Emergency nurses’ Evidence-Based Practice attitudes,self-efficacy,knowledge, skills and behaviors before an educational intervention – Baseline of a Randomized Controlled Trial

BackgroundEmergency nurses are expected to follow recent research findings and ensure that their practice is based on evidence. Yet, during busy work-shifts in overcrowded emergency departments, evidence-based practice (EBP) is not always implemented.AimTo describe emergency nurses’ EBP attitudes, self-efficacy, knowledge, skills and behaviours at the baseline of a RCT.MethodsA baseline study as a part of a randomised, single-blind controlled multicentre intervention trial (RCT). The study population consisted of 300 emergency nurses employed in two university hospitals’ emergency departments in Finland. The total sample size (n = 80) was estimated using a simulation approach. The data were collected from voluntary emergency nurses by using four structured questionnaires.FindingsEmergency nurses’ EBP attitudes, self-efficacy, knowledge and skills were above the average level, and their EBP behaviour was below the average level when measured with the other of the two sum variables measuring behaviour. A significant correlation was found between age, years since graduation, the length of working experience in health care and EBP attitudes, behaviour, knowledge and self-efficacy. Younger emergency nurses who had recently graduated and had shorter work experience showed more positive attitudes towards EBP than older counterparts. No correlation was found between gender, educational background or prior exposure to EBP and EBP attitudes, self-efficacy, knowledge, skills or behaviours.ConclusionsThis study showed that to promote emergency nurses’ use of EBP in future, tailored educational interventions on EBP are needed. This would ensure implementation of EBP in daily clinical practice for quality and effective patient care.     

Evidence-based practice barriers and facilitators from a continuous quality improvement perspective: an integrative review

Solomons N.M. & Spross J.A. (2011) Journal of Nursing Management 19, 109–120
Evidence-based practice barriers and facilitators from a continuous quality improvement perspective: an integrative review Aims The purpose of the present study is to examine the barriers and facilitators to evidence-based practice (EBP) using Shortell’s framework for continuous quality improvement (CQI). Background EBP is typically undertaken to improve practice. Although there have been many studies focused on the barriers and facilitators to adopting EBP, these have not been tied explicitly to CQI frameworks. Methods CINAHL, Academic Search Premier, Medline, Psych Info, ABI/Inform and LISTA databases were searched using the keywords: nurses, information literacy, access to information, sources of knowledge, decision making, research utilization, information seeking behaviour and nursing practice, evidence-based practice. Shortell’s framework was used to organize the barriers and facilitators. Results Across the articles, the most common barriers were lack of time and lack of autonomy to change practice which falls within the strategic and cultural dimensions in Shortell’s framework. Conclusions Barriers and facilitators to EBP adoption occur at the individual and institutional levels. Solutions to the barriers need to be directed to the dimension where the barrier occurs, while recognizing that multidimensional approaches are essential to the success of overcoming these barriers. Implications for nursing management The findings of the present study can help nurses identify barriers and implement strategies to promote EBP as part of CQI.     

The Australian experience of nurses' preparedness for evidence-based practice

Aim  This study aimed to determine current knowledge and attitudes towards evidence-based practice (EBP) among pre- and post-registration nurses in New South Wales (NSW), Australia.
Background  Educational and clinical strategies for EBP in nursing assume a readiness to interpret and integrate evidence into clinical care despite continued reports of low levels of understanding and skill in this area.
Method  Perceptions of EBP were examined through a self-complete, anonymous postal survey distributed to 677 (post-registration) clinical nurses and to 1134 final year (pre-registration) nursing students during 2002 and 2003.
Results  A completed survey was returned by 126 post-registration and 257 final year nursing students (combined 21% response rate). Both pre- and post-registration nurses had a welcoming attitude towards EBP. Pre-registration nurses expressed more confidence in their EBP skills but self-rated knowledge and skill were low to moderate in both groups.
Conclusion  Nurses in Australia are clearly supportive of EBP but it is incorrect to assume that even recent graduates have a level of knowledge and skill that is sufficient to permit direct engagement in evidence implementation.
Implications for nursing management  Among a range of clinical supports, nurse managers and leaders can contribute to evidence-based health care by understanding the EBP knowledge and skills of their workforce and demanding a more practical approach in nursing education towards evidence-based guidelines and summaries appropriate to the clinical context.     

