The barriers to evidence‐based nursing implementation in mainland China: A qualitative content analysis

Academic-practice partnerships in evidence-based nursing practice: A theory-guided scoping review

BACKGROUND

Academic-practice partnerships have the potential to solve many challenges in evidence-based nursing practice which is crucial for high-quality care.

AIMS

To identify the existing knowledge on academic-practice partnerships in evidence-based nursing practice.

METHODS

We conducted this review following the Joanna Briggs Institute scoping review methodology. We performed a comprehensive literature search of nine databases as well as five websites for gray literature. Two researchers independently conducted literature screening and data extraction and analysis. A third researcher was involved when needed.

RESULTS

Dedicated time, dedicated resources, and compatible goals were found to be the top three inputs in academic-practice partnerships for evidence-based nursing practice. Meeting and discussion were the most popular forms of activities. Sufficient resources were the most important facilitators. Insufficient resources, insufficient time, and communication issues were the top three barriers.

CONCLUSIONS

The assumption proposed in the practice-academic partnership logic model (i.e., inputs plus activities can lead to outputs and outcomes) was preliminarily verified by the results of this review in the context of evidence-based nursing practice. Academic-practice partnerships can leverage the advantages of both sides to overcome barriers and promote evidence-based nursing practice. However, it is essential to conduct a broader range of high-quality studies. Such endeavors could offer more comprehensive evidence for refining the framework of academic-practice partnerships in evidence-based nursing practice. IMPLICATIONS FOR NURSING EDUCATION, PRACTICE, POLICY AND RESEARCH: The "theoretical framework of academic-practice partnerships in evidence-based nursing practice" could theoretically guide academic and clinical nursing staff to collaborate on evidence-based nursing practice and related research and education programs. The academic-practice partnerships in evidence-based nursing practice could lead to a win-win situation for both the academic and the clinical sides. Furthermore, the results of this study provide an evidence-based foundation for policymakers to develop supportive policies for academic-practice partnerships in evidence-based nursing practice.

Attitudes and Barriers to Patient Participation in Evidence-Based Practice From Chinese Nurses' Perspectives: A Qualitative Content Analysis

Patient participation plays a vital role in evidence-based practice (EBP), yet its development in clinical nursing is slow. Current research has focused on identifying barriers to patient participation in everyday care, with less research on barriers to patient participation in EBP. Therefore, a questionnaire containing basic information and open-ended questions was used to explore nursing staff attitudes and barriers to patient participation in EBP. Responses to the open-ended question were analyzed with content analysis. Four roles of patient participation, positive and negative attitudes toward patient participation, and 134 barriers to patient participation in EBP were extracted from 121 nursing staff responses through content analysis. Five categories of barriers were extracted from the 134 barriers to patient participation, including patient, cost-effectiveness of EBP, healthcare staff, organization, and resource. This study found that patients' acceptance and trust in EBP also influenced their participation in the practices. Moreover, nursing staff have little knowledge of engaging patients in EBP. More educational strategies and organizational support should be provided to patients and nurses to promote patient participation.

Barriers to implementing nursing evidence-based practice at the Palestinian Medical Complex: A cross-sectional study

Background

The use of nursing evidence-based practice (EBP) has grown more and more important for healthcare professionals globally in their goal of delivering high-quality patient care.

Objective

The aim of this study is to assess barriers to implementing EBP among Palestinian nurses at the Palestinian Medical Complex (PMC).

Methods

The study was carried out at the PMC over the course of a month and employed a cross-sectional descriptive approach. Data were gathered from 100 nurses who satisfied the inclusion criteria by using convenient sampling. Barriers to the application of EBP were measured by the BARRIER Scale.

Results

Participants identified key barriers such as inadequate time (62%, M ± SD: 3.34 ± 1.066) and lack of assistance (30%, M ± SD: 3.15 ± 1.029). Concerns included literature dispersion (45%, M ± SD: 3.23 ± 0.973), inadequate facilities (53%, M ± SD: 3.70 ± 1.010), and methodological issues (52%, M ± SD: 3.16 ± 1.012). In addition, 57% felt that research is published too slowly (M ± SD: 3.39 ± 0.898), 33% noted unjustified conclusions (M ± SD: 3.01 ± 0.882), and 35% highlighted a lack of replication (M ± SD: 3.07 ± 0.879).

