Developing evidence-based practice: experiences of senior and junior clinical nurses

Title. Developing evidence‐based practice: experiences of senior and junior clinical nurses Aim. This paper is a report of a study to compare factors influencing the development of evidence‐based practice identified by junior and senior nurses. Background. Assessing factors influencing the achievement of evidence‐based practice is complex. Consideration needs to be given to a range of factors including different types of evidence, the skills nurses require to achieve evidence‐based practice together with barriers and facilitators. To date, little is known about the relative skills of junior and senior clinical nurses in relation to evidence‐based practice. Method. A cross‐sectional survey was undertaken at two hospitals in England, using the Developing Evidence‐Based Practice Questionnaire administered to Registered Nurses (n = 1411). A useable sample of 598 (response rate 42%) was achieved. Data were collected in 2003, with comparisons undertaken between junior and senior nurses. Findings. Nurses relied heavily on personal experience and communication with colleagues rather than formal sources of knowledge. All respondents demonstrated confidence in accessing and using evidence for practice. Senior nurses were more confident in accessing all sources of evidence including published sources and the Internet, and felt able to initiate change. Junior nurses perceived more barriers in implementing change, and were less confident in accessing organizational evidence. Junior nurses perceived lack of time and resources as major barriers, whereas senior nurses felt empowered to overcome these constraints. Conclusion. Senior nurses are developing skills in evidence‐based practice. However, the nursing culture seems to disempower junior nurses so that they are unable to develop autonomy in implementing evidence‐based practice.     

Patient participation in clinical decision-making in nursing: A comparative study of nurses' and patients' perceptions

Aims and objectives. The aim of this study was to compare the degree of concordance between patients and Registered Nurses’ perceptions of the patients’ preferences for participation in clinical decision‐making in nursing care. A further aim was to compare patients’ experienced participation with their preferred participatory role. Background. Patient participation in clinical decision‐making is valuable and has an effect on quality of care. However, there is limited knowledge about patient preferences for participation and how nurses perceive their patients’ preferences. Methods. A comparative design was adopted with a convenient sample of 80 nurse–patient dyads. A modified version of the Control Preference Scale was used in conjunction with a questionnaire developed to elicit the experienced participation of the patient. Results. A majority of the Registered Nurses perceived that their patients preferred a higher degree of participation in decision‐making than did the patients. Differences in patient preferences were found in relation to age and social status but not to gender. Patients often experienced having a different role than what was initially preferred, e.g. a more passive role concerning needs related to communication, breathing and pain and a more active role related to activity and emotions/roles. Conclusions. Registered Nurses are not always aware of their patients’ perspective and tend to overestimate patients’ willingness to assume an active role. Registered Nurses do not successfully involve patients in clinical decision‐making in nursing care according to their own perceptions and not even to the patients’ more moderate preferences of participation. Relevance to clinical practice. A thorough assessment of the individual's preferences for participation in decision‐making seems to be the most appropriate approach to ascertain patient's involvement to the preferred level of participation. The categorization of patients as preferring a passive role, collaborative role or active role is seen as valuable information for Registered Nurses to tailor nursing care.     

Perceived barriers and facilitators to implementing research findings in the Irish practice setting

Background. Studies have consistently demonstrated that nurses are increasingly recognizing the role research has to play in their daily practice. Despite this recognition the actual application of research findings in the practice setting is still poor. To date, the barriers to implementing research findings in the Republic of Ireland's practice setting have not been explored empirically. This study sought to address this gap. Aims. The aims of this study were to ascertain what Registered Nurses practising in the Republic of Ireland perceive as barriers to the implementation of research findings in the practice setting and to explore what they perceive would facilitate them in using research findings in their daily practice. Design. Cross‐sectional survey. Methods. A non‐probability strategy was employed with all Registered Nurses who commenced a nursing‐focused academic course accredited by the University of Dublin, Trinity College, between September 2001 and February 2002 invited to participate. The ethical rights of the participants in terms of anonymity, privacy and informed consent were assured through a number of mechanisms. Data were collected via the Barriers scale. Findings. Eight of the top 10 ranked barriers were organization centred. The top barrier was a perception of insufficient authority to instigate change in the practice setting. The perceived key facilitators to implementing research findings included protected time for retrieval and evaluation of research findings, instrumental support from management, informed supportive personnel in the practice settings and accessible educational opportunities to augment critical reading skills. Relevance to clinical practice. The Irish Government is committed to provide the people of Ireland with an evidence‐based health service. From a nursing perspective the findings of this study indicate that a number of strategies have to be introduced or enhanced in the practice settings before this commitment can be realized.     

