Clinical nurses' beliefs, knowledge, organizational readiness and level of implementation of evidence-based practice: The first step to creating an evidence-based practice culture

Development of a core set of outcome measures to be applied toward breast cancer-related lymphedema core outcome domains

PURPOSE

For breast cancer survivors (BCS) living with breast cancer-related lymphedema (BCRL), what outcome measures (OMs) are recommended to be used to measure standardized outcome domains to fully assess the burden of the disease and efficacy of interventions? An integral component of a standardized core outcome set (COS) are the OMs used to measure the COS.

METHODS

A supplemental online survey was linked to a Delphi study investigating a COS for BCRL. OMs were limited to a maximum of 10 options for each outcome domain (OD). There were 14 ODs corresponding to the International Classification of Functioning, Disability, and Health (ICF) framework and respondents rated the OMs with a Likert level of recommendation. The feasibility of the listed OMs was also investigated for most outpatient, inpatient, and research settings.

RESULTS

This study identified 27 standardized OMs with a few ODs having 2-3 highly recommended OMs for proper measurement. A few of the recommended OMs have limitations with reliability due to being semi-quantitative measures requiring the interpretation of the rater.

CONCLUSION

Narrowing the choices of OMs to 27 highly recommended by BCRL experts may reduce selective reporting, inconsistency in clinical use, and variability of reporting across interdisciplinary healthcare fields which manage or research BCRL. There is a need for valid, reliable, and feasible OMs that measure tissue consistency. Measures of upper extremity activity and motor control need further research in the BCS with BCRL population.

Actualization of evidence-based nursing in primary, specialized, and social care settings-A cross-sectional survey

BACKGROUND

Basing practice on evidence is a widely acknowledged requirement for nursing, but shortcomings still exist. An increased understanding of the actualization of evidence-based nursing (EBN) across different nursing contexts is needed to develop better support for EBN and promote uniform high-quality nursing.

AIMS

The aim of this study was to compare the actualization of EBN in different organizational contexts in Finland.

METHODS

Data for this survey were collected in 2021. The actualization of EBN in primary, specialized, and social care organizations was evaluated with the Actualization of Evidence-Based Nursing instrument, nurses' version, which focuses on individual and organizational-level EBN support structures. Differences between (1) specialized and primary healthcare, and (2) different nursing practice settings were tested with Welch's two sample t-test, the Kruskal-Wallis rank sum test, and the Wilcoxon rank sum test.

RESULTS

Based on nurse (n = 1020) evaluations, those working in specialized healthcare hold more positive attitudes toward EBN (p = .021) and evaluated their organization's methods for monitoring and evaluating nursing practices (p = .004) more positively than those working in primary healthcare. Regarding different nursing practice settings (n = 1241), the most positive results were observed within preventive healthcare where nurses evaluated their attitudes toward EBN, EBN competence, and personal evidence-based practices more positively compared to other nursing practice settings. The results were parallel regarding several organizational structures for EBN. Positive results were also observed within somatic units at university hospitals, and most negative results were within institutional care settings, health centers, and home care settings.

LINKING EVIDENCE TO ACTION

There is a need for targeted support to strengthen EBN across different organizational contexts, with special attention to those contexts where nursing professionals with lower education levels work. Future research needs to focus on further analyzing the organizational differences and what can be learned, especially from preventive healthcare but also somatic units at university hospitals.

Individual and social system factors influencing evidence-based practices among nurses in general hospitals: A cross-sectional multi-institutional study

AIMS AND OBJECTIVES

To investigate evidence-based practices and examine the influence of individual and social system factors on evidence-based practices among nurses in general hospitals.

BACKGROUND

Evidence-based practice is essential for improving healthcare quality. However, a challenge for nursing worldwide is nurses' limited use of evidence-based practices. It is crucial to determine the individual and social system factors affecting nurses' use of evidence-based practices.

DESIGN

This study employs a multi-institutional cross-sectional design.

METHODS

With a multistage random sampling method, 336 registered nurses were recruited from 17 general hospitals in the Republic of the Union of Myanmar. Data were collected through a seven-part questionnaire, including the Evidence-Based Practice Implementation Scale and individual and social system factors. Data were analyzed using descriptive statistics and multiple linear regression.

RESULTS

Nurses in general hospitals perceived low levels of evidence-based practices. Individual factors, such as perceived barriers (p < .001), knowledge (p < .001) and attitudes (p = .001), were related to EBP as well as social system factors, including the work environment (p < .001) which influence nurses' practice, explaining 34% variance among nurses.

CONCLUSION

Nurses perceived the work environment as the most influencing factor related to evidence-based practices. Individual characteristics, including perceived knowledge, attitudes and barriers, were critical factors in performing evidence-based practices in Myanmar.

RELEVANCE TO CLINICAL PRACTICE

Nurse administrators and policymakers can develop strategies and interventions for improving knowledge, attitudes and work environment towards evidence-based practice. Minimizing the barriers to evidence-based practice will promote evidence-based practices in Myanmar general hospitals.

IMPACT

In addressing the individual and social system factors influencing the evidence-based practices of nurses, this study contributes to enhancing healthcare quality and outcomes.

REPORTING METHOD

This study adhered to the STROBE checklist.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution.

The role of organizational culture and communication skills in predicting the quality of nursing care

AIMS

This study aims to identify the level of nursing care quality and examine its predictors considering nurses' demographic data, organizational culture, and communication skills.

BACKGROUND

Quality of care is a determinant of the sustainability of any healthcare organization. Therefore, it is imperative to understand how factors may contribute to the quality of nursing care. Limited research is available on the interaction between the concepts of quality of nursing care, communication skills, and organizational culture.

METHODS

A cross-sectional multi-site correlational design was used in this study. A convenience sample of 200 nurses from four Jordanian hospitals was recruited. Data was collected using self-reported questionnaires. Descriptive statistics, Pearson correlations, and multiple regression were performed to achieve the study's aims.

RESULTS

The majority of the nurses in this study were females with bachelor's degrees. Age ranged between 22 and 53 years whereas experience ranged from 1 to 30 years. Communication skills significantly predicted the quality of nursing care; however, organizational culture was not a significant predictor of the quality of nursing care. Nevertheless, Pearson r correlation results revealed a significant correlation between organizational culture and communication skills (r = 0.57, p < 0.05).

CONCLUSION

Nurses and organizational managers can increase the level of quality of nursing care by investing in programs that target improving nurses' communication skills. Providing a good environment in the hospital can increase communication skills between staff members, ultimately increasing the quality of nursing care. Further studies are recommended to elaborate and further uncover concerns related to the current research.

