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Today's clinicians have different levels of knowledge and skill related to evidence-based practice, depending on their educational background, level of experience, and interest. This multidisciplinary study assessed nurses' baseline and posteducation practice, attitudes, and knowledge/skills regarding evidence-based practice. A descriptive pre- and postsurvey design study evaluated clinical staff's practice, attitudes, and knowledge/skills regarding evidence-based practice with the Clinical Effectiveness and Evidence-Based Practice Questionnaire. A total of 327 participants (24%) completed the presurvey and 282 (20%) completed the postsurvey. No statistically significant changes were found in practice, attitudes, and knowledge/skills after the online education. In the multivariate analysis, online education was not a significant predictor of practice, attitudes, or knowledge/skills regarding evidence-based practice; graduate educational degree, formal evidence-based practice classes, and registered nurse status were statistically significant positive predictors. Administering self-learning online modules may not be the most effective method for expanding evidence-based practice abilities and knowledge/skills of nurses.
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411
The Journal of Continuing Education in Nursing · Vol 43, No 9, 2012
Staff Practice, Attitudes, and Knowledge/Skills
Regarding Evidence-Based Practice Before and
After an Educational Intervention
Deene Mollon, RN, MSN, NE-BC, Willa Fields, DNSc, RN, FHIMSS, Ana-Maria Gallo, PhD, CNS,
RNC, Rebecca Wagener, RN, Jacqui Soucy, BS, RCP, RRT-NPS, Brandi Gustafson, DPT, and
Son Chae Kim, PhD, RN
Because regulatory agencies are placing increased
importance on the delivery of safe patient care and
improved clinical outcomes, health care leaders are en-
couraging staff to adopt evidence-based practices that
use current research to improve clinical care. However,
recent reports showed substantial gaps between practice
and current research evidence (Bonner & Sando, 2008;
Heiwe et al., 2011; Johansson, Fogelberg-Dahm, &
Wadenstein, 2010).
Implementation of evidence-based practice has been
challenging, with only an average of 25% of staff prac-
ticing within an evidence-based practice framework
(Bonner & Sando, 2008; Gerrish et al., 2007; Schreiber,
Downey, & Traister, 2009). Today’s clinicians have
different levels of knowledge and skill related to evi-
dence-based practice, depending on their educational
background, level of experience, and interest (Gerrish,
Ashworth, Lacey, & Bailey, 2008; McCloskey, 2008;
Schreiber et al., 2009). Obtaining baseline information
about evidence-based practice allows an organization
to create ongoing educational initiatives and process
changes to successfully incorporate evidence-based
practice into daily practice. Because practice, atti-
Background: Today’s clinicians have different levels
of knowledge and skill related to evidence-based prac-
tice, depending on their educational background, level
of experience, and interest. This multidisciplinary study
assessed nurses’ baseline and posteducation practice, at-
titudes, and knowledge/skills regarding evidence-based
practice.
Methods: A descriptive pre- and postsurvey design
study evaluated clinical staff’s practice, attitudes, and
knowledge/skills regarding evidence-based practice with
the Clinical Effectiveness and Evidence-Based Practice
Questionnaire.
Results: A total of 327 participants (24%) completed
the presurvey and 282 (20%) completed the postsurvey.
No statistically significant changes were found in prac-
tice, attitudes, and knowledge/skills after the online
education. In the multivariate analysis, online education
was not a significant predictor of practice, attitudes,
or knowledge/skills regarding evidence-based practice;
graduate educational degree, formal evidence-based
practice classes, and registered nurse status were statisti-
cally significant positive predictors.
Conclusion: Administering self-learning online mod-
ules may not be the most effective method for expanding
evidence-based practice abilities and knowledge/skills of
nurses.
J Contin Educ Nurs 2012;43(9):411-419
abstract
Ms. Mollon is Nurse Manager; Dr. Gallo is Director of Nursing Ed-
ucation, Research and Professional Development; Ms. Wagener is Clini-
cal Nurse; Ms. Soucy is Clinical Lead Respiratory Therapist; and Dr.
Gustafson is Physical Therapist, Sharp Grossmont Hospital, La Mesa,
California. Dr. Fields is Professor, San Diego State University, San Di-
ego, California. Dr. Kim is Professor, Point Loma Nazarene University,
San Diego, California.
The authors have disclosed no potential conflicts of interest, financial
or otherwise.
Address correspondence to Deene Mollon, RN, MSN, NE-BC,
Nurse Manager, Sharp Grossmont Hospital, 5555 Grossmont Center
Drive, La Mesa, CA 91942. E-mail: deene.mollon@sharp.com.
Received: January 25, 2012; Accepted: June 21, 2012; Posted: July
23, 2012.
doi:10.3928/00220124-20120716-89
412 Copyright © SLACK Incorporated
tudes, and knowledge/skills of staff potentially affect
the success of initiatives to implement evidence-based
practice, researching these concepts is important for
evaluating implementation plans. This study evalu-
ated the effect of an online educational program on the
practice, attitudes, and knowledge/skills related to ev-
idence-based practice among multidisciplinary health
care providers.
BACKGROUND
Hospital Description
Sharp Grossmont Hospital is a not-for-profit,
Magnet®-designated community hospital with 536
acute care beds, located in San Diego County, Califor-
nia. The hospital uses predominantly registered nurses
to deliver and coordinate bedside care. Patient care is
supported by other professional clinical and support
staff, such as licensed therapists, registered dieticians,
respiratory therapists, pharmacists, licensed radiol-
ogy technicians, and nursing assistants. Patient care is
planned, implemented, and evaluated from an inter-
disciplinary approach from admission to discharge.
Because of this interdisciplinary approach, it was im-
portant to evaluate the practice, attitudes, and knowl-
edge/skills of nursing and other clinical staff related to
evidence-based practice.
Evidence-based practice is promoted at all levels
within the organization. Policies, procedures, and guide-
lines of care incorporate published evidence. Bedside
practitioners are encouraged to question practices, bring
forward new evidence to the appropriate committee, and
provide care based on the latest evidence. However, most
staff continue to practice based on what they learned in
school and their practice experiences (Fruth et al., 2010;
Koehn & Lehman, 2008). Because practice was not al-
ways based on evidence, the hospital’s leadership team
decided to increase the use of evidence-based practice in
all aspects and areas of practice through an online edu-
cational program.
