Adopting evidence-based practice in clinical decision making: nurses' perceptions, knowledge, and barriers

Objective:

Evidence-based practice (EBP) provides nurses with a method to use critically appraised and scientifically proven evidence for delivering quality health care to a specific population. The objective of this study was to explore nurses'' awareness of, knowledge of, and attitude toward EBP and factors likely to encourage or create barriers to adoption. In addition, information sources used by nurses and their literature searching skills were also investigated.

Method:

A total of 2,100 copies of the questionnaire were distributed to registered nurses in 2 public hospitals in Singapore, and 1,486 completed forms were returned, resulting in a response rate of 70.8%.

Results:

More than 64% of the nurses expressed a positive attitude toward EBP. However, they pointed out that due to heavy workload, they cannot keep up to date with new evidence. Regarding self-efficacy of EBP-related abilities, the nurses perceived themselves to possess moderate levels of skills. The nurses also felt that EBP training, time availability, and mentoring by nurses with EBP experience would encourage them to implement EBP. The top three barriers to adopting EBP were lack of time, inability to understand statistical terms, and inadequate understanding of the jargon used in research articles. For literature searching, nurses were using basic search features and less than one-quarter of them were familiar with Boolean and proximity operators.

Conclusion:

Although nurses showed a positive attitude toward EBP, certain barriers were hindering their smooth adoption. It is, therefore, desirable that hospital management in Southeast Asia, particularly in Singapore, develop a comprehensive strategy for building EBP competencies through proper training. Moreover, hospital libraries should also play an active role in developing adequate information literacy skills among the nurses.

Highlights

• Nurses in Singapore, as in other countries, support the idea of evidence-based practice (EBP) but have limited skills in the area of literature searching and understanding evidence, which limits their use of evidence-based practice.
• Only a small number of nurses were able to pick an appropriate search strategy for a given topic, indicating a lack of basic literature searching skills.
• Sufficient literature searching knowledge is essential to retrieve current, relevant, and accurate evidence. However, a majority of nurses do not know how to properly use Boolean and proximity operators, indexing, truncation, or limits.

Implications

• Librarians need to be part of providing ongoing training for clinical nurses in searching the evidence, especially in hospitals promoting EBP or seeking Magnet status.
• Training is needed for clinical nurses to be able to achieve the use of EBP, and librarians can support this goal by teaching the search strategies portion of an EBP skills course.
• This study''s instrument could be used by librarians as a needs assessment tool to measure their own clinical nurses'' information literacy skills, if justification is needed locally.

     

KILLER AND VICTIM ISSUES: ISSUE COMPETITION IN THE AGENDA-SETTING PROCESS OF GERMAN TELEVISION

The capacity of the mass media to cover issues as well as thecapacity of recipients to be concerned about issues is limited.The coverage on and the concern about new issues will consequentlyremove old issues from the agenda of both the mass media andthe general public. The present study investigates two modelsof this process of issue competition. The equal-displacementmodel assumes that a rise of one issue in the media by a givennumber of stories is matched by an equal fall in all other issuessumming up to a similar number of issues. The restructuringmodel assumes that unexpected, surprising or otherwise newsworthyevents create killer issues that move several other issues completelyoff the agenda and leave others untouched. A content analysisof all news shows of the two major TV stations in Germany and53 weekly surveys regarding 16 different issues covering thewhole year 1986 shows that—within the media agenda—therewere no killer issues affecting the coverage of the TV stations.In the public agenda, however, some killer issues could be identified.Coverage of these issues increased public concern about themand decreased concerns about other issues. Consequences of theseresults for agenda-setting theory and for politics are discussed.     

FROM DATA PROCESSING TO KNOWLEDGE PROCESSING: A FUNDAMENTAL DEVELOPMENT TENDENCY OF INFORMATICS AND OF COMPUTERS AND ITS REFLECTION IN THE TRAINING OFFERED AT A TECHNICAL UNIVERSITY

For, more than two decades, Artificial Intelligence developed in relative isolation from “traditional informatics”. Thus, a distinct reservoir of specifically theoretical underlying principles, methods and means were created for it. At present, a process of fusing and of integration between these two domains is under way. Linked to this process is a marked broadening and deepening of the scientific fundamentals and the efficiency potential of modern information technologies. Yet, the potential for increased efficiency is far from being exhausted, particularly with regard to application. Written from the point of view of a computer scientist, this article analyses the practical problems and the obstacles which have appeared during the process of transition to the level of knowledge processing. The procedures which have been devised in order to overcome the problems in question are aimed not only at increasing the quality of knowledge representation and knowledge administration but also at introducing artificial intelligence into traditional application areas. The consistent pursuit of these aims will lead to the integration of artificial intelligence and informatics, so as to produce a homogeneous, scientific discipline. Integration of this sort, however, cannot be accomplished by the simple addition of new components or by placing the two domains side by side. Rather, informatics as a discipline must be restructured and the contents of its separate domains unified. The integration process has been particularly noticeable in the domain of data bank technology, especially with regard to knowledge representation and knowledge bank administration. This process has led to a qualitatively more advanced development stage as compared t o traditional data bank technology and knowledge administration. It is reflected in higher education in the transition from the traditional qualifications of knowledge engineers to those of data bank and knowledge processing engineers.     

