Nursing practice, knowledge, attitudes and perceived barriers to evidence-based practice at an academic medical center

Development and evaluation of an anti-ageism advisory group with older adults and gerontological experts: a qualitative descriptive study

BACKGROUND

In recent years, academics have increasingly acknowledged the importance of involving health service users and community stakeholders as active partners in health research. Yet, the involvement of older adults, the largest group of health service users, as research partners remains limited, possibly due to ageist attitudes that devalue older adults' contributions. During the three years of our Awakening Canadians to Ageism study, we convened an advisory group consisting of older adults and gerontological experts to discuss issues related to ageism, help interpret the study findings, and develop a range of knowledge mobilization strategies to dispel ageism.

METHODS

To understand the experiences of members of the advisory group and solicit recommendations for improving future groups, we conducted a qualitative descriptive study and interviewed 8 older adults and 6 gerontological experts. Data were content analyzed.

RESULTS

Four categories that were developed to explain participants' experiences and suggestions for future advisory groups included: organization and management, group experience, suggestions for future advisory groups and moving forward. A key finding was the value that the older adults and gerontological experts ascribed to conversations about the prevalence of ageism and their desire to continue these types of conversations in their personal groups and professional networks. Numerous helpful strategies for future advisory groups were identified, such as enhancing social diversity, both in terms of racial/ethnic/cultural representation and gender. Older adults wanted more "getting to know you time" in meetings and gerontological experts wanted more details about the research process and their role.

CONCLUSIONS

This study's partnership approach can guide researchers seeking to involve key health service users and community stakeholders in health research and help enact positive social change.

Ambulance clinicians implementing evidence-based practice: mind the gap! Attitudes, perceptions and experiences of student paramedics

Background

Evidence-based practice (EBP) represents the conscientious and judicious use of the best contemporaneous evidence in partnership with patient values and clinical expertise to guide healthcare professionals. As a result, EBP is a recommended component of undergraduate education and considered fundamental for improving patient outcomes. EBP principles have thus become deeply rooted in higher education curricula, but only in recent years has this begun to permeate the world of paramedic practice. Despite this paradigm, the impact of EBP may be limited because ambulance clinicians may struggle with implementation, as a variety of barriers influence translation and application.

Methods

A survey study aimed to gain insight into the epistemological and metacognitive barriers impacting student experience in order to help improve teaching and learning practices.

Results

A sample of 64 students, across two different undergraduate paramedic science programmes, were recruited. Of these, 70% of BSc (Hons) students versus 33% of DipHE students agreed to some extent or greater that EBP represented minimal benefit in real-world practice due to Trust policy and the guidelines set out by the Joint Royal Colleges Ambulance Liaison Committee (Welch's t = 2.571, df = 26, p = 0.016 two-sided). Furthermore, 25% felt standard operating procedures negatively impacted their ability to implement EBP, and 39% reported their EBP learning had improved their ability to implement improved levels of patient care.

Conclusion

A disparity between theoretical learning and EBP implementation was identified. EBP may not dovetail with standard operating procedure within UK ambulance Trusts, resulting in confusion among student paramedics as to the true worth of EBP.

Investigating behavior, attitudes, knowledge, awareness and barriers to the implementation of evidence-based practice by physiotherapists in Egypt: A cross sectional study

Few studies exist regarding the attitudes and behaviours of Egyptian physiotherapists in relation to the use of evidence in practice (EBP). The purpose of this study was to describe the beliefs, attitudes, knowledge, and behaviours of Egyptian physical therapists as they relate to evidence-based practice. It also explores their perception of possible barriers to implement EBP. Four hundred and seventy Egyptian therapists responded to our questionnaire with results revealing participants' awareness towards EBP was quite diverse. Only terms of systematic review and randomized controlled trial were well understood while remaining terms showed various level of comprehension which were rather low. Results also revealed significant correlations between attitudes towards EBP and overall awareness as well as attitudes and knowledge (r = 0.270 and 0.107) respectively. In addition, a significant relationship was also found between EBP awareness and knowledge with (r = 0.219). With regards to the barriers, insufficient teaching in previous education was identified as the primary barrier (34.4 %), followed by lack of funding and resources (31.1 %), while lack of time (10.2 %) was reported as the least. These barriers highlight the need to enhance implementation of EBP within Egyptian Physiotherapists. Findings of this study can be used as a foundation for the implementation of EBP in various clinical settings by understanding the limitations and barriers reported. Our study concluded that despite Egyptian physiotherapists declare their awareness of EBP, nevertheless, knowledge is restricted to a small number of terms. More focus is required to enhance the knowledge and practice of EBP. Focusing on adjustable factors, including increasing the awareness of value of research would help reduce time and resource demands for physiotherapists when implementing EBP.

Challenges and possible solutions for accessing scholarly literature among medical and nursing professionals and students in low-and-middle income countries: A systematic review

BACKGROUND

Access to high quality research literature is essential for educating nursing and healthcare students to promote evidence-based practice. Within Low- and Middle-Income countries (LMICs) access is limited due to financial and structural constraints within countries and institutions. Reduced access to research literature limits the achievement of the Sustainable Development Goals through its impact on the education of healthcare staff and on the development of contextually appropriate evidence for practice.

OBJECTIVE

To identify the challenges and possible solutions for accessing scholarly literature among medical and nursing professionals and students in low-and-middle income countries.

DESIGN

Systematic review.

DATA SOURCES

Searches were conducted in MEDLINE, CINAHL PLUS, ERIC, ASSIA, EMBASE, and Google Scholar.

REVIEW METHODS

Five bibliography databases were searched using relevant search terms, from January 2002 to July 2022. Additional searches were carried out in Google Scholar. Titles, abstracts, and full texts were independently screened by at least two authors, based on predefined eligibility criteria. Pertinent data were extracted from included studies, and critical appraisal was undertaken. Data were analysed and presented in a narrative approach.

RESULTS

Five papers met the inclusion criteria and were included. Three aspects of challenges at different levels emerged: infrastructure and institutional level factors, individual factors, and lack of contextually appropriate evidence. Three solutions were identified: capacity development opportunities, improving Internet access, and increasing awareness of free resources.

CONCLUSION

This review provides an overview of common barriers medical and nursing professionals and students encounter whilst accessing scholarly literature in LMICs and identifies some possible solutions to address them. The findings can be used to guide institutions, as well as national and international decision makers to elicit policy which can promote the uptake of research in LMICs. Further research should focus on how these solutions could be harnessed to address the problems identified in this review.

