Aim: To evaluate the research findings related to EBP mentor development programs, to identify effective practices, and to assess the outcomes associated with EBP mentor programs. Studies were appraised and reviewed to compare mentor program composition and examine clinician, organizational, and patient outcomes.
Findings : Fifteen studies met inclusion criteria: one randomized control trial RCT , one literature review, eleven descriptive studies, and two case reviews. Most programs included didactic content, an EBP project with coaching, and resources to support learning. Implications to Practice: There is solid justification for healthcare organizations to invest in an EBP mentor development program.
DNP Qualifying Manuscripts. Contact Author. Nursing Administration Commons. Advanced Search. Multiple barriers have contributed to the slow uptake of EBP across healthcare systems, including a inadequate knowledge and EBP skills by healthcare professionals, b misperceptions about EBP, c lack of informatics competencies, d insufficient administrative support and resources at the point of care, e lack of EBP mentors in healthcare systems, and f traditional approaches to teaching healthcare students the rigorous process of how to do research rather than how to use research to guide best practice Fineout-Overholt et al.
Findings also indicate that individuals who rate themselves higher on knowledge and beliefs about the value of EBP and their ability to implement it are more likely to teach it to others Melnyk et al.
Several conceptual models to guide implementation of EBP by individuals and in healthcare delivery systems have been developed. These include models that focus on the process of individual practitioner incorporation of the principles of EBP as well as system-wide strategies for implementation.
Although EBP conceptual models are important and useful in guiding general implementation strategies to advance EBP in individuals and in organizations, few studies have generated empirical evidence to support the proposed relationships in the majority of these models.
Specifically, it is largely unknown what strategies within the proposed models contribute to system-wide adoption, implementation and sustainability of EBP. As a result, there is an urgent need to test strategies to advance EBP throughout international healthcare systems. Melnyk and Fineout-Overholt have further developed the model, which now serves as a guide to advance system-wide implementation and sustainability of EBP See Figure 1. The first step in the ARCC model is an organizational assessment of the culture and readiness for EBP so that EBP facilitators and barriers can be identified, toghether with a plan to overcome them.
EBP mentors are then developed and placed within the healthcare system to work directly with point-of-care staff to foster their EBP knowledge, beliefs and skills in evidence-based care. EBP mentors worked with direct care nurses on clinical research units to strengthen their beliefs about the value of EBP and their ability consistently to deliver evidence-based care. It opened in and remains the largest inpatient facility in the USA devoted exclusively to clinical research.
Its unique design was created to support the development of translational research. The research-intensive nature of the practice environment created a fertile ground for systematic implementation of evidence-based practice in a setting that was simultaneously creating new evidence for practice. The ARCC model was selected for the study reported in this paper because of its focus on advanced practice nurses as EBP mentors and the involvement of staff at all levels in implementation.
The aim of the study was to evaluate the effectiveness of a structured multifaceted mentorship programme designed to implement evidence-based practice in a clinical research intensive environment.
They included nurse managers, clinical nurse specialists, clinical educators, nurse researchers, senior clinical staff, executive staff and leaders in the Shared Governance Nursing Practice Council. For the comparison group, non-workshop attendees were stratified into clinical practice areas and then randomly selected from those areas to complete the survey.
Nurses from ambulatory care clinics and day hospitals were also randomly selected for participation. The baseline survey data included participants: 94 participants in the EBP workshop group and 65 in the non-workshop group.
The post-intervention survey included 99 participants, with 58 in the EBP workshop group and 41 in the non-workshop group. The sample demographics characteristics are described in Table 1.
The programme began with a two-day intensive workshop to provide a general foundation to developing EBP skills among identified nurse champions needed to promote, implement and sustain EBP Fineout-Overholt et al. The workshop was targeted at a core group of nurse leaders, including senior clinical research nursing staff, Shared Governance committee chairs, clinical nurse specialists, nurse managers and nurse educators who were identified as most likely to become EBP mentors throughout the organization.
Additionally, the programme was designed to develop and empower mentors by providing ongoing mentorship skill-building activities. These included activities such as an EBP luncheon workshop on ways to strengthen mentorship, a holiday tea party to celebrate and support EBP mentors and nurse leaders, and interactive lectures on the basics of EBP presented for the Clinical Practice Committee of the Nursing Practice Council.
