The Magnet Journey: Understanding the Role of the Unit Culture in Evidence-Based Practice Adoption Public
Schippits, Kim Marie (2012)
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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