Evidence-based Practice Skills Research Articles

Promotion of Evidence-Based Practice Skill and Attitude Among Advanced Nurses

In response to the call by both the Institute of Medicine and Centers for Medicare and Medicaid Services for increased evidence-based practice (EBP) competence and activity by nurses, healthcare institutions worldwide face the challenge of including quality educative content for effective EBP training (Llasus et al., 2014). The purpose of this evidence-based improvement project is to investigate and address current levels of EBP skill and attitude among nursing professional development specialists in a Magnet hospital and provide data for continued improvement of EBP promotion initiatives for nurses. Conclusions synthesized from a review of literature highlight common barriers and facilitators to EBP implementation among nursing professionals and point to the importance of continued efforts to provide EBP instruction to nurses at all levels, emphasizing a need for institutional support and development of advanced nurses as EBP champions.Keywords: Evidence-based practice, EBP, EBP knowledge, EBP attitudes, EBP instruction

Evidence-Based Practice and Associated Factors Among Health Care Providers Working in Public Hospitals in Northwest Ethiopia During 2017

Background: Despite the fact that evidence-based practice (EBP) is believed to be associated with improved health, safety, and cost outcomes, most medical practice in low- and middle-income countries such as Ethiopia is not evidence-based. Understanding the extent of and barriers to EBP in Ethiopia is important for learning how to best to improve quality of care. Few studies have assessed EBP in Ethiopia.Objective: This study aimed to assess reported level of EBP and associated factors among health care providers working in public hospitals in northwest Ethiopia.Methods: A cross-sectional study was conducted with 415 randomly selected nurses, midwives, and physicians using stratified sampling (97.6% response rate). Data were collected using a structured, self-administered questionnaire that was developed by reviewing the literature and adapting the Melnyk and Fineout-Overholt EBP Implementation Scale. After validating scales, bivariate and multivariate linear regression models were used to identify factors associated with EBP implementation.Results: The mean EBP implementation score was 10.3 points out of a possible 32 points and 60% of respondents scored below average. Most (60.2%) respondents reported poor confidence in their ability to judge the quality of research and half (50.1%) said that they were unable to find resources for implementing EBP. The most frequently mentioned barriers to EBP were lack of training (81.2%), poor health facility infrastructure (79.3%), and lack of formal EBP/patient education units in facilities (78.0%). The factors found to be significantly and independently associated with EBP implementation were years of work experience (β = –0.10; P < 0.05); having been trained as a bachelor's degree-level nurse (β = 3.45; P < 0.001) or a bachelor's degree-level midwife (β = 2.96; P < 0.001), a general practitioner (β = 7.86; P < 0.001), or a specialist physician (β = 15.04; P < 0.001) rather than a diploma-level nurse; working in a pediatrics ward (β = –1.74; P < 0.05); and reporting as barriers either a lack of clarity on the importance of EBP (β = –0.93; P < 0.05) or a lack of orientation sessions on new health priorities (β = –0.91; P < 0.05).Conclusions: Health professionals had low levels of EBP implementation and poor EBP skills. These problems were particularly acute for providers with lower levels of training. A large number of respondents reported structural and institutional barriers to EBP. These results suggest that clear leadership and ongoing, cross-disciplinary, skill-building approaches are needed to increase EBP implementation in Ethiopia. (Curr Ther Res Clin Exp. 2020; 81:XXX–XXX)

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.

Virtual Grand Rounds: A Curricular Model for Translating Evidence-Based Practice From the Classroom to the Clinic

