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Adombire S, Baiden D, Puts M, Puchalski Ritchie LM, Ani-Amponsah M, Cranley L. Knowledge, skills, attitudes, beliefs, and implementation of evidence-based practice among nurses in low- and middle-income countries: A scoping review. Worldviews Evid Based Nurs 2024; 21:542-553. [PMID: 38853345 DOI: 10.1111/wvn.12734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 03/25/2024] [Accepted: 05/05/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Over the past three decades, research studies on nurses' engagement in evidence-based practice (EBP) have been widely reported, particularly in high-income countries, with studies from these countries dominating literature reviews. As low- and middle-income countries (LMICs) continue to join the EBP movement, primary research has emerged over the past decade about nurses' engagement with EBP. AIMS The aim of this scoping review was to identify the types and extent of published research regarding nurses' knowledge, skills, attitudes, beliefs, and implementation of EBP in LMICs. METHODS The JBI scoping review methodology was used. Eight databases were searched up to November 2023. The review included primary studies (quantitative, qualitative, and mixed methods) that reported the knowledge, skills, attitudes, beliefs, or implementation of EBP among nurses in LMICs. Included studies focused on registered nurses in all healthcare settings within LMICs. Studies published in English were included with no limit on publication date. Two independent reviewers screened titles, abstracts, and full-text articles of published studies. Data were analyzed quantitatively using frequencies and counts. Textual data from qualitative studies were analyzed using descriptive content analysis. RESULTS Fifty-three publications were included, involving 20 LMICs. Studies were published between 2007 and 2023, with over 60% published in the past 7 years. Studies that evaluated familiarity/awareness of EBP showed that in general, nurses had low familiarity with or awareness of EBP. Most studies (60%) described nurses' attitudes toward EBP as positive, favorable, or high, and 31% as moderate. However, over 60% of studies described nurses' EBP knowledge/skills as moderate, low, or insufficient. Approximately 84% of studies described EBP implementation in healthcare settings as moderate, low, poor, or suboptimal. LINKING EVIDENCE TO ACTION Studies on nursing EBP have been increasing in LMICs for the past two decades, with findings highlighting opportunities for advancing EBP in nursing within LMICs. Health systems and healthcare organization leaders in LMICs should equip nurses with EBP knowledge and skills while providing the needed resources and support to ensure consistent implementation of EBP to improve health outcomes.
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Affiliation(s)
- Stephen Adombire
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Deborah Baiden
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Lisa M Puchalski Ritchie
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute-St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Lisa Cranley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Schetaki S, Patelarou E, Giakoumidakis K, Kleisiaris C, Patelarou A. Evidence-Based Practice Competency of Registered Nurses in the Greek National Health Service. NURSING REPORTS 2023; 13:1225-1235. [PMID: 37755348 PMCID: PMC10536009 DOI: 10.3390/nursrep13030105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/03/2023] [Accepted: 09/06/2023] [Indexed: 09/28/2023] Open
Abstract
Nurses' competency toward evidence-based practice (EBP) has been extensively investigated by several studies worldwide. However, factors affecting the competence of Greek nurses working in the NHS have not been fully investigated in terms of EBP. Thus, this study aimed to explore the impact of the individual qualifications of nurses on their competence toward EBP. Data from 473 registered nurses working in 10 hospitals in the Greek National Health Service (NHS) were collected between October and December 2020 using a convenience sampling method in a cross-section design. The Greek version of the 35-item (five-point Likert scale) Evidence-Based Practice Competency Questionnaire for Professional Registered Nurses (EBP-COQ Prof) was used to assess the competence level of nurses, focusing on attitudes, skills, and knowledge, as well as the utilization of EBP in clinical practice. One-way ANOVA and Pearson coefficient tests were applied to compare the possible differences among variables (two or more groups) as appropriate. A multi-factorial regression model was applied to explore participants' qualifications, including demographics (MSc degree, gender, English language knowledge, etc.) as independent variables, and to control for potential confounding effects toward EBP competency. The p-values < 0.05 were considered statistically significant. The mean age of the 473 participants (402 women and 71 men) was 44.7 ± 9.2 years old. The mean value of competence subscales was found as follows: attitudes 3.9 ± 0.6, knowledge 3.7 ± 0.6, skills 3.1 ± 0.8, and utilization 3.4 ± 0.7. A multivariate regression analysis revealed that associates of "Master's degree" (t = 3.039, p = 0.003), "Writing an academic article" (3.409, p = 0.001), "Working in a University clinic" (2.203, p = 0.028), and "Computer Skills" (2.404, p = 0.017) positively affected "Attitudes", "Knowledge", "Skills", and "Utilization", respectively. The research data suggest that nurses working in the Greek NHS were limited in competence regarding EBP in comparison with other European countries. Therefore, vocational, educational, and training programs tailored to EBP enhancement are crucially important. This study was not registered.
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Affiliation(s)
| | | | | | | | - Athina Patelarou
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71410 Heraklion, Greece; (S.S.); (E.P.); (K.G.); (C.K.)
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Alomari A, Singh K, Hassan N, Mannethodi K, Kunjavara J, Vellaramcheril Joy G, Al Lenjawi B. The improvement in research orientation among clinical nurses in Qatar: a cross-sectional study. Nurse Res 2023; 31:9-16. [PMID: 36511161 DOI: 10.7748/nr.2022.e1863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The main barrier to engaging nurses in research is the lack of research knowledge and skills. AIM To explore the influence of research workshops on the research orientation of nurses in a large referral hospital in Qatar. DISCUSSION This article describes a cross-sectional study involving 564 nurses working in 14 health facilities who attended research workshops in Qatar. The authors collected data using the Edmonton Research Orientation Survey (EROS) as well as questions considering support and barriers to research. Descriptive statistics were used to summarise and determine the sample characteristics and distribution of participants. The participants who attended the workshop were found to have a higher orientation towards the EROS sub-scales of evidence-based practice, valuing of research, involvement in research, being at the leading edge of the profession and support for research, compared to those who did not attend the workshop. There was no statistical difference between the groups in the research barrier sub-scale. CONCLUSION Despite significant improvements in their responses to the EROS research orientation sub-scales after attending the workshop, the nurses still reported many barriers to being actively engaged in research. IMPLICATIONS FOR PRACTICE Healthcare organisations should assist with integrating evidence-based practice into healthcare. There is a need for research education for clinical nurses to bring evidence into clinical practice to improve the quality of patient outcomes. Increasing the research capacity of nurses will lead to their emancipation in addressing the flaws in clinical practice and motivate them to use evidence in patient care.
