Perceptions and Attitudes towards Evidence Based Practice among Nurses and Nursing Students in Nepal

Understanding factors influencing the use of clinical guidelines in low-income and middle-income settings: a scoping review

OBJECTIVE

A scoping review was undertaken to determine the extent to which existing studies have examined factors influencing healthcare providers' use of clinical guidelines in low and middle-income country (LMIC) settings and determine which factors constrain or facilitate the use of clinical guidelines by healthcare providers.

DESIGN

Scoping review.

DATA SOURCES

The literature search was conducted using PubMed in January 2021.

ELIGIBILITY CRITERIA

We identified empirical studies, published between 2011-2021 in English, which included clinicians and/or nurses as healthcare providers, used a health facility as the study site, and were located in an LMIC.

DATA EXTRACTION AND SYNTHESIS

Information extracted from the literature review was organised using themes and the findings synthesised using thematic analysis.

RESULTS

The review identified five types of interacting factors that influence healthcare providers' use of and compliance with clinical guidelines. The factors identified are organisational factors, factors relating to individual healthcare providers, attributes of the clinical guidelines, patient-related factors and institutional factors. Organisational factors can be further divided into the physical work environment, organisational culture and working conditions. The effective use of clinical guidelines in LMIC settings is greatly impacted by the contextualisation of clinical guidelines, end-user engagement and alignment of the implementation of clinical guidelines with the institutional arrangements in the broader health system.

CONCLUSION

The development and evaluation of concrete interventions is vital to facilitate the implementation of clinical guidelines and improve healthcare service quality. Further studies are necessary to examine the relative importance of the five identified factors on the effective use of clinical guidelines in different contexts.

Examination of evidence-based nursing attitudes and the relationship with professional self-concept in nurses working in a psychiatric hospital

PURPOSE

The study was carried out with nurses working in a psychiatric clinic to examine their attitudes toward evidence-based practices and levels of professional self-concept.

DESIGN AND METHODS

This study was carried out using a descriptive and correlational search design. We used a Personal Information Form developed by the authors and Evidence-Based Nursing Attitude Scale (EBNAS) and Professional Self-Concept Scale for Clinical Nurses (PSCSCN) to obtain data. Percentages and averages, and the Pearson correlation coefficient was used for data analysis.

FINDINGS

The mean scores of the total and subdimensions of EBNAS and PSCSCN were high for the participating nurses. A positive relationship was found between EBNAS and PSCSCN.

PRACTICE IMPLICATIONS

The positive attitude of the nurses toward evidence-based nursing is related to their high professional self-concept.

Evidence-Based Practice and its Relationship to Quality Improvement: A Cross-Sectional Study among ‎Egyptian Nurses

Background:

Implementing Evidence-Based Practice (EBP) and Quality Improvement (QI) were recognized as the core competencies that should be held by all healthcare professionals, especially nurses, as front-line healthcare providers. Assessment of the current level of knowledge, skills, and attitude of nurses, regarding EBP and QI, is important for the design of strategies that could enhance the competence of nurses in such practices and, in turn, promote patient care quality.

Objective:

This study aimed to assess the attitudes, knowledge, and skills of nurses in Evidence-Based Practice (EBP) and Quality Improvement (QI), in addition, to studying the relationship between EBP and QI.

Methods:

A cross-sectional study was conducted using a convenient sample of nurses (N=300) who work in three Egyptian hospitals in Alexandria city, representing the university, governmental, and private health sectors. The EBP and QI questionnaires were used in addition to a demographic form for the studied nurses. Statistical analysis was carried out using ANOVAs, student t-test, Pearson correlation, and Regression analysis (R2).

Results:

Nurses displayed positive attitudes toward both EBP and QI. However, they perceived themselves to be lacking sufficient EBP knowledge and need to improve their QI skills. There was a strong positive correlation between EBP and QI with a predictive power of QI on EBP (r= 0.485, R2 = 0.273, p<0.001).

Conclusion:

Nurses need educational support for enhancing their attitude, knowledge, and skills related to EBP and QI. To prepare for educational programs, hospitals and nursing administrators should consider the characteristics of nurses, work schedules, and obstacles in the use of EBP. Hospital managers should also implement effective strategies to resolve the barriers and boost facilitators to increase the use of EBP among Egyptian nurses and promote QI.

Determining Attitudes of Nurses Toward Evidence-Based Nursing in a University Hospital Sample

AIM

This study aimed to determine the attitudes of nurses working in a university hospital toward evidence-based nursing.

METHOD

This descriptive and cross-sectional research included 529 nurses working in a university hospital during November 1 to November 30, 2018. Data were collected using the information form and Attitude Toward Evidence-Based Nursing Questionnaire (AEBNQ). Descriptive statistical methods, the Shapiro–Wilk test, the Mann–Whitney U test, and the Kruskal–Wallis test were used for statistical analyses.

RESULTS

The average age of the nurses was 36.55±9.29 years, 91.1% were female, and the average work experience was 12.61±9.56 years. Moreover, 53.4% of the nurses were working in surgical departments, and 50.3% were working as clinical nurses. The total mean score of AEBNQ of the nurses was 58.23±9.34, and it was determined that their attitudes toward evidence-based nursing was positive. It was confirmed that for some subscales, the mean scores of AEBNQ of the female nurses and nurses working in internal disease departments were significantly high.

