Nurses reclaiming ownership of their practice: implementation of an evidence-based practice model and process

This article describes a new model and process to implement evidence-based practice. This model builds on concepts from the Iowa Model of Evidence-Based Practice, the Stetler model, and Rosswurm and Larrabee's model. The new model focuses on the centrality and involvement of staff nurses in making evidence-based practice clinical changes. Two figures illustrate the model and the implementation process. A detailed case study based on the model is included. Barriers identified in the literature review are addressed in the case study. Implementation of this model creates opportunities for staff nurses to recognize ownership of their practice and their role in changing the practice setting to a culture of evidence-based practice.     

河南省三级医院硕士学位护士循证实践能力现状及影响因素分析

目的了解河南省三级医院硕士学位护士的护理循证实践能力现状并分析其影响因素,旨在为管理者制订针对性的继续教育方案提供参考。方法采用目的抽样法选取2019年3—4月河南省郑州市6所三级医院的133名硕士学位护士作为研究对象,采用中文版循证实践能力评估量表及循证实践障碍量表对其进行调查,采用多重线性回归分析进行影响因素分。结果133名硕士学位护士的循证实践能力总分为(98.57±11.01)分,循证实践障碍量表总分为(79.66±20.46)分。多重线性回归分析显示,工作年限、职称、参加过循证护理培训、对循证实践知晓度、研究结果的可获得性、开展循证护理的资源条件是硕士学位护士临床循证护理实践能力的影响因素(P<0.05)。结论河南省硕士学位护士循证护理实践能力总体处于中等水平,循证实践态度积极,但循证知识和技能亟待提高。护理管理者应重视硕士学位护士循证护理实践能力的培养,提供更多支持性的资源和环境,促进临床高学历护士循证实践技能的培养,助推专科护理实践的发展。     

Factors affecting evidence translation for general practice nurses

This paper explores the domains of influence affecting practice nurses' ability to find, evaluate and use clinical evidence. A cross-sectional survey of general practice nurses (n = 590) in Victoria, Australia in 2008 provided data for a principal components analysis. The research replicates a study undertaken in the UK using the Developing Evidence-Based Practice Questionnaire. Five domains of influence on nurses' translation of evidence were identified: skills in finding/reviewing evidence; barriers to finding/reviewing evidence; knowledge from published sources; knowledge from other sources; and barriers or facilitators to change. Each domain was interpreted as underlying the relationship of nurses with evidence-based practice and was comparable to the original study's findings when subjected to factor analysis. Findings from this study show that the Developing Evidence-Based Practice Questionnaire-Au is a valid and useful instrument in determining the influences on practice nurses' ability to effect knowledge translation and conduct practice based on evidence. Given these findings, a new model is proposed that explains the influence of a number of domains on Australian general practice nurses' translation of knowledge into practice.     

Factors influencing the development of evidence-based practice: a research tool

AIM: The paper reports a study to develop and test a tool for assessing a range of factors influencing the development of evidence-based practice among clinical nurses. BACKGROUND: Achieving evidence-based practice is a goal in nursing frequently cited by the profession and in government health policy directives. Assessing factors influencing the achievement of this goal, however, is complex. Consideration needs to be given to a range of factors, including different types of evidence used to inform practice, barriers to achieving evidence-based practice, and the skills required by nurses to implement evidence-based care. METHODS: Measurement scales currently available to investigate the use of evidence in nursing practice focus on nurses' sources of knowledge and on barriers to the use of research evidence. A new, wider ranging Developing Evidence-Based Practice questionnaire was developed and tested for its measurement properties in two studies. In study 1, a sample of 598 nurses working at two hospitals in one strategic health authority in northern England was surveyed. In study 2, a slightly expanded version of the questionnaire was employed in a survey of 689 community nurses in 12 primary care organizations in two strategic health authorities, one in northern England and the other in southern England. FINDINGS: The measurement characteristics of the new questionnaire were shown to be acceptable. Ten significant, and readily interpretable, factors were seen to underlie nurses' relation to evidence-based practice. CONCLUSION: Strategies to promote evidence-based practice need to take account of the differing needs of nurses and focus on a range of sources of evidence. The Developing Evidence-Based Practice questionnaire can assist in assessing the specific 'evidencing' tendencies of any given group of nurses.     