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).

Knowledge about the best practice guidelines in the nursing degree: A non-randomized post-test design

AIM

To compare knowledge of Nursing Degree students about Best Practice Guidelines when there are included as teaching content in a subject vs knowledge through having the usual internship experience without teaching specific guidelines contents.

DESIGN

Non-randomized post-test-only design with a comparison group.

METHODS

143 students of the nursing degree at the Autonomous University of Barcelona were recruited. The intervention group received a classroom training in three Best Practice Guidelines with Problem-Based Learning methodology. The comparison group only attended internship, without specific guidelines contents. Knowledge was evaluated with an ad hoc post intervention questionnaire. The information was collected between 2016 and 2018.

RESULTS

The average score of knowledge was low, 5.1 out of 10, and differs between guides. The best results were obtained by the students with internships and that had consulted the guides on some occasions. Synchronized effort and leadership in Academia and Healthcare are needed to favour evidence-based practice. The combination of the consultation of the Best Practice Guidelines in theoretical learning combined with the practice, increases the knowledge of the Best Practice Guidelines and will favour the implementation of evidence-based practice. Some students were involved in questionnaire design.

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.

Clinical Inquiry in Nursing Readiness Fellowship: Increasing Air Force Nurse Corps Evidence-Based Practice Leadership Infrastructure

BACKGROUND

Increasing demands to generate, translate, and implement evidence into practice in manpower and budget-constrained environments triggered innovative support for the nursing scientific community. The Clinical Inquiry in Nursing Readiness (CINR) fellowship is a solution to integrate readiness into clinical inquiry priorities and develop future experts in the field.

METHODS

This article describes the fellowship program structure, implementation, and contributions to nursing science, readiness, and professional development. We share specific recommendations based on our experiences to enhance and sustain this valuable fellowship program.

RESULTS

Six fellows have completed the CINR fellowship since its launch in July 2019. Fellows garnered $40,000 in grant funds for five evidence-based practices, two research studies, and six clinical inquiry initiatives. So far, the fellows have produced 20 knowledge products: Three published manuscripts, three evidence-based resource toolkits, nine professional conference presentations (one international), five professional certifications, a variety of organization-wide leadership briefings, and two military decorations specific to the pandemic response.

CONCLUSIONS

Establishing a fellowship program to develop a pipeline of readiness-focused nurse scientists and evidence-based practice experts builds future capacity for the enterprise while professionally developing individual nurses for advanced degrees and clinical inquiry leadership roles. Individuals and organizations aspiring to promote a culture of nursing inquiry may benefit from fellowships such as the CINR program.

Evidence-based practice confidence and behavior throughout the curriculum of four physical therapy education programs: a longitudinal study

BACKGROUND

Evidence-based practice (EBP) is a foundational process taught in health professional education, yet it is unclear when EBP confidence and skills are obtained. Increases in EBP confidence and behaviors from the start of physical therapy programs to post graduation have been reported in studies that evaluated a single program or used non-valid questionnaires. This study aimed to describe changes in EBP confidence and behavior using validated questionnaires of students from four physical therapy education programs throughout their curriculum and one year post graduation.

METHODS

One hundred and eighty-one students from a potential pool of 269 (67.3%) consented to participate. Students completed the Evidence-Based Practice Confidence (EPIC) Scale and the Evidence-Based Practice Implementation Scale (EBPIS) at 6 timepoints: start of the program, prior to first clinical experience, after first clinical experience, at the end of classroom instruction, graduation, and one year post. Medians (Mdn) and 25th and 75th percentiles (P25, P75) were calculated for 42 (23.2%) students with complete data across all timepoints. Change between timepoints was assessed using Friedman's test and Wilcoxon signed rank test with a Bonferroni correction for post hoc analysis.

RESULTS

There were significant changes in EPIC scores (p < 0.001) from enrollment (Mdn 50.0, P25, P75 35.5, 65.9) to prior to first clinical experience (Mdn 65.5, P25, P75 57.3, 72.5) and after the first clinical experience (Mdn 67.3, P25, P75, 58.9, 73.2) to the end of classroom instruction (Mdn 78.6, P25, P75, 72.0, 84.1). Significant increases on the EBPIS (p < 0.01) were only seen from after the first year of training (Mdn 15, P25, P75, 10.0, 22.5) to end of the first clinical experience (Mdn 21.5, P25, P75 12.0, 32.0).

CONCLUSIONS

EBP confidence increased significantly after classroom instruction but remained the same after clinical experiences and at one year post graduation. EBP behavior significantly increased only after the first clinical experience and remained the same through graduation. Confidence and behavior scores were higher than were previously reported in practicing professionals. Ongoing assessment of EBP confidence and behavior may help instructors build appropriate curricula to achieve their outlined EBP objectives.

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.

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.

Government-supported clinical knowledge and information resource portals are key to ensuring quality, safe health care and evidence-based practice - the Australian context

Objective The aim of this study was to describe Australia's government-supported clinical knowledge and information resource portals and their alignment with government policies for digital health within an Australian context, and to clarify the role of hospital libraries in the public health system as an adjunct to state and territory portals. Methods Government-supported clinical resource portals in Australian states and territories were examined and benchmarked. A comprehensive search of Australian state, territory, and federal government websites was conducted for strategies, policies, and projects relating to medical research, digital health, and health workforce education. These documents were screened for reference to clinical knowledge and information resource portals, clinical decision support tools, hospital libraries, or educational resources for the health workforce. Additionally, information was derived from relevant published Australian studies to provide context and additional information about access to evidence in public hospitals. Results Clinical resource portals are a vital part of evidence-based health care in Australia; however, there are inconsistencies in these portals due to differences in policy, funding, and strategy between Australia's states and territories. Libraries in the healthcare sector play a key role in ensuring centralised clinical knowledge and information resource portals are easily available to clinicians, and in building on the initial portal collection, curate bespoke library collections for their individual organisations. Conclusion This investigation highlights the importance of government-supported clinical knowledge and information resource portals and the role they play in the provision of safe, quality, evidence-based health care. These portals, in conjunction with hospital library activities, are an integral part of the clinical governance framework.