Background and Purpose. The physical therapy profession supports educating physical therapist graduates to use evidence-based practice (EBP) skills in the clinical environment. Educational interventions to teach EBP include a variety of formats, but most focus on changing student and clinician knowledge and skills rather than changing actual clinician behavior. The literature suggests that for clinician behavior to change, educational interventions must be integrated into clinical practice. To describe the restructuring of the ATSU research and EBP curriculum including the development of a course, Virtual Grand Rounds (VGR), that focused on EBP skills and took place during clinical experiences. Method/Model Description and Evaluation. The curriculum and VGR course were designed for students to learn EBP skills, develop tolerance for uncertainty, implement EBP within time demands of the clinic, and use workplace supports. All physical therapy students completed both the Evidence-Based Practice Beliefs (EBPB) scale and the Evidence-Based Practice Implementation (EBPI) scale at program entry and at the end of years 1, 2, and 3 (graduation). Outcomes. A total of 727 EBPB and 719 EBPI surveys were completed and analyzed. Using an analysis of variance with Scheffe post hoc analyses, significant differences (P &lt; .05) were found between the EBPB and EBPI scores for each year of data collection with the exception of a nonsignificant change between year 1 and year 2 (P = .998 and P = .702). The overall EBPI score at graduation indicated that during the final clinical year, students performed each EBP skill somewhere between 1 and 5 times during the clinical experience. Changes in individual question scores indicated increases in students' skills, knowledge, and application throughout all years. Discussion and Conclusion. Evidence-based practice implementation increased throughout the 3 years and was at the highest following the final clinical year when students participated in the newly developed VGR. By situating practice of EBP within the time constraints of the clinical environment, the setting where EBP takes place, students are equipped to move away from the reliance on clinical expertise to evidence-based physical therapy. The development of the VGR course described in this article shifts EBP from an academic exercise in the classroom to an activity imbedded in real clinical practice. Other programs may find this integrated course helpful in removing barriers to EBP and developing graduates equipped to integrate EBP in the clinical environment.

Self-perceived evidence-based practice competencies: a survey of faculty and students at a chiropractic institution.

To assess the self-perceived importance, skills, and utilization of evidence-based practice (EBP) among faculty and students at a chiropractic institution without a structured EBP program. The survey also evaluated EBP satisfaction among students and EBP implementation barriers/facilitators among the faculty. In this cross-sectional study, a set of organized questionnaires to assess the importance of EBP and self-perceived skills, utilization, barriers, and facilitators for faculty members, and student satisfaction was administered to the students and faculty of a chiropractic institution in February-March 2016. Descriptive statistics were used to evaluate responses. A total of 417 (60.1%) students and 27 (60.0%) faculty members completed the survey. Faculty members' and students' EBP importance values were similar (8.4 and 8.3 out of 10, respectively), but faculty members self-reported their EBP skills (7.3/10) at a higher level than the student self-reported skill level (6.1/10). For utilization, students reported a higher utilization of EBP than that reported by the responding faculty members. Perceived student satisfaction on the quality and content of research-related experiences decreased from the first year to the third (final) year. This study found variance in the self-perceived EBP skills, utilization, barriers, and facilitators and that these skills are lagging at our doctor of chiropractic program, which does not have a structured EBP program. Faculty members and students identified the importance for EBP. Similar observations have been found at other chiropractic institutions prior to their implementation of a systematic EBP program. Those developing an EBP curriculum might use these findings to better design, implement, and assess a structured program.

Clinical Physicians' Attitudes towards Evidence-Based Medicine (EBM) and Their Evidence-Based Practice (EBP) in Wuhan, China.

Objective: Numerous studies have proved the importance of Evidence-Based Medicine (EBM) in daily clinical practice, however, clinicians’ attitudes play an important role in determining its implementation. The objective of this study was to investigate Chinese clinical physicians’ perception of and attitude towards EBM and their Evidence-Based Practice (EBP) as well as the barriers towards EBP. Methods: Using a cross-sectional design, self-response questionnaires were distributed to clinical physicians (internal medicine and surgery departments) across three tertiary hospitals in Wuhan, China. Results: In total, 131 out of 195 (67.2%) physicians completed and returned the questionnaire. A total of 64.9% of the physicians either knew moderately or a lot about EBM. The mean score of physicians’ attitude toward EBM was 2.35 ± 0.35, and that of their EBP skill/ competency was 1.51 ± 0.56 (on 0–3 Likert scale). In total, 76.0% of physicians often or sometimes applied EBM in routine daily practice. The largest barrier preventing implementation was the varying individual differences in diseases (61.0%), followed by a lack of investment from the hospital/department (39.8%), and a lack of patient cooperation (37.4%). Chinese physicians in tertiary hospitals possessed expressed positive attitudes towards EBM; however, they only retained a moderate level of clinical evidence competency. Both an individual factor (personal interest) and organizational factors (workload, hospital requirement) had an effect on physicians’ attitudes and their EBP skills. Management and organizational efforts, in addition to time dedicated for EBP projects could help reduce barriers that prevent EBP.

Evidence-Based Practice Curriculum Development for Undergraduate Nursing Students: The Preliminary Results of an Action Research Study in Taiwan.

