Support For Evidence-based Practice Research Articles

Testing an Organizational Implementation Process Model Related to Teachers' Implementation-Related Attitudes and Behaviors: a Multilevel Mediation Analysis.

The effectiveness of school-based universal prevention programs is frequently diminished due to low-quality implementation. Organizational factors support high-quality implementation because of their broad influence across implementers. Conceptually, implementation leadership (i.e., behaviors that prioritize, reward, and support evidence-based practice [EBP] implementation) works to embed a favorable implementation climate (i.e., implementers' collective perceptions that their organization prioritizes, rewards, and support EBP implementation) leading to improved implementation citizenship behavior and attitudes toward EBP. This organizational implementation process model has some empirical support but has not been tested in a multilevel framework or related to hypothesized attitudinal and behavioral outcomes. The sample included 319 teachers across 39 US public elementary schools; all were implementing Schoolwide Positive Behavior Interventions and Supports. Multilevel mediation (level 1 = teacher, level 2 = school) was used to test the indirect association of implementation leadership on implementation-related attitudes and behaviors via implementation climate across two time points (fall and spring). At the school level, the organizational implementation process model was validated related to implementation citizenship behavior, but not attitudes toward EBP. At the teacher level, the process model was validated related to both outcomes, and there was a significant direct effect of implementation leadership on attitudes toward EBP. Developing strong leaders for implementation seems key to achieving high-quality EBP implementation. Implications for schools, principal training, and research are discussed.

Validating process mining in pediatric oncology: Demonstrating protocol adherence and variability in neuroblastoma treatment.

166 Background: Neuroblastoma is the most common extracranial tumor in children. The mortality rate for patients with metastatic disease is over 50%. In the Netherlands, 30 new patients are diagnosed annually. Current clinical treatment guidelines are complex and include multiple treatment arms consisting of chemotherapy, surgery, radiotherapy, and immunotherapy (IT). Although poor patient health and complications are known to cause adaptations to the otherwise standardized treatment regimen, the extent to which these variations occur is unknown. This study aimed to validate the use of process mining, a data-driven technique, to retrospectively examine protocol adherence and variability within current clinical guidelines based upon the GPOH-DCOG NBL2009 neuroblastoma treatment protocol. Methods: Data was extracted from electronic health records, as well as laboratory, pathology, and pharmaceutical databases, to create individual event logs for each patient. Process mining was performed using a fuzzy mining algorithm. The treatment courses for all neuroblastoma patients were mapped. Commonalities and variations were highlighted, and the throughput time for key treatment phases was calculated. Subsequently, conformance with protocol was determined. Results: Analysis of 70 patients treated between 2018-2022 showed 62 distinct treatment processes, revealing significant variations in patient care. Patients with high-risk disease showed the least variation (n=47, 42 variants). Notably, 17 variants were identified among 18 patients who died, indicating a highly personalized approach in the advanced stages of the disease. Subgroup analysis of 17 high-risk patients who received IT consisting of alternating cycles of anti-GD2 antibody and retinoic acid showed 6 variants. 12/17 patients (70.6%) completed the full IT regimen. Other treatment adjustments included shortened anti-GD2 infusions for two patients (5 and 8 days versus the prescribed 10 days, respectively), potentially indicating treatment toxicity. One patient received a 15-day infusion, exceeding the prescribed limit of 11 days. The recorded interval between the administration of anti-GD2 and retinoic acid was a median 5.5 hours (range: 60 seconds – 6.4 days), deviating from the prescribed interval of 24 hours and warranting further investigation. Conclusions: Process mining is a valuable tool for analyzing protocol performance and adherence in neuroblastoma treatment. Despite standardized treatment protocols, significant heterogeneity was observed in the treatment of neuroblastoma patients, especially those with poor prognosis. Throughput time analysis revealed variabilities in the IT regimen that warrant further investigation. This study underscores the potential of data-driven approaches to optimize treatment protocols and support evidence-based practices in clinical oncology.

The Role of Cooperative Extension in Delivering Training and Technical Assistance to Support Evidence-Based Behavioral Health Practices in Rural Communities.

