Evidence Based Practice-Nurses Knowledge

1. Am J Nurs. 2011 Mar;111(3):54-60.

Evidence-based practice, step by step: implementing an evidence-based practicechange.

Gallagher-Ford L, Fineout-Overholt E, Melnyk BM, Stillwell SB.

Center for the Advancement of Evidence-Based Practice at Arizona State Universityin Phoenix, USA. [email protected]

This is the ninth article in a series from the Arizona State University Collegeof Nursing and Health Innovation's Center for the Advancement of Evidence-BasedPractice. Evidence-based practice (EBP) is a problem-solving approach to thedelivery of health care that integrates the best evidence from studies andpatient care data with clinician expertise and patient preferences and values.When delivered in a context of caring and in a supportive organizational culture,the highest quality of care and best patient outcomes can be achieved.The purposeof this series is to give nurses the knowledge and skills they need to implement EBP consistently, one step at a time. Articles will appear every other month toallow you time to incorporate information as you work toward implementing EBP at your institution. Also, we've scheduled "Chat with the Authors" calls every fewmonths to provide a direct line to the experts to help you resolve questions.Details about how to participate in the next call will be published with May'sEvidence-Based Practice, Step by Step.

PMID: 21346469 [PubMed - indexed for MEDLINE]

2. J Nurs Manag. 2011 Jan;19(1):109-20. doi: 10.1111/j.1365-2834.2010.01144.x. Epub 2010 Dec 13.

Evidence-based practice barriers and facilitators from a continuous qualityimprovement perspective: an integrative review.

Solomons NM, Spross JA.

Arizona State University, Phoenix, AZ, USA. [email protected]

AIMS: The purpose of the present study is to examine the barriers andfacilitators to evidence-based practice (EBP) using Shortell's framework forcontinuous quality improvement (CQI).BACKGROUND: EBP is typically undertaken to improve practice. Although there have been many studies focused on the barriers and facilitators to adopting EBP, thesehave not been tied explicitly to CQI frameworks.METHODS: CINAHL, Academic Search Premier, Medline, Psych Info, ABI/Inform andLISTA databases were searched using the keywords: nurses, information literacy,access to information, sources of knowledge, decision making, researchutilization, information seeking behaviour and nursing practice, evidence-basedpractice. Shortell's framework was used to organize the barriers andfacilitators.RESULTS: Across the articles, the most common barriers were lack of time and lackof autonomy to change practice which falls within the strategic and culturaldimensions in Shortell's framework.CONCLUSIONS: Barriers and facilitators to EBP adoption occur at the individualand institutional levels. Solutions to the barriers need to be directed to thedimension where the barrier occurs, while recognizing that multidimensional

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approaches are essential to the success of overcoming these barriers.IMPLICATIONS FOR NURSING MANAGEMENT: The findings of the present study can helpnurses identify barriers and implement strategies to promote EBP as part of CQI.


3. J Am Acad Nurse Pract. 2011 Jan;23(1):8-14. doi:10.1111/j.1745-7599.2010.00569.x. Epub 2010 Nov 5.

Family presence during cardiopulmonary resuscitation: using evidence-basedknowledge to guide the advanced practice nurse in developing formal policy andpractice guidelines.

Doolin CT, Quinn LD, Bryant LG, Lyons AA, Kleinpell RM.

Spalding University, Louisville, Kentucky, USA.

PURPOSE: To provide advanced practice nurses (APNs) with the best availableevidence for implementation of policies and procedures to allow family presenceduring cardiopulmonary resuscitation (CPR) in the acute care environment.DATA SOURCES: A comprehensive review of research-based articles from Ebsco Host, CINAHL, Pre-CINAHL, and Medline Plus, as well as statement alerts from nursingcredentialing bodies, and practice guidelines were reviewed. Kolcaba's Theory of Comfort and Lewin's Three Step Change Theory provide a framework forimplementation of formal policies and procedures.CONCLUSIONS: Best available evidence showed more support in favor of allowingfamilies at the bedside during CPR. Implementation of policies and proceduresallowing family presence enables facilities to change and grow in a holistic and family-oriented atmosphere.IMPLICATIONS FOR PRACTICE: With this evidence-based knowledge the APN will beable to disseminate information to facilitate collaborative change in currentpractices surrounding staff education, decision making, and self-governance. The APN can then address controversial changes when developing formal policies andprocedures, which will increase patient satisfaction and outcomes.


4. Prof Inferm. 2010 Jul-Sep;63(3):161-71.

[Evidence-based practice in nursing curricula: the experience of nursing degreecourse of Reggio Emilia. A pilot study].

[Article in Italian]

Finotto S, Chiesi I, Mecugni D, Casali P, Doro LM, Lusetti S.

Tutor al Corso di Laurea in Infermieristica dell'Università degli Studi di Modenae Reggio Emilia, Azienda Ospedaliera S. Maria Nuova di Reggio Emilia.

Given the lack of evidence in literature concerning the presence ofEvidence-Based Practice (EBP) in nursing curricula, but considering itsimportance in order to educate future nurses to use critical thinking and to basetheir practice on scientific evidence, tutors and nursing teachers of the Nursing

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Degree Course of Reggio Emilia (Università degli Studi di Modena e ReggioEmilia), have decided to introduce a three-year laboratory of EBP. The purposesof this project are: to describe the three-year EBP laboratory of Nursing Degree,its objectives, its structure, its integration with practical training andnursing subjects and its students evaluation strategies; to get students verifythe perception of the usefulness of the three-year EBP laboratory regarding theelaboration of the graduation thesis, the search for appropriatem answers forpatients met during clinical trainings and the usefulness of the EBP process inview of the development of their professional career. The design of research ofthis pilot study is correlation-descriptive. It has been selected a sample ofconvenience consisting of 56 nurses graduated in the autumn session of theacademic year 2007-2008. For data collection we have used an electronicquestionnaire (Microsoft Word with closed fields) structured for the purpose. Thelaboratory has been effective in learning to use the database to search forevidences and to use the database to search for evidences related to nursingproblems met in training placements. Finally, graduated nurses consider the EBPprocess an essential element of professional nursing luggage. Although the sampleis restricted the results indicates the good educational choice made by ourNursing Degree Course of integrating the EBP Laboratory in the curriculum.


5. Nurs Adm Q. 2011 Jan-Mar;35(1):21-33.

Fostering evidence-based practice to improve nurse and cost outcomes in acommunity health setting: a pilot test of the advancing research and clinicalpractice through close collaboration model.

Levin RF, Fineout-Overholt E, Melnyk BM, Barnes M, Vetter MJ.

Lienhard School of Nursing, Pace University, Tuckahoe, NY, USA. [email protected]

Although evidence-based practice (EBP) improves health care quality, decreasescosts, and empowers nurses, there is a paucity of intervention studies designedto test models of how to enhance nurses' use of EBP. Therefore, the specific aim of this study was to determine the preliminary effects of implementing theAdvancing Research and Clinical practice through close Collaboration (ARCC) modelon nurses' EBP beliefs, EBP implementation behaviors, group cohesion,productivity, job satisfaction, and attrition/turnover rates. A 2-grouprandomized controlled pilot trial was used with 46 nurses from the Visiting NurseService of New York. The ARCC group versus an attention control group hadstronger EBP beliefs, higher EBP implementation behaviors, more group cohesion,and less attrition/turnover. Implementation of the ARCC model in health caresystems may be a promising strategy for enhancing EBP and improving nurse andcost outcomes.


6. Pain Manag Nurs. 2010 Dec;11(4):245-58. Epub 2009 Sep 18.

Prior conditions influencing nurses' decisions to adopt evidence-basedpostoperative pain assessment practices.

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Carlson CL.

Northern Illinois University School of Nursing, DeKalb, Illinois 60115, [email protected]

Over the past 30 years, postoperative pain relief has been shown to beinadequate. To provide optimal postoperative pain relief, it is imperative fornurses to use evidence-based postoperative pain assessment practices. Thiscorrelational descriptive study was conducted to identify factors, termed priorconditions, that influenced nurses' decisions to adopt three evidence-basedpostoperative pain assessment practices. A convenience sample of nurses who caredfor adult postoperative patients in two Midwestern hospitals were surveyed, and443 (46.9%) nurses responded. The previous practice and innovativeness of nurses were supportive of adoption of the three practices. Nurses felt that patientsreceived adequate pain relief, which is unsupportive of adoption of the threepractices because there is no impetus to change. Nurses who perceived the priorconditions as being supportive of adoption of pain management practices usedmultiple sources to identify solutions to clinical practice problems, and thosewho read professional nursing journals were more likely to have adopted the threepractices and were more innovative. The number of sources used to identifysolutions to clinical practice problems, previous practices, and innovativenesswere predictive of nurses' adoption of the three evidence-based postoperativepain assessment practices. Nurses need to be encouraged to use multiple sources, including professional nursing journals, to identify solutions to clinicalpractice problems. Innovative nurses may be considered to be opinion leaders and need to be identified to promote the adoption of evidence-based postoperativepain assessment practices. Further exploration of the large unexplained variance in adoption of evidence-based postoperative pain assessment practices is needed.


7. Nurs Educ Perspect. 2010 Sep-Oct;31(5):290-3.

A constructivist model for teaching evidence-based practice.

Rolloff M.

Bellin College, Green Bay, Wisconsin, USA. [email protected]

The Institute of Medicine has reported that it takes roughly 17 years forevidence generated through research to move into clinical practice. Bridging thatgap is an urgent need and will require educators to rethink how nurses areprepared for evidence-based practice. The constructivist theory for learning--in which it is assumed that students construct knowledge and meaning for themselves as they learn--may provide a framework for a redesigned baccalaureate curriculum,one that supports evidence-based practice throughout a nursing student'seducation.


8. Nurs Prax N Z. 2010 Aug;26(2):14-25.

Practice nurse use of evidence in clinical practice: a descriptive survey.

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Prior P, Wilkinson J, Neville S.

Child and Family Service, Waitemata District Health Board, Auckland.

The role of practice nurses is a specific feature of the modernisation agenda of the New Zealand health service. Increasing importance is being placed on service improvement through effective decision making and enhanced clinical performance. To contribute to the development of primary health care it is crucial that nurseshave the skills to appropriately implement research based and other evidence inpractice. This study involved 55 West Auckland practice nurses working in thegeneral practice setting. The aim of the study was to describe nurses'perceptions of their use of evidence-based practice, attitudes towardevidence-based practice and perceptions of their knowledge/skills associated withevidence-based practice. An additional aim was to determine the effect ofeducational preparation on practice, attitudes and knowledge/skills towardevidence-based practice. A descriptive survey design was selected for this study.The results demonstrated that nurses' attitudes toward evidence-based practice,knowledge and skills relevant to the implementation of evidence-based practiceand the educational preparation of the nurses were important factors influencing the effective utilisation and application of research results in practice.Educational interventions are identified as an integral aspect of implementingevidence-based practice and enhancing practice nurses' knowledge and skillrelevant to the use of evidence in practice. Further research is needed to assessthe contextual factors which can inhibit or promote achievement of evidence-basedpractice by practice nurses.


9. Am J Nurs. 2010 Nov;110(11):43-51.

Evidence-based practice, step by step: Critical appraisal of the evidence: partIII.

Fineout-Overholt E, Melnyk BM, Stillwell SB, Williamson KM.

Center for Advancement of Evidence-Based Practice at Arizona State University in Phoenix, USA. [email protected]

This is the seventh article in a series from the Arizona State University Collegeof Nursing and Health Innovation's Center for the Advancement of Evidence-BasedPractice. Evidence-based practice (EBP) is a problem-solving approach to thedelivery of health care that integrates the best evidence from studies andpatient care data with clinician expertise and patient preferences and values.When delivered in a context of caring and in a supportive organizational culture,the highest quality of care and best patient outcomes can be achieved. Thepurpose of this series is to give nurses the knowledge and skills they need toimplement EBP consistently, one step at a time. Articles will appear every twomonths to allow you time to incorporate information as you work towardimplementing EBP at your institution. Also, we've scheduled "Chat with theAuthors" calls every few months to provide a direct line to the experts to helpyou resolve questions. See details below.


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10. J Adv Nurs. 2011 Jan;67(1):33-42. doi: 10.1111/j.1365-2648.2010.05488.x. Epub2010 Oct 25.

Implementation of evidence-based nursing practice: nurses' personal andprofessional factors?

Eizenberg MM.

Department of Health Systems Management, Yezreel Valley College, [email protected]

Comment in J Adv Nurs. 2011 Jan;67(1):3.

AIMS: This paper is a report of a study conducted to explore the relationshipbetween nurses' personal and professional factors and evidence-based nursingpractice.BACKGROUND: Like most health-related professions, nursing is shifting from thetraditional intuition-based paradigm to evidence-based nursing practice.METHODS: A cross-sectional survey was conducted in 2007 with a convenience sampleof 243 nurses from northern Israel, who worked in hospitals or in the community. Associations between background variables and evidence-based nursing practicewere examined. For the purpose of finding factors that predicted behaviour, alogistic regression analysis was conducted.RESULTS: The self-reported professional behaviour of nurses with a degree wasmore evidence-based than that of those without a degree. Moreover, evidence-basednursing practice was more likely where there was access to a rich library withnursing and medical journals, and opportunities for working with a computer andfor searching the Internet in the workplace. The variables emerging as predictingevidence-based nursing practice were: education, skills in locating variousresearch sources, support of the organization for searching and readingprofessional literature, knowledge sources based on colleagues and systemprocedures (inhibiting variable), knowledge sources based on reading professionalliterature, and knowledge sources based on experience or intuition.CONCLUSION: The findings point to the need for research-based information,exposure to professional journals and, in particular, organizational support for evidence-based nursing practice.


11. Qual Manag Health Care. 2010 Oct-Dec;19(4):330-48.

A baseline study of communication networks related to evidence-based infectionprevention practices in an intensive care unit.

Rangachari P, Rissing P, Wagner P, Rethemeyer K, Mani C, Bystrom C, Dillard T,Goins D, Gillespie W.

Department of Health Informatics, Medical College of Georgia, 1120 15th Street,Augusta, GA 30912, USA. [email protected]

This study seeks to gain a baseline understanding of the communication networkstructure, content of communication, and outcomes in a medical intensive care

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unit experiencing higher-than-expected central line blood stream infection(CLBSI) rates. The communication network structure refers to the direction andfrequency of communication on evidence-based CLBSI prevention practices acrossvarious professional subgroups and hierarchical levels in the unit, includingmedical faculty, nurses, residents, students, unit managers, and hospitaladministrators. The content of communication refers to the type of knowledge (ie,tacit vs explicit knowledge) exchanged on CLBSI prevention practices. Outcomesinclude (1) compliance with CLBSI prevention practices and (2) hospital-acquired CLBSI rates in the unit. Data on communication network structure and content ofcommunication are collected using communication logs completed weekly for 4weeks, by individual participants in each professional subgroup and hierarchical level. Outcomes are collected weekly through chart (medical record) review. Studyresults indicate a sparse communication network structure with minimalinteraction across professional subgroups and hierarchical levels. They alsoindicate that primarily explicit knowledge on general infection topics is beingexchanged as against tacit knowledge on specific infection prevention practices. Unit outcomes are poor, with the central line bundle score at zero during all 4weeks. The study represents an original attempt at developing methods formeasuring the communication network structure related to evidence-based infectionprevention practices at the unit level. It lays a foundation for testinghypotheses related to effective communication network structures for hospitalinfection prevention in a larger study. More significantly, the study lays afoundation for generating concrete and context-sensitive strategies fororganizational learning and improvement in the context of evidence-basedpractices. Such insight is critical from the perspective of evidence-based healthcare management.


12. J Clin Nurs. 2010 Jul;19(13-14):1944-51. doi: 10.1111/j.1365-2702.2009.03184.x.

Multi-institutional study of barriers to research utilisation and evidence-based practice among hospital nurses.

Brown CE, Ecoff L, Kim SC, Wickline MA, Rose B, Klimpel K, Glaser D.

Research/Evidence-based Practice Liaison, University of California San DiegoHealthcare, San Diego, CA, USA. [email protected]

AIMS: The study aims were to explore the relationships between perceived barriersto research use and the implementation of evidence-based practice among hospital nurses and to investigate the barriers as predictors of implementation ofevidence-based practice.BACKGROUND: Evidence-based practice is critical in improving healthcare quality. Although barriers to research use have been extensively studied, little is known about the relationships between the barriers and the implementation ofevidence-based practice in nursing. Cross-sectional study. DESIGN: METHOD: Data were collected between December 2006-January 2007 for thiscross-sectional study using computerised Evidence-Based Practice Questionnaireand BARRIERS surveys. A convenience sample (n=1301) of nurses from four hospitalsin southern California, USA, participated. Hierarchical multiple regressionanalyses were performed for each of the three dependent variables: practice,attitude and knowledge/skills associated with evidence-based practice. BARRIERSsubscales were used as predictor variables.

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RESULTS: The perceived barriers to research use predicted only 2·7, 2·4 and 4·5% of practice, attitude and knowledge/skills associated with evidence-based It was unexpected that the barriers to research use practice. Conclusions.predicted such small fractions of practice, attitude and knowledge/skillsassociated with evidence-based practice. The barriers appear to have minimalinfluence over the implementation of evidence-based practice for most hospitalnurses.RELEVANCE TO CLINICAL PRACTICE: In implementing evidence-based practice, thefocus on barriers to research use among general nursing staff may be misplaced.Further studies are needed to identify the predictors of evidence-based practice and to identify the subset of nurses who are most amenable to adoptingevidence-based practice.


13. J Adv Nurs. 2010 Dec;66(12):2761-71. doi: 10.1111/j.1365-2648.2010.05442.x. Epub 2010 Sep 6.

Implementing evidence-based practice: effectiveness of a structured multifaceted mentorship programme.

Wallen GR, Mitchell SA, Melnyk B, Fineout-Overholt E, Miller-Davis C, Yates J,Hastings C.

Nursing Research and Translational Science National Institutes of Health,Clinical Center, Bethesda, Maryland, USA. [email protected]

AIM: This paper is a report of the effectiveness of a structured multifacetedmentorship programme designed to implement evidence-based practice in a clinical research intensive environment.BACKGROUND: Barriers to implementing evidence-based practice are well-documented in the literature. Evidence-based practice is associated with higher quality careand better patient outcomes than care that is steeped in tradition. However, the integration of evidence-based practice implementation into daily clinicalpractice remains inconsistent, and the chasm between research and bedsidepractice remains substantial.METHODS: This quasi-experimental mixed methods study included three focuseddiscussions with nursing leadership and shared governance staff as well as pre-(N = 159) and post-intervention (N = 99) questionnaires administered between June2006 and February 2007. Online questionnaires included measures of organizationalreadiness, evidence-based practice beliefs, evidence-based practiceimplementation, job satisfaction, group cohesion and intent to leave nursing and Participants in the evidence-based practice mentorship the current job. Results.programme had a larger increase in perceived organizational culture and readinessfor evidence-based practice and in evidence-based practice belief scores thanthose who did not participate. Qualitative findings suggested that leadershipsupport of a culture for evidence-based practice and the dedication of resources for sustainability of the initiative needed to be a priority for engaging staffat all levels.CONCLUSION: These findings corroborate other studies showing that nurses' beliefsabout evidence-based practice are significantly correlated with evidence-basedpractice implementation and that having a mentor leads to stronger beliefs andgreater implementation by nurses as well as greater group cohesion, which is apotent predictor of nursing turnover rates.

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PMCID: PMC2981621 [Available on 2011/12/1]PMID: 20825512 [PubMed - indexed for MEDLINE]

14. J Nurs Adm. 2010 Sep;40(9):348-51.

Evaluating the evidence in evidence-based design.

Stichler JF.

School of Nursing, San Diego State University, California, USA. [email protected]

Evidence-based practice has become a valued process on which to base our clinicaland facility design decisions, yet not all evidence is created equal. Thisfacility design department aims to expand nurse leaders' knowledge andcompetencies in health facility design and enables them to take leadership roles in design efforts. This article focuses on the need to critical appraise facilitydesign research articles and rate the strength of the evidence using ahierarchical model.


15. J Nurs Educ. 2010 Dec;49(12):691-5. doi: 10.3928/01484834-20100831-07. Epub 2010 Aug 31.

Teaching research and evidence-based practice using a service-learning approach.

Balakas K, Sparks L.

Clinical Research Partnerships, Goldfarb School of Nursing, Barnes-JewishCollege, St. Louis, MO 63110, USA. [email protected]

Because nurses are expected to engage in evidence-based practice (EBP), nursingstudents must learn to critically evaluate and apply research findings to preparefor professional practice. To connect research and EBP, the focus of abaccalaureate research course was changed from a traditional format to one ofevidence appraisal and synthesis. Using an approach that incorporatedservice-learning and collaborative learning resulted in a new hybrid course that provided students with an opportunity to apply concepts in the real world.Working with a community partner, students were able to develop PICO (Population,Intervention, Comparison, and Outcome) questions and critically appraise theliterature to establish the evidence base for three pediatric programs. Students reported that working with a community partner was a meaningful experiencebecause course assignments had a direct impact on current practice. Researchcourses taught from an EBP perspective can provide motivation for students toincorporate research into their practice as professional nurses.


16. Am J Nurs. 2010 Sep;110(9):41-8.

Evidence-based practice, step by step: critical appraisal of the evidence: part

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II: digging deeper--examining the "keeper" studies.


Center for Advancement of Evidence-Based Practice at Arizona State University in Phoenix, USA. [email protected]

Erratum in Am J Nurs. 2010 Nov;110(11):12.

This is the sixth article in a series from the Arizona State University Collegeof Nursing and Health Innovation's Center for the Advancement of Evidence-BasedPractice. Evidence-based practice (EBP) is a problem-solving approach to thedelivery of health care that integrates the best evidence from studies andpatient care data with clinician expertise and patient preferences and values.When delivered in a context of caring and in a supportive organizational culture,the highest quality of care and best patient outcomes can be achieved. Thepurpose of this series is to give nurses the knowledge and skills they need toimplement EBP consistently, one step at a time. Articles will appear every twomonths to allow you time to incorporate information as you work towardimplementing EBP at your institution. Also, we've scheduled "Chat with theAuthors" calls every few months to provide a direct line to the experts to helpyou resolve questions. Details about how to participate in the next call will be published with November's Evidence-Based Practice, Step by Step.


17. J Nurses Staff Dev. 2010 Jul-Aug;26(4):170-7.

Self-efficacy-based training for research literature appraisal: a competency for evidence-based practice.

Kiss TL, O'Malley M, Hendrix TJ.

School of Nursing, University of Alaska Anchorage, Anchorage, AK 99701, [email protected]

Evidence-based practice requires nurses to integrate research findings intopatient care. The lack of skill and confidence in effective literature appraisal remains a barrier for many nurses. The author describes a self-efficacy-basedpilot project designed to enhance nurses' skill and confidence, thus increasingtheir ability and willingness to critically evaluate research findings. After theintervention, nurses were better prepared to critically appraise the literatureand, through enhanced readiness, were more inclined to make evidence-basedpractice a clinical reality. This approach may be beneficial to staff developmenteducators to develop and enhance an evidence-based practice culture.


18. Gastroenterol Nurs. 2010 Jul-Aug;33(4):263-6.

Evidence-based practices of gastroenterology nurses.

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Baker KA, Ellett ML, Sharon DB.

Texas Christian University, Fort Worth, TX 76129, USA. [email protected]

Evidence-based practice (EBP) incorporates use of the best scientific knowledge, expert opinion, clinician experience, and patient preferences to facilitate thebest patient outcomes in healthcare. Recent studies have suggested that nurseslack the skills and expertise to facilitate EBP in a meaningful way. Thisreplication study (n = 225) investigated the EBPs of gastroenterology nurses inthe United States. Findings generally support the previous studies that suggestnurses do not yet possess the skills or resources to implement EBP.Recommendations for addressing this deficit in the specialty of gastroenterology nursing are discussed.


