A grounded theory study of evidence-based practice in residential aged care
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This paper reports the findings of a study to answer the question: what mechanisms influence the implementation of evidence-based practice in residential aged care and how do those mechanisms interact? The context for the study was a national program to implement evidence-based practice in residential aged care. The methodology used grounded theory from a critical realist perspective and a conceptual framework that differentiates between the context, process and content of change. People were purposively sampled and invited to participate in semi-structured interviews. Data analysis resulted in the identification of four mechanisms that accounted for what took place and participants' experiences. The core category that provided the greatest understanding of the data was the mechanism On Common Ground, comprising several constructs that formed a 'common ground' for change to occur. The mechanism Learning by Connecting recognised the ability to connect new knowledge with existing practice and knowledge, and make connections between actions and outcomes. Reconciling Competing Priorities was an ongoing mechanism whereby new practices had to compete with an existing set of constantly shifting priorities. Strategies for reconciling priorities ranged from structured approaches such as care planning to more informal arrangements such as conversations during daily work. The mechanism Exercising Agency bridged the gap between agency and action. It was the human dimension of change, both individually and collectively, that made things happen. The findings are consistent with the findings of others, but fit together in a novel way and have important implications for policy and practice: 'evidence' can inform practice change, but only as part of a broader mix of factors, including whether a change 'makes sense'; a common language and approach to framing care are important; conversing about practice makes a key contribution to learning; and there is a constant need to reconcile the priorities inherent in daily work.