ABSTRACTBackground:Equipping undergraduate nursing students with sufficient competence in evidence-based practice (EBP) is essential to meeting future practice needs. Integrating necessary EBP knowledge and skills systematically into the formal curriculum allows students to obtain better learning experience and outcomes. However, in Taiwan, a systematic nursing curriculum that integrates EBP concepts across the 4-year nursing baccalaureate program has not yet been developed. Moreover, engaging students in the clinical application of evidence remains a key challenge facing nursing education.Purpose:This study aimed to construct an EBP undergraduate nursing curriculum and develop clinical scenarios that support EBP teaching.Methods:Three cycles of action research, incorporating both focus group interviews and questionnaire surveys, were applied to construct and evaluate the appropriateness and feasibility of the EBP nursing curriculum and relevant teaching strategies.Results:An EBP nursing curriculum was constructed that integrates the three levels of learning objectives and corresponding learning outcomes, teaching content, and learning activities. Scenario activities were developed to familiarize students with the EBP process and to maximize their learning with regard to the clinical application of evidence. Next, a preliminary evaluation showed the appropriateness and feasibility of the developed curriculum, which was shown to foster the EBP competency of students and increase their confidence and positive attitudes toward EBP.Conclusions/Implications for Practice:A systematic EBP bachelor nursing curriculum with effective pedagogical strategies was developed. The associated process and the elicited information may offer a valuable reference for other nursing schools.

An investigation of Australian osteopaths\u2019 attitudes, skills and utilisation of evidence-based practice: a national cross-sectional survey

BackgroundOsteopaths are an integral member of the health care team, playing a pivotal role in the provision of care for patients with musculoskeletal disorders. Osteopaths, like other health care providers, are under increasing pressure to deliver evidence-based health care and to improve patient outcomes. However, the extent to which osteopaths engage in evidence-based practice (EBP), particularly in Australia, is not well understood. This study therefore set out to investigate the attitudes, skills and use of EBP, and perceived barriers and enablers of EBP uptake, among osteopaths practicing in Australia.MethodsNational cross-sectional survey of Australian registered osteopaths. Eligible participants were invited by email and other digital media recruitment strategies to complete the online Evidence-Based Practice Attitude and Utilisation Survey (EBASE).ResultsA total of 332 osteopaths completed the survey. The demographic characteristics of respondents were generally consistent with the characteristics of the Australian osteopathy workforce. The respondents were mostly favourable of EBP, with the majority agreeing or strongly agreeing that EBP assists in making decisions about patient care (86.7%) and improves the quality of patient care (75.6%). While most respondents (88.3%) had some training in EBP, most reported a moderate level of perceived skill in EBP. The majority of respondents engaged infrequently (0–5 times) in EBP activities within the last month, and most indicated that a very small or small proportion of their clinical practice was based on clinical research evidence. Leading barriers to the uptake of EBP were lack of time and lack of clinical evidence in osteopathy. Key enablers of EBP uptake were access to the internet and online databases at work, and access to full-text articles and EBP education materials.ConclusionsOsteopaths participating in the survey were largely supportive of evidence-based practice, yet engaged infrequently in EBP activities. An important next step in this research is to identify suitable strategies that effectively improve EBP uptake in osteopathy, and perchance, improve patient outcomes.

Looking into the nurses’ views regarding implementation of Evidence-Based Nursing in clinical practice

Introduction: Although there are plenty of guidelines and protocols for clinical practice, the implementation, by healthcare professionals, of evidence-based practice (EBP) is not quite widespread in clinical practice. Evidence-based practice is related with improved patient outcomes and cost-effective care. The purpose of this study was to investigate the nurses’s views regarding the implementation of EBP in clinical practice. Methods: This is a systematic review. The literature review was conducted in Pubmed database with specific key-words and it consisted of last five years publications in English or Greek language. Initially 417 articles were found, of which ten, full text, clinical and multicentered studies, meta-analysis and comparison studies were finally selected. Results: Almost half of the nurses knew about EBP, had a positive attitude, and were keen to increasing their knowledge to follow the new trends in clinical practice. Nurses are less familiar with EBP, but argued that it is useful in clinical practice eventhough they lack the knowledge to implement it. Although most nurses knew what EBP was, they were less confident about their own knowledge and skills required. EBP needing advanced scientific knowledge and skills have been less frequently implemented. Lack of time, lack of skills required to search for information, processing and implementation of information, lack of administrative support and the lack of recognition of nursing profession were found to be the main obstacles in applying EBP in clinical practice. Younger nurses, those with a higher level of education, who held an administrative position and a full-time job had stronger views regarding the extent to which clinical nursing practice can be based on EBP. Conclusions: All nurses need to be properly educated and trained in order to be able to evaluate research and apply evidence-based changes in clinical practice. The introduction of evidence-based practice into nursing curricula, as well as its systematic integration into everyday clinical practice, will greatly enhance nurses' conviction.

