Knowledge, Practice and Self-Efficacy in Evidence-Based Practice among Midwives in East Iran

The relationship between evidence-based practices' facilitators and barriers among nurses and their competencies: self-efficacy as a mediator

BACKGROUND

Although evidence-based practices are crucial for enhancing nursing abilities and patient outcomes, many nurses encounter barriers and facilitators that limit their capacity to effectively apply evidence-based practices. Self-efficacy is crucial to how nurses view and overcome these challenges.

AIM

This study aimed to examine the relationship between evidence-based practice facilitators and barriers and nurses' competencies, with a specific focus on self-efficacy as a mediating factor.

DESIGN

A correlational descriptive design was used.

METHODS AND TOOLS

A stratified random sampling of 350 nurses provided data for the study using structured questionnaires that assessed evidence-based practice facilitators, barriers, nurses' self-efficacy, and competencies.

RESULTS

The strongest positive correlation was observed between practice competency and Knowledge (r = 0.903, p < 0.001), skills (r = 0.903, p < 0.001), and utilization (r = 0.921, p < 0.001). On the other hand, EBP barriers show significant negative correlations with attitude (r = -0.140, p = 0.009), knowledge (r = -0.114, p = 0.032), and skills (r = -0.198, p < 0.001).

CONCLUSION

The findings of this study highlight a significant mediating effect of self-efficacy on the relationship between evidence-based practice facilitators, barriers, and nurses' competencies.

NURSING IMPLICATIONS

The results of this study demonstrate how critical it is to support nurses' self-efficacy to help them overcome obstacles and improve their capacity to apply evidence-based practices, which will ultimately improve nursing competence and patient care.

CLINICAL TRIAL NUMBER

Not applicable.

The Place of Evidence-Based Practices in Theoretical and Clinical Practice From the Perspective of Midwifery Students: A Qualitative Study

BACKGROUND

This study was conducted to determine the views of future midwives about the place of evidence-based practices in midwifery education and practice.

MATERIALS AND METHODS

This descriptive qualitative study was conducted with 28 student midwives who took the course of evidence-based practices in midwifery. Data were collected through in-depth and face-to-face interviews using an interview form. Content analysis technique was used to analyze the data.

RESULTS

Four themes and thirteen sub-themes were identified in the data analysis. These themes are belief in evidence-based practice, differences in education and practice, barriers to evidence-based practices and implementation of evidence-based practices.

CONCLUSION

In the current study, students' awareness of evidence-based midwifery practices and their ability to offer opinions and suggestions are related to the fact that they have taken the evidence-based practices course in their education. In this sense, it is important to increase the knowledge, awareness and skills of midwives by integrating evidence-based practices in the education curricula of future midwives.

Knowledge generation towards evidence-based practice and nursing competency

AIM

This study aims to describe the nursing competency, research knowledge and skills of nurses in Ghana regarding evidence-based practice.

METHODS

This nationwide descriptive cross-sectional survey was conducted among 480 clinical nurses and nurse educators from both private and public institutions. Nurses were included in the study if they had a full-time or part-time appointment, were in active service, and had a valid Personal Identification Number from the Nursing and Midwifery Council of Ghana. The Mann-Whitney U-test was used to compare mean rank scores between two groups, and the Kruskal Wallis H-test was used for the comparison.

RESULTS

Thirty percent of them rated their ability to formulate research questions, conduct literature search and retrieval, and critical analysis of scientific literature as fair or poor. Half of the nurses disagreed with changing to new methods, and more than half at least agreed with all the items measuring the use of evidence-based practice. One out of every 20 Nurses somewhat disagreed with formulating answerable research questions at work, and the same proportion disagreed or were neutral to integrating evidence into practice with their expertise. It was statistically significant that females (p-value = 0.001), married (p-value = 0.054), Christians (p-value<0.001), nurse educators (p-value<0.001) and part-time workers (p-value<0.001) were more likely to have higher mean scores on research knowledge and skills. The Kruskal Wallis test showed that research knowledge and skills (H = 97.281, p-value<0.001, df = 2), attitude towards evidence-based practice (H = 10.143, p-value = 0.006, df = 2), and nursing competencies (H = 9.041, p-value = 0.011, df = 2) differ for all the educational level of all nurses.

CONCLUSION

The self-reported competencies in the various aspects of the research process and knowledge generation by both clinicians and nurse educators were good; however, the overall composite score revealed that nurses only had fair knowledge and skills in this regard. Nurses should be given the requisite training to appraise and evaluate nursing research for incorporation into nursing practice.

