Use of Evidence‐based Practice Models and Research Findings in Magnet‐Designated Hospitals Across the United States: National Survey Results

American Association of Heart failure nurses' knowledge, barriers and facilitators in conducting research

BACKGROUND

To provide high-quality patient care, heart failure (HF) nurses must comprehend/use best evidence; however, HF nurses' ability to do so are unknown.

OBJECTIVES

To describe HF nurses' research interest/involvement, confidence, facilitators/motivators, and barriers to lead/collaborate in research studies.

METHODS

A descriptive design with convenience sampling and online data collection (Qualtrics) were used with American Association of HF Nurses members. Recruited/included nurses (n = 145) needed to be of any educational level and currently practicing in any practice setting in the United States. A 30-item, adapted instrument assessed research interest (one-question), involvement (two-questions), confidence (two-questions), facilitators (one-question), motivators (three-questions), and barriers (21-questions).

RESULTS

Subjects (n = 145) were Caucasian (n = 124, 86.1 %) females (n = 137, 96.5 %) with an average age of 52.5 ± 10.38 years and 26.90±12.06 years of nursing experience. Nurses were interested in conducting nursing research (7.78/10±2.37) but involvement was low. Most frequently (n = 73, 50.3 %) nurses served as principal/co-investigators. Confidence with research participation was moderate (70.28/100±26.92) and in their ability to understand/apply research findings were low (21.68/100±80.07). The most frequently reported facilitator was the ability to control their own schedule/work (n = 30, 20.7 %) and the strongest motivator (n = 107, 73.8 %) was the perception presenting nursing research/EBP impacts HF care. The greatest reported barrier was the authority to seek research funding (2.39/5 ± 1.14). Nursing experience (p=.034), interest in participating in nursing research (p=.01), and how much presenting nursing research/EBP impacted one's performance review (p<.001) added to the prediction (R2=0.499, p<.001).

CONCLUSIONS

The gained knowledge may promote development of innovative programs and educational opportunities to increase HF nurses' research activities.

Trends in publication impact of evidence-based healthcare terminology (2013-2022)

AIMS

This article explored the publication impact of evidence-based healthcare terminology to determine usage and discuss options for low usage terms.

BACKGROUND

A plethora of terms describe the scholarship of evidence-based healthcare. Several terms are synonyms, creating redundancy and confusion. The abundance and overlap of terms may impede the discovery of evidence.

DESIGN

This discursive article explored and discussed publication impact of evidence-based healthcare terms.

METHODS

Evidence-based healthcare terms were identified, and their 10-year (2013-2022) publication impact was assessed in the CINAHL and Medline databases. A card sort method was also used to identify terms with low usage.

RESULTS

A total of 18/32 terms were included in the review. The terms evidence-based practice, quality improvement, research and translational research were the most highly published terms. Publication data were presented yearly over a 10-year period. Most terms increased in publication use over time, except for three terms whose use decreased. Several terms related to translational research have multiple synonyms. It remains unknown whether these terms are interchangeable and possibly redundant, or if there are nuanced differences between terms.

CONCLUSION

We suggest a follow-up review in 3-5 years to identify publication trends to assess context and terms with continued low publication usage. Terms with persistent low usage should be considered for retirement in the reporting of scholarly activities. Additionally, terms with increasing publication trends should be treated as emerging terms that contribute to evidence-based healthcare terminology.

IMPLICATIONS FOR NURSING

Confusion about the use of appropriate terminology may hinder progress in the scholarship of evidence-based healthcare. We encourage scholars to be aware of publication impact as it relates to the use of specific terminology and be purposeful in the selection of terms used in scholarly projects and publications.

Evidence-based practice attitudes, knowledge and skills of nursing students and nurses, a systematic review and meta-analysis

AIM/OBJECTIVE

This study aims to carry out a meta-analysis of attitudes, knowledge, and skills level of nursing students and nurses in EBP, providing a reference for optimizing EBP education strategies.