Practicing Healthcare Professionals' Evidence-Based Practice Competencies: An Overview of Systematic Reviews.

Evidence-based practice (EBP) competencies are essential for all practicing healthcare professionals to provide evidence-based, quality care, and improved patient outcomes. The multistep EBP implementation process requires multifaceted competencies to successfully integrate best evidence into daily healthcare delivery. To summarize and synthesize the current research literature on practicing health professionals' EBP competencies (i.e., their knowledge, skills, attitudes, beliefs, and implementation) related to employing EBP in clinical decision-making. An overview of systematic reviews. PubMed/MEDLINE, CINAHL, Scopus, and Cochrane Library were systematically searched on practicing healthcare professionals' EBP competencies published in January 2012-July 2017. A total of 3,947 publications were retrieved, of which 11 systematic reviews were eligible for a critical appraisal of methodological quality. Three independent reviewers conducted the critical appraisal using the Rapid Critical Appraisal tools developed by the Helene Fuld National Institute for Evidence-Based Practice in Nursing & Healthcare. Practicing healthcare professionals' self-reported EBP knowledge, skills, attitudes, and beliefs were at a moderate to high level, but they did not translate into EBP implementation. Considerable overlap existed in the source studies across the included reviews. Few reviews reported any impact of EBP competencies on changes in care processes or patient outcomes. Most reviews were methodologically of moderate quality. Significant variation in study designs, settings, interventions, and outcome measures in the source studies precluded any comparisons of EBP competencies across healthcare disciplines. As EBP is a shared competency, the development, adoption, and use of an EBP competency set for all healthcare professionals are a priority along with using actual (i.e., performance-based), validated outcome measures. The widespread misconceptions and misunderstandings that still exist among large proportions of practicing healthcare professionals about the basic concepts of EBP should urgently be addressed to increase engagement in EBP implementation and attain improved care quality and patient outcomes.

A Multicountry Study on Nursing Students' Self-Perceived Competence and Barriers to Evidence-Based Practice.

Nursing education and training are essential in the attainment of evidence-based practice (EBP) competence in nursing students. Although there is a growing literature on EBP among nursing students, most of these studies are confined to a single cultural group. Thus, cross-cultural studies may provide shared global perspectives and theoretical understandings for the advancement of knowledge in this critical area. This study compared self-perceived EBP competence among nursing students in four selected countries (India, Saudi Arabia, Nigeria, and Oman) as well as perceived barriers to EBP adoption. A descriptive, cross-sectional, and comparative survey of 1,383 nursing students from India, Saudi Arabia, Nigeria, and Oman participated in the study. The Evidence-Based Practice Questionnaire (EBP-COQ) and the BARRIERS scale were used to collect data during the months of January 2016 to August 2017. Cross-country comparisons revealed significant differences in EBP competence (F=24.437, p<.001), knowledge (F=3.621, p=.013), skills (F=9.527, p<.001), and attitudes (F=74.412, p<.001) among nursing students. Three variables including nursing students' gender (β=.301, p<.001), type of institution, (β=-0.339, p=.001), and type of nursing student (β=.321, p<.001) were associated with EBP competence. Barriers to EBP adoption included having no authority to change patient care policies (M=1.65, SD=1.05), slow publication of evidence (M=1.59, SD=1.01), and paucity of time in the clinical area to implement the evidence (M=1.59, SD=1.05). Both academe and hospital administration can play a pivotal role in the successful acquisition of EBP competence in nursing students.

