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Sys ema ic educa ion has a posi i e impac on nu ses' e idence-based p ac ice :
In e en ion s udy esul s
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Vaajoki, Anne; K is , Ta ja; Kulmala, Ma kus; Te o-Heikkinen, Ta ja
Vaajoki, A., K is , T., Kulmala, M., & Te o-Heikkinen, T. (2023). Sys ema ic educa ion has a
posi i e impac on nu ses' e idence-based p ac ice : In e en ion s udy esul s. Nu se Educa ion
Today, 120, A icle 105597. h ps://doi.o g/10.1016/j.ned .2022.105597
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Nu se Educa ion Today 120 (2023) 105597
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Resea ch a icle
Sys ema ic educa ion has a posi i e impac on nu ses' e idence-based
p ac ice: In e en ion s udy esul s
Anne Vaajoki
a
,
*
, Ta ja K is
b
, Ma kus Kulmala
c
, Ta ja Te o-Heikkinen
a
a
Kuopio Uni e si y Hospi al, P.O. Box 100, FI 70029 KYS, Finland
b
Depa men o Nu sing Science, Facul y o Heal h Sciences, Uni e si y o Eas e n Finland, FI P.O.Box 1627, 70211 Kuopio, Finland
c
Uni e si y o Jy ¨
askyl¨
a, Facul y o Spo and Heal h Sciences, P.O. Box 35 (L), FI 40014 Jy ¨
askyl¨
a, Finland
ARTICLE INFO
Keywo ds:
E idence-based
Educa ion
Regis e ed nu se
E idence-based p ac ice ques ionnai e
A i udes o e idence-based p ac ice ques ion-
nai e
In e en ion
ABSTRACT
Aims: To e alua e how an educa ion p og am on e idence-based p ac ice (EBP) a ec ed nu ses´knowledge,
p ac ices, and a i udes ela ed o EBPs in pa ien ca e.
Me hods: Nu ses o one Finnish uni e si y hospi al pa icipa ed in wo sepa a e EBP educa ion p og ams in
2016–2017 and 2018–2019. Da a was collec ed by a ques ionnai e gi en be o e and a e each p og am. Reliable
ins umen s o measu ing EBP we e used: The E idence-Based P ac ice Ques ionnai e (24 i ems) and he A i-
udes o E idence-Based P ac ice Ques ionnai e (17 i ems). Means and equencies we e e alua ed wi h he
Mann-Whi ney U es and linea eg ession.
Resul s: Nu ses epo ed ha hei EBP p ac ice, skills and he Wo k based on EBPs imp o ed subs an ially a e
he educa ion p og am. We ound ha sco es on he Wo k based on EBPs and he a i udes owa ds EBP could
p edic he nu ses' o e all sel -e alua ions o p ac ices, a i udes, and skills.
Discussion: EBP educa ion a ec s posi i ely on implemen a ion o nu ses' p ac ices and skills. The e is s ill a need
o change a i udes owa ds e idence based p ac ice.
Implica ions o p ac ice, esea ch, policy, managemen , and educa ion: O ganiza ions need o main ain and de elop
e icien , a ac i e EBP educa ional p og ams o p omo e li elong lea ning.
Conclusions: When designing EBP educa ional con en , i is c ucial o each pa icipan s o de elop e idence-
based me hods and conside how o implemen hem in p ac ice.
1. Backg ound
Acco ding o Melnyk e al. (2014) “E idence-based p ac ice (EBP) is
a p oblem-sol ing app oach o he deli e y o heal hca e ha in-
co po a es he bes a ailable e idence, clinician's expe ise, and pa ien
alues and p e e ences.” S udies ha e shown ha nu ses a e qui e
amilia wi h EBP. They ha e posi i e a i udes owa ds i , and hey
belie e in he impo ance o e idence-based nu sing in he ca e o pa-
ien s (Lunden e al., 2021; Saunde s and Veh il¨
ainen-Julkunen, 2016).
In addi ion, an unde s anding o cu en esea ch-based e idence gi es
nu ses con idence in changing hei p ac ices and wo king me hods.
(H¨
aggman-Lai ila e al., 2017; Mudde man e al., 2020)
A e yea s o de elopmen and educa ion, nu ses and o he heal h-
ca e clinicians ha e come o unde s and he impo ance and alue o
EBP. I imp o es he quali y o pa ien ca e, pa ien ou comes, and
pa ien sa e y. Mo eo e , EBP is pa ien -cen e ed, imely, e icien , and
equi able. Ne e heless, many nu ses do no cu en ly employ EBP
sys ema ically, o hey a e no commi ed o implemen ing EBP (Koo a
e al., 2021; Lunden e al., 2021).
