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Culture of Evidence-Based Practice and Quality Improvement in Nursing
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Culture of Evidence-Based Practice and Quality Improvement in Nursing

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (30 September 2022) | Viewed by 17726

Special Issue Editors

Dr. Hester Vermeulen

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Guest Editor
Department of IQ Healthcare, Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
Interests: excellence in nursing; evidence-based practice; low value care; quality improvement research; leadership; quality of care; professionalization and implementation
Dr. Anneke van Vught

E-Mail Website
Guest Editor
Department for Organization of Care and Services, University of Applied Sciences of Arnhem and Nijmegen, Ruitenberglaan 31, 6826 CC Arnhem, The Netherlands
Interests: physician assistants and nurse practitioners in a changing healthcare system; evidence-based practice; learning culture, qualitative and quantitative research methods; participatory action research
Dr. Getty G. J. Huisman-de Waal

E-Mail Website
Guest Editor
Department of IQ Healthcare, Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
Interests: fundamental nursing care; general surgery; evidence-based practice; low value care; clinical nutrition; systematic reviews; health promotion

Special Issue Information

Dear Colleagues,

“Doing the right things right”!

The International Journal of Environmental Research and Public Health is calling for papers for a Special Issue on Culture of Evidence-Based Practice and Quality Improvement in Nursing. The substantiation of nursing science has accelerated during the past decade. Accordingly, the attention and demands on evidence-based practice (EBP) and quality improvement (QI) have also grown. EBP is defined as the conscientious explicit and judicious use of current best evidence in helping individual patients make decisions about their care in the light of their personal values and beliefs. EBP is about “doing the right things’’. QI is defined as a continuous systematic data-guided approach to improve processes and outcomes of healthcare—QI is about “doing things right”. EBP and QI offer complementary focus and methods to achieve the best possible patient outcomes.

This Special Issue will focus on the implementation and the permanent assurance of EBP and QI in daily routines and practices. This is important for all healthcare professionals, but in particular for nurses as they are responsible for the provision of fundamental health care. We will explore competencies, barriers, and facilitators, as well as the effectiveness of the implementation of EBP and QI in daily nursing practice. We welcome original research with innovative research designs such as stepped wedge design, interrupted time series, and mixed-methods studies to develop or evaluate evidence-based quality improvement interventions, as well as research articles or reviews on the implementation of EBP and QI in daily nursing practice in all settings of health care.

Dr. Hester Vermeulen
Dr. Anneke van Vught
Dr. Getty G. J. Huisman-de Waal
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • EBQI
  • EBP
  • QI
  • implementation
  • fundamental care
  • daily nursing practice
  • leadership
  • designs for quality improvement research
  • stepped wedge
  • cluster randomized trials
  • interrupted time series
  • controlled before-after studies
  • mixed-methods studies

Published Papers (7 papers)

