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Key Topics
Requirement
How Confident are RCH Advanced Practice Nurses in Utilising Evidence-Based Practice Principles?
Solution
Background
The extent of implementation of EBP principles depends on the level of academic qualification, and years of nursing experience. The confidence in utilising EBP principles at Royal Children’s Hospital, needs to be studied. The study aims to determine whether level of academic qualification and years of nursing experience, have any bearing on their confidence in utilizing EBP principles.
Methods
We carried out a cross-sectional study among 178 nurses at a RCH. The EBP principles are evaluated on a scale
Results
Mixed outcome was observed among the nurses. The results showed that nurses were positive towards EBP, but only practised it to a small extent. Nurses with highest qualification showed statistically significant difference (p<0.05) in comparison to other nurses. Nurses with experience showed diverse outcome in terms of marginal EBP practices.
Conclusions
The study shows that nurses have a positive attitude towards evidence-based practice, but practise it to a lesser extent. Confidence related to knowledge appear to have the greatest effect on implementation of evidence-based practice. Having knowledge and taking part in evidence-based practice working groups seem important.
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1.0 Introduction
Restorative and medicinal services is a standout amongst the most element human controls, and a lot of cash are spent every year on high calibre and complex examination, bringing about an exponential development in health care system (Shaheen et al., 2011). Frequently, new and more viable medications and strategies are imagined. The traditional and existing approaches and practices, human services specialists are embracing imaginative intercessions that depend on best practices and strong exploration based proof. Evidence based practice (EBP) is one such procedure and is rapidly picking up ubiquity because of its capability to adequately handle clinical issues and give better patient consideration across the world.
In Australia, all nurses are expected to use principles of EBP in their nursing roles in treating patients (Nursing and Midwifery Board of Australia, 2013). The implementation of EBP principles can ensure in improvement of patient outcomes (Melnyk et al., 2012). It is expected that nurses performing more advanced roles ought to have more advanced skills in EBP principles and research indicates that Advanced Practice Nurses (APNs) can be effective as leaders in facilitating the implementation of EBP in clinical settings (Gerrish et al., 2011; McDonnell et al., 2012). However, research both internationally and in Australia has shown there are a number of barriers to nurses using EBP principles (Gerrish et al., 2011; Maaskant et al., 2012; Malik et al., 2015). Furthermore, there is great variability in APNs level of competence and confidence in utilising these principles (Gerrish et al., 2011). APNs confidence in the utilisation of EBP principles has never been studied in an Australian tertiary paediatric setting.
2.0 Background
EBP refers to the employment of applicable information that has been derived from research, then further trialled and approved by patients and registered nurses within a clinical setting (Rycroft-Malone, 2004). The need for nurses and health professionals to incorporate EBP became apparent when traditional methods were no longer seen as best practice in advocating for patient safety (Bartelt et al., 2011; Madsen et al., 2005). EBP also shown to support high quality healthcare, improve patient health outcomes and standardise quality of care (Melnyk et al., 2012; Pravikoff et al., 2005; Melnyk & Fineout-Overholt, 2011). According to a report published by the U.S. Institute of Medicine (Committee on Quality of Health Care in America, 2001), EBP should be one of the fundamental aspects of clinical decision-making. APNs play major role in implementing EBP principles in healthcare system (Hockenberry et al., 2007; Melnyk et al., 2014). Research demonstrates that APNs are well placed to implement EBP principles among other RNs working at the bedside by developing their competence, empowering them to use evidence and creating a more questioning culture (Gerrish et al., 2011; McDonnell et al., 2012). APNs act as knowledge brokers by linking ward nurses to EBP and function as educational resources for peers, patients and patient’s families (Gerrish et al., 2011). According to a study by Newhouse et al. (2011), in America APNs help to reduce healthcare costs by applying evidence-based practice, nursing knowledge and experience. APNs support ward nurses in problem solving and facilitating evidence-based practice changes. Despite of the benefits, EBP poses challenges in terms of barriers in implementing the principles (Bartelt et al., 2011; Maaskant et al., 2013). Heavy clinical workload, lack of organisational support, and knowledge have been noted as major barriers to nurses utilising EBP in English, Dutch and Australian studies. (Gerrish et al., 2011; Maaskant et al., 2013; Malik et al., 2015; Hutchinson & Johnston, 2004). A U.S-based descriptive survey (Melnyck et al. 2004) found that American nurses noted similar barriers, including lack of time and access to resources; lack of financial and managerial support, and lack of mentors as barriers to EBP across the world (Jamieson & Williams, 2002). Other study (Melnyck et al., 2012) reported that nurses believe these barriers continue to exist. Therefore, both local and international research suggests that nurses face similar barriers towards utilising EBP principles. It indicates that nurses need extra time apart from bedside practice for reviewing and implementation of research findings (Hutchinson & Johnston, 2004). However, the barriers can overcome by recruiting the nurses with research skills. Providing organisational support and improving availability and accessibility of research reports will also assist in utilising EBP.
