Academic literature on the topic 'Nursing practice and evidence'

Doctor of Philosophy<br>Aim and significance: The aim of this research was to investigate how evidence-based practice (EBP) in nursing homes is understood in the context of Taiwan, a non-Western country. There is a growing movement towards using research evidence to inform practice in the nursing profession with variable success. To date, factors that promote or inhibit implementation of EBP in health care have been investigated through research conducted in hospital settings in Western countries. Remarkably little is known about nurses’ experience and perceptions of EBP in residential aged care facilities (RACFs), especially in non-Western countries. Method: The study adopted a mixed method approach. Subjects were recruited from six nursing homes in the Hsinchu district of Taiwan. In Stage 1, 89 registered nurses completed a comprehensive questionnaire specifically developed for this project. It was designed to elicit information about (1) their experience of and attitudes towards research and EBP; (2) the barriers they perceive to its implementation; and (3) what strategies they believe would enhance its implementation in the nursing home setting. In Stage 2, six nursing managers participated in semi-structured in-depth interviews that explored the same topic areas as those in the questionnaire but used an open-ended format which allowed for new themes to emerge. Findings: The majority of nurses and nursing managers expressed positive attitudes towards research and EBP but reported relatively little experience in its implementation. Nurses relied most heavily on knowledge derived from past experience and on interactions with nursing colleagues, medical staff and patients to inform their clinical practice. They identified the main barriers to EBP as: insufficient authority to change practice, their own lack of research knowledge and insufficient time to implement new ideas in the workplace. They believed EBP would be facilitated by: improved access to computers and internet facilities in the workplace; more effective research training; collaboration with academics; and dedicated time to search for and read research articles. As anticipated, nurses viewed the issues from a practical stance in relation to their own time, resources and lack of authority to effect change. Nursing managers expressed similar views to the nurses in relation to attitudes towards EBP implementation. However, they identified barriers which related to aspects of the organizational framework. In particular, they expressed concerns about issues such as budgetary constraints, staff quality (notably the reliance on minimally trained assistants in nursing (AINs) for direct resident care), as well as factors that reflected the wider political and economic context of health care in Taiwan. Conclusion: The findings of this study have implications for research, policy and practice in both Western and non-Western countries. Further research on EBP would be beneficial if conducted in settings other than hospitals, such as RACFs. There remains also the need to examine the potential for EBP in different social-cultural contexts, such as those in non-Western countries. Nursing managers have generally been excluded in previous research but, because of their particular role, there is a need to examine their perspectives of EBP and then compare these with those of the nurses. In Taiwan specifically, policy change is needed at both government and institutional levels to encourage and support the development of protocols and procedures for the implementation of EBP. If EBP was a government requirement for accreditation and a standard for protocols in hospitals and RACFs, it would lead to improved standards of care and cost effectiveness. This study supports the findings of a number of investigations conducted in Western countries which indicate that further education and training in research for nurses may lead to higher standards of patient care, greater job satisfaction and higher staff retention rates.

This study addresses the challenge of preparing undergraduate student nurses to be able to engage profitably in Evidence -based Practice. It focuses on the tension between learning about Evidence-based Practice within the Academy and the competencies and skills required to utilise it in clinical settings. Evidence-based Practice is a dynamic process which has core components and defined steps. Nurse education programmes are required by regulatory bodies to prepare nurses to utilise the best evidence to underpin their practice. However, they provide no specific guidance on how this should be organised and delivered or how it can be measured within nurse education programmes. This study evaluated a teaching module in nurse education which was re-designed to embed Evidence-based Practice into its teaching, learning and assessment strategies. The new module aimed to foster capability for Evidence-based Practice at undergraduate level through specifically modified teaching, learning and assessment strategies; and to evaluate the impact of the intervention on the attitudes, beliefs, knowledge and utilisation of Evidence-based Practice. The study was a pre-test/post-test quasi-experimental design employing two questionnaires administered to the same cohort on two separate occasions. The pre-test was administered immediately before the module commenced; the post-test was administered after the module, following a year-long placement in clinical nursing practice. Participants were also asked two free text response qualitative questions regarding their views on aspects relating to Evidence-based Practice in practice. Results indicated static levels of knowledge, attitudes and beliefs about Evidence-based Practice between pre-test and post-test phases. Declined levels of utilisation were demonstrated on post-test measurement. The findings suggest that programme-wide curricular reform coupled with a focused, structured collaboration with clinical partners is required if Evidence-based Practice is to become embedded in nurse education and practice. A number of theoretical perspectives offer real promise of greater insight and understanding of how nurses learn, know and practice and the factors that can and do affect these characteristics. Such insight could facilitate more sensitive, appropriate and targeted integration of Evidence-based Practice knowledge into practice ensuring its success and sustainability

