Impact of Good Practice Guidelines on Evidence-based Practice and Nurses' Work Environment

Impact of the Implementation of Good Practice Guidelines on Beliefs-attitudes and Behavior in the Face of Evidence-based Practice and on the Perception of the Nurses' Work Environment

Evidence-based practice (EBP) has improved patient health outcomes. The work environment of nurses is a key element to improving the quality of care and to facilitate EBP, while also improving health outcomes.

The CCEC® / BPSO® program consists of the implementation of Good Practice Guides in health organizations in the Spanish territory, and is carried out through a training and participatory methodology, actively involving nurses in the process.

The present study tries to know if in the health organizations where the CCEC® / BPSO® program has been implemented, the perception of the nurses' working environment has improved, as well as their attitude towards evidence-based practice, with respect to organizations where this program has not been implemented.

Study Overview

• Status: Completed
• Conditions: Nurse Physician Relations; Professional Stress; Practice Nurse's Scope; Nurses' Work Environment; Committed Centers With Excellence in Care (CCEC®) Program; Nurses' Evidence-based-practice Attitudes
• Intervention / Treatment: Other: Good Practice Guidelines implementation

Detailed Description

Quasi-experimental pre-post multicentre study with a non-equivalent control group, within the framework of the third cohort of the RNAO Good Practice Guidelines Implementation Program in Centers Committed to Care Excellence (CCEC® / BPSO®).

PARTICIPATING INSTITUTIONS:

Intervention group(IG): (institutions included in the third cohort of CCEC®):

Estructura de Gestión Integrada de Lugo, Cervo y Monforte de Lemos (Galicia), Hospital General Universitario Santa Lucía (Murcia), Xerencia de Xestión Integrada de A Coruña (Galicia), Hospital Guadarrama (Madrid), Hospital Universitari Germans Trias i Pujol (Cataluña), Hospital Regional Universitario de Málaga (Andalucía), Organización Sanitaria Integrada OSI Araba (Araba).

Control group(CG): Hospital Son Espases (Mallorca), Hospital Son Llàtzer (Mallorca), Hospital de Granollers (Barcelona), Hospital de Puigcerdà (Girona), Hospital d'Igualada (Barcelona), Hospital General Universitario de Alicante (Alicante), Hospital Comarcal de Vinaròs de Castellón de la Plana (Castellón), Hospital Clínic de Barcelona (Barcelona), Hospital Universitario de Fuenlabrada (Madrid), Hospital de la Santa Creu i Sant Pau (Barcelona).

To collect data, two validated questionnaires will be passed to all nurses in 7 health institutions where the RNAO Good Practice Guidelines Implementation Program begins (experimental group) and in 10 where it is not implemented (control group), both groups distributed throughout the Spanish territory. Basal data will be recorded before the beginning of the program and post intervention data will be recorded after one year.

Then the results will be compared to determine whether there are differences between nurses who work in the group of hospitals that have started the program with respect to those who work in other centers. The total duration of the project will be three years.

• Study Type: Interventional
• Enrollment (Actual): 1200
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Spain
  • A Coruña, Spain, 15006
    • Xerencia de Xestión Integrada de A Coruña
  • Alicante, Spain, 03010
    • Hospital General Universitario de Alicante
  • Barcelona, Spain, 08036
    • Hospital Clinic
  • Barcelona, Spain, 08041
    • Hospital de la Santa Creu i Sant Pau
  • Lugo, Spain, 27003
    • Hospital Lucus Augusti
  • Murcia, Spain, 30202
    • Hospital General Universitario Santa Lucia
  • Málaga, Spain, 29010
    • Hospital Regional Universitario de Malaga
  • Palma De Mallorca, Spain, 07120
    • Hospital Universitari Son Espases
  • Palma De Mallorca, Spain, 08198
    • Hospital Son Llatzer
  • Araba
    • Vitoria Gasteiz, Araba, Spain, 01009
      • Organización Sanitaria Integrada (OSI) Araba
  • Barcelona
    • Badalona, Barcelona, Spain, 08916
      • Hospital Universitri Germans Tries i Pujol
    • Granollers, Barcelona, Spain, 08402
      • Hospital de Granollers
    • Igualada, Barcelona, Spain, 08700
      • Consorci Sanitari Anoia-Hospital Igualada
  • Castelló
    • Vinaròs, Castelló, Spain, 12500
      • Hospital Comarcal de Vinaròs
  • Girona
    • Puigcerdà, Girona, Spain, 17520
      • Hospital de Puigcerdà
  • Madrid
    • Fuenlabrada, Madrid, Spain, 28942
      • Hospital Universitario de Fuenlabrada
    • Guadarrama, Madrid, Spain, 28440
      • Hospital de Guadarrama

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 21 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

Nurses Work in the institutions participating in the study Acceptance to participate in the study

Exclusion Criteria:

