Self-reported Evidence-based Practice Research Articles

Missed nursing care in relation to registered nurses' level of education and self-reported evidence-based practice.

Patient safety is one of the cornerstones of high-quality healthcare systems. Evidence-based practice is one way to improve patient safety from the nursing perspective. Another aspect of care that directly influences patient safety is missed nursing care. However, research on possible associations between evidence-based practice and missed nursing care is lacking. The aim of this study was to examine associations between registered nurses' educational level, the capability beliefs and use of evidence-based practice, and missed nursing care. This study had a cross-sectional design. A total of 228 registered nurses from adult inpatient wards at a university hospital participated. Data were collected with the MISSCARE Survey-Swedish version of Evidence-Based Practice Capabilities Beliefs Scale. Most missed nursing care was reported within the subscales Basic Care and Planning. Nurses holding a higher educational level and being low evidence-based practice users reported significantly more missed nursing care. They also scored significantly higher on the Evidence-based Practice Capabilities Beliefs Scale. The analyses showed a limited explanation of the variance of missed nursing care and revealed that being a high user of evidence-based practice indicated less reported missed nursing care, while a higher educational level meant more reported missed nursing care. Most missed nursing care was reported within the subscales Planning and Basic Care. Thus, nursing activities are deprioritized in comparison to medical activities. Nurses holding a higher education reported more missed nursing care, indicating that higher education entails deeper knowledge of the consequences when rationing nursing care. They also reported varied use of evidence-based practice, showing that higher education is not the only factor that matters. To decrease missed nursing care in clinical practice, and thereby increase the quality of care, educational level, use of evidence-based practice, and organizational factors must be considered.

A Study of Medical Surgical Nurses Leaders' Evidence-Based Practice Attributes: Critical Implications for Practice.

The purpose of this study was to determine medical-surgical nurse leaders' evidence-based practice (EBP) attributes, perceived barriers to EBP, and whether there were differences in leaders' EBP competencies and EBP implementation by demographic and organizational factors. Leaders are crucial to the development of cultures that support EBP implementation, but little is known about medical-surgical nurse leaders' capacity to perform this aspect of their role. A cross-sectional design using survey methodology was used. The survey contained demographic/work setting questions and 3 instruments to measure EBP beliefs, implementation, and competencies. Senior leaders self-reported higher EBP attributes compared with nurses in other roles; nurses with an MSN or higher reported greater frequency of EBP implementation. A regression revealed that EBP competencies, EBP beliefs, having a DNP degree, and working in an Academy of Medical-Surgical Nurses Premier Recognition In the Specialty of Med-surg unit or a Pathway to Excellence® organization had significant, positive effects on EBP implementation scores (R2 = 0.37). Findings demonstrate there is a range of EBP beliefs and competencies, and barriers to EBP among medical-surgical nurse leaders. Because medical-surgical nursing is the largest acute care practice specialty in the United States and many other countries, leaders fully integrating EBP into their practice would be a substantial contribution to advancing EBP in healthcare.

Medical-surgical nurses' EBP beliefs and competencies.

The lack of evidence-based practice (EBP) knowledge and inability to implement EBP among nurses is a major barrier to quality nursing care. The literature shows that nurses highly value the use of EBP, however, they lack necessary EBP competencies. Although medical-surgical nurses were included in studies examining cross-sections of the nursing workforce, no studies exist specifically investigating their EBP beliefs and EBP competencies. The purpose of this study was to describe medical-surgical nurses' self-reported EBP beliefs and competencies. A descriptive, cross-sectional design employing survey methodology was used. A total of 1,709medical-surgical nurses participated for a response rate of 13%. The findings revealed that medical-surgical nurses had positive beliefs about EBP. However, they rated themselves competent in only 2EBP competencies of 24. Medical-surgical nurses working in units or organizations that had a special designation such as Academy of Medical-Surgical Nurses Premier Recognition in the Specialty of Med-Surg (AMSN PRISM; p=.001) or Pathway to Excellence (p=.006) reported greater EBP competency scores. Also, nurses educated at the master's level or higher had better EBP competency scores (p < .0001). Medical-surgical nurses need support at the personal and organizational levels to improve their EBP competence and increase uptake of EBP in their practice. Therefore, individual nurses must reflect on their EBP competence level and pursue opportunities to develop these essential attributes. Leaders must also create practice environments where EBP is valued, and barriers to EBP implementation are eliminated. Faculty in prelicensure and graduate programs should integrate EBP into their curricula and assess students' EBP competencies.