This thesis presents a body of publications, in the area of critical care nursing, for consideration for the award of Doctor of Philosophy by Publication. The thesis is presented in three chapters: Introduction; Body of Work; and Research, Knowledge, Evidence and Practice. In the first chapter the emergence of evidence-based practice is described, in general. Initially, an overview of the origins and trends of nursing research methodology is provided; the purpose of which is to set in context the body of work. Utilising a narrative approach (Boje, 2001; McCance et aL, 2001; Sandelowski, 199 1; Vezeau, 1994) as a 'personal journal of discovery' I then reflexively describe my own development as a nurse researcher practitioner, drawing on my own publications to illustrate my progress, the development of my thinking, my research practice and the development of my understanding of pragmatice pistemology. The second chapter is comprised of my publications relevant to critical care nursing. Spanning a period of eleven years, they represent my contribution to critical care nursing knowledge. In the concluding chapter I have summarised initially my own contribution to critical care nursing knowledge, before moving on to a more detailed critique of evidence-based practice. Finally I have made recommendations for the way forward. In addition to presenting my body of work, the aim of this PhD is to challenget he current concept of evidence-based practice, arguing that its definition is too narrow to encompass the rage of different types of knowledge that nurses use when caring for critically ill patients. I have utilised my own publications, to demonstrate how a variety of approaches are necessary to provide the best evidence for developing practice. I have positioned my argument within a theoretical understanding of pragmatic epistemology. In this way, I am working towards the development of a science of practice. Simultaneously I am also, to some extent, challenging conventional concepts of what constitutes doctoral level knowledge and how a PhD looks. My conclusion is that critical care nursing knowledge is drawn from many sources, and should be applied in an integrated way that enables practitioners to make a positive difference to the life of patients.Knowledge that is not or cannot be applied to practice is therefore of no value. The valuing of practice knowledge brings with it the requirement that all forms of knowledge (and their relevant methodologies) are considered as equal,in terms of their potential to impact on practice and that nothing should be rejected on paradigmatic grounds. In contemporary healthcare evidence is hierarchically valued and this raises many questions of equity. Where the value of knowledge becomes unequal is when its application to practice is limited. The corollary of a pragmatice pistemology is that it requires a pragmatic process to make it work. For me, at this point in time, the best available is practice development. In summary,this thesis represents a construction of work that makes an original contribution to knowledge. The product of my thesis is a theory of pragmatic epistemology as the basis for a science of practice.

Translating research to practice takes 10-20 years or more and evidence-based practice (EBP) integration remains at 10%-20%, despite recommendations requiring EBP-guided decisions. EBP integration has been associated with up to 30% decreases in healthcare system spending, improved quality outcomes, and increased staff satisfaction. Nurse leaders are accountable for EBP enculturation, yet rate quality and safety as the highest priority and EBP as the lowest. This knowledge gap perpetuates low EBP integration rates and hinders EBP enculturation. Asking whether EBP facilitative interventions for nurse leaders increase scores on organizational culture and readiness, beliefs, and EBP use scales addressed the knowledge gap via this quality improvement, pre/posttest pilot project. Multiple frameworks guided the project: the nursing process, Lewin's change management model, the Johns Hopkins Nursing EBP model, and the Five Practices of Exemplary Leadership-® model. A comprehensive literature search validated the design using EBP facilitators: educational interventions, transformational leadership, strategic planning, and a systems perspective. Pre/posttest data garnered from 14 non-direct care nurse leaders on the Organizational Culture and Readiness for System-Wide Integration of EBP Scale, the EBP Beliefs Scale, and the EBP Implementation Scale was analyzed using 2-sample t tests. Individual questions on the scales revealed statistically significant differences correlating to the facilitative interventions, yet overall aggregate scores did not change significantly. The limited findings contribute to the existing body of knowledge, while positive social implications include resolving public health and safety issues, reversing fiscal irresponsibility, and overcoming resistance to change.

Thesis (Ph. D.)--University of Sydney, 2008.<br>Title from title screen (viewed 11 February 2009). Includes tables and questionnaires. Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Behavioural and Community Health Sciences, Faculty of Health Sciences. Includes bibliographical references. Also available in print form.

Current gaps in nursing practice can decrease by the translation, implementation, and dissemination of evidence-based practice (EBP). The purpose of this project was to provide staff nurses with EBP education and mentoring in identifying and addressing nursing practice issues using EBP to manage patient care. The Advancing Research & Clinical Practice through Close Collaboration (ARCC) and the social cognitive theory were used as a framework to guide this project development, which addressed if medical surgical nurses receiving education in EBP practice led to improved use, implementation, and improved best practice outcomes. Seven randomly selected medical surgical nurses from a local community 200-bed hospital were recruited to participate in this project. The participants were placed in a quiet room and asked to complete a pre ARCC EBP Beliefs Scale survey, review newly developed EBP education tool, and complete a post ARCC EBP Beliefs Scale survey. The EBP Beliefs Scale (EBPB) survey was used pre and post EBP educational tool review and consisted of 16 statements addressing nurses' beliefs about EBP knowledge. This survey also addressed the implementation of EBP into nursing practice. Descriptive statistical analysis was used to analyze the surveys. The results of the survey show a positive correlation between receiving education and mentoring with utilizing EBP in nursing practice. The results of this quality improvement project's social impact will improve collaboration in healthcare organizations and nursing staff to improve the use, translation, and dissemination of EBP projects for patient care improvements and overall improved patient care outcomes.