Mapeo de la percepción individual y del entorno organizacional para la práctica clínica basada en la evidencia entre enfermeras renales en España

Objetivo: Analizar la percepción de las enfermeras renales en España en relación con el entorno organizacional para la práctica clínica basada en la evidencia (PCBE); y determinar qué factores profesionales y del contexto influenyen esta percepción. Material y Método: Estudio observacional transversal multiéntrico, en 15 servicios de nefrología de distitos hospitales en España y 2 centros de diálisis. Se utilizaron los instrumentos Practice Environment Scale of Nursing Work Index (PES-NWI) y Evidence Based Practice Questionnarie (EBPQ). Se realizó un análisis estadístio descriptivo, bivariado (ANOVA, Kruskall-Wallis), y regresión logística con la puntuación total del EBPQ como variable dependiente. Resultados: Se recibieron 397 encuestas (participación84,28%), tras depuración encuestas, fueron válidas 382 (81,1% población): 82,7% mujeres, edad media 42 años, media de experiencia profesional como enfermera 18,2 años (12,2 años en nefrología), 94,8% clínicas, 81,9% de hemodiálisis. Puntuación media PES-NWI 62,35±15,10 (IC:95% 60,78-48,06). Presentaron menores puntuaciones en algunos factores del PES-NWI las enfermeras de centros >500 enfermeras, que trabajan en hemodiálisis y >11 años de experiencia profesional. Las enfermeras gestoras presentaron mayores puntuaciones en todos los factores del PES-NWI. Puntuación media EBPQ 81,05±21,92 (IC:95% 78,70-83,4). Presentaron mayores puntuaciones en varios factores del EBPQ las enfermeras con menor experiencia profesional, mejor puntuación en PES-NWI y que poseían estudios de postgrado. Conclusiones: Los factores que más influyen en la percepción de las enfermeras renales en España son la experiencia profesional, el rol dentro de la organización, un contexto favorable y la formación de postgrado.

Mapeo de la percepción individual y del entorno organizacional para la práctica clínica basada en la evidencia entre enfermeras renales en España

Objetivo: Analizar la percepción de las enfermeras renales en España en relación con el entorno organizacional para la práctica clínica basada en la evidencia (PCBE); y determinar qué factores profesionales y del contexto influenyen esta percepción. Material y Método: Estudio observacional transversal multiéntrico, en 15 servicios de nefrología de distitos hospitales en España y 2 centros de diálisis. Se utilizaron los instrumentos Practice Environment Scale of Nursing Work Index (PES-NWI) y Evidence Based Practice Questionnarie (EBPQ). Se realizó un análisis estadístio descriptivo, bivariado (ANOVA, Kruskall-Wallis), y regresión logística con la puntuación total del EBPQ como variable dependiente. Resultados: Se recibieron 397 encuestas (participación84,28%), tras depuración encuestas, fueron válidas 382 (81,1% población): 82,7% mujeres, edad media 42 años, media de experiencia profesional como enfermera 18,2 años (12,2 años en nefrología), 94,8% clínicas, 81,9% de hemodiálisis. Puntuación media PES-NWI 62,35±15,10 (IC:95% 60,78-48,06). Presentaron menores puntuaciones en algunos factores del PES-NWI las enfermeras de centros >500 enfermeras, que trabajan en hemodiálisis y >11 años de experiencia profesional. Las enfermeras gestoras presentaron mayores puntuaciones en todos los factores del PES-NWI. Puntuación media EBPQ 81,05±21,92 (IC:95% 78,70-83,4). Presentaron mayores puntuaciones en varios factores del EBPQ las enfermeras con menor experiencia profesional, mejor puntuación en PES-NWI y que poseían estudios de postgrado. Conclusiones: Los factores que más influyen en la percepción de las enfermeras renales en España son la experiencia profesional, el rol dentro de la organización, un contexto favorable y la formación de postgrado.

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.

Implementing an Evidence-Based Feeding Protocol: Impact on Nurses' Knowledge, Perceptions, and Feeding Culture in the NICU

BACKGROUND

Evidence-based feeding practices are often variable among neonatal providers due to lack of knowledge and neonatal intensive care unit (NICU) feeding culture norms.

PURPOSE

To evaluate changes in NICU nurses' knowledge, perceptions, feeding practices and culture following education about, and implementation of, an evidence-based Infant-Driven Feeding (IDF) protocol.

METHODS

A pre-/postprospective comparative design was used to survey 120 registered nurses employed in a level 3 NICU about feeding practices, knowledge, and culture prior to IDF education and 1 to 2 months after IDF implementation.

RESULTS

The preeducation survey yielded 59 respondents; of these, 30 responded to the same survey after IDF implementation. Postimplementation responses were significant for fewer nurses making decisions to begin oral feedings ( P = .035), greater use of gestational age to increase frequency of oral feeding attempts ( P = .03), less reliance on weight loss to decrease oral feeding attempts ( P = .018), an increase in use of combination interventions to prepare infants for oral feeding ( P = .001), and greater willingness to allow a rest period or stop the feeding if an infant falls asleep after completing 70% of the feeding ( P = .03).

IMPLICATIONS FOR PRACTICE AND RESEARCH

Trends in several survey categories following the education program and implementation of IDF support the use of evidence-based practices (EBPs) such as IDF. Future research focused on nurses' perceptions of how education influences integration of specific EBPs into practice is needed. Evaluating EBP mentorship combined with education about EBPs can provide insights on how best to integrate EBPs into practice.

Effectiveness of Educational Interventions to Increase Skills in Evidence-Based Practice among Nurses: The EDITcare Systematic Review

BACKGROUND

Using evidence-based practice (EBP) improves the implementation of safe, high-quality healthcare for patients, reduces avoidable costs, and plays a crucial role in bridging knowledge-action gaps and reducing health inequities. EBP combines the best available evidence in the relevant literature with patient preferences and values and healthcare professionals' (HCPs) expertise.

METHODS

Systematic searches of ten bibliographic databases, unpublished works, and the Grey Literature Report sought studies published up to 30 September 2022.

RESULTS

The 15 studies retained involved 2712 nurses. Three types of effective educational interventions were identified: (1) multifaceted educational strategies incorporating mentoring and tutoring; (2) single educational strategies, often delivered online; and (3) multifaceted educational strategies using the five steps of EBP. Eleven primary outcomes (EBP beliefs, EBP self-efficacy, perceived EBP implementation, EBP competencies, EBP knowledge, EBP skills, EBP attitudes, EBP behaviors, EBP desire, EBP practice, and perceptions of organizational culture and readiness) were assessed using 13 qualitative and quantitative instruments.

CONCLUSIONS

Ensuring the successful implementation of EBP requires effective educational strategies. Computer-based learning seems the most cost-effective and efficient strategy, when considering caregivers' characteristics, the clinical field, and educational interventions across the pre-, peri-, and post-implementation processes.

Promoting a culture of clinical inquiry in nursing

Evidence-based nursing practice supports the provision of high-quality patient care. This article shares how a contest at a community hospital promoted a culture of clinical inquiry and engaged nurses in evidence-based practice.

