Understanding the Role of Influentials in Nursing: A Realist Review

Envoyer Imprimer

Emily Pearsall, Lianne Jeffs, Anna Gagliardi
University of Toronto


To explore whether and how influentials effect the use of evidence based practice (EBP) in nursing through an exploration of influentials’ characteristics, activities and effectiveness


The goal of nursing practice is to deliver high quality, cost effective care and improve health outcomes. The use of evidence in clinical practice has shown to improve patient outcomes and decrease costs. However, the uptake of evidence in nursing has been slow and there is limited information on effective strategies to increase its use. Many studies promote the use of an influential in nursing but little is known about who they are, what they do, and whether they are effective.

Social Influence Theory

  • A process where “the behavior of one person has the effect or intention of changing how another person (or group) behaves, feels, or thinks about something”
  • Behaviors and attitudes of individuals are shaped by habits, customs, assumptions, beliefs and values held by peers, prevailing practices and social norms
  • An influential changes norms byway of peer pressure, social influence, persuasion, and modeling appropriate behaviors

Clarifying the Concepts

Influential: an individual or team of individuals who influence nurses’ beliefs, knowledge, attitudes, and/or behaviour with regards to implementing EBP

Evidence Based Practice: the use of research findings as well as clinical knowledge, and patient preferences when making clinical decisions regarding patient care


A realist review is an explanatory analysis aimed at discerning what works for whom, in what circumstances, in what respects and how. It aims to reach a deeper understanding of the intervention and how it can be made to work most effectively.

Search Strategy

  • Databases: OVID Medline and CINHAL
  • Journals: Evidence Based Nursing, Journal of Advanced Nursing, Worldviews on Evidence Based Nursing
  • Key Concepts: Influentials, Evidence Based Practice, and Nursing

Inclusion Criteria

  • Described, compared, or evaluated the implementation of EBP in the context of nursing in an acute care hospital by an influential
  • Primary empirical studies and reviews
  • Published subsequent to 1993
  • Available in English

Search Results

(See .pdf)


Study type Interviews (5), pre-post test (2), survey (2), mixed methods (2), literature review (1)
Country UK (6), Canada (4), USA (1), Netherlands (1)
Influentials Label Champion (6), knowledge broker (2), change agent (1)

Characteristics of the Influential

  • Varied professional roles
  • Wide social networks, credibility, acceptance by peers
  • Influential role (i.e. leader, facilitator, mentor)
  • Advanced research and clinical knowledge/skills
  • Supportive, empowering, and encouraging

Activities of the Influential

  • Lead teams, problem solve, identify issues and barriers, create and implement action plans
  • Provide ongoing education, disseminate evidence, host formal educational meetings
  • Informal, face-to-face communication, emails


  • Two studies; pre-test post-test designs
  • Assessed Champions who received formal training
  • Found that Champions were successful in increasing nursing related changes (e.g. documentation)


  • Influentials in nursing are often labeled as Champions
  • They tend to be credible, knowledgeable, and supportive
  • They communicate often and provide education
  • Unable to definitively conclude who influentials are, what they do, and how or whether they are effective

View full poster (.pdf)