Objective To explore in depth how primary care clinicians (general practitioners and practice nurses) derive their individual and collective healthcare decisions. Design Ethnographic study using standard methods (non-participant observation, semistructured interviews, and documentary review) over two years to collect data, which were analysed thematically. Setting Two general practices, one in the south of England and the other in the north of England. Participants Nine doctors, three nurses, one phlebotomist, and associated medical staff in one practice provided the initial data; the emerging model was checked for transferability with general practitioners in the second practice. Results Clinicians rarely accessed and used explicit evidence from research or other sources directly, but relied on “mindlines”—collectively reinforced, internalised, tacit guidelines. These were informed by brief reading but mainly by their own and their colleagues9 experience, their interactions with each other and with opinion leaders, patients, and pharmaceutical representatives, and other sources of largely tacit knowledge. Mediated by organisational demands and constraints, mindlines were iteratively negotiated with a variety of key actors, often through a range of informal interactions in fluid “communities of practice,” resulting in socially constructed “knowledge in practice.” Conclusions These findings highlight the potential advantage of exploiting existing formal and informal networking as a key to conveying evidence to clinicians.

https://www.bmj.com/content/bmj/329/7473/1013.full.pdf

Evidence based guidelines or collectively constructed “mindlines?” Ethnographic study of knowledge management in primary care

In a keynote address to the Teacher Training Agency Annual Conference, Professor David Hargreaves suggested that teaching could become an evidence-based profession if educational researchers were made more accountable to teachers. This systematic literature review set out to explore: how teachers use research; which features of research encourage teachers to use research findings in their own practice; whether medical practitioners make greater use of research findings than teachers; and approaches to dissemination. Two key ideas emerge from this review. First, there appear to be common barriers to research use in both medicine and in education. Findings suggest that there is a need to create a culture in the public sector which supports and values research. There are, however, a number of factors, which appear to be more specific to the education field. Key differences in the way that research knowledge is constructed in the social sciences has led to researchers being challenged about their findings, pa...

The use of research to improve professional practice: a systematic review of the literature

Barriers to implementing the evidence base in four NHS therapies

Background Integration of research evidence into clinical nursing practice is essential for the delivery of high-quality nursing care. Leadership behaviours of nurse managers and administrators have been identified as important to support research use and evidence-based practice. Yet minimal evidence exists indicating what constitutes effective nursing leadership for this purpose, or what kinds of interventions help leaders to successfully influence research-based care. Aims (1) To describe leadership activities of nurse managers that influence nurses' use of research evidence; and (2) to identify interventions aimed at supporting nurse managers to influence research use in clinical nursing practice. Methods A search of electronic databases was conducted for studies on behaviours or activities of nurse managers/administrators and the use of research evidence by nurses. Sifting, screening, and quality assessments were done by two reviewers. Results were synthesized by study type (quantitative and qualitative) and reported. Results Twelve studies met inclusion criteria (eight quantitative, four qualitative). Three activities were found in quantitative studies that influenced nurses' use of research: managerial support, policy revisions, and auditing. Qualitative studies showed organizational issues as barriers to managers' abilities to affect research use, while role modeling and valuing research facilitated research use. Four studies, one of which was experimental, included an intervention to support managers, but all had insufficient information about leadership development. Conclusions To date, important descriptive work highlights the strategic role managers have in research transfer. Both facilitative and regulatory activities appear to be necessary for managers to influence research use. These findings have important implications for evolving theoretical models describing factors that affect the process of research utilization. It is time to move the science forward and test a hypothesis linking leadership to outcomes. Qualitative methods are essential for understanding the process of leadership for research transfer.

Managerial Leadership for Nurses' Use of Research Evidence: An Integrative Review of the Literature

Translating research into practice. Considerations for critical care investigators

To ensure effective utilization of research in nursing more evidence is needed which illuminates the way nurses think about research, the value which they put on it, and how they envisage that it may help or hinder them in their everyday work. This English study aimed to meet these objectives by describing the research culture of practising nurses, health visitors and midwives, and their managers. It rests on two assumptions. Firstly that the reasons why practitioners do, or do not, base their practice on research are complex, and secondly, that interventions to increase research utilization must be grounded in an appreciation of this complex ‘whole’. Thus the study took a qualitative approach to exploring: what participants thought and felt about research; the current status of research based practice; and the opportunities and constraints to increasing research based practice. The results confirm the hypothesis that many factors, both individual and organizational affect research utilization. Furthermore, practitioners and managers hold differing perceptions regarding the nature of research, its role, and the opportunities and constraints which effect its dissemination and utilization. The implications of the results for education, policy and practice are discussed.

Bridging the research-practice gap: exploring the research cultures of practitioners and managers.

This paper describes a recent study which investigated the research culture of 21 nurses, midwives and health visitors and their nine managers in three Trusts in England. Data were collected through in‐depth interviews and analysed using an adaptation of Colaizzi's framework. The results presented in this paper describe the opportunities for, and barriers to, research‐based practice within the three cultures. These findings emphasize the complexity of creating and sustaining a research culture within NHS Trusts.

Andree Le May

Papers

Bridging the research-practice gap: exploring the research cultures of practitioners and managers.

Research utilization in nursing: barriers and opportunities

An exploration of opportunities for and barriers to collaboration in interdisciplinary research