The validity and reliability properties of a Persian version of the evidence-based practice profile (EBP2) questionnaire among Iranian students of health-related fields

BACKGROUND

Evidence-based medicine is defined as searching for medical information, reviewing and comparing it to each patient's situation, and then judging the optimal decision. We aimed to measure the psychometric properties of the Evidence-Based Performance Profile (EBP2) Questionnaire among the students of health-related fields at Shiraz University of Medical Sciences.

METHODS

This cross-sectional study was conducted in 2021. The EBP2 questionnaire, which includes 74 five-Likert-scale items, was translated into the Persian language using the forward-backward translation method. A panel of five experts approved the face, content, and structural validity of the questionnaire. The Cronbach's alpha and McDonald's Omega coefficients were utilized to assess the questionnaire's internal consistency. Furthermore, both confirmatory and exploratory factor analyses were used to assess the questionnaire's construct validity. SPSS software version 25 and LISREL software version 8.8 were used for statistical analysis.

RESULTS

Overall, 339 students participated in this study. The cultural adaptability, linguistic equivalence, and content validity of the Persian version of the EBP2 questionnaire were approved by a five-member team of medical experts. In addition, the results showed excellent internal consistency of the Persian version of the EBP2 questionnaire (Cronbach's alpha = 0.962, McDonald's Omega (ML) = 0.963). Moreover, all domains had acceptable reliability (> 0.7), except the Practice domain which had a marginally acceptable Cronbach's alpha coefficient equal to 0.686. Exploratory factor analysis discovered six domains for the questionnaire. Moreover, the confirmatory factor analysis demonstrated that all indices except the comparative fit index (CFI) and adjusted goodness of fit (AGFI) confirmed the validity of the EBP2 questionnaire.

CONCLUSION

The study's findings indicate that the Persian translated of the EBP2 questionnaire exhibited satisfactory validity and reliability for assessing students' evidence-based performance in health-related fields.

The Associations of Perceived Self-Efficacy with Emotional Intelligence, Personality, Resilience, and Attitudes Towards Death among Midwives

Midwives' self-efficacy can significantly affect the provided care and, therefore, maternal and neonatal outcomes. The aim of the present study was to investigate associations of perceived self-efficacy with emotional intelligence, personality, resilience, and attitudes towards death among midwives in Greece. From 2020 to 2022, a total of 348 midwives were recruited in this descriptive cross-sectional study. The participants were employed as independent professionals, in public hospitals or regional health authorities. Data collection involved five research instruments: the General Self-Efficacy Scale (GSES), the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), the Eysenck Personality Questionnaire (EPQ), the Connor-Davidson Resilience scale (CD-RISC), and the Death Attitude Profile-Revised (DAP-R) scale. The mean score for the GSES was 29.1 (SD = 4.2), suggesting a moderately elevated level of self-efficacy among midwives. The results revealed that higher scores on the GSES were significantly associated with higher scores on the Extraversion subscale (p < 0.001) and lower scores on the Neuroticism (p < 0.001) and Lie (p = 0.002) subscales of the EPQ. Additionally, high self-efficacy was significantly correlated with high emotional intelligence (p < 0.001), high neutral acceptance of death (p = 0.009), and high resilience (p < 0.001). These findings highlight the relationship between the self-efficacy of Greek midwives and various psychological factors, as well as the multifaceted nature of self-efficacy and its importance for midwives' psychological well-being and professional functioning.

Assessing Evidence-Based Practice in Operating Room Nursing Students: A Cross-Sectional Study in the Southwest of Iran

Evidence-based practice (EBP) is a clinical decision-making process that is grounded in the utilization of the most reliable and up-to-date evidence. It involves utilizing resources and evidence to enhance patient management. The application of evidence-based decisions in patient care and education is of utmost importance in the performance of health sciences students. However, the emphasis on this concept among operating room nursing students has been lacking. Hence, the objective of this research is to assess the implementation of evidence-based practice among operating room nursing students studying in the operating room department at the Shiraz University of Medical Sciences in Iran. The study follows a descriptive, cross-sectional design, with a sample of 148 operating room nursing students selected through census sampling based on the student list. After obtaining informed consent, participants completed a demographic information form and the Rubin-Parrish evidence-based practice questionnaire. The data that were gathered underwent analysis through the utilization of SPSS version 22 software, employing descriptive statistics, T-tests, and Pearson correlation coefficient tests. The results revealed that the overall average score of evidence-based practice among the students exceeded the standard scores (172.66 ± 14.74). There was a significant association between the evidence-based practice score and prior familiarity with evidence-based practice, interest in the field of study, research experience, intention to participate in the Master's exam, and the participants' grade point average (GPA) (p < 0.05). These findings indicate that operating room nursing students displayed an average level of evidence-based practice, emphasizing the need for effective plans and strategies to improve their performance. Addressing the identified factors from this study becomes crucial in this regard.

