The Journal of Continuing Education in Nursing

CNE Article 

Value of, Attitudes Toward, and Implementation of Evidence-Based Practices Based on Use of Self-Study Learning Modules

Rita Lovelace, BSN, RN, CCCTM; Mary Noonen, MSN, RN-BC; James F. Bena, MS; Anne S. Tang, MS; Michelle Angie, MSN, RN, NP-C; Robbi Cwynar, MSN, ACNP-BC; Rosemary Field, MSN, RN, AOCNS; Jayne Rosenberger, BSN, RN, CCRN; Donna Ross, MSN, RN; Donna Walker, MSN, RN; Nancy M. Albert, PhD, RN, CCNS, CHFN, CCRN, NE-BC, FAAN

Abstract

Background:

It is unknown if completing educational modules on understanding, reviewing, and synthesizing research literature is associated with higher value of, attitudes toward, and implementation of evidence-based practices.

Method:

Nurses completed valid, reliable questionnaires on the value of, attitudes toward, and implementation of evidence-based practice 6 months after four educational modules were introduced. Multivariable modeling was used to learn associations of education modules and evidence-based practice themes.

Results:

Of 1,033 participants, 54% completed at least one education module; 22% completed all modules. Value and attitude about evidence-based practice were moderately high, but implementation was low (mean = 15.15 ± 15.72; range = 0 to 72). After controlling for nurse characteristics and experiences associated with evidence-based practice value, attitudes, and implementation scores, education modules completion was associated with the implementation of evidence-based practice (p = .001), but not with value or attitude of evidence-based practices scores.

Conclusion:

Education on reviewing and synthesizing literature strengthened implementation of evidence-based practices.

J Contin Educ Nurs. 2017;48(5):209–216.

How to Obtain Contact Hours by Reading This Issue

Instructions:

1.1 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded after you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. In order to obtain contact hours you must:

  1. Read the article, “Value of, Attitudes Toward, and Implementation of Evidence-Based Practices Based on Use of Self-Study Learning Modules,” found on pages 209–216, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz.

  2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study.

  3. Go to the Villanova website to register for contact hour credit. You will be asked to provide your name, contact information, and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated.

This activity is valid for continuing education credit until April 30, 2020.

Contact Hours

This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated.

Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

Objectives
  • Describe factors associated with completion of more self-study modules on evidence-based practice.
  • Discuss nurses' perceptions of implementation of evidence-based clinical practices with completion of more self-study modules on evidence-based practice.
Disclosure Statement

Neither the planners nor the authors have any conflicts of interest to disclose.

Do you want to Participate in the CNE activity?

Abstract

Background:

It is unknown if completing educational modules on understanding, reviewing, and synthesizing research literature is associated with higher value of, attitudes toward, and implementation of evidence-based practices.

Method:

Nurses completed valid, reliable questionnaires on the value of, attitudes toward, and implementation of evidence-based practice 6 months after four educational modules were introduced. Multivariable modeling was used to learn associations of education modules and evidence-based practice themes.

Results:

Of 1,033 participants, 54% completed at least one education module; 22% completed all modules. Value and attitude about evidence-based practice were moderately high, but implementation was low (mean = 15.15 ± 15.72; range = 0 to 72). After controlling for nurse characteristics and experiences associated with evidence-based practice value, attitudes, and implementation scores, education modules completion was associated with the implementation of evidence-based practice (p = .001), but not with value or attitude of evidence-based practices scores.

Conclusion:

Education on reviewing and synthesizing literature strengthened implementation of evidence-based practices.

J Contin Educ Nurs. 2017;48(5):209–216.

How to Obtain Contact Hours by Reading This Issue

Instructions:

1.1 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded after you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. In order to obtain contact hours you must:

  1. Read the article, “Value of, Attitudes Toward, and Implementation of Evidence-Based Practices Based on Use of Self-Study Learning Modules,” found on pages 209–216, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz.

  2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study.

