Regardless of the information and efforts taken place to promote evidence-based practices (EBP), there may be potential barriers in any organization/hospital/clinic sustaining the practices. One barrier may be uncertainty or a lack of understanding or knowledge due to a pre-formed bias or current understanding may be or become a barrier which ties in with another potential barrier of resistance per Ginex writing, “because we’ve always done it this way” (2018). To this, Ginex informs us that one voice alone is not sufficient to change, create and sustain a change of practice (2018) and continues of the importance therefore for support (internal and external stakeholders) to see it through and continue it. The capstone project this student chose includes interventions which, although utilized in several countries including a retrospective study done in three US hospitals and two hospitals in Honduras which assessed the outcome of patients receiving a multi-medication approach (MMA) including ivermectin and resulted in positive outcomes for patients who received ivermectin/MMA with the standard of care compared to patients only receiving the standard of care (Pascua et al., 2021).
Strategies to overcome barriers is to remain kind and courteous, no jugular veins quivering nor eyes bulging as the information is provided as has been seen on both “sides” of the information. The information speaks for itself. It simply needs a voice. There are already to amazing MDs in our Valley which have utilized early interventions and have saved countless lives in our community and shared some of their information at a County Board of Supervisors meeting with the public (Tyson & Fareed, 2021). They are the key persons who have made a difference since the beginning of Covid-19. Provision of the many resources and studies proclaiming the prophylactic or illness benefits of off-brand medications including Boldescu et al who provided vital antiviral information pre-Covid, regarding ivermectin which was/is proven to be safe, broad spectrum, effective and cost efficient against such viruses as Dengue, Zika Virus, Yellow fever, River Blindness, and elephantiasis (2017). An example via Kerr et al. is the Brazilian city-wide prophylactic provision {if the person and/or their MD approved/desired it} which resulted in city-wide death rates falling (2020). A supplementation that is not often told of is vitamin D which in the study by Abrishami et al. resulted in “significant” differences for Covid-19 positive persons with to have much higher lung-involvement issues if they were vitamin D deficient and subsequently “significantly” less lung involvement when patients had sufficient vitamin D levels (2021). These are brief glimpses of the information that is readily available. It simply needs to be further told, informed and educated about.
Abrishami. A., Dalili, N., Torbati, P. M., Asgari, R., Arab‑Ahmadi, M., Behnam, B., & Sanei‑Taheri, M. (2021). Possible association of vitamin D status with lung involvement and outcome in patients with COVID‑19: A retrospective study. European Journal of Nutrition. 60, 2249–2257. https://doi.org/10.1007/s00394-020-02411-0
Boldescu, V., Behnam, M., A. M., Vasilakis, N., & Klein, C. D. (2017). Broad-spectrum agents for flaviviral infections: Dengue, Zika and beyond. National Review of Drug Discovery, 16(8), 565-576
Ginex, P. (2018). Overcome barriers to applying an evidence-based process for practice change. Oncology Nursing Society (ONS). ONS Voice. https://voice.ons.org/news-and-views/overcome-barriers-to-applying-an-evidence-based-process-for-practice-change
Kerr, L, Cadegiani, F. A., Baldi, F., Lobo, R. B., Assagra, W. L. O., Proenca, F. C., Kory, P., Hibberd, J. A., & Chamie-Quintero, J. J. (2020). Ivermectin prophylaxis used for COVID-19: A citywide, Prospective, observational study of 223,128 subjects using propensity score matching. Cureus, 14(1). doi:10.7759/cureus.21272
Pascua, V. F., Diaz, O., Medina, R., Contreras, B., Mistroff, J., Espinosa, D., Sekhon, A., Paz Handal, D., Pineda, E., Vargas Pineda, M. and Pineda, H. (2021). A multi-mechanism approach reduces length of stay in the ICU for severe COVID-19 patients. PloS one, 16(1). https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245025
Tyson, B. & Fareed,
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