Background
In New Zealand it is acknowledged access to and utilisation of evidence to inform practice varies widely across the nursing sector. To address this wide variation, the Waikato District Health Board (WDHB), on behalf of the Midland District Health Boards (MDHB), submitted a proposal to an Expressions of Interest issued by the New Zealand Ministry of Health in 2010. The proposal, Improving Nursing Utilisation of Evidence to Inform Clinical Practice, was focused on strengthening the connection between evidence and nursing practice by utilising internationally-recognised, electronic-based approaches. The proposal was based on two interrelated tasks, firstly, the selection of an appropriate electronic manual and secondly, evaluation of the perceptions of a selected group of registered nurses and midwives to the manual’s suitability for deployment across the MDHB.

Method
A thorough investigation of evidence manuals available indicated the Lippincott’s Nursing Procedures and Skills Manual (Lippincott Manual) could meet the proposal’s requirements and was subjected to a detailed review. This review comprised a gap analysis, (comparing current WDHB procedures with procedures in the electronic manual), and a review of evidence (critically examining the clinical evidence used to support the procedures). The gap analysis indicated over 80% of Lippincott procedures correlated to the WDHB policy portfolio. The review of evidence indicated the Lippincott Manual utilised a wide range of contemporary evidence base materials to justify the procedures described.

An initial pilot group was identified that included 135 registered nurses and midwives from across the five Midland DHBs. The pilot group was asked to critically review a minimum of three of the procedures within the manual. The selection of the procedures was designated by the project leader and the review included at least one “non-specialist” procedure. Within the e-environment the project leadership group developed two evaluation instruments to seek participant perceptions of both ease of access to the electronic resources and their evaluation and critique of the actual procedures reviewed.

Results
The analysis of data from the ease of access instrument indicated a significant majority of respondents:
• were confident and competent using computers and searching, retrieving, storing and manipulating information from the Internet,
• were competent and confident in using web-based technologies to access point of care procedures,
• were able to clearly read all materials and the media used was appropriate to the information presented,
• could access the appropriate software applications to complete activities assigned, and
• had robust and reliable connections.
The analysis of the data from the procedure evaluation instrument indicated:
• a significant number of respondents recognised the value of a centralised procedure manual and the supporting resources in improving their practice.
• respondents found it particularly valuable to be able to quickly and efficiently access appropriate procedures. Critical to the success was access ‘close’ to where care was being undertaken.
• although the procedures reviewed were clinically relevant and current, the language style (Americanism) within the product was viewed negatively by some evaluators.
• the context in which the procedures were written to service an American model of nursing and midwifery care did not always match practice undertaken in New Zealand.
Conclusions
In general, the evaluation showed an overwhelmingly-positive response to accessing on-line procedures; and the opinion that the procedures had a good technical fit with New Zealand nursing practice.

Keywords
Clinical Practice, Utilisation of Evidence, Clinical Manuals

How this contributes to knowledge development in the partnership working theme:
• demonstrates that centralised point-of-care manuals can provide an effective platform for the provision of clinical support to practising nurses and midwives
• offers new ways of increasing nurses’ and midwives’ engagement within institutional policy and procedures
• provides an insight into nurses’ and midwives’ perceptions of information and communication technologies.