Effect of comprehensive nursing based on evidence-based nursing on reducing the incidence of pressure ulcers in patients undergoing posterior orthopedic surgery

To analyze the effect of comprehensive nursing based on evidence-based nursing during the perioperative period on reducing the incidence of pressure ulcers in patients undergoing posterior orthopedic surgery. Data on 120 patients who underwent orthopedic posterior surgery in our hospital from February 2021 to December 2022 were retrospectively analyzed. The patients were divided into an observation group (n = 60) and a control group (n = 60) based on different nursing methods. Patients in the control group received routine nursing, whereas those in the observation group received comprehensive nursing under the guidance of the concept of evidence-based nursing. The incidence of postoperative pressure ulcer was also recorded. Fasting venous blood (5 mL) was collected from patients before and after surgery and used to measure levels of myeloperoxidase (MPO) and superoxide dismutase (SOD) using enzyme-linked immunosorbent assay. Ulcer tissue samples of patients with pressure ulcers were collected and used to detect the expression of caspase-3 protein, vascular endothelial growth factor (VEGF) mRNA, tumor necrosis factor-α (TNF-α) mRNA, and interleukin-1β (IL-1β) mRNA. The incidence of postoperative pressure ulcers was 8% in the observation group and 23% in the control group (P = .024). The scores of sensory perceptions of the patients in the observation group were significantly lower than those in the control group (P < .001), as were the scores for moisture (P < .001), activity (P = .008), mobility (P < .001), nutrition (P = .003), friction, and shear (P < .001). After surgery, the serum MPO level in the observation group was significantly lower than that in the control group (P < .001), whereas the SOD level in the observation group was significantly higher than that in the control group (P < .001). The expression of TNF-α, IL-1β, VEGF mRNA, and caspase-3 protein in pressure ulcer tissues in the observation group was significantly lower than that in the control group. Comprehensive nursing based on the concept of evidence-based nursing can significantly reduce the incidence of postoperative pressure ulcers following posterior orthopedic surgery.

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.

Nurses' experience of integrating evidence-based changes into their practice: A qualitative study

AIM

To explore the experiences of neonatal and NICU nurses on participating in evidence-based changes in their neonatal pain management practice.

DESIGN

It is a qualitative conventional content analysis.

METHODS

A purposive sample with nurses working in neonatal and NICUs was used. The data were collected through 11 semi-structured in-depth individual interviews, five focused group discussions, and observations and analyzed using the conventional content analysis method based on the Elo and Kyngäs model. The COREQ checklist was used for writing the report.

RESULTS

Analysis of gathered data led to the emergence of four themes, including 'being in a supportive and encouraging atmosphere', 'a journey from resistance to adherence', 'achieving multi-dimensional improvements', and 'facing obstructive challenges'.

Evidence-Based Practice Among Psychiatric Nurses: Knowledge, Attitudes, Organizational Readiness, Levels of Implementation, and Barriers and Facilitators

The current study examined psychiatric nurses' views, knowledge, attitudes, organizational readiness, levels of evidence-based practice (EBP), as well as barriers and facilitators to EBP in a Nigerian tertiary neuropsychiatric hospital. This study used a cross-sectional descriptive research approach. Structured questionnaires were administered to all psychiatric nurses (N = 131) at the hospital. Results showed that psychiatric nurses had an acceptable degree of EBP knowledge and a positive attitude toward EBP. Levels of EBP implementation were below average, and organizational culture and preparation for EBP were moderate. Participants reported a moderate degree of barriers to EBP adoption (mean = 40.08, SD = 9.63), and a high level of assertion to positive facilitators of EBP (mean = 19.88, SD = 4.16). Findings show that although most psychiatric nurses had adequate knowledge and good attitudes toward EBP, certain barriers prevented its application. Thus, there is a need for a policy framework to mitigate existing barriers and improve EBP facilitators in psychiatric nursing practices in Nigeria to improve productivity measures. [Journal of Psychosocial Nursing and Mental Health Services, 61(9), 47-55.].

Factors related to the knowledge and skills of evidence-based practice among nurses worldwide: A scoping review

BACKGROUND

Promoting evidence-based practice (EBP) among nurses may be a valuable component of improving health care. However, a comprehensive analysis of the factors associated with the knowledge and skill EBP in nurses has not been performed to date. This is essential for facilitating the acquisition of relevant knowledge and skills to effectively implement EBP.

AIMS

The aim of the study was to determine the factors related to the knowledge and skills of EBP among nurses.

METHODS

We searched various literature databases up to October 25, 2021, for relevant studies that investigated the factors associated with the knowledge and skills of EBP in nurses. The authors, year of study, country, study design, study subject information, instruments used for the assessment EBP knowledge and skills, use of multivariable analysis, and factors significantly associated with the knowledge and skills of EBP among nurses were extracted from each eligible study and collated to identify commonly reported factors.

RESULTS

We identified 47 eligible studies conducted in a wide range of countries. Nine articles applied multivariable analyses, and 38 articles did not perform any multivariable analyses. The factors related to the knowledge and skill levels of EBP among nurses were classified into two categories: personal and work-environment factors. In the nine articles that conducted multivariable analysis, personal factors, which included educational level, participation in EBP education, and experience conducting research, and work-environment factors, such as resources and organizational support for EBP, were related to the knowledge and skills of EBP among nurses.

LINKING EVIDENCE TO ACTION

Our review highlighted educational level, participation in EBP education, experience conducting research, and resources and organizational support for EBP as important factors that are associated with the knowledge and skills of EBP in nurses worldwide. Focusing on these factors may help improve nurses' understanding of EBP and facilitate the implementation of EBP.

Towards an Understanding of Successes of the Psychiatric Nurses in Caring for Children with Mental Health Problems: An Appreciative Inquiry

INTRODUCTION

Psychiatric nurses have a specialized body of knowledge and skills in providing care to persons with mental health challenges. The literature provides scanty evidence on child psychiatric nursing practices. This paper explored the successes of psychiatric nurses in caring for children with mental health problems using appreciative inquiry (AI).

DESIGN

A qualitative exploratory and descriptive design was used to allow for new ideas that can fundamentally reshape the practice of child psychiatric nursing. Purposive sampling was used to select psychiatric nurses caring for children with mental health problems. Focus groups were used to generate data.

FINDINGS

The results indicate both positive and negative prospects for psychiatric nursing practice. The positive possibilities included commitment, passion and dedication of staff to the children. The negative aspects that need urgent attention include lack of specific, integrated child mental health within the mental health care services, shortage of resources and not-fit-for purpose infrastructure.

CONCLUSION

Appreciative inquiry verified the commitment of psychiatric nurses in caring for children with mental health problems and the potential for dedicated child psychiatric institutions in realizing the needs of such children. The needs of children with mental health problems must be addressed through positive care in the health system.

Professional development needs of registered nurses in Indonesia: A cross-sectional study

BACKGROUND

Rapid developments in health care technologies and treatments require nurses to keep abreast of current and best evidence to inform their practice. Continuing professional development is a key component in ensuring knowledge and practice meet contemporary demands and best practice.

