Does the use of policies and procedures promote evidence-based nursing practice?

Article type
Authors
Squires J, Moralejo D, LeFort S
Abstract
Background: There is considerable interest in how evidence is translated into nursing practice. Use of a research-based practice is associated with perception that a policy exists dictating its use[1], and policy and procedures (P&P) are one of the top five sources of practice knowledge for nurses[2]. Research in the area of P&P use is limited however.

Objectives: The primary objective of this study was to determine the role of organizational P&P in promoting evidence-based nursing practice (EBP).

Methods: Staff nurses from six regions across Newfoundland and Labrador completed an anonymous questionnaire regarding eight research-based nursing practices and their own use of P&P. Data was obtained from authorities within each region about the existing relevant P&P.

Results: Preliminary results have been tabulated from 233 questionnaires returned thus far. Use of the eight practices was reported by 8.1% to 88.4% of the nurses, depending on the practice. Five of six regions had P&P for at least three practices, while no region had P&P for more than four practices. Nurses correctly perceived a policy existed 43.5% to 94.1% of the time, depending on the policy. Actual existence of a policy was significantly associated with use for only one practice, while perception that a policy existed was significantly associated with use for all eight practices (p<.0005). Nurses ranked P&P manuals as their number one source of practice knowledge. Almost all respondents (93.1%) felt the purpose of P&P was to guide nursing practice and all nurses reported consulting their organization s P&P manual at least sometimes. The majority (87.8%) indicated unfamiliar tasks as their main reason for consulting the manual while being familiar with a task (51.5%) and lack of time (34.2%) were cited as the main reasons for not consulting the manual more frequently. The majority (71.6 %) stated they always adopt new / revised policies, about which they were kept up to date primarily by in-services (70.9%) and e-mail (67.6%). Only 7.3% indicated they would incorporate research findings into practice that were not supported by a current P&P. When deciding to implement a policy, less then 40% of the nurses considered elements of the EBP process such as patient preferences (36.7%), clinical expertise (34.0%), available resources (31.4%), and current research (9.6%).

Conclusion: Preliminary results indicate that perception that a policy exists, rather than its existence, is an important factor in the adoption of research-based practices for nurses. Increasing the research basis of P&P is one step to promoting EBP but is not enough if nurses are not well informed about the P&P. Nurses also need to incorporate the other elements of the EBP process and not merely rely on P&P.

Acknowledgements: The Canadian Cochrane Network and Center - Memorial University Site for funding this study.

References: 1. Coyle LA, Sokop AG. Innovation adoption behavior among nurses. Nurs Res. 1990;39:176-180. 2. Estabrooks CA. Will evidence-based nursing practice make practice perfect? CJNR. 1998;30(1):15-36.