When we teach clinicians the skills of evidence-based practice (EBP), we encourage them to search for and critically appraise research evidence to answer their clinical questions. Then, we expect them to apply this research evidence to improve their clinical practice, despite knowing that this is a complex intervention that is poorly understood.
How best should we conceptualise this process so that we can measure and document success, in order to build the evidence base for implementing research? A key insight was shared in 2007; ” we need to move beyond the static view of knowledge translation and embrace the changing nature of context and individual decision making”. In short we need to find the best ways to understand and work within different healthcare organisational contexts and to recognise individual behaviours that can drive this change forward.
There are many organisational theories that offer explanations of change. From these, many models have been developed to highlight key aspects of organisational cultures. However, few have been validated in practice, and for those that have, there is a delicate balance between identifying key organisational factors for success and tailoring the intervention to the local context.
Social psychology theories offer insights into understanding individual behaviour change. A recent systematic review summarised that individuals’ beliefs about their capabilities and their intentions to act were predictive of their action. This is reminiscent of Bandura’s description of self-efficacy as a belief in one’s own ability to complete tasks and reach goals. It is also what we commonly call confidence, and there are reports from nurses, of the correlation between high levels of self -efficacy and the ability to perform a specific task, and the future propensity to act.
Are we in a position to suggest that teaching EBP skills improves healthcare professionals’ self-efficacy, and their beliefs and behaviour about implementing research evidence? The developers of the Evidence-based Practice Confidence (EPIC) scale argue for this. They suggest that this scale can measure individual change. It sounds very promising – does anyone have any further evidence to contribute to this debate? Perhaps, we should also consider individuals’ views and beliefs in relation to their organisational context.