The fourth step in the evidence-based practice process is to synthesis the best practices from the literature and implement the new practice(s) in place of outdated, less effective, or unsafe current practices.
The Rosswurm and Larrabee (1999) model for guiding nurses through systematic changes with the EBP process:
Assess the need for change in practice.
Link the problem with interventions and outcomes.
Synthesize the best evidence.
Design a change in practice.
Implement and evaluate the practice.
Integrate and maintain the practice change.
To effectively apply the EBP process, in addition to the basic skills required to undertake nursing work, a nurse must be able to:
Identify knowledge gaps
Formulate relevant questions
Conduct an efficient literature search
Apply rules of evidence to determine the validity of studies
Apply the literature findings appropriately to the patient's problem, and
Appropriately involve the patient in the clinical decision making.
Source: Adopting evidence-based practice in clinical decision making. Journal of the Medical Library Association.
* That's the way I was trained.
* We have always done it that way with no problems.
* It's a "sacred cow"; we can't change that.
* Change is uncomfortable.
* It costs too much to change.
* We can't make all these changes at one time.
* When I am in a hurry I do what I have always done... it's just not a habit yet.
* There needs to be more research so we can be sure.
* I don't feel it will make a difference.
* There are too many competing demands.
Source: Why are Nurses so Reluctant to Implement Changes Based on Evidence and What can We Do to Help? Journal for Nurses in Professional Development.
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