Engaging Clinicians in Evidence Based Policy Development: The Case of Nursing Documentation
Jefferies, Diana, Johnson, Maree, Griffiths, Rhonda, Arthurs, Kathy, Beard, David, Chen, Tanghua, Edgetton-Winn, Maureen, Hecimovic, Tony, Hughes, Margaret, Linten, Karen, Maddox, Julie, McCaul, Damien, Robson, Kim, Scott, Shelley, Zarkos, Tina, Contemporary Nurse : a Journal for the Australian Nursing Profession
A lack of consistent policy direction, revealed by a review of nursing and midwifery documentation, presented researchers with an opportunity to engage clinicians in the process of evidence based policy development. By utilising the framework informed by both practice development and the principles of evidence based practice, clinicians were taken through an education program and a series of activities to develop their skills in discerning how research evidence and other literature can inform policy development.
The clinicians' involvement maximised their investment in the final policy. Clinicians synthesised all the evidence associated with nursing and midwifery documentation and produced a set of seven guiding principles that formed the basis of an area wide policy for nursing and midwifery documentation.
The strength of this approach to policy development was that the clinician's experience ensured that the concerns of the clinicians were included in the policy. Difficulties in completing tasks outside meeting times were highlighted.
KEYWORDS: nursing; documentation; policy development; practice development; communication; evidenced based practice
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). …