Evidence-Based Practice and Implementation Barriers

For successful advanced nursing practice, it is essential to establish a proper environment and empower nurses to utilize evidence-based practice (EBP) that is based on scholarly research. Even though the advantageous role to patient outcomes is recognized as one of the pillars of the healthcare area, many nurses still struggle to use recommendations provided by the pertinent literature. As reported by Stokke, Olsen, Espehaug, and Nortvedt (2014), nurses prefer to use their experience and social interactions in determining and delivering care strategies.

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The identified problem is especially critical to inpatient care settings where patient health directly depends on the approach and actions of nurses. Among the key barriers to using EBP, a lack of time, supportive leadership, and authority may be noted (Stokke et al., 2014). In this connection, it is important to consider systems improvement to develop patient safety and outcomes, which can be achieved via a change model led by a strong leader.

Description of Selected Systems Change for Quality Improvement Proposal

In order to address the specified problem, a model of engaging leadership seems to be the most appropriate due to its focus on empowering and assisting nurses in initiating change. Harris and Mayo (2018) state that ethics is put at the core of how the mentioned model identifies the behaviors of care providers and nurse leaders. The first step that should be conducted in terms of this model is the evaluation of the current state of affairs in the given settings to understand the areas to be improved and challenged faced by the staff. During this step, it is critical to clearly reveal what exactly should be improved as well as the strengths and opportunities that can be used.

The next step that is also integrated into all the subsequent stages refers to the creation of an engaging environment. When an employee joins an organization, he or she is inspired by a new position, an interesting job, potential career growth, having inner motivation and emotional boost. Gradually, the loyalty of nurses to the common goals begins to fade. Engaging leadership is the ability to organize the process of a team, using the maximum potential of employees (Harris & Mayo, 2018).

With such a model, employees feel like a team and strive to achieve exceptional results for the success of their organization. Nurses should be actively involved in the professional life and ready to do not only what they are supposed to do according to the regulations but also beyond it. In case if this step is implemented successfully, they are to be happy to express themselves in any occasion and easily agree to make additional efforts to achieve not only personal goals but also those of the entire care facility.

Once engaging leadership is adopted, nurses should be provided with training aimed at clarifying the role of EBP with regard to their specific job responsibilities. It would be better if each team member receives cards with the examples of a positive impact of EBP on their patients. Another essential point is to demonstrate to them that they would also benefit from utilizing EBP. In their study, Harris and Mayo (2018) conducted the case study and revealed that in the engaging leadership model, “change should be facilitated sensitively” (p. 611). It is important to realize that cultural and social aspects of the team need to be taken into account while planning and delivering education, especially for those nurses that have a strong personal position and resistant to change.

The ultimate step of the proposed model should assign EBP a top priority in caring for patients: not only the organizational regulations and national standards but also academic research should be regarded as a valuable source of information. The very approach of nurses to viewing EBP should be transformed from an additional issue to ordinary work.

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The example of a similar change introduction is discussed by Renolen, Høye, Hjälmhult, Danbolt, and Kirkevold (2018), who claim that the organizational integration should be applied, paying attention to time allocated for studying and designing EBP use and the social context of both nurses and patients. Accordingly, the examples from advanced nursing practice include shifts from one model to the other, reducing burnout among the staff, and empowering nurses to increase patient safety through various instruments.

Presentation of Selected Systems Change for Quality Improvement Analysis

The proposed model of engaging leadership is expected to increase the utilization of EBP by nurses. Their increased awareness of the recent recommendations in the field of patient care as well as the enhancement in patient outcomes may serve as the indicators of success. More to the point, nurses are expected to willingly implement the academic evidence instead of acting under the power of a leader. All the mentioned outcomes are to be achieved in a friendly and responsive atmosphere with engaged employees and an empowering leader.

The effectiveness of the proposed model largely depends on a Doctor in Nursing Practice (DNP) leader, who is responsible for implementation, evaluation of results, and sustainability of the project. The assessment of the change results may be conducted by means of nurses’ self-reporting to address reporting threats and the comparison of patient outcomes before and after the change.

In addition, interviews with nurses and some randomly selected patients may also be useful to specify strong and weal points of the proposed model to improve on them. It should be stated that the weakness of engaging leadership is associated with the lack of help in developing employees’ skills to contribute to the organization.

The leader should organize effective internal processes, including communication, task setting, control, correction, and search for solutions. By providing motivating feedback that encourages employees to develop competencies and achieve the desired results, the leader would promote their proactivity. What is also significant, the leader should critically assess one or another situation and take rational yet timely decisions.

Brower (2017) presents such examples of sustaining EBP as sharing with colleagues and the united use of research results in an interdisciplinary team. As for advanced practice examples, EBP may be disseminated through formal ways such as brochures, presentations, and group discussions. The identification of talents and guidance of employees in development to maximize their potential will contribute to mutual trust, understanding, support, and involvement in the organization’s affairs.


To conclude, this paper discusses the current concern to the healthcare system and patient safety: the limited use of EBP by nurses. In order to eliminate the barriers, the engaging leadership model is suggested, which consists of the following steps: the evaluation of the current situation, training, leadership change, and empowerment along with assistance to adopt EBP use. The role of the DNP-prepared nurse leader is identified as the key facilitator of change and sustainability provider. The benefits of the proposed change to advanced nursing practice are increased motivation and commitment of nurses, while patient safety is likely to increase due to the utilization of the best care strategies verified by research.

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Brower, E. J. (2017). Origins of evidence-based practice and what it means for nurses. International Journal of Childbirth Education, 32(2), 14-18.

Harris, J., & Mayo, P. (2018). Taking a case study approach to assessing alternative leadership models in health care. British Journal of Nursing, 27(11), 608-613.

Renolen, Å., Høye, S., Hjälmhult, E., Danbolt, L. J., & Kirkevold, M. (2018). “Keeping on track”— Hospital nurses’ struggles with maintaining workflow while seeking to integrate evidence-based practice into their daily work: A grounded theory study. International Journal of Nursing Studies, 77, 179-188.

Stokke, K., Olsen, N. R., Espehaug, B., & Nortvedt, M. W. (2014). Evidence based practice beliefs and implementation among nurses: A cross-sectional study. BMC Nursing, 13(1), 8-18.

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