In June nurses enrolled in the EBP workshop, as well as a stratified random sample of those not registered to attend the workshop, were invited by email to participate in an online, Survey Monkey, EBP programme evaluation study. The post-test was administered via Survey Monkey in February to both those who attended and those who did not attend the EBP workshops. Each of the three formative focused discussions included the following four questions: 1 What does EBP mean to you?
Content from these focused discussions was used to determine perceptions and potential organizational barriers prior to programme implementation. The 25 items are measured on a 5-point Likert-type scale ranging from not at all to very much. Higher total scores reflect greater organizational readiness for EBP. The items are measured on a 5-point Likert-type scale ranging from strongly disagree 1 to strongly agree 5.
There are two reverse-scored items. Once reversed, all items are summed to give a total score. Higher scores reflect more positive beliefs about EBP.
Construct validity of the scale has been supported through factor analysis Melnyk et al. For each item, respondents indicate how often they have demonstrated a particular EBP implementation behavior over the past 8 weeks e. Responses range from 0 times over the past 8 weeks to more than 8 times over the past 8 weeks. Higher total scores reflect more frequent use of EBP behaviors and skills. Construct validity has been supported through factor analysis Melnyk and Fineout-Overholt Principal component analysis confirmed that each of the scales was measuring a distinct, unidimensional construct Melnyk et al.
This instrument uses a 7-point Likert-type response scale developed to measure group judgment or attitude similarities and was designed so that lower summed scores reflected higher group cohesion. To promote ease of interpretation, all items were reverse-scored so that higher scores indicated greater group cohesion. Previous nursing studies have provided evidence of predictive validity explaining statistically significant variance in job satisfaction Hinds et al.
Job satisfaction represents the degree of satisfaction individual nurses feel toward their job and was measured using the previously validated and reliable 7-item Price and Mueller Job Satisfaction questionnaire Likert responses on the scale range from strongly agree 1 to strongly disagree 5. Typically, lower total scores indicate higher job satisfaction.
However, for ease of interpretation, items that are usually reverse-scored on this scale i. The two-item Intent to Leave Scale asks how likely it is that the respondent will leave their job within the next six months and the frequency with which they have sought out other job possibilities in nursing in the past six weeks Price and Mueller The items were reverse-scored and summed so that higher scores indicated increased intent to leave their current nursing positions.
This 6-item Likert scale has eight responses to each item, ranging from definitely false 1 to definitely true 8. There are two reverse-scored items e. Higher scores indicate stronger retention within the profession. Construct validity has been established through the exploratory and confirmatory factor analysis Cowin Participation in the focus groups or completing the survey was taken as consent to participate in the study. Qualitative analysis of focused discussions prior to the online survey and workshop included content analysis of responses that were used to assess the organizational climate for the implementation of EBP.
Because the electronic survey collection method i. A conservative method was used to examine mean differences in the variables of interest, where scores were arranged so as to maximize the negative pairwise relationship across time and to perform a repeated measures analysis Time X Group. Pretest scores were ranked in ascending order and those from the post-test were ranked in descending order. Ranking occurred within both workshop and non-workshop groups. Substitution of the individual mean was used to impute data for respondents who missed two or fewer responses on the multi-item scales that were comprised of 6 or more questions.
Clinical specialists had the most knowledge of EBP, followed by the nurse managers. Both CNS and Practice Council members said that bedside nurses might be resistant and would perceive that EBP was not necessary unless it was applicable to their practice.
All three groups believed that leadership support of a culture for EBP and the dedication of resources for sustainability of the initiative needed to be a priority for engaging staff at all levels.
CPC members also stated that the existing model of shared governance would promote the sustainability of this effort. Participants emphasized that all success would include a grassroots initiative and administrative initiative, and not just involvement of CNSs or nurse managers. As seen in Table 2 , organizational culture and readiness for EBP were related to multiple variables. Specifically, as perceived organizational culture and readiness increased, there were increases in EBP beliefs, group cohesion, job satisfaction and intentions to remain in the nursing profession.
