Thirteen-year follow-up of long-term treated psychotic disorder: personality aspects.

OBJECTIVE: Personality is an aspect that can affect the symptoms and social function in individuals with psychotic disorders. Several studies have investigated personality in schizophrenia and other long-term psychotic disorders. No study has examined the stability of personality traits exceeding five years in patients with schizophrenia and related disorders. The aim of this study was to investigate the stability of personality traits over a 13-year period among patients with schizophrenia and related disorders and healthy individuals and to evaluate case-control differences. METHODS: At three occasions during a 13-year period patients with schizophrenia and related disorders (n = 28) and healthy individuals (n = 57) completed Swedish universities Scales of Personality (SSP). Mean-level change and case-control differences were investigated for all the individuals using within- and between-subject analyses, respectively. Analyses were performed on three occasions for all 13 subscales and the three overall factors of SSP. Also, correlations, means, and SDs were calculated. RESULTS: Tests of within-subject correlations showed differences in two subscales: Lack of Assertiveness, which were influenced by age, and Physical Trait Aggression, where patients' ratings were stable, whereas controls rated themselves less aggressive at a higher age. Between-subjects correlations showed differences regarding diagnosis, time, age, gender, or age × gender in nine of the 13 subscales as well as in factor Neuroticism. CONCLUSION: Long-term follow-up showed generally high stability of personality traits measured with SSP. Between-subject analyses over the 13 years showed that patients differed compared to controls for the SSP factor Neuroticism as well as the subscale Detachment, which is in accordance with previous studies within this population.

Swedish Universities Scales of Personality: Relation to Other Personality Instruments.

OBJECTIVE: To investigate associations between Swedish universities Scales of Personality (SSP) and scales of the following personality instruments: Structured Clinical Interview for DSM-III-R axis II screening questionnaire (SCID-II screen), revised NEO personality inventory (NEO-PI-R), revised Chapman scales (Chapman) and the psychotic traits questionnaire (STQ). METHODS: Healthy individuals (n=406) completed self-report personality questionnaires including SSP and at least one more personality inventory. Correlations were calculated between the 13 different SSP subscales as well as SSP's three factors and factors and scales/subscales in SCID-II screen, NEO-PI-R, Chapman and STQ. The main factors of the various instruments were factor analysed. ICC were calculated. RESULTS: SSP Neuroticism factor correlated with SCID-II cluster C (r=0.71), NEO Neuroticism (r=0.80) and Chapman Social anhedonia (r=0.62). SSP Extraversion factor correlated with NEO Extraversion (r=0.63) and SSP Aggressiveness factor with NEO Agreeableness (r=-0.62). Strong correlations between SSP factors and scales and scales of the other instruments were sparse, although weaker correlations were common. CONCLUSION: SSP is a useful investigation tool when measuring personality traits related to temperament-like features. SSP partly correlates well to especially three of the NEO-PI-R factors. The different personality inventories are not completely comparable to each other. Instead, they measure personality aspects in partly different ways.

Correction to: Stability of personality traits over a five-year period in Swedish patients with schizophrenia spectrum disorder and nonpsychotic individuals: a study using the Swedish universities scales of personality.

After publication of the original article [1], it was brought to our attention that some of the numbers in Table 3were incorrect.

Personality traits in established schizophrenia: aspects of usability and differences between patients and controls using the Swedish universities Scales of Personality.

BACKGROUND: Personality is considered as an important aspect that can affect symptoms and social function in persons with schizophrenia. The personality questionnaire Swedish universities Scales of Personality (SSP) has not previously been used in psychotic disorder. AIMS: To investigate if SSP has a similar internal consistency and factor structure in a psychosis population as among healthy controls and if patients with psychotic disorders differ from non-psychotic individuals in their responses to the SSP. METHODS: Patients with psychotic disorders (n = 107) and healthy controls (n = 119) completed SSP. SSP scores were analyzed for internal consistency and case-control differences by Cronbach's alfa and multiple analysis of covariance, respectively. RESULTS: Internal consistencies among patients were overall similar to that of controls. The patients scored significantly higher in seven (Somatic trait anxiety, Psychic trait anxiety, Stress susceptibility, Lack of assertiveness, Detachment, Embitterment, Mistrust) and lower in three (Physical trait aggression, Verbal trait aggression, Adventure seeking) of the 13 scales of the inventory. In three scales (Impulsiveness, Social desirability and Trait irritability) there was no significant difference between the scoring of patients and healthy controls. CONCLUSION: The reliability estimates suggest that SSP can be used by patients with psychotic disorders in stable remission. Patients score higher on neuroticism-related scales and lower on aggression-related scales than controls, which is in accordance with earlier studies where other personality inventories were used.

