Nurses' Use of Evidence-Based Practice at Point of Care: A Literature Review

A systematic review and meta-analysis of evidence-based practice and its associated factors among health professionals in Ethiopia

BACKGROUND

Evidence-based practice (EBP) entails utilizing the most up-to-date information to inform clinical decisions. Healthcare professionals at all levels are encouraged to integrate the latest research evidence to ensure high-quality care. In Ethiopia, there is a lack of comprehensive, nationally representative data on the prevalence of EBP among healthcare workers. This systematic review and meta-analysis aims to assess the overall prevalence of EBP and its associated factors among health professionals in Ethiopia.

METHODS

This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The investigators searched electronic databases, including PubMed, Embase, Web of Science, Scopus, Cochrane Library, and Google Scholar, for studies published up to June 1, 2023. Two reviewers independently carried out the extraction of data and evaluation of study quality. We employed STATA version 14 for data synthesis and statistical analysis. The investigators used random-effects and fixed-effects models to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs) to determine the correlation between dependent and independent factors. The researchers conducted subgroup analysis to explore heterogeneity among the studies included and checked heterogeneity using the I2 statistic. The reviewers assessed publication bias using funnel plots and Egger's regression test.

RESULTS

The initial search yielded 215 articles, of which 21 met the inclusion criteria. The pooled prevalence of good evidence-based practice among health professionals in Ethiopia was found to be 47.64 [95% CI: 41.33 to 53.96]. Having a masters and above educational status [pooled odds ratio (OR = 3.11; 95%CI: 1.945 to 4.95], good knowledge of EBP [OR: 2.44; 95%CI: 2.14, 2.78], training in EBP [OR = 2.30; 95% CI: 1.91, 2.77], availability of EBP guidelines [OR: 2.05; 95%CI: 1.60, 2.61], internet access [OR: 1.79; 95%CI:1.47, 2.18], availability of free time [OR: 2.05; 95%CI: 1.54, 2.72], presence of administrative support [OR: 1.89; 95%CI: 1.34, 2.67], clinical experience > 5 years [OR: 2.26; 95%CI: 1.54, 3.33], and positive attitude towards EBP [OR: 1.87; 95%CI: 1.53, 2.28] were significantly associated good evidence-based practice in Ethiopia.

CONCLUSIONS

Despite the importance of EBP in improving healthcare outcomes, its implementation among healthcare professionals in Ethiopia remains suboptimal. This study also identified modifiable factors associated with EBP adoption. Meanwhile, most of these factors are related to individuals and organizations. Strategies aimed at enhancing access to training and resources and fostering a supportive organizational culture are crucial for promoting EBP uptake and ultimately improving healthcare quality in Ethiopia.

Providing evidence-based knowledge on nursing interventions at the point of care: findings from a mapping project

Background

In healthcare there is a call to provide cost-efficient and safe care. This can be achieved through evidence-based practice (EBP), defined as the use of evidence from research, context, patient preferences, and clinical expertise. However, the contemporary and process-integrated supply of evidence-based knowledge at the point of care is a major challenge. An integrative knowledge management system supporting practicing clinical nurses in their daily work providing evidence-based knowledge at the point of care is required. The aim of this study was (1) to map standardized and structured nursing interventions classification and evidence on a knowledge platform to support evidence-based knowledge at the point of care, and (2) to explore the challenge of achieving interoperability between the source terminology of the nursing interventions classification (LEP Nursing 3) and the target format of the evidence provided on the knowledge platform (FIT-Nursing Care).

Methods

In an iterative three-round mapping process, three raters, nurses with clinical and nursing informatics or EBP experience, matched nursing interventions from the LEP Nursing 3 classification and evidence provided from Cochrane Reviews summarized on FIT-Nursing Care as so-called study synopses. We used a logical mapping method. We analysed the feasibility using thematic analysis.

