Newly Graduated Nurses' use of Knowledge Sources in Clinical Decision Making : A qualitative study

Publikation: Ph.d. afhandling/ kandidat/ diplomPh.d. afhandlingForskning


Evidence-based practice has been introduced internationally as a standard for
healthcare delivery to improve the quality of care, thus ensuring safe care and
treatment. Evidence-based practice calls for a decision-making that specifically
requires nurses to place the patient at the centre of clinical decisions, based on
transparent, articulate and reflective use of knowledge sources. Furthermore, it is
implied that nurses are able to retrieve, asses, implement and evaluate research
evidence. To meet these requirements, nursing educations around the world have
organised curricula to educate and support future nurses, enabling them to work
within a framework of evidence-based practice. Recent studies underline that despite
curricula interventions, newly graduated nurses’ use of research evidence and
components within evidence-based practice is limited. However, it is unclear why
the newly graduated nurses do not work within a framework of evidence-based
The overall aim of this thesis was to explore which knowledge sources newly
graduated nurses’ use in their clinical decision-making and why they use them in
order to understand why newly graduated nurses use research and components
within evidence-based practice to a limited extent. The thesis is based on a synthesis
of findings from two studies. The aim of the first study was to explore which
knowledge sources newly graduated nurses use in clinical decision making as
reported within international qualitative research. The purpose was to gain a deeper
insight into the theoretical perspective of knowledge use among newly graduated
nurses and to identify specific aspects of the phenomenon, which could either be
supported, revised or refuted by further exploration of the field. The aim of the
second study was to explore and describe Danish newly graduated nurses’ use of
knowledge sources in clinical decision-making. The two studies are represented in
three papers each guided by the following objectives:
Study 1
 To describe the knowledge sources newly graduated nurses use in their
clinical decision making as documented in qualitative, research-based
Study 2
 To explore and describe which knowledge sources are incorporated in and
guide newly graduated nurses’ clinical decisions, and what influences on
how the knowledge sources are used in clinical decision-making
 To explore and describe how socialisation into a clinical setting influences
the use of knowledge sources among newly graduated nurses
In study 1, meta-ethnography as described by Noblit and Hare was applied as
method of synthesis of international qualitative research. Based on iterative
literature search in the databases CINAHL, PubMed, SCOPUS and Google Scholar
from May 2013 to May 2014 a total of 19 reports, representing 17 qualitative studies
published between 2000-2014 were included in the synthesis. In study 2,
ethnography was chosen as methodology with principles from focused ethnography
integrated in the methodology. Participant-observation and semi-structured
interviews of nine Danish newly graduated nurses were chosen as methods for data
collection. Data was collected from eight different clinical settings from May to
November 2014 at a Danish University Hospital.
To answer the overall aim of the thesis, the findings from the two studies were
synthesized. The findings show that the conscious and reflective use of knowledge
sources is influenced by the following: Education-Clinical Practice Gap, Role
models, Culture of inquiry and Articulation of knowledge sources. Contextual and
individual influences impact the newly graduated nurses’ use of research knowledge
and their use of components within evidence-based practice. The synthesis
underlines that in order to understand why newly graduated nurses use components
within evidence-based practice and research evidence to a limited extent, answers
can partly be found in the newly graduated nurses’ experience of a theory-practice
gap between education and clinical practice. Due to their perception of being
inadequately prepared for clinical practice from nurse education and experiencing an
overwhelming responsibility they do not feel prepared for, they find themselves
highly dependent on the experienced colleagues as a predominant knowledge
source. The experienced colleague is perceived as a role model and indirectly
influences the newly graduated nurses’ inquiring approach and thus the reflective
and articulate use of knowledge sources.
The findings supplement and elaborate on previous research on factors that facilitate
or hinder newly graduated nurses’ use of research evidence and other components
within evidence-based practice. This thesis calls for an articulated clarity to the
reflective use of knowledge sources underpinning decisions taken within a frame of
evidence-based practice. It also underlines a need for a greater concurrence on how
knowledge sources are articulated and used in nursing education and clinical
practice. This study may inform interventions as to how newly graduated nurses can
be supported in their use of knowledge, skills and competencies within evidencebased
practice and put them into use in clinical practice to improve nursing care.
Furthermore, the findings may be used to inform the planning of curricular
interventions at schools of nursing and in organizing introductory programs for
newly graduated nurses in clinical practice.
Bevilgende institution
  • Aalborg Universitet
Sponsorer for afhandling
ISBN'er, elektronisk978-87-7112-781-2
StatusUdgivet - 2016


  • sygeplejerske