Knowledge, skills, and attitudes to implementing best practice in hospitals in Central Vietnam

Knowledge, skills, attitudes, beliefs, and implementation of evidence-based practice among nurses in low- and middle-income countries: A scoping review

BACKGROUND

Over the past three decades, research studies on nurses' engagement in evidence-based practice (EBP) have been widely reported, particularly in high-income countries, with studies from these countries dominating literature reviews. As low- and middle-income countries (LMICs) continue to join the EBP movement, primary research has emerged over the past decade about nurses' engagement with EBP.

AIMS

The aim of this scoping review was to identify the types and extent of published research regarding nurses' knowledge, skills, attitudes, beliefs, and implementation of EBP in LMICs.

METHODS

The JBI scoping review methodology was used. Eight databases were searched up to November 2023. The review included primary studies (quantitative, qualitative, and mixed methods) that reported the knowledge, skills, attitudes, beliefs, or implementation of EBP among nurses in LMICs. Included studies focused on registered nurses in all healthcare settings within LMICs. Studies published in English were included with no limit on publication date. Two independent reviewers screened titles, abstracts, and full-text articles of published studies. Data were analyzed quantitatively using frequencies and counts. Textual data from qualitative studies were analyzed using descriptive content analysis.

RESULTS

Fifty-three publications were included, involving 20 LMICs. Studies were published between 2007 and 2023, with over 60% published in the past 7 years. Studies that evaluated familiarity/awareness of EBP showed that in general, nurses had low familiarity with or awareness of EBP. Most studies (60%) described nurses' attitudes toward EBP as positive, favorable, or high, and 31% as moderate. However, over 60% of studies described nurses' EBP knowledge/skills as moderate, low, or insufficient. Approximately 84% of studies described EBP implementation in healthcare settings as moderate, low, poor, or suboptimal.

LINKING EVIDENCE TO ACTION

Studies on nursing EBP have been increasing in LMICs for the past two decades, with findings highlighting opportunities for advancing EBP in nursing within LMICs. Health systems and healthcare organization leaders in LMICs should equip nurses with EBP knowledge and skills while providing the needed resources and support to ensure consistent implementation of EBP to improve health outcomes.

Translating and Validating the Vietnamese Version of the Health Sciences Evidence-Based Practice Questionnaire

No validated instrument is available for assessing the evidence-based practice capacity of Vietnamese health professionals. This study aimed to translate and validate the Health Sciences Evidence-Based Practice questionnaire (HS-EBP) from English to Vietnamese and ascertain its psychometric properties. Data were collected from two obstetric hospitals in Vietnam. Participants: A total of 343 midwives were randomly selected. The HS-EBP questionnaire was translated by a group of bilingual experts into Vietnamese (HS-EBP-V). Content validity was assessed by two experts. Internal consistency and test-retest reliabilities were assessed using Cronbach's α and intraclass correlation (ICC), respectively. Construct validity was assessed using the contrasted groups approach. As a result, the content validity index of the HS-EBP-V reached 1.0. For the individual subscales, Cronbach's α was 0.92-0.97 and ICC was between 0.45 and 0.66. The validity of the contrasted-groups approach showed discrimination by a significant difference in the subscale scores among diploma holders compared with bachelor's degree holders (p < 0.001). The validation of the HS-EBP questionnaire indicated satisfactory psychometric properties. The results indicate that the HS-EBP is a reliable and valid instrument which assesses the competencies of as well as facilitators of and barriers to the five steps of EBP among midwives. The HS-EBP-V was deemed a reliable and validated tool for assessing the competency and application of EBP among Vietnamese healthcare professionals.

A psychometric evaluation of the Vietnamese version of the Evidence-Based Practice Attitudes and Beliefs Scales

AIM

The aim of this study is to develop and to test the construct validity and reliability of the Vietnamese versions of the Evidence-Based Practice Attitude and Evidence-Based Practice Beliefs scales.

METHODS

This is a psychometric evaluation study. Three hundred and fifty-three nurses and midwives were recruited from a national hospital in Vietnam from September to December 2018. Data were obtained from two scales. Content validity, face validity and construct validity measures were all conducted, whereas exploratory and confirmatory factor analyses were performed from data collected from two cohorts of participants. Cronbach's alpha coefficient represented reliability, and data were analysed in SPSS 20 and AMOS 24.

RESULTS

The four-factor model developed with openness, requirements, appeal and divergence factors accounted for 55% of total variance in the Attitude scale. A three-factor model labelled as value beliefs, knowledge beliefs and resource beliefs with 59% of total variance was explained in the Beliefs scale. Cronbach's α coefficients were .72 for the Attitude scale and .81 for the Beliefs scale.

