Questionnaire to Evaluate the Competency in Evidence-Based Practice of Registered Nurses (EBP-COQ Prof©): Development and Psychometric Validation

Cultural adaptation and reliability testing of the Chinese version of evidence-based practice knowledge assessment in nursing: A cross-sectional study

Objective

The EKAN is a reliable and validated tool for objectively measuring the evidence-based practice (EBP) knowledge of nurses. Thus, we set out to translate and culturally modify the Evidence-Based Practice Knowledge Assessment in Nursing (EKAN), and then evaluate its validity and reliability among Chinese practicing nurses.

Methods

This cross-sectional study consisted of two phases. The first phase involved translating the EKAN into Chinese (EKAN-Chinese), using a process of forward translation, back translation, review, cultural adjustment as well as a pilot study. The second phase aimed to assess the psychometric properties of the EKAN-Chinese and establish a baseline measure of EBP knowledge among 120 nurses from a large general hospital in Beijing, China. Data were collected from August to November 2022 and analyzed with Rasch software. This study was reported using the cross-sectional STROBE checklist.

Results

The newly translated, EKAN-Chinese was pilot-tested after slight modification of four items without altering the intended meaning. The outfit unweighted mean square was 1.03 (SD = -0.13), the infit weighted mean square was 1.00 (-0.17), and the mean difficulty index ranged from -3.43 to 2.85 according to validity indices. The results of the reliability indices revealed low person reliability (0.49), high item reliability (0.96), moderate person separation index (0.99), and sufficient item separation index (4.71). The mean EKAN-Chinese sum score was 9.8 (max score = 20, SD = 2.9).

Conclusion

The newly translated EKAN-Chinese showed sufficient psychometric evidence to support use in practicing Chinese nurses. The EKAN-Chinese can be used by nurse leaders in China as a potential screening tool to 1) objectively identify nurses who need educational training in evidence-based nursing practice, and 2) gauge the effectiveness of education and training programs to improve EBP knowledge and ultimately, evidence-based care.

Implementing a Standardized Phase-of-Care Craniotomy Education Program

Leaders at a community hospital in the southeastern United States sought to add a craniotomy program to meet the needs of the local patient population. Perioperative and critical-care nurses required specific knowledge and skills to care for patients undergoing craniotomy procedures. The facility's education team applied adult learning theories and an innovation diffusion framework when developing an evidence-based craniotomy education program. A clinical nurse specialist conducted a gap analysis and readiness assessment to determine the nurses' knowledge, skills, and competence to care for patients; attitudes and behaviors toward implementation of the new program; and preferred learning methods. The three-tiered phase-of-care education program included didactic learning sessions, shadowing experiences, hands-on experience with equipment, and simulation sessions. The program focused on effective collaboration and care transitions. Nurses were satisfied with the program, and they continue to participate in ongoing quarterly simulation sessions with case study scenarios to enhance their skills.

Instruments measuring evidence-based practice behavior, attitudes, and self-efficacy among healthcare professionals: a systematic review of measurement properties

BACKGROUND

Evidence-based practice (EBP) is well known to most healthcare professionals. Implementing EBP in clinical practice is a complex process that can be challenging and slow. Lack of EBP knowledge, skills, attitudes, self-efficacy, and behavior can be essential barriers that should be measured using valid and reliable instruments for the population in question. Results from previous systematic reviews show that information regarding high-quality instruments that measure EBP attitudes, behavior, and self-efficacy in various healthcare disciplines need to be improved. This systematic review aimed to summarize the measurement properties of existing instruments that measure healthcare professionals' EBP attitudes, behaviors, and self-efficacy.

METHODS

We included studies that reported measurement properties of instruments that measure healthcare professionals' EBP attitudes, behaviors, and self-efficacy. Medline, Embase, PsycINFO, HaPI, AMED via Ovid, and Cinahl via Ebscohost were searched in October 2020. The search was updated in December 2022. The measurement properties extracted included data on the item development process, content validity, structural validity, internal consistency, reliability, and measurement error. The quality assessment, rating of measurement properties, synthesis, and modified grading of the evidence were conducted in accordance with the COSMIN methodology for systematic reviews.

