Knowledge, Attitude, Perceived Barriers and Evidence-based Nursing Practice among Nurses at Tertiary Level Hospital in Dharan, Nepal

Abstract Objective: To determine the level of evidence-based nursing practice, and its related knowledge, attitude, and perceived barriers, and the predicting factors of evidence-based nursing practice among nurses at a tertiary level hospital in Nepal. Method: A total of 234 nurses who were randomly selected by using systematic random sampling technique participated in this study. Data were collected during March to April 2016 in B. P. Koirala Institute of Health Sciences, Dharan, Nepal. Participants were asked to complete 5 self-reported questionnaires. Descriptive statistics, Pearson's correlation and multiple regression were computed for data analysis. Results: Evidence-based nursing practice, knowledge, attitude, and perceived barriers were all at a moderate level. Knowledge of evidence-based nursing practice and perceived barriers towards evidence-based nursing practice were significantly correlated with the practice (r = 0.45, P–value = 0.01 and r = -0.30, P–value = 0.01 respectively). However, attitude towards the practice was not associated with the practice. Results of multiple regression showed that knowledge and perceived barriers together explained about 24% of the practice variance (P-value < 0.001).  Knowledge distinctively acted as the most significant predictor of evidence-based nursing practice (β = 0.40, P-value < 0.001), followed by perceived barriers (β = -0.21, P-value < 0.001). Conclusion: Evidence-based nursing practice of Nepalese nurses was at a moderate level and was significantly associated with knowledge and perceived barriers. These findings suggest that nurses administrators should focus on evidence-based nursing practice and take measures to improve its implementation towards quality of care. Keywords: evidence-based nursing practice, knowledge, attitude, perceived barriers, Nepa

THE IMPACT OF EVIDENCE-BASED PRACTICE ON A CULTURE OF SAFETY

Background: 210,000 to 440,000 deaths have been caused by errors in healthcare. Providers who are committed to core values that emphasize safety contribute to a “culture of safety.’ This culture is required for healthcare institutions to achieve high-reliability status demonstrating high potential for error but few adverse outcomes. There is little known about contributors to the culture of safety and the commitment of providers to its core values. Purpose: To determine relationships among the predictors- EBP culture, individual evidence-based decision making, organizational implementation of evidence-based practice - and a culture of safety. Design: Correlational Predictive Design. Sample: Two-hundred seventeen nurses from nine acute care institutions across East Texas participated in the study. Analysis: Path analysis was used to evaluate the relationships among predictor variables and a culture of safety. Results: Individual evidence-based practice implementation and beliefs were correlated (r = .38, p \u3c .001). Evidence-based practice implementation and beliefs had direct effects on EBP culture (β = .25, p \u3c .001; β = .24, p \u3c .001, respectively). EBP culture had a direct effect on culture of safety (β = 0.38, p \u3c .001). Evidence-based practice implementation and beliefs accounted for 16% of the variance in EBP culture, and evidence-based practice implementation and beliefs, along with EBP culture, accounted for 15% of the variance in culture of safety. Conclusion: Nursing administrators allocating resources to build a culture of safety can now include enhancing evidence-based implementation and beliefs of nursing staff as well as an EBP culture that supports evidence-based practice

THE ROLE OF PROFESSIONAL DEVELOPMENT ON SECONDARY SPECIAL EDUCATORS SELF-EFFICACY REGARDING THE USE OF EVIDENCE-BASED TRANSITION PRACTICES

The purpose of this study was to determine how transition specific professional development influenced secondary special educators’ knowledge and perceived self-efficacy regarding the use of evidence-based transition practices. Past research has suggested that secondary special educators enter the profession with limited knowledge and skills to provide effective evidence-based transition practices to students with disabilities. Based on Bandura’s Social Cognitive Theory, and Desimone’s framework for effective professional development, this study identified how different variables related to professional development can influence teacher self-efficacy in terms of delivering evidence-based transition practices. Specifically, a correlational research design was used to investigate teacher self-efficacy to deliver evidence-based transition practices when (a) the amount of professional development (b) type of professional development, and (c) location of the professional development are factors. Descriptive statistics, an analysis of variance (ANOVA), and a multiple linear regression analysis were performed. Results indicated the amount of professional development received had a significant effect on teachers perceived efficacy, compared to location, and type of professional development received. Further, results of teachers perceived effectiveness, changes made as a result of the professional development, and other factors related to professional development are reported. Limitations and implications for teacher professional development research, practice, and policy are discussed

