Laurie Ecoff

Multi‐institutional study of barriers to research utilisation and evidence‐based practice among hospital nurses

AIMS The study aims were to explore the relationships between perceived barriers to research use and the implementation of evidence-based practice among hospital nurses and to investigate the barriers as predictors of implementation of evidence-based practice. BACKGROUND Evidence-based practice is critical in improving healthcare quality. Although barriers to research use have been extensively studied, little is known about the relationships between the barriers and the implementation of evidence-based practice in nursing. DESIGN   Cross-sectional study. METHOD Data were collected between December 2006-January 2007 for this cross-sectional study using computerised Evidence-Based Practice Questionnaire and BARRIERS surveys. A convenience sample (n=1301) of nurses from four hospitals in southern California, USA, participated. Hierarchical multiple regression analyses were performed for each of the three dependent variables: practice, attitude and knowledge/skills associated with evidence-based practice. BARRIERS subscales were used as predictor variables. RESULTS The perceived barriers to research use predicted only 2·7, 2·4 and 4·5% of practice, attitude and knowledge/skills associated with evidence-based practice. Conclusions.  It was unexpected that the barriers to research use predicted such small fractions of practice, attitude and knowledge/skills associated with evidence-based practice. The barriers appear to have minimal influence over the implementation of evidence-based practice for most hospital nurses. RELEVANCE TO CLINICAL PRACTICE In implementing evidence-based practice, the focus on barriers to research use among general nursing staff may be misplaced. Further studies are needed to identify the predictors of evidence-based practice and to identify the subset of nurses who are most amenable to adopting evidence-based practice.

Regional Evidence-Based Practice Fellowship Program: Impact on Evidence-Based Practice Implementation and Barriers

This quasi-experimental, pre- and posttest study evaluated the impact of a 9-month collaborative regional evidence-based practice (EBP) fellowship program on practice, attitude, knowledge, and perceived barriers associated with implementation of EBP. Three annual cohorts (N = 142) of nurses attending a fellowship program from 2008 to 2010 participated in this study. Paired t tests showed statistically significant increases in practice (+.82; p < .001) and knowledge/skills (+.78; p < .001) associated with EBP, but showed no change in attitude (+.16; p = .198). All four Barriers subscales showed statistically significant decreases (−.10 to −.31; p = .036 to <.001). Hierarchical multiple regression analyses showed that the barriers explained 6.8%, 8.9% and 13.9% of variances in practice, attitude and knowledge/skills, respectively. The collaborative regional fellowship program improved the practice and knowledge/skills associated with EBP. The barriers were significant predictors of the EBP implementation among the targeted group of nurses participating in the fellowship program.

Joint optimization: Merging a new culture with a new physical environment.

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Promoting nurses' knowledge in evidence-based practice: do educational methods matter?

200 billion of healthcare construction is expected by the year 2015, and nurse leaders must expand their knowledge and capabilities in healthcare design. This bimonthly department prepares nurse leaders to use the evidence-based design process to ensure that new, expanded, and renovated hospitals facilitate optimal patient outcomes, enhance the work environment for healthcare providers, and improve organizational performance. In this article, the authors discuss the concept of joint optimization of merging organizational culture with a new hospital facility.

Predictors of Evidence‐Based Practice Implementation, Job Satisfaction, and Group Cohesion Among Regional Fellowship Program Participants

Evidence-based practice (EBP) is a mandate for nursing practice. Education on EBP has occurred in academic settings, but not all nurses have received this training. The authors describe a randomized controlled pretest/posttest design testing the differences in effectiveness of two educational methods to improve nurses’ knowledge, attitudes, and practice of EBP. Results indicated both methods improved self-reported practice. On the basis of the study findings, staff development educators can select the teaching method that best complements their organizational environment.