Organizational Factors Associated with Evidence-Based Practice Knowledge, Attitudes, and Implementation among Nurses in Saudi Arabia

Evidence-based practice (EBP) is crucial in keeping nurses aware of the current knowledge and improving clinical decision-making. The integration of nurses’ EBP competencies and organizational support has been suggested to create an effective arena in implementing EBP. The purpose of the study was to examine organizational factors influencing nurses’ EBP knowledge, attitudes, and implementation and identify staff nurses’ perceptions of EBP nursing leadership and hospital supports in Saudi Arabia. Data were collected from a convenience sample of staff nurses (N = 227) working in four hospitals using a cross-sectional, correlational descriptive design. Level of education (p < 0.05), EBP training (p < 0.05), unit type (ICU (p < 0.001) and ER (p < 0.01)), perceived nursing leadership (p < 0.001), and work environment (p < 0.05) supports were found significantly associated with nurses’ knowledge. Magnet recognition (p < 0.01) and knowledge (p < 0.001) had significant influence on nurses’ attitudes. Unit type (ER) (p < 0.05), knowledge (p < 0.001), and attitudes (p < 0.001) were associated with implementation. Encouragement to attend EBP trainings from nursing leadership was perceived by most nurses (51.1%). Nurses reported their hospitals support EBP through training (68.2%). Findings support the need for healthcare systems to create a culture that facilitates EBP implementation to enhance nurses’ EBP competencies and improve patients’ outcomes. Nursing managers may consider preparing nurses through education.

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.

Knowledge, attitude and use of evidence based practice (EBP) among registered nurse-midwives practicing in central hospitals in Malawi: a cross-sectional survey

BACKGROUND

Even though evidence based practice (EBP) is being considered as a critical element in improving the quality of health services and achieving excellence in patient care, there is currently little knowledge of how EBP relates to nursing and midwifery in Malawi. This paper is a report of a study describing EBP knowledge, attitudes, and use of registered nurse-midwives practicing in central hospitals across Malawi.

METHODS

The descriptive, cross-sectional research design was conducted with a randomly selected sample of 183 nurse-midwives (response rate of 87.9%). The study used a paper version questionnaire to collect the data. The data were analysed using both descriptive and inferential statistics in the Statistical Product and Service Solutions version 23. Descriptive statistics were calculated to summarise overall knowledge levels, attitudes, and use of nurse-midwives as percentages based on their scores on the assessment scale (1 to 7 Likert scale) in the EBP questionnaire. Non-parametric Mann-Whitney and Kruskal-Wallis tests were carried out to compare evidence-based practice scores based on demographics. Pearson's correlation (r) and stepwise regression analysis were further performed to analyse the relationship between the knowledge, attitude and use of nurse-midwives on the overall EBP of nurse-midwives.

RESULTS

The average scores (mean±SD) of evidence-based practice amongst nurse-midwives were 78.7 ± 19.6 for attitude, 70.6 ± 15.1 for knowledge levels, 57.8 ± 23 for use, and 68.9 ± 14.2 for the overall EBP. Higher educational qualification was associated with higher scores in knowledge levels (P = 0.02). Research experience was associated with higher scores in nursing use (P = 0.005), and higher overall evidence-based practice were associated with both research experience (P = 0.035) and educational qualification (P = 0.004). Nurse-midwives attitude was affected by clinical experience (P = 0.006) and the hospital where nurse-midwives worked (P = 0.016). There was no significant difference in the EBP scores of nurse-midwives based on gender and/or their administrative roles in their respective central hospitals.

CONCLUSION

It is important to develop the knowledge or skills of nurse midwives in order to enhance evidence-based practice amongst nurse-midwives in Malawian hospitals. The results can be used by nurse managers, nurse educators, policy makers at the Ministry of Health and Nurses and Midwives Council of Malawi to enhance implementation of EBP.

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.

Barriers to Implementing Evidence-Based Practice among Primary Healthcare Nurses in Saudi Arabia: A Cross-Sectional Study

Several studies have been conducted to investigate the barriers to implementing evidence-based practice (EBP) worldwide. In Saudi Arabia, a few studies were conducted in hospital and mental health settings, and no study has explored the topic in primary healthcare settings. This study aimed to examine the barriers perceived by primary healthcare nurses in implementing EBP. This study employed a correlational and cross-sectional design. A total of 284 nurses were surveyed using the BARRIERS scale. Regression analysis was performed to identify the effects of predictor variables on the four subscales. The overall raw score on the BARRIERS scale was 86.21 (standard deviation = 16.15). The highest mean score was reported in the organizational subscale, followed by the innovation and communication subscales, whereas the lowest mean score was reported in the adopter subscale. The findings showed that the three top-ranked barriers were: (1) results of the studies are not generalizable to nurses’ setting, (2) facilities are inadequate, and (3) physicians do not cooperate with the implementation. Findings showed that nurses encounter organizational-related barriers to a moderate extent and EBP implementation varies depending on gender, level of education, and job position. There is a need to create and implement educational interventions and programs to overcome the barriers to effective EBP implementation among primary healthcare nurses.

Access, Utilization, and Implementation of Research Among Rehabilitation Nurses

Purpose

This study aimed to understand rehabilitation nurses’ perceptions of research information, related barriers, and avenues for future research, specifically in those caring for individuals with burn injury, spinal cord injury, or traumatic brain injury.

Design

Qualitative semistructured interviews were conducted.

Methods

Eighteen interviews were conducted. A thematic network approach identified codes and developed basic, organizing, and global themes.

Results

Researchers identified factors that facilitated research uptake, determined organizational structures that support research culture, and described nurse engagement with literature.

Conclusions

Although participants desired to engage with the research literature, they identified barriers including time constraints, heavy workloads, and lack of access. To facilitate research uptake, research must be easily accessible, be easily digestible, and include clinical practice recommendations. Research must expand its scope to address issues relevant to the rehabilitation population.

Clinical Relevance

Our findings may be used to drive improvements in research competence, facilitate knowledge translation, and support evidence-based practice among rehabilitation nurses.

Evaluation of methods used to verify nasogastric feeding tube placement in hospitalized infants and children - A follow-up study

BACKGROUND

Nasogastric (NG) feeding tubes are used to deliver nutrition, hydration, and medications to hospitalized infants and children but the ongoing use of non-evidence-based practice (EBP) methods to confirm NG tube (NGT) placement has been associated with adverse patient events.

METHODS

A study was undertaken to ascertain if practice changes have occurred since findings from a previous study were published by the New Opportunities for Verification of Enteral tube Location (NOVEL) project. The NOVEL project was an initiative of the American Society of Parenteral and Enteral Nutrition (ASPEN). A survey was distributed to member organizations participating in the NOVEL project. Respondents were also asked if and when a change in practice occurred in the policy for NGT placement verification, if there was variation within the institutional units and if there were barriers to practice change.

FINDINGS

Respondents were primarily nurses (205/245) from 166 institutions that provided care to combined adult/pediatric/neonatal (122/166) patients. Respondents indicated a radiograph (64%) or pH measurement (24%) were best practice but in actual practice 42% use pH measurement and 23% use a radiograph to verify NGT placement. There was variability within institutions, with the Neonatal Intensive Care Unit (NICU) most often using aspiration and direct eye visualization to verify placement and the other units within the institutions using EBP method(s).

DISCUSSION

Comparing these results to previous work by the NOVEL project shows an increase toward the use of EBP method(s) to verify NGT placement verification.

APPLICATION TO PRACTICE

This study demonstrates variation within units at the same facility using methods unsupported by the literature, demonstrating that many centers still rely on non-EBP methods of NG placement confirmation, despite cautions issued by many major healthcare organizations.