Teaching evidence-based practice to undergraduate healthcare students Educators' knowledge, skills, attitudes, current practice, perceived barriers, and facilitators: A Danish cross-sectional study

BACKGROUND

Evidence-Based Practice is recognized as a standard practice and a core competence for clinical healthcare professionals and therefore educators' competences in teaching Evidence-Based Practice are essential. Yet only little is known about the knowledge, skills, attitudes, and teaching practices around Evidence-Based Practice among educators of Danish undergraduate healthcare students.

OBJECTIVES

The objectives of this study were to describe: 1) the Evidence-Based Practice profiles regarding attitudes, knowledge, skills, and teaching practices among educators who teach in undergraduate healthcare educations; 2) the current state of teaching Evidence-Based Practice in undergraduate program curricula; 3) the perceived barriers and facilitators to teach Evidence-Based Practice; and 4) the educators` needs regarding teaching Evidence-Based Practice.

DESIGN, SETTING AND PARTICIPANTS

A cross-sectional survey using a self-administrated online questionnaire among 81 educators at University College South Denmark.

METHODS

The survey covered 1) Demographic questions, 2) Educators Evidence-Based Practice profiles measured by the Evidence-Based Practice Questionnaire for teachers, 3) perceived state of Evidence-Based Practice teaching 4) perceived barriers and facilitators and 5) educators´ needs for competence development regarding teaching Evidence-Based Practice.

RESULTS

The translated version of the Evidence-Based Practice Questionnaire showed that respondents had a mean of 3,6 regarding practicing Evidence-Based Practice when asked to rank on a scale of 1-7 (higher score indicating higher degree). The respondents showed positive attitudes towards Evidence-Based Practice and had a high self-perception of their Evidence-Based Practice skills and knowledge, scoring an overall average value of 5 on these items. In open ended questions educators gave a variety of examples of their Evidence-Based Practice teaching in terms of content, teaching methods and cooperation with clinical practice.

CONCLUSIONS

Educators report limitations to teaching Evidence-Based Practice; however, attitudes, knowledge and skills were perceived generally high. Main facilitator was partnership with clinical practice and main barrier was time lack. MESH: Evidence-Based Practice, Health Educators, Knowledge, Attitude.

Nursing Informatics Competency and Self-Efficacy in Clinical Practice among Nurses in Palestinian Hospitals

This study purposed to determine the levels of nursing informatics competency and self-efficacy in clinical practice and influencing factors on self-efficacy among Palestinian nurses in hospitals. A descriptive-correlational design was adopted. The nurses who worked in the North West Bank of Palestine (N = 331) were recruited. The data were collected using the Self-Assessment of Nursing Informatics Competencies Scale (SANICS) which consists of 30 items rated on a 5-point Likert scale, ranging from 1(not competent) to 5 (expert), and scored by calculating the mean as follows: novice/low (1.00-2.59), beginner/moderate (2.60-3.39), and competent/high (3.40-5.00); and the New General Self-Efficacy Scale (NGSE) that consists of eight items rated on a 5-point Likert scale, ranging from 1(strongly disagree) to 5(strongly agree) and scored according to the average of the scale, whereas the average of > 3 indicated high self-efficacy, and ≤ 3 reflected low self-efficacy. The data were collected during the period from September to November 2020. Findings showed that the total mean score for the nursing informatics competency scale was 2.9 (SD = 0.7), which indicated that the nurses had a moderate level of nursing informatics competency. The average score for the self-efficacy scale was 3.5 (SD = 0.8), which reflected that nurses had high self-efficacy. Self-efficacy in clinical practice increased with age and with nursing informatics competency. Thus, it is necessary to enhance nurses' informatics competency by developing continuous educational programs about this technology for nurses and engaging nurses in such programs to enhance their competencies in this system.

Instruments for assessing healthcare professionals' knowledge and skills of evidence-based practice: A scoping review

OBJECTIVE

The aim of this scoping review was to describe the instruments used to assess the knowledge and skills of evidence-based practice (EBP) in healthcare settings.

METHODS

A scoping review was undertaken. Three electronic databases (CINAHL, PubMed and Cochrane) were searched in January 2022. The search phrases consisted of the following terms: healthcare professionals, EBP, competence and instrument and their synonyms, keywords and MeSH terms. The database search was run without any limitations. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to support reporting.

