Nursing Managers' Perspectives on the Facilitators and Barriers to Implementation of Evidence-Based Management

Emotional labor and burnout among nurses in Iran: core self-evaluations as mediator and moderator

BACKGROUND

This study investigated the mediating and moderating impact of core self-evaluations in the path from emotional labor to burnout. Our hypothesized associations are based on Hobfoll (Rev Gen Psychol 6:307-24, 2002) conservation of resources theory.

METHOD

Three hundred nurses from four hospitals in Abadan, Iran, were invited to participate in our study. Of the 300, 255 completed all sections and questions in our survey for an 85% response rate. The posited direct and indirect effects were evaluated with structural equation modeling and the interaction effects were evaluated with hierarchical moderated regression and simple regression slope plots.

RESULT

Deep acting has indirect effects on burnout through core self-evaluations. Though unrelated to surface acting, core self-evaluations moderate its impact: under low core self-evaluations, surface acting is strongly related to emotional exhaustion and inversely related to personal accomplishment, whereas, under high core self-evaluations, surface acting is unrelated to these burnout dimensions.

CONCLUSION

Our findings reveal the dual functions of CSE as a psychological resource and buffer to offset the interpersonal demands of patient care. Limitations, directions for future research, and practical implications are discussed.

The dilemma of the split between theory and reality as experienced by primary healthcare professionals: a mixed methods study of evidence-based practice in a primary care context

BACKGROUND

Primary care depends upon a good information flow across professional and structural boundaries to provide the best care for patients. Previous research has mainly focused on Evidence-Based Practice (EBP) within specific professions. Mapping of pan-professional experiences of and attitudes to EBP in publicly funded clinical practice is necessary to deepen the understanding of EBP and its implementation. Thus, this study aimed to investigate healthcare professionals' experiences of and attitudes towards working in accordance with EBP in primary care.

METHODS

The study used a convergent mixed methods design divided into two strands: a quantitative enquiry tool (Evidence-Based Practice Attitude Scale, EBPAS) and a set of qualitative interviews analysed by means of qualitative content analysis. Both strands included all primary care employees with patient interaction in the studied county (n = 625), including doctors, nurses, physiotherapists, psychologists and assistant nurses. Out of the original 625 healthcare professionals, 191 finished the first strand and 8 volunteered for the second strand (2 nurses, 2 physiotherapists, 1 psychiatrist and 3 doctors).

RESULTS

The EBPAS value of 2.8 (max 4) indicated a generally positive attitude towards EBP amongst the population, which was also evident in the interviews. However, there were additional experiences of not having the ability or resources to engage in EBP. This was illustrated by the theme that emerged from the qualitative content analysis: "The dilemma of the split between theory and reality". Due to the organisational and managerial focus on efficiency rather than quality of care, there were few or no incentives for promoting individual educational or research development.

CONCLUSIONS

Although the general attitude towards EBP is positive, experiences of practising it differ. There is a need to increase knowledge of EBP concepts, requirements and implementation in the clinical setting. The absence of opportunities to do research and collegial debate about new ways of finding and implementing research-based evidence results might influence the quality of care.

Nurses' experiences and perspectives regarding evidence-based practice implementation in healthcare context: A qualitative study

AIM

To explore nurses' experiences and perspectives about evidence-based practice (EBP) implementation in the healthcare context.

DESIGN

A qualitative descriptive study design using focus group discussions (FGDs).

METHOD

Sixty-four nurses who purposefully selected and worked at various healthcare organizations in Bisha Governorate, Saudi Arabia, were included. Eight FGDs were used to obtain data using open-ended questions. The collected data underwent inductive qualitative content analysis.

RESULTS

Two main categories were extracted: experiences and perspectives towards EBP. The experiences category emerged into four sub-categories: familiarity with concepts and benefits, steps, dissemination sources of EBP and sources of EBP knowledge, while perspectives towards the EBP category included four sub-categories: application of EBP in clinical practice, barriers, facilitators and EBP application methods. The participants experienced being in a non-supportive and non-encouraging atmosphere which results from a lack of organizational commitment to EBP implementation and illuminates the complexities involved in the integration process.

