Aims and objectives: To describe the process of implementing evidence-based practice (EBP) in a clinical nursing setting. Background: EBP has become a major issue in nursing, it is insufficiently integrated in daily practice and its implementation is complex. Design: Participatory action research. Method: The main participants were nurses working in a lung unit of a rural hospital. A multi-method process of data collection was used during the observing, reflecting, planning and acting phases. Data were continuously gathered during a 24-month period from 2010 to 2012, and analysed using an interpretive constant comparative approach. Patients were consulted to incorporate their perspective. Results: A best-practice mode of working was prevalent on the ward. The main barriers to the implementation of EBP were that nurses had little knowledge of EBP and a rather negative attitude towards it, and that their English reading proficiency was poor. The main facilitators were that nurses wanted to deliver high-quality care and were enthusiastic and open to innovation. Implementation strategies included a tailored interactive outreach training and the development and implementation of an evidence-based discharge protocol. The academic model of EBP was adapted. Nurses worked according to the EBP discharge protocol but barely recorded their activities. Nurses favourably evaluated the participatory action research process. Conclusions: Action research provides an opportunity to empower nurses and to tailor EBP to the practice context. Applying and implementing EBP is difficult for front-line nurses with limited EBP competencies. Relevance to clinical practice: Adaptation of the academic model of EBP to a more pragmatic approach seems necessary to introduce EBP into clinical practice. The use of scientific evidence can be facilitated by using pre-appraised evidence. For clinical practice, it seems relevant to integrate scientific evidence with clinical expertise and patient values in nurses’ clinical decision making at the individual patient level.
The aim of the research reported in this thesis was to gain knowledge about the implementation of evidence‐based practice (EBP) in nursing to find a way to integrate shared decision making (SDM) with EBP in a chronic care environment in nursing, and to develop a strategy for an integrated approach of EBP and SDM in daily nursing practice in the individual aftercare for cancer survivors.
Within eGovernment, trust in electronic stored information (ESI) is a necessity. In the last decades, most organizations underwent substantial reorganization. The integration of structured data in relational databases has improved documentation of business transactions and increased data quality. That integration has improved accountability as well. Almost 90% of the information that organizations manage is unstructured (e.g., e-mail, documents, multimedia files, etc.). Those files cannot be integrated into a traditional database in an easy way. Like structured data, unstructured ESI in organizations can be denoted as records, when it is meant to be (and used as) evidence for organizational policies, decisions, products, actions and transactions. Stakeholders in eGovernment, like citizens, governments and courts, are making increasing demands for the trustworthiness of this ESI for privacy, evidential and transparency reasons. A theoretical analysis of literature of information, organization and archival science illustrates that for delivering evidence, reconstruction of the past is essential, even in this age of information overload. We want to analyse how Digital Archiving and eDiscovery contribute to the realization of trusted ESI, to the reconstruction of the past and to delivering evidence. Digital Archiving ensures (by implementing and managing the ‘information value chain’) that: [1] ESI can be trusted, that it meets the necessary three dimensions of information: quality, context and relevance, and that [2] trusted ESI meets the remaining fourth dimension of information: survival, so that it is preserved for as long as is necessary (even indefinitely) to comply to privacy, accountability and transparency regulations. EDiscovery is any process (or series of processes) in which (trusted) ESI is sought, located, secured and searched with the intent of using it as evidence in a civil or criminal legal case. A difference between the two mechanisms is that Digital Archiving is implemented ex ante and eDiscovery ex post legal proceedings. The combination of both mechanisms ensures that organizations have a documented understanding of [1] the processing of policies, decisions, products, actions and transactions within (inter-) organizational processes; [2] the way organizations account for those policies, decisions, products, actions and transactions within their business processes; and [3] the reconstruction of policies, decisions, products, actions and transactions from business processes over time. This understanding is extremely important for the realization of eGovernment, for which reconstruction of the past is an essential functionality. Both mechanisms are illustrated with references to practical examples.