Review of the Literature
Incorporating evidence into practice continues to
be a challenge for clinical staff despite the presence of
evidence-based practice in the literature for the past de-
cade (Pravikoff, Tanner, & Pierce, 2005). Among clinical
staff with some level of exposure to evidence-based prac-
tice, there frequently continues to be a lack of research
knowledge, skills, and understanding in terms of how
to translate evidence into practice (Akindipe & Guidon,
2008; Fruth et al., 2010; Sabus, 2008).
Many studies have identified consistent barriers to
the implementation and use of evidence-based practice
(Brown, Wickline, Ecoff, & Glaser, 2009; Fink, Thomp-
son, & Bonnes, 2005; Fruth et al., 2010; Gerrish et al.,
2007; Koehn & Lehman, 2008). These barriers include
limited skills and knowledge about the use of research,
time, financial constraints, absence of administrative
interest, lack of support for research consultation, and
resistance by peers to the incorporation of new ways of
practice. Understanding how the perception of barriers
affects staff’s use of research and the transfer of research
into practice is vital for the transition to an evidence-
based practice model of care.
Few studies have evaluated the effect of evidence-
based practice education on the practice, attitudes, and
knowledge/skills of bedside nurses and other interdis-
ciplinary staff. Brown et al. (2009) studied nurses’ prac-
tices, knowledge, and attitudes toward evidence-based
practice related to perceived barriers to evidence-based
practice. Organizational barriers (lack of time and lack
of autonomy) correlated with a lower perception of
nurses’ own knowledge and skills related to evidence-
based practice. Nurses’ attitudes toward evidence-based
practice were more positive than their knowledge and
practice regarding evidence-based practice (Brown et
al., 2009). A study by Koehn and Lehman (2008) inves-
tigated nurses’ perceptions, attitudes, and knowledge/
skills associated with evidence-based practice. This
study found a statistically significant difference in atti-
tudes regarding evidence-based practice between nurses
with higher education levels (baccalaureate degree and
higher) and those with lower education levels (associ-
ate’s degree and diploma).
Sherriff, Wallis, and Chaboyer (2007) evaluated the
effect of an evidence-based practice educational pro-
gram on attitudes and perceptions of skills and knowl-
edge related to evidence-based practice. The educational
program was a 4-hour workshop designed to increase
awareness of organizational resources available to assist
staff in engaging in evidence-based practice. Participants
also received an accompanying workbook designed to
supplement skills taught in the workshop. This study
found an improvement in nurses’ attitudes and percep-
tions of skills and knowledge related to evidence-based
practice after the educational workshop (Sherriff et al.,
2007).
Kajermo et al. (2008) found that nursing leadership
support for participation in research and development
activities greatly reduced perceived barriers to research
and facilitated progress toward evidence-based nurs-
ing care. Other studies (Brown et al., 2009; Fink et al.,
2005; Heiwe et al., 2011) found that organizational
characteristics and inadequate support for the develop-
ment of evidence-based practice skills created barriers
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The Journal of Continuing Education in Nursing · Vol 43, No 9, 2012
to evidence-based practice. The findings of Kajermo et
al. (2008) supported the importance of nursing leader-
ship in developing and communicating clear strategies
and goals for increasing evidence-based practice skills
within all levels of the organization. In addition, lead-
ership support for research and evidence-based prac-
tice projects within an interdisciplinary model would
also strengthen and develop evidence-based practice
skills across all disciplines.
Studies of allied health care professionals have shown
similar outcomes to studies conducted solely with nurs-
ing participants. Akindipe and Guidon (2008) examined
physiotherapists’ attitudes toward and use of evidence-
based practice. Results showed an overall positive at-
titude toward evidence-based practice, with 95% of
respondents indicating an interest in learning and im-
proving evidence-based practice skills. This study also
found that master’s- and doctorally prepared physio-
therapists were significantly more confident in their
ability to review and use research for clinical decision
making. Heiwe et al. (2011) explored the attitudes, be-
liefs, knowledge, and behavior of dieticians, occupa-
tional therapists, and physical therapists. Their research
findings also showed positive attitudes toward evidence-
based practice and the use of evidence-based practice to
support clinical decisions. The majority of participants
indicated confidence in their ability to understand and
interpret the evidence.
Several studies reported the effectiveness of and stu-
dent satisfaction with online learning (Lim, Kim, Chen,
& Ryder, 2008; Pullen, 2006; Roberts, Brannan, & White,
2005). Lim et al. (2008) found that students in an online
learning group or a combined online and traditional learn-
ing group had statistically significantly higher levels of
achievement than students in a group who were given tra-
ditional learning only. Most students in this study indicat-
ed an interest in additional online course options. Pullen
(2006) examined the effect of web-based learning on more
than 300 health care professionals. This study found on-
line learning to be an effective means of increasing health
care professionals’ knowledge and improving self-report-
ed practice performance changes (Pullen, 2006).
Research has clearly defined many barriers to the in-
fusion of evidence-based practice, but methods to ad-
dress these barriers are less clear. Providing health care
practitioners with exposure to evidence-based practice
through educational interventions and the literature ap-
pears to improve attitudes and perceptions of knowl-
edge/skills regarding evidence-based practice. However,
future research is needed to evaluate the effect of educa-
tional interventions on knowledge and skills in the actual
use of evidence-based practice.
Theoretical Framework
Two theoretical frameworks were used to guide
this study: Adult Learning Theory (Knowles, 1978)
and Diffusion of Innovation Theory (Rogers, 2003).
Knowles’ (1978) Adult Learning Theory supports the
notion that adult learners are autonomous and self-di-
rected and build new knowledge on existing knowledge
and a framework of life experiences. Rogers’ (2003)
Diffusion of Innovation Theory centers on conditions
that increase or decrease the likelihood that a new prac-
tice will be adopted. According to Rogers (2003), at-
titudes toward a new technology are a key element in
its diffusion.
METHODS
Study Design
A descriptive pre- and postsurvey design was used to
examine the effect of an online evidence-based practice
educational intervention on clinical staff’s practice, at-
titudes, and knowledge/skills related to evidence-based
practice. Survey data were collected 1 month pre- and 1
to 2 months posteducation.
Participants
Clinical staff participating in bedside care (registered
nurses, licensed vocational nurses, case managers, so-
cial workers, respiratory therapists, physical therapists,
occupational therapists, speech therapists, recreational
therapists, dieticians, and pharmacists) were included
in the study, and 1,381 staff members were eligible to
participate. Participants were recruited through unit
staff meetings, posted flyers, e-mail announcements,
and hospital newsletters. Excluded from the study
were nonprofessional clinical staff and those who did
not provide direct care (e.g., nursing assistants, licensed
practitioners with no patient care responsibilities, pa-
tient transporters).
