Findings From a Pilot Study: Bringing Evidence-Based Practice to the Bedside

Evaluating the Impact of an Evidence-Based Practice Education Program in a Nurse Residency Program on Evidence-Based Practice Beliefs, Implementation, and Competency

This quality improvement project examined implementation of the John Hopkins Nursing evidence-based practice (EBP) model, a standardized EBP education curriculum, in a hospital-based nurse residency program. We found that EBP education increased nurse residents' EBP beliefs, implementation frequency, and competencies. Our findings suggest that adopting existing EBP curricula is a convenient and effective approach to EBP education. Staff development professionals should continue to support and advocate for the adoption of EBP education within their organizations.

A Nurse-Led Implementation Science Specialist Program

ABSTRACT

A well-known challenge in health care is integrating evidence into practice. Implementation science (IS) is a growing field that promotes the sustainable application of evidence-based practice (EBP) to clinical care. Health care organizations have an opportunity to support sustainable change by creating robust IS infrastructures that engage nurses in the clinical environment. Integrating IS into a nursing shared governance model is an ideal vehicle to empower direct care nurses to sustain EBP. Importantly, an IS infrastructure may also promote nurse retention and increase interdisciplinary collaboration. This article, the first in a series on applying IS, describes how a multisite health care organization developed a systemwide nurse-led IS Specialist program within a shared governance model.

Nurse Mentoring: A Scoping Review

INTRODUCTION

Mentoring programs minimize stress and anxiety in recent graduates and in newly recruited nurses, guiding their careers and enabling them to retain their skills and correctly care for patients. The objective of this scoping review is to explore and summarize the existing literature on mentoring models and programs in the clinical nursing context.

METHODS

The databases searched include PubMed, Embase, Cochrane Library, Epistemonikos, Cuiden, Scielo, MEDES, OpenGrey, Trove and MedNar. Published and unpublished studies worldwide that included nurse mentoring programs in a clinical context, in public and private systems and primary, secondary and tertiary healthcare settings, and articles published in English, French, Spanish and Portuguese, were included. Nurse students and training specialists were excluded. The papers were screened by two independent reviewers. In cases of discrepancy, a third reviewer made the decision.

RESULTS

Eleven studies were included. Most of them were conducted in the USA. A wide range of nurse mentoring programs were identified with highly variable characteristics. The duration of the programs and the evaluation systems were different, but the expected results matched.

CONCLUSIONS

Mentoring programs need more in-depth and extensive study. In spite of their differences, they all lead to improvements for nurses, patients and organizations. A gender influence was found in our results, which could be studied in future research.

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

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.

Training School Counselors and Nurses to Enhance Collaboration Through Animal-Assisted Therapy

PURPOSE/AIMS

The school nurse and school counselor serve an important role to foster student academic achievement, physical and mental health, and connectiveness. Each is paramount to student success; therefore, efforts should be made to further enhance collaborative efforts. Researchers sought to determine if an online training course centered on integrative methods would enhance collaboration between the school nurse and counselor.

DESIGN

This study used a quasi-experimental design with 3 data points (pretest, posttest, and 6-month follow-up), assessing the impact of educational content and knowledge application based on an online training module incorporating animal-assisted therapy (AAT) concepts and the school counselor and school nurse collaboration model.

METHODS

The continuing professional development questionnaire was used to evaluate professionals' behavior, specifically focusing on how knowledge translates into practice. The intervention included a training course designed for school nurses and counselors. Researchers analyzed data to determine how their collaboration and endorsement of AAT changed over time.

RESULTS

School counselors endorsed collaboration and intention of AAT application in schools at a higher rate than school nurses. However, after the intervention, differences between school counselors and nurses diminished over time.

CONCLUSION

The findings provide recommendations for the clinical nurse specialist to implement evidence-based programs targeting school nurse and school counselor collaboration.

Engaging advanced practice nurses in evidence-based practice: An e-mentoring program

BACKGROUND

Mentoring is highly valued in the nursing profession and essential to building an evidence-based practice (EBP) culture. However, many organizations have a limited number of EBP mentors, who have limited non-clinical time to engage in mentoring.

AIMS

This project aimed to test whether an e-mentoring approach to nursing inquiry could enhance EBP beliefs (EBPB), increase EBP Implementation (EBPI), and improve Organizational Culture and Readiness for System-Wide Implementation of EBP (OCRSIEP).

