Has the BARRIERS Scale changed nursing practice? An integrative review

Development and Testing of the RN Confidence in Evidence-Based Practice (RNcEBP) Survey: Assessing Evidence-Based Practice Culture

Continual assessment of evidence-based culture is essential to inform growth in evidence-based practice (EBP). The RN Confidence in Evidence-Based Practice (RNcEBP) Survey was developed and tested over a 4-year period within a Magnet-designated organization. The primary aim of this institutional review board-approved study was to test reliability and validity of the workplace-focused RNcEBP Survey. The second aim of the electronic survey was to provide practical and concise assessment data to inform nursing professional development and support for EBP.

Effet d’un club de lecture sur le sentiment d’efficacité personnelle, les attentes et les intentions d’étudiantes en sciences infirmières à l’égard de l’utilisation des résultats probants

INTRODUCTION

Nursing associations require that nurses develop the skills to integrate evidence into practice to support the quality of care.

CONTEXT

Lack of self-confidence in the operational steps of evidence-based practice was identified as a barrier to integrating evidence into nursing practice.

OBJECTIVE

To assess the effect of a journal club (JC) on nursing students' self-efficacy (SE), expectations, and intentions to use evidence.

METHOD

Quasi-experimental, longitudinal approach with a non-randomized comparison group.

RESULTS

The development of SE toward the use of evidence-based practices favored students who participated in the JC (n=48) compared to students who received a conventional educational modality (CEM) (n=50). However, there was no significant group x time interaction effect on expectations or intentions.

DISCUSSION

The significant positive changes beyond the CEM may be explained by the fact that the JC incorporated modes of influence on SE.

CONCLUSION

The positive effect associated with the JC on SE is difficult to sustain without continued practice. It is important to maintain high outcome expectations within nursing training.

Barriers to Research Utilization in Nursing: A Systematic Review (2002–2021)

Introduction

There is an existing gap between what people learned from theory and what they clinically practiced, as revealed in research studies in nursing. This gap is primarily due to identified barriers in utilizing the research findings in actual nursing practice.

Objective

To present a scientific mapping of the Scopus-indexed literature published from 2002 to 2021, which studied barriers to research utilization in nursing using the BARRIER scale.

Methods

This systematic review utilized bibliometric analysis. One hundred seventy-nine extracted literature from Scopus was manually reviewed, and the study included 53 documents for further analysis.

Results

Remarkably, almost three-fourths of the documents identified setting-related factors as the most common barrier to research utilization in nursing (n = 39, 73.58%). This is followed by presentation-related factors (n = 16.98%) and nurse-related factors (n = 5, 9.43%), respectively. Findings revealed that insufficient time at work in implementing new ideas was perceived as the top barrier in research utilization in nursing.

Conclusion

It is crucial to determine the hindrances to the utilization of research findings. The results of this study establish the connection between research and evidence-based practice which stimulates in meeting the gap in the current nursing practice. Future studies must include research utilization studies that apply tools other than the BARRIER scale.

The Importance of Context and Organization Culture in the Understanding of Nurses' Barriers Against Research Utilization: A Systematic Review

BACKGROUND

Numerous studies have explored nurses' perceived barriers to research utilization. In this study, considerations of how to break down the barriers are discussed in order to find new ways to develop and strengthen evidence-based practice.

AIMS

The objective of the study was to identify nurses' perceptions of barriers to research utilization in clinical practice between the years of 2000 and 2018 and across continents by reviewing studies that used the Barriers to Research Utilization (BARRIERS) scale (Appl Nurs Res, 4, 1991, 39).

DESIGN

A systematic review of observational studies based on Joanna Briggs specific guidelines.

METHODS

A systematic search to identify and select eligible studies was conducted in PubMed, CINAHL, PsycInfo, and SCOPUS during January 2019. Google Scholar was also searched to identify additional studies using the Funk et al. (Appl Nurs Res, 4, 1991, 39) BARRIERS scale. An instrument for quality appraisal was constructed for this paper by combining two similar and previously used cross-sectional study checklists (Int J Sociol Soc Policy, 23, 8, 2003; Implement Sci, 5, 32, 2010). Descriptive statistics were performed using IBM SPSS Statistics (version 25).

RESULTS

The 27 included studies were conducted in 16 countries across five continents and 11,276 nurses participated. Seven of the top 10 barriers were comprised of organizational factors. These organizational barriers were consistent over time and the five continents, with 56% of the listed top 10 barriers falling under the organizational category. From the year 2000 to 2008, the majority of the studies were conducted in Europe and Australia. However, for the next 10 years (2008-2018), the majority of studies were conducted in Asia, Africa, and North America.

LINKING EVIDENCE TO ACTION

To break down the nurses' barriers to research utilization, our future practice and research focus will be to conduct intervention studies focusing on the effect of facilitators and contextual environment, as well as developing nursing research cultures in clinical practice with support from the nursing management.

Validity and reliability of Evidence-Based Practice Leadership Scale and Evidence-Based Work Environment Scale in Turkish

PURPOSE

This study aims to evaluate the validity and reliability of the Evidence-Based Practice Leadership Scale (EBPLS) and Work Environment Scale (EBPWES) translated into Turkish so that they are used in nursing research.

DESIGN AND METHODS

This methodological study was conducted with nurses. Language and content validity, item analyses were used to test the validity and reliability of the scales.

FINDINGS

The confirmatory factor analysis results demonstrate that t values of each item in both scales are significant (P < .05). All model and data fit indices are higher than the acceptable level. Thus, CFA has shown that the scales with model-data fit are valid.

