Duff Jed, Cullen Laura, Hanrahan Kirsten, Steelman Victoria
Queensland University of Technology, Nursing & Midwifery Research Centre, Royal Brisbane & Women's Hospital, Butterfield St, Herston, QLD 4029 Australia.
University of Newcastle, School of Nursing and Midwifery, University Drive, Callaghan, NSW 2308 Australia.
Implement Sci Commun. 2020 Oct 6;1:85. doi: 10.1186/s43058-020-00070-0. eCollection 2020.
Despite the available research to inform nursing practice, many patients still fail to receive evidence-based care. Several evidence-based practice (EBP) models have been developed to guide nurses through the steps in the process, yet these models have not been uniformly adopted or consistently used. The original purpose of this research was to gather perspectives and experiences of nurses using the Iowa Model of EBP to help inform its introduction into other practice settings. As a more in-depth understanding was gained, the emphasis of the study shifted towards understanding the determinants of the EBP environment.
The study was conducted in an 800-bed comprehensive academic medical centre in the USA with a 25-year history of using the Iowa Model of EBP. Semi-structured in-depth interviews were conducted with twelve nurses from various roles to ascertain their perspectives and experiences using the model. The interview transcripts were reviewed alongside relevant published literature and internal documents in a process of synthesising, theorising, and conceptualising. Data were collected during the first half of 2019.
Four determinants of the local EBP environment were identified from the perspectives and experiences of participants: (1) the importance of a shared model to guide staff through the EBP process; (2) support for EBP in the form of education, hands-on training, and knowledge infrastructure; (3) active team facilitation by direct care nurses, nurse managers, nurse specialists, and nurse scientists; and (4) a culture and leadership that encourages EBP.
Introducing an EBP model is an essential first step for an organisation to improve consistent and reliable evidence-based care; to be most effective, this should be done in conjunction with efforts to optimise the EBP environment.
尽管有现有研究为护理实践提供依据，但仍有许多患者未能接受循证护理。已经开发了几种循证实践（EBP）模型来指导护士完成该过程中的各个步骤，然而这些模型并未得到统一采用或持续使用。本研究的最初目的是收集护士使用爱荷华州循证实践模型的观点和经验，以帮助将其引入其他实践环境。随着理解的深入，研究重点转向了解循证实践环境的决定因素。
该研究在美国一家拥有800张床位的综合性学术医疗中心进行，该中心有25年使用爱荷华州循证实践模型的历史。对来自不同岗位的12名护士进行了半结构化深度访谈，以确定他们使用该模型的观点和经验。在综合、理论化和概念化的过程中，结合相关已发表文献和内部文件对访谈记录进行了审查。数据于2019年上半年收集。
从参与者的观点和经验中确定了当地循证实践环境的四个决定因素：（1）共享模型对指导员工完成循证实践过程的重要性；（2）以教育、实践培训和知识基础设施形式提供的循证实践支持；（3）直接护理护士、护士长、专科护士和护理科学家的积极团队促进作用；（4）鼓励循证实践的文化和领导力。
引入循证实践模型是组织改善持续且可靠的循证护理至关重要的第一步；为了达到最佳效果，这应与优化循证实践环境的努力相结合。
