Melnyk_Evidence-Based Practice in Nursing & Healthcare, 5e

350 Unit 3 / Steps 4 and 5: Moving From Evidence to Sustainable Practice Change

and QI Alignment Model (Gallagher-Ford, 2014) depicts the four discrete domains’ use of evidence. When leaders fail to do their due diligence to understand the domains related to the use of evidence, the organization cannot be “ready” for EBP.

BARRIERS TO EBP The literature is clear that decades-old organizational barriers to implementing EBP persist. The most prevalent barriers are leader and manager resistance to EBP and insuf cient admin istrative support. These barriers manifest in several ways, including: lack of value for research and EBP; insuf cient nancial support; inadequate resources (including protected time); the absence of a critical mass of EBP mentors; a paucity of informatics capabilities and support; and organizational cultures that do not support EBP. In addition, organizations have failed to recognize the need for evidence-based infrastructures to support implementation of EBP (Gallagher-Ford & Connor, 2020; Melnyk et al., 2016; Warren et al., 2016). Finally, many clinicians themselves have not stepped up and taken personal and professional responsibility to gain competence in EBP (Melnyk et al., 2018). Manager/Leader Resistance In 2016, Melnyk et al. (2016) identi ed the new organizational barrier to EBP of manager/ leader resistance. This identi cation that leaders were a major barrier to EBP prompted a study in 2017 that included 207 chief nurse executives (CNEs) from across the United States. The study revealed that CNEs reported that their top priorities were healthcare quality and safety, and EBP was a low priority. This nding revealed that many CNEs erroneously perceived EBP as an outcome, like quality and safety. This was combined with their lack of understanding of what EBP truly is a methodologic approach to improving practice that leads to improved outcomes, including quality and safety . These misperceptions were pervasive among the study participants and revealed a critical disconnect that has been further explored in other recent studies. Välimäki et al. (2020) identi ed that one of the most common barriers to EBP was nursing leadership. Pittman et al. (2019) found that nursing leadership was a key in uence (positive or negative) on organizational context and enhancing a culture of EBP within organizations. These gaps in understanding and pervasive misperceptions about EBP by leaders must be addressed for EBP to become a reality in healthcare. It is essential for leaders to re ect on their “personal” states related to EBP: Are they competent in EBP themselves? What have they done to improve their EBP competence? What have they done through their leadership role to create a culture that supports EBP? What have they built to ensure EBP is the standard of practice? Upon such re ection, leaders must then take action so that patients, families, and clinicians can be the recipients of tremendous bene ts of EBP. There are a handful of examples of leaders who have stepped up and made a commitment to EBP, and their organizations have demonstrated remarkable success and signi cantly improved outcomes.

Cultural Barriers Within the context of clinical practice, many cultural barriers prevent the integration of evidence-based care into clinicians’ daily work. It is widely accepted that clinical practice across disciplines is steeped in tradition, often full of rituals passed down through gener ations, varying across geographical regions, and driven by clinician/provider preference. Copyright © 2022 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.