Evidence-based nursing : reflections from different perspectives

Sammanfattning: The overall aim of this thesis was to describe the use of evidence-based nursing (EBN) with respect to the four cornerstones of EBN: research, nursing theory, the patient’s perspective and clinical competence. Study I explored registered nurses (RNs) self-reported research utilization (RU) in relation to their work climate. A quantitative approach was used; further analyze led to a cluster solution of the measured variables, and low reported RU were compared with higher reported RU. The result showed that an academic degree underpinned the instrumental research utilization (IRU), also women reported higher use of conceptual research utilization (CRU). An association between low RU and dynamism/liveliness was seen, and younger RNs and RNs with shorter working experience reported higher scores for playfulness/humor and conflicts. Study II described how nurses conceived working in a ward where a nursing philosophy had been implemented. A phenomenographic method was used. The philosophy supported the clinical work and underpinned reflection and shared values. A prerequisite was a dedicated leader. The RNs described the care being of high quality. First line nurse managers (FLNMs) role and their experience of opportunities and obstacles to support EBN, was explored in study III. Data was collected using focus groups and analysed using phenomenography. The result showed that the FLNMs need to make an entity of vision and reality to be supportive according of EBN. The last study was an integrative literature review and the perspective of the patient in articles reporting on interventions designed to improve nursing was in focus. The result in study IV showed that the perspective of the patient represents five aspects, and that reporting clinical implications is important. In conclusion; the different perspectives all relates to EBN. Registered nurses need to be encouraged to develop their academic training, to be able to work according to EBN. A nursing philosophy provides time for reflection and a feeling of performing care of high quality. FLNMs need to take their role to support the RNs in order to work evidence-based. Conscious and communicated aspects supported the perspective of the patient.