Exploring Nurse Educators’ and Clinical Nurse Instructors’ Knowledge, Skills and Perceptions of Factors Affecting Evidence-Based Practice in Clinical Settings in Saudi Arabia: A Quantitative Descriptive Study

Abstract

Introduction: Evidence-based practice (EBP) is one of the most important approaches for improving practice and the quality of patient outcomes in healthcare systems today. It is recognised as a problem-solving approach to clinical decision-making in healthcare that integrates the best research evidence with clinical expertise and patient preferences. Enhancing the development of nurses’ EBP knowledge and skills is required to use EBP effectively. The unique position nurse educators (NEs) and clinical nurse instructors (CNIs) hold in clinical settings enables them to act as potential ‘change agents’ and facilitators for evidence-based nursing care among nursing staff. Therefore, it is paramount to understand their perceptions of knowledge, skills and factors affecting EBP implementation in clinical settings. Aim: To explore NEs’ and CNIs’ knowledge and skills, and the factors affecting evidence-based practice in clinical settings in Saudi Arabia. Method: A quantitative descriptive research design was used in carrying out this study. A modified version of an established published and anonymous questionnaire was used and distributed to a convenience sample of 90 NEs and CNIs recruited from six governmental hospitals in the city of Jeddah, Saudi Arabia. Of the 90 potential participants, 80 responded (88.8%). Results: The findings indicate that participants self-rated their knowledge as good or very good. The most frequent sources of knowledge utilised by the entire group were information gained from local policies and protocols, conferences and educational programs, the Internet and textbooks, while the least frequent sources of knowledge used were information derived from their personal experience, published research articles and the media. With regard to knowledge-practice gaps, sharing information with colleagues, integrating evidence into practice, and evaluating the outcome were the most frequently reported responses by the study participants. Their least frequently reported responses were formulating clinical research questions and appraising literature critically. The participants reported high confidence in their skills in using the Internet to search for information, and finding and reviewing organisational information. The study supports previous findings that NEs and CNIs have limited skills in appraising evidence critically. They reported having less confidence in certain skills, including finding research evidence, undertaking comprehensive literature review, and critically appraising evidence. They were in total agreement on the need for educational opportunities to enhance inquiry, research and appraisal skills. This study reflects the persistence of major barriers to EBP, which have been long reported in the literature, including insufficient time at work to implement EBP, insufficient resources to change practice and lack of incentives to develop research skills. In terms of facilitators of EBP, support from management, nursing colleagues and physicians were the most facilitative factors reported by the participants. The main EBP- promoting strategies reported were questioning during discussion and incorporating EBP guidelines in teaching. Conclusion: To successfully implement EBP, NEs and CNIs must collaborate with organisational leaders to address all issues that affect the promotion of EBP, and plan strategies to overcome barriers. Ongoing educational programs and professional development opportunities in EBP are needed to enhance evidence-based knowledge and build skills, and to promote EBP.