Actualization of evidence-based nursing in primary, specialized, and social care settings-A cross-sectional survey.

BACKGROUND: Basing practice on evidence is a widely acknowledged requirement for nursing, but shortcomings still exist. An increased understanding of the actualization of evidence-based nursing (EBN) across different nursing contexts is needed to develop better support for EBN and promote uniform high-quality nursing. AIMS: The aim of this study was to compare the actualization of EBN in different organizational contexts in Finland. METHODS: Data for this survey were collected in 2021. The actualization of EBN in primary, specialized, and social care organizations was evaluated with the Actualization of Evidence-Based Nursing instrument, nurses' version, which focuses on individual and organizational-level EBN support structures. Differences between (1) specialized and primary healthcare, and (2) different nursing practice settings were tested with Welch's two sample t-test, the Kruskal-Wallis rank sum test, and the Wilcoxon rank sum test. RESULTS: Based on nurse (n = 1020) evaluations, those working in specialized healthcare hold more positive attitudes toward EBN (p = .021) and evaluated their organization's methods for monitoring and evaluating nursing practices (p = .004) more positively than those working in primary healthcare. Regarding different nursing practice settings (n = 1241), the most positive results were observed within preventive healthcare where nurses evaluated their attitudes toward EBN, EBN competence, and personal evidence-based practices more positively compared to other nursing practice settings. The results were parallel regarding several organizational structures for EBN. Positive results were also observed within somatic units at university hospitals, and most negative results were within institutional care settings, health centers, and home care settings. LINKING EVIDENCE TO ACTION: There is a need for targeted support to strengthen EBN across different organizational contexts, with special attention to those contexts where nursing professionals with lower education levels work. Future research needs to focus on further analyzing the organizational differences and what can be learned, especially from preventive healthcare but also somatic units at university hospitals.

Development and psychometric testing of the actualisation of evidence-based nursing instrument.

AIM: To describe the development of the Actualisation of Evidence-Based Nursing instrument targeted at nurses working in clinical practice (ActEBN-nurses), meant for evaluating the actualisation of individual and organisational-level support structures for evidence-based nursing within social and healthcare organisations, and to test its validity and reliability. DESIGN: Cross-sectional survey. METHODS: The FinYHKÄ model was used as the theoretical background of the instrument development and supplemented with the JBI Model of Evidence-Based Healthcare, previous literature and items from a previous instrument, the Evidence-Based Practice Process Assessment Scale, with permission of the copyright holders. After two rounds of expert panel and piloting, a national survey was conducted with the instrument in 2021. The target group consisted of nurses working in clinical practice. Psychometric testing included internal consistency (Omega, item analysis) confirmatory factor analysis and t-test for comparison of two groups' differences (sensitivity). RESULTS: A new instrument, ActEBN-nurses was developed, comprising two parts: Individual-level (32 items, 5-point Likert-scale) and Organisational-level support structures for evidence-based nursing (37 items, 5-point Likert-scale). In total, 1289 nurses participated in the survey. The ActEBN-nurses proved to have good internal consistency in both parts (Omega ω .931 and .966), structural validity and sensitivity based on the two educational levels within the sample. The structure of both parts was slightly modified, based on the CFA modification indices, considering the impact of the reverse worded items in part Individual and redundant items within both parts. CONCLUSION: The ActEBN-nurses has promising psychometrics, and it can be used for evaluating individual and organisational-level support structures for evidence-based nursing within social and healthcare organisations. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Evaluation of the support structures within social and healthcare organisations is needed to recognise shortcomings in current structures and advance evidence-based nursing across different contexts. REPORTING METHOD: The authors state that they have adhered to relevant EQUATOR guidelines: STROBE statement for cross-sectional studies. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Clinical decision support in promoting evidence-based nursing in primary healthcare: a cross-sectional study in Finland.