  3. Go to the Villanova website to register for contact hour credit. You will be asked to provide your name, contact information, and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated.

This activity is valid for continuing education credit until April 30, 2020.

Contact Hours

This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated.

Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

Objectives
  • Describe factors associated with completion of more self-study modules on evidence-based practice.
  • Discuss nurses' perceptions of implementation of evidence-based clinical practices with completion of more self-study modules on evidence-based practice.
Disclosure Statement

Neither the planners nor the authors have any conflicts of interest to disclose.

Do you want to Participate in the CNE activity?

Evidence-based practice (EBP) is a problem-solving approach that integrates best research evidence, patient values and preferences, and nurse clinician's expertise to guide decision making (Melnyk, Fineout-Overholt, Gallagher-Ford, & Kaplan, 2012). When nurses use EBP to assess, plan, and implement care activities, patients may benefit through improved outcomes, lower costs, and higher satisfaction. Ultimately, nursing decisions leading to actions should be based on the best available evidence. In the Institute of Medicine (2010) blueprint for the future of nursing, nurses were encouraged to work to the full extent of their education and licensure and take actions to minimize the research–practice gap. In addition, the American Nursing Credentialing Center Magnet Recognition Program® (2013) requires hospitals to show how they promote EBP locally by embedding empirical outcomes into the four key components.

EBP does not occur consistently in hospital-based care (Fitzsimons & Cooper, 2012). In descriptive survey research of more than 1,000 nurses across the United States who were members of the American Nurses Association, 46.4% perceived that EBP was inconsistently implemented in their organizations (Melnyk et al., 2012). In the same report, researchers cited multiple barriers to EBP that included lack of support from managers, leaders, and colleagues, education about EBP, access to information, and health care organization culture (which included educational offerings, encouragement, and support for EBP; making decisions based on EBP; and believing that implementing research findings will improve patient outcomes). Further, nurses working in hospitals without Magnet designation had lower scores for consistently implementing EBP, and survey responses reflected that fewer experts were available to mentor nurses in EBP (Melnyk et al., 2012). Finally, in an integrated review of attitudes toward and use of evidence-based research by nursing students, respondents cited lacking support, opportunities to practice independently, and confidence in using EBP (Ryan, 2016).

Knowledge and education about EBP were consistently cited as issues in implementing EBP clinically (Melnyk et al., 2012; Saunders, Stevens, & Vehviläinen-Julkunen, 2016; Wallin, Boström, & Gustavsson, 2012). When nurses working in Finnish university-based hospitals completed an EBP readiness survey, they reported low to moderate levels of EBP knowledge, despite being familiar with the concept of EBP, and knowledge levels were correlated with self-efficacy in using EBP (Saunders et al., 2016). In one report, barriers to adopting EBP included many education themes surrounding processes associated with EBP decision making: inability to understand statistical and research terms, difficulty in judging the quality of research reports in the literature, inability to properly interpret research results, and inability to determine applicability of research findings (Majid et al., 2011). In qualitative research of primary care nurses, one of three themes that emerged about the need to use knowledge from research to facilitate EBP was that nurses recognized they were knowledge-generation agents but cited competence issues and a desire for institutional support (Bennasar-Veny, Gonzalez-Torrente, De Pedro-Gomez, Morales-Asencio, & Pericas-Beltran, 2016).

Community-based hospitals and ambulatory centers may understand the term EBP but may not use it in everyday practice due to lack of resources and lack of knowledge about terminology, how to review published articles for strength and quality of evidence, and how to synthesize evidence findings on a subject or theme to promote EBP. When a new nurse residency program included an EBP learning module, nurses' perceptions of integrating evidence with expertise decreased; however, knowledge of how to retrieve EBP and communicating new ideas about EBP to colleagues increased (Jackson, 2016). In an effort to increase nurses' knowledge and understanding of EBP, and ultimately improve decision making based on evidence, a Research Council comprising nurses within a nine-hospital health care system developed a four-module self-study on EBP. The purposes of this study were to learn whether the self-study education modules were meaningful in strengthening beliefs about the value of EBP, attitudes toward EBP, and beliefs about EBP implementation.

