INTRODUCTION:

Evidenced-based practice is a practice that leads to higher quality care, improved patient outcome, is cost-effective, and gives greater nurse satisfaction for patient care than a traditional practice.¹ It is a decision-making process to the clinical problems faced by the nurses during clinical practice. The researches in the clinical and educational area provide scientific and empirical solutions to such problems, and these solutions can be used by the nurses in the clinical area during practice to improve the effectiveness of care.² Evidence-based practice is nowadays trending in the health sector although it may take a few decades to overcome the problems faced during actual implementation.³

Nursing is a Nobel profession that is autonomous and provides collaborative care to a sick individual of any age, family, community, or race in all settings.⁴ The nursing profession depends upon practical knowledge and clinical skill.

Nursing education provides knowledge regarding scientific principles however; there is a difference between nursing education and clinical practice. EBP can help to fill this gap and improve clinical nursing practice.⁵

Evidence-based practice and psychiatric nursing:

A nursing specialty, which provides comprehensive care to an individual with problems related to mental or behavioral aspects and improves the adjustment to society to promote physical and psychological well-being is psychiatric nursing also known as mental health nursing. It emphasizes the use of relationships between people as a therapeutic agent and considers the factors that influence mental health. Mental health nurses use the qualities such as socialization and communication during the hospitalization of patient and emphasize in creating the safe, comfortable environment to facilitate the independence of patient.⁶

Like other nursing specialties, psychiatric nursing is expanding the role of a nurse from bedside caretaker to nurse manager, nurse advocator, nurse educator, nurse researcher, etc. nurses nowadays’ work with the doctors for the promotion of the health of the patient and actively participate in the decision-making process. For effective problems solving skills and competence EBP act as a milestone for change. EBP provides a wide variety of solutions to clinical problems for mental health nurses. To achieve evidence-based practice or use of research evidence in mental health nursing, the profession required qualified nurse researchers who conduct research in the area of mental health nursing and generate the evidence for its use.⁷ The daily nursing practice in the clinical area makes nurses efficient in what they do but some of the decisions compared to traditional practice can be improvised through EBP. One of the examples is if the nurse is facing the problem of handling a toddler with a temper tantrum and the conventional methods are not effective then she may find the research evidence regarding handling a toddler with a temper tantrum. This is just one of many cases where a nurse faces problems in the clinical area. If the nurse uses the EBM to find the solution to the problem the intervention may be effective. Sometimes it may happen that the evidence may not be found or that particular area where the problem identified was not previously explored, in that case, the nurse can use the problem-solving approach and generate her new intervention for the problem. Such interventions or solutions must be disseminated properly for the benefit of other nurses.

In mental health nursing, there is a need of improving the implementation of research to practice to improve patient outcomes based on previous research studies.^8,9 Many kinds of research have been done during the last few decades but still, there is a lag between reporting the research findings and the implementation.¹⁰ Other problems involve lack of criticism, information overload, lack of dedicated time to process the information in research, and lack of a system to implement the research findings in practice.¹¹ To improve the quality of mental health care it is important to disseminate the research findings to the nurses.¹²

Challenges and barriers to implementing EBP:

The research studies show that nurses have a positive attitude toward the EBP but the implementation of the EBP is still lacking in nursing.¹³ This happened because there are certain hindrances to the implementation of EBP in an actual setting which involve lack of access to evidenced-based information, heavy workload, and time-lapse. Regarding self-efficacy, related barriers are the moderate level of skill, lack of ability to handle the evidence, no time¹⁴, inability to understand the statistical terms, lack of proper training¹⁵, and inability to understand the research result. Nurses also lack literature searching skills.^13,16