Redesigning Orientation in an Intensive Care Unit Using 2 Theoretical Models

BACKGROUND A regional, collaborative evidence-based practice (EBP) fellowship program utilizing institution-matched mentors was offered to a targeted group of nurses from multiple local hospitals to implement unit-based EBP projects. The Advancing Research and Clinical Practice through Close Collaboration (ARCC) model postulates that strong EBP beliefs result in high EBP implementation, which in turn causes high job satisfaction and group cohesion among nurses. AIMS This study examined the relationships among EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness among the fellowship program participants. METHODS A total of 175 participants from three annual cohorts between 2012 and 2014 completed the questionnaires at the beginning of each annual session. The questionnaires included the EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness scales. RESULTS There were positive correlations between EBP beliefs and EBP implementation (r = 0.47; p <.001), as well as EBP implementation and job satisfaction (r = 0.17; p = .029). However, no statistically significant correlations were found between EBP implementation and group cohesion, or group attractiveness. Hierarchical multiple regression models showed that EBP beliefs was a significant predictor of both EBP implementation (β = 0.33; p <.001) and job satisfaction (β = 0.25; p = .011). However, EBP implementation was not a significant predictor of job satisfaction, group cohesion, or group attractiveness. LINKING EVIDENCE TO ACTION In multivariate analyses where demographic variables were taken into account, although EBP beliefs predicted job satisfaction, no significant relationship was found between EBP implementation and job satisfaction or group cohesion. Further studies are needed to confirm these unexpected study findings.Background A regional, collaborative evidence-based practice (EBP) fellowship program utilizing institution-matched mentors was offered to a targeted group of nurses from multiple local hospitals to implement unit-based EBP projects. The Advancing Research and Clinical Practice through Close Collaboration (ARCC) model postulates that strong EBP beliefs result in high EBP implementation, which in turn causes high job satisfaction and group cohesion among nurses. Aims This study examined the relationships among EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness among the fellowship program participants. Methods A total of 175 participants from three annual cohorts between 2012 and 2014 completed the questionnaires at the beginning of each annual session. The questionnaires included the EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness scales. Results There were positive correlations between EBP beliefs and EBP implementation (r = 0.47; p <.001), as well as EBP implementation and job satisfaction (r = 0.17; p = .029). However, no statistically significant correlations were found between EBP implementation and group cohesion, or group attractiveness. Hierarchical multiple regression models showed that EBP beliefs was a significant predictor of both EBP implementation (β = 0.33; p <.001) and job satisfaction (β = 0.25; p = .011). However, EBP implementation was not a significant predictor of job satisfaction, group cohesion, or group attractiveness. Linking Evidence to Action In multivariate analyses where demographic variables were taken into account, although EBP beliefs predicted job satisfaction, no significant relationship was found between EBP implementation and job satisfaction or group cohesion. Further studies are needed to confirm these unexpected study findings.

Strategies for Success: Cultivating Emotional Competence in the Clinical Nurse Specialist Role

BACKGROUND To accommodate a higher demand for critical care nurses, an orientation program in a surgical intensive care unit was revised and streamlined. Two theoretical models served as a foundation for the revision and resulted in clear clinical benchmarks for orientation progress evaluation. PURPOSE The purpose of the project was to integrate theoretical frameworks into practice to improve the unit orientation program. METHODS Performance improvement methods served as a framework for the revision, and outcomes were measured before and after implementation. RESULTS The revised orientation program increased 1- and 2-year nurse retention and decreased turnover. Critical care knowledge increased after orientation for both the preintervention and postintervention groups. CONCLUSION Incorporating a theoretical basis for orientation has been shown to be successful in increasing the number of nurses completing orientation and improving retention, turnover rates, and knowledge gained.

Disseminating Project Outcomes in a Scholarly Poster.

T role of the clinical nurse specialist (CNS) blends leadership and advanced clinical practice to improve patient care, nursing practice, and organizational outcomes. Successful role implementation as a CNS is dependent on a multitude of factors, including clinical knowledge and skills, individual and group leadership skills, effective communication, and the ability to influence change.1(p13) A leadership skill critical to the success of the CNS and the organization, yet often overlooked, is emotional competence. The focus of this article is to describe the essential role that emotional competence plays in successful CNS practice, provide tools for self-assessment and development, and discuss implications for nurse leaders.

Nursing Practice, Knowledge, Attitudes and Perceived Barriers to Evidence-Based Practice at an Academic Medical Center

Most architects, interior designers, and other design professionals are well acquainted with developing and presenting project posters, since most academic settings emphasize poster presentations of the students’ projects in the curriculum. Presenting project posters at national and international conferences is a means of communicating a firm’s accomplishments in one or more projects. Typically, project posters include photographic displays of the project and narrative regarding the projects’ goals and special features. In addition, the project poster likely includes a listing of design team members, including engineering consultants, other design colleagues, and specific project information about the square footage and cost of the project. The purpose of this methodology column is to discuss designing and presenting a scientific poster that disseminates information about data that were measured prior to and after the completion of the project. While some design professionals may have had experience with scientific posters as a means of disseminating knowledge about their projects and research in graduate and doctoral programs, most design professionals in practice settings may have less experience in developing these types of posters. Scientific posters are a visual communication tool, and therefore, an effective method of communicating project outcomes similar to podium presentations at conferences (Hess, 2014). Many authors writing about evidence-based practice (EBP) in medicine and nursing indicate that dissemination of findings is the last step, and one of the most important steps of EBP. Disseminating findings in the local, regional, national, and international areas allow others to review practice outcomes resulting from specific design interventions with the possibility that other settings may want to replicate the same practice change or the same design feature. At times, the results of an evidence-based design (EBD) feature may inspire researchers to design an interventional study on a broader spectrum to measure the effect of specific design features on patient, provider, or organizational outcomes. Every EBP project or EBD project should include an effective dissemination plan. The plan should include the goals and objectives of the project, audiences who may be interested in the content, content to be included in the presentation, the best process to present the findings, methods to measure the effect of the dissemination, strategies to promote the presentation in several formats, and possible barriers that may be encountered when disseminating the findings. There are two types of poster presentations typically seen in the design field: (1) presentation of proposed or incomplete projects with an outline of the aims of the project, background and significance of the project, anticipated methods