Association between predoctoral evidence-based practice training and later use of peer-reviewed journals: National dental PBRN.

We examined whether evidence-based practice (EBP) during dental school was associated with the increased use of peer-reviewed literature during subsequent clinical practice for National Dental Practice-Based Research Network (PBRN) dentists. We also sought to understand whether this association was moderated by being a dental specialist. We analyzed cross-sectional data from 1228 dentists participating in the PBRN. We used logistic regression to examine the association between self-reported EBP training during dental school and the use of peer-reviewed journals in clinical practice, controlling for the number of years since dental school graduation and dental practice type. We stratified the data by dental specialists and examined effect modification using the Breslow-Day test for homogeneity of the odds ratio. The prevalence of peer-reviewed journal use by PBRN dentists in clinical practice was 87% (n=1070) with no statistical evidence of effect modification by dental specialists on the EBP peer-reviewed journal use relationship (p>0.05). After controlling for years since dental school graduation and dental practice type, dentists who self-reported EBP training during dental school had greater odds of using peer-reviewed journals in clinical practice than dentists who did not self-report EBP training during dental school (OR, 1.47; 95%CI=1.01, 2.15). The use of peer-reviewed published literature by PBRN dentists who had EBP predoctoral training is one important step in the EBP process by which practicing dentists can implement evidence-based findings, interventions, and policies into routine health care and public health settings. These findings add to the body of support for EBP curricula in dental education.

Development of a Cadre of Evidence-Based Practice Mentors for Nurses: What Works?

Development of a critical mass of evidence-based practice (EBP) mentors for healthcare professionals is pivotal in facilitating and sustaining system-wide implementation of evidence-based care, especially for nurses. Empirical evidence shows that organizational factors are strongly associated with EBP. However, the understanding of organizational support to promote EBP competency is found lacking, especially in Mainland China. The purposes of this study were to (1) establish a baseline assessment of EBP nursing leadership and work environment support as well as EBP competency for EBP mentors of nurses in Western China, and (2) explore how nursing leadership and work environment impact the EBP competencies of mentors. A cross-sectional study was conducted. The study population was 286 EBP mentors for nurses from six urban general hospitals in Xi'an City, Shanxi Province. The EBP Nursing Leadership Scale and the EBP Work Environment Scale were used to evaluate their perceived organizational support. EBP competency was measured by the Evidence-Based Practice Questionnaire. There was insufficient time for EBP mentors of nurses to engage in EBP. Lack of experts in EBP and educational offerings about EBP were identified as the two lowest workplace organizational supports for EBP. The respondents reported themselves as not competent in EBP, especially for the knowledge/skills. EBP nursing leadership and work environment support were key predictors of the self-reported EBP competency in the stepwise multiple linear regression models (β=.211-.345, p<.01). It is imperative to provide EBP mentors for nurses with the knowledge and skills to achieve the expected level of EBP competency. Strategies for developing a cadre of EBP mentors for nurses who have competency in EBP need to be multipronged and target the cultivation of an organizational culture that supports EBP.

Prática baseada em evidência: um levantamento em profissionais atuantes na área de fisioterapia hospitalar: um estudo transversal

Introdução: A Prática Baseada em Evidências (PBE) consiste em uma combinação entre a experiência do terapeuta, a melhor evidência disponível e a preferência/adaptação do paciente. O fisioterapeuta hospitalar detém conhecimentos sobre procedimentos terapêuticos validados por pesquisas, com comprovação da eficácia de suas técnicas. Sua presença é indispensável em setores como UTI adulto, UTI neonatal e enfermarias. Por se tratar de uma área primordial para a reabilitação de pacientes internados, faz-se necessário identificar se os profissionais, que atuam nos diversos setores do ambiente hospitalar, estão devidamente aptos a oferecer o melhor serviço disponível utilizando os princípios da PBE.Objetivo: Descrever comportamentos, conhecimentos, habilidades, opiniões e barreiras relacionados à PBE reportados por fisioterapeutas hospitalares atuantes em um hospital público estadual de Santa Catarina.Métodos: Foi utilizado um questionário eletrônico adaptado que identificou comportamentos, conhecimentos, habilidades, opiniões e barreiras em PBE reportados pelos participantes.Resultados: A taxa de resposta ao questionário foi de 72,72% (16 respondentes). O meio de atualização profissional mais utilizado foram os artigos científicos (56,3%), sendo a base mais acessada a Scielo (93,8%) seguida da Pubmed (81,3%). Os fisioterapeutas (87,5%) relatam que sabem o significado do termo PBE e procuram implantar a melhor evidência científica na prática clínica (75,0%), auxiliando na qualidade dos serviços de saúde (56,3%). As barreiras mais relatadas foram o idioma dos artigos, a falta da qualidade de evidências, a dificuldade de obter o artigo na íntegra, a falta de tempo, a dificuldade de entendimento dos dados estatísticos, a interpretação dos resultados e a falta de treinamento em PBE.Conclusão: Os fisioterapeutas hospitalares relatam atitudes positivas quanto ao uso da PBE, apresentam interesse em aprofundar seus conhecimentos sobre o tema a fim de utilizar a melhor evidência científica na prática clínica, visando à qualidade no atendimento ao paciente. Por outro lado, algumas barreiras dificultam a implantação da PBE na rotina diária de atendimento.