Conclusion

This study found that head nurses and men perceived more significant barriers to research quality, while individuals with baccalaureate degrees reported fewer barriers. There was an association between perceived barriers and age and work experience, indicating age as a positive predictor of barriers related to research quality.

Knowledge, skills, attitudes, beliefs, and implementation of evidence-based practice among nurses in low- and middle-income countries: A scoping review

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.

Relationship between critical thinking ability and medication safety competence among clinical nurses: A multicenter cross-sectional study

AIMS AND OBJECTIVES

This study investigated the relationship between clinical nurses' critical thinking ability and medication safety competence, as well as the factors related to medication safety competence.

BACKGROUND

Nurses can have an active role in promoting medication safety. However, the main factors associating with nurses' competence in medication safety are uncertain.

DESIGN

This was a descriptive, multicenter cross-sectional survey study.

METHODS

A total of 1196 nurses from four different tertiary hospital in China were included in this study. A demographic information questionnaire, the Critical Thinking Diagnostic for nurses, and the Medication Safety Competence Scale for nurses were used to survey. Descriptive statistics, comparisons, correlation and regression analysis of the collected data were performed using SPSS 26.00 software. The study was reported using STROBE checklist.

RESULTS

Included nurses obtained satisfactory scores on the critical thinking and medication safety scales and subscales. There was a strong statistically significant positive correlation between critical thinking ability and medication safety competence. Multiple linear regression analysis indicated that personal critical thinking scores and working years were positively associated with nurses' medication safety scores, accounting for 62.50% of the variance.

CONCLUSION

Clinical nurses' critical thinking ability is positively associated with medication safety competence.

RELEVANCE TO CLINICAL PRACTICE

As critical thinking ability positively predicts nurses' medication safety competence, hospitals and nursing administrators should consider continuing nursing education and training to improve critical thinking skills, thereby promoting medication safety competence among clinical nurses.

Pre-treatment assessment of chemotherapy for cancer patients: a multi-site evidence implementation project of 74 hospitals in China

BACKGROUND

Chemotherapy, whilst treating tumours, can also lead to numerous adverse reactions such as nausea and vomiting, fatigue and kidney toxicity, threatening the physical and mental health of patients. Simultaneously, misuse of chemotherapeutic drugs can seriously endanger patients' lives. Therefore, to maintain the safety of chemotherapy for cancer patients and to reduce the incidence of adverse reactions to chemotherapy, many guidelines state that a comprehensive assessment of the cancer patient should be conducted and documented before chemotherapy. This recommended procedure, however, has yet to be extensively embraced in Chinese hospitals. As such, this study aimed to standardise the content of pre-chemotherapy assessment for cancer patients in hospitals and to improve nurses' adherence to pre-chemotherapy assessment of cancer patients by conducting a national multi-site evidence implementation in China, hence protecting the safety of cancer patients undergoing chemotherapy and reducing the incidence of adverse reactions to chemotherapy in patients.

METHODS

The national multi-site evidence implementation project was launched by a JBI Centre of Excellence in China and conducted using the JBI approach to evidence implementation. A pre- and post-audit approach was used to evaluate the effectiveness of the project. This project had seven phases: training, planning, baseline audit, evidence implementation, two rounds of follow-up audits (3 and 9 months after evidence implementation, respectively) and sustainability assessment. A live online broadcast allowed all participating hospitals to come together to provide a summary and feedback on the implementation of the project.

RESULTS

Seventy-four hospitals from 32 cities in China participated in the project, four withdrew during the project's implementation, and 70 hospitals completed the project. The pre-and post-audit showed a significant improvement in the compliance rate of nurses performing pre-chemotherapy assessments for cancer patients. Patient satisfaction and chemotherapy safety were also improved through the project's implementation, and the participating nurses' enthusiasm and belief in implementing evidence into practice was increased.

CONCLUSION

The study demonstrated the feasibility of academic centres working with hospitals to promote the dissemination of evidence in clinical practice to accelerate knowledge translation. Further research is needed on the effectiveness of cross-regional and cross-organisational collaborations to facilitate evidence dissemination.

