Evidence based practice beliefs and implementation among nurses: a cross-sectional study

BMC Nursing

Monica W Nortvedt²  Birgitte Espehaug²  Nina R Olsen²  Kjersti Stokke¹ 

[1] Department of Oncology, Division of Cancer Medicine, Surgery and Transplantation, Oslo University Hospital, Postbox 4953- Nydalen, Oslo N-0424, Norway;Centre for Evidence-Based Practice, Faculty of Health and Social Sciences, Bergen University College, Postbox 7030, Bergen N-5020, Norway

关键词: Survey;    Nurses;    Implementation;    Behaviour;    Beliefs;    Evidence-based practice;   

Others  :  1091225
DOI  :  10.1186/1472-6955-13-8

 received in 2013-04-16, accepted in 2014-03-12,  发布年份 2014

【 摘 要 】

Background

Having a positive attitude towards evidence-based practice and being able to see the value of evidence-based practice for patients have been reported as important for the implementation of evidence-based practice among nurses.

The aim of this study was to map self-reported beliefs towards EBP and EBP implementation among nurses, and to investigate whether there was a positive correlation between EBP beliefs and EBP implementation.

Method

We carried out a cross-sectional study among 356 nurses at a specialist hospital for the treatment of cancer in Norway. The Norwegian translations of the Evidence-based Practice Belief Scale and the Evidence-based Practice Implementation Scale were used.

Results

In total, 185 nurses participated in the study (response rate 52%). The results showed that nurses were positive towards evidence-based practice, but only practised it to a small extent. There was a positive correlation (r) between beliefs towards evidence-based practice and implementation of evidence-based practice (r = 0.59, p = 0.001).

There was a statistical significant positive, but moderate correlation between all the four subscales of the EBP Beliefs Scale (beliefs related to: 1) knowledge, 2) resources, 3) the value of EBP and 4) difficulty and time) and the EBP Implementation Scale, with the highest correlation observed for beliefs related to knowledge (r = 0.38, p < .0001). Participants who had learned about evidence-based practice had significantly higher scores on the Evidence-based Practice Belief Scale than participants who were unfamiliar with evidence-based practice. Those involved in evidence-based practice working groups also reported significantly higher scores on the Evidence-based Practice Belief Scale than participants not involved in these groups.

Conclusion

This study shows that nurses have a positive attitude towards evidence-based practice, but practise it to a lesser extent. There was a positive correlation between beliefs about evidence-based practice and implementation of evidence-based practice. Beliefs related to knowledge appear to have the greatest effect on implementation of evidence-based practice. Having knowledge and taking part in evidence-based practice working groups seem important.

