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Keywords:

  • evidence-based practice;
  • nurses;
  • readiness;
  • beliefs;
  • skills;
  • resources;
  • survey

ABSTRACT

  1. Top of page
  2. ABSTRACT
  3. INTRODUCTION
  4. BACKGROUND
  5. METHODS
  6. FINDINGS
  7. DISCUSSION
  8. CONCLUSIONS
  9. IMPLICATIONS FOR NURSING PRACTICE AND EDUCATION
  10. References

Background

Evidence-based practice (EBP) is essential to the improvement of patient outcomes and the quality of care. Nurses’ use of evidence in practice, however, remains limited. Assessing nurses’ readiness for EBP where it is not as prominent as in countries leading EBP research was of particular interest.

Purpose

To determine Icelandic registered nurses’ (RNs’) ability to provide care based on evidence as measured by their beliefs, perception of skills, and access to resources associated with EBP.

Methods

A descriptive survey was used in which a random sample of 540 Icelandic RNs completed the translated and modified version of the Information Literacy for Evidence-Based Nursing Practice and the translated EBP Beliefs Scale. Descriptive statistics, correlations, chi-square tests, t tests and one-way ANOVAs were used to analyze the data.

Results

Participants strongly believed in the value of EBP for patient care, but were less confident regarding their own knowledge and skills needed for EBP. Most (82%) of the respondents (i.e., RNs) turned to peers when in need of information, rather than peer-reviewed resources. Although over half of the RNs (54%) had received instructions in the use of electronic databases, only a third indicated success in using them. They considered “lack of search skills” as the primary barrier to use of research in practice. Using research findings in practice was associated with positive EBP beliefs, familiarity with EBP and other EBP-related activities. Clinical RNs were found to be at a disadvantage when it came to access to EBP-related resources and participated less frequently in EBP-related activities other than using research in practice.

Conclusion and Implications

Icelandic RNs’ beliefs regarding EBP are similar to those of RNs in other countries. Their access to EBP resources is generally good, but they lack the skills and knowledge needed for EBP. Strategies aimed at changing the organizational and practice context need to be developed.


INTRODUCTION

  1. Top of page
  2. ABSTRACT
  3. INTRODUCTION
  4. BACKGROUND
  5. METHODS
  6. FINDINGS
  7. DISCUSSION
  8. CONCLUSIONS
  9. IMPLICATIONS FOR NURSING PRACTICE AND EDUCATION
  10. References

Evidence-based practice (EBP) is associated with improved patient outcomes and cost-effective care (Melnyk & Feinstein 2009) and is therefore widely promoted by healthcare leaders. Contrary to expectations, nurses’ use of evidence in practice remains limited (Estabrooks et al. 2008; Melnyk et al. 2008a; Wallen et al. 2010). Knowledge of factors that affect nurses’ use of evidence has been accumulating, especially in countries leading the EBP movement. However, less is known about the readiness of nurses for EBP in countries where it is not as prominent. Using existing instruments allows for comparisons of findings between studies and countries. At the time of this study, no studies on Icelandic nurses and EBP could be found.

BACKGROUND

  1. Top of page
  2. ABSTRACT
  3. INTRODUCTION
  4. BACKGROUND
  5. METHODS
  6. FINDINGS
  7. DISCUSSION
  8. CONCLUSIONS
  9. IMPLICATIONS FOR NURSING PRACTICE AND EDUCATION
  10. References

Positive beliefs toward EBP are consistently associated with nurses’ use of evidence in practice and are important motivators to change practice (Estabrooks et al. 2003; Melnyk et al. 2004; Melnyk et al. 2010a; Squires et al. 2011). Nurses generally report a favorable view of EBP and its value for quality of care independent of workplace, role, or nationality (Egerod & Hansen 2005; Kuuppelomaki & Tuomi 2005; Melnyk et al. 2008a; Alanen et al. 2009). Their beliefs in their own skills and knowledge needed for EBP are less positive, however (Estabrooks et al. 2003; Melnyk et al. 2004). Beliefs in the value of EBP are linked to experience of EBP (Melnyk et al. 2008b; Alanen et al. 2009), higher educational level (Koehn & Lehman 2008; Melnyk et al. 2008b; Thiel & Ghosh 2008; Squires et al. 2011), and knowledge of EBP (Thiel & Ghosh 2008).