Exploring Professional Practice Environments and Organisational Context Factors Affecting Nurses' Adoption of Evidence-Based Practice: A Scoping Review

This scoping review, conducted within the Joanna Briggs Institute (JBI) framework, analysed the recent literature (January 2018 to March 2023) addressing factors inherent to professional practice environments and organisational contexts influencing nurses' adoption of evidence-based practice (EBP). This review included studies involving nurses regardless of sector, practice setting, and scope of practice. A systematic search was undertaken across the PubMed, Web of Science, CINAHL, and MEDLINE databases, as well as the EThOS, OATD, and RCAAP platforms. The extracted textual elements underwent a content analysis, resulting in a coding structure established through an inductive approach that categorised information into main categories and subcategories linked by similarity and thematic affinity. Forty-one studies were included, revealing four main categories of factors impacting EBP adoption by nurses: (1) organisational dynamics, (2) management and leadership, (3) teamwork and communication, and (4) resources and infrastructure. The study's limitations acknowledge the subjective nature of categorisation, recognising potential variations based on individual perspectives despite adopting procedures to minimise the risk of bias. The results provide a substantial foundation for developing interventions to cultivate environments conducive to EBP adoption by nurses, thereby enhancing the integration of evidence into nurses' professional practice contexts. This review was prospectively registered on the Open Science Framework (registration no. osf.io/e86qz).

Academic-practice partnerships in evidence-based nursing education: A theory-guided scoping review

OBJECTIVE

To provide a scoping review of the existing literature regarding academic-practice partnership in evidence-based nursing education, with the goal of gathering evidence to support the establishment of such partnerships.

BACKGROUND

Academic-practice partnerships play a crucial role in overcoming separation of theory and practice in evidence-based nursing education and promoting the adoption of evidence-based nursing practice. However, there is a lack of scoping review of related literature.

DESIGN

This scoping review was conducted following the Joanna Briggs Institute updated methodology for scoping reviews and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist.

METHODS

We conducted a comprehensive search in PubMed, Web of Science, SCOPUS, Cochrane Library, CINAHL, EMBASE, Educational Resource Information Centre (ERIC) and five gray websites between November and December, 2022. A total of 10515 articles were retrieved, 26 articles were included in the scoping review. Two reviewers reviewed the articles, screened literature, and extracted data, independently. A third researcher was involved when consensus is needed. Practice-academic partnership logic model was used to analysis and synthesis the results.

RESULTS

Main themes included inputs (time, instructional resources, partnership agreement, key stakeholder commitment, shared mission, leadership support, common vision, instructional design, mutual respect, and instructional objectives), activities (ongoing communication and shared decision-making), outputs (action plan: evidence-based nursing project plans and educational resources), outcomes (improved evidence-based nursing competency, enhanced quality of nursing care, career advancement and personal development, increased evidence-based nursing projects, improve evidence-based nursing education, heightened academic achievement, increased engagement in evidence-based nursing, increased networking opportunities, and improved staff satisfaction), facilitators (sufficient inputs, effective activities, and clear partnership structure, ongoing feedback, and positive outcomes), and barriers (insufficient inputs).

CONCLUSIONS

Inputs and activities could lead to outputs and outcomes. Facilitators and barriers could influence the degree of outputs and outcomes. Academic-practice partnerships can overcome the barriers of disconnection between theory and practice in evidence-based nursing education, and further promote education and research by leveraging the strengths of both parties, resulting in a mutually beneficial collaboration.

Academic-practice partnerships in evidence-based nursing education: Protocol of a theory-guided scoping review

AIM

This theory-guided scoping review aims to provide an overview of existing literature about academic-practice partnerships in evidence-based nursing education.

BACKGROUND

Academic-practice partnership is an approach to improve evidence-based nursing education, to promote evidence-based nursing practice which could reduce the nursing care discrepancy, improve the nursing care quality and patient safety, reduce healthcare costs and promote nursing professional development. However, the related research is limited and there is a lack of systematic review of related literature.

DESIGN

A scoping review guided by the theories of the Practice-Academic Partnership Logic Model and the JBI Model of Evidence-Based Healthcare.

