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

Barriers to evidence-based nursing: a focus group study

AIM

This paper reports a study to explore the barriers to evidence-based nursing among Flemish (Belgian) nurses.

BACKGROUND

Barriers obstructing the call for an increase in evidence-based nursing have been explored in many countries, mostly through quantitative study designs. Authors report on lack of time, resources, evidence, authority, support, motivation and resistance to change. Relationships between barriers are seldom presented.

METHODS

We used a grounded theory approach, and five focus groups were organized between September 2004 and April 2005 in Belgium. We used purposeful sampling to recruit 53 nurses working in different settings. A problem tree was developed to establish links between codes that emerged from the data.

FINDINGS

The majority of the barriers were consistent with previous findings. Flemish (Belgian) nurses added a potential lack of responsibility in the uptake of evidence-based nursing, their 'guest' position in a patient's environment leading to a culture of adaptation, and a future 'two tier' nursing practice, which refers to the different education levels of nurses. The problem tree developed serves as (1) a basic model for other researchers who want to explore barriers within their own healthcare system and (2) a useful tool for orienting change management processes.

CONCLUSION

Despite the fact that the problem tree presented is context-specific for Flanders (Belgium), it gives an opportunity to develop clear objectives and targeted strategies for tackling obstacles to evidence-based nursing.

Nurse practitioner educators' perceived knowledge, beliefs, and teaching strategies regarding evidence-based practice: implications for accelerating the integration of evidence-based practice into graduate programs

The paradigm shift to evidence-based practice (EBP) in the United States has been slow. Evidence has supported that one barrier to accelerating this paradigm shift is that many nurses have negative attitudes toward research, in large part due to the manner in which they were taught research in their educational programs. The primary aims of this study were to (a) describe nurse educators' knowledge, beliefs, and teaching practices regarding EBP; (b) determine whether relationships exist among these variables; and (c) describe major barriers and facilitators to the teaching of EBP in nurse practitioner curriculums. A descriptive survey was conducted with a sample of 79 nurse practitioner educators who are members of the Association of Faculties of Pediatric Nurse Practitioners (AFPNP) and the National Organization of Nurse Practitioner Faculties (NONPF). The 25 AFPNP participants completed the survey while attending a national conference in Orlando, FL. The remaining 54 NONPF randomly selected participants responded to an e-mail version of the survey. Participants' self-reported knowledge and beliefs about the benefits of EBP and the need to integrate it into academic curricula were strong, although their responses indicated a knowledge gap in EBP teaching strategies. Few academic programs offered a foundational course in EBP. Significant relationships were found among educators' knowledge of EBP and (a) their beliefs that EBP improves clinical care, (b) beliefs that teaching EBP will advance the profession, (c) how comfortable they feel in teaching EBP, and (d) whether EBP clinical competencies are incorporated into clinical specialty courses.

CONCLUSION AND IMPLICATIONS

Graduate programs need to offer a foundational course in EBP and integrate EBP throughout clinical specialty courses in order for advanced practice nurses to implement this type of care upon entry into practice. There is a need to educate faculty to become proficient in EBP as knowledge of EBP is highly related to its teaching and incorporation into graduate education. Further research is needed to describe the knowledge and state of teaching EBP in graduate faculty who are not active in clinical practice.

Illuminating the processes of knowledge transfer in nursing

RATIONALE

Over the past 10 years, there has been a propensity to translate research findings and evidence into clinical practice, and concepts such as knowledge transfer, research dissemination, research utilization, and evidence-based practice have been described in the nursing literature.

AIM

This manuscript shows a selective review of the definitions and utilization of these concepts and offers a perspective on their interrelationships by indicating how knowledge transfer processes are the basis of all the concepts under review.

FINDINGS

Definitions and utilization of knowledge transfer in the literature have been influenced by educational and social perspectives and indicate two important processes that are rooted in the mechanisms of research dissemination, research utilization, and evidence-based practice. These processes refer to a cognitive and an interpersonal dimension. Knowledge transfer underlies a process involving cognitive resources as well as an interpersonal process where the knowledge is transferred between individuals or groups of individuals.

CONCLUSION AND IMPLICATIONS

This manuscript can contribute to our understanding of the theoretical foundations linking these concepts and these processes by comparing and contrasting them. It also shows the value and empirical importance of the cognitive and interpersonal processes of knowledge transfer by which research findings and evidence can be successfully translated and implemented into the nursing clinical practice.

Nursing research internship: enhancing evidence-based practice among staff nurses

Many barriers inhibit nurses from using evidence to guide their practice. The authors describe the development of a Nursing Research Internship Program designed to overcome barriers to evidence-based practice and provide staff nurses with an opportunity for professional growth. Evaluation of the program indicates it has increased staff nurses' use of the literature to identify and solve clinical problems, fostered positive attitudes about research, and led to increased professional development activities.