Swedish translation, adaptation and psychometric evaluation of the Context Assessment Index (CAI).

BACKGROUND: The strength of and relationship between the fundamental elements context, evidence and facilitation of the PARIHS framework are proposed to be key for successful implementation of evidence into healthcare practice. A better understanding of the presence and strength of contextual factors is assumed to enhance the opportunities of adequately developing an implementation strategy for a specific setting. A tool for assessing context-The Context Assessment Index (CAI)-was developed and published 2009. A Swedish version of the instrument was developed and evaluated among registered nurses. This work forms the focus of this paper. PURPOSE: The purpose of this study was to translate the CAI into Swedish, adapt the instrument for use in Swedish healthcare practice and assess its psychometric properties. METHODS: The instrument was translated and back-translated to English. The feasibility of items and response scales were evaluated through think aloud interviews with clinically active nurses. Psychometric properties were evaluated in a sample of registered nurses (n = 373) working in a variety of healthcare organisations in the Stockholm area. Item and factor analyses and Cronbach's alpha were computed to evaluate internal structure and internal consistency. RESULT: Sixteen items were modified based on the think aloud interviews and to adapt the instrument for use in acute care. A ceiling effect was observed for many items and the originally identified 37 item five-factor model was not confirmed. Item analyses showed an overlap between factors and indicated a one-dimensional scale. DISCUSSION: The Swedish version of the CAI has a wider application than the original instrument. This might have contributed to the differences in factor structure. Different opportunities for further development of the scale are discussed. CONCLUSIONS: Further evaluation of the psychometric properties of the CAI is required.

The validity of the Health-Relevant Personality Inventory (HP5i) and the Junior Temperament and Character Inventory (JTCI) among adolescents referred for a substance misuse problem.

The aim was to study the validity of 2 personality instruments, the Health-Relevant Personality Inventory (HP5i) and the Junior Temperament and Character Inventory (JTCI), among adolescents with a substance use problem. Clinical interviews were completed with 180 adolescents and followed up after 12 months. Discriminant validity was demonstrated in the lack of correlation to intelligence in both instruments' scales. Two findings were in support of convergent validity: Negative affectivity (HP5i) and harm avoidance (JTCI) were correlated to internalizing symptoms, and impulsivity (HP5i) and novelty seeking (JTCI) were correlated to externalizing symptoms. The predictive validity of JTCI was partly supported. When psychiatric symptoms at baseline were controlled for, cooperativeness predicted conduct disorder after 12 months. Summarizing, both instruments can be used in adolescent clinical samples to tailor treatment efforts, although some scales need further investigation. It is important to include personality assessment when evaluating psychiatric problems in adolescents.

Burnout during nursing education predicts lower occupational preparedness and future clinical performance: a longitudinal study.

BACKGROUND: Early-career burnout among nurses can influence health and professional development, as well as quality of care. However, the prospective occupational consequences of study burnout have not previously been investigated in a national sample using a longitudinal design. OBJECTIVES: To prospectively monitor study burnout for a national sample of nursing students during their years in higher education and at follow-up 1 year post graduation. Further, to relate the possible development of study burnout to prospective health and life outcomes, as well as student and occupational outcomes. DESIGN: A longitudinal cohort of Swedish nursing students (within the population-based LANE (Longitudinal Analysis of Nursing Education/Entry) study) from all sites of education in Sweden was surveyed annually. Data were collected at four points in time over 4 years: three times during higher education and 1 year post graduation. PARTICIPANTS: : A longitudinal sample of 1702 respondents was prospectively followed from late autumn 2002 to spring 2006. METHODS: Mean level changes of study burnout (as measured by the Oldenburg Burnout Inventory, i.e. the Exhaustion and Disengagement subscales) across time, as well as prospective effects of baseline study burnout and changes in study burnout levels, were estimated using Latent Growth Curve Modeling. RESULTS: An increase in study burnout (from 30% to 41%) across 3 years in higher education was found, and levels of both Exhaustion and Disengagement increased significantly across the years in education (p<0.001). Baseline levels, as well as development of study burnout, predicted lower levels of in-class learner engagement and occupational preparedness in the final year. At follow-up 1 year post graduation, earlier development of study burnout was related to lower mastery of occupational tasks, less research utilization in everyday clinical practice and higher turnover intentions. CONCLUSIONS: The results suggest that study burnout may have interfered with learning and psychological well-being. Aspects related to work skills and intention to leave the profession were also affected. Thus, burnout development during higher education may be an important concern, and effective preventive measures to counteract burnout development may be necessary already at the outset of nursing education.

