Abstract
Background: - In spite of all the various programs and strategies to promote the use of research finding there is still gap between theory and practice. Difference in outcomes, health inequalities, and poorly performing health service continue to present a challenge to all nurses. A number of studies from various countries have reported that nurses’ experience of evidence-based practice is low. In Nigeria there is an information gap on the extent of evidence based nursing practice and its associated factors.
Objective: - the study aims to assess the Nurses perception and practice in evidence based nursing practice and associated factors among nurses in Rivers State University Teaching Hospital.
Method: - Institution based cross-sectional study was conducted from March 1-30/2023. A total of 333 sampled nurses for quantitative and 8 in-depth interview of key informants were involved in the study. Semi-structured questionnaire was adapted from funk’s BARRIER scale and Friedman’s test. Multivariable Linear regression was used to determine significance of association between dependent and independent variables. Pretest was done on 17 nurses of Bedele hospital. Ethical issue was secured.
Result:-Of 333 distributed questionnaires 302 were completed, giving 90.6% response rate. Of 302 participants 245 were involved in EBP activities to different level (from seldom to often). About forty five(18.4%) of the respondents had implemented evidence based practice to low level (sometimes), one hundred three (42 %) of respondents had implemented evidence based practice to medium level and ninety seven (39.6 %) of respondents had implemented evidence based practice to high level(often). The first greatest perceived barrier was setting characteristic (mean score=26.60±7.08). Knowledge about research evidence was positively associated with Nurses perception and practice in evidence based nursing practice (β=0.76, P=0.008). Similarly, Place where the respondent graduated was positively associated with Nurses perception and practice in evidence based nursing practice (β=2.270, P=0.047). Also availability of information resources was positively associated with Nurses perception and practice in evidence based practice (β=0.67, P= 0.006).
Conclusion: -Even though larger portion of nurses in this study were involved in evidence-based practice whereas small number of participants had implemented frequently.
Evidence-based nursing practice was positively associated with knowledge of research, place where respondents graduated, and the availability of information resources. Organizational factors were found to be the greatest perceived barrier. Intervention programs on awareness creation, training, resource provision, and curriculum issues to improve Nurses perception and practice in evidence based nursing practice by stakeholders are recommended.
Key words:-evidence based practice, nursing practice, research utilization Nigeria
CHAPTER ONE INTRODUTION
1.1 Background
Evidence based practice (EBP) is the use of best research finding(evidence) to answer a burning clinical question together with one’s own clinical expertise generated from outcome management or quality improvement projects and patient preference and values. Researchers generate new knowledge through rigorous research (external evidence) and evidence based practice (EBP) provides clinicians the tools to translate the evidence into clinical practice and integrate it with internal evidence to improve the quality of health care and patient outcomes (1).
Its basic principles are that practical decision made should be based on research studies and that these research studies are selected and interpreted according to some specific norms and characteristic for evidence-based practice (EBP). evidence based practice utilizes the most up to date methods of providing care, which have been proven through appraisal of high quality studies and statistically significant research finding(2).
Health care that is evidence-based and conducted in a caring context leads to better clinical decision and patient outcomes. Gaining knowledge and skill in the evidence based practice (EBP) process provides nurses and other clinicians the tools needed to take ownership of their practice. There are five sequential steps to the (EBP) process. Step 1: asking the clinical questions in the PICOT (Patient/Population, Intervention/Issue of interest, Comparison, Outcome and Time frame) format to get more effective evidence. Step 2: searching for the best evidence to select. Step 3: critically appraising the evidence. Step 4: addressing the sufficiency of the evidence to implement or not to implement, and evaluating the outcome of the evidence implementation (3).
Evidence-based practice takes resource, work, time, and effort but outcome makes them worthwhile. Every patient deserves care that is based on the best scientific knowledge and that ensures high quality, cost-effective care (4).
For successful implementation of research that supports the effectiveness of a clinical intervention, evidence needs to be located in its highest quality. Successful implementation is a function of the relation between the natures of the evidence, the context in which the proposed change is to be implemented, and the mechanism by which the change is facilitated (5).
Clinicians often ask how much and what type of evidence is needed to change practice. A good rule of thumb to answer this question is that there needs to be strong enough evidence to make a practice change. Specifically, the level of evidence plus the quality of evidence equals the strength of evidence, which provides clinicians the confidence that is needed to change clinical practice (1).
