LIST OF ABBREVIATIONS

EBP :           Evidence Based Practice

EBNP :           Evidence Based Nursing Practice

JCAHO:           Joint Commission on Accreditation of Healthcare Organisation

SIM   :        Self Instructional Module

WHO :           World Health Organisation

Df      :          Degree of freedom

P        :           Probability

r        :       Correlation Coefficient

SD          :          Standard Deviation

CINAHL        :           Cumulative Index to Nursing & Allied Health Literature. RN Registered Nurses

SMSH            :           Sawai Man Singh Hospital

Introduction

“The first step towards knowledge is to know that we are ignorant” Richard Cecil-

The past century has witnessed spectacular changes in the way we live and think. Human brilliance and technology have come together to propose solutions we dared not imagine fifty years ago. Many diseases have been conquered, millions of people have been saved from premature death and disability and the search for better solutions to healthcare is on.[1]

Like most disciplines, nursing consists of both scientific knowledge and conventional wisdom (knowledge that has not been empirically tested). Traditionally only what stands the text of repeated measures constitutes truth or knowledge. Classical scientific process however are net suitable for creating and describing all types of knowledge for the caring profession of nursing.[1]

Social sciences and behavioural sciences and the arts rely on other methods to establish knowledge. There is an ongoing emphasis on development of nursing knowledge through research and theory building to improve their practice base. Nursing relies on multiple ways of knowledge because it has characteristics of social, behavioural and biological science.[1]

Background of the Study

“The learning and knowledge that we have, is, at the most, but little compared with that of which we are ignorant.”  Plato-

It is believed that theory guided practice is the future of nursing enters into the 21^st Century. Theory guided practice must be placed at the core of nursing and must integrate relevant-outcome-driven practice with the art and science of caring and healing.[1]

The concept of EBP in nursing is still in a very primitive stage in many parts of the world. Nursing practice in most parts in India is based on experience, tradition, intuition, common sense and untested theories. Nurses should be encouraged to recognize the theoretical basis for practice and see ways to enhance the knowledge base which supports practice right from the beginning of their working.

Their needs to be an elevated emphasis on increasing reciprocal interaction among theory, research and practice with bridging gap between practices.[1]

Florence Nightingale would probably not recognise the nurse of today. As we move into the next millennium, we expect nurses to care with their hearts and minds; identify patients? actual and potential problems; and develop research-based strategies to prevent, ameliorate, and comfort.[2]

In todays complex and dynamic patient care environment, nursing interventions and process informed by the best evidence are vital to realizing health care improvements and cost savings.[3]

Numbering more than 2 million and practicing in most health-care settings, nurses make up the largest number of health care professionals, Every patient is likely to receive nursing care. Therefore, nurses are in important position to influence the type, quality, and cost of care provided to patients.[3]

Increased emphasis on efficiency, cost containment and quality in a healthcare system that is rapidly changing and advancement of science and technology have lead to the need for reliable, up to date evidence that could improve the healthcare system is accordance with the advancements.[4]

Today, nurses are actively generating, publishing, and applying research in practice to improve client care and enhance nursing?s scientific knowledge base. Recently, there has been increased emphasis on the importance of evidence based practice, that is, the use of some form of substantiation in making clinical decisions. This substantiation, or evidence, can arise from tradition, authority, experience trial and error, logic or reason or research.[4]

Evidence based practice (EBP) has been described as “the integration of best research evidence with clinical expertise and patient values”. There are various models to provide a frame work for moving evidence and research in to practice.[4]

The demand of healthcare increased dramatically all over the world. This presented new opportunities and changes in the nursing profession. A methodology for clinical practice which is emerging across the nursing discipline is termed as “Evidence Based Nursing Practice”. Evidence based nursing integrates the best evidence from research with clinical expertise, patient preference, and existing resources into decision making about the healthcare of individual patients.[5]

Need of the Study

“Unless we are making progress in our nursing every year, every month, Every week, take my word for it we are going back”.  Florence Nightingale

The generation of empirical knowledge is essential to improve clinical practice. It has been the major focus of researchers since 1980. The generation and diffusion of empirical knowledge are expanding each and every day. With the current changes in the healthcare system, society is demanding more of nurses? involvement than ever before.[6]

