Promoting evidence-based practice: an organizational approach

AIM: To examine factors influencing the achievement of evidence-based practice. BACKGROUND: This paper reports on the approach taken by a large teaching hospital in England to promote evidence-based practice. A summary of initiatives spanning a 5 year period is presented in order to set the scene for a recent survey of nurses to review progress made. Consideration is given to how the findings from the survey have been used to inform policy and practice. METHODS: A survey by self-completed questionnaire was undertaken with a sample of clinical nurses (n = 330). The questionnaire examined the extent to which nurses utilised different sources of knowledge to inform their practice; perceived barriers to accessing evidence-based information and effecting change in practice; and a self-assessment of core skills necessary to underpin evidence-based practice. FINDINGS: Nurses relied most heavily on experiential knowledge gained through their interactions with nursing colleagues, medical staff and patients to inform their practice. Organisational information in the form of policies and audit reports was drawn upon more frequently than research reports. Lack of time, resources and perceived authority to change practice influenced the extent to which nurses utilised formal sources of evidence. Whereas nurses were relatively well skilled at accessing and reviewing research evidence, they were less confident about their ability to change practice. CONCLUSION: Health care organisations need to consider multiple strategies to facilitate and promote evidence-based practice. Managerial support, facilitation, and a culture that is receptive to change are essential.     

Developing evidence-based clinicians

Evidence-based care has heralded an advancement for health with extensive rhetoric and incentives encouraging clinicians to become active participants in practice change. This paper explores two mechanisms-research utilization and systematic reviews--as processes to develop empowerment in clinicians, and develop an ethos of basing practice on research. The intent of these approaches is to create an environment that enables clinicians to seek solutions to practice problems, inform practice decisions and develop practice policy using evidence from research. The goal is to develop evidence-based clinicians who remain active and interested in their practice and who are committed to promoting the application of research to practice. The strengths and weaknesses of these methods are explored within two case studies where they are applied to the management of hypothermia and the efficacy of postoperative observations. Key points of application for each of the methods are outlined in the conclusions.     

Developing nursing research

Following an information-giving workshop to senior nurses within the hospital by the Research Nurse Group, a research-practice gap was identified. To ascertain the extent of this, a survey with an explanatory letter was distributed to all qualified nurses within the Trust. Although initially the response rate was thought to be low, it compared favourably to other studies. Results showed that 45% of respondents did not feel confident to undertake a research project but more than 80% felt that research was a part of their clinical role and was relevant to nursing. Three-quarters of respondents also acknowledged that they had read a paper resulting in a change in their clinical practice. When asked about skills and resources, 29% did not know how to conduct a literature search and 39% were unable to critically appraise a paper. Furthermore, 62% did not know what resources were available when considering a research project of their own. It was concluded therefore, that the research-practice gap does exist and nurses need encouragement and support in the implementation of the research process. In view of these conclusions, an action plan was developed.     

The transforming power of research on practice: involving practitioners in analysis

Nurses were invited to participate in the interpretation of transcribed interviews during the data analysis phase of a phenomenological study. They worked with the investigators in learning and using hermeneutic methods to identify and interpret meanings embedded in exemplars. Their expert clinical knowledge of the field of practice added rigor to the analytical process and depth to the understanding achieved. As the analysis progressed, the nurses began to spontaneously describe transformation occurring in their practice. Involving nurses in data analysis has transformative power on practice.     

Behavioural intention and user acceptance of research evidence for Queensland nurses: Provision of solutions from the clinician

In order to maintain high standards of care in practice, renal nurses must become effective utilisers of research and evidence based practice. Many models for effective evidence based implementation have been published in an attempt to encourage a positive cultural shift in meeting this necessary nurse competency. Yet in reality a great disparity still exists between what the profession knows to be an ideal world and what they are actually able to achieve. This paper presents an evaluation of that reality through the eyes of Queensland renal nurses. Initially known barriers to research or evidence based practice utilisation will be discussed in addition to some home grown solutions from those clinicians. Nurses who participated in this study presented some unique perspectives on known barriers to research utilisation, re-affirming those detailed within the literature and conversely revealing new concepts worth additional exploration. New concepts warranting a broader in-depth exploration included the influence of family on nurse decision making and the effect of overseas trained health professionals on necessary change. In addition Queensland renal nurse's overwhelming supported the need for a filtered or a controlled approach to research activity naming this model in post interview discussions “The Spillway Model”.     

Connecting what we do with what we know: building a community of research and practice

How to think about, develop, maintain and optimize connections between research and practice remains a vexed and contested area in the increasingly complex multidisciplinary and inter-professional practice that constitutes contemporary healthcare and service delivery. A body of literature challenging linear and passive notions of research uptake has emerged which views research uptake as a dynamic, contextualized and active process. This paper explores the development of a successful and exciting community of research and practice involving a university and an aged care organization in Australia. The community of research and practice is premised on dynamic, contextual and active interaction between research and practice; where the categories of research and practice are not mutually exclusive or static; and where community is more than just a structure to facilitate collaborative research projects. It is proposed that the idea of a community of research and practice is a useful one in terms of seeking to better understand and provide strategies for knowledge translation between researchers and practitioners and those who are both.     

