Implementation of Evidence‐Based Practice From a Learning Perspective

Abstract

Introduction: For many nurses and other health care practitioners, implementing evidencebased practice (EBP) presents two interlinked challenges: acquisition of EBP skills and adoption of evidence-based interventions, and abandonment of ingrained non-evidence-based practices. The aim of this article is to describe two modes of learning and use these as lenses for analysing the challenges of implementing EBP in health care. Theoretical background and applying learning theory to understand the challenges in implementing EBP: Adaptive learning involves a gradual shift from slower, deliberate behaviours to faster, smoother and more efficient behaviours. Developmental learning is conceptualized as a process in the "opposite" direction, whereby more or less automatically enacted behaviours become deliberate and conscious. The mechanisms by which the two modes of learning occur are explained with reference to habit theory. Discussion: From a learning perspective, EBP will be best supported by means of adaptive learning that yields a habitual practice of EBP such that it becomes natural and instinctive to instigate EBP in appropriate contexts by means of seeking out, critiquing and integrating research into everyday clinical practice as well as learning new interventions best supported by empirical evidence. However, the context must also support developmental learning that facilitates disruption of existing habits to ascertain that the execution of the EBP process and/or the use of evidence-based interventions in routine practice is carefully and consciously considered to arrive at the most appropriate response.

How the dual process model of human cognition can inform efforts to de‐implement ineffective and harmful clinical practices: A preliminary model of unlearning and substitution

“…Others have applied dual process models to learning, unlearning, and implementation of evidence‐based practices . For example, Nilsen et al, drawing from learning and habit theory, propose 2 types of learning—adaptive and developmental.…”

Implementation of Implementation Science Knowledge: The Research‐Practice Gap Paradox

“…Implementation knowledge is not taught in healthcare practitioners’ basic training and only seldom in continuing professional education. Although the literature on evidence‐based implementation is expanding and courses are increasingly being made available, these do not focus on practical issues or guidance on how to actually use implementation science knowledge in implementation endeavors (Nilsen, Neher, Ellström, & Gardner, ). Ovretveit, Mittman, Rubenstein, and Ganz () have noted that healthcare practitioners are not expected to be knowledgeable about implementation science.…”

Indian nurses’ views on a collaborative model of best practices: Evidence-based practice, job satisfaction, learning environment, and nursing quality

“…What is crucial for their success is that EBP projects be long-lasting and adequately facilitated, since their implementation always involves a process of learning. [51] If the focus of research into EBP does not shift to a more practical focus, suspicion could grow that measurements of EBP are proceeding for their own sake, instead of for the sake of improving the quality of nursing care.…”