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.     

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.     

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.     

Assisting undergraduate nursing students to learn evidence-based practice through self-directed learning and workshop strategies during clinical practicum

To equip undergraduate nursing students with basic knowledge and skills and foster positive attitudes toward evidence-based practice (EBP), a pilot learning program during their clinical practicum was developed in a teaching hospital in China. This article describes the specific learning process through which self-directed learning and workshop strategies were used, and a pre- and post-intervention survey were conducted to evaluate the effectiveness of the learning strategies. The findings show a significant improvement in their perceptions of EBP knowledge, attitudes and beliefs, and behavior levels. Beginning competencies in EBP were achieved. Participants reported great satisfaction and have found this program helpful in promoting their analytical and problem-solving abilities, independent learning ability, and cooperative and communication abilities as well.     

The better sleep better well‐being programme: Educating and training community healthcare nurses in developing interventions for families of infants with moderate sleep problems: a pilot study

The main aim of this pilot study was to evaluate the benefit of the Better Sleep Better Well‐being (BSBW) educational and training intervention programme regarding infants sleep problems for Community Health Care (CHC) nurses, on their perceptions on their family nursing practice skills and on their job demand, control and support. There were 6 CHC nurses who participated in the BSBW programme, and 26 nurses in the comparison group. The programme consisted of 4 sessions (8 hours per session) of lectures on the aetiology of infants sleep problems as well as on evidence‐based and family relational practices and on 20 sessions of clinical cases, scenarios, discussions and reflections. The main finding indicated that the nurses in the intervention group reported significantly higher family nursing practices skills compared to the nurses in the comparison group. The findings are promising, since they offered additional resources to the CHC nurses, in their clinical practices.     

Irish psychiatric nurses' self-reported sources of knowledge for practice

Evidence-based practice (EBP) is an approach to health care in which health professionals use the best evidence available to guide their clinical decisions and practice. Evidence is drawn from a range of sources, including published research, educational content and practical experience. This paper reports the findings of a study that investigated the sources of knowledge or evidence for practice used by psychiatric nurses in Ireland. The paper is part of a larger study, which also investigated barriers, facilitators and level of skills in achieving EBP among Irish psychiatric nurses. Data were collected in a postal survey of a random sample of Irish psychiatric nurses using the Development of Evidence-Based Practice Questionnaire. The findings revealed that the majority of survey respondents based their practice on information which was derived from interactions with patients, from their personal experience and from information shared by colleagues and members of the multidisciplinary team, in preference to published sources of empirically derived evidence. These findings are consistent with those of the previous similar studies among general nurses and suggest that Irish psychiatric nurses face similar challenges to their general nursing counterparts in attaining of EBP.     

Evaluation of a cultural competence educational programme

AIM: This paper reports a study, which evaluated the effectiveness of a cultural competence educational programme to increase Public Health Nurses' cultural knowledge. BACKGROUND: Cultural competence has great significance for practising nurses and has become a priority and commitment of the Nursing profession. Public Health Nurses interact regularly with clients from a variety of culturally diverse backgrounds. Thus, there is a need for an integrated programme with theoretical and experiential knowledge related to cultural competence for PHNs to enhance their knowledge and skills to better meet the needs of the population. DESIGN: This study used a combination of quantitative and qualitative methods for data collection. A one-group Repeated Measures design was used to evaluate the effectiveness of the educational programme. METHOD: The sample consisted of 76 Public Health Nurses who attended a cultural competence educational programme, which was offered over five consecutive weeks, of 2 hours duration and reinforced by a booster session at 1 month postimplementation of the programme. Cultural knowledge was measured on the Cultural Knowledge Scale, which was a valid, reliable, 25-item Likert scale. Data were collected at four points in time and were analysed with repeated measures analysis of variance. Qualitative data were content analysed. RESULTS: Findings revealed that the intervention was effective [Wilks' Lambda was F(3,69) = 142.02, P < 0.01] in increasing the nurses' cultural knowledge. Qualitative results complemented the quantitative findings. Participants reported that the programme was effective in increasing their cultural knowledge. CONCLUSION: Although Public Health Nurses, who attended the educational programme increased their cultural knowledge, these findings are not generalizable to nurses working in other settings. However, the programme has clinical utility and could be adapted and given to nurses in other settings.     

