectives from nurses, administrators of health facilities and literature research. Implementation toolkits involve three main steps.

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nReferences

nAarons, G. A., Cafri, G., Lugo, L., & Sawitzky, A. (2012). Expanding the domains of attitudes towards evidence-based practice: The Evidence Based Practice Attitude Scale-50. Administration and policy in mental health and mental health services research, 39(5), 331-340.

nDixon, L., McFarlane, W. R., Lefley, H., Lucksted, A., Cohen, M., Falloon, I., … & Sondheimer, D. (2014). Evidence-based practices for services to families of people with psychiatric disabilities. Psychiatric Services.

nHuffman, J. C., Niazi, S. K., Rundell, J. R., Sharpe, M., & Katon, W. J. (2014). Essential articles on collaborative care models for the treatment of psychiatric disorders in medical settings: a publication by the Academy of Psychosomatic Medicine Research and Evidence-Based Practice Committee. Psychosomatics, 55(2), 109-122.

nJacobs, J. A., Jones, E., Gabella, B. A., Spring, B., & Brownson, R. C. (2012). Peer Reviewed: Tools for Implementing an Evidence-Based Approach in Public Health Practice. Preventing chronic disease, 9.

nLoBiondo-Wood, G., Haber, J., Berry, C., & Yost, J. (2013). Study Guide for Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences.

nSandström, B., Borglin, G., Nilsson, R., & Willman, A. (2011). Promoting the implementation of evidence‐based practice: A literature review focusing on the role of nursing leadership. Worldviews on Evidence‐Based Nursing, 8(4), 212-223.

nTorrey, W. C., Drake, R. E., Dixon, L., Burns, B. J., Flynn, L., Rush, A. J., … & Klatzker, D. (2014). Implementing evidence-based practices for persons with severe mental illnesses. Psychiatric services.