A scoping systematic review of factors influencing evidence-based practice implementation in nursing

Jude N. Ominyi, David A. Agom
<span title="2020-03-30">2020</span> <i title="GSC Online Press"> <a target="_blank" rel="noopener" href="https://fatcat.wiki/container/pl6yccvwzfezniw5ildoicobw4" style="color: black;">World Journal of Advanced Research and Reviews</a> </i> &nbsp;
Internationally, nurses are required to deliver care that is underpinned by sound evidence. However, available evidence suggests that the delivery of evidence-based practice is difficult due to multifaceted problems inherent in healthcare settings. This scoping review aimed to examine factors influencing evidence-based practice in nursing, to identify existing gaps requiring further inquiry. It is a scoping systematic literature search of major electronic databases, including CINAHL, MEDLINE,
more &raquo; ... scoH, Embase, ASSIA, Science Direct, Nursing index, PsycINFO and Google Scholar. Fiftytwo studies met the inclusion criteria and were eligible for review. The PRISMA approach was utilised in retrieving articles which were critically appraised. Findings were qualitatively synthesised using constant comparative approach. Findings were collated and summarised thematically. Outcomes were categorised into four broad themes as well as four subthemes. The scoping review identified dearth of studies utilising qualitative approaches, particularly in the low and middle income countries. Consistent with previous findings, this review exposes the difficulties associated with implementing evidence-based practice. There is need to examine the influence of power dynamics on evidence-based practice implementation in nursing. Study/Country Details [19] Jordan Aim: To describe Jordanian nurses' knowledge, attitudes and practice regarding EBP Design: Descriptive cross-sectional survey Sample 500 registered nurses Key findings: Higher educational qualification was associated with positive attitude towards research and subsequent utilisation of research in practice Nurses who have less research knowledge made less use of research and had less positive attitudes towards EBP while nurses who had better knowledge of research had positive attitudes and made better use of research in practice. [20] Nigeria Aim: To explore nurses' opinions of gap between research and clinical practice, including factors influencing research utilization in nursing in Nigeria Design: Qualitative descriptive interview/focus group Sample: 60 registered nurses Key findings: Organizational policies were not favourable to research utilization as participants reported that lack of adequate ICT facilities impeded research utilization/EBP. Regarding research translation, nurses apply lots of improvisation due to lack of material resources in the ward which did not permit research utilization while procedures adopted within the ward were faulty. This may due to nurse managers' lack of proper knowledge to guide practice regarding research conduct and utilization or EBP. [21] Aim: To review nurses' research behaviour and barrier that nurses meet to utilise research evidence into clinical nursing practice Design: Systematic review of focusing on nurses and nursing practice Sample: 37 published papers Key findings: Barriers to research utilisation mainly relate to characteristics of the practice settings such as lack of resources and issues related to nurses e.g. nursing education, nurses' knowledge and skills [22] USA Aim: To explore perceived barriers to research utilisation by nurses working in a community hospital in the US Design: Cross sectional descriptive survey Sample: 376 RNs Key findings: Barriers reported include lack of authority to change patient care procedures, lack of time to read research, and lack of awareness of research. Organizational strategies that can be used by staff development professionals to influence research awareness and utilization are discussed. Jude and David / World Journal of Advanced Research and Reviews, 2020, 05(03), 090-113 94 [23] Sweden Aim: Evaluated variation in implementation fidelity caused by contextual factors using the Framework for Evaluating Organisational Level Evidence-Informed Intervention Design: Qualitative case study Sample: not stated (Nurses and physicians) Key findings: Implementation fidelity varied across units even though they were supported in the same ways. The variations across contextual elements was explained by the Framework Evaluating Organisational Level Evidence-Informed Intervention [24] Ghana Aim: To understand stroke care professionals' views on the barriers which hinder the provision of optimal acute stroke care in a Ghanaian hospital Design: Qualitative structured interviews Sample: 40 nurses, ward managers and physicians Key findings: Barriers related to patients include financial constraints, delays, socio-cultural or religious practices. Barriers related to health system include inadequate medical facilities, lack of stroke care protocol, limited staff number, and