Ellis Isabelle, Howard Peter, Larson Ann, Robertson Jeanette
Combined Universities Centre for Rural Health, University of Western Australia, Australia.
Worldviews Evid Based Nurs. 2005;2(2):84-93. doi: 10.1111/j.1741-6787.2005.04088.x.
This article examines the process of translating evidence into practice using a facilitation model developed by the Western Australian Centre for Evidence Based Nursing and Midwifery.
Using the conceptual framework Promoting Action on Research Implementation in Health Services (PARIHS), the aims of the study were (1) to explore the relative and combined importance of context and facilitation in the successful implementation of a new evidence-based clinical practice protocol and (2) to examine the establishment of more lasting change to individuals and organizations that resulted in greater incorporation of the principles of evidence-based practice (EBP).
A pre-workshop, semi-structured telephone survey with 16 nurse managers in six rural hospitals; a summative evaluation immediately post-workshop with 54 participants; and follow-up, semi-structured interviews with 23 workshop participants.
The contexts in each of the participating hospitals were very different; of the six hospitals, only one had not implemented the new protocol. Five had reviewed their practices and brought them in line with the protocol developed at the workshop. The rate of adoption varied considerably from 2 weeks to months. The participants reported being better informed about EBP in general and were positive about their ability to improve their practice and search more efficiently for best practice information. Underlying motivations for protocol development should be included in the PARIHS framework. IMPLICATIONS FOR EDUCATION: Good facilitation appears to be more influential than context in overcoming the barriers to the uptake of EBP.
本文探讨了运用西澳大利亚循证护理与助产中心开发的促进模式将证据转化为实践的过程。
运用促进卫生服务研究实施行动（PARIHS）概念框架，本研究的目的是：（1）探讨背景和促进因素在成功实施新的循证临床实践方案中的相对重要性和综合重要性；（2）研究如何在个人和组织中建立更持久的变革，从而使循证实践（EBP）原则得到更大程度的纳入。
对六家农村医院的16名护士长进行会前半结构化电话调查；会后立即对54名参与者进行总结性评估；对23名参加研讨会的人员进行随访半结构化访谈。
各参与医院的背景差异很大；六家医院中只有一家未实施新方案。五家医院对其做法进行了审查，并使其与研讨会上制定的方案保持一致。采用率差异很大，从2周到数月不等。参与者报告说，总体上他们对循证实践有了更多了解，并对自己改进实践和更有效地搜索最佳实践信息的能力持积极态度。方案制定的潜在动机应纳入PARIHS框架。对教育的启示：在克服循证实践应用障碍方面，良好的促进似乎比背景更具影响力。
