EVIDENCED BASED PRACTICE

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1 Using Evidence Based Practice: The Relationship Between Work Environment, Nursing Leadership and Nurses at the Beside Presented by Yvette M. Pryse RN, PhDc This research study was partially supported by the National Institute for Occupational Safety and Health Pilot Research Project Training Program of the University of Cincinnati Education and Research Center. Grant # T42/OH EVIDENCED BASED PRACTICE The careful and practical use of current best evidence to guide healthcare decisions. (Omery & Williams, 1999) Conscientious, explicit and judicious use of theory-derived, research based information in making decisions about care delivery. (Ingersoll, 2000) 1

The Problem Recognized as the Gold Standard New Expectations Evidence Based Practice itself Organizational Barriers Leadership

to implement research (19 out of 35 studies ranked this barrier as one of the top three barriers) Nurse does not feel she has

understandable (9 /35) Unaware of the research (8 /35) Facilities are inadequate for implementation (7/35) No time to read

Research not readily available (3 /35) Management will not allow implementation (1/35) Isolated from knowledgeable colleagues

implementation (1etc ) Other staff not supportive (1/35) Research not reported clearly or understandable (1/35) Hutchinson, A.

2 The Problem Recognized as the Gold Standard New Expectations Evidence Based Practice itself Organizational Barriers Leadership Support Nursing Education The Nurses Workload Retention Internal and External Pressures Funk s Barrier Scale Insufficient time to implement research (19 out of 35 studies ranked this barrier as one of the top three barriers) Nurse does not feel she has the authority to change practice (11 of the 35 ranked this barrier as one of the top three barriers) Statistics are not understandable (9 /35) Unaware of the research (8 /35) Facilities are inadequate for implementation (7/35) No time to read research (7/35) Doctors will not cooperate with implementation (4 /35) Relevant literature not compiled in one place (4 /35) Research not readily available (3 /35) Management will not allow implementation (1/35) Isolated from knowledgeable colleagues (1/35) Literature contains conflicting reports (1/35) Amount of research is overwhelming (1/35) Resources are inadequate for implementation (1etc ) Other staff not supportive (1/35) Research not reported clearly or understandable (1/35) Hutchinson, A. M., & Johnston, L. (2006). Beyond the BARRIERS Scale: commonly reported barriers to research use. Journal of Nursing Administration, 36(4),

Using Evidence Based Practice: The Relationship Between Work Environment, Nursing Leadership and Nurses at the Beside 1.

3 Using Evidence Based Practice: The Relationship Between Work Environment, Nursing Leadership and Nurses at the Beside 1. Explore the relationship among staff nurses tenure, educational level and practice site and their beliefs and attitudes about EBP. 2. Explore the staff nurses perception of nursing leadership support for EBP and its association with the staff nurses ability to engage in EBP. 3. Explore the staff nurses perception of the degree that the healthcare work environment where he/she practices influences the ability to implement EBP. NIOSH Goal Promote safe and healthy workplaces through interventions, recommendations and capacity building This study explored the organization of work under the work environment and workforce priority. 3

managerial/organizational support for EBP?

4 Research Question Which of the following variables, alone or in combination predict staff nurses implementation of EBP: Staff nurses individual characteristics (age, education, tenure and practice setting), beliefs about EBP, and perceptions of managerial/organizational support for EBP? Independent Variable Measurement EBP Beliefs Scale Melnyk,Fineout-Overholt & Mays (2008) 16 items Cronbach s alpha =.90 EBP Work Environment and Leadership Scale Researcher Developed 18 items Cronbach s alpha =.96 4

5 Dependent Variable Measurement EBP Implementation Scale Melnyk,Fineout- Overholt & Mays (2008) 17 items Cronbach s alpha =.96 Melnyk, B., Fineout-Overhold, E., & Mays, M. (2008). The evidence-based practice beliefs and implementation scales: Psychometric properties of two new instruments. Worldviews on Evidence-Based Nursing, 5(4), Melnyk & Fineout-Overhold & Mays, Copyright, 2003 Beliefs Scale: 1-5 Scale (Strongly Disagree to Strongly Agree) I am sure that I can I implement EBP in a time efficient way I am sure that I can implement EBP I believe that I can search for the best evidence to answer clinical questions in a time efficient way I am confident about my ability to implement EBP where I work I believe that I can overcome barriers tin implementing EBP I am sure about how to measure the outcomes of clinical care. I know how to implement EBP sufficiently enough to make practice changes I am sure that I can access the best resources in order to implement EBP I am sure that implementing EBP will improve the care that I deliver to my patients I believe that critically appraising evidence is an important step in the EBP process I am clear about the steps of EBP I am sure that evidence based practice guidelines can improve clinical care I believe that EBP results in the best clinical care for patients I believe the care that I deliver is evidence-based I believe that EBP is difficult (reverse scored) I believe that EBP takes too much time (reverse scored) Implementation Scale: 1-5 Scale (0, 1-3, 4-6, 7-8 or >8 times within the last week) Shared the outcome data collected with colleagues Shared evidence from a study/ies in the form or a report or presentation to > 2 colleagues Shared an EBP guideline with a colleague Shared evidence from a research study with a multidisciplinary team member Used an EBP guideline or systematic review to change clinical practice where I work Changed practice based on patient outcome data Evaluated a care initiative by collecting patient outcome data Promoted the use of EBP to my colleagues Used evidence to change my clinical practice Shared evidence from a research study with a patient/family member Read and critically appraised a clinical research study Informally discussed evidence from a research study with a colleague Critically appraised evidence from a research study Generated a PICO question about my clinical practice Collected data on a patient problem Accessed the National Guidelines Clearinghouse Accessed the Cochrane database of systematic reviews 5