CONCLUSION

The nurses' experience with EBP indicated that there was limited support for the implementation of this approach. Furthermore, they experienced varying barriers to EBP implementation. They viewed EBP as a complex technique as they lacked knowledge and skills related to the formulation of research questions, and retrieving, applying and disseminating of EBP in clinical practice decision-making. That is due to barriers pertinent to the individual, organizational and patient factors. The key to successfully implementing an EBP in nursing practice is to promote professional development, comprehensive and continuous training, a culture of change, organizational support and motivation.

CLINICAL RELEVANCE

Through the construction and provision of ongoing educational interventions and mentoring programmes about EBP, healthcare organizations and nursing leadership may develop a comprehensive strategy to encourage staff nurses' participation in the EBP process. This is to enhance nurses' experiences and perspectives towards the EBP approach and overcome the barriers to effective implementation.

NO PATIENT OR PUBLIC CONTRIBUTION TO THIS STUDY

Patients or the general public were not involved in the design, analysis or interpretation of the data in this study.

Nursing managers' perspectives on facilitators of and barriers to evidence-based practice: A cross-sectional study

AIM

This study aimed to determine the facilitators and barriers to evidence-based practice (EBP) from the perspective of Iranian nursing managers.

DESIGN

Cross-sectional study.

METHODS

Data were collected from 335 top nursing managers of Iran. The research instruments included three electronic questionnaires for demographics, facilitators and barriers of evidence-based practice. Descriptive statistics and appropriate analysis tests were used to clarify the strength of relationships between the factors.

RESULTS

A total of 277 nursing managers participated in the study (response rate of 82%). Iranian nursing managers believed that organizational factors were the most important domain for both facilitators (34.7 ± 9.2) and barriers (28.37 ± 6.2) to EBP. Regarding the Perspectives of nursing managers on Necessity and Extent of EBP implementation, 79.8% (n = 221) considered EBP to be essential, while 45.8% (n = 127) regarded its implementation as moderate.

Understanding factors influencing the use of clinical guidelines in low-income and middle-income settings: a scoping review

OBJECTIVE

A scoping review was undertaken to determine the extent to which existing studies have examined factors influencing healthcare providers' use of clinical guidelines in low and middle-income country (LMIC) settings and determine which factors constrain or facilitate the use of clinical guidelines by healthcare providers.

DESIGN

Scoping review.

DATA SOURCES

The literature search was conducted using PubMed in January 2021.

ELIGIBILITY CRITERIA

We identified empirical studies, published between 2011-2021 in English, which included clinicians and/or nurses as healthcare providers, used a health facility as the study site, and were located in an LMIC.

DATA EXTRACTION AND SYNTHESIS

Information extracted from the literature review was organised using themes and the findings synthesised using thematic analysis.

RESULTS

The review identified five types of interacting factors that influence healthcare providers' use of and compliance with clinical guidelines. The factors identified are organisational factors, factors relating to individual healthcare providers, attributes of the clinical guidelines, patient-related factors and institutional factors. Organisational factors can be further divided into the physical work environment, organisational culture and working conditions. The effective use of clinical guidelines in LMIC settings is greatly impacted by the contextualisation of clinical guidelines, end-user engagement and alignment of the implementation of clinical guidelines with the institutional arrangements in the broader health system.

CONCLUSION

The development and evaluation of concrete interventions is vital to facilitate the implementation of clinical guidelines and improve healthcare service quality. Further studies are necessary to examine the relative importance of the five identified factors on the effective use of clinical guidelines in different contexts.

Barriers and facilitators influencing EBP readiness: Building organizational and nurse capacity

BACKGROUND

Organizational supported evidence-based practice (EBP) enables nurses to be change agents and impact patient outcomes. Globally, a multitude of barriers limits EBP implementation, evaluation, and dissemination, which include time constraints, staff, resource access, education, technology, and fiscal support. These barriers and other disenfranchising elements hinder nurses' ability to actualize EBP and change practice within their workplace.

AIMS

This study describes the EBP readiness, barriers, and facilitators reported by inpatient registered nurses (RNs) employed in a nationwide healthcare system before COVID-19.

METHODS

The study employed a cross-sectional descriptive survey design using the 2005 Nursing EBP Survey for RN EBP readiness. The setting included 14 hospitals in Southern California. The survey was deployed in November 2016 and closed after 23 weeks. Descriptive statistics analyzed demographics and EBP scores, with inferential statistics for associations between demographics and EBP scores. ANOVA examined differences between EBP scores, service lines, years of employment, and education level. A content approach synthesized open-ended barrier and facilitator questions into seven specific themes.

