Every day thinking about becoming a doctor trying to save lives and doing surgery is all part of the dream. There are many obstacles a medical student has to face to reach their goals. Some of the obstacles are taking the MCAT and having a 3.5 GPA throughout four years of college to determine where students will go for medical school. To become a doctor, a medical student has to go through medical schools and then 3 to 7 years of a residency program to become a doctor.  As thinking about becoming an OBGYN that delivers babies and treats diseases of the female reproductive system, there will be many challenges to face to reach the goals. Becoming an OBGYN will  help females who are unable to pay for medical advice and reduce the birth mortality rate. To face these obstacles a medical student and health professionals must learn how to cope with stress, burnout and anxiety disorder.

Stress

Firstly, stress is the response to challenges resulting from stimuli or events that causes emotional and physical tension (Licht, Hull, & Ballantyne, 2017). Stress plays a daily role in our lives from being frustrated about the school to feeling nervous about turning in a homework assignment. A stressor is a stimulus that causes one to release stress hormones that can affect one mentally and emotionally (Licht, Hull, & Ballantyne, 2017). For example, the death of a family member that your close to made you feel lonely can lead to stress. There is also positive stress which is the response to agreeable or positive events which is called eustress (Licht, Hull, & Ballantyne, 2017). An example of eustress is working hard to reach your goals or planning to travel is all part of positive stress. But there is also negative stress response to unpleasant events which is called distress that leads to undesirable stressors (Licht, Hull, & Ballantyne, 2017). For example, studying for a medical exam last minute and not being prepared cause distress. Medical professionals often feel stress when it comes to diagnosing a patient and figuring out what plan will be more effective on the patients. There is also stress about giving the right amount of medication and stress about telling the family about the patient’s condition or death. Medical professionals often have overnight shifts which can have difficult cases and cause stress because there are not enough doctors available. Doing surgery gives a lot of stress because one mistake can create a life and death situation. To cope with stress medical professionals can go to the hospital psychologist to get counseling or write down their stress in a diary or journal. Medical professionals can find something that can relieve stress by going on vacation or meditating. Not dealing with stress can drain you mentally and physically.

Burnout

Secondly, Burnout is the feeling of not being motivated due to overworking the body emotional, mental, and physical (Licht, Hull, & Ballantyne, 2017). Many Medical professionals feel fatigued during long hour shifts because they are on call even when off duty. This may cause a lack of treatment to the patient and some may be left untreated. Medical students tend to burnout more due to stress, workload, and exams. According to a study, about 37% of Canadian medical students meet the criteria for burnout (Glauser, 2017). This shows that a significant amount of medical students do not receive an adequate amount of sleep. A study done by the American Medical Association which is based on an international survey about 27% of medical students showed symptoms of depression (Glauser, 2017). This data explains the correlation between depression symptoms and burnout among medical students. Having a lack of sleep, during 70 hours of clinical rotation and dealing with death first time can add on and the best coping mechanism starts to fail (Glauser, 2017). Many medical professionals forget to take care of their mental and physical health due to the stress of saving the lives of others. This is a problem because exhaustion and overload can lead to mistreating the patient. Medical students and the medical profession need to find a way to cope with their problems by getting eight hours of sleep and taking care of their health.

Anxiety Disorder

Finally, anxiety disorder is a psychological disorder that characterized feelings of extreme anxiety and irrational fears that interfere with daily activity (Licht, Hull, & Ballantyne, 2017). Many medical students worry that they will fail an exam or that they will not pass a class which can lead to anxiety. The cause of anxiety in students is because the amount of money they spend in medical school and how much work they put in. If one mistake is made it can lead to jeopardizing their career which can lead to depression and anxiety. Many physicians and medical students fear the death of their patients. Not having proper care of yourself can lead to failure in taking care of others.