RESULTS

Thirty-four instruments that measure healthcare professionals' EBP attitudes, behaviors or self-efficacy were identified. Seventeen of the 34 were validated in two or more healthcare disciplines. Nurses were most frequently represented (n = 53). Despite the varying quality of instrument development and content validity studies, most instruments received sufficient ( +) ratings on content validity, with the quality of evidence graded as "very low" in most cases. Structural validity and internal consistency were the measurement properties most often assessed, and reliability and measurement error were most rarely assessed. The quality assessment results and overall rating of these measurement properties varied, but the quality of evidence was generally graded higher for these properties than for content validity.

CONCLUSIONS

Based on the summarized results, the constructs, and the population of interest, several instruments can be recommended for use in various healthcare disciplines. However, future studies should strive to use qualitative methods to further develop existing EBP instruments and involve the target population.

TRIAL REGISTRATION

This review is registered in PROSPERO. CRD42020196009. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020196009.

Evidence-Based Practice Competency of Registered Nurses in the Greek National Health Service

Nurses' competency toward evidence-based practice (EBP) has been extensively investigated by several studies worldwide. However, factors affecting the competence of Greek nurses working in the NHS have not been fully investigated in terms of EBP. Thus, this study aimed to explore the impact of the individual qualifications of nurses on their competence toward EBP. Data from 473 registered nurses working in 10 hospitals in the Greek National Health Service (NHS) were collected between October and December 2020 using a convenience sampling method in a cross-section design. The Greek version of the 35-item (five-point Likert scale) Evidence-Based Practice Competency Questionnaire for Professional Registered Nurses (EBP-COQ Prof) was used to assess the competence level of nurses, focusing on attitudes, skills, and knowledge, as well as the utilization of EBP in clinical practice. One-way ANOVA and Pearson coefficient tests were applied to compare the possible differences among variables (two or more groups) as appropriate. A multi-factorial regression model was applied to explore participants' qualifications, including demographics (MSc degree, gender, English language knowledge, etc.) as independent variables, and to control for potential confounding effects toward EBP competency. The p-values < 0.05 were considered statistically significant. The mean age of the 473 participants (402 women and 71 men) was 44.7 ± 9.2 years old. The mean value of competence subscales was found as follows: attitudes 3.9 ± 0.6, knowledge 3.7 ± 0.6, skills 3.1 ± 0.8, and utilization 3.4 ± 0.7. A multivariate regression analysis revealed that associates of "Master's degree" (t = 3.039, p = 0.003), "Writing an academic article" (3.409, p = 0.001), "Working in a University clinic" (2.203, p = 0.028), and "Computer Skills" (2.404, p = 0.017) positively affected "Attitudes", "Knowledge", "Skills", and "Utilization", respectively. The research data suggest that nurses working in the Greek NHS were limited in competence regarding EBP in comparison with other European countries. Therefore, vocational, educational, and training programs tailored to EBP enhancement are crucially important. This study was not registered.

Knowledge in Motion: A Comprehensive Review of Evidence-Based Human Kinetics

This comprehensive review examines critical aspects of evidence-based human kinetics, focusing on bridging the gap between scientific evidence and practical implementation. To bridge this gap, the development of tailored education and training programs is essential, providing practitioners with the expertise and skills to effectively apply evidence-based programs and interventions. The effectiveness of these programs in improving physical fitness across all age groups has been widely demonstrated. In addition, integrating artificial intelligence and the principles of slow science into evidence-based practice promises to identify gaps in knowledge and stimulate further research in human kinetics. The purpose of this review is to provide researchers and practitioners with comprehensive information on the application of scientific principles in human kinetics. By highlighting the importance of evidence-based practice, this review is intended to promote the adoption of effective interventions to optimize physical health and enhance performance.

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.

Self-perceived competences in evidence-based practice of clinical-teaching nurses versus clinical nurses

AIM

To compare the evidence-based practice (EBP) self-perceived competences of clinical teacher nurses (CTN) versus clinical nurses (CN) to detect areas for improvement in practical training.

METHOD

A cross-sectional study by means of a self-assessment questionnaire sent to nurses of two public hospitals of Castilla y León was performed, between February to May 2020. Variables included competences in evidence based practice (EBP) - attitude, knowledge, skills and use-, sociodemographic, job, academic, teaching relations and training in investigation methodology and/or EBP. A validated questionnaire EBP-COQ prof© of 35 questions with answers type Likert (1, very disagree-5, very agree) was used. Data analysis (descriptive and bivariate) was performed by means SPSS v.24 program.