The opioid epidemic in the United States continues to disproportionately affect those in rural, compared to urban, areas due to a variety of treatment and recovery barriers. One mechanism to increase capacity of rural-serving providers is through delivery of training and technical assistance (TTA) for evidence-based programs by leveraging the Cooperative Extension System. Guided by the Interactive Systems Framework, the current study evaluates TTA delivered by the Northwest Rural Opioid Technical Assistance Collabroative to opioid prevention, treatment, and recovery providers on short- (satisfaction, anticipated benefit), medium-, (behavioral intention to change current practice), and long-term goals (changes toward adoption of evidence-based practices). We also evaluated differences in short- and medium-term goals by intensity of TTA event and rurality of provider. Surveys of 351 providers who received TTA indicated high levels of satisfaction with TTA events attended, expressed strong agreement that they would benefit from the event, intended to make a professional practice change, and preparation toward implementing changes. Compared to urban-based providers, rural providers reported higher intention to use TTA information to change current practice. We conclude with a review of remaining gaps in the research to practice pipeline and recommendations for moving forward.

How to use communities of practice to support change in learning health systems: A landscape of roles and guidance for management.

Communities of practice support evidence-based practice and can be, in and of themselves, applied learning spaces in organizations. However, the variety of ways that communities of practice can support learning health systems are poorly characterized. Furthermore, health system leaders have little guidance on designing and resourcing communities of practice to effectively serve learning health systems. We conducted a collective case study, examining a cross-section of Canadian-based communities of practice dedicated to supporting evidence-based practice. We held semi-structured interviews with 21 participants representing 16 communities of practice and 5 community of practice facilitation platforms that provide administration support, tools, and oversight for multiple communities of practice. Using the Conceptual Framework for Value-Creating Learning Health Systems, we characterized the numerous roles that communities of practice can take to support learning health systems. We also pulled insights from the interviews on properly resourcing and managing communities of practice. Communities of practice can advance learning health systems across learning cycles (ie, identifying learning priorities, generating data and knowledge, and implementing and evaluating change). They also act as important infrastructure required to share and coordinate across learning health systems. Community of practice facilitation platforms reduce staff members' workload, in turn, creating greater efficiency and effectiveness across community of practice lifespans. Furthermore, these platforms can be a mechanism to coordinate critical activities (e.g., priority alignment, knowledge brokerage/sharing across the broader system). To the authors' knowledge, this is the first study to characterize communities of practice across the learning health system landscape. With these results, learning health system leaders have a catalog that clarifies the potential communities of practice roles in knowledge generation, implementation, and uptake of new evidence. Furthermore, the results provide evidence that organizational investment in overarching community of practice facilitation platforms will strengthen and accelerate community of practice supports in learning health systems.

Evidence-based practice attitudes and nutrition support guideline knowledge between holders and nonholders of the Certified Nutrition Support Clinician credential.

Clinical practice frequently changes, and professionals should stay abreast of evidence-based practice (EBP) guidelines. Negative attitudes towards EBP are a barrier to guideline adoption. This study explored EBP attitudes and knowledge of a complex nutrition support clinical case scenario of individuals holding or not holding the Certified Nutrition Support Clinician (CNSC) credential. This cross-sectional study used an online survey sent to American Society for Parenteral and Enteral Nutrition (ASPEN) members with and without the CNSC credential and all CNSC credential holders from the National Board of Nutrition Support Certification email list. The survey included the Evidence-Based Practice Attitude Scale Score (EBPAS-15) and eight knowledge questions using a nutrition support case scenario. An independent samples t test compared knowledge and EBPAS-15 total scores and subscores between CNSC holders and nonholders. Pearson correlation determined the correlation between knowledge and EBPAS-15 scores. The response rate was 7.8% (N = 706). CNSC holders (n = 536) had significantly higher mean knowledge scores (4.7 ± 1.6 out of 8) than nonholders (n = 159, 4.1 ± 1.7) (P < 0.001). Total EBPAS-15 scores were not significantly different between CNSC holders (n = 542, 2.9 ± 0.4 out of 4) and nonholders (n = 164, 2.8 ± 0.7) (P = 0.434), and knowledge scores and total EBPAS-15 scores (P = 0.639) or subscores were not significantly correlated. Regardless of holding the CNSC credential, EBPAS-15 scores indicated respondents had positive EBP attitudes. CNSC holders had significantly higher knowledge scores of recent nutrition support EBP guidelines compared with non-CNSC credential holders. Positive EBP attitudes are a precursor to clinical decision-making, but future research should determine the use of guidelines in clinical practice.

Myths About Breastfeeding as Voiced by Lactating Nurses and Midwives: A Qualitative Study at the Greater Accra Region of Ghana.