A multi-dimensional EBP educational program to improve evidence-based practice and critical thinking of hospital-based nurses: Development,implementation, and preliminary outcomes

Improving outcomes and quality of care through evidence-based practice (EBP) is a priority globally. But most nurses have insufficient competence in EBP. How to conduct Educational interventions to enhance clinical nurses' EBP competencies and critical thinking disposition (CTD) requires more evidence. One hundred eleven clinical nurses from a Chinese four-campus hospital were enrolled in our EBP education program. The Johns Hopkins Nursing Evidence-Based Practice Model was used to develop and guide the educational and practical sessions. Multi-dimensional learning strategies —including online self-learning, on-site lectures, workshops, and social media-facilitated group discussions—were used to facilitate the implementation of the education sessions. After education, nurses embedded evidence into practice. The Chinese versions of the EBP Believe scale (EBPB), EBP Implementation scale (EBPI), and the Simplified Chinese Version of the Critical Thinking Disposition Inventory (CTDI-SCV) were applied to assess the relevant competencies among clinical nurses before and after the education program. Clinical nurses' EBPB, EBPI, and CTDI-SCV scores improved. But only EBPB and EBP skills and attitudes were enhanced with a statistical difference (t = −2.980, −4.141, and −2.695, with all p < 0.01). There was a small positive association between EBPB and CTDI-SCV (r = 0.396, p < 0.01). Fifteen EBP programs were successfully accomplished.     

Irish psychiatric nurses' self-reported barriers, facilitators and skills for developing evidence-based practice

Evidence-based practice places an emphasis on integration of clinical expertise with available best evidence, patient's clinical information and preferences, and with local health resources. This paper reports the findings of a study that investigated the barriers, facilitators and skills in developing evidence-based practice among psychiatric nurses in Ireland. A postal survey was conducted among a random sample of Irish psychiatric nurses and survey data were collected using the Development of Evidence-Based Practice Questionnaire. Respondents reported that insufficient time to find and read research reports and insufficient resources to change practice were the greatest barriers to the development of evidence-based practice. Practice development coordinators were perceived as the most supportive resource for changing practice. Using the Internet to search for information was the highest-rated skill and using research evidence to change practice was the lowest-rated skill for developing evidence-based practice. Nurses' precursor skills for developing evidence-based practice, such as database searching and information retrieval, may be insufficient in themselves for promoting evidence-based practice if they cannot find evidence relating to their particular field of practice or if they do not have the time, resources and supports to develop their practice in response to evidence.     

Advancing evidence-based practice: a program series

The call to evidence-based practice (EBP) is evolving and empowers nurses to form innovative learning partnerships with colleagues to nourish wisdom, strengthen critical thinking, integrate research knowledge, and celebrate contributions in leading best practice. Based on clinician interest, Advancing Evidence-Based Practice: A Program Series was designed for nurses to showcase initiatives using Mercy Nursing's EBP Model. Mentoring guides their efforts. This opportunity creates learning partnerships that encourage participants to reflect about their practice and network with colleagues about what is important for clinical excellence. It also nurtures professional growth in research development and formal presentations.     

Development of the Family Nursing Practice Scale

This article describes the development and testing of the Family Nursing Practice Scale (FNPS). This self-report questionnaire is designed to measure perceived changes in family nursing practice including attitudes toward working with families, critical appraisal of their family nursing practice and reciprocity in the nurse-family relationship. Categories were derived from a needs assessment, competence as effective application of knowledge and skill and theoretical foundations for family assessment and intervention. Psychometric testing (content, construct validity, internal consistency, and test-retest reliability) was undertaken with 140 psychiatric nurses in Hong Kong. Practice appraisal and nurse-family relationships accounted for 56.4% of the variance. Cronbach's alpha reliability coefficients were .88 and .73 for the two subscales, respectively, and .86 for the scale overall. Test-retest reliability ranged from .62 to .93 on the individual items. The results provide preliminary evidence of the reliability and validity of the FNPS. The instrument provides quantitative and qualitative evaluation components.     

Use of the Edmonton Research Orientation Scale with nurses

Improved understanding of the determinants of research utilization is fundamental to developing and testing strategies to increase research utilization. Inconsistent findings in this field of research about research utilization may be attributable, in part, to lack of development of measures. This research tested the internal consistency and construct validity of the Edmonton Research Orientation Scale (EROS) and its four subscales (Valuing Research, Research Involvement, Being on the Leading Edge, and Evidence-Based Practice), which are promising measures of research utilization and attitudes towards research. One hundred eighty-five registered nurses in a pediatric teaching hospital completed the EROS. Nurses who reported higher levels of education, better understanding of research topics or participation in quality management or research projects also reported higher levels on the EROS and EROS subscales. The Valuing Research and Evidence-Based Practice subscales were associated with having taken courses in research design and statistics. The findings suggest that the EROS and the Valuing Research and Evidence-Based Practice subscales may be used to measure nurses' attitudes towards research and research utilization.     

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.     

