Nursing Implementation Science: How Evidence‐Based Nursing Requires Evidence‐Based Implementation
Abstract
Purpose: Evidence is not always used in practice, and many examples of problematic implementation of research into practice exist. The aim of this paper is to provide an introduction and overview of current developments in implementation science and to apply these to nursing. Methods: We discuss a framework for implementation, describe common implementation determinants, and provide a rationale for choosing implementation strategies using the available evidence from nursing research and general health services research. Findings: Common determinants for implementation relate to knowledge, cognitions, attitudes, routines, social influence, organization, and resources. Determinants are often specific for innovation, context, and target groups. Strategies focused on individual professionals and voluntary approaches currently dominate implementation research. Strategies such as reminders, decision support, use of information and communication technology (ICT), rewards, and combined strategies are often effective in encouraging implementation of evidence and innovations. Linking determinants to theory‐based strategies, however, can facilitate optimal implementation plans. Conclusions: An analytical, deliberate process of clarifying implementation determinants and choosing strategies is needed to improve situations where suboptimal care exists. Use of theory and evidence from implementation science can facilitate evidence‐based implementation. More research, especially in the area of nursing, is needed. This research should be focused on the effectiveness of innovative strategies directed to patients, individual professionals, teams, healthcare organizations, and finances. Clinical Relevance: Implementation of evidence‐based interventions is crucial to professional nursing and the quality and safety of patient care.
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In the traditional translational pipeline, an implementation study requires that the clinical/preventive intervention has already demonstrated effectiveness.
“Following this pipeline, a prerequisite for conducting an implementation study would be that the clinical/preventive intervention has already demonstrated effectiveness.”
From An Overview of Research and Evaluation Designs for Dissemination and Implementation (2017) · cites this paper as [109]
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Timmermans, O., Van Linge, R., Van Petegem, P., Van Rompaey, B., & Denekens, J. (2013) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2012.06014.x · Cited by 31 · see citing works
Sources of knowledge used by intensive care nurses in Norway: An exploratory study
Bringsvor, H. B., Bentsen, S. B., & Berland, A. K. (2014) · Intensive and Critical Care Nursing · doi:10.1016/j.iccn.2013.12.001 · Cited by 31 · see citing works
“Evidence-based practice has also been described as the optimal use of research evidence in nursing (van Achterberg et al., 2008).”
BackgroundIntegrative Review of Implementation Strategies for Translation of Research-Based Evidence by Nurses
Wuchner, S. S. (2014) · Clinical Nurse Specialist · doi:10.1097/nur.0000000000000055 · Cited by 29 · see citing works
Increasing nursing students’ knowledge of evidence-based hand-hygiene: A quasi-experimental study
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Nurse Advocacy: Adopting a Health in All Policies Approach
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Team learning and innovation in nursing, a review of the literature
Timmermans, O., van Linge, R. H., Petegem, P. V., Rompaey, B. V., & Denekens, J. (2011) · Nurse Education Today · doi:10.1016/j.nedt.2011.07.006 · Cited by 31 · see citing works
Jeon, Y., Govett, J., Low, L., Chenoweth, L., McNeill, G., Hoolahan, A., Brodaty, H., & O’Connor, D. (2013) · Contemporary Nurse · doi:10.5172/conu.2013.44.2.156 · Cited by 29 · see citing works
“One of the critical elements in the process of achieving the goal relates to the notion of integration of new evidence or intervention into routine practice (Ploeg et al., 2007; Stetler et al., 2009; van Achterberg et al., 2008).”
