Understandings of and experiences with evidence-based practice in practice among nurses in a surgical department: A constructivist approach

Aim and objectives To explore nurses' constructions of the concept of evidence-based practice through their understandings of and experiences with evidence-based practice in a clinical care setting. Background The primary purpose of evidence-based practice is high-quality patient outcomes. However, the adoption of evidence-based practice is described as a complex process, and research shows that evidence-based practice is not translated into practice. Research often explores facilitators and barriers of implementing and adopting evidence-based practice. Yet there is limited knowledge on how nurses construct the concept in practice. Design This study has a constructivist approach and follows COREQ guidelines. Method Ten semi-structured interviews with 26 nurses were conducted in 2019. Data were analysed with an emic and inductive approach. Results Three key constructions emerged. Understandings of evidence-based practice were based on the original concept of evidence-based medicine. This included the hierarchy of evidence which was perceived as an inflexible concept not encompassing the nursing care. However, while not using the term evidence-based practice, the nurses were doing evidence-based practice portrayed through outcomes from management-supported nursing-based projects and incorporated reflections and discussions into weekly meetings. A discrepancy between a theoretical understanding and a practical doing of evidence-based practice appeared and was especially evident when the nurses' primary evidence sources consisted of the immediate options, for example asking colleagues or following accessible guidelines. Searching for evidence was central in their theoretical understanding but not an incorporated part of their daily work tasks. Conclusion The nurses' constructions of evidence-based practice indicate a discrepancy between the theoretical understanding of evidence-based practice and the practical doing of evidence-based practice, which hinders the basis of working according to the concept. Relevance to clinical practice Theoretical discussions of evidence-based practice within the nursing field remain academic, as nurses in practice construct the concept on standards from evidence-based medicine.