To provide care informed by evidence nurses must recognize the need for current information, have the skills and means to search for it, and be able to appraise and apply evidence in the work setting (Adib-Hajbaghery 2009; RCN, 2011). Pravikoff et al.'s (2005) often cited national survey of US nurses’ readiness for EBP describes nurses’ skills and access to and use of resources needed for EBP. The study has been replicated in different settings (Cadmus et al. 2008; Thiel & Ghosh 2008) and specialties of nursing (Baker et al. 2010; Ross 2010). The findings from these studies show that most nurses seek information from peers rather than peer-reviewed publications that are available in electronic bibliographic databases and that nurses consistently report having limited EBP skills and knowledge. Findings from studies using different approaches have also demonstrated nurses’ lack of knowledge and skills related to EBP (Egerod & Hansen 2005; Sherriff et al. 2007; Koehn & Lehman 2008; Witzke et al. 2008) and their preference for personal knowledge and turning to peers for information (Egerod & Hansen 2005; Estabrooks et al. 2005).

Several barriers to use of evidence in practice have also been identified. A systematic review of studies using the BARRIER Scale finds most barriers to EBP related to setting and presentation of research findings (Kajermo et al. 2010). The most frequently reported barrier is “lack of time” (McCaughan et al. 2002; Hutchinson & Johnston 2004; Melnyk et al. 2004) and the number one barrier to research use in practice in Pravikoff et al.'s study (2005), lack of time excluded, was “lack of value for research.” Other barriers include lack of administrative support (Hutchinson & Johnston 2006) and lack of EBP mentors (Melnyk et al. 2004). Investigators have concluded that nurses do not fully understand the meaning of the term EBP and what it involves (Egerod & Hansen 2005; Koehn & Lehman 2008) and are not ready for EBP for numerous reasons (Pravikoff et al. 2005).

Research findings indicate clinical nurses are significantly less familiar with EBP than nurses in administrative positions. Clinical nurses report less use of bibliographic databases, less access to resources, and less success in using electronic resources than nurses in other positions (e.g., in administration; Egerod & Hansen 2005; Pravikoff et al. 2005).

EBP Activity in Iceland

The Directorate of Health in Iceland commenced work on evidence-based clinical guidelines in the year 2000 (Aradottir, personal communication, March 12, 2011). The principles of EBP are explained at the Directorate's Web site, where the completed guidelines are made accessible. Since 2000, computers connected to the Internet via an Icelandic Internet Service Provider have open access to vast amounts of electronic information through signed licenses between the government and information providers. For Health Sciences, this means national access to about 2,400 full text journals, 3,500–3,700 journal abstracts, and numerous e-books (Bjornsson, personal communication, March 10, 2011).

Evidence-based guidelines committees for medical and nursing services were established at the nation's only university hospital (UH) in 2003. Since then, the hospital's nursing administration has made efforts to increase nurses’ use of evidence. The term EBP was added to the UH's nursing vision statement and subsequently in-service lectures and workshops on EBP have been offered several times a year. In addition, evidence-based clinical guidelines have been developed and implemented by UH nurses.

Purpose

The purpose of this study was to determine the ability of Icelandic registered nurses (RNs) to provide care based on evidence as measured by their beliefs, perception of skills, and access to resources associated with EBP. The findings present an opportunity to examine Icelandic RNs’ beliefs and their perception of skills and resources available for EBP in comparison with RNs in other countries. The findings will serve as a baseline for measuring and monitoring change in EBP readiness following tailored educational and organizational interventions aimed at increasing the use of evidence in practice.

Ethical Considerations

The Data Protection Commission was informed of the study in accordance with Icelandic law (S3332). The voluntary nature of the study and promise of confidentiality were explained to each participant in an introductory letter in the survey package. Returning the questionnaire was considered consent to participate. Permission to translate and use the Information Literacy for Evidence-Based Nursing Practice© (ILNP) questionnaire (Pierce et al. 2003b) and the EBP Beliefs Scale© (Melnyk & Fineout-Overholt 2003) was obtained.

METHODS

  1. Top of page
  2. ABSTRACT
  3. INTRODUCTION
  4. BACKGROUND
  5. METHODS
  6. FINDINGS
  7. DISCUSSION
  8. CONCLUSIONS
  9. IMPLICATIONS FOR NURSING PRACTICE AND EDUCATION
  10. References

The study was a cross-sectional, descriptive survey. Participants were asked to complete translated versions of the ILNP and the EBP Beliefs Scale. Data were collected over a 2-month period in 2007. The translation, adaptation, and validation of the instruments for use in Iceland have been reported elsewhere (Thorsteinsson 2012).

Participants

The study population was defined as Icelandic RNs registered with the Icelandic Nurses Association (INA) and working within nursing at the time of the study (N = 2,498). The INA is the official body of nurses in Iceland, with members numbering about 94% of the nursing work force (Sveinsdottir et al. 2007). A random sample of 1,040 RNs from the INA registry was obtained using the Rand function in Excel. They were offered participation via mail. Demographics and employment information were collected using six questions applicable to the Icelandic context (Gunnarsdottir 2007).

