Evidence-based practice (EBP) promotes clinical judgements that are based on the best available evidence, with less emphasis on authoritative opinions and traditions. The integration of best available evidence is associated with improved patient outcomes, reduced treatment costs and need for clinical interventions (Melnyk et al. 2012; Levin et al. 2011). Student nurses in the UK and Slovenia understood the importance of EBP and research in their future careers, but struggled to conceptualise how they could maintain these skills on leaving the academic setting as perceived a lack of involvement in EBP and research by clinical nurses (Brooke et al. 2015).
In the UK, student nurses are supported by nurse mentors in clinical settings. The Nursing Midwifery Council’s guidelines (NMC 2010) for nurse mentorship include the acquisition of skills to search, find and review research to change or support their practice, and enable student nurses to understand and implement evidence-based care across both community and hospital settings.
A review of contemporary literature explored EBP beliefs, knowledge and skills of nurses working in acute and community settings, the findings supported the traditional barriers of a lack of time, knowledge, and skills, however nurses’ held more positive beliefs towards EBP, but this was not associated with an increase in their intentions to implement EBP (Mallion and Brooke 2016).
The understanding of nurses’ beliefs regarding EBP is essential, as they are pivotal in supporting student nurses in clinical placements to begin the process of implementing EBP. The aim of this study was to explore the impact of community- and hospital-based nurses’ beliefs of evidence-based practice and how this influences their strategies to support student nurses to understand and implement evidence-based practice.
Methods
Data were collected via 7 focus groups in 2015 with 33 community-based nurse mentors from one community NHS Foundation Trust, and via 4 focus groups in 2016 with 28 hospital-based nurses from one acute NHS Foundation Trust. Participants included: nurses from band 5-8, from different specialities across the two settings. The interview view schedule was developed from previous literature and relevant for both community and hospital mentors. All community-based focus groups were facilitated by the first author, hospital-based focus groups were facilitated by both authors. Data was analysed using thematic analysis, from a social constructionism approach (Burr 2016). All transcripts were read several times in order to become familiar with the text, relevant extracts where highlighted and coded. These codes were developed into a number of themes. The initial analysis was completed by the first author and reviewed by the second author, before being refined and organised into overarching themes (Braun and Clarke 2006).
Results
Themes from both community- and hospital-based nurse mentors included: 1) our practice is evidence-based; community-based nurses cited local and national guidelines to justify their practice, while hospital-based nurses were adamant their practice was evidence-based, but they just didn’t use that language. 2) time as a barrier to mentor student nurses; time was reported as a limitation by all nurses, with the exception of community-based district nurses who used the time spent traveling between patients homes to support students. A unique theme to community-based nurses was the importance of; being current as a nurse practitioner, a mentor and a role model. Community-based nurses discussed the importance of inspiring student nurses to become actively involved in developing their own practice, and this required mentors to be current. A unique theme to hospital-based nurses was; evidence-based practice is essential for harm free care. Hospital-based nurses discussed the importance of understanding harm and the implementation of evidence-based practice was assurance that they were doing their patients no harm.
Discussion
All nurse mentors reported providing evidence-based care, community mentors explicitly described guidelines and policies that supported their practice. Whereas, hospital nurses openly admitted they did not use the term ‘evidence-based practice’ with student nurses, but neither did student nurses ask them for the evidence behind the care they were providing. The use of the same terminology used in Higher Education Institutes and in student nurses practice placements may support a connection between theory and practice. Time has been recognised as a barrier when mentoring student nurses, but hospital nurses felt time was a barrier to implement evidence-based practice. Hospital nurses spoke about the importance of evidence-based practice to support harm free care, when community nurses focused on their need to remain current to support students understanding of evidence-based practice. An understanding of the issues across community- and hospital-based settings is important and will support the development of tailored mentorship/training programmes, which will aid the continued development of nurses’ evidence-based practice and techniques to enable them to implement practical examples when mentoring student nurses.
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