Clinical nurse managers understanding and use of evidence based practice

The quest for evidence-based practice in the Irish healthcare system has not abated as theorists, policy makers, academics, educationalists, strategists, and clinicians strive to determine and ultimately achieve evidence-based practice. Contemporary scholarly literature presents a plethora of research papers outlining the steps to achieving Evidence-Based Practice (EBP). Many theorists concur that professions, including nursing, adopted the Evidence Based Medicine (EBM) model to achieving EBP; yet, there is no consensus that following sequential steps will achieve EBP. Having reviewed the literature I concluded that many of the research studies focused on research utilisation without consideration of other sources of evidence that inform evidence-based decision-making, including clinical expertise and the patient’s perspective. This research study utilised a qualitative descriptive approach based on naturalistic inquiry to gain insight into mid-level and frontline nurse managers’ understandings of EBP. In-depth interviews were conducted with nurse managers (n= 23) in three acute hospitals. Findings are presented using three main themes, ‘Nurse Managers’ Perceptions of Evidence-Based Practice’, ‘Nurse Managers’ Views on Enablers and Barriers to EBP’, and ‘Nurse Managers’ Opinions on making EBP a Reality’. Data were subsequently presented using categories, which captured participants’ understandings of evidence-based practice. ‘Knowing the patient’ was considered fundamental to evidence-based decision-making. ‘Achieving positive patient outcomes through effective clinical governance’ incorporated service user involvement in policy formation and sharing clinical decision-making. ‘Interdisciplinary collaboration and communication’ was perceived as contributing to evidence-based practice. ‘Policies, procedures, protocols and guidelines’ (PPPGs) were linked to EBP, although the extent to which PPPGs contributed to EBP was not confirmed. The current environment of staff shortages impacted on clinical nurse managers’ abilities to achieve EBP, as fundamental patient care took precedence over strategic issues including leadership. The small sample size limits generalisation of the findings; however, participants’ accounts of EBP provide further understandings into enablers and barriers of EBP. Recommendations include re-instating the role of the ward sister/charge nurse as the gatekeeper of quality safe patient care and revising the scope of mid-level nurse managers such that these professionals have clear responsibilities for EBP. Furthermore nurses at all levels must value the contribution of truly knowing the patient, which is the critical first step to achieving evidence-based decision-making