At the time of the study, 72.6% (n = 1,815) of the Icelandic RNs and 69.6% (n = 376) of the participants worked in the capital of Iceland (difference 3%; 95% CI:–0.0863 to +0.0263). Forty-two percent of the Icelandic RNs (n = 1,051) and 46.7% (n = 52) of the participants were employed at the UH (difference 4.6%, 95% CI: –0.015 to +0.107). The mean age of Icelandic RNs was 46.1 years (95% CI: 45.7–46.51) and the mean age of the participants was 45.4 (SD = 10.22) years (95% CI: 44.55–46.32).

The EBP Beliefs Scale©

The EBP Beliefs Scale, developed by Melnyk and Fineout-Overholt (2003), was designed to capture nurses’ beliefs about the value of EBP and their ability to implement it in practice. They defined beliefs in EBP as “endorsement of the premise that EBP improves clinical outcomes and confidence in one's EBP knowledge/skills” (Melnyk et al. 2008b, p. 210). The 16 statements of the scale are listed in Table 1. The respondents are asked to indicate on a five-point Likert scale how strongly they disagree (1 = strongly disagree) or agree (5 = strongly agree) to each of the statements (e.g., “I believe EBP results in the best clinical care for patients”). Responses are summed for a total score, which could range from 16–80 (median 48). The higher the score, the more the positive beliefs are. Negatively phrased items are reverse scored before analysis.

Table 1.  Mean scores of the I-EBP Beliefs Scale and endorsement of statements (n = 471)
 Mean (SD)Strongly Agree/ Agree (%)Neither Disagree nor Agree (%)
1. I believe EBP results in the best clinical care for patients4.23 (0.70)8910
2. I am clear about the steps of EBP2.60 (1.15)2333
3. I am sure I can implement EBP4.00 (0.71)7920
4. I believe that critically appraising the evidence is an important step in the EBP process4.19 (0.67)8712
5. I am sure that EB guidelines can improve clinical care4.37 (0.64)937
6. I believe that I can search for the best evidence to answer clinical questions in a time efficient way3.59 (0.86)5535
7. I believe I can overcome barriers in implementing EBP3.56 (0.76)5243
8. I am sure I can implement EBP in a time efficient way3.37 (0.73)4249
9. I am sure that implementing EBP will improve the care I deliver to my patients4.07 (0.66)8316
10. I am sure about how to measure the outcomes of clinical care3.71 (0.81)6628
11. I believe EBP takes too much time (reverse coded)3.31 (0.83)3949
12. I am sure I can access the best resources to implement EBP3.57 (0.80)5538
13. I believe EBP is difficult (reverse coded)3.46 (0.79)4942
14. I know how to implement EBP sufficiently enough to make practice changes2.83 (0.99)2636
15. I am confident about my ability to implement EBP where I work3.59 (0.80)6031
16. I believe the care that I deliver is evidence based3.54 (0.74)5538

Face and content validity of the EBP Beliefs Scale were established during the scale's development (Melnyk et al. 2008b). The EBP Beliefs Scale and its Icelandic version (I-EBP Beliefs Scale) measure a unidimensional construct and have both construct and criterion validity established, respectively, by principal components analysis and known-groups comparisons (Melnyk et al. 2008b; Thorsteinsson 2012). The internal consistency reliabilities of the EBP Beliefs Scale have been 0.85 or higher (Melnyk et al. 2008b; Melnyk et al. 2010a; Levin et al. 2011), indicative of a sound instrument. The reliability of the I-EBP Beliefs Scale with this sample is satisfactory (Cronbach's α = 0.86 and Spearman–Brown r = 0.87).

The ILNP

The ILNP was developed to assess US nurses’ readiness for EBP from the perspective of information literacy. The ILNP addresses information needs and seeking, as well as availability of EBP resources and their use and experience of and perceived barriers to EBP. The development and validation of the ILNP and previous use have been described (Pierce et al. 2003a; Pravikoff et al. 2005).

Several response formats are used:

  1. “Yes, no, don't know” (e.g., questions about access to information resources).
  2. Four to seven faceted questions (e.g., to indicate information resource use).
  3. Ranking of the top three barriers (besides time) to use in research in practice.
  4. Five-point Likert items (e.g., to grade computer and database search skills). Familiarity with EBP was measured on a five-point Likert item ranging from 1 (very familiar) to 5 (not at all familiar), as were discussions about EBP at work (1 = very frequent discussions; 5 = no discussion at all). Both were reverse coded before further analysis.

