REPORTS & PUBLICATIONS

Core Evidence-Based Practice Competencies and Learning Outcomes for European Nurses: Consensus Statements

Dolezel, J., Zelenikova, R., Finotto, S., Mecugni, D., Patelarou, A., Panczyk, M., Ruzafa-Martínez, M., Ramos-Morcillo, A.J., Skela-Savič, B., Gotlib, J., Patelarou, E., Smodiš, M. and Jarosova, D. (2021), Core Evidence-Based Practice Competencies and Learning Outcomes for European Nurses: Consensus Statements. Worldviews on Evidence-Based Nursing. https://doi.org/10.1111/wvn.12506

Abstract

Background: Consensus on evidence-based practice (EBP) competencies and associated learning outcomes for registered nurses has not yet been achieved in the European context.

Aims: To establish a set of core EBP competencies for nurses and the most important EBP learning outcomes encompassing attitudes, knowledge, and skills dimensions for implementation into nursing education in European countries.

Methods: A multi-phase modified Delphi survey was conducted: Phase 1, a literature review; Phase 2, a two-round consensus of experts; and Phase 3, a Delphi survey. Experts from six European countries participated.

Results: In Phase 1, 88 records were selected and 835 statements extracted, which were grouped according to the seven steps of EBP. After removing 157 duplicates, the remaining competencies (n = 678) were evaluated in Phase 2. Then, a two-round expert consensus was reached, with 24 competencies and 120 learning outcomes identified and divided into affective, cognitive, and skills domains. In Phase 3, based on a Delphi survey expert consensus, all evaluated statements were included in a final set of competencies and learning outcomes. Only two learning outcomes were recommended for allocation to a different domain, and four were reformulated as suggested, with no further changes to the others.

Linking Evidence to Action: The set of EBP competencies and learning outcomes can guide nurse educators, managers, and EBP stakeholders in the development of content that incorporates EBP knowledge, skills, and attitudes into educational programs. Prioritizing the EBP competencies and learning outcomes that are most necessary and adapting them to every context will provide healthcare organizations with guidelines for enhancing the continuing education of nurses. These results could facilitate the development of effective tools for assessing nursing students’ and nurses’ perception of competencies required for EBP processes.

Evidence-Based Practice competency and associated factors among Primary Care nurses in Spain

Fernández-Salazar, S., Ramos-Morcillo, A. J., Leal-Costa, C., García-González, J., Hernández-Méndez, S., & Ruzafa-Martínez, M. (2021). Evidence-Based Practice competency and associated factors among Primary Care nurses in Spain. Atención Primaria, 53(7), 102050. https://doi.org/10.1016/j.aprim.2021.102050

Abstract

Objective: To describe the Evidence-Based Practice (EBP) competency level in Primary Care (PC) nurses in Spain and to determine the associated factors.

Design: Cross-sectional, national survey design, carried out between January and March 2020.

Setting: PC in Spain.

Participants: Seven hundred eighty PC active nurses in the National Health Service with at least one year of professional experience.

Main measurements: (1) Sociodemographic, professional and access to scientific information variables; (2) outcome variable: EBP competency (attitude, knowledge, skills and utilization) assessed through the EBP-COQ Prof© questionnaire. Bivariate and multiple lineal regression analyses were carried out.

Results: The mean score for the EBP competency of the PC nurses was 131.5 (standard deviation [SD] 17.0), according to dimensions: attitude 36.8 (SD 3.6); knowledge 38.2 (SD 8.9); skills 23.0 (SD 3.5); and utilization 33.3 (SD 6.1). The number of articles read in the last month has showed the most influence on all the EBP-COQ Prof© dimensions, followed by EBP training (more than 150 h) and nursing students mentoring. The education level (master, specialist and doctorate) is associated with knowledge and skills dimensions, meanwhile belonging to a BPSO® center is associated with the EBP utilization.

Conclusions: These findings can guide PC service managers to plan strategies that improve the EBP competency level of the nurses, aimed mainly at achieving real application in clinical practice. However, it is necessary to consider the possible impact of selection bias on the results.

