Perceived knowledge,skills, attitude and contextual factors affecting evidence‐based practice among nurse educators,clinical coaches and nurse specialists

Evidence‐based practice (EBP) in the clinical setting is recognized as an approach that leads to improved patient outcomes. Nurse educators (NEs), clinical coaches (CCs) and nurse specialists are in key positions to promote and facilitate EBP within clinical settings and have opportunities to advance practice. Therefore, it is important to understand their perceptions of factors promoting EBP and perceived barriers in facilitating EBP in clinical settings, before developing educational programmes. This paper reports findings from a study that aimed to explore NEs' , CCs' and nurse specialists' knowledge, skills and attitudes associated with EBP. This study used a questionnaire containing quantitative and a small number of qualitative questions to capture data collected from NEs, CCs and nurse specialists working at a tertiary health‐care facility in Victoria, Australia. The questionnaire was distributed to a total of 435 people, of whom 135 responded (31%). Findings revealed that the three senior nurse groups relied heavily on personal experience, organizational policies and protocols as formal sources of knowledge. Furthermore, they had positive attitudes towards EBP. However, participants demonstrated lack of knowledge and skills in appraising and utilizing evidence into practice. They indicated a desire to seek educational opportunities to upskill themselves in the process of EBP.     

Integrating the online nursing evidence‐based information resources for evidence‐based nursing study in China

At present Chinese nurses could not get the up‐to‐date and high‐quality evidences efficiently and conveniently due to language barrier and other practical difficulties. This program built a Chinese website of integrated evidence‐based network information resources for EBN studies. Researchers hope to provide practical guidance and advice for nurses in non‐English‐speaking countries..     

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.     

Evidence‐based nursing: clarifying the concepts for nurses in practice

Aim. To provide a critical analysis of key concepts associated with evidence‐based nursing (EBN) to substantiate an operational definition for nurses to use in practice. Background. Despite the plethora of literature surrounding what evidence‐based nursing is and is not and how it differs from its cousins, evidence‐based medicine and evidence‐based practice, nurses still struggle to get evidence into practice. Several reasons for this have been reported, for example, a lack of understanding about what evidence‐based nursing means or time to engage with and apply the evidence into practice. Design. An in‐depth critical review and synthesis of literature was undertaken. Method. Using the key words; evidence‐based nursing, evidence‐based medicine and evidence‐based practice 496 articles were yielded. These articles were limited to 83. Using Burns and Grove’s (2001) phased approach to reviewing the literature the articles were critically reviewed and categorised into key concepts and themes. Results. The in‐depth critical review and synthesis of the literature demonstrated that evidence‐based nursing could be defined as a distinct concept. The review clearly shows that for evidence‐based nursing to occur, nurses need to be aware of what evidence‐based nursing means, what constitutes evidence, how evidence‐based nursing differs from evidence‐based medicine and evidence‐based practice and what the process is to engage with and apply the evidence. Conclusion. The in‐depth critical review and synthesis of the evidence‐based nursing literature reinforces the need to consolidate a position for nursing in the evidence‐based field. The review confirms that evidence‐based nursing can be defined and conceptualised; however, for nurses to engage and apply with the evidence‐based processes they need to be informed of what these are and how to engage with them in practice. Relevance to clinical practice. This paper examines the concept of evidence‐based nursing and its application to clinical practice.     

A philosophical analysis of evidence‐based practice in mental health nursing

Mental health nurses need to be aware that their knowledge base does not exist in isolation from other cultural practices. They/I/we must become more willing to engage in theoretical problem solving that directly affects clinical practice issues such as the introduction of evidence‐based practice. Critical discussion of evidence‐based practice should be informed by the complex issues that permeate all our socio‐cultural and linguistic practices. This paper examines some of the major philosophical problems in the debate over the use of evidence‐based practice in mental health nursing using both Foucault’s formulation of discourse analysis and Derrida’s construal of deconstruction. The conclusion reached is that postmodern philosophy offers a way to rid nursing of incessant naiive attacks on either quantitative or qualitative research methods which underpin the debate over evidence‐based practice in mental health nursing.     

