title: Nurses experience of using scientific knowledge in clinical practice: a grounded theory study.
abstract: BACKGROUND
  Guidelines recommend the use of evidence-based practice in nursing. Nurses are expected to give patients care and treatment based on the best knowledge available. They may have knowledge and positive attitudes, but this does not mean that they are basing their work on evidence-based practice. Knowledge is still lacking about what is needed to successfully implement evidence-based practice.
  
  
  OBJECTIVE
  The aim of this study was to gain more knowledge about what nurses perceive as the most important challenge in implementing evidence-based practice and to explain how they act to face and overcome this challenge.
  
  
  METHODS
  We used classical grounded theory methodology and collected data through four focus groups and one individual interview in different geographical locations in one large hospital trust in Norway. Fourteen registered clinical practice nurses participated. We analysed the data in accordance with grounded theory, using the constant comparative method.
  
  
  RESULTS
  Contextual balancing of knowledge emerged as the core category and explains how the nurses dealt with their main concern, how to determine what types of knowledge they could trust. The nurses' main strategies were an inquiring approach, examining knowledge and maintaining control while taking care of patients. They combined their own experienced-based knowledge and the guidelines of evidence-based practice with a sense of control in the actual situation.
  
  
  CONCLUSIONS
  The grounded theory contextual balancing of knowledge may help us to understand how nurses detect what types of knowledge they can trust in clinical practice. The nurses needed to rely on what they did, and they seemed to rely on their own experience rather than on research.
authors.affiliation: Department of Medicine, Innlandet Hospital Trust, Lillehammer, Norway.
authors.forename: Åste
authors.initials: Å
authors.lastname: Renolen
authors.affiliation: Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway.
authors.forename: Esther
authors.initials: E
authors.lastname: Hjälmhult
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D055318:Evidence-Based Nursing / Q000592:standards*; D005260:Female; D066296:Grounded Theory; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D024802:Nurse's Role / Q000523:psychology*; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000523:psychology*; D036301:Qualitative Research
keywords: clinical practice; contextual; evidence-based practice; experience; focus groups; grounded theory; implementation; nurse; research use