METHODS

The researchers will use JBI guidelines for scoping reviews and related theories to guide this theory-guided scoping review. The researchers will systematically search Cochrane Library, PubMed, Web of Science, CINAHL, EMBASE, SCOPUS and Educational Resource Information Centre (ERIC) using major search concepts including academic-practice partnership, evidence-based nursing practice and education. Two reviewers will be responsible for independent literature screening and data extraction. Discrepancies would be solved by a third reviewer.

EXPECTED RESULTS

This scoping review will identify related research gaps to provide implications for researchers and identify specific information to provide implications for developing interventions of academic-practice partnerships in evidence-based nursing education.

REGISTRATION NUMBER

This scoping review had been registered on Open Science Framework (https://osf.io/83rfj).

Translation and cross-cultural adaptation of the National Health Service Sustainability Model to the Chinese healthcare context

BACKGROUND

International attention is being paid to the issue of making evidence sustainable after implementation. Developing an identification model is essential to promote and monitor the sustainability of evidence implementation. However, this model is not available in Chinese. This study aims to translate the National Health Service Sustainability Model into Chinese and to verify whether the model is adapted to the Chinese healthcare environment.

METHODS

This study follows the translation and validation guidelines developed by Sousa and Rojjanasrirat. The translations include forward and backward translations and their comparison. Expert reviews were used to validate the content validity of the Chinese version of the National Health Service sustainability model. Cognitive interviews were used to assess the validity of the language in the Chinese setting.

RESULTS

The translation was conducted by a bilingual research team and took 12 months. Expert reviews were undertaken with eight experts, and cognitive interviews with six participants. The content validity of the model is excellent, but at least 20% of the experts still felt that items one, three, five and nine needed refinements. In the cognitive interviews, most items, instructions and response options were well understood by the participants responsible for the evidence-based practice project. However, some language issues were still identified in items one, three, four, five, seven, nine, and ten. Participants reported that the sustainability results of the model assessment were consistent with their previous judgments of the items. Based on the expert review and interview results, items one, three, four, five, seven, nine and ten require further refinement. In summary, seven of the ten items have been amended.

CONCLUSIONS

This study provides insight into how the National Health Service sustainability model can be used in the Chinese healthcare setting and paves the way for future large-scale psychometric testing.

Factors affecting nurses' professional values: A comprehensive integrative review

OBJECTIVES

Values should inform the care every nurse provides. Professional values equally affect patient care and organizational outcomes. In addition, they aid in forming a basis for moral judgments. The aim of this review is to elucidate the whole spectrum of factors affecting the development of nurses' professional values.

DESIGN

An integrative review approach was chosen.

DATA SOURCE

The review included searches in four databases - MEDLINE Complete, CINAHL Plus, ERIC, and Scopus - from January 2015 to November 2021, 572 articles were screened resulting in 35 quantitative and qualitative articles that met the inclusion criteria and passed the critical appraisal.

RESULT

Five major themes and subthemes emerged from the review: Individual determinants was the first theme. Education was the second theme. Experience was the third theme. The fourth theme was nurses' values perceptions. The final theme dealt with the impact of role models.

CONCLUSION

Understanding the power of nursing values as an effective influencer of nursing practice is important because nurses' values can ensure high-quality care and strengthen the professional brand.

Knowledge, skills, attitudes, beliefs, and implementation of evidence-based practice among nurses in low- and middle-income countries: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to identify and map the evidence reporting the knowledge, skills, attitudes, beliefs, and implementation of evidence-based practice among nurses in low- and middle-income countries.

INTRODUCTION

Evidence-based practice aims to improve health care quality, safety, and health system efficiency. Numerous research studies have explored nurses' engagement in evidence-based practice in high-income countries. Developing nations have recently joined the evidence-based practice movement, and primary research about nurses' engagement with it are emerging.

INCLUSION CRITERIA

The scoping review will include primary studies (quantitative, qualitative, and mixed methods) and gray literature addressing knowledge, skills, attitudes, beliefs, and implementation of evidence-based practice among nurses. Participants will include registered nurses working in low- and middle-income countries. Studies conducted in all health care settings, including acute and community settings, in low- and middle-income countries will be included.

