Strategies for EBP Amid Nursing Shortage in Hong Kong
The biggest challenge for Hong Kong’s health care system is to provide an efficient service for patients. On 20 January 2019, around one hundred members of the Association of Hong Kong Nursing Staff gathered outside government headquarters to voice out the problems of critical manpower shortage and lack of ward space and resources. The chairman of the Association of Hong Kong Nursing Staff, Joseph Lee Kok Long, said the ratio of nurses and patients is 1:10. The problem even became worse during the flu season. Besides, there is a growing number of medical malpractices. The Government of Hong Kong Special Administrative Region reported that the total number of medical errors was 192 in 2018 and 2017.
To improve these problems, Evidence-based practice (EBP) is a problem-solving approach that can guide nurses to enhance their knowledge and provide high-quality care for patients. It is based on multiple research and generates valid and in-depth evidence to discover whether there are any improvements in some traditional nursing care. Florence Nightingale was a pioneer of nursing and a reformer of sanitary methods. She decreased the mortality rate, which was caused by unsanitary conditions, by doing data analysis (Cohen March 1984).
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However, there are several obstructions that affect nurses’ will to implement EBP. EBP has numerous advantages for the health care system, so this essay aims to identify the barriers to the implementation of EBP and the solution to curtail the gap between clinical practice and research. Barriers to the Implementation of Evidence-Based Practice in Nursing
Lack of time
One of the limitations is there is a lack of time for nursing staff to do research findings and analyze multiple literature reviews. The major reasons are heavy workload and imbalance in the health workforce.
Iran Zahedan Teaching Hospitals progressed. A cross-sectional study in 2014 showed that of two hundred and eighty nurses, 83.7% of them agreed that they do not have extra time to read various types of research during their working hours. Also, 190 of them agreed that they had a heavy workload (Mohammad et al., 2014).
In Hong Kong, nurses need to work eight hours a day and four to five nurses in one duty session. In the ward, the average patient number was around fifty. Nurses needed to do numerous tasks in the limited hours. For example, assist disabled patients in bathing, feeding, Foley care, wound dressing, administering medication, etc. Every nurse is forced to multitask at the same time. They cannot focus on one task and appear uncontrollable, thinking about what to do next.
Therefore, how can they read the research findings in an inadequate working time? A nurse interviewed by SCMP said: “Each nurse has to take care of more than twenty patients at the same time. Consequently, the quality of health care service would be influenced, and it may increase the chances to make faults.” Although EBP is a good way to deal with the increasing medical malpractice, the major problem is limited manpower and heavy workload.
Four hundred and fifty-eight nurses who were employed in a medical center in California indicated that they had finite time for evidence‐based practice during scheduled working hours because the patient’s health conditions were changeable and unpredictable (Caroline et al., 2009). In a psychiatric ward, patients tend to be less stable than in a general ward. Some of them are suffering from schizophrenia, attention deficit hyperactivity disorder, bipolar disorder, etc. They have high suicidal ideas, a risk of violence, and some aggressive behavior. Therefore, a nurse has to close observation and restrain them in some situations. It is dangerous if a nurse not be aware of the patient’s whereabouts continuously. Therefore, it is hard to implement an EBP.
Considering the time limit, some may say nurses can read the research at home after work. However, few of them will sacrifice their leisure time to do EBP. They would rather finish their personal issues and take a rest than read literature reviews at home(Caroline et al., 2009). Furthermore, lack of time is not only related to reading research findings but also to the time to implement the changes of practice.
The key elements of generating an EBP are encouragement and support (Fathimath, 2014). Most of the nurses are not familiar with EBP and think that they are short of the skills to carry out change (Rodgers, 1994). They have inadequate skills in estimating evidence and lack the skills to acquire research and evaluate its accuracy. So, they are not confident enough to implement change in traditional nursing skills or guidelines. Clinical nurses can enhance their confidence in research skills and motivation unless they get adequate support from the organization and peer staff.
Support means resources and mentoring (Caroline E, 2009). In the resources aspect, it is hard to find literature reviews on the Internet because most of the books need to be paid for the full vision. Not all the resources are free of charge, and you need a desktop to read full-text articles. In Hong Kong, the funding of the healthcare system is in shortage. There is no additional money to buy research sources and expand the resource allocation on research. The Hospital Authority of Hong Kong is facing the challenges of limited funding and an increasing number of admissions. The resources cannot meet the demands. In January 2018, HA arranged 569 time-limited beds for major specialties wards and 1122 temporary beds for acute hospitals. However, the bed shortage problem still occurs and is even worse.
