Aim and objectives To explore nurses’ constructions of the concept of evidence‐based practice through their understandings of and experiences with evidence‐based practice in a clinical care setting. Background The primary purpose of evidence‐based practice is high‐quality patient outcomes. However, the adoption of evidence‐based practice is described as a complex process, and research shows that evidence‐based practice is not translated into practice. Research often explores facilitators and barriers of implementing and adopting evidence‐based practice. Yet there is limited knowledge on how nurses construct the concept in practice. Design This study has a constructivist approach and follows COREQ guidelines. Method Ten semi‐structured interviews with 26 nurses were conducted in 2019. Data were analysed with an emic and inductive approach. Results Three key constructions emerged. Understandings of evidence‐based practice were based on the original concept of evidence‐based medicine. This included the hierarchy of evidence which was perceived as an inflexible concept not encompassing the nursing care. However, while not using the term evidence‐based practice, the nurses were doing evidence‐based practice portrayed through outcomes from management‐supported nursing‐based projects and incorporated reflections and discussions into weekly meetings. A discrepancy between a theoretical understanding and a practical doing of evidence‐based practice appeared and was especially evident when the nurses’ primary evidence sources consisted of the immediate options, for example asking colleagues or following accessible guidelines. Searching for evidence was central in their theoretical understanding but not an incorporated part of their daily work tasks. Conclusion The nurses’ constructions of evidence‐based practice indicate a discrepancy between the theoretical understanding of evidence‐based practice and the practical doing of evidence‐based practice, which hinders the basis of working according to the concept. Relevance to clinical practice Theoretical discussions of evidence‐based practice within the nursing field remain academic, as nurses in practice construct the concept on standards from evidence‐based medicine.

Aims and objectives To explore gains and impacts of job rotation through the experiences of involved nursing personnel responsible for different parts of care during the elective orthopaedic patient's pathway. Background When patients undergo elective orthopaedic surgery, they encounter nurses from different wards. So far, job rotation has only been described through the experiences of the job rotating nurses. This study includes all involved nursing personnel and bases the job rotation on the pathway of the elective orthopaedic patient. Design This study has an exploratory‐descriptive and qualitative approach and follows the Consolidated Criteria for Reporting Qualitative Research guidelines. Method A total of nine focus groups including 16 informants were conducted before, during and after a 5‐month trial period. The data were analysed using thematic analysis. Results The findings show that existing work structures and work content combined with a lack of a common understanding of the job rotation impacted the expectations of the nursing personnel regarding (in)dependence, individual and collegial involvement and investment, as well as the collegial belongingness expressed through terminologies of “home” and “culture.” The personal gains among the job rotating nurses showed increased knowledge, skills and influence. When knowledge was shared and exchanged, the job rotating nurses became “cultural translators” of the care to the elective orthopaedic patient. Conclusions This study shows personal gains among the job rotating nurses through increased knowledge, skills and influence as well as collegial gains by sharing and exchanging knowledge. When this exchange was utilised, the job rotation was evaluated positively, and contrary, when not utilised the job rotation had a negative impact on the work environment. Relevance to clinical practice Job rotation among nurses following the care of the patient's pathway can be a way of promoting patient safety and quality through increased knowledge across wards by including every aspect and element of the patient's pathway.

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BackgroundThe patient role is changing to include further patient involvement, control and empowerment. To accommodate this new patient profile in new hospital construction projects, we tested the medication one stop dispensing (OSD) system. The OSD method involves medications stored in the patients’ bedside lockers, and barcode controlled medication dispensing is performed by mobile dispensing units (MDU). This study presents the first national results for MDU.PurposeTo evaluate nursing staff’s initial experiences with barcode controlled bedside medication dispensing.Material and methodsMDU was designed in November 2014 following an interdisciplinary workshop and produced by MedicSysteme. MDU was equipped with a laptop installed with the hospital’s standard software for real time documentation and access to patient charts and the internet. A 2D bar code reader was connected for bar code verification in the medication dispensing and administration process. In January and February 2015, nursing staff from the orthopaedic surgery ward were trained for bedside dispensing using guided learning videos, peer to peer training and structured reviews of regional medication guidelines. A focus group interview was conducted in May 2015 with four nursing staff members with experience in drug dispensing. A semi-structured interview guide was applied and the interview was audio recorded, transcribed and thematically categorised through content analysis.ResultsQualitative thematic analysis of the interview identified the following topics: hardware, software, patient safety, patient involvement and workflow. The in-line process with bedside access to charts and drug information focuses on the patient’s overall condition and treatment. The use of MDU and OSD invite patient involvement and reduce the risk of medication mix-up errors. Nursing staff experience more interruptions when dispensing at the bedside. Further development of suitable IT solutions and the physical appearance of the MDU are needed. This study found implementation barriers related to workflow and hospital décor, especially in 4-bed rooms.ConclusionA focus group interview identified the following topics: hardware, software, patient safety, patient involvement and workflow. Future studies should focus on optimising MDU design and implementation of the new dispensing practice on a larger scale.No conflict of interest.