BACKGROUND

At present, no meta-analysis has been performed to quantitatively synthesize the attitudes, knowledge and skill levels of nursing students and nurses toward EBP. This makes it difficult to precisely identify the true level of EBP among nurses, implying that there is no evidence to support the adoption of EBP teaching strategies approaches.

DESIGN

A total of 9 Chinese and English databases including CNKI, Wan fang, VIP, CBM, PubMed, Embase, Web of Science, Cochrane Library and CINAHL were used to search cross-sectional quantitative articles on EBP attitudes, knowledge and skills level of nurses and nursing students. The search time limit was from the inception of the database to September 2023.

METHODS

Two researchers independently screened the literature and extracted the data. The Agency for Healthcare Research and Quality (AHRQ) was used to assess the quality of the included studies. Stata15.0 software was used for statistical analysis to summarize the scores of EBP attitude, knowledge and skills level of nursing students and nurses included in the study.

RESULTS

A total of 25 cross-sectional studies from 13 countries were included, involving 11363 nursing students and nurses. The meta-analysis results revealed that nursing students and nurses lacked evidence-based practical knowledge and skills, with pooled mean scores of 3.06 (95 % CI: 2.72, 3.39), 2.91 (95 % CI: 2.60, 3.22), 4.31 (95 % CI: 4.08, 4.54) and 4.45 (95 % CI: 4.20, 4.70). In contrast, nursing students and nurses revealed a positive attitude towards EBP, with pooled mean scores of 3.57 (95 % CI: 3.28, 3.86) and 5.11 (95 % CI: 4.80, 5.42). Subgroup analysis revealed that senior nursing students and nurses with master's degree or above had higher attitudes, knowledge and skills.

CONCLUSIONS

In summary, nursing students and nurses have a positive attitude towards EBP. However, they seem to lack the necessary knowledge and skills. Therefore, nursing educators should consider this as an opportunity to strengthen the teaching of their evidence-based practical knowledge and skills. This will lay a reference for developing nursing discipline.

Perceived Barriers to Administration of Aromatherapy in Nurses Caring for Pediatric Patients With Postoperative Nausea and Vomiting: An Evidence-based Practice Project

INTRODUCTION

Postoperative nausea and vomiting (PONV) is prevalent among surgical patients, causing hospitalizations, extended stays, and patient dissatisfaction. Children are twice as likely to experience PONV than adult patients. Complementary therapy holds promise for PONV treatment but meets clinical use barriers. We explored perioperative nurses' perceived barriers to the use of complementary aromatherapy.

METHOD

Presurvey and postsurveys assessed nurses' (n = 27) knowledge and barriers to aromatherapy use before and after an educational in-service.

RESULTS

Primary PONV treatment involved antiemetics. Barriers to aromatherapy included product availability, caregiver refusal, and patient-specific factors. Post-in-service, the nurses felt more familiar with aromatherapy and inclined to use it.

DISCUSSION

Increased education and guidelines on aromatherapy promote its incorporation into clinical practice. Institutional policies addressing the selection, administration, documentation, and monitoring of aromatherapy should be established to ensure the consistency and standardization of its use.

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.

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).

Evidence-Based Practice Implementation: Dependent on Capacity and Capabilities

OBJECTIVE

This study was conducted to determine the benefits, facilitators, and barriers of implementing evidence-based practice (EBP) into organizational culture.

BACKGROUND

Implementing EBP leads to higher quality of patient outcome care, improved patient outcomes, and decreased healthcare costs. Nurse leader (NL) influence is essential for successful EBP implementation.

METHODS

Data were collected using a descriptive qualitative approach with focus group interviews using 2 open-ended questions. Participants included NL attendees at the 2022 Association of California Nurse Leaders Annual Program/Conference. Data were analyzed and themes were identified using Sandelowski's method.

RESULTS

Two overarching themes emerged: capacity (the amount something can produce) and capabilities (the power or ability to do something).

CONCLUSIONS

Healthcare organizations need to invest in building NLs' capacity to implement EBP and allocate resources to strengthen the organization's capabilities in supporting EBP.

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.