RESULTS

Seven hundred and twenty-four nurses completed the survey. Overall, the scores of inpatient RNs were highest scores for Practice Climate, suggesting the health system fosters a climate conducive to EBP. Scores were lowest for Data Collection and Implementation. Qualitative themes were: (1) Everyone Involved in EBP Implementation, (2) Fear and Resistance to Change, (3) Protected Release Time, (4) Knowing EBP Culture Outside of Current Organization, (5) Organizational Communication and Education, (6) Management and Leadership Support, and (7) Pragmatic Solutions to Facilitate EBP. Fear and Resistance to Change cut across all themes.

LINKING EVIDENCE TO ACTION

Nurses at all organizational levels from the C-suite to the bedside can create strategies to determine essential EBP readiness components, including EBP mentors to guide knowledge uptake activities. Pragmatic solutions for EBP capacity require frontline nurse feedback, commitment, and partnership with nursing leaders.

Knowledge, attitude and behaviour to evidence-based practice among psychiatric nurses: A cross-sectional survey

Objective

Methods

Results

Conclusion

Mapping the evidence-based practice research field in nursing from 1995 to 2021: A bibliometric analysis

BACKGROUND

Evidence-based nursing and its practices are increasing rapidly in the health and nursing literature. A holistic image of evidence-based nursing research is needed to address evidence-based studies and available information on nursing.

AIM

The aim of this study was to evaluate evidence-based nursing-related research with bibliometric analysis in order to provide a structured macroscopic overview of its features and advances.

METHODS

A bibliometric analysis of 4,159 publications from 1995 to 2021 was performed to map the literature of evidence-based nursing studies and assess the structure of the scientific community. The studies' publication output and growth trend, authors and collaborations, publishing journals, terms, current trends, subject categories, global distribution and collaboration, and the authors' average number of citations were all assessed.

RESULTS

It was found that the number of evidence-based nursing publications increased until 2016, reaching the publication peak (n = 369), after which they began to decline. Most studies on the topic (n = 543) have been published in the journal Worldviews on Evidence-Based Nursing. Evidence-based knowledge, dissemination, implementation, implementation barriers, and implementation and training curricula in particular fields have all evolved over time as the key concepts of research. The United States (6,218), Australia (1,247), and England (790) are the three nations with the highest number of publications. On the other hand, it is seen that the subject has yet to be discussed in a few developing or underdeveloped countries.

CONCLUSIONS

In the last 12 years, evidence-based nursing has been a comprehensive area of research. In comparison with the research areas in its field, it can be speculated that it has a more practical focus. It was determined that the authors' keywords primarily began with research implementation, practice development, and knowledge utilization over time, and then evolved to specific areas, educational areas, process applications, and important current topics such as Covid19.

Evidence-based practice in primary healthcare from the managerial point of view - a national survey

Background

The vast availability of and demand for evidence in modern primary healthcare force clinical decisions to be made based on condensed evidence in the form of policies and guidelines. Primary healthcare managers play a key role in implementing these governing documents. Thus, the aim of this article is to investigate the use and availability of evidence-based practice resources from the perspective of first-line primary healthcare managers.

Methods

The study is based on a national survey of primary healthcare managers, consisting of 186 respondents, recruited nationally from Sweden. The data was analysed using empirically constructed concepts and validated using factor analysis. A chi-square test was utilized to determine the statistical significance of comparisons. Associations between variables were calculated using Spearman’s correlation coefficients. All tests were two-sided, and the significance level was set to 0.05.

Results

A majority (97 %) of managers stated that guidelines and policy documents impacted primary healthcare; 84 % of managers observed a direct effect on daily practices. Most of the managers (70 %) stated that some adaptation was needed when new evidence was introduced. The managers emphasized the importance of keeping themselves updated and open to new information about work routines (96 %).

Conclusions

The study illustrates a nearly unanimous response about the influence of clinical evidence on daily practice. The emphasis on the importance of all staff members keeping their professional knowledge up to date is viewed as a direct result of this effect on daily practice. An information-dense organization such as a primary healthcare organization would have much to gain from increased cooperation with regional information resources such as clinical libraries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07023-w.