METHODS

A pre-experimental pilot intervention project was implemented utilizing a pretest-posttest design. The OCRSIEP, EBPB, and EBPI scales were used to measure organizational readiness for EBP implementation, individual beliefs regarding the value of EBP, and the extent to which nurses integrate scientific evidence into their clinical practice, respectively. The Wilcoxon-Signed Rank test was used to analyze the difference between pre-and post-intervention scores. A posthoc analysis was performed to calculate effect sizes.

RESULTS

Eleven APRNs completed the pretest and posttest surveys. When comparing the pre-and post-intervention scores, the median EBPB scores increased from 61 (IQR: 56-69) to 70 (IQR: 64-73), median EBPI scores increased from 13 (IQR: 7-33) to 20 (IQR: 13-31), and median OCRSIEP scores increased from 88 (IQR: 73-97) to 99 (IQR: 90-113).

LINKING EVIDENCE TO ACTION

A 12-week Nurse Inquiry E-mentoring Program can leverage the small number of EBP mentors in an organization to improve EBPB. A program lasting longer in duration may also significantly improve EBPI and OCRSIEP scores. By utilizing technology and leveraging economies of scale, exponentially more nurses can be mentored to create and enhance an EBP culture.

Improvements in Clinician, Organization, and Patient Outcomes Make a Compelling Case for Evidence-Based Practice Mentor Development Programs: An Integrative Review

BACKGROUND

Many organizations struggle to systematically integrate EBP into practice. EBP mentors address organizational barriers and promote the translation of evidence into clinical practice at the bedside.

AIM

To evaluate research findings related to EBP mentor development programs, to identify effective practices, and to assess the outcomes associated with EBP mentor development programs.

METHODS

A comprehensive review of the literature was conducted to retrieve studies from CINAHL, PubMed, and Scopus, using keywords and subject headers related to EBP mentorship and quality and safety outcomes. Studies were appraised and reviewed to compare mentor program composition and examine clinician, organizational, and patient outcomes.

RESULTS

Fifteen studies met inclusion criteria: one randomized control trial (RCT), one literature review, eleven descriptive studies, and two case reviews. Most programs included didactic content, an EBP project with coaching, and resources to support learning. The studies found that these programs led to improvements in clinicians' EBP beliefs, practices, and abilities, the organization's readiness for EBP, and patient safety.

LINKING EVIDENCE TO ACTION

There is solid justification for healthcare organizations to invest in an EBP mentor development program.

Psychometric Properties of the Short Versions of the EBP Beliefs Scale, the EBP Implementation Scale, and the EBP Organizational Culture and Readiness Scale

BACKGROUND

Evidence-based practice (EBP) is a problem-solving approach to clinical decision making that leads to a higher quality and safety of health care. Three valid and reliable scales that measure EBP attributes, including the EBP Beliefs Scale, the EBP Implementation Scale, and the Organizational Culture and Readiness Scale for System-Wide Integration of EBP, are widely used but require approximately 5 min each to complete. Shorter valid and reliable versions of these scales could offer the benefit of less time for completion, thereby decreasing participant burden.

AIM

The aim of this study was to determine the psychometric properties of the three shortened EBP scales, adapted from the longer versions.

METHODS

This study used a descriptive survey design with 498 nurses who completed the three original EBP scales along with a shortened version of each scale. Exploratory factor analysis was conducted with principal components extracted to examine the factor structure of each EBP measure for the three shortened EBP scales. Item intercorrelations and the Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) were used to confirm the validity of using factor analysis. Reliability of each scale using Cronbach's α was examined. Convergent validity of the three shortened EBP scales was assessed by correlating each shortened scale with its longer scale.

RESULTS

Factor analysis supported the construct validity of each of the three shortened scales, as all item intercorrelations were greater than 0.40, and KMO values were 0.62 to 0.74. The shortened scales Cronbach alphas were 0.81 for the EBP Beliefs Scale, 0.89 for the EBP Implementation Scale, and 0.87 for the EBP Culture and Readiness Scale. The three shortened EBP scales had acceptable convergent validity (r = 0.42-.072) for the correlations between the shortened and longer scales.

LINKING EVIDENCE TO ACTION

The three shortened EBP scales, which are valid and reliable, can be used as an alternative to the longer three scales to decrease participant burden when conducting program evaluations, research, or organizational assessments.