OBJECTIVE

To examine professional development needs for registered nurses working in Indonesia.

METHODS

A cross-sectional survey design using the previously validated Indonesian version of the Hennessy Hicks Training Needs Analysis measurement tool was distributed via digital technologies across thirteen hospitals of one private health care provider in four different regions across Indonesia.

RESULTS

A total of 1355 nurses completed the tool. Nurses rated direct care tasks higher on importance, performance and training need, while supporting tasks rated lowest on performance and training need. Nurses with less than one year of experience reported higher need for training.

CONCLUSIONS

Most identified performance development needs were similar to those reported by nurses elsewhere. There is a need for specifically and locally tailored education opportunities for outcomes to motivate learning that are meaningful and applicable to practice needs. Future research should seek to examine training needs for nurses working in other settings such as public hospitals and community health settings.

Nurse Leadership and Work Environment Association with Outcome Expectancy and Self-Efficacy in Evidence-Based Practice among Hospital Nurses in The Netherlands: A Cross-Sectional Study

The active participation of nurses in evidence-based practice (EBP) is challenging and topical, as shown by the worldwide calls for appropriate, accessible, affordable care and the de-implementation of unnecessary care. Nurses' perceived support from their managers and work environments may affect their self-efficacy and outcome expectancy in EBP, as well as hinder them in EBP. Associations between these issues have not yet been explored. This study examines the association of self-efficacy and outcome expectancy levels in EBP, as well as the perceived support for EBP from nurse leaders and in the working environment, among Dutch hospital nurses.

METHODS

Questionnaires measuring nurses' self-efficacy, outcome expectancy, and perceived support for EBP from nurse leaders and their work environment were completed by 306 nurses in eight hospitals between March 2021 and June 2021. We used multilevel regression analyses to determine the associations and covariates.

RESULTS

This study shows that EBP-supportive leaders and work environments positively contribute to nurses' self-efficacy and outcome expectancy in EBP, along with the covariates undertaking EBP activities and educational level.

CONCLUSIONS

To improve nurses' active participation in EBP, nurses need to increase their self-efficacy and outcome expectancy in EBP. Supportive leaders and a supportive work environment do have an impact. Hence, these factors need attention when implementing EBP among nurses.

Organizational culture and readiness for evidence-based practice in the Kingdom of Saudi Arabia: A pre-experimental study

AIM

This study aims to establish postgraduate students' perceptions of the organizational culture and readiness for evidence-based practice of their workplaces in the Kingdom of Saudi Arabia.

BACKGROUND

Nurse shortages and a reliance on a transient nurse workforce have long been a challenge in the Kingdom of Saudi Arabia. Developing a home-grown nurse workforce, a key objective of the Government of Saudi Arabia, can help to address this. Evidence-based practice offers a mechanism to address this. Evidence-based practice implementation is heavily reliant on the prevailing organizational culture. Establishing the organizational culture and readiness for evidence-based practice is crucial for sustainable evidence-based practice implementation.

METHODS

A pre-experimental pilot study collected data from the same participants at three different points. As part of this, a questionnaire measuring organizational culture and readiness for evidence-based practice was administered twice. Descriptive, inferential and correlational statistics were employed to analyse the data.

RESULTS

Results demonstrated improved participant perceptions of the organizational culture and readiness for evidence-based practice of their workplaces between the first (M = 76.58, SD = 19.2) and second (M = 92.10, SD = 23.68) data collection points, indicating moderate movement towards a culture of evidence-based practice. Strengths, challenges and opportunities for improvement were identified.

CONCLUSION

This study established participants' perceptions of the organizational culture and readiness for evidence-based practice of their workplaces, affording insight into context-specific strategies to embed evidence-based practice in health care organizations.

IMPLICATIONS FOR NURSING MANAGEMENT

Assessing an organization's culture and readiness for evidence-based practice (EBP) can afford insight on the strengths, challenges and opportunities that exist to equip nurse managers to advance evidence-based practice at individual, professional and organizational levels. This study demonstrated the importance of promoting an environment conducive to EBP and putting in place the necessary resources to support evidence-based practice implementation. Nurse managers can play a central role in this.

How nursing stakeholders in the Republic of Ireland define evidence-based practice and why it matters

BACKGROUND

Evidence-based practice (EBP) has garnered increasing exposure in professional healthcare discourse over three decades. While the term is used frequently, its interpretation varies widely. An accurate, shared understanding of what EBP means is essential to the achievement of EBP implementation in clinical practice. As part of a national study in the Republic of Ireland, nurses, midwives, educators, and students shared their personal understanding of what EBP was to them.

AIM

To establish nurses', midwives', educators', and students' knowledge and understanding of the concept of EBP in the Republic of Ireland.

METHODS

In a national study exploring EBP beliefs, implementation, and organizational readiness for EBP among nurses, midwives, educators, and students, an open-ended question invited participants to explain what EBP is, in their own words. Content analysis was used to interpret participants' responses.

RESULTS

Five themes emerged from the data from the single open-ended question: (1) varying definitions of EBP, (2) best practice, (3) nurses' and midwives' role in EBP, (4) knowledge, and (5) barriers and facilitators of EBP. The dominant finding centered on the substantial conflation of EBP with research utilization and other concepts such as quality improvement.

LINKING EVIDENCE TO ACTION

Poor knowledge and understanding of EBP is a fundamental challenge to EBP implementation. Conflation of EBP with research utilization and other healthcare concepts is not uncommon among nurses and midwives globally and has persisted for some time. This has the potential to hinder the advancement of EBP in nursing and midwifery and, therefore, measures to enhance EBP knowledge and promote EBP implementation are key. Professional regulating bodies, educators, and clinical and educational organizations all have a role to play. The findings from this aspect of this national study offer a realistic, context-specific starting point for tailored educational interventions for clinicians, educators, and students and identify professional and organizational strategies that promote EBP as the expectation and "the way things are done here."

The Required Competencies of Bachelor- and Master-Educated Nurses in Facilitating the Development of an Effective Workplace Culture in Nursing Homes: An Integrative Review

BACKGROUND

Nursing home care is undergoing significant changes. This requires innovative teams operating in an effective workplace culture characterized by person-centeredness and offering evidence-based care. A pivotal role for bachelor- and master-educated nurses (BNs/MNs) is foreseen to facilitate such cultures; however, there is currently no comprehensive overview of what competencies this requires.

OBJECTIVES

To identify what competencies are required from BNs/MNs in facilitating the development of an effective workplace culture in nursing homes.

