Background
Nurses’ practice of EBP
Factors associated with nurses’ practice of EBP
The Swedish LANE study
Methods
Design
Setting and participants
Instrument
1. Dependent variables
|
Categorization of response alternative
|
---|---|
Formulate questions to search for research-based knowledge a: | high extent vs. low extent |
Seek out relevant knowledge using databases b: | high extent vs. low extent |
Seek out relevant knowledge using other information sources c: | high extent vs. low extent |
Critically appraise and compile best knowledged: | high extent vs. low extent |
Participate in implementing research-based knowledge in practice e: | high extent vs. low extent |
Participate in evaluating whether practice reflects current research-based knowledge f: | high extent vs. low extent |
The response format for the above six items ranged from 1 “To a very low extent” to 4 “To a very high extent”. High extent consists of 3 and 4 and low extent of 1 and 2. | |
2. Independent variables categorized by individual and organizational factors
| |
Individual factors
| |
Sex: | female (reference) vs. male |
Age: | 30 years and older (reference) vs. younger than 30 years |
Previous training as a nurse aide (before studies): | no (reference) vs. yes |
Further study after nursing degree: have studied and study now: | no (reference) vs. yes |
Evidence-based practice capability beliefs: Evidence-based capability was measured by six items a-f following the EBP process (Cronbach’s α = 0.90). The response format ranged from 0 “No, I can’t do that” to 10 “Yes, I can do that”. High capability was characterized by a mean value >7. | low capability (reference) vs. high capability |
Organizational factors
| |
Present form of employment: | temporary (reference) vs. permanent |
Clinical setting: | Hospital (reference) vs. primary care or older people care or psychiatric care |
Full or part time: | part time (reference) vs. full time |
Work shifts: | three shifts (day, evening and night) (reference) vs. office hours (Monday – Friday) or two shifts (day and evening) |
Work overtime: | once per week or less often (reference) vs. several times per week |
Enough staff compared to patients’ needs: | no (reference) vs. yes |
Collective efficacyg: Collective efficacy was measured by 3 items (Cronbach’s α = 0.71). The response format ranged from 1 “Yes, I am sure we manage that” to 11 “No, we do not manage that”. High collective efficacy was characterized by a mean value ≤2.49. | low (reference) vs. high |
Role clarityh: Role clarity was measured using three items (Cronbach’s α = 0.74). The response format ranged from 1 “very often or always” to 5 “seldom or never”. High role clarity was characterized by a mean value ≤2. | low (reference) vs. high |
Leadershipi: Leadership was measured by six items (Cronbach’s α = 0.90). The response format ranged from 1 “very often or always” to 5 “seldom or never”. High-quality leadership was characterized by a mean value ≤2. | low (reference) vs. high |
Job demandsj: Job demands were measured using four items (Cronbach’s α = 0.75). The response format ranged from 1 “very often or always” to 5 “seldom or never”. High job demands were characterized by a mean value ≤2. | low (reference) vs. high |
Controlk: Control was measured using four items (Cronbach’s α = 0.66). The response format ranged from 1 “very often or always” to 5 “seldom or never”. High control was characterized by a mean value ≤2. | low (reference) vs. high |
Job burnout
l
| |
Disengagement: The disengagement scale consisted of six items (Cronbach’s α = 0.83). The response format ranged from 1 “totally disagree” to 4 “totally agree”. High disengagement was characterized by a mean value >3. | low (reference) vs. high |