19. J Am Geriatr Soc. 2010 Aug;58(8):1532-7. doi: 10.1111/j.1532-5415.2010.02964.x.Epub 2010 Jul 19.

Knowledge of evidence-based urinary catheter care practice recommendations among healthcare workers in nursing homes.

Mody L, Saint S, Galecki A, Chen S, Krein SL.

Division of Geriatric Medicine, University of Michigan Medical School, Ann Arbor,Michigan, USA. [email protected]

OBJECTIVES: To assess the knowledge of recommended urinary catheter carepractices among nursing home (NH) healthcare workers (HCWs) in southeastMichigan.DESIGN: Self-administered survey.SETTING: Seven NHs in southeast Michigan.PARTICIPANTS: HCWs.MEASUREMENTS: The survey included questions about respondent characteristics and knowledge about indications, care, and personal hygiene pertaining to urinarycatheters. The association between knowledge measures and occupation (nurses vsaides) was assessed using generalized estimating equations.RESULTS: Three hundred fifty-six of 440 HCWs (81%) responded. More than 90% ofHCWs were aware of measures such as cleaning around the catheter daily, gloveuse, and hand hygiene with catheter manipulation. They were less aware ofresearch-proven recommendations of not disconnecting the catheter from its bag(59% nurses, 30% aides, P<.001), not routinely irrigating the catheter (48%nurses, 8% aides, P<.001), and hand hygiene after casual contact (60% nurses, 69%aides, P=.07). HCWs were also unaware of recommendations regarding alcohol-based hand rub (27% nurses and 32% aides with correct responses, P=.38). HCWs reported informal (e.g., nurse supervisors) and formal (in-services) sources of knowledge about catheter care.CONCLUSION: Significant discrepancies remain between research-provenrecommendations pertaining to urinary catheter care and HCWs' knowledge. Nursesand aides differ in their knowledge of recommendations against harmful practices,such as disconnecting the catheter from the bag and routinely irrigatingcatheters. Further research should focus on strategies to enhance disseminationof proven infection control practices in NHs.

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PMCID: PMC2955179 [Available on 2011/8/1]PMID: 20662957 [PubMed - indexed for MEDLINE]

20. Nurse Educ Today. 2011 Feb;31(2):168-72. Epub 2010 Jun 29.

The practical skills of newly qualified nurses.

Danbjørg DB, Birkelund R.

[email protected]

This paper reports the findings from a study of newly qualified nurses and which subjects the nurses regarded as the most important in order to be able to live upto the requirements of clinical practice, and how they experience their potentialfor developing practical and moral skills, after the decrease in practicaltraining. A qualitative approach guided the research process and the analysis of the data. The data was collected by participant observation and qualitativeinterviews with four nurses as informants. The conclusions made in this study arebased on the statements and the observations of the newly qualified nurses. Ourfindings are discussed in relation to the Aristotelian concept and other relevantliterature. The main message is that the newly qualified nurses did not feelequipped when they finished their training. This could be interpreted as a directconsequence of the decrease in practical training. Our study also underlines thatthe way nursing theory is perceived and taught is problematic. The interviewsrevealed that the nurses think that nursing theories should be applied directlyin practice. This misunderstanding is probably also applicable to the teachers ofthe theories.


21. Am J Nurs. 2010 Jul;110(7):47-52.

Evidence-based practice step by step: Critical appraisal of the evidence: part I.


Center for the Advancement of Evidence-Based Practice, Arizona State University, Phoenix, USA. [email protected]

This is the fifth article in a series from the Arizona State University Collegeof Nursing and Health Innovation's Center for the Advancement of Evidence-BasedPractice. Evidence-based practice (EBP) is a problem-solving approach to thedelivery of health care that integrates the best evidence from studies andpatient care data with clinician expertise and patient preferences and values.When delivered in a context of caring and in a supportive organizational culture,the highest quality of care and best patient outcomes can be achieved.The purposeof this series is to give nurses the knowledge and skills they need to implement EBP consistently, one step at a time. Articles will appear every two months toallow you time to incorporate information as you work toward implementing EBP at your institution. Also, we've scheduled "Chat with the Authors" calls every fewmonths to provide a direct line to the experts to help you resolve questions.Details about how to participate in the next call will be published withSeptember's Evidence-Based Practice, Step by Step.

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22. J Contin Educ Health Prof. 2010 Spring;30(2):132-8.

Comparison of evidence-based practice between physicians and nurses: a nationalsurvey of regional hospitals in Taiwan.

Chiu YW, Weng YH, Lo HL, Hsu CC, Shih YH, Kuo KN.

Division of Health Policy Research and Development, Institute of PopulationHealth Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan,Miaoli, Taiwan.

INTRODUCTION: Although evidence-based practice (EBP) has been widelyinvestigated, few studies compare physicians and nurses on performance.METHODS: A structured questionnaire survey was used to investigate EBP amongphysicians and nurses in 61 regional hospitals of Taiwan. Valid postalquestionnaires were collected from 605 physicians and 551 nurses during February to May 2007.RESULTS: Physicians were more aware of EBP than nurses. Although both groups had high recognition of belief in and favorable attitudes toward EBP, their knowledgeof and skill in EBP were relatively low. When compared with nurses, physicianswere more willing to support the promotion of EBP implementations in clinicalservices. Physicians' knowledge and skills regarding the application of EBPprinciples were greater than nurses. Furthermore, physicians more often accessed the on-line evidence-retrieval databases, including the Cochrane Library. Themost commonly ranked barriers to EBP applications for both groups included lackof designated personnel, lack of convenient kits, limited basic knowledge of EBP,and time. In general, nurses generated more barriers than physicians.DISCUSSION: There were significant discrepancies between physicians and nurses intheir awareness of, attitude toward, knowledge of, skill in, behavior toward, andbarriers regarding EBP. In implementing EBP, strategies to overcome barriers and provide on-line evidence-retrieval systems should differ for physicians andnurses.


23. Nurs Sci Q. 2010 Jul;23(3):226-30.

The limitations of evidenced-based practice.

Baumann SL.

City University of New York, USA.

Comment in Nurs Sci Q. 2010 Oct;23(4):354.

Evidence based practice seeks to replace practice as usual, with practice guided by rigorous outcome-oriented research, ideally randomized controlled trials. Italso seeks to make practice a less subjective enterprise, and to raise it to ahigher level of accountability. It is associated with efforts to identify bestpractices in nursing and other disciplines. The limitations of evidence-based

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practice for nursing are not routinely discussed or considered by manyclinicians. In this article the author raises several critical questions aboutthe use of evidence-based practice in nursing. The author also suggests thatnurses need to develop and use their own nursing perspective to help guide their synthesis of knowledge from diverse sources, which needs to be creatively andrespectfully applied in each patient encounter.


24. Am J Nurs. 2010 May;110(5):41-7.

Evidence-based practice, step by step: searching for the evidence.

Stillwell SB, Fineout-Overholt E, Melnyk BM, Williamson KM.

Nurse Educator Evidence-Based Practice Mentorship Program at Arizona StateUniversity in Phoenix, USA. [email protected]

Comment in Am J Nurs. 2010 Oct;110(10):15.

This is the fourth article in a series from the Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-BasedPractice. Evidence-based practice (EBP) is a problem-solving approach to thedelivery of health care that integrates the best evidence from studies andpatient care data with clinician expertise and patient preferences and values.When delivered in a context of caring and in a supportive organizational culture,the highest quality of care and best patient outcomes can be achieved. Thepurpose of this series is to give nurses the knowledge and skills they need toimplement EBP consistently, one step at a time. Articles will appear every twomonths to allow you time to incorporate information as you work towardimplementing EBP at your institution. Also, we've scheduled "Chat with theAuthors" calls every few months to provide a direct line to the experts to helpyou resolve questions. See details below.


25. Br J Nurs. 2010 Apr 8-21;19(7):442-7.

Observations in acute care: evidence-based approach to patient safety.

Preston R, Flynn D.

University of Bedfordshire, UK.

Both the National Patient Safety Agency and National Institute for ClinicalExcellence have recommended that nurses must competently carry out observations, accurately interpret the data and make appropriate decisions on that data ifunnecessary deaths are to be avoided. This review explores patient safety througha review of nurses' knowledge, skills and practices of recording observations in acute clinical settings (TPR, BP, blood glucose levels, blood oxygen saturationlevels and neurological function). Findings from different research studiesindicate the respiratory rate in particular is a sensitive indicator of clinical

14

deterioration, but is the one observation that is poorly performed in acute care.The review also highlights the advantages and disadvantages of using electronicrecording devices and using early warning systems that have been designed toidentify patients at risk of deterioration. In addition to this, the reviewexplores what nurses need to know about physiological compensatory mechanisms in order to facilitate accurate detection and reporting of clinical deterioration inacute care. Some recommendations for improving nurses' competence in doing theobservations are considered. These recommend nurses should attend the ALERTcourse (acute life threatening events recognition and treatment), within thefirst eighteen months post qualifying if working in acute care. It is alsorecommended that further development of simulation exercises in both pre and postregistration courses may help to foster 'what is best practice' for doing theobservations in acute care.


26. J Healthc Qual. 2010 May-Jun;32(3):15-22.

Evidence-based practice in healthcare: an exploratory cross-discipline comparisonof enhancers and barriers.

Asadoorian J, Hearson B, Satyanarayana S, Ursel J.

School of Dental Hygiene, Faculty of Dentistry, University of Manitoba, Winnipeg,MB, Canada. [email protected]

In order to improve health outcomes, healthcare providers need to base practiceon current evidence. The purpose of this qualitative study was to explore andcompare the understanding and experiences with evidence-based practice (EBP) inthree different disciplines. Researchers conducted individual interviews withpsychiatrists, nurses, and dental hygienists. The majority of study participants demonstrated an understanding of EBP and were able to identify enhancers andbarriers to implementing EBP. Using a grounded theory approach, several majorthemes acting as enhancers and barriers to EBP emerged and revealed bothdifferences and similarities within and across the three health disciplines.While saturation was not attempted, this exploratory research is important incontributing to understanding the cultural practice milieu in relation toindividual characteristics in implementing evidence into practice with theoverall aim of improving healthcare delivery and outcomes.


27. J Nurs Manag. 2010 Jan;18(1):90-5.

Evidence based practice and its critics: what is a nurse manager to do?

O'Halloran P, Porter S, Blackwood B.

School of Nursing and Midwifery, Queen's University Belfast, 10 Malone Road,Belfast, UK. [email protected]

AIM(S): The purpose is to discuss the arguments against the evidence basedpractice (EBP) movement and suggest how nursing management might respond.

15

BACKGROUND: EBP is a pervasive approach to directing and regulating nursing care.There are, however, fierce critics who argue that it is fundamentally flawed and detrimental to patient care.EVALUATION: We consider some of the more radical criticisms of EBP, weighing the arguments and reflecting on the extent to which alleged short-comings aresupported in the literature. Postmodernist critics are amongst the most vocal andare therefore our principal focus. KEY ISSUE(S): 'Best evidence' implies ahierarchical approach to knowledge which excludes other forms of evidence thatare needed to understand the complexity of care. Evidence based guidelines tendto stifle critical thinking amongst nurses.CONCLUSION(S): While EBP is increasingly open to a range of researchmethodologies, it still largely subscribes to a hierarchy of evidence, eventhough this approach to addressing the complexities of healthcare is limiting.Although the EBP approach can be shown to stifle critical thinking, this is notinherent to the approach, which can lend itself to supporting professionalnursing practice.IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers should neither abandon EBP nor accept it uncritically.


28. J Nurs Manag. 2010 Jan;18(1):70-7.

Evidence-based practice: the importance of education and leadership.

Johansson B, Fogelberg-Dahm M, Wadensten B.

Department of Oncology, Uppsala University Hospital, Uppsala, [email protected]

AIM: To describe evidence-based practice among head nurses and to explore whethernumber of years of duty is associated with such activities. Further to evaluatethe effects of education on evidence-based practice and perceived support fromimmediate superiors.BACKGROUND: Registered nurses in Sweden are required by law to perform care basedon research findings and best experiences. In order to achieve this,evidence-based practice (EBP) is of key importance.METHOD: All 168 head nurses at two hospitals were asked to participate.Ninety-nine (59%) completed the survey. Data were collected using astudy-specific web-based questionnaire.RESULTS: The majority reported a positive attitude towards EBP, but also a lackof time for EBP activities. A greater number of years as a head nurse waspositively correlated with research utilization. Education in research methodsand perceived support from immediate superiors were statistically andsignificantly associated with increased EBP activities.CONCLUSIONS: The present study highlights the value of education in researchmethods and the importance of supportive leadership.IMPLICATIONS FOR NURSING MANAGEMENT: Education is an important factor in theemployment of head nurses. We recommend interventions to create increased supportfor EBP among management, the goal being to deliver high-quality care andincrease patient satisfaction.


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29. J Eval Clin Pract. 2009 Dec;15(6):1159-63.

Registered nurses' application of evidence-based practice: a national survey.

Boström AM, Ehrenberg A, Gustavsson JP, Wallin L.

Knowledge Utilization Studies Program, Faculty of Nursing, University of Alberta,Edmonton, AB, Canada. [email protected]

BACKGROUND: Evidence-based practice (EBP) is a worldwide approach to improvinghealth care. There is, however, a shortage of studies examining whether or notnewly graduated health care professionals are actually applying EBP in theirdaily work.OBJECTIVES: To examine the application of EBP in clinical practice by registered nurses (RNs) 2 years post graduation and to explore whether the application ofEBP differed with regard to the clinical settings where RNs were working.METHOD: A cross-sectional design using a national sample. Data were collected in 2007 from 987 RNs (response rate 76%). Six items measuring respondents'self-reported extent of applying EBP were used. Results Of the 987 RNs, 19%formulated questions and performed searches in data bases, 56% used otherinformation sources, 31% appraised the literature, 30% participated in practicedevelopment and 34% participated in evaluating clinical practice. A greaterproportion of the RNs working in elder care applied EBP compared with the RNsworking in hospitals, psychiatric care and primary care.CONCLUSIONS: The RNs applied the components of EBP to a rather low extent 2 yearspost graduation despite EBP being an important objective in Swedish health careand educational programmes since the 1990s. These findings support other studies reporting the implementation of EBP in organizations as a complex and often slow process. The differences in the RNs extent of applying EBP in relation to theirworkplace indicate that contextual factors and the role of the RN in theorganization are of importance for getting EBP into practice.


30. J Perianesth Nurs. 2010 Apr;25(2):64-70.

Information literacy for evidence-based practice in perianesthesia nurses:readiness for evidence-based practice.

Ross J.

Information literacy, the recognition of information required, and thedevelopment of skills for locating, evaluating, and effectively using relevantevidence is needed for evidence-based practice (EBP). The purpose of this studywas to examine perianesthesia nurses' perception of searching skills and accessto evidence sources. The design was a descriptive, exploratory survey. The sampleconsisted of ASPAN members (n = 64) and nonmembers (n = 64). The InformationLiteracy for Evidence-Based Nursing Practice instrument was used. Findings werethat ASPAN members read more journal articles, were more proficient withcomputers, and used Cumulative Index to Nursing and Allied Health Literature(CINAHL) more frequently than nonmembers. The three top barriers to use ofresearch were: lack of understanding of organization or structure of electronicdatabases, lack of skills to critique and/or synthesize the literature, anddifficulty in accessing research materials. In conclusion, education is needed

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for critiquing literature and understanding electronic databases and researcharticles to promote EBP in perianesthesia areas.


31. Nurs Stand. 2010 Feb 17-23;24(24):40-9; quiz 50.

Caring for patients with long-term conditions and depression.

Haddad M.

King's College London, Institute of Psychiatry. [email protected]

Long-term conditions are an increasingly important part of healthcare activity.The prevalence of these health problems is high and their personal and socialeffects are extensive, requiring an approach to health care that emphasisesintegration, continuity and self-care. The risk of depression is significantlyincreased among people with chronic illnesses. Recognising and assisting in themanagement of this aspect of care is a crucial part of the nurse's role. To help people with long-term conditions, services need to be organised so that theassessment and recall of all patients at risk is co-ordinated, and to ensure arange of treatments, including case management, is available for those who aredepressed. Nurses need to be familiar with appropriate case-finding tools, and tohave knowledge of and access to evidence-based treatments ranging from guidedself-help and exercise, to problem-solving, antidepressant and cognitivetherapies.


32. Worldviews Evid Based Nurs. 2010 Dec;7(4):214-25. doi:10.1111/j.1741-6787.2010.00188.x.

Motivating nurses' organizational citizenship behaviors by customer-orientedperception for evidence-based practice.

Chang CS, Chang HC.

Department of Business Administration, National Cheng Kung University andDepartment of Medical Information Management, College of Health Science,Kaohsiung Medical University, Taiwan. [email protected]

BACKGROUND: There is a gap in the literature about the influence ofcustomer-oriented perception on nursing personnel's organizational citizenshipbehaviors. Organizational citizenship behaviors are the type of contextualbehaviors that are difficult to observe and measure as such behaviors are usuallygenerated in quite subtle and unpredictable ways.AIMS: This study tested the hypothesis: Customer-oriented perception isassociated with increased organizational citizenship behaviors for nurses. Ifnursing personnel's customer-oriented perception can increase their willingnessto display organizational citizenship behaviors, it may facilitate hospitaloperation and enhance organizational effectiveness.METHODS: A cross-sectional design using a questionnaire survey of nurses in 10medical centers was used. Five hundred copies of the questionnaire were

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distributed, and 232 effective copies were retrieved, with a valid response rate of 46.4%. Structural equation modeling was performed in SPSS 11.0 and Amos 7.0(SPSS Inc., Chicago, IL, USA) statistical software packages.RESULTS: The main finding was that favorable customer-oriented perception isassociated with increased organizational citizenship behaviors for nurses.IMPLICATIONS: Extensive training and customer-oriented performance evaluation areproposed in the hope of creating customer-oriented perception among nursingpersonnel and subsequently inspiring the display of organizational citizenshipbehaviors.


33. Br J Nurs. 2010 Feb 11-24;19(3):186-93.

Nurses' understanding of patient-centred care in Bhutan.

Pelzang R, Wood B, Black S.

Jigme Dorji Wangchuk National Referral Hospital, Ministry of Health, RoyalGovernment of Bhutan, Thimphu.

AIM: The purpose of the study was to explore nurses' perceptions andunderstanding of patient-centred care (PCC) in Bhutan.BACKGROUND: Nurses' perceptions and understanding of PCC in Bhutan are unknown.METHODS: A non-probability convenience sample was taken and a mixed method(quantitative and qualitative descriptive) used. Survey questionnaires wereadministered to 87 Bhutanese nurses in three types of hospitals--the NationalReferral Hospital, the regional referral hospital and the district hospital.Descriptive statistics including frequency distribution, mean and standarddeviation (SD) were used for analysis. Spearman's correlation coefficients wereused to investigate relationships between demographic variables.RESULTS: The nursing labour force in Bhutan knows which behaviours are considerednecessary for practising PCC. The mean (SD) rating of behaviours consideredcritical for practising PCC was 4.29 (0.22), five being the highest score.Bhutanese nurses described PCC, according to qualitative descriptive analysis, asbeing based on individual patient assessment (22/87 or 25% of respondents), usinga holistic model of care (38/87 or 44%) that was based on evidence (38/87 or44%). A higher level of education (79/87 or 91%) was found to be the main factor that would facilitate the development of PCC, while inadequate staffing, in termsof insufficient numbers of staff and lack of advanced practitioners (56/87 or64%), was revealed as the main factor that hinders development of PCC.CONCLUSION: Bhutanese nurses believed certain behaviours were critical to PCC.Reform of higher nursing education, putting an emphasis on PCC, would improvenursing practice and increase its scope.


34. Neonatal Netw. 2010 Mar-Apr 1;29(2):117-22.

Importance of nursing leadership in advancing evidence-based nursing practice.

Bradshaw WG.

19

Veteran's Administration Medical Center in St. Louis, Missouri, USA.

Our patients depend on us to do the best on their behalf. If we do not takeaccountability for our practice, continually examining what is the best way todeliver care, we are limiting our role to technical skills and not fullyactualizing our professional role. [Evidence-based practice] is essential topracticing safely as nurses (p. 53).1.


35. J Pediatr Health Care. 2010 Mar-Apr;24(2):81-94. Epub 2009 May 21.

Strengthening PNP curricula in mental/behavioral health and evidence-basedpractice.

Melnyk BM, Hawkins-Walsh E, Beauchesne M, Brandt P, Crowley A, Choi M, Greenburg E.

Arizona State University College of Nursing & Healthcare Innovation, Phoenix, AZ,USA.

INTRODUCTION: The incidence of mental health/behavioral and developmentalproblems in children and teens is escalating. However, many primary careproviders report inadequate skills to accurately screen, identify, and managethese problems using an evidence-based approach to care. Additionally,educational programs that prepare pediatric nurse practitioners (PNPs) have been slow to incorporate this content into their curriculums.METHODS: The purpose of this project was to implement and evaluate a strengthenedcurriculum in 20 PNP programs from across the United States that focused on: (a) health promotion strategies for optimal mental/behavioral health anddevelopmental outcomes in children, and (b) screening and evidence-basedinterventions for these problems. An outcomes evaluation was conducted withfaculty and graduating students from the participating programs along withfaculty and students from 13 PNP programs who did not participate in the project.RESULTS: Participating schools varied in the speed at which components of thestrengthened curriculum were incorporated into their programs. Over the course ofthe project, faculty from participating programs increased their own knowledge inthe targeted areas and reported that their students were better prepared toassess and manage these problems using an evidence-based approach. Althoughreports of screening for certain problems were higher in the graduating students from the participating schools than the non-participating schools, the overalluse of screening tools by students in clinical practice was low.DISCUSSION: There is a need for educational programs to strengthen theircurricula and clinical experiences to prepare students to screen for, accurately identify, prevent, and provide early evidence-based interventions for childrenand teens with mental health/behavioral and developmental problems. This project can serve as a national model for curriculum change.


36. Am J Nurs. 2010 Mar;110(3):58-61.

Evidence-based practice, step by step: asking the clinical question: a key step

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in evidence-based practice.

Stillwell SB, Fineout-Overholt E, Melnyk BM, Williamson KM.

Nurse Educator Evidence-Based Practice Mentorship Program at Arizona StateUniversity in Phoenix, USA. [email protected]

This is the third article in a series from the Arizona State University Collegeof Nursing and Health Innovation's Center for the Advancement of Evidence-BasedPractice. Evidence-based practice (EBP) is a problem-solving approach to thedelivery of health care that integrates the best evidence from studies andpatient care data with clinician expertise and patient preferences and values.When delivered in a context of caring and in a supportive organizational culture,the highest quality of care and best patient outcomes can be achieved.The purposeof this series is to give nurses the knowledge and skills they need to implement EBP consistently, one step at a time. Articles will appear every two months toallow you time to incorporate information as you work toward implementing EBP at your institution. Also, we've scheduled "Ask the Authors" call-ins every fewmonths to provide a direct line to the experts to help you resolve questions.Details about how to participate in the next call will be published with May'sEvidence-Based Practice, Step by Step.


37. J Prof Nurs. 2010 Jan;26(1):23-8.

Part III. Reenvisioning undergraduate nursing students as opinion leaders todiffuse evidence-based practice in clinical settings.

Cronje RJ, Moch SD.

University of Wisconsin-Eau Claire, Scientific and Technical Writing Program, EauClaire, WI 54702-4004, USA.

