Differences Between Magnet and Non-Magnet-Designated Hospitals in Nurses' Evidence-Based Practice Knowledge, Competencies, Mentoring, and Culture

Empowering nursing council implementation science: An appeal to action

BACKGROUND

In most hospitals, nursing councils are responsible for EBP implementation and evaluation. To enhance the perceived value of council participation by frontline nurses, administrators must promote the impact of council projects on healthcare outcomes.

PURPOSE

The purposes of this appeal to action are to describe the role of nursing councils in promoting IS and EBP, and to provide recommendations that enhance the value of IS and/or EBP councils to frontline nurses, thereby incentivizing participation on these councils.

METHODS

Nurse researchers from three metropolitan hospitals partnered with a medical librarian to recommend six strategies aimed at enhancing the perceived value of council participation. An argumentative review was conducted to support these strategies.

DISCUSSION

Recommendations are inclusion of methods experts on councils; support from nursing administrators in the development, implementation, and evaluation of projects; formation of partnerships with nursing academic departments; expansion of publication opportunities and availability; and connection of projects to measurable quality indicators.

CONCLUSION

Enhancing the perceived value of nursing councils by providing tools that optimize time and resource management can result in greater council participation and broader dissemination of IS evidence.

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.

The Association Between Magnet ® Recognition and Patient Outcomes : A Scoping Review

BACKGROUND

Previous systematic reviews have explored nurse, patient, and organizational outcomes in Magnet®-recognized hospitals compared with non-Magnet hospitals, yet these did not comprehensively review a wide variety of patient outcomes.

AIM

The purpose of this scoping review was to describe the findings from published research evaluating patient outcomes in Magnet-recognized hospitals compared with non-Magnet hospitals.

METHODS

A medical librarian conducted a systematic search for published peer-reviewed, English-language literature and a search of the reference lists for retrieved publications to identify articles addressing Magnet compared with non-Magnet hospitals related to patient outcomes.

RESULTS

Four patient outcomes improved in Magnet-designated hospitals: mortality, patient satisfaction, failure to rescue, and falls. Four patient outcomes showed undesirable or mixed outcomes. Five patient outcomes had insufficient evidence regarding patient outcomes when treated at Magnet-recognized hospitals.

CONCLUSION

Magnet Recognition® is associated with improvement in a distinct set of patient outcomes, but not all key outcome measures. Standardized outcomes and rigorous study designs are needed to further explore the impact of Magnet Recognition on a wide variety of patient outcomes.

An objective test to measure evidence-based practice knowledge and skill competency of acute care nurses: A psychometric validation study

BACKGROUND

Few objective measures of evidence-based practice (EBP) knowledge/skill exist. The Fresno Test, one objective method, was validated first with medicine, followed by versions for physical therapists, occupational therapists, speech therapists, social workers, dietitians, pediatric nurses, and health care students. The Fresno Test was adapted and tested with cohorts of acute care nurses. Six of the 14 items required revision to achieve acceptable psychometrics.

AIM

The aim of this second validation study was to revise and validate a new version of the test, The Modified Fresno Test-Acute Care Nursing (MFT-ACN), to determine if it could distinguish EBP knowledge/skills among acute care nurses.

METHODS

A panel of eight EBP experts were engaged in multiple Delphi rounds to revise items. Individual-content validity indices (CVI) ranged from 0.83 to 1.0, with scale-CVI 0.92. Using a cohort design, a cross-sectional sample of 90 novice, master, and expert nurses were recruited via national listservs or snowball sampling to complete the revised test. Two doctorally prepared EBP experts independently scored tests using the standardized rubric.

RESULTS

The MFT-ACN yielded strong psychometric properties (intra-class correlation coefficients > 0.80; item discrimination indices > 0.20; item-total correlations > 0.30). One poorly performing item was dropped per a priori cut-off values. The final test included 13 items, with a Cronbach's alpha = 0.77. Item difficulty was moderate to high. Most items discriminated well between cohorts. Mean total scores were positively correlated with age, years since graduation, years of acute care experience, and formal EBP or research workshops or conferences or courses or immersions. Perceived level of EBP expertise was not associated with mean scores. Further research is recommended with a larger sample to assess the tests' responsiveness to change in EBP knowledge/skills over time and enhance its acceptability and feasibility. Additional research should further evaluate construct and concurrent validity against other objective assessments of EBP knowledge/skills.