Resea che s ha e ound indi idual and o ganiza ional ac o s ha
ac as ba ie s o acili a o s in p omo ing EBP. A he indi idual le el,
he ba ie s mos o en men ioned a e he lack o ime and sca ce e-
sou ces, inadequa e knowledge, and a lack o skills o implemen ing
EBP. O ganiza ional obs acles o EBP implemen a ion include he lack o
a os e ing cul u e, wi h app op ia e alues and managemen suppo .
Fac o s ha acili a e EBP include educa ion, leade ship, ime, and a
cul u e ha encou ages imp o emen s in he quali y o ca e. (Be helsen
and Holge-Hazel on, 2021; Cla ijo-Chamo o e al., 2020).
Howe e , nu ses ha e also iden i ied gaps in hei expe ise in pe -
o ming he scien i ic esea ch equi ed o implemen EBP. Fo example,
* Co esponding au ho .
E-mail add esses: [email p o ec ed] (A. Vaajoki), [email p o ec ed] (T. K is ), [email p o ec ed] (M. Kulmala), [email p o ec ed] (T. Te o-
Heikkinen).
Con en s lis s a ailable a ScienceDi ec
Nu se Educa ion Today
jou nal homepage: www.else ie .com/loca e/ned
h ps://doi.o g/10.1016/j.ned .2022.105597
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Nu se Educa ion Today 120 (2023) 105597
2
hey migh ha e di icul y in o mula ing a esea ch ques ion ha ad-
d esses a p ac ical p oblem o hey migh be de icien in hei abili y o
conduc li e a u e sea ches and c i ically e alua e esea ch indings.
(Hines e al., 2018; Mudde man e al., 2020). Mo eo e , hey migh eel
inep o weak in he skills needed o implemen EBPs o p o ocols in
p ac ice (Lunden e al., 2021).
In as uc u al suppo o educa ional in e en ions has played an
impo an ole in p omo ing he adop ion, implemen a ion, and main-
enance o EBPs. Se e al s udies ha e assessed he e ec s o educa ional
ac i i ies on nu ses' a i udes, knowledge, and skills (Sap i e al., 2022).
A e ecei ing an educa ion on EBPs, nu ses el ha hei ways o
hinking had changed. Pa icipa ion in an educa ional in e en ion was
pe cei ed as aluable, and i enhanced he alue o nu sing (Conno
e al., 2016). Fo example, nu ses ques ioned hei p e ious ways o
wo king, and hey made changes in he way hey wo ked (Black e al.,
2015). A sys ema ic e iew o educa ional in e en ions on e idence-
based nu sing in clinical p ac ice by H¨
aggman-Lai ila e al. (2017)
shows posi i e ou comes. Nu ses showed imp o emen s in hei un-
de s anding o esea ch designs and in hei abili ies o in e p e
esea ch esul s, o sea ch o and e alua e e idence, and o plan a
p ojec o implemen ing changes in p ac ice. In pa icula , educa ional
in e en ions should emphasize he e idence ha suppo s changes in
pa ien ca e (Wu e al., 2018).
The du a ion o educa ional in e en ions ha e a ied om ew
weeks (Conno e al., 2016) o one (Sa as e al., 2014), and wo yea s
(Black e al., 2015). Educa ional in e en ions ha e co e ed speci ic
opics ha desc ibe he indi idual s eps ha lead om lea ning abou
EBPs o implemen ing EBPs. Thus, nu ses lea ned o o mula e a
esea ch ques ion om a p ac ical p oblem, pe o m a li e a u e sea ch,
c i ically e alua e s udy esul s, e alua e he deg ee o e idence, syn-
hesize he esea ch knowledge, w i e a esea ch epo , and ansla e
hei knowledge in o p ac ice (Black e al., 2015; Conno e al., 2016;
D’Souza e al., 2021).
2. Aims
This s udy aims o e alua e he e ec s o an EBP educa ion p og am
on nu ses' knowledge, p ac ices, and a i udes ela ed o EBPs o pa ien
ca e.
This s udy add esses he ollowing ques ions:
1. How did nu ses e alua e hei p ac ices, a i udes, and skills, and
hei a i udes owa ds EBP be o e and a e he EBP educa ion
p og am?
2. How did he nu ses' a i udes owa ds EBP, pe cen age o Wo k based
on EBP, g adua ion yea , and educa ion, explain hei p e- and pos -
in e en ion p ac ices, a i udes, and skills?
3. Me hods
3.1. S udy design
This s udy adminis e ed ques ionnai es o assess nu ses' sel - a ed
p ac ices be o e and a e an educa ional in e en ion in wo g oups o
nu ses ha pa icipa ed in one o wo EBP educa ional p og ams con-
duc ed in 2016–2017 and 2018–2019.
