Nevada Nurses Knowledge, Attitude, and Application of Evidencebased Practice

1
Nevada Nurses Knowledge, Attitude, and
Application of Evidence-based Practice

• PI Mary D. Bondmass, RN, PhD - UNLV/SON
• Co PI Sheri Stucke, APN, PhD, CNS - Sunrise MC

Mary Brann, MS UMC, Anne Wagner, MS SRDH,
Teri Kozik, MS St.Marys
This study was supported in part by grant from
the UNLV School of Nursing Research Council
2
Background

• Subsequent to the survey report of the poor state
  of our nations healthcare (To Err Is Human IOM,
  2000), a national directive called for
  evidence-based quality improvements in healthcare
  (IOM, 2001).
• The directive clearly affirmed that healthcare
  services must be consistent with current
  professional knowledge in order to increase the
  likelihood of desired outcomes (Lohr, 1990) and
  current services fall tragically short of what is
  scientifically known to be good healthcare
  (IOM, 2001).
• Evidence-based practice (EBP) is seen as key to
  quality improvement (IOM 2001) and is defined as
  the integration of best available evidence,
  clinical expertise and patient preferences/values
  for clinical decision making (Sackett, et
  al,2000).

3
Background

• The question has been raised as to whether US
  nurses are prepared for EBP. In one of the
  largest nursing studies to date, Pravikoff, D.S.,
  et al. (2003 and 2005) provide data (n760)
  indicating that nurses in the United States are
  not ready for EBP.
• They concluded that gaps in their information
  literacy and computer skills, limited access to
  high-quality information resources, and above
  all, attitudes toward research were the major
  reasons for nurses non-readiness for EBP.

4
Problem

• While education programs were thought to enable
  nurses in basic and professional development, few
  interventions have been proposed and tested to
  improve the knowledge, attitude and application
  of EBP by nurses.
• Moreover, data is still lacking regarding
  relationships of age, educational preparation,
  ethnicity, practice setting, and/or geographical
  location regarding knowledge, attitude and
  application of EBP, in general, and specifically
  in Nevada.
• Prior to any regional (i.e. Nevada)
  interventional studies to improve nurses
  knowledge, attitude and application of EBP, a
  full assessment is needed to determine
  specifically where improvement is needed in
  Nevada

5
Purpose

• The purpose of this study was to determine Nevada
  Nurses Knowledge, Attitude, Application of
  EBP.
• What is the current knowledge level of Nevada
  nurses regarding EBP?
• Is EBP knowledge affected by age, educational
  preparation for practice, ethnicity, practice
  setting, and/or geographical location within
  Nevada?
• What are the current attitudes and feelings of
  Nevada nurses regarding EBP?
• Are attitudes and feelings toward EBP and the
  application of EBP affected by age, educational
  preparation for practice, ethnicity, practice
  setting, and/or geographical location within
  Nevada?
• What is the current application of EBP by Nevada
  nurses?
• Is the current application of EBP by Nevada
  nurses affected by age, educational preparation
  for practice, ethnicity, practice setting, and/or
  geographical location within Nevada?

6
Methodology Design Sample

• A cross-sectional, descriptive/exploratory,
  self-survey design
• Inclusion criteria currently licensed RN in
  Nevada
• Sample recruitment efforts included using the US
  Postal Service (USPS), electron mail (email)
  directing RNs to an Internet survey site, and
  distribution of paper and pencil surveys at
  selected NV Medical Centers.
• According to the Annual Report 2005-2006 of the
  NSBN, there were 22,215 RNs active NV licensees
  (of which, 482 are advanced practice nurses (APN)
  and 123 are certified registered nurse
  anesthetists (CNRN). 17,000 had NV zip codes.
  Therefore the desired sample for this study was
  approximately 5000 RNs however, it was
  anticipated that traditionally low survey
  response rates and available funds a sample
  size to approximately 500 700 RNs was sought as
  realistic. Traditional survey response rates in
  the literature generally range from 23 to 33.

