Nurses' perceived knowledge, beliefs, skills, and needs regarding evidence-based practice: implications for accelerating the paradigm shift

Preconditions for successful guideline implementation: perceptions of oncology nurses

Background

Although evidence-based guidelines are important for improving the quality of patient care, implementation in practice is below expectations. With the recent focus on team care, guidelines are intended to promote the integration of care across multiple disciplines. We conducted an exploratory study to understand oncology nurses' perceptions of guideline implementation and to learn their views on how their experiences affected the implementation.

Methods

A qualitative study was used with focus group interviews. We collected data from 11 nurses with more than 5 years of oncology nursing experience in Japan. The data were analyzed using grounded theory.

Results

Results of the analysis identified "preconditions for successful guideline implementation" as a core category. There were 4 categories (goal congruence, equal partnership, professional self-development and user-friendliness) and 11 subcategories related to organizational, multidisciplinary, individual, and guideline levels.

Conclusions

Although the guidelines were viewed as important, they were not fully implemented in practice. There are preconditions at the organizational, multidisciplinary, individual, and guideline levels that must be met if an organization is to successfully implement the guideline in clinical settings. Prioritizing strategies by focusing on these preconditions will help to facilitate successful guideline implementation.

The development and descriptions of an evidence-based case management educational program

Educational preparation is the key to successful case management and better patient outcomes. Closer examination reveals that existing case management education programs often lack a theoretical underpinning. In order to address the issues, this paper describes the development process of using an expanded version of Donabedian's structure-process-outcome framework as a base and program itself. Four main stages were used in the development process. A systematic literature review and needs assessment provided relevant evidence for the program design. Then, a panel review was undertaken and pilot testing initiated with public health nurses. The expert panel review and the findings of the pilot test both supported the selection of the program content and the learning approaches adopted throughout the program. Sixteen hours of workshops provided detailed content on the case management process. Four main learning strategies were chosen based on transformative learning theory and the findings of the needs assessment. The paper provides an example of the development of a program based on existing theory and evidence.

Evidence-based practice, step by step: sustaining evidence-based practice through organizational policies and an innovative model

The team adopts the Advancing Research and Clinical Practice Through Close Collaboration model.This is the 12th and last article in a series from the Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values. When it's delivered in a context of caring and in a supportive organizational culture, the highest quality of care and best patient outcomes can be achieved. The complete EBP series is available as a collection on our Web site; go to www.ajnonline.com and click on Collections.

Assessment of the pharmacogenomics educational needs of pharmacists

OBJECTIVES

To evaluate the self-perceived knowledge and confidence of inpatient and outpatient pharmacists in applying pharmacogenomics information to clinical practice.

METHODS

A 19-question multiple-choice, electronic needs-assessment survey instrument was distributed to 480 inpatient and outpatient pharmacists in a large, academic, multi-campus healthcare system.

RESULTS

The survey response rate was 64% (303). Most respondents (85%) agreed that pharmacists should be required to be knowledgeable about pharmacogenomics, and 65% agreed that pharmacists should be capable of providing information on the appropriate use of pharmacogenomics testing. Sixty-three percent felt they could not accurately apply the results of pharmacogenomics tests to drug-therapy selection, dosing, or monitoring.

CONCLUSION

Pharmacists believe pharmacogenomics knowledge is important to the profession, but they lack the knowledge and self-confidence to act on the results of pharmacogenomics testing and may benefit from pharmacogenomics education.

Factors influencing evidence-based practice in prosthetics and orthotics

BACKGROUND

The importance of evidence-based practice is being recognized across a broad range of healthcare disciplines as a means for improving patient outcomes and also efficiently managing healthcare resources.

OBJECTIVE

The objective of this work was to obtain information from clinicians about the underlying barriers and facilitators relating to evidence-based practice in prosthetics and orthotics.

STUDY DESIGN

Cross sectional survey.

METHODS

An internet survey was developed and distributed to 300 prosthetists and orthotists currently practicing in Canada.

