FAHC studying nursing knowledge of evidence-based practice.Submitted by The Evidence-Based Practice Team, FAHC FAHC Fletcher Allen Health Care
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Two years ago, nurses on the Quality and Research Council at Fletcher Allen Health Care Fletcher Allen Health Care is a tertiary referral hospital for Vermont and northern New York State, a Level I Trauma Center, and a teaching hospital in alliance with the University of Vermont College of Medicine. (FAHC) voiced their observations that nurses at the bedside did not really know the meaning of evidence-based practice. These observations triggered the creation of a new committee: The Evidence Based Practice The introduction to this article provides insufficient context for those unfamiliar with the subject matter.
Please help [ improve the introduction] to meet Wikipedia's layout standards. You can discuss the issue on the talk page. (EBP EBP Evidence Based Practice
EBP Enterprise Buyer Professional
EBP Education Business Partnership
EBP European Business Programme
EBP Efficiency Bandwidth Product
EBP Electronic Billing and Payment
EBP Extended Base Pointer
EBP Error Back Propagation ) Team. The EBP Team's mission is to create a culture of clinical inquiry, develop a process and resource network to apply evidence or conduct research at the bedside, and educate nurses to become skilled and competent in the use of EBP, thus enriching nursing practice and enhancing patient outcomes at FAHC.
To model the clinical inquiry concept, the team conducted an actual research study. The team developed a survey to assess nurses' knowledge, attitudes, and ultimately determine nurses' learning needs related to EBP. The 56 item survey was adapted from a national survey and distributed to 1200 registered nurses across all practice areas at Fletcher Allen Fletcher Allen (born 1907 in Cleveland, Ohio, U.S.) is an American jazz saxophonist, clarinetist and composer. Compositions
The survey respondents In the context of marketing research, a representative sample drawn from a larger population of people from whom information is collected and used to develop or confirm marketing strategy. from Phase I (n=333, a 28% response rate) and Phase II (n=300, a 25% response rate) had similar demographics The attributes of people in a particular geographic area. Used for marketing purposes, population, ethnic origins, religion, spoken language, income and age range are examples of demographic data. as seen below but there were a few critical characteristics that were significantly different. One demographic difference observed in the two survey samples concerns the year respondents graduated from nursing school. More nurses who graduated between the years 2000 and 2007 responded to the Phase II survey compared to the Phase I survey (29% vs 18%) and furthermore, fewer nurses who graduated in or before 1975 completed the survey in Phase II compared to the Phase I (20% vs 28%). In addition, more nurses with a bachelors or masters degree responded to the Phase II survey compared to the Phase I (60% vs 36%), while at the same time fewer associate or diploma DIPLOMA. An instrument of writing, executed by, a corporation or society, certifying that a certain person therein named is entitled to a certain distinction therein mentioned.
2. nurses responded to the Phase II survey compared to the Phase I survey (39% vs 54%). So an important demographic difference to keep in mind when interpreting the results is that Phase II nurses were on average newer graduates and more educated than respondents in the Phase I survey. Thus, nurses who participated in the Phase II survey were:
* 94% Female
* 69% Age 40-59
* 78% Staff RNs vs nursing leadership, educators This is a list of educators. See also: Education, List of education topics.
* Work experience at FAHC
** 29% 5 years or less
** 18% 6-10 years
** 10% 11-15 years
** 15% 16-20 years
** 28% 21 years or more
* 68% worked in acute inpatient inpatient /in·pa·tient/ (in´pa-shent) a patient who comes to a hospital or other health care facility for diagnosis or treatment that requires an overnight stay.
An educational intervention with three components was provided between Phase 1 and Phase II. The first component of the educational intervention included a presentation to nursing leadership and the nursing shared governance Governance makes decisions that define expectations, grant power, or verify performance. It consists either of a separate process or of a specific part of management or leadership processes. Sometimes people set up a government to administer these processes and systems. councils on the process leading up to the study and the results of the Phase I survey. A Nursing Grand Rounds presentation in November November: see month. 2006 shared mostly the same content with the general nursing staff audience. The main educational component was a colorful pictorial powerpoint A presentation graphics program from Microsoft for Macintosh and Windows. It was the first desktop presentation program for the Mac and provides the ability to create output for overheads, handouts, speaker notes and film recorders. presentation created as a flip chart flip chart
A chart consisting of sheets hinged at the top that can be flipped over to present information sequentially.