Breastfeeding has proven over the years to be one of the most effective means to ensure child survival. The advocators and myth busters of breastfeeding myths are supposed to be health professionals. However very little is known about myths surrounding breastfeeding as expressed by these health professionals (nurses and midwives). Hence this study. The study aimed at exploring the myths about breastfeeding as voiced by lactating nurses and midwives. Qualitative exploratory descriptive design was used to investigate the subject matter. Twenty-five nurses and midwives were purposely selected to participate in the study after they had voluntarily opted to be part of the study. Data was audiotaped, transcribed verbatim and inductively analyzed. It was evident that participants believed in myths about breastfeeding. The main themes discovered were breastfeeding myth beliefs and sociocultural myth influences. Six sub-themes identified were green stools/diarrhoea, childhood disease, teeth discoloration, child becoming stupid, culture and close relatives. Health professionals believe in unfounded myths about breastfeeding. Steps should be taken for them to get better lactation support. The outcomes of this study underscore the need for health professionals to address breastfeeding myths, understand the sociocultural context, and support evidence-based practice. Improving lactation support and education for nurses and midwives can lead to better clinical practice and, as a result, help to promote successful and healthy breastfeeding in Ghana.

Understanding the use of telemedicine across different opioid use disorder treatment models: A scoping review.

The COVID-19 pandemic has instigated the development of telemedicine-mediated provision of medications for opioid use disorder such as buprenorphine and methadone, referred to as TMOUD in this study. As services start to return to pre-pandemic norms, there is a debate around the role of TMOUD as addition to or replacement of the conventional cascade of care for people with opioid use disorder (PWOUD). This scoping review is designed to characterize existing TMOUD services and provide insights to enable a more nuanced discussion on the role of telemedicine in the care of PWOUD. The literature search was conducted in OVID Medline, CINAHL, and PsycINFO, from inception up to and including April 2023, using the Joanna Briggs Institute methodology for scoping reviews. The review considered any study design that detailed sufficient descriptive information on a given TMOUD service. A data extraction form was developed to collect and categorize a range of descriptive characteristics of each discrete TMOUD model identified from the obtained articles. A total of 45 articles met the inclusion criteria, and from this, 40 discrete TMOUD services were identified. In total, 33 services were US-based, three from Canada, and one each from India, Ireland, the UK, and Norway. Through a detailed analysis of TMOUD service characteristics, four models of care were identified. These were TMOUD to facilitate inclusion health, to facilitate transitions in care, to meet complex healthcare needs, and to maintain opioid use disorder (OUD) service resilience. Characterizing TMOUD according to its functional benefits to PWOUD and OUD services will help support evidence-based policy and practice. Additionally, particular attention is given to how digital exclusion of PWOUD can be mitigated against.

Nurse Leader Perceptions of Data in the Veterans Health Administration: A Qualitative Evaluation.

Healthcare systems and nursing leaders aim to make evidence-based nurse staffing decisions. Understanding how nurses use and perceive available data to support safe staffing can strengthen learning healthcare systems and support evidence-based practice, particularly given emerging data availability and specific nursing challenges in data usability. However, current literature offers sparse insight into the nature of data use and challenges in the inpatient nurse staffing management context. We aimed to investigate how nurse leaders experience using data to guide their inpatient staffing management decisions in the Veterans Health Administration, the largest integrated healthcare system in the United States. We conducted semistructured interviews with 27 Veterans Health Administration nurse leaders across five management levels, using a constant comparative approach for analysis. Participants primarily reported using data for quality improvement, organizational learning, and organizational monitoring and support. Challenges included data fragmentation, unavailability and unsuitability to user need, lack of knowledge about available data, and untimely reporting. Our findings suggest that prioritizing end-user experience and needs is necessary to better govern evidence-based data tools for improving nursing care. Continuous nurse leader involvement in data governance is integral to ensuring high-quality data for end-user nurses to guide their decisions impacting patient care.

