Evidence-based practice has become extremely popular and widely used in a variety of public health settings. Public health nurses are expected to be familiar with the most relevant research evidence and successfully translate it into practice. However, according to Doody and Doody (2011), “within the practice setting, there is an increasing challenge to provide clearly measurable care of the highest quality, which is evidence-based” (p. 661). Nevertheless, public health nurses have everything needed to improve the quality of their practices and decisions based on available research evidence. The goal of this paper is to review the strategies used by nurses to implement evidence-based breastfeeding practices in a public health agency. The results of this review will provide strong implications for the use of evidence-based practices across multiple public health settings.
The Article by Rempel and McCleary (2012)
The focus of the article by Rempel and McCleary (2012) is on the application of evidence-based breastfeeding practices by nurses in a public health agency. According to Rempel and McCleary (2012), clinical best practice guidelines exemplify a unique and effective approach to translating research evidence into practice. However, the development and implementation of best practices is a long process. It is impossible without organizational change and subsequent adaptation of evidence-based guidelines to the unique conditions of performance within a public health agency (Rempel & McCleary, 2012). The commitment of nurses to evidence-based practices can change the approaches of mothers to breastfeeding (Rempel & McCleary, 2012).
Many mothers in public health facilities either lack any knowledge of breastfeeding practices or are being torn among the conflicting beliefs about breastfeeding (Rempel & McCleary, 2012). The quality of their knowledge is crucial to breastfeeding success, because nurses provide breastfeeding mothers with prenatal and postpartum support (Rempel & McCleary, 2012). Moreover, nurses are well-known for their participation in public health campaigns (Rempel & McCleary, 2012). No less important is the way nurses put research evidence into practice, and Rempel and McCleary (2012) offer a detailed review of the process.
In Rempel and McCleary (2012), best practice guidelines serve as the most reliable method of translating research evidence into practice. After a comprehensive literature review, a panel of nurses was created to develop best practice guidelines for breastfeeding (Rempel & McCleary, 2012). The public health agency used a variety of strategies to confirm the effectiveness of individual and combined breastfeeding interventions (Rempel & McCleary, 2012). A committee of 12 nurses was organized, and a consensus process was used to ensure that the new practice guidelines fit into the organizational context of agency. Before the guidelines were implemented, a survey was administered among public health nurses to identify gaps in their knowledge and define the most optimal pace and scope of implementing evidence-based practice (Rempel & McCleary, 2012).
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The recommendations were presented to nurses during a lecture, and a series of interactive learning sessions were organized to inform nurses of how well the agency was meeting the recommendations (Rempel & McCleary, 2012). A pamphlet and a checklist were introduced to facilitate the integration of evidence-based recommendations into nursing care (Rempel & McCleary, 2012). Public health nurses received relevant support and guidance through electronic mail reminders and regular feedbacks (Rempel & McCleary, 2012). Finally, a collaborative network of local hospitals and public health agencies was created to share the evidence-based practices and findings applied within the agency with other care providers (Rempel & McCleary, 2012).
Public health nursing offers a favorable ground for implementing evidence-based practices and best practice guidelines to ensure breastfeeding success. Weddig, Baker, and Auld (2011) believe that well-informed nurses have the potential to influence initiation and duration of breastfeeding in mothers. Such knowledge is of greatest importance to the young mothers having their first baby, as they are often inconsistent in their beliefs and unconfident of the importance of breastfeeding. Certainly, the process of translating research evidence on the benefits of breastfeeding into practice is associated with major difficulties. Basically, nurses lack awareness of what counts as short- and long-term advantages of breastfeeding.
Most of them realize that breastfeeding is good for babies, but they may not be aware of the disease conditions and problems that arise in children, who are not breastfed (Brodribb, 2011). Methods used to put evidence into practice represent another major area of concern for nurses: creating best practice guidelines is usually impossible without developing a strong consensus on the way the formal evidence base should be interpreted and understood (Renfrew et al., 2008). Meanwhile, nurses are expected to update their evidence knowledge continuously, while providing measurable care in accordance with the highest evidence-based standards (Doody & Doody, 2011).
In conclusion, translating research evidence into practice is a process associated with many challenges. Nevertheless, public health nursing must be evidence-based. Breastfeeding is one of the many areas, where research evidence and nurses’ commitment to continuous learning and research awareness could greatly improve the quality of breastfeeding practices, their safety, and duration. The process described by Rempel and McCleary (2012) is one of the many approaches to translating evidence into practice, which is based on collaboration, consensus, and support. Still, the development of best practice guidelines is not the final point in the process of putting research evidence into practice. Nurses must update their knowledge regularly. In the meantime, collaborative networks involving public health care facilities and nurses should be organized. These collaborative networks will facilitate the transfer of knowledge and evidence and improve the quality of nursing practices in public health settings.