Cohort Studies

Editor's note: This is the seventh article in a series on clinical research by nurses. The series is designed to give nurses the knowledge and skills they need to participate in research, step by step. Each column will present the concepts that underpin evidence-based practice-from research design to data interpretation. The articles will be accompanied by a podcast offering more insight and context from the authors. To see all the articles in the series, go to http://links.lww.com/AJN/A204.

Who Advances Nursing Science in Practice Settings and How?

Nurse scientist (NS) roles in clinical practice settings are key components of The Future of Nursing and ANCC Magnet® recognition. Despite increased opportunities for NS roles, leveraging these roles to advance nursing science remains at an early stage. We describe opportunities and challenges for NSs in clinical practice settings, highlighting the value of a strong partnership with chief nurse officers as critical for the success of NSs and outcomes associated with these roles.

Measurement in Nursing Research

Editor's note: This is the fourth article in a series on clinical research by nurses. The series is designed to give nurses the knowledge and skills they need to participate in research, step by step. Each column will present the concepts that underpin evidence-based practice-from research design to data interpretation. The articles will be accompanied by a podcast offering more insight and context from the authors. To see all the articles in the series, go to http://links.lww.com/AJN/A204.

Implementing a Mentorship Program for New Nurses During a Pandemic

This article describes the implementation of an evidence-based mentoring program for new registered nurses (RNs) hired into medical-surgical units in a small community-based hospital during the unfolding of the SARS-Cov2 (COVID-19) pandemic. The hospital's nursing leadership supported the program implementation during the COVID-19 pandemic to provide a broader support system to new RNs to improve nurse retention. During a response to the pandemic, the medical-surgical units faced numerous process changes in a short time, which further reinforced the urgency of an additional support system for the newly hired RNs.

Implementing Prone Positioning for COVID-19 Patients Outside the Intensive Care Unit

BACKGROUND

Proning intubated intensive care unit patients for the management of acute respiratory distress syndrome is an accepted standard of practice. We examined the nursing climate in 4 units and its impact on implementing a novel self-proning protocol to treat COVID-19 patients outside the intensive care unit.

LOCAL PROBLEM

Nursing units previously designated for medical/surgical populations had to adjust quickly to provide evidence-based care for COVID-19 patients attempting self-proning.

METHODS

Nurses from 4 nursing units were surveyed about the implementation process on the self-proning protocol. Their perception of unit implementation was assessed via the Implementation Climate Scale.

INTERVENTIONS

A new self-proning nursing protocol was implemented outside the intensive care unit.

RESULTS

Consistent education on the protocol, belief in the effectiveness of the intervention, and a strong unit-based climate of evidence-based practice contributed to greater implementation of the protocol.

CONCLUSIONS

Implementation of a new nursing protocol is possible with strong unit-based support, even during a pandemic.

Determining the level of evidence: Nonresearch evidence

ABSTRACT

To support evidence-based nursing practice, the authors provide guidelines for nonresearch evidence, which includes clinical practice guidelines, consensus or position statements, literature review, expert opinion, organizational experience, case reports, community standards, clinician experience, and consumer preferences. This is the third in a three-part series.

Identifying international barriers and facilitators to research utilization

PURPOSE

To define research utilization (RU) and identify barriers and facilitators to RU in nursing practice.

METHODS

An international integrative review of 42 studies was conducted related to barriers and facilitators of RU.

RESULTS

Following a review of the research that met the inclusion criteria, the author identifies common themes related to the implementation of research into clinical practice and the challenges surrounding RU.

CONCLUSION

Despite consistently perceived barriers to research among nurses from different geographic, cultural, and clinical backgrounds, practice changes are typically out of their hands. Further research is necessary to gauge perception among the nursing associations, regulatory bodies, healthcare organizations, policy makers, and managers responsible for implementing these changes.