Rogers's claims about the importance of social networks to the diffusion ofinnovations are reviewed in light of efforts to promote evidence-based practice(EBP) among nursing students and practicing nurses. We argue that nursingeducators can take more deliberate advantage of the essentially social nature of the diffusion process by devising opportunities for nursing students to formmeaningful social interactions with practicing nurses. We recommend curricularreforms that reenvision undergraduate nursing students as opinion leadersthroughout the curriculum. Rogers's theory predicts that such ongoinginteractions between nursing students and practicing nurses will better integrateEBP among both populations.


38. J Gerontol Nurs. 2010 Jan;36(1):41-8. doi: 10.3928/00989134-20091204-04. Epub2010 Jan 12.

Implementing evidence-based practice in Taiwanese nursing homes: attitudes andperceived barriers and facilitators.

21

Chang HC, Russell C, Jones MK.

Department of Nursing, Faculty of Health Sciences, The University of Yuanpei,Hsinchu, Taiwan. [email protected]

To date, there is a paucity of research investigating nurses' perceptions ofevidence-based practice (EBP) in nursing homes, especially in non-Westerncountries. This descriptive, quantitative study investigated attitudes toward andperceived barriers and facilitators to research utilization among 89 TaiwaneseRNs. The majority of nurses expressed positive attitudes toward research and EBP.The most frequently cited barriers were related to insufficient authority tochange practice, difficulty understanding statistical analyses, and a perceivedisolation from knowledgeable colleagues with whom to discuss the research. EBPfacilitators included improved access to computers and Internet facilities in theworkplace, more effective research training, and collaboration with academicnurses. These findings are similar to those from research conducted in Westerncountries and indicate that further education and training in research for nursesworking in nursing homes would be beneficial.


39. Am J Nurs. 2010 Jan;110(1):51-3.

Evidence-based practice: step by step: the seven steps of evidence-basedpractice.

Melnyk BM, Fineout-Overholt E, Stillwell SB, Williamson KM.

Arizona State University in Phoenix, AZ, USA. [email protected]

This is the second article in a new series from the Arizona State UniversityCollege of Nursing and Health Innovation's Center for the Advancement ofEvidence-Based Practice. Evidence-based practice (EBP) is a problem-solvingapproach to the delivery of health care that integrates the best evidence fromstudies and patient care data with clinician expertise and patient preferencesand values. When delivered in a context of caring and in a supportiveorganizational culture, the highest quality of care and best patient outcomes canbe achieved.The purpose of this series is to give nurses the knowledge and skillsthey need to implement EBP consistently, one step at a time. Articles will appearevery two months to allow you time to incorporate information as you work toward implementing EBP at your institution. Also, we've scheduled "Ask the Authors"calls every few months to provide a direct line to the experts to help youresolve questions. See details below.


40. Worldviews Evid Based Nurs. 2010 Mar;7(1):4-15. Epub 2009 Dec 16.

Supporting evidence-based practice for nurses through information technologies.

Doran DM, Haynes RB, Kushniruk A, Straus S, Grimshaw J, Hall LM, Dubrowski A, Di Pietro T, Newman K, Almost J, Nguyen H, Carryer J, Jedras D.

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Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON,Canada. [email protected]

PURPOSE: To evaluate the usability of mobile information terminals, such aspersonal digital assistants (PDAs) or Tablet personal computers, to improveaccess to information resources for nurses and to explore the relationshipbetween PDA or Tablet-supported information resources and outcomes.BACKGROUND: The authors evaluated an initiative of the Nursing Secretariat,Ontario Ministry of Health and Long-Term Care, which provided nurses with PDAsand Tablet PCs, to enable Internet access to information resources. Nurses hadaccess to drug and medical reference information, best practice guidelines(BPGs), and to abstracts of recent research studies.METHOD: The authors took place over a 12-month period. Diffusion of Innovationtheory and the Promoting Action on Research Implementation in Health Services(PARIHS) model guided the selection of variables for study. A longitudinal designinvolving questionnaires was used to evaluate the impact of the mobiletechnologies on barriers to research utilization, perceived quality of care, and on nurses' job satisfaction. The setting was 29 acute care, long-term care, home care, and correctional organizations in Ontario, Canada. The sample consisted of 488 frontline-nurses.RESULTS: Nurses most frequently consulted drug and medical reference information,Google, and Nursing PLUS. Overall, nurses were most satisfied with the RegisteredNurses Association of Ontario (RNAO) BPGs and rated the RNAO BPGs as the easiest resource to use. Among the PDA and Tablet users, there was a significantimprovement in research awareness/values, and in communication of research. Therewas also, for the PDA users only, a significant improvement over time inperceived quality of care and job satisfaction, but primarily in long-term caresettings.IMPLICATIONS: It is feasible to provide nurses with access to evidence-basedpractice resources via mobile information technologies to reduce the barriers to research utilization.


41. Nurs Res. 2010 Jan-Feb;59(1 Suppl):S22-31.

Care of the patient with enteral tube feeding: an evidence-based practiceprotocol.

Kenny DJ, Goodman P.

TriService Nursing Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814-4799, USA. [email protected]

BACKGROUND: Care of patients with enteral feeding tubes often is based ontradition and textbook guidance rather than best evidence. Care practices canvary widely both between and within institutions, and this was the case at anortheastern military medical center that served as the site for thisevidence-based protocol development and implementation project.OBJECTIVES: The purpose of this study was to describe the development andimplementation of an evidence-based clinical protocol for care of patients withenteral feeding tubes.METHODS: This was an evidence-based implementation project with pretest-posttest measures. Protocol data collection occurred both before and after implementation of the protocol. Data collection tools were based on the literature review and

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included three domains: (a) documentation of patient procedures, (b) nursingknowledge of each of the specific procedures, and (c) environment of care.Descriptive statistics and data were analyzed using independent samples t tests.RESULTS: Overall staff knowledge of enteral feedings and methods used to unclogboth large- and small-bore feeding tubes differed significantly before and after implementation (p < .05). Staff knowledge regarding the danger of using blue dye in feeding solution was significant (p < .001). There was improvement also inadministration of medications separately rather than mixed together and in headof bed elevation of patients with feeding tubes. There was a 10% improvement indocumentation of patient family education and a 15% improvement in recordingfluid flushes during medication administration. After implementation, environmentof care data collection showed 100% of patients with head of bed elevated andwith functioning suction available, an improvement over levels beforeimplementation.DISCUSSION: Care must be taken in the interpretation of these findings because itwas generally not the same nurses who answered both surveys. High staff turnover within this military hospital also affected sustainment of the protocolimplementation. Maintenance activities must be constant and visible within theorganization. A champion for evidence-based practice greatly enhances uptake and maintenance of nursing practice change.


42. Worldviews Evid Based Nurs. 2010 Mar;7(1):16-24. Epub 2009 Nov 16.

Nurses' knowledge of evidence-based guidelines for the prevention of surgicalsite infection.

Labeau SO, Witdouck SS, Vandijck DM, Claes B, Rello J, Vandewoude KH, Lizy CM,Vogelaers DP, Blot SI; Executive Board of the Flemish Society for Critical CareNurses.

Faculty of Medicine and Health Sciences, Ghent University, Ghent, [email protected]

BACKGROUND: Prevention of surgical site infection (SSI) is an importantresponsibility for nurses. Knowledge of the related evidence-basedrecommendations is necessary to provide high-quality nursing care.AIM: Development of an evaluation tool and subsequent evaluation of intensivecare unit (ICU) nurses' knowledge of the SSI prevention guideline to identifytheir specific educational needs, as part of a needs analysis preceding thedevelopment of an e-learning module on infection prevention.METHODS: We developed a multiple-choice knowledge test concerning evidence-based SSI prevention. After expert assessment of its face and content validity, thetest was used in a survey among 809 ICU nurses. Demographics included weregender, ICU experience, number of ICU beds, and whether respondents had obtained a specialized ICU qualification. Based on the test results, an item analysis was performed.RESULTS: Face and content validity were achieved for 9 out of 10 items of thequestionnaire. From the survey, we collected 650 questionnaires (response rate80.3%). The item analysis revealed overall good results with values for itemdifficulty ranging from 0.1 to 0.5 for eight questions, while one question had a value of 0.02; discriminative values ranging from 0.27 to 0.53 and values for thequality of the response alternatives between 0.1 and 0.7. Overall, these results demonstrate the questionnaire's reliability. The nurses' mean score on the

24

knowledge test was 29%. Males were shown to have better scores.CONCLUSIONS: Opportunities exist to improve ICU nurses' knowledge about SSIprevention recommendations. Current guidelines should support their ongoingtraining and education.


43. Rev Esp Salud Publica. 2009 Jul-Aug;83(4):577-86.

[Validation of the Spanish version of the Evidence Based Practice Questionnairein Nurses].

[Article in Spanish]

de Pedro Gómez J, Morales-Asencio JM, Abad AS, Veny MB, Roman MJ, Ronda FM.

Escuela Universitaria de Enfermería y Fisioterapia, Universitat de les IllesBalears, Palma, Islas Baleares, España. [email protected]

BACKGROUND: The lack of adequate instruments prevents the possibility ofassessing the competence of health care staff in evidence-based decision makingand further, the identification of areas for improvement with tailoredstrategies. The aim of this study is to report about the validation process inthe Spanish context of the Evidence-Based Practice Questionnaire (EBPQ) fromUpton y Upton.METHODS: A multicentre, cross-sectional, descriptive psychometric validationstudy was carried out. For cultural adaptation, a bidirectional translation wasdeveloped, accordingly to usual standards. The measuring model from thequestionnaire was undergone to contrast, reproducing the original structure byExploratory Factorial Analysis (EFA) and Confirmatory Factorial Analysis (CFA),including the reliability of factors.RESULTS: Both EFA (57.545% of total variance explained) and CFA(chi(2)=2359,9555; gl=252; p < 0.0001; RMSEA=0,1844; SRMR=0,1081), detectedproblems with items 7, 16, 22, 23 and 24, regarding to the original trifactorial version of EBPQ. After deleting some questions, a reduced version containing 19items obtained an adequate factorial structure (62.29% of total varianceexplained), but the CFA did not fit well. Nevertheless, it was significantlybetter than the original version (chi(2)=673.1261; gl=149; p < 0.0001;RMSEA=0.1196; SRMR=0.0648).CONCLUSIONS: The trifactorial model obtained good empiric evidence and could beused in our context, but the results invite to advance with further refinementsinto the factor "attitude", testing it in more contexts and with more diverseprofessional profiles.


44. Worldviews Evid Based Nurs. 2010 Sep;7(3):135-57. Epub 2009 Sep 22.

Implementation of evidence-based practice in nursing using action research: areview.

Munten G, van den Bogaard J, Cox K, Garretsen H, Bongers I.

25

Fontys University of Applied Science, Eindhoven, the [email protected]

BACKGROUND: As is often reported in the literature exploring theresearch-practice gap, applying the principles of evidence-based practice iseasier said than done. Action research is a methodology with an explicit intentof linking the worlds of research and practice. This review attempts to answerthe question: What is known about implementing evidence-based practice in nursingthrough action research?APPROACH: A total of 21 action research studies have been used to answer thisquestion. To prevent possible confusion over terminology, we used a conceptualframework that distinguishes various influencing factors in terms of four target groups (ranging from the individual end user to society as a whole) at whom thestrategy is aimed and various strategies (ranging from individual feedback tocontracting care providers) related to the same four target groups.FINDINGS: Studies often failed to name the implementation strategies applied,necessitating deduction from the text by the reader. In most of the studies theimplementation strategy was directed at a combination of target groups. Many ofthe projects reviewed reported positive contextual outcomes, "knowledgeimprovement" among nurses, and to a lesser degree, improved "performance."Patient outcomes were the least reported outcome measure.CONCLUSION: With an element of caution, this review concludes that theimplementation of evidence-based practice using action research is a promisingapproach. Caution is needed because of the lack of detailed descriptions ofimplementation strategies, and their intensity and frequency prevents us fromdrawing firm conclusions. These are important considerations for any actionresearcher intending to implement EBP using this approach.


45. Worldviews Evid Based Nurs. 2010 Mar;7(1):36-50. Epub 2009 Sep 9.

Clinical nurse specialists' approaches in selecting and using evidence to improvepractice.

Profetto-McGrath J, Negrin KA, Hugo K, Smith KB.

University of Alberta, Edmonton, Alberta, [email protected]

ABSTRACT Background: Evidence-based practice (EBP) has become the desiredstandard within all health disciplines because the integration of the bestevidence into clinical practice is fundamental to optimizing patient outcomes.The valuing of research and research-based knowledge as the basis for decisionmaking is explicit in current discourse in the health sciences. Despite thedesires of proponents of EBP for use of evidence derived through research, nursesprefer to use knowledge derived from experience and social interactions. Theclinical nurse specialist (CNS) is in the ideal position to act as a link betweenevidence and practice; however, a paucity of knowledge exists on how CNSs select and use evidence in their daily practice. Purpose: The purpose of thisdescriptive, cross-sectional study was to examine the approaches used by CNSs to select and use evidence in their daily practice. Method: A telephone survey,developed for this study from a pilot study conducted by the principalinvestigator (PI), was used to elicit responses from a purposive sample of CNSsliving in a western Canadian province who were willing to be contacted for

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research, and who had practiced clinically as CNSs within the past year. Aresponse rate of 75% (n = 94) was achieved. Descriptive statistics were used todescribe and compare the variables of interest. Results: Literature tailored toparticular specialties and personal experiences were reported as the mostfrequently accessed sources of evidence. This evidence was most often used tofacilitate improvements in patient care, and least often used to develop further research proposals. Conclusion: This study indicates that although CNSs selectand use evidence from a wide variety of sources, further development of theircapacity to retrieve and transfer knowledge may increase the uptake of researchfindings in nursing practice.


46. Am J Crit Care. 2010 May;19(3):272-6. Epub 2009 Aug 17.

Critical care clinicians' knowledge of evidence-based guidelines for preventingventilator-associated pneumonia.

El-Khatib MF, Zeineldine S, Ayoub C, Husari A, Bou-Khalil PK.

Department of Anesthesiology, School of Medicine, American University of Beirut, Beirut, Lebanon.

BACKGROUND: Ventilator-associated pneumonia is the most common hospital-acquired infection among patients receiving mechanical ventilation in an intensive careunit. Different initiatives for the prevention of ventilator-associated pneumoniahave been developed and recommended.OBJECTIVE: To evaluate knowledge of critical care providers (physicians, nurses, and respiratory therapists in the intensive care unit) about evidence-basedguidelines for preventing ventilator-associated pneumonia.METHODS: Ten physicians, 41 nurses, and 18 respiratory therapists working in the intensive care unit of a major tertiary care university hospital center completedan anonymous questionnaire on 9 nonpharmacological guidelines for prevention ofventilator-associated pneumonia.RESULTS: The mean (SD) total scores of physicians, nurses, and respiratorytherapists were 80.2% (11.4%), 78.1% (10.6%), and 80.5% (6%), respectively, with no significant differences between them. Furthermore, within each category ofhealth care professionals, the scores of professionals with less than 5 years of intensive care experience did not differ significantly from the scores ofprofessionals with more than 5 years of intensive care experience.CONCLUSIONS: A health care delivery model that includes physicians, nurses, andrespiratory therapists in the intensive care unit can result in an adequate levelof knowledge on evidence-based nonpharmacological guidelines for the preventionof ventilator-associated pneumonia.


47. J Nurs Manag. 2009 May;17(4):510-8.

The Australian experience of nurses' preparedness for evidence-based practice.

Waters D, Crisp J, Rychetnik L, Barratt A.

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The College of Nursing, Burwood, Sydney, NSW 1805, [email protected]

AIM: This study aimed to determine current knowledge and attitudes towardsevidence-based practice (EBP) among pre- and post-registration nurses in NewSouth Wales (NSW), Australia.BACKGROUND: Educational and clinical strategies for EBP in nursing assume areadiness to interpret and integrate evidence into clinical care despitecontinued reports of low levels of understanding and skill in this area.METHOD: Perceptions of EBP were examined through a self-complete, anonymouspostal survey distributed to 677 (post-registration) clinical nurses and to 1134 final year (pre-registration) nursing students during 2002 and 2003.RESULTS: A completed survey was returned by 126 post-registration and 257 finalyear nursing students (combined 21% response rate). Both pre- andpost-registration nurses had a welcoming attitude towards EBP. Pre-registrationnurses expressed more confidence in their EBP skills but self-rated knowledge andskill were low to moderate in both groups.CONCLUSION: Nurses in Australia are clearly supportive of EBP but it is incorrectto assume that even recent graduates have a level of knowledge and skill that is sufficient to permit direct engagement in evidence implementation.IMPLICATIONS FOR NURSING MANAGEMENT: Among a range of clinical supports, nursemanagers and leaders can contribute to evidence-based health care byunderstanding the EBP knowledge and skills of their workforce and demanding amore practical approach in nursing education towards evidence-based guidelinesand summaries appropriate to the clinical context.


48. Worldviews Evid Based Nurs. 2009;6(2):93-101. Epub 2009 Apr 29.

Evidence-based practice: Iranian nurses' perceptions.

Adib-Hajbaghery M.

Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran. [email protected]

BACKGROUND: During the past 2 decades, evidence-based practice has increasinglybeen proven as a means of standard and higher-quality health care. Nurses whobase their practices on scientific evidence bring their clients and organization better and more cost-effective nursing care. However, little is known aboutIranian nurses' perceptions of evidence-based practice.AIMS: The present study was conducted to evaluate Iranian nurses' perceptions of evidence-based practice.METHODS: A qualitative study was conducted on 21 participants from differentgroups of nurses at Kashan University of Medical Sciences. Semi-structuredinterviews were used to gather data. Content analysis was used to analyze thedata according to the Cheevakumjorn's method.FINDINGS: Two main categories, the concept of "evidence-based nursing" and"nature and the source of evidence," emerged from the data. The participants usedthe term "standard care" as a synonym for evidence-based practice. According tothe participants, the nurses implement evidence-based practice care for clientsbased on their professional knowledge and the patient's needs. The participantsbelieved "caring evidence" includes five different types of knowledge: "knowledgeof patient,""knowledge of the environment,""learned (academic)

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knowledge,""practice-based knowledge," and "research-based knowledge." However,participants stated that, currently, the nursing practice is not based onscientific evidence.CONCLUSIONS: Nurses have a positive attitude concerning the use of scientificevidence to guide practice, but this evidence has little application in theircurrent nursing practice.IMPLICATIONS: Nurses need support from both the organizational management and theeducational system to help them apply evidence in practice.


49. J Clin Nurs. 2009 May;18(10):1442-50.

What is the relationship between nurses' attitude to evidence based practice and the selection of wound care procedures?

Dugdall H, Watson R.

Hull & East Yorkshire Hospitals NHS Trust, Hull Royal Infirmary, Hull, [email protected]

AIM: To investigate qualified nurses' attitudes to evidence-based practice andwhether this influenced their selection of wound care products.BACKGROUND: The literature shows that previous studies on attitudes toevidence-based practice tended to be part of a wider study. The general consensuswas that there was a positive attitude to evidence-based practice. However, thereappeared to be no published studies specifically addressing nurses' attitudes to evidence-based wound care.DESIGN: Survey design using a questionnaire completed by 156 qualified nursesworking in three UK National Health Trusts.RESULTS: A statistically significant difference was seen between those nurseswith a tissue viability link nurse role (p = 0.002) and those without a linknurse role; those educated to first degree (p < 0.001) and those without a first degree; and those who had received formal tissue viability training (p < 0.001)and those with informal tissue viability training. There was also a highlystatistically significant relationship between the clinical grade of staff andthe overall attitude to evidence-based practice (p < 0.001).CONCLUSIONS: Nurses who had attained a higher level academic qualification, had atissue viability link nurse role and those who had received formal tissueviability training scored generally higher in the wound care knowledge tests and in attitude to evidence-based practice.RELEVANCE TO CLINICAL PRACTICE: The care received by patients in relation towound care could be dependent upon factors that are related to the individualcharacteristics of the nurse providing the care and these factors, in turn, arerelated to education and training with respect to wound care. Better generaleducation and better specific training in wound care could lead to better woundcare.


50. World J Surg. 2009 Jul;33(7):1348-55.

Attitudes, awareness, and barriers regarding evidence-based surgery among

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surgeons and surgical nurses.

Knops AM, Vermeulen H, Legemate DA, Ubbink DT.

Department of Quality Assurance and Process Innovation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. [email protected]

BACKGROUND: Evidence-based surgery (EBS) is stressed to increase efficiency andhealth care quality, but not all surgeons and surgical nurses use EBS in clinicalpractice. To define future tailor-made interventions to improve evidence-basedbehavior, the aim of this study was to determine the attitude and awareness amongsurgeons and surgical nurses as to the paradigm of EBS and the barriersexperienced when practicing EBS.METHODS: In this cross-sectional study, surgeons and surgical nurses at auniversity hospital in Amsterdam were invited to complete the BARRIERS scale and McColl et al. questionnaire. An evidence quiz was composed for the surgeons.RESULTS: Response rates were 67% (29/43) for surgeons and 60% (73/122) fornurses. Attitudes toward EBS were positive. Among the surgeons, 90% were familiarwith EBS terms, whereas only 40% of the nurses were. Common barriers for surgeonswere conflicting results (79%, 23/29) and the methodologic inadequacy of researchreports (73%, 21/29); and for nurses they were unawareness of EBS (67%, 49/73)and unclear reported research (59%, 43/73). Only about half of the convincingevidence presented in the quiz was actually applied.CONCLUSIONS: Surgeons have a positive attitude toward EBS and are familiar withEBS terminology, but conflicting results and methodologic shortcomings ofresearch reports are major barriers to practicing EBS. Continual confrontationswith available evidence through frequent critical appraisal meetings or grandrounds and using more aggregate sources of evidence are advocated. Nurses canprobably benefit from EBS training focusing on basic skills. Finally,collaboration is needed among surgeons and nurses with the same zest about EBS.

PMCID: PMC2691930PMID: 19412569 [PubMed - indexed for MEDLINE]

51. Br J Nurs. 2009 Apr 23-May 13;18(8):484-9.

Using evidence-based practice to address gaps in nursing knowledge.

Tagney J, Haines C.

Bristol Royal Infirmary.

Implementing evidence based-practice and research findings into nursing care has been identified as a challenge to nursing staff. This article identifies keybarriers to the use of research in the international literature, however, thereare limited suggestions as to how to improve this in the clinical arena. Thisarticle aims to identify how nurses could optimize the implementation of evidenceand research into their clinical care and reviews barriers to implementing andundertaking nursing research, suggesting a framework for improvement. Itconsiders the widely varied levels of knowledge of research and equally variedcritical appraisal skills present both at a pre and post-registration nursinglevel. The authors discuss an innovative, collaborative approach that considersthe role of the nurse consultant, clinical academic and research facilitatorposts. To ensure quality evidence-based practice is implemented into clinicalnursing care a realistic and practical structure must be applied. With the

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appropriate framework, clinical structure and organizational support, promotionof evidence-based practice and research for patient benefit can be optimized. Theimplications for practice are also discussed. The implementation of a realisticresearch framework into clinical nursing practice has the potential to influence and develop a more active nursing research culture and promote evidence-basedcare within the workplace.


52. Nurs Leadersh (Tor Ont). 2009;22(1):86-98.

Nursing leaders' accountability to narrow the safety chasm: insights andimplications from the collective evidence base on healthcare safety.

Jeffs L, Macmillan K, McKey C, Ferris E.