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Furuki H, Sonoda N, Morimoto A. Factors related to the knowledge and skills of evidence-based practice among nurses worldwide: A scoping review. Worldviews Evid Based Nurs 2023; 20:16-26. [PMID: 36571237 DOI: 10.1111/wvn.12623] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/17/2022] [Accepted: 09/22/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Promoting evidence-based practice (EBP) among nurses may be a valuable component of improving health care. However, a comprehensive analysis of the factors associated with the knowledge and skill EBP in nurses has not been performed to date. This is essential for facilitating the acquisition of relevant knowledge and skills to effectively implement EBP. AIMS The aim of the study was to determine the factors related to the knowledge and skills of EBP among nurses. METHODS We searched various literature databases up to October 25, 2021, for relevant studies that investigated the factors associated with the knowledge and skills of EBP in nurses. The authors, year of study, country, study design, study subject information, instruments used for the assessment EBP knowledge and skills, use of multivariable analysis, and factors significantly associated with the knowledge and skills of EBP among nurses were extracted from each eligible study and collated to identify commonly reported factors. RESULTS We identified 47 eligible studies conducted in a wide range of countries. Nine articles applied multivariable analyses, and 38 articles did not perform any multivariable analyses. The factors related to the knowledge and skill levels of EBP among nurses were classified into two categories: personal and work-environment factors. In the nine articles that conducted multivariable analysis, personal factors, which included educational level, participation in EBP education, and experience conducting research, and work-environment factors, such as resources and organizational support for EBP, were related to the knowledge and skills of EBP among nurses. LINKING EVIDENCE TO ACTION Our review highlighted educational level, participation in EBP education, experience conducting research, and resources and organizational support for EBP as important factors that are associated with the knowledge and skills of EBP in nurses worldwide. Focusing on these factors may help improve nurses' understanding of EBP and facilitate the implementation of EBP.
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Affiliation(s)
- Hideaki Furuki
- Graduate School of Nursing, Osaka Metropolitan University, Osaka, Japan
| | - Nao Sonoda
- Graduate School of Nursing, Osaka Metropolitan University, Osaka, Japan
| | - Akiko Morimoto
- Graduate School of Nursing, Osaka Metropolitan University, Osaka, Japan
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Research Critique Simulation: A Novel Approach to Build Staff Nurses' Confidence. J Perianesth Nurs 2023; 38:148-150. [PMID: 36610869 DOI: 10.1016/j.jopan.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/20/2022] [Indexed: 01/06/2023]
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Hoegen P, Vos M, van Oostveen C, de Bot C, Echteld MA, Maaskant J, Vermeulen H. Nurse Leadership and Work Environment Association with Outcome Expectancy and Self-Efficacy in Evidence-Based Practice among Hospital Nurses in The Netherlands: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14422. [PMID: 36361301 PMCID: PMC9659071 DOI: 10.3390/ijerph192114422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
The active participation of nurses in evidence-based practice (EBP) is challenging and topical, as shown by the worldwide calls for appropriate, accessible, affordable care and the de-implementation of unnecessary care. Nurses' perceived support from their managers and work environments may affect their self-efficacy and outcome expectancy in EBP, as well as hinder them in EBP. Associations between these issues have not yet been explored. This study examines the association of self-efficacy and outcome expectancy levels in EBP, as well as the perceived support for EBP from nurse leaders and in the working environment, among Dutch hospital nurses. METHODS Questionnaires measuring nurses' self-efficacy, outcome expectancy, and perceived support for EBP from nurse leaders and their work environment were completed by 306 nurses in eight hospitals between March 2021 and June 2021. We used multilevel regression analyses to determine the associations and covariates. RESULTS This study shows that EBP-supportive leaders and work environments positively contribute to nurses' self-efficacy and outcome expectancy in EBP, along with the covariates undertaking EBP activities and educational level. CONCLUSIONS To improve nurses' active participation in EBP, nurses need to increase their self-efficacy and outcome expectancy in EBP. Supportive leaders and a supportive work environment do have an impact. Hence, these factors need attention when implementing EBP among nurses.
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Affiliation(s)
- Peter Hoegen
- School of Health and Social Care, Avans University of Applied Science, Hogeschoollaan 1, 4818 CR Breda, The Netherlands
| | - Mireille Vos
- Bachelor of Nursing, Inholland University of Applied Sciences, De Boelelaan 1109, 1081 HV Amsterdam, The Netherlands
| | - Catharina van Oostveen
- Research Department, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM Hoofddorp, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands
- Research and Education in Nursing Consortium (RE-Nurse), Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
| | - Cindy de Bot
- School of Health and Social Care, Avans University of Applied Science, Hogeschoollaan 1, 4818 CR Breda, The Netherlands
| | - Michael A. Echteld
- School of Health and Social Care, Avans University of Applied Science, Hogeschoollaan 1, 4818 CR Breda, The Netherlands
| | - Jolanda Maaskant
- Master EBP in Healthcare, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Hester Vermeulen
- Research and Education in Nursing Consortium (RE-Nurse), Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Kapittelweg 54, 6525 EP Nijmegen, The Netherlands
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Al Nusair H, Bani-Issa W, Alnjadat R, Fonbuena M, Perinchery S, AlAzza R. The effect of multicomponent approach in enhancing the level of confidence with evidence-based practice activities and promoting evidence-based practice culture among nurses in a clinical setting in the United Arab Emirates. J Nurs Manag 2022; 30:4285-4293. [PMID: 36190519 DOI: 10.1111/jonm.13826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 12/30/2022]
Abstract
AIM The aim of this work is to examine the effect of multicomponent interventions on enhancing the level of confidence of staff nurses with evidence-based practice in an acute care hospital in the United Arab Emirates. BACKGROUND Evidence-based practice is one of the strategic pillars of nursing practice and a key to organizational success. To effectively implement and sustain evidence-based practice programmes in clinical sites, well-designed implementations can promote staff attitude, knowledge, skills, and confidence in translating research evidence into optimal patient care. METHODS Experienced and bachelor prepared nurse managers in collaboration with the clinical resource nurse undertook condensed staff training and interventions for the evidence-based practice programme, where 70 registered nurses participated. The intervention was conducted over a period of time extending from December 2019 until December 2020. The study design is quasi-experimental using the pre- and post-Self Efficacy Assessment tool to gauge the nurses' confidence in evidence-based practice. Also, SPSS software was used to explore the effect of the programme. RESULTS Higher significant score on the evidence-based nursing practice self-efficacy scale postprogramme was noted (t = -7.667 and p value <.001). CONCLUSION Participating in a well-structured evidence-based practice programme would positively enhance the nurse's confidence in the programme implementation and promote an evidence-based practice culture in clinical settings. IMPLICATIONS FOR NURSING MANAGERS Nurse managers must recognize their critical role in promoting evidence-based practice among nurses. A focused and well-designed intervention may assist in establishing a culture of evidence-based practice to ensure the best patient outcome.
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Affiliation(s)
| | | | | | | | | | - Rawan AlAzza
- Fatima College of Health Sciences, Abu Dhabi, UAE
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Li C, Li L, Wang Z. Knowledge, attitude and behaviour to evidence-based practice among psychiatric nurses: A cross-sectional survey. Int J Nurs Sci 2022; 9:343-349. [PMID: 35891916 PMCID: PMC9305010 DOI: 10.1016/j.ijnss.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 06/04/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Methods Results Conclusion
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Affiliation(s)
- Ce Li
- School of Nursing, Peking University, Beijing, China
| | - Liyu Li
- Peking University First Hospital, Peking University, Beijing, China
| | - Zhiwen Wang
- School of Nursing, Peking University, Beijing, China
- Corresponding author.