A conceptual model for growing evidence-based practice

Nursing administration at a small medical center is developing and implementing an evidence-based practice (EBP) model of care to support a culture of quality care, clinical excellence, cost-effectiveness, critical thinking, empowerment of staff, and professional growth. The purpose of this article is to describe a conceptual model for EBP that addresses how to overcome barriers to implementation. Clinician expertise and values, experience, patient preference and expectation, and caring become grounded in a practice environment that must strive to become rooted in clinical research to evolve into a practice that is evidence-based. Education helps to nourish EBP, but leadership, enthusiasm, mentorship, clinical inquiry, and reflective practice make EBP thrive. The EBP ambassadors branch out to each department to grow journal clubs, EBP Web pages, EBP projects, research utilization projects, and staff-led practice reviews. The fruits are quality patient care and outcomes, clinical excellence, cost-effectiveness, critical thinking, empowerment of staff, and professional growth.

Creating infrastructure supportive of evidence-based nursing practice: leadership strategies

BACKGROUND

Nursing leadership is the cornerstone of successful evidence-based practice (EBP) programs within health care organizations. The key to success is a strategic approach to building an EBP infrastructure, with allocation of appropriate human and material resources.

PURPOSE

This article indicates the organizational infrastructure that enables evidence-based nursing practice and strategies for leaders to enhance evidence-based practice using "the conceptual model for considering the determinants of diffusion, dissemination, and implementation of innovations in health service delivery and organization."

DISCUSSION

Enabling EBP within organizations is important for promoting positive outcomes for nurses and patients. Fostering EBP is not a static or immediate outcome, but a long-term developmental process within organizations. Implementation requires multiple strategies to cultivate a culture of inquiry where nurses generate and answer important questions to guide practice.

IMPLICATIONS

Organizations that can enable the culture and build infrastructure to help nurses develop EBP competencies will produce a professional environment that will result in both personal growth for their staff and improvements in quality that would not otherwise be possible.

Factors facilitating and inhibiting evidence-based nursing in Iran

AIM

This paper is a presentation of a study to clarify the concept of evidence-based nursing and to explore the factors that influence evidence-based nursing by Iranian nurses.

BACKGROUND

Evidence-based practice was introduced as an approach to high-quality care intended to improve results for patients. Several nurse researchers have studied factors affecting implementation of evidence-based nursing in western countries. However, there is little or no research on the perceptions of evidence-based nursing and its barriers in eastern countries, especially Iran.

METHODOLOGY

Grounded theory method was used. Interviews with 21 participants and 30 hours of observation were conducted in hospitals in Iran during 2005. Constant comparative analysis was used to analyse the data.

FINDINGS

Two main categories, 'the meaning of evidence-based nursing', and 'factors affecting it', emerged from the data. From participants' perspectives, evidence-based nursing was defined as 'caring for patients based on the nurse's professional knowledge in meeting patients' needs'. The second category, factors affecting evidence-based care, had six subcategories: possessing professional knowledge and experience; having time and opportunity; becoming accustomed; self-confidence; the process of nursing education; and the work environment and its expectations.

CONCLUSION

Managers and educators need to be committed to the principles of EBP, provide resources and create a supportive environment for its implementation. Individual nurses also have a responsibility to carry out evidence-based nursing, and researchers should work with practitioners to generate high quality evidence to support nursing practice.

A tool for guiding clinical decisions

“THOSE WHO ARE ENAMORED of practice without science are like a pilot who goes into a ship without rudder or compass and never has any certainty where he is going. Practice should always be based upon a sound knowledge of theory.”1

Brief Reports for Disseminating Systematic Reviews to Nurses

Much has been written about the importance of using research findings to guide nursing practice. How to best disseminate those findings to nurses remains a challenge. In many clinical settings, nurses interested in research utilization and evidence-based practice retrieve, review, and integrate knowledge from research reports to guide decisions about best practices. Major barriers to this approach, however, are staff nurses' lack of time, expertise, and resources for this process. One approach to overcoming these barriers is to disseminate the results of systematic research reviews directly to nurses in the form of brief reports, written in an easy-to-understand style, and sent via e-mail. This article describes the development of brief reports as a strategy for disseminating the results of systematic reviews to staff nurses. To demonstrate the use of brief reports for this purpose, we chose a systematic review published in the Cochrane Database of Systematic Reviews.

Consumer preferences and values as an integral key to evidence-based practice

Although evidence-based practice (EBP) integrates the best evidence from well-designed studies with a clinician's expertise and patient preferences and values, most of what is emphasized in books and reports on EBP is the 5-step EBP process. However, the consideration of patient values and preferences in making clinical decisions is essential to deliver the highest quality of care. This article briefly reviews the status of EBP in the United States, described the ARCC mentorship model, and highlights how to engage consumers in the EBP process.