Respiratory Management of the Preterm Infant: Supporting Evidence-Based Practice at the Bedside

Extremely preterm infants frequently require some form of respiratory assistance to facilitate the cardiopulmonary transition that occurs in the first hours of life. Current resuscitation guidelines identify as a primary determinant of overall newborn survival the establishment, immediately after birth, of adequate lung inflation and ventilation to ensure an adequate functional residual capacity. Any respiratory support provided, however, is an important contributing factor to the development of bronchopulmonary dysplasia. The risks correlated to invasive ventilatory techniques increase inversely with gestational age. Preterm infants are born at an early stage of lung development and are more susceptible to lung injury deriving from mechanical ventilation. Any approach aiming to reduce the global burden of preterm lung disease must implement lung-protective ventilation strategies that begin from the newborn's first breaths in the delivery room. Neonatologists today must be able to manage both invasive and noninvasive forms of respiratory assistance to treat a spectrum of lung diseases ranging from acute to chronic conditions. We searched PubMed for articles on preterm infant respiratory assistance. Our narrative review provides an evidence-based overview on the respiratory management of preterm infants, especially in the acute phase of neonatal respiratory distress syndrome, starting from the delivery room and continuing in the neonatal intensive care unit, including a section regarding exogenous surfactant therapy.

Occupational Therapy to Improve Activities of Daily Living of People With Parkinson's Disease.

Evidence Connection articles are offered by the American Occupational Therapy Association's Evidence-Based Practice Program to inform and assist occupational therapy practitioners in methods that translate findings from the literature into usable knowledge for daily practice. These articles can guide professional reasoning and help practitioners operationalize findings from systematic reviews into practical strategies that can improve patient outcomes and support evidence-based practice. This Evidence Connection article is based on findings from a systematic review of interventions within the scope of occupational therapy practice to improve performance with activities of daily living (ADLs) for adults with Parkinson's disease (Doucet etal., 2021). In this article, we present a case study of an older adult with Parkinson's disease. We discuss suggested evaluation tools and intervention strategies that might be used as part of occupational therapy to address limitations and meet his desired needs for improved participation in ADLs. A client-centered, evidence-based plan was constructed for this case.

Research interest groups: Creating the foundation for professional nursing education, mentorship, and collaboration

BackgroundResearch Interest Groups have been used to enhance collaboration within specialty health care areas. PurposeThis article was to demonstrate the impact of an organic model created by the TriService Nursing Research Program which became a conduit for collaboration across the three branches of Military Nursing Services to answer relevant research questions and support evidence-based practice. MethodsGroups were organized around different specialty topics with a focus on education, mentorship, and collaboration. Modest funding, together with the development of an annual plan and report of scholarly activities allowed the groups to capture their impact and to strategically align efforts to support the National Defense Strategy and excellence in Military Nursing. FindingsFrom 2018 to 2021, overall publications and funded grants for these groups increased each year despite multiple competing priorities. DiscussionTriService Nursing Research Program Research Interest Groups demonstrate a successful, and easily replicable model to generate and disseminate research to inform clinical practice and health policy, both in the public and private sectors.

Development and Testing of the RN Confidence in Evidence-Based Practice (RNcEBP) Survey: Assessing Evidence-Based Practice Culture.

Continual assessment of evidence-based culture is essential to inform growth in evidence-based practice (EBP). The RN Confidence in Evidence-Based Practice (RNcEBP) Survey was developed and tested over a 4-year period within a Magnet-designated organization. The primary aim of this institutional review board-approved study was to test reliability and validity of the workplace-focused RNcEBP Survey. The second aim of the electronic survey was to provide practical and concise assessment data to inform nursing professional development and support for EBP.

Access, Utilization, and Implementation of Research Among Rehabilitation Nurses: A Qualitative Study.

PurposeThis study aimed to understand rehabilitation nurses’ perceptions of research information, related barriers, and avenues for future research, specifically in those caring for individuals with burn injury, spinal cord injury, or traumatic brain injury.DesignQualitative semistructured interviews were conducted.MethodsEighteen interviews were conducted. A thematic network approach identified codes and developed basic, organizing, and global themes.ResultsResearchers identified factors that facilitated research uptake, determined organizational structures that support research culture, and described nurse engagement with literature.ConclusionsAlthough participants desired to engage with the research literature, they identified barriers including time constraints, heavy workloads, and lack of access. To facilitate research uptake, research must be easily accessible, be easily digestible, and include clinical practice recommendations. Research must expand its scope to address issues relevant to the rehabilitation population.Clinical RelevanceOur findings may be used to drive improvements in research competence, facilitate knowledge translation, and support evidence-based practice among rehabilitation nurses.

Evaluation of the agreement, adoption, and adherence to the evidence-based guidelines for the nutritional management of adult patients with head and neck cancer among Australian dietitians.