3.2. Se ing and pa icipan s
In 2016, he hospi al employed abou 1900 nu sing s a membe s,
and o hese, 1226 we e egis e ed nu ses (RNs). In 2018, among he
1920 nu sing s a membe s, 1325 we e RNs. In bo h yea s, he s udy
aimed o ec ui o pa icipa ion in he educa ional in e en ion. The
s udy pa icipan s (2016: n =28 and 2018: n =33) included indi iduals
o he nu sing s a wi h di e en ypes o p o ession (e.g., RNs, mid-
wi es, physio he apis s, nu se manage s, and ice-nu se manage s) ha
had a ended he EBP educa ion p og am.
3.3. Ins umen s
S udy pa icipan s comple ed wo ques ionnai es: he E idence
Based P ac ice Ques ionnai e o nu ses (EBPQ) (Up on and Up on,
2006) and he E idence-Based P ac ice in P imay Ca e ques ionnai e
(McKenna e al., 2004).
The EBPQ was de eloped and alida ed in 2006 (Up on and Up on,
2006). La e , he EBPQ was implemen ed in >40 coun ies and ans-
la ed in o >18 di e en languages, including Finnish (see EBPQ, 2017,
h ps://ebpq.co.uk/). The EBPQ included 24 i ems, and each i em was
a ed on a scale o 1–7, whe e 1 =poo and 7 =bes . The EBPQ included
h ee subscales, including he P ac ice subscale (six i ems), he A i udes
subscale ( ou i ems), and he Skills subscale (14 i ems). In addi ion, he
ques ionnai e included six backg ound ques ions (Up on and Up on,
2006). The Finnish Nu sing Resea ch Founda ion ansla ed he EBPQ
ques ionnai e in o Finnish, wi h pe mission om he de elope s.
The A i udes o E idence-Based P ac ice Ques ionnai e was based
on a p e ious li e a u e e iew and p e iously desc ibed measu emen
ools. I was de eloped and e ined by es ing in ocus g oups (McKenna
e al., 2004). The A i udes o E idence-Based P ac ice ques ionnai e
con ained 26 i ems and 8 backg ound ques ions. The i ems we e a ed
on a scale o 1 =S ongly disag ee o 5 =S ongly ag ee. The aim o his
ques ionnai e was o add ess ba ie s o he use o EBPs, including de-
mog aphic a iables and skills in using esea ch and in o ma ion e-
sou ces (McKenna e al., 2004). In his s udy, we used 17 o he o iginal
26 i ems on he ques ionnai e by McKenna e al. (2004) o es ima e each
pa icipan 's use o EBPs. Also, we emo ed i ele an ques ions
(old ashioned o cul u ally unsui able) and ques ions ha we e dupli-
ca ed in he EBPQ. The A i udes o E idence-Based P ac ice Ques ion-
nai e was ansla ed in o Finnish by he Uni e si y o Eas e n Finland,
Depa men o Nu sing Science, wi h pe mission om he de elope s.
In his s udy, we included se en backg ound ques ions: age, p o es-
sional educa ion, yea ha he las p o essional deg ee was comple ed,
p o essional posi ion, nu sing special y, expe ience (i.e., ime spen ) in
he cu en occupa ion, and an es ima e o he pe cen age o wo k based
on EBP (Wo k based on EBP).
3.4. The educa ional in e en ion
The i s educa ional p og am was conduc ed in 2009–2010. And i
was ca ied ou al oge he i e imes. Each educa ional p og am las ed
app oxima ely eigh mon hs, and al oge he 160 nu ses pa icipa ed in
yea s 2009–2018. Fo each EBP educa ion p og am, we ec ui ed nu ses
ha had olun ee ed wi h hei manage s' suppo . The numbe o
pa icipan s was limi ed o ensu e ha each pa icipan ecei ed u o -
ing. The ole o he u o was o suppo in comple ing he de elopmen
assignmen . Tu o s we e ec ui ed om he o ganiza ion and had o
ha e minimum a mas e 's deg ee quali ica ions. A he beginning o he
educa ion, uni o m p ac ices we e ag eed wi h he u o s. The pa ici-
pan and u o me on con ac days and a o he imes as needed as he
de elopmen ask p og essed. This EBP educa ion p og am was based on
he p inciples o p oblem-based, expe imen al, and collabo a i e
lea ning. Pa icipan s lea ned h ough in e ac i e and ans o ma i e
app oaches ha os e ed hinking skills; c i ical e lec ion, which aimed
o engage lea ne s; and in o ma ion sha ing o enhance unde s anding
(Gallaghe e al., 2020).
