Attitudes of Cardiovascular Nurses Toward Evidence-Based Practice: A Descriptive Study in Turkey - Research Paper

Abstract

Rationale, Aims, and Objectives

Cardiovascular nursing has been a rapidly growing specialty since the 1960s. Assessing cardiovascular nurses' EBN (evidencebased nursing) attitudes and beliefs and the factors supporting EBN is important to assist the training programmes in fostering EBN practice in a clinical environment. Few investigations have been conducted on EBN knowledge, attitudes, beliefs, and implementation among cardiovascular nurses. The present study aims to investigate cardiovascular nurses' attitudes towards EBN, sources of knowledge, and the factors supporting EBN in Turkey.

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Methods

A crosssectional survey with a descriptive and comparative design was conducted with 62 cardiovascular nurses working at two hospitals in Turkey. Data were collected by using the EvidenceBased Nursing Attitude Questionnaire, a sociodemographic questionnaire concerning demographic information and including questions about nurses' sources of knowledge, supporting factors to implement EBN, research experience, use of clinical guidelines, and barriers to applying EBN. Data were analysed with descriptive and inferential statistics.

Results

The research revealed that cardiovascular nurses have positive attitudes, feelings, beliefs, and intention of conduct towards EBN. Cardiac surgery nurses reported significantly higher positive feelings, beliefs, intention of conduct, and attitude towards EBN than cardiology nurses. Nursing experience and information acquired through nursing school were the most frequently used sources of knowledge rather than research results (35.5%) in their clinical practice. Half of the respondents (47%) were familiar with EBN. Cardiovascular nurses who had graduate degrees, reviewed nursing research and were familiar with EBN had significant positive attitudes towards EBN. Nurses needed enough time and resources, a background in clinical practice, and support from the hospital administration to implement EBN.

Conclusions

An education intervention should be provided about EBN knowledge and skills for cardiovascular nurses. Mentor nurses should be trained and assigned in cardiovascular clinics to implement EBN.

Introduction

Evidencebased practice (EBP) has become a priority for health care providers, decision makers, and researchers.1, 2 For nurses, EBP has been considered critical to improve knowledge, quality of patient care, patient outcomes, and patient satisfaction and to develop new nursing interventions1, 3-5 that forces them to be accountable for having the ability to access and evaluate the best research evidence and integrating it into the clinical decisionmaking process.6, 7 Evidencebased nursing (EBN) as defined by DiCenso et al8 is a process by which nurses make clinical decisions integrating their clinical expertise, patient preferences, and the best available evidence in the context of available resources. This definition of EBN ensures patientcentred care and fills the gap between theory, research, and practice. EBN has been recognized by The International Council of Nurses as a gold standard for improving nursing care.6 Hence, nursing care should be based on the best available evidence.9, 10

The literature suggests that there is a considerable gap between transferring research evidence into clinical practice.1, 11, 12 Recent studies concluded that nurses' knowledge/skill and practice levels regarding EBP were relatively low, although they have positive attitudes and beliefs towards EBP.1, 10, 11, 13, 14 Park et al5 reported that nurses' attitudes towards EBN were one of the strongest driving factors of research utilization and utilization intent towards EBN. In addition, another facilitator of EBP was the belief about the value of EBP9 that nurses' positive beliefs towards EBP impacted their intent to implement evidencebased care in their daily practice.15 A few investigations have been performed on EBN knowledge, attitudes, beliefs, and implementation among critical care nurses working with cardiovascular patients.16-18 McKee et al17 found that 12% of nurses and allied health professionals working with cardiac patients from 37 different countries routinely used the European Society of Cardiology prevention guidelines in their clinical practice. The respondents reported that time and lack of leadership were the greatest barriers to implementing the guidelines, and 66% of the respondents indicated additional educational needs. Egerod et al16 reported that cardiac nurses had positive attitudes towards EBN. However, cardiac nurses relied on personal experience as a source of knowledge in clinical practice.

Cardiovascular nursing has been a rapidly growing specialty since the 1960s. The American Heart Association and the World Health Organization recognized the key supporting role of nurses and other team members in reducing death and disability from cardiovascular disease by 25% by 2025. Hence, cardiovascular nurses have to improve their capability to implement clinical practice guidelines, protocols, and EBN to decrease rehospitalization, improve patient outcomes, reduce morbidity and mortality, and save time through standardizing and organizing the patientcentred care in cardiovascular practice.19, 20 In the case of Turkey, nurses need to use available research evidence and be accountable for providing EBN care in practice. EBN was introduced into academic fields in the beginning of the 2000s, although nurses have faced many challenges to promote the use of EBN and research in clinical practice.3 Yava et al18 reported that the most important barriers perceived by cardiovascular nurses were lack of time, collaboration, and selfauthority to utilize research.