Evidence-based guideline translation to practice can improve outcomes but is often impaired by poor implementation. This project aimed to evaluate the implementation of the Evidence-based guidelines for the nutritional management of adult patients with head and neck cancer among Australian dietitians providing clinical care to this population. A questionnaire was developed, with face and content validity confirmed by an expert panel (n=13), to gauge participant perceptions of the guidelines against an implementation evaluation framework. Dietitians were identified through Dietitians Australia and by contacting experts in the field. Eligibility was determined by questionnaire completion and prior guideline awareness. Responses were provided using a 5-point Likert scale. Results were analysed using descriptive statistics; with inferential analysis to determine if demographic information could reveal trends in guideline use and perception. Of the 43 initial respondents, n=28 completed the questionnaire, with n=24/28 (86%) meeting full eligibility criteria for analysis. Median (range) scores for all four domains were high: awareness (4.0 [3.2-4.8]), agreement (4.4 [4.1-4.7]), adoption (3.5 [3.1-3.9]), and adherence (4.3 [4.1-4.9]). However, perception of guideline awareness and use among multidisciplinary team colleagues was low (mean 3.2/5.0 and 3.1/5.0, respectively). Dietitians with <10 years' experience had significantly higher perceptions of the guidelines' ability to positively influence practice; support evidence-based practice; and enhance dietitian credibility (P=0.04) vs dietitians with ≥10 years' experience. Dietitians demonstrated high rates of guideline implementation and positive perceptions for its use in clinical practice. Future implementation strategies and evaluation should expand to engage the wider multidisciplinary team and more experienced clinicians.

Implementation support for contingency management: preferences of opioid treatment program leaders and staff

BackgroundContingency management (CM), a behavioral intervention that provides incentives for achieving treatment goals, is an evidence-based adjunct to medication to treat opioid use disorder. Unfortunately, many front-line treatment providers do not utilize CM, likely due to contextual barriers that limit effective training and ongoing support for evidence-based practices. This study applied user-informed approaches to adapt a multi-level implementation strategy called the Science to Service Laboratory (SSL) to support CM implementation.MethodsLeaders and treatment providers working in community-based opioid treatment programs (OTPs; N = 43) completed qualitative interviews inquiring about their preferences for training and support implementation strategies (didactic training, performance feedback, and external facilitation). Our team coded interviews using a reflexive team approach to identify common a priori and emergent themes.ResultsLeaders and providers expressed a preference for brief training that included case examples and research data, along with experiential learning strategies. They reported a desire for performance feedback from internal supervisors, patients, and clinical experts. Providers and leaders had mixed feelings about audio-recording sessions but were open to the use of rating sheets to evaluate CM performance. Finally, participants desired both on-call and regularly scheduled external facilitation to support their continued use of CM.ConclusionsThis study provides an exemplar of a user-informed approach to adapt the SSL implementation support strategies for CM scale-up in community OTPs. Study findings highlight the need for user-informed approaches to training, performance feedback, and facilitation to support sustained CM use in this setting.

Regional and rural allied health professionals in Australia need better information services training and support for evidence-based practice.

Evidence-based practice requires health professionals to recognise situations of uncertainty in their practice, translate that uncertainty into answerable questions, and find and appraise information relevant to those questions. No research to date has explored the research-based information needs of allied health professionals (AHPs) in regional and rural Australia. To examine the information-seeking experiences and needs of AHPs in regional and rural Australia. A total of 80 AHPs, predominantly occupational therapists and physiotherapists, practising in regional and rural areas of Australia completed an online survey. Almost all respondents reported having questions requiring research evidence, but most of their questions were worded non-specifically. Respondents practising in rural areas had greater perceived difficulty in obtaining relevant evidence than their regional counterparts. Many respondents reported wanting additional support to find relevant research evidence. The findings offer insights regarding information-seeking challenges AHPs face and potential solutions, including improved training and increased health librarian support. However, due to sampling limitations, the results cannot be generalised to all allied health professions. Allied health professionals may require more training and support to engage in efficient and effective information-seeking behaviours. Health librarians have a valuable role to play in providing this training and support.

Mental health clinicians' views of summary and systematic review utility in evidence-based practice.

