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Zhou F, Yuan T, Li Z, Mu X, Lv Y. The evidence-based practice teaching competence of clinical preceptors at different stages of innovation-decision process: A cross-sectional survey in traditional Chinese medicine hospitals. NURSE EDUCATION TODAY 2024; 132:106027. [PMID: 37956570 DOI: 10.1016/j.nedt.2023.106027] [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: 12/20/2022] [Revised: 09/27/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Traditional Chinese Medicine Nursing Clinical Preceptors (TCMN-CPs) are crucial to cultivate undergraduates' evidence-based practice (EBP) competence during clinical practicum in traditional Chinese Medicine (TCM) hospitals. However, the TCMN-CPs' EBP teaching competence is unclear. Underpinned by Rogers' innovation-decision process, our study aimed to investigate TCMN-CPs' EBP teaching competence and the related characteristic factors at five stages of knowledge, persuasion, decision, implementation and confirmation. METHODS An online survey was conducted by using a modified evidence-based practice teaching competence questionnaire (EBPT-COQ) encompassing attitude, knowledge/skill and practice of EBP teaching in four TCM teaching hospitals in Beijing, China. RESULTS A total of 654 TCMN-CPs were included, with a response rate of 91.47 %. Most TCMN-CPs were in knowledge stage (339, 51.83 %), followed by the persuasion stage (166, 25.38 %), decision stage (123, 18.81 %), implementation stage (23, 3.52 %) and confirmation stage (3, 0.46 %). The total and dimension scores of EBPT-COQ increased as the diffusion stage developing, the confirmation stage was the highest (5.48 ± 0.80). Twenty-three items' mean scores were higher than 4 points (95.83 %), except for "Research skills" (3.58 ± 1.38). The related characteristic factors were 1) age (Z = -4.177), working experience (H = 11.087), clinical teaching experience (H = 12.602), management position (Z = 2.565), research experience (Z = -2.867) and EBP training (Z = 3.146) at Knowledge stage; 2) research experience (ZPersuasion = -2.617; ZDecision = -3.510), EBP training (ZPersuasion = 2.528; ZDecision = 3.433) at Persuasion and Decision stage (all P<0.05). And the first three stages TCMN-CPs' EBPT-COQ scores were positively correlated with TCMN-CPs' attitude toward clinical teaching (r = 0.244-0.331, P<0.001). CONCLUSIONS Most of the TCMN-CPs' EBP teaching status are in the first three diffusion stages. Though their attitude, knowledge/skills and practice to EBP teaching competence have gradually improved with the deepening of the diffusion stage, much efforts should be made to keep progressing. TCMN-CPs' qualifications of EBP teaching could include rich clinical work and teaching experience, enjoying teaching. Nursing managers, with higher EBP teaching competence, might play a crucial role in promoting the diffusion of EBP teaching. All TCMN-CPs showed an inadequacy of research skills of EBP teaching. Therefore, it is warranted to explore the minimum research skill requirements for EBP teaching and to establish academic-practice partnerships.
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Affiliation(s)
- Fen Zhou
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China; The Beijing University of Chinese Medicine Centre for Evidence-based Nursing: A JBI Affiliated Group, Beijing, China.
| | - Ting Yuan
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Zhaoyu Li
- School of Nursing, Capital Medical University, No.10 You'anmenwai Xitoutiao Street, Fengtai District, Beijing 100069, China
| | - Xiaoying Mu
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Yunpeng Lv
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
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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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Xu J, Stark AT. A conceptual model of nurses' workplace social capital: a theory synthesis. BMC Nurs 2021; 20:148. [PMID: 34404398 PMCID: PMC8369697 DOI: 10.1186/s12912-021-00660-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 07/07/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Research has confirmed the importance of workplace social capital in the nursing workforce. Integration of the empirical evidence about nurses' workplace social capital into a scientific collection can provide a comprehensive presentation of this concept. This scientific collection can be a conduit for further research and advancement of nursing management and leadership. The purpose of this paper, therefore, is to discuss the process of developing a conceptual model of nurses' workplace social capital, an effective and concise approach to illustrate a scientific phenomenon. METHODS The model of nurses' workplace social capital was developed following Walker and Avant's strategy of theory synthesis. Empirical evidence relevant to nurses' workplace social capital was synthesized by systematically examining the existing literature. PubMed, CINAHL, Web of Science and Google Scholar were searched periodically from October 2017 to July 2020. RESULTS Our proposed conceptual model lays out the determinants and outcomes of nurses' workplace social capital and specifies the relational statements among these concepts. Nurses' workplace social capital is influenced by the organizational and individual determinants shaped by multiple layers of sub-concepts. The development and implementation of nurses' workplace social capital has three themes of consequences: 1) nurses' outcomes; 2) patients' outcomes; and 3) organizational outcomes. All the concepts and statements have been organized and aligned with the principles of "inventory of determinants or results" and "theoretical blocks". CONCLUSION Our theoretical synthesis offers a comprehensive picture of the current knowledge of nurses' workplace social capital. Efforts should be dedicated to evaluating, revising, and revamping this newly developed model based on future empirical evidence. Our synthesized conceptual model is the segue to more comprehensive studies about nurses' workplace social capital. Interventional programs for the development of social capital can be structured based on the identified determinants.
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Affiliation(s)
- Jiamin Xu
- Department of Nursing Sciences, Faculty of Medicine and Health, Lishui University, Lishui, China.
| | - Azadeh T Stark
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, MI, USA
- School of Interdisciplinary Studies, University of Texas at Dallas, Richardson, TX, USA
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Xu JM, Kunaviktikul W, Akkadechanunt T, Nantsupawat A, Turale S. Factors influencing workplace social capital among registered nurses in China. Int Nurs Rev 2021; 68:372-379. [PMID: 33639024 DOI: 10.1111/inr.12666] [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: 08/27/2020] [Revised: 01/12/2021] [Accepted: 01/26/2021] [Indexed: 11/28/2022]
Abstract
AIM To examine the modifiable predictors and the level of workplace social capital, transformational leadership, emotional intelligence and organizational justice among registered nurses in Chinese hospitals. BACKGROUND Workplace social capital is a relational network developed among nurses and other healthcare professionals that provides social support, and gives value to their working lives. Internationally, cultivating high levels of social capital is critical as it can help improve nurse satisfaction and care, and address nurse turnover. However, knowledge of factors influencing nurses' workplace social capital is limited in China. METHODS In this cross-sectional, descriptive predictive study, 344 registered nurses were randomly selected from three urban Chinese hospitals in Zhejiang province. Five standard instruments were applied to collect data. Descriptive statistics were used to present the level of the variables and stepwise multiple regression was performed to identify the predictors of nurses' workplace social capital. RESULTS Among eight potential factors, transformational leadership and emotional intelligence positively predicted workplace social capital. Nurses perceived the overall level of workplace social capital, emotional intelligence and unit managers' transformational leadership as high, and the overall level of organizational justice as moderate. DISCUSSION Enhancing unit managers' transformational leadership and nurses' emotional intelligence was found to positively influence the development of workplace social capital. Although it is not a predictor of workplace social capital, nurses' organizational justice should be improved due to its importance and current unsatisfactory level. CONCLUSION AND IMPLICATIONS FOR NURSING AND HEALTH POLICY Nursing and health policymakers need to consider the enhancement of transformational leadership and emotional intelligence when implementing policies to improve nurses' workplace social capital, nursing retention and job satisfaction.
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Affiliation(s)
- J-M Xu
- Department of Nursing Sciences, Faculty of Medicine and Health, Lishui University, Lishui, China
| | - W Kunaviktikul
- Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | - T Akkadechanunt
- Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | - A Nantsupawat
- Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | - S Turale
- Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.,International Nursing Review, Geneva, Switzerland
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Kerwien-Jacquier E, Verloo H, Pereira F, Peter KA. Adaptation and validation of the evidence-based practice beliefs and implementation scales into German. Nurs Open 2020; 7:1997-2008. [PMID: 33072385 PMCID: PMC7544869 DOI: 10.1002/nop2.593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/15/2020] [Accepted: 07/23/2020] [Indexed: 01/10/2023] Open
Abstract
Aims To culturally adapt and translate the Evidence-Based Practice Belief Scale (EBP-B) and the Evidence-Based Practice Implementation Scale (EBP-I), explore the psychometric properties of their validated German versions and compare results with those of the original scales. Design Cross-sectional descriptive study. Method The study was conducted on a sample of 131 Registered Nurses in a Swiss German hospital. Internal consistency was rated using Cronbach's alpha. Principal component analysis using varimax rotation was used to determine construct validity. The study was undertaken in accordance with the STROBE-checklist in Appendix S1. Results German versions of the EBP-B and EBP-I showed good reliability. Their Cronbach alphas showed lower values than those of the original scales. Principal component analysis showed medium-to-high factor loading. Principal component analyses using varimax rotations of the EBP-B's 16 items and the EBP-I's 17 items resulted in four-factor and five-factor solutions, respectively.
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Affiliation(s)
- Emmanuelle Kerwien-Jacquier
- School of Health Sciences HES-SO Valais/Wallis University of Applied Sciences and Arts of Western Switzerland Visp Switzerland
| | - Henk Verloo
- School of Health Sciences HES-SO Valais/Wallis University of Applied Sciences and Arts of Western Switzerland Visp Switzerland
| | - Filipa Pereira
- School of Health Sciences HES-SO Valais/Wallis University of Applied Sciences and Arts of Western Switzerland Visp Switzerland
| | - Karin Anne Peter
- Division of Applied Research & Development in Nursing Bern University of Applied Sciences Bern Switzerland
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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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Abstract
The concept of social capital appears in the literature of multiple disciplines as a social determinant of health, an important aspect of human interaction, and a means to support population health capacity. Little is known about the use of social capital within the context of nursing. This article's aim provides insight into the concept of social capital and nursing. Avant and Walker methodology was used to analyze a sample of 78 articles. Along with a variety of articles and content themes, findings from this concept analysis include critical attributes, an operational definition, and reflections regarding future use.
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Xu J, Kunaviktikul W, Akkadechanunt T, Nantsupawat A, Stark AT. A contemporary understanding of nurses' workplace social capital: A response to the rapid changes in the nursing workforce. J Nurs Manag 2020; 28:247-258. [PMID: 31793081 PMCID: PMC7328727 DOI: 10.1111/jonm.12914] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/24/2019] [Accepted: 11/29/2019] [Indexed: 11/30/2022]
Abstract
AIM To provide an updated definition of the concept of nurses' workplace social capital that addresses changes in the contemporary nursing workforce. BACKGROUND Social capital explains the components of a constructive work environment. Advancements in psychology of workplace and changes in the demographic structure of nursing workforce call for a revised version of nurses' workplace social capital. METHOD Walker and Avant's approach was implemented. Data were compiled from 'Medline' and 'CINAHL', 'Google' search engine, book chapters and expertise of nursing academicians. RESULTS Nurses' workplace social capital is a relational network that is configured by interactions among healthcare professionals. Although, various attributes influence these interactions, Relational Network, Trust, Shared Understanding, Reciprocity and Social Cohesion are considered as the major attributes. A healthy relational network creates a healthy workplace which can be further fortified by effective communication, active group engagements and a supportive leadership. CONCLUSIONS Results of our concept analysis should establish a theoretical groundwork for nurse leaders to better build and more effectively lead the contemporary nursing workforce. IMPLICATION FOR NURSING MANAGEMENT Leaders' dedication to workplace social capital is the tenet of a constructive workplace, which in return can support nurses to flourish in their clinical and the other professional responsibilities.