Promoting evidence-based practice: an internship for staff nurses

Implementing evidence-based practice is a complex but valued process that requires support for nurses to make it a reality in care delivery. To address this, an Evidence-Based Practice Staff Nurse Internship was developed at the University of Iowa Hospitals and Clinics in the United States. PROGRAM OVERVIEW: The objective of this internship is to promote use of evidence by staff nurses to improve patient outcomes. Through a competitive application process, six nurses are accepted in each cohort. The program provides didactic content and dedicated work time on topics interns select (e.g., family pet visitation, sedation management, bowel sounds assessment, guided imagery, family transition to pediatric floor). Interns receive paid clinical release time for participating. ROLES AND RESPONSIBILITIES: Teams include the staff nurse, the nurse manager, and an advanced practice nurse. Responsibilities for each step are assigned to the person with the appropriate expertise. EVALUATION: Interns report understanding the process, appreciate the opportunity for professional growth, and report their objectives are being met. Participants evaluated the program very positively and also provided recommendations for revision (e.g., revising class content). The program resulted in improved quality of care such as increased patient and family satisfaction, decreased length of stay, and cost savings. IMPLICATIONS: Programs that support practitioners through the evidence-based practice process are needed for use in a variety of settings internationally. This unique program supports staff nurses in making evidence-based practice a reality for their work and patients and might be transferable across settings.     

低年资临床护士循证护理知信行现状及影响因素分析与实践障碍研究

目的:探讨低年资(护龄≤5年)临床护士循证护理(EBN)知信行与循证实践(EBP)障碍现状及相关性,分析影响EBN知信行的因素,为EBN实践的有效开展提供依据。方法:2020年4月1日~6月1日采用方便抽样法,选择济南市3所三甲医院407名低年资(护龄≤5年)临床护士作为研究对象,采用一般资料问卷、循证护理知信行量表(EBPQ)、循证实践障碍量表进行问卷调查。结果:407名低年资临床护士EBPQ问卷均分为(4.61±1.10)分,循证实践障碍问卷各维度得分为开展循证护理的资源条件(29.15±6.82)分、科研报道的质量(25.28±6.51)分、护士对循证护理的主观态度及能力(23.81±5.45)分、研究报道的时效性与系统性(18.69±4.66)分;经单因素分析显示,性别、人事关系、职称、是否为带教老师、工作中感受到的压力、是否有过护理科研经历、阅读文献情况、对学习循证护理是否感兴趣、在临床工作中是否有必要开展循证护理方面EBN知信行得分比较差异有统计学意义(P<0.01,P<0.05);多元线性回归分析显示,性别、对待护理的职业态度、对学习循证护理是否感兴趣为EBN知信行的影响因素。结论:低年资护士EBN知信行水平仍有待提高,造成实践障碍的因素包含各个方面,需要进一步进行针对性的措施加以改进。     

Enhancing utility and understanding of evidence based practice through undergraduate nurse education

Background

The concept of evidence-based practice is globally relevant in current healthcare climates. However, students and teachers struggle with integrating evidence based practice effectively into a curriculum. This has implications for nurse education and in particular the way in which research is presented and delivered to students.A new undergraduate Evidence Based Practice module (Evidence Based Nursing 1) was developed in a large University within the United Kingdom. It commenced in October 2014 running in year one of a 3 year undergraduate nursing programme. This study sought to formally evaluate attitudes and beliefs, knowledge level and utilization of evidence based practice though using two validated questionnaires: Evidence Based Practice Beliefs Scale© and Evidence Based Practice Implementation Scale©.

Method

This was a pilot study using quantitative pre and post-test design. Anonymised data was collected from Year 1 undergraduate student nurses in the September 2014 intake (n = 311) at two time points. Time 1: pre-module in September 2014; and Time 2: post –module in August 2015. All data was collected via Survey Monkey.

Results

Results demonstrate that the educational initiative positively impacted on both the beliefs and implementation of evidence based practice. Analysis highlighted statistically significant changes (p < 0.05) in both the Evidence Based Practice Beliefs Scale (7/16 categories) and the Evidence Based Practice Implementation Scale (13 / 18 categories).

Conclusions

The significance of integrating evidence based practice into undergraduate nurse education curriculum cannot be underestimated if evidence based practice and its positive impact of patient care are to be appreciated in healthcare settings internationally.

