Med. J. Cairo Univ., Vol. 77, No. 2, September: 121-128, 2009 www.medicaljournalofcairouniversity.com

Knowledge, Practice and Attitude of Evidence Based Practice Among Nurses in Kingdom of Saudi Arabia OLFAT A. SALEM, Ph.D., M.S.N., B.Sc.*; AISHAH ALAMRANI, B.Sc., M.Sc.** and MONIRAH M ALBLOUSHI, R.N., B.S.N., M.S.N.** The Departments ofNursing Administration & Educational* and Medical Surgical**, King Saud University, College of Nursing, Riyadh, Saudi Arabia.

of the change in managing risk and uncertainty in health-care.

Abstract Nowadays, increasing number of researches focus on Evidence Based Practice (EBP) in order to achieve higher quality of patient care. Different setting of organizations might result in different way of how the people in organization perceive EBP, due to this the study aim is to assess nurses’ knowledge/skills and attitude about evidence based practice in King Khalid Eye Specialist Hospital (KKESH) and King Faisal Specialist Hospital Research Centre (KFSCRC). Using Evidence Based Questionnaire (EBQP) developed by Dupton & Dupton (2005) a cross sectional descriptive study was used in carrying out the study. The result of the study concluded that there were significant differences between the two main studied hospitals in the nurses’ score for their knowledge, attitude and practice toward EBP. In addition, a high correlation between these three components also supported by this study.

The goal of evidence-based nursing is to provide practicing nurses with evidence-based data to deliver effective care based on the best research; resolve problems in the clinical setting; achieve excellence in care delivery, even exceeding quality assurance standards and to introduce innovation [3] . Furthermore, evidence based practice emphasizes the comprehensive evaluation of all relevant research according to a clinical question using a systematic review. The challenges of integrating evidence-based practice into nursing are many. Nurses are quite familiar with research utilization, but not as familiar with developing good search strategies, identifying the best databases, or doing critical appraisals. Oftentimes, nurses think they are using evidencebased nursing when, in fact, they are utilizing isolated research results [4] . Moreover, a cross sectional study research conducted by Caroline E. Brown et al. [5] with sample of 458 nurses at the Academic Medical Center revealed that the organizational barriers (lack of time and lack of nursing autonomy) were the top perceived barriers. Whereas, research by Mary L. Koehn & Karen Lehman [6] stated that the two most cited barriers to implementing evidence-based practice were time and knowledge.

Key Words: Evidence based practice – (EBP).

Introduction NURSES in clinical practice are increasingly being challenged by the expectation of patients, patient organizations and other healthcare organizations to provide clearly measurable care of the highest quality. In order to achieve this, evidence based practice (EBP) is of key importance and the nurse’s role is to 'bridge the divide' between research and practice via improvement of clinical care on the basis of the evidence regarding best practice [1] . Concomitantly, a lot of factors have been identified as a cause for the increasing role of evidence in policy and practice. The main ones have been described by Davies et al. [2] as the growth of an increasingly well-educated and well-informed public; the explosion of the availability of data; the changing role of professionals; greater emphasis on productivity and cost-effectiveness in healthcare delivery and an increasing emphasis on scrutiny and accountability, which itself is a manifestation

To overcome these barriers, the integration of evidence into nursing practice will strengthen nursing theoretical base, decrease the variation in processes of care, improve patient outcomes, empower nurses and help identify areas for research [7] . Consequently, the research also stated that facilitators were learning opportunities, culture

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building and availability and simplicity of resources. There is a significant correlations found between barriers and practice, knowledge and attitudes related to evidence-based practice [5] . Due to it, it is advisable that educators must work with managers to address organizational barriers and proactively support evidence-based practice. Nurses have a key role in facilitating consensus regarding evidence to be used and ensuring availability of resources for empowering nurse accountability for outcome-oriented patient care through utilizing evidence based nursing practice. They need to be cognizant of what current nursing evidence based practice trends are based on and where they are going [8] . Nevertheless, responsive workforce embraces multiple ways of thinking, respects different paradigms of care and is able to respond to and respect the forms of care people value and seek. As well with it, Peter Nolan et al., [9] study in 2008 recommend that for evidence-based practice to be safe, the nurses must be able to evaluate the strength and relevance of research findings and be able to understand that there are different kinds of evidence which should be called upon in order to respond sensitively and appropriately to the preferences of patients. This study is also supported by Kay Scott and Rob McSherry [10] stated that evidence-based nursing to occur, nurses need to be aware of what evidence-based nursing means, what constitutes evidence, how evidence-based nursing differs from evidence-based medicine and evidence-based practice and what the process is to engage with and apply the evidence. Parallel with this research, Mary L. Koehn & Karen Lehman [6] survey of Registered Nurses (n=1031) in The United State of America reveals that participants had moderate scores on practice and attitudes towards evidence-based practice. The knowledge /skills mean scores were somewhat lower. Significant differences were found for attitudes between those with baccalaureate and higher education compared to those with associate and diploma education. In nursing literature, the most evident study is about nurses attitudes to and perception of research utilization and most of this work has been conducting using a survey approach [11-16] . Banning M [17] survey examine the nurse perception of evidence based practice. The data generated indicate that nurses were familiar with the research process but not the canons of evidenced-based practice, different levels of evidence are used by nurses. This may be a reflection of the level of intrigue of the nurses involved. The principles of evidencebased practice have the capacity to govern the

