Renolen Åste, Hjälmhult Esther
Department of Medicine, Innlandet Hospital Trust, Lillehammer, Norway.
Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway.
Scand J Caring Sci. 2015 Dec;29(4):633-41. doi: 10.1111/scs.12191. Epub 2015 Mar 9.
Guidelines recommend the use of evidence-based practice in nursing. Nurses are expected to give patients care and treatment based on the best knowledge available. They may have knowledge and positive attitudes, but this does not mean that they are basing their work on evidence-based practice. Knowledge is still lacking about what is needed to successfully implement evidence-based practice.
The aim of this study was to gain more knowledge about what nurses perceive as the most important challenge in implementing evidence-based practice and to explain how they act to face and overcome this challenge.
We used classical grounded theory methodology and collected data through four focus groups and one individual interview in different geographical locations in one large hospital trust in Norway. Fourteen registered clinical practice nurses participated. We analysed the data in accordance with grounded theory, using the constant comparative method.
Contextual balancing of knowledge emerged as the core category and explains how the nurses dealt with their main concern, how to determine what types of knowledge they could trust. The nurses' main strategies were an inquiring approach, examining knowledge and maintaining control while taking care of patients. They combined their own experienced-based knowledge and the guidelines of evidence-based practice with a sense of control in the actual situation.
The grounded theory contextual balancing of knowledge may help us to understand how nurses detect what types of knowledge they can trust in clinical practice. The nurses needed to rely on what they did, and they seemed to rely on their own experience rather than on research.
指南推荐在护理中采用循证实践。护士应基于现有的最佳知识为患者提供护理和治疗。他们可能具备知识和积极的态度，但这并不意味着他们的工作基于循证实践。对于成功实施循证实践所需的条件仍缺乏了解。
本研究的目的是更深入地了解护士认为在实施循证实践中最重要的挑战是什么，并解释他们如何应对和克服这一挑战。
我们采用经典的扎根理论方法，通过在挪威一家大型医院信托机构的不同地理位置进行的四个焦点小组讨论和一次个人访谈收集数据。14名注册临床实践护士参与其中。我们根据扎根理论，采用持续比较法对数据进行分析。
知识的情境平衡成为核心类别，解释了护士如何处理他们的主要担忧，即如何确定他们可以信任的知识类型。护士的主要策略是探究方法、审视知识并在照顾患者时保持控制。他们将自己基于经验的知识和循证实践指南与实际情况中的控制感相结合。
扎根理论的知识情境平衡可能有助于我们理解护士如何在临床实践中识别他们可以信任的知识类型。护士需要依靠他们所做的事情，而且他们似乎更依赖自己的经验而非研究。
