Exploring Evidence-Based Practice Norms Among Bedside Nurses in Magnet-Designated Hospitals: A Q Methodology Study

Abstract

Evidence-based practice (EBP) is a recognized standard of professional nursing due to its positive impact on care quality and patient outcomes. Despite ongoing efforts to maximize EBP at the point of care, current estimates indicate that only 30% of healthcare decisions are evidence-based. Individual and organizational factors are commonly identified for their influences on EBP in nursing, but group factors have been largely unexplored. Group-level factors, such as norms, are essential to investigations of phenomena that occur within multilevel organizations (i.e., hospitals) where individuals work in groups. Understanding the EBP norms that emerge among groups of nurses in direct care roles may support the goal to increase evidence-based nursing care. The purpose of this dissertation study was to explore and describe the EBP norms that exist among groups of RNs who practice at bedside within Magnet-designated hospitals. Magnet-designated hospitals are recognized for their positive EBP cultures and infrastructures that support nurses’ EBP beliefs and goals, making them an ideal context to investigate shared viewpoints about EBP. Eligible Registered Nurses (RNs) were recruited from eight units within two Magnet-designated hospitals in the Midwestern United States. Using Q methodology, the participants’ individual perspectives about EBP were collected, then correlated and interpreted to uncover the shared viewpoints, or EBP norms, that existed within and across the study sites. Multiple EBP norms were discovered within each Magnet-designated hospital: four were found at Site A (Engaged, Overextended, Skeptical, and Reliable) and three were found at Site B (Amenable, Resistant, and Discerning). Two higher-order norms were also discovered (Invested and Marginalized). Differences were observed among these norms, especially regarding nurses’ viewpoints around time for EBP, input on EBP, and trust in EBP. The findings confirm that group-level factors should be considered in the study of evidence-based nursing. They also suggest that Magnet designation alone cannot ensure a unified EBP viewpoint. Consequently, standardized approaches for enhancing EBP should be reexamined, and more holistic interventions should be considered to address the variety of complex EBP viewpoints that exist among RNs who practice at bedside in Magnet-designated hospitals.