Integrating Evidence-Based Practice

Integrating Evidence-Based Practice

Integrating Evidence-Based Practice (EBP) into the Clinical Environment

The process of clinical inquiry has as its main aim to ultimately influence and change practice for the better. This means using only interventions that are backed by scholarly evidence in terms of their efficacy in bringing about the best patient outcomes. Dissemination and adoption of EBP recommendations heralds the dawn of integration of EBP into the clinical environment where practitioners and other professionals apply the recommendations into their daily practice (Melnyk & Fineout-Overholt, 2019). This paper is about the integration of EBP into the clinical environment in terms of the steps required, the barriers that may be faced in this quest, strategies to increase success, as well as sources of internal evidence that may provide data on improvement in outcomes.

Part 1: Steps for EBP Integration, Potential Barriers, and Strategies for Success/ Overcoming Barriers

  1. Eight Steps to Integrating Evidence-Based Practice Into the Practice Environment

The eight steps that double up as strategic objectives for the successful integration of evidence-based practice recommendations into clinical practice are as follows (Melnyk & Fineout-Overholt, 2019; Melnyk et al., 2014):  Integrating Evidence-Based Practice


  1. Come up with implementation teams formally

In order to have a realistic chance of success, leaders among the target clinicians and other healthcare professionals must be chosen to spearhead the process of implementation on the ground. This means coming up with a chosen list (either by the innovator or by the staff themselves) that indicates the names of those who have been chosen as the clinical team leaders. These could be expert staff conversant with the clinical problem that inspired the change, or advanced practice registered nurses (APRNs) in the workforce. APRNs are preferable because of their high level of nursing education at the postgraduate level making them excellent nurse educators.

  1. Generate excitement in the impending change

Make the targeted professionals feel uncomfortable with continuing with the common practice and want to embrace change. To achieve this objective, outside speakers who are experts in the field can be brought to inspire the staff to change. The same can be achieved by bringing on board opinion leaders known to the staff that can vouch for the need for the practice change.

  • Disseminate the evidence uncovered in support of the recommended practice change

Use multiple forums to ensure that the new knowledge reaches as many practitioners as possible. Overcome resistance to change by convincing sceptics. Also give enough time for assimilation of the new ideas and knowledge.

  1. Come up with the clinical tools the practitioners will need to change practice

Equip the staff with the tools that they may need to effectively implement the envisioned changes in clinical practice. Look at documentation of patient records and make clinical resources easy to get for the staff. Get the target professionals exposed to routine use of evidence-based practice information.

  1. Perform piloting of the idea before going full scale

Perform the piloting of the intended practice change on a small scale in a clinical environment to evaluate its impact and chances of success. This will be done with regard to amongst others patient diversity, patient population, patient acuity, and geographic location. According to the results of the piloting, make a decision to either abandon full scale implementation or proceed with the same.

  1. Prepare for the long haul by preserving energy and resources

Because the process is expected to be long and to have inevitable drawbacks, it is essential that the implementation is done in small manageable pieces. This will conserve both energy and resources that will ensure sustainability of the effort.  Integrating Evidence-Based Practice

  • Give enough time for comfortable implementation

Provide sufficient timelines to allow for adoption and gradual realization. Objectives should be kept specific, measurable, attainable, realistic, and time-bond. All phases must have a timeline.

  • Celebrate the achievement and perform positive reinforcement

After successful implementation, those who were instrumental in the realization of the project should be congratulated and publicly recognized as a way of positive reinforcement. The success of the implementation should be celebrated publicly to show that it is a good and desired thing.

  1. Potential Barriers to Implementation of a New Practice Related to the identified Practice Problem

In every undertaking such as the project of implementing EBP into the clinical environment, there are barriers that are expected to hinder or slow down success. Some of these barriers in this context are (Melnyk & Fineout-Overholt, 2019; Shayan et al., 2019; Melnyk et al., 2014):

  1. Undesirable attitudes about evidence-based practice

Staff attitudes that are negative about EBP can significantly contribute to the lack of success of the implementation of EBP into the clinical area. This is because these attitudes will make the staff unwilling to change and even actively resist the implementation.

  1. Insufficient skills and knowledge about EBP

When knowledge and skills about EBP among the targeted staff are lacking, it becomes very difficult to explain to them what importance EBP has in the realization of sound patient outcomes.

  • Lack of managerial support

In any project of this nature in an organization, the support of the management and institutional leaders is crucial since they are the decision makers. They decide what becomes part of the institutional culture and what does not. They are also the ones that control the resources, including the financial resources that may for instance be required for training.

  1. Unavailability of EBP mentors and innovators

If the organization does not have enough mentors and innovators to spur change in practice, the rest of the staff will remain complacent and continue with common practice relating to the identified clinical problem such as suicidal ideation as earlier stated.   Integrating Evidence-Based Practice

  • Strategies to Increase Success and Overcome Barriers

Several strategies can be adopted to ensure higher chances of success and to overcome the barriers to EBP implementation. They include (Melnyk & Fineout-Overholt, 2019):

  1. Budgetary allocation for EBP activities

Setting aside of some financial resources to facilitate the process of EBP implementation in the clinical environment. These will go towards activities such as training and buying of stationery.

  1. Requirement for managerial accountability

Making it mandatory for mid-level and lower level nurse managers to be accountable for the success or failure of the process will make them more committed because of the professional consequences.

  • Coming up with EBP-compliant job descriptions and performance evaluation tools

Reviewing the job descriptions to require EBP competencies as well as integrating EBP questions in performance appraisals helps with EBP implementation and adoption.

Part 2: Six Sources of Internal Evidence Supplying Data to Show Improvement in Outcomes

These would include the following (Melnyk & Fineout-Overholt, 2019):

  • Human resources: This includes every detail about staffing, including education, skill mix, turnover, and staffing ratios amongst others.
  • Administration: This will include data on patient feedback amongst others.
  • Health Information Systems: This includes the patient records saved electronically.
  • Department of quality management: This will include Joint Commission on Accreditation of Healthcare Organizations (JCAHO) ratings, incident reports, and accreditation data amongst others.
  • Department of finance: This will include diagnostic coding for reimbursement purposes, payment for medications, tests, and patient days as well as the readmission rates.
  • Clinical systems: This will encompass data derived from the clinical systems unique to the healthcare organization.  Integrating Evidence-Based Practice


Successful implementation of EBP recommendations is the final step in the clinical inquiry process. However, in order to do this successfully strategies that must be employed to allow for overcoming the inevitable potential barriers against implementation. After successful implementation in the clinical area, sources of internal data or evidence must be identified and consulted to find out if the patient outcomes have indeed improved as a result of the change in practice.


Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4th ed. Wolters Kluwer.

Melnyk, B.M., Gallagher-Ford, L., Long, L.E., & Fineout-Overholt, E. (2014). The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. World Views on Evidence-Based Nursing, 11(1), 5-15.

Shayan, S.J., Kiwanuka, F., & Nakaye, Z. (2019). Barriers associated with evidence‐based practice among nurses in low‐ and middle‐income countries: A systematic review. World Views on Evidence-Based Nursing, 16(1), 12-20.

 Integrating Evidence-Based Practice