Testing of the Nursing Evidence-Based Practice Survey.

Clinicians' knowledge and skills for evidence-based practice (EBP) and organizational climate are important for science-based care. There is scant literature regarding aligning organizational culture with EBP implementation and even less for unit and organizational culture. The Nursing EBP Survey examines individual, unit, and organizational factors to better understand registered nurses' (RN) self-reported EBP. Establish and confirm factor loading, reliability, and discriminant validity for the untested Nursing EBP Survey. The study employed a descriptive cross-sectional survey design and was targeted for RNs. The setting included 14 hospitals and 680 medical offices in Southern California. The 1999 instrument consisted of 22 items; 7 items were added in 2005 for 29 items. The questionnaire used a 5 point, Likert-type scale. The survey website opened in November 2016 and closed after 23weeks. Psychometric testing and factor determination used parallel analysis, exploratory factor analysis, confirmatory factor analysis (CFA), and ANOVA post hoc comparisons. One thousand one hundred and eighty-one RNs completed the survey. All factor loadings in the CFA model were positive and significant (p<.001). All standardized loadings ranged from .70 to .94. The covariance estimate between Factor 1 and Factor 2 was marginally significant (p=.07). All other covariances and error variances were significant (p<.001). Final factor names were Practice Climate (Factor 1), Data Collection (Factor 2), Evidence Appraisal (Factor 3), Implementation (Factor 4), and Access to Evidence (Factor 5). Four of 5 factors showed significant differences between education levels (p<.05 level). All factors showed significant differences (p<.05) between inpatient and ambulatory staff, with higher scores for inpatient settings. Nurses' knowledge, attitudes, and skills for EBP vary. The 2019 Nursing EBP survey offers RNs direction to plan and support improvement in evidence-based outcomes and tailors future EBP initiatives.

Nurses' Knowledge, Attitudes, and Implementation of Evidence-based Practice in Oman: A Multi-institutional, Cross-sectional Study.

ObjectivesLittle attention has been paid to the study of evidence-based practice (EBP) among nurses in Oman. Our aim was to explore knowledge, practice, and attitudes towards EBP among nurses working in Oman.MethodsThis multi-institutional cross-sectional study utilized the self-reported EBP Questionnaire with a random sample of 262 nurses working in three different health care settings in Al Dakhliyah governorate, Oman (local hospitals, primary health centers and polyclinics, and schools).ResultsA total of 202 nurses (response rate: 77.1%) completed the questionnaire. The mean age was 32.4±4.7 years. Most respondents were females (92.5%), Omani (79.1%), and holders of a diploma in nursing (73.5%) with a mean clinical experience of 10.9±4.2 years. Attitudes towards EBP showed the highest mean score of 5.5±1.2 followed by knowledge (4.9±0.8) and practice (4.7±1.2). Significant positive correlations were identified between the total years of nursing experience and knowledge (rs = 0.145, n = 198, p = 0.041), practice (rs = 0.172, n = 198, p = 0.015), and attitudes (rs = 0.158, n = 197, p = 0.026) mean scores. No significant difference in EBP scores was found among the three clinical settings.ConclusionAlthough attitudes towards EBP were positive, knowledge and implementation of EBP were low. This study serves as a baseline assessment for future evaluations and provides a basis for the implementation of strategies to promote EBP utilization among nurses in three different health care settings in Oman.