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Research

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10 pages, 334 KiB  
Article
Nurse Leadership and Work Environment Association with Outcome Expectancy and Self-Efficacy in Evidence-Based Practice among Hospital Nurses in The Netherlands: A Cross-Sectional Study
by Peter Hoegen, Mireille Vos, Catharina van Oostveen, Cindy de Bot, Michael A. Echteld, Jolanda Maaskant and Hester Vermeulen
Int. J. Environ. Res. Public Health 2022, 19(21), 14422; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph192114422 - 03 Nov 2022
Cited by 3 | Viewed by 2074
Abstract
The active participation of nurses in evidence-based practice (EBP) is challenging and topical, as shown by the worldwide calls for appropriate, accessible, affordable care and the de-implementation of unnecessary care. Nurses’ perceived support from their managers and work environments may affect their self-efficacy [...] Read more.
The active participation of nurses in evidence-based practice (EBP) is challenging and topical, as shown by the worldwide calls for appropriate, accessible, affordable care and the de-implementation of unnecessary care. Nurses’ perceived support from their managers and work environments may affect their self-efficacy and outcome expectancy in EBP, as well as hinder them in EBP. Associations between these issues have not yet been explored. This study examines the association of self-efficacy and outcome expectancy levels in EBP, as well as the perceived support for EBP from nurse leaders and in the working environment, among Dutch hospital nurses. Methods. Questionnaires measuring nurses’ self-efficacy, outcome expectancy, and perceived support for EBP from nurse leaders and their work environment were completed by 306 nurses in eight hospitals between March 2021 and June 2021. We used multilevel regression analyses to determine the associations and covariates. Results. This study shows that EBP-supportive leaders and work environments positively contribute to nurses’ self-efficacy and outcome expectancy in EBP, along with the covariates undertaking EBP activities and educational level. Conclusions. To improve nurses’ active participation in EBP, nurses need to increase their self-efficacy and outcome expectancy in EBP. Supportive leaders and a supportive work environment do have an impact. Hence, these factors need attention when implementing EBP among nurses. Full article
(This article belongs to the Special Issue Culture of Evidence-Based Practice and Quality Improvement in Nursing)
8 pages, 298 KiB  
Article
Why Are We Frequently Ordering Urinalyses in Patients without Symptoms of Urinary Tract Infections in the Emergency Department?
by Tessa M. Z. X. K. van Horrik, Bart J. Laan, Allard B. Huizinga, Gercora Hoitinga, Walter P. Poortvliet and Suzanne E. Geerlings
Int. J. Environ. Res. Public Health 2022, 19(17), 10757; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191710757 - 29 Aug 2022
Cited by 2 | Viewed by 1769
Abstract
(1) Background: In the emergency department (ED), ordering urine tests in patients without symptoms of a urinary tract infection can lead to inappropriate antimicrobial treatment. We aimed to identify factors contributing to the unnecessary ordering of urinalyses in the ED. (2) Methods: An [...] Read more.
(1) Background: In the emergency department (ED), ordering urine tests in patients without symptoms of a urinary tract infection can lead to inappropriate antimicrobial treatment. We aimed to identify factors contributing to the unnecessary ordering of urinalyses in the ED. (2) Methods: An online survey study among nurses and physicians working in the EDs of five hospitals in the Netherlands was conducted. (3) Results: The overall response rate was 26% (221/850; 85 nurses and 136 physicians). The vast majority of the respondents reported knowing when to order urine tests (197/221; 90%). Almost two-thirds of the respondents (145/221; 66%) agreed that they ordered urinalyses because it is rapid and non-invasive to patients. Most nurses (66/86; 78%) said they informed the doctor if they thought the urine test would not contribute to the patient’s diagnosis, but only one-third of the physicians agreed with this statement (44/136; 32%). Most respondents (160/221; 72%) thought guidelines or protocols about urinalyses in the ED would be functional. (4) Conclusions: These results suggest urinalyses were frequently ordered in the ED to achieve a fast work process. Nurses and physicians could improve their communication about the indications for urine tests. Developing diagnostic guidelines for urine testing may be convenient. Full article
(This article belongs to the Special Issue Culture of Evidence-Based Practice and Quality Improvement in Nursing)
12 pages, 602 KiB  
Article
The Evaluation of an Interprofessional QI Program: A Qualitative Study
by Ilja M. Brugman, Annelies Visser, Jolanda M. Maaskant, Suzanne E. Geerlings and Anne M. Eskes
Int. J. Environ. Res. Public Health 2022, 19(16), 10087; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191610087 - 15 Aug 2022
Cited by 2 | Viewed by 2043
Abstract
Background: Quality Improvement (QI) is the key for every healthcare organization. QI programs may help healthcare professionals to develop the needed skills for interprofessional collaboration through interprofessional education. Furthermore, the role of diversity in QI teams is not yet fully understood. This [...] Read more.
Background: Quality Improvement (QI) is the key for every healthcare organization. QI programs may help healthcare professionals to develop the needed skills for interprofessional collaboration through interprofessional education. Furthermore, the role of diversity in QI teams is not yet fully understood. This evaluation study aimed to obtain in-depth insights into the expectations and experiences of different stakeholders of a hospital-wide interprofessional QI program. Methods: This qualitative study builds upon 20 semi-structured interviews with participants and two focus groups with the coaches and program advisory board members of this QI program. Data were coded and analyzed using thematic analysis. Results: Three themes emerged from the analysis: “interprofessional education”, “networking” and “motivation: presence with pitfalls”. Working within interprofessional project groups was valuable, because participants with different experiences and skills helped to move the QI project forward. It was simultaneously challenging because IPE was new and revealed problems with hierarchy, communication and planning. Networking was also deemed valuable, but a shared space to keep in contact after finalizing the program was missing. The participants were highly motivated to finish their QI project, but they underestimated the challenges. Conclusions: A hospital-wide QI program must explicitly pay attention to interprofessional collaboration and networking. Leaders of the QI program must cherish the motivation of the participants and make sure that the QI projects are realistic. Full article
(This article belongs to the Special Issue Culture of Evidence-Based Practice and Quality Improvement in Nursing)
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14 pages, 1440 KiB  
Article
A Quality Improvement Project to Support Post-Intensive Care Unit Patients with COVID-19: Structured Telephone Support
by Sabine A. J. J. op ‘t Hoog, Anne M. Eskes, Jos A. H. van Oers, José L. Boerrigter, Meike W. J. C. Prins-Smulders, Margo Oomen, Johannes G. van der Hoeven, Hester Vermeulen and Lilian C. M. Vloet