RESULTS

Ultimately, 39 studies were included; most of them (35) were cross-sectional studies. The studies were conducted in 17 countries. A total of 17 evidence-based knowledge and skills instruments were identified. The Upton and Upton instrument was used in 19 studies. Twelve self-reported instruments were used only once. The psychometric properties of the instruments varied. The reliability was typically reported with Cronbach's alpha coefficient. The content of the EBP knowledge/skills instruments consists of five main categories: EBP, evaluation of current practice, preparation for the implementation of EBP, implementation of evidence and active participation in the development of EBP.

CONCLUSION

Almost all instruments are self-assessment instruments. Validated knowledge tests should be further developed. The instruments emphasise the preparation for the implementation of EBP. Further research is needed to develop instruments for healthcare professionals to assess the knowledge and skills of the implementation of evidence.

Factors related to the knowledge and skills of evidence-based practice among nurses worldwide: A scoping review

BACKGROUND

Promoting evidence-based practice (EBP) among nurses may be a valuable component of improving health care. However, a comprehensive analysis of the factors associated with the knowledge and skill EBP in nurses has not been performed to date. This is essential for facilitating the acquisition of relevant knowledge and skills to effectively implement EBP.

AIMS

The aim of the study was to determine the factors related to the knowledge and skills of EBP among nurses.

METHODS

We searched various literature databases up to October 25, 2021, for relevant studies that investigated the factors associated with the knowledge and skills of EBP in nurses. The authors, year of study, country, study design, study subject information, instruments used for the assessment EBP knowledge and skills, use of multivariable analysis, and factors significantly associated with the knowledge and skills of EBP among nurses were extracted from each eligible study and collated to identify commonly reported factors.

RESULTS

We identified 47 eligible studies conducted in a wide range of countries. Nine articles applied multivariable analyses, and 38 articles did not perform any multivariable analyses. The factors related to the knowledge and skill levels of EBP among nurses were classified into two categories: personal and work-environment factors. In the nine articles that conducted multivariable analysis, personal factors, which included educational level, participation in EBP education, and experience conducting research, and work-environment factors, such as resources and organizational support for EBP, were related to the knowledge and skills of EBP among nurses.

LINKING EVIDENCE TO ACTION

Our review highlighted educational level, participation in EBP education, experience conducting research, and resources and organizational support for EBP as important factors that are associated with the knowledge and skills of EBP in nurses worldwide. Focusing on these factors may help improve nurses' understanding of EBP and facilitate the implementation of EBP.

Organizational culture and readiness for evidence-based practice in the Kingdom of Saudi Arabia: A pre-experimental study

AIM

This study aims to establish postgraduate students' perceptions of the organizational culture and readiness for evidence-based practice of their workplaces in the Kingdom of Saudi Arabia.

BACKGROUND

Nurse shortages and a reliance on a transient nurse workforce have long been a challenge in the Kingdom of Saudi Arabia. Developing a home-grown nurse workforce, a key objective of the Government of Saudi Arabia, can help to address this. Evidence-based practice offers a mechanism to address this. Evidence-based practice implementation is heavily reliant on the prevailing organizational culture. Establishing the organizational culture and readiness for evidence-based practice is crucial for sustainable evidence-based practice implementation.

METHODS

A pre-experimental pilot study collected data from the same participants at three different points. As part of this, a questionnaire measuring organizational culture and readiness for evidence-based practice was administered twice. Descriptive, inferential and correlational statistics were employed to analyse the data.

RESULTS

Results demonstrated improved participant perceptions of the organizational culture and readiness for evidence-based practice of their workplaces between the first (M = 76.58, SD = 19.2) and second (M = 92.10, SD = 23.68) data collection points, indicating moderate movement towards a culture of evidence-based practice. Strengths, challenges and opportunities for improvement were identified.

CONCLUSION

This study established participants' perceptions of the organizational culture and readiness for evidence-based practice of their workplaces, affording insight into context-specific strategies to embed evidence-based practice in health care organizations.

IMPLICATIONS FOR NURSING MANAGEMENT

Assessing an organization's culture and readiness for evidence-based practice (EBP) can afford insight on the strengths, challenges and opportunities that exist to equip nurse managers to advance evidence-based practice at individual, professional and organizational levels. This study demonstrated the importance of promoting an environment conducive to EBP and putting in place the necessary resources to support evidence-based practice implementation. Nurse managers can play a central role in this.