RESULTS

A principal component factor analysis of the survey results revealed ten primary factors affecting evidence-based practice. These include time constraints, workload and system demands, limited relevant evidence from research, and gaps in skills and knowledge required to perform evidence-based practice.

CONCLUSIONS

Clinicians value research as a means of improving clinical practice, but they are faced with a number of practical barriers in performing evidence-based practice.

CLINICAL RELEVANCE

This study provides empirical data about the underlying barriers and facilitators relating to evidence-based practice in prosthetics and orthotics. Such data are essential in order to inform those involved in improving existing clinical practices, including educators, professional organizations, and governing bodies.

Results of a clinician-led evidence-based task force initiative relating to pressure ulcer risk assessment and prevention

Integration of research findings into clinical practice is essential for achieving cost-effective, quality patient outcomes. Data confirm that nursing care in most settings is "empiric" and is based largely on untested assumptions, as opposed to being evidence-based. Process improvement efforts must engage clinicians in initiatives that promote the integration of research into clinical practice and acceptance of shared professional accountability for sustaining needed change. A clinician-led task force was assembled to identify and apply current evidence to clinical practice in the areas of risk assessment and prevention of hospital-acquired pressure ulcers in the inpatient setting. Data collected prior to and following our process improvement project demonstrated significant improvement in patient outcomes.

Evidence-based practice: issues, paradigms, and future pathways

Evidence-based practice (EBP) has become a real buzz word, not only in the discipline of nursing, but in all healthcare professions. EBP has been identified as the foundation of accountable, professional nursing practice and it would seem that few could argue with the apparent benefits; however, debate does exist in the literature about whether EBP can realistically be attained. As such, a critical discourse regarding the future of EBP for nursing needs to occur. One of the key questions to be addressed through this discourse is, "what counts as evidence?" A review of the nursing literature on the concept of EBP will be presented in this paper along with a discussion of several of the issues associated with EBP within the discipline of nursing. I will also present some ideas about the implications of the EBP movement in nursing and examine the future pathways for nursing.

Fostering evidence-based practice to improve nurse and cost outcomes in a community health setting: a pilot test of the advancing research and clinical practice through close collaboration model

Although evidence-based practice (EBP) improves health care quality, decreases costs, and empowers nurses, there is a paucity of intervention studies designed to test models of how to enhance nurses' use of EBP. Therefore, the specific aim of this study was to determine the preliminary effects of implementing the Advancing Research and Clinical practice through close Collaboration (ARCC) model on nurses' EBP beliefs, EBP implementation behaviors, group cohesion, productivity, job satisfaction, and attrition/turnover rates. A 2-group randomized controlled pilot trial was used with 46 nurses from the Visiting Nurse Service of New York. The ARCC group versus an attention control group had stronger EBP beliefs, higher EBP implementation behaviors, more group cohesion, and less attrition/turnover. Implementation of the ARCC model in health care systems may be a promising strategy for enhancing EBP and improving nurse and cost outcomes.

Evidence-based practice barriers and facilitators from a continuous quality improvement perspective: an integrative review

AIMS

The purpose of the present study is to examine the barriers and facilitators to evidence-based practice (EBP) using Shortell's framework for continuous quality improvement (CQI).

BACKGROUND

EBP is typically undertaken to improve practice. Although there have been many studies focused on the barriers and facilitators to adopting EBP, these have not been tied explicitly to CQI frameworks.

METHODS

CINAHL, Academic Search Premier, Medline, Psych Info, ABI/Inform and LISTA databases were searched using the keywords: nurses, information literacy, access to information, sources of knowledge, decision making, research utilization, information seeking behaviour and nursing practice, evidence-based practice. Shortell's framework was used to organize the barriers and facilitators.

RESULTS

Across the articles, the most common barriers were lack of time and lack of autonomy to change practice which falls within the strategic and cultural dimensions in Shortell's framework.

CONCLUSIONS

Barriers and facilitators to EBP adoption occur at the individual and institutional levels. Solutions to the barriers need to be directed to the dimension where the barrier occurs, while recognizing that multidimensional approaches are essential to the success of overcoming these barriers.