Nurses’ competence in genetics: An integrative review

The aim of this integrative review was to update a mixed method systematic review by Skirton, O'Connor, and Humphreys (2012) that reported on nurses’ levels of competence in using genetics in clinical practice. Three electronic databases were searched using selected key words. Research studies published in English between January 2011 and September 2017 reporting levels of nurse competence in genetics or genomics were eligible for inclusion. The selected studies were subjected to thematic analysis. Three main themes were identified: (i) genomic knowledge and utilization, (ii) perceived relevance to practice, and (iii) genomic education. While the reviewed papers produced varied findings, many nurses were shown to have poor genomic knowledge and/or competency, and yet there was a consensus that most nurses believe genomics is important to their practice. The present review indicated that in the past 5 years nurses have made minimal progress toward achieving the core genomic competencies appropriate for clinical practice.     

Registered nurses’ evidence-based practice: A longitudinal study of the first five years after graduation

BackgroundThe capacity to provide evidence-based practice is one of five core competencies that it is proposed all healthcare professions should possess to meet the needs of the 21st century healthcare system. New nurses are faced with a challenging work environment which, combined with shortcomings in undergraduate education and their limited clinical experience, may affect their evidence-based practice.ObjectiveThe aim of this study was to prospectively examine the extent of Swedish nurses’ evidence-based practice during the first five years of professional life.DesignAn observational longitudinal study, with yearly data collections over the course of five years.SettingsData was collected in two national cohorts (named EX2004 and EX2006) of Swedish registered nurses. Nurses in EX2006 were followed yearly during the first three years after graduation and nurses in EX2004 yearly three to five years after graduation. They had completed a three year academic nursing program and mainly worked in in-patient care settings.ParticipantsParticipants were recruited while studying at any of the 26 universities in Sweden. A total of 2107 (EX2006) and 2331 (EX2004) nursing students were eligible. 1207 and 1227 nurses were included in the current longitudinal samples. The nurses had a mean age of 31.2/33.9 years old and a majority were female. The cohorts were representative of the general nursing population.MethodsData was self-reported and collected through annual postal surveys. Evidence-based practice was conceptualized as a process and measured with an instrument including six items. Data was analyzed using latent growth curve modeling.ResultsThe extent of evidence-based practice was stable, between the two cohorts and over time. Individual differences existed and remained stable over time. However, the extent of practicing the different components of evidence-based practice on a monthly basis varied considerably, from 10% of the nurses (appraising research reports) to 80% (using information sources other than databases to search for knowledge).ConclusionThe extent of evidence-based practice remained unchanged during the first five years of professional life. It appears important to enhance both the contribution of undergraduate education and the contextual conditions in work life, in order to improve evidence-based practice among newly graduated nurses.     

Barriers and facilitators of nurses’ use of clinical practice guidelines: An integrative review

BackgroundPreventable harm continues to be one of the leading causes of patient death. Each year about 400,000 patients die from sepsis, hospital acquired infections, venous thromboembolism, and pulmonary embolism. However, as shown in the recent reduction in hospital acquired infections, the number of deaths could be reduced if healthcare providers used evidence-based therapies, which are often included in clinical practice guidelines (CPGs).PurposeThe purpose of this integrative review is to appraise and synthesize the current literature on barriers to and facilitators in the use of clinical practice guidelines (CPGs) by registered nurses.DesignWhittemore and Knafl integrative review methodology was used. Primary quantitative and qualitative studies about the nurses’ use of CPGs and published in peer-reviewed journals between January 2000 and August 2015 were included.MethodsThe Critical Skills Appraisal Program (CASP) was used to critically appraise the quality of sixteen selected quantitative and qualitative studies.ResultsInternal factors were attitudes, perceptions, and knowledge whereas format and usability of CPGs, resources, leadership, and organizational culture were external factors influencing CPG use.ConclusionGiven each barrier and facilitator, interventions and policies can be designed to increase nurses’ use of CPGs to deliver more evidence based therapy. In order to improve the use of CPGs and to ensure high quality care for all patients, nurses must actively participate in development, implementation, and maintenance of CPGs.     

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

AimTo examine the effect of incorporating evidence-based practice (EBP) in Nursing Research curriculum on undergraduate nursing students.BackgroundThe competence of EBP is essential for nurses and it is an essential task for educators to implement EBP education in nursing students.DesignA quasi-experimental study.MethodsBased on Astin’s Input-Environment-Outcome model, the study was conducted among 258 third-grade students of a four-year nursing bachelor’s program between September through December 2022. The students were divided into two groups. Students in the intervention group received innovative teaching where EBP elements were incorporated in Nursing Research course in a natural, gradual and spiral way, while students in the control group attended conventional teaching. Effect of EBP teaching was examined in terms of students’ EBP competence, learning experience and satisfaction and score of team-based research protocol assignment.ResultsCompared with conventional teaching, the innovative teaching characterized by EBP improved students’ EBP competence in terms of attitudes and skills and enhanced student’s comprehensive ability in nursing research. Students’ learning experience and satisfaction were similarly favorable between the two groups.ConclusionsFor undergraduate nursing students, the teaching strategy characterized by EBP is an appropriate and effective way to improve their EBP competence of attitudes and skills, as well as their nursing research ability.     

