title: Sustainability in changing clinical practice promotes evidence-based nursing care.
abstract: OBJECTIVE
  To examine the relationship between sustained work with quality improvement (QI) and factors related to research utilization in a group of nurses.
  
  
  METHODS
  The study was designed as a comparative survey that included 220 nurses from various health care organizations in Sweden. These nurses had participated in uniformly designed 4-day basic training courses to manage a method for QI.
  
  
  METHODS
  A validated questionnaire covering different aspects of research utilization was employed. The response rate was 70% (154 of 220). Nurses in managerial positions at the departmental level were excluded. Therefore, the final sample consisted of 119 respondents. Four years after the training courses, 39% were still involved in audit-related activities, while 61% reported that they had discontinued the QI work (missing = 1).
  
  
  RESULTS
  Most nurses (80-90%) had a positive attitude to research. Those who had continued the QI work over a 4-year period reported more activity in searching research literature compared with those who had discontinued the QI work (P = 0.005). The QI-sustainable nurses also reported more frequent participation in research-related activities, particularly in implementing specific research findings in practice (P = 0.001). Some contextual differences were reported: the QI-sustainable nurses were more likely to obtain support from their chief executive (P = 0.001), consultation from a skilled researcher (P = 0.005) and statistical support (P = 0.001). Within the broader health care organization, the existence of a research committee and a research and development strategy, as well as access to research assistant staff, had a tendency to be more common for nurses who had continued the QI work.
  
  
  CONCLUSIONS
  Sustainability in QI work was significantly related to supportive leadership, facilitative human resources, increased activity in seeking new research and enhanced implementation of research findings in clinical practice. It appears that these factors constitute a necessary prerequisite for professional development and the establishment of evidence-based practice.
authors.affiliation: Department of Women's and Children's Health and Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. lwa@du.se
authors.forename: Lars
authors.initials: L
authors.lastname: Wallin
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Boström
authors.forename: Karin
authors.initials: K
authors.lastname: Wikblad
authors.forename: Uwe
authors.initials: U
authors.lastname: Ewald
mesh_terms: D004509:Education, Nursing, Continuing; D019317:Evidence-Based Medicine; D006801:Humans; D009731:Nursing Audit; D015403:Nursing Evaluation Research