individual nurse personally and the nursing profession politically. They constitute an emerging set of social practices that are able to manipulate nursing practice according to predetermined identifiable routines drawn from scientific codes. Practice guidelines and clinical practice manuals informed by systematic reviews have the ability to direct nursing practice or resolve issues where practices differ according to scientifically validated evidence [18] . Increasingly, the efficacy of a number of nursing interventions will become known and able to be ranked in a quantifiable manner. This identification, measurement and review of nursing work makes up the object domains of nursing that enable future government to take place. Other survey was conducted by Olade [19] in rural settings toward evidence based practice indicate that fewer than a quarter of the nurses in had favorable attitudes toward research. Attitudes and interest varied with levels of education and position. So it can be seen that most EBP activities performed by professional nursing associations were found to be competence and attitude-oriented. Other research by Holleman G et al. [20] suggests that greater attention could be paid to the potential role of the associations in promoting evidence-based practice using more behaviororiented activities with a more steering and control character. Where nursing associations currently approach evidence-based practice from a 'free of obligations' perspective, members could be targeted in a less non-committal manner in future initiatives. If a clear connection between association membership and a level of commitment and obligations could be established, this would offer new options for the promotion of evidence based practice in order to achieve a stronger professional profile. Based on the all study describes, researchers found that the most significant factors that affect evidence based practice among nurses are attitude, skills and knowledge associated with evidence based practice. A lot of obstacles found to apply these researches finding in real situation at the kingdom of Saudi Arabia, so this study is attempt to assess nurses factors related to evidence based practice (attitude, knowledge and skills) and applying evidence based practice. Aim of the study: The objective of this study was to assess nurses’ knowledge/skills and attitude about evidence based practice in King Khalid Eye Specialist Hospital (KKESH) and King Faisal Specialist Hospital Research Centre (KFSCRC).

Olfa t A. Salem, et al.

Subjects and Methods Research design: A cross-sectional descriptive study design was used in carrying out the study. Setting: A- King Khaled Eye Specialist Hospital (KKESH): This study was conducted at King Khaled Eye Specialist Hospital (KKESH). It is a tertiary care ophthalmic facility operated by the Ministry of Health (MOH) of the Kingdom of Saudi Arabia. The hospital provides quality tertiary ophthalmic care to the patients it serves and promotes the delivery of Kingdom-wide ophthalmic care through its outreach, educational and research programs. The hospital employs more than 1,200 individuals, including 70 full-time, board-certified physicians, 200 nurses and more than 200 technical support staff and assistants. The hospital has 228 inpatient beds, a major operating room with 12 dedicated ophthalmic theaters, an outpatient clinic with more than 50 examination lanes and a large emergency room providing service round the hour. In 2006, there were approximately 100,000 visits to the outpatient clinic and more than 26,000 visits to the emergency room. There were approximately 10,000 inpatient admissions and more than 10,625 surgical procedures performed in the major operating theater. B- King Faisal Specialist Hospital and Research Center (KFSHRC): Established in 1970 on 450,000 sq. meters the purpose of the KFSHRC in the beginning period was to provide tertiary care to the citizens locally avoiding the hardship and cost of traveling abroad. At this moment, the hospital is striving to be a world leading institution of excellence and innovation in healthcare. In 2007, the hospital had total bed capacity of 866 with average length of stay of 10.6. In addition, in 2006, KFSHRC in general have a high quality of patient satisfaction of 91 % and 90% for inpatient, respectively. The Nursing Staff total is 1,942 and 18% from Canada and 11% from the United States. The other Nursing staffs are from the United Kingdom, Europe, Australia, New Zealand, the Philippines, Saudi Arabia and other countries. Since 2000, KFSHRC has been accredited by JCIA. In addition, other recognition such as "Best Medical Services in the Arab World" was recorded in 2004 in the Sheikh Hamdan Bin Rashed Al Maktoum Award for Medical Sciences [21] .

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Subjects and sample: A non-probability convenience sampling technique was used to select the study subjects from the above-mentioned hospital. It consisted of all staff nurses who were available at the time of the study. The questionnaire distributed was 200 in each hospital at with respondent rate of 33.5% in KFSHRC (67/200) & 61.5% (123/200) in KKESH. The nurses were varied in years of experience. The inclusion criteria were being a bedside nurse at selected hospital, with a minimum of one-year of experience. Data collection tool: In this study the Evidence Based Questionnaire (EBQP) developed by Dupton & Dupton [22] was used. This questionnaire assessed knowledge/skills, attitude and practice associated with evidencebased practice. The EBQP Construct validity Correlation coefficients were found to be in the range of 0.3–0.4 (p