Educational Intervention
In-house clinical educators created the manda-
tory online learning module. The module provided an
overview of evidence-based practice, listed the steps of
evidence-based practice, and offered examples of evi-
dence-based practice projects. The educational mod-
ule was available via the organization’s intranet system
and could be reviewed during working hours or after
hours at home, with no time restriction for completion.
The module was accessible to the staff for a 2-month
period, and completion compliance rates were sent to
managers weekly. Because this education was part of
the infusion of evidence-based practice throughout all
disciplines and was required regardless of study partici-
414 Copyright © SLACK Incorporated
pation, managers were asked to remind staff who had
not completed the module to do so. At the end of the
module, staff were not tested on evidence-based prac-
tice knowledge, although they did certify completion
of the module.
Instruments
Staff practice, attitudes, and knowledge/skills re-
garding evidence-based practice were measured with
the Clinical Effectiveness and Evidence-Based Practice
Questionnaire (EBPQ). The EBPQ is a self-report mea-
sure of practice, attitudes, and knowledge/skills related
to evidence-based practice that was developed by Up-
ton and Upton (2006). The questionnaire explores the
day-to-day use and implementation of evidence-based
practice. Internal reliability for the questionnaire was
reported at 0.87, and reliability ranged from 0.79 to 0.91
for each subscale (Upton & Upton, 2006). Upton and
Upton (2006) showed adequate reliability for internal
consistency and construct and discriminant validity dur-
ing the development of the EBPQ.
Demographic information, including profession, cur-
rent work title, years of experience, gender, race/ethnic-
ity, and educational background, was collected by means
of a demographic questionnaire. Participants were asked
how they learned about evidence-based practice, how
frequently they sought information from various re-
sources, and their perceived skill level for the various
tasks of evidence-based practice. Information resources
were rated on a five-point Likert scale (1 = never to 5 =
every day) and included other people (peers, physicians,
faculty), library databases, print journals, the Internet,
personal digital assistants, medical librarians, textbooks,
and the Cochrane Database. Perceived evidence-based
practice skill level was rated on a five-point Likert scale
(1 = novice to 5 = expert) for ability to formulate a key
clinical question, find the best clinical evidence to an-
swer a question, search electronic databases, understand
research articles, appraise research articles, synthesize
research articles, and apply research evidence to patient
care (Kim et al., 2012).
Data Collection Procedures
Data collection began after approval was received
from the institutional review board and the hospital’s ad-
ministrative review committee. Data collection packets
contained an informed consent letter, the EBPQ survey,
a demographic questionnaire, and a preaddressed return
envelope. Collection boxes were conveniently placed on
each unit for ease in returning completed surveys. Par-
ticipants could also return surveys via internal mail if use
of the collection box was inconvenient or if staff feared
compromised confidentiality. Research team members
visited unit staff meetings during a 1-month period to
TABLE 1
DEMOGRAPHIC CHARACTERISTICS (N = 609)
Characteristic
Presurvey
(n = 327)
Postsurvey
(n = 282)
Mean age in years (range) 42 (22 to 76) 41 (21 to 81)
Gender
Female 289 (88.4) 245 (86.9)
Male 36 (11.0) 37 (13.1)
Ethnicity
White (non-Hispanic) 213 (65.1) 176 (62.4)
Asian/Pacific Islander 68 (20.8) 64 (22.7)
Hispanic 19 (5.8) 16 (5.7)
Black 5 (1.5) 9 (3.2)
Other 15 (4.5) 16 (5.7)
Profession group
RN 256 (78.3) 232 (81.9)
Staff nurse 221 199
Lead 23 23
Educator/CNS 12 10
Respiratory therapist 19 (5.8) 27 (9.6)
Physical therapist 16 (4.9) 9 (3.2)
Occupational therapist 7 (2.1) 4 (1.4)
Speech therapist 3 (0.9) 3 (1.1)
Social worker 7 (2.1) 4 (1.4)
Dietician 6 (1.8) 1 (0.4)
Pharmacist 9 (2.6) 2 (0.7)
Recreational therapist 1 (0.3) 0
LVN 2 (0.6) 0
Highest degree earned
Associate’s degree 88 (26.9) 95 (33.7)
Diploma 22 (6.7) 14 (5.0)
Baccalaureate degree 156 (47.7) 123 (43.6)
Master’s degree 37 (11.3) 26 (9.3)
Doctoral degree 13 (4.0) 5 (1.8)
Years of work experience
(M ± SD)
12.9 ± 11.2 12.6 ± 10.3
Mean number of formal
evidence-based practice
classes
2.8 2.6
Note. RN = registered nurse; CNS = clinical nurse specialist; LVN =
licensed vocational nurse. Values are number (%), unless otherwise
indicated. Percentages may not total 100% because of missing data
or rounding.
415
The Journal of Continuing Education in Nursing · Vol 43, No 9, 2012
introduce and explain the study. Survey materials were
distributed to staff via their unit mailboxes to ensure that
all staff received the study packet materials, not just the
staff present at the unit staff meeting. In addition, unit
managers posted flyers on the unit to encourage staff to
participate in the study.
Two weeks after the distribution of the survey pack-
ets to staff mailboxes, a series of e-mail reminders were
distributed via the internal e-mail system. These e-mail
reminders were repeated every 2 weeks during the ini-
tial 2-month data collection period. Unit managers and
educators were asked to encourage participation in the
study. This same procedure was repeated for postsurvey
data collection.
Data Analysis
SPSS software, version 18.0, was used for data analyses,
and the level of significance was set at p < .05 for all data
analyses. Descriptive statistics were performed to describe
the demographic characteristics and types of informa-
tion resources used. Pre- and postsurvey EBPQ subscale
mean scores were compared with independent t tests. To
identify the potential predictors of practice, attitudes, and
knowledge/skills associated with evidence-based practice,
bivariate Pearson product-moment correlation proce-
dures were first performed among demographic charac-
teristics and EBPQ subscale scores. The dummy variable
of evidence-based practice education and the demographic
characteristics that had statistically significant correlations
with one or more of the evidence-based practice subscales
were selected as the potential predictor variables. These
potential predictors were entered into the exploratory
multiple regression models simultaneously.