In the mentoring aspect, there are less knowledgeable and experienced advanced practice nurses or researchers to guide people on how to read research effectively and use evidence-based to change the caring method in the clinical setting. The research actually is vanity because the authors do not provide the method of applying those skills in clinical practice (Patricia, 2009). As a reason, nurses cannot discover the value of reading research and the benefits of clinical.
The culture of EBP
Some nurses have misunderstandings about EBP. They would rather follow traditional nursing skills than use the new skills. Nurses’ lack of acceptance of the evidence is possible to bring advantages to patients (NICE, 2007). Nurses who have worked for more than five years. They are confident enough to use current knowledge and clinical experience to overcome different challenging situations. When they adapt to the sudden modification, others will misinterpret the reason for the change as what nurses have done before was not effective and professional enough.
Moreover, they are not willing to take the risk of change. When the modification brings about unexpected incidents, for example, a slower rehabilitation rate, death, or medical errors. Who will take the responsibility and accountability? This approach is influencing not only individual patient care but also the stability of the whole healthcare system’s development.
EBP is seen as a time-consuming method. It takes a long time to obtain significant outcomes. Consequently, when there is no improvement shown in this long period, it is a waste of time. To prioritize the urgent needs of the health care system and the need for modification. The present problems are more imperative.
The solution to overcome barriers
Leadership is important for generating an EBP (González, 2012). According to the barrier of limited support, Hospital authority can arrange for knowledgeable nursing staff allocated in different hospitals regularly. The aims are to share multiple visions of the multihospital system and learn strengths and shortages from another ward. An experienced nurse can act as a mentor for the implementation of EBP. To guide the junior staff and answer questions about research findings, the way to apply the evidence effectively, and find the best available evidence (Dalheim, 2012).
Education also vials for the implementation of EBP and the culture of doing research, according to the barrier of culture change. There are obvious differences between nurses with master’s degrees and nurses with bachelor’s or associate degrees. Advanced, certificated nurses who are in leadership roles have more positive attitudes and greater acceptability toward EBP (Warren, 2016). Therefore, establishing a course about EBP in the college’s nursing programs can resolve the misunderstanding and change the culture fundamentally.
On account of teaching nursing students EBP development in nursing, classify the type of evidence, the steps to implementation, etc. Besides, fresh graduate and nurses with fewer years of experience are more positive to EBP as EBP become a major course in the undergraduate nursing program. HA can encourage them to share what they have learned with older and more experienced nurses who have not participated in the EBP project. For the barrier of limited resources, organizations can collaborate with local colleges. Allow nurses to read and borrow resources from colleges’ libraries. So that no extra cost is needed and make good use of existing resources in Hong Kong.
- Cohen, M. M. (1984). Nightingale’s recommendations on noise in the hospital. Applied Nursing Research, 1(1), 4–10.
- Mohammad, M., Mahsa Haj, S., Zahra, K., Shahab, M., & Fatemeh, E. (2014). Obstacles and Facilitators in Implementing Evidence-Based Nursing Practice in Iran. World Applied Sciences Journal, 31(8), 1444-1449.
- Caroline E. Brown. (2009). Implementing evidence-based practice in psychiatric nursing. Issues in Mental Health Nursing, 30(3), 151-155.
- Fathimath, A. S., Athira, K., & Uma, D. (2014). Barriers to implementation of evidence-based practice in Maldives: an exploratory study. International Journal of Nursing Education, 6(1), 1-6.
- Rodgers, H. (1994). Diffusion of Innovations. J Med Libr Assoc, 82(2), 163.
- González, S. A. (2012). Leadership behaviors influencing evidence-based practice implementation. Worldviews on Evidence-Based Nursing, 9(4), 219-226.
- Dalheim, A., Harthug, S., Nilsen, R. M., Nortvedt, M. W., & Factors, A. (2012). Factors influencing the development of evidence-based practice among nurses: A self-report survey. BMC Health Services Research, 12(1), 367.
- Warren, J. I., Mulholland, M., Bakken, S., & Ruland, C. M. (2016). Nursing Students’ Perspectives on the Use of Evidence in Practice: A Cross-Sectional Study. Journal of Professional Nursing, 32(6), 455-464.