Conclusion

In conclusion, medical professionals and medical students  must know how to cope with stress, burnout, and anxiety disorder. Knowing how to deal with stress can help the doctors to treat their patients better and will be able to make better decisions. The medical field has a lot of stress the medical profession should know how to deal with stress by going to a psychologist or finding other ways to deal with stress. The medical profession should realize when they feel they are burnout that way they can take breaks when the body signals them to. For anxiety disorder, medical students should not be hard on themselves and do the best they can. Learning about theses coping mechanism will help medical student to deal with problem efficiently before the problems cause major harm.

References

• Glauser, W. (2017, December 18). Medical schools adressing student anxiety, burnout and depression.
  
  Canadian Medical Association. Journal, 189
  
  (50), E1569-E1570.
• Licht, D. M., Hull, M. G., & Ballantyne, C. (2017).
  
  Scientific American: Psychology 2nd Edition.
  
  New York, N.Y: Worth Publisher.

Teaching Plan for Client in the Medical-Surgical Unit of MountainView Hospital in Clark County, Nevada

Topic for Educational Need

The topic of education for this patient is postoperative care for hip replacement surgery. This topic was chosen because the patient underwent a total right hip arthroplasty procedure on September 16, 2019. The patient will need guidance and instruction on all aspects of recovery to achieve the best outcome of the joint replacement surgery (John’s Hopkins, 2017). Being knowledgeable about how to self-care, what to expect, and what resources will be needed will assist the patient obtain and maintain the best possible function and quality of life after the procedure (Cleveland Clinic, 2015).

Objective Data

Relevant Medical and Surgical History.

Chronic progressive right hip pain; limited in ambulation to about 100 yards without stopping because of pain. Back pain, herniated disc, lumbar fusion 1981, motor vehicle accident in 1983, numbness and tingling from hip area down to legs.

Vital Signs.

September 16, 2019.


Temperature 98.6F, blood pressure 105/71 mmHg, pulse 74 bpm, respirations18 breaths/min, O2 sat 97% on 2.0L/min nasal cannula.

September 17, 2019: 0730.


Temperature 98.8F, blood pressure 92/58 mmHg, pulse 78 bpm, respirations 18 breaths/min, O2 sat 98% 2.0L/min nasal cannula, pain level 7 out of 10.

September 17, 2019: 1130.


Temperature 98.8F, blood pressure 93/59 mmHg, pulse 79 bpm, respirations 18 breaths/min, O2 sat 97% on 2.0L/min nasal cannula, pain level 9 out of 10.

Assessment of Patient

The patient was alert and oriented x4 throughout the clinical day on September 17, 2019. The patient 54 years old, a native English speaker, and high school educated. The patient is unemployed, divorced with three children, lives alone, and on disability from a motor vehicle accident in 1983. The patient has chronic hip pain with numbness and tingling from the hip area down to the legs and has managed the pain throughout the years since the MVA with physical therapy and the use of baclofen and clonazepam for muscle spasms. The patient is accustomed to applying self-care to manage her physical condition. The patient’s plan after discharge from the hospital will be to live at one of her adult daughter’s home which is a one-story unit so the patient will not have the burden of going up and down flights of stairs. The patient’s health goal is to be independent as soon as possible and is motivated to apply all suggested therapeutic interventions. The patient’s current emotional state ranges from willingness to make a rapid recovery as well as some anxiety surrounding the management of pain which ranged from 7 to 9 out of 10 during the clinical day.

Method of Implementation

The patient’s learning style is visual and motor so printed handouts and physical demonstration were chosen as the method of teaching. A hands-on approach where the patient gets to perform a procedure with your guidance is often the best method (Lippincott, 2017). The patient’s style is to keep it simple and get the facts with a simple checklist. The patient does not have hearing or learning impairments so there will not be limitations as to what the patient understands. The patient’s daughter is supportive and will be informed by the patient on how to be cared for so the patient will receive assistance with health care management. The patient has access to a computer and the internet at home and is willing to seek further instruction from reliable sources such as the “Patient Handbook for Total hip Replacement” by Kaiser Permanente for more details on how to perform activities of daily living after surgery.

Teaching Tools

The tools that will be implemented for teaching will be printed handouts and physical demonstrations of how to use adaptive equipment. The printed handouts outline the physical movements and positions that the patient will practice that will reduce pain and improve function. These movements include not bending the hip past 90 degrees, not crossing legs while sitting or standing, not pivoting foot and toes inward (medially), and how to use a walker.