The ILNP consists of 71 items in addition to background questions. It was modified and adapted to fit the Icelandic context (Thorsteinsson 2012), with 44 items used in the current study. The content validity of the original questionnaire was established by a panel of experts made up of nurse informatics specialists, library scientists, and clinicians (Pierce et al. 2003a). Content validity of the Icelandic version (I-ILNP) of the questionnaire was established by six nurses knowledgeable in EBP and a librarian specialized in healthcare information. Because this questionnaire is an information gathering tool rather than a measure of values or psychological traits, validity, and reliability tests are not done (Tanner, personal communication, February 6, 2005; Pravikoff 2005).

Procedure

Dillman's (2000) Tailored Design Method guided data collection. However, because of time and cost restraints, no introductory card was sent to the participants before mailing the survey. A survey package, which contained the I-ILNP and the I-EBP Beliefs Scale, a cover letter, and a stamped envelope, was mailed to the home addresses of potential participants. A reminder postcard was sent 2 weeks later and 4 weeks thereafter a repeat survey package was mailed to those RNs who had not indicated their participation.

Data Analysis

Returned surveys were scanned and subsequently analyzed using SPSS, version 11 (SPSS Inc., Chicago, IL, USA). Descriptive statistics were employed to describe frequencies and distribution of answers. Pearson's r and Spearman's rho (ρ) correlations were calculated to describe relationships between the study variables. Finally, chi-square tests, t tests, and one-way ANOVAs were performed to determine differences between groups of RNs.

FINDINGS

  1. Top of page
  2. ABSTRACT
  3. INTRODUCTION
  4. BACKGROUND
  5. METHODS
  6. FINDINGS
  7. DISCUSSION
  8. CONCLUSIONS
  9. IMPLICATIONS FOR NURSING PRACTICE AND EDUCATION
  10. References

Five hundred and forty completed surveys were returned, yielding a response rate of 54.1%. Forty-two envelopes were undeliverable or returned unopened.

Respondents

Sixteen percent of the respondents (n = 86) worked at hospitals other than the UH and another 14.7% (n = 79) at various healthcare centers. Years in nursing ranged from less than 1 year to 47 years (M = 18.65; SD = 11.49) and 56% of the respondents (n = 305) worked full time. More than half of the RNs (55.7%; n = 273) reported that they had received their most recent nursing degree after 1997, which is when electronic bibliographic databases became readily available. Of the respondents, 38.1% (n = 205) were specialty certified, 9.5% (n = 51) were full or part time students, and 6.5% (n = 35) were studying toward an MS degree. Eleven percent (n = 58) of the respondents already had a Master's or a PhD degree in nursing. For the past 25 years, all basic nursing education in Iceland has been at the baccalaureate level.

The majority of the respondents (71.5% or n = 382) worked in clinical nursing (i.e., bedside or direct care nursing), whereas 24.2% (n = 129) worked in administration, 1.7% (n = 9) in education, and 2.6% (n = 14) in other roles. Less than half of the participants (41.8%; n = 221) were very familiar or familiar with the term EBP, whereas 21% (n = 111) were not at all familiar with it (M = 3.01; SD = 1.42).

EBP Beliefs of Icelandic RNs

Only complete I-EBP Beliefs Scales (n = 471) were used in the analysis. The summed scores of the I-EBP Beliefs Scale ranged from 36 to 80, with a mean of 58.0 (SD = 7.22), reflecting significant (99% CI 57.14–58.86) positive beliefs toward EBP. Individual statements’ mean scores, standard deviations, and percent endorsement showed substantial variation, ranging from M = 2.60 (SD = 1.15) to M = 4.37 (SD = 0.64) and from 22.5% to 92.6% (Table 1). Scores of 4 and 5 were combined and represented agreement with the statements. Statements pertaining to the value of EBP for the clinical care of patients (items 1, 5, 9) were highly endorsed, whereas statements related to knowledge and skills needed for EBP (items 2, 14) were least supported. Two statements (items 8, 11) yielded the highest undecided answers; both of these statements were related to “time.”

Interitem correlations (Pearson's r > 0.4) were as follows: “EB guidelines can improve clinical care” (item 5) with “critically appraising the evidence is an important step in the EBP process” (item 4) (r = 0.631; p < 0.001) and “I believe the care that I deliver is evidence-based” (item 16) correlated with “I am confident about my ability to implement EBP where I work” (item 15) (r = 0.466; p < 0.001).

