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Case study
Advanced practice nurses use role modelling, teaching, clinical problem solving and change facilitation to promote evidence-based practice among clinical staff nurses
  1. Lynn Gallagher-Ford
  1. College of Nursing, The Ohio State University, Columbus, Ohio, USA
  1. Correspondence to Lynn Gallagher-Ford
    College of Nursing, The Ohio State University, 1585 Neil Ave, Columbus, OH 43210, USA; lgallagher{at}con.ohio-state.edu

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Implications for practice and research

  • Advanced practice nurses (APNs) can play a critical role in facilitating evidence-based practice (EBP).

  • Knowledge brokering (KB) is a key aspect of the APN role which can be leveraged to promote EBP.

  • KB requires specific knowledge and skills.

  • The effect of APNs on EBP implementation by clinical (staff) nurses and on clinical outcomes needs further exploration/measurement.

Context

The barriers and organisational constraints related to EBP have been well described.1 2 Recently, the literature has focused on factors that facilitate EBP.3 4 The context of nursing practice settings has emerged as a critical influence on nurses' implementation of EBP. In general, this context consists of the interrelated conditions in which a particular phenomenon exists/occurs and the context of nursing practice has been described as including autonomy to change practice, support from managers, resources and time to devote to EBP.1,,3

One condition of context that influences staff nurses' evidence-based care is the role of APNs as clinical opinion leaders.5 APNs hold a unique place alongside staff nurses to directly influence practice and provide linkages between research and clinical practice. The term ‘knowledge broker’ (KB) denotes this active linking process. Although the role of the APN in this capacity has been well documented, little is understood about the specific activities APNs actually perform in KB to facilitate and promote EBP. The study by Gerrish et al set out to provide a better understanding of APNs in KB activities.

Methods

A multiple instrumental case study of 23 APNs from hospitals and primary care settings was conducted. Case studies were selected from an earlier study using a matrix sampling strategy to capture maximum variety of APN roles in a range of specialties and settings. Eighteen case studies included in depth interviews with APNs and their colleagues. Five of the APNs were selected for shadowing by an observer followed by an interview to reflect on the observations.

Findings

The study explores how APNs functioned as knowledge brokers (KBs) alongside clinical nurses at the bedside, describes the dimensions of KB activities of APNs and highlights the unique place that APNs hold within clinical settings that enables them to be particularly effective in promoting EBP. The study moves beyond a reiteration of APNs as opinion leaders and knowledge brokers and describes how APNs actually perform KB functions.

KB is described as (A) knowledge management and (B) promoting the uptake of knowledge, with the unique dimensions of each component detailed. The first dimension: knowledge management includes (A) generating evidence, (B) accumulating different forms of knowledge, (C) synthesising information, (D) translating knowledge and determining applicability (E) disseminating information. The second dimension: promoting the uptake of knowledge includes (A) building the capacity of clinical nurses (B) engaging with nurses in problem solving (C) facilitating change.

Commentary

This study is compelling because it provides an in depth examination of the KB work of APNs and makes a strong case for how it promotes, enhances and supports EBP by clinical nurses. This new information can help (A) organisations leverage APNs in driving EBP, (B) clinical nurses gain EBP skills in practice, (C) organisations articulate another benefit of APNs and (D) individuals and organisations improve care and outcomes. This deep dive into the unique capacity of the APN and the potential effect on implementation of EBP at the bedside is valuable information that promotes the move toward evidence-based practice.

We know what the EBP barriers are, that EBP can result in improved care, outcomes and nursing satisfaction and that context is a critical element in successfully implementing EBP. We are professionally obligated to conduct our nursing work, supported by the best evidence, in order to deliver the best care possible. To meet these obligations, we must leverage every strategy available. The present study will provide readers with a better understanding of how APNs positively influence best practice and evidence to leverage this potential.

References

View Abstract

Footnotes

  • Competing interests None.

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