Implementation Science Training and Resources for Nurses and Nurse Scientists

PURPOSE

The purpose of this article is to describe the differences between quality improvement and implementation science, the urgency for nurses and nurse scientists to engage in implementation science, and international educational opportunities and resources for implementation science.

ORGANIZING CONSTRUCT

There is a push for providing safe, effective, patient-centered, timely, efficient, and equitable health care. Implementation science plays a key role in adoption and integration of evidence-based practices to improve quality of care.

METHODS

We reviewed implementation science programs, organizations, and literature to analyze the roles of nurses and nurse scientists in translating evidence into routine practice.

FINDINGS

Implementation-trained nurses and nurse scientists are needed as part of multidisciplinary teams to advance implementation science because of their unique understanding of contextual barriers within nursing practice. Likewise, nurses are uniquely qualified for recognizing what implementation strategies are needed to improve nursing care across practice settings.

CONCLUSIONS

Many international clinical and training resources exist and are supplied to aid interested readers in learning more about implementation science.

CLINICAL RELEVANCE

Half of research evidence never reaches the clinical setting, and the other half takes 20 years to translate into clinical practice. Implementation science-trained nurses are in a position to be excellent improvers for meaningful change in practice.

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

BACKGROUND

This study aimed to identify clinical nurses' evidence-based practice (EBP) knowledge, beliefs, organizational readiness, and EBP implementation levels, and to determine the factors that affect EBP implementation in order to successfully establish EBP. This study was conducted at a university-affiliated tertiary hospital located in a provincial area in Korea. The research design was based on Melnyk and Fineout-Overholt's Advancing Research & Clinical Practice through Close Collaboration model as the first step.

METHODS

A descriptive and cross-sectional design was conducted and a convenience sample of 521 full-time registered nurses from an 849-bed tertiary hospital were included. Structured questionnaires were used to assess EBP knowledge, EBP beliefs, organizational culture & readiness and EBP implementation. Data were analyzed using SPSS V 25.0 by using descriptive and inferential statistics and hierarchical multiple regression was performed to determine the factors affecting the implementation of EBP.

RESULTS

Our findings showed that the clinical nurses had a positive level of EBP beliefs, but the level of EBP knowledge, organizational readiness and EBP implementation were insufficient. EBP knowledge, beliefs, and organizational readiness were significantly positively correlated with EBP implementation. In the final model, EBP knowledge and organizational readiness were significant predictors of EBP implementation; the model predicted 22.2% of the variance in implementation.

CONCLUSIONS

Based on these results, the main focus of the study was the importance of individual nurses' efforts in carrying out EBP, but above all efforts to create an organizational culture to prepare and support EBP at the nursing organization level. In the initial process of introducing and establishing EBP, nurse administrators will need to minimize expected barriers, enhance facilitators, and strive to build an infrastructure based on vision, policy-making, budgeting, excellent personnel and facilities within the organization.

How to critically appraise a qualitative health research study

Evidence-based nursing is a process that requires nurses to have the knowledge, skills, and confidence to critically reflect on their practice, articulate structured questions, and then reliably search for research evidence to address the questions posed. Many types of research evidence are used to inform decisions in health care and findings from qualita- tive health research studies are useful to provide new insights about individuals' experi- ences, values, beliefs, needs, or perceptions. Before qualitative evidence can be utilized in a decision, it must be critically appraised to determine if the findings are trustworthy and if they have relevance to the identified issue or decision. In this article, we provide practical guidance on how to select a checklist or tool to guide the critical appraisal of qualitative studies and then provide an example demonstrating how to apply the critical appraisal process to a clinical scenario.

Evaluating the use of multiteam systems to manage the complexity of inpatient falls in rural hospitals

OBJECTIVE

To evaluate the implementation and outcomes of evidence-based fall-risk-reduction processes when those processes are implemented using a multiteam system (MTS) structure.

DATA SOURCES/STUDY SETTING

Fall-risk-reduction process and outcome measures from 16 small rural hospitals participating in a research demonstration and dissemination study from August 2012 to July 2014. Previously, these hospitals lacked a fall-event reporting system to drive improvement.

