Core Evidence-Based Practice Competencies and Learning Outcomes for European Nurses: Consensus Statements

Advanced nurse and midwife practitioners' experience of interprofessional collaboration when implementing evidence-based practice into routine care: An interpretative phenomenological analysis

AIM

To understand advanced nurse and midwife practitioners' experience of interprofessional collaboration in implementing evidence-based practice into routine care.

DESIGN

A qualitative interpretative phenomenological analysis.

METHODS

A purposeful sample of 10 Registered Advanced Nurse and Midwife Practitioners from a range of practice settings in the Republic of Ireland participated in semi-structured interviews over a 10-month timeframe. Interviews were transcribed verbatim and data were analysed using a multi-stage approach in line with guidance for interpretative phenomenological analysis.

RESULTS

Six superordinate themes emerged: Understanding of advanced practice; 'Treated as an equal and as a "nurse"'; Nursing management support; 'A voice to implement anything new'; Confidence and Emotional intelligence. These factors impacted interprofessional relationships and the extent to which advanced practitioners could implement evidence-based practice.

CONCLUSION

There is scope to improve advanced practitioners' ability to collaborate with the interprofessional team in implementing evidence-based practice into routine care.

IMPACT AND IMPLICATIONS

The study findings demonstrate that enhancing understanding of the advanced practice role; increasing organizational support for advanced practitioners and augmenting specific practitioner skills and attributes will increase their ability to collaborate effectively and implement evidence-based practice. Supporting advanced practitioners in this important aspect of their role will positively influence health outcomes for patients.

CONTRIBUTION TO THE WIDER GLOBAL CLINICAL COMMUNITY

As numbers of both nurse and midwife practitioners increase globally, this study provides timely evidence from a range of practice settings to guide the design of education programmes and policies governing advanced practice. Study recommendations have broad applicability to all healthcare professionals who are engaged in implementing evidence-based practice into routine care.

REPORTING METHOD

Consolidated criteria for reporting qualitative research (COREQ).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Developing geriatric nursing micro-credentials for undergraduate nursing students based on training objectives: A modified Delphi study

BACKGROUND

China's population has begun to age rapidly in the past several years and this trend is predicted to continue. In the face of this growing older population, the existing number of aged care personnel, especially medical care professionals, can hardly meet the demand for aged care services.

AIM

To develop geriatric nursing micro-credentials (MCs) for undergraduate nursing students based on standardized training objectives and to specify the learning goals and course modules that correspond to each specific MC.

DESIGN

Modified Delphi study.

METHODS

An initial set of geriatric nursing MCs were developed based on the training objectives. Expert group discussion (n=13) reviewed the clarity and intelligibility of the statements' wording and supplemented the framework. A three-round Delphi survey (n=15) was then employed to obtain a consensus on the learning goals and course modules via an online questionnaire. Descriptive statistics were used to analyze the data.

RESULTS

The final geriatric nursing MCs consisted of six courses, namely fundamentals of geriatric nursing (8 modules), geriatric sociology (6 modules), geriatric clinical nursing (3 modules), geriatric psychological nursing (8 modules), geriatric rehabilitation nursing (8 modules) and geriatric hospice care (10 modules).

CONCLUSION

Nursing faculty can use the geriatric nursing MCs developed in this study to train current undergraduate nursing students to become backups for current, fully credentialed geriatric caregivers.

Assessing evidence-based practice competencies of undergraduate nursing students using a developed multi-criteria decision-analysis model

AIM

The developed multi-criteria decision analysis model was used to identify the inter-influence relationships and key factors affecting the EBP competencies of UNSs, to assess the EBP competencies of UNSs and based on these results, to formulate an improvement strategy to enhance the EBP competencies of UNSs.

BACKGROUND

EBP is considered a core competency in international nursing practice. However, few studies have developed EBP evaluation models and applied them to assessing and improving the EBP competencies of UNSs.

DESIGN

This is a quantitative study with multi-criteria decision-analysis model.

METHODS

Firstly, the questionnaire was designed based on the characteristics of the DEMATEL and VIKOR-AS methods, which was completed by 17 nursing experts from a case hospital in Zhejiang Province, China. Subsequently, the DEMATEL method was used to analyze the inter-influence relationships among various criteria to determine their respective weights. Finally, the VIKOR method is utilized to integrate multiple criteria and their relative weights to assign comprehensive scores to each UNSs.

