Organisational infrastructures to promote evidence based nursing practice

Foxcroft D, Cole N

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Summary

Organisational infrastructures may be important in the development of evidence based nursing practice

We did not find any evaluated infrastructure developments that were of sufficient quality to be included in the systematic review. There are no clear implications for organisational practice as there is no good evidence about the impact of organisational infrastructures on the development of evidence based nursing practice.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Foxcroft D, Cole N. Organisational infrastructures to promote evidence based nursing practice. Cochrane Database of Systematic Reviews 2000, Issue 3. Art. No.: CD002212. DOI: 10.1002/14651858.CD002212.

This version first published online: October 20. 2003

Abstract

Background

The purpose of this systematic review is to determine to what extent organisational infrastructures are effective in promoting the implementation of high quality research evidence on the effectiveness of nursing interventions.

Objectives

To identify and summarize rigorous evaluations of organisational infrastructure developments aimed at promoting evidence based nursing practice.

Search strategy

We searched: The Cochrane Library, MEDLINE, EMBASE, CINAHL, SIGLE, HEALTHLINE, National Research Register, Nuffield Database of Health Outcomes, NIH Databases up to August 2002. We hand searched the Journal of Advanced Nursing, Applied Nursing Research and Journal of Nursing Administration (to 1999), and checked the reference lists of articles obtained. We contacted experts in the field and relevant Internet groups.

Selection criteria

Randomized controlled trials, controlled clinical trials and interrupted times series studies of an entire or identified component of an organisational infrastructure development aimed at promoting effective nursing interventions. The participants were health care organisations comprising nurses, midwives and health visitors in hospital and community settings.

Data collection and analysis

All identified papers were screened independently for relevance, design and outcome by two reviewers.

Main results

No studies were sufficiently rigorous to be included in this systematic review. Seven case study evaluations were identified but excluded from the review because of poor design and lack of controls.

Authors' conclusions

1. There are no clear implications for practice.
2. Several conceptual models on organisational processes to promote evidence based practice have been described in published papers, and a number of organisational infrastructural interventions have been described in published papers. None have been evaluated properly. The next step in this field should be to conduct well planned evaluations of well planned interventions.
3. Interrupted and Complex Interrupted Times Series (ITS and CITS) designs should be adopted as a useful alternative to randomized controlled trials where such trials would be impractical. The health service cost of any infrastructure developments should be assessed in any evaluation. If possible, patient outcomes should be measured directly.

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