【 授权许可】

   
2014 Stokke et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]World Health Organisation: European Observatory on Health Systems and Policies. Health Evidence Network; 2011. http://www.who.int/evidence/en/ webcite
• [2]Sackett D, Straus S, Richardson W, Rosenberg W, Haynes R: Evidence based Medicine: How to Practice and Teach EBM. Edinburgh: Churchill Livingstone; 2000.
• [3]Dawes M, Summerskill W, Glasziou P, Cartabellotta A, Martin J, Hopayian K, Porzsolt F, Burls A, Osborne J: Second international conference of evidence-based health care teachers and developers. Sicily statement on evidence-based practice. BMC Med Educ 2005, 5:1. BioMed Central Full Text
• [4]Melnyk BM, Fineout-Overholt E: Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice. 2nd edition. Philadelphia: Wolters Kluwer Health Lipincott Williams & Wilkins; 2011.
• [5]Melnyk BM, Fineout- Overholt E, Mays MZ: The evidence based practice beliefs and implementation scales: psychometric properties of two new instruments. Worldviews Evid Based Nurs 2008, 5(4):208-216.
• [6]Thompson C, McCaughan D, Cullum N, Sheldon TA, Mulhall A, Thompson DR: Research information in nurses’ clinical decision-making: what is useful? J Adv Nurs 2001, 36:376-388.
• [7]Estabrooks CA, Chong H, Brigidear K, Profetto-McGrath J: Profiling Canadian Nurses’ preferred knowledge sources for clinical practice. Can J Nurs Res 2005, 37(2):118-141.
• [8]Estabrooks CA, Rutakumwa W, O'Leary KA, Profetto-McGrath J, Milner M, Levers MJ, Scott-Findlay S: Sources of practice knowledge among nurses. Qual Health Res 2005, 15(4):460-476.
• [9]Thompson DS, Estabrooks CA, Scott-Findlay S: Interventions aimed at increasing research use in nursing: a systematic review. Implement Sci 2007, 2(1):15. BioMed Central Full Text
• [10]Gerrish K, Ashworth P, Lacey A, Bailey J: Developing evidence-based practice: experiences of senior and junior clinical nurses. J Adv Nurs 2008, 62:62-73.
• [11]Dalheim A, Harthug S, Nilsen RM, Nortvedt MW: Factors influencing the development of evidence-based practice among nurses: a self-report survey. BMC Health Serv Res 2012, 12:367. http://www.biomedcentral.com/1472-6963/12/367 webcite BioMed Central Full Text
• [12]Berland A, Gundersen D, Bentsen SB: Evidence based practice in primary care – an explorative study of nurse practitioners in Norway. Nurs Educ Pract 2012. (in press) doi:10.1016/j.nepr.2012.05.002
• [13]Boström AM, Ehrenberg A, Gustavsson JP, Wallin L: Registered nurses’ application of evidence-based practice: a national survey. J Eval Clin Pract 2009, 15:1159-1163.
• [14]Brown CE, Wickline MA, Glaser D: Nursing practice, knowledge, attitudes and perceived barriers to evidence-based practice at an academic medical center. J Adv Nurs 2008, 65(2):371-381.
• [15]Mashiach EM: Implementation of evidence-based nursing practice: nurses’ personal and professional factors? J Adv Nurs 2011, 67:33-42.
• [16]Boström AM, Rudman A, Ehrenberg A, Gustavsson JP, Wallin L: Factors associated with evidence-based practice among registered nurses in Sweden: a national cross-sectional study. BMC Health Serv Res 2013, 13:165. BioMed Central Full Text
• [17]Kajermo KN, Boström AM, Thompson DS, Thompson DS, Alison M, Hutchinson AM, Estabrooks CA, Wallin L: The BARRIERS scale—the barriers to research utilization scale: a systematic review. Implement Sci 2010, 5:32. BioMed Central Full Text
• [18]Solomons NM, Spross JA: Evidence-based practice barriers and facilitators from a continuous quality improvement perspective: an integrative review. J Nurs Manag 2010, 19:109-120.
• [19]Meijers JM, Janssen MA, Cummings GG, Wallin L, Estabrooks CA, Halfens YGR: Assessing the relationships between contextual factors and research utilization in nursing: systematic literature review. J Adv Nurs 2006, 55(5):622-635.
• [20]Rycroft-Malone J, Harvey G, Seers K, Kitson A, McCormack B, Titcen A: An explorian of the factors that influence the implementation of evidence into practice. J Clin Nurs 2004, 13:913-924.
