Randomized controlled trial on the effectiveness of web-based Genomics Nursing Education Intervention for undergraduate nursing students: a study protocol.

AIM: To describe a randomized controlled trial protocol that will evaluate the effectiveness of two web-based genomic nursing education interventions. BACKGROUND: Preparing future nurses to be competent in genetic and genomic concepts is fundamental to ensure appropriate clinical application. However, genetics-genomics concepts are still new in the field of nursing. Little is known about what type and kind of web-based nursing education is effective in improving the knowledge of nursing students. To address these knowledge gaps, a web-based 'Genomic Nursing Education Intervention' will be developed and compared with an existing online education programme. DESIGN: A randomized controlled trial of two groups with pre-test and repeated posttesting. METHODS: The Genomic Nursing Concept Inventory, a validated tool, will be used to assess the genetics-genomics knowledge of nursing students. Participants will be randomly allocated to either a control or an intervention group. The control group will receive the standard web-based nursing education, while the intervention group will receive a newly developed web-based education intervention. Outcome measures include the students' knowledge level of nursing genetics-genomics concepts. Participants will be retested at 3 and 6 months. CONCLUSION: Current evidence shows that ensuring nurses have adequate education in genetic-genomic concepts is challenging. This study will demonstrate which of two web-based nursing education methods is more effective in teaching genetic-genomic concepts. This research project will better prepare the nursing profession in their careers for the emerging advance technologies in genetics-genomics and personalized health care. IMPACT: Current evidence shows major challenges in ensuring that nurses have adequate education in genetics-genomics concepts. Less is known about what approaches to web-based education are effective to improve the knowledge gaps of nursing students in genetics-genomics concepts. This study will determine which type of web-based nursing education is effective in improving the genetics-genomics knowledge of nursing students. This research project will help better prepare nurses in dealing with advances in genetics-genomics in their careers. TRIAL REGISTRATION:  This study is registered in ClinicalTrials.gov (ID number NCT03963687) https://clinicaltrials.gov/show/NCT03963687.

Endorsement and Validation of the Essential Evidence-Based Practice Competencies for Practicing Nurses in Finland: An Argument Delphi Study.

OBJECTIVES: To explore nurses' views and establish consensus on the key content of the essential evidence-based practice (EBP) competencies developed by Melnyk et al. (2014, Worldviews on Evidence-Based Nursing, 11, 5) for practicing registered nurses (RNs) and advanced practice nurses (APNs) among Finnish nurse panelists. BACKGROUND: Broad-based integration of best evidence into daily practice is central to effectively improving care quality and patient outcomes. EBP competencies allow healthcare professionals and organizations to clarify performance expectations regarding EBP and succinctly outline the expected competencies for successful application of best evidence to daily care. DESIGN: A modified Policy Delphi study design. METHODS: The Delphi panel was conducted in late 2017 among 14 Finnish nurse clinicians, educators, and leaders with a special interest in EBP. The data were collected using an eDelphi Internet application and the Argument Delphi method, highlighting the panelists' different perspectives. Standardized guidelines and descriptive statistics were used to translate the essential EBP competencies into Finnish and analyze the data. RESULTS: The Finnish Delphi panel endorsed and validated the essential EBP competencies for practicing RNs and APNs with a few minor modifications. Of the 13 essential EBP competencies for practicing RNs, consensus was established among the Delphi panelists over two rounds on all but one of the EBP competencies. Of the 11 additional essential EBP competencies for practicing APNs, consensus was established over two Delphi rounds on all the EBP competencies for APNs. LINKING EVIDENCE TO ACTION: As EBP is a shared competency and the key principles and steps of EBP implementation are universal, the international endorsement and validation of national consensus-based, clinical practice-oriented EBP competency sets establish an international quality standard for nurses to aspire to and attain on EBP and provide guidance for nurses in integrating best evidence into their daily practice, facilitating broad-based, consistent implementation of EBP worldwide.

Practicing Healthcare Professionals' Evidence-Based Practice Competencies: An Overview of Systematic Reviews.

