Using action research to construct national evidence-based nursing care guidance for gerontological nursing

Aim. This paper explores the development of a low‐cost, involving methodology for constructing nursing‐focused evidence‐based national care guidance, known as Best Practice Statements, the intended users of which are gerontological nurses practising throughout Scotland. Design. The Best Practice Statement construction methodology forms one cycle in a five‐year longitudinal action research study that aims to achieve evidence‐based nursing, facilitate professional networking to support practice development and promote the principles and practice of gerontological nursing. Achieving these aims involved designing a virtual Practice Development College. Methods. A Community of Practice comprising practising gerontological nurses, expert advisors, academic teaching and research nurses collaborated in face‐to‐face meetings and in the virtual Practice Development College to delineate and refine the procedural model for Best Practice Statement construction. Focus groups, telephone interviews, analysis of on‐line archives and documentary outputs formed the analytic dataset. Results. Qualitative analysis indicated that, from the perspective of the community of practice, the emerging methodology facilitated the melding of knowledge sources reflecting the dominant evidence hierarchy with other forms of evidence valued by gerontological nurses, in the Best Practice Statement. Relevance to clinical practice. Current methods of care guidance construction rarely address the concerns of nurses and the evidence from which guidelines are developed is narrowly defined with regard to inclusion and acceptability. In contrast this model focuses on nursing issues, embraces a wider definition of evidence and ensures that the published Best Practice Statements are credible and achievable in gerontological practice, where they are tested and refined as an inherent aspect of the development process.     

A review of evidence-based practice, nursing research and reflection: levelling the hierarchy

Aim. This paper examines the evidence‐based practice movement, the hierarchy of evidence and the relationship between evidence‐based practice and reflective practice. Background. Evidence‐based practice is equated with effective decision making, with avoidance of habitual practice and with enhanced clinical performance. The hierarchy of evidence has promoted randomized control trials as the most valid source of evidence. However, this is problematic for practitioners as randomized control trials overlook certain types of knowledge that, through the process of reflection, provide useful information for individualized and effective practice. Method. A literature search was undertaken using CINAHL, medline and Ovid electronic databases in early 2006. The search terms used were: evidence‐based practice, research evidence, evidence for practice, qualitative research, reflective practice, reflection and evidence. Other sources included handpicking of books on evidence‐based practice, reflection and research. Only material written in English was included. Findings. The hierarchy of evidence that has promoted randomized control trials as the most valid form of evidence may actually impede the use of most effective treatment because of practical, political/ideological and epistemological contradictions and limitations. Furthermore, evidence‐based practice appears to share very similar definitions, aims and procedures with reflective practice. Hence, it appears that the evidence‐based practice movement may benefit much more from the use of reflection on practice, rather than the use of the hierarchical structure of evidence. Conclusion. Evidence‐based practice is necessary for nursing, but its’ effective implementation may be hindered by the hierarchy of evidence. Furthermore, evidence‐based practice and reflection are both processes that share very similar aims and procedures. Therefore, to enable the implementation of best evidence in practice, the hierarchy of evidence might need to be abandoned and reflection to become a core component of the evidence‐based practice movement. Relevance to clinical practice. Provides an elaborated analysis for clinical nurses on the definition and implementation of evidence in practice.     

Evidence‐based nursing: clarifying the concepts for nurses in practice

Aim. To provide a critical analysis of key concepts associated with evidence‐based nursing (EBN) to substantiate an operational definition for nurses to use in practice. Background. Despite the plethora of literature surrounding what evidence‐based nursing is and is not and how it differs from its cousins, evidence‐based medicine and evidence‐based practice, nurses still struggle to get evidence into practice. Several reasons for this have been reported, for example, a lack of understanding about what evidence‐based nursing means or time to engage with and apply the evidence into practice. Design. An in‐depth critical review and synthesis of literature was undertaken. Method. Using the key words; evidence‐based nursing, evidence‐based medicine and evidence‐based practice 496 articles were yielded. These articles were limited to 83. Using Burns and Grove’s (2001) phased approach to reviewing the literature the articles were critically reviewed and categorised into key concepts and themes. Results. The in‐depth critical review and synthesis of the literature demonstrated that evidence‐based nursing could be defined as a distinct concept. The review clearly shows that for evidence‐based nursing to occur, nurses need to be aware of what evidence‐based nursing means, what constitutes evidence, how evidence‐based nursing differs from evidence‐based medicine and evidence‐based practice and what the process is to engage with and apply the evidence. Conclusion. The in‐depth critical review and synthesis of the evidence‐based nursing literature reinforces the need to consolidate a position for nursing in the evidence‐based field. The review confirms that evidence‐based nursing can be defined and conceptualised; however, for nurses to engage and apply with the evidence‐based processes they need to be informed of what these are and how to engage with them in practice. Relevance to clinical practice. This paper examines the concept of evidence‐based nursing and its application to clinical practice.     

