Evidence Informed in Nursing

Question: Discuss about the Evidence Informed in Nursing. Answer: Introduction: The legitimacy of a profession is based on its ability for the generalization and application of theory. For enjoying and cherish a prestigious status in the society, nursing has undergone struggles to assert its professionalism. Despite the efforts for improving the academic credentials of nursing, there are still exists a crisis in the esoteric expertise. Eclectic pragmatism allows the nurses to serve the patients well, however, articulating a discrete theoretical framework can aid to provide exceptional nursing care. Over the decades, the scholars have attempted for encompassing the trinity of social, psychological and physical aspects of care in the models and theories of nursing (Parahoo, 2014). These have been intended for guiding the practice and providing a platform for research and training curricula thereby supporting the expansion of the professional knowledge. Evidence-based practice has laid down the impact that has echoed across the nursing science, education and practi ce. Evidence-based healthcare transformation and quality improvement underscore the requirement for the redesigning of the nursing that is efficient, safe and effective. Initiatives for evidence-based nursing practice include curricular and education realignment that can uplift the profession of nursing as a theory and research based practice (Munhall, 2012). This assignment will examine the evidence for the widely help claim that the nursing profession is an evidenced based practice and will endeavor to link the critique with the current policies in the delivery of healthcare by considering the shortcomings in the professional practice. Most of the attempts undertaken by the regulatory authorities to implement evidenced based practice in nursing in the various healthcare settings have been either unsuccessful or partially successful. This was an attempt to link the theory with the research-based practice in nursing according to the widely held claim. It is evident that explicit understanding and outlining of the theoretical evidence explaining the reasons for the application of intervention might serve to induce the planned change (Grove, Burns Gray, 2014). This acts as a critical step in the planning of the interventional framework to the patient behavior or change provider for promoting evidence-based care. For the sake of improvement of the quality of nursing care, there can be the reluctance for examining the theoretical bases for the planning of the implementation efforts and activities because of the perceived requirement for differentiating between the nature of research and the nature of activities for qual ity improvement. Focusing on theory may not be relevant especially under the emergency situations where the imperative is to act accordingly and quickly. Even when theories are applied for framing nursing studies, they might get ignored largely during the selection of tools, development of interventions and strategies (Stevens, 2013). The problem that arises with no or little theoretical basis for the planning of intervention is that the adopted strategies with the selected tools are neither linked to underlying theory nor the strategy. This results in the belief that the actions causing the intervention would not succeed in inducing change in the behavior. Nursing research is visualized as an amorphous and single entity which is divided among the qualitative and quantitative split without any differences between the theoretical research and clinical research. Most of the nursing research includes methodologies like grounded theory, ethnography, phenomenology, interviews and surveys that are the social strategies of research (LoBiondo-Wood et al., 2013). Globally, nursing research is committed to the rigorous inquiry on a scientific basis providing a scientific knowledge body for advance practice of nursing that impacts the people's health and shapes the policies of health in all the countries. The nursing research priorities reflect the commitment of the nurses to the promotion of healthy lifestyles and health, excellence in healthcare and advancement of quality and the importance of forming the professional practice of nursing based on research. Nursing research makes a strong scientific foundation for the professional practice of nur sing. The critical issues of society influencing the nursing research direction flow from the population and individual-based health determinants that are multi-factorial in nature and include the physical environment for life and work, individual behavior, communities and families (DiCenso, Guyatt Ciliska, 2014). Application of the multiple theoretical and philosophical based approaches along with the diverse methodologies helps to connect the theoretical learning with the evidenced-based nursing practice. This strengthens the claim that nursing is a profession that is a theory and research based on practice. The profession of nursing is guided by the several major directives of national health policy with the overarching goals of helping the patients and individuals to improve their quality of life and life expectancy and elimination of health disparities among the various segments of the community. The Health Professions Council of the Bahamas governs the professional conduct of the nurses by protecting their interest and welfare along with the general public (Bahamashpc.com, 2016). They device the national policies of the country that guides