Attitudes, skills and use of evidence-based practice among UK Osteopaths: a national cross-sectional survey

Evidence-based practice (EBP) is a clinical decision-making framework that supports quality improvement in healthcare. While osteopaths are key providers of musculoskeletal healthcare, the extent to which osteopaths engage in EBP is unclear. Thus, the aim of this cross-sectional study was to investigate UK osteopaths’ attitudes, skills and use of EBP, and perceived barriers and facilitators of EBP uptake. UK-registered osteopaths were invited to complete the Evidence-Based Practice Attitude and Utilisation Survey (EBASE) online. Of the 5200 registered osteopaths in the UK, 9.9% (517/5200) responded to the invitation, and 7.2% (375/5200) completed the EBASE (< 20% incomplete answers). The demographic characteristics of the survey sample were largely similar to those of the UK osteopathy workforce. The osteopaths reported overall positive attitudes towards EBP, with most agreeing that EBP improves the quality of patient care (69.3%) and is necessary for osteopathy practice (76.5%). The majority reported moderate-level skills in EBP, and most (80.8%) were interested in improving these skills. Participating osteopaths typically engaged in EBP activities 1–5 times over the last month. Barriers to EBP uptake included a lack of time and clinical evidence in osteopathy. Main facilitators of EBP included having access to online databases, internet at work, full-text articles, and EBP education materials. UK osteopaths were generally supportive of evidence-based practice, had moderate-level skills in EBP and engaged in EBP activities infrequently. The development of effective interventions that improve osteopaths’ skills and the incorporation of EBP into clinical practice should be the focus of future research.

"The more you did, the more it made sense": Problem-based learning to improve early evidence-based practice in an undergraduate physiotherapy professional programme.

Evidence-based practice (EBP), which integrates clinical reasoning skills, research evidence, and patient preference, has become standard in curricula for health care professional programs. Students however perceive EBP as difficult and often irrelevant to clinical practice. A problem-based learning (PBL) approach is trialled in an early stage module where EBP knowledge and skills are stated learning outcomes. Prior to this, the content-based approach to EBP teaching and learning received negative student feedback. The impact of delivering EBP through PBL is evaluated by comparing 5 standard Likert feedback scales and open-ended question responses relating to the EBP instruction in the module before and after a PBL approach was implemented. The impact of a PBL approach on EBP profiles is further examined under domains (relevance, sympathy, terminology, practice, and confidence) of the validated Evidence-based Practice Profile Questionnaire. All mean Likert scores relating to subject understanding, relevance of assessments, achievement of learning outcomes, teaching, and overall module satisfaction improved when the PBL approach was compared with the lecture-based format (p<0.05). Student comment post-PBL continued to identify EBP as a difficult concept, but now comments on the teaching and assessment approach were mainly positive, addressing the collaborative nature of PBL, identifying EBP, communication and team-working skills acquired, praising the real life, practical application of EBP taken, and commenting on improvement in EBP self-efficacy. Within group change in the Evidence-based Practice Profile Questionnaire following a PBL approach identified significant improvement in EBP domains of terminology (mean change 3.38; p<0.001); practice (mean change 16.5; p<0.001), and confidence (mean change 10.1; p=0.008). Conceptual links, based on constructivist underpinnings of PBL and EBP, are developed in the paper. Using mixed methods evaluation, PBL is effective at promoting early EBP. Students identified with the interactive, collaborative, and experiential nature of PBL to EBP instruction.

Evidence-Based Practice Competence in Nursing Students: An Exploratory Study With Important Implications for Educators.

Evidence-based practice (EBP) is a core pillar of nursing education and an expectation in clinical practice. Students struggle to conceptualize the use of EBP into actual clinical practice despite the development of EBP competencies. This study explored perceptions of EBP education and competence in baccalaureate students using Melnyk's (Worldviews on Evidence-Based Nursing, 11, 2014 and 5) EBP competencies for practicing registered nurses as a basis for comparison. The researchers used a sequential, mixed-methods design. A survey was developed to assess information sources and patterns of use, and semistructured interviews explored factors affecting students' understanding of EBP and information-seeking behaviors in the clinical setting. There were 118 participants in the survey and 12 in follow-up interviews. A major theme was that participants had difficulties distinguishing between EBP and research. Students were able to identify experiences that fostered attainment of basic EBP competencies, such as searching for evidence, but were less able to describe higher-order activities such as integrating evidence to plan EBP changes or disseminating best practices. Clinical learning environments are an ideal place to apply and see EBP in action, but nurse educators cannot assume students arrive ready to apply EBP knowledge and skills to clinical practice. Nurse educators need evidence-based tools to assess student EBP competence across a variety of settings. Research examining the generalizability of the EBP competencies in varying curricular models as well as didactic and clinical settings is needed.