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Affiliation(s)
- Jiamin Xu
- Faculty of NursingChiang Mai UniversityChiang MaiThailand
- School of NursingLishui UniversityLishuiChina
| | | | | | | | - Azadeh T Stark
- Department of Pathology and Laboratory MedicineHenry Ford Health SystemDetroitMIUSA
- School of Interdisciplinary StudiesUniversity of Texas at DallasRichardsonTXUSA
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Chang H, Huang T, Wong AM, Ho L, Juan Y, Chen Y, Teng C. How career facilitators and barriers influence nurses’ professional turnover intention. J Adv Nurs 2019; 75:3577-3587. [DOI: 10.1111/jan.14191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/06/2019] [Accepted: 08/28/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Hao‐Yuan Chang
- School of Nursing College of Medicine National Taiwan University Taipei Taiwan
- Department of Nursing National Taiwan University Hospital Taipei Taiwan
| | - Tzu‐Ling Huang
- Graduate Institute of Business and Management Chang Gung University Taoyuan City Taiwan
| | | | - Lun‐Hui Ho
- Department of Nursing Chang Gung Memorial Hospital Linkou Taiwan
| | - Yeh‐Chun Juan
- Department of Industrial Engineering and Management Ming Chi University of Technology New Taipei City Taiwan
- Department of Industrial and Business Management Chang Gung University Taoyuan City Taiwan
| | - Yi‐Fang Chen
- Department of Industrial and Business Management Chang Gung University Taoyuan City Taiwan
| | - Ching‐I Teng
- Graduate Institute of Business and Management Chang Gung University Taoyuan City Taiwan
- Department of Rehabilitation Chang Gung Memorial Hospital Linkou Taiwan
- Department of Business and Management Ming Chi University of Technology New Taipei City Taiwan
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Tsuruta K, Shiomitsu T, Hombu A, Fujii Y. Relationship between social capital and happiness in a Japanese community: A cross-sectional study. Nurs Health Sci 2018; 21:245-252. [PMID: 30592119 DOI: 10.1111/nhs.12589] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 11/09/2018] [Accepted: 11/18/2018] [Indexed: 11/28/2022]
Abstract
The influence of social capital on happiness is attracting attention around the world. Many studies that investigated the relationship between social capital and happiness suggest that happiness correlates to a positive social environment. The aim of this study was to examine the relationship between social capital and happiness in a community with the lowest National Health Insurance expenditures in Miyazaki Prefecture (Japan). This cross-sectional study targeted 2730 residents in the community aged 40-75 years who were covered by National Health Insurance in 2015. A self-administered questionnaire consisting of questions focusing on demographic characteristics, happiness, and social capital was sent to the residents, and 1106 of them (40.5%) returned the questionnaires by the deadline. The analysis of responses indicated a positive relationship between social capital and happiness with regard to all three factors of social capital (trust, connections and interaction, and social participation). Evaluating the relationship between social capital and health in terms of happiness is important to creating a lively society in which citizens support one another, in addition to promoting physical and mental well-being.
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Affiliation(s)
- Kurumi Tsuruta
- Department of Community Health and Psychiatric Nursing, School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Tomoko Shiomitsu
- School of Nursing, Faculty of Makuhari Human Care, Tohto College of Health Sciences, Chiba, Japan
| | - Amy Hombu
- Department of English, Language Education Center, University of Miyazaki, Miyazaki, Japan
| | - Yoshinori Fujii
- Department of Mathematics Education, Faculty of Education, University of Miyazaki, Miyazaki, Japan
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Schneider LR, Pereira RPG, Ferraz L. A prática baseada em evidência no contexto da Atenção Primária à Saúde. SAÚDE EM DEBATE 2018. [DOI: 10.1590/0103-1104201811804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A prática baseada em evidência agrega o melhor conhecimento científico, com a experiência clínica do profissional e a escolha do paciente, resultando em uma maior resolutividade na assistência em saúde. O objetivo do estudo foi analisar a prática baseada em evidência dos profissionais das equipes com Estratégia Saúde da Família em um município de Santa Catarina. Trata-se de um estudo quantitativo, realizado por meio de questionários com 112 profissionais de saúde. Os resultados apontaram que eles consideram a prática baseada em evidência fundamental, contudo, em suas ações, ela está mais centrada na experiência clínica. Outrossim, não se sentem plenamente capacitados para realizar a busca de evidências científicas, destacando o pouco conhecimento e habilidades em pesquisa. Além disso, ressaltam a alta demanda de atendimentos, escasso domínio de língua estrangeira e falta de apoio da gestão como dificultadores. Conclui-se que os profissionais da atenção primária precisam se aprimorar para o desenvolvimento da prática baseada em evidência, sendo que isso ultrapassa a sua vontade individual, ficando também ao encargo das instituições formadoras e dos serviços de saúde.
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