STUDY DESIGN

A one-group pretest-posttest embedded in a participatory research framework. We required hospitals to implement MTSs, which we supported by conducting education, developing an online toolkit, and establishing a fall-event reporting system.

DATA COLLECTION

Hospitals used gap analyses to assess the presence of fall-risk-reduction processes at study beginning and their frequency and effectiveness at study end; they reported fall-event data throughout the study.

PRINCIPAL FINDINGS

The extent to which hospitals implemented 21 processes to coordinate the fall-risk-reduction program and trained staff specifically about the program predicted unassisted and injurious fall rates during the end-of-study period (January 2014-July 2014). Bedside fall-risk-reduction processes were not significant predictors of these outcomes.

CONCLUSIONS

Multiteam systems that effectively coordinate fall-risk-reduction processes may improve the capacity of hospitals to manage the complex patient, environmental, and system factors that result in falls.

Implications of a wide-scale educational intervention to engage nurses in evidence-based practice: The Italian RN4CAST experience

BACKGROUND

In Italy, there are still many barriers to the development of a culture of evidence-based practice (EBP) and nurses' knowledge of EBP is lacking. Additionally, in Italy there are still very few advanced practice registered nurses to significantly contribute to the development of EBP.

AIM

This aims to identify the implications of a wide-scale nursing education intervention to engage clinical nurses in EBP through the Italian RN4CAST study.

METHODS

A qualitative study based on a thematic analysis. A total of 800 clinical nurses actively participated in nine training sessions across Italy. At the end of each training session written feedback data were collected and then underwent thematic analysis.

RESULTS

All participants were strongly motivated to engage in EBP thanks to their involvement in the RN4CAST project. With regard to the implications of EBP, the thematic analysis produced the following themes: Professional identity; Quality of care; Perceptions of patients and nurses; Research impact; and Organization.

CONCLUSIONS

The involvement of a large number of clinical nurses in a research project raised their awareness about the advantages of engaging in EBP, and how evidence can be used to raise motivation to change current practice policies.

A Qualitative Description of Nurses' Experiences With Incorporating Research Into Practice

BACKGROUND

Baccalaureate-prepared nurses should be competent in accessing, evaluating, and implementing research evidence into nursing practice. The purpose of this study was to gain insight into nurses' experiences in accessing, evaluating, and implementing research into practice.

METHOD

Researchers conducted a qualitative descriptive study. Data were collected through in-depth interviews and field notes.

RESULTS

Thirteen nurses participated in individual interviews. Themes that emerged included awareness, motivation-empowering change, and barriers to evidence-based practice implementation (EBP). Several experienced nurses expressed the importance of EBP in practice but could not provide clear definitions of EBP. Personal and organizational barriers negatively influence EBP implementation in clinical practice. Nurses could be motivated to use EBP if it were translated in an easy way to understand.

CONCLUSION

The information derived from this study can be used to design learning opportunities that prepare practicing nurses to appropriately appraise research and integrate evidence into practice. J Contin Educ Nurs. 2018;49(7):299-306.

Effects of Education Programs on Evidence-Based Practice Implementation for Clinical Nurses

This study was conducted to identify the effectiveness of an education program for evidence-based practice (EBP) implementation of clinical nursing. EBP knowledge/skill, attitude, and belief; information search ability; and EBP implementation were significantly higher in the experimental group than in the control group. Furthermore, the effect on implementation was maintained at week 4 and week 8, indicating that the education program practically promotes the EBP implementation of nurses. Results confirm that the education program for EBP implementation is critical and the continuous education program is an essential part of EBP implementation. Also, to promote EBP implementation and disseminate it to nursing organizations, an immediate concern should be the cultivation of mentors for EBP and fortification of the belief and ability regarding EBP implementation. J Contin Educ Nurs. 2016;47(8):363-371.