The patient will also be educated on how to perform activities of daily living such as showering, dressing and toileting. For showering, a shower chair or stool should be utilized for safety as well a long-handled brush or sponge to assist with washing. Dressing aids such as a long-handled shoe horn and tongs will assist with dressing. For toileting, a raised seat should be used and rails should be installed if possible to provide support.

The printed handouts were chosen because it shows simple illustrations on what to do and what not to do that will be easy to follow. The patient will be able to glance at the handout be reminded of what movements and positions are recommended and what should be avoided without having to read lengthy paragraphs. In-person physical demonstrations on how to use adaptive equipment will allow the patient to practice utilizing each item before going home to it is familiar once the patient is home and will be using the equipment independently.

Evaluation

The patient demonstrated that learning occurred by return demonstrating the movements and positions that were shown on how to go from sit to stand and to bed. The patient verbally repeated the instructions given regarding what to do and what not to do when performing activities of daily living. The patient acknowledged the adaptive equipment that were in the room to take home upon discharge. An example of a question asked of the patient is, “what is the angle that you should avoid sitting or bending?” and “what should you never do with your legs while sitting or standing?”. The criteria that would show the patient understood the material is if the patient responded with the answers, “Do not sit or bend more than 90 degrees”, and “Do not cross legs while sitting or standing” to the questions aforementioned, respectively. Possible revisions to this plan would be to provide a DVD for the patient to take home to be viewed periodically as a refresher to maintain the best practice for physical therapy exercises and the how to’s for activities of daily living.

References

• Cleveland Clinic Foundation. (2015).
  
  A patient’s guide to total joint replacement and
  
  
  complete care.
  
  Retrieved from
  
  https://my.clevelandclinic.org/ccf/media/Files/Ortho/patient-education/total-joint-replacement-patient-guide.pdf?la=en
  
• John’s Hopkins Medicine. (2017)
  
  Patient education: Hip replacement surgery.
  
  Retrieved from
  
  https://www.hopkinsmedicine.org/johns_hopkins_bayview/_docs/medical_services/orthopaedic_surgery/hip_replacement_surgery_patient_education_guide.pdf
  
• Kaiser Permanente. (2015).
  
  Total hip replacement: Patient handbook
  
  . Retrieved from
  
  https://thrive.kaiserpermanente.org/care-near-you/northern-california/santarosa/wp-content/uploads/sites/15/2015/09/Total-Hip-Replacement-Booklet.09416-085-3-10_tcm75-244262.pdf
  
• Lippincott Solutions. (August 22, 2017).
  
  5 Strategies for Providing Effective Patient Education.
  
  Retrieved from
  
  http://lippincottsolutions.lww.com/blog.entry.html/2017/08/22/5_strategies_forpro-kDDq.html
  

Critically discuss the relationship between social factors and health inequalities. Making reference to at least two theoretical approaches to explaining health inequalities, suggest how useful they are, as well as addressing their weaknesses.

Understanding the inequalities in health and their association with various social issues/factors is the objective of this essay. The essay also seeks to explain these underlying health inequalities with social factors using different theoretical methodologies.

But, before discussing the correlation between the various social factors and health inequalities we need to comprehend ourselves with the significance of Health. As per the World Health Organization (WHO): “

Health is a state


of complete physical, social and mental well-being and not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being, without distinction of race, religion, political beliefs or economic and social conditions

”(WHO, 1948).1

Based on this definition, National Institute Health Excellence (NICE, 2012) defines Health Inequalities as “an inability to attain the health among different groups or individuals due to difference in their social, geographical, cultural/behavioural, biological or other factors.”2 In simpler terms, health inequalities can be defined as “

an unjust disparity in the health when these differences are not only preventable but are also unnecessary

”.3

To further explain these differences, different theoretical attempts were made including social class, material deprivation, behaviour and culture, artefact, environmental and selection theory, the geographical aspects, difference in genetics and the life course perception of health played a vital role in understanding the health inequalities.3

The diagram above shows the various causes of health inequalities divided into different categories of fundamental causes; environmental influences; and finally individual experiences which finally in-turn lead to the disparity in wellbeing and health of different groups or individuals.