INTRODUCTION AND AIMS: The aim was to explore clinical decision support (CDS) use in the practice of primary healthcare nurses. The objectives were to recognize to what extent nurses (registered nurses, public health nurses, and practical nurses) use CDS, what factors were associated with the CDS used, what kind of organizational support nurses need, and what were nurses' views about CDS development needs. METHODS: The study was conducted with a cross-sectional study design, using an electronic questionnaire developed for this purpose. The questionnaire contained 14 structured questions and nine open-ended questions. The sample consisted of randomly selected primary healthcare organizations ( N  = 19) in Finland. Quantitative data were analyzed using cross-tabulation and Pearson's chi-squared test, and qualitative data with quantification. RESULTS: A total of 267 healthcare professionals (age range 22-63 years) volunteered to participate. Participants were mainly registered nurses, public health nurses, and practical nurses (46.8, 24, and 22.9%, respectively). Overall, 59% of the participants had never used CDS. The majority (92%) found it necessary to develop nursing-specific content for CDS. The most commonly used features were medication recommendations and warnings (74%), reminders (56%), and calculators (42%). Half of the participants (51%) had not received training on the use of CDS. The older age of participants was associated with the feeling of not having enough training to use CDS ( P  = 0.039104). Nurses felt that CDS was helpful in their clinical work and decision-making, promoting evidence-based practice, and narrowing the research-into-practice gap, improving patient safety and the quality of care, and helping those who are new in their work. CONCLUSION: CDS and its support structures should be developed from a nursing perspective to achieve the full potential of CDS in nursing practice.

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

OBJECTIVE: The aim of this scoping review was to describe the instruments used to assess the knowledge and skills of evidence-based practice (EBP) in healthcare settings. METHODS: A scoping review was undertaken. Three electronic databases (CINAHL, PubMed and Cochrane) were searched in January 2022. The search phrases consisted of the following terms: healthcare professionals, EBP, competence and instrument and their synonyms, keywords and MeSH terms. The database search was run without any limitations. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to support reporting. RESULTS: Ultimately, 39 studies were included; most of them (35) were cross-sectional studies. The studies were conducted in 17 countries. A total of 17 evidence-based knowledge and skills instruments were identified. The Upton and Upton instrument was used in 19 studies. Twelve self-reported instruments were used only once. The psychometric properties of the instruments varied. The reliability was typically reported with Cronbach's alpha coefficient. The content of the EBP knowledge/skills instruments consists of five main categories: EBP, evaluation of current practice, preparation for the implementation of EBP, implementation of evidence and active participation in the development of EBP. CONCLUSION: Almost all instruments are self-assessment instruments. Validated knowledge tests should be further developed. The instruments emphasise the preparation for the implementation of EBP. Further research is needed to develop instruments for healthcare professionals to assess the knowledge and skills of the implementation of evidence.

Experiences of fatigue among people with chronic obstructive pulmonary disease: a qualitative systematic review protocol.

OBJECTIVE: The objective of this review is to explore the experiences of adults with chronic obstructive pulmonary disease living with fatigue. INTRODUCTION: Chronic obstructive pulmonary disease is an incurable disease that causes multiple physical, social, and psychological burdens to those affected as well as their caregivers. One symptom that affects the quality of life of people with chronic obstructive pulmonary disease is fatigue. However, the experiences of fatigue disclosed by people with chronic obstructive pulmonary disease have not been widely documented in previous reviews. The findings of this review will provide insights into how people with chronic obstructive pulmonary disease experience fatigue, which will be useful for developing, targeting, and implementing needs-based counseling interventions to help them deal with fatigue and maintain functioning. INCLUSION CRITERIA: This review will consider studies that include adults (>18 years) with chronic obstructive pulmonary disease at any stage, and that focus on the experiences of fatigue in any context, including health services (in- and out-patient), community, work, leisure, and home. METHODS: MEDLINE, CINAHL, PsycINFO, Academic Search Premier, Web of Science, Medic, OpenGrey, and ProQuest Dissertation and Theses will be searched for relevant published and unpublished literature with no restrictions on publication date. Study selection, quality appraisal, and data extraction will be conducted by 2 independent reviewers. Eligible studies will be evaluated using the JBI critical appraisal tool for qualitative research. Findings will be pooled using the JBI method of meta-aggregation, and a level of credibility will be assigned to the findings. The findings will be graded according to the ConQual approach for establishing confidence in findings. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021242227.