[Nursing care perspectives and foresights]

As a continuation of its work and of the seminar on nursing sciences education in 2014, the “Association de recherche en soins infirmiers” (Arsi) organized a seminar on the 3rd and-4th of June 2016 in Nantes entitled : “nursing : perspectives and foresights”. More than fifty participants from the francophone area representing various sectors of practice : clinical, teaching, management and students gathered to debate and produce benchmarks to support the development of nursing sciences in France and to draw future directions for clinical practice and training. The successive sessions made it possible to reflect, to confront opinions, to make proposals and to identify the terms of the problematic of care and nursing knowledge today and the methodological elements relating to foresight. At the end of this very creative seminar, new avenues of reflection emerged shifting our usual look at the nurse profession. Orientations for training and practice have been defined with different stakes depending on the level of training and professional commitment. The strong links between professional, scientific and academic discipline have also been clarified, highlighting the importance to hold a high theoretical and scientific requirement, rigorous clinical practice, strong professional commitment and effective leadership.

Evidence-based nursing implementation in Mainland China: A scoping review

BACKGROUND

It is crucial to identify the challenges of evidence-based nursing implementation faced by countries in transitional stage.

PURPOSE

The purpose of this study was to identify the state of evidence on implementation in Chinese nursing contexts and to determine gaps that need to be pursued.

METHODS

We performed a scoping review on existing literature on implementation studies conducted in nursing context in Mainland China. After systematically searching eight (four Chinese and four English) databases, we extracted and analyzed data from the included studies.

RESULTS

Ninety-five articles met inclusion criteria. Publications were on the rise, with most funding from academic institutions. Most studies were quantitative, with patient outcomes as primary indicators. Eighteen studies used a theoretical framework. Frequently used strategies and barriers to evidence-based nursing implementation were mainly from the organizational level.

CONCLUSIONS

This scoping review indicates an urgent requirement of Chinese evidence-based nursing resources, more funding and support from clinical managerial level, cooperation between academic and clinical institutes, and a call for more rigorous studies of implementation science under a Chinese nursing context.

Evidence based nursing and midwifery practice in a regional Australian healthcare setting: Behaviours, skills and barriers

AIM

To establish self-reported skill levels, behaviours and barriers in relation to evidence-based practice (EBP) among a representative sample of regional Australian nurses and midwives in senior roles.

BACKGROUND

It has been widely established that nurses and midwives continue to face challenges in relation to putting evidence into practice on the clinical floor. Prior to conducting an EBP capacity building activity in a regional Australian Local Health District, a survey assessing needs and skill and barrier areas was conducted.

METHODS

A quantitative descriptive survey which utilised the 'Developing Evidence Based Practice Questionnaire' (DEBPQ) was conducted in early 2012 among senior nurses and midwives of a regional New South Wales Local Health District (LHD). The survey results were contrasted with reported DEBPQ results from a sample of UK metropolitan nurses and a sample of Australian general practice nurses (GPNs).

RESULTS

One hundred and sixty nine nurses completed the survey (response rate 42%). Survey respondents' reliance on accepted evidentiary knowledge sources was found to be low. Research literature-related knowledge sources were ranked outside of the top 10 sources, compared with numerous personalised and subjective sources, which ranked within the top 10. Access to and understanding of research material was a primary barrier to reviewing evidence in the study sample. Time-related barriers to changing practice on the basis of evidence figured prominently in the study sample and the UK and Australian GPN samples. The study sample rated their EBP skill levels significantly higher than both their UK counterparts and the Australian GPN sample (P < 0.0001).

CONCLUSION

Capacity building interventions are needed among senior nurses and midwives in Australian regional LHDs, as the most prominent knowledge sources reported are non-evidentiary in nature and barriers to finding and reviewing evidence, along with barriers to making practice change, remain significant.