inadequate staff development opportunities. Barriers related to professionals -limited knowledge of EBP, poor collaboration [25] Canada Aim: Analysis of factors influencing development of evidence-based nursing practice in Canada Design: Descriptive survey utilising electronic questionnaire Sample: 68 RNs Key findings: Nurses who have higher educational qualification reported better skills in EBNP and more skills in synthesising and applying information from research findings into their nursing practice. Clinical practice setting has an impact on the extent to which nurses engaged with EBNP as nurses who were less educated are likely to draw on their experience and intuition whereas expert nurses and those who had MSc degree reported being more skilful in synthesising evidence from various sources. Evaluation of the organisational context and culture of practice setting would be useful to assess the extent to opportunities are presented to novice nurses to practice EBNP [26] Guinea Bissau Aim: To test whether strict implementation of standardised protocol for malaria and provision of financial incentives for healthcare worker improved implementation Design: Randomised control trial Sample: 951 children, nurses and doctors Key findings: Financial incentives facilitated compliance of staff members to a standardised treatment protocol which was associated with greatly reduced in-hospital mortality [27] Aim: To examine the perceived relevance of the sub-elements of the organisational context cornerstone of the PARIHS framework and whether other factors in the organisational context were perceived to influence KT in a specific low-income setting Uganda Design: Qualitative interviews Sample: 23 nurse midwives and ward managers Key findings: The sub-elements (receptive context, culture, leadership, and evaluation) of organisational context in the PARIHS framework were also relevant for evidence implementation in the Ugandan context. However, additional factors to consider include access to resources, commitment and informal payment and community involvement. Thus, these additional factors should be considered when applying the PARIHS framework in the developing countries like Uganda [28] Australia Aim: To determine the knowledge, attitudes and use of research by nurses working in a regional area in Australia Qualitative (focus groups and interviews) and cross-sectional survey Sample: 347 RNs Key findings: Senior Nurse Managers were more likely to have a positive attitude towards research, and completion of university subjects on nursing research was significant in determining attitude and knowledge of research. All nurses, regardless of position identified barriers to performing research. Conclusion Nurses require specific research education, clinical nursing leadership and work environments conducive to ensure practice is evidenced-based [29] USA Aim: This paper is a report of a study to describe nurses' practices, knowledge, and attitudes related to evidence-based nursing, and the relation of perceived barriers to and facilitators of evidence-based practice in the USA Design: Descriptive cross-sectional survey Sample: 458 RNs Key findings: Organizational barriers (lack of time and lack of nursing autonomy) were the top perceived barriers. Facilitators were learning opportunities, culture building, and availability and simplicity of resources. Statistically significant correlations were found between barriers and practice, knowledge and attitudes related to evidence-based practice [30] Qatar Aim: To explore the prevailing attitudes and knowledge of EBP and compare the relationship between EBP attitudes and knowledge amongst nurses in Qatar Design: Cross sectional survey Sample: 400 RNs Key findings: Attitudes were closely associated with knowledge. Higher educational qualification was associated with positive attitudes 'towards EBP [31] China Aim: To explore influencing factors from staff nurses, nurse managers, nurse director and a physician involved in nursing EBP implementation in Mainland China Design: Qualitative interviews Key findings: Most enabling factors include having a leader and manager who is involved, and who has positive attitudes towards EBP. Inhibitory factors include lack of time to incorporate evidence into practice. However, participants admitted that EBP was necessary in caring for old people and should be promoted to spread, adopted and widely implemented in care homes [48] Belgium Aim: To explore the barriers to evidence-based nursing among Flemish (Belgian) nurses Design: Focus group utilising a Grounded Theory approach Sample: 53 RNs Key findings: Major barriers were the doctors, patients and family, management/supervisors, nurses/nursing and evidence. In addition to findings which were already reflected in the literature, Flemish nurses reported a potential lack of responsibility in the uptake of evidence-based nursing, their 'guest position' in a patient's environment leading to the different education levels of nurses. [49] Iran Aim: To present a comprehensive literature review describing barriers and facilitators of RU among Iranian nurses Design: An integrative review of studies focusing nurses and nursing practice Key findings: Major factors were: Organisational -inadequate facilities, insufficient time on the job, lack of authority to change practice, lack of administrative support and physicians' cooperation. Major facilitators were relevant educational skills, support from knowledgeable nursing colleagues, faculty and setting, access to an expert clinical and quality appraisal committee within the setting, improved research skills, sufficient funds to undertake research and access to internet facility. Barriers related to the setting were the most frequently cited obstacles to RU. Health care managers should plan strategically to promote research use by nurses [50] Netherland Aim: To identify factors that influence the implementation of the Triage in emergency department guideline in the Netherlands and develop strategies for implementation of this guidelines Design: Focus group and in-depth interviews Sample: 108 RNs, ward managers and physicians Key findings: Key factors were at individual, social context and organisational level. Factors were level of knowledge, insights and skills, workplace preferences, motivation and or commitment, support, workload and resources. Strategies tailored to improve implementation include education, maintenance of change. Motivation and consensus-building, information, organisation and facilitation [51] Iran Aim: To determine the barriers to implementation of EBP among nurses working in Zahedan Teaching Hospital Design: Cross sectional survey utilising EBP implementation barriers questionnaire Sample: 280 RNs Jude and David / World Journal of Advanced Research and Reviews, 2020, 05(03), 090-113 101 Key findings: Barriers to implementation of EBP were largely categorised into two issues; individual and organisational. Barriers related to the organisation include lack of human resources, lack of internet facilities at work, heavy workload. Barriers related to the individuals include education, lack of time allocated time to read the literature, lack of ability to work with the computer, insufficient proficiency in English language, age, educational level, experience and employment status. Barrier to implementation of EBP occur at both individual and organisational levels. Health care systems and organisations should pay attention on how to provide relevant training for the nurses as relevant structural and support facilities that can enable nurses implement EBP [52] Singapore Aim: To implement and test a multifaceted implementation strategy for preventing falls and to achieve a change in fall prevention practices in acute care setting Design: A comparative case study of two hospital Sample: 41 nursing staff Key findings: There was an increase compliance with the use of the strategy for risk assessment. The implementation programme did not yield significant reduction in the incidence of falls (result:1.44 to 1.09/1000 patient days in the unit). This is in both intervention and control hospitals. However, the implementation strategy for preventing falls enhanced nurses' understanding of use of the fall risk assessment. [53] Canada Aim: To identify contextual factors described by NMs to drive change and facilitate EBP at the unit level, comparing these perspectives across nursing units in selected Design: Qualitative semi-structured interviews Sample: 9 nurse managers Key findings: Workplace culture, structure, resources were either facilitators or barriers to empowering nurses under their supervision to use EBP and drive change. Workplace culture that clearly communicates EBP goals, regulatory changes and provides good contact between the CEOs and NMs were perceived as promoters of EBP. In the units that performed well in EBP, there were structures such as nursing-specific committees and nurses were allowed and supported to drive change in practice within the units. NMs within the high performing nursing units were perceived to have been to articulate internal resources such as quality-monitoring departments which were all seen as critical to EBP implementation in their units. Thus, these findings contribute to in depth understanding of organisational contextual factors that can support NMs in their efforts towards driving EBP changes at the unit levels. [54] Aim: A systematic review of relationship between contextual factors and research utilisation in nursing, examining strength of these relationships, and mapping the contextual factors to the PARIHS Design: A systematic review of studies focusing on nurses and nursing practice Sample: 10 studies Key findings: Six contextual factors were significant to research utilisation and they include the role of the nurse, multifaceted access to resources, organisational climate, multifaceted support, time for research activities and provision of education.
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