Capability beliefs regarding evidence-based practice are associated with application of EBP and research use: validation of a new measure.

BACKGROUND: Beliefs about capabilities, or self-efficacy, is a construct originating in social cognitive psychology. Capability beliefs have been found to be positively associated with intention and healthcare practice behaviour. A measure of an individual's beliefs about his/her capability to apply the components of evidence-based practice (EBP) has potential to be useful in implementation research. AIMS: To evaluate the concurrent validity and internal structure of a new scale measuring nurses' capability beliefs regarding EBP. METHODS: Data were taken from a prospective longitudinal study in Sweden (the Longitudinal Analyses of Nursing Education and Entry in Worklife [LANE]). A cohort of nursing students who graduated in the autumn of 2004 that was followed up 2 years after their graduation was used (n= 1,256). Concurrent validity was tested relating different levels of capability beliefs to extent of research use and application of EBP. An item-response approach was applied in the evaluation of internal structure of the proposed scale (six items). RESULTS: The psychometric analyses indicated that the six items could be summed to reflect a one-dimensional scale. Nurses with the highest level of capability beliefs reported that they used research findings in clinical practice more than twice as often as those with lower levels of capability beliefs. They also participated in the implementation of evidence seven times more often. IMPLICATIONS: There is a need for further studies of the construct and predictive validity of the scale. It should also be validated in other groups of health professionals. Learning including mastery experiences, role modelling, social persuasion, and manageable stress could be used in undergraduate education as well as practice development to increase beliefs about capabilities which might open the way to increased application of EBP in healthcare practice. CONCLUSIONS: This new measure is well grounded in social cognitive theory, functions as a one-dimensional scale and possesses promising properties of concurrent validity.

Personality traits and abnormal glucose regulation in middle-aged Swedish men and women.

AIMS: To examine associations between personality and abnormal glucose regulation. METHODS: This cross-sectional study comprised 2152 men and 3143 women (43-66 years). Oral glucose tolerance test identified 316 men and 213 women with previously unknown impaired fasting glucose (IFG), impaired glucose tolerance (IGT), IFG+IGT, or type 2 diabetes. Personality traits antagonism (low agreeableness), impulsivity (low conscientiousness), hedonic capacity (high extraversion), negative affectivity (high neuroticism) and alexithymia (low openness) were measured by a self-report inventory. Based on distribution of scores, responses were divided into "low" (<1 SD), "middle" (±1 SD) and "high" (>1 SD). Middle groups were considered reference groups. Prevalence odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. RESULTS: In men, OR for low antagonism was 0.3 (CI 0.2-0.6) (age- and multi-adjusted models) while in women, neither high nor low antagonism was associated to abnormal glucose regulation. Men and women with high hedonic capacity had ORs 0.5 (0.3-0.9) and 0.6 (0.4-1.0), respectively (age- and multi-adjusted models). The other scales illustrated no significant associations. CONCLUSIONS: No elevated risk of abnormal glucose regulation was observed for deviating scores on personality scales. Instead, reduced risks were indicated in men with low antagonism, and in men and women with high hedonic capacity.

Factors affecting burnout and work engagement in teachers when entering employment.

OBJECTIVE: When entering employment many beginning teachers experience a reality shock and a crisis of competence. These two factors, in combination with high levels of job demands and low levels of job resources, may lead to the development of burnout. The purpose of the study was to investigate how individual characteristics, the educational context, and the work context predicted levels of burnout and work engagement during this transition period. PARTICIPANTS: The sample consisted of 1290 beginning teachers from Sweden. METHODS: Data were collected using surveys during the final year of education and during the initial period of employment. Data were analyzed using hierarchical regression. RESULTS: Job demands, job resources, and spillover between private life and work accounted for the largest amount of explained variance in both burnout and work engagement. Job demands were more strongly related to burnout, whereas job resources more strongly related to work engagement. The predictors with the greatest relative influence on both burnout and work engagement were unmet expectations and mastery of skills. CONCLUSIONS: The results support the importance of the work context's impact on burnout and work engagement. Additionally, the interaction between private life and work should be further studied in future studies.

Early-career burnout among new graduate nurses: a prospective observational study of intra-individual change trajectories.

