Newly graduated nurses' use of knowledge sources in clinical decision-making: an ethnographic study.
OBJECTIVE
To explore which knowledge sources newly graduated nurses' use in clinical decision-making and why and how they are used.


BACKGROUND
In spite of an increased educational focus on skills and competencies within evidence-based practice, newly graduated nurses' ability to use components within evidence-based practice with a conscious and reflective use of research evidence has been described as being poor. To understand why, it is relevant to explore which other knowledge sources are used. This may shed light on why research evidence is sparsely used and ultimately inform approaches to strengthen the knowledgebase used in clinical decision-making.


METHODS
Ethnographic study using participant-observation and individual semistructured interviews of nine Danish newly graduated nurses in medical and surgical hospital settings.


RESULTS
Newly graduates use of knowledge sources was described within three main structures: 'other', 'oneself' and 'gut feeling'. Educational preparation, transition into clinical practice and the culture of the setting influenced the knowledge sources used. The sources ranged from overt easily articulated knowledge sources to covert sources that were difficult to articulate. The limited articulation of certain sources inhibited the critical reflection on the reasoning behind decisions. Reflection is a prerequisite for an evidence-based practice where decisions should be transparent in order to consider if other evidentiary sources could be used.


CONCLUSIONS
Although there is a complexity and variety to knowledge sources used, there is an imbalance with the experienced nurse playing a key role, functioning both as predominant source and a role model as to which sources are valued and used in clinical decision-making. If newly graduates are to be supported in an articulate and reflective use of a variety of sources, they have to be allocated to experienced nurses who model a reflective, articulate and balanced use of knowledge sources.
Department of Nursing, University College of Northern Denmark, Aalborg, Denmark.|Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.
Siri Lygum
SL
Voldbjerg
Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.
Mette
M
Grønkjaer
Centre for Evidence-based Practice South Australia, School of Nursing, University of Adelaide, Adelaide, SA, Australia.
Rick
R
Wiechula
Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.|Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Erik Elgaard
EE
Sørensen
D000884:Anthropology, Cultural; D002983:Clinical Competence; D000066491:Clinical Decision-Making; D003718:Denmark; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009730:Nursing Assessment / Q000458:organization & administration; D009736:Nursing Process / Q000458:organization & administration*; D009741:Nursing Staff, Hospital / Q000458:organization & administration*; D011795:Surveys and Questionnaires
clinical decision-making; critical reflection; knowledge sources; newly graduated nurses; transition