Effectiveness of Evidence-Based Practice (EBP) Education on Emergency Nurses' EBP Attitudes, Knowledge, Self-Efficacy, Skills, and Behavior: A Randomized Controlled Trial

BACKGROUND

Emergency care clinicians are expected to use the latest research evidence in practice. However, emergency nurses do not always consistently implement evidence-based practice (EBP). An educational intervention on EBP was implemented to promote emergency nurses' use of EBP, and the effectiveness of it was evaluated.

AIMS

This study aimed to evaluate the effectiveness of an EBP educational intervention on emergency nurses' EBP attitudes, knowledge, self-efficacy, skills, and behavior. The study also examined learners' satisfaction with the EBP educational intervention.

METHODS

A randomized controlled trial with parallel groups with evaluations before the education, immediately after it, and 6 and 12 months after the education was conducted at four emergency departments in two university hospitals. The experimental group (N = 40) received EBP education while the control group (N = 40) completed self-directed EBP education. The primary outcomes were emergency nurses' EBP attitudes, knowledge, self-efficacy, skills, and behavior, while the secondary outcome was satisfaction with the EBP education.

RESULTS

Thirty-five participants of an experimental and 29 participants of a control group completed the study. There were no statistically significant (p < .05) improvements and differences between groups in EBP attitude, self-efficacy, or behavior immediately after the EBP education. At the 6-month measurement point, the experimental group showed significantly better EBP attitudes, behavior, knowledge, and self-efficacy than the control group. At the 12-month measurement point, the improvements began to decrease. The groups also differed significantly in terms of participant satisfaction with how the teacher encouraged learners to ask clinical questions.

LINKING EVIDENCE TO ACTION

The EBP educational intervention implemented in this study had a positive effect on emergency nurses' EBP attitudes, knowledge, self-efficacy, skills, and behavior. The effects of the education appeared the best 6 months after the education. After this point, the results began to decrease and approached baseline levels. EBP educational interventions designed for emergency nurses should apply various teaching strategies to improve their EBP attitude, knowledge, self-efficacy, skills, behavior, and satisfaction with the education.

A multi-dimensional EBP educational program to improve evidence-based practice and critical thinking of hospital-based nurses: Development, implementation, and preliminary outcomes

Improving outcomes and quality of care through evidence-based practice (EBP) is a priority globally. But most nurses have insufficient competence in EBP. How to conduct Educational interventions to enhance clinical nurses' EBP competencies and critical thinking disposition (CTD) requires more evidence. One hundred eleven clinical nurses from a Chinese four-campus hospital were enrolled in our EBP education program. The Johns Hopkins Nursing Evidence-Based Practice Model was used to develop and guide the educational and practical sessions. Multi-dimensional learning strategies -including online self-learning, on-site lectures, workshops, and social media-facilitated group discussions-were used to facilitate the implementation of the education sessions. After education, nurses embedded evidence into practice. The Chinese versions of the EBP Believe scale (EBPB), EBP Implementation scale (EBPI), and the Simplified Chinese Version of the Critical Thinking Disposition Inventory (CTDI-SCV) were applied to assess the relevant competencies among clinical nurses before and after the education program. Clinical nurses' EBPB, EBPI, and CTDI-SCV scores improved. But only EBPB and EBP skills and attitudes were enhanced with a statistical difference (t = -2.980, -4.141, and -2.695, with all p < 0.01). There was a small positive association between EBPB and CTDI-SCV (r = 0.396, p < 0.01). Fifteen EBP programs were successfully accomplished.

Midwifery leaders' views on the factors considered crucial to implementing evidence-based practice in clinical areas

PROBLEM

The evidence-to-practice gap continues to persist in healthcare and midwives report limited knowledge and use of effective intervention strategies to support the implementation of new evidence-based practices in clinical settings.

BACKGROUND

Despite ongoing development and dissemination of high quality research findings, the translation of latest research evidence by midwives into new evidence-based practices remains sub-optimal. This inefficiency places consumers at risk of obsolete or potentially dangerous healthcare interventions.

AIM

To explore midwifery leaders' views on what information and support midwives require to lead practice change initiatives in clinical areas.

