The Contextual Influence of Professional Culture : Certified Nurse Midwives Knowledge of and Reliance on Evidence Based Practice  

Oleh:

Bogdan-Lovis, Elizabeth A. ; Sousa, Aron

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: Social Science & Medicine (www.elsevier.com/locate/sosscimed) vol. 62 no. 11 (Jun. 2006), page 2681-2693.
Topik: midwifery; USA; midewifery; research utilization; evidence based; diffusion of innovations; authoritative knowledge

Ketersediaan

Perpustakaan Pusat (Semanggi) Nomor Panggil: SS53.4 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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This paper reports research undertaken to assess US certified nurse midwives (CNMs) knowledge, of access to and use of evidence based medicine (EBM). Findings are presented int he context of interprofessional, institutional and popular culture. The descriptive study follows concepts of diffusion of innovation, evidence based patient choice and authoritative knowledge to anlayse incentives and abrriers to the implementation of evidence based midwifery care. Structured interviews were conducted with practicing CNMs in an urban practice site and a regional teaching centre. The analysis of responses explored congruence between practitioner knowledge, professed practice, and published professional as well as hospital based internal practice guidelines, for two specific interventions for which there is ample systematic review, epidural and episiotomy. THe CNMs demonstrated enthusiasm for their own individual understanding of EBM, but responses to specific quwstions about EBM supported practice indicate that many had an incomplete understanding of the concept. Furthermore, in those cases where CNMs demonstrated accurate knowledge of EBM, practice protocols followed subspecialty dictates, thereby preventing their knowledge from translating into adherence to EBM guided clinical practice guidelines. Finally, patient expextations for technological intervention appeared to influence CNMs' care decisions, even when those expectations lacked sound supporting evidence. If as conceived by its priginators and champions, EBM is to be widely adopted then practitioners such as CNMs need to accurately understand its concepts and also to be afforded the opportunity to exercise professional control over its implementation. Central to an epistemically balanced EBM is the need to ensure that midwifery knowledge contributes in a robust and on going fashion to EBM's scientific research base. Lastly, EBM advocates must identify balanced strategies to both rationally and fairly address consumerist pressure for aggresive health care consumption.

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