Document Detail

The contextual influence of professional culture: certified nurse-midwives' knowledge of and reliance on evidence-based practice.
MedLine Citation:
PMID:  16377047     Owner:  NLM     Status:  MEDLINE    
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 in the context of interprofessional, institutional, and popular culture. The descriptive study follows concepts of diffusion of innovation, evidence-based patient choice, and authoritative knowledge to analyse incentives and barriers 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 questions 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 expectations for technological intervention appeared to influence CNMs' care decisions, even when those expectations lacked sound supporting evidence. If, as conceived by its originators 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 ongoing fashion to EBM's scientific research base. Lastly, EBM advocates must identify balanced strategies to both rationally and fairly address consumerist pressures for aggressive health care consumption.
Elizabeth A Bogdan-Lovis; Aron Sousa
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Publication Detail:
Type:  Journal Article     Date:  2005-12-27
Journal Detail:
Title:  Social science & medicine (1982)     Volume:  62     ISSN:  0277-9536     ISO Abbreviation:  Soc Sci Med     Publication Date:  2006 Jun 
Date Detail:
Created Date:  2006-04-28     Completed Date:  2006-11-03     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8303205     Medline TA:  Soc Sci Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  2681-93     Citation Subset:  IM    
Center for Ethics and Humanities in the Life Sciences, Michigan State University, East Lansing, USA.
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MeSH Terms
Access to Information
Diffusion of Innovation
Evidence-Based Medicine*
Health Knowledge, Attitudes, Practice*
Interviews as Topic
Nurse Midwives*
United States

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