Newman M, Papadopoulos I, Sigsworth J
Chase Farm Hospital NHS Trust & School of Health, Middlesex University, London, UK.
Intensive Crit Care Nurs. 1998 Oct;14(5):231-8. doi: 10.1016/s0964-3397(98)80634-4.
This paper reports the findings of a study which aimed to identify the barriers to evidence-based practice in an acute National Health Service (NHS) trust. The study was carried out as part of an action research project designed to promote evidence-based practice.
A rapid organizational appraisal design was used. This involved formal and informal interviews, focus groups, and observation of staff interactions at meetings and in clinical practice in an acute hospital NHS trust. Interviews were undertaken with key stakeholders within the organization and focus groups held with nurse managers, audit staff, staff nurses, and junior medical staff. Observation took place in meetings and in clinical areas.
At an organizational level, the main issues identified were: (1) evidence-based practice was a low management priority, (2) problems with dissemination, (3) inadequate systems for personal and professional development, (4) difficulties in the management of innovations, (5) accessing evidence and resource constraints. At the individual practice level, the main issues were motivation, a lack of clarity about roles and practice, and a culture of practice which emphasizes 'routine' patient care.
The results of this study demonstrate that structures and cultures within organizations can be important barriers to evidence-based practice. Factors which are external to individual trusts are also important. Existing hierarchical structures both in the NHS and within and between the different professional groups, are manifest in the existence of a largely deferential culture which emphasizes the routine in practice decision making. Given this reality, organizations will have to adopt multiple strategies to facilitate and promote the use of evidence in practice decision making.
本文报告了一项研究的结果，该研究旨在确定国民保健服务（NHS）急性信托机构中基于证据的实践的障碍。该研究是作为一项旨在促进基于证据的实践的行动研究项目的一部分进行的。
采用了快速组织评估设计。这包括正式和非正式访谈、焦点小组以及对一家急性医院NHS信托机构会议和临床实践中工作人员互动的观察。对该组织内的关键利益相关者进行了访谈，并与护士经理、审计人员、注册护士和初级医务人员进行了焦点小组讨论。观察在会议和临床区域进行。
在组织层面，确定的主要问题有：（1）基于证据的实践在管理上的优先级较低；（2）传播问题；（3）个人和专业发展体系不完善；（4）创新管理困难；（5）获取证据和资源限制。在个人实践层面，主要问题是动机、角色和实践不明确以及强调“常规”患者护理的实践文化。
本研究结果表明，组织内的结构和文化可能是基于证据的实践的重要障碍。个别信托机构外部的因素也很重要。国民保健服务体系内以及不同专业群体内部和之间现有的等级结构，体现在一种很大程度上强调实践决策常规性的顺从文化的存在。鉴于这一现实，组织将不得不采取多种策略来促进和推动在实践决策中使用证据。
