Evidence-Based Nursing Implementation: An Impact Study of a Short Formative Intervention in Northern Portugal

ABSTRACT

Purpose: To conduct a baseline assessment of nurses’ perceived attitudes, barriers and practices related to evidence-based nursing (EBN) and research utilization. Examine the effectiveness of a short formative intervention program on nurses’ perceptions of practices, barriers and attitudes related to EBN and research utilization.

Design: A descriptive, quasi-experimental design with a one-group, pre-intervention survey, intervention, and post-intervention survey method was used. A convenience sample of 412 nurses working in several organizational settings (mainly hospital centers and primary health care services) was recruited. The study was conducted from September 2014 through January 2015.

Ethical Considerations: The research study was approved by the northern section of the Portuguese Nurse Association (Ordem dos Enfermeiros). To ensure the protection of human subjects all the participants signed a permission agreement using a cover letter that indicated the ethical responsibilities of the researchers and the rights of participants. All collected data were treated confidentially and anonymously. Completion of the surveys by the participants was acknowledged as consent to participate in the study.

Methods & Tools: Data collection instruments were a demographic data questionnaire and the Portuguese versions of the following instruments: Barriers to Research Utilization Scale (Funk, Champagne, Wiese & Tornquist, 1991), the Attitudes to Evidence-Based Practice Questionnaire (Mckenna, Ashton & Keeney, 2004) and the Evidence-Based Practice Questionnaire (Upton & Upton, 2006). An educative intervention on principles of EBN and research utilization was conducted using a training program which had a duration of one full day (7 hours) of direct contact between the trainer and the trainees and a total of six intervention sessions were replicated to the entire sample under study. The post-intervention evaluation was held two months after the training intervention and the pre-intervention assessment data collection was held using paper support while the post-intervention assessment was conducted with the help of an online form using the MedQuest application.

Quantitative data were analyzed using the Statistical Package for the Social Sciences (SPSS) for Windows (version 20). Descriptive statistics (percentages, frequencies, means, and standard deviations) and inferential statistics (dependent t tests) were used to describe demographic data and answer the research questions. A p value of ≤ .05 was considered statistically significant.

Key-Findings and Implications: Statistically significant differences in perceptions of practices, attitudes and barriers were found after nurses participated in the educative intervention. Although nurses indicated having positive attitudes about using research to support best nursing practice, gaps in knowledge and skills in retrieving research publications. In general nurses have positive attitudes towards EBN but still point several barriers booth from personal, academic, professional and organizational etiology. Because of the degree of differentiation of our sample (specialization in nursing and post-graduate academic education), there was a high perception of the use of EBN in daily practice. However, the estimated percentage of evidence-based practice throughout the day was situated at 63.9%. The study findings have implication for nursing practice in several dimensions: education and ongoing training, nursing accountability, and organizational support for EBN. Nurses’ perceptions of barriers, attitudes, and practice level in incorporating EBN into their practice is crucial in ensuring positive patient outcomes. Although nurses have positive attitudes about using research to support best nursing practice, there remains a substantial gap in knowledge and skill level in retrieving research publications, evaluating the evidence, and incorporating evidence into practice.

Conclusions: Nurses in clinical settings need to be able to use research findings and incorporate the best available evidence into their nursing practice to promote positive patient outcomes. Although considering the complexity of the translational sciences and their role in closing the gap between research and practice, appropriate organizational infrastructures are essential for promoting EBN and research utilization in clinical settings. Diverse and effective methods are essential in educating and engaging nurses in EBN and research utilization. A short education programs is an effective approach that can be used by nursing leaders in health care organizations to educate and engage nurses in EBN initiatives and research utilization. Nevertheless and according to the evidence review, multi-mixed methods approaches are the most successful ones. Tailored interventions according to specific contexts, settings and staff should be considerate primarily.