From recommendation to action: psychosocial factors influencing physician intention to use Health Technology Assessment (HTA) recommendations

BACKGROUND: Evaluating the impact of recommendations based upon health technology assessment (HTA) represents a challenge for both HTA agencies and healthcare policy-makers. Using a psychosocial theoretical framework, this study aimed at exploring the factors affecting physician intention to adopt HTA recommendations. The selected recommendations were prioritisation systems for patients on waiting lists for two surgical procedures: hip and knee replacement and cataract surgery. METHODS: Determinants of physician intention to use HTA recommendations for patient prioritisation were assessed by a questionnaire based upon the Theory of Interpersonal Behaviour. A total of 96 physicians from two medical specialties (ophthalmology and orthopaedic surgery) responded to the questionnaire (response rate 44.2%). A multiple analysis of variance (MANOVA) was performed to assess differences between medical specialties on the set of theoretical variables. Given the main effect difference between specialties, two regression models were tested separately to assess the psychosocial determinants of physician intention to use HTA recommendations for the prioritisation of patients on waiting lists for surgical procedures. RESULTS: Factors influencing physician intention to use HTA recommendations differ between groups of specialists. Intention to use the prioritisation system for patients on waiting lists for cataract surgery among ophthalmologists was related to attitude towards the behaviour, social norms, as well as personal normative beliefs. Intention to use HTA recommendations for patient prioritisation for hip and knee replacement among orthopaedic surgeons was explained by: perception of conditions that facilitated the realisation of the behaviour, personal normative beliefs, and habit of using HTA recommendations in clinical work. CONCLUSION: This study offers a model to assess factors influencing the intention to adopt recommendations from health technology assessment into professional practice. Results identify determinant factors that should be considered in the elaboration of strategies to support the implementation of evidence-based practice, with respect to emerging health technologies and modalities of practice. However, it is important to emphasise that behavioural determinants of evidence-based practice vary according to the specific technology considered. Evidence-based implementation of HTA recommendations, as well as other evidence-based practices, should build on a theoretical understanding of the complex forces that shape the practice of healthcare professionals

Colleague appraisal of Australian general practitioners in training: an analysis of multisource feedback data

Background: Multisource feedback is an evidence-based and validated tool used to provide clinicians, including those in training, feedback on their professional and interpersonal skills. Multisource feedback is mandatory for participants in the Royal Australian College of General Practitioners Practice Experience Program and for some Australian General Practice Training Registrars. Given the recency of the Practice Experience Program, there are currently no benchmarks available for comparison within the program and to other comparable cohorts including doctors in the Australian General Practice Training program. The aim of this study is to evaluate and compare colleague feedback within and across General Practice trainee cohorts. Methods: Colleague feedback, from multisource feedback of Practice Experience Program participants and Australian General Practice Training Registrars, collected between January 2018 and April 2020, was compared to identify similarities and differences. Analyses entailed descriptive statistics, between and within groups rater consistency and agreement measures, principal component analysis, t-tests, analysis of variance, and psychometric network analysis. Results: Colleague ratings of Practice Experience Program participants (overall average 88.58%) were lower than for Registrars (89.08%), although this difference was not significant. ‘Communication with patients’ was rated significantly lower for Practice Experience Program participants (2.13%) while this group was rated significantly better for their ‘Ability to say no’ (1.78%). Psychometric network analyses showed stronger linkages between items making up the behavioural component (compared to the items of the performance and self-management components, as found by principal component analysis) for Practice Experience Program participants as compared to Registrars. Practice Experience Program participants were stronger in clinical knowledge and skills as well as confidentiality, while Registrars were stronger in communicating with patients, managing their own stress, and in their management and leadership skills. Conclusions: The multisource feedback scores of doctors undertaking the Practice Experience Program suggests that, while all mean values are ‘very good’ to ‘excellent’, there are areas for improvement. The linkages between skills suggests that Practice Experience Program doctors’ skills are somewhat isolated and have yet to fully synthesise. We now have a better understanding of how different groups of General Practitioners in training compare with respect to professional and interpersonal skills. Based on the demonstrated differences, the Practice Experience Program might benefit from the addition of educational activities to target the less developed skills