The

fundamental causes

are the factors which cannot be undone such as, Global economic forces, socio-political environment and priorities lead to an unequal distribution of income, power and wealth which can further trigger poverty and marginalization of the individuals belonging to different social groups and classes.

These initial differences further influence the distribution of

environmental influences

, such as availability or accessibility of employment, schooling, better housing, health services and various societal & cultural opportunities. Thus, shaping the individual experiences across the population leading the inequalities in the health outcomes.

There are numerous examples across the globe which have claimed the link between these various social factors to the health of the individual or groups.

The very first information in this group is the

Black Report of 1980

stating the effect of the social classification of a person on his/her health.4 The findings reported a huge gap in the proportion of people suffering from ill-health increased as we go down the social ladder, which had nothing to do with the health services delivered by the National Health Services (NHS) in the country but was mainly due to unemployment, poor hygiene, low income and poor housing.4-7

Similarly, a publication by

Wilkinson and Pickett

(2009)  “

The Spirit Level

” also claimed that economically weaker sections of the societies have an additional ill-health and social problems compared to their stronger counterparts. This argument was further strengthened by the finding of “Strategic Review of Health Inequalities in England” (2010).8 Thus, advocating income inequality as a key explanation for all the prevailing health disparities.

However,the novel

Neoliberal discourse

was another factor which also provided an explanation to the health inequalities using factors other than income disparity. Few studies carried out in past have exhibited that more neoliberal countries (the United States of America) have poorer health compared to the less neoliberal countries (Canada).8 This was proven by a comparative study carried out by Siddiqui A et al.,(2013) to understand the effect of Neoliberal reform in both the countries. The findings of the study indicated that Canada was more resilient in terms of health inequalities despite the income inequality among various social groups. Canada was able to achieve this because of their policies of maintaining equality in the provision of various social goods like healthcare and education and maintaining a social cohesiveness across different racial/cultural & class-based groups.9  Additionally, Corburn D (2004), have also demonstrated the association of neo-liberalism (using infant mortality) with greater poverty and health inequalities and the countries with less neo-liberalism have better health compared to ones which are more neo-liberal.10

Another landmark example describing the effect of social factors on health disparity was the

Whitehall (I)Study.

The study concentrated on a group of British Civil Servants

–

wherein the people within each occupational grade tend to be similar, yet socially distinct between the grades. The study investigated the cardiovascular function, high blood pressure, smoking, hobbies etc among the individuals. The results showed that there was a steep inverse relationship between social class and high blood pressure. Summing up the outcomes, the researchers concluded more attention need to given to the social environment, job design and income inequality to avoid health disparities.11

These are a few pioneering examples depicting the effect of various social factors on the prevalence of health inequalities not only amongst different but also within similar social groups/ individuals.

As mentioned previously in the essay there are different theories explaining the health inequalities. However,  there are four main theories which are mostly applied to explain them ie., 5,6

1. 
   Behavioural Theory
   
   : Explaining the health-damaging/ promoting behaviour among the individuals/ groups such as diet choices, intake of alcohol and tobacco, usage of maternal & child care and other health services. This theory is useful in establishing a clear link between certain practices and outcomes (smoking and lung cancer), thus helping in planning for future health promotive/preventive measure. However, cohort studies (Whitehall’s study) have shown that health behaviour justifies only one-third of social differences in mortality. Furthermore, evaluations of these promotive/preventive interventions have seldom given any clear cut improvements in health.
2. 
   Materialist Theory:
   
   Poverty imperils individuals to health risks. Deprived individuals are more likely to reside in areas with higher risks like inadequate housing, air pollution etc.  The Black Report (1980) gave a materialist description to the importance of social class variances in health.4 However, many experts find the model to be insufficient since the so-called disadvantaged individuals are often provided with numerous benefits by the state making food or housing an unlikeable cause for disparity in health outcomes.
3. 
   Psycho-social Theory:
   