The EBP can be executed where there is access to a library that has a large number of nursing and medical journals including computer facilities with internet access. This is the main barrier to EBP is the lack of facilities in the hospital area.¹⁷ The other important thing is nurses are reluctant to rely on traditional practice, personal experiences^16,18 with patients, conferences, continuous nursing education programs, hospital policies and procedures¹⁹, and suggestions from colleagues¹⁶ rather than formal sources of knowledge.²⁰ advanced practitioners use the different sources for searching the evidence and the practice of EBP is seen more among the nurses working in the front line and those who have completed higher education in nursing.¹⁸ The age, the experience of nursing practice¹⁵, and experience from the last professional degree are the factors that influence the use of knowledge and self-reported flaws.¹⁶ The nurses also have an issue with time to find and read research reports, updated researches and insufficient or no resources at the hospital for practicing the EBP.²¹

The most frequently found barriers in the utilization of evidence by nurses are inadequate information, structural unavailability, and lack of professional support.¹⁷ Nurse-related barriers involve lack of time, lack of information/knowledge¹⁵, and lack of interest in the utilization of resources. These barriers are found to increase when education level and experience decrease.¹⁴ Regarding the ability to use the online sources by the nurse and their utilization to individual cases found average.²² The nurses need information for the practice and they are very confident and comfortable asking things to colleagues or friends ofthe same profession, or co-workers and searching it on the internet than searching in the databases such as PubMed, Cochrane, or CINAHL.²³

Solution for implementing EBP in practice:

To introduce the EBP to the practice, the nurse who has a master's degree in nursing is required because she will be a better solution as finding and understanding the literature, and using and translating research findings into the practice are required skills. It can be achieved through the use of various resources, training programs, the standard of practice, journal clubs, and interdisciplinary opinions.^24,25 Nurses need to get involved in the discussion and take interest in updating their knowledge. Utilization of the organization's resources with the help of hospital management.^25,26 The librarian can be helpful as a resource person who is interested in EBP because there are nurses who are poor in technical skills but have excellent nursing practice.²⁷

There are certain considerations when we apply EBP in actual practice. The individual differences may vary the application strategy like for application of “therapeutic use of self” vary with the health practitioners. This is the reason for the difficulty in the application of EBP in mental health nursing.²⁸

Involving in doing research and its application requires the personal interest and positive attitude of the nurse.²⁹ Now the government and the health agencies are making efforts to boost interest among nurses through induction programs, training programs, and continuing nursing education programs. For the treatment of common mental health disorders, the mental health treatment guidelines and norms are now available on the internet which include the management of schizophrenia, bipolar disorders, anorexia nervosa, panic disorder, adult deliberate self-harm, etc.³⁰

Evidenced-based practice resources:

Following are the resources that can be utilized to find the appropriate scientific solution to the clinical problem.

The electronic library:

The library is available at the institution or other online libraries such as Cochran. It is aroutinely updated electronic library that is available on computers and the Internet. It contains research articles and systematic reviews related to clinical practice. The research on Cochran library is regularly updated with new evidence. The website can be accessed at www.cochrane.org.

The National Guideline Clearinghouse:

A database of evidence-based clinical practice. It is readily available on the internet for use. It also had guidelines related to evidenced based practice. The website can be accessed at www.guideline.gov.

The Substance Abuse and Mental Health Services Administration (SAMHSA):

It is an online resource that provides research kits to motivate the user to use evidenced based practice in the clinical area. The website can be accessed at mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits.

The Joanna Briggs Institute, based in Australia, produces best-practices information sheets and systematic reviews. The website can be accessed at www.joannabriggs.edu.au/pubs/best_practice.php.

World Views on Evidence-Based Nursing: It is a journal of the honor society of nursing that emphasizes applying knowledge to practice. It is a quarterly journal and has great clinical evidence in the area of psychiatry.

Evidence-Based Mental Health: It is a British journal that helps the reader to access the abstracts and comments related to the research.³¹

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Received on 15.11.2022 Modified on 22.01.2023

Asian J. Nursing Education and Research. 2023; 13(2):111-114.

DOI: 10.52711/2349-2996.2023.00024