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Glass G, Tan H, Chan EY. Effect of an evidence-based poster on the knowledge of delirium and its prevention in student nurses: A quasi-experimental study. Contemp Nurse 2022; 57:462-471. [PMID: 35184674 DOI: 10.1080/10376178.2022.2044872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND A major barrier to nurses adopting evidence-based practice (EBP) has been the limited awareness of evidence underpinning clinical practice, often due to poor access and understanding of the literature base. To address this, we piloted the development of educational posters summarizing the evidence base around clinical practices to see if they help nurses better understand the rationale behind their care. Our first poster focused on the evidence supporting the management of delirium in older persons, specifically delirium identification and its prevention. OBJECTIVE To examine the effect of an evidence-based poster education on the delirium knowledge of student nurses. DESIGN A prospective two-armed quasi-experimental study. METHODS 188 student nurses were recruited in December 2017. Participants were alternated to receive either an evidence-based poster education session or a reflective education session as a control. Both groups were assessed on their general knowledge on delirium, knowledge on delirium detection and knowledge on delirium prevention. This was conducted both before exposure to either the intervention or control, and one week after exposure. Unpaired t-tests with 95% confidence intervals (CI) were applied to compare the mean change in pre-test and post-test delirium knowledge. We used the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) checklist to report our methods and findings. RESULTS Students in the poster education group reported greater improvements in mean scores of delirium identification (Mean increase =1.0, p = 0.007, 95% CI: 0.3-1.6), delirium prevention (Mean increase =1.6, p < 0.001, 9% CI: 1.0-2.2) and overall delirium knowledge (Mean increase = 2.7, p < 0.001, 95% CI: 1.5-3.8) than students in the control. CONCLUSION Summarised research evidence within a poster format can increase student nurses' access to the evidence base. This has shown to increase their knowledge to guide their clinical practice. IMPACT STATEMENT Exposure to poster summaries of research evidence underpinning delirium care increases student nurses' clinical knowledge of delirium identification and prevention.
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Affiliation(s)
- George Glass
- Nursing Research Unit, Nursing Service, Tan Tock Seng Hospital, Singapore
| | - Hongyun Tan
- Nursing Service, Tan Tock Seng Hospital, Singapore
| | - Ee-Yuee Chan
- Nursing Research Unit, Nursing Service, Tan Tock Seng Hospital, Singapore.,Alice Lee Centre of Nursing Studies, National University of Singapore, Singapore
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Unal A, Teskereci G. Mapping the evidence-based practice research field in nursing from 1995 to 2021: A bibliometric analysis. Int J Nurs Knowl 2021; 33:196-206. [PMID: 34693654 DOI: 10.1111/2047-3095.12347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/17/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Evidence-based nursing and its practices are increasing rapidly in the health and nursing literature. A holistic image of evidence-based nursing research is needed to address evidence-based studies and available information on nursing. AIM The aim of this study was to evaluate evidence-based nursing-related research with bibliometric analysis in order to provide a structured macroscopic overview of its features and advances. METHODS A bibliometric analysis of 4,159 publications from 1995 to 2021 was performed to map the literature of evidence-based nursing studies and assess the structure of the scientific community. The studies' publication output and growth trend, authors and collaborations, publishing journals, terms, current trends, subject categories, global distribution and collaboration, and the authors' average number of citations were all assessed. RESULTS It was found that the number of evidence-based nursing publications increased until 2016, reaching the publication peak (n = 369), after which they began to decline. Most studies on the topic (n = 543) have been published in the journal Worldviews on Evidence-Based Nursing. Evidence-based knowledge, dissemination, implementation, implementation barriers, and implementation and training curricula in particular fields have all evolved over time as the key concepts of research. The United States (6,218), Australia (1,247), and England (790) are the three nations with the highest number of publications. On the other hand, it is seen that the subject has yet to be discussed in a few developing or underdeveloped countries. CONCLUSIONS In the last 12 years, evidence-based nursing has been a comprehensive area of research. In comparison with the research areas in its field, it can be speculated that it has a more practical focus. It was determined that the authors' keywords primarily began with research implementation, practice development, and knowledge utilization over time, and then evolved to specific areas, educational areas, process applications, and important current topics such as Covid19.
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Affiliation(s)
- Aysun Unal
- Assistant Professor, MSc, PhD, Nursing Management Department, Akdeniz University Kumluca Faculty of Health Sciences, Antalya, Turkey
| | - Gamze Teskereci
- Assistant Professor, MSc, PhD, Obstetrics and Gynecology Nursing Department, Akdeniz University Kumluca Faculty of Health Sciences, Antalya, Turkey
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Perceived Knowledge, Attitudes, and Implementation of Evidence-Based Practice Among Jordanian Nurses in Critical Care Units. Dimens Crit Care Nurs 2021; 39:278-286. [PMID: 32740199 DOI: 10.1097/dcc.0000000000000431] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
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.
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An embedded EBP project: Effect on student nurses’ practice, attitude, and knowledge. TEACHING AND LEARNING IN NURSING 2021. [DOI: 10.1016/j.teln.2020.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Dagne AH, Beshah MH, Kassa BG, Dagnaw EH. Implementation of evidence-based practice and associated factors among nurses and midwives working in Amhara Region government hospitals: a cross-sectional study. Reprod Health 2021; 18:36. [PMID: 33579309 PMCID: PMC7881559 DOI: 10.1186/s12978-021-01096-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/31/2021] [Indexed: 11/10/2022] Open
Abstract
Background Implementation of evidence-based practice is crucial to enhance quality health care, professional development, and cost-effective health service. However, many factors influence the implementation of evidence-based practice. Therefore, this study aimed to assess the implementation of evidence-based practice and associated factors among nurses and midwives. Methods Institutional-based cross-sectional study design was conducted to assess the implementation of evidence-based practice and associated factors from February 15 to March 15, 2019, among 790 nurses and midwives. Data were entered into EpiData version 3.1 then exported to SPSS version 20 for statistical analysis. Categorical variables were presented as frequency tables. Continuous variables were presented as descriptive measures, expressed as mean and standard deviation. Cronbach’s alpha was used to measure reliability, mean, standard deviation, and inter-items correlation of the factors. Independent variables with a probability value (P-value) of less than 0.2 in the Chi-square analysis were entered in the multivariable logistic regression model. Statistically significant associated factors were identified at probability value (P-value) less than 0.05 and adjusted odds ratio with a 95% confidence interval. Results The mean age of participants was 28.35 (SD ± 4.5) years. This study revealed that 34.7% (95% CI 31.5–38%) of participants implemented evidence-based practice moderately or desirably. Age of participants (AOR = 5.98, CI 1.34–26.7), barriers of implementation of evidence-based practice (AOR = 4.8, CI 2.2–10.6), the attitude of participants (AOR = 5.02, CI 1.2–21.5), nursing/midwifery work index (AOR = 3.9, CI 1.4–10.87), self-efficacy of implementation of evidence-based practice skills (AOR = 12.5, CI 5.7–27.5) and knowledge of participants (AOR = 3.06, CI 1.6–5.77) were statistically significant associated factors of implementation of evidence-based practice Concussion Implementation of evidence-based practice of nurses and midwives was poor. Age of participants, barriers of implementation of evidence-based practice, the attitude of participants, self-efficacy of implementation of evidence-based practice skills, nursing/midwifery work index, and knowledge of participants were found to be predictors of implementation of evidence-based practice. Insufficient time and difficulty in judging the quality of research papers and reports were the most common barriers to the implementation of evidence-based practice.