   Relates to the aspects of the social life affecting people’s state of mind. the researchers through the Whitehall Study have explained the effect of social environment on the health outcome of individuals working in different occupational rank.11 The theory is also been able to explain certain risky behaviour (smoking) prevalent among a certain group of people. However, it cannot fully explain the uneven distribution of employment and services between various classes and races.
4. 
   Life-course Theory:
   
   A relatively recent theory undertaking various social, psycho-social and biological factors experienced by a person during their lifetime. For example, a child experiencing inadequate living condition is more likely to have an educational and occupational disadvantage in future. The theory, on one hand, allows us to understand the implication of life experiences on future life outcomes. However, investigating life-course explanations becomes difficult as they require longitudinal data which is difficult to obtain.

A brief explanation of The Black Report (1980) using the above-mentioned theories

These theories help to differentiate the characteristics affecting health across different social classes over their lifetime.

For instance, the

behavioural theory

was used to describe the difference among numerous health-related choices such as dietary patterns, consumption of tobacco, alcohol and drugs, utilization of preventive healthcare services among different social groups.4-6 Similarly, the

materialist theory

was aptly used in the report as a decisive factor leading the health inequalities. The theory encompassed the factors like air pollution, infestations and respiratory hazards which has risen due to poor income condition.4,5,7

Likewise, the

psycho-social theory

explains the concept of people’s experiences determining the changes in the physiology of their body. For instance, a hectic social atmosphere associated with the lower working groups of an organization can produce a negative biological effect in the body leading to a greater incidence of morbidity and mortality among the people belonging to that societal section.

And finally, the

life-course theory

which focused on all the aspects of societal, emotional and biological advantages and disadvantages occurring during the lifetime of a person which eventually defines the health outcome of that particular individuals. This could be again be used for the people living in the poorer section of society who were at a disadvantage since their birth, thus ultimately resulting in inferior health and social outcomes during their entire lifetime.

Therefore, in the end, there are few things which can be concluded through this essay. Firstly, even though there are many theories explaining health inequalities among different social groups, its mainly the socio-economic conditions along with the political, societal and environmental forces which predominantly create or destroy a person’s health and wellbeing. Secondly, there isn’t one full-proof theory which can explain prevailing gaps in the healthcare system. Finally, despite having numerous theoretical explanations to numerous health inequalities the political and societal forces across the nations have failed to address these social factors. Henceforth, there is a dire need to address these factors in order to ensure an equal chance of a healthy life for everyone.

References

1. World Health Organization. Constitution. World Health Organization.1989.
2. The National Insititute for Health and Care Excellence. Health Inequality and population health. The National Institute for Health and Care Excellence. 2012.
3. Arcaya MC, Arcaya AL, Subramanian SV. Inequalities in health: definitions, concepts, and theories. Global health action. 2015 Dec 1;8(1):27106.
4. Black SD. Inequalities in health: report of a Research Working Group. Department of Health and Social Security; 1980.
5. Bartley M. Health Inequality: An Introduction to Theories, Concepts and Methods Cambridge. Polity. 2004.
6. Bartley M, Blane D. Inequality and social class. Sociology as applied to medicine. Elsevier. 2008 Jun 27.
7. Steinbach R. Inequalities in the distribution of health and health care and its access, including inequalities relating to social class, gender, culture and ethnicity, and their causes. Equality, equity and policy: inequalities in the distribution of health and health care and its access.2009
8. Peacock M, Bissell P, Owen J. Dependency denied: health inequalities in the neo-liberal era. Social Science & Medicine. 2014 Oct 1;118:173-80.
9. Siddiqi A, Kawachi I, Keating DP, Hertzman C. A comparative study of population health in the United States and Canada during the neoliberal era, 1980–2008. International Journal of Health Services. 2013 Apr;43(2):193-216.
10. Coburn D. Beyond the income inequality hypothesis: class, neo-liberalism, and health inequalities. Social science & medicine. 2004 Jan 1;58(1):41-56.
11. Marmot MG, Shipley MJ, Rose G. Inequalities in death—specific explanations of a general pattern?. The Lancet. 1984 May 5;323(8384):1003-6.