METHODS AND DESIGN

We conducted an integrative review (IR) using Whittemore and Knafl's method. We searched the PubMed, CINAHL, and PsycINFO databases for studies published between January 2010 and December 2021 in English. Two independent reviewers determined whether studies met inclusion: bachelor- or master-educated nurse; nursing home; professional competencies; and mixed methods or qualitative and qualitative studies. We applied the CASP appraisal tool and analyzed the data by applying content analysis.

RESULTS

Sixteen articles were included. Five themes were identified representing required competencies for BNs/MNs facilitating: (1) learning cultures in nursing practice; (2) effective work relationships within teams; (3) leadership capability within teams; (4) implementation of guidelines, standards, and protocols; (5) a work environment acknowledging grief and loss of residents within teams.

CONCLUSIONS

It shows that the BN/MN applies five competencies associated with a facilitator role to promote the development of an effective workplace culture to achieve a safe, high-level quality of care, satisfaction, and well-being. An overarching leadership as a change champion will support teams to achieve a quality that should guide the transformation in nursing care.

Barriers to implementing evidence-based nursing practice from the hospitals' point of view in China: A regional cross-sectional study

BACKGROUND

There is a widespread international agreement that healthcare should be based on high-quality evidence; however, bridging the gap from evidence to practice is still problematic. Although barriers to the implementation of evidence-based nursing practice have been identified, most studies have focused on clinical nurses' perceptions of the barriers to evidence-based nursing practice, with a lack of investigation into barriers from the hospitals' viewpoint.

OBJECTIVES

To identify existing barriers to implementing evidence-based nursing practice from the hospitals' viewpoint.

DESIGN

A descriptive study employing a regional cross-sectional survey.

SETTINGS AND PARTICIPANTS

A convenience sample of 91 hospitals in Guangdong Province, China.

METHODS

The survey used an online questionnaire containing basic hospital information and an open-ended question. Descriptive statistics were used to analyse basic hospital data. Responses to the open-ended question were analysed with thematic analysis.

RESULTS

The sample consisted of 89 valid responses to the open-ended question. Five themes were identified: (1) knowledge (70.8 %); (2) environmental context and resources (42.7 %); (3) social influences (7.9 %); (4) intentions (7.9 %); and (5) beliefs about capabilities (1.1 %).

CONCLUSION

Introduced early in 2001, China has embraced evidence-based nursing for more than 20 years. However, lack of knowledge is still the top barrier to implementing evidence-based nursing practice in hospitals in China. The findings indicate a need for more evidence-based nursing practice teaching strategies towards further enhancing clinical nurses' and nursing managers' evidence-based nursing practice beliefs, knowledge, and skills.

Evidence implementation among complementary medicine practitioners: a meta-summary

OBJECTIVES

To explore the factors impacting evidence implementation in complementary medicine (CM) practice.

CONTENT

MEDLINE and CINAHL were systematically searched for cross-sectional studies examining evidence implementation among CM practitioners. Qualitative data from eligible studies were collated and analysed using a meta-summary approach. Data were coded according to the five domains of the Consolidated Framework for Implementation Research (CFIR), and translated into barriers and enablers.

SUMMARY

Qualitative data were available for 614 participants (from 16 disciplines) across 14 studies. Coding identified 34 themes, with most themes aligning with the Inner Setting (11 themes) and Characteristics of the Intervention (10 themes) domains of the CFIR. The most commonly referenced barriers to evidence implementation were: 'Lack of supportive resources' (Effect size [ES]=33.3%), 'Research misalignment with profession and practice' (ES=14.5%) and 'Lack of access to knowledge and information' (ES=10.5%). The most common enablers were: 'Recognition of a need for change' (ES=8.2%) and 'Perceived adaptability of EBP to the profession' (ES=7.8%).

OUTLOOK

This research offers new insights into the challenges and opportunities to implementing evidence-based practices in the field of CM. The findings underline the complexity of the phenomenon, and the need for a nuanced, multi-faceted and multi-stakeholder approach to improving evidence implementation in CM.

A Qualitative Force Field Analysis of Facilitators and Barriers to Evidence-Based Practice in Healthcare Using an Implementation Framework

Research has identified facilitators and barriers to implementation of evidence-based practices (EBPs). Few studies have evaluated which factors persist among healthcare clinicians with extensive education and training on EBP implementation. Therefore, the purpose of this study was to examine facilitators and barriers to EBP implementation across a national sample of specialty-prepared EBP mentors in healthcare settings. Healthcare clinicians participating in an immersive 5-day EBP knowledge and skill building program were invited to complete a follow-up survey 12 months later to report on implementation experiences. The Consolidated Framework for Implementation Research (CFIR) guided content analysis of responses. A force field analysis using Lewin’s change theory was used to assign numerical ‘weights’ to factors. Eighty-four individuals reported facilitators and barriers to implementation. The majority occurred within the inner setting of the CFIR model. Facilitators were strong leadership engagement (n = 15), positive EBP culture (n = 9), and resources (n = 4). Barriers included lack of resources (n = 21), poor leadership engagement (n = 19), implementation climate (n = 17), lack of relative priority (n = 12), and organizational characteristics (n = 9). Respondents also identified simultaneous facilitators and barriers within the process domain of the CFIR model. The construct of stakeholder engagement was a barrier when absent from the implementation process (n = 23), yet was a strong facilitator when present (n = 23). Implementation in healthcare settings appears most effective when conducted by an interprofessional team with strong leadership, resources, stakeholder engagement, and positive EBP culture. When these same factors are absent, they remain persistent barriers to implementation, even among specialty-trained healthcare clinicians.

Sociodemographic and Work-Related Variables Affecting Knowledge of, Attitudes toward, and Skills in EBNP of Nurses According to an EBPPQ

(1) This study examines sociodemographic and work-related variables to determine their impact on the knowledge of, attitudes toward, and skills in Evidence-Based Nursing Practice (EBNP). (2) The study included 830 nurses from four voivodships in Poland, Dolnośląskie, Łódzkie, Podlaskie, and Zachodniopomorskie and was conducted by the diagnostic survey method, using the questionnaire technique. The following research tools were applied in the study: an Evidence-Based Practice Profile Questionnaire (EBPPQ) and a survey questionnaire developed by the authors, containing questions on sociodemographic data and work-related variables. (3) Sociodemographic variables with an impact on the knowledge of, attitudes toward, and skills in EBNP include age, marital status, and educational background. Older nurses find it problematic to apply EBNP, and their level of relevant knowledge and skills is lower; whereas, those with university education possess the best EBNP-related skills, and they are also more eager to expand them and apply them in their work. The work-related variables with an impact on the knowledge of, attitudes toward, and skills in EBNP among nurses include work experience, which has a negative effect on applying EBNP and the skills associated with it. The type of school from which the nurses graduated and the nursing specialisation training also have a strong impact on expanding nurses’ competence in EBNP.