Nursing/Clinical Research, Scientist, Keenan Research Centre, Li Ka ShingKnowledge Institute, St. Michael's Hospital, Toronto, ON, [email protected]

Challenges continue to exist in bridging the safety gap to ensure thatconsistent, high-quality nursing care is provided based on the best scientificknowledge available. This paper examines findings from nursing research presentedat the symposium Advancing Nursing Leadership for a Safer Healthcare System, heldin Toronto, Ontario in 2007. Four central themes emerged: (1) place the patientin safety; (2) generate a broader knowledge base on safety across the continuumof care; (3) create a safe culture and healthy work environment to mitigatecurrent threats to patient safety; and (4) advance translation of evidence topractice at the organizational and clinical levels. The aim of this exchange ofknowledge was to equip nursing leaders and their decision partners with evidence that can become a catalyst for mobilizing change in practice to address thesafety chasm.


53. Perspect Infirm. 2008 Sep-Oct;5(7):36-42.

[Evidence-based practice and the development of a nursing research culture].

[Article in French]

Halabi-Nassif H, Hatem M.

L'Institut de Gestion, L'Université Saint-Joseph de Beyrouth.

The article looks at the perceptions of nurses at the Hôtel-Dieu de Franceuniversity hospital (CHU-HDF) in Lebanon regarding the obstacles to and potentialbenefits of implementing an evidence-based practice. For front-line nurses, theorganization and characteristics of nurses appear to be the main obstacles to theuse of research findings, along with the quality of the research and the way the findings are communicated. To ensure its credibility as a university hospital andguarantee quality care for patients, CHU-HDF authorities should clearly statetheir commitment and support for nurses in establishing a research unit,

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simplifying access to resources (e.g. the Internet) and to scientific articles,and recognizing teams that support such a practice. It would also be a good idea to develop nurses' knowledge of research methodology and back them up in theirinitial research work. Lastly, nursing management must reconsider nurses'workload, to allow them time to consult research findings.


54. J Nurs Adm. 2009 Feb;39(2):91-7.

Organizational readiness for evidence-based practice.

Gale BV, Schaffer MA.

Hennepin County Medical Center, Minneapolis, Minnesota 55415, [email protected]

OBJECTIVE: This study explored factors that affect the adoption or rejection ofevidence-based practice (EBP) changes and differences in nurse manager and staff nurse perceptions about those factors.BACKGROUND: Roger's Diffusion of Innovations Theory explains relevantorganizational strategies for guiding practice change.METHODS: The primary author developed the Evidence-Based Practice Changes Survey consisting of 12 items, completed by 92 nurses at a level 1 trauma center.RESULTS: Top barriers to EBP were insufficient time, lack of staff, and nothaving the right equipment and supplies. Top reasons to adopt EBP were havingpersonal interest in the practice change, avoiding risk of negative consequences to the patient, and personally valuing the evidence. Several statisticallysignificant differences emerged for demographic variables.CONCLUSION: Planning for EBP change must address barriers and facilitators topractice change and emphasize the benefit for patients and value of the practice change to nurses.


55. J Am Acad Nurse Pract. 2008 Dec;20(12):585-9.

Saying "no" to professional recommendations: client values, beliefs, andevidence-based practice.

Michaels C, McEwen MM, McArthur DB.

College of Nursing, University of Arizona, Tucson, AZ 85721, [email protected]

PURPOSE: The purpose of this article is to explore the phenomenon of saying "no" to secondary prevention recommended by healthcare providers.DATA SOURCES: Extracted findings from two qualitative studies in whichparticipants have said "no" to provider recommendations for secondary prevention,specifically screening mammograms or treatment for latent tuberculosis infection,are discussed.CONCLUSIONS: Although these two studies focus on different aspects of secondaryprevention, both studies emphasize how client values and beliefs impact health

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decisions. In evidence-based practice (EBP), both scientific evidence and client values and beliefs must be considered. Nurse practitioners (NPs) have the skillset and are in a position to assist clients to mediate between their values andbeliefs and current scientific evidence.IMPLICATIONS FOR PRACTICE: Several findings from the two qualitative studies are relevant for practice: qualitative studies provide information about values andbeliefs for EBP, and findings from these particular qualitative studiesdemonstrated that women were protective about their health even though theirvalues and beliefs did not align with current scientific evidence. Through clientnarratives, NPs can facilitate clients aligning personal values and beliefs with current scientific evidence in relationship to caring for self.


56. J Adv Nurs. 2008 Dec;64(6):632-43.

Development and testing of four instruments to assess prior conditions thatinfluence nurses' adoption of evidence-based pain management practices.

Carlson C.

Northern Illinois University, DeKalb, USA. [email protected]

AIM: This paper is a report of the development and testing of the psychometricproperties of a set of four instruments measuring prior conditions influencingnurses' decisions to adopt evidence-based pain management practices.BACKGROUND: Nurses do not use evidence-based pain management practicesconsistently. Their adoption of pain management practices depends on severalprior conditions. Prior conditions are factors that influence the need to learnmore about an innovation and begin the adoption process.METHOD: Four instruments were developed, collectively known as Carlson's PriorConditions Instruments, to assess the four theoretically-derived prior conditionsof previous practice, felt needs/problems, innovativeness and norms of the socialsystem that influence nurses' decisions to adopt evidence-based pain managementpractices. Item-to-total correlations and Cronbach's alpha were used to determineinternal consistency reliability. Construct validity was examined throughprincipal components factor analysis with varimax rotation. Data were collectedas part of a larger study in 2005.RESULTS: Content validity of the four instruments was supported through review byexperts. The instruments were distributed to nurses (n = 187). Each instrumentdemonstrated internal consistency (alpha range = 0.731-0.825). Factor analysisdemonstrated that the Felt Needs/Problems and Norms of the Social SystemInstruments were unidimensional, with six and seven items respectively. ThePrevious Practice Instrument (11 items, three factors) and InnovativenessInstrument (six items, two factors) were multidimensional.CONCLUSION: Initial psychometric testing revealed adequate estimates ofreliability and validity for Carlson's Prior Conditions Instruments. Furtherresearch is needed using the tools with nurses in different countries andcultures to test and confirm the constructs.


57. Worldviews Evid Based Nurs. 2008;5(4):193-204.

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Ventilator-associated pneumonia bundled strategies: an evidence-based practice.

O'Keefe-McCarthy S, Santiago C, Lau G.

CIHR/CHSF FUTURE Program for Cardiovascular Nurse Scientists, University ofToronto, Ontario, Canada. [email protected]

BACKGROUND: Ventilator-associated pneumonia (VAP) is an ongoing challenge forcritical care nurses as they use current evidence-based strategies to decreaseits incidence and prevalence. Mechanical intubation negates effective coughreflexes and impedes mucociliary clearance of secretions, causing leakage andmicroaspiration of virulent bacteria into the lungs. VAP is responsible for 90%of nosocomial infections and occurs within 48 hours of intubation. VAP is a majorhealth care burden in terms of mortality, escalating health care costs, increasedlength of ventilator days and length of hospital stay.AIM: (1) To provide a review of the literature on VAP bundle (VAPB) practices.(2) To describe the etiology and risk factors and define bundled practices. (3)To discuss an explanatory framework that promotes knowledge translation of VAPBs into clinical settings. (4) To identify areas for further research andimplications for practice to decrease the incidence of VAP.METHODS: Electronic searches in MEDLINE, EMBASE, CINAHL, PsycINFO, and CochraneCollaboration were conducted using keywords specific to VAP. The inclusioncriteria were: (1) Studies were original quantitative research published in anEnglish peer-reviewed journal for the years 1997 to 2007. (2) Each study includedan examination of bundled practices. (3) The clinical outcomes of critically ill adults with VAP were assessed. The studies were identified from thebibliographies of key references. Six studies were accepted based on theinclusion criteria. Each contributing author conducted the review and analysis ofselected studies independently. The findings were compared and contrasted by all authors to establish consensus.RESULTS: Evidence shows that VAPB practices decrease VAP rates. Bundled practicesresult in decreased ventilator days, intensive care unit length of stay, andmortality rates. A strong association was seen, with an increased cliniciancompliance with VAPB protocols with decreased VAP rates.CONCLUSIONS AND IMPLICATIONS: Methodologically robust randomized controlledtrials are required to examine the efficacy of VAPBs and determine causalitybetween VAPBs and clinical outcomes. Organizational commitment is needed to adopta conceptual framework that promotes effective knowledge translation,incorporating factors of evidence, context, and facilitation of VAPBs intoclinical settings. Instituting nurse-led intervention champion leaders tofacilitate reliable and consistent implementation of VAPBs into practice iswarranted.



Determining registered nurses' readiness for evidence-based practice.

Thiel L, Ghosh Y.

University of Detroit Mercy, Detroit, Michigan, USA. [email protected]

BACKGROUND: As health care systems worldwide move toward instituting

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evidence-based practice (EBP), its implementation can be challenging. Conducting a baseline assessment to determine nurses' readiness for EBP presentsopportunities to plan strategies before implementation. Although a growing bodyof research literature is focused on implementing EBP, little attention has been paid to assessing nurses' readiness for EBP.OBJECTIVE: The purpose of this study was to assess registered nurses' readinessfor EBP in a moderate-sized acute care hospital in the Midwestern United Statesbefore implementation of a hospital-wide nursing EBP initiative.DESIGN AND METHODS: A descriptive cross-sectional survey design was used; 121registered nurses completed the survey. The participants (n= 121) completed the64-item Nurses' Readiness for Evidence-Based Practice Survey that allowedmeasurement of information needs, knowledge and skills, culture, and attitudes.Data were analyzed using descriptive statistics and a post hoc analysis.RESULTS: The majority (72.5%) of respondents indicated that when they neededinformation, they consulted colleagues and peers rather than using journals andbooks; 24% of nurses surveyed used the health database, Cumulative Index toNursing & Allied Health Literature (CINAHL). The respondents perceived their EBP knowledge level as moderate. Cultural EBP scores were moderate, with unit scores being higher than organizational scores. The nurses' attitudes toward EBP werepositive. The post hoc analysis showed many significant correlations.CONCLUSIONS AND IMPLICATIONS: Nurses have access to technological resources andperceive that they have the ability to engage in basic information gathering but not in higher level evidence gathering. The elements important to EBP such as aworkplace culture and positive attitudes are present and can be built upon. A"site-specific" baseline assessment provides direction in planning EBPinitiatives. The Nurses' Readiness for EBP Survey is a streamlined tool withestablished reliability and validity.


59. J Adv Nurs. 2009 Feb;65(2):371-81. Epub 2008 Nov 27.

Nursing practice, knowledge, attitudes and perceived barriers to evidence-basedpractice at an academic medical center.

Brown CE, Wickline MA, Ecoff L, Glaser D.

UCSD Medical Center, University of California, San Diego, [email protected]

AIM: This paper is a report of a study to describe nurses' practices, knowledge, and attitudes related to evidence-based nursing, and the relation of perceivedbarriers to and facilitators of evidence-based practice.BACKGROUND: Evidence-based practice has been recognized by the healthcarecommunity as the gold standard for the provision of safe and compassionatehealthcare. Barriers and facilitators for the adoption of evidence-based practicein nursing have been identified by researchers. Healthcare organizations havebeen challenged to foster an environment conducive to providing care based onevidence and not steeped in ritualized practice.METHODS: A descriptive, cross-sectional research study was conducted in 2006-2007with a convenience sample of 458 nurses at an academic medical center inCalifornia (response rate 44.68%). Two reliable and valid questionnaires wereelectronically formatted and administered using a secured website. Relationships between responses to the two instruments were examined and results compared with previously published data.

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RESULTS: Organizational barriers (lack of time and lack of nursing autonomy) werethe top perceived barriers. Facilitators were learning opportunities, culturebuilding, and availability and simplicity of resources. Statistically significantcorrelations were found between barriers and practice, knowledge and attitudesrelated to evidence-based practice.CONCLUSION: Similar barriers to the adoption of evidence-based practice have beenidentified internationally. Educators must work with managers to addressorganizational barriers and proactively support evidence-based practice.


60. J Adv Nurs. 2009 Feb;65(2):337-47. Epub 2008 Nov 6.

How evidence-based is venous leg ulcer care? A survey in community settings.

Van Hecke A, Grypdonck M, Beele H, De Bacquer D, Defloor T.

Department of Public Health-Nursing Science, Faculty of Medicine and HealthSciences, Ghent University, Belgium. [email protected]

Republished in Nurs Times. 2009 Mar 3-9;105(8):24.

AIM: This paper is a report of a study to describe venous leg ulcer careregarding compression, pain management and lifestyle advice in community settingsand to identify factors that predict the provision of lifestyle advice by nurses.BACKGROUND: Incongruence between evidence and practice in leg ulcer care has beenreported. Little is known about predictive factors related to the provision oflifestyle advice.METHOD: Two focus interviews and a Delphi procedure were used to develop aself-administered questionnaire based on the Graham questionnaire. Nursesemployed by community healthcare organizations and independent nurses in private practices participated (n = 789). The data were collected in 2006.FINDINGS: Compression was applied in 58.7% of patients with venous ulcers. Painwas present in 82.9%. A third of patients with pain received analgesics, but halfof these patients (52.1%) took analgesics as prescribed. Half of the nurses(50.8%) gave lifestyle advice related to the leg ulcer. It was mainlyinstructions about leg elevation (68.3%), promoting physical activity (39.8%) andoptimizing nutrition (16.7%) that were provided. Nurses who perceived themselves to have adequate leg ulcer knowledge and skills were 3.75 times more likely toprovide lifestyle advice compared with those lacking such knowledge and skills.Nurses who found leg ulcer care not rewarding, rarely successful or difficultgave statistically significantly less lifestyle advice than those who found itrather rewarding, successful and not difficult.CONCLUSION: Patients with leg ulcers receive less than optimum care and patienteducation. A particular challenge lies in leg ulcer education programmes and painmanagement.


61. J Nurs Adm. 2008 Nov;38(11):494-503.

Nurses' skill level and access to evidence-based practice.

36

Cadmus E, Van Wynen EA, Chamberlain B, Steingall P, Kilgallen ME, Holly C,Gallagher-Ford L.

Organization of Nurse Executives of New Jersey, Englewood Hospital and MedicalCenter, New Jersey, USA. [email protected]

Integrating evidence-based practice into the culture of an acute care hospitalrequires assessment, planning, and intervention by nursing leadership. Theauthors discuss a statewide study that assessed the skill level of nurses inobtaining evidence for their nursing practice, using computers and databases, as well as evaluating the perceived availability of resources in their hospitals to access evidence.


62. Nurs Econ. 2008 Sep-Oct;26(5):319-22.

Resourcing evidence-based practice in ambulatory care nursing.

Haas SA.

Niehoff School of Nursing, Loyola University, Chicago, IL, USA.

Ambulatory care nurses may benefit from not only developing knowledge and skills in evidence-based practice (EBP), but also in identifying and providingsufficient resources for EBP to be implemented and sustained. Organizationsshould select one of the five conceptual models available in the literature toguide development and implementation of EBP. Costs of implementing and sustainingEBP include expert consultation, facilitators, staff time, informatician time,and data management. Benefits of EBP include improvements in patient care qualityand safety, as well as regulatory compliance and risk management. Resourcessupporting EBP include professional literature available via the Internet anddatabases or agencies, such as ARHQ, professional organizations, and fundingthrough grants.


63. N Z Med J. 2008 Oct 3;121(1283):51-8.

Evidence-based resource use by practice nurses in the Greater Auckland region of New Zealand.

Hoare KJ, Steele J, Ram FS, Arroll B.

Goodfellow Unit, School of Nursing, ProCare Department of General Practice andPrimary Health Care, School of Population Health, The University of Auckland,Private Bag 92019, Auckland, New Zealand. [email protected]

AIM: To determine self-reported use of New Zealand's Guidelines Group (NZGG) and BPAC resources by practice nurses (PNs) in the Greater Auckland area of NewZealand.METHOD: A postal survey of all PNs registered on the University of Auckland's

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Department of General Practice and Primary Health Care's database.RESULTS: A total of 419 of 917 (46%) PNs working in 280 general practicesreturned completed questionnaires. The majority of PNs did not use either theNZGG (53%) or BPAC guidelines (57%) and 35% did not use any evidence resources.The main reason these resources were not used was lack of knowledge about them,one-third of PNs had never heard of NZGG guidelines and 42% had never heard ofBPAC guidelines. Of those who knew of NZGG guidelines, 74% found them useful, (a 'fair amount' or 'very') and 94% found BPAC guidelines useful (a 'fair amount' or'very'). When PNs knew of these resources, 74% used NZGG guidelines and 69% used BPAC guidelines for patient care.CONCLUSION: PNs who knew of New Zealand Guidelines and BPAC found them useful in patient management. Practice nurses are not routinely on the mailing list ofthese two organisations. Strategies to increase PN awareness of these publiclyfunded evidence-based resources may increase their use and thus contribute to thereduction in health inequalities between ethnic groups in New Zealand.


64. J Nurs Manag. 2008 Sep;16(6):682-91.

Achieving evidence-based nursing practice: impact of the Caledonian DevelopmentModel.

Tolson D, Booth J, Lowndes A.

School of Nursing, Midwifery & Community Health, Glasgow Caledonian University,Glasgow, UK. [email protected]

AIM: To determine the impact of the Caledonian Development Model, designed topromote evidence-based practice.BACKGROUND: The model features practice-development activities, benchmarking,knowledge pooling and translation through membership of a community of practiceand a virtual college.METHODS: Twenty-four nurses, from 18 practice sites formed three communities ofpractice, each selecting evidence-based guidance to implement. A modified groupsupervision framework empowered nurses to champion local implementation. Outcomeswere determined at 6 months.RESULTS: Eighty per cent of the patient-related criteria and 35% of thefacilities criteria were achieved. The Revised Nursing Work Index indicated thesenurses experienced greater autonomy (P = 0.019) and increased organizationalsupport (P = 0.037). Focus groups revealed a deepening organizational support forthe initiative over time, illuminated work-based learning challenges and overall enthusiasm for the approach.CONCLUSION: Implementation of the model effectively promoted evidence-basedpractice, most notably at the level of the individual patient.IMPLICATIONS FOR NURSING MANAGEMENT: Time and budgetary constraints necessitatesmart, value for money approaches to developing evidence-based practice andimproved care standards. This work demonstrates an effective model that strikes abalance between individual and group learning, virtual and real-time activities, coupled with resource pooling across organizations and sectors.


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65. J Contin Educ Nurs. 2008 Sep;39(9):402-6.

Advancing evidence-based practice: a program series.

Soukup M, McCleish J.

Mercy Medical Center-The Iowa Heart Hospital, Des Moines, Iowa 50314, USA.

The call to evidence-based practice (EBP) is evolving and empowers nurses to forminnovative learning partnerships with colleagues to nourish wisdom, strengthencritical thinking, integrate research knowledge, and celebrate contributions inleading best practice. Based on clinician interest, Advancing Evidence-BasedPractice: A Program Series was designed for nurses to showcase initiatives using Mercy Nursing's EBP Model. Mentoring guides their efforts. This opportunitycreates learning partnerships that encourage participants to reflect about their practice and network with colleagues about what is important for clinicalexcellence. It also nurtures professional growth in research development andformal presentations.


66. J Hosp Infect. 2008 Oct;70(2):180-5. Epub 2008 Aug 23.

Evidence-based guidelines for the prevention of ventilator-associated pneumonia: results of a knowledge test among European intensive care nurses.

Labeau S, Vandijck D, Rello J, Adam S, Rosa A, Wenisch C, Bäckman C, Agbaht K,Csomos A, Seha M, Dimopoulos G, Vandewoude KH, Blot S; EVIDENCE studyinvestigators.

Collaborators: Adam S, Agbaht K, Bäckman C, Blot S, Borg M, Csomos A, Dimopoulos G, Dumpis U, Fawcett J, Gastmeier P, Geffers C, Harden S, Ioanna S, Jaklic A,Jurca T, Kasanen A, Kolar M, Labeau S, Luiking ML, Macor A, Mäkelä T, Manno EP,Marianthi G, Norrenberg M, Parkel A, Piner AR, Pujate E, Rello J, Ritmala-CastrénM, Rosa A, Seha M, Sierra R, Sølje P, Katsioulas T, Vandewoude K, Vandijck D,Vosylius S, Wenisch C, Xuereb D, Zahorec R.

Faculty of Healthcare, University College Ghent, Ghent, [email protected]

As part of a needs analysis preceding the development of an e-learning platformon infection prevention, European intensive care unit (ICU) nurses were subjectedto a knowledge test on evidence-based guidelines for preventingventilator-associated pneumonia (VAP). A validated multiple-choice questionnaire was distributed to 22 European countries between October 2006 and March 2007.Demographics included nationality, gender, ICU experience, number of ICU beds andacquisition of a specialised degree in intensive care. We collected 3329questionnaires (response rate 69.1%). The average score was 45.1%. Fifty-fivepercent of respondents knew that the oral route is recommended for intubation;35% knew that ventilator circuits should be changed for each new patient; 38%knew that heat and moisture exchangers were the recommended humidifier type, but only 21% knew that these should be changed once weekly; closed suctioning systemswere recommended by 46%, and 18% knew that these must be changed for each newpatient only; 51% and 57%, respectively, recognised that subglottic drainage and kinetic beds reduce VAP incidence. Most (85%) knew that semi-recumbent

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positioning prevents VAP. Professional seniority and number of ICU beds wereshown to be independently associated with better test scores. Further researchmay determine whether low scores are related to a lack of knowledge, deficienciesin training, differences in what is regarded as good practice, and/or a lack ofconsistent policy.


67. Can J Nurs Res. 2008 Jun;40(2):94-114.

Implementation of a two-part unit-based multiple intervention: movingevidence-based practice into action.

Rashotte J, Thomas M, Grégoire D, Ledoux S.

Children's Hospital of Eastern Ontario, Ottawa, Canada. [email protected]

This study examined the impact of a 2-part unit-based multiple intervention onthe use by pediatric critical care nurses of best practice guidelines forpressure-ulcer prevention. A total of 23 nurses participated in arepeated-measures design pre- and post-intervention to address 2 questions: Isthere a difference in nurses' evidence-based practices following implementationof an educational intervention only versus implementation of both an educational and an innovative intervention? Are the changes sustained 6 months aftercompletion of the intervention? A significant change occurred in theimplementation of 2 of 11 recommended practices following both interventions:assessment of risk of pressure ulcers using an age-appropriate tool (p < or =0.001), and the documentation of same (p < or = 0.001). These changes may havebeen sustained. The findings bring to light the real challenges encountered when attempting to implement and evaluate multiple knowledge translation strategiesassociated with complex best practice guidelines in clinical practice.


68. Nurse Res. 2008;15(4):51-67.

Evidence-based nursing practice: what US nurse executives really think.

Sredl D.

University of Missouri at St Louis, St Louis, MO, USA.

This article by Darlene Sredl considers qualitative statements from US nurseexecutives about their belief in and implementation of evidence-based nursingpractice. Their statements suggest uncertainty about the way forward.


69. AMIA Annu Symp Proc. 2007 Oct 11:423-7.

Clinician adoption patterns and patient outcome results in use of evidence-based

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nursing plans of care.

Kim TY, Lang NM, Berg K, Weaver C, Murphy J, Ela S.

University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA.

Delivery of safe, effective and appropriate health care is an imperative facinghealth care organizations globally. While many initiatives have been launched in a number of countries to address this need from a medical perspective, a similar focus for generating evidence-based nursing knowledge has been missing. Thispaper reports on a collaborative evidence-based practice (EBP) researchinitiative that adds nursing knowledge into computerized care protocols. Here, a brief overview of the study's aims, purpose and methodology is presented as well as results of data analysis and lessons learned. The research team examinednurses' adoption patterns of EBP recommendations with respect to activitytolerance using four-month patient data collected from a pilot hospital. Studyfindings indicate a need for more focus on the system design and implementationprocess with the next rollout phase to promote evidence-based nursing practice.