PRACTICE IMPLICATIONS

The characteristics of nurse leaders and the suitability of the working environment are crucial for the maintenance of evidence-based practices. EBPLS and EBPWES will be effective and reliable tools in our country and an effective tool for contributing to the maintenance and development of evidence-based practices. The analyses indicate that the Turkish versions of the EBPLS and the EBPWES are acceptable, valid, and reliable for Turkish nurses.

Meeting the Best Practice for Hearing Aid Verification in Children: Challenges and Future Directions

Purpose This study examined the current pediatric amplification practice with an emphasis on hearing aid verification using probe microphone measurement (PMM), among audiologists in Klang Valley, Malaysia. Frequency of practice, access to PMM system, practiced protocols, barriers, and perception toward the benefits of PMM were identified through a survey. Method A questionnaire was distributed to and filled in by the audiologists who provided pediatric amplification service in Klang Valley, Malaysia. One hundred eight (N = 108) audiologists, composed of 90.3% women and 9.7% men (age range: 23-48 years), participated in the survey. Results PMM was not a clinical routine practiced by a majority of the audiologists, despite its recognition as the best clinical practice that should be incorporated into protocols for fitting hearing aids in children. Variations in practice existed warranting further steps to improve the current practice for children with hearing impairment. The lack of access to PMM equipment was 1 major barrier for the audiologists to practice real-ear verification. Practitioners' characteristics such as time constraints, low confidence, and knowledge levels were also identified as barriers that impede the uptake of the evidence-based practice. Conclusions The implementation of PMM in clinical practice remains a challenge to the audiology profession. A knowledge-transfer approach that takes into consideration the barriers and involves effective collaboration or engagement between the knowledge providers and potential stakeholders is required to promote the clinical application of evidence-based best practice.

Comprehensive geriatric assessment in Swedish acute geriatric settings

PURPOSE

Comprehensive geriatric assessment (CGA) is a widely used approach in geriatric care and involves multidisciplinary assessments focused on determining a frail elderly person's medical, psychological and functional capability to develop an integrated plan for treatment. The purpose of this paper is to describe and scrutinize the CGA implementation process at six acute geriatric departments in three county councils and to study the outcome by the documentation in the patient medical records, and the staff perceptions using CGA.

DESIGN/METHODOLOGY/APPROACH

The paper describes the implementation process stages. Outcome measures were based on patient medical records reviews at baseline and follow-ups at year 1 and year 2. Staff perceptions of using CGA were gathered by a questionnaire at the second follow-up.

FINDINGS

The implementation had not yet reached sustainability so the implementation process must continue. Results show that documentation on the different areas increased in year 1, as well as the use of standardized assessment tools. However, results from the reviews for year 2 showed some decrease. Staff considered CGA to have high value for the geriatric patient but pointed out the need for continuing education.

ORIGINALITY/VALUE

Successful strategies for this implementation were strong support from the managers, small seminars, CGA rounds, good introduction routines for new staff and the use of reminders such as pocket-sized focus cards. A high staff turnover occurred during the study, which probably had a significant negative impact on the results.

Transformative agency and tensions in knowledge management-A qualitative interview study for nurse leaders

AIM

To describe Finnish nurse leaders' perceptions of and experiences with knowledge management.

BACKGROUND

Health science research has traditionally focused on knowledge transfer and research evidence instead of knowledge management, culture and organisational learning. Systematic reviews indicate a lack of awareness about nurse leaders' activities in knowledge management.

DESIGN

Qualitative interview study according to the consolidated criteria for reporting qualitative research (see Supporting Information Table S1).

METHODS

Data were collected at a Finnish public, social and healthcare organisation from 33 persons in 2015 and 2017 through 35 individual interviews and seven focus groups. Data were analysed by thematic analysis.

RESULTS

Nurse leaders' daily knowledge management activities included assurance of smooth work functions and decisions about sudden changes. When managing knowledge promotion, nurse leaders focused on the near future and served information providers, coaches and developers of operating culture. Anticipatory management of knowledge requirements emphasised nurse leaders' roles as assessors and visionaries. Tensions while managing knowledge were related to the following: changes in clients' service needs, insufficient structures and tools to support the assessment and joint development of competence, time and information management, the operating culture, and nurse leader support. Participants reported only few attempts to solve tensions and therefore little to no transformative agency.

CONCLUSION

Nurse leaders prioritised daily knowledge management over management of knowledge promotion and anticipatory management of knowledge requirements. Knowledge management in nursing is a complex task requiring a command of different kinds of agency and related leadership styles. The structures, processes and tools supporting knowledge management should be developed to ensure that activities are systematic.

RELEVANCE TO CLINICAL PRACTICE

A description of nurse leaders' perceptions of and experiences with knowledge management could improve recognition of nurse leaders' agencies for knowledge management, identification of related tensions and application of lessons learned from tensions. This description could also promote nurses' professional competence and supplement nurse leaders' training.

Professional practice-related training and organizational readiness for change facilitate implementation of projects on the national core value system in care of older people

AIM

To explore whether professional training contributed to implementation of the national core value system in practice in care of older people and to identify course participants' perceptions about factors that facilitated or obstructed them in implementing their projects. To identify participants' perceptions concerning factors that facilitate or obstruct implementation.

DESIGN

Descriptive and cross-sectional.

METHODS

Data were retrieved from 451 participants who had completed the course "Understanding and providing leadership based on the national core value system for older people" at Uppsala University during spring semester and autumn semester of 2018. Quantitative and qualitative data were obtained using a web-based questionnaire.

