Determinants of an Evidence-Based Practice Environment: An Interpretive Description

Abstract

Background Despite the available research to inform nursing practice many patients still fail to receive care that is evidence-based. A number of evidence-based practice (EBP) models have been developed to guide nurses through the steps in the process, yet these models have not been uniformly adopted or consistently used. The original purpose of this research was to gather perspectives and experiences of nurses using the Iowa Model of EBP to help inform its introduction into other practice settings. As a deeper understanding was gained the emphasis of the study shifted towards understanding the determinants of the EBP environment.Method The study was conducted in a 800 bed comprehensive academic medical centre with a 25 year history of using the Iowa Model of EBP. Semi-structured in-depth interviews were conducted with twelve nurses from various roles to ascertain their perspectives and experiences of using the model. The interview transcripts were reviewed alongside relevant published literature and internal documents in a process of synthesising, theorising, and conceptualising. Data were collected during the first four months of 2019.Results The determinants of the local EBP environment were clustered into four themes: 1) The importance of a shared model to guide staff through the EBP process; 2) Support for EBP in the form of education, hands-on training, and knowledge infrastructure; 3) Active team facilitation by direct care nurses, nurse managers, nurses specialists, and nurse scientists; and 4) A culture and leadership that encourages EBP.Conclusion Introducing an EBP model is an important first step for an organisation to improve consistent and reliable evidence-based care; to be most effective, this should be done in conjunction with efforts to optimise the EBP environment.