Barriers to EBP Prepared by: Dr. Hoda Abed El-Azim

Lecture III

Learning Outcomes (ILOs): Discuss barriers to EBP. Explain barriers categorization according to Cabana and colleagues (1999). Identify conditions that have been found to enhance EBP. Define strategies for change. Recognize steps to overcome barriers to EBP. Identify requirements of change to EBP within an organization or practice require.

Nurses, physician and other health professionals cite a number of barriers to EBP that include: What are the barriers to EBP?  Lack of knowledge regarding EBP strategies.   Negative views about research and evidence based care.  Lack of belief that EBP will result in more positive outcomes than traditional care.

Lack of time and resources to search for and appraise evidence. Overwhelming client loads. Organizational constraints such as lack of administrative support or incentives. What are the barriers to EBP? Cont.,

Demands from clients for a certain type of treatment (client who demand antibiotics for their viral upper respiratory infections when they are not indicated). Peer pressure to continue with tradition practices. Inadequate content and behavior skills regarding EBP in educational program.

Cabana and colleagues (1999), How they categorize barriers ? Knowledge and lack of awareness (e.g. lack of familiarity with guidelines, guideline accessibility). Attitude (e.g. lack of confidence of guideline developer, lack of the outcome expectancy that the guideline will be effective with there population, and lack of motivation to perform the guideline recommendations. Behaviors (e.g. the inability to incorporate client preference into the clinical decision making process).

What are the Facilitating conditions that have been found to enhance EBP? Support and encouragement from administration. Time to critically appraise studies and implement their finding. Clearly written research reports. Implementation infrastructure (adequate resources and time).

Cont. Characteristics of the health team (e.g., a shared vision and mission). Guideline characteristics (e.g., importance of guideline to the clinicians, credibility of guideline and update). Organizational capability for change.

What are the strategies for change? System supports. Emphasis on physician benefit (who the change would make practice easier). Barrier reduction. Measurement of improvement (follow up). Information and training.

How to overcoming barriers to EBP? 1. Promoting Acceptance Barriers to EBP must be assessed within particular system. Assess baseline knowledge, attitude, beliefs and behaviors regarding EBP. Practitioners must possess basic knowledge and skills about EBP.

Cont. It is critically for them to believe that EBP will produce better outcomes in order for change in their practices. Health care providers who do not believe that EBP results in improved care and client outcomes need to be exposed to real case scenarios in which evidence based care resulted better outcomes than care in traditional practice.

2. Correcting Misperceptions Clarifying these perceptions about EBP to advancing evidence care. e.g. many practitioners believe that searching and appraising research articles is a waste of time ( provide them with quick, easily retrievable systematic reviews and evidence based guideline).

Cont. Clinicians may have the misperception that the EBP process is not practicable in the context of their current practice environment. Create baseline knowledge and skills through provide basics EBP e.g.  how to formulate a searchable question,  how to search for and appraise relevant studies.

Cont. Continuing education conferences, interactive workshops, and distribution of educational materials such as journal articles, textbooks and information handouts.

3. Questioning clinical practices: Developing guidelines Ask question about their current clinical practice. Prioritize practice problems within practice setting. Identify colleagues who have an interest in the same clinical question. Collaboration can be formed to search for and critically appraise the evidence found.

Cont. The results of this search and appraisal can be shared with colleagues through (journal clubs, practice round or informational handouts). Developed and implement clinical practice guideline. Guideline development should be (accurate, it tack adequate time for accomplishes). Evaluation of the outcome of guideline implementation is essential to determine its effects on the process and outcomes of care.

Change to EBP within an organization or Practice Require: Clear vision. A written strategic plan. A culture in which EBP is valued and expected. Administrative support, encouragement. Start with a small change and elevated levels of complacency within a system. Advancing evidence based care must be made by both individuals and organizations.

Cont. Basic and graduate professional programs must teach the value and process of EBP. Doctoral programs must create researchers who advance EBP through: the generation of new knowledge from research to support the most effective practices, testing EBP implementation, determine which models are most effective on both staff and client outcomes.