Advanced practice nursing role development: factor analysis of a modified role delineation tool

Aim his study reports the use of exploratory factor analysis to determine construct validity of a modified advanced practice role delineation tool. Background Little research exists on specific activities and domains of practice within advanced practice nursing roles, making it difficult to define service parameters of this level of nursing practice. A valid and reliable tool would assist those responsible for employing or deploying advanced practice nurses by identifying and defining their service profile. This is the third paper from a multi-phase Australian study aimed at assigning advanced practice roles. Methods A postal survey was conducted of a random sample of state government employed Registered nurses and midwives, across various levels and grades of practice in the state of Queensland, Australia, using the modified Advanced Practice Role Delineation tool. Exploratory factor analysis, using principal axis factoring was undertaken to examine factors in the modified tool. Cronbach’s alpha coefficient determined reliability of the overall scale and identified factors. Results There were 658 responses (42% response rate). The five factors found with loadings of ≥.400 for 40 of the 41 APN activities were similar to the five domains in the Strong model. Cronbach’s alpha coefficient was .94 overall and for the factors ranged from 0.83 to 0.95. Conclusion Exploratory factor analysis of the modified tool supports validity of the five domains of the original tool. Further investigation will identify use of the tool in a broader healthcare environment

Strategies for teaching evidence-based practice to undergraduate health students: a systematic review protocol

Review question/objective The objective of this review is to find, critically appraise and synthesize the available quantitative evidence on the effectiveness of interventions that promote successful teaching of the evidence-based practice process in undergraduate health students, in preparation for them to become professional evidence-based practitioners. More specifically, the question that this review seeks to answer is: What is the effectiveness of teaching strategies for evidence-based practice for undergraduate health students? Inclusion criteria Types of participants This review will consider studies that include undergraduate health students from any undergraduate health discipline, including but not limited to medicine, nursing and allied health. Post graduate and post-registration students will not be included. Types of interventions This review will consider studies that evaluate strategies or interventions aimed at teaching any or all of the five steps of evidence-based practice, namely asking a structured clinical question; collecting the best evidence available; critically appraising the evidence to ensure validity, relevance and applicability; applying or integrating the results into clinical practice, and evaluating outcomes. The strategy may take place solely within a tertiary education environment or may be combined with a clinical setting. Types of outcomes This review will consider studies that include the following outcome measures: evidence-based practice behavior, knowledge, skills, attitudes, self-efficacy (or self-confidence), beliefs, values, intention to use evidence-based practice (future use) and confidence levels. Tools used to measure these outcomes will be assessed for reported validity, reliability and generalizability. Outcomes will be measured during the student’s education period up to graduation. If studies are conducted across different year levels this will be taken into account during analysis and reported accordingly

Factors that influence and predict undergraduate nursing and paramedic students' intention and use of evidence-based practice

Despite professional requirements, educational research across disciplines, provides limited evidence indicating undergraduate health students, are confident with or intend to use evidence in their clinical practice after graduation. Using Bandura's self-efficacy theory, this research investigated factors influencing undergraduate nursing and paramedicine students' intention to use and their current use of evidence-based practice (EBP). Through development and validation of two multivariate prediction models, the study identified EBP self-efficacy as one important factor necessary for supporting students' intentions to translate EBP into clinical contexts. The research results provide theoretically-based components for curriculum developers when designing strategies to support students' advancement in EBP

The experience of being an advanced practice nurse within Australian acute care settings: a systematic review of qualitative evidence.