Effect of Teaching Method, Educational Level, or Years of Experience on Evidence-Based Practice Implementation by RNs

Evidence-based practice (EBP) is an approach to nursing practice using research evidence for clinical decisions, incorporating patient preferences and previous clinical experience. EBP integrates technical skills and professional knowledge with clinical research to plan and provide nursing care. A fundamental role of nursing education is to enable the nurse to comprehend and implement EBP. The purpose of my study, guided by Benner’s novice to expert theory, was to determine if EBP teaching strategies, nursing education level, and years in nursing practice affect the RN’s ability to implement EBP. Study participants were recruited among the RN population in Florida and Ohio with 235 RNs participating. Using analysis of variance, results indicated that the various teaching methods had no significant effect on the RNs’ EBP implementation behaviors (p = .534), whereas there were significant differences in the effects of academic level (p = .001, ŋ2 = .074) and years of nursing experience (p = .006, ŋ2 = .060). Higher academic levels demonstrated increased EBP implementation behaviors as did greater number of years of experience. However, the overall mean EBP Implementation Scale (EBPI) score for all factors remained low at 26.68. Future research should focus on discovering additional factors which affect the implementation of EBP in nursing practice. It is important to strengthen nurses’ EBP skills and increase the practicality of EBP in the clinical setting to improve and maintain quality nursing care which effects positive social change

Challenging but positive! – An exploration into teacher attitude profiles towards differentiated instruction (DI) in Germany

Background Research has highlighted that personal characteristics such as teachers’ attitudes play an important role in the implementation of inclusive education. However, there are only a few studies that have shed empirical evidence on the relationship of attitudes and inclusive teaching approaches, such as differentiated instruction. In this vein, the present study tackles this research gap and aims to explore teachers’ attitudes specifically towards the inclusive practice of DI in Germany. Aims The present study aimed to investigate teacher profiles based on their attitudes towards differentiated instruction, as well as further to explore whether teachers differentiated instructional implementation varies between the teacher profiles. Sample The sample consists of 450 teachers (Mage = 42.89, SD = 10.48, 65% female), from different school tracks in Germany. Methods A two‐step cluster analysis was performed in order to identify teacher attitude profiles concerning their implementation of differentiated instruction. Moreover, an analysis of variance was conducted in order to identify variations in terms of the implementation of differentiated instruction across the three clusters. Results Results from the cluster analyses indicate three distinct teacher attitude profiles: Cluster 1 ‘The valuing‐teacher’, Cluster 2 ‘The non‐valuing‐teacher’ and Cluster 3 ‘The challenged‐but‐valuing‐teacher’. Moreover, the findings reveal gender and school track differences between the three teacher attitude profiles. Lastly, an analysis of variance indicated that teachers’ differentiated instruction practice varied significantly across the clusters. Conclusions The findings from the present study indicate that teachers not only perceive the value of DI but also the insufficient resources. Thus, it can be assumed that teachers identify both the ‘positive’ and the ‘negative’ aspect of DI, and more importantly, they can recognize both attitude domains towards DI in a similar or different level. Consequently, the results show that attitudes in the context of inclusion cannot be characterised as continuum with two distinct poles.Peer Reviewe

Development and validation of the competence in evidence based practice questionnaire (EBP-COQ) among nursing students