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

Objective

Methods

Results

Conclusion

From Evidence Synthesis to Transfer: Results from a Qualitative Case Study with the Perspectives of Participants

The increase in health research brings challenges to the production, synthesis, and use of research findings in clinical practice. In the case of undergraduate training in nursing, it is necessary to think about the curricular contents and create opportunities to develop skills for learning evidence-based practice. The objective of this study was to analyze nurses’ perspectives regarding the effects of their participation in a project of translation of knowledge into clinical practice during undergraduate nursing education, specifically involving knowledge, attitudes, and competencies related to the use of evidence. This is a qualitative case study grounded in the knowledge-to-action theoretical framework. The participants were 13 nurses who were involved in a project about the translation of knowledge into clinical practice during the last term of their undergraduate course. The data were collected by applying interviews between December 2020 and April 2021. Content analysis was carried out by using the qualitative data analysis software tool webQDA^®. The following categories emerged from the content analysis carried out on the material gathered during the interviews: understanding evidence; learning how to use evidence; transferring evidence; adjusting to the context; and observing the advantages of evidence-based practice. Extracurricular activities were perceived as an opportunity to understand what evidence is and observe in loco the advantages of health care for clients, teams, and services. During the project, the participants developed cross-sectional competencies and envisaged changes to their professional activity as a result of changes in their attitude regarding evidence and its use. We concluded that the opportunity to develop evidence-related activities allows for the development of skills and influences the attitude towards evidence-based practice and knowledge use.

Effectiveness of educational interventions on evidence-based practice for nurses in clinical settings: A systematic review and meta-analysis

OBJECTIVES

This study aimed to synthesise the best available evidence on the effectiveness of education interventions to teach evidence-based practice (EBP) on nurse-related and patient-related outcomes.

DESIGN

This is a systematic review and meta-analytic paper.

DATA SOURCES

Published and unpublished studies in English were searched from 10 databases from 2005 to 2021.

REVIEW METHODS

Randomised controlled trials (RCTs) and clinical controlled trials (CCTs) describing education interventions to improve EBP knowledge, skills, attitude, confidence and behaviours among nurses were eligible. Two reviewers independently screened, appraised and extracted data. Meta-analysis was conducted using a random-effect model to synthesise data using review manager software. Standardised mean difference (SMD) represented an effect measure. Heterogeneity was assessed using Cochran-Q square test and I square statistics. Subgroup and narrative synthesis were also conducted.

RESULTS

Ten studies (6 RCTs and 4 CCTs) were selected for this review. Results from a CCT suggested that education interventions improved EBP knowledge with a large effect size (SMD = 2.01). Education interventions also enhanced EBP skills (n = 1), combined knowledge/skills (SMD = 0.48, N = 5), attitude toward EBP (SMD = 0.39, N = 4), confidence to conduct EBP (SMD = 0.43, n = 1) and EBP behaviour (SMD = 0.26, n = 5). None of the studies used patient-related outcomes.

CONCLUSION

Overall, education interventions improved nurses' EBP knowledge, skills, attitude, confidence and behaviour. EBP education interventions should be part of nurses' professional development in clinical settings. The interventions may be delivered through combined lectures, group discussions, hands-on practice via face-to-face and/or online learning. Future research should test education interventions using RCTs, large sample size, and in-depth qualitative data.

Exploring nurse beliefs and perceived readiness for system wide integration of evidence based practice in a large pediatric health care system

PURPOSE

Evidence-based practice (EBP) within healthcare leads to improved patient outcomes, high-quality care, job satisfaction, reduced turnover, professional autonomy, and validates nursing practice. Although a plethora of research focuses on implementing EBP, there has been little attention on assessing organizational readiness for integration. The primary aims of this study were to explore nursing beliefs and attitudes about EBP and explore the culture and readiness among pediatric nurses for system-wide integration of EBP.

DESIGN AND METHODS

This study was a quantitative, cross-sectional survey-based study conducted at a large pediatric health system.

RESULTS

Overall pediatric nurses had a mean score of 61.78 ± 9.32 on the EBPB (n = 396). Results of the EBPB Scale and OCRSIEP showed no statistical difference between nursing roles EBPB scores; however, nursing leaders had higher scores than any other nursing role. The OCRSIEP had a mean score of 84.98 ± 19.53 (n = 388).

CONCLUSIONS

Findings suggest that pediatric nurses believe that EBP results in the best clinical care for patients and can improve clinical care, but they lack the skills and time necessary to engage in the process. This study found that increasing awareness of EBP resources and developing EBP competencies may assist pediatric nurse leaders with EBP integration into daily practice.

PRACTICE IMPLICATIONS

Increasing visibility and competencies of EBP may positively impact organizational readiness by increasing confidence needed to remove identified barriers and engrain EBP in the organization's culture.

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.

Developing an Evidence-Based Nursing Culture in Nursing Homes: An Action Research Study

Background: Nursing homes face challenges caused by increasing numbers of older adults with multimorbidity and the demand for quality of care. Developing an evidence-based nursing (EBN) culture is a promising strategy to face these challenges. Therefore, the aim of this study was to develop an EBN culture in nursing homes and gain insight into the influencing factors. Methods: An action research study was conducted with 12 nursing teams in 4 Dutch nursing homes, using the Practice Development approach to develop an EBN culture. The teams (mostly certified nurse assistants) were coached by internal facilitators (bachelor’s or master’s degree nurses) and external facilitators (nursing teachers). Data were gathered at baseline and after 15 months using questionnaires and individual and focus group interviews. Results: With varying degrees, most nursing teams implemented elements (related to values, attitudes, and behaviors) of an EBN culture with appropriate leadership, advocacy, and training. The team members became open to new insights and asked critical questions. During the project, participants learned how EBN could be incorporated into daily practice, for example, by keeping it small, discussing information from professional journals, and using creative methods such as quizzes. Influencing factors of an EBN culture were: (a) support of managers, (b) inspiring facilitators close to the team, and (c) stable teams with driving forces and student nurses. Conclusions: Integrating EBN into daily practice in creative and motivating ways contributes to the development of an EBN culture in nursing homes. To facilitate this, managers should support teams in the process and content of EBN, and internal facilitators should collaborate with driving forces on the teams.