Evidence-based practice nurses' competency: Spanish national survey and establishment of a scale of the EBP-COQ-Prof©

Ramos-Morcillo, AJ, Fernández-Salazar, S, Leal-Costa, C, Ruzafa-Martinez, M. Evidence-based practice nurses’ competency: Spanish national survey and establishment of a scale of the EBP-COQ-Prof©. J Nurs Manag. 2021; 29: 793803. https://doi.org/10.1111/jonm.13220

Abstract

Aims: To discover the level of evidence-based practice competency of Spanish nurses, to develop a scale of the EBP-COQ-Prof© and to analyse the influence of different variables on the level of competency.

Background: The evidence-based practice competency has previously been assessed using a wide variety of instruments, although these have methodological limitations and lack associated scales that allow for the interpretation of the score obtained.

Method: Observational, cross-sectional, national study. Using an online questionnaire, data were obtained between January and March 2020 from nurses working in the National Health System. An ANOVA was performed along with multiple regression analyses. The T-score and percentiles were calculated to obtain the scale of the EBP-COQ-Prof©.

Results: 2,942 nurses participated. The score for the evidence-based practice competency was 130.29 (standard deviation 17.55). The multiple regression analysis showed a model comprised of 8 variables that explained 33% of the variance.

Conclusions: The Spanish nurses have a moderate level of evidence-based practice competency. The scale classifies the subjects into 3 levels: low, moderate and high competency.

Implications for Nursing Management: The scale proposed for the EBP-COQ-Prof© could be utilized to facilitate the diagnosis of evidence-based practice competency, and to monitor and plan individual and collective strategies to improve this competency

Validation study and setting norms of the evidence based practice competence questionnaire for nursing students: A cross-sectional study in Poland

Panczyk, M., Iwanow, L., Gaworska-Krzemińska, A., Grochans, E., Kózka, M., Kulik, H., Lewko, J., Marcysiak, M., Młynarska, K., Nowak-Starz, G., Uchmanowicz, I., Ramos-Morcillo, A. J., Ruzafa-Martínez, M., & Gotlib, J. (2020). Validation study and setting norms of the evidence based practice competence questionnaire for nursing students: A cross-sectional study in Poland. Nurse Education Today, 88, 104383. https://doi.org/10.1016/j.nedt.2020.104383

 

Abstract

Background: Achieving high quality care through full use of potential stemming from the use of the principles of evidence based practice (EBP) requires adequate shaping of student attitudes toward EBP already at an early stage of education, as well as teaching in the scope of knowledge and skills essential to apply EBP in future professional work. Therefore, nursing educators need a tool to assess competency in EBP. This study aims to present the adaptation of the psychometric test and setting norms to the Polish version of the Evidence Based Practice Competence Questionnaire (EBP-COQ_P).

Methods: Poland-wide multicentre study, cross-sectional validation design, a representative sample of 1636 nursing students. The EBP-COQ_P was validated in terms of content validity through an expert review. The EBP-COQ_P was administered to evaluate test reliability and validity. Settings norms for the Polish nurse population were also done.

Results: Confirmatory factor analysis demonstrated that 25 items are grouped into three categories which define competences related to EBP: attitude, knowledge, and skills. Cronbach’s alpha was 0.856 for the entire questionnaire. EBP-COQ_P had good parameters of absolute stability. EBP-COQ_P was also characterized with external construct validity. Measurement with the use of EBP-COQ_P allowed for a good differentiation of the respondents in terms of their expertise in EBP (known-groups validity).

Conclusions: In terms of reliability and validity, EBP-COQ_P is compared with its original version. EBP-COQ_P may be used in educational practice (graduate and postgraduate education). Polish norms set for a representative group of nursing students may serve as a benchmark for the results obtained from individual and group measurements.

 

Teaching evidence-based practice (EBP) in nursing curricula in six European countries—A descriptive study

Skela-Savič, B., Gotlib, J., Panczyk, M., Patelarou, A. E., Bole, U., Ramos-Morcillo, A. J., Finotto, S., Mecugni, D., Jarosova, D., Patelarou, E., Dolezel, J., & Ruzafa-Martínez, M. (2020). Teaching evidence-based practice (EBP) in nursing curricula in six European countries—A descriptive study. Nurse Education Today, 94, 104561. https://doi.org/10.1016/j.nedt.2020.104561

Abstract

Background: Teaching evidence-based practice (EBP) in nursing education varies among nurse educators and universities. Lack of nurses’ knowledge and skills are among the barriers commonly associated with the limited use of EBP in practice.