Nurses now have the attention of healthcare policy makers and can influence the future delivery system. Meeting policy makers expectations require carrying out of high quality research and the use of those findings in practice.[6]

During the 1980s, the term “Evidence Based Medicine” emerged to describe the approach that use scientific evidence to determine the best practice. The Evidence based practice takes resources, work, time, and effort, but the outcomes make them worthwhile. Every patient deserves care that is based on the best scientific knowledge and that ensures high quality , cost-effective.[7]

A recent study provided in 2005 evidence that most nurses provide care in accordance with what they learnt in nursing school and rarely used journal articles, research reports, and hospital libraries for reference. That finding, combined with the fact that the average nurse is more than 40 years of age, makes it apparent that many nurses? knowledge is probably out-dated. Practice based on such knowledge does not translate into quality patient care or health outcomes. Evidence based practice provides a critical strategy to ensure that care is up to date and that it reflects the latest research evidence.[7]

A study conducted in 2003, that the nurses? most helpful knowledge source was experience or advice from colleagues or patients. Of concern, reports that up to date electronic resources that included evidence-based materials were not useful to nurses in clinical practice. This barrier contributes to significant gaps in clinicians applying research findings to practice and dissemination of innovations. The failure to use evidence results in care that is of lower quality, less effective, and more expensive.[7]

In 2002, the Centres for Disease Control & Prevention published Guideline for Hygiene in Health-Care Settings, which provides healthcare workers with a review of data regarding hand-washing and hand antisepsis in healthcare environments. Furthermore, it makes recommendations to improve hand-hygiene practices and reduced transmission of pathogenic micro organisms to both patients and health care personnel.[7]

Evidence-Based Nursing Practice (EBNP) is the wave of the future. Increasingly, Evidence Based Nursing Practice is being identified as a key to quality and excellence in nursing services. Incorporating evidence into practice is necessary to deliver scientifically sound patient care. Despite the growing popularity of evidence based nursing practice and its documented significant benefits, there is only 15% of the nursing work force consistently practices within the evidence based nursing practice frame work. If evidence based nursing practice adoption is to increase in the profession, it will require the active efforts of nurses to increase their knowledge regarding evidence based nursing practice.[8]

Evidence-Based Nursing Practice, or evidence based decision making, is rapidly developing as a growth industry in nursing and the health professions more widely. It has its origins in the work of the British Epidemiologist Archie Cochrane and has recently been re- energized in Canada by the National Forum on Health and its call for culture evidence - based decision making. Before we adopt EBN as a Mantra for the 21^st Century, we should examine its origins and its consequences, and we should probe related concepts, two of which are the nature and structure of practice-based knowledge and the nature and structure evidence generally.[9]

A survey that was established by the Sigma Theta Tau International, Honor Society of Nursing (2002) and completed by registered nurses provided that 69% have a low to moderate knowledge regarding Evidence

- Based Practice and half of those that responded did not feel sure of the steps, the process consist of Evidence-Based Nursing Practice leads to higher quality care, improved patient outcomes, reduced costs and greater nurse satisfaction than traditional approaches to care.[10]

Nurses are responsible for the care they provide to their patients. Evidence- based practice in nursing means making decisions about patient care on the basis of current best available evidence. It helps the nurse to provide high-quality care to her patients based on research and knowledge. Evidence - based practice increases the efficiency of nurses. Making decisions based on knowledge that is backed by research makes it easier for a nurse to choose what care to provide to her patient as opposed to trying something that may or may not be beneficial to her patient. This saves her time, which she can devote to patients who need more intensive care from her.[11] Using Evidence-based practice to provide care to patients increases the nurse?s confidence. This is because she knows that she is basing her decisions about patient care on valid information that has been thoroughly researched. For nurses to apply Evidence-based practice in the care they provide, they have to say informed on any new discoveries that have been made. This encourages them to read materials that cover nursing research thus keeping their practice current. [11]

Evidence-based practice has gained momentum in nursing, and definitions vary widely. Research findings, knowledge from basic science, clinical knowledge, and expert opinion are all considered “evidence”, however, practices based on research findings is more likely to result in the desired patient outcomes across various settings and geographic locations. The impetus for Evidence based practice comes from payer and healthcare facility pressure for cost containment, greater availability of information, and greater consumer savvy about treatment and care options. Evidence-based practice demands changes in education of students, more practice-relevant research, and closer working relationships between clinicians and researchers. Evidence-based practice also provides opportunities for nursing care to be more individualized, more effective, streamlined, and dynamic, and to maximize effects of clinical judgment. When evidence is used to define best practices rather than to support existing practices. Nursing care keeps pace with the latest technological advances and takes advantage of new knowledge developments.[12]