In addition, as organizational culture and readiness increased, intention to leave current roles decreased. Participants of the programme had a larger increase in perceived organizational culture and readiness for EBP as compared to those who did not attend Combined EBP culture and readiness scores for the entire sample increased from Scores for those attending increased by 7.
For those who attended the workshop, EBP Belief scores increased significantly after the workshop from Generalizability of the results of this study is limited because the EBP Mentorship Programme group was a non-random sample that was restricted to nursing leadership and shared governance staff leaders. In addition, once the sample was selected random assignment was not used to assign participants to the mentorship or comparison groups, which threatens the internal validity of the study.
Attrition from the pre- to the post-intervention survey also was substantial, which again threatens the internal validity of the study. Mentorship is commonly accepted in the nursing literature as a positive strategy for bringing nurses into a new system, supporting them while practice changes take place, and increasing not only the quality of their care but also scholarly productivity Barker , Greene and Puetzer , North et al.
These findings corroborate others showing that EBP beliefs of nurses are significantly correlated with EBP implementation, and that having an EBP mentor leads to stronger beliefs and greater EBP implementation by nurses, as well as greater group cohesion, which is a potent predictor of nursing turnover rates Melnyk et al.
The financial investment made by the organization was viewed by those in the focused discussion groups as a positive cultural indicator of the value of EBP.
Organizations are often concerned about return on investment, particularly with increasing demands on existing financial resources.
While there is a cost to cultural change, the return on investment could be realized by the retention of nurses alone. The improvement in patient outcomes that would be anticipated with EBP mentors in place would give even greater potential cost savings.
Combining skill-building for mentors and department-wide and unit based initiatives for staff were key to building beliefs and increasing EBP implementation.
With this culture shift, increased job satisfaction and group cohesion may follow and nurses will remain in their roles. These findings further support the evidence of the key role of EBP mentors for sustainable change Melnyk In an era of severe nursing shortage crisis, investing in the development of nurses as EBP champions and mentors could not only improve the quality of care through improved clinical practice, but also lead to greater nurse satisfaction and less turnover rates resulting in substantial cost savings for healthcare systems see Table 3.
There is a need however, for replication of this study in other practice settings, since differences across international educational systems, service delivery models and organizational structures may influence results.
It may be, for example, that particular service delivery models and interdisciplinary team structures promote or limit effectiveness of EBP mentors in sustaining an EBP culture and in shifting EBP beliefs and implementation. Replication in other settings where the organizational culture is thoroughly described would be helpful in determining if the ARCC mentorship model and our findings hold across international settings and organizational cultures.
In an organizational culture that promotes best practices, evidence-based practice is associated with higher quality care and better patient outcomes than care that is steeped in tradition. The integration of evidence-based practice implementation into daily clinical practice remains inconsistent, and the chasm between research and bedside practice remains substantial. Leadership support of a culture for evidence-based practice and the dedication of resources for sustainability of the initiative need to be priorities for engaging staff at all levels.
In an era of severe nursing shortages, investing in the development of nurses as evidence-based practice champions and mentors may not only improve the quality of care through improved clinical practice, but also lead to greater nurse satisfaction and lower turnover rates, resulting in substantial cost savings for healthcare systems. Conflicts of Interest: The authors of this paper have no conflicts of interest to report. National Center for Biotechnology Information , U.
J Adv Nurs. Author manuscript; available in PMC Dec 1. Gwenyth R. Sandra A. Author information Copyright and License information Disclaimer. Corresponding Author: Gwenyth R.
Copyright notice. The publisher's final edited version of this article is available at J Adv Nurs. See other articles in PMC that cite the published article. Abstract Aim This paper is a report of the effectiveness of a structured multifaceted mentorship programme designed to implement evidence-based practice in a clinical research intensive environment.
Background Barriers to implementing evidence-based practice are well-documented in the literature. Results Participants in the evidence-based practice mentorship programme had a larger increase in perceived organizational culture and readiness for evidence-based practice and in evidence-based practice belief scores than those who did not participate. Keywords: Evidence-based practice, mentors, mentorship programme, nursing, quasi-experiment.
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