The Influences on New Graduates' Ability to Implement Evidence-Based Practice: A Review of the Literature

Article excerpt

The purpose of this literature review is to identify influences on new graduate occupational therapists to apply evidence-based practice (EBP) within the work place. Current education programmes ensure that new graduates have the ability to locate, critically appraise and evaluate research to consider what would be 'best practice'. Although new graduates have these skills, implementing them is often difficult and they may be lost if not practiced. There are many barriers to using EBP such as lack of time, skills, access to resources and service resistance. For a new graduate this is compounded by the challenge of having responsibility for a case load for the first time, lack of confidence in making clinical decisions, trying to identify their role within the setting and proving professional competence to a supervisor (Hodgetts, Hollis, & Triska, et al., 2007; Morley, Rugg, & Drew, 2007).

Review of the literature

To explore the topic of new graduates' use of EBP the following data bases were searched: CINAHL with full text, PubMed, and OT seeker. The search terms included: 'evidence-based,' 'new-graduate,' 'occupational therapy*' 'novice' 'expert' 'clinical*'

Defining a new graduate (NG)

One of the first questions to consider, is what period of time does a therapist remain as a new graduate? According to Tryssenaar and Perkins (2001) the transition period typically lasts four to six months until adaptation strategies are displayed. These strategies consist of spending less time on routine tasks and an increased awareness of the role. Others consider a novice occupational therapist to be someone who holds a base graduate position and has less than eighteen months experience (Kuipers & Grice 2009). Benner (1984) developed a 'novice to expert' continuum to identify stages of career development and this has been used in occupational therapy. In this account, novices are considered to have knowledge of theories, principles and specific patient attributes but they are usually rigid in their application because of limited experience in clinical situations. Benner's explanation is helpful as it defines the characteristics of a novice therapist rather than a specific time frame. Another defining characteristic is reported to be difficulty in being able to recognise significant critical cues when working with clients (Jensen, Shepard, & Hack, 1990).

Defining evidence-based practice

EBP has many definitions within the health system and was previously recognised as evidence-based medicine in the 1980's (Taylor, 2007). It is now widely accepted as being the application of up to date best evidence used in conjunction with clinical decision making, to ensure the best care for clients (Taylor, 2007). Specifically in the New Zealand context, the Occupational Therapy Board of New Zealand (OTBNZ, 2004) uses the following definition:

   Evidence based practice utilises clients' knowledge of their
   occupational concerns and circumstances, insights drawn from
   experience and reflection, and critical appraisal of best available
   evidence drawn from research, experts and theory to inform practice
   decisions (p 3).

The occupational therapy profession was considered slow to integrate evidence into their clinical decision making processes (Dubouloz et al., as cited in Taylor, 2007) because research evidence was viewed as being incompatible with client-centred practice. There are still issues regarding the compatibility of research evidence within a practice that primarily has a humanistic focus (Blair & Robertson, 2005). However, recent research by Unsworth (2011) indicates that "occupational therapists now have an excellent grasp of evidence-based practice ..." (p209), but need to consider how to deliver EBP services within the daily constraints of a work environment.

This is supported by Bondoc & Burkhardt (2004) who stated that EBP used to guide clinical decision making should be a part of occupational therapists' core competencies. …