Int. J. Environ. Res. Public Health 2022, 19(15), 9689; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19159689 - 06 Aug 2022
Viewed by 2090
Abstract
Background: More than 50% of intensive care unit (ICU) survivors suffer from long-lasting physical, psychosocial, and cognitive health impairments, also called “post-intensive care syndrome” (PICS). Intensive care admission during the COVID-19 pandemic was especially uncertain and stressful, both for patients and for their [...] Read more.
Background: More than 50% of intensive care unit (ICU) survivors suffer from long-lasting physical, psychosocial, and cognitive health impairments, also called “post-intensive care syndrome” (PICS). Intensive care admission during the COVID-19 pandemic was especially uncertain and stressful, both for patients and for their family. An additional risk of developing symptoms of PICS was feared in the absence of structural aftercare for the patient and family shortly after discharge from the hospital. The purpose of this quality improvement study was to identify PICS symptoms and to support post-intensive care patients and families in the transition from the hospital to the home. Therefore, we offered post-ICU patients and families structured telephone support (STS). Methods: This was a quality improvement study during the 2019 COVID-19 pandemic. A project team developed and implemented a tool to structure telephone calls to identify and order symptoms according to the PICS framework and to give individual support based on this information. We supported post-ICU patients diagnosed with COVID-19 pneumonia and their family caregivers within four weeks after hospital discharge. The reported findings were both quantitative and qualitative. Results: Forty-six post-ICU patients received structured telephone support and reported symptoms in at least one of the three domains of the PICS framework. More than half of the patients experienced a loss of strength or condition and fatigue. Cognitive and psychological impairments were reported less frequently. Family caregivers reported fewer impairments concerning fatigue and sleeping problems and expressed a need for a continuity of care. Based on the obtained information, the ICU nurse practitioners were able to check if individual care plans were optimal and clear and, if indicated, initiated disciplines to optimize further follow-up. Conclusions: The implementation of the STS tool gave insight in the impairments of post-ICU patients. Surprisingly, family caregivers expressed fewer impairments. Giving support early after hospital discharge in a structured way may contribute to providing guidance in the individual care plans and treatment of the early symptoms of PICS (-F). Full article
(This article belongs to the Special Issue Culture of Evidence-Based Practice and Quality Improvement in Nursing)
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9 pages, 294 KiB  
Article
Three-Questions-Method for Coping with the Emotional Burden of Nurses and Nursing Students during COVID-19
by Cindy M. A. de Bot and Annemarie J. B. M. de Vos
Int. J. Environ. Res. Public Health 2022, 19(11), 6538; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19116538 - 27 May 2022
Viewed by 1529
Abstract
Background: Nurses and nursing students experienced an emotional burden while working during the COVID-19 outbreak. During the COVID-19 outbreak three questions for nurses working under these extreme circumstances were formulated: 1. What today’s events do you remember? 2. How do you feel (physically [...] Read more.
Background: Nurses and nursing students experienced an emotional burden while working during the COVID-19 outbreak. During the COVID-19 outbreak three questions for nurses working under these extreme circumstances were formulated: 1. What today’s events do you remember? 2. How do you feel (physically and mentally)? 3. Do you have enough support? The purpose of this study was to obtain insight into whether nurses and nursing students perceive that the use of the three-questions-method contributes to effective coping with the emotional burden during the COVID-19 outbreak. Methods: Focus group interviews were held with hospital nurses (n = 11) and nursing students with internships in mental health care (n = 2), hospital (n = 9), and homecare/nursing home care (n = 3) in September 2020 followed by twenty semi-structured interviews one year later. Results: Almost all nurses and nursing students named factors that contributed to the emotional burden: fear, powerlessness, frustration, lack of knowledge about COVID-19, and pressure to pass the internship. Participants indicated that using the three-questions-method can help to effectively cope with the emotional burden during and after the COVID-19 outbreak. Conclusions: Using the three-questions-method offers added value in coping with emotional burden and can be used in education as well as in practice. Full article
(This article belongs to the Special Issue Culture of Evidence-Based Practice and Quality Improvement in Nursing)
13 pages, 328 KiB  
Article
Developing an Evidence-Based Nursing Culture in Nursing Homes: An Action Research Study
by Marleen H. Lovink, Frank Verbeek, Anke Persoon, Getty Huisman-de Waal, Marleen Smits, Miranda G. H. Laurant and Anneke J. van Vught
Int. J. Environ. Res. Public Health 2022, 19(3), 1733; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19031733 - 02 Feb 2022
Cited by 6 | Viewed by 4625
Abstract
Background: Nursing homes face challenges caused by increasing numbers of older adults with multimorbidity and the demand for quality of care. Developing an evidence-based nursing (EBN) culture is a promising strategy to face these challenges. Therefore, the aim of this study was to [...] Read more.
Background: Nursing homes face challenges caused by increasing numbers of older adults with multimorbidity and the demand for quality of care. Developing an evidence-based nursing (EBN) culture is a promising strategy to face these challenges. Therefore, the aim of this study was to develop an EBN culture in nursing homes and gain insight into the influencing factors. Methods: An action research study was conducted with 12 nursing teams in 4 Dutch nursing homes, using the Practice Development approach to develop an EBN culture. The teams (mostly certified nurse assistants) were coached by internal facilitators (bachelor’s or master’s degree nurses) and external facilitators (nursing teachers). Data were gathered at baseline and after 15 months using questionnaires and individual and focus group interviews. Results: With varying degrees, most nursing teams implemented elements (related to values, attitudes, and behaviors) of an EBN culture with appropriate leadership, advocacy, and training. The team members became open to new insights and asked critical questions. During the project, participants learned how EBN could be incorporated into daily practice, for example, by keeping it small, discussing information from professional journals, and using creative methods such as quizzes. Influencing factors of an EBN culture were: (a) support of managers, (b) inspiring facilitators close to the team, and (c) stable teams with driving forces and student nurses. Conclusions: Integrating EBN into daily practice in creative and motivating ways contributes to the development of an EBN culture in nursing homes. To facilitate this, managers should support teams in the process and content of EBN, and internal facilitators should collaborate with driving forces on the teams. Full article
(This article belongs to the Special Issue Culture of Evidence-Based Practice and Quality Improvement in Nursing)

