Columbus Publishers

International Journal of Nursing and Health Care Science

Volume 02: Issue 09

Guthrie DR.

The purpose of this study is to determine barriers interfering with the timely updating and current evidence based uptake for a healthcare organizations policies. The specific aims were to (1) identify the current factors that interfere with policy updating at the healthcare organization and (2) determine a systematic and effective method that can be employed to facilitate policies being updated with the most current evidence-based research/practice.

## Literature Review

Not every US adult receives care that is consistent with current evidence-based recommendations. Evidence-based practice is defined as the application and standardization of healthcare practices based on scientific research and consensus of stakeholders in the field [1]. There is cause for concern and need for improvement, for quality of practice as well as the rate of scientific evidence use.

Positive population based health outcomes at the local, state, and national level can be achieved with the adoption of evidence based strategies. Increased access to high quality information, a greater likelihood for successful policies and programs being implemented, a greater workforce productivity, and greater efficiency of public/private resource utilization are all benefits of an increased focus on evidence based practice [2]. However, variations in the uptake of evidence to inform policy persists at every level of the health care system [3]. A closer look shows that these variations are related to barriers to evidence uptake and evidence-based policy making.

### Barriers to Evidence Uptake

The literature is rich with discussions regarding barriers to evidence-based policy making. Davies [4] lists, in general, financial obstacles, the sheer volume of research evidence, the difficulty in applying global evidence in a local clinical context, limited time, impaired awareness of evidence sources, limited critical appraisal skills, and the limited relevance of research findings. Similarly, Beretta [5] found that research evidence competes with many other factors in decision-making processes; decision-makers may not value research evidence as the information input into decisions; available research evidence may not be relevant for certain audiences; and research evidence is not always easy or cost-effective to use. Even when there is excellent communication between researchers, policymakers, and practitioners, there are structural and symbolic restrictions on the circulation, popularization, and subsequent enactment of new knowledge [6]. A closer examination of some of these barriers may help in developing interventions to overcome them.

Making information more available has largely been the focus of initiatives intended to increase evidence uptake. It's assumed that the major barriers to decision-making revolve around data availability, accessibility, and user capacity. This assumption is supported in the literature [2]. However, in settings where politicized decision- making and organizational factors dominate policy, evidence uptake was marginalized. This can be problematic for those with an exclusive paradigm of evidence-based policy making; that is, if reliable and complete, research evidence will largely determine an unproblematic course of action [7].

Sheldrick, et al. [8] proposes that that the practical, ethical, and moral questions integrated in the policymaking process may not be answerable through searching for more empirical evidence. It's made clear, though, that robust epidemiological and clinical trials are still needed as part of policy and policy making; this type of evidence may not, in of itself, be complete for any policy. Instead, human agency is also often involved and manifests as the deliberative processes of reason giving, argument, and judgment; and may carry as much weight in policymaking as evidence-based findings. It may be difficult to apply new evidence-based findings due to policy inertia. Policies are processed in a manner that historically favors particular interpretations funneled towards the goals of particular political actors, and this process gains inertia and is difficult to change.

### Lessons to Learn from the Nursing Profession

While the barriers to health evidence uptake and evidence-based policy making are apparent, some similarities can be found in the nursing profession [9]. Nurses, in general, are slow to adopt evidence-based practice into their daily decision-making. Research-based nursing decisions are uncommon. Nurses routinely rely on their own experience or information from colleagues. Research journals (online or in print), libraries, and Internet sources are generally not viewed as useful and are accessed on a limited basis. Preprocessed information like protocols, guidelines, and drug reference manuals are more likely to be used. This has important implications, as the practice of underutilization of evidence based findings is similar between the nursing and public health professionals.