According to Olade (2004), nursing practice using observed phenomena and evidences is an example of education which refers to formalized experiences designed to enlarge the knowledge or skills of nursing educators or practitioners. Through experiences and evidences, the ability to learn actual clinical practice and the orientation in health care protocols and policies in handling patients' needs will be achieved. This method is also termed as Evidence-based practice. Evidence-based practice involves a combination of many disciplines, including aspects of multidisciplinary sciences to promote the restoration and maintenance of health in our clients (Davies, 2005). Much literature has been published on this topic in recent years, an evolving subject and concept for specific practices that promote more effective, safer and more efficient ways of caring (Drenkard & Cohen, 2004). Maintaining and improving high satisfaction and job retention among nurses is an important area to discover (Ebell, 2008). To achieve this, we need a workforce to continually strive for excellence, be responsible and flexible enough, have the confidence to face the challenges, and inspire everyone with a shared vision. These are strengths needed by nursing staff to motivate others health care provider to fulfill their potential and achieve goals (Littlefield, 2005). Researches, studies and articles were utilized and analyzed in gathering the necessary information needed. Clinical education, skills and practices are the key concepts used in this paper.
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Possession of knowledge and competency in performing skills and interventions which can be acquired in hands on training is essential in practicing the profession especially in the medical-surgical unit where I supervise. As a nursing professional, tangible skills and knowledge in a hospital setting is very important in managing clients and supervising clients (Burns & Foley, 2005). Evidences were identified through thorough assessment and research. The challenges discussed below were identified through gathering of recent information in my Medical-Surgical unit and data that focuses on this subject.
Communicating effectively at all levels is a common barrier in the implementation of change among health care in various settings (Kleinman, 2004). As a member of the hospital workforce, a nurse must have the capability to communicate effectively in a non-judgmental way and stimulate other colleagues to think critically. They must also arouse enthusiasm and develop quick thinking and imagination. Moreover, they must also demonstrate resourcefulness and professionalism with infinite patience, understanding, confidence and perseverance are also challenges (Bryar et al, 200).
According to Kleinman (2004), health care professionals are striving constantly to improve and develop the standards of care. Meeting the challenges require health care providers to be effective leaders who foster a culture and develop partnerships that embraces innovation (Salsberg, 2008). Organizational culture and leadership style result to staff satisfaction, increased productivity, improved patient care well-functioning teams (Drenkard & Cohen, 2004). Getting health information about new knowledge is also a critical case or situation, but we have to look at how to make the system on healthcare execute its purpose better for certain facility so that the provided care is more efficient, accessible and effective (Pravikoff et al., 2005).
Recent studies have reported gaps between nursing practice and researches (Brancato 2006) and identified different challenges that prevent the evidence to clinical practice to translate into clinical settings (Olade 2004). These challenges in applying evidence-based practice in nursing have been consistent across researches. One challenge is that, in the generation and development of new medical and nursing knowledge, the resistance of profession has often been incorporated with the new ways of practice (Young, 2004).
The study suggests that much recent practices are based frequently on tradition, experience and intuition, rather than validation of science (Pravikoff et al., 2005, Egerod & Hansen 2005). Furthermore, the growing numbers of nurse studies and researches designed to develop and improve nursing practice at the staff nurse level cannot make nurses improve their skills, research knowledge and understanding. They frequently lack nurses formal training such as scientific inquiries (Fink et al. 2005, Melnyk 2005, Melnyk et al. 2004, Pravikoff et al. 2005, Olade 2004). Institutional challenges to Evidenced-based Practice have also been identified.
Moreover, challenges according to Melnyk (2005) were also found such as difficulty gaining support financially for the programs and trainings that ensure the effectiveness of skills, practice, leadership and integration of the program with existing practice of care through trainings and seminars and sustainable momentum during the shift of culture. Study also revealed that these challenges are not limited to those who implement the program (Young, 2004).
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In general, the main role of nurses is focused on providing effective, quality care. Hence, more advanced and competent means of preparing nurses to supervise and manage their patient is important (Briggs et al., 2004). These challenges must be addressed properly by the implementation of appropriate approach and programs to increase the knowledge and experience. Skill development for nursing educators must constantly be framed within the context of individualized patients. Nursing educators should make themselves aware of every situation happening in the field and make it a motivational means to improve the profession by proper preparation and education (Welk, 2007). Therefore, the need for implementing evidenced-based approach to nursing practice is essential in addressing these issues.
Strategies for Implementing an Evidence-based Approach to Nursing Practice
The nursing profession enters a new era not knowing what to expect. Yes, patient care is the "same" everywhere, but they must be comfortable with the environment they are placed in. Adaptation is crucial in the clinical arena (Kleinman (2004). Evidenced-based practice and clinical experience may become a highly useful and effective strategy in clinical practice. The nurse becomes less apprehensive about the clinical environment and becomes more client-focused, therefore increasing the effectiveness of care. This also provides the nurse an opportunity for role modeling as the client and family maintains and develops standards of practice and competent care in a familiar environment (Foster, 2007).
In implementing an evidenced-based approach to nursing practice, nursing professionals must learn the ability to have excellent learning and communication skills, exhibit organizational and leadership ability (Salsberg, 2008). The particular problem which is the main issue of the study conducted by Rosswurm and Larrabee (2005) which suggests that the ability of nurses to perform their responsibilities and duties by exhibiting clinical skills and professional abilities are important. Nurses must possess good assessment skills and have good insight and judgment skills in order to anticipate or interpret the needs of the client in health care practice (Hewson, 2006). This evidenced-based model can be used to accommodate change process for the observed facts and laws that can be related to a particular aspect of nursing practice (Burns & Foley, 2005).