Military Nursing Evidence-Based Practice Summit: A Descriptive Analysis of EBP Barriers and Solutions Within the Military Healthcare System

BACKGROUND

Evidence-based practice (EBP) is an innovative systematic problem-solving methodology that incorporates the best research evidence into clinical practice to improve patient outcomes, job satisfaction, and reduced healthcare costs. Although there are significant advances to implement EBP into military healthcare and operational settings, many barriers and challenges still exist. Civilian healthcare organizations have examined barriers and solutions to integrate EBP into clinical practice, but limited data exists to identify barriers and solutions to integrate EBP into military healthcare settings. Advancing the implementation of EBPs within military healthcare settings has the power to transform the administrative processes of healthcare management and most importantly, the delivery of healthcare for service members and beneficiaries. The purpose of this article is to present findings from a qualitative descriptive research study which analyzed data obtained during an EBP military summit.

METHODS

A qualitative descriptive research study was used to examine EBP barriers and solutions to implement EBP in military healthcare settings. Participants attended a virtual 1-day military EBP summit (n = 182). As part of the summit, participants were invited to voluntarily participate in focus groups. Focus groups were conducted to gain an understanding of EBP barriers and solutions from military and civilian nurses and medics with interest and experience conducting EBP within military healthcare settings (n = 42). Focus group discussions were transcribed and analyzed by the study team.

RESULTS

The study analysis identified six themes: leadership, command culture, EBP barriers (specific to MTF/operational environments), communication, infrastructure support, and outcome measures. Sub-themes identified additional dimensions military-specific barriers and solutions within the six identified themes.

CONCLUSIONS

The results of this research study identify actionable tasks and recommendations to advance EBP within the military healthcare system. EBP is currently underutilized in the military healthcare system, and supportive implementation of EBP can be accomplished through enhanced leadership engagement, changing command culture, addressing EBP barriers, infrastructure, communication planning, and integration of existing national clinical and financial outcome measures. Given the critical need to further transition of military healthcare to evidence-based data driven decisions, the knowledge gained from this study can optimize readiness and advance healthcare delivered to service members and beneficiaries within the military healthcare system.

The role practice approach for exercise and enhancement of nursing research capacity: A qualitative study

BACKGROUND

Strategies to improve the teaching effectiveness of nursing research courses are a fundamental objective of contemporary nursing educators. The role practice method is the sum of ways, means, and procedures used to perform role-specific practical learning activities through the adaptation of concepts, models and subjective abilities in an authentic environment. This technique enhances teaching effectiveness by encouraging students to actively participate in practice.

OBJECTIVE

The main aim of this study was to explore the effectiveness of the role practice approach within the framework of nursing research courses and provide guidance for subsequent teaching efforts.

METHODS

The purposive sampling method was used to recruit 16 students who participated in teaching of the role practice approach and completed all tasks set within the nursing research course in the third year of the undergraduate nursing program of a comprehensive university in south China. Data obtained from semi-structured interviews were analyzed using Colaizzi's seven-step analysis method.

RESULTS

Three themes were evaluated, specifically, self-improvement, self-inadequacy and course optimization.

CONCLUSION

The role practice method is effective in teaching nursing research courses and can enhance the ability of students to conduct research activities. However, deficiencies in the implementation plan exist that need further revision.

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.

Understanding the Patient's Perspective on Nursing Excellence: Insights From Patient Experience Data

This performance improvement project leverages patient experience data to better understand patient preferences and values with respect to care from nurses. Through the analysis of both quantitative and qualitative data collected in patient experience surveys, the authors explore the concept of nursing excellence from the patient's perspective and discuss practical approaches, based on the Compassionate Connected Care model, to achieve desired improvement goals for nursing.

Frontline Clinician Appraisement of Research Engagement: "I feel out of touch with research"

BACKGROUND

Health services research can benefit from frontline clinician input across all stages of research, yet their key perspectives are often not meaningfully engaged.

OBJECTIVE

How can we improve clinician engagement in research?

DESIGN

Convenience sampling and semi-structured interviews followed by descriptive content analysis with an inductive approach, followed by group participatory listening sessions with interviewees to further contextualize findings.