APN represent in nursing in the use of critical questioning and utilisation of an evidence base to lead the improvement of nursing care (Bryant-Lukosius et al., 2004). The variability in terms of practise for APN and the varying skills and requirements needed to fulfil these roles. APNs in Australia are not required to have a graduate level education (Ramis et al., 2013) to meet the requirements of their positions, whereas nurses in Canada for example, are required to have a graduate education prior to fulfilling APN roles (Bryant-Lukosius, 2004). While the definition of APN is variable, one framework that attempts to conceptualise advanced practice nursing is the Strong model (Chang et al., 2010; Chang et al., 2011). The model was validated and used to form an operational framework for conceptualising advanced practice roles (Chang et al.,2010; Chang et al., 2011). APN roles may vary globally in terms of implementation of EBP however, are quite similar among Registered Nurses (RNs). Most RNs agree that the use of EBP will result in best practice and benefit patients (Maaskant et al., 2013; Shaheen et al., 2011; Melnyck et al., 2004; Melnyk et al., 2012), the ability of nurses to utilise EBP is highly variable with most lacking in the skills required to adequately utilise EBP (Gerrish et al., 2011; Shaheen et al., 2011; Malik et al., 2015). A cross sectional survey of English APNs (Gerrish et al., 2011) found that APNs had varied skills in EBP with little understanding of EBP principles, and only half were confident to evaluate research reports. Furthermore, those nurses with Masters Qualifications perceived themselves as more skilled in all aspects of EBP. Melnyk et al., (2004) showed similar findings, with RNs being favourable towards EBP but less confident in their knowledge and use of evidence based practice principles. Over all the study found that RNs had strong belief in the benefit of EBP but their knowledge and use of EBP principles was comparatively limited. It can be understood from literature that RNs from Australia possess positive attitudes towards EBP, but had poor confidence in their ability to search for evidence. It reveals that there exists variability locally and internationally in EBP skills in the nursing profession. The preparedness of more senior nurses to utilise EBP principles has never been studied in an Australian tertiary paediatric setting. The hypothesis was developed based on the scenario including (i) the APNs with higher academic qualification will have greater confidence in utilising EBP principles. (ii) APNs with greater years of nursing experience will have less confidence in utilising EBP principles. This hypothesis is based on the assumption that these nurses may have been away from academic study for longer because they have been working in the field and therefore may have had less exposure to academic training in EBP principles. Therefore, a research question is arisen to what extent the APNs at RCH are confident in utilising EBP principles. The aim of the study is to determine the baseline level of confidence that APN have in utilising EBP principles. The study also aims to determine whether level of academic qualification, and years of nursing experience, have any bearing on their confidence in utilising EBP principles. The nurses, who are working at the Royal Children’s Hospital (RCH), were enrolled in the study. Determining a baseline measure of confidence in EBP principles will assist in future professional development programs at RCH, as it will enable training in EBP principles to be targeted to the specific needs of senior nursing groups.
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Place Your Order3.0 Methods
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3.1. Study design
This study will utilise a cross-sectional survey design. An online survey will be distributed via email distribution list to Advanced Practice Nurses at the Royal Children’s Hospital (RCH). -
3.2. Study population and Inclusion/Exclusion Criteria
APNs (grade 3 and above) from RCH are included in the study and are participated voluntarily. The nurses including practitioner, clinical nurse consultant, nurse coordinator, clinical support nurse, clinical nurse educator, associate unit manager, nurse unit manager and nurse executive. Nurses from all the disciplines at a level of grade 3 and above are included in the study. Nurses with grade 1 and 2 are excluded from the study at the time of screening. The study was conducted with the approval of Ethics Committee of the RCH. A written consent was obtained from each participant at the time of the study -
3.3. Procedure
The study comprises an online survey with a set 24 questions and takes about 5-7 minutes for completion. APNS needs to indicate their own level of confidence in EBP principles on a 7-point scale, where 1= novice and 7= expert. Three demographic questions will also be included in the survey and participants will be asked to select their response from a list of pre-set options. The demographic data including nursing domain of practice, highest level of academic qualification, and years of nursing. -
3.4. Data Collection Tool
The competence in EBP questionnaire is comprised 24 EBP competencies for practicing registered professional nurses (Melnyk et al., 2014). The tool asks participants to indicate their own level of competence in EBP principles on a 7-point likert scale, where 1=Novice and 7= Expert. Three demographic questions will also be included in the survey and participants will be asked to select their response from a list of pre-set options (Table-1). The demographic data that will be collected are, nursing domain of practice, highest level of academic qualification for instance diploma or pre-bachelor; bachelor degree; post graduate diploma; honours program; masters degree; doctorate degree) and total years of nursing (5 years or less; 6-10 years; 11-15 years; 16-20 years; 21-25 years; 26 years or more). -
3.5. Data Collection Process
The survey will be loaded into the online tool called Lime Survey. An email with a plain language statement outlining the purpose of the study and with a link to the survey will be emailed to the RCH email address of all eligible nurses using RCH distribution lists. Distribution lists will be used to protect individual email addresses and names from being identified.