RESULTS

The results showed that the majority (73%) of project plans were initiated, although not always completed and sometimes interrupted. Organizational readiness in terms of management supporting and prioritizing these plans were two principle facilitators chosen by half of the respondents and consequently the absence of these factors was an obstacle. In addition, successful implementation required dedicated co-workers and certain resources, such as time and funds. Surprisingly, factors related to the project leader were reported to be of limited importance.

Pediatric Nurses' Knowledge, Values, and Implementation of Evidence-based Practice and Use of Two Patient Safety Goals

PURPOSE

To describe knowledge, values, and implementation of evidence-based practice (EBP) and use of two National Patient Safety Goals-Central Line Associated Blood Stream Infections (CLABSI) and Surgical Site Infections (SSI)-between nurses working in Magnet® versus non-Magnet® designated hospitals.

BACKGROUND

There is a gap in the literature concerning nurses' understanding of EBP and how EBP guidelines are used in practice and if guidelines are being used as intended. The Conceptual Model of Nursing and Health Policy was used to guide the study.

METHODS

A descriptive survey methodology using three instruments was delivered electronically to members of the Society of Pediatric Nurses-the Quick-EBP-VIK, the Use of Evidence-based Practice Questionnaire, and a Background Data Sheet.

RESULTS

Results revealed statistically significant differences between the Magnet and non-Magnet participants only for the Quick-EBP-VIK value domain; nurses from Magnet hospitals had a higher value for EBP compared with nurses from non-Magnet hospitals, nurses from both groups had a moderate amount of knowledge about EBP, and very few nurses indicated they were implementing EBP. There were no differences in CLABSI and SSI prevention care for patients in acute care hospitals in the United States by nurses working in Magnet versus non Magnet designated hospitals.

CONCLUSION

The findings of this study have implications for practice, education, policy, and research. A disconnect between the use of policy and implementation of EBP has been identified. Specifically, nurses need to understand how EBP is embedded in hospital and organizational policy.

The development and validation of the Evidence-Based Practice Questionnaire: Japanese version

AIM

To develop and test the validity and reliability of a Japanese version of the Evidence-Based Practice Questionnaire.

METHODS

The Evidence-Based Practice Questionnaire was translated into Japanese, and a back-translation was performed. In March 2016, the survey was conducted among 843 nurses in 2 university hospitals in Japan. After 2 weeks, the same questionnaire for test-retest reliability was distributed to 197 nurses. We evaluated construct validity by factor analysis: convergent, discriminant, criterion-based and known-group validity, and reliability (internal consistency via Cronbach' alpha and test-retest reliability).

RESULTS

A total of 533 (66%) of nurses who agreed to our study returned the completed questionnaire, and 108 nurses (55%) agreed to the test-retest. Factor analysis confirmed that the original model of the Evidence-Based Practices Questionnaire was not statistically appropriate for Japanese nurses. Therefore, the final version of the Japanese version adopted 18 items and 4 subscales including practice, attitudes, and knowledge/skills related to research and practice. In the final version, the validity and reliability were moderate (Cronbach alpha = .90).

CONCLUSION

The Japanese version of the Evidence-Based Practices Questionnaire is a reliable and valid tool and can be used to assess evidence-based practice, attitudes, and research knowledge/skills in Japan.

Investigation of Turkish nurses frequency and knowledge of administration of intramuscular injections to the ventrogluteal site: Results from questionnaires

BACKGROUND

Intramuscular injection is important in the administration of parenteral medication and is a frequently-performed nursing responsibility.

OBJECTIVE

The objective of this study was to identify the frequency of use of the ventrogluteal site and the level of nurses' knowledge of administering an intramuscular injection to this site.

DESIGN

A descriptive cross-sectional study was conducted of nurses working in four hospitals (n=362). Data collection tools included a 12 item sociodemographic questionnaire and a 24 item questionnaire on knowledge of the ventrogluteal site for intramuscular injection.

FINDINGS

17.1% of participants reported using the VG site frequently in intramuscular injections. On the other hand, 35.9% reported that they do not use the VG site in intramuscular injections just because they are not used to giving injections on this site. Level of knowledge of ventrogluteal site was also limited with the mean score of correct answers from 24 questions being 14.37.

CONCLUSION

It was found in the study that nurses' knowledge of the ventrogluteal site was limited, and they are not preferentially using the ventrogluteal site for intramuscular injections to adults even though it is recommended in recent nursing literature.

Korean Translation of the Barriers to Research Utilization Scale: Psychometric Testing

PURPOSE

The purpose of this study was to assess the psychometric properties of the Barriers or Facilitators to Using Research in Practice (BARRIERS) scale for use in Korea.

METHODS

A cross-sectional study design was used with 364 nurses working in clinical settings. Item analysis was conducted and convergent and discriminant validity were evaluated using confirmatory factor analysis. Internal consistency reliability was evaluated using Cronbach's alpha coefficients.

RESULTS

Confirmatory factor analysis revealed a 4-factor structure with 25 items that explained 62.9% of the variance. Convergent and discriminant validity were confirmed as examining the factor loading, average variance extracted, and composite reliability. The values of factor loading for 25 items were having higher estimate than criterion and the average variance extracted value for 4 factors ranged from .575 to .667. The Cronbach's alpha was .90 for the 25 items.

CONCLUSION

The Korean version of the 25-item BARRIERS scale was a reliable and valid scale to measure barriers to research use in Korean health care settings. Based on this psychometric evaluation, research barriers and its associated factors will be investigated using the Korean version of the BARRIERS scale in further study.