PMCID: PMC2655848PMID: 18693871 [PubMed - indexed for MEDLINE]

70. J Nurses Staff Dev. 2008 Jul-Aug;24(4):E13-9.

Increasing knowledge level of evidence-based nursing through self-directedlearning: lessons learned for staff development.

Zadvinskis IM.

Riverside Methodist Hospital, Columbus, Ohio 43214, USA. [email protected]

Recent literature and Magnet standards emphasize the promotion of evidence-based practice in nursing. Nurses prepared over 5 years ago may not necessarily havereceived education regarding the principles of evidence-based practice.Therefore, an independent study was developed to educate staff nurses regardingthe basics of evidence-based practice. The development of a self-directedindependent study is described, including the rationale, benefits, coursecontent, and lessons learned when teaching evidence-based practice throughself-directed learning.



Effectiveness of a computer-based educational program on nurses' knowledge,attitude, and skill level related to evidence-based practice.

Hart P, Eaton L, Buckner M, Morrow BN, Barrett DT, Fraser DD, Hooks D, SharrerRL.

Clinical Onboarding, Organizational Learning, Wellstar Health System, 2000 ParkPlace, Atlanta, GA, USA. [email protected]

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PURPOSE: To conduct a baseline assessment of nurses' perceptions of knowledge,attitude, and skill level related to evidence-based practice (EBP) and researchutilisation; determine the level of organisational readiness for implementing EBPand research; and examine the effectiveness of a computer-based educationalprogram on nurses' perceptions of knowledge, attitude, and skill level related toEBP and research utilisation.DESIGN: A descriptive, quasi-experimental design with a one-group,pre-intervention survey, intervention, and post-intervention survey method wasused. A convenience sample of 744 nurses working in an integrated health caresystem was recruited. The study was conducted from May 2006 through November2006.METHODS: Data collection instruments were a demographic data questionnaire andthe Evidence-Based Nursing Questionnaire. An education intervention on principlesof EBP and research utilisation was conducted via three computer-based learningmodules.FINDINGS: Statistically significant differences in perceptions of knowledge,attitude, and skill level, as well as beliefs about organisational readiness werefound after nurses participated in the computer-based education intervention.Although nurses indicated having positive attitudes about using research tosupport best nursing practice, gaps in knowledge and skills in retrievingresearch publications, evaluating the evidence, and incorporating the evidenceinto practice remain. Nurses rated their managers, senior nursing administrators,and staff nurses on their unit higher than hospital managers in supportingchanges to practice based on research.CONCLUSIONS: Nurses in clinical settings need to be able to use research findingsand incorporate EBP into their nursing practice to promote positive patientoutcomes. Appropriate organisational infrastructures are essential for promoting EBP and research utilisation in clinical settings. Diverse and effective methods are essential in educating and engaging nurses in EBP and research utilisation.Computer-based education is an effective approach that can be used by nursingleaders in health care organisations to educate and engage nurses in EBPinitiatives and research utilisation.


72. Dimens Crit Care Nurs. 2008 Mar-Apr;27(2):74-82; quiz 83-4.

Barriers and facilitators to the use of evidence-based best practices.

Leasure AR, Stirlen J, Thompson C.

University of Oklahoma College of Nursing, USA. [email protected]

The continued use of healthcare interventions without an evidence base increases healthcare costs without positively impacting patient care outcomes. Reportsdisseminated by bodies such as the Institute of Medicine and initiatives such as the Institute for Health Care Improvement's 5 Million Lives Campaign haveincreased emphasis on improving outcomes. Results of a descriptive correlational study indicated that 64% of the nurses surveyed read 7 or more specialtyjournals, 53% read 1 or more general nursing journal, 20% did not regularly read any professional journal, and none of the nurses surveyed read a journal that wasprimarily dedicated to the publication of original research. Almost half of thenurses indicated that the hospital library was the nearest location to conductsearches, and 34% indicated that they did not know what literature-searchingcapabilities were available to them. Although knowledge in itself is not

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sufficient for behavior change, it is an essential prerequisite. Regular reading of journals either through personal subscriptions or access through facilitylibraries can encourage the adoption of new evidence through lifelong learning.Modeling and skill building in use of readily available Internet resources canserve as a mechanism to increase awareness of and skill in accessing currentinformation. Evidence-based changes can then be empirically examined,implemented, and evaluated in examining nursing's contribution to the dailyoperation of the healthcare organization.


73. J Clin Nurs. 2008 Jun;17(12):1652-9.

Defining an evidence-based work environment for nursing in the USA.

Kotzer AM, Arellana K.

The Children's Hospital, Aurora, and University of Colorado at Denver and Health Sciences Center, School of Nursing, Aurora, CO, USA. [email protected]

AIMS: To describe and compare staff nurses' perceptions of their real and idealwork environment in a tertiary paediatric facility; to provide administratorswith research evidence for identifying areas for improvement.BACKGROUND: The workforce shortage of hospital nurses is a global problem having an impact on the financial resources and efficient operations of an organisation and the quality of care delivered to patients. A direct relationship existsbetween job satisfaction, retention, turnover and elements of the nurses' workenvironment. Research identifying specific elements of the current work settingthat are in conflict with nurses' views of their preferred practice milieu canhelp define an evidence-based work environment for nursing.DESIGN AND METHODS: Using a descriptive survey design, a convenience sample of385 nurses on five inpatient units and the float team completed two forms (realand ideal) of the work environment scale. The work environment scale consists of 10 subscales within three dimensions: relationship, personal growth and systemmaintenance and change.RESULTS: A consistent pattern was seen across all units with reported high levelsof involvement, peer cohesion, task orientation and managerial control. Scoresfor work pressure and autonomy were moderate-high and physical comfort,supervisor support, clarity and innovation were moderate. Overall, highest scoreswere reported for involvement and lowest for physical comfort. Significantdifferences were found between real and ideal subscale scores suggesting thatstaff were able to identify areas for improvement.CONCLUSIONS: Despite moderate work pressure, staff affirmed a highly positivework environment on their units. Specific areas in their current work settingthat were not congruent with their preferred work environment were identified andtargeted for change.RELEVANCE TO CLINICAL PRACTICE: Understanding dimensions of the nurses' workenvironment needing improvement and involving staff in making and evaluatingchange supports an evidence-based environment to attract and retain qualifiedstaff.


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74. Orv Hetil. 2008 May 18;149(20):929-34.

[Intensive care nurses' knowledge about the evidence-based guidelines ofpreventing central venous catheter related infection].

[Article in Hungarian]

Csomós A, Orbán E, Konczné Réti R, Vass E, Darvas K.

Semmelweis Egyetem, Altalános Orvostudományi Kar I. Sebészeti Klinika BudapestUlloi út 78. 1082. [email protected]

OBJECTIVES: To determine intensive care unit (ICU) nurses' knowledge ofevidence-based guidelines for preventing central venous catheter (CVC) relatedinfection.METHOD: We used a validated multiple-choice questionnaire which was distributedto intensive care units between October and December 2006. We collecteddemographic data, like gender, years of ICU experience, number of ICU beds andwhether respondents hold a special degree in intensive care.RESULTS: We collected 178 questionnaires from 11 intensive care units; the meanscore was 3.66 on 10 questions (37%). Eighteen per cent knew that CVCs should be replaced on indication only, and 61% knew that this recommendation concerns also replacement over a guidewire. Recommendations for replacing pressure transducers and tubing every 4 days, and for using coated devices in patients requiring a CVC< 5 days in settings with high infection rates were recognized only by 48% and66%, respectively. Regarding CVC dressings, 15% knew that these should be changedonly when indicated and at least once weekly, and 35% recognized that bothpoly-urethane and gauze dressings can be recommended. Only 20% checked 2% aqueouschlorhexidine as recommended disinfection solution; 14% knew antibiotic ointmentsare not recommended because they trigger resistance. The recommendation toreplace administration sets within 24 hours after administering lipid emulsionswas recognized by 85%, but it was known by 5% only that these sets should bereplaced every 96 hours when administering neither lipid emulsions nor bloodproducts. Professional seniority and the number of intensive care beds in the ICUwhere nurses work showed not to be associated with better scores on the test.DISCUSSION: Knowledge regarding CVC-related infection is poor among Hungariannurses. Prevention guidelines should be included in the nurse educationcurriculum as well as in continuing refresher nursing education programs.


75. J Contin Educ Nurs. 2008 Apr;39(4):166-72.

Nurses reclaiming ownership of their practice: implementation of anevidence-based practice model and process.

Reavy K, Tavernier S.

Boise State University, Department of Nursing, Boise, Idaho 83725-1840, USA.

This article describes a new model and process to implement evidence-basedpractice. This model builds on concepts from the Iowa Model of Evidence-BasedPractice, the Stetler model, and Rosswurm and Larrabee's model. The new modelfocuses on the centrality and involvement of staff nurses in makingevidence-based practice clinical changes. Two figures illustrate the model and

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the implementation process. A detailed case study based on the model is included.Barriers identified in the literature review are addressed in the case study.Implementation of this model creates opportunities for staff nurses to recognize ownership of their practice and their role in changing the practice setting to a culture of evidence-based practice.


76. Int J Palliat Nurs. 2008 Jan;14(1):45-7.

A question of evidence: decision-making in palliative care nursing.

Murray MA.

University of Ottawa, Ottawa, Ontario, Canada. [email protected]

Nurses are urged to integrate research evidence into their practice. Currentperspectives of evidence-based practice promote a hierarchy of empiricalevidence. Notwithstanding the contribution of empirical knowledge, this approach constrains our understanding of the value and contribution of other forms ofknowledge. Shifting to a model of 'evidence informed practice', where multipleforms of knowledge are considered and valued, may better reflect the complexitiesof end-of-life care and offer a fuller understanding of palliative care nursingbest practice.


77. J Nurs Manag. 2008 May;16(4):440-51.

Tensions and contradictions in nurses' perspectives of evidence-based practice.

Rolfe G, Segrott J, Jordan S.

School of Health Science, Swansea University, UK.

AIM: To explore nurses' understanding and interpretation of evidence-basedpractice (EBP).BACKGROUND: EBP has been welcomed into the nursing lexicon without a criticalexamination of its interpretation by practitioners. The literature suggests that there is a great deal of confusion and contradiction over the meaning andapplication of EBP. Although work has been conducted on how EBP might beimplemented, the general issue of how nurses understand and use EBP is largelyunexplored. This paper seeks to examine in depth the understandings of EBP, toenable managers, educationalists and policy makers to implement it moreeffectively.METHODS: All registered nurses, midwives and health visitors in one UK NationalHealth Service (NHS) Trust were asked to complete a questionnaire in October2006.RESULTS: Despite a disappointing response rate (8.9%, 218/2438), the surveyrevealed interesting tensions and contradictions in nurses' understanding of EBP.National and local guidelines, practitioners' own experience and patients'preferences were the main influences on nurses' practice. Published research had relatively little impact, particularly among nurses graded E, F and G and those

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who had not attended a study day on EBP.CONCLUSIONS: The hierarchies of evidence propounded in local and nationalguidelines are not adopted by practising nurses, who use other sources ofevidence, such as reflection on their own experiences, when making clinicaldecisions. However, subsuming published evidence to clinical judgement does notcontradict the original tenets of EBP.IMPLICATIONS FOR NURSING MANAGEMENT: Unless it is incorporated into national orlocal guidelines, research has relatively little impact on practice. To developnursing practice and nursing knowledge, nurse leaders need to foster thesynthesis of experiential knowledge and published research, in accordance withthe founding principles of the EBP movement.


78. J Adv Nurs. 2008 Apr;62(2):209-15.

Nurses' perceptions of evidence-based nursing practice.

Koehn ML, Lehman K.

School of Nursing, Wichita State University, Wichita, Kansas, [email protected]

AIM: This paper is a report of a study to investigate Registered Nurses'perceptions, attitudes and knowledge/skills associated with evidence-basedpractice.BACKGROUND: Evidence-based practice has emerged as a marker for healthcarequality. Previous studies have primarily used researcher-developed descriptivesurveys to examine nurses' perceptions, as well as facilitators and barriers,related to evidence-based practice. Research suggests the value of understanding the organizational context prior to taking steps to implement evidence-basedpractice.METHODS: This study, conducted in 2006, had a descriptive, cross-sectional surveydesign using a psychometrically-validated measure of evidence-based practice. AllRegistered Nurses (n = 1031) employed by a large medical centre in the UnitedStates of America were asked to complete the questionnaires. The final responserate was 40.9% (n = 422).FINDINGS: Participants had moderate scores on practice and attitudes towardsevidence-based practice. The knowledge/skills mean scores were somewhat lower.Statistically significant differences were found for attitudes between those withbaccalaureate and higher education compared to those with associate and diplomaeducation. The two most cited barriers to implementing evidence-based practicewere time and knowledge.CONCLUSION: The findings suggest the value of a methodical assessment whendeveloping a systematic plan for implementing an institutional culture ofevidence-based practice.


79. Crit Care Nurs Q. 2008 Apr-Jun;31(2):150-60.

An evidence-based evaluation of tracheostomy care practices.

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Dennis-Rouse MD, Davidson JE.

Emergency Department, Palomar Pomerado Health, Escondido, California 92025, USA. [email protected]

Adverse outcomes related to tracheal occlusion and peritracheal skin breakdownstimulated a review of tracheostomy care. An evidence-based practice approach wastaken to evaluate the problem. Organizational tracheostomy care policies werereviewed. Subcategories related to tracheostomy care were queried includingsecuring devices, sutures and their removal, type and choice of dressings,prevention of skin breakdown, frequency of care and role delineation, andsuctioning. A literature review was done. National experts were surveyed. Ageographical survey was taken and vendors of tracheostomy products wereinterviewed. Collected evidence was scored along a continuum. Costs of supplieswere evaluated. Physicians, staff, and patients were interviewed. Skin macerationon the neck was found on multiple audits. The type of tie was identified as aproblem. Nurses and respiratory therapists reported difficulty providingtracheostomy care due to suturing technique and securing methods. The stockeddressing was too large to fit under sutures. Several conflicting policies existedregarding tracheostomy care, none of which identified responsibility forperforming care: respiratory versus nursing or time standards for care. Newsupplies were trialed. A list of practice changes were agreed upon byrespiratory, nursing, and medical staff. Primary responsibility for tracheostomy care was shifted to the registered nurse.


80. J Adv Nurs. 2008 Apr;62(1):62-73.

Developing evidence-based practice: experiences of senior and junior clinicalnurses.

Gerrish K, Ashworth P, Lacey A, Bailey J.

Centre for Health & Social Care Research, Sheffield Hallam University/SheffieldTeaching Hospitals NHS Foundation Trust, Sheffield, UK. [email protected]

AIM: This paper is a report of a study to compare factors influencing thedevelopment of evidence-based practice identified by junior and senior nurses.BACKGROUND: Assessing factors influencing the achievement of evidence-basedpractice is complex. Consideration needs to be given to a range of factorsincluding different types of evidence, the skills nurses require to achieveevidence-based practice together with barriers and facilitators. To date, little is known about the relative skills of junior and senior clinical nurses inrelation to evidence-based practice.METHOD: A cross-sectional survey was undertaken at two hospitals in England,using the Developing Evidence-Based Practice Questionnaire administered toRegistered Nurses (n = 1411). A useable sample of 598 (response rate 42%) wasachieved. Data were collected in 2003, with comparisons undertaken between juniorand senior nurses.FINDINGS: Nurses relied heavily on personal experience and communication withcolleagues rather than formal sources of knowledge. All respondents demonstrated confidence in accessing and using evidence for practice. Senior nurses were more confident in accessing all sources of evidence including published sources andthe Internet, and felt able to initiate change. Junior nurses perceived more

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barriers in implementing change, and were less confident in accessingorganizational evidence. Junior nurses perceived lack of time and resources asmajor barriers, whereas senior nurses felt empowered to overcome theseconstraints.CONCLUSION: Senior nurses are developing skills in evidence-based practice.However, the nursing culture seems to disempower junior nurses so that they areunable to develop autonomy in implementing evidence-based practice.


81. J Prof Nurs. 2008 Jan-Feb;24(1):7-13.

Nurse practitioner educators' perceived knowledge, beliefs, and teachingstrategies regarding evidence-based practice: implications for accelerating theintegration of evidence-based practice into graduate programs.

Melnyk BM, Fineout-Overholt E, Feinstein NF, Sadler LS, Green-Hernandez C.

Arizona State University College of Nursing & Healthcare Innovation, Phoenix, AZ 85004, USA. [email protected]

The paradigm shift to evidence-based practice (EBP) in the United States has beenslow. Evidence has supported that one barrier to accelerating this paradigm shiftis that many nurses have negative attitudes toward research, in large part due tothe manner in which they were taught research in their educational programs. The primary aims of this study were to (a) describe nurse educators' knowledge,beliefs, and teaching practices regarding EBP; (b) determine whetherrelationships exist among these variables; and (c) describe major barriers andfacilitators to the teaching of EBP in nurse practitioner curriculums. Adescriptive survey was conducted with a sample of 79 nurse practitioner educatorswho are members of the Association of Faculties of Pediatric Nurse Practitioners (AFPNP) and the National Organization of Nurse Practitioner Faculties (NONPF).The 25 AFPNP participants completed the survey while attending a nationalconference in Orlando, FL. The remaining 54 NONPF randomly selected participants responded to an e-mail version of the survey. Participants' self-reportedknowledge and beliefs about the benefits of EBP and the need to integrate it intoacademic curricula were strong, although their responses indicated a knowledgegap in EBP teaching strategies. Few academic programs offered a foundationalcourse in EBP. Significant relationships were found among educators' knowledge ofEBP and (a) their beliefs that EBP improves clinical care, (b) beliefs thatteaching EBP will advance the profession, (c) how comfortable they feel inteaching EBP, and (d) whether EBP clinical competencies are incorporated intoclinical specialty courses. CONCLUSION AND IMPLICATIONS: Graduate programs needto offer a foundational course in EBP and integrate EBP throughout clinicalspecialty courses in order for advanced practice nurses to implement this type ofcare upon entry into practice. There is a need to educate faculty to becomeproficient in EBP as knowledge of EBP is highly related to its teaching andincorporation into graduate education. Further research is needed to describe theknowledge and state of teaching EBP in graduate faculty who are not active inclinical practice.


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82. Am J Crit Care. 2008 Jan;17(1):65-71; quiz 72.

Critical care nurses' knowledge of evidence-based guidelines for preventinginfections associated with central venous catheters: an evaluation questionnaire.

Labeau S, Vereecke A, Vandijck DM, Claes B, Blot SI; executive board of theFlemish Society for Critical Care Nurses.

Faculty of Healthcare, Ghent University College, Ghent, Belgium.

BACKGROUND: Lack of adherence to recommended evidence-based guidelines forpreventing infections associated with use of central venous catheters may be due to nurses' lack of knowledge of the guidelines.OBJECTIVE: To develop a reliable and valid questionnaire for evaluating critical care nurses' knowledge of evidence-based guidelines for preventing infectionsassociated with central venous catheters.METHODS: A total of 10 nursing-related strategies were identified from currentevidence-based guidelines for preventing infections associated with use ofcentral venous catheters. Face and content validation were determined forselected interventions and multiple-choice questions (1 question perintervention). The test results of 762 critical care nurses were evaluated foritem difficulty, item discrimination, and quality of the response alternatives oroptions for answers (possible responses).RESULTS: All 10 items had face and content validity. Values for item difficultyranged from 0.1 to 0.9. Values for item discrimination ranged from 0.05 to 0.41. The quality of the response alternatives (0.0-0.8) indicated widespreadmisconceptions among the critical care nurses in the sample.CONCLUSION: The questionnaire is reliable and has face and content validity.Findings from surveys in which this questionnaire is used can lead to bettereducational programs for critical care nurses on infections associated with useof central venous catheters.


83. J Contin Educ Nurs. 2007 Nov-Dec;38(6):262-70.

The role of the clinical nurse specialist in promoting evidence-based practiceand effecting positive patient outcomes.

LaSala CA, Connors PM, Pedro JT, Phipps M.

Massachusetts General Hospital, Patient Care Services, Boston, Massachusetts02114, USA.

Clinical nurse specialists (CNSs) are vital members of the healthcare deliveryleadership team. The knowledge and expertise of the CNS is germane to the qualityof care a patient receives. More than 50 CNSs practice at Massachusetts GeneralHospital (the state's first Magnet hospital), where they share their clinicalskills, mentor staff through difficult situations, identify learning needs, andimplement innovative approaches to patient care. This article presents a briefhistory of the CNS role and describes how the CNS role is operationalized atMassachusetts General Hospital and its impact on unit-based and organizationaloutcomes. In addition, several programs and interventions identified by the CNSs in response to results of the Staff Perception of the Professional PracticeEnvironment Survey are discussed. How the CNS influences the professional

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development of staff and potential implications for the future role of the CNSare described. An exemplar is included depicting a typical work day of a CNS onan acute adult medical unit.


84. J Nurses Staff Dev. 2007 Nov-Dec;23(6):293-7.

The moved to evidenced-based practice from a clinical nursing question.

Heinzer MM, Bish C, Detwiler R.

Frances Payne Bolton School of Nursing, Case Western Reserve University,Cleveland, Ohio 44106-4904, USA. [email protected]

Registered nurses on a medical unit questioned whether current practiceadequately met the emotional needs of patients with chronic obstructive pulmonarydisease hospitalized for acute dyspnea. The unit's education committee surveyednursing staff regarding priority nursing activities during dyspneic episodes.After discussion with staff development educators, several registered nurses met with the center's nurse researcher, formed a research team, and designed adescriptive study. Findings of the study gave evidence for clinical practicechange and revision of care guidelines.


85. Int J Nurs Pract. 2007 Dec;13(6):363-9.

Nurses' attitudes to and perceptions of knowledge and skills regardingevidence-based practice.

Sherriff KL, Wallis M, Chaboyer W.

Nursing Education ans Research Unit, Gold Coast Health Services District,Southport, Queensland, Australia. [email protected]

The study evaluated the effect of an evidence-based practice (EBP) educationalprogramme on attitudes and perceptions of knowledge and skills, of registerednurses, towards EBP. The study was conducted using a quasiexperimentalinterrupted time series design. Participants were clinical nurses in educational and leadership roles within a Health Service District in south-east Queensland.The data were collected using a self-administered questionnaire at three points. Nurses' belief in the value of EBP for practice was high prior to the programmeand did not change subsequently. There was an improvement following theintervention in nurses' attitudes to organizational support for EBP and theirperceptions of their knowledge and skills in locating and evaluating researchreports. Providing educational courses in a clinical setting is useful inimproving clinicians' attitudes to and perceptions of knowledge and skillsrelated to EBP.


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86. Nurs Leadersh (Tor Ont). 2007;20(3):86-97.

Using Appreciative Inquiry to promote evidence-based practice in nursing: theglass is more than half full.

Marchionni C, Richer MC.

McGill University Health Centre, Montreal, QC. [email protected]

It is now understood that successful implementation of evidence-based practice(EBP) requires a focus on the context of the care setting. While the focal point of many reports is the limitations and barriers, this paper proposes a newapproach to "making EBP happen." Appreciative Inquiry (AI), both a method ofsocial research and an organizational development or change intervention, is anovel means to elicit enthusiasm and support for EBP in nursing. Readers will be introduced to the theoretical foundations and assumptions as well as the "4-DModel" of AI. It is proposed that the advanced practice nurse (APN) is in a keyposition to introduce and support this intervention in healthcare organizationsto promote the successful implementation of EBP.


87. Rehabil Nurs. 2007 Sep-Oct;32(5):203-9.

Evidence-based practice in rehabilitation nursing.

Pierce LL.

