Integration of evidence-based practice in hospital nursing practice: A grounded theory study of clinical nurses' and their ward leaders' challenges and patterns of behaviour

Abstract

Despite extensive research aimed at facilitating evidence-based practice, it has not been sufficiently integrated into the nursing workplace. Thereby, quality of care, patient safety, and disease outcomes may suffer. Additional research regarding clinical nurses’ and their leaders’ challenges in integrating evidence-based practice, and the strategies used to resolve these challenges, is needed.

The purpose of the thesis was to gain an understanding of clinical nurses’ and their leaders’ challenges and patterns of behaviour when attempting to integrate evidence-based practice into their daily work in hospital wards, and to understand their challenges in the use of evidence-based practice during clinical patient situations.

Data were collected from nurses from two distinct hospital wards in a large Norwegian hospital trust. Data from the nurses were obtained during participant observation, focus group discussions and individual interviews.

The thesis developed new knowledge that helps to better understand and explain how to adjust evidence-based practice integration into clinical practice. The clinical nurses were seeing evidence-based practice as something additional to their daily workflow.

The leader behaviour was characterized by strategies that made the leaders capable of adjusting their tasks and responsibilities to facilitate the clinical nurses in evidence-based practice integration. The leaders were striving to succeed in evidence-based practice integration without overextending the nurses.

The main challenges for the nurses was to integrate new research evidence into daily work, being more conscious about which knowledge to use and the actual knowledge sources, and to use this knowledge in individual patient situations. The findings revealed that there is a need to extend efforts to promote evidence-based practice integration at the individual as well as at the systems level, to enhance the use of evidence-based practice in clinical settings.