Effect of Evidence-Based Practice Programs on Individual Barriers of Workforce Nurses: An Integrative Review

HOW TO OBTAIN CONTACT HOURS BY READING THIS ISSUE Instructions: 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded after you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. In order to obtain contact hours you must: 1. Read the article, "Effect of Evidence-Based Practice on Individual Barriers of Workforce Nurses: An Integrative Review" found on pages 398-406, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website to register for contact hour credit. You will be asked to provide your name, contact information, and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until August 31, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. OBJECTIVES Identify individual barriers in the implementation of evidence-based practice (EBP) by nurses. Describe interventions of the programs reviewed in the article that directly affect barriers to clinical nurses' adoption of EBP or the use of research. DISCLOSURE STATEMENT Neither the planners nor the author have any conflicts of interest to disclose.

BACKGROUND

Individual barriers such as a lack of research awareness, electronic database navigation skills, and research comprehension prevent nurses from implementing evidence-based practice (EBP). The aim of this review article is to examine EBP programs and their influence on individual barriers among workforce nurses.

METHOD

A keyword search of online databases was conducted for original research published from 2004- 2015. A review of cited references and footnote searching of significant articles was conducted to identify additional relevant articles.

RESULTS

Twenty articles met the inclusion criteria. Although there was great variation among EBP programs, the majority of participants reported increased awareness, value, belief, knowledge, and skill as it relates to research utilization and EBP.

CONCLUSION

This review suggests that individual barriers to EBP may be influenced by clinically based EBP programs. However, a lack of randomized controlled studies and inconsistencies in measurement make it difficult to recommend best practices for developing EBP programs for nurses in the clinical setting. J Contin Educ Nurs. 2016;47(9):398-406.

A systematic review of factors influencing knowledge management and the nurse leaders' role

AIM

To describe factors facilitating or inhibiting the development of registered nurses' competency and nurse leader's role in knowledge management.

BACKGROUND

Nurses' competency directly influences patient safety and the quality and effectiveness of patient care. Challenges of nurse leaders in knowledge management include acquiring, assessing and utilising current knowledge and assessing and enhancing competency.

EVALUATION

A systematic search was conducted in PubMed, CINAHL, SCOPUS and ERIC databases in April 2015. The search identified 18 relevant research articles published between 2009 and 2015. The quality of the studies was appraised in accordance with study designs.

KEY ISSUE

Knowledge management is facilitated by an organisation culture that supports learning, sharing of information and learning together. Leader commitment and competency were factors related to leadership facilitating knowledge management.

CONCLUSION

Nurse leaders need evidence-based interventions to support shared learning and to create infrastructures that facilitate competence development. Future research is especially needed to evaluate connections between knowledge management and patient outcomes.

IMPLICATIONS FOR NURSING MANAGEMENT AND LEADERSHIP

The results of this review can be utilised in enhancing factors to facilitate knowledge management in clinical practice and identifying nurse leaders' role in strengthening nurses' competency.

Patient Advocacy in an Obstetric Setting

A correlation study design was used to examine the interrelatedness of power, attitudes regarding intermittent fetal monitoring, and perceived barriers to research utilization with a labor and delivery nurse’s attitude toward patient advocacy using the conceptual framework of the science of unitary human beings. The linear combination of the three independent variables was significantly correlated to attitude toward patient advocacy and power as knowing participation in change had the greatest impact on patient advocacy.

[Barriers and motivations of nurses for conducting research in Intensive Care Units and Emergency Medical Service]

BACKGROUND

The implementation of evidence based practice is essential in clinical practice. However, it is still a challenge in critical care patients.

AIM

To identify the barriers for conducting research that nursing professionals perceive in intensive care and medical emergency departments, as well as to investigate the areas of interest and motivations to carry out research projects.

METHOD

Cross-sectional and multicentre study carried out in 4 intensive care units and in one Medical Emergency Department emergency pre-hospital carein Catalonia on 2014. The instrument used was The Barriers to Research Utilization Scale which had been previously validated into Spanish. A descriptive and bivariate analysis was performed. A statistical significance of P<.05 was assumed.

RESULTS

One hundred seventy-two questionnaires were obtained (69.9% response). Of the total, 135 were from critical care, 27 to pre-hospital care, and 10 from both. Just over half (57.3%) had research experience, although 44.4% had related training. The questionnaire dimension considered most relevant was organisational characteristics. The most important barriers were: there is not enough time at work [3.11 (SD 1.21)], physicians do not collaborate in its implementation [2.99 (SD 1.22)], and nurses are isolated with respect to other professionals [2.86 (SD 1.32)]. Significant differences were observed in the barriers according to research experience and work place. The main motivation was to be updated in critical patient care.

CONCLUSIONS

The main barriers perceived are related to the organisation. There are differences in the barriers according to research experience and work place.

Educational interventions on evidence-based nursing in clinical practice: A systematic review with qualitative analysis

AIMS

To gather, assess and synthesise the currently available evidence of educational interventions on evidence-based nursing (EBN).

BACKGROUND

Previous systematic reviews have focused on the items used in reporting educational interventions for facilitating evidence-based practices in medicine and health care or teaching research literacy in nursing as well as on the outcomes of these interventions.

DESIGN

A systematic review based on a procedure of the Centre for Reviews and Disseminations for conducting a systematic review of health interventions.

DATA SOURCES AND METHODS

Texts from 2008 to 2015 were sought from the Cochrane, CINAHL and PubMed Medline databases. Eight studies were selected for the final data and reviewed for quality. Data were analysed with narrative synthesis including qualitative content analysis.