Experiences of nurse managers and practitioners on implementation of an evidence-based practice intervention

Background

An evidence based practice (EBP) research project was undertaken to implement EBP interventions utilising the Iowa model in order to build the capacity of the nurses in using research evidence to improve decision making and quality care.

Aim

Exploring and understanding the experiences of nurse managers and practitioners who participated in the EBP change project.

Setting

The study was conducted in the intensive care unit (ICU) of a tertiary hospital in Lilongwe district in Malawi.

Methods

A qualitative approach and an exploratory-descriptive design was employed. The ICU was purposively selected as a unit where the EBP change project was implemented. A purposive sample of 10 nurse managers and practitioners was selected. Semi-structured interviews were conducted. All interviews were audio-recorded with a digital recorder and transcribed verbatim. Thematic analysis was applied to the transcripts.

Results

The participants’ experiences of implementing EBP interventions were underpinned by four themes namely, evidence-based patient management, effective nursing care, competence in delivering EBP, and factors interplaying in EBP. Use of model, protocol and availability of supportive managers and team were major determinants of EBP.

Conclusion

It is recommended to continue utilising the Iowa Model to facilitate building the EBP capacities of providers during scale up.

Contribution

Utilising the Iowa Model facilitates building of the capacity and empowers frontline nurses to effectively develop, implement and evaluate discipline specific EBP changes needed to improve practice and optimum care.

Replication of Implementing a Sit-to-Stand Exercise Program in an Assisted Living Facility

The current quality improvement project aimed at replicating the implementation of a sit-to-stand exercise program in a small 20-bed assisted living facility (ALF) in rural North Carolina. The primary outcome was for residents to maintain or improve function in performance of activities of daily living (ADLs). Even with the challenges of the coronavirus disease 2019 pandemic, ALF staff and residents found a way to continue the exercise program with a high level of participation and thus prevent avoidable decline in residents' independence with ADLs. [Journal of Gerontological Nursing, 48(3), 30-36.].

Using an E-learning activity to enhance student nurses' understanding of cognitive impairment

BACKGROUND

Nurses often lack the knowledge and expertise to work with older people with cognitive impairment, which includes dementia, delirium and depression. This is due in part to deficits in their basic nursing education related to older people and managing the care needs of people with cognitive impairment. We developed an e-learning activity to facilitate student nurses' knowledge of cognitive impairment.

OBJECTIVES

To test if the e-learning activity could improve student nurses' knowledge of cognitive impairment and whether they would find the style of learning beneficial.

DESIGN

A quasi-experimental pre-post-test design was used to test if the cognitive impairment e-learning activity could improve student nurses' knowledge about assessing and managing the needs of older people who are experiencing cognitive impairment. A 12-item true/false quiz was completed by participants.

SETTINGS

One large Western Canadian university.

PARTICIPANTS

Second year nursing students in the four-year baccalaureate degree program, second year nursing students in the bilingual four-year baccalaureate degree program, and first year nursing students in the two-year after-degree nursing program were invited to participate. Data from 166 students were included in the analysis (n = 166).

RESULTS

Based on the results of a paired t-test (p < 0.001 and an average score increase of 1.12 out of nine), we conclude that students' knowledge about cognitive impairment in older people increased following the e-learning activity. Students also offered qualitative feedback that identified the activity as both helpful and as an enjoyable way to learn and provided suggestions for improvement.

CONCLUSIONS

This e-learning activity was effective in helping students learn about how to work with older people experiencing cognitive impairment. This mode of learning might be useful for other difficult-to-teach content areas.

Awakening Canadians to ageism: a study protocol

Background

Making fun of growing older is considered socially acceptable, yet ageist humour reinforces negative stereotypes that growing old is linked with physical and mental deterioration, dependence, and less social value. Such stereotypes and discrimination affect the wellbeing of older people, the largest demographic of Canadians. While ageism extends throughout professions and social institutions, we expect nurses—the largest and most trusted group of healthcare professionals—to provide non-ageist care to older people. Unfortunately, nurses working with older people often embrace ageist beliefs and nursing education programs do not address sufficient anti-ageism content despite gerontological nursing standards and competencies.

Methods

To raise awareness of ageism in Canada, this quasi-experimental study will be supported by partnerships between older Canadians, advocacy organizations, and academic gerontological experts which will serve as an advisory group. The study, guided by social learning theory, will unfold in two parts. In Phase 1, we will use student nurses as a test case to determine if negative stereotypes and ageist perceptions can be addressed through three innovative e-learning activities. The activities employ gamification, videos, and simulations to: (1) provide accurate general information about older people, (2) model management of responsive behaviours in older people with cognitive impairment, and (3) dispel negative stereotypes about older people as dependent and incontinent. In Phase 2, the test case findings will be shared with the advisory group to develop a range of knowledge mobilization strategies to dispel ageism among healthcare professionals and the public. We will implement key short term strategies.

Discussion

Findings will generate knowledge on the effectiveness of the e-learning activities in improving student nurses’ perceptions about older people. The e-learning learning activities will help student nurses acquire much-needed gerontological knowledge and skills. The strength of this project is in its plan to engage a wide array of stakeholders who will mobilize the phase I findings and advocate for positive perspectives and accurate knowledge about aging—older Canadians, partner organizations (Canadian Gerontological Nurses Association, CanAge, AgeWell), and gerontological experts.

Nurses' view of implementation evidence-based fall prevention interventions: A qualitative study

AIM

The purpose of this descriptive qualitative study was to evaluate nurses' views of implementation evidence-based fall prevention interventions.

METHODS

The study was conducted with participation of nurses who worked in a training and research hospital after evidence-based fall prevention interventions had been implemented. Interviews were done with 17 nurses who participated in all training courses.

RESULTS

The evaluation of the interventions was examined, and three themes were extracted through analysis: 'effectiveness of training programme', 'barriers' and 'suggestions'.

CONCLUSION

Nurses emphasized that evidence-based fall prevention interventions are usable in hospital, but team collaboration and administrative support are required for better outcomes.

IMPLICATIONS FOR NURSING MANAGEMENT

The study result shows that fall prevention interventions should be introduced to all health care professionals, through the use of various training methods. Training should be given to patients and their caregivers, and barriers that nurses stated like understaffing, lack of materials and tools that ensure patient safety and internet (research/scientific information) access restriction should be reduced.

Barriers and requirements in the off-line emergency medical protocols implementation in Iranian Pre-hospital system: A qualitative study

BACKGROUND

To avoid making decisions based on the unproven opinions of emergency medical technicians (EMTs), many emergency medical service (EMS) systems rely on emergency medical protocols. As protocol-based on-scene decision-making is influenced by many challenges, identifying these challenges can result in providing appropriate conditions for EMTs' decision-making. Therefore, this study aimed to identify the barriers and requirements in the off-line emergency medical protocols implementation m in the prehospital emergency medical system.

MATERIALS AND METHODS

To conduct this study, qualitative content analysis using 10 field observations, 22 interviews, and 2 rounds of focus group discussions was applied. The duration of interviews lasted from October 2019 to January 2020. The Graneheim and Lundman approach was used to analyze the data.