BACKGROUND: Evidence-based practice (EBP) competencies are essential for all practicing healthcare professionals to provide evidence-based, quality care, and improved patient outcomes. The multistep EBP implementation process requires multifaceted competencies to successfully integrate best evidence into daily healthcare delivery. AIMS: To summarize and synthesize the current research literature on practicing health professionals' EBP competencies (i.e., their knowledge, skills, attitudes, beliefs, and implementation) related to employing EBP in clinical decision-making. DESIGN: An overview of systematic reviews. METHODS: PubMed/MEDLINE, CINAHL, Scopus, and Cochrane Library were systematically searched on practicing healthcare professionals' EBP competencies published in January 2012-July 2017. A total of 3,947 publications were retrieved, of which 11 systematic reviews were eligible for a critical appraisal of methodological quality. Three independent reviewers conducted the critical appraisal using the Rapid Critical Appraisal tools developed by the Helene Fuld National Institute for Evidence-Based Practice in Nursing & Healthcare. RESULTS: Practicing healthcare professionals' self-reported EBP knowledge, skills, attitudes, and beliefs were at a moderate to high level, but they did not translate into EBP implementation. Considerable overlap existed in the source studies across the included reviews. Few reviews reported any impact of EBP competencies on changes in care processes or patient outcomes. Most reviews were methodologically of moderate quality. Significant variation in study designs, settings, interventions, and outcome measures in the source studies precluded any comparisons of EBP competencies across healthcare disciplines. LINKING EVIDENCE TO ACTION: As EBP is a shared competency, the development, adoption, and use of an EBP competency set for all healthcare professionals are a priority along with using actual (i.e., performance-based), validated outcome measures. The widespread misconceptions and misunderstandings that still exist among large proportions of practicing healthcare professionals about the basic concepts of EBP should urgently be addressed to increase engagement in EBP implementation and attain improved care quality and patient outcomes.

Key considerations for selecting instruments when evaluating healthcare professionals' evidence-based practice competencies: A discussion paper.

AIM: A discussion of key considerations related to selecting instruments and tools for evaluating healthcare professionals' evidence-based practice (EBP) competencies. DESIGN: A discussion paper. DATA SOURCES: Articles published in international peer-reviewed journals from January 2000 - November 2017 on validated instruments for assessing healthcare professionals' performance-based EBP competencies. IMPLICATIONS FOR NURSING: Validated EBP competency instruments based on actual performance to evaluate the EBP competencies of healthcare professionals are currently available in the field of medicine. Although some of these instruments have already been adapted for use in physical and occupational therapy, their modification for use in nursing has begun only in the last few months. CONCLUSION: A concerted effort on modifying and validating objective measures of actual performance for use in nursing should be commenced to evaluate directly measurable EBP competencies, instead of continuing to rely on nurses' self-assessments. Future studies focusing on development and validation of objective instruments to evaluate EBP competencies based on actual performance and exploring the modification of currently available objective instruments from medicine are urgently needed in nursing. IMPACT: Instead of measuring actual EBP competencies, the majority of competency evaluations in nursing are still being conducted via self-assessments, despite growing evidence of their poor accuracy in evaluating directly measurable constructs such as evidence-based practice knowledge and skills. Accurate measurement of nurses' EBP competencies is essential to increasing systematic implementation of EBP in healthcare organizations, thus promoting the attainment of improved care quality and patient outcomes in healthcare delivery.

Nurses' Evidence-Based Practice Beliefs and the Role of Evidence-Based Practice Mentors at University Hospitals in Finland.

BACKGROUND: Although systematic implementation of evidence-based practice (EBP) is essential to effectively improve patient outcomes, quality, and value of care, nurses do not consistently use evidence in practice. Uptake is hampered by lack of nurses' readiness for EBP, including nurses' EBP beliefs and lack of EBP mentors. Favorable EBP beliefs are foundational to Registered Nurses' (RNs) use and integration of best evidence into clinical decision making, whereas EBP mentors are in a key role for strengthening RNs' beliefs in the value of EBP and confidence in their ability to implement EBP. Although nurses' EBP beliefs and role of BP mentors have been widely studied in countries leading the EBP movement, less is known about them in the non-English-speaking world. AIMS: To determine RNs EBP beliefs and the role of EBP mentors at Finnish university hospitals and to explore the associations between RNs' EBP beliefs and sociodemographic factors. METHODS: A cross-sectional descriptive survey was conducted in November-December 2014 at every university hospital in Finland with a convenience sample (n = 943) of practicing RNs. The data were collected via an electronic survey, and analyzed using descriptive and inferential statistics. RESULTS: RNs reported low levels of EBP beliefs in the degree to which they believed that clinical nursing practice and their own practice were based on evidence. EBP mentors worked in many professional nursing roles. Several significant differences were found between RN's EBP beliefs and sociodemographic variables. LINKING EVIDENCE TO ACTION: Although RNs were familiar with and believed in the value of EBP in improving care quality and patient outcomes, their ratings were low about the degree to which they believed that clinical nursing practice and their own practice were based on evidence, indicating a modest level of individual EBP readiness among Finnish RNs required for integrating best evidence into clinical care delivery.

Evidence-Based Practice and Job-Related Nurse Outcomes at Magnet®-Aspiring, Magnet-Conforming, and Non-Magnet University Hospitals in Finland: A Comparison Study.