Method

This research study used a comparative design and questionnaire methods to learn whether EBP self-study education modules were associated with beliefs about the value of EBP (defined as confidence in using current research evidence in clinical practice), attitudes toward EBP (defined as thoughts or feelings about EBPs), and about EBP implementation (defined as taking steps toward translating evidence into clinical practice). The health system's institutional review board approved this study and research was conducted in accordance with the Declaration of Helsinki.

Setting and Sample

This study was conducted within a system of nine hospitals and 18 ambulatory care centers in northeastern Ohio and western Florida. Hospitals included one quaternary care, urban medical center with 1,200 beds and multiple community hospitals that ranged in size from 95 to 500 beds. Ambulatory care centers varied in size and scope and included those with and without ambulatory surgery and specialty services. Participants were all licensed practical and registered nurses in the health care system. Inclusion criteria were nurses with roles as clinicians (i.e., in nursing units), educators, quality coordinators, assistant nurse managers, nurse managers, clinical nurse specialists, nurse practitioners, or other job roles with a routine patient interface and willingness to participate. Exclusion criteria were nurses who developed the self-study EBP education modules or this research study and nurses who were in orientation during the time of data collection.

Intervention

The intervention was composed of four self-study education modules. Module content was based on themes included in an EBP live course taught by a local academic university and expert opinion from three doctoral-prepared nurse scientists employed by the authors' hospital health care system. Each module had unique themes and learning objectives. In module one, participants were introduced to the term EBP and definitions were provided for EBP and stating the problem in a PICO (Population, Intervention, Control group, and Outcomes) question format. Strength and quality of evidence were also discussed. The focus of module two was to understand how to search for evidence on a topic or theme using Web-based search engines. As part of the module, nurses inputted data into a mock search engine to learn how to choose the best words and phrases and to learn the steps of finding evidence. Participants were provided with a handout on the rapid review of a published article and the reference of one nursing research article that used a randomized, controlled research design. The rapid review posed five questions to ask when reviewing a research paper; nurses were asked to review the article and respond to the five review questions. In module three, participants practiced reviewing four articles, two review articles, and two research articles. Each set of two articles were on the same theme; one had a higher quality or strength of evidence than the other. The module screens posed questions to participants related to strength and quality of evidence. Participants were asked to search articles to answer questions, and then each article received an overall strength and quality rating. Module four focused on synthesizing evidence on a topic (after reviewing multiple articles) and the next steps in translating EBP. Examples were provided of topics with inconsistent research findings to help participants understand the need for reviewing multiple articles before determining the totality of evidence and taking next steps.

Each module offered continuing education. Minutes of education were based on the mean time to complete each module by nurses who tested the system. Education assigned to the four modules were 40 minutes, 110 minutes, 116 minutes, and 38 minutes in duration, respectively. Before administering continuing education credit, modules one, two, and four used a quiz format with multiple choice response options to ensure participant completion. In module three, participants had to respond to questions about the strength and quality of evidence. Modules were open to all nurses, and all were asked to complete module one.

Outcomes, Measures, and Data Collection

Beliefs about the value of EBP was measured using a 16-item valid, reliable instrument titled the EBP Beliefs Scale (Melnyk, Fineout-Overholt, & Mays, 2008). The scale had face and content validity and internal consistency. Items were scored on a 5-point scale ranging from 1 = strongly disagree to 5 = strongly agree. Two items were reverse scored. The total was summed for a range of 16 to 80; higher scores indicated stronger value for EBP. Among participants of this study, the standardized Cronbach's alpha was .92.

Nurses' attitudes toward EBP was measured using 4 items from a 24-item valid, reliable instrument titled the Evidence-Based Practice Questionnaire (Upton & Upton, 2006). In psychometric testing, the tool had three factors, and all four items that made up the attitudes factor were used as described in the literature. The scale had face and contact validity, as well as internal consistency reliability. Items were scored on a scale of 1 to 7. The total was summed for a range of 4 to 28 points, with higher scores indicating more positive attitudes toward EBP. Among participants of this study, the standardized Cronbach's alpha was .73.

