Assignment: Research Training Programs For Evidence Based Practice In Healthcare
Assignment: Research Training Programs For Evidence Based Practice In Healthcare
Assignment: Research Training Programs For Evidence Based Practice In Healthcare ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Research Training Programs For Evidence Based Practice In Healthcare Can you help me understand this question? Assignment: Research Training Programs For Evidence Based Practice In Healthcare This is an opinion-based question, based on an article that I found: Promoting Evidence-Based Practice Through a Research Training Program for Point-of-Care Clinicians (2015) Before reading the article: What is your opinion regarding research training programs for point-of-care clinicians? Do you believe that this would promote or enhance EBP in your practice setting, improve patient care, etc ? After reading the article: Has your opinion changed? promoting_evidence_based_practice.pdf JONA Volume 45, Number 1, pp 14-20 Copyright B 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins THE JOURNAL OF NURSING ADMINISTRATION Promoting Evidence-Based Practice Through a Research Training Program for Point-of-Care Clinicians Agnes T. Black, MPH, RN Lynda G. Balneaves, PhD, RN Candy Garossino, MSN, RN Joseph H. Puyat, MA, MSc Hong Qian, MSc OBJECTIVES: The purpose of this study was to evaluate the effect of a research training program on clinicians knowledge, attitudes, and practices related to research and evidence-based practice (EBP). BACKGROUND: EBP has been shown to improve patient care and outcomes. Innovative approaches are needed to overcome individual and organizational barriers to EBP. METHODS: Mixed-methods design was used to evaluate a research training intervention with point-of-care clinicians in a Canadian urban health organization. Participants completed the Knowledge, Attitudes, and Practice Survey over 3 timepoints. Focus groups and interviews were also conducted. RESULTS: Statistically significant improvement in research knowledge and ability was demonstrated. Par- ticipants and administrators identified benefits of the training program, including the impact on EBP. CONCLUSIONS: Providing research training opportunities to point-of-care clinicians is a promising strategy for healthcare organizations seeking to promote EBP, empower clinicians, and showcase excellence in clinical research. Author Affiliations: Research Leader (Ms Black) and Director of Professional Practice (Ms Garossino), Providence Health Care; Associate Professor (Dr Balneaves), School of Nursing, University of British Columbia; and Research Methodologist (Mr. Puyat) and Statistician (Ms Qian), Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada. Funding for this project was received from the Michael Smith Foundation for Health Research. The authors declare no conflicts of interest. Correspondence: Ms Black, Providence Health Care, 1190 Hornby St, Ste 409G, Vancouver, BC, Canada V6Z 2 K5 (ablack@ providencehealth.bc.ca). Assignment: Research Training Programs For Evidence Based Practice In Healthcare Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journals Web site (www.jonajournal.com). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0. DOI: 10.1097/NNA.0000000000000151 14 Research confirms that patient outcomes improve when nurses practice in an evidence-based manner. Described as a problem-solving approach to clinical care that incorporates the conscientious use of current best practice from well-designed studies, a clinicians expertise, and patient values and preferences,1(p335) evidencebased practice (EBP) has been shown to increase patient safety, improve clinical outcomes, reduce healthcare costs, and decrease variation in patient outcomes.1-4 The importance of EBP is substantiated; however, barriers to widespread use of current research evidence in nursing remain, including the fluency and knowledge level of clinical nurses. Nurses have identified individual and organizational barriers to research utilization. Individual barriers include lack of knowledge about the research process and how to critique research studies, lack of awareness of research, colleagues not supportive of practice change, and nurses feeling a lack of authority to change practice.5-8 Organizational barriers identified include insufficient time to implement new ideas, lack of access to research, and lack of awareness of available educational tools related to research.5-7,9-11 Research demonstrates that the most important factor related to nurses EBP is support from their employing organizations to use and conduct research.7,9 Other facilitators include the presence in the clinical JONA Vol. 45, No. 1 January 2015 setting of advanced practice nurses, research mentors, and educators knowledgeable about research12-16; nursing research internships17; and designated nurseresearchers.15 In their BARRIERS scale studies,18,19 Funk and colleagues recommended strategies for reducing barriers to EBP, including employment of research role models, establishment of collegial relationships with academics, and participation in research interest groups. Similar strategies have been more recently highlighted in the context of the Magnet Recognition