     

Increasing understanding of nursing research for general duty nurses: an experiential strategy

Misconceptions and trepidation about research abound among practicing nurses. However, in light of the movement toward increasing accountability to consumers and the concurrent drive toward evidence-based practice, the need for nursing research can no longer be ignored. Innovative approaches to augment nurses' training and education in research and evidence-based practice must be incorporated into continuing education programs. The Nursing Research and Evidence-Based Practice Committee of a large tertiary care teaching hospital in Winnipeg, Manitoba, Canada, developed a series of opportunities for staff nurses to participate in research projects and have ongoing exposure to the steps in the research process. The Great Canadian Cookie Experiment was an opportunity to participate in quantitative research. Qualitative data from patients' thank you cards were analyzed in an interactive fashion during luncheon seminars held during Nursing Week in 2 subsequent years. A survey of nurses who participated in the luncheon seminars indicated an overall increase in their knowledge about qualitative research methods and an appreciation for participating in the process of nursing research. Continued visibility of nursing research will contribute to changing nurses' attitudes toward fostering an evidence-based approach to clinical practice.     

Barriers to research implementation by community nurses

This article presents the community findings from a study of nurses in community and acute settings using Funk et al's Barriers to Research Utilization Scale (Barriers) (Funk et al, 1991a), which aimed to identify the main barriers to implementing research in practice. The Barriers questionnaire was sent to all nurses working in three community trusts in Yorkshire (n=2327), and practice nurses in one Yorkshire health authority (n=190). A 51.5% response rate gave a sample of 1297 nurses. The top two barriers were reported to be lack of time and resources. There were significant differences between sub-samples, e.g. older women perceived more barriers than younger colleagues, and practice nurses had particular problems with the cooperation of GPs. Factor analysis generated four new factors different from those found by Funk et al (1991a) (shown in brackets): benefits (nurse characteristics); quality (research characteristics); accessibility (presentation of the research characteristics) and resources (setting characteristics). Recommendations include developing nurses' critical appraisal skills so that, given more time and adequate resources, research findings might be judiciously implemented in practice.     

Nurses' perceptions of the barriers to and the facilitators of research utilization in Turkey

The aim of this study was to determine nurses' perceptions of the barriers to and facilitators of research utilization in Turkey. Barriers Scale was utilized in the research, and the population was 631 nurses. According to the research results, the first three important barriers were inadequate authority (63.6%), lack of time (54.0%), and insufficient facilities (52.8%). Nurses have perceived the organizational management support as the most important easing factor in their applications (n = 156). It is highly recommended that nurses be trained in research methods and evidence-based practice, that research articles be written more clearly, and that Research and Development centers where nurses could get consultation services be established.     

Barriers to and Facilitators of End-of-Life Decision Making by Neonatologists and Neonatal Nurses in Neonates: A Qualitative Study

ContextMaking end-of-life decisions (ELDs) in neonates involves ethically difficult and distressing dilemmas for health care providers. Insight into which factors complicate or facilitate this decision-making process could be a necessary first step in formulating recommendations to aid future practice.ObjectivesThis study aimed to identify barriers to and facilitators of the ELD-making process as perceived by neonatologists and nurses.MethodsWe conducted semistructured face-to-face interviews with 15 neonatologists and 15 neonatal nurses, recruited through four neonatal intensive care units in Flanders, Belgium. They were asked what factors had facilitated and complicated previous ELD-making processes. Two researchers independently analyzed the data, using thematic content analysis to extract and summarize barriers and facilitators.ResultsBarriers and facilitators were found at three distinct levels: the case-specific context (e.g., uncertainty of the diagnosis and specific characteristics of the child, parents, and health care providers, which make decision making more difficult), decision-making process (e.g., multidisciplinary consultations and advance care planning, which make decision making easier), and overarching structure (e.g., lack of privacy and complex legislation making decision making more challenging).ConclusionBarriers and facilitators found in this study can lead to recommendations, some simpler to implement than others, to aid the complex ELD-making process. Recommendations include establishing regular multidisciplinary meetings to include all health care providers and reduce unnecessary uncertainty, routinely implementing advance care planning in severely ill neonates to make important decisions beforehand, creating privacy for bad-news conversations with parents, and reviewing the complex legal framework of perinatal ELD making.     

浙江省临床护士循证素质及影响因素的现状分析

目的了解浙江省临床护士的循证素质及其影响因素,为临床实施循证护理干预提供可靠的理论依据。方法采用临床护士循证基本素质调查表及中文版循证护理实践障碍量表,以分层整群抽样法选择浙江全省11个行政区22所医院的831名临床护士进行横断面调查。结果62．2％的临床护士循证素质得分处于稍差等级,5．2％处于很差等级;45．5％的临床护士循证护理实践障碍得分等级为中度影响,24．3％的为重度影响,在循证护理实践中存在障碍。临床护士循证素质的独立影响因素是护士的职称、职务和循证实践障碍得分（P〈0．05）,职称和职务越高、循证实践障碍得分越低的护士,循证素质越好。结论浙江省临床护士整体的循证素质有待提高,医院应提供组织保障,采取精英式培训和分层培训相结合的方法加强循证护理教育,完善硬件设施,促进循证护理的发展．