BackgroundA University and Health Care Organization Partnership to Prepare Nurses for Evidence-Based Practice
Missal, B. E., Schafer, B. K., Halm, M. A., & Schaffer, M. A. (2010) · Journal of Nursing Education · doi:10.3928/01484834-20100430-06 · Cited by 28 · see citing works
Jackson, B. D., Con, D., Liew, D., & Cruz, P. P. D. (2017) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365521.2017.1278785 · Cited by 27 · see citing works
Vyth, E. L., van der Meer, E. W. C., Seidell, J. C., & Steenhuis, I. H. (2011) · Health Promotion International · doi:10.1093/heapro/dar034 · Cited by 25 · see citing works
“Low Medium High 49.0 43.5 7.5 44.6 45.5 9.9 53.0 41.8 5.2 46.9 42.5 10.6 50.7 44.2 5.1 Age (mean) (SD) 45.6 (10.3) 44.7 (10.8) 46.5 (9.8) 46.0 (10.6) 45.6 (10.0)”
InfluentialThe effect of hospital-based antithrombotic stewardship on adherence to anticoagulant guidelines
Dreijer, A. R., Diepstraten, J., Leebeek, F. W. G., Kruip, M. J. H. A., & van den Bemt, P. M. L. A. (2019) · International Journal of Clinical Pharmacy · doi:10.1007/s11096-019-00834-2 · Cited by 26 · see citing works
Factors Associated with Effective Implementation: Research and Practical Implications
Barwick, M. A., Dubrowski, R., & Damschroder, L. J. (2020) · Springer eBooks · doi:10.1007/978-3-030-03874-8_4 · Cited by 27 · see citing works
Ebben, R. H. A., van Grunsven, P. M., Moors, M. L., Aldenhoven, P., de Vaan, J., van Hout, R., van Achterberg, T., & Vloet, L. C. M. (2015) · Scandinavian Journal of Trauma Resuscitation and Emergency Medicine · doi:10.1186/s13049-015-0113-3 · Cited by 27 · see citing works
Factors influencing the implementation of evidence in Chinese nursing practice
Cheng, L., Broome, M. E., Feng, S., & Hu, Y. (2017) · Journal of Clinical Nursing · doi:10.1111/jocn.14053 · Cited by 26 · see citing works
Embracing Implementation Science: A Paradigm Shift for Nursing Research
Zullig, L. L., Deschodt, M., & Geest, S. D. (2019) · Journal of Nursing Scholarship · doi:10.1111/jnu.12507 · Cited by 26 · see citing works
Voogdt-Pruis, H. R., Beusmans, G. H. M. I., Gorgels, A. P. M., & van Ree, J. W. (2011) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2011.05627.x · Cited by 26 · see citing works
“These positive attitudes promote effective implementation (Grol et al. 2005, van Achterberg et al. 2008).”
BackgroundInfluentialSeaton, T. (2017) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2017.05.021 · Cited by 26 · see citing works
Leading Change for Sustainability
Parsons, M. L., & Cornett, P. A. (2011) · Nurse Leader · doi:10.1016/j.mnl.2011.05.005 · Cited by 24 · see citing works
Wilson, D. S., Montie, M., Conlon, P. F., Reynolds, M. A., Ripley, R. T., & Titler, M. G. (2016) · Western Journal of Nursing Research · doi:10.1177/0193945916644995 · Cited by 24 · see citing works
Noome, M., Dijkstra, B. M., van Leeuwen, E., & Vloet, L. C. M. (2016) · Journal of Advanced Nursing · doi:10.1111/jan.13219 · Cited by 24 · see citing works
Use of Implementation Science to Advance Nurse-Led Evidence-Based Practices in Clinical Settings
McNett, M., Tucker, S., Thomas, B. K., Gorsuch, P., & Gallagher‐Ford, L. (2021) · Nurse Leader · doi:10.1016/j.mnl.2021.11.002 · Cited by 23 · see citing works
Ebben, R., Vloet, L. C. M., van Grunsven, P. V., Breeman, W., Goosselink, B., Lichtveld, R., Groot, J. M. M.-D., & van Achterberg, T. (2015) · European journal of emergency medicine · doi:10.1097/mej.0000000000000133 · Cited by 24 · see citing works
Using an intervention mapping approach to develop a discharge protocol for intensive care patients.
van Mol, M., Nijkamp, M., Markham, C., & Ista, E. (2017) · BMC Health Services Research · doi:10.1186/s12913-017-2782-2 · Cited by 22 · see citing works
“Successful implementation of interventions such as the discharge protocol starts with the identification of barriers and facilitators [58, 59].”
BackgroundJansson, I., Pilhammar, E., & Forsberg, A. (2010) · Worldviews on Evidence-Based Nursing · doi:10.1111/j.1741-6787.2010.00195.x · Cited by 22 · see citing works
Sutherland‐Fraser, S., McInnes, E., Maher, E. J., & Middleton, S. (2012) · BMC Nursing · doi:10.1186/1472-6955-11-25 · Cited by 22 · see citing works
Perruchoud, É., Fernandes, S., Verloo, H., & Pereira, F. (2021) · Journal of Clinical Nursing · doi:10.1111/jocn.15826 · Cited by 21 · see citing works
“Clinical decision- making is more influenced by nursing staff's professional experience or established knowledge (van Achterberg et al., 2008).”
BackgroundSion, K., Verbeek, H., de Vries, E., Zwakhalen, S. M. G., Odekerken‐Schröder, G., Schols, J. M. G. A., & Hamers, J. P. H. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17145118 · Cited by 21 · see citing works
Evidence-based practice in primary care—An explorative study of nurse practitioners in Norway
Berland, A. K., Gundersen, D., & Bentsen, S. B. (2012) · Nurse Education in Practice · doi:10.1016/j.nepr.2012.05.002 · Cited by 21 · see citing works
Hoben, M., Mahler, C., Bär, M., Berger, S. J., Squires, J. E., Estabrooks, C. A., & Behrens, J. (2013) · BMC Health Services Research · doi:10.1186/1472-6963-13-478 · Cited by 21 · see citing works
“Closing the research-practice gap is complex and challenging [6-15].”