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Affiliation(s)
- Asrat Hailu Dagne
- Department of Midwifery, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia.
| | - Mekonnen Haile Beshah
- Department of Midwifery, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
| | - Bekalu Getnet Kassa
- Department of Midwifery, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
| | - Eyaya Habtie Dagnaw
- Department of Midwifery, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
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A national cross-sectional survey of the attitudes, skills and use of evidence-based practice amongst Spanish osteopaths. BMC Health Serv Res 2021; 21:130. [PMID: 33563266 PMCID: PMC7874623 DOI: 10.1186/s12913-021-06128-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/21/2021] [Indexed: 12/15/2022] Open
Abstract
Background Although evidence-based practice (EBP) is largely supported across healthcare professions, its implementation in manual therapy professions such as osteopathy remains limited and debated. There is currently little knowledge of how Spanish osteopaths relate to EBP. Objectives The main aim of this study was to investigate the attitudes, skills and use of EBP among Spanish osteopaths. A secondary aim was to identify barriers and facilitators for the adoption of EBP in the Spanish osteopathic context. Methods National cross-sectional survey of Spanish osteopaths registered and non-registered to an osteopathic association in Spain. Eligible participants were invited by a range of recruitment strategies including email and social media campaigns to complete the Spanish-translated Evidence-Based practice Attitude and utilization Survey (EBASE) anonymously online. Results A total of 567 osteopaths completed the survey which represents an approximate response rate of 9%. Participant’s attitudes toward EBP were largely positive. Most respondents agreed or strongly agreed that EBP was necessary in the practice of osteopathy (89.6%) and that professional literature and research findings were useful to their day-to-day practice (88.9%). Levels of perceived skill in EBP were reported as low to moderate with lowest levels for items related to ‘research conduct’. Except reading/reviewing professional literature and using online search engines to find practice-related literature, participant engagement in all other EBP-related activities was generally infrequent. The perceived proportion of clinical practice that was based on clinical research evidence was reported to be very small. Main barriers to EBP uptake included a lack of clinical evidence in osteopathy and insufficient skills for applying research findings. Main facilitators of EBP uptake included access to full-text articles, internet at the workplace and online databases. Conclusions Spanish osteopaths were largely supportive of evidence-based practice, had low to moderate skills in EBP and engaged in EBP activities infrequently. Formal regulation of the profession in Spain and the inclusion of osteopathic programs into the university sector would potentially improve EBP skills and use. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06128-6.
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Chiwaula CH, Kanjakaya P, Chipeta D, Chikatipwa A, Kalimbuka T, Zyambo L, Nkata S, Jere DL. Introducing evidence based practice in nursing care delivery, utilizing the Iowa model in intensive care unit at Kamuzu Central Hospital, Malawi. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2020.100272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Dagne AH, Ayalew MM. Factors affecting research utilisation of nurses and midwives working in North Gondar and West Gojjam Zone public hospitals, Ethiopia: a cross-sectional study. BMJ Open 2020; 10:e039586. [PMID: 33208328 PMCID: PMC7677350 DOI: 10.1136/bmjopen-2020-039586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/27/2020] [Accepted: 10/11/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Research utilisation in clinical decision-making is crucial to enhance quality healthcare, professional development and cost-effective health service. Nurses and midwives have a vital role in research utilisation. However, many factors influence research utilisation of nurses and midwives. OBJECTIVES To determine research utilisation and identify factors that affect research utilisation among nurses and midwives. METHODS An institutional-based, cross-sectional study was conducted from 23 May to 30 June 2019. A total of 631 nurses and midwives participated in the study. Categorical variables were coded with dummy variables and multiple linear regression model was carried out. The level of significance was set at p value less than or equal to 0.05 with 95% CI. RESULTS Participants' total mean score in the research utilisation scale was 2.27 (SD±0.77) and their mean age was 28.41 (SD±4.71) years. The study revealed that 70.4% (444) of participants had poor research utilisation. Self-efficacy in research utilisation skills (B=0.86, 95% CI 0.75 to 0.97), support for research utilisation (B=0.4, 95% CI 0.25 to 0.55), attitude (B=0.23, 95% CI 0.07 to 0.38), barriers to research utilisation (B=-0.63, 95% CI -0.72 to -0.54), nursing/midwifery work index (B=0.07, 95% CI 0.04 to 0.11) and hospital's level of healthcare (B=4.5, 95% CI 2.13 to 6.9) were statistically significantly associated factors of research utilisation. CONCLUSIONS This study revealed poor research utilisation among nurses and midwives. Barriers to research utilisation, supporting factors for research utilisation, attitude, self-efficacy in research utilisation skills, hospital's level of healthcare and nursing/midwifery work index were found to be statistically significant predictors of research utilisation. The most common barriers to research utilisation were insufficient time and inability to understand statistical terms used in research articles.
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Affiliation(s)
- Asrat Hailu Dagne
- Midwifery, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
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Stucky CH, De Jong MJ, Rodriguez JA. A Five-Step Evidence-Based Practice Primer for Perioperative RNs. AORN J 2020; 112:506-515. [PMID: 33113177 DOI: 10.1002/aorn.13220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/17/2020] [Accepted: 08/17/2020] [Indexed: 11/06/2022]
Abstract
Perioperative nurses work in a complex health care setting and are well-positioned to mitigate unexpected events and promote optimal patient outcomes. Thus, perioperative nurses must adapt to rapid advances in technology, treatments, and scientific discoveries to maintain clinical competence and provide care that reflects current evidence. Evidence-based practice (EBP) is a standard of professional nursing performance and an expectation of professional nursing practice. Because EBP is foundational to health care quality and safety, perioperative nurses must understand the concepts of EBP and have the capacity to apply evidence to their clinical practice. However, some perioperative nurses struggle with EBP concepts and find it difficult to access, appraise, and apply evidence. In this article, we describe the five-step EBP process and provide valuable insights into EBP for perioperative RNs.