PARTICIPANTS

Twenty-one multidisciplinary clinicians from one healthcare system.

KEY RESULTS

We identified two major themes: perceptions of research (how research fits within job role) and characterizing effective engagement (what works and what does not work in frontline clinician engagement). "Perceptions of Research" encompassed three subthemes: prior research experience; desired degree of engagement; and benefits to clinicians engaging in research. "Characterizing Effective Engagement" had these subthemes: engagement barriers; engagement facilitators; and impact of clinician's racial identity.

CONCLUSIONS

Investing in frontline clinicians as research collaborators is beneficial to clinicians themselves, the health systems that employ them, and those for which they care. Yet, there are multiple barriers to meaningful engagement.

Determination of Nurses' Knowledge Levels on Skin Tears: A Cross-sectional Study

OBJECTIVE

To determine nurses' knowledge level about skin tears (STs).

METHODS

This cross-sectional study included 346 nurses working in acute care hospitals in Turkey who completed web- or paper-based surveys in September and October 2021. Researchers used the Skin Tear Knowledge Assessment Instrument, which consists of 20 questions across six domains, to assess nurses' level of ST knowledge.

RESULTS

The mean age of the nurses was 33.67 (SD, 8.88) years, 80.6% were women, and 73.7% had an undergraduate degree. Nurses' mean number of correct answers on the Skin Tear Knowledge Assessment Instrument was 9.33 (SD, 2.83) of 20 (46.66% [SD, 14.14%]). The mean numbers of correct answers by domain were as follows: etiology, 1.34 (SD, 0.84) of 3; classification and observation, 2.21 (SD, 1.00) of 4; risk assessment, 1.01 (SD, 0.68) of 2; prevention, 2.68 (SD, 1.23) of 6; treatment, 1.66 (SD, 1.05) of 4; and specific patient groups, 0.74 (SD, 0.44) of 1. Significant associations were found among the nurses' ST knowledge scores and whether they had graduated from a nursing program (P = .005), their working years (P = .002), their working unit (P < .001), and whether they provided care to patients with STs (P = .027).

CONCLUSIONS

Nurses' level of knowledge of the etiology, classification, risk assessment, prevention, and treatment of STs was low. The authors recommend including more information about STs in basic nursing education, in-service training, and certificate programs to increase nurses' ST knowledge.

Nurses' evidence-based practice competence and hospital practice environment after specific training under the Best Practice Spotlight Organization® Programme. A cross sectional study

BACKGROUND

Barriers to implementing training strategies for the improvement of evidence-based practice competence of nurses in hospital practice environments still persist.

OBJECTIVE

The aim of the study was to evaluate the impact of a specific training within the framework of the Best Practice Spotlight Organization® programme, on nurses' evidence-based practice competence and the practice environment in two hospitals.

DESIGN

This is a observational cross-sectional study assessing evidence-based practice competence and perceptions of Practice Environments.

PARTICIPANTS

The study sample were 204 nurses working at medical and surgical inpatient units at two hospitals involved in the Best Practice Spotlight Organization® programme.

METHODS

The study was conducted from February 2020 to May 2020. Three questionnaires were used to collect data: a sociodemographic/occupational questionnaire, a questionnaire exploring evidence-based practice skills, and a questionnaire exploring nurses' perceptions of their hospital practice environments.

RESULTS

A total of 204 nurses participated. They were classified into two groups: those who had received specific training within the framework of the programme, called trained-champions (n = 66), and those who had not yet received training, control group (n = 138). The trained-champions exhibited better evidence-based practice competence values than the control group in all dimensions (p < 0.001), with a higher difference in means in the "Utilisation" dimension (-0.80; CI:-0.99,-0.60) and the "Knowledge" dimension (-0.63; CI:-0.88,-0.38). Trained-champions also had a more positive perception of the practice environments than the controls in all dimensions (p ≤ 0.001). The largest differences in means were in the "Participation" dimension (-0.48; CI:-0.66,-0.31) and in the "Leadership" dimension (-0.41; CI:-0.59,-0.23).

