Factors that predict evidence use by Australian perioperative Factors that predict evidence use by Australian perioperative nurses nurses

Evidence-based practice has been demonstrated to positively impact patient outcomes; unfortunately, there are many factors that hinder the use of research evidence by healthcare clinicians. Our previous study reported a multisite survey assessing Australian perioperative nurses knowledge, practice, attitude, and perceived barriers to evidence use. This subsequent analysis used univariate and multivariate binary logistic regression with odds ratios (OR) and 95% confidence intervals (CI) to compare individual nurse and organisational characteristics with high evidence-based practice (EBP) use. Two individual nurse characteristics found to be related to EBP were postgraduate qualifications (OR 1.69, 95% CI 1.07–2.6, p=0.02) and previous research experience (OR 1.9, 95% CI 1.6–2.4, p=0.01). Organisational characteristics related to EBP included access to the internet (OR 2.04, 95% CI 1.3–3.0, p=0.001) and access to ongoing EBP education (OR 1.6, 95% CI 1.1–2.5, p=0.01). Previous research experience (OR 1.6, 95% CI 1.0–2.3, p=0.01) was the only independent predictor of EBP. Given our finding, we suggest that considerably greater effort be made to facilitate nurses involvement in research studies in the perioperative setting.


Background
It is now widely accepted by clinicians, the community, and regulatory agencies that clinical care should be based on the best available research evidence.Perioperative nursing scholars, however, have expressed concerns that our profession may not be meeting these expectations 1 .Many examples of substantial evidencepractice gaps can be found in this very journal and others that support these concerns [2][3][4] .The ongoing struggle with translating evidence into practice has led to calls for an increased focus on research and research utilisation to ensure the continued growth of the perioperative nursing specialty 5 .
The barriers to evidence-based practice (EBP) and strategies to increase evidence use by nurses have been the focus of a growing body of research.Two systematic reviews have identified the complexity of, and challenges with, integrating research evidence into nursing practice 6,7 .The reviews synthesise the findings of prior studies to identify individual nurse and organisational factors that influence and are predictors of EBP use.
Squires et al. 6 reviewed 45 studies to examine the relationship between individual nurse characteristics and EBP.The characteristics identified from the reviewed studies can broadly be categorised into demographics (age and sex), professional characteristics (role, designation, and qualifications), and exposure (previous research experience and ongoing EBP education).The authors of the review acknowledged significant variation in the findings of the included studies, but, in general, concluded that postgraduate qualification, current role, information seeking, and clinical specialty were significantly related to EBP.
In their review of 10 studies, Meijers et al. 7 examined the relationship between contextual factors (including organisational characteristics) and EBP in nursing.The organisational characteristics identified by the authors can broadly be categorised into research resources, structural supports and skills, education and training.Again, there was a significant variation identified between the included studies, but the authors did report a relationship between EBP and access to resources, multifaceted research support, time for research activities, and provision of education.
The findings of these reviews offer the potential for researchers and educators to develop specifically targeted interventions aimed at increasing EBP in nursing 8 .Although the findings are beneficial, both reviews identify that many of the included studies had substantial methodological problems.The authors recommend that the findings be replicated in further research using more robust study designs, larger samples and multivariate assessment methods 6,7 .
In this paper we aim to contribute to this body of knowledge by analysing data from a large survey of Australian perioperative nurses 9 using multivariate binary logistic regression analysis to identify individual nurse and organisational characteristics significantly related to EBP.The univariate analysis of the relationship between individual nurse and organisation characteristics are presented in Tables 1 and 2 with number and percentage plus OR and p-value.Statistically significant characteristics entered into the multivariate analysis are presented in Table 3 with B Wald scores plus OR and p-value.

Individual nurse characteristics and EBP
According to the univariate analysis (Table 1) there were no significant relationships between a nurse's age, sex, perioperative experience, employment status, role, designation, time since last nursing qualification, previous EBP training, and reported EBP.Postgraduate education (OR 1.69, 95% CI 1.07-2.6,p=0.02) and previous research experience (OR 1.9, 95% CI 1.6-2.4,p=0.01) were found to be statistically related to EBP.

Organisation characteristics and EBP
The univariate analysis of the organisational characteristics (Table 2) found that there were no significant relationships between EBP and a nurses' sector (public or

Independent predictors of high EBP
The four individual nurse and organisational characteristics found to have a significant relationship with EBP were entered into a multivariate model ( The same US study identified that the majority of nurses felt more comfortable finding research evidence on the internet than using research databases such as CINAHL 22 .Access to the internet for staff is a simple measure that health services could implement to immediately increase nursing staff's access to evidence for practice.

Implications for practice
In their paper on strategies for developing EBP in perioperative nursing, Osborne and Gardner 1 propose that a strategic response to increasing EBP needs to occur at three levels: the individual, the organisational, and the professional.The following paragraphs discuss potential practice implications for these three levels.
At the individual clinician level it can sometimes feel overwhelming to try and introduce evidence into our practice because our practice is so dependent on other members of the nursing and multidisciplinary team.This interdependence is often a strength but it can also provide a significant challenge when it comes to introducing changes

Conclusion
EBP has been demonstrated to positively impact patient outcomes, yet nurses are still having difficulty incorporating it into their practice.This study identified that postgraduate qualifications; previous research experience; access to the internet; and ongoing EBP education were significantly related to higher levels of EBP.These findings offer the potential for targeted initiatives to increase the capacity of perioperative nursing for EBP.In particular, we suggest that considerably greater effort be made to facilitate nurses' involvement in research studies in the perioperative setting.

Table 2 :
Univariate analysis of organisational predictors of EBP

Table 3 :
Multivariate logistic regression analysis of predictors of EBP