Elucidating the context for implementing nonpharmacologic care for neonatal opioid withdrawal syndrome: a qualitative study of perinatal nurses

BACKGROUND

Up to 95% of neonates exposed to opioids in utero experience neonatal opioid withdrawal syndrome at birth. Nonpharmacologic approaches (e.g., breastfeeding; rooming-in; skin-to-skin care) are evidence-based and should be implemented. These approaches, especially breastfeeding, rely on engagement of the neonates' mothers to help deliver them. However, little is known about the structural and social dynamic context barriers and facilitators to implementing maternal-delivered nonpharmacologic care.

METHODS

Using a qualitative descriptive design, perinatal nurses from a Midwest United States hospital family birthing center, neonatal intensive care unit, and inpatient pediatric unit were interviewed. These units were involved in caring for mothers and neonates affected by opioid use. Telephone interviews followed a semi-structured interview guide developed for this study, were audio-recorded, and lasted about 30-60 min. Interviews were transcribed verbatim and independently analyzed by five investigators using the constant comparative method. Themes were discussed until reaching consensus and subsequently mapped to a conceptual model adapted for this study.

RESULTS

Twenty-one nurses participated in this study (family birth center, n = 9; neonatal intensive care, n = 6; pediatrics, n = 6). Analysis resulted in four major themes: 1) Lack of education and resources provided to staff and mothers; 2) Importance of interdisciplinary and intradisciplinary care coordination; 3) Flexibility in nurse staffing models for neonatal opioid withdrawal syndrome; and 4) Unit architecture and layout affects maternal involvement. Minor themes supported each of the four major themes. All themes mapped to the conceptual model.

CONCLUSIONS

This study provides a more comprehensive understanding of the barriers and facilitators affecting implementation of maternal involvement in nonpharmacologic care of newborns with neonatal opioid withdrawal syndrome. Future efforts implementing nonpharmacologic approaches must consider the context factors affecting implementation, including structural and social factors within the units, hospital, and broader community.

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.

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.

Nurse Practitioners' Implementation of Evidence-Based Practice Into Routine Care: A Scoping Review

BACKGROUND

Implementation of evidence-based practice (EBP) is essential for ensuring high-quality health care at minimum cost. Although all nurses have a responsibility to implement EBP at an individual patient level, nurse practitioners (NPs) as clinical leaders have additional responsibilities in leading and collaborating with transdisciplinary teams to implement EBP across patient groups and embed practice change into routine care.

AIM

To explore the factors affecting the implementation of EBP into routine care by NPs. Specifically, to examine NP beliefs, levels of EBP implementation, and barriers and enablers to EBP implementation into routine care.

METHODS

A scoping review was conducted using the Arksey and O'Malley (International Journal of Social Research Methodology, 8, 2005, 19) framework. The electronic databases CINAHL, Medline, and PsycINFO were searched for studies published between 2009 and 2018 along with gray literature and reference lists of included articles. Abstracts and studies were screened using predefined eligibility criteria. Data extraction was undertaken using a standardized framework and data synthesis completed.

RESULTS

Seven studies were included in the review. Findings indicated NPs valued EBP and believed it to be important in standardizing patient care. NPs' implementation of EBP was found to be relatively low overall. It was not possible to fully determine the extent to which NPs implemented EBP into routine care. NPs experienced similar barriers to EBP implementation as do nurse generalists such as lack of time, lack of EBP competence, lack of support from colleagues and managers, and inadequate resources. In particular, NPs identified collaborative practice issues as factors affecting EBP implementation. Identified barriers included physician-driven practice and the need to maintain professional and political boundaries. Supportive collaborative relationships and having professional confidence were identified facilitators.

LINKING EVIDENCE TO ACTION

An exploration of NPs' experience of interprofessional collaboration when implementing EBP into routine care is needed to identify requirements for support in this area.

Contribution of students to nursing practice settings during clinical training: Design and validation of a questionnaire

BACKGROUND

A validated questionnaire to measure the contributions of nursing students to clinical settings could potentially assist in the improved management of students in healthcare institutions.

AIM

To develop and test the psychometric properties of the questionnaire 'Nursing Student Contributions to Clinical Settings' (CEEEC, Spanish acronym for 'Contribuciones de los Estudiantes de Enfermería a los Entornos Clínicos').

DESIGN

Instrument design and psychometric testing.

PARTICIPANTS/SETTINGS

A multicentre study involving 1,098 nursing professionals from three universities and five hospitals of Spain, between January 2019 and March 2020.

METHODS

The study was carried out in two phases. Phase 1 involved the questionnaire design by experts (n = 28), which required a review of the available literature, cognitive interviews and Delphi rounds, and a preliminary validity study, which included a pilot test with responses from a sample of nurses (n = 143). Phase 2 involved a formal validation with a wider sample of nurses (n = 927), including factor analysis and a study of convergent validity with the Practice Environment Scale-Nursing Work Index and Health Sciences-Evidence Based Practice.

RESULTS

Experts selected 42 items on student contributions. After cognitive interviews, three items were eliminated and seven failed to reach the minimum content validity index (78%). Based on the remaining 32 items, the discrimination index of each item was calculated, and those with <0.3, eight items were sequentially eliminated. The resulting questionnaire contained 24 items grouped into a single factor, which explained 41% of the variance. The internal consistency was excellent (Cronbach's alpha: 0.94), and the convergent validity was confirmed.

CONCLUSIONS

A 24-item questionnaire was designed and validated to measure the contributions of nursing students to clinical practice settings.

IMPACT

Most hospitals are also teaching centres where nursing students undergo clinical practice. The application of this test will provide insight into the nursing professionals' perception of the students' role.

Effect of predictive nursing on the comfort, illness perception, metabolism of calcium and phosphorus, and complications in hemodialysis patients

OBJECTIVE

This study aimed to explore the effect of predictive nursing on the comfort, illness perception, metabolism of calcium and phosphorus, and complication of hemodialysis patients.

METHODS

A total of 160 patients admitted to our hospital were selected as the research participants. Among them, 80 patients who did not undergo predictive nursing before admission were divided into the control group, and 80 patients who received predictive nursing before admission were divided into the study group. The comfort of nursing intervention, illness perception, metabolism of calcium and phosphorus, and complication rate of the patients was compared between the two groups.

RESULTS

The result of the comparison showed that the general comfort questionnaire (CGQ), illness perception questionnaire (IPQ-R), level of calcium and phosphorus metabolism, and nursing satisfaction of the study group were significantly higher than those of the control group (P<0.05). The incidence of complications such as anaphylaxis and hemorrhage in the study group was lower than that in the control group (P<0.05), and the levels of nutritional indicators (serum albumin, total serum protein) in the study group after intervention were higher than those in the control group (P<0.05).