A study of nurses' knowledge of a palliative approach in residential aged care facilities

Aim. To identify residential aged care nurses’ current knowledge of palliative care for older residents in need of end‐of‐life care. Background. Recently, there has been a growing interest in the delivery of palliative care in residential aged care facilities. While it is recognized that aged care nurses do possess palliative care knowledge the actual level of their knowledge has not been well documented. Design/method. An analytical study using a validated questionnaire tool – Palliative Care Quiz for Nursing, developed by Ross et al. [Journal of Advanced Nursing 23 (1996) 126–137] , combined with a demographic survey of Registered Nurses and assistants in nursing working in five high care residential aged care facilities in inner city region of Sydney, Australia. Results. The total Palliative Care Quiz for Nursing score possible was 20. The mean score for Registered Nurses was 11.7 (SD 3.1) and for AINs 5.8 (SD 3.3), the difference between scores being significant (t = 8.7, df 95, P = 0.000). Misconceptions in palliative care were identified for both the groups of carers. Conclusion. This research has highlighted the need for ongoing palliative care education for both the groups of primary carers. Relevance to clinical practice. The findings of this research highlight the existing palliative care knowledge of residential aged care nurses and provides evidence for education programmes.     

Research use in the care of older people: a survey among healthcare staff

Background. Sweden has one of the largest proportions of older people in the world. To manage the healthcare needs of an aging population, there has been an alteration from hospital care to community‐based care. In these settings, the majority of staff is enrolled nurses (EN) and nurse aides (NA) without university education. Aim and design. The overall aim of this cross‐sectional survey was to explore staff perceptions of factors related to research utilization in the care of older people. Method. Questionnaires covering research utilization and demographics were sent to all staff (n = 132) working in seven units in older people care. The response rate was 67% (n = 89). The respondents consisted of ENs/NAs (n = 63), Registered Nurses (RN) and rehabilitation professionals (RP) as physiotherapists and occupational therapists (RN/RP n = 26). Results. Most of staff reported positive attitudes towards research. The RNs/RPs stated more often than the ENs/NAs that they wanted to base their practice on research (81% vs. 25%; P = 0.001). The RNs/RPs also reported a greater extent of research use in daily practice (54% vs. 17%; P = 0.001). Support from colleagues (77% vs. 22%; P < 0.001) and unit managers (73% vs. 10%; P < 0.001) for implementing research findings was also more frequently reported by the RNs/RPs compared with the ENs/NAs. The majority of the ENs/NAs stated Do not know on many items concerning attitudes towards research, support for research utilization and actual use of research. Conclusions. Despite overall positive attitudes towards research, the majority of staff did not use research findings in daily practice. This was particularly valid for the EN/NA group. Relevance to clinical practice. There is an urgent need for managers and others in the care of older people to develop strategies for implementing evidence‐based practice that involves the EN/NA group.     

Factors influencing evidence‐based nursing utilization intention in Korean practice nurses

The purpose of this study was to describe Korean nurses' perceptions, attitudes and utilization intention for evidence‐based nursing (EBN), and to explore what factors influence utilization intention. We conducted a cross‐sectional survey in 2012. Registered nurses directly involved in clinical practice were recruited at a medical centre in Korea. A total of 420 nurses completed a self‐report questionnaire. Results showed that participants reported moderate scores regarding their perceptions and attitudes towards EBN, and rated themselves as higher than the median for utilization intention. Furthermore, this study revealed that perceptions of and attitudes towards EBN, occupational view and previous EBN education were significant factors affecting utilization intention. Nurse educators and managers should encourage nurses to have better attitudes towards EBN, help them be more satisfied with their work and provide them with appropriate education for EBN to establish evidence‐based practice as a part of daily nursing care.     