Exhaustion: The exhaustion scale consisted of five items (Cronbach’s α = 0.74). The response format ranged from 1 “totally disagree” to 4 “totally agree”. High exhaustion was characterized by a mean value >2.5. | low (reference) vs. high |
Dependent variables
Independent variables
Data analysis
Ethical considerations
Results
Description of the sample and the extent of practicing EBP activities
Variables | Response categories | n | % |
---|---|---|---|
Dependent variables
| |||
Formulate questions | High extent | 183 | 19 |
Search databases | High extent | 190 | 19 |
Search other sources | High extent | 545 | 56 |
Compile information | High extent | 297 | 31 |
Implement knowledge | High extent | 296 | 30 |
Evaluate practice | High extent | 336 | 34 |
Independent variables
| |||
Individual factors
| |||
Sex | Men | 108 | 11 |
Women | 874 | 89 | |
Age | Born 1972 or earlier | 430 | 44 |
Born 1973 or later | 554 | 56 | |
Previous nurse aide training | Yes | 462 | 47 |
No | 516 | 53 | |
Further study after nursing degree | Have studied/Study now | 130 | 13 |
No | 845 | 87 | |
EBP capability | High | 619 | 63 |
Low | 360 | 37 | |
Organizational factors
| |||
Present form of employment | Permanent | 566 | 57 |
Temporary | 421 | 43 | |
Clinical setting | Hospital | 723 | 74 |
Primary care | 42 | 4 | |
Care of older people | 118 | 12 | |
Psychiatric care | 101 | 10 | |
Full or part time | Full time | 668 | 68 |
Part time | 312 | 32 | |
Work shifts (Three shifts) | Daytime | 114 | 12 |
Day and evening shifts (no nights) | 466 | 48 | |
Three shifts (incl nights) | 395 | 40 | |
Work overtime | Several times per week | 204 | 21 |
About once a week or less often | 728 | 79 | |
Enough staff compared to patients’ need for care | Yes | 385 | 39 |
No | 598 | 61 | |
Collective efficacy | High | 492 | 50 |
Low | 490 | 50 | |
Role clarity | High | 713 | 73 |
Low | 269 | 27 | |
Leadership | High | 287 | 29 |
Low | 695 | 71 | |
Work demands | High | 307 | 31 |
Low | 675 | 69 | |
Control | High | 77 | 8 |
Low | 904 | 92 | |
Disengagement | High | 140 | 14 |
Low | 841 | 86 | |
Exhaustion | High | 461 | 47 |
Low | 520 | 53 |
Factors associated with the six EBP activities
Framework area and variables | Formulate questions (n = 914) | Search databases (n = 918) | Search other sources (n = 915) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
OR (CI) (step1) | Chi-square | OR (CI) (step 2) | Chi-square | OR (CI) (step1) | Chi-square | OR (CI) (step 2) | Chi-square | OR (CI) (step 1) | Chi-square | OR (CI) (step 2) | Chi-square | |
Block 1
| ∆ 93.7*** | ∆ 53.2*** | ∆ 63.8*** | |||||||||
Individual factors
| ||||||||||||
Sex | 1.2 (0.7;2.1) | 1.2 (0.7;2.0) | 1.0 (0.6;1.7) | 1.0 (0.6;1.8) | 1.0 (0.7;1.6) | 1.1 (0.7;1.7) | ||||||
Age | 1.2 (0.8;1.7) | 1.2 (0.8;1.8) | 1.2 (0.8;1.7) | 1.2 (0.8;1.8) | 1.0 (0.7;1.3) | 1.1 (0.8;1.5) | ||||||
Previous nurse aide training | 1.4 (0.9; 2.0) | 1.3 (0.9;2.0) | 1.3 (0.9;1.9) | 1.3 (0.9;1.8) | 1.3 (0.9;1.7) | 1.2 (0.9;1.6) | ||||||
Further study after nursing degree | 1.1 (0.7; 1.8) | 1.0 (0.6;1.7) | 1.1 (0.7;1.8) | 1.1 (0.7;1.8) | 1.0 (0.6;1.4) | 1.0 (0.6;1.5) | ||||||
EBP capability | 8.3 (4.8;14.5) | 7.3 (4.1;12.9) | 4.0 (2.6;6.2) | 3.8 (2.4;5.9) | 3.0 (2.2;3.9) | 2.6 (2.0;3.5) | ||||||
Block 2
| ∆ 30.9* | ∆ 10.7 | ∆ 39.3** | |||||||||
Organisational factors
| ||||||||||||
Present form of employment | 1.1(0.8;1.7) | 0.9 (0.6;1.3) | 1.2 (0.9;1.6) | |||||||||
Clinical setting Hospital
| ||||||||||||
• Primary care | 0.3 (0.1;1.1) | 1.0 (0.4;2.7) | 1.9 (0.8;4.3) | |||||||||
