Evidence-based practice: still a hard nut to crack!

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As is often the case with new policies, evidence-based practice (EBP) has been described by sceptics as a ‘passing fad’ (Waldman 2006). It was expected to be popular or fashionable for a short period of time. But the question of whether EBP for the masses (of healthcare professionals) has really ‘caught-on’ remains unanswered. The paper by Comino & Kemp (2008) in this edition of JAN is the latest in a number of studies across the globe that are looking for answers to this question.

There have been many studies exploring the research activities of healthcare professionals and their use of research findings (see e.g. Parahoo 2000, Carrion et al. 2004). Comino & Kemp (2008) recognize the need for more studies aimed at exploring research-related activities in the community where most health care is delivered. This study is refreshing in that it uses a multi-method approach to explore research as well as research-related activities, which the authors define as reflective practice, quality improvement and evaluation. Thus, they do not set research against reflective practice or quality improvement, but instead acknowledge that healthcare professionals use a range of approaches to improve practice and that evidence can be generated in different ways and not just through research.

Previous studies on research utilization have reported that nurses perceived the lack of managers’ support as a main barrier to the uptake of research findings in clinical practice (Parahoo 2000). Comino & Kemp’s study was initiated by health service managers thus showing that some managers, at least, are responding to the challenge of EBP.

Comino & Kemp’s study provides a useful insight into, and detailed analysis of, the research and research-activities of healthcare professionals (including nurses, doctors, social workers, psychologists and allied health professionals). The findings show that these healthcare professionals engaged to some extent in reflective practice and quality improvement activities but there was ‘limited participation in research and evaluation activities’ (p. 271). Understaffing and the shortage of funds earmarked for research were reported as barriers to undertaking these research-related activities. This is nothing new. What is interesting however, are the findings related to the interface between researchers from agencies external to the health service and clinicians. There was a perception among clinicians that ‘projects undertaken by the external agencies such as universities involved limited participation of (clinical) team members, frequently did not include feedback’ and ‘included few opportunities to build research-related capacity within the team’ (p. 271). Clinicians reported the need to get external researchers involved in research which has clinical relevance. Many of the participants perceived their core activities as the delivery of clinical services and regarded research by external researchers as having ‘the potential to contribute to the research base underpinning’ practice (p. 271).

Despite the limitations of exploring research-related activities in one setting (i.e. community-based child health services in a large urban healthcare service in Australia), these findings are likely to have some resonance with other clinicians elsewhere in Australia and beyond. The conclusion that ‘the evidence-based practice movement has had limited influence in this setting’ (p. 273) is depressing. This means that the research-practice link remains tenuous. Ciliska (2006), in her oration at the Joanna Briggs Institute, described her vision for nursing practice for the year 2010 as one in which the research transfer gap is successfully bridged. Comino & Kemp’s study shows that much remains to be done and it will require more than 2 years before EBP becomes reality.

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