Program .15,16 There is, however, a notable lack of rigorous intervention studies focused on identifying organizational barriers to improve nurses engagement in EBP.20 Only 1 study focused on the implementation of Magnet standards in American hospitals that showed promise in diminishing the barriers to EBP.21 To address this gap, leaders at a tertiary healthcare organization implemented a point-of-care research training program, led by the organizations nursing research facilitator, targeting nurses and other clinicians to reduce EBP barriers and to promote engagement in research (Job Description for Nursing Research Facilitator, see Document, Supplemental Digital Content 1,Assignment: Research Training Programs For Evidence Based Practice In Healthcare http://links.lww.com/JONA/A369). The program provided mentoring and funding for teams of novice researchers to conduct small-scale studies in their practice settings. The purpose of this study was to evaluate the impact of the training program on clinicians knowledge, attitudes, and practices related to research and EBP. A A Methods A mixed-methods design22,23 was utilized to support the evaluation of the training program. A before-after survey design was used to assess the effect of the training program on clinicians, and focus groups and interviews were conducted with clinicians and administrators to explore their perceptions of the training program. Ethical approval was obtained from the appropriate institutional ethics board. Sample and Sampling Participants were recruited from organizational employees who had applied, in teams, to be part of the training program. Each research team was required to have at least 1 point-of-care clinician whose job was limited to clinical practice and did not include administrative or research responsibilities. A total of 27 teams and 153 clinicians (including 78 RNs) were accepted into the training program in 2 years (2011-2013). Of the 25 teams funded in the 1st 2 years, 10 teams were led by RNs, and 30 other nurses were team members of funded teams. These clinicians were invited to complete a baseline survey and 2 follow-up surveys as well as participate in focus groups. Assignment: Research Training Programs For Evidence Based Practice In Healthcare The administrative leaders JONA Vol. 45, No. 1 January 2015 of these clinicians were invited to participate in qualitative interviews. Intervention Potential research teams submitted letters of intent that outlined the team membership and the proposed research problem, which were reviewed for feasibility and clinical significance by an advisory committee composed of academic and clinical leaders. Approved teams were invited to join the training program and assigned a research mentor to assist in the development of the full research proposal. Research teams attended 3 research workshops that provided foundational knowledge about research methods, research ethics, and literature review techniques (see Document, Supplemental Digital Content 2, which shows a curriculum sample, http://links .lww.com/JONA/A370). Following the workshops, research teams had 3 months to develop a brief proposal, in consultation with their assigned mentor. The proposals were evaluated for their feasibility, significance, and soundness of design, and those funded received small research grants (Can $2,000-$5,000). Over the next year, funded teams conducted their research studies and engaged in knowledge translation activities.Assignment: Research Training Programs For Evidence Based Practice In Healthcare Instruments Knowledge, Attitudes, and Practice Survey The Knowledge, Attitudes, and Practice (KAP) survey is an instrument that assesses 33 research activities that an RN or other health professional might encounter in clinical practice, including utilization and conduct of research. The KAP consists of 5 factors: (1) identifying clinical problems, (2) establishing current best practice, (3) implementing research into practice, (4) administering research implementation, and (5) conducting and communicating. For each activity listed on the survey, the participants indicated their level of knowledge, willingness to engage (attitudes), and ability to perform (practices) specific research and knowledge translation activity on a 3-point scale. The KAP has strong content and construct validity and is a reliable measure (ie, internal consistency = .93 to .97)24 that has been used extensively in studies exploring EBP in nursing and other health professions. A brief demographic form (see Table, Supplemental Digital Content 3, http://links.lww.com/JONA/A371), including age, gender, profession, position, level of education, years in practice, and practice area, was completed by participants at the time of enrollment. Data Collection Surveys The instruments were administered through an online survey program (FluidSurveys; Ottawa, Ontario, Canada) and were administered in 3 waves at various stages 15 of the training program (Figure 1). The baseline survey (survey 1) was conducted at the time of program enrollment. Survey 2 was conducted 3 months later, after participants completed the research workshops and submitted their proposals. The final survey (survey 3) was done at the end of the program