• [21]Ehrenberg A, Estabrooks CA: Why using research matters. J Wound Ostomy Continence Nurs 2004, 31(2):62-64.
• [22]Egerod I, Hansen GM: Evidence-based practice among Danish cardiac nurses: a national survey. J Adv Nurs 2005, 51(5):465-473.
• [23]Kuuppelomaki M, Tuomi J: Finnish nurses’ attitudes towards nursing research and related factors. Int J Nurs Stud 2005, 42(2):187-196.
• [24]Melnyk BM, Fineout-Overholt E, Feinstein NF, Sadler LS, Green-Hernandez C: Nurse practitioner educators’ perceived knowledge, beliefs, and teaching strategies regarding evidence-based practice: implications for accelerating the integration of evidence-based practice into graduate programs. J Prof Nurs 2008, 24(1):7-13.
• [25]Yoo JY, Oh EG: Level of beliefs, knowledge and performance for evidence-based practice among nurses experienced in preceptor role. J Korean Acad Nurs Adm 2012, 18(2):202-212.
• [26]Thorsteinsson HS: Icelandic Nurses’ beliefs, skills, and resources associated with evidence-based practice and related factors: a national survey. Worldviews Evid Based Nurs 2013, 10:67-126.
• [27]Estabrooks CA, Floyd JA, Scott-Findlay S, O’Leary KA, Gushta M: Individual determinants of research utilization: a systematic review. J Adv Nurs 2003, 43(5):506-520.
• [28]Melnyk BM, Fineout-Overholt E, Feinstein NF, Li H, Wilcox L, Kraus R: Nurses’ perceived knowledge, beliefs, skills and needs regarding evidence-based practice: implications for accelerating the paradigm shift. Worldviews Evid-Based Nurs 2004, 1(4):185-193.
• [29]Varnell G, Haas B, Duke G, Hudson K: Effect of an educational intervention on attitudes toward and implementation of evidence-based practice. Worldviews Evid Based Nurs 2008, 5(4):172-181.
• [30]Melnyk BM, Fineout-Overholt E, Giggleman M, Cruz R: Correlates among cognitive beliefs, EBP implementation, organizational culture, cohesion and job satisfaction in evidence-based practice mentors from a community hospital system. Nurs Outlook 2010, 58:301-308.
• [31]Squires JE, Estabrooks CA, Gustavsson P, Wallin L: Individual determinants of research utilization by nurses: a systematic review update. Implement Sci 2011, 6:1. BioMed Central Full Text
• [32]Ajzen I: The theory of planned behavior. Oragan Behav Hum Decis Process 1991, 50:179-211.
• [33]Kyrkjebø JM, Mekki TE, Hanestad BR: Short report: Nursing education in Norway. J Adv Nurs 2002, 38(3):296-302.
• [34]Gifford W, Davies B, Edwards N, Griffin P, Lybanon V: Managerial leadership for Nurses’ Use of research evidence: an integrative review of the literature. Worldviews Evid-Based Nurs 2007, 4:126-145.
• [35]Melnyk BM, Fineout-Overholt E: EBP Beliefs Scale. Gilbert, AZ: ARCC llc Publishing; 2003.
• [36]Estrada NA, Verran J: Nursing practice environments: strengthening the future of health systems: learning organizations and evidence-based practice by RNs. Commun Nurs Res 2007, 40:187-191.
• [37]Long EL, Berkett K, McGee S: Promotion of safe outcomes: incorporating evidence into policies and procedures. Nurs Clin North Am 2009, 44(1):57-70.
• [38]Estrada N: Exploring perceptions of a learning organization by RNs and relationship to EBP beliefs and implementation in the acute care setting. Worldviews Evid-Based Nurs 2009, 6(4):200-209.
• [39]Mariano KD, Caley LM, Escherberger L, Woloszyn A, Volker P, Leonard ML, Tung Y: Building evidence- based practice with staff nurses through mentoring. J Neonatal Nurs 2009, 15:81-87.
• [40]Melnyk BM, Bullock T, McGrath J, Jacobson D, Kelly S, Baba L: Translating the evidence-based NICU COPE program for parents of premature infants into clinical practice. Impact on Nurses’ evidence- based practice and lessons learned. J Perinat Neonatal Nurs 2010, 24(1):74-80.
• [41]Prochaska JM, Prochaska JO, Levesque DA: A transtheoretical approach to changing organizations. Admin Pol Ment Health 2001, 28(4):247-261.
