A structured course in evidence-based radiography was associated with a shift in how experienced registered nurses conceptualize and apply evidence-based practice, although implementation in clinical practice remained constrained by organizational factors, according to a longitudinal phenomenographic study published in the Journal of Radiology Nursing.
Researchers found that participants moved from a narrow, research-focused view of evidence-based radiography (EBR) to a broader understanding of it as a practical tool for quality improvement in daily clinical work. However, time constraints, production pressures, and limited managerial support continued to hinder implementation. The researchers emphasized that evidence-based radiography is essential for high-quality care and not optional in modern practice.
The study included five clinically experienced participants enrolled in a university-level course, “Knowledge-based quality development: A bridge between clinical practice and research,” at Karolinska Institutet in Sweden during the spring semester of 2023. The course combined instruction in research methods with a clinical quality improvement project conducted in participants’ own departments. Participants were interviewed at multiple time points throughout the course and approximately 6 months following completion.
Using a phenomenographic approach, researchers identified three distinct ways participants understood EBR over time.
At the beginning of the course, participants described EBR as “The Path of Proof,” reflecting a narrow, research-centered perspective in which evidence was primarily viewed as a tool for verifying or challenging findings. Some participants expressed concern that an overemphasis on formal evidence could overshadow clinical experience.
As the course progressed, participants’ understanding evolved to “A Tool, Not a Goal.” In this phase, EBR was seen as a structured and iterative process involving formulating clinical questions, searching for evidence, and evaluating study quality. Participants described the process as complex and sometimes time-consuming, requiring both qualitative and quantitative approaches.
By the project phase of the course, participants described EBR as “The Path of Discovery,” integrating evidence into routine practice through continuous improvement and clinical decision-making. Participants recognized that evidence-based practice incorporates research findings alongside clinical expertise, patient needs, and contextual factors.
At the 6-month follow-up, participants retained the broader conceptual understanding developed during the course. However, interviews focused more on challenges in applying EBR in clinical settings.
Participants identified several barriers to implementation, including limited time due to high volumes of radiological examinations, production-oriented workflows that deprioritized development work, and insufficient managerial support. Some participants reported that task shifting within departments was perceived as moving practice further from evidence-based approaches.
Participants who described stronger managerial support expressed greater optimism about implementing EBR and a broader perspective on its role in clinical practice, whereas those reporting less support described frustration and limited opportunities for change.
Leadership was identified as a key factor influencing whether evidence-based approaches could be implemented. Participants suggested that training in evidence-based practice may be particularly beneficial for methodological or section leaders who work closely with clinical processes while also holding responsibility for development initiatives.
The study design allowed for in-depth exploration of how understanding of EBR evolves over time. To reduce bias, the course instructor did not conduct interviews, which were performed by independent researchers. However, the small sample size limits generalizability, and findings are intended to describe variation in perception rather than produce population-level estimates.
The researchers concluded that structured education in evidence-based quality improvement can deepen understanding and sustain motivation among radiology nurses. However, successful implementation requires organizational commitment, leadership involvement, and dedicated time within clinical workflows. As one participant noted, “Dare to give people time to work in this way… I think that’s the key.”
The researchers reported no conflicts of interest and no external funding.
Source: Journal of Radiology Nursing