METHODS

The study formed part of a broader Participatory Action Research (PAR) project designed to improve the processes by which midwives implement evidence-based practice change in clinical settings. The study employed a qualitative design and was guided by the methodological underpinnings of Action Research (AR).

FINDINGS

One core finding emerged to fulfil the aim and objectives of the study. To lead implementation of evidence-based practices, midwives need practical solutions and a map of the process, packaged into a centralised web-based resource.

DISCUSSION

The findings reported in this study provide valuable insight into the specific needs of midwives wanting to improve the uptake and longevity of new evidence based practices in clinical areas. This includes information specific to evidence implementation, support networks and knowledge of Implementation Science.

CONCLUSION

To lead practice change initiatives, midwives require a web-based resource that standardises the process of evidence implementation, while providing midwives with clear direction and the support needed to confidently champion for evidence base change in clinical areas.

Development, implementation and evaluation of an evidence-based practice model in a new hospital in Chile

AIMS

To describe an implementation programme for an evidence-based practice (EBP) model in a new Chilean hospital and to analyse the programme evaluation results.

BACKGROUND

Evidence-based practice is key to professional nursing for improving health care safety and quality.

METHODS

First, a literature review was performed to develop an institutional EBP model. Second, internal and external analyses contributed to assessing facilitators for and barriers to implementation. Third, a multi-stage implementation plan was conducted. Fourth, process and outcome indicators were evaluated.

RESULTS

The model considered the basic elements of EBP and outlined different decision-making levels in clinical practice. Several facilitators for implementation were identified. Each implementation stage included activities addressing EBP knowledge, attitude and skills. Outcome indicators showed significant improvement regarding knowledge (p = .038). Providers with formal EBP training, compared with providers without training, showed a significant difference of 8.6% (0.6 points) in the average CPBE-19 score in knowledge, attitude and application in the last evaluation (p < .01).

CONCLUSION

Having an EBP programme with ongoing implementation strategies improves knowledge over time, and formal training enhances positive results.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers can build an institutional research culture to improve the quality of care using an EBP programme that fits organisational needs.

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

Background

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

Methods

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

Results

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

Conclusions

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

Registration

PROSPERO #CRD42018088754.

A Quasi-Experimental Study of a Basics of Evidence-Based Practice Educational Intervention for Health and Social Care Professionals

Education is one of the central interventions to promote evidence-based practice (EBP) in service organizations. An educational intervention to promote EBP among health and social care professionals was implemented in a Finnish hospital. The aim of this study was to explore the outcomes of an educational intervention, focusing on the basics of EBP for health and social care professionals, using a quasi-experimental study design. The data were collected with a questionnaire before, immediately after, and 6 months after the education (n = 48). The data were analyzed with descriptive statistics and nonparametric tests. Immediately after the education, an increase was found in the EBP knowledge of participants, in participants’ confidence in their own ability to conduct database searches and read scientific articles, and in the number of participants using databases at work. Six months after the education, improvements were still found between the first and the third measurement in the participants’ knowledge and confidence in their own ability to conduct database searches and read scientific articles. The number of those who had made an initiative about a research topic regarding the development of their own work had increased from the first to the third measurement. The educational intervention produced a statistically significant improvement on most of the areas evaluated. Significant improvements were often found even 6 months after the education was finished. However, the low completion rate and a quasi-experimental before and after design limit the conclusions that can be derived from this study.

Cultivating evidence-based practice through mentorship

BACKGROUND

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

AIM

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

RESULTS

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

SUMMARY

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

Longitudinal Comparison of Hospital Nurses' Values, Knowledge, and Implementation of Evidence-Based Practice

BACKGROUND

Hospital-based educators use resource-intensive residency and continuing education programs to assist RNs in delivering evidence-based practice (EBP). Yet, little is known about whether such programs improve or sustain nurses' EBP values, knowledge, and implementation.

METHOD

A two-group longitudinal posttest-only study was conducted using a convenience sample of 115 RNs; 51 participants received a comprehensive EBP continuing education intervention, and 64 participants received no intervention.

RESULTS

Participation rates were 85% at 6 months and 65% at 12 months. Knowledge scores between the two groups were significantly different at 6 months and sustained at 12 months, although the intervention group comprised more master's-prepared nurses. EBP values and implementation scores did not differ between the two groups, and EBP values were not associated with EBP use. The only nurse characteristic demonstrating a statistically significant relationship with the outcomes was highest degree earned.

