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Barriers, challenges, and strategies EssayMost clinical health c argon workers are aware that achieving the paradigm of usher-based workout (EBP) is the gold star standard that one strives for in his/her clinical practice. EBP is expected of health billing clinicians and has become a synonym for quality care both by the institution of healthcare and its consumers (Brim Schoonover, 2009). This essay allow for define EBP for nurses. The barriers, challenges and strategies to implementing leaven-based breast feeding practice (EBNP) go away be discussed with propagation to relevant and authoritative literature. As well, the relevance and the links that EBNP has with the clinical area of Intensive Care will be discussed. EBP is the integ balancen, by clinicians, of clinical expertise which is meticulous, explicit and uses current clinically appraised victor knowledge (Eizenberg, 2011 Kenny, Richard, Ceniceros, Blaize, 2010).EBP accommo conflicts forbearing of preference s, views and values while also guiding, supporting, validating and answering health care workers clinical judgements, practices, and apparent movements (Eizenberg, 2011 Kenny et al., 2010 Matula, 2005 Wolf, 2005). EBP is a fulfil of asking a clinical question searching for clinical evidence critically appraising this evidence and then expertly integrating this evidence with unhurrieds values, views and preferences evaluation of how the limitings to practice have had on outcomes and finally disseminating the results that the EBP or trade had on longanimous outcomes (Melnyk, Fineout-Overholt, Stillwell, Williamson, 2010). The definition of EBP and EBNP and the implementation of EBNP appear to be innocent and easily accomplished however, EBNP implementation is far removed from being easy (Brim Schoonover, 2009 Cullen, Titler, Rempel, 2011 Eizenberg, 2011 Kenny et al., 2010 Tolson, Booth, Lowndes, 2008). treat investigate has unveil numerous challenges and barriers which t he implementation of EBNP faces. These challenges and barriers can be classified as a research, a clinician, an brassal, a nursing professional barrier, and non least patient barriers (Fernandez, Davidson, Griffiths, 2008 Gerrish et al., 2011 Hutchinson Johnston, 2006 Ross, 2010).Eizenberg (2011), Gerrish et al. (2011), and Ross (2010) found that nurses face research and clinician barriers that include not having the clock, skills and knowledge to critically critique and/or synthesise research literature, unable to effectively use and search databases electronically, befuddle negative views toward research and feel research is too complex, aswell research at time is not clear on how to implement the findings and findings can be contradictory. Due to these barriers, nurses tend to rely on synthesised evidence such as evidence-based protocols, policies and procedures (Gerrish et al., 2011). Eizenberg (2011) and Gerrish et al. (2011) also found that nurses prefer to acquire infor mation through deuce-ace parties such as their colleagues, the workplace, through patient care experience, and the knowledge they received from their nursing education. Eizenberg (2011) found that the organisation is the greatest factor in successful EBNP implementation.The organisation controls access and the budget to and for evidence resources such as computers with internet access, a well-equipped library, and access to educational opportunities in EBNP procedures and theory (Eizenberg, 2011). The barrier of not having the chest of drawers to change a nursing practice also lies with the organisation a nurse may have the necessary research knowledge and experience to effectively change practice but cannot implement practice change due to the organisation not giving him/her the authority to move change (Eizenberg, 2011). Few nursing cater members are given the opportunity to get in in the development of evidence-based policies and procedures therefore, most nurses are not engaged to support EBP.Ross (2010) further found organisational barriers such as the organisation giving priority to other goals (for subject excess sick leave) over EBNP, the organisation may perceive that the staff are not piece or willing to implement EBNP, and that the organisation believes EBNP is unachievable. These organisational barriers prevent EBNP being accomplished and to the greater extent of not being implemented. A barrier of nursing profession relates to the medical dominance of healthcare as such, nurses are not afforded the power, authority, autonomy and respect from colleagues for nursing practice that the status of being a profession decrees (Brim Schoonover, 2009 Eizenberg, 2011 Gerrish et al., 2011).A further nursing profession barrier is it can be difficult to instill enthusiasm or information about an EBNP if turnover is high there is a shortage of experienced nurses and support from colleagues is absentminded (Gerrish et al., 2011 Mark, Latimer, Hardy, 2010). Due to high turnover and staff shortages, nurses are unable to leave the bedside and have limited time to participate in EBNP projects such as journal clubs, or to attend training in EBP, PICO(Population/ hinderance/Comparison/Outcome), and database searches (Brim Schoonover, 2009 Brown, Johnson, Appling, 2011). Nurses, as Kenny et al. (2010) found were hesitant to change their practice if the change would perceivably increase an already sedate workload. Brim Schoonover (2009) found that some nurses believed EBNP to be an optional course of action as they were never plantn a clear direction of what EBNP is infixed to nursing and his/her practice. One of the main premises of EBNP is that the evidence and the values and beliefs of the patient/s are synthesised together to form an EBNP which is foremost favourable for a positive outcome for the patient/s (Fernandez et al., 2008).Such factors as treatment, travel, and prescription costs denial of diagnosis inadequate knowle dge level of disease and strategies to decrease risk factors lack of social support and cultural issues can all potentially become barriers to implementing an EBNP for a