Communication practices must be addressed to identify and effectively set goals. Communicating effectively at all levels is a common barrier in the implementation of change among health care in various settings (Henderson, 2009). In addition,Littlefield (2005) strongly agrees that effective communication is the major factor in the success of effective learning outcomes for the implementation of new approaches, especially in a multicultural environment. As nurses play a different role at different time periods, communication should be considered in my Medical-Surgical unit in order to maintain the effectiveness and quality for the future improvement. Communication plays an essential role in enhancing clinical learning environment. Hallin & Danielson (2009) describe that the role of communication is more concerned with the development of clinical competency by using strategies such as role modeling, feedback and questioning, within a supportive, safe and welcoming manner.
For experienced nursing practitioners in hospital settings such as the Medical-Surgical unit, financial support and educational programs should provide resources to maintain theoretical and clinical competence (Hagger & McIntyre, 2007). The key to successful client management is communication in caring for patients. Some of the activities being practiced in a hospital setting are the provision of the most current information possible for the nurses and nursing educators using the evidence-based practice and through collaborative approach of health care professionals (Lichtman, 2008).
It is also useful to have and possess general skills needed to be competent in educating and training nursing personnel in health facility (Welk, 2007). I can share my ability to have excellent teaching and communication skills, exhibit organizational and leadership ability in my unit. The particular factor which is the main issue in improving the knowledge to perform their responsibilities and duties through exhibiting clinical skills and professional abilities is really important. Nursing practitioners must also support the possession of good assessment skills and have good insight and judgment skills in order to anticipate or interpret the needs of the client in health care practice (Foster, 2007).
Lastly, trainings, workshops or programs should be properly planned and outlined to provide information and instruction for nurses in the principles of teaching and learning different skills, pedagogical styles, and valid evaluation techniques. According to Hewson (2006), workshops for nurses would impart knowledge and skills essential for success in the clinical setting. Embracing the knowledge and acquired skills in a familiar environment provides the practitioner with an increased level of confidence in the educational development of nursing professionals (Salsberg, 2008).
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To properly accommodate the strategies mentioned above, the conceptual model for translating evidence into clinical practice authored by Rosswurm and Larrabee (2005) will be helpful to promote the change process. This model recognized that translation of research into practice requires a solid grounding in change theory, principles of research utilization, and use of standardized nomenclature. The model has the following six phases: 1) assess the need for change in practice, 2) link the problem with interventions and outcomes, 3) synthesize the best evidence, 4) design a change in practice, 5) implement and evaluate the practice, and 6) integrate and maintain the practice change. The model provides a pragmatic, theory-driven framework for empowering clinicians in the process of evidence-based practice. The first phase is assessing the need for change in practice which searches for evidence to support the change. The second phase is linking the problem, interventions, and outcomes by using standardized nursing classification systems and nomenclature to identify the problem, and the desired outcomes .The third phase is synthesizing the best evidence by organizing systematic and critical strategies. The fourth phase is designing the practice change by identifying strategies to explore the original issue further and to implement it into practice. The fifth phase is the implementation and evaluation of change in practice by building and fortifying systems identifying problems, communicating and managing changes. The last phase is integrating and maintaining the change in practice, this step of the model is pending further evaluation and consideration (Rosswurm and Larrabee, 2005). This model is applicable to the subject because of its nature in terms of change process and method. Behavior, skills, competency, personal traits and knowledge can be addressed through the utilization of this model (Lichtman, 2008).
Freiburger (2004) suggests that learning style in practice can be changed according to the situation such as when going through a new experience and at different maturation. Towards the end when an individual becomes confident and starts to discover new things by him/herself shows that evidenced-base approach of learning (Young, 2004).
Knowledge and competitiveness is a product of evidenced-based practice. Experience and effective learning processes are essential in actual clinical practice of the nursing profession. To be an effective nurse, one should begin with the individual appraisal of one's self competency and enhanced education based on practices and trainings taken previously during undergraduate and graduate studies, workshops, trainings, continuing education, and preparation for teaching seminars or modules including the conceptual, academic and clinical orientation (Foster, 2007). Competitiveness is largely based on innate potentials and motivations afforded by the familiarity of a learning environment.
Accordingly, the primary responsibility of the nurse to the patient is to give him/her the kind of care the patient condition needs regardless of race, creed, color, nationality or status (Salsberg, 2008). The nurse must also advocate the rights and serve as facilitator of patient's well being (Foster, 2007). In doing so, the patient's care shall be based on subjective and objective evidence, needs, the physician's order and the ailment, and the involvement of the patient and the family. Evidence-based practice promotes understanding of the differing values held by people in other cultures (Henderson, 2009). For example, it helps the client understand why other people in one culture may regard with approval of their practices of exposing their elderly members to the harmful elements, while people in other cultures may abhor such practice (Henderson, 2009). The strength of this critical thinking and decision-making is its recognition of the relationship between personal values and a choice of action. It also equates personal values and wrong action and recognizes limits of personal experience and perspective and it implies that a person's moral judgments are infallible.
I believe the richness or intensity of the inculcation of knowledge, positive values and skills of a person is not simply based on the innate capacity of one to evaluate, think, reason and interact in a learning situation. It also equally depends on the quality of the nursing experiences which are either limited by the nurses' ability and will to choose or by what is desirable to her which is readily accessible in the environment. Nursing education, concepts and programs for improving the knowledge in health facility should also be provided to maintain theoretical and clinical competence of health setting and facilities. From what I have learned in my own area of practice, the key to successful knowledge development is competent learning and effective communication during the practice to achieve the goal of competency. This will determine the path of being an effective and competent nursing professional.