Introduction

The term of evidence based practice (EBP) was firstly used in medicine as evidence based medicine, after that the term developed and being used in nursing with purpose of build up scientific database to improve nursing as science (Colyer and Kamath, 1999). Evidence based practice was passed through three stages; in which the EBP was appeared in Old Testament which was the first form and appearance of EBP; after that the EBP was developed in different form in middle ages, in which the period of middle ages was considered a stage of “renaissance” of the EBP which characterized by beliefs-related methods of treatment; the third stage of EBP was the modern stage, in which the modern stage considered the last version of EBP that began at 1972; in which the modern version of EBP was the EBP that widely known form among highly educated and professional nurses (Claridge and Fabian, 2005).

The Bible was the oldest known source in EBP documentation, in which the Bible contains a story that was represented as an interventional research that progress for ten days (Weingarten, 2003); the story in the Bible said ” Then Daniel said to the guard whom the master of the eunuchs had put in charge of Hananiah, Miscael and Azariah and himself “.Submet us lo this rest for ten days. Give us only vegetables to eat and water to drink: then compare our looks with those of the young men who have lived on the food assigned by the king and be guided in your treatment of us by what you see.” The guard listened to what they said and tested them for ten days. At the end of ten days they looked healthier and were better nourished than all the young men” (Claridge and Fabian, 2005, P. 548).

During the second stage of EBP (1700s-1900s), the EBP was restricted to believes-related methods of treatment; in which “Blood-letting” was the main treatment for many diseases in middle age period (Klar and Donner, 2002). Physicians and priests were used “Blood-letting”; in which Physicians and priests were believed that diseases caused by wicked souls; in which the diseased patients should be injured to expel the wicked souls with blood outside of patients’ bodies (Klar and Donner, 2002).

During the last four decades, the EBP was featured in a modern form; in which the borderline for modern period of EBP was began in 1972 by Archie Cochrane (Klar and Donner, 2002). Cochrane (1972) published a paper with title of “Effectiveness and efficiency: random reflections on health services”; in which the paper was discuss and evaluate the effect of randomization (the randomization was regard to patients and regard to intervention) on the outcomes of the patients’ health. The Cochrane’s paper was the first paper reflects the importance of randomized clinical trials; in which Cochrane was found that the randomization of the sample and intervention will exhibit evidence with high quality which improve the quality of health care provided and improve health outcomes of the patients (Cochrane, 1972).

Melnyk and Fineout-Overholt (2005) defined EBP as a knowledge-based conflict-resolving strategy that performed by adapting best available evidence to provide best possible care for patients and their families. Furthermore, Evidence Based Practice is a process of integration of research-based results which contribute to achieve best practice (Institute of Medicine, 2001). In addition, Sackett, Rosenberg, Gray (1996) estimated that evidence based practice is synchronous combination of professional nursing experience and research with high level of evidence under patient’s believes and values consideration. Besides that, Ingersoll (2000) documented that evidence based practice is “meticulous, unambiguous, and well-judged theoretical information and reliable research-findings to provide effective decisions about patients’ care regard to patients’ and organizational needs” (P. 152). Furthermore, evidence based practice defined as “Explicit and judicious decision making about health care delivery for individuals or groups of patients based on the consensus of the most relevant and supported evidence derived from theory-derived research and data-based information to respond to consumers’ preferences and societal expectations” (Driever, 2002, p. 593).

Evidence based practice is considered as a magical solution for complicated health problems (Institute of Medicine, 2001). Furthermore, evidence based practice considered wide discipline term used as a solution to clinical-related problems which began to provide findings and basics of clinical decision on best reliable and evident researches with purpose of improving health care provided (Sackett, Strauss, Richardson, Rosenberg, and Haynes, 2000). The Institute of Medicine (2001) was illustrated that EBP process provide intensive care to patients, using effective recent researches to achieve desired outcomes, and provide cost effective standard care. In addition, another study found that EBP enhance nurses’ professions by improving nurses’ knowledge and skills to analyze, understand and develop research (Melnyk and Fineout-Overholt, 2005). Evidence Based Practice improves nurses’ ability to be excellence profession in areas of practice, and improves patients’ health outcomes by providing high qualified nurses (Institute of Medicine, 2001).