From scientific discovery to health outcomes: A synergistic model of doctoral nursing education

Across the globe, health system leaders and stakeholder are calling for system-level reforms in education, research, and practice to accelerate the uptake and application of new knowledge in practice and to improve health care delivery and health outcomes. An evolving bi-dimensional research-practice focused model of doctoral nursing education in the U.S. is creating unprecedented opportunities for collaborative translational and investigative efforts for nurse researchers and practitioners. The nursing academy must commit to a shared goal of preparing future generations of nurse scientists and practitioners with the capacity and motivation to work together to accelerate the translation of evidence into practice in order to place nursing at the forefront of health system improvement efforts and advance the profession.

Improving nurses' access to healthcare evidence

This article describes how the education team and library services at Betsi Cadwaladr University Health Board found a way to help nurses keep updated, and support them with the introduction of nurse revalidation in April 2016. The education team bridged the gap between nurses and library resources by delivering "5 a Month", a small selection of current literature on chosen monthly topics from the library, to nurses at their place of work.

Linking Nurses with Evidence-Based Information via Social Media Tools: An Analysis of the Literature

Many health professional believe that social media tools can play a pivotal role in sharing and facilitating the use of evidence-based information with patients and other healthcare providers. By understanding how social media tools function, healthcare professionals can capitalize on these interactive platforms to improve the health of others. However, limited information exists to guide nurse educators in preparing healthcare professionals to engage patients or share evidence-based information among peers. The purpose of this literature review was to determine the extent to which professional development programs using social media for sharing evidence-based information have reported their research and/or experience in the published literature.

Changing Nephrology Nurses' Beliefs about the Value of Evidence-Based Practice and Their Ability to Implement in Clinical Practice

A rapidly evolving healthcare environment demands sound research evidence to inform clinical practice and improve patient outcomes. Over the past several decades, nurses have generated new knowledge by conducting research studies, but it takes time for this evidence to be implemented in practice. As nurses strive to be leaders and active participants in healthcare redesign, it is essential that they possess the requisite knowledge and skills to engage in evidence-based practice (EBP). Professional nursing organizations can make substantial contributions to the move healthcare quality forward by providing EBP workshops similar to those conducted by the American Nephrology Nurses'Association.

Evidence-Based Teaching Practice in Nursing Education: Faculty Perspectives and Practices

PURPOSE

This national online study was conducted to describe nursing faculty perspectives and practices about evidence-based teaching practice (EBTP).

BACKGROUND

Professional standards for nurse educator practice stress the importance of EBTP; however, the use of evidence by faculty in curriculum design, evaluation and educational measurement, and program development has not been reported.

METHOD

Nurse administrators of accredited nursing programs in the United States (N = 1,586) were emailed information about the study, including the research consent form and anonymous survey link, and invited to forward information to nursing faculty.

RESULTS

Respondents (551 faculty and nurse administrators) described the importance of EBTP in nursing education, used multiple sources of evidence in their faculty responsibilities, and identified factors that influence their ability to use EBTP.

CONCLUSION

EBTP in nursing education requires sustained institutional, administrative, and collegial support to promote faculty effectiveness and student learning.

Staying Connected: Sustaining Collaborative Care Models with Limited Funding

Providing psychiatric services in the primary care setting is challenging. The multidisciplinary, coordinated approach of collaborative care models (CCMs) addresses these challenges. The purpose of the current article is to discuss the implementation of a CCM at a free medical clinic (FMC) where volunteer staff provide the majority of services. Essential components of CCMs include (a) comprehensive screening and assessment, (b) shared development and communication of care plans among providers and the patient, and (c) care coordination and management. Challenges to implementing and sustaining a CCM at a FMC in Virginia attempting to meet the medical and psychiatric needs of the underserved are addressed. Although the CCM produced favorable outcomes, sustaining the model long-term presented many challenges. Strategies for addressing these challenges are discussed.

Part two: Qualitative research

This second article in the series Spotlight on Research focuses on qualitative research, its applications, principles and methodologies. It provides an insight into how this approach can be used within the perioperative setting and gives advice for practitioners looking to undertake a qualitative research study.