Objectives: To describe the presence, characteristics and content of courses of EBP in nursing bachelor’s, master’s, and PhD programs in six European countries.

Design: A descriptive study design was employed.

Settings: The study was implemented as part of the EBP e-Toolkit Project as a strategic partnership of six European higher education institutions from six countries in the framework of the Erasmus+ Programme.

Participants: Census sampling (N = 225) was used. A total of 162 (72%) faculties responded from the following countries: Spain (79), Italy (44), the Czech Republic (15), Poland (12), Greece (7), and Slovenia (5).

Methods: Three structured instruments were developed by using the consensus development panel. The research was conducted from December 2018 to March 2019. For names of subjects, a manual narrative Template Analysis was used with open descriptive coding.

Results: Subjects in “EBP in Nursing or Health Care” are included in 45 (29.2%) bachelor’s programs, mostly worth 180 European Credit Transfer System (ECTS) credits, 30 (28%) master’s, and 6 (40%) PhD programs. In bachelor’s programs, an average of 134 h are spent teaching EBP steps, followed by 127 h in master’s programs and 52 h in PhD programs. EBP subjects have different focuses: clear topics in EBP, development of research knowledge, awareness of the need for evidence-based clinical work, and understanding the needs of the profession.

Conclusions: Teaching EBP is not yet sufficiently integrated into nursing curricula. For more efficient integration, guidelines on the standardization of teaching approaches and content have to be developed in all three cycles of higher education. Further research is needed on the implementation of teaching at master’s and PhD levels of nursing curricula.

Educational Interventions for Teaching Evidence-Based Practice to Undergraduate Nursing Students: A Scoping Review

Patelarou, A. E., Mechili, E. A., Ruzafa-Martinez, M., Dolezel, J., Gotlib, J., Skela-Savič, B., Ramos-Morcillo, A. J., Finotto, S., Jarosova, D., Smodiš, M., Mecugni, D., Panczyk, M., & Patelarou, E. (2020). Educational Interventions for Teaching Evidence-Based Practice to Undergraduate Nursing Students: A Scoping Review. International Journal of Environmental Research and Public Health, 17(17), 6351. https://doi.org/10.3390/ijerph17176351

Abstract

Background: Evidence-based practice (EBP) is the appropriate approach to guide healthcare personnel in their clinical practice. Despite the importance of EBP, undergraduate nursing students are not very much engaged and have a lack of knowledge and skills.

Aim: The aim of this study was to gather, assess and synthesize evidence on educational interventions promoting evidence-based practice competencies in traditional undergraduate nursing students.

Methods: This is a scoping review on sixteen English and non-English databases. A data extraction form was established including authors, year of publication, country, types of participant, specific objectives, study design, educational intervention, comparison if existed, and outcomes of significance.

Results: The search strategy retrieved 8901 records in total. After screening for duplicates and eligibility, 20 articles were included in the qualitative synthesis. Improvement in EBP domains such as knowledge, skills, attitudes/behaviours, EBP beliefs, use, practice, level of evidence, critical thinking and future use of EBP were mentioned and assessed in different studies.

Conclusions: EBP training can improve nursing students’ capacity in healthcare provision. Teaching EBP competencies along undergraduate nursing curricula should be a high priority at nursing programmes. The use of innovative approaches seems to be more effective than traditional ways. Education of EBP increases its future use and critical thinking and EBP programs improve self-efficacy and the level of evidence utilization

Questionnaire to Evaluate the Competency in Evidence-Based Practice of Registered Nurses (EBP-COQ Prof©): Development and Psychometric Validation

Ruzafa-Martínez, M., Fernández-Salazar, S., Leal-Costa, C. and Ramos-Morcillo, A.J. (2020), Questionnaire to Evaluate the Competency in Evidence-Based Practice of Registered Nurses (EBP-COQ Prof©): Development and Psychometric Validation. Worldviews on Evidence-Based Nursing, 17: 366-375. https://doi.org/10.1111/wvn.12464

Abstract

Background: The availability of valid and reliable instruments, based on current competency frameworks, is essential to respond to the need for accurate measurement of the competency of registered nurses in evidence-based practice (EBP).

Aims: To develop and validate a questionnaire capable of measuring EBP competencies in registered nurses following the competency framework developed by Melynk et al. (2014).

Methods: The study was developed in two stages: (a) creation of the questionnaire based on an operational definition of the construct, its face, and content validation by 10 experts, and cognitive piloting; (b) psychometric evaluation of the questionnaire by a cross-sectional, and multicenter study between February and November 2018. Analyses were conducted of the questionnaire’s reliability and construct validity (exploratory [EFA] and confirmatory [CFA] factor analyses).

Results: First phase: The initial version of EBP-COQ© Prof contained 50 items grouped into four dimensions (attitudes, knowledge, skills, and utilization). After two expert validation rounds, a 35-item version was obtained with content validity index of 0.86. Second phase: The questionnaire was completed by 579 nurses; EFA with PROMAX rotation revealed that the four-factor model had the best fit (χ2 = 311.32; p = .001, root mean square error of approximation [RMSEA] = 0.000, 90% confidence interval [CI] = 0.000 – 0.010; comparative fit index [CFI] = 1), and it showed a good CFA fit index: CFI = 0.932, and RMSEA = 0.093 (90% CI = 0.097 − 0.108). Cronbach’s α for each factor ranged from 0.817 (factor III) to 0.948 (factor II).

Linking Evidence to Action: EBP-COQ Prof© is a valid, reliable, and easily administered questionnaire that measures the self-perceived competency of registered nurses in EBP based on an updated and specific competency framework. It permits the independent evaluation of attitudes, knowledge, and skills related to EBP and of its utilization in hospital and primary care settings, allowing the monitoring of compliance with EBP.

Providing a teaching and learning open and innovative toolkit for evidence-based practice to nursing European curriculum (EBP e-Toolkit): Project rationale and design

Patelarou, E., Vlasiadis, K., Panczyk, M., Dolezel, J., Jarosova, D., Gotlib, J., Skela-Savič, B., Mecugni, D., Finotto, S., Ruzafa-Martinez, M., Ramos-Morcillo, A., & Patelarou, A. (2020). Providing a teaching and learning open and innovative toolkit for evidence-based practice to nursing European curriculum (EBP e-Toolkit): Project rationale and design. Population Medicine, 2(November), 1–7. https://doi.org/10.18332/popmed/128272

Abstract

Evidence-based practice (EBP) is an instrument of great utility in making clinical decisions in nursing care, improving the quality of nursing care and patients’ health outcomes. There is no European framework for EBP competency, and no guidelines for EBP teaching. The general concept of the project ‘Providing a Teaching and Learning Open and Innovative Toolkit for Evidence-based Practice to Nursing European Curriculum: (EBP e-Toolkit)’ is to fill this gap in Nursing education across Europe and to foster and harmonize the teaching and learning of EBP in the European nursing curricula and to produce the acquisition of EBP competence earlier in professional life.

The project is organized along four major outputs, and a dissemination and sustainability plan has been set up. A mixed method research constitutes the main methodological approach applied in the project.

This methodology requires the active participation of all research groups, partners, steering committee, nursing students, and educators, in the project. The use of the EBP e-Toolkit will increase nurses’ and nursing students’ level of EBP competence by formulating specific guidelines to be implemented in EBP teaching.

Italian Validation of Evidence Based Practice Evaluation Competence Questionnaire (EBP-COQ)

Finotto, S., & Garofalo, E. (2020). Italian Validation of Evidence Based Practice Evaluation Competence Questionnaire (EBP-COQ). PROFESSIONI INFERMIERISTICHE, 73(2). Recuperato da https://www.profinf.net/pro3/index.php/IN/article/view/766

Abstract

Introduction: due to the nature of Evidence-Based Practice and its relevance to nursing, the skills that it requires should be integrated in the healthcare degree programs. Therefore, the Evidence-Based Practice process should be introduced in the nursing education program to strengthen the students’ independence and self-learning skills. The evaluation of the effectiveness of the academic teaching and the assessment of the competence degree achieved by students are hindered by the lack of validated assessment instruments. In the Italian context, today there is no instrument to assess the knowledge, skills and attitudes to Evidence-Based Practice.

Objective: the authors aimed at validating, for the Italian context, the Evidence-Based Practice Evaluation Competence Questionnaire (EBP-COQ).