CONCLUSION

Predictive nursing can not only help improve the comfort and calcium and phosphorus metabolism of hemodialysis patients during the treatment process, and improve patients' illness perception and nursing satisfaction, but also help reduce the incidence of various complications, and adjust the nutritional level of patients, which is worthy of clinical application.

Differences in beliefs on and implementation of evidence-based practice according to type of health care institution-A national cross-sectional study among Slovenian nurses

AIM

To explore the differences in beliefs on and implementation of evidence-based practice in nurses working in different types of health care institutions.

BACKGROUND

Optimal organizational context and knowledge are essential to support evidence-based practice and sustain the use of evidence in professional nursing practice.

METHOD

A cross-sectional study was conducted. A total of 1,014 nurses from 20 Slovenian hospitals and 29 primary health care centres participated. Variables included the following: Evidence-Based Practice Beliefs and Implementation Scale, educational and training activities, job satisfaction, job training, perceived research and evidence-based practice knowledge, and access to databases.

RESULTS

Beliefs on evidence-based practice were explained by evidence-based practice (β = 0.249) and research (β = 0.162) knowledge, length of employment (β = 0.124), job satisfaction (β = 0.117), training in evidence-based practice (β = -0.092) and holding a master's degree (β = 0.077). Implementation of evidence-based practice depended on beliefs (β = 0.306) and the type of health care institution (β = 0.132). The highest implementation result was seen in primary health care centres (<0.001).

CONCLUSION

Training in evidence-based practice and perceived knowledge of evidence-based practice significantly influence the beliefs on and implementation of evidence-based practice. Nurses employed at primary health care centres who had completed a task-shifting training programme achieved significantly better results for implementation of evidence-based practice.

IMPLICATIONS FOR NURSING MANAGEMENT

The indirect effects of development training programmes for the implementation of EBP have not yet been studied. Development activities and change implementation processes in nursing foster education and training opportunities, which have significantly influenced the implementation of EBP.

Longitudinal Use of the Consolidated Framework for Implementation Research to Evaluate the Creation of a Rural Center of Excellence in Transgender Health

Background: Transgender people face numerous barriers to accessing care, particularly in rural settings. Transportation, travel time, a lack of providers offering transgender care, and discrimination all contribute to these barriers. The Gender Wellness Center was established in New York State, USA, to fill a gap in rural transgender care and was subsequently awarded a Robert Wood Johnson Foundation grant to establish a Center of Excellence. This study examined the implementation of the Center of Excellence, a complex intervention, to assess barriers and facilitators to implementation over 18 months. Methods: The Consolidated Framework for Implementation Research (CFIR) was used to develop baseline and follow-up surveys. These were distributed to members of the core implementation team at the Gender Wellness Center at the midpoint and conclusion of the Robert Wood Johnson Foundation grant. Responses were largely open-ended and analyzed qualitatively. Results: Results are presented in terms of CFIR domains and constructs, as well as the relative outlook (positive or negative) of implementation. Overall, there were improvements over time, with more encouraging feedback and examples of success at follow-up. Though true, organizational culture and individual beliefs about the provision of transgender care challenged implementation of the Center of Excellence throughout the project. Conclusions: This study highlights the importance of organizational culture on implementation efforts, as well as the need for complex, multifaceted interventions to overcome such challenges in order to improve care for marginalized populations.

A psychometric evaluation of the Vietnamese version of the Evidence-Based Practice Attitudes and Beliefs Scales

AIM

The aim of this study is to develop and to test the construct validity and reliability of the Vietnamese versions of the Evidence-Based Practice Attitude and Evidence-Based Practice Beliefs scales.

METHODS

This is a psychometric evaluation study. Three hundred and fifty-three nurses and midwives were recruited from a national hospital in Vietnam from September to December 2018. Data were obtained from two scales. Content validity, face validity and construct validity measures were all conducted, whereas exploratory and confirmatory factor analyses were performed from data collected from two cohorts of participants. Cronbach's alpha coefficient represented reliability, and data were analysed in SPSS 20 and AMOS 24.

RESULTS

The four-factor model developed with openness, requirements, appeal and divergence factors accounted for 55% of total variance in the Attitude scale. A three-factor model labelled as value beliefs, knowledge beliefs and resource beliefs with 59% of total variance was explained in the Beliefs scale. Cronbach's α coefficients were .72 for the Attitude scale and .81 for the Beliefs scale.

CONCLUSIONS

The two scales could be used to assess Vietnamese nurses' attitudes and beliefs to adopt evidence-based practice enabling hospitals to align individual and organizational goals for developing evidence-based practice and enable comparison of the results with international samples.

Predictors of health workers' knowledge about artesunate-based severe malaria treatment recommendations in government and faith-based hospitals in Kenya

Background

Health workers’ knowledge deficiencies about artesunate-based severe malaria treatment recommendations have been reported. However, predictors of the treatment knowledge have not been examined. In this paper, predictors of artesunate-based treatment knowledge among inpatient health workers in two hospital sectors in Kenya are reported.

Methods

Secondary analysis of 367 and 330 inpatient health workers randomly selected and interviewed at 47 government hospitals in 2016 and 43 faith-based hospitals in 2017 respectively, was undertaken. Multilevel ordinal and binary logistic regressions examining the effects of 11 factors on five knowledge outcomes in government and faith-based hospital sectors were performed.

Results

Among respective government and faith-based health workers, about a third of health workers had high knowledge of artesunate treatment policies (30.8% vs 32.9%), a third knew all dosing intervals (33.5% vs 33.3%), about half knew preparation solutions (49.9% vs 55.8%), half to two-thirds knew artesunate dose for both weight categories (50.8% vs 66.7%) and over three-quarters knew the preferred route of administration (78.7% vs 82.4%). Eight predictors were significantly associated with at least one of the examined knowledge outcomes. In the government sector, display of artesunate administration posters, paediatric ward allocation and repeated surveys were significantly associated with more than one of the knowledge outcomes. In the faith-based hospitals, availability of artesunate at hospitals and health worker pre-service training were associated with multiple outcomes. Exposure to in-service malaria case-management training and access to malaria guidelines were only associated with higher knowledge about artesunate treatment policy.

Conclusion

Programmatic interventions ensuring display of artesunate administration posters in the wards, targeting of health workers managing adult patients in the medical wards, and repeated knowledge assessments are likely to be beneficial for improving the knowledge of government health workers about artesunate-based severe malaria treatment recommendations. The availability of artesunate and focus on improvements of nurses’ knowledge should be prioritized at the faith-based hospitals.