Perceived frequency of EBP implementation was measured using an 18-item valid, reliable instrument titled the EBP Implementation Scale (Melnyk et al., 2008). The tool had face and content validity, as well as internal consistency reliability. Items were scored based on frequency in the past 8 weeks using a 5-point scale, ranging from 0 = 0 times, 1 = 1–2 times; 2 = 3–5 times; 3 = 6–8 times; to 4 = > 8 times. The total was summed for a range of 0 to 72, and higher scores indicated a higher frequency of EBP implementation. Among participants of this study, the standardized Cronbach's alpha was .96.

EBP education module completion was assessed using one variable with five response options that asked nurses to respond to the modules they had completed (one through four). The fifth option reflected that none were completed. Nurse characteristics were assessed using a survey of 27 demographic and work- or professional-related questions. Items used a checklist, fill-in-the-blank, or choose-the-best-response format. After implementing the four self-study EBP education modules, investigators waited 6 months to initiate data collection for this study. All 66 items that made up data collection were placed into a computer-based survey and administered to nurses anonymously using a survey link that was attached to an e-mail request. The e-mail request was sent out two times over a period of 6 weeks to encourage study participation.

Statistical Analysis

Categorical factors were described using frequencies and percentages, and continuous measures were summarized as means, standard deviations (SD), medians, and quartiles. Associations between number of modules completed and EBP scores were evaluated using Spearman correlations. After dichotomizing the number of modules completed into none versus greater than or equal to one, associations with EBP scores were evaluated using analysis of variance models. Associations between number of modules completed, the dichotomized version of this variable, and EBP scores with nursing characteristics were evaluated using Kruskal-Wallis tests, chi-square tests, analysis of variance models, and correlation statistics, as appropriate. Multivariable linear regression models were fit. Factors that were significantly associated with univariate outcomes were included in the multivariable models. If overall tests for association of each outcome across module completion groups were significant, pairwise comparisons of module groups using a corrected significance level of 0.05/6 = 0.008 were performed. An overall significance level of 0.05 was assumed for all tests. Analyses were performed using SAS® version 9.3 software.

Results

Questionnaires were distributed electronically to approximately 7,000 nurses within the health system, although the exact number of nurses who did not receive the message (due to a full mailbox or other issue), deleted the message without opening it, or opened and deleted the message without reading it was unknown. In total, 1,177 (16.8%) of the nurses responded, but 144 were excluded due to incomplete responses, leaving 1,033 nurse responders (14.8%) with data included in the analyses. Mean (SD) age was 46.7 (±11.6) years, 92.6% (n = 936) were women, and 25.4% worked in ambulatory settings. Most responders (n = 602; 60.9%) were clinical nurses, 193 (19.6%) were in managerial or leadership roles, 97 (9.8%) were advanced practice nurses, 40 (4.0%) were clinical instructors or educators, and 56 (5.6%) were in other roles (Table 1). Overall, 555 (53.7%) of the nurses completed at least one module, with the mandatory module one being completed most often, followed by failure to complete any module (Figure 1).

�A;Characteristics of Nurse Participants (N = 1,033)

Table 1:

Characteristics of Nurse Participants (N = 1,033)

�A;Percentage of nurse participant completion of each module.

Figure 1.

Percentage of nurse participant completion of each module.

Beliefs About the Value of and Attitudes Toward EBP and Its Implementation

Among 1,033 nurses, mean (± SD) nurses scores about the value of EBP, attitudes toward EBP, and implementation of EBP were 60.5 (± 9.3), reflecting a moderate to high value for EBP; 21.1 (± 4.2), reflecting positive attitudes toward EBP; and 15.1 (± 15.7), reflecting very low implementation of EBP. Educational modules viewed were positively associated with higher beliefs about the value of EBP (rho = 0.12; p < .001; univariate model, p = .002), higher attitudes toward EBP (rho = 0.082; p = .009; univariate model, p = .03), and higher implementation of EBP (rho, 0.24; p < .001; univariate model p < .001; Figure 2).

