Factors influencing the implementation of evidence in Chinese nursing practice

Promoting sleep in hospitals: An integrative review of nurses' attitudes, knowledge and practices

AIMS

To explore nurses' knowledge, attitudes and practices related to improving hospitalized patients' sleep.

DESIGN

Integrative review.

DATA SOURCES

We searched CINAHL, PubMed and PsycInfo electronically including a manual search of references listed within the relevant studies. Original, peer-reviewed studies published in English between 2000 and 2022 evaluating nurses' sleep knowledge, attitudes, or practices to improve inpatients' sleep were reviewed.

REVIEW METHODS

This review was guided by Whittemore and Knafl method and followed PRISMA guidelines to search the literature. Fifteen articles reporting nurses' sleep knowledge, attitudes or practices to improve inpatients' sleep were included. The quality appraisal was done using the Mixed Methods Appraisal Tool version 2018.

RESULTS

Inadequate training of nurses regarding sleep hygiene and insufficiency in sleep-promoting practices were apparent. Most studies reported that nurses hold positive attitudes about sleep. The acuity of patients' health conditions affected their perception of sleep priorities. Lack of organizational sleep policies/protocols and coworkers' attitudes negatively impacted nurses' motivation to implement sleep hygiene interventions. Interventions reported in the studies were reducing noise and nursing interventions at night, using a clock for time orientation, earplugs, reducing light, keeping patients awake during the daytime, maintaining comfortable room temperature and managing patients' stress. These practices were hindered by poor knowledge, negative attitudes, patients' acuity and lack of sleep assessment tools.

CONCLUSION

It is essential to support nursing practice to improve patients' sleep in hospitals through interventions that target nurses' knowledge, attitudes and confidence towards implementing sleep hygiene interventions to improve patients' sleep and, consequently, their health outcomes during hospitalization.

IMPACT

This integrative review explored nurses' knowledge, attitudes and practices to improve patients' sleep during hospitalization. It revealed that expanding nurses' sleep knowledge and empowering them to implement sleep promotion practices are needed. Nursing educators and leaders need to be involved.

NO PATIENT OR PUBLIC CONTRIBUTION

This paper is an integrative review and does not include patient or public contribution.

Evaluating factors that influenced the successful implementation of an evidence-based neonatal care intervention in Chinese hospitals using the PARIHS framework

Background

Evidence based interventions (EBIs) can improve patient care and outcomes. Understanding the process for successfully introducing and implementing EBIs can inform effective roll-out and scale up. The Promoting Action on Research Implementation in Health Services (PARIHS) framework can be used to evaluate and guide the introduction and implementation of EBIs. In this study, we used kangaroo mother care (KMC) as an example of an evidence-based neonatal intervention recently introduced in selected Chinese hospitals, to identify the factors that influenced its successful implementation. We also explored the utility of the PARIHS framework in China and investigated how important each of its constructs (evidence, context and facilitation) and sub-elements were perceived to be to successful implementation of EBIs in a Chinese setting.

Method

We conducted clinical observations and semi-structured interviews with 10 physicians and 18 nurses in five tertiary hospitals implementing KMC. Interview questions were organized around issues including knowledge and beliefs, resources, culture, implementation readiness and climate. We used directed content analysis to analyze the interview transcript, amending the PARIHS framework to incorporate emerging sub-themes. We also rated the constructs and sub-elements on a continuum from “low (weak)”, “moderate” or “high (strong)” highlighting the ones considered most influential for hospital level implementation by study participants.

Results

Using KMC as an example, our finding suggest that clinical experience, culture, leadership, evaluation, and facilitation are highly influential elements for EBI implementation in China. External evidence had a moderate impact, especially in the initial awareness raising stages of implementation and resources were also considered to be of moderate importance, although this may change as implementation progresses. Patient experience was not seen as a driver for implementation at hospital level.

Conclusion

Based on our findings examining KMC implementation as a case example, the PARIHS framework can be a useful tool for planning and evaluating EBI implementation in China. However, it’s sub-elements should be assessed and adapted to the implementation setting.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07493-6.

Development and psychometric evaluation of nurses' perception towards the gap between knowledge and practice

AIM

The aim of the study was to develop a survey instrument and psychometrically evaluate nurses' perceptions of the gap between knowledge and practice. Although the nursing literature has widely documented a gap between knowledge and practice, no instrument has been developed to measure this gap.

DESIGN

Psychometric analysis was done on 513 nurses working in different positions at two large hospitals in Jeddah City.

METHODS

Cronbach's alpha was used to determine the internal consistency and reliability of the research instrument, and a panel of experts evaluated the validity of the tool's content.