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Fu Y, Wang C, Hu Y, Muir‐Cochrane E. The barriers to evidence‐based nursing implementation in mainland China: A qualitative content analysis. Nurs Health Sci 2020; 22:1038-1046. [DOI: 10.1111/nhs.12763] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Yanfen Fu
- School of Nursing, Fudan University Shanghai China
- School of Nursing, Dali University Dali China
- College of Nursing and Health Sciences, Flinders University Adelaide South Australia Australia
| | | | - Yan Hu
- School of Nursing, Fudan University Shanghai China
| | - Eimear Muir‐Cochrane
- College of Nursing and Health Sciences, Flinders University Adelaide South Australia Australia
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Hu MY, Wu YN, McEvoy MP, Wang YF, Cong WL, Liu LP, Li XX, Zhou CL. Development and validation of the Chinese version of the evidence-based practice profile questionnaire (EBP 2Q). BMC MEDICAL EDUCATION 2020; 20:280. [PMID: 32838782 PMCID: PMC7445933 DOI: 10.1186/s12909-020-02189-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 08/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Evidence-based practice (EBP) education or training are considered fundamental to building and strengthening an EBP culture, as well as to encouraging evidence-based academic and clinical practice in the nursing community. However, few valid and reliable instruments are available for the assessment of EBP teaching and learning in clinical nurses in China. Translation, reliability, and validity testing of the English Evidence-Based Practice Profile Questionnaire (EBP2Q), which has strong psychometric properties, may encourage evaluation and promote the implementation of EBP in Mainland China. METHODS Based on established guidelines for the development of questionnaires, the English EBP2Q was translated and cross-culturally adapted. The Chinese version of the EBP2Q (EBP2Q-C) was validated using a sample of 543 nurses. Structural validity was evaluated through exploratory factor analysis and confirmatory factor analysis, and the questionnaire was tested for convergent and criterion validity. The internal consistency and test-retest reliability were also evaluated. RESULTS The content validity index demonstrated good content validity (≥0.98). An eight-factor structure was obtained in the exploratory factor analysis, and verified by a three-order factor model from the confirmatory factor analysis (χ2/df = 2.001; RMSEA = 0.065; SRMR = 0.077; and CFI = 0.884). The Spearman's rank correlation analysis of the EBP2Q-C with the Evidence-Based Practice Questionnaire showed moderate correlations for Practice (0.58) and Confidence (0.68) and a low correlation for Sympathy (0.32). Criterion validity was demonstrated by significant differences in terms of nurses' highest education, present position, EBP training, involvement in research programs, and level of understanding of English. Both the overall Cronbach's α and the Cronbach's α for the domains exceeded 0.70. The intraclass correlation coefficients for the domains ranged between 0.75 and 0.96, indicating satisfactory repeatability. CONCLUSIONS Except for the convergent validity of the Sympathy domain, the EBP2Q-C provided evidence of validity and reliability. Therefore, it can be applied in EBP education or training assessment in Mainland China.
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Affiliation(s)
- Ming-Yu Hu
- Department of Nursing, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong, China
| | - Yan-Ni Wu
- Department of Nursing, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong, China
| | - Maureen Patricia McEvoy
- Allied Health and Human Performance Unit, University of South Australia, North Terrace, Adelaide, 5000, Australia
| | - Yan-Fang Wang
- Department of Nursing, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong, China
| | - Wei-Lian Cong
- Department of Nursing, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong, China
| | - Li-Ping Liu
- Department of Nursing, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong, China
| | - Xiao-Xia Li
- Department of Nursing, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong, China
| | - Chun-Lan Zhou
- Department of Nursing, Nanfang Hospital, Southern Medical University, No.1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong, China.
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Azami M, Sharifi H, Alvandpur S. Evaluating the relationship between information literacy and evidence-based nursing and their impact on knowledge and attitude of nurses working in hospitals affiliated to Kerman University of Medical Sciences on medication errors. J Family Med Prim Care 2020; 9:4097-4106. [PMID: 33110816 PMCID: PMC7586513 DOI: 10.4103/jfmpc.jfmpc_5_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/11/2020] [Accepted: 03/29/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION AND PURPOSE Nowadays, due to the importance of information literacy in obtaining documented and credible information, the necessity of nurses to achieve high levels of information literacy to improve their performance in accessing documentary and scientific information has become more evident. OBJECTIVE The aim of this study was to investigate information literacy, evidence-based nursing, nurses 'attitudes, nurses' knowledge, medication errors, Kerman University of Medical Sciences. METHODOLOGY This study was a survey study. The study units were 164 nurses working in 4 hospitals of Kerman University of Medical Sciences. The participants were chosen by simple random sampling. The instrument used included four sections: demographic information, information literacy, evidence-based practice, and medication errors. Data were analyzed using software SPSS 22. RESULTS The results of this study showed that nurses were familiar with the terminology used in evidence-based medicine (p < 0.0001). Also, in this study, there was a significant increase in nurses' attitude level and their ability to implement and use evidence-based nursing was observed. CONCLUSIONS The result findings of the normal distribution of samples showed that 29% were male and 71% were female. The results show that there is a significant relationship between information literacy and evidence-based nursing. The direction of the relationship is positive (p < 0/05). This means that increased information literacy is associated with increased evidence-based nursing and on the contrary. The intensity of the relationship is moderate and it's equal to 0.37. The findings also showed that there is a significant relationship between information literacy and evidence-based nursing with the knowledge and attitude of nurses toward medication error.
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Affiliation(s)
- Mohammad Azami
- Medical Informatics Research Center, Institute of Futures Studies in Health, Kerman Medical University, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Kerman, Iran
| | - Saiedeh Alvandpur
- Modeling in Health Research Center, Institute of Futures Studies in Health, Kerman Medical University, Kerman, Iran
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Belita E, Squires JE, Yost J, Ganann R, Burnett T, Dobbins M. Measures of evidence-informed decision-making competence attributes: a psychometric systematic review. BMC Nurs 2020; 19:44. [PMID: 32514242 PMCID: PMC7254762 DOI: 10.1186/s12912-020-00436-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 05/19/2020] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Emily Belita
- McMaster University, School of Nursing, McMaster Innovation Park (MIP), 175 Longwood Road South, Suite 210a, Hamilton, ON L8P 0A1 Canada
| | - Janet E Squires
- University of Ottawa/Université d'Ottawa, School of Nursing/École des sciences infirmières, Room RGN 3038, Guindon Hall, 451 Smyth Road, Ottawa, ON Canada
| | - Jennifer Yost
- Villanova University, M. Louise Fitzpatrick College of Nursing, Driscoll Hall, Room 330, 800 Lancaster Avenue, Villanova, PA 19085 USA
| | - Rebecca Ganann
- McMaster University, School of Nursing, 1280 Main St. W., HSC 3N25F, Hamilton, ON Canada
| | - Trish Burnett
- McMaster University, School of Nursing, McMaster Innovation Park (MIP), 175 Longwood Road South, Suite 210a, Hamilton, ON L8P 0A1 Canada
| | - Maureen Dobbins
- McMaster University, School of Nursing, McMaster Innovation Park (MIP), 175 Longwood Road South, Suite 210a, Hamilton, ON L8P 0A1 Canada
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Chan EY, Glass GF, Phang KN. Evaluation of a Hospital-Based Nursing Research and Evidence-Based Practice Mentorship Program on Improving Nurses' Knowledge, Attitudes, and Evidence-Based Practice. J Contin Educ Nurs 2020; 51:46-52. [PMID: 31895470 DOI: 10.3928/00220124-20191217-09] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 08/06/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Evidence-based practice (EBP) is a core requirement for nurses, contributing toward better clinical outcomes. Mentorship could prepare early adopters of EBP to create an EBP culture. METHOD Nine nurses in an acute hospital in Singapore participated in a mentorship program throughout 2015. Mentees conducted ward-based EBP education sessions for nursing colleagues. The Evidence-Based Practice Questionnaire (EBPQ) was used to measure the program's effect on mentees' and their ward colleagues' knowledge, attitude, and practice of EBP. Both groups completed the EBPQ before and 3 months after completion of the program. Wilcoxon rank-sum tests were performed to compare changes in EBPQ scores. RESULTS Both mentees and ward colleagues reported improved posttest median scores for all EBPQ subscales and the overall score. However, mentees reported a larger magnitude of improvement. CONCLUSION A hospital-based research and EBP mentorship program increases nurses' knowledge, attitude, and practice of EBP, creating an EBP culture change. [J Contin Educ Nurs. 2020;51(1):46-52.].
