Date of Award

Fall 2012

Degree Type

Thesis

Degree Name

Doctor of Philosophy (PhD)

Department

Clinical Health Sciences (Nursing)

Supervisor

Maureen Dobbins

Co-Supervisor

Rick Hackett

Language

English

Committee Member

Colleen McKey

Abstract

Background: Hospitalization is stressful, and anxiety is a common experience among hospital inpatients. Nurses who use a standardized patient anxiety assessment tool can improve their recognition of patient anxiety and its management. Implementing evidence-informed practice changes among nurses is a challenge, and there is little compelling evidence on how best to proceed with such implementations. Two theoretical frameworks that have shown promise for designing effective interventions among nurses are the Theory of Planned Behaviour (TPB), which focuses on individual determinants of behaviour, and Promoting Action on Research in Health Services (PARiHS), which focuses on the nature of the evidence, the context in which change is to take place, and the type of facilitation used to induce change. The current study attempts to fill a gap in our understanding of the relationship between the context of practice and nurses’ intention to adopt evidence-informed practices.

Objective: The purpose of this study was to investigate whether adding context among those variables derived from the TPB enhances prediction of nurses’ behavioural intentions to adopt an evidence-informed practice change.

Methods: Following an educational intervention aimed at teaching nurses the use of a tool for assessing patient anxiety, 174 participants (70% of those attending the educational classes) completed a survey measuring (1) attitude, ( 2) subjective norm, (3) perceived behavioural control, (4) context, and (5) intention to perform anxiety assessments.

Results: Intention to perform anxiety assessments on patients was greater for nurses who (a) perceived that they had control over performing anxiety assessments, (b) had a positive attitude toward providing such assessments, and (c) perceived their work context to be positive.

Conclusion: This study adds to our understanding of the variables influencing nurses’ adoption of evidence-informed practices. Context, defined in terms of leadership, culture, and evaluation, appears to influence individual adoption of evidence-based practices. These results suggest that the success of attempts to encourage health professionals to adopt evidence-based practices will be enhanced when contextual variables important to the success of the change intervention are put into place. Future research can build on the current study by seeking to replicate the findings reported here and expanding the list of contextual variables investigated.

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