CHAPTER ONE
INTRODUCTION
Background to the Study
The increased emphasis internationally on clinical and cost effectiveness in health policy has highlighted the need for quality health services to be built upon the use of best evidence (McKenna, Ashton & Keeney, 2010). Various governments have introduced initiatives to support the development of evidence-based healthcare systems in which decisions made by healthcare practitioners, managers, policy makers and patients are based on high quality evidence. Activity has focused on developing evidence-based guidelines for clinical interventions. For example, in the USA, the Agency for Healthcare Research and Quality leads national efforts in the use of evidence to guide healthcare decisions.
Evidence-based practice (EBP) is an interdisciplinary approach to clinical practice that started in medicine as evidence based medicine (EBM) and spread to other fields such as dentistry, nursing, psychology, education, library, information science and other fields. (Titler, Cullen & Ardery, 2013). Polit and Beck (2011) define EBP as requiring the use of the best available research evidence and practical experience to make clinical decisions. EBP leads to cost-efficient, quality patient care and improved patient outcomes (Burns & Grove, 2010). Policy, political and professional imperatives have made EBP a clinical prerequisite for daily practice. Over the years since its formal introduction in 1992, EBP has emerged as a major policy theme in Western healthcare systems, especially, the United States of America (USA), Australia and the United Kingdom (Rycroft-Malone, 2011).
EBP is not only applying research-based evidence to assist in making decision about the healthcare of patients but rather extends to identify the knowledge gaps and finding systematically appraising and condensing the evidence to assist clinical expertise, rather than replacing it (Elshaug, 2010). In accordance with most health-related professions, there has been a growing focus on quality improvement including moving from a traditional intuition-based paradigm to evidence-based nursing practice (EBNP) (Melnyk & Fineout-Overholt, 2011).
The EBNP process consists of five stages: (1) formulating a question that will yield the most suitable answer; (2) gathering the most relevant information by systematic search of the literature or clinical guidelines; (3) performing critical evaluation of the evidence and its validity, relevance and feasibility; (4) integrating research evidence with clinical experience, patients’ values and preferences and (5) assessing treatment outcomes (Melnyk & Fineout-Overholt, 2010). Implementing EBNP is potentially beneficial for patients and healthcare systems in general, and for nurses in particular. It enhances patients’ access to information about effective treatment (Melnyk & Fineout-Overholt, 2012). EBNP can also improve the healthcare system by facilitating consistent decision making and advancing cost-effectiveness. Furthermore, EBNP can help nurses by facilitating informed and evidence-based clinical decision-making, support them to bewell informed with technologies and enable greater efficiency (Melnyk & Fineout-Overholt, 2011).
EBP in nursing has been strongly presented in the agendas of many professional organisations as an undergraduate requirement in countries, like the USA, Canada and Jordan (Baumbusch, 2010). Among the many professional organisations is the Jordanian Nursing Council (JNC), which emphasizes the implementation of EBP as one fundamental component of nursing practice and education (Jordanian Nursing Council, 2010).It is believed that the evidence-based practice in nursing education should commence in the undergraduate preparation, which provide the skills required to find, analyze and, later, synthesize best evidence for practice (Balakas & Sparks, 2010). Therefore, assessing factors influencing the implementation of EBP in nursing programs, withfuture graduate nurses, is crucial to prepare nursing graduates to adopt and implement these principles in their work.
Despite the plethora of literature on what evidence-based nursing is and is not, EBP in nursing education is still struggling and has not been addressed adequately. Many researchers identified that some problems that inhibit the implementation of EBP in nursing practice (Brown, 2009; Thompson, 2010), include insufficient educators’ skills and time to find research studies, inadequate knowledge on how to evaluate research findings, and lack of organisational support, lack of adequate understanding of technologies associated with the teaching strategies promoting EBP such as the use of human simulation in the nursing laboratories and lack of consensus on the best strategies, material, time and level of students to engage in EBP (Stichler, 2013). Other related problem to teaching process, especially in undergraduate education, focuses mainly on the process of deducting evidence from research rather than conducting research (Ciliska, 2010) abandoning an essential component of EBP.
By and large, the predicament of EBP is enormous. Thus, in Nigeria, EBP is still far from its realizations and under studied. It is in line with the above that the researcher seeks to find out factors that influence the implementation of evidence-based practice among nurses in selected tertiary hospitals in Enugu urban.
Statement of the Problem