Noun 1. binder binder: see combine.
An earlier Microsoft Office workbook file that let users combine related documents from different Office applications. The documents could be viewed, saved, opened, e-mailed and printed as a group. for every inpatient and outpatient outpatient /out·pa·tient/ (-pa-shent) a patient who comes to the hospital, clinic, or dispensary for diagnosis and/or treatment but does not occupy a bed.
n. nursing unit. The binder presentation described how EBP fits in FAHC's philosophy of nursing, our adopted definition of EBP, rationale rationale (rash´nal´),
n the fundamental reasons used as the basis for a decision or action. for EBP, examples of evidence and multiple examples of EBP at work at FAHC.
Responses on a number of survey items were significantly different between Phase I and Phase II. One of the key outcomes that we had hoped to see was for nurses to know that EBP was imbedded imbedded,
adj See embedded. in our philosophy of nursing here at FAHC. The nurses' awareness that EBP was in the nursing philosophy did improve after the educational intervention (45% vs 69%). In addition, the incidence of nurses reporting no awareness about EBP in the nursing philosophy dropped from 52% to 34% in Phase II after the intervention (p>0.0001). Most survey items were assessed using a 5-point Likert scale Likert scale A subjective scoring system that allows a person being surveyed to quantify likes and preferences on a 5-point scale, with 1 being the least important, relevant, interesting, most ho-hum, or other, and 5 being most excellent, yeehah important, etc :
* 0 = I don't know Don't know (DK, DKed)
"Don't know the trade." A Street expression used whenever one party lacks knowledge of a trade or receives conflicting instructions from the other party.
* 1 = Never
* 2 = Rarely
* 3 = Sometimes
* 4 = Frequently
* 5 = Always
One item measured on the survey was whether nurses could identify an expert in the use of EBP. This outcome showed a statistically significant difference (p>0.0001) between Phase I and Phase II; in Phase I, only 38% of nurses responded that they "always" or "frequently" knew an expert in EBP versus 54% after the educational intervention.
Another survey question addressing organizational structures--such as whether or not policy committees examine and search for evidence of best practice--was also assessed by having nurses choose a response from the above-mentioned A`bove´-men`tioned
a. 1. Mentioned or named before; aforesaid; mentioned or named earlier in the same text (in written documents).
Adj. 1. Likert scale. When the responses of 4s (Frequently) and 5s (Always) were lumped together and compared to the remaining responses of sometimes, rarely, never and I don't know, we again found a statistically significant difference (p=0.004) between Phase I and Phase II. After the educational intervention, more nurses agreed that FAHC's hospital-wide policy committees searched for best practice evidence.
Another question asked on the survey was, "When you need nursing information, how do you find it?" Responses to this question are shown below, ranked in order of the greatest responses to always and frequently:
1. Colleagues and peers (71% Phase I vs 69% Phase II)
2. Internet/WWW (49% vs 57%)
3. Journals and Books (46% vs 48%)
4. Conferences/inservices (32% vs 36%)
5. Databases (CINAHL CINAHL Cumulative Index to Nursing and Allied Health Literature , OVID) (14% vs 21%)
6. Assistance from Librarian (1) A person who works in the data library and keeps track of the tapes and disks that are stored and logged out for use. Also known as a "file librarian" or "media librarian." See data library.
(2) See CA-Librarian. (3% vs 5%).
The rank order was the same for Phase I and II and only one item was statistically significant between Phase I and II and that was: "I search the databases." The differences in how this question was ranked may be related to the fact that the sample in Phase II included more new graduates as well as nurses with bachelors and masters degrees.