IMPLICATIONS FOR NURSING MANAGEMENT

The findings of the present study can help nurses identify barriers and implement strategies to promote EBP as part of CQI.

Evidence-Based Practice Among Nurses in Italy

A cross-sectional survey was conducted among a random sample of 449 nurses in Italy, using a self-administered questionnaire to assess knowledge, attitudes, and behaviors regarding evidence-based practice (EBP). A significantly higher level of knowledge was observed among nurses who (a) did not work in medical and surgical wards; (b) believed that the evaluation of the efficacy of the health interventions is needed in their activity; (c) believed that the clinical experience must be combined with the evidence; (d) attended a course about EBP in the last year; and (e) received information from courses and scientific journals. The perceived importance of the application of guidelines and protocols was significantly higher among nurses who (a) worked in medical wards; (b) agreed that the guidelines are useful in identifying and selecting interventions; (c) believed that the evaluation of the efficacy of the health interventions is needed in their activity; (d) believed that the clinical experience must be combined with the evidence; (e) attended a course about EBP in the last year; and (f) received information from courses and scientific journals. Nurses were more likely to have modified their practice in the last year if they attended a course about EBP in the last year and if they often/always read scientific journals and guidelines. While these data were cross-sectional and the response rate was only 49%, the results suggest that continuing education programs are needed for improving nurses’ knowledge and practice of EBP among nurses in Italy.

Implementing evidence-based practice: effectiveness of a structured multifaceted mentorship programme

AIM

This paper is a report of the effectiveness of a structured multifaceted mentorship programme designed to implement evidence-based practice in a clinical research intensive environment.

BACKGROUND

Barriers to implementing evidence-based practice are well-documented in the literature. Evidence-based practice is associated with higher quality care and better patient outcomes than care that is steeped in tradition. However, the integration of evidence-based practice implementation into daily clinical practice remains inconsistent, and the chasm between research and bedside practice remains substantial.

METHODS

This quasi-experimental mixed methods study included three focused discussions with nursing leadership and shared governance staff as well as pre- (N = 159) and post-intervention (N = 99) questionnaires administered between June 2006 and February 2007. Online questionnaires included measures of organizational readiness, evidence-based practice beliefs, evidence-based practice implementation, job satisfaction, group cohesion and intent to leave nursing and the current job. Results.  Participants in the evidence-based practice mentorship programme had a larger increase in perceived organizational culture and readiness for evidence-based practice and in evidence-based practice belief scores than those who did not participate. Qualitative findings suggested that leadership support of a culture for evidence-based practice and the dedication of resources for sustainability of the initiative needed to be a priority for engaging staff at all levels.

CONCLUSION

These findings corroborate other studies showing that nurses' beliefs about evidence-based practice are significantly correlated with evidence-based practice implementation and that having a mentor leads to stronger beliefs and greater implementation by nurses as well as greater group cohesion, which is a potent predictor of nursing turnover rates.

The impact of Nursing Rounds on the practice environment and nurse satisfaction in intensive care: pre-test post-test comparative study

BACKGROUND

Factors previously shown to influence patient care include effective decision making, team work, evidence based practice, staffing and job satisfaction. Clinical rounds have the potential to optimise these factors and impact on patient outcomes, but use of this strategy by intensive care nurses has not been reported.

OBJECTIVES

To determine the effect of implementing Nursing Rounds in the intensive care environment on patient care planning and nurses' perceptions of the practice environment and work satisfaction.

DESIGN

Pre-test post-test 2 group comparative design.

SETTINGS

Two intensive care units in tertiary teaching hospitals in Australia.

PARTICIPANTS

A convenience sample of registered nurses (n=244) working full time or part time in the participating intensive care units.

METHODS

Nurses in participating intensive care units were asked to complete the Practice Environment Scale-Nursing Work Index (PES-NWI) and the Nursing Worklife Satisfaction Scale (NWSS) prior to and after a 12 month period during which regular Nursing Rounds were conducted in the intervention unit. Issues raised during Nursing Rounds were described and categorised. The characteristics of the sample and scale scores were summarised with differences between pre and post scores analysed using t-tests for continuous variables and chi-square tests for categorical variables. Independent predictors of the PES-NWI were determined using multivariate linear regression.