RESULTS

Four main categories and sixteen subcategories were identified. The learning contents included principles of EBN and research, the process of EBN, and planning a change in practice. The most popular teaching/learning methods were lectures/didactic presentations and group work. The interventions encouraged learners to critically examine and evaluate their practice. The interventions also improved participants' capacity to identify the need for research evidence in clinical practice.

CONCLUSION

The educational interventions were fairly similar and had promising results. However, as the level of evidence was modest in the studies, there are several development needs for interventions and further research challenges. Interventions should provide participants with sufficient competences for implementing every step of EBN, with special focus on the implementation of evidence in patient care. The assessment of the outcomes of interventions should cover all learning categories of EBN with focus on medium to long-term effectiveness. The influence of different teaching/learning methods and learning contexts and settings should be investigated further.

Measuring Clinical Decision Support Influence on Evidence-Based Nursing Practice

PURPOSE/OBJECTIVES

To measure the effect of clinical decision support (CDS) on oncology nurse evidence-based practice (EBP).
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DESIGN

Longitudinal cluster-randomized design.
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SETTING

Four distinctly separate oncology clinics associated with an academic medical center.
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SAMPLE

The study sample was comprised of randomly selected data elements from the nursing documentation software. The data elements were patient-reported symptoms and the associated nurse interventions. The total sample observations were 600, derived from a baseline, posteducation, and postintervention sample of 200 each (100 in the intervention group and 100 in the control group for each sample).
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METHODS

The cluster design was used to support randomization of the study intervention at the clinic level rather than the individual participant level to reduce possible diffusion of the study intervention. An elongated data collection cycle (11 weeks) controlled for temporary increases in nurse EBP related to the education or CDS intervention.
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MAIN RESEARCH VARIABLES

The dependent variable was the nurse evidence-based documentation rate, calculated from the nurse-documented interventions. The independent variable was the CDS added to the nursing documentation software.
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FINDINGS

The average EBP rate at baseline for the control and intervention groups was 27%. After education, the average EBP rate increased to 37%, and then decreased to 26% in the postintervention sample. Mixed-model linear statistical analysis revealed no significant interaction of group by sample. The CDS intervention did not result in an increase in nurse EBP.
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CONCLUSIONS

EBP education increased nurse EBP documentation rates significantly but only temporarily. Nurses may have used evidence in practice but may not have documented their interventions.
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IMPLICATIONS FOR NURSING

More research is needed to understand the complex relationship between CDS, nursing practice, and nursing EBP intervention documentation. CDS may have a different effect on nurse EBP, physician EBP, and other medical professional EBP.

Facilitators and barriers to evidence-based practice: perceptions of nurse educators, clinical coaches and nurse specialists from a descriptive study

BACKGROUND

Implementation of evidence-based practice (EBP) is a major initiative within health care settings to ensure clinical and policy decisions incorporate best available evidence.

AIMS

This paper reports findings from a descriptive study exploring nurse educators', clinical coaches' and nurse specialists' perceptions of factors associated with using EBP.

METHODS

Data was collected from a senior group of nurses working in a tertiary health care network in Victoria, Australia by employing a questionnaire that was distributed to a total of 435 people, of whom 135 responded.

DATA ANALYSIS

Descriptive statistics for each questionnaire item were determined using SPSS (Statistical Package for Social Sciences version 17). Thematic analysis was performed for the qualitative part of the questionnaire. Results Findings revealed that organisational support, sufficient resources, and access to continuing education were perceived as factors promoting acceptance of EBP. Barriers to such acceptance in health care settings were identified as lack of knowledge and skills, poor time allowance, limited support, and insufficient resources.

CONCLUSION

The reported findings create evidence-based information for organisational strategic planning. Organisations need to develop educational programs to promote EBP and employ strategies to overcome barriers to implementation.

A Systematic Review of Journal Clubs for Nurses

BACKGROUND

Two previous systematic reviews describe studies on journal clubs from 1995 to 2007.

AIMS

To gather, assess, and synthesize the current empirical evidence on implementation of journal clubs, influencing factors, and outcomes of journal clubs in promoting evidence-based nursing.

DESIGN

A systematic review based on the procedure of the Centre for Reviews and Dissemination.

DATA SOURCES AND METHODS

Cochrane, CINAHL, and PubMed Medline databases were sought from 2008 to 2015. The final data consisted of 10 studies. Articles' references were searched manually. The quality appraisal was made according to study design. Data were analyzed by qualitative content analysis and narrative synthesis.

RESULTS

The analyses produced four main categories with 14 subcategories that described the journal clubs: organization, conduct of meetings, influencing factors, and intervention outcomes. Journal clubs had been carried out in a fairly uniform manner in different nursing communities. There remains a lack of evidence on journal clubs' impact on evidence-based nursing (EBN) implementation, which challenges the development of journal clubs' content and methods.

LINKING EVIDENCE TO ACTION

Because journal clubs have achieved a uniform and easy-to-follow manner that is suitable for different nursing contexts and provide multiple positive outcomes, they are recommended for EBN. In work communities, journal clubs should be combined with other well-known factors that promote EBN implementation. The assessment of the outcomes of journal clubs should cover all learning categories of EBN with a focus on medium- to long-term effectiveness. The evaluation of the effectiveness of journal clubs on patient care is of great importance for future studies.

A cross-cultural investigation into the dimensional structure and stability of the Barriers to Research and Utilization Scale (BARRIERS Scale)

Background

It is important that scales exhibit strong measurement properties including those related to the investigation of issues that impact evidence-based practice. The validity of the Barriers to Research Utilization Scale (BARRIERS Scale) has recently been questioned in a systematic review. This study investigated the dimensional structure and stability of the 28 item BARRIERS Scale when completed by three groups of participants from three different cross-cultural environments.