EBP educa ion p og ams (4 ec s, Eu opean C edi T ans e and
Accumula ion Sys em) we e ca ied ou in he Kuopio Uni e si y Hos-
pi al as a mul imodal educa ion p og am, in collabo a ion wi h he
Uni e si y o Eas e n Finland, Depa men o Nu sing Science. The main
aim was o imp o e e idence-based skills among he nu sing s a . The
p og am consis ed o con ac eaching (44 h), online eaching (6 h) and
independen s udying (58 h).The EBP educa ion p og am included se en
s eps ha we e comple ed in he ollowing o de (Fig. 1): 1) de elop
A. Vaajoki e al.
Nu se Educa ion Today 120 (2023) 105597
3
knowledge abou EBP, 2) o m a PICO (Pa ien , In e en ion, Compa -
ison, Ou come)-ques ion based on a clinical p oblem, 3) sea ch o and
e ie e e idence, 4) c i ically app aise e idence o alidi y and clinical
impo ance, 5) apply he app aised e idence ( ega ding esea ch, clin-
ical expe ise, pa ien /clien pe spec i es, alues, o esou ces) o you
p ac ice, 6) e alua e he esul s o he changes made, and 7) inco po a e
he new ac ion model in o you p ac ice (Melnyk e al., 2014).
A e comple ing hese se en s eps, e e y pa icipan w o e hei
own EBP p ojec , based on a ecognised clinical p oblem (PICO) in hei
own uni . A he end o he educa ional p og am, he p ojec s we e
p esen ed in a closing con e ence. Du ing he en i e educa ion p og am,
he pa icipan s wo ked in a web-based lea ning en i onmen , a ended
lec u es, ecei ed men o ing, and pa icipa ed in discussions.
3.5. Da a collec ion
The ac shee and a co e le e we e included wi h he ques ion-
nai es o p o ide in o ma ion on con iden iali y and he igh s o s udy
olun ee s. The pa icipan s had he igh o p ohibi he use o hei
answe s in he s udy. Da a was collec ed be o e (Oc obe 2016 and
2018) and a e (Ap il 2017 and 2019) he educa ional p og ams.
Howe e , consecu i e que ies we e no linked o an indi idual. The
2016–2017 EBP educa ion p og am included 28 pa icipan s a he s a ,
and 23 pa icipan s comple ed i . The 2018–2019 EBP educa ion p o-
g am included 33 pa icipan s a he s a , and 28 pa icipan s
comple ed i . These wo coho s (2016 and 2018) we e he mos simila
compa ed o p e ious educa ion p og ams, and he measu emen s we e
pe o med in he same way.
3.6. Da a analysis
The da a collec ed om bo h educa ion p og ams we e combined o
da a analysis. Pa icipan cha ac e is ics a e exp essed as he equency
and pe cen age, and each EBPQ subscale esul is exp essed as he mean
sco e. The i ems on he A i udes o EBP ques ionnai e ha we e wo ded
in nega i e e ms we e e e sed o posi i e e ms o acili a e he ana-
lyses. Reliabili y was e alua ed by Ch onbach alpha alues. Two sub-
scales (P ac ise and Skills) had good Ch onbach alpha alues and also
wo o he (A i udes and A i udes owa ds EBP) accep able, a ound 0.6.
So, i was app op ia e o calcula e subscale sco es (G o e e al., 2013, p.
544). The Mann-Whi ney U es was pe o med o assess di e ences
be ween esponses gi en be o e and a e he educa ional p og am.
Linea eg ession analyses we e pe o med o assess ela ionships
be ween ou come a iables (P ac ice, A i udes, and Skills) and
explana o y a iables (p o ession, a i udes owa ds EBP, wo k based on
EBP, yea o g adua ion, educa ion, and whe he da a was collec ed
be o e o a e he educa ional p og am). S a is ical analyses we e pe -
o med wi h SPSS e sion 27.0 o Windows (SPSS Inc., Chicago, IL,
USA) and The R P ojec o S a is ical Compu ing (R, e sion 4.1.0).
4. Resul s
4.1. Cha ac e is ics o pa icipan s in he educa ional p og am
The ques ionnai es we e comple ed by 60 pa icipan s be o e he
educa ion p og am and 50 pa icipan s a e he educa ion p og am.
Pa icipan s' cha ac e is ics a e p esen ed in Table 1. O e hal o pa -
icipan s we e RNs, and 1/3 we e aged 40–49 yea s (Table 1).
4.2. Sel -e alua ions o p ac ices, a i udes, and skills, and a i udes
owa ds EBP be o e and a e he EBP educa ion p og am
The pa icipan s' sel -e alua ions pe o med be o e and a e he
educa ional p og am showed signi ican changes in hei Skills subscale
(p <0.0001; be o e mean =4.27, SD =0.63; a e mean =4.94, SD =
Fig. 1. EBP educa ion se en s eps p og am (acco ding o Melnyk e al., 2014).
Table 1
Cha ac e is ics o he pa icipan s be o e and a e educa ion.
