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Nursing Research Roundtable Notes November 3, 2005 Readiness for U.S. Nurses for Evidence-Based Practice Am J Nurs 2005 Sep; 105(9): 40 – 51 D.S. Pravikoff, A.B. Tanner, S.T. Pierce Roundtable Facilitator Jeanne St. Pierre Participants Margie Pyron, Cherlynn Bennett, Linda Hamilton, Susan Paige, Joe Wheatley, Emma Gayle Collins, Kathy Cheslik, Chanel Flake, Sherry Simmonds, Debra Siela, Janey McKinley, Kris Larson, Leslie Cowan, Doreen Johnson, Gwendolyn Rook, Kari Hargreaves, Lorna Springston Introduction The Nursing Research Roundtable has evolved from the Nursing Journal Club. The purpose of the Roundtable is to promote evidence-based practice (EBP), to discuss the content and the quality of the research presented in a pre-selected article, and to facilitate discussion on how to bring new knowledge (from the literature) to the bedside for the purposes of improving the delivery, and quality of patient care at Ball Memorial Hospital. Journal Article The article “Readiness for U.S. Nurses for Evidence-Based Practice” was summarized for participants (article summary attached at end of this note). From the article it was determined that only 46% of respondents were familiar with the term evidence-based practice, and the number one barrier to research was nurses do not believe it has value to nursing practice. Participants found the article was weak in its discussion of the research limitations. However, overall, it was agreed that the results of the survey were reliable. Discussion on the Comparison of Survey Respondents and Survey Results to BMH Nursing Participants agreed that the nurses participating in the survey, which assessed the readiness for evidence-based practice of RNs in various work settings, were representative of nurses at Ball Memorial Hospital (BMH), with the exceptions that BMH employs more BSNs, and BMH is not as ethnically diverse as the respondents to the survey. Participants also agreed that the barriers to the literature at BMH – older nurses lacking computer, literature search, and research training were similar to barriers listed in the article. It was pointed out that pre-1990 nursing education did not emphasize research, nursing literature, or statistical methods, and that nurses trained before 1990 are not comfortable with obtaining information from the literature, or engaging in research. Generational differences in their approach to technology and research/literature management was also discussed. Another barrier cited by participants was the number of working computers available in BMH nursing care areas. It was noted that there are several computers available, but they may not be functional. The March 2004 in-house survey on research was discussed and compared to the survey in the article. There were 138 BMH nursing respondents; 50% responded that they were aware that research was integrated into their unit’s processes; 75% responded that they were interested in learning more about EBP. From the in-house survey the barriers to research and the literature at BMH were determined to be -- lack of knowledge on how to obtain the literature; lack of time; inability to understand a research article (usually refers to statistical outcome). Participants also discussed the willingness of BMH nurses to deliver research at the bedside, their recognition of “research experts”, and the value of the Library’s engagement and support in this process. It was noted that BMH nurses are looking at nursing research, as well as the research from other disciplines. Bringing EBP to BMH Nurses It was suggested that clinical nurse specialists promote EBP by engaging in modeling behaviors, analyzing the research/literature and assisting with the delivery of research to the bedside. The importance of communication and dissemination of EBP was discussed. It was agreed that how the research results are communicated is as important as the what and why of research. It was recommended that local performance improvement (PI) measures be shared with nursing as an introduction to EBP even though PI places less emphasis on statistical evidence. BMH nurses might then be more receptive to a shift to EBP if they could see that nursing was invested in the process through clinical queries, and research, and that the Administration supports nursing research and EBP. Participants also agreed that there is a new awareness of nursing research and EBP, and the numbers of nurses, who look at the literature for evidence, is growing. Participants agreed that the next steps to bringing EBP to BMH nurses is basic education for all nursing staff in the units, to train nursing management, and to address the problems of working computers with IS. The Next Nursing Research Roundtable To be announced. Respectfully submitted, Lorna Springston, MIS Director, Library and Information Services Readiness of U.S. Nurses for Evidence-based Practice. Am J Nurs. 2005 Sep;105(9):40-51 D.S. Pravikoff, A.B. Tanner, S.T. Pierce Article Summary Most nurses deliver nursing care according to what they’ve learned in nursing school, and the skills they acquired early-on in their careers (the average age of today’s nurse is older than 40, and their education and training was attained 15 to 20 or more years ago). Most recognize the need for information in their practice, and their most frequent source of information cited was a peer or colleague. Today, there is a demand for nurses to practice professionally, based on up-to-date information available from online resources, government agencies, payers, accrediting bodies (JCAHO, American Nurses Credentialing Center), and patients, but nurses lack the access, skills, and time to obtain the information. Without the knowledge and the tools to access the information their participation in evidence-based practice – use of the best evidence available from nursing, medical, and healthcare literature combined with clinical expertise to provide the best possible care for patients - is not possible. For this study 3,000 RNs from across the U.S. were randomly selected to participate in a survey examining nurses’ perceptions of their access to the literature, and whether they have the skills to effectively search literature resources. The survey identified institutional level and individual level barriers to the literature to support evidence-based practice, and they were as follows -- Primary institutional barriers (other than time) were identified by the survey respondents as Other institutional goals with a higher priority Difficulty in recruiting and retaining staff Organizational budget for acquiring information resources Organizational budget for training in resource use Organizational perception that nurses are not eager or prepared to incorporate or pursue evidence-based practice Organizational perception that evidence-based practice or research use is not realistically achievable Primary individual barriers (other than time) were identified by the survey respondents as Lack of value for research in practice (this was the most frequently selected barrier) Difficulty accessing research materials Lack of computer skills Difficulty understanding research articles Lack of access to a computer Lack of library access Lack of search skills Lack of knowledge about research Lack of skills to critique or synthesize the literature (or both) In conclusion nurses are not ready for evidence-based practice because of gaps in their information literacy, computer skills, limited access to information resources, and their attitudes toward research. These barriers are reinforced by nurses’ perception of organizational priorities.
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