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Castiglione SA. Implementation leadership: A concept analysis. J Nurs Manag 2019; 28:94-101. [DOI: 10.1111/jonm.12899] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 11/06/2019] [Indexed: 11/29/2022]
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Kilicli AB, Kelber ST, Akyar I, Litwack K. Attitude, source of knowledge, and supporting factors on evidence-based nursing among cardiovascular nurses: A cross-sectional descriptive study in Turkey. J Eval Clin Pract 2019; 25:498-506. [PMID: 30938022 DOI: 10.1111/jep.13132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 12/31/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Cardiovascular nursing has been a rapidly growing specialty since the 1960s. Assessing cardiovascular nurses' EBN (evidence-based nursing) attitudes and beliefs and the factors supporting EBN is important to assist the training programmes in fostering EBN practice in a clinical environment. Few investigations have been conducted on EBN knowledge, attitudes, beliefs, and implementation among cardiovascular nurses. The present study aims to investigate cardiovascular nurses' attitudes towards EBN, sources of knowledge, and the factors supporting EBN in Turkey. METHODS A cross-sectional survey with a descriptive and comparative design was conducted with 62 cardiovascular nurses working at two hospitals in Turkey. Data were collected by using the Evidence-Based Nursing Attitude Questionnaire, a sociodemographic questionnaire concerning demographic information and including questions about nurses' sources of knowledge, supporting factors to implement EBN, research experience, use of clinical guidelines, and barriers to applying EBN. Data were analysed with descriptive and inferential statistics. RESULTS The research revealed that cardiovascular nurses have positive attitudes, feelings, beliefs, and intention of conduct towards EBN. Cardiac surgery nurses reported significantly higher positive feelings, beliefs, intention of conduct, and attitude towards EBN than cardiology nurses. Nursing experience and information acquired through nursing school were the most frequently used sources of knowledge rather than research results (35.5%) in their clinical practice. Half of the respondents (47%) were familiar with EBN. Cardiovascular nurses who had graduate degrees, reviewed nursing research and were familiar with EBN had significant positive attitudes towards EBN. Nurses needed enough time and resources, a background in clinical practice, and support from the hospital administration to implement EBN. CONCLUSIONS An education intervention should be provided about EBN knowledge and skills for cardiovascular nurses. Mentor nurses should be trained and assigned in cardiovascular clinics to implement EBN.
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Affiliation(s)
- Arnel Boke Kilicli
- Faculty of Nursing, Department of Medical Nursing, Hacettepe University, Ankara, Turkey
| | | | - Imatullah Akyar
- Faculty of Nursing, Department of Medical Nursing, Hacettepe University, Ankara, Turkey
| | - Kim Litwack
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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Adoption of an Electronic Template to Promote Evidence-Based Practice for Policies, Procedures, Guidelines, and Directives Documents. Dimens Crit Care Nurs 2018; 37:225-234. [PMID: 29847435 DOI: 10.1097/dcc.0000000000000305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Policies, procedures, and guidelines standardize care, meet regulatory requirements, and can promote safety in clinical practice. The existing protocols, policies, guidelines, and directives (PPGDs) at a level 1 trauma academic medical center were underused by the intensive care unit clinicians and did not always clearly represent the supporting evidence. AIMS The goals of this project were to update the Critical Care Practice Manual (CCPM) and to ensure that clinical practice was aligned with best evidence. The aim was to design a new PPGD template that used technology to enhance the presentation and functionality of these documents. METHODS Nurse project consultants reviewed every PPGD and solicited feedback from critical care nurses who consistently identified 2 barriers to utilization of CCPM: difficulty finding PPGDs and the cumbersomeness of lengthy policies. This improvement project used the principles of the Plan-Do-Study-Act cycle to test changes in real time. When 95% of the PPGDs were in the new format, a 22-question survey was created to elicit feedback from the direct care nurses who used the PPGD in the new electronic format. RESULTS On the basis of the survey results, nurses at the medical center accessed a PPGD at least once a month. The overall results indicated that the respondents agreed or strongly agreed that the PPGDs provided guidance (85%), reflected current practice (76%), were clear and concise (75%), and were evidence based (73%). Only 24% of those surveyed were still having difficulty finding PPGDs. DISCUSSION/CONCLUSION To facilitate timely modification and early adoption of the new PPGD format, the Plan-Do-Study-Act cycle was effectively used. The CCPM adopted a new electronic format that met the aims of the project. When making a commitment to develop evidence-based practice policies and guidelines, it is important to revisit the process, consider ongoing support, and educate frontline staff as applicable. The new template restored and enhanced the standardization of PPGDs. Technology can enhance usability and improve functionality, but it can also prove to be frustrating when implementing changes that use it, especially if users are not comfortable with it.
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Azmoude E, Aradmehr M, Dehghani F. Midwives' Attitude and Barriers of Evidence Based Practice in Maternity Care. Malays J Med Sci 2018; 25:120-128. [PMID: 30899193 PMCID: PMC6422555 DOI: 10.21315/mjms2018.25.3.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 05/03/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Midwives have a crucial role in providing optimal care for pregnant women. One of the most important policies for quality improvement in maternity care is implementation of evidence-based practice. However, the application of evidence-based practice within the maternity health care setting faces many challenges. The purpose of this study was to describe Iranian midwives' attitude and perceived barriers of evidence based practice in maternity care. METHODS In this descriptive, cross-sectional study, a census sample of 76 midwives from two public hospitals and urban health centers in Torbat Heydariyeh, a city east of Iran were surveyed. Data collection tools were two reliable and valid questionnaires that measure midwives' attitudes and barriers of implementation of evidence-based practice. Data were analysed using SPSS version 16. RESULTS The mean age and years of experience were 29.30 ± 4.86 and 5.22 ± 4.21 years, respectively. The mean score of attitude was 40.85 ± 4.84 (range = 30-60). This study also found time constraints (2.70 ± 0.92), inadequate facilities (2.64 ± 0.72), non-compilation of literature in one place (2.59 ± 0.92), lack of cooperation of physicians (2.48 ± 1.06) and the feeling of inadequate authority (2.45 ± 0.88) as the top five barriers to implementing EBP. CONCLUSION Survey participants demonstrated a positive attitude toward EBP. Organisational comprehensive strategies such as time efficiency, adequate material and human resources, familiarity with organisations such as the Cochrane Collaboration and managerial support for increasing professional legitimate authority are recommended to promote the use of Evidence-Based Practice in Iran.
