Implementing Evidence-Based Practice In Taiwanese Nursing

Implementing evidence-based practice in Taiwanese nursing homes: Attitudes

My article: Chang, H. C., Russell, C., & Jones, M. K. (2010). Implementing evidence-based practice in Taiwanese nursing homes: Attitudes and perceived barriers and facilitators. Journal of Gerontological Nursing, 36 (1), 41-50.

In this study, Chang, Russell, and Jones (2010) aimed to explore the attitudes, perceived barriers, and facilitators related to implementing evidence-based practice (EBP) in Taiwanese nursing homes. The purpose was to identify factors influencing EBP adoption among nursing staff to improve gerontological nursing care.

This was a descriptive, cross-sectional study, providing Level VI evidence on Melnyk & Fineout-Overholt’s evidence scale, as it gathered data through questionnaires without experimental manipulation or longitudinal follow-up.

The researchers utilized a modified version of the Iowa Organizational Culture Survey and a barriers and facilitators questionnaire based on prior frameworks. Although the article did not explicitly mention using a specific change model, the process resembled the steps outlined in Rosswurm and Larrabee’s Model for EBP Practice Change (Melnyk & Fineout-Overholt, 2015). This model involves assessing needs, locating evidence, critically appraising evidence, designing practice change, implementing and evaluating, and sustaining change.

The strategies used to promote EBP implementation included educational sessions to increase staff knowledge, fostering a supportive organizational culture, and encouraging leadership engagement. The authors also emphasized the importance of establishing a multidisciplinary team to facilitate the EBP process and provided ongoing feedback through audits to motivate staff and measure progress. Motivational strategies involved fostering positive attitudes towards EBP by demonstrating its benefits for patient care outcomes and encouraging nurse participation in decision-making processes.

Several barriers to EBP implementation were identified. Resistance to change from staff was prominent, often due to limited understanding of evidence or fear of increased workload. Structural issues such as inadequate staffing levels and limited access to resources toped the list of obstacles. Some staff perceived a lack of management support, and organizational culture was sometimes resistant to the adoption of new practices. Additionally, language barriers and limited availability of evidence specific to Taiwanese gerontological care also posed challenges.

In conclusion, this study highlights the importance of addressing both individual and organizational barriers to facilitate the successful implementation of evidence-based practices in nursing homes. Strategies such as staff education, leadership support, and fostering a culture receptive to change are crucial in overcoming resistance and advancing quality care for elderly populations.

Paper For Above instruction

The implementation of evidence-based practice (EBP) in healthcare settings is essential for improving patient outcomes and ensuring the delivery of high-quality care. Chang, Russell, and Jones (2010) conducted a study to examine the attitudes and perceived barriers and facilitators related to EBP among nurses working in Taiwanese nursing homes. Understanding these factors is critical, especially considering the cultural and organizational challenges faced in adopting new practices within such institutions.

The study was a descriptive, cross-sectional survey designed to capture a snapshot of staff perceptions at a specific point in time. Given its design, the evidence level aligns with Level VI on Melnyk and Fineout-Overholt’s scale, as it relied on questionnaires without an experimental or longitudinal approach. Such studies provide valuable insight into organizational and attitudinal factors influencing EBP adoption, though they lack the rigorous control of experimental designs to establish causality.

In terms of theoretical framework, the researchers did not explicitly specify employing a particular change model. However, the approach taken to facilitate EBP change resembled the steps outlined in Rosswurm and Larrabee’s Model for Evidence-Based Practice Change (Melnyk & Fineout-Overholt, 2015). This model emphasizes sequential phases: assessing needs, locating best evidence, critically analyzing evidence, designing practice change, implementing and evaluating, and maintaining the change. The study mirrored these steps by initially assessing staff attitudes and organizational readiness, then identifying perceived barriers, and finally suggesting strategies to facilitate change.

The strategies employed to enhance implementation included educational interventions aimed at increasing knowledge of EBP, fostering a supportive organizational culture, and ensuring leadership engagement. The authors underlined the importance of multidisciplinary teamwork, where nurses, administrators, and other healthcare professionals collaborated to foster an environment conducive to change. Additionally, ongoing audits and feedback mechanisms were implemented to track progress and reinforce positive behaviors, which also served as motivational tools. Such strategies align with evidence-based approaches that leverage staff engagement, continuous education, and organizational support to motivate change.

Despite these strategies, several barriers impeded effective EBP implementation. Resistance from staff emerged as a significant obstacle, often rooted in limited familiarity with research evidence, fear of increased workload, or skepticism about the benefits of change. Structural barriers such as understaffing and resource constraints limited staff capacity to engage fully with new practices. Management support was inconsistent across facilities, which further diminished staff motivation. Language and cultural differences posed additional challenges, as relevant evidence from Western contexts might not always be directly applicable or easily accessible in Taiwan. The lack of localized evidence and language barriers hindered the seamless integration of EBP into daily routines.

Addressing these barriers requires a multifaceted approach. Staff education must be ongoing, with tailored strategies that consider language and cultural barriers. Leadership plays a pivotal role; charismatic and supportive managers can influence organizational culture and reduce resistance. Building a culture of continuous learning and improvement, perhaps through recognition and reinforcement, encourages staff to embrace EBP. Moreover, organizational policies should allocate resources and time for staff to participate in EBP-related activities, such as workshops and audits. Developing local evidence and translating existing research into culturally appropriate formats are also vital in fostering acceptance.

In conclusion, Chang et al.'s (2010) study underscores the complex interplay of attitudes, barriers, and facilitators in implementing EBP within Taiwanese nursing homes. Successful adoption depends not only on educating staff but also on structural and cultural reforms that promote a positive environment for change. Future efforts should focus on strengthening managerial support, resource provision, and culturally adapted evidence dissemination to embed EBP into routine practice effectively.

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