BACKGROUND: Newly qualified and inexperienced nurses are at particular risk of suffering emotional exhaustion and burnout in unsupportive practice environments. Despite new nurses' potential vulnerability, development of burnout after graduation has rarely been studied longitudinally and in relation to demographic and educational characteristics prior to working life entry, i.e. during education. OBJECTIVES: To identify and compare typical change trajectories (i.e. common patterns of intra-individual development) in burnout symptoms for new graduate nurses annually over a three-year period, during which there was reason to believe that this group was especially vulnerable. DESIGN: A prospective longitudinal and national cohort of 1153 nurses within the population-based LANE study (Longitudinal Analyses of Nursing Education), where new graduate nurses were assessed four times annually, i.e. in their final year of nursing education and three times post graduation (after 1, 2 and 3 years). PARTICIPANTS: A longitudinal sample of 997 respondents was prospectively followed. METHODS: Within-group changes in burnout levels were analysed using a repeated-measures analysis of variance, and cluster analytic techniques were used to identify typical trajectories of burnout. RESULTS: At group level, mean levels of burnout were rather stable across time. However, underlying these levels we identified eight change trajectories, explaining 74% of all individual variation; seven of them reflected significant changes across time. Almost every fifth nurse reported extremely high levels of burnout at some point during their first three years after graduation. Changes in burnout levels were accompanied by concurrent changes in depressive symptoms and intention to leave the profession. This study also showed that negative development of burnout was predicted by not feeling well prepared for a nursing job, lacking study interest, high levels of performance-based self-esteem and depressive mood in the final year of education. CONCLUSIONS: An investigation of burnout symptoms over time disclosed numerous development patterns, some of which were stable while others changed significantly. Hence, this study gave a more nuanced picture of burnout development among new graduate nurses, highlighted by eight different trajectories. Regarding the time frame, nearly every second new graduate showed a significant increase in levels of burnout during their second year post graduation.

A psychometric evaluation of the Scale of Work Engagement and Burnout (SWEBO).

OBJECTIVE: Burnout and work engagement are generally defined as psychological states but the methods used to measure these constructs are more in line with methods used to assess psychological traits. Thus, a new instrument called the Scale of Work Engagement and Burnout (SWEBO) measuring the state mood of burnout and work engagement was developed during the fall of 2007. The purpose of the present study was to evaluate the SWEBO using psychometrical methods. PARTICIPANTS: The sample consisted of 2,266 newly graduated Swedish nurses and teachers. METHODS: Measurement models of both burnout and work engagement were evaluated using confirmatory factor analysis (CFA). Both burnout and work engagement were also tested for measurement invariance across occupation and age. RESULTS: The fit of the measurement model of burnout was satisfactory and it was invariant across both occupation and age. The measurement model of work engagement as initially defined did not fit the data satisfactorily. The model was therefore revised and reanalyzed. The revised model had a satisfactory fit and was invariant across occupation. Analysis of its invariance across age, however, gave ambiguous results that were difficult to interpret. CONCLUSIONS: The SWEBO presents a psychometrically sound alternative for measuring burnout and work engagement.

Karolinska Interpersonal Violence Scale predicts suicide in suicide attempters.

BACKGROUND: Both childhood trauma and violent behavior are important risk factors for suicidal behavior. The aim of the present study was to construct and validate a clinical rating scale that could measure both the exposure to and the expression of violence in childhood and during adult life and to study the ability of the Karolinska Interpersonal Violence Scale (KIVS) to predict ultimate suicide in suicide attempters. METHOD: A total of 161 suicide attempters and 95 healthy volunteers were assessed with the KIVS measuring exposure to violence and expressed violent behavior in childhood (between 6-14 years of age) and during adult life (15 years or older). The Buss-Durkee Hostility Inventory (BDHI), "Urge to act out hostility" subscale from the Hostility and Direction of Hostility Questionnaire (HDHQ), and the Early Experience Questionnaire (EEQ) were used for validation. All patients were followed up for cause of death and a minimum of 4 years from entering in the study. RESULTS: Five patients who committed suicide within 4 years had significantly higher scores in exposure to violence as a child, in expressed violent behavior as an adult, and in KIVS total score compared to survivors. Suicide attempters scored significantly higher compared to healthy volunteers in 3 of the 4 KIVS subscales. There were significant correlations between the subscales measuring exposure to and expression of violent behavior during the life cycle. BDHI, Urge to act out hostility, and EEQ validated the KIVS. CONCLUSIONS: Exposure to violence in childhood and violent behavior in adulthood are risk factors for completed suicide in suicide attempters. Behavioral dysregulation of aggression is important to assess in clinical work. The KIVS is a valuable new tool for case detection and long-term clinical suicide prevention.