CONCLUSIONS

The two scales could be used to assess Vietnamese nurses' attitudes and beliefs to adopt evidence-based practice enabling hospitals to align individual and organizational goals for developing evidence-based practice and enable comparison of the results with international samples.

Surgical wound assessment in Vietnam: a think-aloud technique and interview analysis

OBJECTIVE

To identify the key components of a surgical wound assessment tool that nurses in Vietnam could use when conducting a surgical wound assessment. The study also explored Vietnamese nurses' perceptions of current practices in surgical wound assessment and assessed their requirements for a surgical wound assessment tool.

METHOD

Registered nurses from surgical wards in a Vietnamese hospital were invited to participate in this descriptive, qualitative study. A combination of the think-aloud technique and semi-structured interviews was undertaken. Transcribed responses were analysed using inductive content analysis to indicate how Vietnamese nurses undertook wound assessment and the data they collected.

RESULTS

A total of 13 nurses took part. Data from both the think-aloud process and interviews indicated that nurses evaluated surgical wounds based on their experience and observation without using standard guidelines. Some components, such as wound edge, periwound skin, exudate volume and signs of infection, were identified by the nurses. Other wound characteristics, such as wound site, wound bed, exudate and pain, and risk factors were less frequently collected. Nurses expressed their need for a tool with comprehensive content, precise terms, user-friendly language and a scoring system to facilitate their wound assessment.

CONCLUSION

Hospitals in Vietnam need a standard tool to help nurses improve surgical wound assessment in daily nursing practice, and to enhance multidisciplinary communication and patient care.

Attitude, source of knowledge, and supporting factors on evidence-based nursing among cardiovascular nurses: A cross-sectional descriptive study in Turkey

RATIONALE, AIMS, AND OBJECTIVES

Cardiovascular nursing has been a rapidly growing specialty since the 1960s. Assessing cardiovascular nurses' EBN (evidence-based nursing) attitudes and beliefs and the factors supporting EBN is important to assist the training programmes in fostering EBN practice in a clinical environment. Few investigations have been conducted on EBN knowledge, attitudes, beliefs, and implementation among cardiovascular nurses. The present study aims to investigate cardiovascular nurses' attitudes towards EBN, sources of knowledge, and the factors supporting EBN in Turkey.

METHODS

A cross-sectional survey with a descriptive and comparative design was conducted with 62 cardiovascular nurses working at two hospitals in Turkey. Data were collected by using the Evidence-Based Nursing Attitude Questionnaire, a sociodemographic questionnaire concerning demographic information and including questions about nurses' sources of knowledge, supporting factors to implement EBN, research experience, use of clinical guidelines, and barriers to applying EBN. Data were analysed with descriptive and inferential statistics.

RESULTS

The research revealed that cardiovascular nurses have positive attitudes, feelings, beliefs, and intention of conduct towards EBN. Cardiac surgery nurses reported significantly higher positive feelings, beliefs, intention of conduct, and attitude towards EBN than cardiology nurses. Nursing experience and information acquired through nursing school were the most frequently used sources of knowledge rather than research results (35.5%) in their clinical practice. Half of the respondents (47%) were familiar with EBN. Cardiovascular nurses who had graduate degrees, reviewed nursing research and were familiar with EBN had significant positive attitudes towards EBN. Nurses needed enough time and resources, a background in clinical practice, and support from the hospital administration to implement EBN.

CONCLUSIONS

An education intervention should be provided about EBN knowledge and skills for cardiovascular nurses. Mentor nurses should be trained and assigned in cardiovascular clinics to implement EBN.

Are physical therapists in Viet Nam ready to implement evidence-based practice? A survey

BACKGROUND

Evidence-based practice (EBP) enhances healthcare services and keeps providers current with best practices. EBP has been adopted and spread worldwide. However, people will not apply it if they do not know, understand, or believe it. Few studies have considered EBP application in Viet Nam. This study explores whether Vietnamese physical therapists' attitude, knowledge, skills toward EBP and barriers to its use make them ready to implement its practice.

METHODS

A survey questionnaire was sent directly to physical therapists in governmental healthcare organizations in Ho Chi Minh City, Viet Nam, from July to October, 2017. It consisted of 41 closed- and open-ended questions related to knowledge, attitude, behaviors, frequency of use, and barriers of EBP and the demographic characteristics of participants. Descriptive statistics and significant correlations were determined from Chi-Square statistics or odds ratios between the variables.