after participants completed their projects, which ranged from 18 to 24 months from baseline.Assignment: Research Training Programs For Evidence Based Practice In Healthcare The final data collection timepoint varied because of extraneous circumstances (eg, slow accrual, loss of team members) that resulted in some teams requiring additional time to complete their research. Focus Groups and Qualitative Interviews All participants of the funded research teams were invited to participate in focus groups scheduled within 6 months of the completion of their projects. Openended questions were used to explore participants experiences in the training program and the impact on their ability to engage in EBP. Several participants who were unable to take part in the focus groups completed individual interviews. A $20 gift card was provided to compensate focus group and interview participants. Key informant interviews were conducted with administrators whose staff participated in the program and gathered their perceptions regarding the impact of the program on clinicians ability to engage in research and EBP. Data Analysis Demographic characteristics were summarized using descriptive statistics. Knowledge, willingness, and ability levels across survey waves were summarized using means and SDs. Linear mixed regression analyses comparing outcome measures between survey timepoints were performed to evaluate the impact of training at various stages of the program. This analytic approach was chosen to account for the correlation among measures from the same subject and to include participants with missing data, which were mostly caused by participants not completing all 3 surveys. To facilitate interpretation and where appropriate, average differences in the mean Figure 1. Mean scores on research knowledge, willingness, and ability to conduct research. 16 scores of the outcomes between survey waves were expressed as standardized effect sizes (Cohen d). Statistical data analyses were performed using version 9.2 of the SAS system (SAS Institute Inc, Cary, North Carolina; 2008) for Windows.Assignment: Research Training Programs For Evidence Based Practice In Healthcare The focus groups and interviews were recorded and transcribed verbatim. Transcriptions were analyzed line-by-line for emerging concepts, which were developed into a coding scheme. Transcripts were coded and validated by at least 2 investigators, and disagreements were discussed until consensus. Coded data were entered into a qualitative management software program (NVivo; QSR International (Americas) Inc, Burlington, Massachusetts). Key themes and relationships were identified using a thematic analytical approach and confirmed by multiple research team members. Results Quantitative Findings There were 136 participants in the study (response rate of 88.9%) (see Table, Supplemental Digital Content 3, http://links.lww.com/JONA/A371), mostly women (87%), between 25 and 44 years of age (80%), and working in acute care (85%). Approximately half of the participants were nurses (52%), had a baccalaureate degree (55%), and had been in practice for more than 10 years (58%). Except for education, no statistically significant differences in outcome measures by demographic characteristics were observed at baseline. Research Knowledge A significant improvement in research knowledge was found following participation in the research workshops and submission of the proposals (Table 1), with the observed mean knowledge score increasing from 1.67 (on a scale of 1 to 3) at baseline to 1.93 at survey 2. The change in mean scores between the 2 surveys, estimated using linear mixed models, was 0.23 (95% confidence interval [CI], 0.14-0.33) and was statistically significant (P G .0001). This estimated difference in mean scores represents a change that was moderate in magnitude (d = 0.50). Further significant improvement in research knowledge was achieved following the completion of funded research projects, with an estimated increase in mean scores from survey 2 to survey 3 of 0.34 (95% CI, 0.17-0.52), indicating a large effect size (d = 0.77). Research Ability Participants perceived ability to conduct research did not significantly increase from survey 1 to survey 2 but improved considerably after completion of the research project (Table).Assignment: Research Training Programs For Evidence Based Practice In Healthcare The observed mean score on survey 2 was 1.99 (on a scale of 1 to 3) and increased to 2.30 in survey 3. The estimated change in mean scores based JONA Vol. 45, No. 1 January 2015 Table 1. Means and Estimated Changes in Mean Scores on Research Knowledge, Willingness, and Ability Across Survey Timepoints Mean Scores,a Mean (SD) Outcome Knowledge Ability Willingness Estimated Mean Change,b (95% CI), P Survey 1 (n = 101) Survey 2 (n = 68) Survey 3 (n = 34) Survey 1 to Survey 2 Survey 2 to Survey 3 1.67 (0.46) 1.91 (0.52) 2.34 (0.50) 1.93 (0.45) 1.99 (0.42) 2.31 (0.49) 2.26 (0.42) 2.30 (0.44) 2.45 (0.48) 0.23 (0.14 to 0.33), G0.0001 0.07 (j0.06 to 0.20), 0.27 0.04 (j0.07 to 0.16), 0.48 0.34 (0.17 to 0.52), 0.0002 0.32 (0.14 to 0.49), 0.001 0.15 (j0.04 to 0.35), 0.12 a Observed mean scores at different timepoints. Changes in means between timepoints