�A;Association of completion of evidence-based practice (EBP) self-study education modules and self-perception of beliefs about the value of, attitudes toward, and implementation of EBP.

Figure 2.

Association of completion of evidence-based practice (EBP) self-study education modules and self-perception of beliefs about the value of, attitudes toward, and implementation of EBP.

Of the nurse characteristics studied, nurses' age was not associated with the number of self-study EBP education modules completed (p = .19) or with beliefs about the value of EBP, attitude toward EBP, or implementation of EBP (p = .41, .31, and .39, respectively). No difference was observed in education module completion by year the highest nursing degree was obtained (p = .57). Nurses with less time since receiving their highest college degree were more likely to have positive beliefs about the value of EBP (rho = 0.20; p < .001), about attitude toward EBP (rho = 0.17; p < .001), and about implementation of EBP (rho = 0.23; p < .001). All nurse professionalism-related factors were associated with completion of more self-study EBP education modules (Table 2). Factors reflecting nurse professionalism were also associated with higher beliefs about the value of EBP, higher beliefs about attitudes toward EBP, and higher self-perceptions about implementation of EBP (Table 2). Of nonprofessional-related factors, nurses who worked full time had higher attitudes toward EBP, and nurses who worked at the quaternary care urban medical center had stronger self-perceptions of implementing EBP.

�A;Association of Factors Studied With Evidence-Based Practice (EBP) Module Completion and Self-Assessed EBPa

Table 2:

Association of Factors Studied With Evidence-Based Practice (EBP) Module Completion and Self-Assessed EBP

In multivariate models that controlled for significant nurse characteristics presented in Table 2, self-study EBP education module completion was no longer associated with beliefs about EBP value (p = .46) or EBP attitudes (p = .92). Self-study education module completion remained associated with nurses' self-assessment of EBP implementation (p = .001).

Discussion

Among the sample of nurses, scores for beliefs about the value and implementation of EBP were similar to the findings of Melnyk, Fineout-Overholt, and May (2008), reflecting a need to educate nurses about EBP so they can apply findings in clinical practice. Historically, knowledge and competence in EBP were limitations to EBP-based clinical practices (Bennasar-Veny et al., 2016), confidence in EBP was strongly related to using EBP (Duffy et al., 2015), and higher capability beliefs promoted the use of research findings in clinical practice (Wallin et al., 2012). Therefore, nurse educators need to develop novel continuing education programs to enhance nurses' EBP knowledge, competence, and confidence.

In this research, the authors assessed the importance of self-study EBP education modules on beliefs about the value of EBP, attitudes toward EBP, and implementation of EBP. The self-study module concept allowed nurses to gain knowledge at their own pace and at a time when learning was optimized. When online versus classroom education were compared using random assignment, no differences in student performance were found (Porter, Pitterle, & Hayney, 2014). Further, an online EBP learning module program of four sessions was associated with significant changes in nurse practice and knowledge of EBP among new graduate nurses who attended a residency program (Jackson, 2016). Jackson did not describe module content except to say that the program included presentations and application experiences. In the current self-study EBP modules, content included practice sessions on searching for literature, reviewing the literature for strength and quality, and synthesizing the literature to determine the next steps. Competence of material presented was assessed by recall, application, and analysis. Although it is unknown whether this EBP content and the self-assessment methods were the right mix of information sharing and evaluation to create the association with higher implementation of EBP scores, the self-study EBP modules achieved the goal of enhancing implementation of EBP. Nurse educators and leaders should consider a self-study continuing education program, especially if nurses need enduring materials they can refer to over time and if in-person classroom sessions on EBP are not practical or feasible.

