Facilitating the implementation of evidence-based practice through contextual support and nursing leadership

Abstract

Background/purposeNurse managers (NMs) play an important role promoting evidence-based practice (EBP) on clinical units within hospitals. However, there is a dearth of research focused on NM perspectives about institutional contextual factors to support the goal of EBP on the clinical unit. The purpose of this article is to identify contextual factors described by NMs to drive change and facilitate EBP at the unit level, comparing and contrasting these perspectives across nursing units.MethodsThis study employed a qualitative descriptive design using interviews with nine NMs who were participating in a large effectiveness study. To stratify the sample, NMs were selected from nursing units designated as high or low performing based on implementation of EBP interventions, scores on the Meyer and Goes research use scale, and fall rates. Descriptive content analysis was used to identify themes that reflect the complex nature of infrastructure described by NMs and contextual influences that supported or hindered their promotion of EBP on the clinical unit.ResultsNMs perceived workplace culture, structure, and resources as facilitators or barriers to empowering nurses under their supervision to use EBP and drive change. A workplace culture that provides clear communication of EBP goals or regulatory changes, direct contact with CEOs, and clear expectations supported NMs in their promotion of EBP on their units. High-performing unit NMs described a structure that included nursing-specific committees, allowing nurses to drive change and EBP from within the unit. NMs from high-performing units were more likely to articulate internal resources, such as quality-monitoring departments, as critical to the implementation of EBP on their units. This study contributes to a deeper understanding of institutional contextual factors that can be used to support NMs in their efforts to drive EBP changes at the unit level.

A review of the role of nurse leadership in promoting and sustaining evidence-based practice

“…Nurse managers clearly have a role in the implementation of new practices, processes, and activities in clinical settings and, as such, are the primary gatekeepers of EBP for the profession (Bleich & Kist, ; Fleiszer et al., ; Innis & Berta, ; Kueny, Titler, Mackin, & Shever, ; Stetler, Ritchie, Rycroft‐Malone, & Charns, ). They are often responsible for implementing new practices, processes, and activities in their organisations (Bleich & Kist, ; Fleiszer et al., ; Innis & Berta, ; Kueny et al., ; Stetler et al., ). To promote EBP, both leadership and facilitation interventions are needed (Dogherty, Harrison, & Graham, ; Fleiszer et al., ; Sandström, Borglin, Nilsson, & Willman, ).…”

Routines for change: how managers can use absorptive capacity to adopt and implement evidence-based practice

“…, Kueny et al . ). The construct of absorptive capacity routines has been used to understand how health‐care organisations implement new practices (Berta & Baker , Berta et al .…”

“…This framework highlights important absorptive capacity metaroutines and routines that nurse managers might put in place to support the identification, adoption, implementation, adaptation and replication of evidence-based practices. As leaders within healthcare organisations, nurse managers are ideally situated to use these routines to foster the adoption and use of new practices (Stetler 2004, Fleiszer et al 2015, Kueny et al 2015. Nurse managers can ensure that there are organisational members who are committed to scanning the environment for new ideas to improve patient care, as this has been shown to increase the ª 2016 John Wiley & Sons Ltd uptake of evidence-based practice (Panzano & Roth 2006, Berta et al 2010.…”

“…Despite the promise of evidence-based practices for health-care improvement, the literature shows that all too often patient care is not based on the current best scientific evidence and that it can take over a decade for research findings to be adopted and used by healthcare organisations (Grol & Grimshaw 2003, Okafor & Thomas 2008, Smith et al 2013. Nurses are lead-ers in the adoption and implementation of evidencebased practice within health-care organisations, and it is nurse managers who are often responsible for implementing new practices within their organisations in a variety of health-care settings (Stetler et al 2014, Bleich & Kist 2015, Fleiszer et al 2015, Kueny et al 2015. The construct of absorptive capacity routines has been used to understand how health-care organisations implement new practices (Berta & Baker 2004, Berta et al 2013.…”

Implementation leadership: A concept analysis

“…A number of barriers have been identified that contribute to this gap, including unfavourable attitudes towards EBPs, inaccessibility to technology and computer systems, limited training on finding and implementing research knowledge and strained resources (Grimshaw, Eccles, Lavis, Hill, & Squires, ; Tacia, Biskupski, Pheley, & Lehto, ). Another important barrier is lack of awareness of the surrounding or contextual factors that may support or thwart efforts to implement and sustain EBPs (Kueny, Shever, Lehan Mackin, & Titler, ). Deeper understanding of these factors and their impact on the uptake of EBPs has become a major research focus for implementation science in the past decade (Eccles et al, ).…”