RESULTS

The return rate was 93% (421 out of 453). Eliminated were 40 responses inconsistent with inclusion criteria. The 381 eligible participants were more female (62%) than male, about 53% had vocational degrees, less than 1% had M.S. degrees. Participants reported a positive attitude toward EBP. An incongruity existed between knowledge/ skills of EBP and the frequency of using its 5 steps. English competence was the most critical barrier to applying EBP. The significant associations between attitude and knowledge, and demographical attributes indicated that younger therapists with lower educational degrees had less knowledge of EBP and they rarely employed the application and analytical steps 4 and 5.

CONCLUSIONS

The incongruity between knowledge and use of EBP may result from the lack of EBP in academic education. The skills of reading professional articles in the English language and understanding and applying the steps of EBP should be emphasized in academic physical therapy programs. Additionally, policy makers should consider the number of patients a day per physical therapist which impacts EBP use and the quality of healthcare service.

Odnos in znanje medicinskih sester ter ovire pri implementaciji na dokazih temelječe prakse

Uvod: Na dokazih temelječa praksa velja za zlati standard obravnave pacientov. Namen raziskave je bil preučiti odnos, znanje in ovire pri implementaciji na dokazih temelječe prakse v zdravstveni negi.Metode: Uporabljen je bil sistematični pregled znanstvene in strokovne literature. V pregled so bile vključene naslednje baze: CINAHL Plus, ProQuest Dissertations & Theses Global, SpringerLink, WILEY in PubMed. Omejitvena kriterija iskanja sta bila objava članka med letoma 2008 in 2017 ter dostopnost celotnega besedila člankov v angleščini. Ključne besede iskanja: nurse, evidence based practice, implementation barriers. V končni pregled je bilo vključenih 37 člankov. Ocena kakovosti dokazov je prikazana v hierarhiji dokazov. Podatki so bili obdelani s tematsko kvalitativno analizo.Rezultati: Identificiranih je 73 kod, ki so združene v 7 vsebinskih kategorij: (1) dejavniki, ki vplivajo na negativen odnos medicinskih sester do na dokazih temelječe prakse, (2) dejavniki, ki vplivajo na pozitiven odnos medicinskih sester do na dokazih temelječe prakse, (3) znanje raziskovanja medicinskih sester za uporabo znanstvenih dokazov v kliničnem okolju, (4) znanje uporabe informacijske tehnologije za iskanje dokazov, (5) vpliv mentorstva in kompetenc za implementacijo na dokazih temelječe prakse v klinično okolje, (6) ovire organizacije za implementacijo na dokazih temelječe prakse v klinično okolje in (7) ovire medicinskih sester za implementacijo na dokazih temelječe prakse v klinično okolje.Diskusija in zaključek: Raziskava pokaže pozitiven kot tudi negativen odnos medicinskih sester do na dokazih temelječe prakse. Osredotoča se na pomanjkanja znanja in ovire, s katerimi se srečujejo medicinske sestre pri implementaciji na dokazih temelječe prakse v klinično okolje.

Barriers for nurses' participation in and utilisation of clinical research in three hospitals within the Kumasi Metropolis, Ghana

Introduction

Scientific research results are a necessary base for high quality nursing practice. The level of implementation of research in the clinical setting, including nurses' participation in and knowledge of research results, have gained considerable attention internationally. However, the remarkable international increase of such studies does not apply to the Ghanaian context. We therefore set out to evaluate the degree of involvement of nurses in research, as well as their utilization patterns of research findings in Ghana. Objectives: the study sought to investigate the proportion of nurses involved in clinical research as well as barriers for nurses' participation and utilization of research findings, within the Kumasi Metropolis area, Ghana.

Methods

A descriptive and analytical cross-sectional study design was used in this study. A 47 item questionnaire elicited data on 158 participants' demographics, the proportion and the barriers to participation, which was then analyzed using SSPS version 17 software. Qualitative interviews with key informants complemented quantitative survey data. In-depth interviews with nurse managers at the hospitals in focus was conducted and analyzed thematically.

Results

The study shows that 36.1% of the nurses, included in the study, had participated in research and only 25.3% of these had (knowingly) used specific research results in clinical practice. However, the level of research participation differed greatly between nurses working at different hospitals. Nurses' participation in clinical research was shown to be associated with their perception of benefit of research to practice as well as their understanding of time as a factor for them engaging in reading scientific articles. In addition, barriers associated with nurses' integration of research findings into the daily practice was their perceived lack of support from the collegium and their perception of research as not part of the nursing role.

Conclusion

Findings from the study suggest that there is a need to create institutional support to facilitate and encourage nurses' participation in research, yet also to formalize nurses' continuous professional development. This, could change nurses' attitudes towards research, and contribute to improving health care as it would increase nurses' role as agents for evidence based clinical practice.