Method

Data from the BARRIERS Scale completed by 696 occupational therapists from Australia (n = 137), Taiwan (n = 413), and the United Kingdom (n = 144) were analysed using principal components analysis, followed by Procrustes Transformation. Poorly fitting items were identified by low communalities, cross-loading, and theoretically inconsistent primary loadings, and were systematically removed until good fit was achieved. The cross-cultural stability of the component structure of the BARRIERS Scale was examined.

Results

A four component, 19 item version of the BARRIERS Scale emerged that demonstrated an improved dimensional fit and stability across the three participant groups. The resulting four components were consistent with the BARRIERS Scale as originally conceptualised.

Conclusion

Findings from the study suggest that the four component, 19 item version of the BARRIERS Scale is a robust and valid measure for identifying barriers to research utilization for occupational therapists in paediatric health care settings across Australia, United Kingdom, and Taiwan. The four component 19 item version of the BARRIERS Scale exhibited good dimensional structure, internal consistency, and stability.

Barriers and facilitators of nursing research utilization in Iran: A systematic review

BACKGROUND

According to professionalization in nursing profession, the nursing researches expanded dramatically and rapidly in a very short period. Research results showed improvement in quality of provided care by using research findings. But there is still a gap between nursing research and practice, which led scientists to explore the barriers and facilitators of research utilization that could affect the application of research results. The aim of this review was to appraise and synthesize evidences of studies about the facilitators and barriers to research utilization in Iranian nurses.

MATERIAL AND METHODS

A systematic review of quantitative and qualitative studies about the barriers and facilitators of nursing research utilization in Iran was undertaken.

RESULTS

The results showed that items such as "The nurse is isolated from knowledgeable colleagues with whom to discuss the research," "There is insufficient time on the job to implement new ideas," "The nurse does not have time to read research," "The nurse does not feel she/he has enough authority to change patient care procedures," "The facilities are inadequate for implementation," "Physicians will not cooperate with implementation," and "The relevant literature is not compiled in one place" were rated as the main barriers.

CONCLUSIONS

The results of 10 studies about research utilization in Iran showed that the barriers and facilitators remained constant through time and across different locations. The rank orders of barriers and facilitators were the same approximately. The nurse managers and administrators could utilize the findings of this review to allocate human resources and other sources and promote nursing research utilization in clinical field.

Integrative review of implementation strategies for translation of research-based evidence by nurses

OBJECTIVES

The purpose of this review was to synthesize and critique experimental and/or quasi-experimental research that has evaluated implementation strategies for translation of research-based evidence into nursing practice.

BACKGROUND

Successfully implementing evidence-based research can improve patient outcomes. Identifying successful implementation strategies is imperative to move research-based evidence into practice.

RATIONALE

As implementation science gains popularity, it is imperative to understand the strategies that most effectively translate research-based evidence into practice.

DESCRIPTION

The review used the CINAHL and MEDLINE (Ovid) databases. Articles were included if they were experimental and/or quasi-experimental research designs, were written in English, and measured nursing compliance to translation of research-based evidence. An independent review was performed to select and critique the included articles.

OUTCOME

A wide array of interventions were completed, including visual cues, audit and feedback, educational meetings and materials, reminders, outreach, and leadership involvement. Because of the complex multimodal nature of the interventions and the variety of research topics, comparison across interventions was difficult.

CONCLUSION

Many difficulties exist in determining what implementation strategies are most effective for translation of research-based evidence into practice by nurses.

IMPLICATIONS

With these limited findings, further research is warranted to determine which implementation strategies most successfully translate research-based evidence into practice.

Nurse practitioner clinical decision-making and evidence-based practice

Evidence-based practice is key to improving patient outcomes but can be challenging for busy nurse practitioners to implement. This article describes the process of critically appraising evidence for use in clinical practice and offers strategies for implementing evidence-based innovations and disseminating the findings.

Factors influencing evidence-based practice for community nurses

Factors influencing the development of evidence-based nursing practice (EBNP) were examined in Prince Edward Island, Canada. An adapted electronic questionnaire was distributed to practicing registered nurses and nurse practitioners (n=68). An analysis of variance revealed a significant difference between nurses' clinical practice setting and the EBNP scale. Significant differences were also found between age and education level when compared with the EBNP subscales where novice nurses were less likely to rely on experience and intuition, and expert nurses with a higher level of education reported being more skilful at synthesising and applying information from research findings into their nursing practice.

Perceived knowledge, skills, attitude and contextual factors affecting evidence-based practice among nurse educators, clinical coaches and nurse specialists

Evidence-based practice (EBP) in the clinical setting is recognized as an approach that leads to improved patient outcomes. Nurse educators (NEs), clinical coaches (CCs) and nurse specialists are in key positions to promote and facilitate EBP within clinical settings and have opportunities to advance practice. Therefore, it is important to understand their perceptions of factors promoting EBP and perceived barriers in facilitating EBP in clinical settings, before developing educational programmes. This paper reports findings from a study that aimed to explore NEs' , CCs' and nurse specialists' knowledge, skills and attitudes associated with EBP. This study used a questionnaire containing quantitative and a small number of qualitative questions to capture data collected from NEs, CCs and nurse specialists working at a tertiary health-care facility in Victoria, Australia. The questionnaire was distributed to a total of 435 people, of whom 135 responded (31%). Findings revealed that the three senior nurse groups relied heavily on personal experience, organizational policies and protocols as formal sources of knowledge. Furthermore, they had positive attitudes towards EBP. However, participants demonstrated lack of knowledge and skills in appraising and utilizing evidence into practice. They indicated a desire to seek educational opportunities to upskill themselves in the process of EBP.

