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Senior nurses 'resistant' to evidence-based practice


Nurse managers are often “serious barriers” to preventing the implementation of new evidence-based practice by other nursing staff, US researchers have claimed.

Researchers from Ohio State University randomly selected 20,000 members of the American Nurses Association, of which 1,015 completed a survey on evidence-based practice.

Less than half of respondents, 46.4%, agreed findings from research studies were routinely implemented to improve patient outcomes at their organisation.

Fewer than a third said mentors were available in their healthcare setting to help them learn more about how to adopt evidence-based practices.

Lead author Bernadette Melnyk, dean of the university’s college of nursing, said: “Another disconcerting finding in our survey was that a substantive number of nurses said their leader or manager is resistant to evidence-based practice.

“If leaders do not role model evidence-based decision-making and they are not providing tools, education and resources for their clinicians to get the knowledge and skills they need to consistently implement this, it’s probably not going to happen nor will it be sustained.”

Other barriers to evidence-based practice identified by nurses included “politics and organisational cultures that avoid change”. 

Ms Melnyk said such barriers were a “huge problem” that was preventing the best outcomes for patients.

“The average age of nurses [in the US] is 47, and they were educated at a time when evidence-based practice was not well integrated into educational programs,” she said. “As a result, many nurses are practicing the way they were taught or steeped in tradition of the healthcare system in which they work.

“When new graduates who have learned to take an evidence-based approach to care are meeting these nurses in real-world settings, they encounter this prevalence of a ‘this is the way we do it here’ culture.”

Ms Melnyk said the findings indicated the need for widespread cultural change in healthcare settings and a new direction in nursing education.

She suggested nursing faculties tended to emphasise teaching research methods and critique of existing research, rather than how to put research findings to use in clinical practice settings.

The study is published in the Journal of Nursing Administration.



Readers' comments (20)

  • 'Other barriers to evidence-based practice identified by nurses included “politics and organisational cultures that avoid change”.'

    Oh yes - very difficult to get things changed !

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  • maybe the need is for senior nurses to be included in educational programs to update their knowledge about evidence based practice, how to access information and how to analyse the information.This is a learned behaviour. senior nurses require inclusion, knowledge and information, then motivation to change will be obvious to them. Too much emphasis is placed upon the new graduates being "future" and the "provider of evidence based practice", rather than provideing senior nurses who have been providing care, with knowledge and information to update ther opinions. Fear is the unknown, and the barrier is lack of inclusion about the information and how to access this.

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  • maybe they would prefer to go back to the good old days of ritualistic care. one always feels safer with what one knows and it was probably easier to keep control over and manage, although far less beneficial for the recipients and practitioners of such care!

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  • I think it is more to do with the job than the age of the person. As a specialist nurse my role is to keep up to date with current practice and disseminate the latest evidence based clinical knowledge. The greatest barriers are some doctors, and many managers, most of whom are younger than me! Something about being removed from the front line clinical role I think, and forgetting that we are here to improve peoples' lives and not just to make savings and produce income.

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  • grumpy

    Hmm - 'the good old days of ritualistic care'. Isn't that where we're headed now?
    Intentional rounding - how much more ritualistic can you get?
    No doubt based on some dubious 'research' evidence!

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  • As a research nurse conducting current trials, the apathy of many staff to ensure accurate data is collected makes me wonder if the EBP/EBM we are practicing today is the right treatment that patients are receiving. Yet, the same staff would quote that they are giving/promoting EBP/EBM. As for senior nurses, I don't think they even know, or want to know, that research in their hospital is going on. I haven't received any support, it's an uphill battle.

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  • George Kuchanny

    "their leader or manager is resistant to evidence-based practice." What an indictment and what folly.

    Life long learning is what we MUST engage in. Just imagine what computers and the internet would look like if this head in the sand approach to professionalism were emulated in other walks of life. Just image what air travel would be like!

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  • George Kuchanny | 1-Sep-2012 2:05 am

    what do mean?

    travel by hot air balloon was a very attractive alternative! fastest and larger capacity is not always best.

    change always comes at a cost whether financial, discomfort/effort to somebody, or other. maybe managers fear this, especially the former which makes them reluctant to do anything. the status quo is often the most comfortable option even if not the most beneficial. there are always winners and losers and advantages and disadvantages for somebody in any change.

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  • Quite true, Anonymous | 31-Aug-2012 5:24 pm

    Where any 'ritualistic care' has been developed and shown to be the most correct and patient friendly method of care delivering, why on earth change it?
    The answer is almost inevitably shown to be;
    Fiscal Prudence.

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  • Anonymous | 1-Sep-2012 2:39 pm

    Quite true, Anonymous | 31-Aug-2012 5:24 pm

    My apologies if my post was unclear. I was inferring the opposite through sarcasm! there is no place in modern nursing for outmoded ritualistic care and it should strongly be discouraged.

    Many people are more comfortable with old habits and I was suggesting this may be one of the reasons for resisting change but I most certainly do not condone such an attitude. Nursing must be innovative and advance according to the latest research based evidence and methods in order to find the best possible care solutions for patients.

    I do not accept the responses to any proposed changes I have often heard in the workplace 'oh well we have always done it that way', 'sister says ....', 'we have being doing it that way for the last 10 years and it has always worked before', etc.

    each task concerned with patient care needs to be considered on its merits and reflected upon to ensure it is the best solution for each particular patient and situation according to how they may be expected to respond in the light of their medical and nursing history and not be treated ritualistically, automatically and blindly without reflection.

    The same goes for ward routines and the conveyor belt system where tasks have long since become obsolete. Ritualistic and routine nursing care is not patient centred or holistic care, is not always conducive to the highest quality and can be very unsafe.

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