Leadership as a Facilitator of Evidence Implementation by Nurse Managers: A Metasynthesis

Evidence-based practice is often not implemented in nursing for reasons relating to leadership. This article aims to cast light on the factors that facilitate nursing evidence implementation perceived by nurse managers in their practical experiences of this implementation. It is a qualitative, narrative metasynthesis of primary studies on nurse managers' leadership-related facilitation experiences, following the Joanna Briggs Institute meta-aggregative approach and the Promoting Action on Research Implementation in Health Services (PARiHS) model. Eleven primary studies were included and three general categories were identified as leadership-related factors facilitating evidence implementation: teamwork (communication between managers and staff nurses), organizational structures (strategic governance), and transformational leadership (influence on evidence application and readiness for change among leaders). Nurse managers act as facilitators of evidence-based practices by transforming contexts to motivate their staff and move toward a shared vision of change. Always providing support as managers and colleagues, sharing their experience in the clinic environment.

An Examination of the Factors Associated With Implementation of Evidence-Based Management Practices for Improving Nurse Work Environments

BACKGROUND

Evidence-based management practices (EBMPs) that improve nurses' work environments have been linked to improvements in patient outcomes such as patient satisfaction and mortality. Yet, the extent to which nurse managers implement these EBMP or the factors associated with their implementation is not known.

AIMS

Guided by the Promoting Action on Research Implementation in Health Services (PARIHS) Framework, we examined individual, evidence, and organizational characteristics associated with nurse managers' implementation of the five EBMPs.

METHODS

A cross-sectional, correlational, survey design was used. Nurse managers from 10 public hospitals in New York City were recruited. Evidence and contextual variables were measured with the Organizational Readiness for Change Assessment instrument. EBMPs were measured with a modified version of the Practice Environment Scale of the Nursing Work Index. All multi-item scales were validated with confirmatory factors analysis in the studied sample. Additionally, the scales had Cronbach's alpha reliability greater than .8. A multivariate linear regression analysis with robust standard error correction was used to analyze the data and to adjust for clustering of managers in hospitals.

RESULTS

A total of 331 nurse managers responded for a 47.4% response rate. Bachelor's degree, number of staff supervised, managers' personal experience with evidence for EBMPs, staff culture, and organizational resources were significant predictors of nurse managers' implementation of EBMPs for NWE improvement (p < .05).

LINKING EVIDENCE TO ACTION

Staff culture was positively associated with implementation of all five EBMPs for improving nurses' work environments. Managers should prioritize nursing unit culture that encourages staff to innovate and change in order to improve care.

A mapping of facilitators and barriers to evidence-based management in health systems: a scoping review study

BACKGROUND

Healthcare settings are complex, and the decision-making process is usually complicated, too. Precise use of best evidence from different sources for increasing the desired outcomes is the result of EBM. Therefore, this study aimed to map the potential facilitators and barriers to EBM in health systems to help the healthcare managers to better implement EBM in their organizations.

METHODS

The present study was a scoping review (SR) conducted in 2020 based on the integration of the frameworks presented by Arksey and O'Malley (2005) and Levac et al. (2010) considering the Joanna Briggs Institute guideline (2015). These frameworks consist of 6 steps. After finalizing the search strategy, 7 databases were searched, and the PRISMA-ScR was used to manage the retrieval and inclusion of the evidence. Microsoft Excel 2013 was used to extract the data, and the graphic description was presented. The summative analysis approach was used applying MAXQDA10.

RESULTS

According to the systematic search, 4815 studies were retrieved after eliminating duplicates and unrelated articles, 49 articles remained to extract EBM facilitators and barriers. Six main aspects attitude toward EBM, external factors, contextual factors, resources, policies and procedures, and research capacity and data availability were summarized as EBM facilitators. The barriers to EBM were similarly summarized as attitude toward EBM, external factors, contextual factors, policies and procedures, limited resources, and research capacity and data availability. The streamgraphs describe that the international attention to the sub-aspects of facilitators and barriers of EBM has been increased since 2011.

CONCLUSIONS

The importance of decision-making regarding complex health systems, especially in terms of resource constraints and uncertainty conditions, requires EBM in the health system as much as possible. Identifying the factors that facilitate the use of evidence, as well as its barriers to management and decision-making in the organization, can play an important role in making systematic and reliable decisions that can be defended by the officials and ultimately lead to greater savings in organization resources and prevent them from being wasted.

Using the Methodology of Systematic Review of Reviews for Evidence-Based Medicine

Systematic Review of Reviews without abstract. Authors' invited you to read the whole review article since it is short.