Effect of Evidence‐Based Practice (EBP) Courses on MSN and DNP Students’ Use of EBP

The purpose of this study was to evaluate the effect of evidence-based practice (EBP) courses on nursing students' attitudes, perceived support from their professional network, self-efficacy, knowledge, and implementation of EBP. This study utilized a two-group, pre- and posttest design with 190 Masters of Science in Nursing (MSN) and 37 Doctorate of Nursing Practice (DNP) students. An EBP instrument based on the theory of planned behavior was administered both before and after the EBP course (the intervention). Both the pre- and posttest were completed by 126 students for a 56% response rate. No significant differences between the MSN (n=102) and DNP (n=24) students were found in precourse scores on any of the subscales except behavior, with the DNP students reporting they performed more EBP behaviors in the clinical setting. Overall, student scores on three of the four subscales of the EBP instrument (attitudes, self-efficacy, and behavior) significantly increased pre- to postcourse. The self-efficacy subscale demonstrated the greatest pre- to postcourse change scores. When the DNP and MSN students were compared, change scores on attitudes and self-efficacy remained significant in both groups. There was a significant positive change in EBP behavior only for the MSN students. Knowledge scores increased significantly only for the DNP students. EBP courses can increase self-reported EBP behaviors in the clinical setting, especially in MSN students. A precourse student evaluation will help faculty determine their learning needs in order to develop appropriate learning activities to support their acquisition of the essential knowledge, skills, and abilities to use EBP in the clinical setting. Administering the same evaluation postcourse can help faculty evaluate the effectiveness of their teaching. As a result, advanced practice nurses will be better equipped to facilitate and promote the implementation of EBP to support high-quality care and improved health outcomes.

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.

Attitude, Knowledge, and Practice on Evidence-Based Nursing among Registered Nurses in Traditional Chinese Medicine Hospitals: A Multiple Center Cross-Sectional Survey in China.

Objective. This study was to describe RNs' attitude, knowledge, and practice on evidence-based practice (EBP) in traditional Chinese nursing field and to estimate the related sociodemographic and professional factors. Methods. A multiple institutional cross-sectional survey design with self-reported EBP Questionnaire (EBPQ) and self-designed questionnaires were used. Results. The average scores of the total EBPQ were with a mean of 4.24 (SD = 0.79). The score of attitude was the highest one, followed by the knowledge score, and the lowest one is practice. RNs with longer experience reported stronger EBP knowledge (H = 6.64, P < 0.05). And RNs under higher working pressure reported less positive attitudes (ρ = 0.17, P < 0.001), whereas RNs holding negative professional attitude reported lower scores (Spearman's ρ: 0.12 to 0.15, P < 0.001). Significant statistics were found between RNs with research experience and without in attitude (t = −2.40, P < 0.05) and knowledge (t = −2.43, P < 0.05). Conclusions. Respondents generally viewed EBP positively and their attitudes towards EBP tended to be more positive than knowledge and practice of EBP. Data also showed that longer working experience, having administrative position, research experience, lighter working load, and better professional attitude might facilitate EBP.

Validity and Reliability Evidence for a New Measure: The Evidence-Based Practice Knowledge Assessment in Nursing.

Studies of evidence-based practice (EBP) among nurses often focus on attitudes and beliefs about EBP and self-reported EBP knowledge. Because knowledge self-assessments can be highly inaccurate, the authors developed and tested a new objective measure of EBP knowledge--the Evidence-Based Practice Knowledge Assessment in Nursing (EKAN). Seven subject matter experts reviewed candidate items, resulting in a scale content validity index of 0.94. Rasch modeling was used to evaluate item-person performance on the proposed unidimensional trait of EBP knowledge. The candidate item pool was then tested among 200 undergraduate nursing students. Strong evidence of unidimensionality was confirmed by narrow item infit statistics centering on 1.0. The item separation index was 7.05, and the person separation index was 1.66. Item reliability was 0.98, and person reliability was 0.66. The 20-item EKAN showed strong psychometric properties for an instrument developed under the Rasch model and is available for use in research and educational contexts.