RESULTS
Sample Characteristics
A total of 609 participants completed the survey:
327 for the presurvey and 282 for the postsurvey, with
response rates of 24% and 20%, respectively. Table 1
shows the demographic characteristics of the partici-
pants. Most were female, White, registered nurses who
had earned baccalaureate degrees. The average work ex-
perience was approximately 13 years, and approximately
one fourth did not have any previous formal training in
evidence-based practice.
Type of Information Resources Used
There were no statistically significant changes be-
tween pre- and postsurvey use of information resources
when clinical questions arise (Fig. 1). The most frequent
pre- versus postsurvey types of information resourc-
es used at least once weekly were Internet (76.9% vs.
77.1%) and peers (60.6% vs. 64.9%). The least frequent-
ly used resources were librarians (7.2% vs. 9.2%) and the
Cochrane Database (3.6% vs. 4.3%).
Pre- Versus Postsurvey Comparisons of Evidence-
Based Practice
The Cronbach’s alpha internal consistency reliabil-
ity was 0.94, 0.78, and 0.96 for the practice of evidence-
based practice, attitude toward evidence-based practice,
and knowledge/skills associated with evidence-based
practice subscales, respectively. Table 2 presents the
Figure 1. Type of information resources used at least weekly (N =
609). Black bars represent presurvey values; gray bars represent
postsurvey values. PDA = personal digital assistant.
TABLE 2
COMPARISON OF PRE- VERSUS POSTSURVEY EVIDENCE-BASED PRACTICE QUESTIONNAIRE MEAN SCORES
Subscales Presurvey M (SEM) Postsurvey M (SEM) Mean Differenceat (Independent) p
Practice of evidence-based practice 4.51 (0.09) 4.46 (0.10) -0.05 -0.396 .692
Attitude toward evidence-based practice 5.22 (0.07) 5.16 (0.08) -0.06 -0.547 .585
Knowledge/skills associated with
evidence-based practice
4.55 (0.06) 4.58 (0.07) 0.03 0.330 .741
Note. aPostsurvey minus presurvey. Possible range for each subscale was 1 to 7.
416 Copyright © SLACK Incorporated
comparisons of pre- and postsurvey mean scores of sub-
scales. There were no statistically significant changes in
practice, attitudes, and knowledge/skills associated with
evidence-based practice after the online evidence-based
practice education.
Predictor Variables of Evidence-Based Practice
Table 3 shows the bivariate Pearson’s correlations
among independent demographic characteristics and the
three dependent variables of the EBPQ subscales. Regis-
tered nurse status, White ethnicity, graduate degree, and
number of formal evidence-based practice classes had
statistically significant positive correlations with one or
more of the three EBPQ subscale scores (r = 0.088 to
0.182; p < .05). In contrast, female gender, associate’s de-
gree or diploma, and Hispanic ethnicity had statistically
significant negative correlations. However, the online
educational program had no statistically significant cor-
relation with any of the EBPQ subscale scores. These
statistically significant independent variables were en-
tered as potential predictors in the exploratory multiple
regression model simultaneously.
The results of the simultaneous multiple regression
analyses using the EBPQ subscale scores as dependent
variables are shown in Table 4. For the practice of evi-
dence-based practice subscale as the dependent variable,
the combination of predictor variables explained 5.8%
of the variance (R2 = 0.058, p = .024). Among the pre-
dictor variables, registered nurse status (beta = 0.13, p =
.015), graduate degree (beta = 0.18, p = .002), and number
of formal evidence-based practice classes (beta = 0.11,
p = .031) reached statistical significance. For the attitude
toward evidence-based practice subscale, 8.3% of the
variance was explained by the predictor variables (R2 =
0.083, p = .001). Among the predictor variables, regis-
tered nurse status (beta = 0.13, p = .019), baccalaureate
degree (beta = 0.15, p = .008), and graduate degree (beta
= 0.20, p = .001) reached statistical significance. For the
knowledge/skills associated with evidence-based prac-
tice subscale, the predictor variables explained 8.8% of
the variance (R2 = 0.088, p = .001). Among the predictor
variables, female gender (beta = -0.10, p = .046), gradu-
ate degree (beta = 0.25, p < .001), and number of formal
evidence-based practice classes (beta = 0.11, p = .043)
reached statistical significance.
Ability to Perform Evidence-Based Practice Steps
Figure 2 shows the comparison of pre- and postsur-
vey mean scores for ability to perform tasks related to the
steps in evidence-based practice. There were no statisti-
cally significant changes in the ability to perform these
tasks after the online evidence-based practice education.
The mean rating of the respondents’ ability to perform
these tasks was “competent” for most of the steps, ex-
cept for appraising articles critically and synthesizing the
research article findings, for which the mean rating was
“advanced beginner.”
First Exposure to Evidence-Based Practice
Narrative data describing how participants first
learned about evidence-based practice showed that a
majority of participants’ first interaction with evidence-
based practice was through a formal school setting, de-
spite area of profession. However, most of the partici-
pants who had exposure through school were nurses and
physical therapists compared with other participating
disciplines. The majority of the other study participants
who did not have formal school exposure learned about
evidence-based practice through coworkers, confer-
ences, professional journals, previous employment, and
professional organizations. In addition, a few partici-
TABLE 3
BIVARIATE CORRELATIONS AMONG VARIABLES
(N = 609)
Variable
Practice of
Evidence-
Based
Practice
Attitude
Toward
Evidence-
Based
Practice
Knowledge/
Skills
Associated
With
Evidence-
Based
Practice
Age 0.059 0.002 -0.042
Years of work
experience
0.050 -0.037 -0.035
Female gender 0.071 -0.009 -0.105*
Registered nurse 0.047 0.088* 0.030
Hispanic ethnicity -0.061 -0.098* -0.001
Black ethnicity 0.034 -0.044 0.059
White ethnicity 0.025 0.108** 0.034
Asian ethnicity 0.015 -0.042 -0.034
Associate’s de-
gree/diploma
-0.109* -0.137** -0.121**
Baccalaureate
degree
0.020 0.071 -0.010
Graduate degree 0.123* 0.088* 0.182**
No. of formal
evidence-based
practice classes
0.140** 0.012 0.144**
Online evidence-
based practice
education
-0.016 -0.023 0.014
Note. *p < .05. **p < .01.
417
The Journal of Continuing Education in Nursing · Vol 43, No 9, 2012
pants learned about evidence-based practice from online
literature search engines, research committees, and hos-
pital-specific leadership and practice council meetings.
