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.