Understandings of and experiences with evidence‐based practice in practice among nurses in a surgical department: A constructivist approach

Abstract

Aim and objectives To explore nurses’ constructions of the concept of evidence‐based practice through their understandings of and experiences with evidence‐based practice in a clinical care setting. Background The primary purpose of evidence‐based practice is high‐quality patient outcomes. However, the adoption of evidence‐based practice is described as a complex process, and research shows that evidence‐based practice is not translated into practice. Research often explores facilitators and barriers of implementing and adopting evidence‐based practice. Yet there is limited knowledge on how nurses construct the concept in practice. Design This study has a constructivist approach and follows COREQ guidelines. Method Ten semi‐structured interviews with 26 nurses were conducted in 2019. Data were analysed with an emic and inductive approach. Results Three key constructions emerged. Understandings of evidence‐based practice were based on the original concept of evidence‐based medicine. This included the hierarchy of evidence which was perceived as an inflexible concept not encompassing the nursing care. However, while not using the term evidence‐based practice, the nurses were doing evidence‐based practice portrayed through outcomes from management‐supported nursing‐based projects and incorporated reflections and discussions into weekly meetings. A discrepancy between a theoretical understanding and a practical doing of evidence‐based practice appeared and was especially evident when the nurses’ primary evidence sources consisted of the immediate options, for example asking colleagues or following accessible guidelines. Searching for evidence was central in their theoretical understanding but not an incorporated part of their daily work tasks. Conclusion The nurses’ constructions of evidence‐based practice indicate a discrepancy between the theoretical understanding of evidence‐based practice and the practical doing of evidence‐based practice, which hinders the basis of working according to the concept. Relevance to clinical practice Theoretical discussions of evidence‐based practice within the nursing field remain academic, as nurses in practice construct the concept on standards from evidence‐based medicine.

Implementing Evidence Informed Practice Changes

“…23,[26][27][28] Nurse-led research and EBP projects have demonstrated benefits in clinical settings, [29][30][31] yet only an estimated 25% of clinical decisions are made based on evidence, and an even lower percentage results in major changes within the nursing profession. [32][33][34][35] These low implementation rates indicate that the challenges in translating research findings and evidence into practice include issues beyond those of individual knowledge and skill development. Although it may be argued that widespread, rapid-cycle changes occurred during the COVID-19 pandemic (eg, procedures, staffing models, resource allocation), many resulted from necessity rather than enduring paradigm shifts.…”

“…Although there is much research on the abilities of individual nurses in regard to EBP, the importance of the context in which interventions are to occur cannot be overstated 23,26-28 . Nurse-led research and EBP projects have demonstrated benefits in clinical settings, 29-31 yet only an estimated 25% of clinical decisions are made based on evidence, and an even lower percentage results in major changes within the nursing profession 32-35 . These low implementation rates indicate that the challenges in translating research findings and evidence into practice include issues beyond those of individual knowledge and skill development.…”

Acute care nurses' experience in providing evidence‐based care for patients with laparotomy wounds: A scoping review

“…The educational level attainment of acute care nurses from Turkey was positively associated with awareness of procedures and knowledge of evidence‐based wound care 20 . Nevertheless, nurses' theoretical knowledge of EBC does not habitually translate into providing EBC 30,34 . An Australian study reported that most acute care nurses (75.4%) sought the advice of wound specialists in contrast to clinical guidelines (60.7%) for information on EBC 19 .…”

“…Despite the introduction of standardised surgical site management guidelines, 29 acute care nurses' rely on practice‐based experience, challenging consistent, EBC delivery. 30 , 31 , 32 , 33 The educational level attainment of acute care nurses from Turkey was positively associated with awareness of procedures and knowledge of evidence‐based wound care. 20 Nevertheless, nurses' theoretical knowledge of EBC does not habitually translate into providing EBC.…”

“… 20 Nevertheless, nurses' theoretical knowledge of EBC does not habitually translate into providing EBC. 30 , 34 An Australian study reported that most acute care nurses (75.4%) sought the advice of wound specialists in contrast to clinical guidelines (60.7%) for information on EBC. 19 Clinicians have circumstantially used tried‐and‐true wound care approaches due to out‐of‐date knowledge.…”