BackgroundMeerhoff, G. A., van Dulmen, S. A., Maas, M. J. M., Bakker‐Jacobs, A., der Sanden, M. W. G. N., & van der Wees, P. J. (2019) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2019.1678205 · Cited by 20 · see citing works
“As explained by van Achterberg, Schoonhoven, and Grol (2008), numerous determinants for a successful implementation are identified.”
BackgroundThe 2009-2013 Research Agenda for Oncology Nursing
The 2009-2013 Oncology Nursing Society Research Agenda Team (2009) · Oncology nursing forum · doi:10.1188/09.onf.e274-e282 · Cited by 21 · see citing works
Wie gelangt Wissen in die Versorgung?
Vollmar, H. C., Santos, S., de Jong, A., Meyer, G., & Wilm, S. (2017) · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz · doi:10.1007/s00103-017-2612-z · Cited by 20 · see citing works
Koivunen, M. H., Anttila, M., Kuosmanen, L., Katajisto, J., & Valimaki, M. A. (2014) · Informatics for Health and Social Care · doi:10.3109/17538157.2013.872112 · Cited by 19 · see citing works
“Normative beliefs related to social pressures may also facilitate or hinder the intention to use interventions among nurses (19), which may further indicate that individual nurses’ attitudes toward ICT use may be affected by attitudes among other nurses on the ward (20).”
BackgroundLeach, V. A., Tonkin, E. T., Lancastle, D., & Kirk, M. (2016) · International Journal of Nursing Practice · doi:10.1111/ijn.12431 · Cited by 18 · see citing works
Evidence-based nursing practice and its correlates among Korean nurses
Kang, Y., & Yang, I. (2015) · Applied Nursing Research · doi:10.1016/j.apnr.2015.11.016 · Cited by 18 · see citing works
“…and applying various research sources; attitudes towards research; regular reading of research articles; knowledge based on literature; collaboration with colleagues; and technological deficiencies (Clarke et al., 2005; Eizenberg, 2011; Milner et al., 2006; van Achterberg et al., 2008).”
BackgroundPsychometric testing of the Chinese evidence‐based practice scales
Wang, S., Lee, L. L., Wang, W., Sung, H., Chang, H., Hsu, M., Chang, S., & Tai, C. (2012) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2012.06011.x · Cited by 18 · see citing works
Nursing implementation science: 10 ways forward
van Achterberg, T. (2013) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2013.02.004 · Cited by 18 · see citing works
Using Implementation Science to Implement Evidence‐Based Practice: A Discursive Paper
Chays‐Amania, A., Schwingrouber, J., & Colson, S. (2024) · Journal of Advanced Nursing · doi:10.1111/jan.16571 · Cited by 19 · see citing works
Monitoring Sedation in Patients Receiving Opioids for Pain Management
Smith, A., Farrington, M. M., & Matthews, G. (2014) · Journal of Nursing Care Quality · doi:10.1097/ncq.0000000000000059 · Cited by 17 · see citing works
Gentizon, J., Borrero, P., Vincent-Suter, S., Ballabeni, P., Morin, D., & Eicher, M. (2017) · Recherche en soins infirmiers · doi:10.3917/rsi.127.0028 · Cited by 17 · see citing works
Scaling up improvements more quickly and effectively
Øvretveit, J., Garofalo, L., & Mittman, B. S. (2017) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzx147 · Cited by 17 · see citing works
“The ‘choosing wisely’ initiative in the USA and similar ones word-wide could have a greater- and faster-impact if we used knowledge about effective approaches for de-implementation at scale or ‘de-scaling’ [3, 10, 11].”