The University of Toledo, College of Nursing, Health Science Campus, OH43614-2598, USA. [email protected]

How to use research is a learned skill. With this skill rehabilitation nurses canhelp ensure that their practice is based on the best evidence available.Evidence-based practice is a balance of using external research-based clinicalevidence and clinical expertise. The purpose of this article is to showrehabilitation nurses how to build the skills for using evidence, rather thanjust doing research. This involves asking questions, finding and appraisingrelevant data, and putting that information into everyday practice. Whenevidence-based practice is merged into a clinician's daily routine, the result isa more analytical and, ultimately, effective clinical practice.


88. Am J Nurs. 2007 Oct;107(10):50-8; quiz 58-9.

Motivational interviewing: an evidence-based approach to counseling helpspatients follow treatment recommendations.

Levensky ER, Forcehimes A, O'Donohue WT, Beitz K.

New Mexico Veterans Affairs Medical Center, Albuquerque, NM, [email protected]

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Motivational interviewing is an evidenced-based counseling approach that healthcare providers can use to help patients adhere to treatment recommendations. Itemphasizes using a directive, patient-centered style of interaction to promotebehavioral change by helping patients explore and resolve ambivalence. Thisarticle will help nurses learn how to use motivational interviewing to encourage patients to adhere to treatment recommendations. The basic theoreticalunderpinnings, principles, and methods of motivational interviewing arediscussed, with an emphasis on acting in accordance with the "spirit" of theapproach.


89. J Adv Nurs. 2007 Oct;60(2):162-71.

Barriers to evidence-based nursing: a focus group study.

Hannes K, Vandersmissen J, De Blaeser L, Peeters G, Goedhuys J, Aertgeerts B.

Belgian Centre for Evidence-Based Medicine, Belgian Branch of the CochraneCollaboration, Leuven, Belgium. [email protected]

AIM: This paper reports a study to explore the barriers to evidence-based nursingamong Flemish (Belgian) nurses.BACKGROUND: Barriers obstructing the call for an increase in evidence-basednursing have been explored in many countries, mostly through quantitative studydesigns. Authors report on lack of time, resources, evidence, authority, support,motivation and resistance to change. Relationships between barriers are seldompresented.METHODS: We used a grounded theory approach, and five focus groups were organizedbetween September 2004 and April 2005 in Belgium. We used purposeful sampling to recruit 53 nurses working in different settings. A problem tree was developed to establish links between codes that emerged from the data.FINDINGS: The majority of the barriers were consistent with previous findings.Flemish (Belgian) nurses added a potential lack of responsibility in the uptakeof evidence-based nursing, their 'guest' position in a patient's environmentleading to a culture of adaptation, and a future 'two tier' nursing practice,which refers to the different education levels of nurses. The problem treedeveloped serves as (1) a basic model for other researchers who want to explorebarriers within their own healthcare system and (2) a useful tool for orientingchange management processes.CONCLUSION: Despite the fact that the problem tree presented is context-specific for Flanders (Belgium), it gives an opportunity to develop clear objectives andtargeted strategies for tackling obstacles to evidence-based nursing.


90. Collegian. 2007 Apr;14(2):20-5.

Evidence-based management practice: reducing falls in hospital.

McKinley C, Fletcher A, Biggins A, McMurray A, Birtwhistle S, Gardiner L,Lampshire S, Noake N, Lockhart J.

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Peel Health Campus, Mandurah, Western Australia.

This paper reports on a falls prevention and management program at one regionalWestern Australian hospital. The report focuses on the processes and outcomes of a quality management initiative to reduce falls in hospital to illustrate thenexus between research and quality improvement in clinical practice. The FallsPrevention program was based on statistical evidence of the level of risk in the hospital and development of an evidence-based multidimensional, multidisciplinaryprogram to reduce the risks of falling and the number of falling events.Evaluative data demonstrate the effectiveness of the program in terms of asubstantial reduction in falls. The program illustrates the value ofevidence-based practice, particularly in relation to evidence-based managementpractice. It supports the merits of creating an organisational climate where all clinicians are encouraged to use research data to plan strategies for qualityimprovement and risk management and, in the process, advance clinical nursingknowledge development.


91. Med J Aust. 2007 Jul 16;187(2):108-10.

Practice nurses in Australia: current issues and future directions.

Keleher H, Joyce CM, Parker R, Piterman L.

School of Primary Health Care, Monash University, Melbourne, VIC, [email protected]

Almost 60% of general practices now employ at least one practice nurse.Australian Government initiatives to support the expansion of practice nursingare not consistently based on strong evidence about effectiveness, outcomes orefficiencies. Reviews from other countries suggest that practice nurses canachieve good health outcomes, but there is little information about theAustralian practice-nurse workforce, funding models to support their work, scope of their practice, or its outcomes. Australian practice nursing lacks a careerstructure and an education framework to advance nurses' skills and knowledge. To maximise the contribution of nurses in primary care, a more systematic approachis needed, with a stronger evidence base for policy to support effectiveoutcomes.


92. Am J Crit Care. 2007 Jul;16(4):371-7.

Critical care nurses' knowledge of evidence-based guidelines for preventingventilator-associated pneumonia: an evaluation questionnaire.

Labeau S, Vandijck DM, Claes B, Van Aken P, Blot SI; executive board of theFlemish Society for Critical Care Nurses.

Faculty of Healthcare, Ghent University College, Ghent, Belgium.

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Comment in Am J Crit Care. 2007 Nov;16(6):532-3.

BACKGROUND: Nurses' lack of knowledge may be a barrier to adherence toevidence-based guidelines for preventing ventilator-associated pneumonia.OBJECTIVE: To develop a reliable and valid questionnaire for evaluating critical care nurses' knowledge of evidence-based guidelines for preventingventilator-associated pneumonia.METHODS: Ten nursing-related interventions were identified from a review ofevidence-based guidelines for preventing ventilator-associated pneumonia.Selected interventions and multiple-choice questions (1 question perintervention) were subjected to face and content validation. Item difficulty,item discrimination, and the quality of the response alternatives or options for answers (possible responses) were evaluated on the test results of 638 criticalcare nurses.RESULTS: Face and content validity were achieved for 9 items. Values for itemdifficulty ranged from 0.1 to 0.9. Values for item discrimination ranged from0.10 to 0.65. The quality of the response alternatives led to the detection ofwidespread misconceptions among critical care nurses.CONCLUSION: The questionnaire is reliable and has face and content validity.Results of surveys with this questionnaire can be used to focus educationalprograms on preventing ventilator-associated pneumonia.


93. J Neurosci Nurs. 2007 Jun;39(3):190-1.

The role of the nurse academician in promoting evidence-based practice in a braininjury rehabilitation unit.

Gebhardt MC, Testani-Dufour L.

Byrdine F. Lewis School of Nursing, Georgia State University, Alpharetta, GA,USA. [email protected]

There are many rehabilitation teams and rehabilitation consultants. The teampresented here involved the unique collaboration of university nursing scholarsand clinicians from a local rehabilitation hospital. The melding of these twogroups is providing new opportunities for staff nurses, administrators, andfaculty members to work together and use nursing research to provide the base of evidence necessary to enhance rehabilitation nursing knowledge in the braininjury setting.


94. J Nurs Care Qual. 2007 Jul-Sep;22(3):234-8.

Optimizing nursing care by integrating theory-driven evidence-based practice.

Pipe TB.

Nursing Administartion, Mayo Clinic Arizona, Phoenix, AZ 85054, [email protected]

54

An emerging challenge for nursing leadership is how to convey the importance ofboth evidence-based practice (EBP) and theory-driven care in ensuring patientsafety and optimizing outcomes. This article describes a specific example of aleadership strategy based on Rosswurm and Larrabee's model for change to EBP,which was effective in aligning the processes of EBP and theory-driven care.



Clinical nurse specialists' use of evidence in practice: a pilot study.

Profetto-McGrath J, Smith KB, Hugo K, Taylor M, El-Hajj H.

Faculty of Nursing, Knowledge Utilization Studies Program (KUSP), and Centre for Knowledge Transfer, University of Alberta, Edmonton, Alberta, [email protected]

BACKGROUND: The interest in finding ways to bridge the gap between nursingresearch and implementation of findings into practice has been increasing.Clinical nurse specialists (CNSs) may be a bridge between frontline nurses andcurrent developments in practice. While several researchers have studied the use of evidence by nurses in general, no known studies have been focused specificallyon the use of evidence by CNSs.PURPOSE: The purpose of this pilot study was to develop an understanding of thesources, nature, and application of evidence used by CNSs in practice and toinvestigate the feasibility of conducting a qualitative study focused on the CNS role in relation to evidence use in practice.METHODS: This pilot study is a descriptive exploratory design in the qualitative paradigm. Seven CNSs from a large Western Canadian health region wereinterviewed. Interview transcripts were reviewed for recurrent themes aboutsources of evidence, evidence use, and barriers and facilitators to evidence use.FINDINGS: CNSs access and use evidence from a variety of sources. All CNSsindicated that research literature was a primary source of evidence and research was used in decision-making. Peers and experience were also important sources of evidence. CNSs used the Internet extensively to consult research databases,online sources of evidence, and to contact peers about current practice. CNSsalso gathered evidence from frontline nurses, healthcare team members, andfamilies before decision-making. The choice of evidence often depended upon thetype of question they were attempting to answer. Barriers cited by CNSs supportprevious research and included lack of time, resources, and receptivity atclinical and organizational levels. Facilitators included peers, organizationalsupport, and advanced education.DISCUSSION: CNSs in Canada have advanced education and clinical expertise andmany are employed in roles that permeate organizational management and clinicalnursing care. It is suggested that qualitative research in naturalized settingsthat investigates the role of CNSs in relation to the dissemination of evidencein nursing practice needs attention.


96. Intensive Care Med. 2007 Aug;33(8):1463-7. Epub 2007 Jun 1.

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Evidence-based guidelines for the prevention of ventilator-associated pneumonia: results of a knowledge test among intensive care nurses.

Blot SI, Labeau S, Vandijck D, Van Aken P, Claes B; Executive Board of theFlemish Society for Critical Care Nurses.

Department of Intensive Care, Ghent University Hospital, De Pintelaan 185, 9000Ghent, Belgium. [email protected]

OBJECTIVE: To determine intensive care nurses' knowledge of evidence-basedguidelines for the prevention of ventilator-associated pneumonia (VAP).DESIGN: A survey using a validated multiple-choice questionnaire, developed toevaluate nurses' knowledge of VAP prevention. The questionnaire was distributedand collected during the annual congress of the Flemish Society for Critical CareNurses (Ghent, November 2005). Demographic data included were gender, years ofintensive care experience, number of critical beds, and whether respondents hold a special degree in emergency and intensive care.MAIN RESULTS: We collected 638 questionnaires (response rate 74.6%). Nineteenpercent of the respondents recognized the oral route as the recommended way forintubation. It was known by 49% of respondents that ventilator circuits should bechanged for each new patient. Heat and moisture exchangers were checked as therecommended type of humidifier by 55% of respondents, but only 13% knew that itis recommended to change them once weekly. Closed suctioning systems wereidentified as recommended by 17% of respondents, and 20% knew that these must be changed for each new patient only. Sixty percent and 49%, respectively,recognized subglottic drainage and kinetic beds to reduce the incidence of VAP.Semi-recumbent positioning is well known to prevent VAP (90%). The averageknowledge level was higher among more experienced nurses (> 1 year experience)and those holding a special degree in emergency and intensive care.CONCLUSION: Nurses lack knowledge regarding recommendations for VAP prevention.Nurses' schooling and continuing education should include support from currentevidence-based guidelines.


97. J Emerg Nurs. 2007 Jun;33(3):202-7. Epub 2006 Dec 22.

Emergency nurses' knowledge of evidence-based ischemic stroke care: a pilotstudy.

Harper JP.

QM&I and Per Diem Clinical Educator, Taylor Hospital, Ridley Park, PA, [email protected]

INTRODUCTION: The purpose of this pilot study was to assess emergency nurses'knowledge of evidence-based ischemic stroke care.DESIGN AND METHODS: A descriptive, correlational design was used. Emergencynurses (N = 20) working in 2 hospitals in the Mid-Atlantic region completed a10-item multiple choice test on evidence-based ischemic stroke care.RESULTS: Test scores ranged from 30% to 90%, with a mean of 53% (SD = 12.93) on ascale of 0 to 100%. Forty-five percent (N = 9) of respondents indicated that theyread literature on evidence-based ischemic stroke care within the previous 12months. Respondents who read literature on evidence-based ischemic stroke care

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had a significantly higher mean test score (P = .04) than did respondents who didnot read any literature on evidence-based ischemic stroke care. Only 15% (N = 3) of respondents reported that they had participated in continuing education onevidence-based ischemic stroke care within the previous 12 months. In addition,there was a significant correlation (P = .02) between number of years worked inemergency nursing as a registered nurse and test scores. Nurses with more yearsexperience in emergency nursing had higher test scores.DISCUSSION: Overall, emergency nurses demonstrated a knowledge deficit inevidence-based ischemic stroke care. The majority of nurses had not participated in continuing education on evidence-based ischemic stroke care within theprevious 12 months. Nurses should be provided with evidence-based education onischemic stroke care and opportunities to participate in continuing education.


98. J Clin Nurs. 2008 Jan;17(2):214-23. Epub 2007 Apr 5.

A review of evidence-based practice, nursing research and reflection: levellingthe hierarchy.

Mantzoukas S.

Institute of Health & Human Sciences, Thames Valley University, London, [email protected]

AIM: This paper examines the evidence-based practice movement, the hierarchy ofevidence and the relationship between evidence-based practice and reflectivepractice.BACKGROUND: Evidence-based practice is equated with effective decision making,with avoidance of habitual practice and with enhanced clinical performance. Thehierarchy of evidence has promoted randomized control trials as the most validsource of evidence. However, this is problematic for practitioners as randomized control trials overlook certain types of knowledge that, through the process ofreflection, provide useful information for individualized and effective practice.METHOD: A literature search was undertaken using CINAHL, medline and Ovidelectronic databases in early 2006. The search terms used were: evidence-basedpractice, research evidence, evidence for practice, qualitative research,reflective practice, reflection and evidence. Other sources included handpicking of books on evidence-based practice, reflection and research. Only materialwritten in English was included.FINDINGS: The hierarchy of evidence that has promoted randomized control trialsas the most valid form of evidence may actually impede the use of most effective treatment because of practical, political/ideological and epistemologicalcontradictions and limitations. Furthermore, evidence-based practice appears toshare very similar definitions, aims and procedures with reflective practice.Hence, it appears that the evidence-based practice movement may benefit much morefrom the use of reflection on practice, rather than the use of the hierarchicalstructure of evidence.CONCLUSION: Evidence-based practice is necessary for nursing, but its' effective implementation may be hindered by the hierarchy of evidence. Furthermore,evidence-based practice and reflection are both processes that share very similaraims and procedures. Therefore, to enable the implementation of best evidence in practice, the hierarchy of evidence might need to be abandoned and reflection to become a core component of the evidence-based practice movement.RELEVANCE TO CLINICAL PRACTICE: Provides an elaborated analysis for clinical

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nurses on the definition and implementation of evidence in practice.


99. J Nurs Manag. 2007 Mar;15(2):230-43.

Building the capacity for evidence-based clinical nursing leadership: the role ofexecutive co-coaching and group clinical supervision for quality patientservices.

Alleyne J, Jumaa MO.

Healthcare and Nursing Management, School of Health and Social Sciences,Middlesex University, London, UK. [email protected]

AIM: The general aims of this article were to facilitate primary care nurses(District Nurse Team Leaders) to link management and leadership theories withclinical practice and to improve the quality of the service provided to theirpatients. The specific aim was to identify, create and evaluate effectiveprocesses for collaborative working so that the nurses' capacity for clinicaldecision-making could be improved.BACKGROUND: This article, part of a doctoral study on Clinical Leadership inNursing, has wider application in the workplace of the future where professional standards based on collaboration will be more critical in a world of work thatwill be increasingly complex and uncertain. This article heralds the type ofresearch and development activities that the nursing and midwifery professionsshould give premier attention to, particularly given the recent developmentswithin the National Health Service in the United Kingdom. The implications of:Agenda for Change, the Knowledge and Skills Framework, 'Our Health, Our Care, OurSay' and the recent proposals from the article 'Modernising Nursing Career', toname but a few, are the key influences impacting on and demanding new ways ofclinical supervision for nurses and midwives to improve the quality of patientmanagement and services.METHOD: The overall approach was based on an action research using acollaborative enquiry within a case study. This was facilitated by a process ofexecutive co-coaching for focused group clinical supervision sessions involvingsix district nurses as co-researchers and two professional doctoral candidates asthe main researchers. The enquiry conducted over a period of two and a half yearsused evidence-based management and leadership interventions to assist theparticipants to develop 'actionable knowledge'. Group clinical supervision wasnot practised in this study as a form of 'therapy' but as a focus for thedevelopment of actionable knowledge, knowledge needed for effective clinicalmanagement and leadership in the workplace.FINDINGS: 1. Management and leadership interventions and approaches havesignificantly influenced the participants' capacity to improve the quality ofservices provided to their patients. 2. Using various techniques, tools, methods and frameworks presented at the sessions increased participants' confidence toperform. 3. A structured approach like the Clinical Nursing Leadership Learningand Action Process (CLINLAP) model makes implementing change more practical andmanageable within a turbulent care environment. The process of StakeholderMapping and Management made getting agreement to do things differently mucheasier. Generally it is clear that many nurses and midwives, according to theparticipants, have to carry out management and leadership activities in theirday-to-day practice. The traditional boundary between the private, the public andthe voluntary sector management is increasingly becoming blurred.

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CONCLUSION: It is conclusive that the district nurses on this innovativeprogramme demonstrated how they were making sense of patterns from the past,planning for the future and facilitating the clinical nursing leadershipprocesses today to improve quality patient services tomorrow. Their improvedcapacity to manage change and lead people was demonstrated, for example, through their questioning attitudes about the dominance of general practitioners. Theydid this, for example, by initiating and leading case conferences with themulti-disciplinary teams. It became evident from this study that to use groupclinical supervision with an executive co-coaching approach for theimplementation and to sustain quality service demand that 'good nursing' isaccepted as being synonymous with 'good management'. This is the future of 'newnursing'.


100. Arch Psychiatr Nurs. 2007 Feb;21(1):12-6.

Evidence-based nursing: effects of a structured nursing program for the healthpromotion of Korean women with Hwa-Byung.

Choi YJ, Lee KJ.

University of Maryland School of Nursing, Baltimore, MD 21201-1579, [email protected]

The objectives of this study were to develop a culturally tailored nursingprogram for patients with Hwa-Byung (HB) and to test the effects of the nursingintervention. The structured nursing intervention program was based on atranscultural theoretical framework in which patients with HB received therapies consisting of music therapy, drama, and group therapy. Hwa-Byung is aculture-bound syndrome, literally translated as anger syndrome, attributed to thesuppression of anger. Individuals experience a decrease in quality of life as aresult of insufficient treatment. Current health care programs do not meet theneeds of these individuals, who still need nursing interventions. A culturallytailored therapy is effective and appropriate for patients with illnesses relatedto their cultural background. Evidence-based nursing is a crucial approach inverifying the effects of nursing care and in enhancing the body of knowledge onnursing science. A nonequivalent, nonsynchronized, and controlled study designwas applied to experimental and control groups of an even number of women. Thenursing program was generally effective in the mental health condition test; the mental health condition of the experimental group was significantly more improvedas compared with that of the control group. The program was particularlyeffective in the categories of somatization, depression, psychoticism, andhostility. The data indicate that the mental health of patients with HB could be improved with the use of nursing intervention programs. Nurses need to understandthe cultural background of patients and provide culture-sensitive interventionsfor effective patient-oriented care.


101. J Adv Nurs. 2007 Feb;57(3):328-38.

Factors influencing the development of evidence-based practice: a research tool.

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Gerrish K, Ashworth P, Lacey A, Bailey J, Cooke J, Kendall S, McNeilly E.

Nursing Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.

AIM: The paper reports a study to develop and test a tool for assessing a rangeof factors influencing the development of evidence-based practice among clinical nurses.BACKGROUND: Achieving evidence-based practice is a goal in nursing frequentlycited by the profession and in government health policy directives. Assessingfactors influencing the achievement of this goal, however, is complex.Consideration needs to be given to a range of factors, including different types of evidence used to inform practice, barriers to achieving evidence-basedpractice, and the skills required by nurses to implement evidence-based care.METHODS: Measurement scales currently available to investigate the use ofevidence in nursing practice focus on nurses' sources of knowledge and onbarriers to the use of research evidence. A new, wider ranging DevelopingEvidence-Based Practice questionnaire was developed and tested for itsmeasurement properties in two studies. In study 1, a sample of 598 nurses workingat two hospitals in one strategic health authority in northern England wassurveyed. In study 2, a slightly expanded version of the questionnaire wasemployed in a survey of 689 community nurses in 12 primary care organizations in two strategic health authorities, one in northern England and the other insouthern England.FINDINGS: The measurement characteristics of the new questionnaire were shown to be acceptable. Ten significant, and readily interpretable, factors were seen tounderlie nurses' relation to evidence-based practice.CONCLUSION: Strategies to promote evidence-based practice need to take account ofthe differing needs of nurses and focus on a range of sources of evidence. TheDeveloping Evidence-Based Practice questionnaire can assist in assessing thespecific 'evidencing' tendencies of any given group of nurses.


102. J Nurs Manag. 2007 Jan;15(1):107-13.

Challenges for new nurses in evidence-based practice.

Ferguson LM, Day RA.

College of Nursing, University of Saskatchewan, 107 Wiggins Road, Saskatoon,Saskatchewan, Canada. [email protected]

AIM: The purpose of this article was to examine issues that new nurses encounter as they enter nursing practice, particularly in an evidence-based practiceenvironment.BACKGROUND: These issues are not new. In part, these issues arise from ourfailure to acknowledge the developmental issues that new nurses experience onentry to practice and the lack of role models in evidence-based practice andholistic care.EVALUATION: This article synthesizes research reported over the last decade todelineate the issues of transition to practice and strategies that have proveneffective in addressing them.KEY ISSUES: The key issues relate to the need to support new nurses in

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evidence-based and holistic practice, the strategies needed to do so, and thenurse manager's role in this process.CONCLUSIONS: We must invest resources in assisting new nurses into practice,which may have benefits in terms of both recruitment and retention of new nurses in practice.



Promoting evidence-based practice: an internship for staff nurses.

Cullen L, Titler MG.

Department of Nursing Services and Patient Care, University of Iowa Hospitals andClinics, Iowa City, IA 52242-1009, USA. [email protected]

Implementing evidence-based practice is a complex but valued process thatrequires support for nurses to make it a reality in care delivery. To addressthis, an Evidence-Based Practice Staff Nurse Internship was developed at theUniversity of Iowa Hospitals and Clinics in the United States. PROGRAM OVERVIEW: The objective of this internship is to promote use of evidence by staff nurses toimprove patient outcomes. Through a competitive application process, six nursesare accepted in each cohort. The program provides didactic content and dedicated work time on topics interns select (e.g., family pet visitation, sedationmanagement, bowel sounds assessment, guided imagery, family transition topediatric floor). Interns receive paid clinical release time for participating.ROLES AND RESPONSIBILITIES: Teams include the staff nurse, the nurse manager, andan advanced practice nurse. Responsibilities for each step are assigned to theperson with the appropriate expertise. EVALUATION: Interns report understandingthe process, appreciate the opportunity for professional growth, and report theirobjectives are being met. Participants evaluated the program very positively and also provided recommendations for revision (e.g., revising class content). Theprogram resulted in improved quality of care such as increased patient and familysatisfaction, decreased length of stay, and cost savings. IMPLICATIONS: Programs that support practitioners through the evidence-based practice process are neededfor use in a variety of settings internationally. This unique program supportsstaff nurses in making evidence-based practice a reality for their work andpatients and might be transferable across settings.



