References
Enacting evidence-based practice: pathways for community nurses
Abstract
Community nurses are expected to deliver evidence-based practice, which is challenging given the diversity and breadth of the evidence base from which they can draw. This study aimed to explore community nurses' experiences of implementing change in their practice. Qualitative semi-structured interviews (n=9) and focus groups (n=2) with community nurses (n=17) were conducted. Three pathways to introduce change in practice were identified by participants: bottom-up, top-down and collaborative pathways. These are based on the nature of the proposed change, the available evidence, ‘buy in’ from colleagues and issues around implementation. The findings identify approaches to implementing change in community nursing practice. Practitioners would benefit from support to navigate the complex process of change through managerial support, ongoing education, accessible online resources and support through a practice development role.
Community nurses are a large and diverse group within the nursing workforce, and their role includes preventive, therapeutic, supportive and end-of-life care. The evidence base they draw from to inform their practice includes a broad range of academic disciplines and knowledge. Although a commitment to ensuring that practice is evidence based is now firmly established, the challenges of implementing this in reality are well recognised and documented (Thompson et al, 2005; Orton et al, 2011; Nursing and Midwifery Council, 2018; Mathieson et al, 2018).
Evidence-based practice (EBP) evolved from evidence-based medicine and is defined by Sackett et al (1996:71) as ‘the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients'. Rycroft-Malone et al (2004) go on to define evidence as a combination of research, clinical experience, patient experience and information from the local context. EBP demands that clinicians assume a questioning approach to practice and have skills in the analysis and synthesis of all forms of evidence. Clinicians then ‘match’ this to the individual needs, preferences and values of patients using their professional expertise (Greenhalgh et al, 2014). This is at the heart of the ‘realistic’ approach to care advocated by NHS England and Scotland's Chief Medical Officer, ensuring that the values and preferences of patients are central to care delivery (NHS England, 2013; Scottish Government, 2018).
Register now to continue reading
Thank you for visiting Community Nursing and reading some of our peer-reviewed resources for district and community nurses. To read more, please register today. You’ll enjoy the following great benefits:
What's included
-
Limited access to clinical or professional articles
-
New content and clinical newsletter updates each month