Implementation of evidence‐based nursing practice for diabetic patients: An Iranian experience

Evidence‐based nursing is recognized as an indicator of quality in nursing practice, a basis for accountability and the gold standard of professional nursing care. The aim of this study was to explore nurses’ experiences and perceptions about evidence‐based nursing practice in giving care to patients with diabetic foot ulcers. A qualitative research design was adopted, and content analysis was used to analyse data. Semistructured interviews were held with 19 bachelor‐degree nurses working in a teaching hospital in an urban area of Iran. During data analysis, two main themes developed: ‘structural backgrounds of the organization’ and ‘empowerment’. Accordingly, it was concluded that successful implementation of evidence‐based nursing requires the reconfiguration of the administrative structure in the hospital. In addition, it requires the support of nurse leaders to facilitate the implementation of evidence‐based nursing in the practice.     

Recovery of evidence‐based practice

Consumer recovery is now enshrined in the national mental health policy of many countries. If this construct, which stems from the consumer/user/survivor movement, is truly to be the official and formal goal of mental health services, then it must be the yardstick against which evidence‐based practice (EBP) is judged. From a consumer‐recovery perspective, this paper re‐examines aspects of services chosen for study, methodologies, outcomes measures, and standards of evidence associated with EBP, those previously having been identified as deficient and in need of expansion. One of the significant differences between previous investigations and the present study is that the work, writing, perspectives, and advocacy of the consumer movement has developed to such a degree that we now have a much more extensive body of material upon which to critique EBP and inform and support the expansion of EBP. Our examination reinforces previous findings and the ongoing need for expansion. The consumer recovery‐focused direction, resources, frameworks, and approaches identified through the present paper should be used to expand the aspects of services chosen for study, methodologies, outcomes measures, and standards of evidence. This expansion will ultimately enable services to practice in a manner consistent with the key characteristics of supporting personal recovery.     

Implications of evidence‐based practice for mental health nursing

The introduction of evidence‐based practice (EBP) and the hierarchical approach to evidence it engenders within research and evaluation has aroused controversy in the mental health professions. The aim of this paper is to present a critique of EBP with a specific relationship to mental health nursing. It will be argued that in its current form, EBP presents a potential impediment to the facilitation of consumer participation in mental health services and to the recovery model. The need for the consumer voice and the importance of the lived experience of mental illness are not readily reconciled with a strong scientific paradigm that promotes detachment and objectivity. The importance of evidence in contemporary mental health care will also be acknowledged and discussed in light of the current climate of increased consumer knowledge, fiscal constraint, and extensive social criticism of mental health‐care services. The current approach to EBP requires reconstruction to support the consumer‐focused nature of mental health nursing, and to facilitate the implementation of a recovery model for mental health care.     

Mechanistic understanding in clinical practice: complementing evidence‐based medicine with personalized medicine

In the last century, medicine has undergone an unprecedented wave of radical changes. From the implementation of surgery up to the development of single gene‐targeted therapies, clinical decision making has become increasingly complex to handle. Today, this complexity needs to be rethought in the light of two emerging paradigms: evidence‐based medicine (EBM) and personalized medicine (P‐Med). The new availability of diverse sources of scientific evidence raises significant issues concerning how clinicians will compare, evaluate and orient their decisions in front of a rapidly growing plethora of therapies, procedures, medical technologies and drugs. In this paper, we compare the background visions behind these two paradigms, evaluating their respective relevance for present and future clinical decision making. In particular, we argue that EBM and P‐Med are driven by two diverse modes of reasoning about ‘evidence making’ in medicine. EBM is grounded on statistical notions and epidemiological data, generally gathered through systematic meta‐reviews of randomized controlled trials; P‐Med, instead, is grounded on mechanistic explanations of molecular interactions, metabolic pathways and biomarkers. While both paradigms are epistemically sound, we argue that they cannot, and should not, be hybridized into a unique model. Rather, they ought to represent two compatible, but alternative ways of informing the clinical practice. Hence, we conclude that clinicians may expect to see their responsibility increasing as they will deal with diverse, but equally compelling, ways of reasoning and deciding about which intervention will qualify as the ‘best one’ in each individual case.