Nurses' perceived knowledge, beliefs, skills, and needs regarding evidence-based practice: implications for accelerating the paradigm shift.

Melnyk BM, Fineout-Overholt E, Fischbeck Feinstein N, Li H, Small L, Wilcox L,Kraus R.

Center for Research & Evidence-Based Practice, University of Rochester School of Nursing, NY 14642, USA. [email protected]

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BACKGROUND: The paradigm shift to evidence-based nursing practice in the UnitedStates has been slow. Although multiple barriers to evidence-based practice (EBP)have been identified through prior studies, there is a gap in the literaturespecifically identifying key variables (e.g., belief that EBP produces qualityoutcomes) that are correlated with the extent to which nurses engage in EBP.AIM: The primary aims of this study were to (1) describe nurses' knowledge,beliefs, skills, and needs regarding EBP; (2) determine whether relationshipsexist among these variables; and (3) describe major barriers and facilitators to EBP.METHODS: A descriptive survey was conducted with a convenience sample of 160nurses who were attending EBP conferences or workshops in four states locatedwithin the Eastern Region of the United States.RESULTS: Although participant beliefs about the benefit of EBP were high,knowledge of EBP was relatively low. Significant relationships were found betweenthe extent to which the nurses' practice is evidence-based and (1) nurses'knowledge of EBP, (2) nurses' beliefs about the benefits of EBP, (3) having anEBP mentor, and (4) using the Cochrane Database of Systematic Reviews and theNational Guideline Clearinghouse.CONCLUSION AND IMPLICATIONS: Health care systems need to implement interventions that not only increase nurses' EBP knowledge and skills, but also strengthentheir beliefs about the benefit of evidence-based care. EBP mentors may be key inaccelerating a more rapid shift toward evidence-based nursing practice.Theoretically driven randomized controlled trials are urgently needed to test theeffectiveness of interventions on advancing evidence-based care.



Strategic collaborative model for evidence-based nursing practice.

Olade RA.

College of Nursing, University of Nebraska Medical Center, Omaha 68198-5330, [email protected]

PURPOSE: To describe a model that has been developed to guide nurses and otherhealth professionals in collaborative efforts toward evidence-based nursingpractice.METHOD: A review of literature was conducted using MEDLINE and CINAHL to searchfor articles on research utilization for evidence-based practice in health caredelivery. Empirical studies; reviews; and theoretical, opinion, and informationarticles were included in the review in order to provide a more comprehensiveview of the state of evidence-based nursing internationally.FINDINGS: Findings revealed a number of barriers to evidence-based nursingpractice, which have persisted over the last two decades, including inadequateknowledge of research among practicing nurses, lack of administrative support forresearch activities in clinical settings, lack of empowerment of nurses, and lackof needed mentoring from nursing research consultants.CONCLUSIONS: Barriers in the areas of nursing education and administrativesupport appear to be major. A need was identified for a pragmatic model thatencourages cooperation and collaboration between educators/researchers inacademia and the administrative leaders in the clinical facilities ifevidence-based nursing practice is to become the norm. FRAMEWORK OF MODEL: TheTyler Collaborative Model is based on an eclectic approach to planned change for

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creating evidence-based practice. This model identifies a step-by-step processfor change, while allowing for the opportunity to integrate any of the previouslyavailable methods of critical appraisal to determine the best evidence forpractice in each clinical setting.


106. Worldviews Evid Based Nurs. 2004;1(1):9-17; discussion 18-9.

Fortuitous phenomena: on complexity, pragmatic randomised controlled trials, and knowledge for evidence-based practice.

Thompson C.

Centre for Evidence-Based Nursing, University of York, UK. [email protected]

CONTEXT: Many of the interventions that nurses develop and implement are inthemselves complex and have to operate in situations of irreducible complexityand uncertainty. MAIN ARGUMENT: This article argues that the primary means ofgenerating knowledge for the evidence-based deployment of complex interventionsshould be the pragmatic randomised controlled trial. Randomised controlled trialsrepresent the only research design to adequately deal with that which we know and(far more importantly) that which we do not. LITERARY METHOD: Using the exampleof practice development as an exemplar for complexity, and drawing on theobjections often voiced as a response to calls to make use of randomisedcontrolled trials in nursing and nursing research, the article presents adevelopmental framework and some methodological solutions to problems oftenencountered. CONCLUSION: Randomised controlled trials, whilst undoubtedlymethodologically and strategically challenging, offer the most robust basis fordeveloping primary research knowledge on the effects of complex interventions in nursing and their active components.


107. Minerva Anestesiol. 2007 Mar;73(3):129-34. Epub 2006 Nov 20.

Nurses' knowledge and application of evidence-based guidelines for preventingventilator-associated pneumonia.

Biancofiore G, Barsotti E, Catalani V, Landi A, Bindi L, Urbani L, Desimone P,Stefanini A, Sansevero A, Filipponi F.

Transplant and Postsurgical Intensive Care Unit, Anesthesia and Critical CareMedicine Unit 1, Cisanello Hospital, Pisa, Italy. [email protected]

AIM: The aim of the study was to evaluate the nurses' knowledge and to highlight the causes that hinder guidelines implementation.METHODS: Experimental design: descriptive study. Setting and participants: 106nurses working in the ICUs of a major Italian hospital of national importance.Intervention: administration of a questionnaire listing 21 non-pharmacologicalstrategies considered the most useful in the literature.RESULTS: Eighty-four nurses responded to the questionnaire. Only 19 (22.6%)declared that their knowledge of ventilation associated pneumonia (VAP) and the

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strategies used to prevent it were satisfactory, whereas 46 (54.8%) declared thatthey were poorly informed; 68 nurses (80.9%) said that they applied one or morestrategies, and 15 (17.9%) that they applied none. The reasons given for notapplying the strategies were: method not foreseen in Department protocols(31.5%), lack of the necessary resources (14.3%), disagreement with the method(3.2%), high costs (2.6%), the possibility of causing discomfort (1%) or sideeffects (0.6%).CONCLUSIONS: In our experience, VAP preventive strategies are widely applied bynurses, but not in a responsible and informed manner. It is important to ensurethat nurses receive continuous training and are involved in drawing up andupdating Departmental protocols and guidelines for care and behaviour.


108. J Wound Ostomy Continence Nurs. 2006 Nov-Dec;33(6):610-8.

Nursing staff beliefs and expectations about continence care in nursing homes.

Resnick B, Keilman LJ, Calabrese B, Parmelee P, Lawhorne L, Pailet J, OuslanderJ.

University of Maryland School of Nursing, Baltimore, MD, USA. [email protected]

OBJECTIVE: The purpose of this qualitative study was to consider the currentbeliefs of nursing assistants and directors of nursing about management ofurinary incontinence (UI) among the residents in nursing homes.DESIGN: This was a qualitative study using purposive sampling and a focus groupmethodology.SETTING AND SUBJECTS: Three focus groups including 38 participants were held in 2different regions. Two of the focus groups comprised nursing assistants and 1comprised directors of nursing.METHOD: The focus groups were facilitated by 2 different advanced practice nurses(BR and LJK), and 2 similar interview guides were used: 1 for the nursingassistants and 1 for the nurses. The interviews were tape recorded andtranscribed verbatim; data were analyzed via content analysis.RESULTS: Ten themes were identified from the data; 3 focused on resident factors that influence UI, 4 related to staff and family contributors to UI, and 3focused on recommendations to improve UI management in the nursing home setting.CONCLUSIONS: The findings from this study can be used to guide interventions todecrease or eliminate barriers to continence care and thereby facilitate theimplementation of clinical practice guidelines and evidence-based interventionsto improve urinary continence among nursing home residents.


109. Stud Health Technol Inform. 2006;124:651-6.

Evidence-based practice in primary health care.

De Smedt A, Buyl R, Nyssen M.

Vrije Universiteit Brussel, Brussels, Belgium.

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This study aims to describe primary care professionals' self-reported attitudestowards evidence-based practice (EBP), attention to information sources,perceptions of the barriers to EBP and strategies to improve insight in EBP andpatient care. An e-mail invitation with link to an Internet-based survey was sentto Belgian medical doctors (MDs), nurses and paramedics. Under paramedics, we've included emergency medical technicians, firemen and medical volunteers (RedCross). In general, respondents were supportive towards EBP and agreed that this concept improves patient care, but still, physicians claim that only 50% of theirpractice is evidence-based and nurses and paramedics spend respectively 59% and54% of their time to EBP. Doctors depend mostly on clinical guidelines, theInternet and textbooks, while nurses prefer conferences and protocols andparamedics rely on courses and their own judgement. All respondents strongly relyon experimental knowledge gained through interaction with colleagues, althoughthe majority reported that colleagues are often not supportive towards EBP. Lack of time, the overwhelming mass of literature, difficulties with implementation ofevidence in to practice are the most common barriers. Nurses show lack ofcritical appraisal of research results and paramedics have difficultiesunderstanding research and have limited access to computer facilities and theirworking environment. Communication in group and workshops are very highly valued.Nurses and paramedics are less reluctant towards the opinion of seniorcolleagues, audits on clinical practice and individual feedback than doctors. EBPgenerally enjoys a positive attitude at every level of the health care system,but still many obstacles have to be overcome to conquer 'experience-basedpractice'. The most appropriate method for actual implementation ofevidence-based practice at all levels of health care is to provide summaries ofevidence, easily understandable protocols and web-based databases accessible fromthe working environment. Students should not only learn the skills related toEBP, but should be able to integrate knowledge effectively in the clinicalsetting and routine care. Above all, their supervisors themselves need to evolve from 'experience-based' to evidence-based practice'.


110. Nurse Educ Today. 2007 Aug;27(6):518-28. Epub 2006 Oct 24.

Preparing for professional practice: how well does professional training equiphealth and social care practitioners to engage in evidence-based practice?

Caldwell K, Coleman K, Copp G, Bell L, Ghazi F.

School of Health and Social Sciences, Middlesex University, The Archway Campus,Highgate Hill, London N19 5LW, United Kingdom. [email protected]

This paper reports on the findings of a study that aimed to explore how relevant initial training is in relation to evidence-based practice, and explore theperceptions of recently qualified practitioners about their confidence to engage in evidence-based practice. A cross-sectional postal survey was used to ascertainthe views of nurses, social workers, occupational therapists and physiotherapistswho had been qualified no longer than two years prior to the survey, and hadqualified at one of three London Universities. Fifty questionnaires were sent outto each professional group (a sample of 200 overall) and there was a 43% responserate achieved. The results show a clear discrepancy between what are generallypositive attitudes towards evidence-based practice and the value of researchevidence and the infrequency with which they actually do make use of researchresources and engage in evidence-based practice. A number of constraints to

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engagement in accessing and utilising evidence were identified.


111. Hu Li Za Zhi. 2006 Oct;53(5):52-7.

[An experience promoting evidence-based nursing at a medical center in centralTaiwan].

[Article in Chinese]

Huang CY, Huang ST, Lee YW, Liao YC, Chang SC.

Department of Nursing, Changhua Christian Hospital.

In the 21st Century, evidence-based nursing (EBN) may provide a mechanism bywhich nurses can manage the explosion in published information in the literature,introduce new techniques, effectively control healthcare costs, and increaseattention on nursing quality and health outcomes. The objective of this paper is to share the experience implementing evidence-based nursing. We had appliedstrategies to implement evidence-based nursing care in our hospital since 2002.Over a more than three-year period (January 2002 to October 2005), we held 46basic course sessions (around 1,840 attendees) and 58 advanced course sessions(around 500 attendees). There are 445 clinical questions with answered reports,Most questions related to foley care, central vein care and peripheralintravenous injection. Our nursing department revised three guidelines on nursingcare skills related to suction and foley and nasal-gastric feeding to meet local conditions. Based on our subjective experience, promotion and implementation ofEBN is feasible and helpful to update knowledge and decrease variance in clinicalnursing care. However, further outcome research is needed in the future in order to obtain more objective evidence.


112. J Clin Nurs. 2006 Oct;15(10):1287-98.

Determining factors that have an impact upon effective evidence-based painmanagement with older people, following colorectal surgery: an ethnographicstudy.

Brown D, McCormack B.

Royal Hospitals Trust, Belfast, UK. [email protected]

AIM: The aim of this project was to examine pain management practices with older people admitted to the colorectal unit of an acute hospital trust.BACKGROUND: Although pain assessment and management are judged to be a priority, little research has examined the care older people receive in the acute surgical setting. Thus, pain in older people (65 years and over) can be under recognizedand unrelieved. With the number of older people requiring surgery increasing, it is important to identify factors in the practice context that enhance or inhibit effective pain management.DESIGN: The project drew upon an in-depth ethnographic approach.

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METHOD: Sixty-two hours of around the clock, non-participant observation ofnursing practice was completed. Thirty-nine (78%) nurses and forty-six (42%)patients were observed. Seven (6%) additional patients participated in pre- andpostoperative interviews and 35 (90%) nurses completed the Nursing WorkIndex--Revised Questionnaire.FINDINGS: Holistic pain assessment for older people was found to be deficient in the acute surgical setting. Nurses appeared unaware of the importance ofaddressing the particular pain needs of older patients. Inflexible analgesicprescriptions provided the mainstay treatment of pain, with minimal considerationgiven to non-pharmacological strategies. Older people wanted to be activeparticipants in their care. However, existing pain management practicesdisempowered older patients, making them reluctant or unable to discuss theirpain with ward staff.CONCLUSION: Comprehensive pain assessment, improved documentation and proficient communication, inclusive of older patients, are necessary to improve painmanagement practices. It is imperative that patients, nurses, doctors and AcutePain Service work in collaboration to challenge pain management practices andimplement change.RELEVANCE TO CLINICAL PRACTICE: The project demonstrated some of the multiple andcomplex factors that affect the older persons' pain experience and identifiedthree action research cycles for further development work.


113. Nurs Adm Q. 2006 Jul-Sep;30(3):291-4.

Evidence-based practice: how nursing administration makes IT happen.

Simpson RL.

Nursing Informatics, Cerner Corporation, Kansas City, MO 64117, [email protected]

As the voice of and advocate for nurses, nursing administration should assume theleadership position in the development of evidence-based practice models. One of its most important tasks is to advocate for ubiquitous information technology(IT) to support these models. This article examines evidence-based nursing andthe importance of IT to its development and growth. It explains the role ofnursing administration in guiding IT implementation, as well as key issues thatmust be examined in system selection and development.


114. Nurs Adm Q. 2006 Jul-Sep;30(3):252-65.

Evidence-based practice: how nurse leaders can facilitate innovation.

Shirey MR.

Shirey & Associates, Evansville, IN, USA. [email protected]

Evidence-based nursing practice (EBNP) is the wave of the future. Increasingly,EBNP is being identified as a key to quality and excellence in nursing services.

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Incorporating evidence into practice is necessary to deliver scientifically soundpatient care. In addition, understanding the importance of evidence is crucialfor meeting the excellence requirements of Magnet designation. Despite thegrowing popularity of EBNP and its documented significant benefits, theliterature demonstrates that only 15% of the nursing workforce consistentlypractices within an EBNP framework. If EBNP adoption is to increase in theprofession, it will require the active efforts of nurse leaders to pursue anaggressive innovation diffusion strategy. The purpose of this article is todiscuss the nurse leader's role in facilitating EBNP in nursing using atheoretical framework grounded in innovation diffusion theory. The articledevelops 4 areas of focus. First, the components of innovation diffusion theoryare discussed. Second, a pertinent empirical review of the EBNP adoptionliterature is presented. Third, strategies for applying innovation diffusiontheory to facilitate EBNP adoption are proposed. Lastly, the article ends with a leadership call to action.


115. Nurs Adm Q. 2006 Jul-Sep;30(3):236-42.

Diffusion of innovation: the leaders' role in creating the organizational contextfor evidence-based practice.

Crow G.

Tim Porter-O'Grady Associates, San Francisco, CA, USA. [email protected]

Successfully leading change represents one of the most, if not the most,challenging aspects of a leader's role. The traditional top-down command andcontrol structures and processes present in healthcare institutions and nursingare the enemies of effective change. Transitioning from traditional structures tostructures that are more of a partnership between point-of-service staff andadministrators is the foundation for creating an evidence-based practice culture.


116. Nurs Adm Q. 2006 Jul-Sep;30(3):193-202.

Quantifying patient care intensity: an evidence-based approach to determiningstaffing requirements.

Beglinger JE.

St. Marys Hospital Medical Center, Madison, WI 53715, [email protected]

Over the course of the past decade, the intensity of patient care requirementshas increased because of an aging patient population with increasingly complexcare requirements and declining length of stay. At the same time, thereimbursement pressure in hospitals continues. The nursing organization of St.Marys Hospital Medical Center in Madison, Wis, recognized that increasing thehours of nursing care in some areas would be essential to maintaining anenvironment in which the nurses could deliver on the promise of the

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organization's mission: exceptional healthcare. The nursing organizationundertook the challenge of quantifying the increasing intensity to enable arigorous, evidence-based approach to the 2006 staffing budget. The compellingresults enabled the nurses to successfully negotiate the necessary increases instaffing, despite the financial pressures prevalent throughout acute care today.


117. Int J Nurs Pract. 2006 Aug;12(4):232-40.

Analysis of the impact of a national initiative to promote evidence-based nursingpractice.

Ring N, Coull A, Howie C, Murphy-Black T, Watterson A.

Department of Nursing and Midwifery, University of Stirling, Stirling, [email protected]

Best Practice Statements (BPS) are designed to facilitate evidence-basedpractice. This descriptive, exploratory study evaluated the impact of five ofthese statements in Scotland. A postal survey of 1,278 registered nurses wasundertaken to determine use of these statements and their perceived benefits(response rate: 42%). Use of the BPS differed across clinical sites and somestatements were more likely to be used than others. Identified barriers anddrivers to their use were similar to factors known to encourage or hinderevidence-based practice generally. Although approximately 25% of clinicalrespondents reported using the BPS, most respondents reported perceived benefits to patients usually through quality improvement. Results highlight the importanceof facilitation and supportive contexts in encouraging clinical use of thesestatements. Findings suggest that variation in clinical implementation of the BPSneed to be addressed locally and nationally if their benefits are to bemaximized.


118. J Adv Nurs. 2006 Mar;53(6):702-9.

Promotion of evidence-based practice by professional nursing associations:literature review.

Holleman G, Eliens A, van Vliet M, van Achterberg T.

Centre for Quality of Care Research, Nursing Science Section, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. [email protected]

AIM: This paper reports a literature review examining the activities ofprofessional nursing associations in the promotion of evidence-based practice.BACKGROUND: Professional nursing associations can play a role in theimplementation and achievement of evidence-based practice as such associationsaim to develop and further educate nurses professionally, build professionalnetworks representing the interests of nurses and the nursing profession,influence the government and policymakers, and support and protect the basicvalues of nurses. The exact role of professional nursing associations in the

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promotion of evidence-based practice is as yet unclear, along with just how therole of such associations can be expanded and which strategies can be used topromote evidence-based practice among members.METHOD: A literature and Internet search was undertaken using the PUBMED, CINAHL,SCIRUS, INVERT, and the Cochrane databases using the terms evidence-basedpractice(s)* or EBP*, which were then combined with Nursing Society*, NursingOrganization*, Nursing Organisation*, Nursing Association* or Nursing Council*.Other sources included a Google search of the Internet, and the sites of various members of the International Council of Nurses. Publications in English, Frenchor German from 1993 to 2004 were used, and the Internet search was conducted on17 July 2003.RESULTS: Sixty nursing associations described the dissemination of evidence-basedpractice using one or more types of activities (179 activities in total). All of these activities were of a voluntary nature, with a predominant focus (132/179activities) on intrinsic motivation of nurses. More specifically, most of theactivities were aimed at nurses' competences and attitudes in relation toevidence-based practice.CONCLUSION: Professional nurses' associations are active in promotingevidence-based practice among their nurse members, but only those focusing onchanging competences and attitude by addressing intrinsic motivation are wellused. Other types of activities deserve to be explored, includingbehaviour-oriented approaches, approaches using structural, social or financialinfluence measures and perhaps methods based on 'involuntary involvement'.


119. J Adv Nurs. 2006 Feb;53(4):454-8.

Development of an evidence-based practice questionnaire for nurses.

Upton D, Upton P.

Psychology Division, University of Worcester, Worcester, UK. [email protected]

AIM: The aim of this paper is to report the development and validation of aself-report measure of knowledge, practice and attitudes towards evidence-basedpractice (EBP).BACKGROUND: Evidence-based practice has become increasingly important in healthcare since the mid-1990s as it provides a framework for clinical problem-solving.However, to date no means exist to quantify the extent to which barriers, such aslack of time in the working day, lack of appropriate skills and negativeattitudes, may prevent greater uptake of EBP.METHODS: Questionnaire development was based on established psychometric methods.Principal component factor analysis was used to uncover the underlying dimensionsof the scale. Internal consistency of the scale was assessed by Cronbach's alpha.Finally, construct validity was assessed via convergent and discriminantvalidity.RESULTS: The final questionnaire comprised three distinct scales (EBP, attitudes towards EBP and knowledge of EBP), which had robust validity and internalreliability.CONCLUSION: This tool can be used to measure the implementation of EBP.


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120. Soc Sci Med. 2006 Jun;62(11):2681-93. Epub 2005 Dec 27.

The contextual influence of professional culture: certified nurse-midwives'knowledge of and reliance on evidence-based practice.

Bogdan-Lovis EA, Sousa A.

Center for Ethics and Humanities in the Life Sciences, Michigan State University,East Lansing, USA. [email protected]

This paper reports research undertaken to assess US certified nurse-midwives'(CNMs) knowledge of, access to, and use of evidence-based medicine (EBM).Findings are presented in the context of interprofessional, institutional, andpopular culture. The descriptive study follows concepts of diffusion ofinnovation, evidence-based patient choice, and authoritative knowledge to analyseincentives and barriers to the implementation of evidence-based midwifery care.Structured interviews were conducted with practicing CNMs in an urban practicesite and a regional teaching centre. The analysis of responses exploredcongruence between practitioner knowledge, professed practice, and publishedprofessional as well as hospital-based internal practice guidelines, for twospecific interventions for which there is ample systematic review, epidural andepisiotomy. The CNMs demonstrated enthusiasm for their own individualunderstanding of EBM, but responses to specific questions about EBM-supportedpractice indicate that many had an incomplete understanding of the concept.Furthermore, in those cases where CNMs demonstrated accurate knowledge of EBM,practice protocols followed subspecialty dictates, thereby preventing theirknowledge from translating into adherence to EBM-guided clinical practiceguidelines. Finally, patient expectations for technological intervention appearedto influence CNMs' care decisions, even when those expectations lacked soundsupporting evidence. If, as conceived by its originators and champions, EBM is tobe widely adopted, then practitioners such as CNMs need to accurately understand its concepts and also to be afforded the opportunity to exercise professionalcontrol over its implementation. Central to an epistemically balanced EBM is the need to ensure that midwifery knowledge contributes in a robust and ongoingfashion to EBM's scientific research base. Lastly, EBM advocates must identifybalanced strategies to both rationally and fairly address consumerist pressuresfor aggressive health care consumption.


121. J Prof Nurs. 2005 Nov-Dec;21(6):364-71.

Critical thinking and evidence-based practice.

Profetto-McGrath J.

Faculty of Nursing, University of Alberta, Edmonton, Alberta, [email protected]

Critical thinking (CT) is vital to evidence-based nursing practice.Evidence-based practice (EBP) supports nursing care and can contribute positivelyto patient outcomes across a variety of settings and geographic locations. Thenature of EBP, its relevance to nursing, and the skills needed to support itshould be required components of baccalaureate education and must be introduced

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early in students' development as independent, self-directed learners and asprofessional nurses. Among the knowledge, skills, and processes needed to supportEBP, CT is paramount. The development of CT can prepare nurses with the necessaryskills and dispositions (habits of mind, attitudes, and traits) to support EBP.The intents of this study were to explore the importance of CT as an essentialskill to support EBP and to describe some of the strategies and processesconsidered key to the ongoing development of CT.