CONCLUSIONS

Specific EBP training within the framework of the Best Practice Spotlight Organization® programme has succeeded in nurses (trained-champions) obtaining better EBP competence than others without this training. This could have contributed to increase nurses' abilities to integrate evidence into decision making in their clinical practice, while positively influencing them to perceive their PEs more favorably.

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.

De-adopting low-value care: The missing step in evidence-based practice?

BACKGROUND

Low-value care provides little or no benefit to pediatric patients, has the potential to cause harm, waste healthcare resources, and increase healthcare costs. Nursing has a responsibility to identify and de-adopt low-value practices to help promote quality care.

PURPOSE

1) Describe the process of identifying and de-adopting low-value clinical practices guided by a conceptual model using a case study approach. 2) Identify facilitators and barriers to de-adoption practices, including levels of stakeholder engagement, organizational structures, and the quality of available scientific and non-scientific evidence.

METHODOLOGY

An evidence-based practice (EBP) project investigating the efficacy of antihistamines in decreasing infusion reactions to infliximab identified a low-value practice within a pediatric infusion center. The Synthesis Model for the Process of De-adoption was then applied to guide the de-adoption of this low-value practice. Case study analysis highlighted facilitators and barriers to de-adoption efforts.

CONCLUSIONS

The process for de-adopting care is an essential component of EBP and, as such, should be explicated through robust, standardized EBP processes and education.

PRACTICE IMPLICATIONS

Nurses are best positioned to identify, assess and prioritize low-value practices and facilitate the de-adoption of low-value practice that impact pediatric patients and families. Models to support de-adoption and a focus on site-specific practices including a prepared nursing workforce, continuous evaluation of care processes and the use of resources to assess for contextual determinants facilitates success and sustainability of this essential EBP approach.

Nursing's Wicked Problems: Partnering With Academic Leadership to Develop Solutions

Nursing is in a challenging place, and we are facing many incredibly complex issues that are steeped in culture and tradition. These "wicked problems" often arise when organizations face constant change or unprecedented challenges. In this article, we discuss current issues that hinder all nurse leaders from elevating nursing as a profession, with a particular focus on the role and contributions of the academic nurse leader in creating and sustaining positive change. By prioritizing meaningful collaboration, reimagining education for nursing outside the hospital walls, investing in evidence for practice, and advocating by amplifying new voices, we can identify shared goals and develop coordinated plans of action. The goal of academic nursing is to work to understand wicked disciplinary problems while also analyzing and critiquing what is not working, articulating possible solutions, and collaborating with other nurse leaders to address these complex issues. This also means that academic nursing should be held equally accountable for delivering results.

Influence of a Formal Mentor on Hospital-Based Nurse Research Resources and Outcomes

ABSTRACT

Magnet® hospitals must conduct nursing research to maintain designation. Relationships between hospital research infrastructure, activities, and a designated nurse research mentor were explored in a large health system using survey methodology. Hospitals with a formal mentor reported more research resources (n = 23, m = 2.5) compared with those without (n = 16, m = 1.8, P < 0.001). Hospitals aspiring for Magnet may benefit from a doctorally prepared research mentor.

Linking Hospitals to Communities Through Evidence-Based Practice

ABSTRACT

Evidence-based practice (EBP) and innovation are critical to quality and improved outcomes in the acute care setting and are often driven by bedside caregiver and clinical nurse specialist collaboration. Several EBP models and frameworks exist to guide these efforts. Although existing models do not preclude external evidence and community-based stakeholders, they largely do not explicitly connect the hospital-based effort to the community either. In our experience in facilitating EBP projects within an acute care hospital in the upper Midwest, we observed multiple situations in which nurse-led EBP projects intersected with the surrounding community in multiple phases of the project. The purpose of this article is to demonstrate an explicit connection between hospital-placed EBP processes and community/population health. To illustrate this assertion, 3 exemplars of nurse-driven, hospital-placed innovation are presented. Implications for practice and research are discussed.

