Evidence-Based Practive Sustainability and Nursing Professional Governance

Abstract

Patient care that is not based on evidence-based practice (EBP) could be considered malpractice, and it threatens patient safety, quality, and fiscal performance. EBP implementation is complex, and sustainment of these practices is such a persistent challenge that up to 70% of organizational change fails to be sustained. Sustainment of EBP decreases healthcare costs and improves patient outcomes. Professional attributes that influence sustainability are not well understood. Nursing professional governance (PG) is a framework of professional attributes that includes accountability, professional obligation, collateral relationships, and decision-making. This framework includes attributes that are necessary for professionals to effectively govern their profession and influence outcomes. Healthcare professionals are an important component of sustainability frameworks; however, the professional attributes that influence sustainability have not been validated by research. The purpose of this dissertation was to examine the influence of professional attributes on the sustainability of EBP and patient outcomes. This was accomplished through 1) an ethnographic qualitative study, 2) a cross-sectional study, and 3) a scoping review. The researcher used a qualitative study to described cultural characteristics, nurse values, and beliefs that influenced the sustainability of an EBP in the acute care setting. This was accomplished through a focused ethnographic approach with semi-structured interviews and observations. The study setting was a community hospital and the sample included registered nurses. In this study, nurses’ described experiences, beliefs, and values of an EBP intervention that influenced sustainability. The purpose of the cross-sectional study was to examine associations between professional governance attributes and unit-level central line-associated bloodstream infection outcomes. Secondary cross-sectional data were analyzed with independent-sample t-test, point-biserial correlation, and univariate logistic regression. The study setting included ninety-one inpatient units within eight acute care hospitals. In this study, results revealed possible connections between professional governance attributes and patient outcomes. Finally, a scoping review included 31 articles to provide an overview of evidence about sustainability and EBP champion responsibilities. The scoping review summarized literature on EBP champion responsibilities that influenced EBP sustainability. The findings of this dissertation can inform research, practice, and policy regarding professional attributes that enhanced or hindered EBP sustainability.