were estimated using linear mixed models that account for clustering and unbalanced data due to repeated measurements and missing data, respectively. The estimated changes may differ from changes calculated using the actual or observed mean scores. b on the linear mixed models was 0.32 and was statistically significant (P = .001). This estimated change represents a large effect size (d = 0.74). Research Willingness No significant improvement in willingness to conduct research was noted across the study (Table 1). Mean scores remained at the upper end of the rating scale (on a scale of 1 to 3) throughout the study period, starting from the observed mean score of 2.34 at baseline, decreasing slightly to 2.31 at survey 2 and increasing to 2.45 in the final survey (Figure 1). The estimated change in mean scores was small (survey 1 to 2 = 0.04, survey 2 to 3 = 0.15). Qualitative Findings Three key themes emerged from the qualitative data: benefits from participating in the training program, impact of the training program on EBP, and challenges faced by beginning researchers. Assignment: Research Training Programs For Evidence Based Practice In Healthcare Benefits of Training Program Participation Administrators were overwhelmingly positive about the benefits of the training program for both clinicians and their organization. They perceived the program as filling a gap by offering education, mentorship, and funding to support clinicians engagement in the generation of evidence. Participants described the program as providing an important opportunity to learn and engage in research and knowledge translation activities that are rarely available to those without advanced education. Participants reported being less intimidated by research, having a greater appreciation for the complexities and limitations of research, and being better prepared to understand and apply evidence appropriately within clinical settings. As 1 administrator noted, Theyre not afraid of research anymoreI. Both administrators and participants described the program as creating a sense of excitement and enthusiasm among the healthcare team about research. One administrator described, It was fun to see them evolve and develop in their journey as they took on this JONA Vol. 45, No. 1 January 2015 project. I saw a sense of confidence, a sense of ownership and pride. For some participants, the program broadened their perceived scope of practice and made their job more enjoyable. As shared by 1 participant, You feel you are learning in your job. You want to feel youre moving somewhere and not standing in the same spot. Its great at making a job that youre stable in exciting and progressive. The training program was further perceived to benefit the organization by showcasing excellence in nursing and other professions among the larger healthcare community: Assignment: Research Training Programs For Evidence Based Practice In Healthcare Because of the program, we were able to present papers at our national conference, which is an advantage for our [organization]I. Interprofessional collaboration within the organization, as well as partnerships between clinicians, administrators, and academics, was seen to be strengthened as a result of the program. Increase in Evidence-Based Practice The link between participation in the training program and promotion of EBP was clearly articulated by both administrators and participants. In particular, participants saw the training program as cultivating critical thinking: It encourages you to seek answers regarding how things can improve or the effectiveness of certain methods and to search out and emphasize an evidence-based practice. This has been wonderful to open your eyes to all the different things you can do for your patients. Administrators perceived the training program to raise awareness of the links between good clinical practice and research evidence: There is more of an understanding or realization that whatever we implement or whatever practice we are carrying out, we do need to be more conscious of whether there is any evidence for it. There is more intentional scrutiny of what we are doing now, and the training program certainly reinforced that. The training program also enhanced participants ability to advocate for change in the larger healthcare 17 organization. Not only did they gain the language, resources, and evidence needed to be taken seriously by other members of the healthcare team, but also their motivation and commitment to promote practice change were enhanced by their engagement in the research process: It makes the frontline workers really push to get the best possible evidence-based guidelines and practice because they want it. They know its better based on their really hard data collection and analyzing of the results. [It ] gives you buy-inI through blood, sweat, and tears. Some participants and their teams did report practice change to result from their research, including shifts in practice guidelines and care standards. Three examples of practice and policy changes as a result of the training program and subsequent research included (1) a qualitative project that examined the experience of newly admitted residents to a Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10