RESULTS

The use of the DEMATEL method reveals that "Knowledge (C1)", "Mastering the basic scientific research methods during the study of the undergraduate courses (C11)", "Being able to consult clinical experts appropriately when encountering problems in clinical practice (C23)" and "Understanding the importance of reading journals related to the nursing profession regularly (C34)" were critical influencing factors. "Skill (C2)," "Being able to explain the essential roles of the best research evidence in determining clinical practice (C15)," "Being able to apply the collected research evidence to the individual case in nursing care (C25)" and "Paying attention to using the evidence-based nursing practice concept to determine the best clinical practice (C35)" were the most influential factors. According to the VIKOR method, the performance of the UNSs in the case hospitals in terms of EBP competencies from highest to lowest was Student C, Student B and Student A. However, all of these students suffered from deficiencies at the knowledge level.

CONCLUSIONS

The application of the DEMATEL and VIKOR methods provides a systematic and comprehensive approach to the assessment of EBP competencies of UNSs. The lack of EBP competencies of UNSs in case hospitals is mainly reflected in knowledge level. To improve UNSs' EBP competencies, medical schools and hospital educators should propose short- and long-term strategies to improve knowledge.

The evidence-based practice teaching competence of clinical preceptors at different stages of innovation-decision process: A cross-sectional survey in traditional Chinese medicine hospitals

BACKGROUND

Traditional Chinese Medicine Nursing Clinical Preceptors (TCMN-CPs) are crucial to cultivate undergraduates' evidence-based practice (EBP) competence during clinical practicum in traditional Chinese Medicine (TCM) hospitals. However, the TCMN-CPs' EBP teaching competence is unclear. Underpinned by Rogers' innovation-decision process, our study aimed to investigate TCMN-CPs' EBP teaching competence and the related characteristic factors at five stages of knowledge, persuasion, decision, implementation and confirmation.

METHODS

An online survey was conducted by using a modified evidence-based practice teaching competence questionnaire (EBPT-COQ) encompassing attitude, knowledge/skill and practice of EBP teaching in four TCM teaching hospitals in Beijing, China.

RESULTS

A total of 654 TCMN-CPs were included, with a response rate of 91.47 %. Most TCMN-CPs were in knowledge stage (339, 51.83 %), followed by the persuasion stage (166, 25.38 %), decision stage (123, 18.81 %), implementation stage (23, 3.52 %) and confirmation stage (3, 0.46 %). The total and dimension scores of EBPT-COQ increased as the diffusion stage developing, the confirmation stage was the highest (5.48 ± 0.80). Twenty-three items' mean scores were higher than 4 points (95.83 %), except for "Research skills" (3.58 ± 1.38). The related characteristic factors were 1) age (Z = -4.177), working experience (H = 11.087), clinical teaching experience (H = 12.602), management position (Z = 2.565), research experience (Z = -2.867) and EBP training (Z = 3.146) at Knowledge stage; 2) research experience (ZPersuasion = -2.617; ZDecision = -3.510), EBP training (ZPersuasion = 2.528; ZDecision = 3.433) at Persuasion and Decision stage (all P<0.05). And the first three stages TCMN-CPs' EBPT-COQ scores were positively correlated with TCMN-CPs' attitude toward clinical teaching (r = 0.244-0.331, P<0.001).

CONCLUSIONS

Most of the TCMN-CPs' EBP teaching status are in the first three diffusion stages. Though their attitude, knowledge/skills and practice to EBP teaching competence have gradually improved with the deepening of the diffusion stage, much efforts should be made to keep progressing. TCMN-CPs' qualifications of EBP teaching could include rich clinical work and teaching experience, enjoying teaching. Nursing managers, with higher EBP teaching competence, might play a crucial role in promoting the diffusion of EBP teaching. All TCMN-CPs showed an inadequacy of research skills of EBP teaching. Therefore, it is warranted to explore the minimum research skill requirements for EBP teaching and to establish academic-practice partnerships.

Impact of a teaching strategy to promote evidence-based practice on nursing students' knowledge and confidence in simulated clinical intervention choices

BACKGROUND

Nurses self-efficacy, confidence and their competency for evidence-based practice have a relevant impact in the quality of care provided to patients. However, the implementation of evidence-based practice continues to be limited to date and the relationship between these elements has not been thoroughly understood. Thus, the aim of this study was to analyze the impact on confidence levels of a teaching strategy to promote evidence incorporation into clinical decisions made by student nurses in hypothetical scenarios. Besides, students' satisfaction with the new teaching strategy was assessed.

METHODS

The teaching strategy was asynchronous, on-line and based on multiple-choice questionnaires related to decision making on an intensive care unit patient. Confidence levels were assessed by introducing the scoring tool confidence-based marking. Changes between pre- and post-tests in correct answers, confidence levels and expected-observed ranges of accuracy at each level of certainty were analyzed through non-parametric McNemar's sign tests for paired-samples differences. To assess students' satisfaction with the teaching strategy, a mixed-methods approach was followed. Descriptive statistical methods and Qualitative Content Analysis were followed respectively in order to analyze students' satisfaction.

