Evidence-Based Practice In Nursing.
Evidence-Based Practice In Nursing.
ABSTRACT
Background: Facilitation is proposed as an important strategy to assist practitioners to implement evidence into practice. However, from a front‐line nursing perspective, what is actually involved in facilitation, particularly in regards to research utilization, is poorly understood.Evidence-Based Practice In Nursing.
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Aim: To examine the current state of knowledge surrounding the concept of facilitation as a role and process in the implementation of research findings within the nursing context. Building on a previous concept analysis, we examined how facilitation has evolved over the last decade, particularly focusing on the practical elements (e.g., what it entails to operationalize and implement facilitation in nursing).Evidence-Based Practice In Nursing.
Methods: A systematic search of electronic databases identified theory and research‐based nursing papers explicitly focused on facilitation in research utilization. Through a content analysis, we examined how the concept is being used, described, and applied within nursing.
Results: Facilitation continues to be described as supporting and enabling practitioners to improve practice through evidence implementation. Certain aspects of the role and the strategies being employed to promote change are more evident. It was possible to formulate these into a taxonomy. Key findings include:
• facilitation is now being viewed as an individual role as well as a process involving individuals and groups;
• project management/leadership are important components;
• no matter which approach is selected, tailoring facilitation to the local context is critical;
• there is a growing emphasis on evaluation, particularly linking outcomes to nursing actions.Evidence-Based Practice In Nursing.
Conclusions: Further understanding of what facilitators are actually doing to enable changes in nursing practice based on research findings will provide the groundwork for the design and evaluation of practical strategies for evidence‐based practice in nursing. Research is needed to clarify how facilitation may be used to implement change in nursing practice along with evaluation of the effectiveness of various approaches.
BACKGROUND
Facilitation is emerging as an important concept in evidence uptake in clinical nursing practice. It is viewed as a means of bridging the gap between theory and practice. Kitson and colleagues (1998) developed a conceptual framework proposing that facilitation, in addition to the nature of the evidence and the quality of the context, is an essential component enabling successful research implementation. Facilitation is presented as a technique whereby facilitators provide support to help individuals and groups realize what they need to change and how to make changes to incorporate evidence into practice.Evidence-Based Practice In Nursing.
In further developing the framework, Harvey et al. (2002) conducted a concept analysis of facilitation across a range of health care literature published between 1985 and 1998. Their findings show that facilitation involves helping others change practice with facilitation “ranging from a discrete task‐focused activity to a more holistic process of enabling individuals, teams and organizations to change” (Harvey et al. 2002, p. 578).Evidence-Based Practice In Nursing. However, facilitation effectiveness is poorly understood. Harvey et al. (2002) found facilitation has some influence on changing clinical practice, but findings are equivocal. At issue are the limited descriptions and lack of rigorous evaluations of facilitation. In summary, the authors concluded that the concept of facilitation is therefore partially developed and further research is needed to describe and illustrate how it relates to evidence implementation.Evidence-Based Practice In Nursing.
To explore the concept’s maturity, we undertook this enquiry to understand how the nature of facilitation has evolved over the last decade, especially given rapid advancements in the implementation science field. From Harvey et al.’s (2002) analysis, it is apparent that the meaning and application of facilitation varied depending on the applied field. It can be used generally within education and practice development (PD) and specifically for implementation of evidence‐based practice (EBP). From a pragmatic point‐of‐care perspective, there is a need to clarify how facilitation plays out in a bedside nursing situation. Therefore, the scope of this review is purposefully limited to facilitation related to evidence implementation in nursing. We chose specifically to study the concept in terms of operationalizing it at the point‐of‐care focusing on instrumental knowledge use and the implementation of research evidence to gain a comprehensive view of facilitation in the research utilization (RU) process. While Harvey et al.’s analysis examined a range of health care literature, this review focused specifically on nursing. An important focus of the current review is particular attention to the practical elements and what is entailed to operationalize and implement facilitation.Evidence-Based Practice In Nursing.
It is true that the role of nurse managers in promoting evidence-based practice cannot be overstated. There is however a dearth of research that focuses on the perspectives of this group about institutional contextual factors that support the goal of evidence-based practice in clinical practice settings. This research is aimed at identifying th3e contextual factors that nurse managers understand to be the driving forces of change and that facilitate evidence-based practice in clinical practice.Evidence-Based Practice In Nursing.
For instance research by Duncombe (2018) would reveal that nurse managers perceived workplace structure, culture and resources to be the facilitators or the barriers to the empowerment of nurses who were under their supervision at the time to implement best practice and to drive change. Workplace cultures that provide channels for clear communication on evidence-based practice goals, channels for directly contacting executives and clearly defined expectations worked to support nursing managers in their initiatives to support EBP within their units.Evidence-Based Practice In Nursing.
Nursing managers from high-performing units went on to describe a structure that includes allowing nurses to drive change, nursing-specific committees, and evidence-based practice from within the unit.Evidence-Based Practice In Nursing. Furthermore, nurse managers from these units would be more likely to articulate the existence of internal resources like departments for monitoring quality as being essential to implementation of evidence-based practice within their successful units.Evidence-Based Practice In Nursing. Therefore using the same example in the post, part of the administrative aspects of implementing a project should involve gathering and utilizing feedback from departments that monitor quality and ensuring that they are part of the implementation process. Nurse practitioners will then receive direction on how to improve the quality of their care.Evidence-Based Practice In Nursing.
