Looking Back to the Future

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  • Editorial

    Looking Back to the Future

    Over the last decade evidence-based practice hasevolved as the dominant theme of practice, policy,management, and education within health services acrossthe developed world. It has become a policy imperativebut also seems to have been broadly, although not ex-clusively, embraced. As an ideology it has penetrated theconsciousness, discourse, and working practices of manyprofessionals. From its inception, our vision for World-views on Evidence-Based Nursing has been to bridge the gapbetween knowledge and application and become a primarysource of information for nurses and health care profes-sionals more generally. Having reached its fifth birthday,it seems like an opportune time to reflect on the past bypresenting a collection of Worldviews on Evidence-BasedNursings articles. Our virtual special issue can be accessedat www.wiley.com/go/evidencebasednursing.

    The virtual collection provides some examples of thesort of evidence-based practice themes and issues that havebeen prevalent during the last 5 years, and those that willcontinue to vex us for some time to come.

    In 2008, Sigma Theta Tau Internationals Research andScholarship Advisory Committeewas taskedwith updatingthe organisations position statement on evidence-basedpractice. Within this update there has been the recognitionthat a variety of types of evidence could inform practiceand policy decision making (Rycroft-Malone et al. 2004;McCourt 2005; Sigma Theta Tau International 20052007Research and Scholarship Advisory Committee 2008). Ad-ditionally, the use of these sources of information occurswithin health care organisational contexts that may be fa-cilitative or hindering. This means that the adoption andsustained use of evidence through practice improvementsrequires multileveled and interactive strategies that takeinto account some of these complexities.

    The idea that context is important has gained increas-ing prominence over the last 5 years and is reflected in thejournals content. For example, French (2005) found thatmultiple contextual factors influenced clinical nurse spe-cialists decision making. These decisions were boundedby setting and system considerations, relationships withothers, and resource constraints. The importance of con-text is also echoed in the findings of others work (e.g.,Abbott et al. 2006; Wallin et al. 2006; Coffey et al. 2007;Ploeg et al. 2007). The findings fromWallin et al.s (2006)

    Copyright2009 Sigma Theta Tau International1545-102X1/09

    research led to the conclusion that the potential for or-ganisational improvement could be enhanced by develop-ing a learning and supportive environment at a unit level.The theme of context is continued within this issue byMcCormack et al. (2009) reporting on the developmentand testing of an instrument to evaluate the quality of con-texts for implementation.

    Sometimes conceived as part of context, the role of lead-ership and leaders is also receiving increasing attention(e.g., Gifford et al. 2007; Gifford & Davies 2008). Specifi-cally, Gifford and colleagues make the point that what isimportant . . . is to recognize that both effective leadershipand skilled management are necessary to influence changein nursing practice (Gifford&Davies 2008, p. 170). Theirresearch shows that multileveled leadership (staff nurses,educators, supervisions, and senior leaders) is coordinatedtoward the same goals and vision and is important forevidence-based change (Gifford & Davies 2008). As theauthors state, there is much to learn about what appropri-ate leadership and management behaviors are required inorder to support nurses and others in the sustained useof evidence in practice. Of course, we hope to be report-ing on such research endeavors within future issues ofWorldviews.

    Whilst context and leadership will continue to be on theagenda, a developing area likely to gain more prominencein the future concerns the increasing use of technologyin promoting evidence-based practice. We have alreadyseen a hint of this within Worldviews with Doran and col-leagues, reporting on the potential of handheld computerswithin an outcomes-focused knowledge translation frame-work (Doran & Sidani 2007; Doran et al. 2007). The deliv-ery of timely, relevant information straight to practitionersis an important area ripe with fruitful research opportuni-ties. Additionally, with a different focus, but still explor-ing the potential of information technology, Hart et al.(2008) described a quasi-experimental study to examinethe effectiveness of a computer-based education programon nurses perceptions of knowledge, attitude, and skillsrelated to evidence-based practice. Findings showed thateducation delivered in this way could impact positivelyon nurses perceptions. These articles provide exemplarsof the growing potential of technology within both healthservice and educational contexts.