Psychometric properties of the evidence-based practice mentorship scale

BACKGROUND

Evidence-based practice (EBP) improves the quality of care, decreases healthcare costs, and improves job satisfaction. However, nurses and other clinicians, as well as their institutions, struggle to consistently implement EBP. The Advancing Research and Clinical practice through close Collaboration (ARCC©) Model established that a cadre of EBP mentors is key to improving EBP knowledge, beliefs, competency, and implementation in clinicians. Yet, there has not been a valid and reliable measure of EBP mentorship.

AIMS

The aim of this study was to determine the psychometric properties of the new 8-item EBP Mentorship Scale. This scale measures the degree to which clinicians perceive that EBP mentorship is available to them.

METHODS

The EBP Mentorship Scale data were obtained from a previous national cross-sectional descriptive study with 2344 nurses from 19 hospitals and healthcare systems. Descriptive statistics summarized the sample and distributions of the scale items. Cronbach's alpha, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) were conducted.

RESULTS

Cronbach's alpha of the scale was 0.99. A one-factor model was supported by EFA and retained for CFA. Model fit indices for CFA indicated a good fit.

LINKING EVIDENCE TO ACTION

The new EBP Mentorship Scale is valid and reliable and can be used to assess the level of EBP mentorship support available in hospitals and healthcare systems. EBP mentors are key in sustaining an EBP organizational culture and enhancing clinician EBP knowledge, beliefs, competency, and implementation.

Transition to Practice: Implementing Healthy Work Environment Standards through Nurse Resident-Led Evidence-based Practice Change in Transcatheter Aortic Valve Replacement Care on a Cardiac Telemetry Unit

Implementing healthy work environment standards helps to improve the care environment for nurses and patients. These standards were used as a framework during a nurse resident-led evidence-based practice project. The transcatheter aortic valve replacement team collaborated with the nurse residents throughout the evidence-based practice project to design a fast-track patient selection checklist and give input into a care protocol for their cardiac telemetry unit.

Implementing the Synergy Model: A Qualitative Descriptive Study

Hospitals across our nation are seeking to implement models of care that meet the primary goals of Quadruple Aim: Improved population health, cost-effective care delivery, and patient and provider satisfaction. In an effort to address the Quadruple Aim and our patients’ care needs, Hamilton Health Sciences (HHS) embarked on a model of care delivery redesign, beginning with nursing care delivery. From 2013 to 2018, 12 clinical programs at HHS implemented the Synergy Model with its accompanying synergy patient needs assessment tool for nurses to objectively assess patients’ acuity and dependency needs. Data on patients’ priority care needs were used to inform a nursing model of care redesign at HHS, including skill mix and staffing levels. This five-year project was an organization-wide quality improvement initiative. As part of the evaluation, HHS leaders partnered with health services nurse researchers to conduct a mixed methods study. This paper describes the evaluation outcomes from the qualitative component of the study, which included interviews with clinical nurse leaders and direct care nurses. Data were analyzed using descriptive thematic analysis. Some key findings were increased nurse awareness of patients’ holistic care needs and leaders’ capacity to plan staffing assignments based on patients’ priority care needs. Themes helped inform recommendations for key stakeholders, including nurse leaders and direct care nurses.

Iowa Implementation for Sustainability Framework

Background

An application-oriented implementation framework designed for clinicians and based on the Diffusion of Innovations theory included 81 implementation strategies with suggested timing for use within four implementation phases. The purpose of this research was to evaluate and strengthen the framework for clinician use and propose its usefulness in implementation research.

Methods

A multi-step, iterative approach guided framework revisions. Individuals requesting the use of the framework over the previous 7 years were sent an electronic questionnaire. Evaluation captured framework usability, generalizability, accuracy, and implementation phases for each strategy. Next, nurse leaders who use the framework pile sorted strategies for cultural domain analysis. Last, a panel of five EBP/implementation experts used these data and built consensus to strengthen the framework.