Conceptions of evidence, evidence-based medicine, evidence-based practice and their use in nursing: independent nurse prescribers' views

Aim. The purpose of this study was to explore nurses’ conceptions of evidence and evidence‐based practice, whether there are differences between evidence‐based practice and evidence‐based medicine and to identify the uptake of research evidence in the workplace. Background. The use and comprehension of the term ‘evidence‐based practice’ in relation to nursing shows remarkable variation. Numerous definitions are provided, some tend to be closely related to the concept ‘evidence‐based medicine’. Independent nurse prescribers need to be able to understand the concept of evidence‐based practice to utilize and apply this concept in order to provide adequate medication management of their patients. Method. Data were generated by focus group interview and open question questionnaire and analysed by analytical abstraction. Results. Nurses offered a variety of views on the use and uptake of evidence in the workplace. Some nurses acknowledged that they did not read research papers but were aware that they used a lot of evidence in their practice. Nurses had difficulty differentiating evidence‐based practice from evidence‐based medicine. Conclusions. Nurses were familiar with the research process but not the canons of evidenced‐based practice. The data generated indicate different levels of evidence are used by nurses. This may be a reflection of the level of intrigue of the nurses involved. Relevance to clinical practice. The education and training of independent nurse prescribers should include the exploration of evidence from randomized controlled trials and from naturalistic studies and their contribution to evidenced‐based practice and evidence‐based medicine. Both concepts need to be explored in relation to the medication management of patients.     

Integrating the online nursing evidence‐based information resources for evidence‐based nursing study in China

At present Chinese nurses could not get the up‐to‐date and high‐quality evidences efficiently and conveniently due to language barrier and other practical difficulties. This program built a Chinese website of integrated evidence‐based network information resources for EBN studies. Researchers hope to provide practical guidance and advice for nurses in non‐English‐speaking countries..     

国外循证实践组织管理模式的研究进展及对我国的启示

通过阐述研究与实践合作促进模式、健康服务领域研究成果应用的行动促进框架和医疗机构与高等院校合作的促进方式,分析国外成功的循证实践组织管理促进模式,探讨如何在我国医院护理管理中多方面、多角度促进循证护理实践发展.     

Nursing based evidence: moving beyond evidence-based practice in mental health nursing

Various authors suggest mental health nursing is dominated by knowledge borrowed from psychiatry, pharmacology and the behavioural sciences. These disciplines favour knowledge developed using quantitative methodologies so they and evidence-based practice (EBP) and evidence-based nursing (EBN), increasingly called for in mental health nursing, fit seamlessly together. Nevertheless, as these movements dismiss qualitative approaches to knowledge (evidence) development, I argue against the move toward EBP/EBN in mental health nursing. This is because the specialty's primary interests - human experiences of illness/health care and human relationships, often do not lend themselves to being quantitatively researched. Using nursing examples, I demonstrate how qualitative research, wholly unacceptable in relation to EBP/EBN quality of evidence scales, is indispensable to mental health nursing. The need for evidence arising from qualitative research in no way precludes the need for quantitatively derived evidence. Indeed, the specialty's twofold interest - the work of nurses with clients and the explication of phenomena which inform practice, require diverse knowledge and thus, diverse research approaches. This twofold interest defines the area of mental health nursing practice, and knowledge informing it is referred to as nursing based evidence (NBE). Because it values multiple approaches to knowledge development, NBE provides a way to articulate the specialty's distinct contribution to the health care of people experiencing mental illness and advances mental health nursing.     

A critical realist approach to knowledge: implications for evidence-based practice in and beyond nursing

This paper will identify some of the key conceptual tools of a critical realist approach to knowledge. I will then apply these principles to some of the competing epistemologies that are prevalent within nursing. There are broadly two approaches which are sometimes distinct from each other and sometimes inter-related. On one side, there is the view that all healthcare interventions should be judged on the principles of randomised controlled trials and the other is a preoccupation with language in which healthcare interventions are subjected to a discursive interrogation. These debates are configured through the idea of a hierarchy of knowledge that is accorded uncritical acceptance by some and virulent distaste by others. I will argue that the notion of hierarchy is problematic and is largely argued for in unproductive epistemological terms. What is required is a shift towards a theory that emphasises the contextual nature of the ways that knowledge is produced and disseminated. In other words, there is no single hierarchy of knowledge, but there are multiple hierarchies of knowledge.