The Magnet Journey: Understanding the Role of the Unit Culture in Evidence-Based Practice Adoption Open Access

Abstract

Abstract

The Magnet Journey: Understanding the Role of Unit Culture in Evidence-Based Practice Adoption
Purpose: The purpose of this exploratory study was to identify salient cognitive beliefs
and cultural assumptions that affect the emergence and maintenance of evidence-based
practice (EBP) in the hospital setting.
Scope: The use of EBP does not consistently occur in the nation's hospitals and this
leads to substandard patient/family outcomes. EBP is a decision-making process that
integrates the use of best evidence or research, patient/family preferences, and clinical
expertise. This definition parallels the IOM's calls for transformation of the healthcare
system to one that is evidence-based and patient/family centered. Understanding
individual and cultural attributes that influence nurses' behavior is vital to achieving this
goal.
Methods: This exploratory study utilized a qualitative approach, consisting of in-depth
interviews of 35 Registered Nurses on adult medical-surgical or critical care units in a
Magnet journey or Magnet designated hospital in a large metropolitan area in the
Southeastern US. Data were analyzed using the principles of analytic ethnography.
Results: The multilevel theoretical model framing this study was extended and refined
based on the data resulting in the creation of a new multilevel model. Extensions to the
model included the identification of two antecedent variables: hospital-level basic
assumptions and unit leader characteristics. Refinements to the model included
specification of the unit-level culture and individual cognitive beliefs. New relationships
among all variables were identified.
Significance: The new EBP implementation and sustainability model provides a more
complete description of how nurses implement and maintain EBP in the acute care
setting. Further study of the hospital-level culture and unit-level nurse leader
characteristics is needed to develop effective interventions to accelerate the use of EBP
in the hospital staff nurses.
Key Words: EBP model, research utilization, culture, magnet, qualitative, leadership,
empowerment

Table of Contents

Table of Contents

Chapter One
Statement of the Problem, Specific Aims, and Theoretical Framework 1

Chapter Two
Background and Significance 10

Chapter Three
Research Methodology 18

Chapter Four
Nurses' Cognitive Beliefs Concerning EBP 31
Behavioral Beliefs 33
Control Beliefs 63

Normative Beliefs 106
Multiple Cognitive Beliefs 132
Chapter Summary 149

Chapter Five
Unit Level Basic Assumptions and Evidence-Based Practice 155
Concept Review 155
The Nature of Reality and Truth 157
The Nature of Human Activity 180
The Nature of Human Relationship 208
Chapter Summary 278

Chapter Six
Conclusions, Discussions, Limitations, and Next Steps 288
Summary of Findings 288
Model Refinement 300
Discussion 304
Limitations 317
Future Research 318
Conclusion 320

References 321

Appendices
Appendix A Emory Informed Consent 336
Appendix B MJH Recruitment Poster 338
Appendix C MH Recruitment Poster 339
Appendix D Recruitment Email/Letter 340
Appendix E MJH Informed Consent Form 341
Appendix F MH Informed Consent Form 344
Appendix G Interview Guide 347
Appendix H Revised Interview Guide 350
Appendix I Coding Matrix 352
Appendix J Abbreviated MJH MS Unit Data Summary Matrix 354
Appendix K MH ICU Context Chart 355

List of Figures

Figure 1. Integration of Schein's (2004) Organizational Culture Conceptual

Framework with Ajzen's (1988, 2005) Theory of Planned Behavior 7 & 302

Figure 2. MJH MS Unit Organizational Chart 107

Figure 3. MJH ICU Organizational Chart 108

Figure 4. MH MS Unit Organizational Chart 108

Figure 5. MH ICU Organizational Chart 108

Figure 6. Revised EBP Implementation and Sustainability Model 303

List of Tables

Table 1. Hospital Demographics 20

Table 2. Nurse Demographics 24

Table 3. Key Cognitive Beliefs and Basic Assumptions 289

About this Dissertation

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Laney Graduate School
Department	Nursing
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Sociology, Organizational Health Sciences, Nursing Health Sciences, Health Care Management
Keyword	leadership EBP Model Culture research utilization qualitative empowerment magnet
Committee Chair / Thesis Advisor	Lamb, Gerri, Emory University Hepburn, Kenneth, Emory University
Committee Members	Scott, Tracy L, Emory University Shapiro, Susan, Emory University

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