OBJECTIVE: The aim of this study was to compare nurses' evidence-based practice (EBP) beliefs, EBP knowledge, and nurse workforce outcomes between Magnet®-aspiring, Magnet-conforming, and non-Magnet university hospitals in Finland. BACKGROUND: The effect of Magnet designation on EBP and nursing workforce outcomes is well studied where Magnet hospitals exist. Less is known about it in countries where hospitals are embarking upon the initial Magnet journey. METHODS: A descriptive cross-sectional national survey was conducted at Finnish university hospitals with a convenience sample (n = 943) of practicing nurses. Data were analyzed using descriptive and inferential statistics. RESULTS: Although nurses' EBP beliefs were favorable and they were satisfied with their jobs, they reported low levels of EBP knowledge. Statistically significant differences were found between hospitals' Magnet journey status and nurses' levels of perceived EBP knowledge. CONCLUSIONS: Although nurses believed in the value of EBP and were satisfied with and likely to stay in their jobs and in nursing, they lacked the EBP knowledge required for integrating best evidence into clinical care.

Nurses' readiness for evidence-based practice at Finnish university hospitals: a national survey.

AIMS: The aim of this study was to determine nurses' readiness for evidence-based practice at Finnish university hospitals. BACKGROUND: Although systematic implementation of evidence-based practice is essential to effectively improving patient outcomes and value of care, nurses do not consistently use evidence in practice. Uptake is hampered by lack of nurses' individual and organizational readiness for evidence-based practice. Although nurses' evidence-based practice competencies have been widely studied in countries leading the evidence-based practice movement, less is known about nurses' readiness for evidence-based practice in the non-English-speaking world. DESIGN: A cross-sectional descriptive survey design. METHODS: The study was conducted in November-December 2014 in every university hospital in Finland with a convenience sample (n = 943) of practicing nurses. The electronic survey data were collected using the Stevens' Evidence-Based Practice Readiness Inventory, which was translated into Finnish according to standardized guidelines for translation of research instruments. The data were analysed using descriptive and inferential statistics. RESULTS: Nurses reported low to moderate levels of self-efficacy and low levels of evidence-based practice knowledge. A statistically significant, direct correlation was found between nurses' self-efficacy in employing evidence-based practice and their actual evidence-based practice knowledge level. Several statistically significant differences were found between nurses' socio-demographic variables and nurses' self-efficacy in employing evidence-based practice, and actual and perceived evidence-based practice knowledge. CONCLUSIONS: Finnish nurses at university hospitals are not ready for evidence-based practice. Although nurses are familiar with the concept of evidence-based practice, they lack the evidence-based practice knowledge and self-efficacy in employing evidence-based practice required for integrating best evidence into clinical care delivery.

Effectiveness of an education intervention to strengthen nurses' readiness for evidence-based practice: A single-blind randomized controlled study.

BACKGROUND: Nurses' lack of readiness for evidence-based practice slows down the uptake, adoption, and implementation of evidence-based practice which is of international concern as it impedes attainment of the highest quality of care and best patient outcomes. There is limited evidence about the most effective approaches to strengthen nurses' readiness for evidence-based practice. OBJECTIVES: To evaluate the effectiveness of an Advanced Practice Nurse-delivered education program to strengthen nurses' readiness for evidence-based practice at a university hospital. DESIGN: A single-blind randomized controlled trial with repeated measures design, with measures completed during spring and fall 2015, before the education program (T0), within 1week after (T1), 8weeks after (T2), and 4months after completion of education interventions (T3). SETTING: One large university hospital system in Finland, consisting of 15 acute care hospitals. PARTICIPANTS: The required sample size, calculated by a priori power analysis and including a 20% estimated attrition rate, called for 85 nurse participants to be recruited. Nurses working in different professional nursing roles and care settings were randomly allocated into two groups: intervention (evidence-based practice education, N=43) and control (research utilization education, N=34). METHODS: The nurse participants received live 4-h education sessions on the basic principles of evidence-based practice (intervention group) and on the principles of research utilization (control group). The intervention group also received a web-based interactive evidence-based practice education module with a booster mentoring intervention. Readiness for evidence-based practice data, previous experience with evidence-based practice, and participant demographics were collected using the Stevens' EBP Readiness Inventory. RESULTS: Nurses' confidence in employing evidence-based practice and actual evidence-based practice knowledge were lower at T0, compared with the post-education scores, specifically at T1. The improvement in the confidence or actual evidence-based practice knowledge levels did not differ between the intervention and control groups. Confidence in employing evidence-based practice was directly correlated with level of education and inversely correlated with age. Actual evidence-based practice knowledge was lowest among nurses who had no previous knowledge or experience of evidence-based practice. CONCLUSIONS: Both the evidence-based practice and research utilization education interventions improved nurses' confidence in employing evidence-based practice and actual evidence-based practice knowledge, strengthening their evidence-based practice readiness at least in the short-term. Most of the variation in the confidence in employing evidence-based practice and actual evidence-based practice knowledge levels was due to background factors, such as primary role and education level, which emphasize differences in educational needs between nurses with diverse backgrounds.

