What Influences Changing Practice to Evidence-Based Care in Individual Providers?

Objective:  

In maternity care, a number of current practices are not evidence-based while many of those that are supported by evidence remain underutilized. Studies investigating efforts to incorporate evidence into practice reveal that, at the organizational level, many initiatives are unsuccessful. Research into provider change at the level of the individualhas been sparse in all medical fields.

This study sought to explore the experiences of individual maternity care professionals (midwives and physicians) who had changed a practice to one with more scientific support. For the purposes of having the providers share a common phenomenon, the change from early to delayed cord clamping was chosen.

Design:

This qualitative study was conducted using a constructivist, grounded theory approach. The work of grounded theorist Kathy Charmaz (2010) informed the study.  

Setting:

Participants were interviewed by phone. Practice settings ranged from home birth to both freestanding and in-hospital birth centers to the hospital - which was the most common setting with eight out of the seventeen subjects providing care there.

Sample:

Participants were in active clinical practice or had been within the past three years. They practiced early cord clamping for at least six months, changed to delayed cord clamping and then practiced that for at least six months.

The sample was made up of 17 providers (12 midwives and five physicians) from throughout the United States.

Methods:

Participant interviews were recorded with permission and then transcribed. Coding and data management was conducted using ATLAS .ti Version 6.1. The study was approved by the IRB of George Washington University with multiple steps taken to protect the participants during analysis.

Results:  

Five emergent themes acting as ‘drivers of change’ were 1) trusting colleagues, 2) believing the evidence 3) honoring mothers and families, 4) knowing with personal certainty and 5) protecting the integrity of the mother and the baby.  Three domains of influence developed from the background of the stories of change: personal, professional and institutional. From the findings, the Evolution to Provider Change Model was developed.

Conclusion/Implications for nursing practice:

This study provides new understanding about how individual maternity care professionals change practice. A new theoretical model is proposed which may be used in future nursing research on improving practice. Focusing on individual vs. group change and on learning from those who have successfully changed practice toward more evidence-based care offers fertile ground for further study.

Keywords: Practice change, provider change, medical decision-making, evidence-based care, nurse-midwifery, improving maternity care