The information needs of people with COPD-The holistic approach with special reference to gender and time since diagnosis.

AIMS: The aim of this study was to determine what kinds of unmet information needs people with COPD have and whether there are differences in information needs between genders or based on the time since COPD diagnosis. DESIGN: A descriptive cross-sectional study. METHODS: Data on people with COPD (N = 169) were collected from a two-part questionnaire distributed via website. On the first part, information needs concerning the medical aspects of self-management were measured by the Lung Information Needs Questionnaire (LINQ). On the second part, which was developed specifically for this study, a more holistic view of self-management counselling was sought. Statistical methods were used to analyse the data. RESULTS: The respondents had wide-ranging information needs in many areas of COPD self-management. The most often reported areas of unmet information needs included exacerbations, diet, fatigue, stress and anxiety, palliative care and sexual life. The information needs varied by gender and time since COPD diagnosis.

Psychosocial issues need more attention in COPD self-management education.

Objective: To find out how regularly the contents of patient education regarded as essential for COPD patients' self-management are provided by healthcare professionals in specialised healthcare (SHC) and primary healthcare (PHC) in Finland.Design: A cross-sectional study based on an e-questionnaire with 42 items on the content of self-management education of COPD patients.Setting: The study sample included all public SHC units with pulmonary outpatient clinics (n = 29) and nine out of 160 health centres in Finland.Subjects: 83 doctors and 162 nurses.Main outcome measures: The respondents' answers on how regularly they included the contents regarded as essential for COPD patients' self-management in their education of COPD patients.Results: COPD patients were educated regularly on medical issues regarding COPD treatment, such as smoking cessation, exercise and pharmacological treatment. However, issues vital for coping with the disease, such as psychological well-being, stress management or fatigue, were often ignored. Patient education in SHC seemed to be more systematic than education in PHC. The education provided by the asthma/COPD nurses (n = 70) was more systematic than the education provided by the other nurses (n = 84).Conclusion: Healthcare professionals' continuous education should cover not only the medical but also the psychosocial aspects of coping with COPD. The role of doctors and nurses should be considered to ensure that there is no gap in COPD patients' education. Training asthma/COPD nurses and promoting specialised nurse-led asthma/COPD clinics in primary care could be beneficial while improving practices of patient education that enhance patients' ability to cope with the disease.KEY POINTSIssues vital for coping with chronic obstructive pulmonary disease (COPD), such as psychological well-being, stress and fatigue, are irregularly included in self-management education both in primary and specialised healthcare.Patient education provided by asthma/COPD nurses is more regular than patient education provided by other nurses.The distribution of work between doctors and nurses should be considered to ensure that there is no gap in COPD patients' education.

Family members' experiences and expectations of self-management counseling while caring for a person with chronic obstructive pulmonary disease: a systematic review of qualitative evidence.