122. J Adv Nurs. 2005 Nov;52(4):432-44.

Barriers to evidence-based practice in primary care nursing--why viewingdecision-making as context is helpful.

Thompson C, McCaughan D, Cullum N, Sheldon T, Raynor P.

Department of Health Sciences, University of York, York, UK. [email protected]

AIM: This paper reports a study examining the barriers associated with researchknowledge transfer amongst primary care nurses in the context of clinicaldecision-making.BACKGROUND: The research literature on barriers to nurses' use of researchknowledge is characterized by studies that rely primarily on self-report data,making them prone to reporting biases. Studies of the barriers to evidence-based practice often fail to examine information use and behaviour in the context ofclinical decision-making.METHODS: A multi-site, mixed method, case study was carried out in 2001. Datawere collected in three primary care organizations by means of interviews with 82primary care nurses, 270 hours of non-participant observation and 122 Q-sorts.Nurses were selected using a published theoretical sampling frame.Between-methods triangulation was employed and data analysed according to theprinciples of constant comparison. Multiple linear regression was used to explorerelationships between a number of independent demographic variables (such aslength of clinical experience) and the dependent variable of nurses' perspectiveson the barriers to their use of research knowledge.RESULTS: Three perspectives on barriers to research information use emerged: the need to bridge the skills and knowledge gap for successful knowledge transfer;information formats need to maximize limited opportunities for consumption; andlimited access in the context of limited time for decision-making and informationconsumption. Demographic variables largely failed to predict allegiance to any ofthe perspectives identified.CONCLUSIONS: Researchers should consider using decision-making as a contextualbackdrop for exploring information use and behaviour, avoid relying solely onself-reported behaviour as data, and use a variety of research methods to providea richer picture of information-related behaviour. Practice developers need torecognize that understanding the decisions to which research knowledge is to beapplied should be a characteristic of any strategy to increase research uptake bynurses.


123. Contemp Nurse. 2005 Jul-Aug;19(1-2):96-104.

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Clinical nurses' knowledge of evidence-based practice: constructing a frameworkto evaluate a multifaceted intervention for implementing EBP.

Mott B, Nolan J, Zarb N, Arnison V, Chan R, Codner T, Casey T, Jenkins B, Ulrych G, Blackburn C, Glanfield L, Halcomb E, Davidson PM.

Blacktown Mt Druitt Health, Sydney, New South Wales.

Critical reflection upon nursing practice is pivotal in achieving optimal patientoutcomes. Implicit in this statement is knowledge about and an understanding ofthe implementation of evidence-based practice (EBP). This study sought toevaluate baseline knowledge in order to assess and inform a multifacetedintervention to promote EBP in a multi-site facility in Western Sydney,Australia. On two consecutive days in February 2003, a convenience sample of 229 nurses were surveyed using a five-item, investigator developed, written surveytool. Data were analysed using descriptive statistics. Although the majority ofrespondents (n = 143: 62%) stated that they were aware of EBP, a considerablenumber (n = 86: 38%) stated they had not previously heard of the term. Ofconcern, 43% (n = 99) of respondents were unable to identify a source ofinformation and resources about EBP. The results of this observational,descriptive survey underscore the importance of ongoing strategic interventionsto improve knowledge, access and implementation of EBP amongst clinical nurses.This study also provides baseline data upon which to evaluate local interventionsto promote knowledge of EBP amongst clinicians.


124. Am J Nurs. 2005 Sep;105(9):40-51; quiz 52.

Readiness of U.S. nurses for evidence-based practice.

Pravikoff DS, Tanner AB, Pierce ST.

Online Journal of Clinical Innovations, Glendale, CA, USA. [email protected]

Comment in Am J Nurs. 2005 Sep;105(9):11.

Evidence-based practice is a systematic approach to problem solving for healthcare providers, including RNs, characterized by the use of the best evidencecurrently available for clinical decision making, in order to provide the mostconsistent and best possible care to patients. Are RNs in the United Statesprepared to engage in this process? This study examines nurses' perceptions oftheir access to tools with which to obtain evidence and whether they have theskills to do so. Using a stratified random sample of 3,000 RNs across the United States, 1,097 nurses (37%) responded to the 93-item questionnaire. Seven hundred sixty respondents (77% of those who were employed at the time of the survey)worked in clinical settings and are the focus of this article. Although thesenurses acknowledge that they frequently need information for practice, they feel much more confident asking colleagues or peers and searching the Internet andWorld Wide Web than they do using bibliographic databases such as PubMed orCINAHL to find specific information. They don't understand or value research and have received little or no training in the use of tools that would help them findevidence on which to base their practice. Implications for nursing and nursing

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education are discussed.


125. J Adv Nurs. 2005 Sep;51(5):465-73.

Evidence-based practice among Danish cardiac nurses: a national survey.

Egerod I, Hansen GM.

University Hospitals Centre for Nursing and Care Research, University Hospital,Copenhagen, Denmark. [email protected]

AIMS: This paper presents a survey of evidence-based practice among cardiacnurses exploring nurses' attitudes towards evidence-based practice and the types of knowledge they employ in clinical practice.BACKGROUND: Research utilization and evidence-based practice are required athospitals around the world, although the definition of evidence-based practice isstill unclear. An ongoing debate exists about the sources of knowledge and thehierarchy of research evidence in clinical practice, and nursing research hasbeen threatened by the dominance of randomized controlled trials. Evidence-based practice has been described as a new paradigm, which promotes patient-centredcare by integrating external evidence and patient preferences.METHODS: The study was a cross-sectional survey with a descriptive andcomparative design, using self-administered postal questionnaires. Thequestionnaires were sent to 33 head nurses and 51 bedside nurses representing oneor two units in each cardiac department in Denmark (n = 28). The final responserate was 81%. The study was carried out in 2004.RESULTS: Respondents had a positive attitude towards evidence-based practice,although they relied upon personal clinical experience. Head nurses werestatistically significantly more familiar with the concept of evidence-basedpractice than bedside nurses, and read scientific journals more frequently.Introductory courses to evidence-based practice are rare and seldom mandatory,and the data suggest that respondents lacked knowledge of the finer points ofevidence-based practice and equated the concept with research utilization.CONCLUSIONS: Barriers to evidence-based practice are inadequate education,unfamiliarity with English, and low organizational position. Facilitators includethe implementation of guidelines, provision of continuing education, and anincrease in the accountability of bedside nurses.


126. Nurs Stand. 2005 Jun 15-21;19(40):48-53.

Evidence-based practice: compatibility with nursing.

Dale AE.

Faculty of Health and Sciences, Staffordshire University, [email protected]

This article explores the compatibility of evidence-based practice with nursing. The generation of relevant research evidence in nursing and determining best

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evidence are discussed. The article concludes that different forms of research,other than randomised controlled trials, are valid and in many cases moreapplicable to nursing practice, and that nurses need to determine whatconstitutes relevant and best evidence for the profession.


127. Br J Nurs. 2005 Mar 10-23;14(5):284-8.

Nurses' attitudes to evidence-based practice: impact of a national policy.

Upton D, Upton P.

University of Wales Institute, Cardiff.

Clinical effectiveness and evidence-based practice should be key cornerstones of current nursing practice. This study used postal questionnaires to explore theimpact of a national initiative on nurses' attitudes, knowledge and practicerelating to these twin concepts. Results indicated that attitudes can beinfluenced by national policy initiatives. Influencing behaviour, however,appears to be more difficult; no change was seen in reported application ofevidence-based practice. Nurses did, however, report a desire to increase theirimplementation of evidence-based practice; reasons for not doing so included lackof the necessary skills and time in the working day. It is recommended that theseeducation and training needs must be addressed by allocating sufficient protectedlearning time and funds. A more difficult issue relates to the burden of clinicalwork, which may also be preventing greater uptake of evidence-based practice.


128. J Clin Nurs. 2005 Apr;14(4):411-7.

Conceptions of evidence, evidence-based medicine, evidence-based practice andtheir use in nursing: independent nurse prescribers' views.

Banning M.

Faulty of Health, Department of Nursing, Canterbury Christ Church UniversityCollege, Canterbury, UK. [email protected]

AIM: The purpose of this study was to explore nurses' conceptions of evidence andevidence-based practice, whether there are differences between evidence-basedpractice and evidence-based medicine and to identify the uptake of researchevidence in the workplace.BACKGROUND: The use and comprehension of the term 'evidence-based practice' inrelation to nursing shows remarkable variation. Numerous definitions areprovided, some tend to be closely related to the concept 'evidence-basedmedicine'. Independent nurse prescribers need to be able to understand theconcept of evidence-based practice to utilize and apply this concept in order to provide adequate medication management of their patients.METHOD: Data were generated by focus group interview and open questionquestionnaire and analysed by analytical abstraction.RESULTS: Nurses offered a variety of views on the use and uptake of evidence in

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the workplace. Some nurses acknowledged that they did not read research papersbut were aware that they used a lot of evidence in their practice. Nurses haddifficulty differentiating evidence-based practice from evidence-based medicine.CONCLUSIONS: Nurses were familiar with the research process but not the canons ofevidenced-based practice. The data generated indicate different levels ofevidence are used by nurses. This may be a reflection of the level of intrigue ofthe nurses involved.RELEVANCE TO CLINICAL PRACTICE: The education and training of independent nurseprescribers should include the exploration of evidence from randomized controlledtrials and from naturalistic studies and their contribution to evidenced-basedpractice and evidence-based medicine. Both concepts need to be explored inrelation to the medication management of patients.


129. J Adv Nurs. 2005 Apr;50(2):124-33.

Progressing evidence-based practice: an effective nursing model?

Tolson D, McAloon M, Hotchkiss R, Schofield I.

School of Nursing, Midwifery and Community Health, Glasgow Caledonian University,Govan Mbeki Building, Cowcaddens Road, Glasgow G4 0BA, Scotland, [email protected]

AIMS: This paper presents findings from telephone interviews completed with link nurses 2 years into the project to explore how participation progressedachievement of evidence-based practice where the link nurses worked.BACKGROUND: In 2001, an innovative practice development initiative was launchedin Scotland. A national network of experienced nurses from across the country wasrecruited to form the inaugural Community of Practice. This involved describinggerontological nursing, pioneering a nurse-sensitive methodology to craft careguidance that reflects the agreed practice model, and constructing a virtualcollege based on a situated learning model.METHODS: A volunteer sample of link nurses took part in telephone interviewsexploring experiences of using the virtual college and the extent to which thedescription of gerontological nursing and the first best practice statement onnutrition had influenced practice.FINDINGS: Five components (themes) were identified as facilitating the attainmentof evidence-based practice. These focussed on confidence-building and thepositive benefits of achieving vision and clarity for gerontological nursing.Membership of a national Community of Practice afforded status and strengthenedsense of professional identity. The inclusive knowledge synthesis methodologyused to prepare, pilot and support implementation of the best practice statement was highly valued. Progress towards evidence-based practice in all affiliatedareas was reported. Major challenges for nurses in participating in the virtualcollege included the absence of a learning-at-work culture, lack of time anddoubts about the legitimacy of internet-based learning.CONCLUSION: The evaluation indicates the potential merits of e-practicedevelopment, particularly for nurses who feel geographically and professionallyisolated or disenchanted with available continuing professional developmentopportunities. Participation in the virtual college appeared to enrich practiceand foster a culture of change.

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130. Nurs Leadersh (Tor Ont). 2004 Nov;17(4):64-75.

Setting the climate for evidence-based nursing practice: what is the leader'srole?

Udod SA, Care WD.

Faculty of Nursing, University of Manitoba, Winnipeg, MB. [email protected]

Nurses are being challenged today to justify their practice. Many clinical andpolicy decisions in nursing are based upon isolated, ritualistic and unsystematicforms of clinical practice. The growing movement towards establishingevidence-based nursing practice (EBNP) is situated in a systematic appraisal ofthe best evidence available. Nurse leaders have an obligation to cultivate sound clinical and economic practices leading to quality patient care and positive worklife environments for nurses.


131. J Nurs Adm. 2005 Jan;35(1):35-40.

Evidence-based practice: a practical approach to implementation.

Newhouse R, Dearholt S, Poe S, Pugh LC, White KM.

Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD21205, USA.

Organizations often do not have processes in place to support nurses through asystematic approach for developing and evaluating nursing interventions,protocols, critical pathways, and policies that are derived from scientificevidence. The development of a framework to guide inquiry will have a positiveimpact on patients. This process may foster a higher level of professionalengagement by nurses that may, in the long-term, help improve nurse retention andrecruitment. The authors discuss a nursing evidence-based practice model andguidelines that were developed by a team of hospital and academic nurse leadersand is practical and easy to use. This model has been successfully implementedacross the department of nursing as a strategic initiative. Results of theimplementation have shown that staff nurses can effectively use this model withthe help of knowledgeable mentors.


132. Br J Nurs. 2004 Nov 11-24;13(20):1216-20.

The issues for nurses involved in implementing evidence in practice.

Gagan M, Hewitt-Taylor J.

Institute of Health and Community Studies, Bournemouth University, UK.

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Evidence-based practice (EBP) is currently high on political and professionalagendas. However, there is a suggestion that despite apparent enthusiasm for EBP,it is not becoming a reality. A variety of reasons for evidence not beingimplemented in practice exist, including the way in which evidence iscommunicated, how staff are involved in changes in practice, the availability of resources, patient expectations and the priority afforded to EBP by individualsand organizations. These issues must be addressed if EBP is to succeed.


133. Appl Nurs Res. 2004 Nov;17(4):239-47.

Implementing evidence-based practice: walking the talk.

Thurston NE, King KM.

Faculty of Nursing, University of Calgary, Alberta, Canada.

Russworm and Larrabee's (1999) six-step model for evidence-based practice (EBP)was used by 10 nursing teams to seek answers to clinical questions. These teams, primarily composed of staff nurses, participated in a health region-wide EBPprogram over 1 year. Overall, the model served as a useful mechanism forexamining practice-derived questions. However, additional strategies needed to beincorporated by the project teams. These included making decisions aboutchange/no change at an earlier stage than was suggested by the model; seekingadditional evidence including survey data to benchmark "best" practices; andensuring colleagues' and managers' input, support, and involvement. Four project teams (three of which addressed nursing procedural questions) found insufficient empirical evidence on which to base change; the outlook for directingevidence-based practice was promising for the remaining six projects. The EBPprogram was judged to be highly satisfactory to participants and their managers.


134. J Nurs Scholarsh. 2004;36(3):220-5.

Evidence-based practice and research utilization activities among rural nurses.

Olade RA.

University of Nebraska Medical Center, College of Nursing, 985330 NebraskaMedical Center, Omaha, NE 68198-5330, USA. [email protected]

Comment in J Nurs Scholarsh. 2005;37(1):3.

PURPOSE: To identify the extent to which rural nurses utilize evidence-basedpractice guidelines from scientific research in their practice; to describe both previous and current research utilization activities in which they haveparticipated, and to identify the specific barriers they face in their practicesettings.DESIGN AND METHODS: Data for this descriptive study were collected through

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questionnaires with open-ended questions focused on (a) current utilization ofnursing research findings, (b) previous involvement in nursing researchactivities, and (c) participation in medical research activities. Theparticipants were 106 nurses from various practice areas in six rural counties ofa southwestern state in the United States.FINDINGS: Results revealed that only 20.8% of the participants stated they werecurrently involved in research utilization, and they were mostly nurses withbachelor's degrees. The two most common areas of current research utilizationwere pain management and pressure ulcer prevention and management. Barriers toresearch utilization, such as rural isolation and lack of nursing researchconsultants, were identified.CONCLUSIONS: The types of research utilization activities identified by thesenurses indicate how much the facilities in which these nurses work in the ruralareas are striving with the utilization of available scientific evidence. Ruralnurses face unique barriers related to situational and geographic factors, withimplications for nursing administrators, researchers, and educators.


135. J Eval Clin Pract. 2004 May;10(2):197-205.

Attitudes and knowledge of primary care professionals towards evidence-basedpractice: a postal survey.

O'Donnell CA.

University of Glasgow, UK. Kate.O'[email protected]

OBJECTIVES: To describe the attitudes, awareness and use of evidence across keyprofessional groups working in primary care.METHODS: A postal questionnaire was sent to all lead/chairs, general managers,clinical governance leads, lead nurses, lead pharmacists and public healthpractitioners working in local health care cooperatives in Scotland.RESULTS: 289 (66.1%) health care professionals responded, ranging from 51% ofgeneral managers to 80% of lead nurses. All professional groups supportedevidence-based practice. General practitioners (GPs) were less likely to agreethat they had the skills to carry out literature reviews or appraise evidencecompared to nurses and public health facilitators (36% vs. 75% vs. 80%; 51% vs.64% vs. 70%). Access to the internet and bibliographic databases was good for allgroups but GPs used a narrower spectrum of evidence-based journals, relyingmainly on medical literature. Only nurses and public health practitionersappeared to have any understanding of qualitative research terms. Public healthpractitioners were also least likely to view guidelines or protocols developed byothers as the best source of evidence for primary care. The major perceivedbarrier to practising evidence-based practice was time. Consequently the mostimportant facilitator was protected time, but increased resources (financial and staff) and training were also cited. Professional groups other than GPs perceivedinter-professional boundaries as a barrier and suggested multi-professionalteamworking and learning as potential supports for evidence-based practice.CONCLUSIONS: While all professional groups welcome and support evidence-basedpractice, there are clear differences in the starting point and perspectivesacross the groups. These need to recognized and addressed to ensure that learningthe skills of evidence-based practice and implementing evidence are effective.This will also enhance the ability of primary care organizations to developrobust mechanisms for supporting key aspects of clinical governance.

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136. J Eval Clin Pract. 2004 May;10(2):177-86.

Nursing based evidence: moving beyond evidence-based practice in mental healthnursing.

Geanellos R.

University of Western Sydney, School of Nursing, Family & Community Health,Hawkesbury Campus, NSW, Australia. [email protected]

Various authors suggest mental health nursing is dominated by knowledge borrowed from psychiatry, pharmacology and the behavioural sciences. These disciplinesfavour knowledge developed using quantitative methodologies so they andevidence-based practice (EBP) and evidence-based nursing (EBN), increasinglycalled for in mental health nursing, fit seamlessly together. Nevertheless, asthese movements dismiss qualitative approaches to knowledge (evidence)development, I argue against the move toward EBP/EBN in mental health nursing.This is because the specialty's primary interests - human experiences ofillness/health care and human relationships, often do not lend themselves tobeing quantitatively researched. Using nursing examples, I demonstrate howqualitative research, wholly unacceptable in relation to EBP/EBN quality ofevidence scales, is indispensable to mental health nursing. The need for evidencearising from qualitative research in no way precludes the need for quantitativelyderived evidence. Indeed, the specialty's twofold interest - the work of nurseswith clients and the explication of phenomena which inform practice, requirediverse knowledge and thus, diverse research approaches. This twofold interestdefines the area of mental health nursing practice, and knowledge informing it isreferred to as nursing based evidence (NBE). Because it values multipleapproaches to knowledge development, NBE provides a way to articulate thespecialty's distinct contribution to the health care of people experiencingmental illness and advances mental health nursing.


137. Br J Nurs. 2004 Feb 26-Mar 10;13(4):211-6.

Evidence-based practice is a time of opportunity for nursing.

Tod A, Palfreyman S, Burke L.

Sheffield Teaching Hospitals NHS Trust, and Department of Acute and CriticalCare, University of Sheffield, Sheffield, UK.

The debate regarding evidence-based practice (EBP) continues to rage withinnursing. This article reviews the existing situation regarding policy and theability of nurses to engage with EBP. Recommendations are made regarding movingthe debate away from a focus on barriers to EBP towards seizing it as anopportunity. The article suggests that a fundamental change in attitude isrequired by nurses in order for the nursing profession to progress. There is aneed to recognize that the nature of health services are changing and that nurses

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need to grasp the opportunities this makes available, but in order to do thisnurses need support.


138. J Nurses Staff Dev. 2003 Nov-Dec;19(6):279-85; quiz 286-7.

Evidence-based practice. The role of staff development.

Krugman M.

University of Colorado Hospital, Denver, CO, USA. mary.krugman@uch

Knowledge and use of evidence-based practice are essential to ensure bestpractices and safe patient outcomes. Staff development specialists must beleaders in this initiative to support clinical nurses toward improved practiceoutcomes. This article describes the background for understanding the historical evolution from research utilization to evidence-based practice, defines some key concepts related to evidence-based practice, and suggests essential componentsfor building evidence-based practice programs in healthcare institutions.


139. Am J Obstet Gynecol. 2004 Feb;190(2):413-21.

Implementing evidence-based practice: evaluation of an opinion leader strategy toimprove breast-feeding rates.

Sisk JE, Greer AL, Wojtowycz M, Pincus LB, Aubry RH.

Department of Health Policy, Mount Sinai School of Medicine, New York, NY, USA.

OBJECTIVE: The objective was to evaluate the effectiveness of opinion leaders in raising breast-feeding rates.STUDY DESIGN: A randomized controlled trial of an opinion leader strategy in 18hospitals in Central New York State compared mothers' intention to breast-feedduring baseline and study years. Multivariate logistic regression with a mixedmodel analyzed the effects on breast-feeding exclusively and on breast- andformula-feeding combined.RESULTS: Obstetric clinicians had a high degree of knowledge about breast-feedingbenefits and of perceived responsibility to recommend breast-feeding.Obstetricians, family practitioners, and midwives agreed on the person identifiedas the opinion leader, in each case an obstetrician who was chief of obstetricsor obstetrics-gynecology. Breast-feeding rates in hospitals with the opinionleader intervention did not differ significantly from those in control-grouphospitals during the study year.CONCLUSION: The opinion leader strategy in this case did not improvebreast-feeding rates during the study year. Opinion leader strategies may makeassumptions about clinician control that are not justified in situations such as breast-feeding.


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140. J Adv Nurs. 2004 Jan;45(2):178-89.

Barriers to evidence-based practice in primary care.

McKenna HP, Ashton S, Keeney S.

Head of School of Nursing, University of Ulster, Ulster, UK.

BACKGROUND: Evidence-based practice is one of the most important underlyingprinciples in modern health care. In the United Kingdom, successive governmentshave highlighted the fact that a quality health service is built upon the use of best evidence. Health professionals are becoming more accountable within clinicalgovernance structures for the care they provide. The need to use robust research findings effectively is a critical component of their role. However, studies showthat a number of barriers prevent the effective use of best available evidence.AIM: This study aimed to identify barriers to evidence-based practice in primary care.METHOD: A specially designed questionnaire was used to gather respondents'perceptions of the barriers to evidence-based practice. Data were collected in2000/2001.FINDINGS: Findings show that general practitioners (GPs) ranked barriersdifferently to community nurses. GPs believed that the most significant barriers to using evidence in practice were: the limited relevance of research topractice, keeping up with all the current changes in primary care, and theability to search for evidence-based information. In contrast, the mostsignificant barriers to the identified by community nurses were poor computerfacilities, poor patient compliance and difficulties in influencing changeswithin primary care. This suggests that these two groups may require differentstrategies for barrier removal.CONCLUSIONS: Identifying barriers is just the first step to addressing issuessurrounding the use of evidence-based practice. Extra resources will be needed ifthese barriers are to be tackled. However, if the resultant change improves thehealth and wellbeing of people and communities, then the extra costs would beoffset by more efficient use of services.


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Evidence Based Practice-Nurses Knowledge

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