Promoting evidence-based practice: an organizational approach.
OBJECTIVE
To examine factors influencing the achievement of evidence-based practice.


BACKGROUND
This paper reports on the approach taken by a large teaching hospital in England to promote evidence-based practice. A summary of initiatives spanning a 5 year period is presented in order to set the scene for a recent survey of nurses to review progress made. Consideration is given to how the findings from the survey have been used to inform policy and practice.


METHODS
A survey by self-completed questionnaire was undertaken with a sample of clinical nurses (n = 330). The questionnaire examined the extent to which nurses utilised different sources of knowledge to inform their practice; perceived barriers to accessing evidence-based information and effecting change in practice; and a self-assessment of core skills necessary to underpin evidence-based practice.


RESULTS
Nurses relied most heavily on experiential knowledge gained through their interactions with nursing colleagues, medical staff and patients to inform their practice. Organisational information in the form of policies and audit reports was drawn upon more frequently than research reports. Lack of time, resources and perceived authority to change practice influenced the extent to which nurses utilised formal sources of evidence. Whereas nurses were relatively well skilled at accessing and reviewing research evidence, they were less confident about their ability to change practice.


CONCLUSIONS
Health care organisations need to consider multiple strategies to facilitate and promote evidence-based practice. Managerial support, facilitation, and a culture that is receptive to change are essential.
School of Nursing and Midwifery, The University of Sheffield, Sheffield Formerly Research Fellow in Nursing, Sheffield Hallam University, Sheffield, UK. k.a.gerrish@sheffield.ac.uk
Kate
K
Gerrish
Jane
J
Clayton
D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D004059:Diffusion of Innovation; D004509:Education, Nursing, Continuing / Q000379:methods; D004739:England; D019317:Evidence-Based Medicine / Q000193:education / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006302:Health Services Research; D006801:Humans; D007318:Inservice Training / Q000379:methods; D007400:Interprofessional Relations; D020380:Needs Assessment; D024802:Nurse's Role; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000458:organization & administration / Q000523:psychology; D015279:Organizational Culture; D009936:Organizational Innovation; D009937:Organizational Objectives; D020377:Self Efficacy; D012944:Social Support; D011795:Surveys and Questionnaires; D013997:Time Factors