RESULTS

Seven categories (15 subcategories) including education and awareness (professional training and education and community-based education); attitudes (professional attitude and community attitude); interactions and coordination (interpersonal interactions, organizational interferences, and community's interactions); rules and instructions (instructions and supportive rules); control system (monitoring and evaluation and motivational system); accessibility (recourses and communication); and organization (structure and process) were obtained as the obstacles and challenges in the offline emergency medical protocol implementation in the prehospital system.

CONCLUSIONS

There are many challenges in implementing offline emergency medical protocols in the prehospital emergency system. To achieve the effectiveness and efficiency of offline prehospital emergency protocols, it is necessary to facilitate these challenges and improve the EMTs' knowledge, attitude, and performance through cooperative and skill-based education. The findings of this study can be useful for EMS systems from national to local levels.

Effectiveness of an Evidence-Based Practice Training Program for Nurse Educators: A Cluster-Randomized Controlled Trial

BACKGROUND

Evidence-based practice (EBP) endeavors to integrate the best available evidence with clinical expertise and patient preference to enhance clinical outcomes. For nurses to effectively demonstrate EBP, the concepts of EBP should be systematically incorporated into the nursing curriculum, with nurse educators playing a pivotal role in execution. However, the effect of EBP training programs on nurse educators remains largely unexplored.

AIM

To evaluate the effectiveness of an EBP training program on the knowledge, attitude, practice, and competency of nurse educators.

METHODS

A pragmatic randomized controlled trial was conducted at a nursing education institution. Fifty-one nurse educators were cluster randomized into intervention and control groups. A 30-hour EBP training intervention was provided for nurse educators in the intervention group. The outcome variables were knowledge, attitude, practice, and competency regarding EBP. These outcomes were evaluated using the EBP knowledge and practice questionnaire, EBP attitude scale, and Fresno test. Data were collected at baseline, the end of 5 months, and the end of 10 months.

RESULTS

Fifty-one eligible participants were enrolled in the study. The intervention and control group had three clusters each with 27 and 24 participants, respectively. Participants in both groups were comparable for variables such as age, years of experience, and educational background (p > .05). Between groups, outcome variables were compared using mixed linear multi-level modeling. Nurse educators who received the EBP training program demonstrated significant differences in knowledge (p < .05), attitude (p < .05), practice (p < .05), and competency scores (p < .05), than that of the control group, indicating the intervention effectiveness.

LINKING EVIDENCE TO ACTION

EBP training programs are effective in improving the knowledge, attitude, practice, and competency of nurse educators.

Harnessing nursing to diminish ageism

BACKGROUND

The common practice of making fun of aging and older people demonstrates that ageism towards older people is socially acceptable. It is so accepted that even those of us who are aging or have moved into the 'third act' believe and fear the negative stereotypes that growing old is linked with physical and mental deterioration, dependence, and less social value. Ageism is evident in work places, family relationships, when older people purchase goods and services, in health and social institutions and extends throughout professions that work with older people.

OBJECTIVES

We explore how nurses-the largest group of healthcare professions- may be inadvertently perpetuating negative perceptions about older people in nursing practice, nursing education, and through common misconceptions about what gerontological nursing means.

METHODS

This is discussion paper using the literature.

RESULTS

We suggest that nursing education is well situated to diminish negative perspectives of ageing by incorporating theories of life-course and harmonious aging into the holistic perspective of individuals that nursing is well known for.

CONCLUSIONS

Greater understanding about the diversity of ageing and the context that have influenced older persons could encourage nurses to treat them holistically with dignity, which would ultimately improve older people's experiences. Improving older persons' experiences is like paying it forward, as we all are ageing and if we are to have a different experience when we are old, it is necessary to diminish stereotypes about ageing, and work towards inclusion of older people in social and healthcare institutions.

IMPLICATIONS FOR PRACTICE

It is important for nurses, particularly those in nursing education, to support the incorporation of a life course and harmonious view of aging in which the social, political, and environmental context of individuals are viewed as part of the difference of ageing.

Building Veterinarians beyond Veterinary School: Challenges and Opportunities for Continuing Professional Development in Veterinary Medicine

Continuing professional development (CPD) is an important mechanism for veterinarians to acquire, maintain, and enhance their capability to perform competently in their chosen practice area over their career. Although most licensing bodies require veterinarians to complete a minimum number of CPD hours each registration cycle, there are known issues with verifying that these activities are having the desired effects of ensuring professional competence and improving outcomes for patients, owners, and veterinarians. In this review, we summarize the literature across different health care professions to highlight three key challenges for veterinary CPD programs. These are (a) defining what it means to be professionally competent across different career stages from graduation to retirement, (b) delivering CPD activities that are effective in promoting evidence-based medicine and behavioral change in practice, and (c) developing reliable and sustainable systems to formally assess the continued professional competence of veterinarians. A common theme across all challenges was the importance of interacting with colleagues as an opportunity to receive external feedback on their professional strengths and weaknesses and to develop stronger support networks for managing common stressors in clinical practice. There was also a recognized need to develop more transparent outlines of the available and acceptable options for managing different animal health concerns as a first step toward identifying new opportunities for the veterinary profession to elevate the level of care provided. Based on these findings, we propose a new framework for defining, delivering, and evaluating CPD that promotes stronger collaboration between veterinarians to improve professional and personal well-being.

Upskilling health and care workers with augmented and virtual reality: protocol for a realist review to develop an evidence-informed programme theory

INTRODUCTION

Augmented reality (AR) and virtual reality (VR) are increasingly used to upskill health and care providers, including in surgical, nursing and acute care settings. Many studies have used AR/VR to deliver training, providing mixed evidence on their effectiveness and limited evidence regarding contextual factors that influence effectiveness and implementation. This review will develop, test and refine an evidence-informed programme theory on what facilitates or constrains the implementation of AR or VR programmes in health and care settings and understand how, for whom and to what extent they 'work'.

METHODS AND ANALYSIS

This realist review adheres to the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) standards and will be conducted in three steps: theory elicitation, theory testing and theory refinement. First, a search will identify practitioner, academic and learning and technology adoption theories from databases (MEDLINE, Scopus, CINAHL, Embase, Education Resources Information Center, PsycINFO and Web of Science), practitioner journals, snowballing and grey literature. Information regarding contexts, mechanisms and outcomes will be extracted. A narrative synthesis will determine overlapping configurations and form an initial theory. Second, the theory will be tested using empirical evidence located from the above databases and identified from the first search. Quality will be assessed using the Mixed Methods Appraisal Tool (MMAT), and relevant information will be extracted into a coding sheet. Third, the extracted information will be compared with the initial programme theory, with differences helping to make refinements. Findings will be presented as a narrative summary, and the MMAT will determine our confidence in each configuration.

ETHICS AND DISSEMINATION

Ethics approval is not required. This review will develop an evidence-informed programme theory. The results will inform and support AR/VR interventions from clinical educators, healthcare providers and software developers. Upskilling through AR/VR learning interventions may improve quality of care and promote evidence-based practice and continued learning. Findings will be disseminated through conference presentations and peer-reviewed journal articles.

