What nurses understand by the term evidence-based practice, and how it shapes their clinical decision making : a thesis presented in partial fulfilment of the requirements for the degree of Master of Education in Adult Education at Massey University

Abstract

There are professional and legislative expectations that nurses deliver care to their patients' that is evidence-based. Previous research findings have indicated nurses do not value research in the clinical setting, yet believed they deliver evidence-based practice. This study explores what practising nurses understand by the term evidence-based practice and how it shapes their clinical decision making. There was interest in the individual nurses' experiences and interpretations, as well as their preparation for practice. Contextual influences were also a focus, to give insight into influences that might affect the delivery of evidence-based practice. A qualitative interpretive research approach was used, and implemented using a naturalistic paradigm. Case Study methodology, using complexity theory, provided the theoretical framework to explore contextual variables that might affect the delivery of evidence-based practice. Relationships, interdependencies and interconnections became the focus to allow a depth to the inquiry and understanding of the case. A review of the literature, focus group and semi-structured interviews (n=10). provided the source of data collection, and were completed during 2006. Despite evidence-based practice being a professional and legislative requirement of the practising nurse, there remains a significant gap between what the professional and legislative documents state and the reality of clinical practice. The extent to which evidence-based practice is delivered within the case is based on the extent to which evidence is incorporated in policy statements. There are concerns associated with education, organisational culture, and contextual variables which impede the delivery of evidence-based practice. Existing skill levels are variable, and there is potential to encourage individual creativity and contribution, but there are significant skill deficits which need to be addressed Findings confirm progress is being made, but also reinforce the need for further education review and support, and a culture 'makeover' in some contexts within the case to advance the evidence-based practice agenda.