    Finally, Wallin (2008) has recently drawn our attentionto how evidence-based practice could make a significantdifference in the context of developing countries. Draw-ing on the example of neonatal care, he points out that

    Worldviews on Evidence-Based Nursing First Quarter 2009 1

  • Editorial

    well-designed implementation research in low-incomecountries is lacking, and to his mind this is very disturb-ing. In these contexts simple (low-cost, low-technology)interventions have the potential to make a big impact. Hismessage is a reminder to us that in order for Worldviewson Evidence-Based Nursing to be truly global, we need tostart considering the best way to share knowledge aboutissues specific to these countries. Also, we need to beginthis consideration in a collaborative and culturally sensi-tive manner.

    In a short time Worldviews on Evidence-Based Nursinghas achieved much. Recently the journal was given its firstimpact factor, and despite being relatively young, World-views is currently the 12th most cited nursing journal inthe world. Of course, this is only one measure of success.As we move forward, we continue to work toward our vi-sion, which is to become the key source of evidence-basedpractice information.

    Jo Rycroft-MaloneEditor

    j.rycroft-malone@bangor.ac.uk

    ReferencesAbbott C.A., Dremsa T., Stewart D.W., Mark D.D. &

    Swift C.C. (2006). Adoption of a ventilator-associatedpneumonia clinical practice guideline. Worldviews onEvidence-Based Nursing, 3(4), 139152.

    Coffey A., McCarthy G., McCormack B., Wright J. & SlaterP. (2007). Incontinence: Assessment, diagnosis, andmanagement in two rehabilitation units for older peo-ple. Worldviews on Evidence-Based Nursing, 4(4), 179186.

    Doran D., Mylopoulos J., Kushniruk A., Nagle L., Laurie-Shaw B., Sidani S., Tourangeau A., Lefebre N., Reid-Haughian C., Carryer J.R., Cranley L.A. & McArthur G.(2007). Evidence in the palm of your hand: Develop-ment of an outcomes-focused knowledge translation in-tervention.Worldviews on Evidence-Based Nursing, 4(2),6977.

    Doran D. & Sidani S. (2007). Outcomes-focused knowl-edge translation: A framework for knowledge transla-tion and patient outcomes improvement.Worldviews onEvidence-Based Nursing, 4(1), 313.

    French B. (2005). Contextual factors influencing researchusing in nursing.Worldviews on Evidence-Based Nursing,2(4), 172183.

    GiffordW.&Davies B. (2008). Doing the right things to dothings right: A commentary on leadership and the useof evidence in practice. Worldviews on Evidence-BasedNursing, 5(4), 170171.

    Gifford W., Davies B., Edwards N., Griffen P. & LybabonV. (2007). Managerial leadership for nurses use of re-search evidence: An integrative review of the literature.Worldviews on Evidence-Based Nursing, 4(3), 126145.

    Hart P., Eaton L., Buckner M., Morrow B.N., BarrettD.T., Fraser D.D., Hooks D. & Sharrer R.L. (2008). Ef-fectiveness of a computer-based educational programon nurses knowledge, attitude, and skill level aboutevidence-based practice. Worldviews on Evidence-BasedNursing, 5(2), 7584.

    McCormack B., McCarthy G., Wright J., Slater P. & CoffeyA. (2009). Development and testing of the context as-sessment index (CAI). Worldviews on Evidence-BasedNursing, 6(1), 2735.

    McCourt C. (2005). Research and theory for nursing andmidwifery: Rethinking the nature of evidence. World-views on Evidence-Based Nursing, 2(2), 7583.

    Ploeg J., Davies B., Edwards N., Gifford W. & Elliot MillerP. (2007). Factors influencing best-practice guide-line implementation: Lessons learnt from administra-tors, nursing staff, and project leaders. Worldviews onEvidence-Based Nursing, 4(4), 210219.

    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), 8190.

    Sigma Theta Tau International 20052007 Research andScholarship Advisory Committee. (2008). Sigma ThetaTau International position statement on evidence-based practice, February 2008, summary. Worldviewson Evidence-Based Nursing, 5(2), 5759.

    Wallin L. (2008). Evidence-based practice in a globalcontextthe case of neonatal mortality. Worldviews onEvidence-Based Nursing, 5(4), 167169.

    Wallin L., Ewald U.,Wikblad K., Scott-Findlay S.&ArnetzB. (2006). Understanding work contextual factors: Ashort-cut to evidence-based practice? Worldviews onEvidence-Based Nursing, 3(4), 153163.

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