RESULTS

A total of 165 students completed the assignment, 101 answered the satisfaction survey and 7 participated in the interviews. Statistically significant better scoring and higher confidence levels were found in the post-intervention. Statistically significant differences in expected-observed ranges of accuracy were found for the three levels of certainty. Students were highly satisfied with the proposed task. In the qualitative analysis one category was elaborated which illustrated the students' perceived added value of this new assignment.

CONCLUSIONS

On-line teaching strategies based on clinical scenarios that focus on evidence-based decision-making have the potential to increase the confidence of nursing students. Additionally, interventions designed by teams incorporating clinical nurses, university librarians and academic nurses have the potential to bridge the evidence-practice gap in nursing education.

How Teaching and Internship Influence the Evidence-Based Practice Approach of Nursing Students: A Longitudinal Study

AIM

The study aimed to analyze students' approach to evidence-based practice and evaluate the effect of teaching (based on lessons in statistics, epidemiology, evidence-based nursing, bioengineering, English language) and internship experiences on the attitude of nursing students to evidence-based practice.

METHOD

In 2019,one hundred nineteen second-year nursing students from an Italian university were involved in a pre-post longitudinal study. The Italian version of the Student-Evidence Based Practice Questionnaire was administered to nursing student in four moments of one academic year.

RESULTS

The Student-Evidence Based Practice Questionnaire showed different mean scores based on the four moments of the survey with a significant increase after the experience of planning clinical cases with an online simulation system. In particular, the aptitude subscale does not have significant improvements in the various phases of the study. Conversely, the support of the clinical tutor affects student performance. The didactic module on evidence-based nursing develops the ability to assess the quality of the information found and its sharing. Basic English proficiency is not significantly correlated.

CONCLUSION

To develop evidence-based practice knowledge, aptitude, and skills in nursing students, it is necessary to strengthen the learning opportunities both in classroom lessons and in simulation and internship experiences.

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.

Incorporating evidence-based practice education in nursing research curriculum of undergraduate nursing students: A quasi-experimental study

AIM

To examine the effect of incorporating evidence-based practice (EBP) in Nursing Research curriculum on undergraduate nursing students.

BACKGROUND

The competence of EBP is essential for nurses and it is an essential task for educators to implement EBP education in nursing students.

DESIGN

A quasi-experimental study.

METHODS

Based on Astin's Input-Environment-Outcome model, the study was conducted among 258 third-grade students of a four-year nursing bachelor's program between September through December 2022. The students were divided into two groups. Students in the intervention group received innovative teaching where EBP elements were incorporated in Nursing Research course in a natural, gradual and spiral way, while students in the control group attended conventional teaching. Effect of EBP teaching was examined in terms of students' EBP competence, learning experience and satisfaction and score of team-based research protocol assignment.

RESULTS

Compared with conventional teaching, the innovative teaching characterized by EBP improved students' EBP competence in terms of attitudes and skills and enhanced student's comprehensive ability in nursing research. Students' learning experience and satisfaction were similarly favorable between the two groups.

CONCLUSIONS

For undergraduate nursing students, the teaching strategy characterized by EBP is an appropriate and effective way to improve their EBP competence of attitudes and skills, as well as their nursing research ability.

Barriers to the Adoption of Evidence Based Practice in Nursing: a Focus Group Study

Background

Evidence Based Practice is considered a complex process with many factors hindering its implementation. The use of focus groups to detect barriers to its application can provide an in-depth investigation of the phenomenon.

Objective

The investigation of nurses' views regarding the obstacles connected to the implementation of Evidence Based Practice.

Methods

This is a qualitative study carried out using focus groups and constitutes the continuation of a quantitative study. Deliberate sampling was used to recruit a total of 31 nurses.

Results

The main categories that emerged regarding the obstacles in the implementation of Evidence Based Practice in nursing, concerned the lack of logistical support, the difficulty of accessing data, the insufficient knowledge of nurses as well as their attitude, the nature of the work, the decision-making process and the impossibility of safeguarding decisions made.

Conclusion

In this study, various factors were identified that affect the application of Evidence Based Practice, in the nursing environment of Cyprus. Identifying these factors can be the basis for discussions and finding ways to resolve the problems that exist by health care managers.

Developing a professional competence framework for the master of nursing specialist degree program in China: A modified Delphi study

BACKGROUND

The urgency of ensuring adequate professional competence in clinical nursing practice is evident. However, there is little formal professional competence framework for the education of master's degree students in nursing specialist programs in China.

OBJECTIVE

To develop a professional competence framework for the Master of Nursing Specialist (MNS) degree program in China.

DESIGN

A modified Delphi study.

PARTICIPANTS

An expert panel discussion was held with 12 experts, and Delphi rounds were conducted with 24 experts.