Assignment: Research Training Programs For Evidence Based Practice In Healthcare
Assignment: Research Training Programs For Evidence Based Practice In Healthcare ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Research Training Programs For Evidence Based Practice In Healthcare Can you help me understand this question? Assignment: Research Training Programs For Evidence Based Practice In Healthcare This is an opinion-based question, based on an article that I found: Promoting Evidence-Based Practice Through a Research Training Program for Point-of-Care Clinicians (2015) Before reading the article: What is your opinion regarding research training programs for point-of-care clinicians? Do you believe that this would promote or enhance EBP in your practice setting, improve patient care, etc ? After reading the article: Has your opinion changed? promoting_evidence_based_practice.pdf JONA Volume 45, Number 1, pp 14-20 Copyright B 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins THE JOURNAL OF NURSING ADMINISTRATION Promoting Evidence-Based Practice Through a Research Training Program for Point-of-Care Clinicians Agnes T. Black, MPH, RN Lynda G. Balneaves, PhD, RN Candy Garossino, MSN, RN Joseph H. Puyat, MA, MSc Hong Qian, MSc OBJECTIVES: The purpose of this study was to evaluate the effect of a research training program on clinicians knowledge, attitudes, and practices related to research and evidence-based practice (EBP). BACKGROUND: EBP has been shown to improve patient care and outcomes. Innovative approaches are needed to overcome individual and organizational barriers to EBP. METHODS: Mixed-methods design was used to evaluate a research training intervention with point-of-care clinicians in a Canadian urban health organization. Participants completed the Knowledge, Attitudes, and Practice Survey over 3 timepoints. Focus groups and interviews were also conducted. RESULTS: Statistically significant improvement in research knowledge and ability was demonstrated. Par- ticipants and administrators identified benefits of the training program, including the impact on EBP. CONCLUSIONS: Providing research training opportunities to point-of-care clinicians is a promising strategy for healthcare organizations seeking to promote EBP, empower clinicians, and showcase excellence in clinical research. Author Affiliations: Research Leader (Ms Black) and Director of Professional Practice (Ms Garossino), Providence Health Care; Associate Professor (Dr Balneaves), School of Nursing, University of British Columbia; and Research Methodologist (Mr. Puyat) and Statistician (Ms Qian), Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada. Funding for this project was received from the Michael Smith Foundation for Health Research. The authors declare no conflicts of interest. Correspondence: Ms Black, Providence Health Care, 1190 Hornby St, Ste 409G, Vancouver, BC, Canada V6Z 2 K5 (ablack@ providencehealth.bc.ca). Assignment: Research Training Programs For Evidence Based Practice In Healthcare Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journals Web site (www.jonajournal.com). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0. DOI: 10.1097/NNA.0000000000000151 14 Research confirms that patient outcomes improve when nurses practice in an evidence-based manner. Described as a problem-solving approach to clinical care that incorporates the conscientious use of current best practice from well-designed studies, a clinicians expertise, and patient values and preferences,1(p335) evidencebased practice (EBP) has been shown to increase patient safety, improve clinical outcomes, reduce healthcare costs, and decrease variation in patient outcomes.1-4 The importance of EBP is substantiated; however, barriers to widespread use of current research evidence in nursing remain, including the fluency and knowledge level of clinical nurses. Nurses have identified individual and organizational barriers to research utilization. Individual barriers include lack of knowledge about the research process and how to critique research studies, lack of awareness of research, colleagues not supportive of practice change, and nurses feeling a lack of authority to change practice.5-8 Organizational barriers identified include insufficient time to implement new ideas, lack of access to research, and lack of awareness of available educational tools related to research.5-7,9-11 Research demonstrates that the most important factor related to nurses EBP is support from their employing organizations to use and conduct research.7,9 Other facilitators include the presence in the clinical JONA Vol. 45, No. 1 January 2015 setting of advanced practice nurses, research mentors, and educators knowledgeable about research12-16; nursing research internships17; and designated nurseresearchers.15 In their BARRIERS scale studies,18,19 Funk and colleagues recommended strategies for reducing barriers to EBP, including employment of research role models, establishment of collegial relationships with academics, and participation in research interest groups. Similar strategies have been more recently highlighted in the context of the Magnet Recognition Program .15,16 There is, however, a notable lack of rigorous intervention