Nurses' Knowledge, Use, and Ratings of EBP Implementation Strategies

Purpose: Evidence-based practice (EBP) is widely recognized as the most effective approach to improving the quality and safety of patient care for optimal patient outcomes. A general definition of EBP supported by most health care professionals is that it is a process by which clinical decision making is shared between patients/families and providers and guided by the research evidence, provider expertise and patient values and preferences. Many EBP models and resources exist to guide the systematic process. However, the most challenging step in the process, the implementation phase, is often underappreciated and under-resourced leading to challenges with integration and sustainability of a practice change. Many studies have addressed nurses’ understanding of EBP in general and their knowledge and confidence in the EBP process. Moreover, numerous studies have examined facilitators and barriers to EBP. While this science is informative, there is still much unknown about the implementation phase and what combination of strategies can support sustained implementation. The purpose of this study is to examine registered nurses’ self-reported 1) knowledge of implementation models and implementation strategies known to facilitate EBP, 2) use of selected implementation strategies to integrate and sustain a practice change, and 3) ratings of the effectiveness of selected implementation strategies.

Methods: The study is guided by several frameworks or models that have focused on how to promote and expedite implementation of EBP in practice. These include the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework (Glasgow, Vogt, & Boles, 1999), PRISM (Practice, Robust Implementation and Sustainability Model; Feldstein & Glasgow, 2008), Implementation Guide (Cullen & Adams, 2012), Diffusion of Innovation Theory (Rogers, 2003), and the ERIC (Expert Recommendations for Implementing Change) Project (Powell et al., 2015). These models present phased approaches with multiple key targets for practice changes, as well as suggest specific implementation strategies and tools at each phase. For example, Powell et al. (2015) conducted a Delphi study with a panel of experts who identified 73 implementation strategies. Cullen et al. (2018) published a book on implementation strategies aligned with phases of implementation (creating awareness, building knowledge and commitment, promoting action and adoption, and pursuing integration and sustained use). They defined and described 63 strategies, a majority of which are supported with published evidence. These strategies can facilitate the process of EBP and lead to practice changes that are effective and sustained. Yet, what nurses know about the process of implementation and what strategies they believe can facilitate EBP is limited. Following IRB approval, 30 randomly selected hospitals across the United States will be invited to participate in the study. Using Qualtrics software, a survey will be electronically sent to chief nurse officers (CNO), inviting them to send the survey to their nursing point of care staff and nurse leaders. It is expected that the 30 hospitals will vary in bed size from 100-1000 beds, and employ 250-3000 staff nurses and nurse leaders. Expecting a 20% response rate, the proposed sample size will be 1500-4000. The survey includes: 1) demographics items; 2) questions about one’s organizational EBP implementation process, EBP culture, EBP training offered, and EBP resources dedicated to the change process; and 3) a list of implementation strategies from Powell et al. and Cullen et al. For each implementation strategy, staff nurses and nurse leaders will be asked to use a Likert-type scale to rate their knowledge of the strategy, whether they have used the strategy and to what extent, and their rating of how effective the strategy is in facilitating the EBP change Two reminder emails will be sent to CNOs, one week apart. Findings will be analyzed using descriptive and exploratory statistics.

Results: Findings will be reported by models used, knowledge of the select implementation strategies, most frequently used strategies, and ratings of perceived effectiveness. We will report perceptions of the EBP culture, resources and training provided by participant organization. Demographic data will be examined with exploration of associations and co-variates of participant responses.

Conclusion: Findings will guide future research in the study of implementation strategies that nurses use, effects of EBP implementation strategies on sustained practice change, and impact on patient outcomes.