A descriptive, exploratory study of knowledge utilization among experienced staff nurses in an acute care setting

Despite a plethora of knowledge utilization literature, information is lacking on how staff nurses select and transfer new knowledge to clinical practice. In pilot work interviews, eight experienced cardiac nurses in a Northeastern community hospital identified sixteen knowledge utilization examples, reflecting four processes (Traditional, Comparative Questioning, Active Comparison/Analysis and Expansion, Personal Experiential). A descriptive exploratory study, including interviews over nine months with three experienced float nurses was used to refine pilot processes, identify additional ones, variations in processes used across units and influencing factors. Thirteen examples were identified in which gaining new knowledge resulted in changes in a nurse\u27s thinking/acting in clinical situations. Two new processes emerged, flowing from each nurse\u27s float role perception, as task-doer and staff-helper, and embedded in a daily practice approach organized around tasks and timed routines, provided through task-focused, episodic care. Knowledge-Seeking was the most frequently occurring: nurses actively seek knowledge needed for immediate clinical tasks. In Problem-Solving , nurses encounter unexpected clinical situations and use problem-solving to obtain knowledge for immediate use. In another process, similar to pilot work (Active Comparison/Analysis and Expansion), nurses observe a situation differing from a mental image, build a new image and anticipate use. Two pilot processes were confirmed. In Traditional , new knowledge is presented by organizational decision makers; later, nurses recognize similarities between this knowledge and a clinical situation and apply the knowledge. Reflective steps occur when new knowledge is related to established procedures. In Personal Experiential, nurses have personal experiences leading to changes in thinking about similar clinical situations. Additionally, nurses often incorporated a cognitive step, comparison by similarity, to arrive at decisions on knowledge use. No differences appeared in processes used by nurses across units. Influencing factors related to knowledge (relevance, presentation) supported the literature; additional factors were identified for individual (biography, perception of role, definition of clinical situation, personal experience) and context (task-focused situation, resource availability). Findings are interpreted based on nurses\u27 biographies, role perceptions and approach to practice. Knowledge utilization images should be broadened to incorporate multiple processes, nurses\u27 biographies and orientations to nursing. Suggestions for developing resource personnel and providing unit-based knowledge are included