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Learning Challenges Associated with Evidence-Based Practice in Rheumatology
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Rheumatology is a field of practice that is undergoing many changes, leading to growing demand for rheumatology practitioners to keep up-to-date about the research developments in their field and to implement new findings and recommendations into clinical practice. Research within implementation science has shown that there are numerous barriers to the clinical use of research-based knowledge in health care. Implementation of evidencebased practice (EBP) requires a great deal of learning on the part of practitioners. It is likely that practitioners in rheumatology face similar challenges to those in other clinical fields, but there is a paucity of research concerning the implementation of EBP in rheumatology and the learning required.

Aims: The overall aim of the research project was to generate knowledge concerning the learning challenges associated with evidence-based practice in rheumatology.

Methods: Qualitative methods were used to explore the use of knowledge sources in rheumatology nursing and the learning opportunities in clinical rheumatology for participants belonging to five professional groups. Quantitative methods sought to examine to what extent evidence-based practice was implemented in clinical rheumatology practice and which individual and organizational factors affected research use. A theory-based study analysed the learning processes associated with achieving an evidence-based practice.

Results: Four sources of knowledge were identified for rheumatology nursing practice: interaction with other people in the workplace (peers in particular) and previous knowledge and experience were perceived as preferred sources of knowledge, while written materials and contacts outside the workplace were less privileged. Learning opportunities occurring during daily practice were perceived by participants of all professional groups to consist predominantly of interactions with professional peers in the workplace. Participants perceived a lack of recognized learning opportunities such as continuing professional education and regular participation in rheumatology-specific courses and conferences. Participants also expressed that time for reflection and up-dating knowledge was short in everyday clinical work. The quantitative data showed that while the general interest for EBP was high in rheumatology practice, individual interest and professional self-efficacy related to EBP varied. A longer work-experience in rheumatology, better self-efficacy concerning the use research-based knowledge and more experience from research activities were positively associated with the use of research in practice. The theoretical analysis showed that challenges of implementing evidence-based practice concern not only the acquisition of research-based knowledge and the integration of this knowledge in practice, but also the abandonment of outdated practices.

Conclusions: In this thesis, implementation of EBP in rheumatology has been shown to be a complex issue. Social, contextual and individual aspects were found to be involved in the learning processes, the use of knowledge sources and learning opportunities, as well as in the EBP-relevant behaviours that are enacted in clinical rheumatology. The thesis hopes to contribute to a better understanding of the learning challenges in connection with the implementation of EBP in rheumatology practice.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. , 79 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1517
National Category
Public Health, Global Health, Social Medicine and Epidemiology
URN: urn:nbn:se:liu:diva-127495DOI: 10.3384/diss.diva-127495ISBN: 978-91-7685-799-1 (Print)OAI: diva2:924282
Public defence
2016-06-07, Belladonna, Hus 511-001, Campus US, Linköping, 13:00 (English)
Available from: 2016-04-28 Created: 2016-04-28 Last updated: 2016-05-02Bibliographically approved
List of papers
1. Knowledge Sources for Evidence-Based Practice in Rheumatology Nursing.
Open this publication in new window or tab >>Knowledge Sources for Evidence-Based Practice in Rheumatology Nursing.
2015 (English)In: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 24, no 6, 661-679 p.Article in journal (Refereed) Published
Abstract [en]

As rheumatology nursing develops and extends, knowledge about current use of knowledge in rheumatology nursing practice may guide discussions about future knowledge needs. To explore what perceptions rheumatology nurses have about their knowledge sources and about what knowledge they use in their practice, 12 nurses working in specialist rheumatology were interviewed using a semi-structured interview guide. The data were analyzed using conventional qualitative content analysis. The analysis yielded four types of knowledge sources in clinical practice: interaction with others in the workplace, contacts outside the workplace, written materials, and previous knowledge and experience. Colleagues, and physicians in particular, were important for informal learning in daily rheumatology practice. Evidence from the medical arena was accessed through medical specialists, while nursing research was used less. Facilitating informal learning and continuing formal education is proposed as a way toward a more evidence-based practice in extended roles.

Place, publisher, year, edition, pages
Sage Publications, 2015
extended roles, health care, informal learning, workplace learning, qualitative
National Category
Public Health, Global Health, Social Medicine and Epidemiology
urn:nbn:se:liu:diva-118283 (URN)10.1177/1054773814543355 (DOI)000364723000006 ()25059719 (PubMedID)
Available from: 2015-05-25 Created: 2015-05-25 Last updated: 2016-04-28
2. Learning opportunities in rheumatology practice: a qualitative study
Open this publication in new window or tab >>Learning opportunities in rheumatology practice: a qualitative study
2015 (English)In: Journal of Workplace Learning, ISSN 1366-5626, E-ISSN 1758-7859, Vol. 27, no 4, 282-297 p.Article in journal (Refereed) Published
Abstract [en]


– This paper aims to explore what opportunities for learning practitioners in rheumatology perceive of in their daily practice, using a typology of workplace learning to categorize these opportunities.


– Thirty-six practitioners from different professions in rheumatology were interviewed. Data were analyzed using conventional qualitative content analysis with a directed approach, and were categorized according to a typology of formal and informal learning.


– The typology was adjusted to fit the categories resulting from the analysis. Further analysis showed that work processes with learning as a by-product in general, and relationships with other people in the workplace in particular, were perceived as important for learning in the workplace. The use of many recognized learning opportunities was lower. Barriers for learning were a perceived low leadership awareness of learning opportunities and factors relating to workload and the organization of work.

Research limitations/implications

– The generalizability of results from all qualitative inquiries is limited by nature, and the issue of transferability to other contexts is for the reader to decide. Further studies will need to confirm the results of the study, as well as the proposed enhancement of the typology with which the results were categorized.

Practical implications

– The study highlights the importance of relationships in the workplace for informal learning in rheumatology practice. In the clinical context, locally adapted strategies at organizational and individual levels are needed to maximize opportunities for both professional and interprofessional informal learning, taking the importance of personal relationships into account. The findings also suggest a need for increased continuing professional education in the specialty.


– The workplace learning typology that was used in the study showed good applicability to empirical health-care study data, but may need further development. The study confirmed that informal workplace learning is an important part of learning in rheumatology. Further studies are needed to clarify how informal and formal learning in the rheumatology clinic may be supported in workplaces with different characteristics.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2015
Health care, Continuing professional development, Workplace learning, Collaborative relationships
National Category
Chemical Sciences
urn:nbn:se:liu:diva-127494 (URN)10.1108/JWL-07-2014-0054 (DOI)
Available from: 2016-04-28 Created: 2016-04-28 Last updated: 2016-05-18Bibliographically approved

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