Results

In the third and final mapping round, a total of 47.01% (252 of 536) of nursing interventions from LEP Nursing 3 were mapped to 92.31% (300 of 325) of synopses from FIT-Nursing Care. The interrater reliability of 77.52% suggests good agreement. The experience from the whole mapping process provides important findings: (1) different content orientations—because both systems pursue different purposes (content validity), (2) content granularity—differences regarding the structure and the level of detail in both systems, and (3) operationalization of knowledge.

Conclusion

Mapping of research evidence to nursing classification seems feasible; however, three specific challenges were identified: different content orientation; content granularity; and operationalization of knowledge. The next step for this integrative knowledge management system will now be testing at the point of care.

Effects of a blended emergent research training programme for clinical nurses on nursing research competence and critical thinking (Part 2): A quasi-experimental study

AIMS AND OBJECTIVES

To evaluate the effects of a blended emergent research training programme for clinical nurses on research competence and critical thinking.

BACKGROUND

With the development of the nursing discipline and evidence-based nursing practice, nursing research competence is increasingly important for clinical nurses. Current nursing research training programmes cannot meet the needs of clinical nurses.

DESIGN

A quasi-experimental study.

METHODS

A total of 104 clinical nurses from two tertiary hospitals participated in this study. The intervention group received a blended emergent research training programme for clinical nurses, and the control group received no intervention. Nursing research competence and critical thinking were measured at baseline, after the intervention and three months after the intervention. The satisfaction with the training of clinical nurses in the intervention group was also measured after the intervention. Generalised linear mixed models were used to evaluate the effects of the intervention on outcome variables. Qualitative data were analysed by two researchers using the content analysis method. Our reporting complies with the TREND checklist.

RESULTS

The blended emergent research training programme for clinical nurses finally showed positive effects on nursing research competence and critical thinking. The effects lasted until three months after the training programme. 'Learner-centred Training', 'Skilled Trainers', 'Encouraging Training Environment' and 'Positive Outcomes' are the main categories generated from the qualitative data.

CONCLUSION

The blended emergent research training programme for clinical nurses could be used for clinical nurses' research education to improve their nursing research competence and critical thinking.

RELEVANCE TO CLINICAL PRACTICE

The blended emergent teaching method could be considered as an effective method to provide an encouraging learning environment and promote learner-centred teaching for clinical nurses. The blended emergent research training programme could be used to improve nursing research competence and critical thinking of clinical nurses which are important for evidence-based nursing practice.

The impact of a participatory intervention on the therapeutic relationship in mental health nurses: A multicentre study

AIMS

To evaluate the effects of an intervention aimed at improving the therapeutic relationship, using the participatory-action research method, in terms of improving the quality of the nurse-patient therapeutic relationship.

DESIGN

A single-group pre-post research design.

METHODS

Quantitative data were collected between January 2018 and June 2019 using an online form completed by nurses from 18 mental health units (N = 95). Data were collected before and after the intervention, which consisted of the design, implementation and evaluation of strategies to improve the therapeutic relationship through participatory-action research involving nurses. The Working Alliance Inventory-Short, Interpersonal Reactivity Index, Evidence-Based Practice Questionnaire and Practice Environment Scale of the Nursing Work Index were used. The Wilcoxon rank-sum test was used together with the Spearman's correlation coefficient. Two multiple linear regressions models were constructed.

RESULTS

Overall, the intervention improved the nurse-patient therapeutic relationship. In addition, the results revealed that, above all, the improvement in evidence-based practice along with a decrease in nurses' personal distress were the factors associated with the improvement of the nurse-patient therapeutic relationship.

CONCLUSION

In mental health units, the therapeutic nurse-patient relationship can be improved through participatory interventions that include the implementation of evidence-based practices.

IMPACT

This research examined the effects of an intervention aimed at improving the therapeutic relationship among nurses working at mental health units using participatory action research. The results show that the therapeutic relationship can be improved through participatory methods where evidence-based practice is implemented and enhanced among nurses, since a better therapeutic relationship along with reduced staff discomfort are determining factors that influence the quality of the therapeutic relationship. Institutional managers should promote participatory group interventions to enable nurses to develop evidence-based aspects of the therapeutic relationship together with expanding personal aspects and self-knowledge.