• Care of older people | 1.0 (0.6;1.7) | 1.1 (0.6;1.9) | 1.7 (1.0;2.7) | |||||||||
• Psychiatry care | 1.5 (0.8;2.7) | 1.4 (0.8;2.6) | 1.0 (0.6;1.6) | |||||||||
Full or part time | 0.7 (0.5;1.1) | 0.7 (0.5;1.1) | 1.0 (0.7;1.4) | |||||||||
Work shifts (Three shifts) | ||||||||||||
• Office hours | 0.9 (0.5;1.7) | 0.8 (0.4;1.4) | 1.4 (0.8;2.4) | |||||||||
• Two shifts | 0.8 (0.6;1.3) | 1.0 (0.7;1.4) | 1.0 (0.7;1.3) | |||||||||
Work overtime | 1.2 (0.7;1.9) | 1.2 (0.8;1.8) | 1.5 (1.0;2.1) | |||||||||
Enough staff | 1.0 (0.7;1.5) | 1.0 (0.7;1.4) | 0.9 (0.7;1.2) | |||||||||
Collective efficacy | 1.3 (0.9;2.0) | 1.2 (0.8;1.7) | 1.4 (1.0;1.9) | |||||||||
Role clarity | 2.0 (1.2;3.2) | 1.3 (0.9;2.0) | 1.0 (0.7;1.4) | |||||||||
Leadership | 1.3 (0.9;2.0) | 1.2 (0.8;1.8) | 1.5 (1.1;2.1) | |||||||||
Job demands | 1.5 (0.9;2.2) | 1.1 (0.8;1.7) | 0.9 (0.7;1.3) | |||||||||
Control | 1.2 (0.7;2.2) | 1.2 (0.6;2.1) | 1.4 (0.8;2.5) | |||||||||
Disengagement | 0.8 (0.5;1.5) | 1.0 (0.6;1.8) | 0.8 (0.5;1.1) | |||||||||
Exhaustion | 1.0 (0.7;1.4) | 1.1 (0.8;1.6) | 0.9 (0.7;1.3) | |||||||||
Final model | 93.7*** | 124.7*** | 53.2*** | 63.9*** | 63.8*** | 103.1*** |
Framework area and variables | Compile information (n = 913) | Implement evidence (n = 917) | Evaluate practice (n = 919) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
OR (CI) (step1) | Chi-square | OR (CI) (step 2) | Chi-square | OR (CI) (step1) | Chi-Square | OR (CI) (step 2) | Chi-square | OR (CI) (step 1) | Chi-square | OR (CI) (step 2) | Chi-square | |
Block 1
| ∆ 53.7*** | ∆ 61.7*** | ∆ 91.0*** | |||||||||
Individual factors
| ||||||||||||
Sex | 1.2 (0.7;1.8) | 1.1 (0.7;1.8) | 0.8 (0.5;1.2) | 0.7 (0.4;1.2) | 0.9 (0.5;1.4) | 0.8 (0.5;1.4) | ||||||
Age | 0.8 (0.6;1.1) | 0.9 (0.7;1.3) | 1.0 (0.7;1.4) | 1.2 (0.8;1.7) | 1.1 (0.8;1.5) | 1.3 (0.9;1.8) | ||||||
Previous nurse aide training | 1.1 (0.8;1.5) | 1.0 (0.7;1.4) | 1.5 (1.1;2.0) | 1.3 (0.9;1.8) | 1.6 (1.2;2.2) | 1.5 (1.1;2.0) | ||||||
Further study after nursing degree | 1.1 (0.7;1.6) | 1.1 (0.7;1.7) | 1.1 (0.7;1.6) | 0.9 (0.6;1.5) | 1.1 (0.7;1.6) | 1.0 (0.7;1.6) | ||||||
EBP capability | 3.1 (2.2;4.3) | 2.7 (1.9;3.8) | 3.2 (2.3;4.5) | 2.6 (1.8;3.7) | 4.1 (3.0;5.8) | 3.4 (2.4;4.8) | ||||||
Block 2
| ∆ 27.7* | ∆ 83.8*** | ∆ 57.9*** | |||||||||
Organisational factors
| ||||||||||||
Present form of employment | 1.0 (0.8;1.4) | 1.2 (0.9;1.7) | 1.0 (0.8;1.4) | |||||||||
Clinical setting Hospital
| ||||||||||||
• Primary care | 1.6 (0.7;3.5) | 0.7 (0.3;1.8) | 0.6 (0.3;1.6) | |||||||||
• Care of older people | 2.1 (1.3;3.3) | 2.0 (1.2;3.2) | 2.2 (1.4;3.6) | |||||||||
• Psychiatry care | 1.4 (0.8;2.4) | 2.4 (1.4;4.0) | 1.6 (0.9;2.7) | |||||||||
Full or part time | 1.2 (0.8;1.7) | 1.4 (0.9;1.9) | 1.3 (0.9;1.8) | |||||||||
Work shifts (Three shifts) | ||||||||||||
• Office hours | 1.0 (0.6;1.8) | 1.4 (0.8;2.4) | 1.0 (0.6;1.8) | |||||||||
• Two shifts | 0.8 (0.6;1.2) | 1.1 (0.8;1.6) | 1.0 (0.7;1.4) | |||||||||
Work overtime | 1.2 (0.8;1.8) | 1.5 (0.9;2.2) | 1.1 (0.7:1.6) | |||||||||
Enough staff | 0.9 (0.6;1.3) | 1.2 (0.8;1.6) | 1.0 (0.7;1.4) | |||||||||
Collective efficacy | 1.1(0.8;1.5) | 1.7 (1.2;2.4) | 1.7 (1.2;2.3) | |||||||||
Role clarity | 1.0 (0.7;1.4) | 0.9 (0.6;1.4) | 1.1 (0.7;1.5) | |||||||||
Leadership | 1.1 (0.8;1.5) | 2.0 (1.4;2.8) | 1.6 (1.2;2.3) | |||||||||
Job demands | 1.2 (0.8;1.7) | 1.5 (1.1;2.2) | 1.6 (1.2;2.3) | |||||||||
Control | 1.9 (1.1;3.2) | 1.4 (0.8;2.5) | 1.3 (0.7;2.3) | |||||||||
Disengagement | 0.9 (0.6;1.5) | 0.6 (0.4;1.1) | 0.7 (0.4;1.1) | |||||||||
Exhaustion | 1.2 (0.9;1.6) | 0.8 (0.6;1.1) | 1.0 (0.8;1.4) | |||||||||
Final model | 53.7*** | 81.3*** | 61.7*** | 145.6*** | 91.0*** | 148.9*** |