CONCLUSION

Attitudes of the nurses toward evidence-based nursing were found to be positive. It was concluded that the department in which the nurses worked and being female affected their attitudes toward evidence-based nursing.

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.

Nurses' Knowledge, Attitudes, and Implementation of Evidence-based Practice in Oman: A Multi-institutional, Cross-sectional Study

Objectives

Little attention has been paid to the study of evidence-based practice (EBP) among nurses in Oman. Our aim was to explore knowledge, practice, and attitudes towards EBP among nurses working in Oman.

Methods

This multi-institutional cross-sectional study utilized the self-reported EBP Questionnaire with a random sample of 262 nurses working in three different health care settings in Al Dakhliyah governorate, Oman (local hospitals, primary health centers and polyclinics, and schools).

Results

A total of 202 nurses (response rate: 77.1%) completed the questionnaire. The mean age was 32.4±4.7 years. Most respondents were females (92.5%), Omani (79.1%), and holders of a diploma in nursing (73.5%) with a mean clinical experience of 10.9±4.2 years. Attitudes towards EBP showed the highest mean score of 5.5±1.2 followed by knowledge (4.9±0.8) and practice (4.7±1.2). Significant positive correlations were identified between the total years of nursing experience and knowledge (r_s = 0.145, n = 198, p = 0.041), practice (r_s = 0.172, n = 198, p = 0.015), and attitudes (r_s = 0.158, n = 197, p = 0.026) mean scores. No significant difference in EBP scores was found among the three clinical settings.

Conclusion

Although attitudes towards EBP were positive, knowledge and implementation of EBP were low. This study serves as a baseline assessment for future evaluations and provides a basis for the implementation of strategies to promote EBP utilization among nurses in three different health care settings in Oman.

Predictors of evidence-based practice knowledge, skills, and attitudes among nursing students

PROBLEM

Evidence-based practice (EBP) competence is one of the most desirable outcomes in nursing education. Assessment of knowledge, skills, and attitudes of nursing students regarding EBP is vital in examining the extent to which current approaches to EBP teaching is effective.

PURPOSE

This study examined the predictors of knowledge, skills, and attitudes regarding EBP among Omani nursing students.

METHODS

This study utilized a descriptive, cross-sectional approach. Two hundred and forty-eight nursing students enrolled in one of the universities in Oman participated in the study during the months of May 2016 to August 2017. The evidence-based practice questionnaire (EBP-COQ) was used for data collection. Descriptive and inferential statistical tools were used to analyze the data.

FINDINGS

The mean values for the three EBP domains (knowledge, skills, and attitudes) were 3.41 (SD = 0.66), 3.62 (SD = 0.51), and 3.41 (SD = 0.68), respectively. Nursing students' sex (being female), classification (being a registered nurse to Bachelors of Science degree in Nursing nursing student), and access to the internet and to nursing journals strongly predicted the knowledge, skills, and attitudes regarding EBP. Overall, 79.0% of Omani nursing students intended to adopt EBP in the future.

CONCLUSIONS

Omani nursing students possessed moderate knowledge, skills, and attitudes on EBP; however, more efforts are needed to ensure that future Omani nurses are competent and confident to apply EBP in the actual clinical area. Both academe and the hospital administration play a pivotal role in the acquisition and achievement of EBP competence in student nurses.

Assessment of Insulin Injection Practice of Nurses Working in a Tertiary Healthcare Center of Nepal

Introduction

Sound knowledge and good practice on insulin injection technique are essential for nurses in order to administer insulin correctly and to educate patients or their relatives adequately. This study aimed to assess the insulin injection practice through the use of insulin pen among nurses working in a tertiary healthcare center of Nepal.

Materials and Methods

A cross-sectional descriptive study was conducted among 67 nurses working in one of the tertiary healthcare centers of Nepal. Demographic information and insulin injection practice of nurses through the use of insulin pen were assessed using self-administered questionnaire. Each correct practice was scored “1” and incorrect practice was scored “0.” Results. The median (IQR) insulin injection practice score of nurses was 11 (9-12) out of 16. Thirty-seven (55.2%) nurses store insulin pen filled with insulin cartridge at room temperature while 57 (85.1%) nurses store unopened cartridge at refrigerator (2-8°C). The practice of hand washing and injection site cleaning was mentioned by 92.5% and 82.1% of the nurses, respectively. However, just over half of the nurses mix the premix (cloudy) insulin and prime insulin pen before each injection. Thirty-four (50.7%) nurses do not lift skin during injection and more than half of the nurses keep needle beneath the skin for less than 5 seconds after completely injecting the required dose of insulin. One out of ten nurses massage injection site after injecting insulin. Most of the nurses (86.6%) use single needle more than once and the median (IQR) frequency of needle reuse was 6 (3-12). Similarly, systematic site rotation was performed by 59 (88.1%) nurses and twenty (29.9%) nurses claim that they use single insulin pen for two different cartridges.

Conclusion

The insulin injection practice of nurses assessed through the use of insulin pen was suboptimal and highlights the need for urgent educational intervention.