RESULTS

171 questionnaires were answered by nurses. CN 52%, CTN 48%. There were no significant differences between both groups regarding sociodemographic variables. Mean age was 43.6 ± 9.9 and 42.9 ± 8.5 for CN and CTN, respectively. Total sample showed a mean EBP competency score of 3.54 ± 1.00 (attitudes: 4.40 ± 0.60; knowledge: 3.08 ± 0.94; skills: 3.57 ± 0.66; utilization: 3.36 ± 0.75). The CTN group obtained higher mean scores in knowledge dimension, compared with CN (P = .02) and with total sample (P = .02). There were no significant differences in other dimensions.

CONCLUSION

CTN showed better self-perceived competences scores only in the knowledge dimension compared with CN. Taking in account the level of responsibility they support in their daily practice, it would be advisable to design management strategies in order to improve attitudes, skills and utilize EBP, acting as professional role models for students and peer mentors.

Instruments for assessing healthcare professionals' knowledge and skills of evidence-based practice: A scoping review

OBJECTIVE

The aim of this scoping review was to describe the instruments used to assess the knowledge and skills of evidence-based practice (EBP) in healthcare settings.

METHODS

A scoping review was undertaken. Three electronic databases (CINAHL, PubMed and Cochrane) were searched in January 2022. The search phrases consisted of the following terms: healthcare professionals, EBP, competence and instrument and their synonyms, keywords and MeSH terms. The database search was run without any limitations. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to support reporting.

RESULTS

Ultimately, 39 studies were included; most of them (35) were cross-sectional studies. The studies were conducted in 17 countries. A total of 17 evidence-based knowledge and skills instruments were identified. The Upton and Upton instrument was used in 19 studies. Twelve self-reported instruments were used only once. The psychometric properties of the instruments varied. The reliability was typically reported with Cronbach's alpha coefficient. The content of the EBP knowledge/skills instruments consists of five main categories: EBP, evaluation of current practice, preparation for the implementation of EBP, implementation of evidence and active participation in the development of EBP.

CONCLUSION

Almost all instruments are self-assessment instruments. Validated knowledge tests should be further developed. The instruments emphasise the preparation for the implementation of EBP. Further research is needed to develop instruments for healthcare professionals to assess the knowledge and skills of the implementation of evidence.

Translation and Validation of the Greek Version of the Evidence-Based Practice Competency Questionnaire for Registered Nurses (EBP-COQ Prof©)

(1) Background: Evidence-based nursing is the benchmark of the nursing profession. It is widely recognized that evidence enhances knowledge, skills, and competencies in nursing education and thus the quality of patient care. Although several proposals have been introduced to reinforce nurses through education in evidence-based practice (EBP) for clinical practice, there is no validated EBP competence tool to determine how nurses approach evidence-based nursing in healthcare practices in Greece. Therefore, the aim of the present study was to translate and validate the Greek version of the Evidence-Based Practice Competency Questionnaire, Professional version (EBP-COQ Prof©). (2) Methods: A cross-sectional study was conducted in a sample of registered nurses working in the public sector. (3) Results: 414 clinical nurses were recruited in total with a response rate of 75.3% and a mean age of 43 years old. Most of the nursing personnel were females, 354 (85.5%), and there were 60 (14.5%) males. Confirmatory factor analysis (CFA) showed a confirmation of the developer's four-factor design. The estimated association between items on each scale showed a strong relationship. The competence questionnaire showed a high internal consistency between the components of attitude, knowledge, skills, and utilization. (4) Conclusions: The competence questionnaire shows a strong relationship between four the components, highlighting the four factors that should be promoted to improve the use of EBP nursing practices.

Translation, Adaptation, and Psychometric Validation of the Spanish Version of the Attitudes towards Research and Development within Nursing Questionnaire

The promotion of research competence is essential for the development of the nursing profession and discipline. The aim of this study was to translate into Spanish, adapt, and validate an instrument measuring nurses’ attitudes towards nursing research and development. A quantitative, cross-sectional, analytical design was used for the cross-cultural adaptation and cultural validation of the instrument. A total of 367 participants were selected using intentional sampling. A process of translation, back-translation, expert consultation, and pilot testing was followed. Subsequently, reliability and statistical validity were assessed, a new factor structure was proposed, and means were compared to assess the power to discriminate between factors by groups of participants. The results showed internal consistency tests with a Cronbach’s alpha of 0.913. Confirmatory factor analysis of the comparative fit index (CFI = 0.549) and Tucker–Lewis index (TLI = 0.491) indicate that the factors did not match the original clustering model. The new factor structure consisted of seven factors. Between-group comparisons revealed statistically significant differences. In conclusion, the instrument exhibits high levels of statistical reliability and validity compared to the original instrument. The new factorial proposal is consistent, but further research is needed to verify its replicability in other contexts.