Domains of competence in midwifery students: a basis for developing a competence assessment tool for iranian undergraduate midwifery students

BACKGROUND

Current study was conducted with the aim of explaining domains of clinical competence in undergraduate midwifery students so that it addresses the challenges in midwifery curriculum and improving clinical assessment methods in Iranian undergraduate midwifery students.

METHODS

Qualitative approach and conventional content analysis were used in the design of the present study. The research setting included midwifery and nursing schools and hospitals and health centers affiliated to Tehran and Guilan universities of medical sciences in Iran. The target population consisted of undergraduate midwifery students in the fourth to eighth semesters of school, midwives working in hospitals and health centers, midwifery faculty members, and obstetricians. The participants were selected through purposive maximum variation sampling, which continued until data saturation. After in-depth semi-structured interviews, the content of the interviews was analyzed according to the steps proposed by Zhang & Wildemuth.

RESULTS

Twenty-four people participated in this study, including seven midwifery students, seven midwives, nine midwifery and reproductive and sexual health faculty members, and one obstetrician. The participants were aged 20-56 years and their mean age was 39.75 years. Their level of education varied from midwifery student to PhD. The mean work experience of the participants was 13.62 years and the mean duration of the interviews was 48 min. The analysis of the data obtained from the experiences of the participants led to the formation of the four categories of ethical and professional function in midwifery, holistic midwifery care, effective interaction, and personal and professional development, along with ten subcategories.

CONCLUSION

The findings of the present study showed that clinical competence in midwifery students involves different domains that correspond well overall to the general definitions of clinical competence in different sources. These findings can be used as a basis for the design and psychometric assessment of a clinical competence assessment tool for undergraduate midwifery students.

How nursing stakeholders in the Republic of Ireland define evidence-based practice and why it matters

BACKGROUND

Evidence-based practice (EBP) has garnered increasing exposure in professional healthcare discourse over three decades. While the term is used frequently, its interpretation varies widely. An accurate, shared understanding of what EBP means is essential to the achievement of EBP implementation in clinical practice. As part of a national study in the Republic of Ireland, nurses, midwives, educators, and students shared their personal understanding of what EBP was to them.

AIM

To establish nurses', midwives', educators', and students' knowledge and understanding of the concept of EBP in the Republic of Ireland.

METHODS

In a national study exploring EBP beliefs, implementation, and organizational readiness for EBP among nurses, midwives, educators, and students, an open-ended question invited participants to explain what EBP is, in their own words. Content analysis was used to interpret participants' responses.

RESULTS

Five themes emerged from the data from the single open-ended question: (1) varying definitions of EBP, (2) best practice, (3) nurses' and midwives' role in EBP, (4) knowledge, and (5) barriers and facilitators of EBP. The dominant finding centered on the substantial conflation of EBP with research utilization and other concepts such as quality improvement.

LINKING EVIDENCE TO ACTION

Poor knowledge and understanding of EBP is a fundamental challenge to EBP implementation. Conflation of EBP with research utilization and other healthcare concepts is not uncommon among nurses and midwives globally and has persisted for some time. This has the potential to hinder the advancement of EBP in nursing and midwifery and, therefore, measures to enhance EBP knowledge and promote EBP implementation are key. Professional regulating bodies, educators, and clinical and educational organizations all have a role to play. The findings from this aspect of this national study offer a realistic, context-specific starting point for tailored educational interventions for clinicians, educators, and students and identify professional and organizational strategies that promote EBP as the expectation and "the way things are done here."

Evidence implementation among complementary medicine practitioners: a meta-summary

OBJECTIVES

To explore the factors impacting evidence implementation in complementary medicine (CM) practice.

CONTENT

MEDLINE and CINAHL were systematically searched for cross-sectional studies examining evidence implementation among CM practitioners. Qualitative data from eligible studies were collated and analysed using a meta-summary approach. Data were coded according to the five domains of the Consolidated Framework for Implementation Research (CFIR), and translated into barriers and enablers.

SUMMARY

Qualitative data were available for 614 participants (from 16 disciplines) across 14 studies. Coding identified 34 themes, with most themes aligning with the Inner Setting (11 themes) and Characteristics of the Intervention (10 themes) domains of the CFIR. The most commonly referenced barriers to evidence implementation were: 'Lack of supportive resources' (Effect size [ES]=33.3%), 'Research misalignment with profession and practice' (ES=14.5%) and 'Lack of access to knowledge and information' (ES=10.5%). The most common enablers were: 'Recognition of a need for change' (ES=8.2%) and 'Perceived adaptability of EBP to the profession' (ES=7.8%).