Evidence based practice improve patients’ outcomes within four dimensions; clinical dimension (improve signs and symptoms of patients’ diseases), life quality dimension (improve patient satisfaction upon to life), functional dimension (improve patients ability to achieve daily living activity), and economic dimension (using EBP was prove ensure of cost effectiveness for patient and hospital) (Weaver, Warren, and Delaney, 2005). In addition, Newhouse, Dearholt, Poe, Pugh, and White (2005) demonstrated that the evidence based practice improve “efficacy” of health care provided to achieve pleasurable patient’s outcomes, save patients/nurse time, and use of EBP considered cost effective for patients, families, and hospitals.

Melnyk, Fineout-Overholt, Sadler, and Green-Hernandez (2008) documented that implementation of evidence based practice can be achieved by improving nurses’ knowledge and skills about research and evidence based practice, improve and strengthening nurses’ beliefs to reinforce nurses to be integrated within evidence based practice environment. Evidence based practice education allow nurses to formulate and answer any research question raised from clinical area by recent and reliable researches, allow nurses to critique and evaluate any research according to level of evidence, allow nurses to conduct researches according to patients’ needs; family; nurse; and hospital needs, and allow nurses to share research findings as journal club activity (Melnyk, Fineout-Overholt, Sadler, and Green-Hernandez, 2008).

Another study conducted by Wolf and Greenhouse (2007) documented that using of EBP is significantly needed in clinical practice, in which EBP pleasured to achieve improvement in patientfamilynurse education regard to condition and treatment, improve quality of health care provided by nurse and hospital, improve using new technology in clinical setting as computers, and build nurses community prepared with recent scientific information.

Most of health care provided by nurses nowadays is based on traditional practice with observable lacking in evidence-based practice (Mariano, Caley, Eschberger, Woloszyn, Volker, Leonard, et, al. 2009). Furthermore, an Iranian study was conducted to identify the Iranian nurses perception toward EBP, the Iranian study was conducted by using convenience sample of 21 nurses who undergone within qualitative research design; in which the Iranian study was documented that 21 participants from nurses did not listen about the concept of “evidence based practice” before and they did not implement EBP in clinical area (Adib-Hajbaghery, 2009).

American and Netherlandic studies conducted at 1998 and 2001 respectively; was estimated that about 35% of hospitalized patients do not receive evidence based care (the nurses treat patients according to traditional care that was not based on researches) (Schuster, McGlynn and Brook, 1998; Grol, 2001); in which Estrada (2009) conducted a descriptive study to assess nurses’ knowledge and attitudes toward EBP, in which the Estrada’s study was founded that 25% of sample did not hear about EBP previously. Moreover, Melnyk and Fineout-Overholt (2007) was conducted a study to develop two scales; attitude toward EBP scale and implementation of EBP scale, in which Melnyk’s and Fineout-Overholt’s study was estimated that 40% of collected sample did not listen and dealt with the concept of EBP previously. Evidence based practice improve patients’ outcome; in contrast, lack of nurses prepared evidence based practice will affect patients’ outcomes negatively (Institution of Medicine, 2001); in which, about 25% of health care provided was not sufficient to meet patients needs and the health care provided was not safe for hospitalized patients (Schuster, McGlynn and Brook, 1998; Grol, 2001). Furthermore, Pravikoff, Pierce, and Tanner (2005) conducted a study to evaluate nurses perception to integrate within EBP which conducted by random sample of 1,097 nurses, the researchers were found that more than half of the sample did not listened about EBP previously, more than half of the sample had a negative attitudes toward EBP and those nurses was not integrated within EBP activities, 73% of the nurses had not ability to use electronic database, and all 1,097 nurses had not sufficient information about choosing best researches.