the nursing profession and the distribution of the nursing responsibilities determine the linkage of the theory with the practical. The council has prescribed several job responsibilities of the nurses in the government and private hospitals that include managing the resources and work load for achieving the desired outcomes, provision of nursing care continuity, maintenance of patient administrative records and conduction of patient orientation, e valuation and assessment (Hamric et al., 2013). Although most of these tasks require the application of the theoretical knowledge provided in the nursing educational institutions and the nursing council of Bahamas, the actual application of the theoretical knowledge in these activities is limited since the jobs have not been extensively described to include the theoretical and research-based perspectives. The nursing council in the Bahamas has been established for framing the nursing policies in the country for producing better-equipped nurses with the critical skills required for the line of work (Kitson et al., 2013). The government of Bahamas and the ministry of health promote the research-based policies for nursing practices in the country with an attempt to link theory with practice. The United Nations have set the Millennium Development Goals which is a global ambition that calls the nursing workforce to action on evidence based practice. These goals are achievable only if the health policies are well informed and well managed (Un.org, 2016). However, the reality states that decision making that is poorly informed is the prime reason why the nursing services fail to deliver promptly that contributes towards the variations in practices making the services less inequitable, ineffective and efficient. Nursing leadership ensures that the patients receive effective and safe person-centered care that is based on the evidence that is best available (Bostrm et al., 2013). The ability of the nurses to combine evidence, clinical reasoning and technical expertise that is appropriate for a broad range of healthcare settings develop due to the result of reflective practice, effective mentorship, experimental learning and formal teaching. It is evident that most of the nurses provide patient care that is based on their learning from schools and rarely uses the hospital libraries, research reports and journal articles for keeping themselves updated with the nursing research articles (Hoffmann, Bennett Del Mar, 2013). This proves that fact that although theory is applied in nursing practices to some extent, the application of research to the evidenced based practice is very limited. Evidenced based healthcare has become the language of the policy makers globally to promote health and disparity. Many of the developed countries like US and UK established a national policy on research and development for tracking all the research projects that have been currently funded (Ubbink, Guyatt Vermeulen, 2013). This policy reviews and advises on the adoption of the newer interventions of healthcare and the government of these countries has increased the investment in recent times with the creation of a national database for the research projects on health services. Evidence based practice and clinical effectiveness have been the core theme consistently in the health policies of several countries for a long time that has received considerable amount of investments and resources. The current policies of the government have emphasized on the planned approach to the adoption and appraisal of the new and rational health technologies. Establishment of national frameworks for de fining the delivery of services and elimination of the variations unjustified in the clinical practice owes much to the healthcare practices that are evidenced based (Mason, Leavitt Chaffee, 2013). The process of innovation is incorporated in the policies of evidenced-based practices that are well received in the systems of healthcare globally. In healthcare, the nurses have started to implement the evidenced based practices for challenging the way decisions are made for the management of the organizations of healthcare for delivering healthcare (Melnyk et al., 2014). Therefore, policies are being made with the better utilization of the evidence by the policymakers. Evidence-based practice tends to replace the usual practice with the practice that is guided by rigorous research that is outcome oriented. It is intended to make the nursing practice a lesser subjective enterprise by raising the aspect of accountability to a higher level. Apart from the benefits of the evidence-based practice in nursing, there are also few shortcomings. Although it is a new practice to include evidence-based practice in the nursing courses in the universities, the number nursing professionals who are not familiar with this practice as a routine is significantly high (Schmidt Brown, 2014). The senior nurse practitioners who entered the profession long before the implementation of this process feel that it undermines the value of their earned experience and clinical expertise to a greater degree. This factor is also effective while considering the approach of the individual practitioners to provide patient care. Evidence-based care is also associated with multiple sh ort-term costs, however, on a long-term, it proves to be effective. There occurs a lack of evidence for several illnesses especially for the ones that are uncommon due to lack of funding for the research (Townsend, 2014). If there is a lack