METHODS

A literature review and an expert panel discussion were conducted to develop an initial competence framework. A two-round Delphi survey was employed to obtain a consensus on the framework through either an online or paper questionnaire. Descriptive statistics were used to analyze the data. The consensus threshold was set according to the mean (≥ 4.0), coefficient of variation (< 0.25), and consensus level of agreement (≥70 %).

RESULTS

A consensus on seven domains and 54 items of the professional framework for the MNS degree program was achieved. The framework domains included clinical practice (12 items), professional attitude (8 items), collaboration and communication (5 items), professional development (8 items), research (7 items), education (7 items), and administration (7 items).

CONCLUSION

The professional competence framework offers guidelines for MNS degree programs in China. Future research should focus on imbedding these competences in MNS degree programs to prepare qualified advanced practice nurses.

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.

Self-assessment the competencies of surgical and critical area nurses. A cross-sectional study

BACKGROUND AND AIM

This study aims to measure the competencies of surgical and critical area nurses, and to compare the nurses' involved competencies in relation to the area to which they belong Methods: A cross-sectional study. The study was based on a convenience sample. The registered nurses were recruited from a hospital of the Friuli Western Health Authority. The Italian version of the Nurse Competence Scale composed from 58 items and validated in Italy in 2018 as a self-assessment tool for nursing competencies in the surgical and critical area, was self-administrated in October- November 2020.

RESULTS

The average competence level was found to be 68.7, with a median of 70 and a standard deviation of 19.7. The nurses felt more competent belongs to "Management of the care process", specifically in "Recognizing critical situations for the patient's life early" (82.0). Most deficient was found in "Raising problems to be deepened with research" (50.9).

CONCLUSIONS

The study found that nurses perceive a good level of competence with differences related to care settings. The results obtained from the study can provide nurses with the opportunity to reflect on their behaviours and periodically evaluate their knowledge and competencies, to promote professional development and continuing education. (www.actabiomedica.it).

Home-based nursing care competencies: A scoping review

AIMS AND OBJECTIVES

To identify and consolidate the available evidence about nursing-related competencies for home-based care.

BACKGROUND

Over recent years, the demand for home-based nursing care has increased because of the need to meet the increasing need for chronic disease care to be delivered in patients' homes. However, knowledge is lacking about the expected competencies for home-based care nurses.

DESIGN

A scoping review was conducted in accordance with Arksey and O'Malley's six-step scoping review framework and the PRISMA-ScR guidelines. The review identified literature using five electronic databases (CINAHL, PubMed, Embase, Cochrane and Scopus) and a hand search for grey literature in relevant home-based care journals and online searches. Key search terms and inclusion and exclusion criteria were used as strategies to identify relevant articles.

RESULTS

Sixty-four articles were eligible for inclusion. Mapping and narrative synthesis of 116 elements related to home-based nursing care competencies identified the following 10 competencies: (1) care assessments; (2) performance of nursing procedures; (3) management of health conditions; (4) critical thinking and problem-solving skills; (5) interpersonal relationships and communication; (6) interdisciplinary collaboration; (7) leadership and resource management; (8) professional development; (9) technological literacy; (10) quality and safety.

CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE

This review provides insight into current knowledge about home-based nursing care competencies. These competencies could be used to evaluate nurses' competence level for home-based care or for development of appropriate professional education. The review also outlines the scope of nursing practice in home-based care, which provides support for some form of standardisation of home-based nursing care expectations across various stakeholders.

Validation of the Evidence-Based Practice Competence Questionnaire for Nursing Students: A Cross-Sectional Study in Greece

(1) Background: evidence-based nursing has been widely adopted by healthcare facilitators, and it is predicated on the connection between research evidence and clinical practice. The knowledge and implementation of evidence-based practice (EBP) depend on a variety of long-established barriers and attitudes. The purpose of this study was to translate and validate the Greek version of the evidence-based practice competence questionnaire (EBP-COQ) and test it on a sample of Greek undergraduate nursing students. (2) Methods: a cross-sectional analysis was conducted on data obtained between November 2018 and January 2019. A convenience sample of 320 Greek undergraduate nursing students participated in a survey to examine the psychometric properties of the tool. The reliability and validity of the tool was examined. Cronbach’s coefficient alpha was used to determine the scale’s internal consistency reliability. (3) Results: the EBP-COQ was translated and validated. The estimated Cronbach’s alpha was higher than 0.70 for all scales. Of the participants, 22.5% were men and 77.5% were women, while 31% of them were in their final year of nursing education. A total of 61% of the students stated that they had not participated in an EBP seminar in the past. High Spearman’s correlation coefficients were found for “Knowledge in EBP” with “Personal attitude towards EBP” (rs = 0.329, p < 0.001). (4) Conclusions: the Greek version of the EBP-COQ is a valid instrument that can be used in the Greek population. It provides information about attitude, knowledge and skills in the EBP approach.

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.