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Affiliation(s)
- Elham Azmoude
- Department of Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Maryam Aradmehr
- Department of Midwifery, School of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Faezeh Dehghani
- Student Research Committee, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
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Herliani YK, Harun H, Setyawati A, Ibrahim K. Self-Efficacy and the Competency of Nursing Students Toward the Implementation of Evidence-Based Practice. JURNAL NERS 2018. [DOI: 10.20473/jn.v13i1.6359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Professional nurses should have adequate competency in order to apply Evidence Based Practice (EBP) in their nursing care. However, many nurses provide nursing care based on traditions, habits and personal experience. Less confidence in the feeling of nurses about their competency when employing EBP could inhibit successful EBP implementation in nursing care. Therefore, introducing and applying EBP during clinical placements in the Ners program is essential to form a professional attitude and to provide a basic level of experience when applying EBP in patient care. However, the self-efficacy and competence of the students when applying EBP has not yet been evaluated properly and there is little known about the nursing students’ competences and self-efficacy toward EBP implementation during clinical practice. Thus, the study aims to describe the self-efficacy and competency of nursing students toward the implementation of EBP, while also investigating the relationship between self-efficacy and the competency of nursing students in the implementation of EBP.Methods: This descriptive correlational study involved 120 nursing students who were actively registered on the Ners program 2016/2017. The data was collected by using the self-reporting Evidence-Based Practice Questionnaire (EBPQ), which was then analysed descriptively and inferentially using statistics.Results: The results of this study revealed that more than half (55%) of the participants had a high score of self-efficacy and almost half (49%) were categorised as having a high competence when implementing EBP. The self-efficacy score was significantly correlated to the score of competency (r = 0.607, p < 0.01).Conclusion: This study recommends that the development of the students’ competence in implementing EBP is essential to promote self-efficacy when applying EBP, and vice versa.
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Zhao J, Liu X, Zhang W, Xing Y, Cho SW, Hao Y. Evidence-based nursing outputs and hot spot analysis of the last 5 years in mainland China: Results of a bibliometric analysis. Int J Nurs Pract 2018; 24:e12628. [DOI: 10.1111/ijn.12628] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Junqiang Zhao
- School of Nursing; Beijing University of Chinese Medicine; Beijing China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization; Beijing China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute; Beijing China
| | - Xinjuan Liu
- School of Nursing; Beijing University of Chinese Medicine; Beijing China
| | - Wei Zhang
- School of Nursing; Beijing University of Chinese Medicine; Beijing China
| | - Yana Xing
- School of Nursing; Beijing University of Chinese Medicine; Beijing China
| | - Sang Wouk Cho
- Department of Information Management; Peking University; Beijing China
| | - Yufang Hao
- School of Nursing; Beijing University of Chinese Medicine; Beijing China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization; Beijing China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute; Beijing China
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Karami A, Farokhzadian J, Foroughameri G. Nurses' professional competency and organizational commitment: Is it important for human resource management? PLoS One 2017; 12:e0187863. [PMID: 29117271 PMCID: PMC5678726 DOI: 10.1371/journal.pone.0187863] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/27/2017] [Indexed: 11/18/2022] Open
Abstract
Background Professional competency is a fundamental concept in nursing, which has a direct relationship with quality improvement of patient care and public health. Organizational commitment as a kind of affective attachment or sense of loyalty to the organization is an effective factor for professional competency. Objective This study was conducted to evaluate the nurses´ professional competency and their organizational commitment as well as the relationship between these two concepts. Methods and materials This descriptive-analytic study was conducted at the hospitals affiliated with a University of Medical Sciences, in the southeast of Iran in 2016. The sample included 230 nurses who were selected using stratified random sampling. Data were gathered by three questionnaires including socio-demographic information, competency inventory for registered nurse (CIRN) and Allen Meyer's organizational commitment. Results Results showed that professional competency (Mean±SD: 2.82±0.53, range: 1.56–4.00) and organizational commitment (Mean±SD: 72.80±4.95, range: 58–81) of the nurses were at moderate levels. There was no statistically significant correlation between professional competency and organizational commitment (ρ = 0.02; p = 0.74). There were significant differences in professional competency based on marital status (p = 0.03) and work experience (p<0.001). Conclusion The results highlighted that the nurses needed to be more competent and committed to their organizations. Developing professional competency and organizational commitment is vital, but not easy. This study suggests that human resource managers should pursue appropriate strategies to enhance the professional competency and organizational commitment of their nursing staff. It is necessary to conduct more comprehensive studies for exploring the status and gaps in the human resource management of healthcare in different cultures and contexts.
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Affiliation(s)
- Abbas Karami
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Department of Angiography, Ali-ibn Abi Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Jamileh Farokhzadian
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Department of Community Health Nursing, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
- * E-mail: (JF); (GF)
| | - Golnaz Foroughameri
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Department of Community Health Nursing, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
- * E-mail: (JF); (GF)
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Azmoude E, Farkhondeh F, Ahour M, Kabirian M. Knowledge, Practice and Self-Efficacy in Evidence-Based Practice among Midwives in East Iran. Sultan Qaboos Univ Med J 2017; 17:e66-e73. [PMID: 28417031 DOI: 10.18295/squmj.2016.17.01.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 09/24/2016] [Accepted: 10/23/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The successful implementation of evidence-based practice (EBP) can lead to appropriate and effective midwifery care during pregnancy, childbirth and in the postnatal period. However, levels of knowledge and confidence in one's ability to apply EBP are related to its effective implementation. This study aimed to investigate levels of knowledge, practice of and self-efficacy towards the use of EBP among midwives in East Iran. METHODS This cross-sectional study took place between January and February 2016 and involved 98 midwives employed at two hospitals and all four urban health care centres in Torbat-e Heydariyeh, Iran. Two subscales of the Evidence-Based Practice Questionnaire were used to assess participants' knowledge and practice of EBP, respectively, while a modified version of a previously described scale was used to determine self-efficacy. RESULTS A total of 76 midwives participated in the study (response rate: 77.6%). Mean knowledge, practice and self-efficacy scores were 4.48 ± 0.94, 3.53 ± 0.68 and 2.80 ± 0.81, respectively. Significant relationships were found between mean self-efficacy, practice and knowledge scores and proficiency in English language (P = 0.001 each) and statistical methods (P <0.050 each). Additionally, significant relationships were found between knowledge and practice of EBP and proficiency in the use of databases (P <0.050 each). Knowledge and self-efficacy scores were significantly correlated with practice (P = 0.001 each). CONCLUSION These findings demonstrate a need for improvement in the self-efficacy, practice and knowledge of EBP among midwives in East Iran. Interventions that promote these factors may help increase the use of EBP in this population.
