Evaluación de la competencia en práctica basada en la evidencia de las enfermeras españolas mediante el cuestionario EBP-COQ Prof©

Abstract

Evidence-Based Practice (EBP) improves the quality of healthcare, health outcomes and patient safety. Despite the importance of EBP, there is a gap between knowledge and its actual implementation in clinical practice by healthcare professionals, including nurses. Health services need nurses to be competent in EBP, so it is necessary to have instruments to measure this competence. The instruments developed so far have some methodological limitations, psychometric weaknesses and do not have associated scales. Studies on EBP competence of nurses have been developed at international level, most of them in the hospital setting, although we do not have updated national data in Spain. The general objective of this Doctoral Thesis was to know the EBP competency of Spanish nurses by means of the EBP-COQ Prof© questionnaire and the associated factors. The Doctoral Thesis is organized in two phases. In phase 1, the EBP-COQ Prof© questionnaire was developed and validated through a process that consisted of the operational definition of the construct, item creation, face and content validation by experts and cognitive piloting. This was followed by an observational, multicenter, cross-sectional study to conduct the psychometric assessment in which 579 nurses participated. In phase 2, an observational, cross-sectional, national study, stratified by autonomous community, was carried out with the aim of determining EBP competence and its associated factors, in which 2942 nurses from 17 autonomous communities participated. Subsequently, the specific subsample of nurses working in the primary care setting was analyzed. The results show that the EBP-COQ Prof© questionnaire has adequate psychometric properties and allows measuring self-perceived competence in EBP through four dimensions: attitudes, knowledge, skills and utilization. The scale developed for this questionnaire helps in the interpretation of the scores so that the level of EBP can be easily compared between subjects. Spanish nurses, regardless of the care setting, have moderate EBP competence: favorable attitudes towards EBP, moderate knowledge and skills and lower scores on the utilization dimension. The factors that influence EBP competency are associated with the characteristics of the professionals (academic level, reading of scientific articles, years of study completion, specific training in EBP) and the work environment (tutoring of nursing students and participation in evidence implementation programs). In addition, in the Primary Care setting, the use of social networks and health blogs to access scientific information and frequent access to the Internet at work are positively related to the use of EBP by nurses. The main conclusions of this Doctoral Thesis are linked to three aspects. First, the ability of the EBP-COQ Prof© to accurately measure nurses' EBP competency in different work settings (hospital care or primary care). Secondly, the usefulness of the scale developed for the instrument, which will allow health services to know the EBP competency of nurses and to direct their training strategies to improve specific dimensions of competence (attitudes, knowledge, skills or utilization). Third, the practical guidelines derived from the factors that have been associated with nurses' EBP competency, which can be useful to health services in the development of interventions for the implementation of EBP in clinical practice