A national study exploring knowledge, beliefs and implementation of evidence based practice among nurses, midwives, lecturers and students in the Republic of Ireland

Background: Evidence-based practice (EBP) is a problem-solving approach to healthcare that combines the use of best available evidence, healthcare professionals’ expertise, and patient preferences/values (Melnyk and Fineout-Overholt, 2019). It yields proven benefits for patients, healthcare professionals and organisations alike. However, EBP implementation remains inconsistent among nurses and midwives. Understanding the factors involved here is key to facilitating system-wide integration of EBP.

Aim: This study aimed to establish the EBP beliefs, knowledge, and implementation of nurses and midwives, and the organizational culture of their workplaces.

Methods: Seven validated EBP questionnaires and one open question were provided to nursing/midwifery lecturers (n=71) and students (n=222) in nine randomly sampled Higher Education Institutions, and clinical nurses and midwives (n=292) in affiliated general hospitals in the Republic of Ireland. Response rates were 22.3%, 19.4% and 7% respectively. Descriptive, inferential and correlational statistics were used to analyse the demographic characteristics, group mean scores and distribution of each cohort on the seven scales, and identify relationships between EBP beliefs, implementation and organisational culture and readiness for EBP. Content analysis was used to analyse participants’ responses to the open question on the survey.

Results: Overall findings revealed a substantial dearth of EBP knowledge in all cohorts. Participants generally demonstrated positive beliefs about EBP (Lecturers M=87.72 SD=10.91 on a scale of 22-110; Students M=55.18 SD10.29; and Clinical M=59.98 8.68, both on a scale of 16-80. Higher scores indicate higher beliefs). However, beliefs regarding their own ability to implement EBP were lower. EBP implementation proved low across the three cohorts (Lecturers M=31.09 SD=16.54; Students M=16.59 SD12.11; Clinical M=12.85 SD=14, on a scale of 0-72. Higher scores indicate higher implementation). Participants’ perceptions of their organisations’ support and readiness for EBP varied (Lecturers M=86.43 SD=15.01; Students M=93.21 SD=16.21; Clinical M=74.07 SD=19.65, on a scale of 25-125. Higher scores indicate greater organisational culture and readiness for EBP).

Discussion: Nurses and midwives are one of the largest groups of healthcare professionals in the healthcare system and therefore potentially an opportune means by which to facilitate system-wide integration of EBP. However, they must be equipped with appropriate knowledge and skills, and supported by their organisations to do so. Strengths, opportunities and challenges were uncovered that can be used to craft an organisational culture and environment that supports and encourages an EBP approach to nursing and midwifery education as well as to patient care.

Conclusion: Recommendations aimed at improving EBP knowledge, beliefs and implementation include effective integration of EBP into nursing and midwifery programme curricula, EBP training for nurses and midwives in practice, preparation of lecturers to teach EBP, and provision of the necessary resources/supports for a sustainable culture of EBP in the clinical and educational organisations. A collaborative approach to evidence-based patient care maximizing the pooled EBP knowledge and skills of clinicians and lecturers is strongly advocated. It is hoped that these approaches will engender EBP implementation in daily nursing and midwifery practice, and lead to improved outcomes for patients in Ireland for generations to come.