The challenges of evidence implementation: it's all about the context
Whenever we consider where we are and where we would like to go, it is always important to consider how we got to where we are now. Evidence-based health care was initially derived from the concept of evidence-based medicine (EBM), a term first proposed by Gordon Guyatt, leader of an international group of clinicians formed to consider results of recent research when treating patients, first appearing in print in 1992 (Evidence based Medicine Working Group 1992).1 While this initial focus of EBM was on bedside decision-making, the underpinning ideas have been evolving for centuries, with roots in psychology, sociology and philosophy, and a large part of the underpinning vocabulary invented and developed by statisticians and epidemiologists.2 Similar interest within nursing in a topic labeled “research utilization” had also began in the 1970s when one of the first articles “Adopters and Laggards” was published.3 Despite waning interest in the 1980s, this field grew rapidly in the 1990s with the development of several research utilization models, often criticized for their focus on individual aspects of implementation and a failure to account for wider organizational issues. A substantive body of work using the BARRIERS scale developed by Funk et al.4 led the field in identifying common barriers that nurses face when implementing evidence. However, while work using this method may be of historical interest to track evolution of attitudes toward evidence in relation to changes in the profession, it is unlikely to determine a way forward for nurse leaders and clinicians.5 Evidence-based medicine was radically expanded, adopted and adapted under the guise and term of evidence-based practice/EBHC6 to include all aspects of health care rather than being limited to medicine. The term knowledge utilization arose and became popular in the 1990s and is considered a more inclusive term encompassing research, scholarly practice and programmatic interventions aimed at increasing the use of knowledge to solve human problems.