Finally, a few participants reported not knowing much
about evidence-based practice.
DISCUSSION
The current study results indicate that the online
educational intervention was not effective in improv-
ing the practice, attitudes, and knowledge/skills regard-
ing evidence-based practice among multidisciplinary
health care providers. In the multivariate analysis, the
online education again was not a significant predictor
of practice, attitudes, and knowledge/skills in terms of
evidence-based practice; instead, a graduate educational
degree, attendance at a formal evidence-based practice
class, and registered nurse status were found to be sta-
tistically significant positive predictors. It is not surpris-
ing that educational and professional backgrounds ap-
pear to have a significant effect on the practice, attitudes,
and knowledge/skills related to evidence-based practice.
These results support the narrative data, which showed
the majority of participants reporting their first exposure
to evidence-based practice in school and not at work.
Because the educational intervention did not include
a test of knowledge at the end of the module, it was dif-
ficult to know whether staff actually read and learned
from the module. Administering self-learning online
modules may not necessarily be the most effective meth-
od for introducing and expanding practical evidence-
based practice ability and knowledge/skills. The staff
need opportunities to practice evidence-based practice,
not necessarily simply education modules. Creating av-
enues for individuals to practice, such as journal clubs,
evidence-based practice workshops, and formal classes,
might be a more effective method for increasing ability
and knowledge/skills of evidence-based practice than
education alone.
Staff with graduate-level education or previous for-
mal training in evidence-based practice had a statistically
TABLE 4
SIMULTANEOUS MULTIPLE REGRESSION MODELS PREDICTING SUBSCALES OF EVIDENCE-BASED PRACTICE
QUESTIONNAIRE (N = 609)
Practice of Evidence-Based
Practice
Attitude Toward
Evidence-Based Practice
Knowledge/Skills Associated
With Evidence-Based
Practice
Variable B SE (B) Beta B SE (B) Beta B SE (B) Beta
Constant 4.19 0.57 4.21 0.46 4.31 0.41
Female gender -0.23 0.23 -0.05 -0.08 0.18 -0.02 -0.32 0.16 -0.10*
Registered nurse 0.50 0.21 0.13* 0.38 0.16 0.13* 0.26 0.14 0.11
Baccalaureate degree 0.22 0.17 0.07 0.36 0.14 0.15** 0.12 0.12 0.06
Graduate degree 0.76 0.25 0.18** 0.67 0.20 0.20** 0.71 0.17 0.25***
Number of formal evidence-based
practice classes
0.02 0.01 0.11* -0.00 0.01 -0.02 0.01 0.01 0.11*
R2 = 0.058
FD(12,391) = 1.990*
R2 = 0.083
FD(12,387) = 2.919**
R2 = 0.088
FD(12,360) = 2.903**
Note. *p < .05. **p < .01. ***p < .001. Age, ethnicity, and years of work experience and dummy variable of online evidence-based practice education were
entered, but the coefficients were not statistically significant and were not shown.
Figure 2. Rating of ability to perform evidence-based practice (N =
609). Black bars represent presurvey values; gray bars represent
postsurvey values.
418 Copyright © SLACK Incorporated
significant positive correlation in two or more EBPQ
subscales. With staff with an associate’s degree or a di-
ploma showing a negative correlation for practice, atti-
tudes, and knowledge/skills, it is important for leaders
and educators to highly encourage staff at this level of
educational preparedness to return to school for higher-
level degrees. Because no statistically significant positive
or negative correlation was seen for baccalaureate-pre-
pared staff, encouraging these staff members to return to
school for advanced degrees, or at least to attend formal
classes and workshops in evidence-based practice train-
ing and skills practice, would be beneficial for advancing
practice, attitudes, and knowledge/skills in evidence-
based practice.
The results of this study are congruent with previous
research on self-rating of ability to perform the steps
of the evidence-based practice process. Staff consis-
tently rated themselves as “competent” in most of the
evidence-based practice steps. However, staff perceived
their ability in critically appraising and synthesizing
research article findings at the lower “advanced begin-
ner” level. Having the ability to critically appraise and
synthesize research is at the core of the evidence-based
practice process, and without these skills, staff will be
unable to implement practice changes based on current,
valid, and statistically significant research. Staff should
be encouraged to use professional databases with critical
appraisals of the literature, such as the Cochrane Library,
MD Consult, and UpToDate®. Many hospital libraries
subscribe to these or similar services.
In addition, in both the pre- and postsurveys, staff
reported a positive attitude toward evidence-based prac-
tice. Leadership can leverage this positive attitude by
offering opportunities for practice, which will increase
knowledge/skills regarding evidence-based practice. Be-
cause self-rating of abilities in evidence-based practice
did not change pre- to postsurvey, there continues to be
room for improvement in all aspects of evidence-based
practice.
The EBPQ was developed with nursing professionals,
and all previous research appears to have used only nurs-
es in the samples. This study is the first known study to
include interdisciplinary professional staff as part of the
sample. Further research is needed to determine whether
this tool is appropriate for measuring practice, attitudes,
and knowledge/skills related to evidence-based practice
beyond nurses.
The results of this study provide guidance for lead-
ers and educators to promote growth in the practice,
attitudes, and knowledge/skills related to evidence-
based practice within the interdisciplinary team. Ana-
lyzing the results of this study shows that promoting
and encouraging advanced educational degrees and
formal classes, programs, and in-services in evidence-
based practice correlates with improved practice, at-
titudes, and knowledge/skills in the area of evidence-
based practice. In addition, creating opportunities for
staff to critically appraise and synthesize research arti-
cles through journal clubs and evidence-based practice
projects would create situations for staff to use and im-
prove knowledge and skills in this area. To allow staff
to grow and evidence-based practice to progress, orga-
nizations must not only provide evidence-based prac-
tice role models at all levels of the organization but also
actively integrate the tenets of evidence-based practice
into everything they do.