CONCLUSION

Further research is needed with more robust study designs to determine how best to facilitate the use of EBP among hospital RNs. Support for RN advanced education and evidence-based continuing education strategies are recommended. [J Contin Educ Nurs. 2020;51(5):209-214.].

A Quality Improvement Project Utilizing a Clinical Practice Guideline in Women During Second-Stage Labor

Second-stage labor is the most challenging stage of labor, as it requires increasing exertion of the birthing woman. Variances in nursing interventions in second-stage labor have an influence on outcomes. There is disparity in nursing care during second-stage labor. The purpose of this project was to evaluate a clinical practice guideline in second-stage labor with respect to positioning, timing of pushing, type of pushing effort, and the effect on birth method and perineal trauma. Spontaneous vaginal birth increased, vacuum extraction birth decreased, and vaginal birth after cesarean doubled. The rate of episiotomy decreased, the rate of multiple types of lacerations decreased, the rate of vaginal wall tears decreased, and the need for wound suturing of birth acquired lacerations decreased.

Leveraging the Librarian in a Nurse Residency Program

Hospitals are increasingly implementing Nurse Residency Programs (NRPs), but medical librarians are often left out of their institution's respective programs. Librarians possess a unique, knowledge-based skill set that is a natural fit for the content and goals of a NRP and should be more frequently considered and used by such programs. This article identifies and explores several roles for librarians in NRPs and discusses the impact and results of including librarians.

Antimicrobial stewardship and the hospital nurse and midwife: how do they perceive their role?

OBJECTIVES

Our aim was to determine the views of nurses and midwives in an acute hospital regarding a potential role in an antimicrobial stewardship programme.

METHODS

An online survey about antimicrobial stewardship was distributed to nursing and midwifery staff at the Royal Cornwall Hospitals NHS Trust. Descriptive statistics were used for analysis.

RESULTS

Eighty responses were received. Forty-three (54%) claimed to have heard the term antimicrobial stewardship. Only seven (9%) had cause to look at the hospital's antimicrobial guidelines at least once a week. Between 47 (60%) and 68 (87%) respondents agreed they should be involved in a range of stewardship roles. Constraints of time and workload, lack of knowledge and lack of adequate staff training were the three main perceived challenges to a wider role.

CONCLUSIONS

Staff in this survey recognise the potential for wider antimicrobial stewardship roles. They also identify challenges to undertaking these roles. Some of these barriers could be overcome by provision of education and support; hospital pharmacists may be able to assist with this role development.

Going Along With It: Neonatal Intensive Care Nurses' Views of a Donor Milk Practice Change

BACKGROUND AND PURPOSE

Donor human milk (DHM) is used when a mother's own milk is not available. Donor human milk is available as a frozen pasteurized or commercially sterilized product. An abrupt change in practice in use of donor milk products raised concerns among nurses caring for infants in the neonatal intensive care unit (NICU). The change in practice occurred without the input of nurses and without the sharing of supportive evidence with them. The purpose of this study was to explore NICU nurses' perceptions of the practice change from using frozen pasteurized DHM to using sterilized DHM in this context.

STUDY DESIGN AND METHODS

A grounded theory study was conducted in a 38-bed Level III NICU. Nurse participants were interviewed using open-ended questions aimed at eliciting their perceptions of using pasteurized and sterilized DHM.

RESULTS

There were nine nurse participants. They described their perceptions of feeling confident about pasteurized DHM to feeling uncertain about sterilized DHM. The core category of going along with it was linked to judging DHM based upon attributes, questioning benefits of sterilized DHM, and preferring past practice of using pasteurized DHM. Nurses noted that they could move from feeling uncertain about the practice change to feeling certain if they had evidence to support the practice change. Barriers to seeking evidence were time, knowledge, and waiting for someone else to do it.

CLINICAL IMPLICATIONS

Practice change without interprofessional collaboration is threatened by uncertainty and lack of support for the new practice. Nurses want to give evidence-based care, but they often face barriers to seeking evidence. Removing barriers to evidence-based practice and including nurses as stakeholders in practice change decisions are suggested.