Strength of EBP beliefs increased the more familiar the nurses were with EBP, F(5, 468) = 44.62, p < 0.001. The respondents were divided into four groups depending on frequency of identifying researchable problems, evaluating research reports, participating in research, and using research findings in practice 1 year before the study. The total score on the I-EBP Beliefs Scale increased significantly (p < 0.001) with increased participation (Table 2).

Table 2.  Mean scores of I-EBP Beliefs Scale by participation in EBP-related activities
 Never M (SD)Once M (SD)2–3 Times M (SD)More Than 3 Times M (SD)F(df, n)
  1. *p ≤ 0.001.

Identified researchable problems56.56 (6.55)58.79 (6.59)64.21 (8.24)65.48 (6.93)F(3, 459) = 25.48*
Evaluated research reports55.96 (6.43)58.90 (6.54)60.69 (6.06)66.30 (6.85)F(3, 455) = 42.56*
Participated in research56.59 (6.46)59.96 (7.40)59.00 (6.94)62.25 (9.20)F(3, 465) = 11.60*
Used research in practice55.21 (6.62)56.78 (5.48)59.38 (6.05)64.73 (7.07)F(3, 455) = 44.28*

Information Seeking and Use of Information Sources

Many of the RNs (58%; n = 308) indicated they needed information twice a month or less, about a third (30.1%; n = 160) needed information weekly, and 12% (n = 63) several times a week. When they needed information, 82% (n = 431) primarily asked their peers and 53% (n = 277) often searched the Internet. The majority of the RNs (84.4%; n = 430) sought information from their peers weekly to many times daily. In contrast, 85.7% (n = 433) rarely or never sought the assistance of librarians and about a third rarely or never used electronic databases (36.2%; n = 188; Table 3).

Table 3.  Frequency of use of specific information resources
 Many Times Daily or Daily2–3 Times a Week or WeeklyMonthly3–4 Times a YearNever
Peer or colleague38.1%46.3%9.6%5.3%0.6%
N = 509(n = 194)(n = 236)(n = 49)(n = 27)(n = 3)
Reference text/manual12.9%54.4%20%11.7%1.2%
N = 506(n = 65)(n = 275)(n = 101)(n = 59)(n = 6)
Internet/Google7.1%33.2%23.7%20.2%15.8%
N = 505(n = 37)(n = 168)(n = 120)(n = 100)(n = 80)
Electronic bibliographic databases3.4%18.4%20%31.3%26.9%
N = 501(n = 17)(n = 92)(n = 100)(n = 157)(n = 135)
Journal article/research report1.6%19.5%33.2%33%12.7%
N = 503(n = 8)(n = 98)(n = 167)(n = 166)(n = 64)
Hospital library0.6%11.8%22.4%37.8%27.0%
N = 498(n = 3)(n = 59)(n = 112)(n = 189)(n = 135)

The respondents answered comparable questions about their peers’ use of information resources. They believed that nurses in their work environment use information resources more often than they do themselves (Table 4).

Table 4.  Perceived frequency of other nurses’ use of information resources
 Many Times Daily or Daily2–3 Times a Week or WeeklyMonthly3–4 Times a YearNeverχ2; df = 36 (N = Valid Cases)
  1. *p ≤ 0.001.

Peer or colleague60.9%30.8%5.7%1.8%0.4%294.98*
N = 487(n = 311)(n = 157)(n = 31)(n = 9)(n = 2)(N = 486)
Reference text/manual19.6%49.4%20.4%10.2%0.4%200.58*
N = 501(n = 98)(n = 247)(n = 102)(n = 51)(n = 3)(N = 475)
Internet/Google9.8%42.8%24%17.9%5.6%279.94*
N = 496(n = 48)(n = 212)(n = 119)(n = 89)(n = 28)(N = 474)
Journal article/research report2%21.2%38.3%32.1%6.5%221.34*
N = 496(n = 10)(n = 105)(n = 190)(n = 159)(n = 32)(N = 470)
Hospital library1.4%9.9%21.9%50.6%16.2%168.39*
N = 488(n = 7)(n = 48)(n = 107)(n = 247)(n = 79)(N = 460)

EBP-Related Skills and Barriers

Current nursing practice requires skills in using computers. Rated on a Likert item from 1 (beginner) to 5 (expert), the RNs were confident in using e-mail (M = 4.20; SD = 0.949), word processing programs (M = 3.94; SD = 1.648), and computers in general (M = 3.61; SD = 0.937), but less confident in using electronic databases (M = 2.76; SD = 1.263). Nearly a third (29.6%; n = 128) indicated success in using electronic databases and one fourth (25.4%; n = 110) felt that they were not successful in finding information they needed. Twenty-one percent (n = 114) said they never searched electronic databases and 35% (n = 188) did not answer this question.