LIMITATIONS
There are several limitations associated with this
study. First, because the pre- and postsurveys were iden-
tical in content, it was difficult for staff to understand
that they needed to complete both surveys. Despite ef-
forts to clarify the need to complete both surveys, some
staff completed only the presurvey. This difficulty re-
sulted in a low overall response rate for both the pre-
and postsurveys. Another limitation was related to the
educational intervention. With no knowledge evaluation
associated with the online learning module, it was im-
possible to determine whether the module was read and
whether staff knowledge improved after reading. This
study was also limited by the focus on lack of knowl-
edge, and there may be a need to focus on multiple barri-
key points
Evidence-Based Practice
Mollon, D., Fields, W., Gallo, A.-M., Wagener, R., Soucy, J.,
Gustafson, B., Kim, S. C. (2012). Staff Practice, Attitudes, and
Knowledge/Skills Regarding Evidence-Based Practice Before
and After an Educational Intervention. The Journal of Continu-
ing Education in Nursing, 43(9), 411-419.
1
Administering self-learning online modules may not be the most
effective method for expanding evidence-based practice abilities
and knowledge/skills of nurses.
2 Graduate-level education is predictive of better practice, at-
titude, and knowledge/skills regarding evidence-based practice.
3 While staff are improving their competency in critically apprais-
ing and synthesizing research article findings, they should be
encouraged to use professional databases with critical appraisals
of the literature, such as the Cochrane Library.
419
The Journal of Continuing Education in Nursing · Vol 43, No 9, 2012
ers related to evidence-based practice, not just an educa-
tional deficit. Finally, because the study population was
drawn from convenience sampling in only one hospital
setting, the results of this study may not be generalizable
to other settings.
CONCLUSION
Although this study did not provide many statistical-
ly significant correlations within the EBPQ subscales or
in relation to the demographic data, there was valuable
information gained from the results. Incorporating evi-
dence-based practice into the culture of an organization
is a process that takes time and consistent leader sup-
port and resources. Advancing evidence-based practice
and knowledge/skills is important for improving patient
safety, patient outcomes, and staff satisfaction. Obtain-
ing baseline data on practice, attitudes, and knowledge/
skills related to evidence-based practice is a necessary
step for determining staff levels of ability and for future
planning of interventions specific to the organization’s
population. Skill comes only through multiple exposures
and repeated practice of evidence-based practice.
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Reproducedwith permissionofthecopyright owner.Furtherreproductionprohibitedwithoutpermission.
... In studies by Chang et al. (2013) and Reviriego et al. (2014), a knowledge test showed an improvement of knowledge on critical appraisal after education. In self-evaluations, Mollon et al. (2012) and Moore (2017) did not find any improvements after education, whereas in studies by Allen et al. (2015) and Ramos-Morcillo et al. (2015), self-evaluation of knowledge showed improvement after education. ...
... Evaluations of nurses' EBP skills in educational interventions have been subjective, as the participants have been invited to self-evaluate their skills with a questionnaire. In such evaluations, no improvement in skills was found by Mollon et al. (2012) and Moore (2017). However, in a study by Ramos-Morcillo et al. (2015), the nurses' skills had improved after education, and improvement in most critical appraisal competencies was found by Billingsley et al. (2013). ...
... When evaluating attitudes toward EBP, Mollon et al. (2012), Ramos-Morcillo et al. (2015), Moore (2017), and Friesen et al. (2017) found no statistically significant improvements, whereas Snibsøer et al. (2017) found positive changes in nurses' beliefs about EBP after education. Brown et al. (2011) found that at least 80% of nurses were excited about nursing research, valued reading it, and were interested in using it already before education; after education, there were no changes in attitudes. ...
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Education is one of the central interventions to promote evidence-based practice (EBP) in service organizations. An educational intervention to promote EBP among health and social care professionals was implemented in a Finnish hospital. The aim of this study was to explore the outcomes of an educational intervention, focusing on the basics of EBP for health and social care professionals, using a quasi-experimental study design. The data were collected with a questionnaire before, immediately after, and 6 months after the education (n = 48). The data were analyzed with descriptive statistics and nonparametric tests. Immediately after the education, an increase was found in the EBP knowledge of participants, in participants’ confidence in their own ability to conduct database searches and read scientific articles, and in the number of participants using databases at work. Six months after the education, improvements were still found between the first and the third measurement in the participants’ knowledge and confidence in their own ability to conduct database searches and read scientific articles. The number of those who had made an initiative about a research topic regarding the development of their own work had increased from the first to the third measurement. The educational intervention produced a statistically significant improvement on most of the areas evaluated. Significant improvements were often found even 6 months after the education was finished. However, the low completion rate and a quasi-experimental before and after design limit the conclusions that can be derived from this study.
... After the FGDs, a systematic review of literature was performed. The review revealed that the majority of interventions had components of the five-step model of EBP (Jalali-Nia, Salsali, Dehghan-Nayeri, & Ebadi, 2011; Kim, Brown, Fields, & Stichler, 2009;Mollon et al., 2012). Based on the FGDs and the review of literature, a draft intervention was developed. ...
... Contradictory to this study findings, a few studies reported that EBP interventions did not impact change in EBP knowledge (Jalali-Nia et al., 2011;Mollon et al., 2012), attitude (Kim et al., 2009;Larrabee, Sions, Fanning, Withrow, & Ferretti, 2007;Mollon et al., 2012), and practice (Mollon et al., 2012). Two possible factors could have contributed to these findings. ...
... Contradictory to this study findings, a few studies reported that EBP interventions did not impact change in EBP knowledge (Jalali-Nia et al., 2011;Mollon et al., 2012), attitude (Kim et al., 2009;Larrabee, Sions, Fanning, Withrow, & Ferretti, 2007;Mollon et al., 2012), and practice (Mollon et al., 2012). Two possible factors could have contributed to these findings. ...
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... Previous work in this area has used survey methodology to examine the SLPs' perspectives regarding the definition of EBP and implementation barriers (Closs & Lewin, 1998;Enderby, 2004;Hoffman et al., 2013;Meline & Paradiso, 2003;Mollon et al., 2012;O'Connor & Pettigrew, 2009;Pennington, 2001;Vallino-Napoli & Reilly, 2004;Zipoli & Kennedy, 2005). While these studies provided crucial quantitative information about EBP use in CSD, this specific methodology does not allow for the careful examination of complex behavioral interactions, such as the impact of employment settings on the professional behaviors of school-based SLPs. ...
... Even though EBP has been a part of the CSD discipline for over 10 years, challenges to its implementation in clinical practice continue to exist (Closs & Lewin, 1998;Enderby, 2004;Hoffman et al., 2013;Meline & Paradiso, 2003;Mollon et al., 2012;O'Connor & Pettigrew, 2009;Pennington, 2001;Vallino-Napoli & Reilly, 2004;Zipoli & Kennedy, 2005). Barriers to implementation can be separated into three different factors: clinician, organization, and evidence (Harold, 2019;Ludemann et al., 2017). ...