studies focused on identifying organizational barriers to improve nurses engagement in EBP.20 Only 1 study focused on the implementation of Magnet standards in American hospitals that showed promise in diminishing the barriers to EBP.21 To address this gap, leaders at a tertiary healthcare organization implemented a point-of-care research training program, led by the organizations nursing research facilitator, targeting nurses and other clinicians to reduce EBP barriers and to promote engagement in research (Job Description for Nursing Research Facilitator, see Document, Supplemental Digital Content 1,Assignment: Research Training Programs For Evidence Based Practice In Healthcare http://links.lww.com/JONA/A369). The program provided mentoring and funding for teams of novice researchers to conduct small-scale studies in their practice settings. The purpose of this study was to evaluate the impact of the training program on clinicians knowledge, attitudes, and practices related to research and EBP. A A Methods A mixed-methods design22,23 was utilized to support the evaluation of the training program. A before-after survey design was used to assess the effect of the training program on clinicians, and focus groups and interviews were conducted with clinicians and administrators to explore their perceptions of the training program. Ethical approval was obtained from the appropriate institutional ethics board. Sample and Sampling Participants were recruited from organizational employees who had applied, in teams, to be part of the training program. Each research team was required to have at least 1 point-of-care clinician whose job was limited to clinical practice and did not include administrative or research responsibilities. A total of 27 teams and 153 clinicians (including 78 RNs) were accepted into the training program in 2 years (2011-2013). Of the 25 teams funded in the 1st 2 years, 10 teams were led by RNs, and 30 other nurses were team members of funded teams. These clinicians were invited to complete a baseline survey and 2 follow-up surveys as well as participate in focus groups. Assignment: Research Training Programs For Evidence Based Practice In Healthcare The administrative leaders JONA Vol. 45, No. 1 January 2015 of these clinicians were invited to participate in qualitative interviews. Intervention Potential research teams submitted letters of intent that outlined the team membership and the proposed research problem, which were reviewed for feasibility and clinical significance by an advisory committee composed of academic and clinical leaders. Approved teams were invited to join the training program and assigned a research mentor to assist in the development of the full research proposal. Research teams attended 3 research workshops that provided foundational knowledge about research methods, research ethics, and literature review techniques (see Document, Supplemental Digital Content 2, which shows a curriculum sample, http://links .lww.com/JONA/A370). Following the workshops, research teams had 3 months to develop a brief proposal, in consultation with their assigned mentor. The proposals were evaluated for their feasibility, significance, and soundness of design, and those funded received small research grants (Can $2,000-$5,000). Over the next year, funded teams conducted their research studies and engaged in knowledge translation activities.Assignment: Research Training Programs For Evidence Based Practice In Healthcare Instruments Knowledge, Attitudes, and Practice Survey The Knowledge, Attitudes, and Practice (KAP) survey is an instrument that assesses 33 research activities that an RN or other health professional might encounter in clinical practice, including utilization and conduct of research. The KAP consists of 5 factors: (1) identifying clinical problems, (2) establishing current best practice, (3) implementing research into practice, (4) administering research implementation, and (5) conducting and communicating. For each activity listed on the survey, the participants indicated their level of knowledge, willingness to engage (attitudes), and ability to perform (practices) specific research and knowledge translation activity on a 3-point scale. The KAP has strong content and construct validity and is a reliable measure (ie, internal consistency = .93 to .97)24 that has been used extensively in studies exploring EBP in nursing and other health professions. A brief demographic form (see Table, Supplemental Digital Content 3, http://links.lww.com/JONA/A371), including age, gender, profession, position, level of education, years in practice, and practice area, was completed by participants at the time of enrollment. Data Collection Surveys The instruments were administered through an online survey program (FluidSurveys; Ottawa, Ontario, Canada) and were administered in 3 waves at various stages 15 of the training program (Figure 1). The baseline survey (survey 1) was conducted at the time of program enrollment. Survey 2 was conducted 3 months later, after participants completed the research workshops and submitted their proposals. The final survey (survey 3) was done at the end of the program after participants completed their projects, which ranged from 