7
Methodology Procedure

• IRB approval was obtained from UNLV, UMC, SRDH,
  and St. Marys Medical Center
• Survey were distributed to NV RNs as described
  (1700 USPS,1500 UMC, 1350 SRDH, 1200 St Marys,
  approximately 500 emails sent out)
• Data were collected from July 07 January 08

8
Methodology

• Statistical Analysis
• Wilcoxon-Mann-Whitney U, Chi-square, one-way
  ANOVA, and Pearson Product Moment and Spearmens
  correlations will be used to address the totality
  of research questions
• The above tests were relative to the level and
  distribution of the data for each of the studys
  variables.
• Only descriptive i.e. frequencies and percentages
  are presented here.

9
Results Sample (N 785)
10
N 785
11
N 785
12
N 785
13
N 785
14
Conceptual Framework
Stevens, K. R. (3003, 2004). ACE Star Model of
EBP Knowledge Transformation. Academic Center
for Evidence-based Practice. The University of
Texas Health Science Center at San Antonio.
www.acestar.uthscsa.edu
15
Conceptual Framework

• This conceptual model was developed with an
  understanding of the cycles, nature, and
  characteristics of knowledge that are utilized in
  various aspects of EBP related to clinical
  decision making.
• It depicts the relationships between various
  stages of knowledge transformation, as newly
  discovered knowledge is moved into practice.
• The ACE Star Model is configured as a simple
  5-point star? the model points explain how
  knowledge is transformed at five major stages,
  from original research, through the stages of
  evidence summary, translation, implementation,
  and evaluation.

16
Conceptual Framework
Stevens, K. R. (3003, 2004). ACE Star Model of
EBP Knowledge Transformation. Academic Center
for Evidence-based Practice. The University of
Texas Health Science Center at San Antonio.
www.acestar.uthscsa.edu
17
Results Knowledge

• Knowledge was assessed with several survey
  questions those presented here are related to
• Cochran Library/Database
• AHRQ
• Clinical Practice Guidelines
• Evidence Rating Systems
• Quality Indicators
• Definition of EBP

18
Knowledge Cochran AHRQ
407
433
265
136
220
76
22
11
Cochran Library
AHRQ
19
Knowledge Clinical Guidelines Evidence Rating
648
374
215
172
65
49
23
24
Clinical Guidelines
Evidence Rating Systems
20
Knowledge Quality Indicators
380
231
113
61
21
Knowledge Definition of EBP
EBP is the integration of best available
evidence, clinical expertise and patient
preference/values for clinical decision making
(Sackett, et al, 2000).
22
Results Attitude

• Attitude was assessed using a survey, adapted in
  part with permission ( Olade, R.A. (2003)
  Attitudes and factors affecting research
  utilization. Nursing Forum, 38(4)
• Participants were asked how they felt about both
  Nursing Research and Other Health-related
  research. The items choices included positive and
  negative attitudes/feelings.

23

Attitude
NURSING RESEARCH
OTHER HEALTH RESEARCH
24
Attitude Comfortable
53
77
206
366
427
245
99
97
Other Health Research
Nursing Research
25
Attitude Interest
52
79
170
181
502
467
61
95
Other Health Research
Nursing Research
26
Attitude Good
102
74
163
162
481
466
68
54
Other Health Research
Nursing Research
27
Attitude Pleasant
117
91
392
185
197
395
91
102
Other Health Research
Nursing Research
28
Attitude Adequate
93
121
278
291
202
188
199
198
Other Health Research
Nursing Research
29
Attitude Cold
41
43
96
126
71
95
575
523
Other Health Research
Nursing Research
30
Attitude Afraid
22
22
91
113
66
72
606
578
Other Health Research
Nursing Research
31
Attitude Tired
60
90
82
115
102
110
478
533
Other Health Research
Nursing Research
32
Attitude Disinterested
48
42
116
92
92
103
518
559
Other Health Research
Nursing Research
33
Attitude Turned Off
40
46
94
116
73
73
578
550
Other Health Research
Nursing Research
34
Implications

• Initial data
• So what ?
• Now what ?
• Interventions at various institutions
• Post intervention analysis
• Potential to improve quality of care

35
Limitations

• sample size

Limits generalization to other than this study
sample May limit the power to detect significant
differences when comparisons are made

• internal validity

Variance introduced by mult. Degrees/education,
positions, location, type of institutions Low
response rate missing data

• design

36
Conclusion

• For this sample of Nevada Nurses, these data
  suggest the generally Nevada Nurses have a
  positive attitude toward EBP however basic
  knowledge related to EBP is lacking