Physiotherapists' use of evidence based practice: a cross-national study

This study investigated clinical physiotherapists' reasons for their use of treatment techniques, with a particular focus on their utilisation of journal review and research literature. A questionnaire was completed by 180 physiotherapists in England and 141 physiotherapists in Australia. Despite the greater prevalence of pre-registration degree respondents in Australia, there were no differences between the two national groups in their reasons given for choice of treatment techniques. The basis of over 90% of each groups' choice of techniques reflected what was taught during their initial training. Experience of treatment effects on prior patients, and information gained in practice-related courses, were also primary reasons. Research literature ranked least in importance as a basis for choosing techniques, and review articles fared little better. The results indicated that these physiotherapists relied mainly on information gained from formal pre- and post- registration courses. By implication, the most obvious means of influencing physiotherapists' attitudes to research utilisation lies with those responsible for physiotherapy education. Copyright © 1997 Whurr Publishers Ltd.     

Translating disability-related research into evidence-based advocacy: the role of people with disabilities

Purpose. The purpose of this article is to make a case for the inclusion of people with disabilities in disability research and in important decisions relating to the utilisation of the research results.

Methods. This is a review article, involving extensive review of both international and local published materials, commissioned research, government policy and related official documents, as well as the use of anecdotal evidence based on the author's own previous research work, experience, knowledge and observations.

Central argument. For disability research to influence positive changes in their lives, people with disabilities ought to play a central role at all stages of the research process, and in decisions made regarding the dissemination and use of the research results.

Conclusions. If properly utilised, research can have positive influence in the lives of people with disabilities. However, this can only be achieved if people with disabilities participate in determining the scope, depth and the conduct of disability research, and the utilisation of the research results. In this way, people with disabilities, in collaboration with their non-disabled counterparts, are likely to ensure that research results have a bearing on the policies and programmes designed for them.     

长沙市三级甲等综合医院非内分泌科护士糖尿病护理知信行的调查研究

目的:了解长沙市三级甲等综合医院非内分泌科护士糖尿病护理知信行的现状。方法:采用多级整群随机抽样的方法,抽取长沙市4所三级甲等综合医院非内分泌科护士702名,通过自行设计的临床护士糖尿病护理知识、态度、行为问卷进行调查分析。结果 :非内分泌科护士的糖尿病护理知识、态度、行为标准得分分别为(48.11±13.47)分、(78.75±10.94)分和(83.63±9.23)分;知识及格率为19.94%(140人)、良好率为1.28%(9人),态度良好率为72.65%(510人),行为良好率为86.32%(588人);年龄、职称和工作年限是非内分泌科护士知信行的影响因素。结论:三级甲等综合医院非内分泌科护士对糖尿病病人的护理行为较规范,但糖尿病护理知识掌握情况和认知态度有待进一步改善和提高。应加强对其进行糖尿病知识的培训,进一步提高临床护士糖尿病护理的知识水平、认知态度和护理行为质量。     

HPE as a Field: Implications for the Production of Compelling Knowledge

Issue: Research in education, including health professions education, has long struggled with the competing concerns of academic and practice-based stakeholders. Inspired partially by the work of Stokes and other theorists in science and technology studies, we propose that discussions about compelling research in health professions education might be usefully advanced by considering what it would mean if the community framed itself as a knowledge-producing field instead of aligning itself with either disciplinary or practical interests. Evidence: Efforts to foreground disciplinary or practical interests in education research have been unproductive, leading to the privileging of one group's expertise at the expense of the other. Currently proposed principles and practices for responding to the divergence between these interests, such as knowledge translation or practitioner inquiry, have yielded comparatively little in the way of mutual satisfaction. Implications: As a field, health professions education research would not privilege either disciplinary or practical interests, nor would it attempt any sort of definitive blueprint for resolution to the tension. Rather it would regard these interests as inherently interconnected and, therefore, always in tension to varying degrees. The challenge for a field is not to resolve that tension but to harness it in productive ways through collaboration, negotiation, and compromise, through ever-shifting engagements that will not necessarily be comfortable but will nonetheless foster knowledge that resonates with all parts of the community.     

A model for research-based practice

• ? Nursing practice is based on experience, tradition, intuition, common sense, untested theory and sometimes research.
• ? There are a number of reasons why nurses may see research as irrelevant to their practice.
• ? This paper provides a model identifying possible strategies to help nurses develop research-based practice.

     

Language, research and nursing practice

AIM OF THE PAPER: This paper highlights the centrality of language in constructing knowledge. It aims at making us sensitive to the political nature of knowledge production and the complex power relationships that may emerge as a result of our efforts to create new knowledge. BACKGROUND: Science, as understood here, is a linguistic construction, rather than a mirror reflection of reality. A number of examples are presented, demonstrating the complex ways in which language is central in shaping all our attempts to know, science included, and nursing practice. CONCLUSION: Based on the analysis presented in this paper an argument is made for a substantial re-thinking of nursing research and its relationship to nursing practice. Research needs to be an integral part of everyday nursing practice, a way of posing questions and reflecting on answers. Further, nurses need to be aware of the potentially coercive nature of knowledge as well as its liberating effect.