Do educational interventions aimed at nurses to support the implementation of evidence-based practice improve patient outcomes? A systematic review

BACKGROUND

Numerous articles have sought to identify the impact of educational interventions for improving evidence-based practice (EBP) amongst nurses, most of these focus on skills and knowledge acquired. No systematic review has explored whether this educational input translates into improved patient outcomes.

OBJECTIVES

To review the evidence on (1) The change in patient outcomes following educational interventions to support practising nurses in implementing EBP. (2) The instruments or methods used to determine whether EBP education improves patient outcomes.

METHODS

A systematic review following PRISMA guidance was conducted. Literature was comprehensive searched including 6 databases, journal handsearching, citation tracking, and grey literature websites. Studies were included if they reported an EBP educational intervention aimed at practising nurses and contained objective or self-reported measures of patient related outcomes. The quality of the included studies was assessed using a modified Health Care Practice R&D Unit (HCPRDU) tool. Because of the poor homogeneity of the included studies, the data were analysed by narrative synthesis.

RESULTS

Of the 4284 articles identified, 18 were included: 12 pre-post studies, three qualitative studies, and three mixed-methods study designs. The level of quality was modest in the studies. The results of the EBP educational interventions on patient outcomes were assessed using three methods: individual projects to implement an evidence-based approach, qualitative approaches, and a questionnaire survey. The majority of the articles concluded there was a positive change in patient outcomes following an educational intervention to improve EBP; a wide range of context specific outcomes were described.

CONCLUSION

Educational interventions for clinical nurses to support the implementation of EBP show promise in improving patient outcomes. However, the direct impact of EBP interventions on clinical outcomes is difficult to measure. Further testing and development is needed to improve the quality of studies and evaluation instruments in order to confirm the current findings.

Odnos in znanje medicinskih sester ter ovire pri implementaciji na dokazih temelječe prakse

Uvod: Na dokazih temelječa praksa velja za zlati standard obravnave pacientov. Namen raziskave je bil preučiti odnos, znanje in ovire pri implementaciji na dokazih temelječe prakse v zdravstveni negi.Metode: Uporabljen je bil sistematični pregled znanstvene in strokovne literature. V pregled so bile vključene naslednje baze: CINAHL Plus, ProQuest Dissertations & Theses Global, SpringerLink, WILEY in PubMed. Omejitvena kriterija iskanja sta bila objava članka med letoma 2008 in 2017 ter dostopnost celotnega besedila člankov v angleščini. Ključne besede iskanja: nurse, evidence based practice, implementation barriers. V končni pregled je bilo vključenih 37 člankov. Ocena kakovosti dokazov je prikazana v hierarhiji dokazov. Podatki so bili obdelani s tematsko kvalitativno analizo.Rezultati: Identificiranih je 73 kod, ki so združene v 7 vsebinskih kategorij: (1) dejavniki, ki vplivajo na negativen odnos medicinskih sester do na dokazih temelječe prakse, (2) dejavniki, ki vplivajo na pozitiven odnos medicinskih sester do na dokazih temelječe prakse, (3) znanje raziskovanja medicinskih sester za uporabo znanstvenih dokazov v kliničnem okolju, (4) znanje uporabe informacijske tehnologije za iskanje dokazov, (5) vpliv mentorstva in kompetenc za implementacijo na dokazih temelječe prakse v klinično okolje, (6) ovire organizacije za implementacijo na dokazih temelječe prakse v klinično okolje in (7) ovire medicinskih sester za implementacijo na dokazih temelječe prakse v klinično okolje.Diskusija in zaključek: Raziskava pokaže pozitiven kot tudi negativen odnos medicinskih sester do na dokazih temelječe prakse. Osredotoča se na pomanjkanja znanja in ovire, s katerimi se srečujejo medicinske sestre pri implementaciji na dokazih temelječe prakse v klinično okolje.

Tools for evidence-based vascular nursing practice: Achieving information literacy for lifelong learning

Information literacy is essential in facilitating evidence-based practice (EBP) activities. In vascular nursing, the implementation of EBP is of utmost importance. Best practice grounded in research evidence can contribute to improved patient care outcomes for individuals with vascular disease. The following paper discusses information literacy competencies for nurses to develop in the context of EBP, with an emphasis on formulating a clinical question and searching for evidence. Relevant health science information resources are described, including their value and purpose in the 6S model of evidence. Also discussed are practical and supportive solutions with proven effectiveness in ensuring nurses' success with EBP.