Early career burnout among nurses: modelling a hypothesized process using an item response approach.

BACKGROUND: Cherniss's pioneering research on burnout, based on grounded theory, focused specifically on competence crisis among new graduates, and identified negative attitude changes as the core phenomenon in the progression from competence crisis into early career burnout. In this model, the two main burnout dimensions of exhaustion and dysfunctional coping are ordered sequentially; i.e., initial exhaustion develops, due to dysfunctional coping (cynicism and disengagement), into burnout. OBJECTIVE: To test the sequential-developmental model of burnout originally proposed by Cherniss, using a psychometric approach. DESIGN: A sample of 933 early-career nursing professionals, recruited from a Swedish population-based cohort (response rate 81%), were assessed three years after graduation, using items from a burnout inventory. Data were analysed using the Rasch measurement model. RESULTS: The psychometric tests showed that data adhere to a sequential-developmental model when examined using the one-parameter item response approach. When tested against external variables, the prevalence of low mood, low levels of job performance and health problems increased monotonically along this sequential-developmental model of early career burnout. CONCLUSION: Among early-career nursing professionals burnout may be operationalized as a one-dimensional sequential-developmental model. This model resembles the results found in the literature on transition and socialization, and the association between these psychometric results and studies on nursing students' transition and socialization into working life are discussed.

Association between striatal and extrastriatal dopamine D2-receptor binding and social desirability.

Research on the biological underpinnings of personality can provide leads to the pathophysiology of psychiatric disorders. In particular, interpersonal aspects of behavior are a common problem during the course of psychiatric illness. Animal research has demonstrated a role for the dopamine system in social behaviour, and recent molecular imaging studies have shown a negative correlation between dopamine D2-receptor binding in the striatum and social desirability. The emotional and cognitive aspects of social behavior suggest involvement of brain regions outside of the striatum, such as limbic structures. The aim of the present study was to explore associations between the personality trait social desirability and dopamine D2-receptor binding in both striatal and extrastriatal brain regions. We examined 16 control subjects with Positron Emission Tomography and the radioligands [(11)C]raclopride and [(11)C]FLB 457, in relation to social desirability in the inventory Swedish universities Scales of Personality. [(11)C]raclopride D2-receptor binding in the striatum showed negative correlations to social desirability scores, corroborating previous findings. Furthermore, a correlation of a higher statistical significance was demonstrated for [(11)C]FLB 457 binding in the hippocampal-amygdala complex. A separate analysis of social desirability items in relation to a model of interpersonal behaviour revealed that the associations were driven by items reflecting high submissiveness and high affiliation. Taken together with previous evidence on D2-receptor binding and social behaviour, a role for dopaminergic neurotransmission in regulating displays of dominance vs. submissive behaviour is proposed.

Can scales assessing psychological and social factors at work be used across different occupations?

AIM: To assess the psychometric properties of a comprehensive tool for assessing psychosocial work characteristics(the QPSNordic), focusing on measurement invariance (MI) across occupations. METHODS: QPSNordic consists of 26 scales covering task, individual, and organizational aspects of work. Multiple group confirmatory factor analyses were performed in order to elucidate MI across a variety of occupational groups. SUBJECTS: Private sector employees and health care workers from the public sector participated. Equal size (n = 500) groups from six different occupations were drawn and entered in multiple group confirmatory factor analyses for assessment of MI. RESULTS: Nine of the 24 analysed scales functioned well across all occupational groups and could thus be used for valid comparisons across professions. The majority of the remaining scales showed MI at least across some groups. CONCLUSION: With some exceptions, the QPSNordic has good psychometric properties. Scales measuring organizational aspects of work could also be used across professional groups, enabling valid comparisons between differing workplaces and occupations.

Psychometric properties of scales in the General Nordic Questionnaire for Psychological and Social Factors at Work (QPS): confirmatory factor analysis and prediction of certified long-term sickness absence.

Psychometric properties, particularly predictive validity, of scales in the General Nordic Questionnaire for Psychological and Social Factors at Work (QPS(Nordic)) were assessed. The analysis is confined to the scales in the QPS(Nordic,) and 24 of the 26 scales are included. A large group of Swedish county council employees (n= 3,976; response rate = 65%) participated in a study and were given the QPS(Nordic). Register data for long-term sick leave (>90 days), with diagnosis, were used for predictive analysis. The following main results were obtained: Reliability was generally satisfactory, confirmatory factor analysis indicated good fit, concurrent validity was good, some less often investigated organizational variables predicted sickness absence, and scales were differentially associated with absence due to psychiatric and musculoskeletal disorders. In conclusion, the psychometric testing of the QPS(Nordic) so far suggests that it is a good instrument for assessing health-related factors at work.