Methods: this study was an Italian linguistic and cultural adaptation of a research instrument. To this end, the Beaton and Sousa Model were used. These models require six phases and aim at producing a pre-final version of the instrument to be submitted to a sample of nursing students.

Results: Each item has reached a content validity index (I-CVI) value equal to or greater than 0.9 and a scale validity index (S-CVI) value of 0.992 for the whole questionnaire. The study has confirmed the reliability of the instrument’s internal consistency with a Cronbach’s alpha value of 0.892. The reliability of the test–retest confirms the stability of the questionnaire over time (Pearson’s r = 0.976). The factorial analysis confirmed the construct validity.

Conclusion: the instrument has been validated in its psychometric characteristics and is ready to be administered to Italian nursing students

Development and validation of the competence in evidence based practice questionnaire (EBP-COQ) among nursing students

Ruzafa-Martinez, M., Lopez-Iborra, L., Moreno-Casbas, T. et al. Development and validation of the competence in evidence based practice questionnaire (EBP-COQ) among nursing students. BMC Med Educ 13, 19 (2013). https://doi.org/10.1186/1472-6920-13-19

Abstract

Background: Nursing educators need rigorously developed instruments to assess competency in evidence based practice (EBP) at undergraduate level. This concept is defined as the capability to choose and use an integrated combination of knowledge, skills and attitudes with the intention to develop a task in a certain context. Also, we understand that EBP is gaining knowledge and skills, as well as increasing positive attitudes toward EBP that will promote a change in behaviour to implement EBP in practice. This study aims to develop a psychometric test of the Evidence Based Practice Evaluation Competence Questionnaire (EBP-COQ) among undergraduate nursing students.

Methods: The questionnaire was developed by item generation through a review of scientific literature and focus groups. The instrument was validated in terms of content validity through an expert review. The EBP-COQ was administered to a cohort of nursing students (n =100) to evaluate test reliability and select the best items. Psychometric properties of the final instrument were assessed in a sample of 261 nursing students.

Results: The EBP-COQ consisted of 25 items. A factorial analysis grouped the items into the three categories that define competence relating to EBP: attitude, knowledge and skills. Cronbach’s alpha was 0.888 for the entire questionnaire. The factor solution explained 55.55% of the variance.

Conclusions: EBP-COQ appears to measure with adequate reliability the attributes of undergraduate nursing students’ competence in EBP. The instrument is quick to disseminate and easy to score, making it a suitable instrument for nursing educators to evaluate students’ self-perceived competence in EBP.

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Attitude towards Evidence-Based Nursing Questionnaire: development and psychometric testing in Spanish community nurses

Ruzafa-Martínez, M., López-Iborra, L. and Madrigal-Torres, M. (2011), Attitude towards Evidence-Based Nursing Questionnaire: development and psychometric testing in Spanish community nurses. Journal of Evaluation in Clinical Practice, 17: 664-670. https://doi.org/10.1111/j.1365-2753.2011.01677.x

Abstract

Background A readiness assessment for identifying and measuring variables that can facilitate evidence-based nursing (EBN) is important. Attitude towards EBN is one of its components. However, questionnaires that exclusively measure attitude to EBN do not exist in Spanish-speaking contexts.

Aim This paper is a report of the development and psychometric testing of a Spanish-language assessment tool: the Evidence-Based Nursing Attitude Questionnaire (EBNAQ).

Methods The questionnaire was developed in three phases: item generation through a review of scientific literature and focus groups; item selection through an expert review; content and construct validity testing, and internal consistency reliability testing. The instrument was validated in terms of construct validity by a factorial analysis and content validity by grouping the items into the three categories of attitude: cognitive, affective and behavioural. Data were collected from May to November of 2008.

Results The questionnaire was validated in a sample of 219 Spanish community nurses, who had a mean age of 43.21 (SD 10.3) years, and 64.5% (141) were women. A total of 54.3% (121) had been working in the community for more than 10 years. The questionnaire consisted of 15 items grouped into the three factors that make up the concept of attitude. Cronbach’s alpha was 0.853 for the entire questionnaire. The factor solution explained 54.70% of the variance.

Conclusions The EBNAQ is brief, making it a user-friendly tool. It is the first Spanish-language questionnaire that exclusively measures attitude towards EBN in nurses who work in the community. The EBNAQ can be used efficiently in research and practice settings to better understand nurses’ attitudes towards evidence-based practice.