• [42]Levin RF, Fineout-Overholt E, Melnyk BM, Barnes M, Vetter MJ: Fostering evidence-based practice to improve nurse and cost outcomes in a community health setting: a pilot test of the advancing research and clinical practice through close collaboration model. Nurs Adm Q 2011, 35:21-33.
• [43]Wallen GR, Mitchell SA, Melnyk B, Fineout-Overholt E, Miller-Davis C, Yates J, Hastings C: Implementing evidence-based practice: effectiveness of a structured multifaceted mentorship programme. J Adv Nurs 2010, 66(12):2761-2771.
• [44]Lynch SH: Nurses’ Beliefs about and Use of evidence-based practice. In Doctoral Dissertations Paper. University of Connecticut, ProQuest, UMI Dissertations Publishing; 2012. 3520427
• [45]Polit DF, Beck CT: Nursing Research – Generating and Assessing Evidence for Nursing Practice. Philadelphia: Lippincott Williams & Wilkins; 2008.
• [46]Sciarra E: Does journal club membership empower practice? Nurs Manag 2011, 42(1):17-18.
• [47]Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, O’BrienMA JM, Grimshaw J, Oxman AD: Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2012, Issue 6(Art. No):CD000259. doi:10.1002/14651858.CD000259.pub3
• [48]Nylenna M, Eiring O, Strand G, Røttingen J: Wiring a nation: putting knowledge into action. Lancet 2010, 375(20):1048-1051.
• [49]Novak D, Doodley S, Clark R: Best practices: understanding nurses perspectives. J Nurs Adm 2008, 38(10):448-453.
• [50]Gale BV, Schaffer MA: Organizational readiness for evidence-based practice. J Nurs Adm 2009, 39(2):91-97.
• [51]Nagy S, Lumby J, McKinley S, Macfarlane C: Nurses’ beliefs about the conditions that hinder or support evidence-based nursing. Int J Nurs Pract 2001, 7(5):314-321.
• [52]Wallin LA, Bostrøm M, Wikblad K, Ewald U: Substaining ability in Chanching clinical practice promotes evidence-based nursing care. J Adv Nurs 2003, 41(5):509-518.
• [53]Hutchinson AM, Johnston L: Beyond the BARRIERS scale - commonly reported barriers to research use. J Nurs Admin 2006, 36(4):189-199.
• [54]French B: Contextual factors influencing research use in nursing. Wordviews Evid Based Nurs 2005, 2(4):172-183.
• [55]Straus S, Haynes B: Managing evidence-based knowledge: the need for reliable, relevant and readable resources. Can Med Assoc J 2009, 180(9):942-945.
• [56]Guyatt GH, Meade MO, Jaeschke RZ, Cook DJ, Haynes RB: Practitioners of evidence based care. Not all clinicians need to appraise evidence from scratch but all need some skills. Br Med J 2000, 320:954-955.
• [57]Ciliska D: Evidence-based nursing: how far have we come? What’s next? Evid Based Nurs 2006, 9:38-40.
• [58]Melnyk BM, Fineout-Overholt E: Putting research into practice. Reflect Nurs Leadership 2002, 28(2):22-25. 45
• [59]Polit DF, Beck CT: Nursing Research Generating and Assessing Evidence for Nursing Practice. Philadelphia, PA: Lippincott Williams & Wilkins; 2007.
• [60]Rycroft- Malone J: Evidence-informed practice: from individual to context. J Nurs Manag 2008, 16:404-408.
• [61]Aarons A, Fettes D, Flores L, Sommerfeld D: Evidence-based practice implementation and staff emotional exhaustion in children’s services. Behav Res Ther 2009, 47(11):954-960.
• [62]Proctor KE, Fedoravicius N, Hovmand P, Knudsen JK, Perron B, Rosen A: Implementation of evidence-based practice in community behavioral health:Agency director perspectives. Admin Policy Mental Health Mental Health Sev Res 2007, 34(5):479-488.
• [63]Barwick M, Kimber M, Fearing G: Shifting sands: a case study of process change in scaling up for evidence-based practice. Int J Knowl Culture Change Manag 2011, 10(8):97-114.
• [64]Lawler J, Bilson S: Towards a more reflexive research aware practice: the influence and potential of professional and team culture. Soc Work Soc Sci Rev 2004, 11(1):52-69.
• [65]Shaneyfelt T, Baum KD, Bell D, Feldstein D, Houston TK, Kaatz S, Whelan C, Green M: Instruments for evaluating education in evidence-based practice: a systematic review. J Am Med Assoc 2006, 296:1116-1127.