From a list of 10 barriers, the RNs were asked to identify and rank the top three barriers they thought interfered most with their use of research in practice, excluding “lack of time.” Many of the RNs apparently found this difficult. When barriers were not ranked or more than three barriers were chosen, answers were coded as missing, resulting in several missing cases. The barrier most frequently selected as the principal barrier was “lack of search skills.” Lack of search skills was also most often ranked as either a first, second, or third barrier, followed by “lack of skills to critique or synthesize the literature.” The barriers chosen by the greatest number of respondents in order of importance are shown in Table 5.

Table 5.  Barriers to RNs’ own use of research in practice (in order of importance, with 1st, 2nd, and 3rd barriers combined)
1Lack of search skills
2Lack of skills to critique or synthesize the literature
3Not enough interest
4Lack of library access
5Difficulty accessing research materials
6Lack of access to computer
7Difficulty understanding research articles (tied with the eighth barrier)
8Lack of knowledge about research
9Lack of value for research in practice
10Lack of computer skills

Resource Availability and Use

Forty-five percent of the RNs (n = 237) reported that EBP guidelines were available at work whereas 26% (n = 142) did not know whether EBP guidelines were available. Forty-one percent of the RNs (n = 215) had been to lecture(s) on EBP and a third (33.5%; n = 181) said that such lectures were offered where they work. The majority of the RNs (59.2%; n = 312) stated that instructions in the use of electronic databases were available at work and 54% (n = 287) had attended such lessons. Although nearly all the RNs (99.2%; n = 527) had Internet access at work to search electronic bibliographic databases (95%; n = 511), 63% (n = 334) had never used the national access to information resources. Forty-eight percent of the RNs (n = 250) perceived their access to electronic databases as adequate or more than adequate.

About a fifth of the respondents (21.5%; n = 113) said they had participated in EBP projects. Participation in other EBP-related activities in the year before the study was infrequent: over half of the respondents had never identified researchable problems, evaluated research reports, or participated in research (Table 6). However, over half had used research findings at work at least once in the year before the study (Table 6). Those respondents who had participated in EBP projects had more often used research findings at work (χ2 = 61.593; df = 6; p < 0.001).

Table 6.  Frequency of participation in EBP-related activity in the year before the study
 >3 Times1–3 TimesNever
Used research in practice16.5% (n = 84)37.0% (n = 188)46.5% (n = 236)
Evaluated research reports11.0% (n = 56)22.2% (n = 115)66.5% (n = 339)
Participated in research8.3% (n = 43)31.4% (n = 163)60.2% (n = 313)
Identified researchable problems5.0% (n = 26)25.9% (n = 134)68.8% (n = 355)

Seventy-seven of the RNs (14.5%) reported that EBP was much or very much discussed, whereas 32% (n = 170) claimed that there was no discussion at all (M = 2.23; SD = 1.115).

Relationships

No correlations above Pearson's r = 0.4 were found between demographic factors and familiarity with EBP, discussion of EBP at work, skills in using electronic databases, use of resources, and the I-EBP Beliefs Scale. Spearman's rho (ρ) correlations were calculated for age, work experience, educational level, years since most recent nursing degree, and select variables related to EBP. Years since most recent nursing degree was correlated with skills in using electronic databases (Spearman's ρ = –0.509; p ≤ 0.001), indicating the longer time since receiving a nursing degree, the less skills. No other correlations were found between demographic factors and EBP-related variables above Spearman's ρ = 0.4.

Frequency of participating in EBP-related activities was intercorrelated and correlated with total I-EBP Beliefs Scale scores and familiarity with EBP. Frequency of discussions about EBP was correlated with familiarity with EBP (ρ = 0.715; p < 0.001) and using research findings in practice (ρ = 0.411; p < 0.001). Evaluating research reports correlated with frequency of searching electronic databases (ρ = 0.425; p < 0.001). Skills in and frequency of using electronic databases were correlated (ρ = 0.403; p < 0.001). Other correlations are shown in Table 7.

Table 7.  Correlations between frequencies of participation in EBP-related activities, familiarity with EBP skills in searching electronic databases, and I-EBP Beliefs Scale scores
 Evaluate Research ReportsParticipate in ResearchUse Research in PracticeFamiliarity with EBPSkills in SearchingI-ebp Beliefs Scores
  1. *Significant at p ≤ 0.01.

