Implementation of Evidence‐Based Practice in Relation to a Clinical Nursing Ladder System: A National Survey in Taiwan

Abstract

BackgroundAlthough evidence-based practice (EBP) has been widely investigated, few studies have investigated its correlation with a clinical nursing ladder system. The current national study evaluates whether EBP implementation has been incorporated into the clinical ladder system.MethodsA cross-sectional questionnaire survey was conducted nationwide of registered nurses among regional hospitals of Taiwan in January to April 2011. Subjects were categorized into beginning nurses (N1 and N2) and advanced nurses (N3 and N4) by the clinical ladder system. Multivariate logistic regression model was used to adjust for possible confounding demographic factors.ResultsValid postal questionnaires were collected from 4,206 nurses, including 2,028 N1, 1,595 N2, 412 N3, and 171 N4 nurses. Advanced nurses were more aware of EBP than beginning nurses (p < 0.001; 90.7% vs. 78.0%). In addition, advanced nurses were more likely to hold positive beliefs about and attitudes toward EBP (p < 0.001) and possessed more sufficient knowledge of and skills in EBP (p < 0.001). Furthermore, they more often implemented EBP principles (p < 0.001) and accessed online evidence-based retrieval databases (p < 0.001). The most common motivation for using online databases was self-learning for advanced nurses and positional promotion for beginning nurses. Multivariate logistic regression analyses showed advanced nurses were more aware of EBP, had higher knowledge and skills of EBP, and more often implemented EBP than beginning nurses.Linking Evidence to ActionThe awareness of, beliefs in, attitudes toward, knowledge of, skills in, and behaviors of EBP among advanced nurses were better than those among beginning nurses. The data indicate that a clinical ladder system can serve as a useful means to enhance EBP implementation.

How does burnout impact the three components of nursing professional commitment?

“…In the process, nurses advanced their knowledge, skills and experiences , showing a clear pathway for nurses to advance their expertise. Given such significance, it was implemented in Taiwan and also named as clinical nursing ladder levels . Owing to space limits, details of the nursing accreditation levels were not included but are available in Teng et al and Weng et al .…”

“…Given such significance, it was implemented in Taiwan and also named as clinical nursing ladder levels . Owing to space limits, details of the nursing accreditation levels were not included but are available in Teng et al and Weng et al . Workload was measured using the nurses’ responses to the average number of patients cared for.…”

Odnos in znanje medicinskih sester ter ovire pri implementaciji na dokazih temelječe prakse

“…Na uporabo na dokazih temelječe prakse v kliničnih okoljih pomembno vpliva odnos medicinskih sester (Saunders & Vehviläinen-Julkunen, 2017), njihovo znanje in spretnosti raziskovanja (Gentizon, et al, 2016) ter ovire, s katerimi se srečujejo pri implementaciji v klinično prakso (Middlebrooks, et al, 2016). Odnos do na dokazih temelječe prakse v zdravstveni negi tako niha od pozitivnega do neopredeljenega ali celo negativnega in je v veliki meri odvisen od organizacijske klime (Stokke, et al, 2014;Farokhzadian, et al, 2015;Weng, et al, 2015;Mallion & Brooke, 2016;Nguyen & Wilson, 2016). Pomanjkanje znanja in spretnosti pri raziskovanju implementacijo dokazov še dodatno oteži (Kim, et al, 2013).…”

“…Ovire, s katerimi se srečujejo medicinske sestre pri uporabi na dokazih temelječe prakse, so si v raziskavah zelo podobne. Tako so najpogostejše ovire pomanjkanje časa, slabo znanje in spretnosti s področja raziskovanja, nepoznavanje angleškega jezika, pomanjkljivo znanje uporabe računalniške tehnologije, nepoznavanje statističnih izrazov, pomanjkanje izobraževanj, pomanjkljivo poznavanje podatkovnih baz (Farokhzadian, et al, 2015;Weng, et al, 2015;Gentizon, et al, 2016;Nguyen & Wilson, 2016Skela-Savič, et al, 2016Zhou, et al, 2016;Saunders & Vehviläinen-Julkunen, 2017).…”

“…Teme, kategorije in kode ter podatke o avtorjih in povzetke raziskav prikazuje Tabela 2. Foo, et al, 2011;Gerrish, et al, 2011;Mehrdad, et al, 2012;Thorsteinsson, 2013;Köpke, et al, 2013;Stokke, et al, 2014 ;Melnyk, et al, 2014;Ammouri, et al, 2014;Weng, et al, 2015;Skela-Savič, et al, 2016;Skela-Savič et al, 2017 Pomanjkanje znanja -pomanjkanje spretnostitradicionalna prepričanja -slabo poznavanje dokazovslaba seznanjenost z DTP -nepoznavanje konteksta DTP -slaba izobraženost -pomanjkanje izobraževanj -uporaba lastnih izkušenj -lastna opazovanja -tiskani medijičloveški vir -preobremenjenost Kategorija 2: Dejavniki vpliva na negativen odnos medicinskih sester do DTP Majid, et al, 2011;Mokhtar, et al, 2012;Farokhzadian, et al, 2015;Skela-Savič, et al, 2016;Nguyen & Wilson, 2016;Mallion & Brooke, 2016 Pomanjkanje raziskovanja -pomanjkanje randomizioranih raziskav -sistematična uporaba strategij -preoblikovanje znanja -vloga izobraževalnega sistema -nepoznavanje raziskovanja -sodelovanje izobraževalnih in kliničnih okolij Kategorija 3: Znanje medicinskih sester o raziskovanju za uporabo znanstvenih dokazov v kliničnem okolju Prior, et al, 2010;Mokhtar, et al, 2012;Filippini, et al, 2011;White-Williams, et al, 2013;Ramos-Morcillo, et al, 2015;Skela-Savič, et al, 2016;Saunders & Vehviläinen-Julkunen, 2016 Znanje uporabe interneta -znanje iskanja dokazovznanje iskanja po podatkovnih bazah -angleški jezikusposabljanje iz informacijskih znanj Melnyk, et al, 2008;Gerrish, et al, 2011;Mokhtar, et al, 2012;Köpke, et al, 2013;Yoder, et al, 2014;…”