Journal of Community Nursing - page 100

100 JCN
2013,Vol 27, No 4
IMPROVING PRACTICE
from the greatest to the least barrier,
are shown in
Table 4
.
The findings highlight how time
is a major constraint in achieving
evidence-based practice. Lack
of resources is also problematic.
Barriers to changing practice
were less problematic than those
relating to finding and reviewing
information, indicated by the higher
mean scores (higher score = less of
a barrier).
Transferring these figures to the
percentage of nurses who perceived
these items a barrier highlights that
the workforce is quite empowered.
Only 5% of the sample agreed that
lack of confidence was a barrier; 8.6%
agreed that the culture of the team
was a barrier to changing practice; and
13.2% thought that lack of authority
was a barrier.
FACILITATORS TO
CHANGING PRACTICE
This section of the questionnaire
examined the extent to which nurses
perceived other staff to be supportive
of changing practice. A 5-point
scale was used to judge the degree
of support ranging from‘always
supportive’(score 1) through to
‘never supportive’(score 5). The mean
scores, ordered from the greatest to
the least lack of support, are shown
in
Table 5
. These findings indicate that
community nurses generally work in
an environment where colleagues,
managers and doctors are supportive
of changing practice.
USING DIFFERENT SOURCES OF
EVIDENCE TO CHANGE PRACTICE
Nurses were asked to rate how
experienced they were in finding,
reviewing and using different sources
of evidence to change practice using a
5-point scale ranging from‘complete
beginner’to‘expert’. The percentage
of nurses falling into each category is
shown in
Table 6
.
Nurses felt most skilled at finding
information from the internet and
the library. The areas where nurses
perceive themselves as less skilled
(novice/complete beginner) related
to finding, reviewing and using
research evidence.
IMPLICATIONS FOR PRACTICE
This study highlights that nurses use a
range of information sources to inform
their practice, including patients,
protocols, experience, in-service
training and conferences. Face-to-face
discussions with colleagues were
also a highly used source of
knowledge. Nurses used journal
articles less frequently than other
sources of knowledge.
While barriers to finding and
reviewing information existed, those
to changing management and practice
were less evident, with most nurses
feeling that they had the authority and
confidence to instigate such changes.
The greatest barrier to evidence-
based practice was lack of time.
Nurses also lacked confidence in
finding research evidence, reviewing
it, and judging its quality, with over
40% feeling that they were at the level
of a complete beginner/novice. High
levels of skills were reported around
using the internet, even though it was
rated low in terms of being a source
of evidence. These findings indicate
that strategies to promote evidence-
based practice should consider the
constraints that community nurses
are working under, and ensure that
evidence-based information is readily
available and the implications for
practice made clear.
Care protocols and guidelines were
frequently used by nurses. Therefore,
it is important that these are based
on the best available evidence and
regularly updated, as new evidence
becomes available.
Table 3:
Barriers to finding and reviewing information
Rank order Barrier
Mean score
1
I do not have sufficient time to find research reports
2.49
2
I do not feel confident in judging the quality of research reports
2.96
3
Research reports are not easy to find
3.03
4
I find it difficult to understand research reports
3.14
5
I do not have sufficient time to find organisational information (guidelines/
protocols, etc)
3.20
6
I find it difficult to identify the implications of research findings for my
own practice
3.37
7
I find it difficult to identify the implications of organisational information
for my own practice
3.50
8
Organisational information (protocols, guidelines etc) is not easy to find
3.69
9
I do not know how to find appropriate research reports
3.72
10
I do not know how to find organisational information (guidelines,
protocols, etc)
4.18
Table 4:
Barriers to changing practice
Rank order Barrier
Mean score
1
There is insufficient time at work to implement changes in practice
3.00
2
There are insufficient resources (i.e. equipment) to change practice
3.09
3
I lack the authority in the work place to change practice
3.75
4
I do not feel confident about beginning to change my practice
3.95
5
The culture of my team is not receptive to changing practice
3.97
Table 5:
Facilitators to changing practice
Rank order Facilitator
Mean score
1
Nursing colleagues are supportive of my changing practice
2.23
2
Nurse managers are supportive of my changing practice
2.41
3
Practice managers are supportive of my changing practice
2.67
4
Doctors with whom I work are supportive of my changing practice
2.71
1...,90,91,92,93,94,95,96,97,98,99 101,102,103,104,105,106,107,108,109,110,...116