Identify researchable problems0.635*0.596*0.450*0.343*0.299*0.317*
Evaluate research reports 0.533*0.516*0.476*0.346*0.423*
Participate in research  0.402*0.271*0.221*0.240*
Use research in practice   0.432*0.292*0.438*
Familiarity with EBP .  0.385*0.423*
Skills in searching     0.456*

Comparisons of Groups of Nurses

UH RNs were compared with RNs who work elsewhere and clinical RNs with administrators and educators. UH RNs’ scores on the I-EBP Beliefs Scale were 59.29 (SD = 7.29) as compared with 56.85 (SD = 6.97; p < 0.001) for RNs who worked elsewhere and clinical RNs scores were 57.59 (SD = 6.91) compared with 59.51 (SD = 7.59; p = 0.012) for administrators or educators. UH RNs’ use of research in practice was no different from RNs who worked elsewhere and the research use of clinical RNs did not differ from that of RNs working in administration or education.

UH RNs’ participation in EBP-related activities at work did not differ from those of RNs who worked elsewhere, but UH RNs did report more availability of EBP-related resources. In addition, the UH RNs had more often received instructions in the use of electronic databases (χ2 = 61.707; df = 2, p ≤ 0.001), perceived themselves as having more skills in searching electronic databases (χ2 = 15.794; df = 4, p < 0.003), and had better access to these databases (χ2 = 10.107; df = 3, p = 0.018). The UH RNs were also more familiar with EBP (χ2 = 34.442; df = 4, p ≤ 0.001), reported having more discussions about EBP at work (χ2 = 41.887; df = 4, p ≤ 0.001), and participated more frequently in EBP projects (χ2 = 13.828; df = 2, p ≤ 0.001) than RNs who did not work at the UH. Lectures on EBP were more often available to UH RNs (χ2 = 24.264; df = 2, p ≤ 0.001) and they had more often been to such lectures (χ2 = 17.047; df = 2, p ≤ 0.001).

RNs working in administration and education had more often identified researchable problems (χ2 = 26.503; df = 3, p ≤ 0.001), evaluated research reports (χ2 = 35.744; df = 3, p ≤ 0.001), and participated in research (χ2 = 17.777; df = 3, p ≤ 0.001) than clinical RNs, but had not used research findings more often. In comparison with the clinical RNs, the nurse administrators and educators had better access to electronic databases (χ2 = 22.006; df = 3, p ≤ 0.001) and had more often received instructions in their use (χ2 = 6.877; df = 2, p = 0.032); however, their skills in searching electronic databases were not different from those of the clinical RNs. Nurse administrators and educators were more familiar with EBP (χ2 = 12.776; df = 4, p = 0.012), had better access to lectures on EBP (χ2 = 15.819; df = 2, p ≤ 0.001), and had more often been to such lectures (χ2 = 10.892; df = 2, p = 0.004) than had clinical RNs. Moreover, the nurse administrators and educators participated more frequently in EBP projects than did clinical RNs (χ2 = 6.277; df = 2, p = 0.043).

DISCUSSION

  1. Top of page
  2. ABSTRACT
  3. INTRODUCTION
  4. BACKGROUND
  5. METHODS
  6. FINDINGS
  7. DISCUSSION
  8. CONCLUSIONS
  9. IMPLICATIONS FOR NURSING PRACTICE AND EDUCATION
  10. References

The findings demonstrate that, like RNs in other countries, the participants believed in the value of EBP and that care could be improved by implementing EBP, but at the same time they were less certain they could implement EBP where they work or do so in a time efficient way. These results may indicate a perceived lack of authority to change practice, a finding confirmed in previous studies (Hutchinson & Johnston 2004; Hutchison & Johnston 2006; Gerrish et al. 2008), or they may relate to lack of time that nurses often experience (Hutchinson & Johnston 2004; Kuuppelomaki & Tuomi 2005; Hutchinson & Johnston 2006). Just like their colleagues elsewhere (Melnyk et al. 2004; Pravikoff et al. 2005; Gerrish et al. 2008; Koehn & Lehman 2008), the RNs in the present study felt they lacked skills and knowledge needed for EBP, including skills to search for information in electronic databases. They identified “lack of search skills” and “lack of skills to critique or synthesize literature” as the two main barriers to use of research in practice. Unlike nurses in the Pravikoff study, the majority of the RNs in the present study had received instructions on how to use electronic databases. Yet, despite good Internet access and national access to information, the nurses did not use the electronic databases available to them. Lack of success in using the databases, as well as lack of opportunity and time may explain the limited use.

Familiarity with EBP was associated with several factors, including using research findings in practice. The majority of the RNs had used research findings in practice at least once in the year before the study whereas only a few had done so more than three times. Using research in practice was also correlated with participation in EBP projects, which is consistent with the suggestion that involvement in research activities results in greater use of research findings (Cargo & Mercer 2008).