Background: Shortages of health care professionals and an ageing nursing workforce are some of the factors leading to the creation and evolution of many new nursing roles. Advanced practice nurses across the globe are working under many different titles and within various contexts, in order to address gaps within current health care systems. Comparison of roles between countries is difficult and possibly inappropriate due to Australia’s unique environmental and demographic characteristics. A context-specific systematic review on the qualitative evidence of the experience of being an advanced practice nurse in Australia has not been undertaken previously, however it is imperative for nursing managers and leaders to understand the complexities of advanced nursing roles in order to effectively utilise and retain these experienced and valuable nurses. Aim: This study aims to provide deeper understanding of the experience of being an advanced practice nurse working in Australian acute settings and identify personal, professional and organisational factors influencing experiences. Methods: A three-step search strategy, following the Joanna Briggs Institute method was used to identify published and unpublished interpretive studies meeting set inclusion criteria. Critical appraisal and data extraction were completed the Joanna Briggs Institute Qualitative Assessment and Review Instruments. Results: Following the search and appraisal process, four studies were assessed as meeting the inclusion criteria and from these, 216 findings were extracted. Six meta-syntheses under the headings of expert knowledge, confidence, education, relationships, negative experiences and patient centered experience were formed from the findings. Conclusion: This review has increased our understanding about the experience of being an advanced practice nurse in Australian acute care settings and provided evidence of the role being multifactorial and complex. The patient is central to the APN experience but organisational factors impact and influence their experience also. Health care organisations must be aware of the impact they have on the nurse’s experience if they are to commit to nurse retention and patient safety. Nurses must continue to improve articulating their experiences in order to quantify the more intangible aspects of their practice. Implications: There is a pragmatic aspect to this review as implications for practice are specific to the functioning of the advanced practice nurse in the Australian acute care environment. The complexity of the role has been highlighted which may assist to inform future research into other aspects of APN practice.Thesis (M.Phil.) -- University of Adelaide, School of Nursing, 201

The effectiveness of communication interventions in providing older people with information on access to in-home health and social care services: a systematic review protocol

The objective of this review is to locate, critically appraise and synthesize evidence on the effectiveness of communication strategies for providing older people access to information regarding in-home health and social care services. The review question is: What is the effectiveness of communication interventions in providing older people with information about in-home health and social care services

Undergraduate health students' intention to use evidence-based practice after graduation: A systematic review of predictive modeling studies

Background Incorporating evidence-based practice (EBP) into clinical decision making and professional practice is a requirement for many health disciplines, yet research across health disciplines on factors that influence and predict student intention to use EBP following graduation has not been previously synthesized. Aim To synthesize research on factors that influence development of EBP behaviors and subsequently predict undergraduate students’ intention toward EBP uptake. Methods A systematic review of prediction modeling studies was conducted according to a protocol previously published on the Prospero database. The outcome variable was undergraduate students’ future use or intention to use EBP. Evidence synthesis methods were guided by resources from the Cochrane Methods Prognosis Group Web site. Results and Findings Only three studies were found to meet inclusion criteria for the review. Factors relating to EBP capability, EBP attitudes, as well as clinical and academic support were identified as influential toward students’ intention to use evidence in practice. Heterogeneity limited data pooling, consequently, results are presented in narrative and tabular form. Linking Evidence to Action Although using a developing method, this review presents a unique contribution to further discussions regarding students’ intention to use EBP following graduation. Despite limitations, consideration of identified factors for undergraduate curriculum could support student’s intention to use EBP in their respective clinical environments

Factors influencing undergraduate students' intention to use evidence-based practice after graduation: Development and validation of a theory-based prediction model

Background Despite curriculum requirements for evidence‐based practice (EBP) to be a key component of undergraduate health students’ training, few studies have investigated factors influential to students’ intention to use EBP after graduation. Self‐efficacy is known to mediate and motivate behavior; therefore, it may be a crucial factor linking undergraduate students’ EBP education and adoption of positive EBP behaviors. Aims To develop, test, and validate a multivariate, theory‐based prediction model with the outcome of students’ intention to use EBP after graduation. Methods A correlational study with structural equation modeling was conducted. Model factors were determined from Bandura's self‐efficacy theory and previous literature. An online survey comprised of seven validated scales and a demographic tool was distributed to a sample of undergraduate nursing and paramedic students. Two episodes of data collection were conducted to test and validate the model. Results Evidence‐based practice beliefs directly and significantly influenced student intention to use EBP in both models. Sources of EBP self‐efficacy also had significant but indirect influence on the outcome variable. Overall variance for intention to use EBP was 25% for the initial model and 18% for the validated model. Linking Evidence to Action Evidence‐based practice curriculum that supports positive EBP beliefs and integrates Bandura's sources of self‐efficacy has potential to positively influence students’ intention to use EBP after graduation