... Clinician barriers may also exist due to training differences SLPs receive in EBP (Closs & Lewin, 1998;Hoffman et al., 2013;Mollon et al., 2012;O'Connor & Pettigrew, 2009;Vallino-Napoli & Reilly, 2004;Zipoli & Kennedy, 2005). Typically, SLPs receive formal training through a state association, a graduate-level training course, or an ASHA continuing education seminar (Hoffman et al., 2013). ...
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... Online learning has been widely adopted as a strategy to address IL challenges experienced by university students, but there are some conflicting findings in the literature as to the best approach for its implementation. Mollon et al. (2012) developed a self-paced, self-directed online learning module to influence practice, attitudes, knowledge and skills regarding EBP in multidisciplinary health care providers but found no statistically significant improvements. A later study did find a weak but positive relationship between completion of online modules and higher marks in assessments (Russell et al., 2018). ...
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Background: Information literacy (IL) skills are essential for the translation of current knowledge into evidence-based practice (EBP) in healthcare, which in turn improves patient outcomes. However, students enter pre-registration nursing programs with variable IL skills, which can present challenges when preparing research-literate nursing graduates. Objectives: To develop an online module for nursing students to learn the information literacy skills they require to effectively implement EBP. Project design: A self-paced, interactive online module was developed for final year pre-registration nursing students at an Australian university and launched in late January 2019. Four different digital tools, including screen-capture videos, split-screen tutorials, e-portfolio/learning journey platforms, and digital badges, were integrated to create an interactive module on database searching and systematic reviews. A student feedback survey was added to collect information on the students’ learning experience. Results: Students reported the online module was challenging but engaging and that its self-paced interactive nature assisted their learning. Digital badges were reported as a motivating factor by students, and their attitudes toward EBP were positive. Students were able to complete the module on their own, but a handful required face-to-face assistance. Conclusion: This project successfully integrated screen-capture videos, split-screen tutorials, e-portfolios and micro-credentialing into one online learning module to assist nursing students with developing the IL skills required for effective EBP.
... Leung, Trevena, and Waters (2014) also recommend this questionnaire as one of the questionnaires able to account for EBP. Translated into more than 10 languages, the questionnaire has studied EBP in health professionals around the world (AbuRuz, Abu Hayeah, Al-Dweik, & Al-Akash, 2017; Ahmad et al., 2009;Ammouri et al., 2014;Brown, Wicklines, Ecoff, & Glaser, 2009;Gerrish, Ashworth, Lacey, & Bailey, 2008;Koehn & Lehman, 2008;Mollon et al., 2012;Pravikoff, Tanner, & Pierce, 2005;Upton, Upton, & Scurlock-Evans, 2017;Waters, Crisp, Rychetnik, & Barratt, 2009;Zhou, Hao, Guo, & Liu, 2016). A valid Indonesian version is needed as it has not been previously available. ...
Preprint
Full-text available
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Electronic learning (e-learning) for continuing professional education (CPE) in healthcare has been shown to improve learners' satisfaction, attitudes, and performance. E-learning outcomes for continuing interprofessional education (CIPE) are less known, and the features of electronic CIPE programs that promote behavior change are unclear. In this scoping review, we sought to identify the program features and areas of behavior change in healthcare professionals using e-learning for CIPE. PubMed, CINAHL, ERIC, PsycINFO, Cochrane Library databases, and Google/Google Scholar were searched for all English articles published in the last 10 years. From the 32 studies included in our review, eight types of e-learning methods were identified. More than 35,542 healthcare professionals of different professions had participated in the programs. Thirty studies demonstrated positive behavior changes, with four areas of behavior changes identified. The most common area of change was in patient care practices. Five common program features facilitating behavior change were also identified. Most successful programs provided interactive and authentic learning experiences, which promoted direct clinical application. Future researche should include monitoring of sustained behavior changes at work, linked to patient outcomes.
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Introduction: The use of evidence-based practice (EBP) has been demonstrated to increase the quality of patient care. However, the extent to which it is practiced in Indonesia is yet to be determined. It was necessary to develop a means of measuring EBP in order to acquire a profile of the use of EBP in Indonesia. The EBP questionnaire (EBPQ) developed by Upton and Upton was selected in the current study to evaluate the perceptions of healthcare workers regarding their knowledge of, attitudes toward, and practice of EBP. This questionnaire is widely recognized; however, an Indonesian version has not yet been developed. This study aimed to translate the EBPQ developed by Upton and Upton into Indonesian and to evaluate its reliability. Method: WHO framework on how to translate and adapt an instrument was applied. On completion of the forward translation and discussion process, backward translation of the EBPQ was performed, after which it was pretested and finalized. Reliability was tested by testing the questionnaire on 42 nurses at five hospitals in Depok and Jakarta. Result: Four words were changed. All items are valid. The reliability analysis resulted Cronbach's  of 0.96 ( = 0.92, 0.80, and 0.96 for practice, attitude, and knowledge, respectively. Thus, 24 translated statements determined to be valid and reliable, were included in the final version. Conclusion: The Indonesian translated version of the EBPQ proposed by Upton and Upton was demonstrated to be valid and reliable. Further studies on the perceptions of healthcare workers are warranted.
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Background: Implementation of evidence-based practice (EBP) is necessary for healthcare systems to improve quality, safety, patient outcomes, and costs. Yet, EBP competency is lacking in many nurses and clinicians across the country. Aim: The purpose of this initiative was to determine whether nursing teams (Executive Leader, Clinical/Mid-level Leader, and Direct Care Nurse) attending a 5-day EBP continuing education skill-building program (immersion) was an effective strategy to build EBP competence, practice, and culture sustainability over time. The Advancing Research and Clinical Practice Through Close Collaboration Model was used to guide this initiative. Methods: A project team was assembled, including leaders with EBP expertise from the Air Force Medical Service and The Helene Fuld Health Trust National Institute for EBP in Nursing and Healthcare at The Ohio State University. Five survey instruments were used to evaluate outcomes, including Organizational Culture and Readiness for System-Wide Implementation of Evidence-Based Practice, Evidence-Based Practice Beliefs, Evidence-Based Practice Implementation, and Evidence-Based Practice Competencies, as well as the Knowledge Assessment Questionnaire test. Nursing teams were invited to participate and complete the program with the implementation of EBP projects over the following year. Results: Participants' EBP knowledge, skills, competencies, and beliefs were significantly improved and sustained over 12 months. Linking evidence to action: A team-based EBP skill-building program was an effective strategy for building EBP competence, practice, and culture. This initiative demonstrated that the direct involvement of leadership and infrastructure to support EBP were crucial factors for building and sustaining an EBP culture.