Of concern is the finding that the majority of respondents indicated they needed information less than twice a month. In contrast, the majority of US nurses need information at least weekly (Pravikoff et al. 2005; Cadmus et al. 2008; Thiel & Ghosh 2008). One must ask whether information seeking is associated with novice nurse behavior in Iceland rather than expert nurse behavior and whether this is related to the nurses’ beliefs that other nurses use information resources more often than they do themselves. Another explanation could be the assumption that “other” nurses have more time.

The RNs primarily used information resources that are easily accessible and quickly provide answers, i.e., peers, reference texts, and the Internet. This may reflect the reality of nursing practice: the need for rapid decision making and limited time and opportunity to seek information beyond what is readily available, as described by Thompson et al. (2004). Findings from previous research show that information resources are used more when available at the point of care (Sherriff et al. 2007; Thiel & Ghosh 2008; Ross 2010). The findings from this study, however, show that despite better access to resources the UH RNs do not use research in practice more often.

Limitations

Although the study sample is representative of the population of nurses in Iceland, general limitations of surveys, i.e., self-report data rather than observations, apply. Furthermore, despite the acceptable response rate, a bias may have influenced the results in that the RNs who did not respond may have beliefs, skills, and access to resources that differ from the participating RNs.

CONCLUSIONS

  1. Top of page
  2. ABSTRACT
  3. INTRODUCTION
  4. BACKGROUND
  5. METHODS
  6. FINDINGS
  7. DISCUSSION
  8. CONCLUSIONS
  9. IMPLICATIONS FOR NURSING PRACTICE AND EDUCATION
  10. References

Icelandic RNs are not ready for EBP. For the most part, they face similar barriers as what RNs in other countries experience. Although their access to information resources is good and their beliefs toward EBP quite positive, they still lack confidence in their skills and knowledge needed for EBP and its implementation. Skills can be taught through education initiatives (Melnyk et al. 2004; Sherriff et al. 2007; Wallen et al. 2010), but doing so is not sufficient to increase the use of evidence in practice (Rycroft-Malone et al. 2004). The findings from this study suggest that the implementation of EBP requires attention to several other key elements (e.g., the nature of the evidence and organizational and practice contexts; Greenhalgh et al. 2004; Rycroft-Malone et al. 2004). Several models and frameworks for implementing EBP have been developed and tested in different contexts (Rycroft-Malone & Bucknall 2010).

IMPLICATIONS FOR NURSING PRACTICE AND EDUCATION

  1. Top of page
  2. ABSTRACT
  3. INTRODUCTION
  4. BACKGROUND
  5. METHODS
  6. FINDINGS
  7. DISCUSSION
  8. CONCLUSIONS
  9. IMPLICATIONS FOR NURSING PRACTICE AND EDUCATION
  10. References

Existing barriers to EBP can be eliminated and RNs’ use of research in practice facilitated with the involvement of nursing leaders and educators. The present findings indicate that increased attention must be focused on all seven steps of the EBP process (Melnyk et al. 2010b) and allocation of resources, including time, is essential to provide nurses with opportunities to practice and maintain their EBP skills. Developing and teaching practical ways to integrate searching for and using evidence with patient care are necessary. Nurses at all levels should be better prepared to use the peer-reviewed information resources available to them in a competent manner. Courses on the use of electronic databases applicable to all settings of work should be made available to all nurses and nursing students. In rural areas or small institutions, online educational courses can be provided to ensure access and training. The instruments used in this study can be applied in a nursing context different from the one in which they were developed. They can be used to assess changes in nurses’ readiness for and beliefs about EBP over time and the effectiveness of strategies aimed at increasing the use of evidence in practice.

Clinical RNs were clearly at a disadvantage when it came to access of EBP resources and opportunities to participate in EBP-related activities. Similar findings have been reported elsewhere (Egerod & Hansen 2005; Pravikoff et al. 2005). EBP mentoring by advanced practice nurses is a recommended strategy, supported by findings from a randomized controlled pilot trial (Levin et al. 2011), to promote and sustain EBP of clinical RNs (Fineout-Overholt et al. 2005; Fineout-Overholt et al. 2010; Melnyk & Fineout-Overholt 2010; Gerrish et al. 2011). In summary, RNs are expected to provide care based on evidence. Nursing leaders have an obligation to support and enable nurses on their staff to meet that expectation.

References

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  2. ABSTRACT
  3. INTRODUCTION
  4. BACKGROUND
  5. METHODS
  6. FINDINGS
  7. DISCUSSION
  8. CONCLUSIONS
  9. IMPLICATIONS FOR NURSING PRACTICE AND EDUCATION
  10. References
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