4.2. Effect of nursing experience on EBP
It appears that Nurses with an experience of 11 years and above showed greater responses towards the expertise compared to professionals with below 11 years of experience. Within the group i.e., respective experience group the differences are statistically different (p<0.05). However, there exist diverse fluctuations in the results in terms of responses Nurses with a work experience of up to 11 years showed greater responses for some of the responses pertaining to the implementation of EBP principles, policies and strategies. Twenty-seven responses observed or the question, cclinical practices for the purposes of improving the quality of care. About 39 responses obtained for the question, search for external evidence based on research. Majority of responses are related to near to expertise and moderate expertise with a score of '6'.
4.3. Effect of qualification on the implementation of EBP
It appears that Nurses with higher qualification such as doctoral program are following greater EBP principles in comparison to other nurses. However nurses with masters and bachelors also showing significant difference (p<0.05) for the implementation of EBP in comparison to honours. The trend of frequency distribution looks to be haphazard among the qualifications
5.0 Discussion
EBP refers to the employment of applicable information that has been derived from thorough research, then further trialled and approved by patients and registered nurses within a clinical setting (Rycroft-Malone, 2004). The confidence will be the key outcome measure evaluated in the study. RCH is the major specialist paediatric hospital in Victoria with a staff of about 4000, providing a wide range of clinical services, acute care, and health promotion and prevention programs to children and young people.
Nurses with highest level of academic qualification have greater confidence in utilising EBP principles. Total years of nursing have less confidence in utilising EBP principles. Measures will be taken to protect the data security in terms of the disclosure. The results showed that nurses were positive towards EBP, but only practised EBP to a small extent. This study was conducted among all nurses employed at a RCH, regardless of their knowledge of EBP. The average total score on the EBP Implementation Scale proved to be relatively good compared to earlier studies (Melnyk et al., 2008). They included nurses in management and senior positions that would lead and mentor nurses throughout the nursing department. Despite the low average score on the EBP Implementation Scale in our study, we saw signs of EBP implementation. For example, most participants had discussed a research article informally with a colleague during the study and critically appraised a research article and communicated evidence from a research study to a patient about a clinical guideline. Consequently, this is an area that needs to be focused on in the future, for example by audit and feedback. Audit and feedback is widely used as a strategy to improve professional practice either on its own or as a component of multifaceted quality improvement interventions.
EBP principles are influenced with the education background and is in agreement with past studies (Egerod and Hansen, 2005). Thus, nurses who have knowledge and competence in EBP; access to resources; experience support; or are active in developing evidence-based guidelines and procedures have more belief in EBP.
In this study there was a significant difference between the nurses who took part in evidence-based working groups and those who did not. Findings from a survey support the idea that mentorship in EBP facilitates the implementation of evidence-based care. Although the use of questionnaires replied by individual nurses implies that we measure practice of EBP at the individual level, as nurses actually perform the components of EBP, we do not believe that practicing EBP is a purely individual responsibility. As nurses often say that they lack the autonomy to change practice, implementing EBP requires a whole system change implicating individuals, teams and the organization.
6.0 Conclusions
This study will provide a baseline assessment of the levels confidence of RCH APNs (grade 3 and above) to utilise EBP principles. Determining a baseline measure of confidence in EBP principles will assist in future professional development programs at RCH, as it will enable training in EBP principles to be targeted to the specific needs of senior nursing groups. The findings of this research will create a platform for future research in EBP in paediatric settings. Furthermore, it has the potential to inform future professional development programs at RCH, and to develop strategies for implementation of EBP, hence improving clinical outcomes for patients, and decreasing hospital expenditure.
The survey helps in propagating knowledge and skills to support the knowledge brokering aspect of their role. The study will provide recommendations to overcome barriers and to enhance the nurse's skills and developing the competence by providing in-house training programs at RCH, with a view to effectively use EBP in the care of patients. It will enable recognition of role that promotes EBP within the nursing profession.
References
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To be continued....
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