BackgroundEducating for the implementation of evidence-based healthcare in Brazil: the JBI methodology
Püschel, V. A. D. A., de Oliveira, L. B., Gomes, E. T., dos Santos, K. B., & Carbogim, F. D. C. (2021) · Revista da Escola de Enfermagem da USP · doi:10.1590/s1980-220x2020016303718 · Cited by 16 · see citing works
“Alguns fatores podem ser considerados como influenciadores no processo de implementação de evidências em enfermagem, incluindo: cultura e clima organizacional, liderança de enfermagem, tamanho do hospital, suporte de pessoal, inovação organizacional, capacidade de resposta da administração, acesso a recursos, oferta d…”
BackgroundImplementatie van EBP: Professionals in een context
Tiemens, B. G., Munten, G., & Vermeulen, H. (2012) · Nederlands Tijdschrift voor Evidence Based Practice · doi:10.1007/s12468-012-0002-y · Cited by 16 · see citing works
Stallinga, H. A., ten Napel, H., Jansen, G. J., Geertzen, J. H. B., Robbé, P. F. D. V., & Roodbol, P. F. (2014) · Journal of Clinical Nursing · doi:10.1111/jocn.12624 · Cited by 16 · see citing works
Implementation strategies for guidelines at ICUs: a systematic review
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Team learning and team composition in nursing
Timmermans, O., van Linge, R. H., Petegem, P. V., Elseviers, M. M., & Denekens, J. (2011) · Journal of Workplace Learning · doi:10.1108/13665621111128673 · Cited by 16 · see citing works
van de Glind, I., Heinen, M. M., Evers, A. W. M., Wensing, M., & van Achterberg, T. (2012) · Implementation Science · doi:10.1186/1748-5908-7-104 · Cited by 15 · see citing works
“This leads to an in-depth picture of how and why implementation is feasible in different settings, which contributes to better implementation [30,31].”
Friel, K. M., McCauley, C. O., O’Kane, M., McCann, M., Delaney, G., & COATES, V. E. (2022) · Frontiers in Clinical Diabetes and Healthcare · doi:10.3389/fcdhc.2022.883283 · Cited by 14 · see citing works
“Research active hospitals have been shown to have better patient care outcomes, contribute to a better inpatient experience and have a positive effect on staff and service performance (57, 58).”
BackgroundDubrowski, R., Barwick, M. A., & Dubrowski, A. (2018) · Springer eBooks · doi:10.1007/978-3-319-90518-1_10 · Cited by 14 · see citing works
Khazaei, A., Afshari, A., Khatiban, M., Borzou, S. R., Oshvandi, K., Nabavian, M., & Maddineshat, M. (2024) · BMC Emergency Medicine · doi:10.1186/s12873-024-00955-6 · Cited by 18 · see citing works
“Despite the instructions and protocols, there is still a gap between the established guidelines and clinical practice [17, 18].”
BackgroundJohnson, P. M., Patterson, C. J., & O'Connell, M. P. (2013) · The Nurse Practitioner · doi:10.1097/01.npr.0000437576.14143.b9 · Cited by 14 · see citing works
Matthew‐Maich, N., Ploeg, J., Jack, S. M., & Dobbins, M. (2012) · Journal of Clinical Nursing · doi:10.1111/jocn.12027 · Cited by 14 · see citing works
Meerhoff, G. A., van Dulmen, S. A., Cruijsberg, J. K., der Sanden, M. W. G. N., & van der Wees, P. J. (2019) · Physiotherapy Canada · doi:10.3138/ptc-2018-0028 · Cited by 14 · see citing works
Synthesizing Quantitative Evidence for Evidence-based Nursing: Systematic Review
Oh, E. G. (2016) · Asian Nursing Research · doi:10.1016/j.anr.2016.05.001 · Cited by 13 · see citing works
Nutritional care of older people: Investigating nurses’ attitudes in medical and surgical units
Bonetti, L., Terzoni, S., Lusignani, M., Negri, M., Froldi, M., & Destrebecq, A. L. L. (2021) · Contemporary Nurse · doi:10.1080/10376178.2021.1934501 · Cited by 13 · see citing works
“As stated by van Achterberg et al. (2008), in cases where patients are found to receive inferior care, it is important to identify the precise reasons behind the problem, and use that information to improve care.”
Background
- Authors
- Van Achterberg, T., Schoonhoven, L., & Grol, R.
- Affiliations
- Radboud University Medical Center (NL)
- Corresponding author
- Schoonhoven, Lisette
- Grol, Richard
- ORCID
- Schoonhoven, Lisette
- Venue
- Journal of Nursing Scholarship
- Publisher
- Wiley
- Published
- 2008-11-25
- Volume
- 40
- Issue
- 4
- Pages
- 302-310
- ISSN
- 0363-2792 (ISSN-L)
- 1527-6546
- 1547-5069
- OpenAlex
- W2017533262
- Cited by
- 217
- References
- 47
- Citations by year
- 2026: 3 · 2024: 7 · 2023: 7 · 2022: 13 · 2021: 18 · 2020: 10 · 2019: 8 · 2018: 11 · 2017: 16 · 2016: 14 · 2015: 12 · 2014: 15 · 2013: 21 · 2012: 27
- FWCI
- 22.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Nursing Scholarship (publishedVersion)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- implementation science, evidence-based nursing, implementation factors, implementation strategies, research utilization, implementation barriers, decision support, information and communication technologies, organizational factors
- MeSH terms
- Diffusion of Innovation, Quality of Health Care, Evidence-Based Nursing
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