Research Projects

Managing to Implement Evidence-Based Practice in Nursing?

Researcher

Joyce E. Wilkinson, Centre for Public Policy & Management
University of St Andrews.

Background

The imperative to use evidence-based practice as a means of improving patient care, clinical outcomes and manage scarce health care resources is not new. However, the progress made towards implementing evidence into nursing has been slow. Various initiatives to increase the use of evidence-based practice, including providing individual nurses with research knowledge and skills, have had a limited effect. There has been a growing awareness that implementing evidence is a complex process often hampered by organisational factors. Research undertaken into the implementation process in nursing has shown that nurses feel poorly supported by managers in this aspect of their work and also that they lack the authority to make changes in practice. In addition, some feel that managers block implementation of evidence-based practice. Changes to the structure of health care management over the last 20 years have had an effect on the roles and responsibilities of nurse managers, indeed in some Trusts these posts have ceased to exist. Review of the literature relating to implementing evidence in nursing did not reveal any empirical work relating to the role of nurse managers in implementing evidence-based practice in nursing. Therefore, the research question is

"What is the role of nurse managers in implementing evidence-based practice and what strategies do they use to achieve this goal?"

Methods

Case study methodology, using interviews, documentary analysis and observation, has been used in an in-depth study of the role of nurse managers in relation to evidence-based practice, in four Scottish Acute Trusts. Pettigrew's (1985) Contextual Approach to the study of change provided the theoretical basis for the study. In addition, this has provided structure to both data collection and analysis in attempting to understand the context, content and process of evidence implementation and the role of nurse managers in this.

Findings

Data analysis is underway. Provisional findings from two study sites suggest that the role of nurse managers in evidence implementation is significant. However it is a role that is often described by them as more 'facilitative' and they are not involved in direct implementation of evidence-based practice. Changes to the structure of nurse management do appear to have a detrimental effect putting greater distance between practitioners and managers than previously existed. Both managers and nurses felt that this had been significant. Nurse managers are also involved in supporting evidence implementation through the creation of new posts, including practice development nurse posts, with these staff being directly involved in evidence implementation.

Data analysis is ongoing and further findings will be reported in due course.

Funding

This study is funded as a PhD studentship (2001-2004) by the CSO of the Scottish Executive.