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Evidence-based practice: reflections from five European case studies.

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Evidence-based practice (EBP) in stroke care faces challenges outside acute settings, impacting clinician status and knowledge integration. Context, knowledge types, and professional hierarchies influence EBP implementation.

Keywords:
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Area of Science:

  • Healthcare delivery
  • Clinical practice
  • Evidence-based practice

Background:

  • Evidence-based practice (EBP) is standard in clinical settings, originating from evidence-based medicine.
  • EBP prioritizes evidence from randomized controlled trials (RCTs), which is more applicable to acute care.
  • Applying EBP in community and primary care settings presents challenges for clinicians like nurses and therapists.

Purpose of the Study:

  • To examine the influence of context on evidence in stroke care.
  • To explore the nature of tacit and encoded knowledge in clinical practice.
  • To analyze professional hierarchies within stroke care teams.

Main Methods:

  • Conducted five qualitative case studies in stroke care services across England, Sweden, and Poland.
  • Gathered data through 120 semi-structured interviews with diverse healthcare professionals.
  • Focused on interprofessional perspectives on EBP in acute, community, and primary care settings.

Main Results:

  • Lack of RCT evidence in community/primary care can lower clinician status.
  • Clinicians utilize both tacit and encoded knowledge, leading to intra- and interprofessional tensions.
  • Professional hierarchies in stroke teams vary by country, with non-specialist roles often undervalued.

Conclusions:

  • Context is crucial for evidence interpretation and application in stroke care.
  • Understanding the interplay of different knowledge types is essential for effective EBP.
  • Addressing professional hierarchies and valuing diverse roles can improve EBP implementation in stroke care.