Assessing Evidence-Based Practice Knowledge: An Innovative Approach by a Nursing Research Council

OBJECTIVE

The aim of this study was to describe the structure and processes implemented by nursing research councils to conduct a nurse-led research study at an urban community teaching hospital.

BACKGROUND

We assessed nurses' knowledge, skills, and attitudes toward evidence-based practice (EBP) to inform development plans.

METHODS

This is an institutional review board-approved single-site cross-sectional anonymous online survey (Evidence-Based Practice Questionnaire [EBPQ]) emailed to 850 participants. Data were analyzed using SPSS v25 (Armonk, New York).

RESULTS

Initial response rate was 11%. Deployment of new strategies achieved an overall response rate of 57.5%. EBPQ subscale scores were highest for "attitude," followed by "knowledge/skills," and "practice." Lowest-scoring items included critical appraisal of literature, converting information needs into a question, time for new evidence, information technology, and research skills.

CONCLUSIONS

Our EBPQ scores were consistent with prior findings. Our strategies provide a framework for other institutions in similar stages of implementing EBP and nurse-led research initiatives.

Perceived Knowledge, Attitudes, and Implementation of Evidence-Based Practice Among Jordanian Nurses in Critical Care Units

BACKGROUND

Evidence-based practice (EBP) has become of great interest to policymakers, health care practitioners, and researchers.

OBJECTIVE

This study aimed at assessing knowledge associated with, attitudes toward, and implementation of EBP among Jordanian registered nurses (RNs) in critical care units.

METHOD

A descriptive, correlational, and cross-sectional study was conducted in 5 hospitals: 3 public and 2 private. A convenience sample of 200 RNs was invited. Data were collected using a paper-based and self-administered questionnaire, in 2 sections; the first section was the demographic and contextual characteristics and the second was the Evidence-Based Practice Questionnaire (J Adv Nurs. 2006;53(4):454-458) to measure RNs' knowledge, attitudes, and EBP.

RESULTS

A total of 187 RNs were included in this study. Findings revealed that Jordanian RNs in critical care units perceived themselves as having a satisfactory level of knowledge and practice of evidence-based interventions. In addition, RNs strongly recognized the value of EBP. There were significant positive associations between EBP and knowledge associated with EBP (r = 0.708, P < .001) and attitude toward EBP (r = 0.490, P < .001).

CONCLUSION

Knowledge associated with EBP, a positive attitude toward EBP, higher educational qualifications, and training in EBP all increased the implementation of EBP. It is recommended that continuing education programs on EBP for nurses be conducted. Nursing educators in clinical settings have to consider a number of strategies to improve EBP. A qualitative research design and/or including open-ended questions are encouraged to gain more in-depth views about EBP.

Nurses' perceptions of their role with respect to promoting physical activity in adult patients: a systematic review

AIMS AND OBJECTIVES

To identify the nurses' perceptions of their role with respect to promoting physical activity in adult patients and factors related to this role perceptions.

BACKGROUND

Ageing and chronic diseases are often accompanied by a decrease in physical activity. Nurses are in an excellent position to promote physical activity, because of their close and frequent interactions with patients. However, they often fail to actively stimulate patients to physical activity due to a lack of time, competing priorities and their focus on acute problems. Unclear was how nurses view their professional role in the promotion of physical activity.

DESIGN

Systematic literature review.

METHODS

PubMed, COCHRANE and CINAHL EBSCO were searched for papers published from 2006 to September 2019. Two reviewers independently assessed the methodological quality, using MMAT criteria. Thematic synthesis was used to analyse the data. The PRISMA statement was followed for reporting.

RESULTS

Overall, 10 quantitative, eight qualitative and one mixed methods study were included in the review. Analyses of these studies resulted in six themes: (1) active and professional role; (2) the recognised importance; (3) fear of patient falling; (4) patient's present health and need; (5) interdisciplinary context and responsibility; and (6) nurses' knowledge.

CONCLUSIONS

Nurses perceive they have an active role in the promotion of physical activity and consider it as important and part of their professional role. Clear guidance increased education and stronger awareness of guidelines might enable nurses to translate their perceived role into daily practice. This will enhance professional fulfilment as well as patients' physical activity.

RELEVANCE TO CLINICAL PRACTICE

The findings guide the development of interventions that aim to improve nursing care with respect to the promotion of physical activity and help managers and educators to provide appropriate resources and education.

Knowledge translation for the everyday optometrist

A gap exists between best evidence and actual clinical care provided to patients. The advent of evidence-based practice was meant to address this gap by providing practitioners with a method to search, evaluate and incorporate evidence into practice. However, the gap continues to exist. The health research fields of knowledge translation and implementation science have evolved over the last few decades to assist practitioners in embedding research findings and best evidence into routine practice. Knowledge translation seeks to improve public health outcomes by facilitating the movement of best evidence from the bench to clinical practice. Implementation science is the study of methods to integrate research findings and evidence-based practice into routine practice. This literature review aims to revisit the concepts of evidence-based practice and to introduce knowledge translation and implementation science by exploring their roles and influences in the delivery of appropriate glaucoma care by optometrists.

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.

Research focus and thematic trends in magnet hospital research: A bibliometric analysis of the global publications

AIMS

The study aims to carry out a bibliometric analysis of the research on magnet hospital from 1988-2020.

DESIGN

A statistical and visualization bibliometric analysis was conducted between February-May 2020.

METHODS

The information was extracted from Web of Science by the topic advanced search strategy. HistCite-Pro, Excel, GunnMap, BibExcel and VOSviewer were used to extract, integrate and visualize the bibliometric information. Furthermore, the research contents of the core-authors were explored and summarized by reviewing all the published articles.

RESULTS

Articles (N = 396) published in 107 journals were retrieved in the Web of Science from 1988-2020. The USA (N = 319) and University of Pennsylvania (N = 38) were the most productive country and institution respectively. Author co-citation and bibliographic-coupling network analysis identified that Aiken, Kramer, Laschinger, Schmalenberg, Lake and Johantgen were the major contributors and leaders in this field. According to the research content of the main contributors and keyword co-occurrence analysis result, the research focus could be divided into four parts: the mechanism leading to the outcomes differences for magnet hospital, the evidence-based practice, the outcomes comparison between magnet hospital and non-magnet hospital and the practice environment.

CONCLUSION

This bibliometric study offered a comprehensive overview of current study status of magnet hospital and this area has been drawn increasing attention over the years. However, the research on magnet hospital is still relative limited and needs to be paid more attention, especially in developing countries.

IMPACT

This study showed the most contributed countries, journals, institutions, authors and the main themes related to magnet hospital, which would help researchers find potential partners, optimize and deepen future research, such as enhancing the magnet hospital research in developing countries, improving the evidence-based research and considering the impact caused by different culture. Furthermore, this study can also give suggestions for magnet hospital policy makers.

Reinvigorating Evidence-Based Practice

Nurses' capabilities for evidence-based practice (EBP) cannot be presumed. Even in institutions with longstanding commitment to promoting the use of EBP, nurses may not have the EBP knowledge and skills needed to support clinical decision-making. This article describes a multifaceted approach to (a) renewing a spirit of inquiry about EBP and research and (b) strengthening nurses' EBP capabilities at a comprehensive cancer center.

