Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0318 Oslo, Norway; Department of Medicine, Innlandet Hospital Trust, Lillehammer, Norway.
Faculty of Public Health, Inland Norway University of Applied Sciences, Postboks 400, 2418 Elverum, Norway,.
Int J Nurs Stud. 2018 Jan;77:179-188. doi: 10.1016/j.ijnurstu.2017.09.006. Epub 2017 Sep 12.
Evidence-based practice is considered a foundation for the provision of quality care and one way to integrate scientific knowledge into clinical problem-solving. Despite the extensive amount of research that has been conducted to evaluate evidence-based practice implementation and research utilization, these practices have not been sufficiently incorporated into nursing practice. Thus, additional research regarding the challenges clinical nurses face when integrating evidence-based practice into their daily work and the manner in which these challenges are approached is needed.
The aim of this study was to generate a theory about the general patterns of behaviour that are discovered when clinical nurses attempt to integrate evidence-based practice into their daily work.
We used Glaser's classical grounded theory methodology to generate a substantive theory.
The study was conducted in two different medical wards in a large Norwegian hospital. In one ward, nurses and nursing assistants were developing and implementing new evidence-based procedures, and in the other ward, evidence-based huddle boards for risk assessment were being implemented.
A total of 54 registered nurses and 9 assistant nurses were observed during their patient care and daily activities. Of these individuals, thirteen registered nurses and five assistant nurses participated in focus groups. These participants were selected through theoretical sampling.
Data were collected during 90h of observation and 4 focus groups conducted from 2014 to 2015. Each focus group session included four to five participants and lasted between 55 and 65min. Data collection and analysis were performed concurrently, and the data were analysed using the constant comparative method.
"Keeping on track" emerged as an explanatory theory for the processes through which the nurses handled their main concern: the risk of losing the workflow. The following three strategies were used by nurses when attempting to integrate evidence-based practices into their daily work: "task juggling", "pausing for considering" and "struggling along with quality improvement".
The "keeping on track" theory contributes to the body of knowledge regarding clinical nurses' experiences with evidence-based practice integration. The nurses endeavoured to minimize workflow interruptions to avoid decreasing the quality of patient care provided, and evidence-based practices were seen as a consideration that was outside of their ordinary work duties.
循证实践被认为是提供高质量护理的基础，也是将科学知识融入临床问题解决的一种方式。尽管已经进行了大量研究来评估循证实践的实施和研究利用情况，但这些实践并没有充分融入护理实践中。因此，需要进一步研究临床护士在将循证实践融入日常工作中所面临的挑战，以及他们处理这些挑战的方式。
本研究旨在生成一种理论，说明临床护士在试图将循证实践融入日常工作时所表现出的一般行为模式。
我们使用格拉斯的经典扎根理论方法生成了一个实质性理论。
该研究在挪威一家大医院的两个不同的医疗病房进行。一个病房的护士和护理助理正在开发和实施新的循证程序，另一个病房则在实施循证风险评估小组板。
共有 54 名注册护士和 9 名助理护士在他们的病人护理和日常活动中被观察。其中 13 名注册护士和 5 名助理护士参加了焦点小组。这些参与者是通过理论抽样选择的。
数据收集于 2014 年至 2015 年期间进行的 90 小时观察和 4 次焦点小组会议。每次焦点小组会议包括 4 到 5 名参与者，持续 55 到 65 分钟。数据收集和分析是同时进行的，数据采用恒定性比较方法进行分析。
“保持正轨”成为一个解释性理论，说明护士处理主要关注点（即失去工作流程的风险）的过程。护士在试图将循证实践融入日常工作时使用了以下三种策略：“任务杂耍”、“暂停思考”和“在质量改进中挣扎”。
“保持正轨”理论有助于增加关于临床护士实施循证实践经验的知识体系。护士努力减少工作流程中断，以避免降低提供的患者护理质量，并且将循证实践视为超出其日常工作职责的考虑因素。