Backg ound a iable Be o e (N =60)
n (%)
A e (N =50)
n (%)
Age (yea s)
20–29 15 (25.4) 10 (20.0)
30–39 16 (27.1) 17 (34.0)
40–49 20 (33.9) 17 (34.0)
50–59 8 (13.6) 6 (12.0)
G adua ion yea
Be o e 2000 18 (31.6) 16 (32.6)
2001–2010 16 (28.1) 12 (24.5)
A e 2011 23 (40.3) 21 (42.9)
P o ession
Regis e ed Nu se 43 (71.7) 35 (70.0)
O he s
a
16 (28.3) 15 (30.0)
Educa ion
RN 15 (25.9) 15 (30.6)
Bachelo deg ee 39 (67.2) 31 (63.3)
Mas e deg ee
b
4 (6.9) 3 (6.1)
a
Physio he apis , occupa ional he apis .
b
Mas e deg ee om Uni e si y o Applied Sciences o Uni e si y.
A. Vaajoki e al.
Nu se Educa ion Today 120 (2023) 105597
4
0.59) and P ac ices subscale (p =0.014; be o e: mean =4.24, SD =1.31;
a e : mean =4.91, SD =0.85; Table 2.) The Wo k based on EBP was
highe a e (69 %, n =50) han be o e (60 %, n =60) he educa ional
p og am (p =0.012) (Table 2).
4.3. Rela ionships associa ed wi h a i udes owa ds EBP
Th ee di e en linea eg ession models (Table 3) we e i o assess
he ela ionships be ween he pa icipan s' A i udes owa ds EBP, he
Wo k based on EBP, he g adua ion yea , and educa ion a iables and
he changes obse ed in he pa icipan s' P ac ices, A i udes, and Skills
subscales. In each o he models, he explana o y a iables a e: p o es-
sional special y, A i udes owa ds EBP, Wo k based on EBP, yea o
g adua ion, educa ion, and he ime pe iod o he measu emen . The
a iable Wo k based on EBP was cen e ed a ound he mean alue (64 %,
N =110). The ime pe iod o he measu emen was dicho omized o 0 =
be o e and 1 =a e he educa ional p og am. The p o essional special y
was dicho omized o 0 =RN and 1 =o he . The educa ion and he yea
o g adua ion a e conside ed ca ego ical a iables: he e e ence o
educa ion is “RN” and he e e ence o he yea o g adua ion is “be o e
2000”.
The eg ession esul s indica e ha he Wo k based on EBP signi i-
can ly p edic ed a change in P ac ice subscale. A 10-pe cen age poin
change in Wo k based on EBP a iable p edic ed an expec ed 0.15-poin
change in P ac ice subscale. The p o essional special y o pa icipan s
also had a signi ican e ec . The mean sco e o a change in P ac ice
subscale was 0.60 poin s highe among pa icipan s in p o essional
special ies o he han a RN, compa ed o he RNs. Mo eo e , he mea-
su emen pe o med a e he educa ional in e en ion was 0.55 poin s
highe han he measu emen pe o med be o e he in e en ion, which
was also a signi ican di e ence. The P ac ice model p edic ed 27 % (N
=110) o he a ia ion in he changes in P ac ice subscale (Table 3). In
con as , A i udes owa ds EBP subscale, educa ion, and he yea o
g adua ion did no signi ican ly p edic a change in P ac ice subscale.
The wo k based on EBP a iable signi ican ly p edic ed he pa ici-
pan s' A i udes subscale. A 10-pe cen age poin change in Wo k based
on EBP a iable was associa ed wi h a 0.09-poin change in A i ude
subscale. Addi ionally, he A i udes owa ds EBP a iable had a posi i e
e ec on he pa icipan s' A i udes subscale and he e ec was signi i-
can . A one-poin inc ease in he A i ude owa ds EBP a iable p e-
dic ed a 0.83-poin inc ease in he pa icipan s' A i udes subscale.
Compa ed o pa icipan s ha g adua ed (be o e 1992) om nu sing
school as a RNs, hose ha g adua ed om a uni e si y o applied sci-
ences wi h a bachelo 's o mas e 's deg ee had, espec i ely −0.42 and
−1.07 lowe A i ude subscale sco es, bu only he mas e 's deg ee
sco es we e signi ican ly di e en om he nu sing school sco es. I
should be no ed ha RNs who g adua ed be o e 1992 did no ha e a
uni e si y o applied sciences deg ee a ha ime, and he co esponding
educa ion be o e −92 is desc ibed he e as a Nu sing school. In addi ion,
compa ed o pa icipan s ha g adua ed be o e 2000, A i ude subscale
sco es we e app oxima ely 0.5 poin s highe among pa icipan s ha
g adua ed in 2001–2010 and 0.78 poin s highe among hose ha
g adua ed a e 2011. Bo h di e ences we e s a is ically signi ican . The
A i ude subscale sco es o pa icipan s wi h p o essional special ies
o he han RNs we e 0.33 poin s highe han he A i ude subscale sco es
o RNs. This e ec was also s a is ically signi ican . The A idues model
p edic ed 40 % (N =110) o he a ia ion in pa icipan s' A i udes
subscale (Table 3).