1.2 Statement of the problem
In spite of the all the programs and strategies to promote the use of research finding, there is still a gap between theory and practice (6). And there are many practices that are being implemented in healthcare that have no or little evidence to support their use (e.g. double-checking of pediatric medication, routine assessment of vital signs every 2 or 4 hours in hospitalized patients (1).
Difference in outcomes, health inequalities, and poorly performing health service continue to present a challenge to all nurses. Poorly informed decision-making is one of the main reasons to service can fail to be delivered in an optimal way and can also contribute variation in practice which makes less efficient, ineffective and inequitable. Half of the world’s death could be prevented with simple cost effective interventions not enough is known about how to make these more widely available to the people who need them. Changing practice is difficult, wastes time and can have unexpected outcome. However change can be exciting and motivating. Understanding and planning how to take evidence into practice, to action knowledge, is important. This area because it is so critical, has been the subject of an increasing amount of research itself (7).
All over the world there is a growing appreciation of the importance and difficulty of evidence based nursing practice (EBNP). As part of international efforts to facilitate the dissemination of EBNP, research has focused on identifying barriers to utilization of EBNP. Identifying such barriers can help international efforts to develop strategies to overcome these. One of these barriers found to be lacking the knowledge and skills to evaluate research finding (8).
A number of studies from various countries have reported that nurses practice EBP and distinct EBP activities to low extent (9).
Researchers have argued that daily practice in nursing care is influenced more by tradition, intuition, and experiences and less by scientific research. Reviews in literature focus on the difficulty that exists trying to apply research finding into practice. The major barriers to the utilization of research finding were found to be the work organization (setting), the adopter (nurse), and presentation of research findings (6).
Even though evidence based health care has been shown to be an efficient and much needed practice worldwide, developing countries have difficulties in accessibility of existing evidence and medical resources than in developed countries.
In Africa EBP implementation is late compared to developed world. Incorporating evidence- based health care (EBHC) into the African context means setting priorities, developing evidence summaries and guidelines and implementing research finding relevant for African countries to support health care for all. Contextualizing evidence relates to several issues, including the lack of evidence available for an African setting. The effectiveness of an intervention in Africa may be different from that found in studies elsewhere because of factors such as: later presentation, co-infections, malnutrition, higher levels of self-medication and use of traditional, reduced level of resources, including human resource for basic health care, and political instability. In addition, effective interventions, as determined by many systematic reviews, may not be available or affordable in most African settings. This means that Africa needs valid African-specific research and that authors of systematic reviews should consider this by avoiding overgeneralization when making conclusion (10).
In Nigeria, the federal ministry of health lacks skilled health professionals who could help to synthesize evidence for policy-making. Moreover, at all levels of the health systems there is little culture or tradition of trusting or using evidence (11).
Also in Nigeria as well as in study area there is a gap of (shortage) of research articles published concerning EBP utilization. This study seeks to explore level of EBP implementation and will give information concerning factors, which hinder implementation of EBP among nurses working in Rivers State University Teaching Hospital.
1.3 Objective of The Study
General Objective of the study
To assess Nurses perception and practice in evidence based nursing practice and factors associated among nurses working in Rivers State University Teaching Hospital southwest Nigeria, 2023
Specific Objectives of the study
1. To determine level of evidence based nursing practice implementation among nurses working in Rivers State University Teaching Hospital, south west Nigeria, 2023
2. To identify factors associated with Nurses perception and practice in evidence based nursing practice among nurses working in Rivers State University Teaching Hospital, south west Nigeria, 2023
1.4 Significance of the study
This study will offer pertinent information related to the level of evidence based nursing practice (EBNP) implementation and its factors associated. The research adds to the body of scientific knowledge development in utilization of evidence based nursing practice. The finding of this study will show basic factors, which hindered the utilization evidence based nursing practice in the study area. The finding of this study will also give clues for planners hospital administers and policy makers in the quality of nursing care. Since there is shortage of published research in this specified problem area in Nigerian context, the finding of this study will show direction for further study.
It also helps to design the strategic way to improve outcomes of patient care by enhancing implementation of new best evidence from research finding.
1.5 Limitation of the study
Since this study was based on self-report the response on the EBP practice may be inflated due to social desirability bias of respondents.
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