The problems that impede of EBP for nursing and medical societies has been reported by Institution of Medicine (2001) in which around 45% of patient did not received professional health care; the implementation of new discovered evidence needs about two decades at least to let the recent of evident researches to be handled and public with nurses and medical stuff worldwide, and health care providers were not adequately prepared to translate recent researches in clinical practice.

Hunt (1996) concluded that there is a wide whole between using the findings of researches and clinical practice; in which an interventional study was conducted to evaluate the effect of educational intervention on nurses’ knowledge and attitudes toward EBP, the pre- test of these educational study was showed that 50% of 49 convenience sample of nurses did not listen about EBP and professional health care provided previously (Varnell, Haas, Duke, and Hudson, 2007). In addition, Melnyk (2006) concluded that the implementation of evidence based practice was little in nursing that explained by Hunt (1996) who documented that there are several factors prevent evidence based practice implementation as: disorientation toward research, lack of beliefs (attitudes) exhibited toward using research, and lack of understanding of research elements.

There are some barriers to EBP were appeared; these barriers limit nurses’ engagement within evidence based practice (Weaver and Sorrells-Jones, 1999). Funk, Champagne, Wiese, and Tornquist (1991) estimated that these barriers had been originated from different sources and organized within four categorical origins; characteristic of the nurse, characteristic of setting, characteristic of research and characteristic of presentation of research. Furthermore, Funk, Champagne, Wiese, and Tornquist (1991) documented that nurse can be considered as a barrier to implement EBP; in which nurses were unaware about principles of research and research process, and nurses had not sufficient time to implement EBP . Moreover, Funk, Champagne, Wiese, and Tornquist (1991) concluded that practice setting can be considered as a barrier to implement EBP; in which hospitals were not provided sufficient facilitation to implement EBP activity within clinical setting, and nurses had not ability to change patient-care procedure without getting permission from hospitals’ authority to change guidelines. Indeed, Funk, Champagne, Wiese, and Tornquist (1991) documented that research and research presentation can be considered as barrier to implement EBP; in which nurses were believed that research elements as introduction, literature review, methodology, statistical analysis, and conclusion were not understandable clearly within articles.

Melnyk (2006) concluded that nurses need applicable teaching strategies to provide nurses with adequate evidence based practice knowledge and skills and provide nurses with positive beliefs (attitudes) toward integration within evidence based practice activity. Di Leonardi (2007) documented that lecture presentation for educational intervention was considered most effective and appropriate teaching strategy; lectures were widely-spread and known perfectly to all universitiescolleges-certificated persons. In addition, Hart, Eaton, Buckner, Morrow, Barrett, Fraser, et, al. (2008) were conducted an educational intervention to teach nurses about nursing research and evidence based practice by using computer-based modules strategy; in which the result was exhibit that the educational intervention improve nurses’ knowledge and skills about using research and evidence based practice, and improve nurses’ attitude toward evidence based practice.

Lacey (1996) was evaluated 870 courses of the English National Board which contain materials enable student nurses to understand research and evidence based practice, with convenience sample of 30 nurses student; 65% of the students were demonstrated that knowledge, skills about research and evidence based practice were significantly improved after the educational intervention. Furthermore, Hundley, Milne, Leighton-Beck, Graham, Fitzmaurice (2000) compared between long term research course (six months) and short term research course (one month); the study conducted by convenience sample of 481 nurses and midwives; the result showed that nurses who integrated within long term research course were exhibited more knowledge, skills, and attitudes toward evidence based practice than respondent received short term research course.

The purposes of this study were to evaluate the effect of educational intervention about evidence based practice and nursing research lectures on the beliefs toward using evidence based practice, to evaluate the effect of educational intervention about evidence based practice and nursing research lectures on the frequency of the implementation of evidence based practice, to determine any differences between two groups (experimental and control group) regard to variables (age, gender, level of education, the experience in clinical area, and the effect of educational intervention that will be implemented), to investigate the variation among socio-demographic variables in response to evidence based practice beliefs and frequency of evidence based practice implementation, and to fixing first block in building EBP team in King Abdulla University Hospital.