The Wo k based on EBP a iable could signi ican ly p edic pa ici-
pan Skills subscale. A 10-pe cen age poin change in Wo k based on
EBP a iable indica ed a 0.01-poin change in Skills subscale. Howe e ,
he e ec s o Wo k based on EBP a iable we e qui e small o bo h Skills
and A i udes subscales, compa ed o i s e ec on P ac ice subscale. In
con as , he A i udes owa ds EBP a iable had a signi ican e ec on
pa icipan Skills subscale, wi h a slope o 0.31. Mo eo e , pa icipan s
ha g adua ed a e yea 2011 had signi ican ly highe Skills subscale
sco es compa ed o pa icipan s ha g adua ed be o e 2000. Addi ion-
ally, pa icipan s wi h p o essional special ies o he han RNs had
signi ican ly highe Skills subscale sco es han RNs. The measu emen s
pe o med be o e and a e he educa ional in e en ion showed ha
pa icipan Skills subscale had imp o ed signi ican ly; he Skills sub-
scale sco e imp o ed, on a e age, by 0.53 poin s. The skills model
p edic ed 43 % (N =110) o he a ia ion in pa icipan Skills subscale
(Table 3).
4.4. S udy limi a ions and s eng hs
This s udy has some limi a ions. Fi s , he small coho in Finland, in
one o ganiza ion limi ed he global adop ion o he indings; he e o e,
he esul s a e only indica i e. The esul s o he linea eg ession models
p edic ed qui e s ong e ec s, bu i is impo an o no e ha he da a
was based on small g oups, and he e we e qui e a ew explana o y
a iables. This should be aken in o accoun when c i ically examining
he esul s. Ne e heless, he models p edic ed he a ia ions in he
ou come a iables qui e well.
Despi e hese limi a ions, he ollowing s eng hs a e wo h poin ing
ou . Fi s , he EBPQ ques ionnai e was p e iously alida ed by Up on
and Up on (2006). Second, he con en o he EBP educa ion p og ams
we e designed in collabo a ion wi h he uni e si y and based on in e -
na ional expe iences, which emained la gely he same o e he s udy
pe iod. Howe e , based on pa icipan eedback, he o de and emphasis
o he con en a ied. Ne e heless, he indi iduals in cha ge o he
educa ional in e en ions we e he same du ing he s udy pe iod. In
addi ion, he expe lec u e s on EBP and he in o ma ion specialis we e
om he Uni e si y o Eas e n Finland, Nu sing Resea ch Founda ion,
and he doc o s o heal h sciences we e om Kuopio Uni e si y Hospi al.
The indi idual in cha ge o he coo dina ion and accoun abili y was a
Clinical Nu se Consul an , PhD, om Kuopio Uni e si y Hospi al.
4.5. Recommenda ions o educa ion and managemen
The aim o EBP educa ion has changed om p o iding knowledge o
eaching EBP implemen a ion in p ac ice. I is c ucial o de elop
e idence-based me hods o implemen ing EBPs in p ac ice, and his
poin should be conside ed when designing educa ional con en .
Ne e heless, educa ion alone does no ein o ce nu ses' p ac ices, skills,
o a i udes owa ds e idence-based ac ions and decision-making in
nu sing. I is pa amoun o he o ganiza ion o build he s uc u es and
cul u e necessa y o os e EBP. Nu ses need ime, esou ces (e.g.,
educa ional in e en ions, men o ship), and suppo om nu se leade s.
I is also necessa y o nu sing s a membe s o commi o e idence-
based ac ions and ongoing e alua ions. Nu ses mus lea n o u ilize
esea ch in o ma ion in hei wo k. A a ime when he e is a sho age o
nu ses, consis en e idence-based app oaches a e o pa amoun impo -
ance. EBP educa ion mus ocus mo e on he implemen a ion o
e idence-based ac i i ies in he clinical se ing. In e ac i e lea ning
me hods and u o suppo should ecei e mo e conside a ion in
designing u u e educa ional in e en ions.
Table 2
E idence-based p ac ice (EBP) be o e and a e he educa ional p og am.
Time P ac ice A i udes Skills A i udes
owa ds EBP
Wo k based
on EBP (%)
Ch onbach
α
0.904 0.618 0.931 0.598 –
Be o e 4.24
(1.31)
5.42
(0.89)
4.27
(0.63)
3.16 (0.34) 59.60
(19.84)
A e 4.91
(0.85)
5.38
(0.88)
4.94
(0.59)
3.15 (0.41) 69.05
(17.79)
p- alue 0.014 0.816 <0.0001 0.500 0.012
(Ch onbach
α
, Mean, SD, Mann-Whi ney, p- alue)
A. Vaajoki e al.

Nu se Educa ion Today 120 (2023) 105597
5
5. Discussion
The main esul o his s udy is ha , a e he educa ional in e en-
ion, nu ses epo ed imp o emen s in hei p ac ices, skills, and pe -
cen ages o wo k based on EBP. P e ious s udies (D’Souza e al., 2021;
Algha ani e al., 2019) ha e shown simila esul s. EBP educa ion is
impo an , when he o ganiza ion aims o implemen EBP in he clinical
se ing.