OBJECTIVE: The objective of this review was to identify and synthesize existing evidence on the experiences and expectations of self-management counseling of adult family members who are informal caregivers of a person with chronic obstructive pulmonary disease (COPD) in the context of inpatient or outpatient care. INTRODUCTION: Chronic obstructive pulmonary disease is the fourth leading cause of mortality and morbidity worldwide. It is a progressive, lifelong and unpredictable disease. As the disease progresses, both the people with COPD and their family members require information and practical skills to manage the disease. The role of family members is particularly important at the advanced stage of COPD. This systematic review examined family members' experiences and expectations of self-management counseling. INCLUSION CRITERIA: This review considered qualitative studies that investigated adult (older than18 years) family members' experiences or expectations of COPD self-management counseling in the context of inpatient or outpatient care. "Family member" refers to a person who is an informal caregiver because of his or her relationship to the person with COPD. METHODS: A three-step search strategy was utilized in this review. The search strategy aimed to find published and unpublished studies in English and Finnish. The databases MEDLINE, CINAHL, PsycINFO, Scopus and the Finnish medical bibliographic database, Medic, were searched. The search was conducted in December 2015 and updated in September 2018. Titles and abstracts were screened by two independent reviewers for the review's inclusion criteria. Eligible studies were then critically appraised by two independent reviewers for methodological quality. The findings and illustrations of the findings were extracted and assigned a level of credibility. The qualitative research findings were pooled using the JBI method of meta-aggregation. RESULTS: Ten papers were selected for inclusion in this review. These studies were published from 2002 to 2017. The quality of all included studies was at least moderate. Each study had a total score between 7 and 10 on the JBI Critical Appraisal Checklist for Qualitative Research. The following four synthesized findings were aggregated from nine categories and 39 study findings: i) Family members' experiences with unresponsive behavior from health professionals, ii) Family members' experiences of unmet needs in self-management counseling, iii) Family members' information needs concerning COPD management, and iv) Family members' information needs concerning coping strategies. CONCLUSIONS: The synthesized findings indicate that family members are frustrated by the shortcomings of self-management counseling. They also feel unprepared for and uncertain about their caring role. They need more information about COPD and coping strategies for COPD. Counseling is essential to high-quality care and should be offered to family members caring for a loved one at any stage of COPD.

Evidence-based practices in Finland based on nurse professionals' descriptions.

AIM: Evidence-based practices (EBPs) seek to promote the implementation of interventions that are effective, appropriate, feasible and meaningful for patients. The current demand for updated EBPs in Finland is shaped by national legislation. This study's aim was to describe nurses', nurse directors' and clinical nurse specialists' (CNSs') perceptions of how well EBPs are being implemented in nursing in Finland. METHODS: In this quantitative descriptive study, the data were collected with an e-questionnaire distributed in Finland in 2017 and analysed using descriptive statistical methods. RESULTS: A total of 1063 nurses and 340 nurse directors and CNSs participated. The majority of nurses (64%, n = 669) reported that evidence is not clearly used to develop clinical practices. Most nurses (67%, n = 702) and over half of nurse directors and CNSs (57%, n = 184) also observed that knowledge of evidence-based protocols is not widespread within their organizations. However, 39% of nurses (n = 407) and 53% of nurse directors and CNSs (n = 171) stated that they are developing EBPs. CONCLUSION: The results indicate that nurses need more support to implement EBPs.

Factors Associated with the Quality of Life of People with Dementia and with Quality of Life-Improving Interventions: Scoping Review.

OBJECTIVES: To synthesise current research exploring the factors and interventions associated with the quality of life of people with dementia. BACKGROUND: Dementia is a progressive condition affecting an estimated 40 million people worldwide. The illness has a significant impact on the lives of the persons affected and their loved ones, and may thus impair the quality of life of both. As it progresses, dementia weakens the patients' ability to express their own views about their quality of life and the factors associated with it. DESIGN: Scoping review. DATA SOURCES: Electronic database search of MEDLINE, CINAHL, PsycINFO, Joanna Briggs Institute Library, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), EMBASE, Medic published up to March 2016; and incremental hand search. Review method: Systematic or other kinds of reviews and single studies were included for the review if they met the inclusion criteria. Results: A total of 20 reviews and 7 primary studies were retained for synthesis. Key findings were abstracted and a themes matrix was generated to identify patterns of meaning. The factors associated with the quality of life of people with dementia were sociodemographic factors, factors related to dementia and social and caring environment. Interventions supporting quality of life focused on the activation of people with dementia. Conclusions: This scoping review identified a large body of knowledge exploring the factors and interventions associated with the quality of life of people with dementia. The interventions were heterogeneous and the sample sizes small, which is why more research is needed.