DISCUSSION
Factors Influencing EBPI in the Cases
As one of the first studies to investigate the NM role in
EBPI, the findings from this study highlight the complexity
of EBPI, which is contingent on a range of contextual
factors. EBPI had the highest profile in Case A and we first
consider the factors at play in this case. We then discuss
whether the presence or absence of the same factors influenced
the profile of EBPI in the other cases. Our focus is
on whether the role played by NMs is an important factor
that helps to explain relative EBPI progress.
Although it was clear that most progress in relation to
EBPI had been in made in recent years in Case A, it is important
not to overstate this level of progress. There were
still difficulties in gaining agreement about the nature of
evidence and lack of clarity about roles and responsibilities
relating to EBPI. In addition, nurses felt that medical
dominance in decisions about the local development and
adoption of EBP was a significant hindrance. Several contextual
factors were important in explaining developments
in Case A: it had not experienced any recent organizational
restructuring problems; the nursing workforce, from senior
management to frontline nurses, was relatively stable
and the organization had not experienced any significant
retention or recruitment problems; the Nurse Director actively
championed the importance of EBP in nursing; and
the organization had a well-staffed and experienced PDU,
which coordinated nurse-led EBPI activities. The latter was
important and its activities were facilitated by the good
informal relationships it had with NMs and other operational
managers in the organization; these good relationships
were largely due to the fact that the PDU was staffed
by several former NMs. Although Case A had experienced
the effects of an increasing management-practice gap, the
effects of this had been mitigated to some extent by the
stability of the workforce and the creation of a few joint
management/practice posts. The stability of the workforce
meant that it had been possible for NMs to accumulate
local knowledge and relevant expertise over time, both