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Nursing research teaching is seen as central to nurse education and practice, but the impact of exposure to research teaching on students' attitudes towards research remains unclear. The aims of this study were to explore the attitudes towards research of undergraduate nursing students, before and after exposure to research teaching online. A further aim of this study was to better understand students' attitudes towards research, to inform future teaching strategies. This descriptive quasi-experimental study used pre-semester and post-semester data collected by means of an online questionnaire. The Attitudes Towards Nursing Research Scale measured student attitudes via 18 Likert items that assessed four domains: Research Abilities, Usefulness of Research, Personal Interest in Research and Using Research in Clinical Practice. There were no statistically significant changes in the overall Attitude Towards Research Scale. Individual item analysis did show statistically significant changes in two items: Understanding of research terminology increased (p = 0.001), but Intention to conduct research decreased (p = 0.035). This study generated evidence on attitudes of nursing students toward research before and after their exposure to a research subject. Research teaching online may be insufficient to effect a change in student nurses’ attitudes towards research. Summary of Relevance Issue: Research is a foundational topic in undergraduate nursing curricula, but students often find the topic to be challenging to learn, while academics find it challenging to engage students in learning about research.What is Already Known: A validated instrument, Attitudes Towards Research, can be used to ascertain if teaching affects attitudes.What this Paper Adds: Overall attitudes of first year, second semester students did not change after experiencing a semester long introductory research subject. However, two item statements did show a statistically significant change, in disparate directions. Understanding of Research Terminology increased, while Intention to Conduct Research decreased.
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This quasi-experimental, pre- and posttest study evaluated the impact of a 9-month collaborative regional evidence-based practice (EBP) fellowship program on practice, attitude, knowledge, and perceived barriers associated with implementation of EBP. Three annual cohorts (N = 142) of nurses attending a fellowship program from 2008 to 2010 participated in this study. Paired t tests showed statistically significant increases in practice (+.82; p < .001) and knowledge/skills (+.78; p < .001) associated with EBP, but showed no change in attitude (+.16; p = .198). All four Barriers subscales showed statistically significant decreases (-.10 to -.31; p = .036 to <.001). Hierarchical multiple regression analyses showed that the barriers explained 6.8%, 8.9% and 13.9% of variances in practice, attitude and knowledge/skills, respectively. The collaborative regional fellowship program improved the practice and knowledge/skills associated with EBP. The barriers were significant predictors of the EBP implementation among the targeted group of nurses participating in the fellowship program.
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To explore dieticians', occupational therapists' and physical therapists' attitudes, beliefs, knowledge and behaviour concerning evidence-based practice within a university hospital setting. Cross-sectional survey. University hospital. All dieticians, occupational therapists and physical therapists employed at a Swedish university hospital (n = 306) of whom 227 (74%) responded. Attitudes towards, perceived benefits and limitations of evidence-based practice, use and understanding of clinical practice guidelines, availability of resources to access information and skills in using these resources. Findings showed positive attitudes towards evidence-based practice and the use of evidence to support clinical decision-making. It was seen as necessary. Literature and research findings were perceived as useful in clinical practice. The majority indicated having the necessary skills to be able to interpret and understand the evidence, and that clinical practice guidelines were available and used. Evidence-based practice was not perceived as taking into account the patient preferences. Lack of time was perceived as the major barrier to evidence-based practice. The prerequisites for evidence-based practice were assessed as good, but ways to make evidence-based practice time efficient, easy to access and relevant to clinical practice need to be continuously supported at the management level, so that research evidence becomes linked to work-flow in a way that does not adversely affect productivity and the flow of patients.
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Evidence-based practice (EBP) is an important objective as physical therapists strive for autonomous practice. The most commonly identified barrier to EBP is clinicians' lack of time. Purposes of this study were to determine (1) clinicians' opinions of EBP; (2) whether EBP presentations would influence clinicians' beliefs and practices; and (3) if additional barriers would be identified. Twenty-four physical therapists, representing four clinical settings, participated. Each facility selected one presentation topic. Presenations were prepared, then given at each facility. Data were collected from three surveys. The majority of participants agreed that EBP is an essential component of practice. Most reported a willingness to change their practice to be more aligned with research. The top three barriers identified were lack of time, access to publications, and research in specific areas. Most reported gaining new information and integration of the material. EBP is considered essential by most clinicians, but lack of time is consistently identified as a primary barrier. Clinicians found it helpful to have EB information presented to them. Many would welcome additional presentations. Clinicians may increase their use of EBP if the barrier "lack of time" is lessened by locating, synthesizing, and presenting this information to them.
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This chapter answers the question: how does the development ideology become an integral part of the Langtangpa?s conception of the ?good life?? The authors? analysis is both historical and synchronic, and adopts a socio-semiotic method. Socio-semiotics takes the epistemological position that both the artificially produced material object and our understanding of it ?derives from codified ideologies that are aspects of social practices and their socialisation processes?. Under Nepal?s present economic circumstances, many Langtangpa see operating a hotel as a means of social mobility and the attainment of greater material comfort. As a result, hotels have become status symbols, with their owners regarded as being a step closer to bikās than the others in the village. The chapter finally highlights the importance of treating the hotel as an important new materiality that has emerged in tourism-affected Himalayan communities.Keywords: bikās; development ideology; good life; hotel; Langtangpa; Nepal; social practices; socio-semiotics; tourism-affected Himalayan communities
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The study evaluated the effect of an evidence-based practice (EBP) educational programme on attitudes and perceptions of knowledge and skills, of registered nurses, towards EBP. The study was conducted using a quasiexperimental interrupted time series design. Participants were clinical nurses in educational and leadership roles within a Health Service District in south-east Queensland. The data were collected using a self-administered questionnaire at three points. Nurses' belief in the value of EBP for practice was high prior to the programme and did not change subsequently. There was an improvement following the intervention in nurses' attitudes to organizational support for EBP and their perceptions of their knowledge and skills in locating and evaluating research reports. Providing educational courses in a clinical setting is useful in improving clinicians' attitudes to and perceptions of knowledge and skills related to EBP.