The expectation for high quality, cost-effective care and the rapid expansion of easily accessible knowledge in a competing healthcare market place have driven the need for the daily use of evidence to improve point

• of- service care (i.e.; at the bedside). Regulatory and accrediting agencies (i.e, Joint Commission on Accreditation of Healthcare Organization [JCAHO] ) now require that practice be based on evidence. All of these factors have led to the need for all healthcare providers to gain knowledge and skills in Evidence- based practice. Evidence-based practice, in which synthesis of the evidence is the key element, encompasses both research utilization and the conduct of research. [13]

The primary task of nursing research is to contribute to the scientific base of nursing practice. Science is needed to determine the effectiveness of nursing interventions and nursing care. Through such research efforts, the science of nursing will grow and a scientifically based rational for making changes in nursing practice and patient care will be generated. Evidence-based practice will be facilitated, with a resultant increase in the quality of patient care.[14]

So, the researcher felt that it is necessary to impart knowledge through Self Instructional Module on Evidence Based Nursing Practice among staff nurses for quality care in turn to promotion of total healthcare delivery system.

Statement of the Problem:

“A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE (SIM) ON KNOWLEDGE REGARDING EVIDENCE BASED NURSING PRACTICE AMONG STAFF NURSES WORKING IN SELECTED HOSPITALS AT JAIPUR”.

Objectives of the Study:

1.To assess the existing knowledge of staff nurses regarding Evidence Based Nursing Practice working in selected hospital.

2.To develop, validate & administer self instructional module.

4.To find an association of knowledge with selected demographic variables like age, gender, experience, professional qualification etc.

Operational Definitions

1.ASSESS: It refers to the measurement of knowledge of the nurses working in hospitals regarding Evidence Based Nursing Practice.

2.EFFECTIVENESS: It refers to the gain in the knowledge on Evidence Based Nursing Practice among staff nurses working in selected hospital at Jaipur city.

3.SELF INSTRUCTIONAL MODULE: It is planned and documented information given to staff nurses regarding Evidence Based Nursing Practice.

4.KNOWLEDGE: It refers to the awareness, amount of information or understanding about Evidence Based Nursing Practice among staff nurses as measured by structured questionnaire. Knowledge will be measured in terms of knowledge scores.

5.EVIDENCE BASED NURSING PRACTICE: Evidence Based Nursing Practice means making decisions about patient care on the basis of current best available evidence.

6.STAFF NURSE: Is a person who has successfully completed the General Nursing & Midwifery course or Bachelor of Science in nursing and working in selected hospital at Jaipur city.

7.DEMOGRAPHIC VARIABLES: The demographic variable is an uncontrolled variable that greatly influences the results of the study. The study also consists of demographic variables such as, gender, age, professional qualification, professional experience, area of working, and source of knowledge etc.

Assumptions:

The researcher assumes that:

a.Evidence Based Nursing Practice may improves the quality of patient care.

b.Evidence Based Nursing Practice may improves the nurses confidence to give nursing care.

Research Hypothesis:

H1: There will be a significant difference between existing and post-test level scores of knowledge regarding Evidence Based Nursing Practice among staff nurses.

H2: There will be a significant association between the level of knowledge and selected demographic variables of staff nurses regarding Evidence Based Nursing Practice.

Delimitations:

The research will be confines to nursing staffs;

Who are working in selected hospital.

Who are like to participate in the study.

Variables:

The independent variable:

The independent variable is the condition or characteristics is manipulated by the researcher. In experimental studies, the independent variable is the “cause” or the variable that is thought to influence the independent variable.[15]In this study the independent variable is the Self Instructional Module on Evidence Based Nursing Practice.

The dependent variable:

The dependent variable is the effect or the variable that is influenced by the researcher?s manipulation of the independent variable. It is the effect of the action of independent variable.15

The dependent variable in this study is the knowledge score of the staff nurses.

The demographic variable: