Kueny Angela, Shever Leah L, Lehan Mackin Melissa, Titler Marita G
Luther College, Decorah, IA.
The University of Michigan Hospital and Health Center, Ann Arbor, MI.
J Healthc Leadersh. 2015 Jun 24;7:29-39. doi: 10.2147/JHL.S45077. eCollection 2015.
BACKGROUND/PURPOSE: Nurse managers (NMs) play an important role promoting evidence-based practice (EBP) on clinical units within hospitals. However, there is a dearth of research focused on NM perspectives about institutional contextual factors to support the goal of EBP on the clinical unit. The purpose of this article is to identify contextual factors described by NMs to drive change and facilitate EBP at the unit level, comparing and contrasting these perspectives across nursing units.
This study employed a qualitative descriptive design using interviews with nine NMs who were participating in a large effectiveness study. To stratify the sample, NMs were selected from nursing units designated as high or low performing based on implementation of EBP interventions, scores on the Meyer and Goes research use scale, and fall rates. Descriptive content analysis was used to identify themes that reflect the complex nature of infrastructure described by NMs and contextual influences that supported or hindered their promotion of EBP on the clinical unit.
NMs perceived workplace culture, structure, and resources as facilitators or barriers to empowering nurses under their supervision to use EBP and drive change. A workplace culture that provides clear communication of EBP goals or regulatory changes, direct contact with CEOs, and clear expectations supported NMs in their promotion of EBP on their units. High-performing unit NMs described a structure that included nursing-specific committees, allowing nurses to drive change and EBP from within the unit. NMs from high-performing units were more likely to articulate internal resources, such as quality-monitoring departments, as critical to the implementation of EBP on their units. This study contributes to a deeper understanding of institutional contextual factors that can be used to support NMs in their efforts to drive EBP changes at the unit level.
背景/目的：护士长在促进医院临床科室的循证实践（EBP）方面发挥着重要作用。然而，针对护士长对支持临床科室循证实践目标的机构背景因素的看法的研究却很匮乏。本文的目的是确定护士长所描述的背景因素，以推动变革并促进科室层面的循证实践，同时比较和对比各护理科室的这些观点。
本研究采用定性描述性设计，对9名参与一项大型有效性研究的护士长进行访谈。为了对样本进行分层，根据循证实践干预措施的实施情况、迈耶和戈斯研究应用量表的得分以及跌倒率，从被指定为高绩效或低绩效的护理科室中挑选护士长。采用描述性内容分析法来确定主题，这些主题反映了护士长所描述的基础设施的复杂性以及支持或阻碍他们在临床科室推广循证实践的背景影响因素。
护士长认为工作场所文化、结构和资源是促进或阻碍其监督下的护士使用循证实践并推动变革的因素。一种能清晰传达循证实践目标或监管变化、与首席执行官直接接触且期望明确的工作场所文化，有助于护士长在其科室推广循证实践。高绩效科室的护士长描述了一种结构，其中包括护理特定委员会，使护士能够在科室内部推动变革和循证实践。高绩效科室的护士长更有可能明确指出内部资源，如质量监测部门，对其科室实施循证实践至关重要。本研究有助于更深入地理解机构背景因素，这些因素可用于支持护士长在科室层面推动循证实践变革的努力。