patient or patients (Fernandez et al., 2008). The high acuity of an intensive care unit (ICU) patient significantly affects a nurses ability to search a database for answers (Brim Schoonover, 2009 Kenny et al., 2010). An answer to a question is usually needed immediately or momentarily therefore, ICU nurses rely on experience, colleagues, and knowledge of evidence-based policies, procedures and guidelines (Eizenberg, 2011 Gerrish et al., 2011). I know I rely heavily upon in-services, experience, and speaking with the ICU Clinical Nurse Educators and Nurse Educators who will do a literature search to acquire information or answers to a question I have posed but once again this evidence/information has been synthesised by others and is third contact and I have not ripey practiced EBN (Eizenberg, 2011 Gerrish et al ., 2011).To try and challenge this barrier I do try and read the clinical information the educator obtained at a later date usually at home or on a break. Strategies to overcome these challenges and barriers abound from EBP and EBNP journal articles and books. most of the leading strategies are for the organisation to fully support EBNP through infrastructure, strong leadershiphip from nurse managers and/or march on practice nurses, and by ensuring a context in which EBNP can flourish (Gerrish et al., 2011 Tolson et al., 2008). The infrastructure needs to provide access to a computer which can access online databases. Infrastructure needed to be in place includes a staffed evidence based nursing library with a librarian able to direct nurses on the process ofEBNP (Pochciol Warren, 2009). The added challenge is to have EBNP info accessible to the nurse at the patients bedside (Pochciol Warren, 2009).Nursing leaders need a Masters degree or above, as studies show that leaders with these credentials read and implement more research literature are more positive and they consider themselves more competent in supporting others through the EBNP process (Eizenberg, 2011 Gerrish et al., 2011). Leaders, as suggested by Cullen et al. (2011), patronise the responsibility to provide support to build, to create, and maintain an organisational culture that has the capacity to support EBP at both a clinical and administration level. Leaders must be given the power, authority, and support to introduce change without this authority change cannot occur (Eizenberg, 2011). Scholars agree that if EBNP is to succeed and be sustainable nurses need to be educated and mentored on the implementation process of EBNP (Brim Schoonover, 2009 Brown et al., 2011 Eizenberg, 2011 Gerrish et al., 2011 Pochciol Warren, 2009 Ross, 2010 Tolson et al., 2008).EBNP education of nurses needs to begin at orientation to the hospital and is essential that this education is continually built u pon and supported with extra education given to nurse managers, educators and advanced practice nurses (Pochciol Warren, 2009 Tolson et al, 2008). Ross (2010) suggests nurses information literacy be improved to ensure nurses are able to practice EBN. tuition literacy is the ability to competently recognise, locate, and evaluate the fundamental information required at a given point (Ross, 2010). The ICU, where I am employed, has undergone significant changes to the staff and managerial side of the unit. At one point the Clinical Nurse Specialists ratio lessen to less than 5% of nursing staff and there was not a permanent full time Clinical Nurse Consultant. Without the necessary support acquired from these roles the education of ICU nurses and the implementation of new practices, policies and procedures decreased significantly.These barriers significantly halted EBNP from occurring in the ICU as there were very few highly educated leaders available to support EBNP. As suggested by Eizenberg, (2011), Gerrish et al. (2011), and Cullen et al. (2011), educated leaders and managers are needed to keep and instill EBNP to an institution. To obtain Magnet Status hospitals must ensure that EBNP is in place, is supported, and is sustained by the organisation (Brown et al., 2011). To batten nurseinterest in EBNP, and maintain Magnet Status, some hospitals have linked participation in EBNP to clinical scarper advancement and a monetary reward in the form of a profit increase with advancement up the ladder (Whitmer, Aver, Beerman, Weishaupt, 2011). To hold their position on the clinical advancement ladder the nurse must show, yearly, that he/she is supporting, or implementing, or participating in EBNP within the setting they are employed (Whitmer et al, 2011).The benefits of practicing EBN includes patients ability to access effective evidence based treatment information facilitates consonant improvement, through decision making, to healthcare systems facilitates d ecisions based on up-to-date evidence and technologies and reduces variances in nursing care from one nurse to another standard and competencies are evidence based and consistent through evidence based competencies the professional status of nursing is elevated to higher heights (Gerrish et al., 2011 Eizenberg, 2011). In conclusion, the challenges/barriers, barrier strategies, and benefits of EBNP has been discussed. precise discussion on EBNP within an ICU was attempted as the ICU nurses face the same situations, challenges/barriers, strategies and benefits as nurses in other areas of healthcare (Sciarra, 2011). Nurses must be given organisational support, education and knowledge needed to participate proficiently in EBNP.ReferencesBrim, C. B., Schoonover, H. D. (2009). Lessons learned while conducting a clinical trial to facilitate evidence-based practice the starter researcher experience. The ledger of Continuing Education in Nursing, 40(8), 380-384. inside 10.3928/00220124-2 0090723-06 Brown, C. R., Johnson, A. S., Appling, S. E. (2011). A taste of nursing research an interactive program, introducing evidence-based practice and research to clinical nurses. Journal for Nurses in Staff development, 27(6), E1-E5. DOI 10.1097/NND.0b013e3182371190 Cullen, L., Titler, M. G., Rempel, G. (2011). 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