METHODS

We will search MEDLINE, Embase, CINAHL, Scopus, ERIC, JBI Evidence-based Practice Database, Cochrane Library, LILACS, and AIM. Gray literature will be sourced from ProQuest Dissertations and Theses Global and Google Scholar for primary studies. Studies published in the English language will be included, with no limit on publication date. Titles, abstracts, and full-text articles will be assessed against the inclusion criteria by 2 independent reviewers. The extracted data will be analyzed quantitatively using frequencies and counts. Textual data from qualitative studies will be analyzed using descriptive content analysis. Results of the data analysis will be presented using graphs, tables, and a narrative format.

SCOPING REVIEW REGISTRATION

Open Science Framework ( https://osf.io/hau5y ).

Barriers to implementing evidence-based nursing practice from the hospitals' point of view in China: A regional cross-sectional study

BACKGROUND

There is a widespread international agreement that healthcare should be based on high-quality evidence; however, bridging the gap from evidence to practice is still problematic. Although barriers to the implementation of evidence-based nursing practice have been identified, most studies have focused on clinical nurses' perceptions of the barriers to evidence-based nursing practice, with a lack of investigation into barriers from the hospitals' viewpoint.

OBJECTIVES

To identify existing barriers to implementing evidence-based nursing practice from the hospitals' viewpoint.

DESIGN

A descriptive study employing a regional cross-sectional survey.

SETTINGS AND PARTICIPANTS

A convenience sample of 91 hospitals in Guangdong Province, China.

METHODS

The survey used an online questionnaire containing basic hospital information and an open-ended question. Descriptive statistics were used to analyse basic hospital data. Responses to the open-ended question were analysed with thematic analysis.

RESULTS

The sample consisted of 89 valid responses to the open-ended question. Five themes were identified: (1) knowledge (70.8 %); (2) environmental context and resources (42.7 %); (3) social influences (7.9 %); (4) intentions (7.9 %); and (5) beliefs about capabilities (1.1 %).

CONCLUSION

Introduced early in 2001, China has embraced evidence-based nursing for more than 20 years. However, lack of knowledge is still the top barrier to implementing evidence-based nursing practice in hospitals in China. The findings indicate a need for more evidence-based nursing practice teaching strategies towards further enhancing clinical nurses' and nursing managers' evidence-based nursing practice beliefs, knowledge, and skills.

Perspectives and experiences of Chinese nurses on quality improvement initiatives: A mixed-methods study

AIM

To investigate Chinese nurses' views and experiences in relation to quality improvement implementation, as well as to determine the impact of contextual factors on nursing quality improvement initiatives.

BACKGROUND

Nurses play a major role in carrying out quality improvement initiatives. Contextual factors influence the implementation and success of quality improvement initiatives. Studies that investigated the impact of contextual factors on Chinese nurses' practice in quality improvement remain limited.

METHODS

A sequential explanatory mixed-methods design was used for this study. A quantitative cross-sectional survey was used to assess the context of quality improvement initiatives. Simple random sampling was used to recruit quality improvement teams. The sample included 356 nurses from tertiary teaching hospitals; 291 (81.7%) of them completed questionnaires. Nursing managers and nurses (n = 18) were purposively selected to participate in semi-structured interviews; their experiences and perceptions regarding the contextual factors of quality improvement initiatives were obtained.

RESULTS

In the quantitative phase, the "microsystem" (mean=5.24) and "QI team" (mean = 4.97) contexts were reported as supportive contexts. The organizational context was weak, with a mean score of 3.92. In the qualitative phase, three themes related to the contextual challenges emerged: (1) nurses' attitudes and satisfaction, (2) team efficacy, and (3) organizational infrastructure and culture.

CONCLUSIONS

Efforts to elevate organizational culture and reward systems are needed in Chinese hospitals. Further education aimed at increasing skills and knowledge should be provided, to ensure effective quality improvement implementation.

IMPLICATIONS FOR NURSING MANAGEMENT

During quality improvement initiatives, management tasks should focus on increasing nurses' satisfaction, solving skill and knowledge deficits, and clarifying nurses' roles in relation to quality improvement.