In his s udy, a la e g adua ion p edic ed imp o emen s in pa ici-
pan p ac ices, a i udes, and skills. Mo eo e , a Mas e 's deg ee edu-
ca ion played a signi ican ole in he a i udes owa ds EBP. This migh
be explained by assuming ha pa icipan s ha g adua ed be o e 2000
migh no ha e had e idence-based con en in hei nu sing educa ion
cu iculum; mo eo e , a sys ema ic educa ion in e idence-based nu sing
was no a ailable in he o ganiza ion a ha ime. The esul s o his
s udy con i m he impo ance o a sys ema ic educa ion in EBPs. This
educa ional in e en ion also had a posi i e e ec on pa icipan a i-
udes owa ds e idence-based ac ions and decision-making.
An in e es ing esul o his s udy was ha he skills and p ac ice
sco es we e highe among pa icipan s in special ies o he han RNs han
among RNs. The o he special ies included physio he apy and occupa-
ional he apy, and hose indi iduals wo ked a ou pa ien clinics. This
inding is consis en wi h a s udy by Rudman e al., 2020, which shows
ha nu ses wi h specialis educa ion ha wo ked in ou pa ien clinics
pe o med EBPs mo e o en han nu ses wi hou specialis educa ion.
EBP skills e lec he abili y o apply knowledge o nu sing p ac ices
and clinical decision-making. Ou indings sugges ha , a e he EBP
educa ional in e en ions, he wo k based on EBP, and he a i udes
owa ds EBPs could p edic imp o emen s in pa icipan skills. These
esul s suppo p e ious indings ha EBP educa ion signi ican ly im-
p o es skills and he use o EBP (D’Souza e al., 2021), which imp o es
he e iciency o nu ses. Thus, EBP educa ional in e en ions ein o ce
EBPs in nu sing.
EBP- ela ed nu sing p ac ices e lec he nu ses' con idence and
abili y o o mula e a ques ion abou a p ac ical p oblem, o e ie e
ele an e idence, and o sha e i wi h colleagues. In he p esen s udy,
he wo k ime based on EBP inc eased signi ican ly a e he educa ional
in e en ion, and pa icipan p ac ices imp o ed. This esul migh be
due o a heigh ened awa eness in pa icipan s a e he educa ional
in e en ion, which led o inc eased a en ion o e idence-based ac i -
i ies. Mo eo e , he in e en ion included a de elopmen ask ha had
o be comple ed acco ding o an e idence-based p ocess. Nu ses e-
po ed ha o mula ing a ques ion abou a p ac ical p oblem and
e ie ing in o ma ion on he opic was pe cei ed as challenging. This
pe cep ion migh be due o di e ences in educa ional backg ounds and
wo k expe iences among pa icipan s and a lack o esea ch skills.
Resea ch li e acy is essen ial o e idence-based ac ion (Hines e al.,
2018).
The nu ses' a i udes e lec how much impo ance he indi idual
places on e idence-based ac ions in nu sing and clinical decision-
making. In his s udy, be o e he educa ional in e en ion, he nu ses'
a i udes we e a a mode a e le el, bu hey did no imp o e a e he
educa ional in e en ion. This esul con as wi h he esul s om a
s udy by Koo a e al. (2021), whe e nu ses' a i udes imp o ed imme-
dia ely a e an educa ional in e en ion. Mo eo e , in a s udy by
Algha ani e al. (2019), nu ses' a ings on a i udes we e highe han
hei a ings on knowledge and implemen a ion. Fu he mo e, Algha-
ani e al. (2019) shows ha a i udes in luenced he implemen a ion o
EBPs. Howe e , in he p esen s udy, sel -e alua ions o he wo k based
on EBP did no a ec he pa icipan s' a i udes owa ds EBP.
