Implementation of Evidence in Nursing Practice: the Role and Process of Facilitation

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Dogherty, Elizabeth J.
Guideline Implementation , Evidence-Based Practice , Facilitation , Nursing
Background: Moving the latest evidence from research into nursing practice remains a challenge. We are only beginning to recognize the processes involved and little is known as to which approaches are effective in different contexts. Facilitation is an intervention that involves helping practitioners recognize what it is they need to change in practice and how to make these changes to incorporate evidence into practice. Objective: To describe the role, function, and practice of facilitation in moving evidence into nursing practice. A secondary element is to determine if a provisional facilitation framework, developed to reflect the concept in guideline adaptation and the early stages of implementation, accurately depicts facilitation in the context of actual implementation. Methods: The thesis employs an emergent mixed-methods design and is composed of two phases each with multiple components. The first phase explores the conceptual, theoretical, and experiential foundations of facilitation and examines: (1) how the concept has evolved over 16 years in a comprehensive literature review, (2) facilitation as described by experienced nurses in guideline implementation, and (3) how facilitation relates to other guideline implementation interventions in a review of studies included in an existing systematic review. The second phase describes the practical foundations of facilitation and follows the facilitation occurring naturally over time in a guideline implementation involving front-line nurses at the point of care. Results: The comprehensive review provides a description of how facilitation has evolved and presents a current synopsis of the state of knowledge regarding facilitation. The conceptual, theoretical, and empirical understandings of the concept were integrated with the practical foundations to confirm and refine the framework to reflect facilitation across the continuum from guideline adaptation to implementation. The revised framework is displayed and represents a comprehensive view and understanding of facilitation of evidence-based practice in nursing from multiple perspectives. Conclusions: The detail in the revised framework provides a useful guide for practitioners and organizations in planning for change. Further testing is required to determine its applicability and usability in the practice setting.
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