Critical Thinking and Evidence-Based Practice

Critical thinking (CT) is vital to evidence-based nursing practice. Evidence-based practice (EBP) supports nursing care and can contribute positively to patient outcomes across a variety of settings and geographic locations. The nature of EBP, its relevance to nursing, and the skills needed to support it should be required components of baccalaureate education and must be introduced early in students' development as independent, self-directed learners and as professional nurses. Among the knowledge, skills, and processes needed to support EBP, CT is paramount. The development of CT can prepare nurses with the necessary skills and dispositions (habits of mind, attitudes, and traits) to support EBP. The intents of this study were to explore the importance of CT as an essential skill to support EBP and to describe some of the strategies and processes considered key to the ongoing development of CT.     

Nursing students' changing orientation and attitudes towards nursing during education: A two year longitudinal study

BackgroundPrevious studies have shown that nursing students' perceptions of nursing change over time. Little research has been undertaken in the Netherlands of students entering nursing programmes and of how they progress.ObjectivesThe aims of this study were to explore whether nursing students' orientation and attitudes towards nursing changed over time, when these changes occurred, and what factors influenced the changes. We also aimed to identify the factors which prompted them to consider leaving their programmes, and what factors affected their motivation to stay.DesignThe study used a longitudinal quantitative design.ParticipantsQuestionnaires were administered to all students enrolled in a Bachelor's of Nursing programme at four nursing universities of applied sciences in the Netherlands (n = 1414). The data for this study were collected during the first two years of the programme, from September 2011 to June 2013. A total of 123 respondents completed the survey each year and this group was used to examine changes over time.MethodsAt four time intervals respondents completed a survey consisting of 1) the Nursing Orientation Tool, 2) the Nursing Attitude Questionnaire and 3) background characteristics. Non-parametric tests were used to explore changes in factor scores over time.ResultsThe results showed an improvement in the students' orientation and attitudes towards knowledge, skills and the professional roles of nurses, while empathic behaviour decreased over time. Although the changes showed non-linear patterns over time, the results showed clear effects between the different time points. The reasons for attrition (24%) proved to be related both to problems with the educational programme and to personal problems. An important motivator for students to stay in the course was their passionate desire to become nurses, suggesting that the positive aspects of a nursing career dominated the problems they encountered.ConclusionsTutors and mentors should pay more attention to the individual perceptions and problems of first and second-year students, both in the classroom and during clinical placements. Knowledge of the students' perceptions from the very beginning could be vital to study success.     

Undergraduate nursing students' perceptions of substance use and misuse: a Brazilian position

Alcohol, cocaine and cannabis are the substances most commonly abused in Brazil. There is limited evidence on the perceptions of undergraduate nursing students towards substance misuse. Negative attitudes, in combination with the lack of appropriate knowledge and skills, may result in minimal care provided to substance misusers. The aims of the study are to examine the knowledge and attitudes of undergraduate nursing students towards substance misusers and consider the implications of these attitudes for nursing education. The Nurse Education in Alcohol and Drug Educational Faculty Survey (NEADA) questionnaire on knowledge and education, nursing interventions, attitudes and values was distributed to undergraduate nurses (n = 227) in the south and south-eastern part of Brazil. The findings showed that there is a lack of adequate education in drug and alcohol use and misuse, including competency skills, but the participants were positive about treatment interventions. A paradigm shift in nurse education curricula and further research studies on attitudes and values towards substance misuse should be on the educational agenda. These are challenges faced by nurses to meet the healthcare needs of substance misusers.     

Effectiveness of a geriatric urinary incontinence educational program for nursing staff

Incontinence is becoming an increasingly widespread phenomenon. Individuals who suffer from incontinence-related problems, as well as their loved ones, must learn to live with daily situations that are often extremely demanding. In recent years, it has become evident that incontinence can be cured, or at least successfully managed. Many nurses, however, lack sufficient knowledge and skills to intervene appropriately in dealing with problems associated with a lack of bladder control. Therefore, the continence team of the Sherbrooke Geriatric University Institute developed a urinary incontinence educational program for nurses who care for older persons with this problem. An assessment of the impact of this program on nurses' knowledge, intervention skills and attitudes was conducted. A quasi-experimental protocol based on single-group with repeated-measures design was used for this study. A convenience sample was made up of 10 staff members at the Sherbrooke Geriatric University Institute. The study demonstrated a significant improvement in participants' knowledge, skills and attitudes (p=0.005, p=0.005 and p=0.017, respectively). Furthermore, the effects of the program in regard to the acquisition of skills and knowledge by nurses were still evident nine weeks after the program. The value of the present study lies in the development and positive evaluation of a new incontinence educational program for nurses based on a problem-solving approach.     

