Strategies designed to encourage the uptake of research into clinical practice have demonstrated only a modest (?10%) to moderate (>10% to ?20%) effect (Cheater et al., 2006) in changing practice. A systematic review published in 1998 showed that the most common methods of disseminating research evidence were ineffective because clinicians were not engaged in an active learning process. Clinicians were receiving information passively through publication of consensus conferences in journals, the mailing of educational materials, and didactic lectures (Bero et al., 1998). According to other writers, the best method of implementing research evidence into clinical practice is to engage clinicians in professional communities and social networks (Dopson, Fitzgerald, Ferlie, Gabbay, & Locock, 2002).
A Clinical Development Group (CDG), consisting of interested clinicians, was established in a metropolitan health service. The purpose of the CDG was to engage clinicians in the process of examining research evidence and developing policies to produce a quality improvement in nursing practice throughout a large area health service. This paper describes the process of developing an evidence based policy by engaging clinicians in an active learning process of accessing and assessing the evidence, as well as acting as consultants so that policy development remained relevant to the local context.
The integration of evidence based approaches to policy development and practice change within organisations has resulted in some refinement of the processes. The St. Luke's Evidence Based Practice Model describes discrete stages of practice change. These stages are the identification of a problem, clarification of the clinical issue, literature review, research analysis, and evaluation of findings. If a need to change practice is demonstrated, the model requires an evaluation of feasibility including the designing of a practice change strategy, the pilot testing of the strategy, and the measurement of the change (Anderson, Mokracek, & Lindy, 2009). Policy or guideline development is central to this process. Thomas (2007) describes the stages of guideline development as the selection of the topic, composition of the development group, defining the scope of the guideline, systematic review of the literature, formation of recommendations, consultation and peer review, dissemination, implementation, audit, and review (Thomas, 2007). Osborne and Webster (2005) define the characteristics of 'effective clinical guidelines' (p. 185) as being: outcome-focussed; based on the best available evidence or evidence that demonstrates a link between recommendation and outcome; combining the evidence with the strongest method available; development by multidisciplinary teams and consumers; flexible and adaptable to local conditions; considerate of resource limits; thoughtful of the target audience; reviewed regularly; and evaluated for effect, value, validity and usage (Osborne & Webster, 2005). Taking all these approaches into consideration, this paper outlines a strategy used to develop a policy relating to nursing and midwifery documentation and focuses on the methods used to support this change in practice.
NURSING AND MIDWIFERY DOCUMENTATION AS A FOCUS FOR CHANGE
Nursing and midwifery documentation is an essential component of the nurse's or midwife's care of their patient. However, documentation is also an aspect of care that many nurses and midwives find burdensome (Staunton & Chiarella, 2008). Confusion about what is required in nursing and midwifery documentation has resulted in numerous changes initiated by legal precedent and public enquiries. Quality nursing and midwifery documentation not only protects the nurse or midwife if they are required to explain their care, but also improves patient care outcomes. Quality nursing and midwifery documentation facilitates the continuity of care by keeping all members of the health care team informed of the patient's condition and care (Gebru, Ahsberg, & Willman, 2007). …