Abstract

Background

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.

Method

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.

Results

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.

Conclusion

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.

Peer Review reports

Contributions to the literature

• The findings from this research support the idea that EBP is most effective in a supportive practice environment.

• A supportive practice environment includes EBP education and training, team facilitation, and a supportive culture and leadership.

• Organisations wishing to implement an EBP model should do so in conjunction with efforts to optimise the practice environment.

Show more

Background

Evidence-based practice (EBP) is considered the gold standard of care, and as such, it is now an expectation of patients, regulatory agencies, and healthcare funders. Despite the abundance of research to inform clinical practice, many patients still fail to receive evidence-based care. Population-level estimates of the quality of health care are limited, but two landmark studies, one from the USA [1] and one from Australia [2], estimate adherence to clinical practice guidelines at 55% and 57%, respectively. Both studies audited a nationwide random sample of medical records to compare the care delivered with nationally endorsed guidelines. The studies found that almost four out of every ten people do not get evidence-based care, or worse still, get care that is known to be ineffective, or even harmful [1, 2].

There have been many reasons put forward as to why it is so challenging to provide evidence-based care. One of the most obvious is the fact that new evidence is being generated at an ever-increasing rate. It is estimated that nearly one million new articles are posted on PubMed annually [3]. Healthcare professionals face the challenge of providing care while also finding, appraising, and integrating new evidence into their routine practice. Unfortunately, for many clinicians, the environments they work in are not always conducive to this [4].

Several models have been developed to guide nurses through the steps necessary for EBP [5]. Although they vary in explicit criteria, they generally