Preliminary research exists indicating the importance of counselor attitudes and organizational features as influencing use of evidence-based practices (EBPs). Conceptual models of evidence-based practice implementation posit relationships among factors theoretically associated with use of an EBP, yet little research exists that explores how a constellation of counselor characteristics relate to counselors’ use of evidence-based practices. Research is also lacking on the role of counselor characteristics in use of motivational interviewing, a specific evidence-based practice. In addition to identifying counselor characteristics associated with use of MI, this study explores how counselor characteristics directly and indirectly affect implementation relationships for MI. The study sample comes from a larger study testing how organizational facilitation influences outpatient substance abuse counselors’ use of MI, and client outcomes. Multiple regression was used to explore the contribution of counselor characteristics (amount of MI training, MI skill level, motivation to use MI, supportive attitudes toward MI, perception of organizational climate and MI skill level) on reported use of MI. Analyses with each dependent variable had different sample sizes: N=76 for relationships tested between counselor characteristics and use of MI and N=46 for relationships tested between counselor characteristics and MI skill level. Results suggest that among these characteristics, supportive attitudes related to MI and motivation to use MI significantly contribute to counselors’ use of MI with clients. Further, supportive attitudes related to MI and motivation to use MI each partially mediates the relationship between amount of MI training and counselor use of MI. But, findings are tempered by a sample comprised of relatively low levels of training and low MI skill level. Despite having very little training, and low skill levels, high usage of MI was reported by counselors. More empirical research utilizing larger samples with higher training levels is needed to better understand how counselor characteristics may affect EBPs implementation in order to promote the effective use of evidence-based practices. / text

Nurses face ongoing difficulties in using evidence and making a reality of evidence-based practice. Studies of the factors that facilitate or impede evidence-based practice suggest that nurse managers should have a key role, but the nature of this role has not yet been fully articulated. This study aimed to explore and explain the roles of nurse managers in relation to evidence-based practice implementation. Four case studies in Scottish NHS Acute Trusts provide rich data on evidence-based practice implementation, drawing on interviews (n = 51), observation and documentary analysis. A wide literature on evidence use in nursing suggests that implementation is hindered by confusion and debate about what counts as evidence, and by an incomplete understanding by staff of the complexity of implementation processes. This study confirms such conclusions. Moreover, the study reveals that the roles of nurse managers in facilitating evidence use are currently limited, largely passive and under-articulated. As such, the findings expose significant discrepancies between nurse managers' roles in practice and those espoused in much of the literature. Partial explanation for this can be found in the organisational contexts in which nurses and their managers work (e.g. competing demands; confused communication; diffuse and overloaded roles and limits to authority and autonomy). In particular, the role of the contemporary nurse manager is one that places considerable emphasis on aspects of general management to the detriment of clinical practice issues. More positively, the study uncovered genuine facilitation in two study sites where hybrid roles of nurse manager and clinical nurse specialist were in place. In both sites, these roles had been successful in supporting and progressing implementation in discrete areas of practice and show some potential for advancing evidence-based practice more widely. These findings have significant implications for research, policy and practice in relation to evidence-based practice in nursing.

Evidence-based practice is an integral part of multi-disciplinary healthcare, but its routine clinical implementation remains a challenge internationally. Written asthma action plans are an example of sub-optimal evidence-based practice because, despite being recommended, these plans are under-issued by health professionals and under-used by patients/carers. This thesis is a critical analysis of the generation and implementation of evidence in this area and provides fresh insight into this specific theory/practice gap. This submission brings together, in five published papers, a body of work conducted by the candidate. Findings report that known barriers to action plan use (such as a lack of practitioner time) are symptomatic of deeper and more complex underlying factors. In particular, over-reliance on knowledge derived from randomised controlled trials and their systematic review, as the primary and sole source of evidence for healthcare practice, hindered the implementation of these plans. A lack of evidence reflecting the personal experience of using these plans in the real world, rather than in trial settings, contributed to a mismatch between what patients/carers want from asthma action plans and what they are currently being provided with by professionals. This submission illustrates the benefits of utilising a broader range of knowledge as a basis for clinical practice. The presented papers report how new and innovative research methodologies (including meta-ethnography and cross-study synthesis) can be used to synthesise individual studies reporting the personal experiences of patients and professionals and how such findings can then be used to better understand why interventions can be implemented in trial settings rather than everyday practice. Whilst these emerging approaches have great potential to contribute to evidence-based practice by, for example, strengthening the ‘weight’ of experiential knowledge, there are methodological challenges which, whilst acknowledged, have yet to be fully addressed.