RESULTS

Nursing Rounds resulted in 577 changes being initiated for 171 patients reviewed; these changes related to the physical, psychological--individual, psychological--family, or professional practice aspects of care. Total PES-NWI and NWSS scores were similar before and after the study period in both participating units. The NWSS sub-scale of interaction between nurses improved in the intervention unit during the study period (pre--4.85±0.93; post--5.36±0.89, p=0.002) with no significant increase in the control group. Factors independently related to higher PES-NWI included intervention site and less years in critical care (p<0.05).

CONCLUSIONS

Implementation of Nursing Rounds within the intensive care environment is feasible and is an effective strategy for initiating change to patient care. Application and testing of this strategy, including identification of the most appropriate methods of measuring impact, in other settings is needed to determine generalisability.

Advancing evidence-based nursing practice in a children's hospital using competitive awards

When creating an evidence-based practice (EBP) nursing environment became an organizational mandate for the authors' tertiary care pediatric hospital, they assessed the state of EBP at their hospital. Findings revealed inconsistent use of EBP principles by the nursing staff. Nurses routinely cited literature to inform practice guidelines and performance improvement initiatives, but they lacked skills to comprehensively search available literature and critically appraise evidence for its quality. In addition, evaluating practice changes was not universally used. To stimulate the consistent use of the full scope of EBP, we created a call for competitive awards for EBP projects. Three teams (Of eight proposals submitted) each received $5,000 to implement their projects. Teams also received comprehensive education and were assigned EBP experts to help them implement and evaluate their EBP projects. We report the steps taken to implement and evaluate this approach to stimulating nurses' interest in and use of EBP.

Impact of a nationwide outreach program on the diffusion of evidence-based practice in Taiwan

RATIONALE

To disseminate evidence-based practice (EBP) among hospital-based health professionals, since 2007 the National Health Research Institutes (NHRI) of Taiwan has run a complex outreach program that includes information resource support and promotional campaigns.

OBJECTIVE

The aim is to evaluate the impact of this outreach program on the diffusion of EBP.

SETTING

Sixty-one regional hospitals in Taiwan.

DESIGN

A cross-sectional, pre- and post-survey of a nationally representative sample of physicians and nurses was carried out in 2007 and 2009 to examine views related to EBP including changes in beliefs, attitudes, knowledge, skills, perceived barriers and behaviors.

RESULTS

Physicians and nurses in the 2009 survey tended to have more knowledge and skill of EBP than their counterparts in the 2007 survey. They were less likely, however, to believe that EBP can improve patient care quality and to support the implementation of EBP. The prevalence of perceived barriers to EBP declined during the 2-year study period. In addition, physicians and nurses were more likely to access the online evidence retrieval databases according to the 2009 survey when compared with responses to the 2007 survey.

CONCLUSIONS

The knowledge of, skill in, and behavior regarding EBP have improved among physicians and nurses of regional hospitals in Taiwan after a promotion period of 2 years and they perceive fewer barriers to EBP. These data suggest that the multifaceted nationwide promotion program of the type conducted by NHRI succeeded in diffusion and implementation of EBP among professionals.

Importance of nursing leadership in advancing evidence-based nursing practice

Our patients depend on us to do the best on their behalf. If we do not take accountability for our practice, continually examining what is the best way to deliver care, we are limiting our role to technical skills and not fully actualizing our professional role. [Evidence-based practice] is essential to practicing safely as nurses (p. 53).1.

Translating the evidence-based NICU COPE program for parents of premature infants into clinical practice: impact on nurses' evidence-based practice and lessons learned

BACKGROUND AND PURPOSE

Many interventions that have been supported as efficacious through research never make it to clinical practice to improve care and patient outcomes. Therefore, the purposes of this dissemination-implementation study were to determine (a) the impact of translating the evidence-based Creating Opportunities for Personal Empowerment (COPE) program for parents of premature infants into clinical practice on nurses' EBP (evidence-based practice) beliefs and implementation; (b) the best strategy for disseminating COPE into the neonatal intensive care unit (NICU), including evaluating the use of a COPE EBP mentor; and (c) barriers and facilitators to successful implementation of the COPE program.