Personality traits measured by the Swedish universities Scales of Personality: factor structure and position within the five-factor model in an Estonian sample.

The study aims to test the reliability and validity of the Estonian version of the Swedish universities Scales of Personality (SSP), and to characterize the position of the SSP-measured traits within the basic personality dimensions of the five-factor model. A total of 529 participants completed the Estonian version of the SSP. A subsample of 197 persons completed the SSP together with the Revised NEO Personality Inventory (NEO-PI-R). The internal consistency of the SSP scales was satisfactory. Principal component analysis yielded three factors representing neuroticism, aggression and disinhibition. The factor solution obtained in the Estonian sample was similar to the original SSP study in the Swedish normative sample. NEO-PI-R Neuroticism had highest correlations with SSP neuroticism factor scales. Extraversion had strongest relationship with adventure seeking and low detachment. Agreeableness correlated positively with SSP social desirability and negatively to aggression-irritability scales. Conscientiousness facet Deliberation correlated with Impulsiveness. The Estonian SSP showed acceptable reliability and validity, which confirms that SSP is applicable in different social and cultural background. The SSP measures traits that correspond to the major personality models. The SSP characterizes three broad dimensions of personality, namely neuroticism, disinhibition and aggression, which are useful in assessment of personality correlates of mental disorders.

Using the Rasch model in nursing research: an introduction and illustrative example.

OBJECTIVE: The purpose was to introduce the Rasch model by showing an application in nursing research. METHODS: The Rasch model was used to examine the psychometric properties of the nursing self-efficacy (NSE) scale. Data were collected among nursing students in Sweden. Two sets of items were analysed more thoroughly: an original set of nine items with eleven response categories and a revised set of seven items with seven response categories. Invariance of the item functioning and the categorisation of the items were analysed. Targeting was examined by comparisons of the items and persons locations. Differential Item Functioning across sample groups such as gender was examined using analysis of variance. The final set of seven items was also analysed more closely with respect to possible multidimensionality and response dependence. RESULTS: The Rasch analysis of the original set of nine items showed high reliability measured by a person separation index, but it also indicated severe problems with the targeting, the categorisation of the items as well as lack of invariance. Although the revised set comprising seven items with seven categories performed better than the original item set some items showed misfit according to formal test statistics. Graphical examination showed, however, that the items operated in the right direction. The formal test of local independence of the items indicated minor signs of multidimensionality, alternatively response dependence. CONCLUSIONS: The Rasch model is useful for rigorous examination and development of measurement instruments in nursing research. The Rasch model facilitates disclosure of lack of invariance and other measurement problems that may not be easily detected by traditional analyses. Hence, the NSE-scale would probably have performed much better if the developmental work had been guided by Rasch analyses. In future work on the scale, priority should be given to improving the targeting and the categorisation of the items.

Registered nurses' application of evidence-based practice: a national survey.

BACKGROUND: Evidence-based practice (EBP) is a worldwide approach to improving health care. There is, however, a shortage of studies examining whether or not newly graduated health care professionals are actually applying EBP in their daily work. OBJECTIVES: To examine the application of EBP in clinical practice by registered nurses (RNs) 2 years post graduation and to explore whether the application of EBP differed with regard to the clinical settings where RNs were working. METHOD: A cross-sectional design using a national sample. Data were collected in 2007 from 987 RNs (response rate 76%). Six items measuring respondents' self-reported extent of applying EBP were used. Results Of the 987 RNs, 19% formulated questions and performed searches in data bases, 56% used other information sources, 31% appraised the literature, 30% participated in practice development and 34% participated in evaluating clinical practice. A greater proportion of the RNs working in elder care applied EBP compared with the RNs working in hospitals, psychiatric care and primary care. CONCLUSIONS: The RNs applied the components of EBP to a rather low extent 2 years post graduation despite EBP being an important objective in Swedish health care and educational programmes since the 1990s. These findings support other studies reporting the implementation of EBP in organizations as a complex and often slow process. The differences in the RNs extent of applying EBP in relation to their workplace indicate that contextual factors and the role of the RN in the organization are of importance for getting EBP into practice.