When asked, "How often do you need to access nursing information to support your role?," there was no difference between the Phase I & II responses and the four response choices were roughly even; 22% said they often (several times a week) access information, 27% said regularly (weekly), 29% occasionally (once or twice a month) and 22% seldom (less than once a month). How does this compare nationally? A 2005 AJN AJN American Journal of Nursing
AJN American Journal of Nephrology article, using the same survey, reported 28% often, 33% regularly, 27% occasionally and 12% seldom, a statistically significant difference (p>0.0001). In addition, Sigma Theta Tau The Honor Society of Nursing, Sigma Theta Tau International exists to improve the health of people by increasing the scientific base of nursing research. It is the second-largest nursing organization in the world with approximately 125,000 active members. asked the same question of its membership in 2006 and reported 30% often, 34% regularly, 26% occasionally and 10% seldom or never, again a statistically significant difference between FAHC results (p>0.0001). See the sidebar (1) A Windows Vista desktop panel that holds mini applications (gadgets) such as a calendar, calculator, stock ticker and Vonage phone dialer. It is the Windows counterpart to the Dashboard in the Mac. See Windows Vista and gadget. graphs depicting the AJN, Sigma Theta Tau, and FAHC data for comparison.
How Often Do You Need Info to Support Your Role? AJN Sept 2005 N=749 Often (several times per week) 28.4% (n=212) Regularly (weekly) 32.8% (n=246) Occassionally (1-2 times/month) 26.7% (n=200) Seldom (less than once per month) 12.1% (n=91) Note: Table made from pie chart. Nationally Perceived Need for Info/Research Regularly (weekly) 34% Occassionally (1-2 times/month) 26% Seldom (less than once per month) 8% Never 2% Often (several times per week) 30% Note: Table made from pie chart. How Often Do You Need to Access Nrs Info to Support Your Role? [GRAPHIC OMITTED] Nurses were also asked to respond yes or no to a list of potential individual barriers to nurses' use of research in practice (other than time which we know is number one based on the literature). Only the first three items (from the list of barriers below) were statistically different between Phase I and Phase II; nurses picked items 1, 2 and 3 as barriers more frequently in Phase I than they did in Phase II, which might again be related to the demographic differences in the two groups. Below is the rank order based on the total number of yes responses. Individual Barriers # Respondents # Respondents P value selecting selecting item in item in Phase I Phase II 1. Lack of understanding 62 50 (p=0.001) of electronic databases 2. Difficulty accessing 43 33 (p=0.012) research materials 3. Lack of literature 35 23 (p=0.001) search skills 4. Lack of skills to 26 24 critique and/or synthesize 5. Lack of knowledge of 25 22 the research process 6. Difficulty 22 18 understanding research article 7. Lack of computer 20 20 skills 8. Lack of access to 18 14 library 9. Lack of access to 5 6 computer 10. Lack of value for 2 3 research in practice The last question on the survey asked nurses to respond yes or no to a list of potential institutional barriers to nurses' use of research in practice. Only two items were statistically different between Phase I & II populations. Below is the rank order based on the total number of yes responses. Institutional Barriers # Respondents # Respondents P value selecting selecting item in item in Phase I Phase II Inadequate budget for educating nurses in the use of information resources 79 72 FAHC goals with a higher 72 74 priority Inadequate budget for acquisition of information resources 71 61 (p=0.029) FAHC perceives that nursing staff is not eager or prepared to 45 40 incorporate or pursue EBP FAHC perceives EBP or research as not achievable in the "Real World" 35 26 (p=0.006) Overall, the EBP committee was very excited about these results because it validated that our educational intervention had an impact on the knowledge and attitudes of nurses around EBP at FAHC. More nurses could identify that EBP was part of our philosophy, identify an expert to help, felt rewarded for innovations in practice, felt colleagues and other professionals support EBP, and felt satisfied with the work environment's support of EBP. Findings suggest that nurses need to access and provide care based on nursing information and that nearly half indicate that the need arises at least weekly and 70% say it happens at least 1-2 times per month. In addition, nurses typically access more than one source of nursing information and are most likely to consult with peers or use the internet than journals/books. At least 75 % of nurses indicate they understand newly published EBP. Learning needs identified from the survey reaffirm that it is the "fine motor" skills of EBP/research that are the biggest barrier. Thus, future projects will focus on building nurses' understanding of electronic databases, accessing research materials and literature search skills for EBP at the bedside to assure the best patient outcomes.