OUTLOOK

This research offers new insights into the challenges and opportunities to implementing evidence-based practices in the field of CM. The findings underline the complexity of the phenomenon, and the need for a nuanced, multi-faceted and multi-stakeholder approach to improving evidence implementation in CM.

Evidence-Based Practice Beliefs, Implementation, and Organizational Culture and Readiness for EBP Among Nurses, Midwives, Educators, and Students in the Republic of Ireland

BACKGROUND

Evidence-based practice (EBP) is an approach to health care that combines best available evidence, healthcare professionals' expertise, and patient preferences, yielding benefits for patients, healthcare professionals, and organizations. However, globally, EBP implementation remains inconsistent among nurses. Exploring this in an Irish context will establish a national baseline from which progress can be made on system-wide integration of EBP in nurse and midwife (i.e., clinician) practice, nursing/midwifery education, and the Irish healthcare system.

AIM

To establish clinician, educator, and student's EBP beliefs, knowledge, and implementation, and the organizational culture of the clinical and educational settings within the Republic of Ireland.

METHODS

Using a descriptive study design, a national survey with demographic questions, uniquely focused EBP scales, and an open-ended question were administered to clinicians, nursing/midwifery educators, and students. Ethical review was obtained. Descriptive and inferential statistics were used to analyze the quantitative data.

RESULTS

Clinicians, educators, and students reported positive beliefs about EBP (M = 59.98, SD 8.68; M = 87.72, SD = 10.91; M = 55.18, SD = 10.29, respectively). Beliefs regarding their ability to implement EBP were lower overall. EBP implementation was low across all groups (clinicians: M = 12.85, SD = 14; educators: M = 31.09, SD = 16.54; students: M = 16.59, SD = 12.11). Clinicians, educators, and students reported varying perceptions of organizational support and readiness for EBP (M = 74.07, SD = 19.65; M = 86.43, SD = 15.01; M = 93.21, SD = 16.21, respectively). Across all measures, higher scores indicated higher beliefs, implementation, and organizational culture and readiness for EBP.

LINKING EVIDENCE TO ACTION

Clinicians have a unique opportunity to facilitate system-wide integration of EBP. Furthermore, given the variable EBP knowledge, beliefs, and implementation, opportunities to enhance these attributes abound, particularly when supported by their organizations. This study established a contemporary baseline in Ireland from which to engage the identified strengths, challenges, and opportunities required to craft an organizational culture and environment that supports and advances an EBP approach to nursing and midwifery practice and education.

A pre-experimental pilot study exploring EBP Beliefs and EBP Implementation among post-graduate student nurses in Saudi Arabia

AIM

This study aimed to measure the impact of a dedicated EBP module on the knowledge, skills and capability for EBP of students undertaking the inaugural MSc in Nursing: Advanced Practice programme in the KSA.

BACKGROUND

Evidence-based practice (EBP) yields multiple benefits for all key stakeholders of healthcare. Key to this are healthcare professionals armed with necessary EBP knowledge and skills. Nurses, the largest professional group in healthcare, can be instrumental in effecting sustained EBP implementation. In the Kingdom of Saudi Arabia (KSA) achieving this is hindered by a chronic shortage of nurses and a heavy reliance on expatriate nurses who are often a transient workforce, resulting in a high turnover. The Government of Saudi Arabia 2030 Vision aspires to address the indigenous nurse shortage and the quality of healthcare. In 2017 the inaugural MSc in Nursing: Advanced Practice programme was established in the KSA to prepare Saudi nurses for emerging advanced practice roles. A dedicated EBP module was a core component of the programme.

METHODS

A pre-experimental pilot study conducted over 18-months collected data from the same participants at three different points. Two validated EBP questionnaires measuring EBP Beliefs and EBP Implementation were administered to post-graduate students undertaking the MSc in Nursing: Advanced Practice programme in one Higher Education Institution in the KSA. Descriptive, inferential and correlational statistics were employed to analyse the demographic data, group mean scores and distribution on the EBP scales, as well the correlation between EBP Beliefs and EBP Implementation.

FINDINGS

Findings demonstrated that the educational intervention did improve participants' EBP beliefs and implementation. Participants reported positive beliefs about EBP at all 3 data collection points (M = 57.4 SD = 7.0; M = 62.54 SD = 7.21; M = 55.31 SD = 15.81, respectively). EBP implementation was low prior to undertaking the module but improved thereafter as illustrated across the 3 data collection points (M = 15.14 SD = 11.9; M = 27.64 SD = 14.35; M = 25.9 SD = 20.43). On both measures, higher scores indicate higher EBP beliefs and implementation.