Translating knowledge into best practice care bundles: a pragmatic strategy for EBP implementation via moving postprocedural pain management nursing guidelines into clinical practice.

AIMS AND OBJECTIVES: To describe quantitative and qualitative best evidence as sources for practical interventions usable in daily care delivery in order to integrate best evidence into clinical decision-making at local practice settings. To illustrate the development, implementation and evaluation of a pain management nursing care bundle based on a clinical practice guideline via a real-world clinical exemplar. BACKGROUND: Successful implementation of evidence-based practice requires consistent integration of best evidence into daily clinical decision-making. Best evidence comprises high-quality knowledge summarised in systematic reviews and translated into guidelines. However, consistent integration of guidelines into care delivery remains challenging, partly due to guidelines not being in a usable form for daily practice or relevant for the local context. DESIGN: A position paper with a clinical exemplar of a nurse-led, evidence-based quality improvement project to design, implement and evaluate a pain management care bundle translated from a national nursing guideline. METHODS: A pragmatic approach to integrating guidelines into daily practice is presented. Best evidence from a national nursing guideline was translated into a pain management care bundle and integrated into daily practice in 15 medical-surgical (med-surg) units of nine hospitals of a large university hospital system in Finland. CONCLUSIONS: Translation of best evidence from guidelines into usable form as care bundles adapted to the local setting may increase implementation and uptake of guidelines and improve quality and consistency of care delivery. RELEVANCE TO CLINICAL PRACTICE: A pragmatic approach to translating a nursing guideline into a pain management care bundle to incorporate best evidence into daily practice may help achieve more consistent and equitable integration of guidelines into care delivery, and better quality of pain management and patient outcomes.

Linguistic Validation of Genomic Nursing Concept Inventory to Finnish Applying Mandysova's Decision Tree Algorithm.

Background and Purpose: Currently, there is no available Finnish version of the Genomic Nursing Concept Inventory tool (GNCI). This study tested the validity, reliability, and clinical usability of a Finnish translation. Methods: A decision tree algorithm was used to guide the translation, as per International Society for Pharmacoeconomics and Outcomes Research guidelines. Item-Content Validity Index (I-CVI), modified kappa (k*) statistics, and Cronbach's alpha were calculated. Results: The I-CVI and k* values were "good" to "excellent" (I-CVI = 0.63-1.00, k* = 0.52-1.00), and Cronbach's alpha value was "good" (α = 0.816; 95% confidence interval: 0.567-0.956). Conclusion: The Mandysova's decision tree algorithm provided clear and rigorous direction for the translation and validity of the Finnish GNCI.

The state of readiness for evidence-based practice among nurses: An integrative review.

OBJECTIVES: To review factors related to nurses' individual readiness for evidence-based practice and to determine the current state of nurses' evidence-based practice competencies. DESIGN: An integrative review study. DATA SOURCES: Thirty-seven (37) primary research studies on nurses' readiness for evidence-based practice, of which 30 were descriptive cross-sectional surveys, 5 were pretest-posttest studies, and one study each was an experimental pilot study and a descriptive qualitative study. Included studies were published from the beginning of 2004 through end of January 2015. REVIEW METHODS: The integrative review study used thematic synthesis, in which the quantitative studies were analyzed deductively and the qualitative studies inductively. Outcomes related to nurses' readiness for evidence-based practice were grouped according to the four main themes that emerged from the thematic synthesis: (1) nurses' familiarity with evidence-based practice (EBP); (2) nurses' attitudes toward and beliefs about evidence-based practice; (3) nurses' evidence-based practice knowledge and skills; and (4) nurses' use of research in practice. Methodological quality of the included studies was evaluated with Joanna Briggs Institute critical appraisal tools. RESULTS: Although nurses were familiar with, had positive attitudes toward, and believed in the value of EBP in improving care quality and patient outcomes, they perceived their own evidence-based practice knowledge and skills insufficient for employing evidence-based practice, and did not use best evidence in practice. The vast majority (81%) of included studies were descriptive cross-sectional surveys, 84% used a non-probability sampling method, sample sizes were small, and response rates low. Most included studies were of modest quality. CONCLUSIONS: More robust, theoretically-based and psychometrically sound nursing research studies are needed to test and evaluate the effectiveness of interventions designed to advance nurses' evidence-based practice competencies, especially teaching them how to integrate evidence-based practice into clinical decision-making. All efforts should be focused on systematically using knowledge transformation strategies shown to be effective in rigorous studies, to translate best evidence into practice-friendly, readily usable forms that are easily accessible to nurses to integrate into their clinical practice.