SUBJECTS AND METHODS

The subjects for this study were 81 (45%) out of 180 nurses from a 55-bed NICU of a large children's hospital located in the Southwest region of the United States. The nurses completed the EBP beliefs and EBP implementation scales at baseline and 6 months after a full-day workshop on COPE and EBP and introduction of the COPE program into the unit. Evaluations from the nurses assisted in the identification of barriers and facilitators that fostered implementation of COPE in the NICU.

FINDINGS AND CONCLUSIONS

Nurses in the 2 pods in which COPE was being implemented reported higher EBP beliefs and greater EBP implementation than did nurses in the non-COPE pods. The EBP mentor was instrumental in routine delivery of COPE to the parents. Strategies to accelerate the translation of efficacious interventions into clinical practice and to create cultures to support evidence-based care in healthcare systems are urgently needed.

Comparison of evidence-based practice between physicians and nurses: a national survey of regional hospitals in Taiwan

INTRODUCTION

Although evidence-based practice (EBP) has been widely investigated, few studies compare physicians and nurses on performance.

METHODS

A structured questionnaire survey was used to investigate EBP among physicians and nurses in 61 regional hospitals of Taiwan. Valid postal questionnaires were collected from 605 physicians and 551 nurses during February to May 2007.

RESULTS

Physicians were more aware of EBP than nurses. Although both groups had high recognition of belief in and favorable attitudes toward EBP, their knowledge of and skill in EBP were relatively low. When compared with nurses, physicians were more willing to support the promotion of EBP implementations in clinical services. Physicians' knowledge and skills regarding the application of EBP principles were greater than nurses. Furthermore, physicians more often accessed the on-line evidence-retrieval databases, including the Cochrane Library. The most commonly ranked barriers to EBP applications for both groups included lack of designated personnel, lack of convenient kits, limited basic knowledge of EBP, and time. In general, nurses generated more barriers than physicians.

DISCUSSION

There were significant discrepancies between physicians and nurses in their awareness of, attitude toward, knowledge of, skill in, behavior toward, and barriers regarding EBP. In implementing EBP, strategies to overcome barriers and provide on-line evidence-retrieval systems should differ for physicians and nurses.

An exploration of nurses' perceptions regarding the implementation of a best practice guideline on the assessment and management of foot ulcers for people with diabetes

The aim of this qualitative study was to explore nurses' perceptions regarding the implementation of a best practice guideline (BPG) on the assessment and management of foot ulcers for people with diabetes. Fourteen nurses from a community care setting and three hemodialysis units participated in five focus groups and one individual interview. The findings focus on key points regarding the impact of BPG implementation in the areas of patient outcomes, nursing practice, and interdisciplinary teamwork.

Neonatal advanced practice nurses as key facilitators in implementing evidence-based practice

EVIDENCE-BASED PRACTICE (EBP) is a process that utilizes the best available evidence, expert opinion, and patient preference to guide clinical practice decisions. Although the process itself is relatively straightforward and understandable (See Five Steps of Evidence-Based Practice), implementation requires an infrastructure and knowledge base that can support all five steps of the EBP process.

Lessons from Evidence-Based Medicine: What Healthcare Designers Can Learn from the Medical Field

This paper explores the history of evidence-based medicine (EBM) in comparison to the relatively short history of evidence-based design (EBD). Throughout its development, EBM has encountered a number of challenges, including dealing with initial objections to the concept, creating safeguards to ensure rigor in research, supporting practitioners in their efforts to stay current with a growing body of research data, applying the literature to real-life situations, making decisions when literature to inform decision making is absent, and educating students and professionals to become EBM practitioners. The ways in which the field of EBM has handled these challenges provides a number of lessons for the relatively young field of EBD.