VALIDATION OF COMPETENCIES ASSESSMENT SCALE IN A UNIVERSITY HOSPITAL NURSING TEAM

ABSTRACT Objective: to analyze the evidence of validity of an instrument for the evaluation of competencies in a nursing team of a university hospital. Method: methodological study to investigate evidence of validity of the scale, with previously validated content, was sent to 978 technical-administrative employees in education who worked in the nursing team in a university hospital, and the non-parametric sample consisted of 143 employees. The scale consisted of 10 competencies and 25 measurable actions in four levels of competencies. The internal consistency of the instrument was analyzed by calculating Cronbach's alpha coefficient and construct validity by confirmatory factor analysis. Results: 53 nurses, 30 nursing technicians and 60 nursing assistants participated, totaling 143 professionals working in the hospital of a federal university in the state of São Paulo, Brazil. The confirmatory factor analysis of the instrument, based on the structure of 10 competencies, presented good adjustment indexes with χ²/GL=1.706, SRMR=0.071, RMSEA=0.070 and CFI=0.906, conferring construct validity. Cronbach's alpha was 0.924. Conclusion: through the statistical procedures adopted, it was concluded that the instrument has evidence of validity based on both the internal structure - construct, and internal consistency.

Use of Social Media to Exchange Critical Care Practice Evidence During the Pandemic

BACKGROUND

The evidence-based practice (EBP) process was challenged during the early phase of the COVID-19 pandemic by factors such as a novel disease, rapidly changing guidelines, shortage of personal protective equipment, and other health care supplies.

OBJECTIVES

Our aims were to (1) explore sources of evidence sought by critical care nurses during a pandemic and (2) explore nurses' perceptions of EBP.

METHODS

A qualitative exploratory study was conducted using deidentified data from the American Association of Critical-Care Nurses (ACCN) open-access Facebook page, January 28 to April 30, 2020.

RESULTS

Two major themes were identified: (1) "sharing and seeking evidence," that is, nurses used both formal and informal sources to explore evidence supporting evolving clinical practices, and (2) "concerns about evidence," that is, nurses expressed concerns about lack of evidence and mistrust of evolving evidence.

DISCUSSION

Initially, there was a mismatch in nurses' expectations of the American Association of Critical-Care Nurses Facebook page. A major limitation of Facebook is the lack of a repository for quick retrieval of information. Despite these limitations, and fear and mistrust of changing guidelines, social media was used to communicate, collaborate, and share evidence to support clinical practice. Critical care nurses seemed to value evidence to support patient management and their personal safety during this evolving health crisis.

CONCLUSIONS

Social media played a large role in dissemination of timely evidence-based information during the early pandemic. Our results show that current EBP models should be revised to prepare for future crises and include direction for dealing with limited health care resources, and lack of and/or rapidly changing evidence.

Evidence-Based Practices and Use among Employees and Students at an Austrian Medical University

Developed in the pre-internet era in the early 1980s, empirical medical practice, i.e., evidence-based practice (EBP) has become crucial in critical thinking and statistical reasoning at the point-of-care. As little evidence is available so far on how EBP is perceived in the Austrian academic context, we conducted a cross-sectional online survey among a nonrandom purposive sample of employees and students at the Medical University Vienna, Austria (total n = 1247, 59.8% females). The German questionnaire assessed both EBP capability beliefs and EBP use, with the respective indices both yielding good internal consistency. We conducted subgroup comparisons between employees (n = 638) and students (n = 609). In line with Bandura's self-efficacy theory, we found a correlation between EBP capability beliefs and EBP use, with higher scores reported in the employee group. The results indicated that the participants did not strictly follow the sequential EBP steps as grounded in the item-response theory. Since its emergence, EBP has struggled to overcome the dominating traditional way of conducting medicine, which is also known as eminence-based medicine, where ad hoc decisions are based upon expert opinions, and nowadays frequently supplemented by quick online searches. Medical staff and supervisors of medical students should be aware of the existing overlaps and synergies of these potentially equivalent factors in clinical care. There is a need for intensifying the public and scientific debate on how to deal with the divergence between EBP theory and EBP practice.