Evidence-based practice training in nurse residency programs: Enhancing confidence for practice implementation

BackgroundResearch on evidence-based practice (EBP) training demonstrates effectiveness in increasing the knowledge and attitudes of nurses toward EBP, but does not consistently result in willingness to implement EBP.PurposeThe purpose of this quality improvement project was to examine how EBP training of nurse residents affects their EBP self-efficacy and outcome expectancy.MethodA survey of EBP self-efficacy was obtained for a convenience sample of nurses at the beginning, middle and end of their residency program.ResultsImproved confidence in implementing EBP was demonstrated in posttest self-efficacy scores (M = 182.24; SD = 33.68; p < 0.001) and improved expectations of the benefits of use of EBP in post-test outcome expectancy scores (M=54.09; SD=12.77; p < 0.001).ConclusionIn 12-month nurse residency programs providing EBP training, increases in EBP self-efficacy and outcome expectancy were noted as measures positively associated with willingness to implement EBP.     

Evidence-based practice and evidence-informed practice competencies in undergraduate pre-registration nursing curricula: A document analysis at a university in England

BackgroundIn response to the heightened emphasis on incorporating the best available evidence into healthcare decision-making, healthcare training institutions have been actively incorporating Evidence-Based Practice (EBP), and/or Evidence-Informed Practice (EIP) competencies into undergraduate healthcare curricula. However, there is a gap in the scientific knowledge about the actual contents, as well as the extent of integration of EBP and EIP in undergraduate pre-registration nursing programmes.MethodA document analysis utilising Rohwer et al.’s (2014) framework was conducted to review and analyse the content of EBP and EIP competencies in the 2018/2019 curriculum of the undergraduate pre-registration nursing programme of a University located in England, United Kingdom.ResultsCompetencies relevant to EBP were included in four nursing modules. However, EIP competencies were not included in the curriculum.ConclusionThere is an urgent need for a more structured and holistic way of teaching and assessing EBP competencies through the integration of the principles of EIP, in order to enhance the effective application of evidence into clinical nursing practice.     

Fostering graduate nurse practice readiness in context

BackgroundThe healthcare environment is highly pressured, dynamic and demanding of staff. Existing research indicates that when graduate nurses begin work, they are not practice ready and struggle to adapt and manage their responsibilities as registered nurses.AimAs part of a larger study, this paper examines the impact of the healthcare environment on graduate nurses’ practice readiness and the factors that assist them to become practice ready.MethodMultiple case study design with 67 participants from four different professional groups employed in four healthcare institutions in one state in Australia. Grounded theory methods of data analysis, document review, and cross case analysis were utilised in this study.FindingsThe healthcare system, workplace environment and quality of workplace interactions impact on actual and perceived graduate nurse performance. Graduate nurses develop practice readiness progressively along a transition continuum and attaining practice readiness is reliant on factors present in both the education and workplace environments.DiscussionEducation and workplace factors collectively create the right environment for graduate nurses to flourish. Education and practice sectors need to work together to ensure graduate readiness over a four-year timeline from the commencement of nursing studies through to the end of the graduate year to ensure practice readiness.ConclusionCreating positive workplace environments that support nursing students and graduate nurses to develop practice readiness can enhance the quality of care they provide, promote their retention in the health workforce and contribute to improved healthcare practice and outcomes.     

An integrative review of nurse practitioner practice and its relationship to the core competencies

BackgroundCompetency based education (CBE) has been suggested for nurse practitioner (NP) education reform. For this to occur, competencies should reflect the knowledge, skills, and attitudes that NPs need for independent practice.PurposeThis integrative review examined the general practice activities of NPs across all population foci to determine the extent to which these activities are reflected in current NP competencies.MethodUsing the Whittemore and Knafl (2005) integrative review method, 17 studies that focused on NP practice between 2008 and 2018 were retrieved from three electronic databases. These studies were evaluated, analyzed and synthesized for themes. Afterwards the themes were compared with seven sets of current NP core competencies.ResultsThe themes for NP practice activities were direct and indirect patient care activities with a majority of NP time spent performing direct patient care activities. However, only 14% of the NP core competencies reflected these direct care activities.ConclusionIn order to successfully implement CBE, a need exists for the NP core competencies to reflect current NP practice.