What is the relationship between nurses’ attitude to evidence based practice and the selection of wound care procedures?

Aim. To investigate qualified nurses’ attitudes to evidence‐based practice and whether this influenced their selection of wound care products. Background. The literature shows that previous studies on attitudes to evidence‐based practice tended to be part of a wider study. The general consensus was that there was a positive attitude to evidence‐based practice. However, there appeared to be no published studies specifically addressing nurses’ attitudes to evidence‐based wound care. Design. Survey design using a questionnaire completed by 156 qualified nurses working in three UK National Health Trusts. Results. A statistically significant difference was seen between those nurses with a tissue viability link nurse role (p = 0·002) and those without a link nurse role; those educated to first degree (p < 0·001) and those without a first degree; and those who had received formal tissue viability training (p < 0·001) and those with informal tissue viability training. There was also a highly statistically significant relationship between the clinical grade of staff and the overall attitude to evidence‐based practice (p < 0·001). Conclusions. Nurses who had attained a higher level academic qualification, had a tissue viability link nurse role and those who had received formal tissue viability training scored generally higher in the wound care knowledge tests and in attitude to evidence‐based practice. Relevance to clinical practice. The care received by patients in relation to wound care could be dependent upon factors that are related to the individual characteristics of the nurse providing the care and these factors, in turn, are related to education and training with respect to wound care. Better general education and better specific training in wound care could lead to better wound care.     

Stroke unit Nurse Managers' views of individual and organizational factors liable to influence evidence‐based practice: A survey

The uptake of evidence into practice may be impeded or facilitated by individual and organizational factors within the local context. This study investigated Nurse Managers of New South Wales, Australia, stroke units (n = 19) in their views on: leadership ability (measured by the Leadership Practices Inventory), organizational learning (measured by the Organizational Learning Survey), attitudes and beliefs towards evidence‐based practice (EBP) and readiness for change. Overall Nurse Managers reported high‐level leadership skills and a culture of learning. Nurse Managers' attitude towards EBP was positive, although nursing colleague's attitudes were perceived as less positive. Nurse Managers agreed that implementing evidence in practice places additional demands on staff; and almost half (n = 9, 47%) reported that resources were not available for evidence implementation. The findings indicate that key persons responsible for evidence implementation are not allocated sufficient time to coordinate and implement guidelines into practice. The findings suggest that barriers to evidence uptake, including insufficient resources and time constraints, identified by Nurse Managers in this study are not likely to be unique to stroke units. Furthermore, Nurse Managers may be unable to address these organizational barriers (i.e. lack of resources) and thus provide all the components necessary to implement EBP.     

A Statewide Evaluation of the Breastfeeding Resource Nurse Model

ObjectiveTo evaluate a statewide initiative to increase the provisioning of human milk in NICUs.DesignA survey of nurses before participation in an educational session, immediately after education, and again 9 months later.SettingNurses from 22 hospitals throughout Florida.ParticipantsWe surveyed 121 participants, including some nurses who had prior breastfeeding education or certification as well as those without specialized breastfeeding training.InterventionAn educational project called the Breastfeeding Resource Nurse Master program was intended to educate NICU nurses to implement the “Ten Steps to Promote and Protect Human Milk and Breastfeeding in Vulnerable Infants.”MeasurementA quantitative needs assessment survey was administered to participants to determine current hospital practices, policies, and perceived areas for improvement. Pre- and immediate posttraining surveys assessed NICU nurses’ knowledge, attitudes, and beliefs about human milk feeding of critical care infants and their self-efficacy for implementing the program in their respective NICUs. A follow-up, open-ended survey was administered at 9 months to yield information on program implementation.ResultsNICU breastfeeding practices varied widely at baseline. Nurses’ scores for knowledge, beliefs, and behavioral intentions improved postsession, but the implementation of practice changes related to the Ten Steps for Vulnerable Infants proved difficult. Nurses identified insufficient time and resources as barriers to educating others and changing practice.ConclusionsPolicies and regulations that make hospitals accountable for increasing human milk provision to vulnerable infants may be necessary to ensure that hospitals devote adequate resources to implementing practice changes in this area.