Organisational infrastructures to promote evidence based nursing practice

 

Abstract

Background

The purpose of this systematic review is to determine to what extent organisational infrastructures are effective in promoting the implementation of high quality research evidence on the effectiveness of nursing interventions.

Objectives

To identify and summarize rigorous evaluations of organisational infrastructure developments aimed at promoting evidence based nursing practice.

Search methods

We searched: The Cochrane Library, MEDLINE, EMBASE, CINAHL, SIGLE, HEALTHLINE, National Research Register, Nuffield Database of Health Outcomes, NIH Databases up to August 2002. We hand searched the Journal of Advanced Nursing, Applied Nursing Research and Journal of Nursing Administration (to 1999), and checked the reference lists of articles obtained. We contacted experts in the field and relevant Internet groups.

Selection criteria

Randomized controlled trials, controlled clinical trials and interrupted times series studies of an entire or identified component of an organisational infrastructure development aimed at promoting effective nursing interventions. The participants were health care organisations comprising nurses, midwives and health visitors in hospital and community settings.

Data collection and analysis

All identified papers were screened independently for relevance, design and outcome by two reviewers.

Main results

No studies were sufficiently rigorous to be included in this systematic review. Seven case study evaluations were identified but excluded from the review because of poor design and lack of controls.

Authors' conclusions

1. There are no clear implications for practice.
2. Several conceptual models on organisational processes to promote evidence based practice have been described in published papers, and a number of organisational infrastructural interventions have been described in published papers. None have been evaluated properly. The next step in this field should be to conduct well planned evaluations of well planned interventions.
3. Interrupted and Complex Interrupted Times Series (ITS and CITS) designs should be adopted as a useful alternative to randomized controlled trials where such trials would be impractical. The health service cost of any infrastructure developments should be assessed in any evaluation. If possible, patient outcomes should be measured directly.

 

Plain language summary

Organisational infrastructures may be important in the development of evidence based nursing practice

We did not find any evaluated infrastructure developments that were of sufficient quality to be included in the systematic review. There are no clear implications for organisational practice as there is no good evidence about the impact of organisational infrastructures on the development of evidence based nursing practice.

 

摘要

背景

促進以實證為基礎的護理實務的組織系統

這篇系統性回顧的目的是確定何種範圍的組織系統可以有效促進高品質研究證實有效的護理措施的執行。

目標

確認並總結嚴格評值組織系統發展，要旨在促進以實證為基礎的護理實務。

搜尋策略

我們檢索：The Cochrane Library， MEDLINE，EMBASE，CINAHL，SIGLE，HEALTHLINE，National Research Register，Nuffield Database of Health Outcomes，NIH Databases至2002年8月止。我們人工檢索the Journal of Advanced Nursing，Applied Nursing Research及Journal of Nursing Administration(至1999年)，並檢視已取得文章的參考文獻。我們聯絡該領域的專家及相關的網際網路群體。

選擇標準

組織系統發展中全部或部分要素以促進有效之護理介入為目的的隨機對照試驗，對照臨床試驗與間斷時間序列研究。研究對象為健康照護組織包括醫院與社區機構中的護士，助產士及訪視員。

資料收集與分析

由兩名回顧者分別檢視所有相關的文章，研究設計及結果。

主要結論

沒有充分嚴謹的研究可被納入這篇系統性回顧中。確定了7篇病例研究，但因為研究設計不良且缺少對照組而被排除。

作者結論

1.沒有明顯對於實務的影響。2.在已發表的文章中描述了幾種組織過程促進實證實務的概念模型，以及許多組織系統的介入措施。但都沒有被妥善地評估。這個研究領域的下一個步驟應該是建立妥善計畫的介入措施以及評估方式。3.應採用間斷的及複雜的間斷時間序列(Interrupted 及 Complex Interrupted Times Series (ITS及CITS))設計，以取代隨機對照試驗這種不實用的試驗。如果可以的話，應直接測量病患的結果。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

組織系統對於以實證為基礎的護理實務發展也許是重要的。我們沒有發現任何評估系統發展的研究具有足夠的品質可被納入這篇系統性回顧中。由於沒有組織系統會影響以實證為基礎的護理實務發展的良好證據，因此沒有明顯對於組織實務的影響。