Healthcare innovation barriers: results of a survey of certified professional healthcare risk managers

Medical errors cause significant patient injuries, including deaths. Innovations designed to improve quality and reduce risk are numerous, as are the barriers that prevent innovation implementation. The purpose of this research was to analyze the relationships, if any, between the independent variables of hospital bed size and organizational structure, and the dependent variable barriers to three innovations: implementing a surgical safety checklist, preventing catheter-associated urinary tract infections, and adopting patient- and family-centered care. The findings strengthen and expand existing research and serve as the foundation for understanding barriers to implementation of three healthcare innovations. Future research should focus on organizational culture instead of innovation-specific barriers and should incorporate other independent variables, such as organizational profitability.

Nurses' intention to support informed decision-making about breast cancer screening with mammography: a survey

There is growing interest in informed decision-making about breast cancer screening with mammography and growing advocacy for the provision of balanced information about potential benefits and harms. The authors report on a survey evaluating nurses' intention to support women targeted by the Quebec Breast Cancer Screening Program in making informed decisions about breast cancer screening with mammography. Of the 840 questionnaires completed, 618 were included in the data analysis. The mean +/- standard deviation score for intention was 1.7 +/- 1.2 on a 6-point Likert scale ranging from -3 to +3, indicating strong intention to support the targeted women. Perceived behavioural control was the theory-based variable most strongly associated with intention, followed by attitude and social norm. These results can be used to develop interventions to train nurses in integrating informed decision-making about breast cancer screening with mammography into their practice and to design relevant decision support tools.

Barriers to and facilitators of research utilization: a survey of registered nurses in China

AIMS

This survey aims to describe the perception of barriers to and facilitators of research utilization by registered nurses in Sichuan province, China, and to explore the factors influencing the perceptions of the barriers to and facilitators of research utilization.

METHODS

A cross sectional survey design and a double cluster sampling method were adopted. A total of 590 registered nurses from 3 tertiary level hospitals in Sichuan province, China, were recruited in a period from September 2006 to January 2007. A modified BARRUERS Scale and a Facilitators Scale were used. Data were analyzed with descriptive statistics, rank transformation test, and multiple linear regression.

RESULTS

Barriers related to the setting subscale were more influential than barriers related to other subscales. The lack of authority was ranked as the top greatest barrier (15.7%), followed by the lack of time (13.4%) and language barrier (15.0%). Additional barriers identified were the reluctance of patients to research utilization, the lack of funding, and the lack of legal protection. The top three greatest facilitators were enhancing managerial support (36.9%), advancing education to increase knowledge base (21.1%), and increasing time for reviewing and implementing (17.5%), while cooperation of patients to research utilization, establishing a panel to evaluate researches, and funding were listed as additional facilitators. Hospital, educational background, research experience, and knowledge on evidence-based nursing were the factors influencing perceptions of the barriers and facilitators.

CONCLUSIONS

Nurses in China are facing a number of significant barriers in research utilization. Enhancing managerial support might be the most promising facilitator, given Chinese traditional culture and existing health care system. Hospital, educational background, research experience and knowledge on evidence-based nursing should be taken into account to promote research utilization. The BARRIERS Scale should consider funding and involvement of patients in research utilization.

Development and psychometric testing of the Nursing Research Self-Efficacy Scale (NURSES)

BACKGROUND AND PURPOSE

The Nursing Research Self-Efficacy Scale (NURSES) was designed to measure individual nurses' degree of research self-efficacy and their perceptions regarding their unit's collective support of research use. Development for the NURSES instrument spanned a 4-year period, which included initial development, revisions, and psychometric evaluations.

METHOD

The NURSES is a 38-item Likert-scale instrument developed through ongoing instrument validation that included content validation and exploratory and confirmatory analysis. The 5 subscales include obtaining science-based knowledge resources, critically reading and evaluating quantitative research literature, critically reading and evaluating qualitative research literature, understanding and applying theory, and collective research efficacy.

RESULTS

Over a 4-year period, approximately 1000 practicing nurses from multiple hospitals responded to the instrument. Exploratory and confirmatory factor analyses supported the existence of four subscales for research self-efficacy and one subscale for collective research efficacy. Reliability for the subscales was excellent, ranging from .94 to .97.

CONCLUSIONS

Hospitals may wish to use the NURSES instrument as an orientation tool, or to examine relationships between research efficacy and nurses' professional development. Health care facilities on a Magnet journey might also use the NURSES instrument to assess their nursing staff as they pursue evidence-based practice and conduct research.

Strategies from bedside nurse perspectives in conducting evidence-based practice projects to improve care

This article presents the bedside nurses' perspectives on their experience with conducting an evidence based practice project. This is especially important in the climate of hospitals working to achieve Magnet Recognition. The facilitators and barriers to project design and completion are discussed in detail. Strategies to overcome barriers are presented. Facilitators for bedside nurses include motivation and professional development. Most common barriers were lack of time and limited knowledge about the process. Interventions aimed at research utilization can be successful when mindful of commonly understood barriers to project completion with steps taken to resolve those barriers.

Using a knowledge utilization framework to explore how findings from one study can be applied to other nursing contexts

AIM

To discuss the complexities of moving research into practice and through a case example, explore how empirical findings from one specific study could be applied to nursing in other contexts.

