Rolfe Gary, Segrott Jeremy, Jordan Sue
School of Health Science, Swansea University, UK.
J Nurs Manag. 2008 May;16(4):440-51. doi: 10.1111/j.1365-2834.2008.00864.x.
To explore nurses' understanding and interpretation of evidence-based practice (EBP).
EBP has been welcomed into the nursing lexicon without a critical examination of its interpretation by practitioners. The literature suggests that there is a great deal of confusion and contradiction over the meaning and application of EBP. Although work has been conducted on how EBP might be implemented, the general issue of how nurses understand and use EBP is largely unexplored. This paper seeks to examine in depth the understandings of EBP, to enable managers, educationalists and policy makers to implement it more effectively.
All registered nurses, midwives and health visitors in one UK National Health Service (NHS) Trust were asked to complete a questionnaire in October 2006.
Despite a disappointing response rate (8.9%, 218/2438), the survey revealed interesting tensions and contradictions in nurses' understanding of EBP. National and local guidelines, practitioners' own experience and patients' preferences were the main influences on nurses' practice. Published research had relatively little impact, particularly among nurses graded E, F and G and those who had not attended a study day on EBP.
The hierarchies of evidence propounded in local and national guidelines are not adopted by practising nurses, who use other sources of evidence, such as reflection on their own experiences, when making clinical decisions. However, subsuming published evidence to clinical judgement does not contradict the original tenets of EBP.
Unless it is incorporated into national or local guidelines, research has relatively little impact on practice. To develop nursing practice and nursing knowledge, nurse leaders need to foster the synthesis of experiential knowledge and published research, in accordance with the founding principles of the EBP movement.
探讨护士对循证实践（EBP）的理解与阐释。
循证实践已被纳入护理词汇，但从业者对其阐释却未经过严格审视。文献表明，在循证实践的意义和应用方面存在大量混淆与矛盾之处。尽管已开展了关于如何实施循证实践的工作，但护士如何理解和运用循证实践这一总体问题在很大程度上仍未得到探究。本文旨在深入考察对循证实践的理解，以使管理人员、教育工作者和政策制定者能更有效地实施它。
2006年10月，要求英国一家国民健康服务（NHS）信托机构的所有注册护士、助产士和健康访视员填写一份问卷。
尽管回复率令人失望（8.9%，218/2438），但该调查揭示了护士对循证实践理解中有趣的紧张关系和矛盾之处。国家和地方指南、从业者自身经验以及患者偏好是对护士实践的主要影响因素。已发表的研究影响相对较小，尤其是在E级、F级和G级护士以及那些未参加过循证实践学习日的护士当中。
执业护士并未采用地方和国家指南中提出的证据等级体系，他们在做出临床决策时会使用其他证据来源，比如对自身经验的反思。然而，将已发表的证据纳入临床判断并不与循证实践的最初原则相矛盾。
除非研究被纳入国家或地方指南，否则它对实践的影响相对较小。为了发展护理实践和护理知识，护士领导者需要根据循证实践运动的基本原则，促进经验知识与已发表研究的融合。