BACKGROUND: Nursing educators need rigorously developed instruments to assess competency in evidence based practice (EBP) at undergraduate level. This concept is defined as the capability to choose and use an integrated combination of knowledge, skills and attitudes with the intention to develop a task in a certain context. Also, we understand that EBP is gaining knowledge and skills, as well as increasing positive attitudes toward EBP that will promote a change in behaviour to implement EBP in practice. This study aims to develop a psychometric test of the Evidence Based Practice Evaluation Competence Questionnaire (EBP-COQ) among undergraduate nursing students. METHODS: The questionnaire was developed by item generation through a review of scientific literature and focus groups. The instrument was validated in terms of content validity through an expert review. The EBP-COQ was administered to a cohort of nursing students (n =100) to evaluate test reliability and select the best items. Psychometric properties of the final instrument were assessed in a sample of 261 nursing students. RESULTS: The EBP-COQ consisted of 25 items. A factorial analysis grouped the items into the three categories that define competence relating to EBP: attitude, knowledge and skills. Cronbach's alpha was 0.888 for the entire questionnaire. The factor solution explained 55.55% of the variance. CONCLUSIONS: EBP-COQ appears to measure with adequate reliability the attributes of undergraduate nursing students' competence in EBP. The instrument is quick to disseminate and easy to score, making it a suitable instrument for nursing educators to evaluate students' self-perceived competence in EBP.This work has been supported by a grant from FIS (Fondo de Investigación Sanitaria, Grant PI060913S

Is mental practice an effective adjunct therapeutic strategy for upper limb motor restoration after stroke? A systematic review and meta- analysis

Stroke is one of the most common conditions requiring rehabilitation, and its motor impairments are a major cause of permanent disability. Hemiparesis is observed by 80% of the patients after acute stroke. Neuroimaging studies showed that real and imagined movements have similarities regarding brain activation, supplying evidence that those similarities are based on the same process. Within this context, the combination of mental practice (MP) with physical and occupational therapy appears to be a natural complement based on neurorehabilitation concepts. Our study seeks to investigate if MP for stroke rehabilitation of upper limbs is an effective adjunct therapy. PubMed (Medline), ISI knowledge (Institute for Scientific Information) and SciELO (Scientific Electronic Library) were terminated on 20 February 2015. Data were collected on variables as follows: sample size, type of supervision, configuration of mental practice, setting the physical practice (intensity, number of sets and repetitions, duration of contractions, rest interval between sets, weekly and total duration), measures of sensorimotor deficits used in the main studies and significant results. Random effects models were used that take into account the variance within and between studies. Seven articles were selected. As there was no statistically significant difference between the two groups (MP vs control), showed a - 0.6 (95% CI: -1.27 to 0.04), for upper limb motor restoration after stroke. The present meta-analysis concluded that MP is not effective as adjunct therapeutic strategy for upper limb motor restoration after stroke

Students\u27 Scientific Evaluations of Water Resources

Socially-relevant and controversial topics, such as water issues, are subject to differences in the explanations that scientists and the public (herein, students) find plausible. Students need to be more evaluative of the validity of explanations (e.g., explanatory models) based on evidence when addressing such topics. We compared two activities where students weighed connections between lines of evidence and explanations. In one activity, students were given four evidence statements and two models (one scientific and one non-scientific alternative); in the other, students chose four out of eight evidence statements and three models (two scientific and one non-scientific). Repeated measures analysis of variance (ANOVA) showed that both activities engaged students\u27 evaluations and differentially shifted students\u27 plausibility judgments and knowledge. A structural equation model suggested that students\u27 evaluation may influence post-instructional plausibility and knowledge; when students chose their lines of evidence and explanatory models, their evaluations were deeper, with stronger shifts toward a scientific stance and greater levels of post-instructional knowledge. The activities may help to develop students\u27 critical evaluation skills, a scientific practice that is key to understanding both scientific content and science as a process. Although effect sizes were modest, the results provided critical information for the final development and testing stage of these water resource instructional activities