Background Nurses and midwives form the bulk of the clinical health workforce and play a central role in all health service delivery. There is potential to improve health care quality if nurses routinely use the best available evidence in their clinical practice. Since many of the factors perceived by nurses as barriers to the implementation of evidence-based practice (EBP) lie at the organisational level, it is of interest to devise and assess the effectiveness of organisational infrastructures designed to promote EBP among nurses. Objectives To assess the effectiveness of organisational infrastructures in promoting evidence-based nursing. Search methods We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, LILACS, BIREME, IBECS, NHS Economic Evaluations Database, Social Science Citation Index, Science Citation Index and Conference Proceedings Citation Indexes up to 9 March 2011. We developed a new search strategy for this update as the strategy published in 2003 omitted key terms. Additional search methods included: screening reference lists of relevant studies, contacting authors of relevant papers regarding any further published or unpublished work, and searching websites of selected research groups and organisations. Selection criteria We considered randomised controlled trials, controlled clinical trials, interrupted times series (ITSs) and controlled before and after studies of an entire or identified component of an organisational infrastructure intervention aimed at promoting EBP in nursing. The participants were all healthcare organisations comprising nurses, midwives and health visitors. Data collection and analysis Two authors independently extracted data and assessed risk of bias. For the ITS analysis, we reported the change in the slopes of the regression lines, and the change in the level effect of the outcome at 3, 6, 12 and 24 months follow-up. Main results We included one study from the USA (re-analysed as an ITS) involving one hospital and an unknown number of nurses and patients. The study evaluated the effects of a standardised evidence-based nursing procedure on nursing care for patients at risk of developing healthcare-acquired pressure ulcers (HAPUs). If a patient’s admission Braden score was below or equal to 18 (i.e. indicating a high risk of developing pressure ulcers), nurses were authorised to initiate a pressure ulcer prevention bundle (i.e. a set of evidence-based clinical interventions) without waiting for a physician order. Re-analysis of data as a time series showed that against a background trend of decreasing HAPU rates, if that trend was assumed to be real, there was no evidence of an intervention effect at three months (mean rate per quarter 0.7%; 95% confidence interval (CI) 1.7 to 3.3; P = 0.457). Given the small percentages post intervention it was not statistically possible to extrapolate effects beyond three months. Authors...

No abstract

The aim of this formative evaluation (action research) study was to develop and apply a set of criteria for benchmarking evidence-based nursing. There were three phases: the identification (through literature searches and contact with experts) of previous work on the development and assessment of evidence-based nursing; the development (through a consultation exercise) of criteria for measuring and benchmarking evidence-based nursing; and applying these criteria (through semi-structured interviews) in six discrete clinical areas. Numerous papers were found that discussed evidence-based nursing and barriers to research utilisation, but no previous work on benchmarking or assessing evidence-based nursing was found. Fourteen 'benchmarking evidence-based nursing' criteria were developed, organised around four key themes for achieving effective practice: Selecting a particular aspect of practice to question or examine; finding out from the literature, professional networks and other sources what is current best practice, and critically appraising the available literature and sources of information; implementing and/or learning how to provide best-known clinical practice; and confirming that you are providing best practice. All six clinical areas were generally poor on all 14 benchmarking criteria. However, there were some positive attributes: nurses with degree level post-registration education had better knowledge of searching for and critically appraising research; some senior clinical specialists were supportive of evidence-based changes; and one ward had stronger communication/dissemination links for relevant evidence with related clinical areas (paediatrics). It was concluded that the benchmarking tool developed in the study was useful in identifying positive and negative aspects of evidence-based nursing practice. The tool may be helpful to other organizations considering how to take forward evidence-based nursing practice.