Rycroft-Malone Jo
Health Services Research, Centre for Health-Related Research, School of Healthcare Sciences, College of Health & Behavioural Sciences, University of Wales, Bangor, UK.
J Nurs Manag. 2008 May;16(4):404-8. doi: 10.1111/j.1365-2834.2008.00859.x.
This commentary considers the shift in evidence-informed practice away from the individual practitioner to an acknowledgement that context is also important.
The view of practitioner as 'rational agent' capable of searching, appraising and translating research evidence into individual practice has dominated the literature. However, a growing body of research leads us to question whether evidence use is indeed an individual activity.
Key research studies were purposively selected to build the case for the arguments made.
Apart from attitude, there is little to indicate that any potential individual determinants influence research use. Views of what constitutes evidence for evidence-based practice have become more inclusive and sophisticated. Evidence tends to be contextually bound and individually interpreted and particularized within that context. As such, evidence use is beginning to be recognized more widely as a contingent process, which varies across setting and time. A number of contextual factors have been found to be potentially influential including culture and leadership. CONCLUSION(S) AND IMPLICATIONS FOR NURSING MANAGEMENT: It cannot be assumed that evidence-based resources such as clinical guidelines will be accepted at face value by practitioners. Developing the skills of individuals to critically appraise research will not automatically lead to greater evidence use. Reviewing organizations' capacity for evidence-informed practice as a system property and cultural factor may lead to insights about the barriers and facilitators to evidence use. Investing in the capability of key individuals at multiple levels of the organization as leaders of evidence-based practice activities may be one promising organizational strategy.
本评论探讨了循证实践从关注个体从业者转向承认背景同样重要的转变。
将从业者视为能够搜索、评估并将研究证据转化为个体实践的“理性主体”这一观点在文献中占据主导地位。然而，越来越多的研究使我们质疑证据的应用是否确实是一项个体活动。
有目的地选取了关键研究以论证所提出的观点。
除态度外，几乎没有迹象表明存在任何潜在的个体因素会影响研究的应用。对于循证实践中何为证据的观点已变得更加包容和复杂。证据往往受背景限制，在该背景下会被个体解读并具体化。因此，证据的应用开始被更广泛地视为一个视情况而定的过程，因环境和时间而异。已发现一些背景因素可能具有影响力，包括文化和领导力。
不能假定从业者会照单全收诸如临床指南等循证资源。培养个体批判性评估研究的技能不会自动带来更多的证据应用。将组织的循证实践能力作为一种系统属性和文化因素进行审视，可能会洞察到证据应用的障碍和促进因素。在组织的多个层面投资培养关键个体作为循证实践活动领导者的能力，可能是一项有前景的组织战略。
