The EBP Toolkit: More Tools than You Thought!

Background: Evidence-based practice (EBP) is a cornerstone of safe, high-quality care. Many factors influence successful use of EBP, from clinician attitudes/beliefs, self-efficacy and knowledge/skills to contextual factors like unit/organizational culture. Based on a recent integrative review, this presentation will increase nurses understanding of valid and reliable EBP instruments so they can utilize these tools to advance critical EBP domains in their healthcare organizations and thereby improve health outcomes.

Methods: A systematic search of CINAHL, PubMed, EMBASE, Joanna Briggs and Cochrane Library was performed to acquire original research testing the reliability/validity of EBP nursing instruments. Key search terms included EBP, instruments, tools, nurses, beliefs, attitudes, self-efficacy, readiness, knowledge/skills, implementation, behaviors, leadership, and culture.

Results: Of 347 records, 50 instruments underwent at least one method of reliability or validity testing. Data extracted for each instrument included author, year, name, country, evaluation aim, conceptual base, item type, data collection method, scoring, psychometric properties, acceptability, feasibility, and readability. Most instruments were validated in English. Of all 50 instruments: Three measured attitudes/beliefs about one’s EBP ability or its value. Eight measured self-efficacy or confidence in one’s EBP ability or its expected outcomes. Ten measured knowledge/skills in EBP steps/components. Five measured implementation of evidence and how contextual factors hinder or facilitate it. Five measured EBP culture, such as perceptions of readiness, leadership or mentorship at the unit/organizational level. 19 measured >1 above EBP domains. Standards for content validity, construct validity and internal consistency were met for 70%, 62% and 94% of instruments, respectively. Limited testing was found for other types of validity, test-retest reliability, acceptability, feasibility, or responsivity/sensitivity and thus, represent gaps in psychometric validation. Less than 20% of instruments have been translated to other languages limiting their use to advance EBP worldwide.

Implications for practice: This collection of EBP instruments is a significant contribution to advancing EBP cultures. Nurses can utilize these tools in education and practice to shape necessary beliefs, knowledge/skills, and culture to globally support EBP in ambulatory care areas and the broader healthcare organization. These instruments can serve multiple purposes such as devising strategic plans and setting goals to build infrastructures that support EBP practice environments; acquiring resources (e.g., databases, librarians, advanced practice nurses) to support EBP cultures; examining beliefs, self-efficacy, and knowledge/skills to identify nurses’ professional development needs; investigating how often nurses apply EBP knowledge/skills to discover opportunities for coaching/mentoring; assessing barriers/facilitators to develop strategies to address contextual factors; and evaluating improvement in EBP domains after tailored interventions are implemented at the unit/division/organizational level.
Using these instruments in research is also imperative to advance the global EBP agenda. Comparative effectiveness research is vital to generate new knowledge about educational and system interventions that improve nurses’ beliefs and confidence in their knowledge/skills to routinely implement EBP in practice.

Conclusion: 82% of instruments met minimal psychometric standards. Expanding psychometric testing and utilizing validated EBP instruments in education, practice, and research will further the EBP movement to improve population health across the globe.