18 to 24 months from baseline.Assignment: Research Training Programs For Evidence Based Practice In Healthcare The final data collection timepoint varied because of extraneous circumstances (eg, slow accrual, loss of team members) that resulted in some teams requiring additional time to complete their research. Focus Groups and Qualitative Interviews All participants of the funded research teams were invited to participate in focus groups scheduled within 6 months of the completion of their projects. Openended questions were used to explore participants experiences in the training program and the impact on their ability to engage in EBP. Several participants who were unable to take part in the focus groups completed individual interviews. A $20 gift card was provided to compensate focus group and interview participants. Key informant interviews were conducted with administrators whose staff participated in the program and gathered their perceptions regarding the impact of the program on clinicians ability to engage in research and EBP. Data Analysis Demographic characteristics were summarized using descriptive statistics. Knowledge, willingness, and ability levels across survey waves were summarized using means and SDs. Linear mixed regression analyses comparing outcome measures between survey timepoints were performed to evaluate the impact of training at various stages of the program. This analytic approach was chosen to account for the correlation among measures from the same subject and to include participants with missing data, which were mostly caused by participants not completing all 3 surveys. To facilitate interpretation and where appropriate, average differences in the mean Figure 1. Mean scores on research knowledge, willingness, and ability to conduct research. 16 scores of the outcomes between survey waves were expressed as standardized effect sizes (Cohen d). Statistical data analyses were performed using version 9.2 of the SAS system (SAS Institute Inc, Cary, North Carolina; 2008) for Windows.Assignment: Research Training Programs For Evidence Based Practice In Healthcare The focus groups and interviews were recorded and transcribed verbatim. Transcriptions were analyzed line-by-line for emerging concepts, which were developed into a coding scheme. Transcripts were coded and validated by at least 2 investigators, and disagreements were discussed until consensus. Coded data were entered into a qualitative management software program (NVivo; QSR International (Americas) Inc, Burlington, Massachusetts). Key themes and relationships were identified using a thematic analytical approach and confirmed by multiple research team members. Results Quantitative Findings There were 136 participants in the study (response rate of 88.9%) (see Table, Supplemental Digital Content 3, http://links.lww.com/JONA/A371), mostly women (87%), between 25 and 44 years of age (80%), and working in acute care (85%). Approximately half of the participants were nurses (52%), had a baccalaureate degree (55%), and had been in practice for more than 10 years (58%). Except for education, no statistically significant differences in outcome measures by demographic characteristics were observed at baseline. Research Knowledge A significant improvement in research knowledge was found following participation in the research workshops and submission of the proposals (Table 1), with the observed mean knowledge score increasing from 1.67 (on a scale of 1 to 3) at baseline to 1.93 at survey 2. The change in mean scores between the 2 surveys, estimated using linear mixed models, was 0.23 (95% confidence interval [CI], 0.14-0.33) and was statistically significant (P G .0001). This estimated difference in mean scores represents a change that was moderate in magnitude (d = 0.50). Further significant improvement in research knowledge was achieved following the completion of funded research projects, with an estimated increase in mean scores from survey 2 to survey 3 of 0.34 (95% CI, 0.17-0.52), indicating a large effect size (d = 0.77). Research Ability Participants perceived ability to conduct research did not significantly increase from survey 1 to survey 2 but improved considerably after completion of the research project (Table).Assignment: Research Training Programs For Evidence Based Practice In Healthcare The observed mean score on survey 2 was 1.99 (on a scale of 1 to 3) and increased to 2.30 in survey 3. The estimated change in mean scores based JONA Vol. 45, No. 1 January 2015 Table 1. Means and Estimated Changes in Mean Scores on Research Knowledge, Willingness, and Ability Across Survey Timepoints Mean Scores,a Mean (SD) Outcome Knowledge Ability Willingness Estimated Mean Change,b (95% CI), P Survey 1 (n = 101) Survey 2 (n = 68) Survey 3 (n = 34) Survey 1 to Survey 2 Survey 2 to Survey 3 1.67 (0.46) 1.91 (0.52) 2.34 (0.50) 1.93 (0.45) 1.99 (0.42) 2.31 (0.49) 2.26 (0.42) 2.30 (0.44) 2.45 (0.48) 0.23 (0.14 to 0.33), G0.0001 0.07 (j0.06 to 0.20), 0.27 0.04 (j0.07 to 0.16), 0.48 0.34 (0.17 to 0.52), 0.0002 0.32 (0.14 to 0.49), 0.001 0.15 (j0.04 to 0.35), 0.12 a Observed mean scores at different timepoints. Changes in means between timepoints were estimated using linear mixed models that account for clustering