Implementing evidence‐based nursing practice: a tale of two intrapartum nursing units

Angus, Jan; Hodnett, Ellen; O’Brien‐Pallas, Linda

doi:10.1046/j.1440-1800.2003.00193.x

Cited by 42 publications

(55 citation statements)

References 23 publications

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“…Therefore, systematic reviews of effectiveness studies alone may not be sufficiently sensitive to deliver all the learning necessary to improve the use of research evidence in clinical practice and service improvement. A deeper understanding may be gained by complementing these studies with the findings from social science research that considers the important issues of context and process [32,33]. This review identified a much smaller literature focusing explicitly on getting research evidence into practice] [12-24].…”

Section: Discussionmentioning

confidence: 99%

Effective implementation of research into practice: an overview of systematic reviews of the health literature

2011

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BackgroundThe gap between research findings and clinical practice is well documented and a range of interventions has been developed to increase the implementation of research into clinical practice.FindingsA review of systematic reviews of the effectiveness of interventions designed to increase the use of research in clinical practice. A search for relevant systematic reviews was conducted of Medline and the Cochrane Database of Reviews 1998-2009. 13 systematic reviews containing 313 primary studies were included. Four strategy types are identified: audit and feedback; computerised decision support; opinion leaders; and multifaceted interventions. Nine of the reviews reported on multifaceted interventions. This review highlights the small effects of single interventions such as audit and feedback, computerised decision support and opinion leaders. Systematic reviews of multifaceted interventions claim an improvement in effectiveness over single interventions, with effect sizes ranging from small to moderate. This review found that a number of published systematic reviews fail to state whether the recommended practice change is based on the best available research evidence.ConclusionsThis overview of systematic reviews updates the body of knowledge relating to the effectiveness of key mechanisms for improving clinical practice and service development. Multifaceted interventions are more likely to improve practice than single interventions such as audit and feedback. This review identified a small literature focusing explicitly on getting research evidence into clinical practice. It emphasizes the importance of ensuring that primary studies and systematic reviews are precise about the extent to which the reported interventions focus on changing practice based on research evidence (as opposed to other information codified in guidelines and education materials).

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Section: Discussionmentioning

confidence: 99%

Effective implementation of research into practice: an overview of systematic reviews of the health literature

2011

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“…Several studies examining the impact of context on research implementation in both the nursing [2,23-26] and organizational behaviour literature [27] support the importance of contextual factors to research use. We assessed construct validity of the ACT by examining associations between each of its factors and instrumental research utilization.…”

Section: Methodsmentioning

confidence: 99%

Development and assessment of the Alberta Context Tool

Estabrooks

Squires

Cummings

et al. 2009

BMC Health Serv Res

240

350

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BackgroundThe context of healthcare organizations such as hospitals is increasingly accepted as having the potential to influence the use of new knowledge. However, the mechanisms by which the organizational context influences evidence-based practices are not well understood. Current measures of organizational context lack a theory-informed approach, lack construct clarity and generally have modest psychometric properties. This paper presents the development and initial psychometric validation of the Alberta Context Tool (ACT), an eight dimension measure of organizational context for healthcare settings.MethodsThree principles guided the development of the ACT: substantive theory, brevity, and modifiability. The Promoting Action on Research Implementation in Health Services (PARiHS) framework and related literature were used to guide selection of items in the ACT. The ACT was required to be brief enough to be tolerated in busy and resource stretched work settings and to assess concepts of organizational context that were potentially modifiable. The English version of the ACT was completed by 764 nurses (752 valid responses) working in seven Canadian pediatric care hospitals as part of its initial validation. Cronbach's alpha, exploratory factor analysis, analysis of variance, and tests of association were used to assess instrument reliability and validity.ResultsFactor analysis indicated a 13-factor solution (accounting for 59.26% of the variance in 'organizational context'). The composition of the factors was similar to those originally conceptualized. Cronbach's alpha for the 13 factors ranged from .54 to .91 with 4 factors performing below the commonly accepted alpha cut off of .70. Bivariate associations between instrumental research utilization levels (which the ACT was developed to predict) and the ACT's 13 factors were statistically significant at the 5% level for 12 of the 13 factors. Each factor also showed a trend of increasing mean score ranging from the lowest level to the highest level of instrumental research use, indicating construct validity.ConclusionsTo date, no completely satisfactory measures of organizational context are available for use in healthcare. The ACT assesses several core domains to provide a comprehensive account of organizational context in healthcare settings. The tool's strengths are its brevity (allowing it to be completed in busy healthcare settings) and its focus on dimensions of organizational context that are modifiable. Refinements of the instrument for acute, long term care, and home care settings are ongoing.

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“…The second comparator hospital was not having financial issues. 39 It is quite possible that the hospital's failure to implement the evidence-based practice was associated with the hospital's lack of financial resources.…”

Section: Education and Trainingmentioning

confidence: 99%

“…In the second hospital, where the intervention had some success, there were no financial difficulties and the hospital was actively engaged in the delivery of outreach programs to several cultural community groups. 39 Similarly, a study of Ontario hospitals where nursing clinical best practice guidelines had been implemented over a 2-year period found that providing patient equipment resources, such as pressure relief mattresses and wound care products, was a facilitating factor to the implementation of the guidelines. 21 …”

Section: Resources For Patient Carementioning

confidence: 99%

How do health care organizations take on best practices? A scoping literature review

Innis

Dryden-Palmer

Perreira

et al. 2015

International Journal of Evidence-Based Healthcare

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Several gaps were identified by this review. There is a lack of research on how evidence-based practices may be sustained by organizations. Most of the research done to date has been cross-sectional. Longitudinal research would give insight into the relationship between organizational characteristics and the uptake, implementation, and sustainability of evidence-based practice. In addition, although it is clear that financial resources are required to implement evidence-based practice, existing studies contain a lack of detail about the cost of adopting and using new practices. This scoping review contains a number of implications for healthcare administrators, managers, and providers to consider when adopting and implementing evidence-based practices in healthcare organizations.

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Implementing evidence‐based nursing practice: a tale of two intrapartum nursing units

Cited by 42 publications

References 23 publications

Effective implementation of research into practice: an overview of systematic reviews of the health literature

Effective implementation of research into practice: an overview of systematic reviews of the health literature

Development and assessment of the Alberta Context Tool

How do health care organizations take on best practices? A scoping literature review

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