Socioeconomic and demographic characteristics
Among 422 respondents, 58.5% were female. The mean age was 32 years (SD±7.77), minimum age is 25 and maximum age is 59 years old. Majority were BSc holders. Staff nurses constituted the majority of our sample which is 389 (92.2%). The majority of participants 82 (19.4%) worked on emergency department (Table 1).
Table 1: Sociodemographic characteristics of Nurses at Public Hospitals, Addis Ababa, Ethiopia, 2020(n=422).
Variables
|
Frequency
|
Percentage
|
Sex
|
|
|
Male
|
175
|
41.5
|
Female
|
247
|
58.5
|
Marital status
|
|
|
Single
|
197
|
46.7
|
Ever married
|
225
|
53.3
|
Educational level
|
|
|
Diploma
|
18
|
4.3
|
BSC and above
|
404
|
95.7
|
Working position
|
|
|
Head
|
33
|
7.8
|
Staff
|
389
|
92.2
|
Level of evidence-based practice
A total 422 participants involved in different level of evidence-based practice activities. Out of 422 participant 363 (86%) had involved in different EBP activities to different level (from seldom to often). Total score was computed for individuals EBP and Tertian classification was done on the total score of EBP activity measurements for descriptive purpose. Accordingly, about 120 (28.4) of the respondents implemented EBP to low level (sometimes), about 206(48.8%) of the respondents implemented EBP to medium level and about 37 (8.8%) of respondents implemented EBP to high level (Table 2).
Table 2: Distribution of respondents by involvement in EBP activities at Public Hospitals, Addis Ababa, Ethiopia, 2020
Activities
|
Never
|
Seldom
|
Occasionally
|
Regularly
|
Often
|
N
|
%
|
N
|
%
|
N
|
%
|
N
|
%
|
N
|
%
|
Formulate question
|
119
|
28.2
|
139
|
32.9
|
119
|
28.2
|
36
|
8.5
|
9
|
2.1
|
Search for research findings or evidence
|
105
|
24.9
|
128
|
30.3
|
138
|
32.7
|
43
|
10.2
|
8
|
1.9
|
Read for research findings
|
87
|
20.6
|
111
|
26.3
|
157
|
37.2
|
55
|
13
|
12
|
2.8
|
Critically appraised evidence
|
117
|
27.7
|
99
|
23.5
|
147
|
34.8
|
51
|
12.1
|
8
|
1.9
|
Apply best evidence to clinical practice
|
99
|
23.5
|
112
|
26.5
|
136
|
32.2
|
60
|
14.2
|
15
|
3.6
|
Assess or evaluate outcomes of care
|
95
|
22.5
|
116
|
27.5
|
1!4
|
27
|
84
|
19.9
|
13
|
3.1
|
Teaching new evidence
|
106
|
25.1
|
111
|
26.3
|
122
|
28.9
|
65
|
15.4
|
18
|
4.3
|
From qualitative study key informants mentioned about utilization of EBP that they have never heard about EBP but they explained as it helps for having a better care for the patient. A 28 years old matron from Rasdesta Dametew hospital described that they had no information regarding the utilization of EBP but they know that it helps for having a good patient care.
“We have no information about utilization of EBP in clinical practice and also utilization of EBP in clinical practice is good for patient’s care improvement, it saves time and increases their satisfaction.” [Participant 7 age 28, sex male, BSc. Nurse, Matron]
Another 36 year-old matron from Minilik explained that majority of nurses explained that they used different sources to have a recent and updated evidence for their clinical practice but not applied frequently
“Most of nurses used evidence from hospital protocols, guidelines and others asked information from senior staff nurses /colleagues and other health professionals like doctors and most of nurses sometimes used EBP.” [Participant 1 age 36, sex male, BSc. Nurse, Matron]
Factors associated with utilization of EBP
Knowledge about evidence-based practice
Among total respondents, 187 (44.3%) were categorized as knowledgeable about EBP as those nurses who score >= to the calculated demarcation threshold formula.
Attitudes about EBP
Among total respondents, 366(86.7%) were categorized as having favorable attitude about EBP as they score >= mean score and from those nurses who had a favorable attitude.
Organizational and individual factors
Participants were asked about the organizational, and personal provider factors that posed barriers to incorporate EBP into their clinical practice. The most frequently agreed barriers were an authority to change the practice (66.2%), lack of manager’s support and incentive (61.3%), culture of the team to change the practice (64.5%), and physician cooperation with implementation of new evidence (61.7%). Almost more than half of respondents (60%) said that the available national treatment guidelines and protocols were difficult to understand.
From qualitative results majority of key informants mentioned that there are different barriers to utilize of EBP such as: insufficient resources (e.g. current literature; internet access; updated guidelines; computers); lack of financial support (incentives); closed minds (we have always done it this way); lack of library and lack of support (e.g. management, physicians),lack of time due to workload, nurses’ willingness to perform new procedure to patient care, nurse’s ability in finding new procedure, nurses communication skill with nurses and physicians.
A 38 years old case team leader from Minilik hospital explained that they face many challenges to utilize EBP.
“……there are experienced nurses/ colleague, doctors and other health professionals to support nurses in their clinical practice but they have many challenges from their colleagues……”“[participant 3 age 38, sex male, Nurse, Case team leader]
“nurses have no interest, they don’t want to read and update themselves even they have no confidence and majorly no hospital library, updated guidelines, internet services, motivation, enough training and no enough computers for nurses to updating themselves “[participant 6 age 35, sex male, Medical doctor, Medical director]
The 30 years old case team leader from St.Pawlos hospital described that they have a crowded working environment which makes it harder to utilize EBP.
“There are times when I do not know things and I do not have even time to sit down and also most of nurses were ask doctors and colleagues during ward rounds while some most of them have no interest in updating themselves.”[Participant 3 age 30, sex male, BSc. Nurse, case team leader]
However, some of the key informants described as there is some movement regarding giving training for staffs but still there is a gap in having a good training session on how to implement EBP.
“Even if it is not enough sometimes there is training for some nurses, hospital protocols and guidelines but most of them doesn’t apply on their practice.”[Participant 4 age 35, sex female, BSc. Nurse, case team leader]
Factors associated with implementation of evidence based nursing practice
Knowledge about EBP was positively associated with EBNP implementation (β=0.338, P=0.000). Those with a good knowledge about EBP, increases their implementation by 0.338. Educational status of nurses was significantly associated with evidence-based practice implementation (β=0.647, P=0.02). Having a BSc and above increases evidence-based practice by 0.647. Nurses attitude regarding EBP was positively associated with EBNP (β=0.139, P=0.018). Nurses with a favorable attitude regarding EBNP increases evidence based practice by 0.139.
Managers support and incentive was significantly associated with nurses evidence-based practice (β=0.103, P=0.018).Having a managerial support will increase the implantation by 0.103. Insufficient information to find new guidelines or protocols was significantly associated with implementing evidence-based practice (β=1.196, P=0.000).