Review

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20 pages, 974 KiB  
Review
The Required Competencies of Bachelor- and Master-Educated Nurses in Facilitating the Development of an Effective Workplace Culture in Nursing Homes: An Integrative Review
by Rachida Handor, Anke Persoon, Famke van Lieshout, Marleen Lovink and Hester Vermeulen
Int. J. Environ. Res. Public Health 2022, 19(19), 12324; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191912324 - 28 Sep 2022
Cited by 3 | Viewed by 2566
Abstract
Background: Nursing home care is undergoing significant changes. This requires innovative teams operating in an effective workplace culture characterized by person-centeredness and offering evidence-based care. A pivotal role for bachelor- and master-educated nurses (BNs/MNs) is foreseen to facilitate such cultures; however, there is [...] Read more.
Background: Nursing home care is undergoing significant changes. This requires innovative teams operating in an effective workplace culture characterized by person-centeredness and offering evidence-based care. A pivotal role for bachelor- and master-educated nurses (BNs/MNs) is foreseen to facilitate such cultures; however, there is currently no comprehensive overview of what competencies this requires. Objectives: To identify what competencies are required from BNs/MNs in facilitating the development of an effective workplace culture in nursing homes. Methods and design: We conducted an integrative review (IR) using Whittemore and Knafl’s method. We searched the PubMed, CINAHL, and PsycINFO databases for studies published between January 2010 and December 2021 in English. Two independent reviewers determined whether studies met inclusion: bachelor- or master-educated nurse; nursing home; professional competencies; and mixed methods or qualitative and qualitative studies. We applied the CASP appraisal tool and analyzed the data by applying content analysis. Results: Sixteen articles were included. Five themes were identified representing required competencies for BNs/MNs facilitating: (1) learning cultures in nursing practice; (2) effective work relationships within teams; (3) leadership capability within teams; (4) implementation of guidelines, standards, and protocols; (5) a work environment acknowledging grief and loss of residents within teams. Conclusions: It shows that the BN/MN applies five competencies associated with a facilitator role to promote the development of an effective workplace culture to achieve a safe, high-level quality of care, satisfaction, and well-being. An overarching leadership as a change champion will support teams to achieve a quality that should guide the transformation in nursing care. Full article
(This article belongs to the Special Issue Culture of Evidence-Based Practice and Quality Improvement in Nursing)
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