Evidence-based practice (EBP) requires integration of research evidence with clinical expertise and patient preferences. It is endorsed by many regulatory bodies, using the approach is challenging for many busy clinicians. To explore mental health practitioners' perceptions of the factors which help, and which hinder, EBP and their views of two formats for presenting research findings - a systematic review and a one-page summary of that review. (written by a clinical librarian) METHODS: Qualitative semi-structured interviews with a multi-professional sample of mental health clinicians. (n=7) RESULTS: Participants worked under varying time constraints, with some participants perceiving a conflict between research activities such as reading the evidence and their clinical duties one-page research summary would help some participienrs to identify potentially valuable evidence quickly. However, participants agreed that they would need to read full systematic review to assess whether and how their practice could or should change. A one-page research summary can perform useful functions for clinicians; however, they require more detailed research reports such as systematic reviews to judge research's external validity. This exploratory study indicates that writing evidence summaries is a useful role for clinical librarians, as part of training and support for EBP.

Supporting evidence-based practice through teacher education: A profile analysis of teacher educators’ perceived challenges and possible solutions

Higher education-based teacher education has been tasked with addressing the gap between research and teaching and to promote their closer alignment in terms of evidence-based practice. University-based teacher educators are seen as central agents in supporting evidence-based practice among future teachers. To better understand and design appropriate support for this diverse group of professionals, research needs to examine the relevant characteristics of teacher educators concerning the support of evidence-based practice. An online survey study with 484 university-based teacher educators was conducted to examine attitudes and perceived challenges regarding evidence-based practice. Latent profile analysis revealed five significantly different subgroups: high-challenges, no-challenges, knowledge- & resource-challenges, resource-challenges, and skeptical profile. Importantly, profiles partly differed in their reported use of evidence in their teaching. Moreover, whether a service platform for evidence-based teacher education meets reported challenges of teacher educators was also explored. The selected platform appeared to provide effective support for all profiles investigated.

Organizational structure, climate, and collaboration between juvenile justice and community mental health centers: implications for evidence-based practice implementation for adolescent substance use disorder treatment

BackgroundSubstance use disorders are prevalent among youth involved with the criminal justice system, however, evidence-based substance use disorder treatment is often unavailable to this population. The goal of this study was to identify barriers to effective implementation of evidence-based practices among juvenile justice and community mental health organizations through the lens of an adopter-based innovation model.MethodsIn this mixed-methods study, qualitative interviews were conducted with n = 15 juvenile justice staff and n = 14 community mental health staff from two counties implementing substance use services for justice involved youth. In addition, n = 28 juvenile justice staff and n = 85 community mental health center staff also completed quantitative measures of organizational effectiveness including the implementation leadership scale (ILS), organizational readiness for change (ORIC), and the implementation climate scale (ICS).ResultsOrganizationally, staff from community mental health centers reported more “red tape” and formalized procedures around daily processes, while many juvenile justice staff reported a high degree of autonomy. Community mental health respondents also reported broad concern about their capacity for providing new interventions. Staff across the two different organizations expressed support for evidence-based practices, agreed with the importance of treating substance use disorders in this population, and were enthusiastic about implementing the interventions.ConclusionsWhile both community mental health and juvenile justice staff express commitment to implementing evidence-based practices, systems-level changes are needed to increase capacity for providing evidence-based services.

Determinants of an evidence-based practice environment: an interpretive description

BackgroundDespite the available research to inform nursing practice, many patients still fail to receive evidence-based care. Several evidence-based practice (EBP) models have been developed to guide nurses through the steps in the process, yet these models have not been uniformly adopted or consistently used. The original purpose of this research was to gather perspectives and experiences of nurses using the Iowa Model of EBP to help inform its introduction into other practice settings. As a more in-depth understanding was gained, the emphasis of the study shifted towards understanding the determinants of the EBP environment.MethodThe study was conducted in an 800-bed comprehensive academic medical centre in the USA with a 25-year history of using the Iowa Model of EBP. Semi-structured in-depth interviews were conducted with twelve nurses from various roles to ascertain their perspectives and experiences using the model. The interview transcripts were reviewed alongside relevant published literature and internal documents in a process of synthesising, theorising, and conceptualising. Data were collected during the first half of 2019.ResultsFour determinants of the local EBP environment were identified from the perspectives and experiences of participants: (1) the importance of a shared model to guide staff through the EBP process; (2) support for EBP in the form of education, hands-on training, and knowledge infrastructure; (3) active team facilitation by direct care nurses, nurse managers, nurse specialists, and nurse scientists; and (4) a culture and leadership that encourages EBP.ConclusionIntroducing an EBP model is an essential first step for an organisation to improve consistent and reliable evidence-based care; to be most effective, this should be done in conjunction with efforts to optimise the EBP environment.