Evidence-based practice (EBP), a problem-solving approach to patient care that integrates the best evidence from well-designed studies with clinicians' expertise, patient assessments, and patients' own preferences, leads to better, safer care; better outcomes; and lower health care costs. Yet despite the fact that nurses report that engaging in EBP leads to greater professional satisfaction, nurses in the United States aren't consistently using it.
To assess nurses' current readiness and willingness to implement EBP, Melnyk and colleagues at Ohio State University (OSU), Columbus, conducted a descriptive survey of a random sample of 1,015 members of the American Nurses Association. The results showed that only 34.5% of respondents (350) agreed or strongly agreed that their colleagues consistently used EBP in treating patients. Although a majority (76.2%) felt it was important for them to have more education and skills in EBP, most found educational opportunities wanting, as they did access to knowledgeable mentors, resources, and tools needed to use EBP. The two most frequently cited barriers to EBP, however, were a lack of time and an organizational culture that didn't support it—getting past workplace resistance and the constraining power of the phrase, “That's the way we've always done it here.”
“There's a resistance that staff nurses are getting from nurse managers and nurse leaders,” says Melnyk. “That's a big problem, because managers are critical for providing the support needed to do this and for providing role models.”
Education is a big factor, Melnyk points out. “People educated 20 years ago didn't learn an EBP approach to care,” she says, adding that educators still spend more time teaching students how to do rigorous research than they do teaching them how to use research in practice.
“Behavior change is tough,” says Melnyk, who is also dean of the College of Nursing, associate vice president for health promotion, and chief wellness officer at OSU. The key seems to lie in creating a context and support system under which EBP efforts can be sustained. Nurse leaders who want to encourage EBP among their staff, Melnyk says, “need to realize that a one- or two-day workshop isn't likely to cause sustainable change.” To really make it happen, she believes, nurse leaders need to place enough EBP mentors at the bedside who can work hand in hand with clinicians to help them learn these skills and implement them consistently.
Melnyk and her colleagues at OSU are currently launching an online continuing education program so that people can access EBP mentorship skills from around the world. Information on the program can be found at http://bit.ly/Ps1pgw.—Laura Wallis
Melnyk BM, et al. J Nurs Adm. 2012;42(9):410–7