ASPAN and the organizational EBP vision: synergistic opportunities for perianesthesia nurses

Health care organizations and the American Society of PeriAnesthesia Nurses (ASPAN) both have set a goal to promote quality by providing evidence-based nursing care. This shared goal provides a synergistic opportunity for ASPAN members to align with the organizational vision by incorporating evidence-based standards into practice and by answering important perianesthesia clinical questions. The purpose of this article is to discuss the forces that foster the health care organization's goals to implement evidence-based practice within their setting and to consider strategies for how ASPAN and ASPAN members can combine efforts with the health care organizational vision.

Implementing practice guidelines: a workshop on guidelines dissemination and implementation with a focus on asthma and COPD

The present supplement summarizes the proceedings of the symposium "Implementing practice guidelines: A workshop on guidelines dissemination and implementation with a focus on asthma and COPD", which took place in Quebec City, Quebec, from April 14 to 16, 2005. This international symposium was a joint initiative of the Laval University Office of Continuing Medical Education (Bureau de la Formation Médicale Continue), the Canadian Thoracic Society and the Canadian Network for Asthma Care, and was supported by many other organizations and by industrial partners. The objectives of this meeting were to examine the optimal implementation of practice guidelines, review current initiatives for the implementation of asthma and chronic obstructive pulmonary disease (COPD) guidelines in Canada and in the rest of the world, and develop an optimal strategy for future guideline implementation. An impressive group of scientists, physicians and other health care providers, as well as policy makers and representatives of patients' associations, the pharmaceutical industry, research and health networks, and communications specialists, conveyed their perspectives on how to achieve these goals. This important event provided a unique opportunity for all participants to discuss key issues in improving the care of patients with asthma and COPD. These two diseases are responsible for an enormous human and socioeconomic burden around the world. Many reports have indicated that current evidence-based guidelines are underused by physicians and others, and that there are many barriers to an effective translation of recommendations into day-to-day care. There is therefore a need to develop more effective ways to communicate key information to both caregivers and patients, and to promote appropriate health behaviours. This symposium contributed to the initiation of what could become the "Canadian Asthma and COPD Campaign", aimed at improving care and, hence, the quality of life of those suffering from these diseases. It is hoped that this event will be followed by other meetings that focus on how to improve the transfer of key recommendations from evidence-based guidelines into current care, and how to stimulate research to accomplish this.

Transforming health care from the inside out: advancing evidence-based practice in the 21st century

Health care is in need of change. Major professional and health care organizations as well as federal agencies and policy-making bodies are emphasizing the importance of evidence-based practice (EBP). Using this problem solving approach to clinical care that incorporates the conscientious use of current best evidence from well designed studies, a clinician's expertise, and patient values and preferences, nurses and other health care providers can provide care that goes beyond the status quo. Health care that is evidence-based and conducted in a caring context leads to better clinical decisions and patient outcomes. Gaining knowledge and skills in the EBP process provides nurses and other clinicians the tools needed to take ownership of their practices and transform health care. Key elements of a best practice culture are EBP mentors, partnerships between academic and clinical settings, EBP champions, clearly written research, time and resources, and administrative support. This article provides an overview of EBP and offers recommendations for accelerating the adoption of EBP as a culture in education, practice and research.

Evidence-Based Nursing Care Management for the Pregnant Woman With an Ostomy

Pregnancy presents many problems without working through additional problems in coping with an ostomy. Yet many women with an ostomy do get pregnant and do deliver healthy babies. Evidence-based nursing is of the utmost importance, as there is little published information on this topic. Because of the scarcity of pregnant subjects within the ostomy category, most studies, by necessity, select a purposive subject base. Therefore, other information sources regarding nursing management of the pregnant woman with an ostomy take on considerably more importance. This article explores other forms of evidence that can be used in managing the care of pregnant ostomy patients and specifically how nurses can integrate various sources of information in designing an evidence-based nursing care plan. Nonpharmacologic forms of relaxation therapy, easily used by nurses, such as mindfulness-based stress reduction, guided imagery, and hypnosis, are also identified as some ways nurses can relieve anxiety and experiential stress associated with pregnancy in women who have an ostomy.

Building a Foundation for an Evidence-Based Approach to Practice: Teaching Basic Concepts to Undergraduate Freshman Students

The University of Pittsburgh School of Nursing introduced evidence-based practice (EBP) into the freshman-level curriculum this year. This article describes the reasons behind this decision, the development of the curriculum, the specific EBP content, and the student assignments. The introduction of EBP into the first-level nursing curriculum has proven to be successful; consideration is even being given to expanding the EBP content.