6 EBP Leadership and Work Environment Scale (Pryse, 2010) Work Environment Experts in EBP are available in my work setting. In my organization I have access to databases that have full length nursing research articles. I believe my organization values evidence based nursing practice. The nurses on my unit discuss research relevant to our clinical practice. The physicians I work with support EBP changes based on nursing research. The nurses on my unit base their practice on the best evidence. My manager makes sure that I have access to relevant research on my unit. My organization pays for me to attend educational offerings about EBP. Nursing Leadership My manager is able to communicate how EBP is important for improving patient outcomes on my unit. My manager encourages me to examine evidence to guide clinical decision-making. My manager has a vision for EBP on my unit. My manager can explain EBP in terms that are easy to understand. My manager helps me resolve conflicts between nursing research and clinical practice. My manager supports my efforts to change practice in response to new knowledge/evidence. My manager is able to influence others to engage in EBP. My manager facilitates my use of resources for EBP (e.g., data bases, experts, literature). My manager facilitates practice change based on relevant nursing research. My manager provides time for me to engage in EBP. Demographics 1. Two Sites Magnet: 689 Beds Non-Magnet: 695 Beds RNs in sample population met the inclusion criteria responded 5. 24% return rate Variable Educational Level 1. ASN 2. BSN 3. MSN/NP/DN S/PhD Practice Area 1. Adult Med/Surg 2. Critical Care 3. OB/Maternity 4. Emergency 5. OR 6. Psychiatric/Re hab Length of time in years as Nurse (Tenure) >30 Age Categories >60 Attended EBP CEUs 1. Yes 2. No EBP College Courses 1. Yes 2. No Magnet Hospital N=207 n (%) 118(57%) 84(40.58%) 5 (2.42%) 74(35.75%) 73(35.27%) 36(17.39%) 3(1.45%) 4(1.93%) 17(8.21%) 72(34.78%) 22(10.63%) 29(14.01%) 15(7.25%) 20(9.66%) 26(12.56%) 23(11.11%) 50(24.15%) 54(26.09%) 52(25.12%) 47(22.71%) 4(1.93%) 117(56.52%) 90(43.48%) 104(50.24%) 103(49.76%) Non-Magnet Hospital N=215 n (%) 93(43.26%) 109(50.70%) 13(6.05%) 70(32.56%) 79(36.74%) 21(9.77%) 17(7.91%) 15(6.98%) 13(6.05%) 79(36.74%) 30(13.95%) 20(9.30%) 19(8.84%) 22(10.23%) 24(11.16%) 21(9.77%) 49(22.79%) 53(24.65%) 56(26.05%) 45(20.93%) 12(5.58%) 113(52.56%) 102(47.44%) 114(53.02%) 101(46.98%) Combined N=422 n (%) 211(49.9%) 193(45.6%) 18(4.26%) 144(34%) 152(35.9%) 57(13.5%) 20(4.7%) 19(4.5%) 30(7.1%) 1 51(35.7%) 52(12.3%) 49(11.6%) 34(8.0%) 42(9.9%) 50(11.8%) 44(10.4%) 99(23.4%) 107(25.3%) 108(25.5%) 92(21.7%) 16(3.8%) 230(54.4%) 192(45.4%) 218(51.5%) 204(48.2%) 6

49% of the Workforce is Educationally prepared at the ASN level Education was found significant for the Implementation of EBP in the multivariate Poisson regression analysis and confirmed in the

7 49% of the Workforce is Educationally prepared at the ASN level Education was found significant for the Implementation of EBP in the multivariate Poisson regression analysis and confirmed in the univariate analysis as the only demographic variable of significance. RESEARCH QUESTION Does Staff nurses individual characteristics (age, education, tenure and practice setting), alone or in combination predict staff nurses implementation of EBP? RESEARCH QUESTION Does the staff nurses beliefs about EBP predict staff nurses implementation of EBP? Don t know what they don t know!! Beliefs were found to be strongly significant for implementation in both univariate analysis and multivariate analysis. Respondents report high beliefs about the importance and value of EBP, but implementation actions were reported as very low. 7

Research Question Does the staff nurses work environment or nursing leadership predict the staff nurses implementation of EBP DV=Implementation Magnet n= 207 Non-Magnet n=215 X 2 df β SE Sig X 2 df β

8 Research Question Does the staff nurses work environment or nursing leadership predict the staff nurses implementation of EBP DV=Implementation Magnet n= 207 Non-Magnet n=215 X 2 df β SE Sig X 2 df β SE Sig Multivariate Regression Overall Model Beliefs Work Environment Nursing Leadership Simple Regression X 2 df β SE Sig X 2 df β SE Sig Beliefs Work Environment Nursing Leadership Magnet versus Non-Magnet ( β=standardized Coefficients) Future Questions Intervention study Change based on evidence Work Environment/Stress evaluation Barriers and Facilitators What are the Managers Beliefs and Attitudes about EBP Management support system 8

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Effect of DNP & MSN Evidence-Based Practice (EBP) Courses on Nursing Students Use of EBP

Effect of DNP & MSN Evidence-Based Practice (EBP) Courses on Nursing Students Use of EBP Richard Watters, PhD, RN Elizabeth R Moore PhD, RN Kenneth A. Wallston PhD Page 1 Disclosures Conflict of interest