RESULT

The content validity index computed from expert rankings was 0.89. Factor analysis yielded four major components: knowledge, practice, environment and learning. Cronbach's alpha indicated a high level of internal consistency and reliability for the component items. The newly developed scale will facilitate measuring nurses' perceptions of the knowledge-practice gap in clinical settings.

Conceptualizing the clinical decision-making process in managing temporomandibular disorders: A qualitative study

Management of patients with temporomandibular disorders (TMD) appears to be more challenging than for other dental conditions. This study aimed to explore the decision-making process in TMD management, and thereby to conceptualize the decision-making process in dentistry. Individual semi-structured interviews were conducted during 2018 and 2019 with a purposive sample of 22 general dental practitioners from the Public Dental Healthcare Services and private practices in the Region of Västerbotten, Northern Sweden. The interviews were analysed using the Grounded Theory approach of Charmaz. Data analysis resulted in the core category 'Combining own competence and others' expectations in the desire to do the right thing'. The dentists showed interest in and a desire to apply professional knowledge, but also reflected on challenges and complexity in the decision-making process for TMD. The challenges were primarily related to organisational factors and lack of self-confidence. This identifies a need for re-organisation of daily clinical management in dentistry, and a need for more postgraduate training to improve self-confidence. The complexity of the decision-making process for TMD makes the study findings applicable in other dental situations.

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

BACKGROUND

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

AIMS AND OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

RELEVANCE TO CLINICAL PRACTICE

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

A qualitative examination of the perceived impact of bureaucratic managerialism on evidence-based practice implementation in Nigeria: a collective case study

Background

Evidence-based practice (EBP) is widely recognised as an essential aspect of contemporary healthcare delivery. However, the rise in cost containment and quest for profitability in healthcare management is found to be compromising implementation of evidence-based initiatives aimed at improving care quality.

Aims

The aim of this work was to examine perspectives of nurses regarding the impact of bureaucratic managerialism on EBP implementation in the Nigerian acute care setting.

Methods

A qualitative case study methodology was utilised to gather data from two large acute care settings. Drawing on semi-structured interviews, 12 staff nurses, 21 ward managers and 2 nurse managers were interviewed. Data were inductively analysed and themes generated.

Results

The managerial practice in this context is founded on bureaucratic managerialism, which in turn generated hierarchical constraints that denied nurses the opportunity to self-govern. Implementation of evidence-based initiatives was consequently opposed by the managerial desire to maximise throughput.

Conclusions

There is need for nurse managers to have greater managerial influence, which would allow opportunities for implementing EBPs to be created. Managerial autonomy for nurse managers would allow them to create enabling environments capable of facilitating successful implementation.

Managerial leadership for research use in nursing and allied health care professions: a systematic review

Background

Leadership by point-of-care and senior managers is increasingly recognized as critical to the acceptance and use of research evidence in practice. The purpose of this systematic review was to identify the leadership behaviours of managers that are associated with research use by clinical staff in nursing and allied health professionals.

Methods

A mixed methods systematic review was performed. Eight electronic bibliographic databases were searched. Studies examining the association between leadership behaviours and nurses and allied health professionals’ use of research were eligible for inclusion. Studies were excluded if leadership could not be clearly attributed to someone in a management position. Two reviewers independently screened abstracts, reviewed full-text articles, extracted data and performed quality assessments. Narrative synthesis was conducted.

Results

The search yielded 7019 unique titles and abstracts after duplicates were removed. Three hundred five full-text articles were reviewed, and 31 studies reported in 34 articles were included. Methods used were qualitative (n = 19), cross-sectional survey (n = 9), and mixed methods (n = 3). All studies included nurses, and six also included allied health professionals. Twelve leadership behaviours were extracted from the data for point-of-care managers and ten for senior managers. Findings indicated that managers performed a diverse range of leadership behaviours that encompassed change-oriented, relation-oriented and task-oriented behaviours. The most commonly described behavior was support for the change, which involved demonstrating conceptual and operational commitment to research-based practices.

Conclusions

This systematic review adds to the growing body of evidence that indicates that manager-staff dyads are influential in translating research evidence into action. Findings also reveal that leadership for research use involves change and task-oriented behaviours that influence the environmental milieu and the organisational infrastructure that supports clinical care. While findings explain how managers enact leadership for research use, we now require robust methodological studies to determine which behaviours are effective in enabling research use with nurses and allied health professionals for high-quality evidence-based care.

Trial registration

PROSPERO CRD42014007660

Electronic supplementary material

The online version of this article (10.1186/s13012-018-0817-7) contains supplementary material, which is available to authorized users.