Assessment of learning needs and the development of an educational programme for registered nurses in advanced midwifery and neonatology

A key step in the development of any educational programme is learning needs assessment. This is however often neglected. The purpose of this research was to identify learning needs of potential students in order to develop a relevant educational programme for registered nurses in advanced midwifery and neonatology. A survey design was used, and the population of the study was the registered nurses in the Free State. Two thousand questionnaires were mailed to respondents, selected by means of simple random sampling. Advanced educational programmes emphasize the teaching of advanced knowledge and skills and accept that the students entering these programmes already have specific knowledge and skills included in the curricula for basic programmes. This is contrary to the findings of this study. The results underline the importance of learning needs assessment in the development of relevant educational programmes.     

Evaluation of an elderly care training programme for women

BAYIK T.A. & UYSAL A. (2010) Evaluation of an elderly care training programme for women. International Nursing Review 57 , 240–246 Background: Caregiving across different cultures has been perceived conventionally as a private or family responsibility, predominantly performed by women who accept their caregiving as part of their gender role. Aim: This study aimed to design, deliver, and evaluate an elderly training programme for women by assessing their knowledge, attitudes and skills as a lay caregiver. Encouraging the women to find suitable positions for employment in private or governmental institutions was the further objective of the study. Design: The study was a quasi‐experimental one‐group pre‐test post‐test design. Methods: The study was conducted in a solidarity centre for women and in a nursing home for the elderly. The sample covered 120 women selected from the community by convenience sampling. Data were gathered through pre‐ and post‐test evaluation and observation forms in 2 May–22 December 2005. The training programme consisted of 230 h of didactic sessions, demonstrations and clinical practices. Findings: The mean change in the participants' knowledge score (pre‐test: 41.44 ± 0.92; post‐test: 71.16 ± 1.34) demonstrated a statistically significant improvement in their knowledge. According to clinical observations, most of them displayed satisfactory caring and communication skills towards the elderly. Virtually all participants reported increased skill, knowledge and confidence. Conclusion: The developed training programme was effective, resulting in an increased knowledge, the acquisition of good attitudes towards the elderly, and performing satisfactory caring and communication skills. Similar community‐based programmes managed by nurses are recommended to support non‐professional caregivers. The research is not only an innovative but also a revolutionary model to promote women.     

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.     

Evaluation of the training course for a nursing intervention programme to promote maternal role attainment in pregnant Japanese women who have undergone assisted reproductive technology

This study evaluated the effectiveness of a 2 day training course for a nursing intervention programme to promote maternal role attainment in pregnant Japanese women who have undergone assisted reproductive technology. Participants were 12 Japanese nurses with more than 3 years of clinical experience at reproductive institutions. The effectiveness of the training course was evaluated by assessing the following: (i) understanding of the nursing intervention programme; (ii) attitudes of nurses towards women who are pregnant following assisted reproductive technology; and (iii) self-efficacy for implementing the programme. The training course was effective in increasing basic understanding of the programme and in assisting self-evaluation of the attitudes of participants towards pregnant women. However, acquisition of effective interview skills and changes to make the programme clinically feasible are still needed. Findings suggest that researchers who use this training programme may need to evaluate and include training of nurses in interview skills suitable for their working environments.     

From students to professionals: results of a longitudinal study of attitudes to pre-qualifying collaborative learning and working in health and social care in the United Kingdom

During a longitudinal evaluation of a pre-qualifying interprofessional curriculum, health and social care students completed questionnaires concerning communication and teamwork skills and interprofessional learning and working. Data were collected on entry to their educational programme, during the second year of study, at qualification and after 9-12 months' qualified practice. This paper presents results from practice data from 414 professionals; 275 were educated on the interprofessional curriculum, 139 on previous uniprofessional curricula. The former were more confident at qualification about their communicative skills, their interprofessional relationships and other professionals' interaction, and showed positive correlations between perceptions of their relevant skills and their interprofessional relationships. They were also more positive about their interprofessional relationships than practitioners educated on uniprofessional curricula. Age and previous experience of higher education influenced professionals' attitudes negatively: mature individuals may require more support when entering the workforce. Between qualification and practice, respondents from the interprofessional cohorts grew more critical of interprofessional education. However, experience of interprofessional education appears to produce and sustain positive attitudes towards collaborative working, suggesting that individuals' perceptions of their own educational experience are inadequate as an evaluative measure of interprofessional learning initiatives. This study reinforces the argument for including IPE in pre-qualifying curricula.