Getting evidence into practice: the role and function of facilitation.

AIM OF PAPER This paper presents the findings of a concept analysis of facilitation in relation to successful implementation of evidence into practice. BACKGROUND In 1998, we presented a conceptual framework that represented the interplay and interdependence of the many factors influencing the uptake of evidence into practice. One of the three elements of the framework was facilitation, alongside the nature of evidence and context. It was proposed that facilitators had a key role in helping individuals and teams understand what they needed to change and how they needed to change it. As part of the on-going development and refinement of the framework, the elements within it have undergone a concept analysis in order to provide theoretical and conceptual clarity. METHODS The concept analysis approach was used as a framework to review critically the research literature and seminal texts in order to establish the conceptual clarity and maturity of facilitation in relation to its role in the implementation of evidence-based practice. FINDINGS The concept of facilitation is partially developed and in need of delineation and comparison. Here, the purpose, role and skills and attributes of facilitators are explored in order to try and make distinctions between this role and other change agent roles such as educational outreach workers, academic detailers and opinion leaders. CONCLUSIONS We propose that facilitation can be represented as a set of continua, with the purpose of facilitation ranging from a discrete task-focused activity to a more holistic process of enabling individuals, teams and organizations to change. A number of defining characteristics of facilitation are proposed. However, further research to clarify and evaluate different models of facilitation is required.

[1]  B. Rodgers Concepts, analysis and the development of nursing knowledge: the evolutionary cycle. , 1989, Journal of advanced nursing.

[2]  A. Szczepura,et al.  Effectiveness and cost of different strategies for information feedback in general practice. , 1994, The British journal of general practice : the journal of the Royal College of General Practitioners.

[3]  G. Fowler,et al.  Promoting prevention in primary care: controlled trial of low technology, low cost approach. , 1987, British medical journal.

[4]  C. Johns,et al.  Learning through supervision: a case study of respite care , 1993 .

[5]  Andrew D Oxman,et al.  Closing the gap between research and practice : an overview of systematic reviews of interventions to promote the implementation of research findings , 2011 .

[6]  S Dawson Inhabiting different worlds: how can research relate to practice? , 1997, Quality in health care : QHC.

[7]  T A Sheldon,et al.  The accessibility of research-based knowledge for nurses in United Kingdom acute care settings. , 2001, Journal of advanced nursing.

[8]  Lorraine O. Walker,et al.  Strategies for theory construction in nursing , 1983 .

[9]  J. Avorn,et al.  A controlled trial of educational outreach to improve blood transfusion practice. , 1993, JAMA.

[10]  D Ruth,et al.  Randomised trial of three approaches for marketing smoking cessation programmes to Australian general practitioners. , 1992, BMJ.

[11]  P. A. Carney,et al.  Cancer: improving early detection and prevention. A community practice randomised trial. , 1992, BMJ.

[12]  P. Reason,et al.  Human inquiry : a sourcebook of new paradigm research , 1983 .

[13]  A. Kitson,et al.  Using a supervisory framework to support and evaluate a multiproject practice development programme. , 1998, Journal of clinical nursing.

[14]  E. Ferlie,et al.  Some limits to evidence-based medicine: a case study from elective orthopaedics. , 1999, Quality in health care : QHC.

[15]  A D Oxman,et al.  Changing physician performance. A systematic review of the effect of continuing medical education strategies. , 1995, JAMA.

[16]  Health care standards: the interstitial matter of quality programs. , 1993, Journal of nursing care quality.

[17]  L Carroll,et al.  Medical audit and the role of the facilitator. , 1994, International journal of health care quality assurance.

[18]  J. Morse Exploring the theoretical basis of nursing using advanced techniques of concept analysis , 1995, ANS. Advances in nursing science.

[19]  J. Wilson‐Barnett Freedom to practice: The development of patient-centred nursing , 2001 .

[20]  B. McCormack,et al.  Achieving dignified care for older people through practice development: A systematic approach , 1999 .

[21]  A. Titchen,et al.  Practice development in mental health nursing , 1998 .

[22]  J. Morse,et al.  Concept Analysis in Nursing Research: A Critical Appraisal , 1996, Scholarly Inquiry for Nursing Practice.

[23]  G. Goelen,et al.  Facilitating general practitioners in Belgium , 1996 .

[24]  P. Reason Human inquiry in action : developments in new paradigm research , 1988 .

[25]  C. O. Kennedy A controlled trial , 1971, British Homeopathic Journal.

[26]  A. McBride,et al.  The hospital health-promotion facilitator: an evaluation. , 1994, Journal of clinical nursing.

[27]  A Kitson,et al.  Enabling the implementation of evidence based practice: a conceptual framework. , 1998, Quality in health care : QHC.

[28]  J. Heron,et al.  The Complete Facilitator's Handbook , 1999 .

[29]  C. Rogers Client-Centered Therapy: Its Current Practice, Implications and Theory , 1951 .

[30]  H. Hearnshaw,et al.  The facilitation of multiprofessional clinical audit in primary health care teams-from audit to quality assurance , 1995 .

[31]  Moore Ch,et al.  Task force: a management technique that produces quality decisions and employee commitment. , 1988 .

[32]  J. Paley How not to clarify concepts in nursing. , 1996, Journal of advanced nursing.

[33]  Stephen B. Soumerai,et al.  Improving Drug-Therapy Decisions through Educational Outreach , 1983 .

[34]  G. Fowler,et al.  Facilitating prevention in primary care. , 1984, BMJ.

[35]  D. Weller,et al.  Will facilitators be acceptable in Australian general practice? A before and after feasibility study. , 1993, Australian family physician.

[36]  G. Lippitt Cutting Edge Trends in Organization Development. , 1984 .

[37]  T A Sheldon,et al.  ISSUES AND INNOVATIONS IN NURSING PRACTICE Research information in nurses' clinical decision-making: what is useful? , 2018 .

[38]  J Gabbay,et al.  Understanding the role of opinion leaders in improving clinical effectiveness. , 2001, Social science & medicine.

[39]  Eugene Vayda,et al.  Opinion leaders vs audit and feedback to implement practice guidelines. Delivery after previous cesarean section. , 1991, JAMA.

[40]  H. Hearnshaw,et al.  Multidisciplinary audit in primary healthcare teams: facilitation by audit support staff. , 1994, Quality in health care : QHC.

[41]  C. van Weel,et al.  Changing preventive practice: a controlled trial on the effects of outreach visits to organise prevention of cardiovascular disease. , 1997, Quality in health care : QHC.

[42]  Brendan McCormack,et al.  A concept analysis of practice development , 2002 .

[43]  A Kitson,et al.  Towards practice development--a vision in reality or a reality without vision? , 1999, Journal of nursing management.

[44]  R. Burchfield Oxford English dictionary , 1982 .

[45]  Carl R. Rogers,et al.  Freedom to learn for the 80\'s / Carl R. Rogers , 1983 .

[46]  Carl R. Rogers,et al.  Freedom to learn for the 80's , 1982 .

[47]  R. Tamblyn,et al.  Problem-based learning : an approach to medical education , 1980 .