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Affiliation(s)
- Elham Azmoude
- Department of Nursing & Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat-e Heydariyeh, Iran
| | - Fereshteh Farkhondeh
- Student Research Committee, Torbat Heydariyeh University of Medical Sciences, Torbat-e Heydariyeh, Iran
| | - Maryam Ahour
- Student Research Committee, Torbat Heydariyeh University of Medical Sciences, Torbat-e Heydariyeh, Iran
| | - Maryam Kabirian
- Department of Nursing & Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat-e Heydariyeh, Iran
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Poorchangizi B, Farokhzadian J, Abbaszadeh A, Mirzaee M, Borhani F. The importance of professional values from clinical nurses' perspective in hospitals of a medical university in Iran. BMC Med Ethics 2017; 18:20. [PMID: 28249603 PMCID: PMC5333397 DOI: 10.1186/s12910-017-0178-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 02/14/2017] [Indexed: 12/05/2022] Open
Abstract
Background Today, nurses are required to have knowledge and awareness concerning professional values as standards to provide safe and high-quality ethical care. Nurses’ perspective on professional values affects decision-making and patient care. Therefore, the present study aimed to investigate the importance of professional values from clinical nurses’ perspective. Methods The present cross-sectional study was conducted in 2016 in four educational hospitals of Kerman University of Medical Sciences, Iran. Data were collected via the Persian version of Nursing Professional Values Scale-Revised (NPVS-R) by Weis and Schank. Sampling was conducted through the use of stratified random sampling method and 250 clinical nurses participated in the study. Results Results indicated that the total score of the nurses’ professional values was high. (102.57 ± 11.94). From nurses’ perspective items such as “Maintaining confidentiality of patients” and “Safeguarding patients’ right to privacy” had more importance; however, “Recognizing role of professional nursing associations in shaping healthcare policy” and “Participating in nursing research and/or implementing research findings appropriate to practice had less importance. A statistically significant relationship was observed between NPVS-R mean scores and nurses’ age, work experience as well as participation in professional ethical training (P < 0.05). Conclusions Although the total score related to the clinical nurses’ perspective on professional values was high, the importance of certain values was at a lower level. Owing to the emerging ethical challenges, it is indispensable to design educational programs in order to improve nurses’ awareness and understanding of the comprehensive importance of professional values. Furthermore, it is recommended that mixed methods studies should be conducted in order to design an instrument to evaluate the use of values in nursing practice.
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Affiliation(s)
- Batool Poorchangizi
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Jamileh Farokhzadian
- Department of Community Health Nursing, School of Nursing and Midwifery, Nursing Research Center, Kerman University of Medical Sciences, PO Box: 7716913555, Haft-bagh Highway, Kerman, Iran.
| | - Abbas Abbaszadeh
- Department of Nursing, Nursing & Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Moghaddameh Mirzaee
- Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Fariba Borhani
- Department of Nursing Ethics, Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Niyayesh Complex, Niyayesh Cross-Section, Vali Asr St, PO Box: 1985717443, Tehran, Iran.
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Craig LE, Churilov L, Olenko L, Cadilhac DA, Grimley R, Dale S, Martinez-Garduno C, McInnes E, Considine J, Grimshaw JM, Middleton S. Testing a systematic approach to identify and prioritise barriers to successful implementation of a complex healthcare intervention. BMC Med Res Methodol 2017; 17:24. [PMID: 28173749 PMCID: PMC5297164 DOI: 10.1186/s12874-017-0298-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/23/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Multiple barriers may inhibit the adoption of clinical interventions and impede successful implementation. Use of standardised methods to prioritise barriers to target when selecting implementation interventions is an understudied area of implementation research. The aim of this study was to describe a method to identify and prioritise barriers to the implementation of clinical practice elements which were used to inform the development of the T3 trial implementation intervention (Triage, Treatment [thrombolysis administration; monitoring and management of temperature, blood glucose levels, and swallowing difficulties] and Transfer of stroke patients from Emergency Departments [ED]). METHODS A survey was developed based on a literature review and data from a complementary trial to identify the commonly reported barriers for the nine T3 clinical care elements. This was administered via a web-based questionnaire to a purposive sample of Australian multidisciplinary clinicians and managers in acute stroke care. The questionnaire addressed barriers to each of the nine T3 trial clinical care elements. Participants produced two ranked lists: on their perception of: firstly, how influential each barrier was in preventing clinicians from performing the clinical care element (influence attribute); and secondly how difficult the barrier was to overcome (difficulty attribute). The rankings for both influence and difficulty were combined to classify the barriers according to three categories ('least desirable', desirable' or 'most desirable' to target) to assist interpretation. RESULTS All invited participants completed the survey; (n = 17; 35% medical, 35% nursing, 18% speech pathology, 12% bed managers). The barriers classified as most desirable to target and overcome were a 'lack of protocols for the management of fever' and 'not enough blood glucose monitoring machines'. CONCLUSIONS A structured decision-support procedure has been illustrated and successfully applied to identify and prioritise barriers to target within an implementation intervention. This approach may prove to be a useful in other studies and as an adjunct to undertaking barrier assessments within individual sites when planning implementation interventions.
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Affiliation(s)
- Louise E. Craig
- Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, Executive Suite, Level 5, deLacy Building, St Vincent’s Hospital, Victoria Street, Darlinghurst, NSW 2010 Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW Australia
| | - Leonid Churilov
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
- School of Science, RMIT University, Melbourne, Australia
| | - Liudmyla Olenko
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
| | - Dominique A. Cadilhac
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC Australia
| | - Rohan Grimley
- Sunshine Coast Hospital and Health Service/Sunshine Coast Clinical School, The University of Queensland, Nambour, QLD Australia
| | - Simeon Dale
- Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, Executive Suite, Level 5, deLacy Building, St Vincent’s Hospital, Victoria Street, Darlinghurst, NSW 2010 Australia
| | - Cintia Martinez-Garduno
- Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, Executive Suite, Level 5, deLacy Building, St Vincent’s Hospital, Victoria Street, Darlinghurst, NSW 2010 Australia
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, Executive Suite, Level 5, deLacy Building, St Vincent’s Hospital, Victoria Street, Darlinghurst, NSW 2010 Australia
| | - Julie Considine
- Department of Nursing, Deakin University, Geelong, Victoria Australia
- Eastern Health – Deakin University Nursing and Midwifery Research Centre, Box Hill, Victoria Australia
| | - Jeremy M. Grimshaw
- Clinical Epidemiology Program, Ottawa Health Research Institute, 1053 Carling Avenue, Administration Building, Room 2-017, Ottawa, Ontario K1Y 4E9 Canada
- Department of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
| | - Sandy Middleton
- Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, Executive Suite, Level 5, deLacy Building, St Vincent’s Hospital, Victoria Street, Darlinghurst, NSW 2010 Australia
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Lockwood C. Applying Theory Informed Global Trends in a Collaborative Model for Organizational Evidence-based Healthcare. ACTA ACUST UNITED AC 2017. [DOI: 10.11111/jkana.2017.23.2.111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Craig Lockwood
- The Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, North Adelaide, Australia
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Pashaeypoor S, Ashktorab T, Rassouli M, Alavi-Majd H. Predicting the adoption of evidence-based practice using “Rogers diffusion of innovation model”. Contemp Nurse 2016; 52:85-94. [DOI: 10.1080/10376178.2016.1188019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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