[Evidence-Based Practice competency and associated factors among Primary Care nurses in Spain]

OBJECTIVE

To describe the Evidence-Based Practice (EBP) competency level in Primary Care (PC) nurses in Spain and to determine the associated factors.

DESIGN

Cross-sectional, national survey design, carried out between January and March 2020.

SETTING

PC in Spain.

PARTICIPANTS

Seven hundred eighty PC active nurses in the National Health Service with at least one year of professional experience.

MAIN MEASUREMENTS

(1) Sociodemographic, professional and access to scientific information variables; (2) outcome variable: EBP competency (attitude, knowledge, skills and utilization) assessed through the EBP-COQ Prof© questionnaire. Bivariate and multiple lineal regression analyses were carried out.

RESULTS

The mean score for the EBP competency of the PC nurses was 131.5 (standard deviation [SD] 17.0), according to dimensions: attitude 36.8 (SD 3.6); knowledge 38.2 (SD 8.9); skills 23.0 (SD 3.5); and utilization 33.3 (SD 6.1). The number of articles read in the last month has showed the most influence on all the EBP-COQ Prof© dimensions, followed by EBP training (more than 150h) and nursing students mentoring. The education level (master, specialist and doctorate) is associated with knowledge and skills dimensions, meanwhile belonging to a BPSO® center is associated with the EBP utilization.

CONCLUSIONS

These findings can guide PC service managers to plan strategies that improve the EBP competency level of the nurses, aimed mainly at achieving real application in clinical practice. However, it is necessary to consider the possible impact of selection bias on the results.

Design of the EBE-ST Questionnaire among Nursing Students: Multicenter Study from Eight Universities in Spain

Background: Twenty years after the degree in nursing was introduced in Spain, the subject of evidence-based nursing is still unstructured and unestablished in most faculties. Moreover, there are hardly any rigorous studies at a national level that evaluate the current state of this competence in our faculties. Understanding the starting point is essential for the curricular design to ensure that evidence-based practice is implemented among future professionals. Aim: To design and validate an evidence-based nursing competency questionnaire for fourth-year nursing students. Methods: A specific questionnaire was developed and validated (EBE-ST). A cross-sectional survey design with psychometric validation of an instrument. Participants were 304 senior year nursing students from eight universities in Spain (2020). Results: The EBE-ST questionnaire is composed of 33 items that determine eight factors. It presents adequate reliability and validity (alpha = 0.882), measuring knowledge, attitudes and the practical application of evidence-based practice. Conclusions: We have created an instrument with good psychometric properties to measure evidence-based practice competence among senior nursing students. The heterogeneity of knowledge regarding evidence-based nursing in our country suggests that further reflection is warranted on the incorporation of this topic during undergraduate training. We have designed and validated an evidence-based nursing competency questionnaire specific to nursing students.

Evidence-based practice nurses' competency: Spanish national survey and establishment of a scale of the EBP-COQ-Prof©

Aims

To discover the level of evidence‐based practice competency of Spanish nurses, to develop a scale of the EBP‐COQ‐Prof© and to analyse the influence of different variables on the level of competency.

Background

The evidence‐based practice competency has previously been assessed using a wide variety of instruments, although these have methodological limitations and lack associated scales that allow for the interpretation of the score obtained.

Method

Observational, cross‐sectional, national study. Using an online questionnaire, data were obtained between January and March 2020 from nurses working in the National Health System. An ANOVA was performed along with multiple regression analyses. The T‐score and percentiles were calculated to obtain the scale of the EBP‐COQ‐Prof©.

Results

2,942 nurses participated. The score for the evidence‐based practice competency was 130.29 (standard deviation 17.55). The multiple regression analysis showed a model comprised of 8 variables that explained 33% of the variance.

Conclusions

The Spanish nurses have a moderate level of evidence‐based practice competency. The scale classifies the subjects into 3 levels: low, moderate and high competency.

Implications for Nursing Management

The scale proposed for the EBP‐COQ‐Prof© could be utilized to facilitate the diagnosis of evidence‐based practice competency, and to monitor and plan individual and collective strategies to improve this competency.