BACKGROUND

The processes of moving research findings into practice are complex and multidimensional. In this paper, an innovative approach to social support, network-focused nursing (NFN), is used as a case example to illustrate these complexities. Social support is associated with better recovery and survival after illness and based on this, a NFN programme was developed in a Danish oncology youth unit. Subsequently, a research study was undertaken to investigate the programme and based on the findings, the concept NFN was developed.

METHODS

A knowledge utilization framework is used to explore how empirical findings from the NFN study could be applied to nursing more generally. Aligned with this, the specific considerations for implementing NFN are explicated.

DISCUSSION

Strong leadership, education, management support and effective communication are critical factors for research utilization. Moving research into practice requires openness to new ideas. Nursing and healthcare policies therefore need to support environments in which creativity and innovation can flourish. NFN was developed in teenager and young adult cancer care, but its principles may be transferable to other clinical environments.

CONCLUSIONS

It is important that nurse managers and policy makers ensure that support and education are available to nurses to facilitate moving research into practice. Moreover, resources need to be considered, particularly in countries where financial and organizational infrastructures may be weak.

Evidence-based practice: a survey among pediatric nurses and pediatricians

This survey compared the attitude, awareness, and knowledge of pediatric nurses and pediatricians regarding evidence-based practice (EBP). Potential barriers were also investigated. Both nurses and pediatricians welcomed EBP (mean scores are 73.3 and 75.4 out of 100). Overall, 52% of the nurses and 36% of the pediatricians did not know relevant sources of information, and 62% of the nurses versus 19% of the pediatricians did not know common EBP terms. Time constraints and lack of knowledge were considered as major barriers. Recommendations include multilevel training and continuous exchange of information.

Framework of policy recommendations for implementation of evidence-based practice: a systematic scoping review

OBJECTIVES

Evidence-based practice (EBP) may help improve healthcare quality. However, not all healthcare professionals and managers use EBP in their daily practice. We systematically reviewed the literature to summarise self-reported appreciation of EBP and organisational infrastructure solutions proposed to promote EBP.

DESIGN

Systematic review. Two investigators independently performed the systematic reviewing process.

INFORMATION SOURCES

MEDLINE, EMBASE and Cochrane Library were searched for publications between 2000 and 2011.

ELIGIBILITY CRITERIA FOR INCLUDED STUDIES

Reviews and surveys of EBP attitude, knowledge, awareness, skills, barriers and facilitators among managers, doctors and nurses in clinical settings.

RESULTS

We found 31 surveys of fairly good quality. General attitude towards EBP was welcoming. Respondents perceived several barriers, but also many facilitators for EBP implementation. Solutions were proposed at various organisational levels, including (inter)national associations and hospital management promoting EBP, pregraduate and postgraduate education, as well as individual support by EBP mentors on the wards to move EBP from the classroom to the bedside.

CONCLUSIONS

More than 20 years after its introduction, the EBP paradigm has been embraced by healthcare professionals as an important means to improve quality of patient care, but its implementation is still deficient. Policy exerted at microlevel , middlelevel and macrolevel, and supported by professional, educational and managerial role models, may further facilitate EBP.

Framework of policy recommendations for implementation of evidence-based practice: a systematic scoping review

OBJECTIVES

Evidence-based practice (EBP) may help improve healthcare quality. However, not all healthcare professionals and managers use EBP in their daily practice. We systematically reviewed the literature to summarise self-reported appreciation of EBP and organisational infrastructure solutions proposed to promote EBP.

DESIGN

Systematic review. Two investigators independently performed the systematic reviewing process.

INFORMATION SOURCES

MEDLINE, EMBASE and Cochrane Library were searched for publications between 2000 and 2011.

ELIGIBILITY CRITERIA FOR INCLUDED STUDIES

Reviews and surveys of EBP attitude, knowledge, awareness, skills, barriers and facilitators among managers, doctors and nurses in clinical settings.

RESULTS

We found 31 surveys of fairly good quality. General attitude towards EBP was welcoming. Respondents perceived several barriers, but also many facilitators for EBP implementation. Solutions were proposed at various organisational levels, including (inter)national associations and hospital management promoting EBP, pregraduate and postgraduate education, as well as individual support by EBP mentors on the wards to move EBP from the classroom to the bedside.

CONCLUSIONS

More than 20 years after its introduction, the EBP paradigm has been embraced by healthcare professionals as an important means to improve quality of patient care, but its implementation is still deficient. Policy exerted at microlevel , middlelevel and macrolevel, and supported by professional, educational and managerial role models, may further facilitate EBP.

The perceived impact of advanced practice nurses (APNs) on promoting evidence-based practice amongst frontline nurses: findings from a collective case study

The aim of this study was to explore the perceived impact of advanced practice nurses in promoting evidence-based practice amongst frontline nurses. A collective instrumental case study was undertaken involving five extended case studies and eighteen short case studies in a range of hospital and primary care settings across seven Strategic Health Authorities in England. The study participants were a purposive sample of 23 advanced practice nurses selected to represent a range of settings, clinical specialities, organisational responsibilities and ways of working. In-depth interviews were undertaken with the advanced practice nurse and up to 10 interviews with health care professionals with whom they worked. For the extended case studies, non-participant observation and follow-up interviews were also undertaken. Data analysis drew on the principles of the Framework approach.

From the perspectives of the participants, these advanced practice nurses enhanced the ability of frontline nurses to provide evidence-based care. They improved the competence, knowledge and skills of frontline nurses and empowered them to deliver care which they considered to be safer, holistic, more timely and of a higher standard. This is likely to have a positive effect on patient outcomes and on patient experience. However, this impact is inherently hard to capture.