of funding for the research work, progress in the field of research will be hampered for the investigation of the treatment procedures of the uncommon diseases thereby reducing the possibilities of scientific research and technological advances. This will ultimately lead to a decline in the availability of evidence and the evidence-based care for the patients. It has found by the critics that the nurses who are not trained specifically in evidence-based care for the interpretation of the received data might not be skilled enough to comply with the nursing guidelines and provide evidence-based care (Abbott, Mc Sherry Simmons, 2013). Additionally, the allocated time for the learning of these skills is also not sufficient for the nurses due to thei r stressful job responsibilities and busy schedule leading to the lack of application of evidence-based practice to patient care. Emotional neglect and unable to meet the individual needs of the patient may happen due to the evidence-based practices. According to the existing protocols, the patients will not have access to the best available treatment if it has not been proved to be effective. The involvement of the insurance companies in the evidenced based practice has made the coverage process difficult for the patients undergoing new treatment since the policies are intended to cover only the existing standards of care. Most of the licensed hospitals provide care based on the existing evidenced-based practices that prevent the nursing professionals from implementing creative care solutions for the patients. Since the practices are untested, the nurses fear to try out the care procedures that could have served to improve the life of the patients. Evidence-based practices require a significant amount of time and money to implement the novel practices of treatment. Since a significant amount of time is required for determining the treatment effectiveness, the cost of the study also increases that makes the evidenced based practi ce difficult to afford. Evidence-based practice has left its impact on the various aspects of the nursing discipline like science, education and practice. The recommendations to overcome the shortcomings of evidence-based practice require the nurses to lead the inter-professional teams for improving the care delivery systems. This requires the necessity for the new competencies that are beyond the evidence-based care for helping the nurses transforming the system of healthcare (Brown, 2013). For this, new competencies are required that are focused on utilization of knowledge in the process of clinical decision making leading to the production of research evidence on the provided interventions promoting their uptake by the provider groups or individual providers. Since evidence-based practice is a novel concept in the nursing curriculum, it should not be restricted only to the curriculum, but it should be included in the micro systems and the entire healthcare system by the policy makers. This will provide a universal adoption of the system without depriving anyone of the knowledge and expertise, including the senior nursing professionals. Although the nurses had an exposure of evidence-based practice in their educational curriculum, they still lack in their skills and knowledge and face barriers in their practical employment (Bo et al., 2014). Therefore, a sophisticated implementation plan is recommended for wide adoption of the theory across healthcare institution. Nursing profession is required to provide patient-centered care and work in interdisciplinary teams by employing evidenced based practice in their care processes. However, either they are not provided with the requisite skills and time to learn the evidenced based learning, or they do not have access to the novel treatment procedures due to lack of evidence. This can be overcome by bringing about changes in the policies where the nurses can provide the novel therapy and mitigate error with the application of support decisi on making by the usage of information technology. Policies should also be made to cover the uncommon diseases and novel therapies to promote the widespread application of evidence-based practices at an affordable cost. Application of quality improvement measures can reasonably test and design the interventions for changing the systems and processes of care for improving the quality. For stimulating the faculty development and curricular reformations, accreditations can be utilized for encouraging the adoption of the core competencies of the nurses. Nascent fields can be engaged for increasing the timeliness, safety, efficiency and effectiveness of healthcare for improving the delivery systems of health service to spur the improvement of performance. In a nutshell, it can be stated that evidence-based practice is the integration of best research evidence, patient values and clinical expertise into the process of decision making for patient care. Since nursing is a theory and research based practice, the current policies in healthcare help to promote the delivery of healthcare in the Bahamas. In spite of the shortcomings in the implementation of evidence-based practices, recommendations are available to overcome them with appropriate remedies and promote their widespread application in patient care. Evidence-based practice is a collaboration of patient preference, clinical expertise and research that incorporates components for improving the quality of life and patient outcomes. 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