Many health professionals use evidence to inform their practice but a study revealed more would do so if evidence information was more accessible and readily available
All health professionals should use evidence-based information to guide their clinical practice but, despite it being part of the Nursing and Midwifery Council’s revised code of practice, nurses and midwives often find it difficult to achieve. This article reports on a study of their attitudes to evidence-based practice, available resources, barriers to implementation and strategies that could facilitate it becoming routine.
Citation: Veeramah V (2016) Using an evidence base to inform practice. Nursing Times; 112: 14, 20-21.
Author: Ven Veeramah is senior lecturer, health development, University of Greenwich, London.
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It is widely recognised that the main benefits of using evidence-based practice (EBP) are to improve or update clinical practice and enhance the quality of care and outcomes for patients. In the UK, governments have, over the past decade, encouraged and promoted the use of best evidence to provide a high-quality health service (Tagney and Haines, 2009; McKenna et al, 2004). Due to the rise in patient empowerment, health professionals are expected to deliver high-quality care underpinned by the best, most up-to-date evidence (Emanuel et al, 2011); the Nursing and Midwifery Council’s (2015) code of practice explicitly states that nurses and midwives should base their practice on the best available evidence.
Aims and method
The study examined nurses’ and midwives’ use of EBP to:
- Ascertain their attitude towards EBP;
- Explore the resources available to them to access evidence-based information;
- Identify some of the barriers to using evidence-based information;
- Identify ways to promote the use of EBP.
Ethical approval was obtained from the University of Greenwich’s research ethics committee. An online questionnaire was used to collect data from a convenience sample of 386 nurses and midwives; with 172 completed, the response rate was 45%.
The respondents came from a range of specialties and trusts across the UK. Most (69%, n = 118) were band 5, a quarter (24%, n = 41) were band 6, 7% (n = 12) band 7 and 0.6% (n = 1) band 8. Band 7 and 8 respondents were senior nurses with overall ward or community team managerial responsibilities.
Over 92% of respondents expressed a very positive attitude towards EBP and 94% felt evidence-based nursing or midwifery should be an important part of daily practice. The most encouraging finding was that 97% agreed every nurse or midwife should make a conscious effort to use evidence-based information to guide their practice. A positive, albeit rather weak, relationship (r = 0.3, p<0.01) was found between attitudes towards EBP and the use of evidence-based information but many respondents (85%) said they always or frequently used evidence-based information to inform their practice.
Most respondents (78%) reported having regular access to current research through professional journals in paper or electronic form, and 82% said they have access to relevant databases and the internet at their place of work. A large proportion (80%) reported having regular access to several relevant databases and the internet at home or somewhere outside of work. Almost all claimed to be able to search for relevant evidence-based information (92%) and critically appraise relevant primary research (91%) or systematic reviews (88%) before using the findings to inform practice.
However, several respondents (33%) still felt they lacked the skills to critically evaluate evidence-based information. This could account for the fact that a sizeable proportion (38%) used information provided at work – such as information from doctors, policy and procedure manuals and audit reports – rather than research literature to inform practice. As so many staff still rely on such sources, it is vital they are underpinned by reliable evidence-based information that is relevant to local contexts and readily accessible.
Many respondents (85%) stated that EBP guidelines relevant to their specialty were available at work and knew they were available online (90%). More interestingly, nearly all (95%) said they regularly actively looked for, and used, these guidelines. A large number (63%) firmly believed an effective strategy to make the delivery of care evidence based is needed for more nurses and midwives to use evidence-based guidelines. This is crucial to promote and implement EBP as most respondents said time constraints make it difficult to search and appraise the latest evidence-based information to inform practice. Clinical guidelines based on sound research findings are an essential component of evidence-based information (Rycroft-Malone et al, 2004) and vital for the provision of high-quality care (McKillop et al, 2012).
Many respondents claimed to still experience several major barriers to implementing EBP that were highlighted in the literature nearly 20 years ago, including:
- Lack of time to search for, and review, relevant evidence-based information (86%);
- Finding time during the working day to search for new information (67%).
Lack of time has been cited nationally and internationally across nearly all clinical settings as perhaps the greatest barrier to using evidence- or research-based information by health professionals (Yadav and Fealy, 2012; Breimaier et al, 2011).
Most respondents were aware of several strategies aimed at making care more evidence based. The most popular strategies were those designed to ensure evidence-based information – which should include relevant evidence-based protocol, policy manuals and guidelines – was readily available and in a format that allows nurses and midwives to easily understand the implications for their practice.
A significant proportion (59%) also felt it would be helpful to have a website providing 24-hour access to relevant evidence-based information through an open-access networked computer while on duty. In addition, 31% perceived a lack of autonomy and authority to change care procedures as a significant barrier; this concurs with recent studies such as Yadav and Fealy (2012) and Solomon and Spross (2011). This obstacle is difficult to overcome in a climate of accountability and litigation but more support from management, the multidisciplinary team and the NMC could help.
Only a minority (15%) of respondents reported a lack of support from managers. This is a major step towards promoting and implementing EBP. Management support is vital to implement EBP and managers are in a key position to create an environment and culture that could ensure the necessary resources are available in clinical areas (Linton and Prasun, 2013; Everett and Sitterding, 2011; Gerrish et al, 2011).
Implications for practice
This study provides an insight into the challenges faced by nurses and midwives in using evidence-based information to inform their practice, and highlights strategies that respondents believed could improve implementation. As lack of time to search for and review relevant information has been identified as a major obstacle, it is crucial that major stakeholders such as government agencies and managers explore ways of initiating necessary changes to work patterns to facilitate this. A large number also reported using workplace source knowledge rather than research literature to inform practice, so it is crucial these sources have a solid evidence base. Evidence-based guidelines should be appropriate to the identified practice needs.
These findings highlight the need to develop innovative ways of providing readily available evidence-based resources to meet practitioners’ around-the-clock needs. Because of the severe constraints under which they are working, more effort should be made to ensure evidence-based information is in a format that can be easily used to inform practice.
The consensus, nationally and internationally, is that using evidence-based information to inform practice is fundamental to the provision of high-quality care, so all nurses and midwives should ensure it is central to their care delivery. However, if EBP is to become a reality, health services and government agencies must make a concerted effort to ensure nurses and midwives have the necessary technological facilities and time away from bedside responsibilities to access and appraise evidence. There is an urgent need to explore ways to empower and support nurses and midwives to implement changes to their practice using evidence-based information.
- This is a summary of: Veeramah V (2016) The use of evidenced-based information by nurses and midwives to inform practice. Journal of Clinical Nursing; 25: 3-4, 340-350.
- Using evidence-based information to inform care improves the quality of care and patient outcomes
- Most health professionals have a positive attitude towards using evidence-based information
- A third of respondents said they did not feel they had the skills to critically evaluate evidence-based information
- Lack of time at work is a major barrier to accessing evidence-based information
- Ensuring evidence is in a format that shows how it is relevant to individual specialities could increase implementation
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