CONCLUSION

This study established the EBP Beliefs and EBP Implementation of a sample of postgraduate nursing students in the KSA. Findings revealed a substantial improvement in both EBP Beliefs and EBP Implementation following the EBP module. Findings support the use of a dedicated module to prepare nurses to use EBP and to practice at an advanced level while simultaneously preparing them for leadership roles in healthcare in KSA. In so doing, this will help to advance the healthcare goals of the KSA 2030 vision.

Assessing the effect of virtual education on information literacy competency for evidence-based practice among the undergraduate nursing students

Background

Information literacy competency is one of the requirements to implement Evidence-Based Practice (EBP) in nursing. It is necessary to pay attention to curricular development and use new educational methods such as virtual education to strengthen information literacy competency in nursing students. Given the scarcity of the studies on the effectiveness of virtual education in nursing, particularly in Iran, and the positive university atmosphere regarding the use of virtual education, this study investigated the effect of virtual education on the undergraduate nursing students’ information literacy competency for EBP.

Methods

This interventional study was performed with two groups of intervention and control and a pretest and posttest design. Seventy-nine nursing students were selected and assigned to the intervention or control groups by random sampling. Virtual education of the information literacy was uploaded on a website in the form of six modules delivered in four weeks. Questionnaires of demographic information and information literacy for EBP were used to collect data before and one month after the virtual education.

Results

The results showed no significant difference between the control and intervention groups in all dimensions of information literacy competency in the pre-test stage. In the post-test, the virtual education improved dimensions of information seeking skills (t = 3.14, p = 0.002) and knowledge about search operators (t = 39.84, p = 0.001) in the intervention groups compared with the control group. The virtual education did not have any significant effect on the use of different information resources and development of search strategy with assessing the frequency of selecting the most appropriate search statement in the intervention group.

Conclusion

Virtual education had a significant effect on information seeking skills and knowledge about search operators in nursing students. Nurse educators can benefit from our experiences in designing this method for the use of virtual education programs in nursing schools. Given the lack of effectiveness of this program in using different information resources and development of search strategy, nurse educators are recommended to train information literacy for EBP by integrating several approaches such as virtual (online and offline) and face-to-face education.

Effects of Dispositional Resilience and Self-Efficacy on Practice in Advanced Care Planning of Terminally Ill Patients among Taiwanese Nurses: A Study Using Path Modeling

This study aimed to expand on previous research elucidating the effects of dispositional resilience and self-efficacy on practice in advanced care planning (ACP) of terminally ill patients among Taiwanese nurses using path modeling. This cross-sectional study was conducted using cluster sampling. Data were collected using demographics, nurses’ knowledge, attitude, and practice of ACP (KAP-ACP) inventory, Dispositional Resilience Scale, and General Self-Efficacy Scale. A total of 266 nurses from a tertiary medical center in northern Taiwan participated in this study in 2019. The results showed that gender and ward were significant K-ACP predictors among nurses. The ACP knowledge, ward, and experience of caring for terminally ill friends or relatives were significant A-ACP predictors, whereas ACP attitudes, dispositional resilience, self-efficacy, ward, and the frequency of caring for terminally ill patients were the key predictors of P-ACP. The path modeling showed that dispositional resilience; self-efficacy; medical, surgical, hematology and oncology wards; previous experience in caring for terminally ill friends or relatives; participating in the do-not-resuscitate signature; and the frequency of caring for terminally ill patients directly influenced ACP practices. We recommend that nurses enhance their dispositional resilience and self-efficacy, which may encourage them to appreciate the value of ACP practice of terminally ill patients and improve the quality of care.

The Effect of Practice toward Do-Not-Resuscitate among Taiwanese Nursing Staff Using Path Modeling

This study aimed to elucidate the predictors and the effects of path modeling on the knowledge, attitude, and practice toward do-not-resuscitate (DNR) among the Taiwanese nursing staff. This study was a cross-sectional, descriptive design using stratified cluster sampling. We collected data on demographics, knowledge, attitude, and practice as measured by the DNR inventory (KAP-DNR), Mindful Attention Awareness Scale, General Self-Efficacy Scale, and Dispositional Resilience Scale. Participants were 194 nursing staff from a medical center in northern Taiwan in 2019. The results showed that participation in DNR signature and education related to palliative care were significant positive predictors of knowledge toward DNR. The DNR predictors toward attitude included DNR knowledge, mindfulness, self-efficacy, dispositional resilience, and religious belief of nurses. Generally, the critical predictors of DNR practice were DNR attitude, dispositional resilience, and male nurses. In path modeling, we identified that self-efficacy, dispositional resilience, master’s degree, and religious belief directly influenced practice constituting DNR. Based on the findings of this study, we propose that nurses should improve their self-efficacy and dispositional resilience through training programs. Encouraging staff to undertake further education and have religious beliefs can enhance the practice of DNR and provide better end-of-life care.