Results

Participants (n = 127/1578; 8% response) were predominately nurses (94%), highly educated (94% Master’s or higher), and from across healthcare (52% hospital/system, 31% academia, and 7% community) in the USA (84%). Most (96%) reported at least some experience using the framework and 88% would use the framework again. A 4-point scale (1 = not/disagree to 4 = very/agree) was used. The framework was deemed useful (92%, rating 3–4), easy to use (72%), intuitive (67%), generalizable (100%), flexible and adaptive (100%), with accurate phases (96%), and accurate targets (100%). Participants (n = 51) identified implementation strategy timing within four phases (Cochran’s Q); 54 of 81 strategies (66.7%, p < 0.05) were significantly linked to a specific phase; of these, 30 (55.6%) matched the original framework. Next, nurse leaders (n = 23) completed a pile sorting activity. Anthropac software was used to analyze the data and visualize it as a domain map and hierarchical clusters with 10 domains. Lastly, experts used these data and implementation science to refine and specify each of the 75 strategies, identifying phase, domain, actors, and function. Strategy usability, timing, and groupings were used to refine the framework.

Conclusion

The Iowa Implementation for Sustainability Framework offers a typology to guide implementation for evidence-based healthcare. This study specifies 75 implementation strategies within four phases and 10 domains and begins to validate the framework. Standard use of strategy names is foundational to compare and understand when implementation strategies are effective, in what dose, for which topics, by whom, and in what context.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13012-021-01157-5.

Role of Dutch internal policy advisors in a hospital quality improvement programme and their influence on nurses' role development: a qualitative study

OBJECTIVE

Nurses are vital in providing and improving quality of care. To enhance the quality improvement (QI) competencies of nurses, hospitals in the Netherlands run developmental programmes generally led by internal policy advisors (IPAs). In this study, we identify the roles IPAs play during these programmes to enhance the development of nurses' QI competencies and studied how these roles influenced nurses and management.

DESIGN

An exploratory ethnographical study comprising observations, informal conversations, semistructured interviews, focus groups and a strategy evaluation meeting.

SETTING

A teaching hospital in an urban region in the Netherlands.

PARTICIPANTS

IPAs (n=7) in collaboration with four teams of nurses (n=131), team managers (n=4), senior managers (n=4) and the hospital director (n=1).

RESULTS

We identified five distinct advisory roles that IPAs perform in the hospital programme: gatekeeper, connector, converter, reflector and implementer. In describing these roles, we provide insights into how IPAs help nurses to develop QI competencies. The IPA's professional background was a driving force for nurses' QI role development. However, QI development was threatened if IPAs lost sight of different stakeholders' interests and consequently lost their credibility. QI role development among nurses was also threatened if the IPA took on all responsibility instead of delegating it timely to managers and nurses.

CONCLUSIONS

We have shown how IPAs' professional background and advisory knowledge connect organisational, managerial and professional aims and interests to enhance professionalisation of nurses.

The Relationship Between Transformational Leadership Practices of First-Line Nurse Managers and Nurses' Organizational Resilience and Job Involvement: A Structural Equation Model

BACKGROUND

Nurse leaders play a unique role in seeking ways to promote a strong nurse workforce and positive work attitudes and behaviors among nurses to assist in their success. The leadership practice of nurse managers could be an important factor in promoting nurses' organizational resilience and job involvement.

AIM

To determine the relationship between transformational leadership practices of first-line nurse managers and nurses' organizational resilience and job involvement.

METHODS

A descriptive correlational research design was conducted at a Saudi university hospital. The study consisted of 60 nurse managers and 211 nurses. Measures included Leadership Practices Inventory, organizational resilience, and job involvement questionnaires. Results were analyzed using inferential statistics and Structural Equation Modeling.

RESULTS

In addition to the positive significant correlation found among the studied variables, First-Line Nurse Managers' Leadership practices accounted for 43% and 40% of the variance of nurses' organizational resilience and job involvement.

LINKING EVIDENCE TO ACTION

Nurse leaders perform a crucial role in embracing and executing effective strategies through their transformational leadership and managerial caring to support nurses' resilience and job involvement. Shared governance and a respectful working atmosphere that conveys gratitude to nurses are popular strategies that enhance the efficacy of nursing leadership and promote positive work attitudes among nurses.

