Theoretical and experiential perspectives on facilitating evidence-based practice in nursing: toward a conceptual framework
Dogherty, J. Elizabeth
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The Issue: The integration of evidence into practice is a complex process. Facilitation is a strategy that may assist practitioners with enhancing evidence uptake in nursing practice. However, the concept is not well understood from a front-line nursing perspective. Thesis Objectives: To describe facilitation in moving evidence into nursing practice and determine the nature of the facilitator role and the process of facilitation in theory and from actual experience to develop a conceptual framework to guide practitioners. Methods: A descriptive design utilizing mixed methods was employed: 1) Focused review of the literature that synthesized the current state of knowledge on facilitation as role and process in the implementation of evidence-based practice (EBP) in nursing. 2) Case audit and focus group interview with facilitators of cases involved in adapting guidelines and planning for implementation. A provisional framework was developed based on the literature review which guided the case audit and focus group interview. The data from the literature was integrated with data from those actively involved in facilitation to refine the framework. Results: Focused literature review: A final set of 39 papers were identified. Facilitation is described as supporting and enabling practitioners to improve practice through evidence implementation. Certain aspects of the role and the strategies being employed to promote change are evident. Current literature reveals that facilitation is viewed as an individual role as well as a process involving individuals and groups. Case audit and focus group interview: Forty-six discrete, practical facilitation activities discovered in the literature were in large part found as occurring within the cases. An additional 5 new, distinct activities related to facilitation were found in the case documentation. Findings suggest that facilitation is a multifaceted process and a team effort. Communication and relationship-building are key elements. Conclusion: The transparency and detail displayed in the revised framework may contribute to systematically developing, implementing, and testing facilitation interventions in nursing contexts. Facilitation is clearly an important strategy to advance EBP and the improved understanding of facilitation offered in this thesis provides a guiding framework for future investigations of evidence implementation where facilitation is a key element.