Midwives' Educational Needs in Iran: A Narrative Review

Background

Midwives have a major role in the improvement of health indicators in every country. In order for midwives to be able to play their role well, they must have sufficient updated knowledge. For this purpose, it is necessary to review their educational needs. The aim of the present research was to review Iranian studies that have investigated midwives' educational needs.

Materials and Methods

In this narrative review, PubMed, Scopus, Web of Science, Google Scholar, ProQuest, Ovid, SID, and Magiran databases were searched for the full texts of Iranian studies published in Persian and English languages in the period of 2000-2018. Review, descriptive, and interventional articles consistent with the research aim were included in this study.

Results

Of the 53 found articles, 23 articles that were relevant to midwives' educational needs in Iran were investigated. The findings of the studies showed that the educational needs of the midwives can be categorized into the four groups of knowledge and performance, communication skills, occupational rules/regulations, and religious rules.

Conclusions

The results showed that midwives in Iran have different educational needs. Because the midwifery practice leads to the promotion of public health, it is imperative that midwives have comprehensive knowledge and the skills necessary for providing optimal care. In order to achieve this, short-term and long-term training programs tailored to the needs of midwives are recommended.

Midwives' Attitude and Barriers of Evidence Based Practice in Maternity Care

OBJECTIVES

Midwives have a crucial role in providing optimal care for pregnant women. One of the most important policies for quality improvement in maternity care is implementation of evidence-based practice. However, the application of evidence-based practice within the maternity health care setting faces many challenges. The purpose of this study was to describe Iranian midwives' attitude and perceived barriers of evidence based practice in maternity care.

METHODS

In this descriptive, cross-sectional study, a census sample of 76 midwives from two public hospitals and urban health centers in Torbat Heydariyeh, a city east of Iran were surveyed. Data collection tools were two reliable and valid questionnaires that measure midwives' attitudes and barriers of implementation of evidence-based practice. Data were analysed using SPSS version 16.

RESULTS

The mean age and years of experience were 29.30 ± 4.86 and 5.22 ± 4.21 years, respectively. The mean score of attitude was 40.85 ± 4.84 (range = 30-60). This study also found time constraints (2.70 ± 0.92), inadequate facilities (2.64 ± 0.72), non-compilation of literature in one place (2.59 ± 0.92), lack of cooperation of physicians (2.48 ± 1.06) and the feeling of inadequate authority (2.45 ± 0.88) as the top five barriers to implementing EBP.

CONCLUSION

Survey participants demonstrated a positive attitude toward EBP. Organisational comprehensive strategies such as time efficiency, adequate material and human resources, familiarity with organisations such as the Cochrane Collaboration and managerial support for increasing professional legitimate authority are recommended to promote the use of Evidence-Based Practice in Iran.

Self-Efficacy and the Competency of Nursing Students Toward the Implementation of Evidence-Based Practice

Introduction: Professional nurses should have adequate competency in order to apply Evidence Based Practice (EBP) in their nursing care. However, many nurses provide nursing care based on traditions, habits and personal experience. Less confidence in the feeling of nurses about their competency when employing EBP could inhibit successful EBP implementation in nursing care. Therefore, introducing and applying EBP during clinical placements in the Ners program is essential to form a professional attitude and to provide a basic level of experience when applying EBP in patient care. However, the self-efficacy and competence of the students when applying EBP has not yet been evaluated properly and there is little known about the nursing students’ competences and self-efficacy toward EBP implementation during clinical practice. Thus, the study aims to describe the self-efficacy and competency of nursing students toward the implementation of EBP, while also investigating the relationship between self-efficacy and the competency of nursing students in the implementation of EBP.Methods: This descriptive correlational study involved 120 nursing students who were actively registered on the Ners program 2016/2017. The data was collected by using the self-reporting Evidence-Based Practice Questionnaire (EBPQ), which was then analysed descriptively and inferentially using statistics.Results: The results of this study revealed that more than half (55%) of the participants had a high score of self-efficacy and almost half (49%) were categorised as having a high competence when implementing EBP. The self-efficacy score was significantly correlated to the score of competency (r = 0.607, p < 0.01).Conclusion: This study recommends that the development of the students’ competence in implementing EBP is essential to promote self-efficacy when applying EBP, and vice versa.