Addressing the Practice Context in Evidence-Based Practice Implementation: Leadership and Climate

Implementation of evidence-based practices (EBP) is complicated with barriers, many of which are associated with the context of care. However, little is known regarding social dynamic context factors (e.g., leadership and climate) that affect implementation. As leaders of patient care units, nurse managers have a pivotal role in fostering unit climates supportive of implementation of EBPs into care delivery; however, nurse managerial leadership and unit climate are widely overlooked in this area of science. The purposes of this study were to: 1) describe nurse manager EBP competencies, nurse manager EBP leadership behaviors, and unit climates for EBP implementation; 2) examine the unique contributions of nurse manager EBP leadership behaviors and nurse manager EBP competencies in explaining unit climate for EBP implementation; and 3) examine the unique contributions of these social dynamic context factors in explaining patient outcomes. A multi-site, multi-unit cross sectional design was used in this study. Institutional review board approvals at the investigator’s site and at each participating hospital were obtained prior to collecting data from a sample of 287 staff nurses and 23 nurse managers from 24 medical-surgical units in 7 acute care hospitals, geographically dispersed across the Northeast and Midwest United States. While controlling for key confounding variables and nested effects of units in hospitals, nurse manager EBP leadership behaviors (b= 0.64, p < .0001) and EBP competency (b=-0.22, p= .003) explained 50.2% of variance in unit climate for EBP implementation. In models explaining unit fall rates, unit climates for EBP implementation demonstrated the largest effect (b=-0.86, p<.01). Post hoc mediation analyses provided preliminary evidence suggesting the relationship between nurse manager EBP leadership behaviors and fall rates is mediated by unit climate for EBP implementation. The study identified a need for future work to address nurse manager EBP competency, nurse manager EBP leadership behaviors, and unit climates for EBP implementation in acute care medical-surgical units. This study is the first to describe nurse manager EBP competencies, nurse manager EBP leadership behaviors, and nursing unit climate for EBP implementation. Equipped with EBP leadership behaviors and competencies, nurse managers likely foster practice climates more conducive for EBP implementation resulting in patient receipt of evidence-based care and improved patient outcomes. Future work to develop interventions addressing these social dynamic context factors are needed as well as studies to test the effect of these context factors on implementation processes and outcomes.PHDNursingUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/138458/1/clayshu_1.pd