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How is Promoting Evidence-Based Practice Through a Research Training Program for Point-of-Care Clinicians?

OBJECTIVES:

The purpose of this study was to evaluate the effect of a research training program on clinicians’ knowledge, attitudes, and practices related to research and evidence-based practice (EBP).

BACKGROUND:

EBP has been shown to improve patient care and outcomes. Innovative approaches are needed to overcome individual and organizational barriers to EBP.

METHODS:

Mixed-methods design was used to evaluate a research training intervention with point-of-care clinicians in a Canadian urban health organization. Participants completed the Knowledge, Attitudes, and Practice Survey over 3 timepoints. Focus groups and interviews were also conducted.

RESULTS:

Statistically significant improvement in research knowledge and ability was demonstrated. Participants and administrators identified benefits of the training program, including the impact on EBP.

CONCLUSIONS:

Providing research training opportunities to point-of-care clinicians is a promising strategy for healthcare organizations seeking to promote EBP, empower clinicians, and showcase excellence in clinical research.

Research confirms that patient outcomes improve when nurses practice in an evidence-based manner. Described as “a problem-solving approach to clinical care that incorporates the conscientious use of current best practice from well-designed studies, a clinician’s expertise, and patient values and preferences,”1(p335) evidence-based practice (EBP) has been shown to increase patient safety, improve clinical outcomes, reduce healthcare costs, and decrease variation in patient outcomes.14 The importance of EBP is substantiated; however, barriers to widespread use of current research evidence in nursing remain, including the fluency and knowledge level of clinical nurses.

Nurses have identified individual and organizational barriers to research utilization. Individual barriers include lack of knowledge about the research process and how to critique research studies, lack of awareness of research, colleagues not supportive of practice change, and nurses feeling a lack of authority to change practice.58 Organizational barriers identified include insufficient time to implement new ideas, lack of access to research, and lack of awareness of available educational tools related to research.57,911

Research demonstrates that the most important factor related to nurses’ EBP is support from their employing organizations to use and conduct research.7,9 Other facilitators include the presence in the clinical setting of advanced practice nurses, research mentors, and educators knowledgeable about research1216; nursing research internships17; and designated nurse-researchers.15 In their BARRIERS scale studies,18,19 Funk and colleagues recommended strategies for reducing barriers to EBP, including employment of research role models, establishment of collegial relationships with academics, and participation in research interest groups. Similar strategies have been more recently highlighted in the context of the Magnet Recognition Program®.15,16

There is, however, a notable lack of rigorous intervention studies focused on identifying organizational barriers to improve nurses’ engagement in EBP.20 Only 1 study focused on the implementation of Magnet® standards in American hospitals that showed promise in diminishing the barriers to EBP.21 To address this gap, leaders at a tertiary healthcare organization implemented a point-of-care research training program, led by the organization’s nursing research facilitator, targeting nurses and other clinicians to reduce EBP barriers and to promote engagement in research (Job Description for Nursing Research Facilitator, see Document, Supplemental Digital Content 1, http://links.lww.com/JONA/A369). The program provided mentoring and funding for teams of novice researchers to conduct small-scale studies in their practice settings. The purpose of this study was to evaluate the impact of the training program on clinicians’ knowledge, attitudes, and practices related to research and EBP.

Methods

A mixed-methods design22,23 was utilized to support the evaluation of the training program. A before-after survey design was used to assess the effect of the training program on clinicians, and focus groups and interviews were conducted with clinicians and administrators to explore their perceptions of the training program. Ethical approval was obtained from the appropriate institutional ethics board.

Sample and Sampling

Participants were recruited from organizational employees who had applied, in teams, to be part of the training program. Each research team was required to have at least 1 point-of-care clinician whose job was limited to clinical practice and did not include administrative or research responsibilities. A total of 27 teams and 153 clinicians (including 78 RNs) were accepted into the training program in 2 years (2011-2013). Of the 25 teams funded in the 1st 2 years, 10 teams were led by RNs, and 30 other nurses were team members of funded teams. These clinicians were invited to complete a baseline survey and 2 follow-up surveys as well as participate in focus groups. The administrative leaders of these clinicians were invited to participate in qualitative interviews.

Intervention

Potential research teams submitted letters of intent that outlined the team membership and the proposed research problem, which were reviewed for feasibility and clinical significance by an advisory committee composed of academic and clinical leaders. Approved teams were invited to join the training program and assigned a research mentor to assist in the development of the full research proposal. Research teams attended 3 research workshops that provided foundational knowledge about research methods, research ethics, and literature review techniques (see Document, Supplemental Digital Content 2, which shows a curriculum sample, http://links.lww.com/JONA/A370). Following the workshops, research teams had 3 months to develop a brief proposal, in consultation with their assigned mentor. The proposals were evaluated for their feasibility, significance, and soundness of design, and those funded received small research grants (Can $2,000-$5,000). Over the next year, funded teams conducted their research studies and engaged in knowledge translation activities.

Instruments

Knowledge, Attitudes, and Practice Survey

The Knowledge, Attitudes, and Practice (KAP) survey is an instrument that assesses 33 research activities that an RN or other health professional might encounter in clinical practice, including utilization and conduct of research. The KAP consists of 5 factors: (1) identifying clinical problems, (2) establishing current best practice, (3) implementing research into practice, (4) administering research implementation, and (5) conducting and communicating. For each activity listed on the survey, the participants indicated their level of knowledge, willingness to engage (attitudes), and ability to perform (practices) specific research and knowledge translation activity on a 3-point scale. The KAP has strong content and construct validity and is a reliable measure (ie, internal consistency = .93 to .97)24 that has been used extensively in studies exploring EBP in nursing and other health professions.

A brief demographic form (see Table, Supplemental Digital Content 3, http://links.lww.com/JONA/A371), including age, gender, profession, position, level of education, years in practice, and practice area, was completed by participants at the time of enrollment.

Data Collection

Surveys

The instruments were administered through an online survey program (FluidSurveys; Ottawa, Ontario, Canada) and were administered in 3 waves at various stages of the training program (Figure (Figure1).1). The baseline survey (survey 1) was conducted at the time of program enrollment. Survey 2 was conducted 3 months later, after participants completed the research workshops and submitted their proposals. The final survey (survey 3) was done at the end of the program after participants completed their projects, which ranged from 18 to 24 months from baseline. The final data collection timepoint varied because of extraneous circumstances (eg, slow accrual, loss of team members) that resulted in some teams requiring additional time to complete their research.

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