Pandemic Challenges: Keeping Nursing Research Alive

Nursing has been pandemic-slammed. Although 2020 will be forever entangled with the COVID-19 pandemic, we, as nurse leaders, must continue to move forward and beyond this endemic challenge. We cannot lose focus on generating new knowledge to continue nursing excellence and move our profession forward.

Implementation of the MATRIX Staffing Grid Improves Nurse Satisfaction With Rehabilitation Unit Staffing

ABSTRACT

BACKGROUND: Information on nurse satisfaction and unit acuity is scarce in the literature. The purpose of this study is to evaluate the effect of the MATRIX Staffing Grid (MSG) on nurse assignment satisfaction in a 20-bed inpatient rehabilitation facility. METHODS: Prospective systematic implementation study of the MSG occurred in 5 phases: development, baseline, run-in, implementation, and sustainability. Pretest/posttest nursing satisfaction data were analyzed using Wilcoxon-Mann-Whitney tests. RESULTS: Analysis of 128 satisfaction surveys demonstrated that the median total satisfaction score increased by 35% after MSG implementation (P < .05), with no change in patient satisfaction or adverse event rates. CONCLUSION: A systematic approach to implementation of the MSG evidence-based practice significantly improved nursing satisfaction with patient assignment in a way that addressed specific needs. The MSG has now been adopted into practice at our institution. The MSG may be feasible for implementation in inpatient rehabilitation units to improve staffing satisfaction.

Evidence-Based Practice Culture and Mentorship Predict EBP Implementation, Nurse Job Satisfaction, and Intent to Stay: Support for the ARCC© Model

BACKGROUND

The Advancing Research and Clinical practice through close Collaboration (ARCC^© ) Model is a system-wide framework for implementing and sustaining evidence-based practice (EBP) in hospitals and healthcare systems. The model involves assessing organizational culture and readiness for EBP in addition to the development of a critical mass of EBP mentors who work with point-of-care clinicians to facilitate the implementation of evidence-based care. Determining how the various components of the ARCC^© Model relate to one another is important for understanding how EBP culture and mentorship impact EBP implementation, nurses' job satisfaction, and intent to stay.

AIMS

The current study aimed to test a model that could explain the relationships and direct pathways among eight key variables in the ARCC^© Model: (1) EBP culture, (2) mentorship, (3) knowledge, (4) beliefs, (5) competency, (6) implementation, (7) nurses' job satisfaction, and (8) intent to stay.

METHODS

Structural equation modeling was used to test relationships among the variables in the ARCC^© Model with data obtained from an earlier cross-sectional descriptive study with 2,344 nurses from 19 hospitals and healthcare systems across the United States.

RESULTS

The final structural equation model found that EBP culture and mentorship were key variables that positively impacted EBP knowledge, beliefs, competency, implementation, job satisfaction, and intent to stay among nurses.

LINKING EVIDENCE TO ACTION

As described in the ARCC^© Model, establishing a strong sustainable EBP culture along with a critical mass of EBP mentors is crucial for the development of EBP competency and consistent implementation of evidence-based care by nurses. A strong EBP culture along with EBP mentorship also can result in higher job satisfaction and intent to stay. Implementation of the ARCC^© Model is a key strategy in assisting systems to reach health care's Quadruple Aim.

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.

A Five-Step Evidence-Based Practice Primer for Perioperative RNs

Perioperative nurses work in a complex health care setting and are well-positioned to mitigate unexpected events and promote optimal patient outcomes. Thus, perioperative nurses must adapt to rapid advances in technology, treatments, and scientific discoveries to maintain clinical competence and provide care that reflects current evidence. Evidence-based practice (EBP) is a standard of professional nursing performance and an expectation of professional nursing practice. Because EBP is foundational to health care quality and safety, perioperative nurses must understand the concepts of EBP and have the capacity to apply evidence to their clinical practice. However, some perioperative nurses struggle with EBP concepts and find it difficult to access, appraise, and apply evidence. In this article, we describe the five-step EBP process and provide valuable insights into EBP for perioperative RNs.