Step 0: The Spirit of Inquiry

It stands to reason that competency in every area of practice, including the evidence-based practice process, improves through participation in the practice. But before engagement in the evidence-based practice process can occur, Melnyk and Fineout-Overholt¹ assert, there must be a "spirit of inquiry." This column describes strategies to spark and cultivate a spirit of inquiry for evidence-based practice and barriers that can dampen the spirit.

Predictors of Intensive Care Unit Nurses' Practice of Evidence-Based Practice Guidelines

Although many studies discussed evidence-based practice among general nurses, few studies were found by the researchers among intensive care unit nurses. Also, no study has been conducted to investigate the predictors of evidence-based practice among intensive care unit nurses in Jordan. Therefore, this study aims to identify the predictors of evidence-based practice among intensive care unit nurses in Jordan. A descriptive cross-sectional design was used to conveniently recruit 132 participants. Self-reported questionnaires were utilized including the Evidence-Based Practice Questionnaire and Evidence-Based Practice barrier scale. Participants’ rate of evidence-based practice was 60% (M = 4.2/7), which was significantly correlated with their knowledge (r = 0.739, P < .01) and attitudes (r = 0.564, P < .01) of evidence-based practice. The results revealed a 2-predictor model that explained 62.2% of the variance in evidence-based practice among intensive care unit nurses. The 2 variables were attitude (β = 0.245) and knowledge (β = 0.563). The outcomes of this study added new information regarding the prediction of evidence-based practice among intensive care unit nurses. An educational program for nurses regarding this issue is crucial to improve their practice aiming at enhancing nursing care. Also, nursing schools should update their curricula to explain the importance of evidence-based practice and to enhance students’ competencies in research utilization and statistical skills.

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.

Capability beliefs and the intention to adopt evidence-based practices in the future among nursing students: An international study

BACKGROUND

Capability beliefs and the intention to adopt EBP in future nursing practice have been identified as strong antecedents of subsequent utilization of EBP. Despite this, a multicountry comparison may yield interesting findings that can be useful in designing empirically based and culturally tailored strategies to facilitate and enhance students' capability beliefs as well as their intentions to integrate evidence into nursing practice.

AIMS AND OBJECTIVES

This report sought to compare capability beliefs and intentions to adopt EBP in the future among student nurses from four countries-specifically, Oman, India, Nigeria, and Saudi Arabia-and to identify specific variables that predict the intention to adopt EBP.

METHODS

This study employed a descriptive, cross-sectional, comparative research design to gather data from a convenience sample of 1387 nursing students from four countries using self-report questionnaires that captured their EBP capability beliefs and their intention to adopt EBP in clinical practice upon graduation. This study adhered to STROBE guideline for cross-sectional studies.

RESULTS

Overall, nursing students reported a high intent to adopt EBP in their future nursing practice; however, the exact rate varied according to the country of origin. Students' gender, student track, education, country of origin, access to the internet, and capability beliefs were seen as important in explaining the likelihood of future implementation of evidence in clinical nursing practice. Capability beliefs among students were moderate, with large differences observed between countries.

CONCLUSIONS

Although the surveyed nursing students reported moderate capability beliefs, their intention to adopt and integrate EBP in their future nursing practice was relatively high.

RELEVANCE TO CLINICAL PRACTICE

The findings of this study highlight the critical role of nurse educators and nurse administrators in fostering EBP capability beliefs and future intentions to adopt among students through curricular review, implementation of evidence-based strategies, and the promotion of EBP culture within the clinical learning sites.

Research utilization in municipality nursing practice in rural districts in Norway: a cross-sectional quantitative questionnaire study

BACKGROUND

Scientific knowledge and theory constitute part of the nurse's competence and evidence-based nursing practice. To obtain and maintain these skills, nurses require access to research utilization. The aim of the present study was therefore to describe and compare nurses in nursing homes and home-based nursing care and their use of research knowledge in their practice in elderly care in Norwegian rural districts.

METHODS

The Research Utilization Questionnaire (RUQ) was employed in cross-sectional quantitative design. One hundred nurses were recruited from ten rural municipalities that participated in the study. Inclusion criteria for participating were registered nurses and employees working in the municipal elderly care service for 6 months or more.

RESULTS

Most participants were younger than 55 years old, worked in permanent jobs, and were educated more than 5 years ago. The result showed that nurses in nursing homes were significantly more positive compared to nurses in home-based nursing care when analyzing all three domains in the RUQ together, as well as for attitudes towards research when testing each domain separated. Overall, each item in the domains revealed opinions that were more positive for nurses in nursing homes. The regression analysis showed that attitudes towards research, as well as availability and support of research utilization predicted the use of research in daily practice.

CONCLUSIONS

Positive attitudes, availability, and support for research utilization can contribute to greater use of research in nursing practice and improve the quality of service. Younger nurses' knowledge about using research should be shared with senior colleagues, who possess much experience in practice. In collaboration, they can develop evidence-based practice by the implementation of research seen in the context of nurses' experiences, user involvement, and person-centred practice. The i-PARIHS (Promoting Action on Research Implementation in Health Services) framework can be a useful tool in this implementation process.

Practices, preferences, and opinions of New Zealand veterinarians towards continuing professional development

Aims: To describe the current practices and preferences of New Zealand veterinarians towards continuing professional development (CPD), explore factors acting as perceived barriers to CPD engagement, and identify opportunities for reforming the current CPD regulations. Methods: A cross-sectional survey of all veterinarians registered with the Veterinary Council of New Zealand (VCNZ) was conducted in October 2019. Descriptive statistics were provided for all quantitative study variables and thematic analysis was performed on the free-text survey comments to identify key issues regarding the current CPD regulations in New Zealand. Results: Complete survey responses were provided by 222/3,484 (6.4%) registered veterinarians. Most respondents (153/222; 68.9%) were satisfied with the amount of CPD completed and spent a mean of $2,511 (median $2,000; min $0; max $20,000) on CPD activities each year. The most popular CPD formats were those involving collegial interaction including conference and skills training workshops. The choice of CPD activities was most commonly influenced by interest in the topics and the desire to become more competent in their work while the main barriers were difficulties fitting CPD around work and family commitments. There were 164 (73.9%) respondents who cited at least one occasion in the previous 12 months where participating in CPD caused them to modify their existing practices. Thematic analysis of the free-text comments revealed several major themes related to the administrative burden of recording CPD activities under the current regulatory framework, and the need to develop CPD plans tailored towards the unique circumstances and goals of individual veterinarians. Respondents also expressed concerns over the reliability of using CPD record audits for evaluating professional competency. Factors identified as being the most helpful for improving the current CPD framework were simplifying the CPD points categories and developing a mechanism to record and share CPD activities in real-time. Conclusions: While most respondents felt there was significant value in completing CPD, the current regulatory framework was perceived to be administratively burdensome and inflexible in allowing them to tailor CPD activities to match their unique employment situation, learning style and professional goals. Clinical relevance: Providing resources that could assist veterinarians to design and implement tailored CPD programmes may improve professional and personal outcomes. However, further research is needed to develop more effective mechanisms for identifying veterinarians who are not performing competently without placing excessive administrative burdens on those who are.

