Elaine Ball, Paul Regan
Journal of Health Visiting, Vol. 7, Iss. 1, 16 Jan 2019, pp 32 - 38

This article examines the hierarchy of evidence (HoE) framework and evidence-based practice for clinical practice and nurse education. Student evaluations of a post-qualifying evidence-based practice module identified consistent tension in interpreting research papers that did not appear to fit into their experience of nursing practice. Community nurses identified a lack of evidence informing their practice. A mixed methods study facilitated a comparative analysis of HoE framework and a complimentary Familial model developed to improve student understanding. Data collection methods included a focus group of module members (n=5), and a sample of 314 respondents identified the HoE framework fails to help nurses interpret high and low evidence, reducing the potential to implement evidence into clinical practice, but it was not clear why. The Familial model appeared to enable a better understanding and relevance of evidence to inform clinical action. This is a unifying principle for evidence-based practice, yet one not found within a HoE framework. The art of nursing does not merely respond to published literature, but patient interaction and clinical implementation for community nursing requires a broader interpretation of evidence-based practice.

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