Furthermore, nurses indicated educational and administrative support for utilizing research. Understanding cardiovascular nurses' attitudes and beliefs towards EBN is crucial to plan training programmes, fill in knowledge gaps, develop strategies for breaking the barriers, and shift the attitudes towards EBP implementation and dissemination in Turkey.18 The present study sought to examine cardiovascular nurses' attitudes towards EBN, sources of knowledge, and the factors supporting EBN in Turkey. The aims of this study were to investigate the following:

• Cardiovascular nurses' attitudes, feelings, beliefs, and intention of conduct towards EBN.
• Differences between cardiology and cardiac surgery nurses' attitudes, feelings, beliefs, and intention of conduct towards EBN.
• Differences between demographic variables and cardiovascular nurses' attitudes, feelings, beliefs, and intention of conduct towards EBN.
• Cardiovascular nurses' research experience and barriers to applying EBN.
• Cardiovascular nurses' sources of knowledge and the factors supporting EBN.

METHODS

Study design

A crosssectional survey with a descriptive and comparative design was used to investigate cardiovascular nurses' attitudes towards EBN, sources of knowledge, and the factors supporting EBN in Turkey.

Participants and Setting

The present study was conducted in two hospitals that provide inpatient and outpatient health care in cardiology clinics and are among the most preferred hospitals in the field of cardiology and cardiovascular surgery in Ankara. In Turkey, nurses working in cardiology wards and intensive care units (ICUs) deliver care to patients with chronic heart diseases and to interventional cardiology patients. On the other hand, nurses working in cardiovascular surgery wards and ICUs deliver care to preop and postop cardiac surgery patients. All cardiovascular nurses have a key role in reducing death and disability from cardiovascular disease.

A convenience sample of the 172 nurses working in cardiology and cardiovascular surgery wards and ICUs at a university and at a state hospital in Ankara, Turkey, was invited to participate in the study. A total of 68 nurses (37%) returned the questionnaire. Inclusion criteria were delivering cardiovascular care to adult patients, working in cardiovascular wards and ICUs, and not being on leave at the time of data collection. Six respondents (8%) did not meet the criteria, so they were excluded from the study, resulting in 62 (36%) nurses participating in this study.

Data Collection

Data Collection Procedure

Data were collected from January to May 2017. The researchers approached all nurses directly. All nurses were provided with a paperbased survey on their clinical practice and were invited by the researchers to participate. The nurses were asked to place the completed questionnaires in a closed envelope to assure anonymity. The researchers, who visited cardiovascular wards and ICUs once a week, reminded the participants to complete the survey.

Measurements

The survey included a sociodemographic questionnaire form and the EBNAQ (EvidenceBased Nursing Attitude Questionnaire). The sociodemographic questionnaire consisted of two sections. The first section included demographic information: age (continuous), gender (male vs female), level of education (high school, associate degree, graduate degree), years of nursing experience (continuous), years of cardiovascular nursing experience (continuous), years since graduation from nursing school (continuous), specialty (cardiology vs cardiac surgery), working shift (daytime, night shift, rotation), weekly working hours (continuous), number of patients cared for per nurse during one shift (continuous), familiarity with EBN (categorical), attendance of an EBN course (categorical), and possession of information about EBN (categorical). The second section had questions about nurses' sources of knowledge in clinical practice (nursing experience, knowledge from nursing school, research results, hospital policy and procedures, and clinical practice guidelines), supporting factors to implement EBN (EBN and research training, mentor nurses, sufficient time, adequate facilities for EBN in the clinical setting, support from the hospital administration and a national EBN centre), professional conferences attended, research experience, practice reviewing nursing research, believed in nursing research results, and adherence to clinical guidelines. In addition, two openended questions inquired about access to nursing databases and journals and asked for comments on the barriers to applying EBN. A sociodemographic questionnaire was developed by the researchers and was guided by the literature.1-4, 10-13, 16, 21

The EBNAQ was developed by RuzafaMartinez et al22 to assess nurses' attitudes towards EBN among Spanishspeaking nurses. In 2015, Ayhan et al,23 the authors of the Turkish validity and reliability study of the EBNAQ, translated it into Turkish. The Turkish version of the EBNAQ demonstrated strong psychometric properties.23 In this study, Cronbach a coefficient was 0.85 for the entire questionnaire, 0.89 for the beliefs and expectation subscale, 0.56 for the intention of conduct subscale, and 0.76 for the feelings towards EBN subscale.

The EBNAQ consists of 15 items, including three subscales measuring beliefs and expectations, the intention of conduct and feelings towards EBN. The responses were presented on a 5point Likerttype scale, with responses ranging from 1 "strongly disagree" to 5 "strongly agree." Seven questions were worded negatively and were reverse...