Evidence-based Practice Exposure and Physiotherapy Students' Behaviour during Clinical Placements: A Survey

Physiotherapists are expected to practice in an evidence-based way. Evidence-based practice (EBP) should be an integral part of the curriculum to ensure use of the five EBP steps: asking clinical questions, searching for and appraising research evidence, integrating the evidence into clinical practice and evaluating this process. The aim of this study was to compare self-reported EBP behaviour, abilities and barriers during clinical placements reported by five cohorts of final year physiotherapy students' with different EBP exposure across the 3-year bachelor programme. A cross-sectional study was conducted among five cohorts (2006-2010) with third year physiotherapy students at a University College in Norway. In total, 246 students were eligible for this study. To collect data, we used a questionnaire with 42 items related to EBP behaviour, ability and barriers. Associations were investigated using the Spearman's rho (r). In total, 180 out of 246 third year physiotherapy students, who had recently completed a clinical placement, filled out the questionnaire (73 %). The association between the level of EBP exposure and students' self-reported EBP behaviour, abilities and barriers was low for most items in the questionnaire. Statistically significant correlations were found for eight items, related to information need, question formulation, use of checklists, searching and perceived ability to search for and critically appraise research evidence. The strongest correlation was found between the level of EBP exposure and ability to critically appraise research evidence (r = 0.41, p < 0.001). An association between the level of EBP exposure and physiotherapy students' EBP behaviour was found for elements such as asking and searching, ability to search for and critically appraise research evidence, and experience of critical appraisal as a barrier. Further research need to explore strategies for EBP exposure throughout the curriculum, regarding content, timing, amount and type of training.

Entry-Level Evidenced-Based Practice Training in Physiotherapy Students: Does It Change Knowledge, Attitudes, and Behaviours? A Longitudinal Study

Evidence-based practice (EBP) is an integral part of health professionals’ training. However, there is little research concerning learning outcomes in the allied health student population. This study explored changes in self-reported EBP knowledge, attitudes, and behaviours, and actual EBP knowledge of entry-level physiotherapy students following exposure to formal EBP training. Methods: Entry-level Bachelors and Masters physiotherapy students were surveyed before and after completing EBP training courses. Two validated and reliable surveys, the Evidence-Based Practice Profile Questionnaire (EBP2) and the Knowledge of Research Evidence Competencies (K-REC) survey were used. The EBP2 included self-reported domains: relevance, sympathy, terminology (knowledge), practice, and confidence. The K-REC survey measured actual EBP knowledge. Paired t-tests and effect sizes (ES) were used to assess the change in scores after exposure to one or both EBP training courses. Mixed design between-within ANOVAs were performed to assess the impact of EBP training on participants’ scores in the two different student groups (Masters and Bachelors). Results: In the group of 77 students, completion of EBP courses resulted in significant change in all self-reported domains: relevance p &lt; 0.001 (ES = 0.49), sympathy p = 0.005 (ES = 0.30), terminology p &lt; 0.001 (ES = 1.07), practice p &lt; 0.001 (ES = 1.34) and confidence p &lt; 0.001 (ES = 0.89), and also actual knowledge p &lt; 0.001 (ES = 1.13). There were no interaction effects between time and the student sub-group (Masters or Bachelors) for relevance, terminology, confidence, and sympathy (p≥ 0.05). There was a significant interaction between time and the student sub-group for practice and actual knowledge (p&lt; 0.05). Conclusion: These findings allow identification of the size of changes likely to result from current EBP courses in entry-level training. The results provide a basis for measuring the effect of modifications to EBP courses and for future EBP training interventions.

Predictors of Practitioner Self-reported Use of Evidence-Based Practices: Practitioner Training, Clinical Setting, and Attitudes Toward Research

In light of the recent movement toward evidence-based practice (EBP) in mental health services, practitioner adoption of EBPs in clinical settings has emerged as an important area for study. This paper reports on the results of a national online survey of mental health practitioners in an attempt to identify correlates of self-reported EBP use in practice. The survey consisted of 214 mental health practitioners from 15 states drawn from a diverse set of clinical settings and representing a variety of theoretical orientations. The results indicated that practitioner training (i.e., taking a class in EBPs), the perceived openness of the clinical setting toward EBPs, and the practitioner's attitudes toward treatment research were significant predictors of self-reported EBP use. The relationship between clinical setting and EBP use was partially mediated by attitudes toward treatment research. Negative attitudes toward treatment research partially mediated the relationship between practitioner training and self-reported EBP use. The findings are presented within the context of efforts to increase EBP use in clinical settings and implications for clinical training, treatment research, and EBP dissemination efforts are discussed.