Barriers to implementation of evidence-based practice in physiotherapy

Background: Patient and clinician relationship plays a pivotal role in the progress of treatment. Evidence based practice is the key methodology which integrates the best research evidence, clinical expertise and patient need for a better outcome. To evaluate the factors that influence the application of evidence based physiotherapy in public and private sectors of Karachi, Pakistan.&#x0D; Methodology: A cross-sectional survey was conducted from July to December 2017 in major physiotherapy clinics and rehabilitation centers of Karachi covering major government, semi-government and private sectors. Data was collected from 75 practicing physiotherapists through convenience sampling technique and were asked to fill self-administered close-ended questionnaire. Data entry and analysis was done using SPSS Version 16 and chi-square test applied.&#x0D; Result: Lack of availability of resources to access information was noted to be the biggest practitioner barrier while disinterest in evidence based practice (EBP) was considered as the least important. Among various organizational barriers, lack of time provided by management and lack of support among physiotherapists were stated to be the biggest barriers. Perception of evidence based physiotherapy was noted to be generally positive among the physiotherapists. Graduates with experience of 1-5 years were found to be keener to refine their EBP skills and were more likely to agree that EBP integration with practical knowledge improved prognosis. Almost 70% well experienced (10 years +) physiotherapists were reported to have access to research publications whereas 80.4% fresh experienced said they were confident of their capability to search relevant research.&#x0D; Conclusion: Individuals and organizations should work to rectify the identified barriers from this study and express learning in a way that helps them in applying research findings to ordinary patients in ordinary clinical settings.

Home Healthcare Nurses' Attitudes, Confidence, and Engagement in Evidence-Based Practice.

Evidence-based practice (EBP) is becoming standard in today's healthcare arena and home care organizations are not exempt from integrating evidence into practice to improve patient outcomes. There is a scarcity of research literature that examines the behaviors and attitudes of home healthcare nurses (HHNs) regarding EBP. In this study, a descriptive survey design was used to investigate HHNs' a) information-seeking behaviors when providing nursing care, b) administrative support for EBP (as perceived by HHNs), c) attitudes toward EBP, and d) EBP engagement and confidence in providing EBP nursing care. Self-reported data were collected by internet and paper survey. The survey consisted of a 65-item questionnaire that included the Nurses' Attitudes Toward Evidence-Based Practice Scale, which has previously established validity and reliability. A convenience sample of 95 HHNs participated in the study. Results suggest HHNs' EBP attitudes are positive. A positive and significant relationship was found between attitudes and hours worked (r = 0.21, p = 0.047) and educational level (r = 0.45, p = 0.0001); 95% confidence level. Confidence levels in providing EBP care were moderate, and HHNs did not perceive EBP as an agency priority. HHNs need to be supported and encouraged in the facilitation of EBP, a task made easier when they are knowledgeable about EBP, have confidence in their EBP skills, and have the support of their organizations.

Re-visioning library support for undergraduate educational programmes in an academic health sciences library

McMaster University’s Health Sciences Library (HSL) began to transition to a new liaison service model in early 2018. One of its librarians sought to understand how an academic health sciences library can optimise its support for academic undergraduate programmes. This scoping review of the literature was pursued with the aim to submit an informed recommendation to HSL’s new Education and Lifelong Learning team, so the library could shift its approach to information literacy instruction in a manner that would optimise its outcomes for students and improve relationships with faculty staff. The author searched seven databases: Library, Information Science &amp; Technology Abstracts (LISTA), ProQuest ERIC, OVID Embase, EBSCO CINAHL, OVID Medline, Web of Science and PapersFirst. She developed a robust and comprehensive search strategy that used a combination of subject headings and keywords to describe information literacy, metaliteracy, libraries and health sciences education. The author also hand-searched bibliographies of seminal publications to broaden her search for relevant literature. The findings in this review indicate that metaliteracy as a concept has not been intentionally implemented into information literacy training at academic health sciences libraries. The review finds that it is preferable to integrate information literacy skills directly into course or programme curricula and align those skills with the evidence-based practice skills undergraduates are already learning. Further, establishing a programme that builds on these skills gradually throughout the duration of the academic programme, rather than one-shot library instruction, is also preferred. To achieve success, libraries must build strong collaborative relationships with faculty staff. The author provides recommendations for practice that reflect the findings of this review. Other academic health libraries may benefit from this review by taking into consideration its findings and subsequent recommendations.