The EBP educa ional in e en ion included lec u es and discussions,
u o suppo , da abase sea ch suppo , and sel -di ec ed lea ning
me hods. Al hough he du a ions o p e ious EBP educa ional in-
e en ions ha e a ied, an 8-mon h du a ion was shown o be app o-
p ia e. In his s udy, i was conduc ed in a single pe iod wi hou summe
holiday b eaks, and i engaged pa icipan s in he subjec . The educa-
ional con en was e idence-based, and he cou se ollowed an e idence-
based s uc u e. The educa ion cou se was in ensi e and demanding. I
was conduc ed alongside wo k; hus, pa icipan s had o comple e he
assigned asks du ing hei ee ime. Each pa icipan had a u o o
suppo and guidance o he asks. Abou 10–20 % o pa icipan s
d opped ou o he in e en ion, due o he demands o he assignmen s,
he doub in hei own skills, and di icul ies in coping wi h cu en li e
si ua ions. Ne e heless, he in e ac i e lea ning me hod was shown o
be e ec i e o p omo ing EBP knowledge and skills. This conclusion is
consis en wi h he conclusions o Koo a e al. (2021), who ound ha
con ac lea ning and eaching p oduced good esul s. A simila conclu-
sion was eached in a sys ema ic e iew conduc ed a he Joanna B iggs
Ins i u e on in e en ions o imp o ing nu ses' esea ch li e acy (Hines
e al., 2018).
6. Conclusions
Regula , well planned and o ganized e idence-based p ac ice edu-
ca ion, as in s udy hospi al, imp o es p ac ices, skills, and pe cen ages o
wo k based on EBP. Sys ema ic educa ion p og ams sol ing p ac ical
p oblems acco ding o an e idence-based p o ocol a e equi ed o
Regis e ed Nu ses o make hem mo e p epa ed o e idence-based
p ac ices. Due o his, he p epa edness o use EBP is highe han
yea s ago. Success ul expe iences inc ease RNs' con idence in e idence-
based p ac ice. Howe e , he e is s ill a need o p ac ical educa ion and
suppo o nu ses o iden i y clinical p oblems and ans e e idence
Table 3
Th ee models show he abili ies o backg ound a iables o p edic changes in pa icipan s’ P ac ice, A i udes, and Skills subscales.
Dependen a iable P ac ice
F- alue =5.224 (DF =83,
p <0.000) Adj. R^2 =0.2708
A i udes
F- alue =8.377 (DF =80,
p <0.000) Adj. R^2 =0.4014
Skills
F- alue =9.654 (DF =83,
p <0.000) Adj. R^2 =0.4321
Va iable Es ima e p- alue Es ima e p- alue Es ima e p- alue
(In e cep ) 2.14 0.022 2.68 <0.000 3.17 <0.000
Wo k based on EBP (cen e ed) 0.02 0.014 0.01 0.014 0.01 0.012
A i udes owa ds EBP 0.55 0.061 0.83 <0.000 0.31 0.045
P o ession (o he s han RN) 0.60 0.019 0.33 0.024 0.40 0.004
Educa ion RN ( e e ence)
Educa ion (bachelo ) −0.08 0.836 −0.42 0.079 −0.29 0.165
Educa ion (mas e ) −0.12 0.860 −1.07 0.010 0.15 0.696
Yea o g adua ion, be o e 2000 ( e e ence)
Yea o g adua ion 2001–2010 0.06 0.888 0.55 0.035 0.21 0.362
Yea o g adua ion a e 2011 0.66 0.093 0.78 0.002 0.56 0.008
Time o measu emen (a e ) 0.55 0.014 −0.10 0.365 0.53 <0.000
A. Vaajoki e al.
Nu se Educa ion Today 120 (2023) 105597
6
in o daily pa ien ca e.
6.1. E hical conside a ions
XX Hospi al g an ed a esea ch pe mi o he s udy (TAJ No 24/
2018 23.10.2018). Acco ding o Finnish law, his ype o esea ch did
no equi e app o al om an o icial esea ch e hics commi ee. Ano-
nymi y and con iden iali y we e p o ec ed by assigning nume ical codes
o each pa icipan , and all pe sonal da a and in o ma ion ha migh
iden i y pa icipan s we e emo ed (Finnish Na ional Boa d on Resea ch
In eg i y, TENK, 2019). Pe mission o use bo h E idence-Based Ques-
ionnai es was ob ained om hei de elope s by email. A he begin-
ning o he educa ional p og am, all pa icipan s o he s udy we e
in o med abou he s udy, he igh s o he olun ee s, and he measu es
o main ain con iden iali y.
Funding s a emen
This esea ch did no ecei e any speci ic g an om unding
agencies in he public, comme cial, o no - o -p o i sec o s.
CRediT au ho ship con ibu ion s a emen
Anne Vaajoki: Concep ualiza ion, In es iga ion, Me hodology,
W i ing – o iginal d a , W i ing – e iew & edi ing. Ta ja K is :
Concep ualiza ion, Fo mal analysis, Me hodology, W i ing – o iginal
d a , W i ing – e iew & edi ing. Ma kus Kulmala: Fo mal analysis,
So wa e, W i ing – o iginal d a . Ta ja Te o-Heikkinen: Concep u-
aliza ion, In es iga ion, Me hodology, W i ing – o iginal d a , W i ing –
e iew & edi ing, Visualiza ion.
Decla a ion o compe ing in e es
None.
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