Innovation in Education With Acute Care Nurses

As health care is continuously changing, it is important that nurses are continually learning to promote evidence-informed practice. eLearning has gained prominence to gain information and enhance learning within time and space constraints. Innovation such as gamification within and outside of eLearning has also risen in interest to increase engagement in the learning process. In this article, we discuss the usefulness of innovation such as gamification via an ePlatform for continuing education of acute care nurses. Although innovative methods using an ePlatform have the potential to meet nurses' desires for continuing education that is flexible and applicable to their work, more research is needed to understand its effectiveness among acute care nurses. [J Contin Educ Nurs. 2020;51(9):420-424.].

Knowledge translation: Radiographers compared to other healthcare professionals

OBJECTIVES

This narrative review examines the current status of evidence-based practice and knowledge translation in diagnostic radiography. It explores knowledge translation efforts in the allied health professions aimed at systematically implementing evidence-based practice and suggests ways that these may be applied within diagnostic radiography.

KEY FINDINGS

Knowledge translation in diagnostic radiography is in its infancy with numerous examples of key findings of rigorous studies not implemented in practice. Utilising frameworks, models and theories to systematically translate knowledge into evidence-based practice has been shown to be effective in other allied health professions. Whilst few studies in diagnostic radiography report utilising these systematic approaches to implementing evidence-based practice, those that do, show promising results. Attitudes towards evidence-based practice within diagnostic radiography are becoming more positive and it is important to use this positive shift in attitudes to create real evidence-based change in the profession.

CONCLUSION

The potential benefits of systematically translating knowledge into evidence-based practice in diagnostic radiography are wide reaching with positive implications for our patients, the profession and wider community. Leaders at all levels of radiography must work towards implementing evidence-based practice in their daily work.

IMPLICATIONS FOR PRACTICE

Systematic approaches to knowledge translation should be adopted and reported in diagnostic radiography in order to more effectively translate knowledge into evidence-based practice.

Measures of evidence-informed decision-making competence attributes: a psychometric systematic review

Background

The current state of evidence regarding measures that assess evidence-informed decision-making (EIDM) competence attributes (i.e., knowledge, skills, attitudes/beliefs, behaviours) among nurses is unknown. This systematic review provides a narrative synthesis of the psychometric properties and general characteristics of EIDM competence attribute measures in nursing.

Methods

The search strategy included online databases, hand searches, grey literature, and content experts. To align with the Cochrane Handbook of Systematic Reviews, psychometric outcome data (i.e., acceptability, reliability, validity) were extracted in duplicate, while all remaining data (i.e., study and measure characteristics) were extracted by one team member and checked by a second member for accuracy. Acceptability data was defined as measure completion time and overall rate of missing data. The Standards for Educational and Psychological Testing was used as the guiding framework to define reliability, and validity evidence, identified as a unified concept comprised of four validity sources: content, response process, internal structure and relationships to other variables. A narrative synthesis of measure and study characteristics, and psychometric outcomes is presented across measures and settings.

Results

A total of 5883 citations were screened with 103 studies and 35 unique measures included in the review. Measures were used or tested in acute care (n = 31 measures), public health (n = 4 measures), home health (n = 4 measures), and long-term care (n = 1 measure). Half of the measures assessed a single competence attribute (n = 19; 54.3%). Three measures (9%) assessed four competence attributes of knowledge, skills, attitudes/beliefs and behaviours. Regarding acceptability, overall missing data ranged from 1.6–25.6% across 11 measures and completion times ranged from 5 to 25 min (n = 4 measures). Internal consistency reliability was commonly reported (21 measures), with Cronbach’s alphas ranging from 0.45–0.98. Two measures reported four sources of validity evidence, and over half (n = 19; 54%) reported one source of validity evidence.

Conclusions

This review highlights a gap in the testing and use of competence attribute measures related to evidence-informed decision making in community-based and long-term care settings. Further development of measures is needed conceptually and psychometrically, as most measures assess only a single competence attribute, and lack assessment and evidence of reliability and sources of established validity evidence.

Registration

PROSPERO #CRD42018088754.

Systematic and integrative reviews: synthesising evidence for community nursing practice

Ease of access to vast amounts of information presents significant opportunities and challenges for nurses in the community as they seek to base their practice on the best available evidence. Growing expectations around evidence-based practice have developed alongside developments in evidence synthesis, which adopts robust approaches to identifying, appraising and synthesising key evidence for clinical decision-making. The context in which evidence-based practice occurs is key, and this article discusses the skills and knowledge needed for community nurses to discern how evidence and information should influence their decisions to review and change approaches to clinical practice. Importantly, if nurses understand the status of evidence underpinning areas of practice, they can ensure that the preferences and needs of patients and families are met.

Effectiveness of an Evidence-Based Practice Educational Intervention among School Nurses

The evidence-based practice (EBP) approach to high-quality care is designed to improve patient outcomes. However, little research has been conducted to determine how EBP is adopted and implemented among school nurses in Taiwan. This study evaluated an EBP training program implemented among school nurses in Taiwan to determine whether and how effectively it improved their knowledge levels, attitudes, skills, and self-efficacy. A pretest-posttest research design was employed. Participants were recruited via convenience sampling from among 193 primary schools throughout Tao-Yuan and New Taipei City in Taiwan. The EBP program implemented both mobile learning technology and the flipped classroom format. The learning outcomes were evaluated before, immediately after, and at a 3-month follow-up. In this regard, the data were collected using the School Nurse Evidence-Based Practice Questionnaire. The results showed that the participant scores for the items of knowledge and self-efficacy significantly increased over the study period. Somewhat differently, scores for the skill items significantly increased from the pre-test to the immediate post-test, but significantly decreased from the immediate post-test to the final follow-up. Overall, however, the EBP program led to marked improvements in knowledge, skills, and self-efficacy. These findings can help guide the development of a creative evidence-based school nursing curriculum.

Cultivating evidence-based practice through mentorship

BACKGROUND

Nurses' use of evidence-based practice (EBP) improves patient outcomes through provision of optimal patient care.

AIM

The Evidence-Based Practice Mentorship Program (EBPMP) is a self-directed, year-long immersion program implemented for staff nurses to experience the EBP process with close mentor support. The aim of this program is to bolster a culture of EBP at a single large pediatric quaternary care hospital in the Northeast.

RESULTS

A total of 81 nurses across 4 cohorts participated in this organization wide program from 2016 to 2019. To date the program has produced 46 internally and externally disseminated EBP projects. Of the graduates, 7-nurse mentees have become formal EBPMP mentor's, 3 have applied and been accepted into the organizational based Nursing Science Fellowship to carry out clinical inquiry projects to fill important literary gaps, and 6 have received promotions or career advancements. Most importantly, graduates have anecdotally reported that program participation inspired deeper critical reflection of patient care.

SUMMARY

Utilizing mentorship to facilitate EBP was a key educational strategy for the busy mentors and mentees, as many of the nurse participants were direct care providers. This self-directed program resulted in a high project completion rate leading to continued organizational support for the program, which is now in its fourth year.