De-implementation of tradition-based practices in critical care: A qualitative study.

To explore the process of tradition-based practice (TBP) de-implementation by critical care nurses. Ritualistic and routine practices have been described as sacred cows or TBPs. Many clinical practices have insufficient or no evidence and may lead to poor patient outcomes. De-implementation (termination) of potentially harmful, ineffective, or non cost-effective TBP is necessary to facilitate evidence-based practice (EBP) in the clinical setting. Descriptive qualitative inquiry guided this study. Twenty-two critical care nurses from an acute care hospital in central Florida participated. Individual and focus group interviews were performed March to July 2016 and analysed using thematic analysis. Three themes were identified: (a) uncertainty, (b) desire to know, and (c) preparing for practice change. Nurses were uncertain about the scientific underpinnings of everyday clinical practices and had difficulty differentiating TBP from EBP. De-implementation processes and strategies appeared to replicate implementation processes. More research is needed to evaluate de-implementation processes and strategies used for de-implementation. An emphasis should be placed on ensuring that nurses are knowledgeable about fundamental EBP skills to encourage assessment of clinical practices for supporting research evidence. Awareness and understanding of TBPs will facilitate a more comprehensive approach towards achieving the gold standard of EBP.

The experiences of nurse educators in implementing evidence-based practice in teaching and learning.

BackgroundNurse educators have a vital role to mentor student nurses in relation to developing evidence-based practice (EBP) skills, accessing research products and participating in research projects. This requires more innovative teaching approaches that promote active participation, creativity and critical thinking in students such as online teaching and learning, accessing electronic resources, video conferencing and research-based teaching and learning.AimTo determine the nurse educators’ experiences in implementing EBP in teaching and learning, and to describe the importance and benefits of EBP teaching and learning to the nursing profession, especially for nurse educators and student nurses.SettingTwo chosen campuses from Umgungundlovu Health District under the KwaZulu-Natal College of Nursing (KZNCN) and offering a 4-year R425 training programme.MethodsQualitative research design and methods were followed in conducting the study. A non-probability purposive sampling technique was used to access the sample of 12 nurse educators. Data were collected using semi-structured interviews, the interview guide, and the digital voice recorder.ResultsData were analysed manually, following a content thematic approach and two themes emerged as challenges experienced by nurse educators with the implementation of EBP in teaching and learning and benefits and value of EBP in teaching and learning. Findings revealed that, although most of the nurse educators are supportive and displayed a positive attitude towards implementing EBP in teaching and learning, the level of knowledge and skills was questionable. This was coupled with a lack of motivation and commitment towards research.ConclusionsEvidence-based practice has an essential potential role to play through incorporating more practice-based evidence of nurse educators in teaching and learning implementation. The nurse educators should use EBP to ensure that student nurses receive high-quality nursing education.

Development and pilot testing of a tool to assess evidence-based practice skills among French general practitioners

BackgroundThere is currently an absence of valid and relevant instruments to evaluate how Evidence-based Practice (EBP) training improves, beyond knowledge, physicians’ skills. Our aim was to develop and test a tool to assess physicians’ EBP skills.MethodsThe tool we developed includes four parts to assess the necessary skills for applying EBP steps: clinical question formulation; literature search; critical appraisal of literature; synthesis and decision making. We evaluated content and face validity, then tested applicability of the tool and whether external observers could reliably use it to assess acquired skills. We estimated Kappa coefficients to measure concordance between raters.ResultsTwelve general practice (GP) residents and eleven GP teachers from the University of Bordeaux, France, were asked to: formulate four clinical questions (diagnostic, prognosis, treatment, and aetiology) from a proposed clinical vignette, find articles or guidelines to answer four relevant provided questions, analyse an original article answering one of these questions, synthesize knowledge from provided synopses, and decide about the four clinical questions. Concordance between two external raters was excellent for their assessment of participants’ appraisal of the significance of article results (K = 0.83), and good for assessment of the formulation of a diagnostic question (K = 0.76), PubMed/Medline (K = 0.71) or guideline (K = 0.67) search, and of appraisal of methodological validity of articles (K = 0.68).ConclusionsOur tool allows an in-depth analysis of EBP skills, thus could supplement existing instruments focused on knowledge or specific EBP step. The actual usefulness of such tools to improve care and population health remains to be evaluated.