Many factors influenced nurses' beliefs about the value of EBP, attitudes toward EBP, and implementation of EBP. Similar to the study by Melynk et al. (2012), the current study found that nurses with higher education levels had stronger positive beliefs about the value and implementation of EBP, but unlike the study by Melynk et al., the current study did not find differences in outcomes based on nurses' age, only in years since obtaining their highest degree. Because the term evidence-based medicine was not coined until 1992 (Smith & Drummond, 2014) and was not used in nursing curricula until much later, it was not surprising that nurses with more recent education, regardless of their age, had more positive beliefs regarding the outcomes. Melynk et al. (2012) also learned that the value of EPB was lowest among staff nurses and highest among educators. This study did not assess associations between outcomes and nursing roles, given that the majority of responders were staff nurses. However, the findings that nurses who were more involved in professional activities that used EBP concepts were more likely to have positive beliefs about the value of, attitudes toward, and implementation of EBP reflected that nurses used EBP knowledge and competencies, once educated.

It may be difficult to obtain and sustain enthusiasm for clinical courses on EBP, as nurses may be more focused on skills and technology associated with a specific patient population or theme. Nursing leaders are a critical link to self-study EBP course completion. Of nurses who completed the questionnaire, over 50% had completed at least one self-study EBP module in the previous 6 months after the program was introduced. The self-study module system may have had a quick uptake because nurse leaders requested that all nurses complete the first module, at minimum. Nurse educators electronically assigned the first module to all newly hired nurses, and currently employed nurses received flyers from research shared governance council members and unit leaders to promote EBP module completion. Nurse managers were required to complete the first and second modules. It is unknown whether their participation in EBP self-study learning had an effect on individual nurse completion or in nurse responses to questionnaires on value, attitudes, and implementation of EBP. In one report, nursing director's knowledge, skills, and behaviors toward EBP were higher after their involvement in a 5-year promotional campaign (Weng et al., 2016). More research is needed to determine whether belief outcomes are based on specific EBP program content, duration, and use in clinical practice.

Limitations

The research was conducted within a large health system. Individual hospital leadership was unified, including in the Nursing Institute, and policies and procedures were systematic. Results may not be generalizable to hospitals within systems that continue to function independently, rather than as a system. Overall, the sample of nurse responders was small (approximately 17%) in relation to the total possible nursing staff available. It is unknown whether a higher participation rate would have changed results and increased the reliability of the findings.

Conclusion

Implementation of self-study continuing education EBP modules may be an important method to enhance EBP knowledge and competence. Knowledge and competence of EBP was associated with beliefs about the value of and attitudes toward using EBP. Further, the number of EBP education modules viewed was positively associated with beliefs about EBP implementation. Because EBP implementation is important for the highest quality of care, nurses should be encouraged to use learning modules as an education source or become educated via alternate means.

References

  • American Nurses Credentialing Center. (2013). 2014 Magnet® application manual. Silver Spring, MD: Author.
  • Bennasar-Veny, M., Gonzalez-Torrente, S., De Pedro-Gomez, J., Morales-Asencio, J.M. & Pericas-Beltran, J. (2016). Using knowledge as the basis for evidence-based practice in primary care nurses. International Nursing Review, 63, 250–258. doi:10.1111/inr.12263 [CrossRef]
  • Duffy, J.R., Culp, S., Yarberry, C., Stroupe, L., Sand-Jecklin, K. & Sparks Coburn, A. (2015). Nurses' research capacity and use of evidence in acute care: baseline findings from a partnership study. Journal of Nursing Administration, 45, 158–164. doi:10.1097/NNA.0000000000000176 [CrossRef]
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  • Melnyk, B.M., Fineout-Overholt, E., Gallagher-Ford, L. & Kaplan, L. (2012). The state of evidence-based practice in US nurses: Critical implications for nurse leaders and educators. Journal of Nursing Administration, 42, 410–417. doi:10.1097/NNA.0b013e3182664e0a [CrossRef]
  • Melnyk, B.M., Fineout-Overholt, E. & Mays, M.Z. (2008). The evidence-based practice beliefs and implementation scales: Psychometric properties of two new instruments. Worldviews on Evidence-Based Nursing, 5, 208–216. doi:10.1111/j.1741-6787.2008.00126.x [CrossRef]
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Characteristics of Nurse Participants (N = 1,033)

