Editorial

Editorial

Leadership and the Use of Evidencein Practice

Until relatively recently, the use of evidence in prac-tice was viewed as primarily an individual activity.

The view that individuals or practitioners are “rationalagents” capable of searching, appraising, and translatingevidence has dominated. However, findings from a sys-tematic review that examined individual nurse characteris-tics and how they influence research utilisation found thatapart from the attitude to research, there was little to sug-gest that any potential individual determinants influenceresearch use (Estabrooks et al. 2003). Additionally, a num-ber of researchers have found that the context of practicemay influence the use, or not, of evidence in practice (e.g.,Dopson et al. 2002; Dopson & Fitzgerald 2005). So, overtime, there has been a shift away from focusing entirely onthe responsibility of individual practitioners in using evi-dence in practice to acknowledge that there may be otherfacilitating and/or inhibiting contextual factors that play apart. One of these contextual factors is the presence, role,and potential influence of leaders.

Whilst some evidence-based practice frameworks ex-plicitly or implicitly acknowledge the potential role of lead-ers (e.g., Promoting Action on Research Implementationin Health Services (PARIHS); Stetler 2001 model; Rycroft-Malone et al. 2002 & 2004), the evidence base for the exactrole that leaders might play is underdeveloped. However,this is also changing. For example, in an integrative review,Gifford et al. (2007) described the leadership activities ofnurse managers that might influence nurses’ use of researchevidence. The evidence base of included research was lim-ited to 12 studies in which quantitative studies showed thatleadership activities such as managerial support, policy re-visions, and auditing were influential. Qualitative studiesshowed that leaders’ role modelling and valuing of researchcould facilitate research use. Furthermore, a secondaryanalysis of qualitative data collected as part of the Reg-istered Nurses Association of Ontario Best Practice Guide-lines project found that three broad leadership strategieswere critical to the successful and sustained use of guide-lines in practice (Gifford et al. 2006). These included: (1)facilitating staff to use the guidelines, (2) creating a positivemilieu of best practice, and (3) influencing organisationalstructures and processes. It also emerged that leadership

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behavior could operate at many levels, which is consistentwith recent research on determinants of the sustained useof clinical guidelines in practice (Davies et al 2006). Theseresearchers found that one of the facilitators of sustainedguideline use was nursing leadership, which included keyleaders at front line and executive level in various positions,including champions, advanced practice nurses, managers,and executives. The authors conclude that nursing lead-ership is critical to sustaining and expanding the use ofclinical practice guidelines.

This research has begun to provide a more robust ba-sis for the assertion (and long-standing belief) that lead-ers can play an important role in the use of evidence inpractice; be that positively or negatively. It also indicatesthat there are factors within the context of care that canbe modified. Whilst more research needs to be conducted,there are implications that could be considered now. Forexample, investing in key individuals at multiple levels ofthe organisation and developing their leadership capacityand ability to support their colleagues and regulating sys-tems and processes to influence the routine use of evidencein their practice seems a potentially testable intervention.Within implementation research, continuing to study theinfluence that those in informal or formal leadership po-sitions have on implementation efforts is critical in orderthat the knowledge base continues to develop.

It is a welcome relief that the implementation of evi-dence in practice is now more commonly being viewed asa complex activity involving more than individual factors.Thinking about the individual as an actor in the context ofpractice, whilst complex, will enable a more realistic andcomprehensive approach to evidence-based practice. In re-lation to the contextual factor of leadership, as Gifford et al.point out, “While the use of clinical guidelines in nurs-ing is both an individual and organizational responsibility,the contributions of leadership are substantial. Throughdirect and indirect influences, nurse leaders are in a strate-gic position to encourage and enable research transfer”(2006, p. 86).

Jo Rycroft-Malone, RN, PhDEditor

j.rycroft-malone@bangor.ac.uk

ReferencesDavies B., Edwards N., Ploeg J., Virani T., Skelly J. &

Dobbins M. (2006). Determinants of sustained use of re-search evidence in nursing. Final report. Canadian Health

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Services Research Foundation and Canadian Institutesfor Health Research. Ottawa, Canada. Retrieved January5, 2008, from www.chrsf.ca.

Dopson S. & Fitzgerald L. (2005). Knowledge into action.Oxford, England: Oxford University Press.

Dopson S., Fitzgerald L., Ferlie E., Gabbay J. & Locock L.(2002). No magic targets! Changing clinical practice tobecome more evidence based. Health Care ManagementReview, 27(3), 35–47.

Estabrooks C. A., Floyd J. A., Scott-Findlay S., O’LearyK. A. & Gushta M. (2003). Individual determinants ofresearch utilization: A systematic review. Journal of Ad-vanced Nursing, 43(5), 506–520.

Gifford W. A., Davies B., Edwards N. & Graham I. D.(2006). Leadership strategies to influence the use of clin-ical practice guidelines. Nurse Leadership, 19(4), 72–88.

Gifford W., Davies B., Edwards N., Griffin P. & LybanonV. (2007). Managerial leadership for nurses’ use of re-search evidence: An integrative review of the litera-ture. Worldviews on Evidence-Based Nursing, 4(3), 126–145.

Rycroft-Malone J., Kitson A., Harvey G., McCormack B.,Seers K., Titchen A. & Estabrooks C.A. (2002). Ingre-dients for change: Revisiting a conceptual framework.Quality and Safety in Health Care, 11, 174–180.

Rycroft-Malone J., Seers K., Titchen A., Harvey G., KitsonA. & McCormack B. (2004). What counts as evidencein evidence-based practice? Journal of Advanced Nursing,47(1), 81–90.

Stetler C. B. (2001). Updating the Stetler model of researchutilization to facilitate evidence-based practice. NursingOutlook, 49(6), 272–279.

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