Not be active

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Good Practice Guidelines group; Implementation of Good Practice Guidelines	Other: Good Practice Guidelines implementation; Implementation of Good Practice Guidelines on the framework of the Best Practice Spotlight Organization in Spain (CCEC® / BPSO®), that allows a standardized methodology for providing care and registering indicators.
No Intervention: usual practices group; Not Implementation of Good Practice Guidelines, so working as the usual way

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
change in Nurses' work environment	self reported perceived current work environment through the Practice Environment Scale-Nursing Work Index (PES-NWI) questionaire, with 31 Likert type questions (1: "Strongly Disagree" -> 4 "Strongly Agree"), including 5 sub-scales: Nurse participation in hospital affairs (8 questions); nursing foundations for quality of care (10 questions); nurse manager ability, leadership and support of nurses (5 questions); staffing and resource adequacy (4 questions); and collegial nurse-physician relationships (3 questions)	baseline and 1 year
change in Beliefs- attitudes and behavior in front of EBP	self-reported Beliefs- attitudes and behavior in front of EBP, through the 60 Likert type questions (from 1: minimum agreement to 10: maximum agreement) of the Health Sciences-Evidence Based Practice questionnaire (HS-EBP), that are classified in 5 dimensions: Beliefs and attitudes, (12 items); Results from scientific research (14 items); Development of professional practice (10 items); Evaluation of results (12 items) and Barriers / Facilitators (12 items).	baseline and 1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
change in Job satisfaction: Likert type question rating	self-reported job satisfaction through a unique Likert type question rating 1: very unsatisfied; 5: very satisfied.	baseline and 1 year
change in Institutional attitude perceived by nurses in relation to nursing research	self-reported 4 question rating: yes, not, unknown.	baseline and 1 year

Collaborators and Investigators

• Sponsor: Parc de Salut Mar
• Collaborators: Hospital del Mar Research Institute (IMIM); COIB, Col·legi d'Infermers i infermeres de Barcelona; Department of Health, Generalitat de Catalunya (PERIS)
• Investigators: Principal Investigator: Silvia Esteban-Sepúlveda, IMIM (Hospital del Mar Medical Research Institute), Barcelona

Publications and helpful links

General Publications

• Aiken LH, Sermeus W, Van den Heede K, Sloane DM, Busse R, McKee M, Bruyneel L, Rafferty AM, Griffiths P, Moreno-Casbas MT, Tishelman C, Scott A, Brzostek T, Kinnunen J, Schwendimann R, Heinen M, Zikos D, Sjetne IS, Smith HL, Kutney-Lee A. Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ. 2012 Mar 20;344:e1717. doi: 10.1136/bmj.e1717.
• Aiken LH, Sloane DM, Clarke S, Poghosyan L, Cho E, You L, Finlayson M, Kanai-Pak M, Aungsuroch Y. Importance of work environments on hospital outcomes in nine countries. Int J Qual Health Care. 2011 Aug;23(4):357-64. doi: 10.1093/intqhc/mzr022. Epub 2011 May 11.
• Cho E, Chin DL, Kim S, Hong O. The Relationships of Nurse Staffing Level and Work Environment With Patient Adverse Events. J Nurs Scholarsh. 2016 Jan;48(1):74-82. doi: 10.1111/jnu.12183. Epub 2015 Dec 7.
• Fernandez-Dominguez JC, de Pedro-Gomez JE, Morales-Asencio JM, Bennasar-Veny M, Sastre-Fullana P, Sese-Abad A. Health Sciences-Evidence Based Practice questionnaire (HS-EBP) for measuring transprofessional evidence-based practice: Creation, development and psychometric validation. PLoS One. 2017 May 9;12(5):e0177172. doi: 10.1371/journal.pone.0177172. eCollection 2017.
• Fuentelsaz-Gallego C, Moreno-Casbas MT, Gonzalez-Maria E. Validation of the Spanish version of the questionnaire Practice Environment Scale of the Nursing Work Index. Int J Nurs Stud. 2013 Feb;50(2):274-80. doi: 10.1016/j.ijnurstu.2012.08.001. Epub 2012 Sep 1.
• Heater BS, Becker AM, Olson RK. Nursing interventions and patient outcomes: a meta-analysis of studies. Nurs Res. 1988 Sep-Oct;37(5):303-7.

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2018
• Primary Completion (Actual): November 30, 2019
• Study Completion (Actual): April 21, 2022

Study Registration Dates

• First Submitted: December 10, 2019
• First Submitted That Met QC Criteria: December 12, 2019
• First Posted (Actual): December 13, 2019

Study Record Updates

• Last Update Posted (Actual): April 22, 2022
• Last Update Submitted That Met QC Criteria: April 21, 2022
• Last Verified: April 1, 2022

More Information

Terms related to this study

• Keywords: Hospital; Evidence-Based Practice; nurses' Workplace; Good Practices Guides
• Additional Relevant MeSH Terms: Behavioral Symptoms; Stress, Psychological; Occupational Diseases; Occupational Stress
• Other Study ID Numbers: CEIm-PSMAR 2018/8087/I

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Not considered, since the data processing will be done on an aggregate basis.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No