Factor n
Education, highest level
  Licensed practical nurses/associate RN/diploma RN 316 (31.3%)
  Bachelor's degree 487 (48.2%)
  Master's or doctorate degree 208 (20.6%)
Years of previous nursing experience (mean [standard deviation]) 20.0 (±13)
Years of experience in current role 9.1 (±9.1)
Place of employment
  Community hospitals 545 (54%)
  Urban, quaternary care hospital 291 (28.8%)
  Ambulatory care centers 173 (17.1%)
Work status, full time 852 (84.4%)
In the clinical ladder program (yes) 248 (24.6%)
One or more certifications 478 (47.5%)
Completed a review of the literature in the last 6 months (yes) 457 (45.3%)
Participated in a nurse lead quality project (any role) (yes) 438 (44.3%)
Been a project leader (yes) 231 (23.4%)
Participated in nurse-led research study (any role; yes) 287 (29%)
Been a principal investigator in nurse-led research (yes) 99 (10%)
Previously exposed to EBP (yes) 945 (91.5%)
Authored a published research article/first author 41 (4.1)/13 (1.3)

Association of Factors Studied With Evidence-Based Practice (EBP) Module Completion and Self-Assessed EBPa

Factor More Modules Completedb EBPc

Higher Value Positive Attitudes Implementation
Gender .67 .54 .56 .36
Higher education <.001 <.001 <.001 <.001
Certification (yes) <.001 <.001 <.001 <.001
More than one certification <.001 <.001 <.001 <.001
Project leader (yes) <.001 <.001 <.001 <.001
Past exposure to EBP (yes) <.001 <.001 <.001 <.001
Registered nurse-led quality project (yes) <.001 <.001 <.001 <.001
Registered nurse-led research (yes) <.001 <.001 <.001 <.001
Principal investigator (yes) <.001 <.001 <.001 <.001
Clinical ladder (yes) <.001 .64 .22 .63
Higher clinical ladder level <.001 .042 .056 .079
Work full time (versus part time) .32 .20 .039 .15
Work at urban hospital (versus community) .069 .074 .23 <.001
Literature review completed ⩽ 6 months (yes) <.001 <.001 <.001 <.001
Hospital based (versus ambulatory) .003 .059 .60 <.001
Authors

Ms. Lovelace is Care Coordinator, Stephanie Tubbs-Jones Health Center, East Cleveland; Ms. Noonen is Manager, Nursing Education and Professional Development, Marymount and South Pointe Hospitals; Mr. Bena is Lead Biostatistician, and Ms. Tang is Statistical Programmer, Department of Quantitative Health Sciences, Ms. Cwynar is Acute Care Nurse Practitioner, Critical Care Transport, Dr. Albert is Associate Chief Nursing Officer, Nursing Research and Innovation, Ms. Field is Clinical Nurse Specialist, and Ms. Walker is Advanced Practice Nurse, Office of Advanced Practice Nursing, Cleveland Clinic Health System, Cleveland; Ms. Angie is Nurse Practitioner, Glickman Urological Institute, Beachwood Family Health Center, Beachwood; Ms. Rosenberger is Critical Care and Emergency Nurse, Hillcrest Hospital, Mayfield Heights; and Ms. Ross is Heart Failure Care Coordinator, Lakewood Ambulatory Care, Lakewood, Ohio.

This research was internally funded by the Cleveland Clinic Health System, Nursing Institute.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Rita Lovelace, BSN, RN, CCCTM, Care Coordinator, Stephanie Tubbs-Jones Health Center, 13944 Euclid Avenue, East Cleveland, OH 44112; e-mail: rlovelac@ccf.org.

Received: September 01, 2016
Accepted: December 06, 2016

10.3928/00220124-20170418-05

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