OPINION FORMATION IN MEDIATED CONFLICTS AND CRISES: A THEORY OF COGNITIVE-AFFECTIVE MEDIA EFFECTS

This paper analyzes opinion formation in the cases of threemediated conflicts using a complex model that evaluates therespondents' value systems, the coverage of the mass media used,the recipients' familiarity with specific events occurring inthe conflicts, and their positions on the issues. The modelpredicts that the recipients' long-term value systems influencetheir positions on the issue in two ways. Firstly, value systemshave a direct impact on the short-term positions on an issue.Secondly, value systems have an indirect impact on the positionsof issues by influencing the recipients' selection of news mediaand thus the type and amount of news information they are exposedto. The type and amount of news influences how knowledgeablethey are of the events related to the conflicts. The familiaritywith these events influences their positions on the issues.Value systems, media usage, familiarity and positions on theissues were measured in a survey. A parallel content analysisexamined the coverage of the conflicts in the German mass media(press, radio, television) during the six-month time frame priorto the survey. Both data sets were merged in order to give anestimate of the information each recipient was exposed to. Theresults of multiple regression analyses support the theoreticalmodel. Furthermore, this paper discusses the relevance of themodel for the analysis of opinion formation as well as the limitationsof the model.     

Retelling herstory: to be a female Bedouin teacher differently

The aim of this article is to contribute to the discussion on education in Palestinian/Bedouin society in the Negev in Israel and it proposes the narrative of female trainee teachers as the basis of an analysis of the changing status of Bedouin women and their community. The academic discourse on teaching in Bedouin society ignores the potential existence of an alternative discussion outside the dichotomous area of ‘traditional and modern’ and/or ‘Jewish and Bedouin’. Bedouin society in the Negev constitutes a particularly interesting case for a meaningful study of the perception of teaching, chiefly because education has already become a significant practice in the life of a community that seeks integration into Israeli society. The teaching profession gives Bedouin women from the Negev a relatively new opportunity to integrate into education and employment and by so doing they reconstruct a new educational discourse.

Il’il: When we were little, we used to laugh about me—hmm—a teacher. Me with pupils, and I’d teach them, like the teacher who used to teach us, with a little board, and I write for them and they are my pupils, as it were, and I give them tests and all sorts. And I love the profession very, very much because I love the pupils…

Nura: I loved learning but this isn’t the profession that I want to study—to be a teacher … You can help someone in this profession. I see myself going in that direction … First of all, you have to give, to impart something to the children in front of you, who have come to learn. You have to give to these children, to be conscientious. You don’t just come. You haven’t chosen the profession because you wanted to, but you have to cope with it.     

Science students' approaches to learning

A small group of science students were closely followed through their under-graduate course. The problems and issues which arose as they came to terms with university are described. The notions of course-focussed and interest-focussed behaviour are introduced as ways of characterising the degree of independence the student demonstrated in relation to his learning objectives. These notions are discussed and further employed to indicate various attitudes and approaches to study which students adaptively developed in relation to their university work.Formerly of the Centre for Educational Technology, University of Sussex.     

The National Library for the Handicapped Child

Beverley Mathias is one of the trustees of the Sidney Robbins Trust, set up in memory of the founder ofChildren's Literature in Education. Since 1985 she has been Director of The National Library for the Handicapped Child in the U.K. The Editors invited her to describe the work of this important institution in the field of learning to read.Beverley Mathias worked as a librarian in Australia, where she was also associated with Court and Joyce Oldmeadow, winners of the Eleanor Farjeon Award, specialising in children's books. From 1979 to 1985, Ms. Mathias was Children's Books Officer for the National Book League (now the Book Trust) in London. She has published two poetry compilations for children and a new series of books for deaf and hearing children.     

Twelve- and Fourteen-Year-Old School Children Differentially Benefit from Sensorimotor- and Multisensory-Enriched Vocabulary Training

Educational Psychology Review - Both children and adults have been shown to benefit from the integration of multisensory and sensorimotor enrichment into pedagogy. For example, integrating pictures...     

Schools in the making: mapping digital spaces of evidence

In this article, the focus is on educational governing in the making. Drawing on conceptual underpinnings of socio-technical approaches, this implies an interest both on the way in which a sound knowledge base for policy measures is created, as on the distribution of that knowledge through publically available instruments. Governing by evidence only is possible when it relies on concrete instruments, such as feedback reports, publically consultable audits and examples of good practice. Since knowledge-related practices increasingly make use of online tools where knowledge is accessible for each and all, three websites are analysed in a particular way to describe the making of evidence. First, considered as active devices, the websites are analysed as essential components of the governing by evidence: by publishing specific data and information in a particular way, they come to constitute what comes to count as evidence and the way in which it comes to count. By addressing their visitors in a particular way, moreover, they constitute for whom it comes to count as evidence. As such, we argue, it becomes visible that digital spaces of evidence actually make schools real, and, at once, that there are different modes for schools to exist.