LINKING EVIDENCE TO ACTION

The validated 13-item MFT-ACN can be used to evaluate EBP competencies of acute care nurses in academic and practice settings. It can also be used by nurse scientists to build a stronger evidence base on types of educational programs that excel in advancing the critical competency of EBP among our nursing workforce.

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.

Development, Validity and Reliability of Objective Structured Clinical Examination in Nursing Students

Introduction

The adoption of measurement instruments such as the Objective Structured Clinical Examination (OSCE) is essential to assess clinical competencies in nursing students.

Objective

The purpose of this study is to develop an OSCE, analyze its validity and reliability in the nursing curriculum and measure self-assessment, stress and satisfaction.

Methods

The observational validation study of a measurement instrument was carried out in two phases: the design and development of the OSCE and validity and reliability analysis.

Results

A total of 118 students participated in the study. Ten scenarios were designed that incorporated six competency components extracted from the curriculum. Good results were obtained in face validity, content validity (CVI .82-.95), criterion validity (r = .71, p < .001), and reliability (α Cronbach .84). Satisfaction and stress scores were high, and self-assessment scores were lower than the scores obtained.

Conclusion

A rigorously designed OSCE provides a reliable and valid method for assessing the clinical competence of nursing students.

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.

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.

Determining the relationship between magnet properties of hospitals and the professional values of the nurses: A cross-sectional study

AIM

To identify the relationship between the characteristics of hospitals in recruiting and retaining nurses (magnet properties) and nurses' professional values.

BACKGROUND

In Turkey, there is a limited number of hospitals with the characteristics to enable nurses to stay in their institutions. The magnet properties of these hospitals and the professional values of the nurses working in these hospitals are not known.

METHODS

This descriptive cross-sectional research included 612 nurses working in 6 hospitals accredited by the Joint Commission International. Data were collected using the Nursing Professional Values Scale-Revised (NPVS-R) and the Essentials of Magnetism Scale (EOM II).

RESULTS

The mean NPVS-R score was high 102.0 (26-130). However, the mean EOM II score was found to be low at 2.2 (1.0-3.4). As the magnet properties of the hospitals increased, the professional values of the nurses decreased.

CONCLUSION

There was a negative correlation between the magnet properties of hospitals and the professional values of the nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

The findings of this study highlight the necessity of creating a working environment with high magnet characteristics, which also includes the professional values of nurses. Nurse Managers should investigate the reasons behind the low magnet properties of hospitals, raise awareness, and plan interventions to increase magnet properties of hospitals. Creating a supportive working environment, promotion of the salaries and work environment and decreasing workload are some of the important intervention areas in attracting and keeping nurses in the institution.

Medical-surgical nurses' EBP beliefs and competencies

BACKGROUND

The lack of evidence-based practice (EBP) knowledge and inability to implement EBP among nurses is a major barrier to quality nursing care. The literature shows that nurses highly value the use of EBP, however, they lack necessary EBP competencies. Although medical-surgical nurses were included in studies examining cross-sections of the nursing workforce, no studies exist specifically investigating their EBP beliefs and EBP competencies.

AIMS

The purpose of this study was to describe medical-surgical nurses' self-reported EBP beliefs and competencies.

METHOD

A descriptive, cross-sectional design employing survey methodology was used.

RESULTS

A total of 1,709 medical-surgical nurses participated for a response rate of 13%. The findings revealed that medical-surgical nurses had positive beliefs about EBP. However, they rated themselves competent in only 2 EBP competencies of 24. Medical-surgical nurses working in units or organizations that had a special designation such as Academy of Medical-Surgical Nurses Premier Recognition in the Specialty of Med-Surg (AMSN PRISM; p = .001) or Pathway to Excellence (p = .006) reported greater EBP competency scores. Also, nurses educated at the master's level or higher had better EBP competency scores (p < .0001).

LINKING EVIDENCE TO ACTION

Medical-surgical nurses need support at the personal and organizational levels to improve their EBP competence and increase uptake of EBP in their practice. Therefore, individual nurses must reflect on their EBP competence level and pursue opportunities to develop these essential attributes. Leaders must also create practice environments where EBP is valued, and barriers to EBP implementation are eliminated. Faculty in prelicensure and graduate programs should integrate EBP into their curricula and assess students' EBP competencies.