and unbalanced data due to repeated measurements and missing data, respectively. The estimated changes may differ from changes calculated using the actual or observed mean scores. b on the linear mixed models was 0.32 and was statistically significant (P = .001). This estimated change represents a large effect size (d = 0.74). Research Willingness No significant improvement in willingness to conduct research was noted across the study (Table 1). Mean scores remained at the upper end of the rating scale (on a scale of 1 to 3) throughout the study period, starting from the observed mean score of 2.34 at baseline, decreasing slightly to 2.31 at survey 2 and increasing to 2.45 in the final survey (Figure 1). The estimated change in mean scores was small (survey 1 to 2 = 0.04, survey 2 to 3 = 0.15). Qualitative Findings Three key themes emerged from the qualitative data: benefits from participating in the training program, impact of the training program on EBP, and challenges faced by beginning researchers. Assignment: Research Training Programs For Evidence Based Practice In Healthcare Benefits of Training Program Participation Administrators were overwhelmingly positive about the benefits of the training program for both clinicians and their organization. They perceived the program as filling a gap by offering education, mentorship, and funding to support clinicians engagement in the generation of evidence. Participants described the program as providing an important opportunity to learn and engage in research and knowledge translation activities that are rarely available to those without advanced education. Participants reported being less intimidated by research, having a greater appreciation for the complexities and limitations of research, and being better prepared to understand and apply evidence appropriately within clinical settings. As 1 administrator noted, Theyre not afraid of research anymoreI. Both administrators and participants described the program as creating a sense of excitement and enthusiasm among the healthcare team about research. One administrator described, It was fun to see them evolve and develop in their journey as they took on this JONA Vol. 45, No. 1 January 2015 project. I saw a sense of confidence, a sense of ownership and pride. For some participants, the program broadened their perceived scope of practice and made their job more enjoyable. As shared by 1 participant, You feel you are learning in your job. You want to feel youre moving somewhere and not standing in the same spot. Its great at making a job that youre stable in exciting and progressive. The training program was further perceived to benefit the organization by showcasing excellence in nursing and other professions among the larger healthcare community: Assignment: Research Training Programs For Evidence Based Practice In Healthcare Because of the program, we were able to present papers at our national conference, which is an advantage for our [organization]I. Interprofessional collaboration within the organization, as well as partnerships between clinicians, administrators, and academics, was seen to be strengthened as a result of the program. Increase in Evidence-Based Practice The link between participation in the training program and promotion of EBP was clearly articulated by both administrators and participants. In particular, participants saw the training program as cultivating critical thinking: It encourages you to seek answers regarding how things can improve or the effectiveness of certain methods and to search out and emphasize an evidence-based practice. This has been wonderful to open your eyes to all the different things you can do for your patients. Administrators perceived the training program to raise awareness of the links between good clinical practice and research evidence: There is more of an understanding or realization that whatever we implement or whatever practice we are carrying out, we do need to be more conscious of whether there is any evidence for it. There is more intentional scrutiny of what we are doing now, and the training program certainly reinforced that. The training program also enhanced participants ability to advocate for change in the larger healthcare 17 organization. Not only did they gain the language, resources, and evidence needed to be taken seriously by other members of the healthcare team, but also their motivation and commitment to promote practice change were enhanced by their engagement in the research process: It makes the frontline workers really push to get the best possible evidence-based guidelines and practice because they want it. They know its better based on their really hard data collection and analyzing of the results. [It ] gives you buy-inI through blood, sweat, and tears. Some participants and their teams did report practice change to result from their research, including shifts in practice guidelines and care standards. Three examples of practice and policy changes as a result of the training program and subsequent research included (1) a qualitative project that examined the experience of newly admitted residents to a Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10
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