Contextual factors influencing research use in nursing.

BACKGROUND: Contextual factors are perceived to be significant barriers to research-utilisation-related activity, but little is known about how context impacts on specific research-based decisions, or how the individual interacts with the organisation in the requirement for research-based change. AIM: This study describes the impact of contextual factors on the practical reasoning of nurse specialists in the construction of policy for practice.
METHODS: Three groups of clinical nurse specialists were observed during a series of meetings convened to construct evidence-based guidelines for nursing practice. Transcripts of the meetings were analysed to identify and categorise the physical, social, political, and economic influences on 31 nursing issues.
FINDINGS: Multiple contextual factors influenced each decision made, with decisions about nursing practice bounded by setting and system considerations, relationships with others in the care team, and resource constraints. Practitioners were involved in weighing up alternative scenarios, contexts, and contingencies for each decision, requiring strategies to adapt and reconstruct the nature of care, to influence others, and to affect organisational decision-making processes. DISCUSSION: The practical accomplishment of evidence-based practice required diverse skills: translating between evidence and practice; mediating the values, preferences, and working practices of multiple stakeholders; negotiating organisational complexity and the management of boundaries; and coordinating inter-organisational and inter-agency working. Nurse specialists in this study had a significant role in instigating, fuelling, and coordinating policy review, predominantly by communication across professional and organisational boundaries. IMPLICATIONS/
CONCLUSIONS: Clinical specialists acting as organisational boundary spanners require skills in the informal cultural work of organising, facilitating, and maintaining links across professional, team, and organisational boundaries. If their role in the negotiation of evidence-based practice patterns across professional and organisational boundaries is to be successful, wider skills than information management need to be recognised and their development and enactment supported.