Acceptance of evidence-based nursing databases by educational nurses using Rogers’ model

Abstract

Nurses always need accurate, up-to-date and reliable information. Evidence-based resources can be an appropriate approach to this need. The first step in utilizing these resources is to acknowledge them and use them in clinical practice. This descriptive cross-sectional study was designed to determine the acceptance rate of evidence-based databases by nurses based on Rogers’ innovation-diffusion model. A total of 214 nurses working in educational hospitals participated in the study in 2019. The data collection tool was a questionnaire, with confirmed validity and reliability, which was designed based on five components of Rogers’ model: knowledge, persuasion, decision, implementation and confirmation. The data analysis was performed using SPPS Version 23 to compute descriptive and analytical statistics indices. Based on the categories in Rogers’ model, the nurses had moderate views on the rate of acceptance of evidence-based databases, limited (low) knowledge and awareness of the databases, a favorable persuasion level and a low implementation rate. Well-educated, senior educational supervisors and nurses were more in line with persuasion, knowledge and implementation of evidence-based resources. According to the regression analysis (p < 0.001), persuasion and confirmation components had the greatest effect on the acceptance of databases, indicating the significance of providing evidence-based nursing education, both formal and informal, using the related databases.

Keywords

Databases evidence-based nursing nurses Rogers’ innovation-diffusion model

Introduction

Care is a vital part of health-care services. Nursing staff are amongst the most important providers of health care in health centers and play a vital role in the continuity of care, promotion of care, and maintenance of the health of patients (Hajbaghery et al., 2004). Nurses must always keep their information and knowledge up to date with the latest developments in clinical care in order to make the best decisions on patient care. The process whereby nursing care is performed on the basis of recent research findings, and nurses make informed decisions using existing research results and their clinical skills, is called evidence-based nursing (Levin and Feldman, 2006). This approach involves the precise and explicit use of the scientific findings of nurses in the decision-making process for patient care through a systematic search of databases (Koivunen et al., 2010). Researchers have found it necessary to use this approach to inform nurses of available evidence, as well as the application of research findings to clinical decision-making processes (Hoekenberry et al., 2006). The lack of up-to-date knowledge and the gap between research and clinical work are among the issues that can sometimes prevent high-quality care from being provided. Evidence-based practice as a model for clinical decision-making and problem-solving can help to reduce this gap (Duff et al., 2011; Ozsoy and Ardahan, 2008). In other words, evidence-based practice is a problem-solving approach to clinical care that utilizes current best evidence from well-designed studies, which is obtained from searching electronic databases to review relevant articles (Smith et al., 2015).

One of the most important effects of the use of research is the standardization of the care process, leading to the improved quality of nursing care and the increased validity and quality of nursing work (Florin et al., 2012; Ozsoy and Ardahan, 2008). A new perspective on efficient and effective patient care is that nursing care must be research-based (Rodgers, 2000). Nursing research through appropriate management practices is an essential component of professional performance (Layman, 2008). Krugman (2003) considers the use of research findings as one of the most important ways of empowering the nursing profession and believes that the use of research results can reduce caregiving errors and improve the quality of nursing services. This means that better care is consistent with the ultimate goal of nursing.

The process of evidence-based nursing care and access to research results requires an increased understanding of and access to electronic resources and the use of evidence-based databases. These databases are searchable and patient-centric, and provide the full-text articles found in previous studies and experiences that have been critically evaluated by researchers in each field (Farrell, 2008). On the other hand, the most important step in the implementation of evidence-based nursing is to gather the best and most relevant evidence to answer a clinical question. It is therefore essential for nurses to be aware of the relevant databases and how to search effectively and efficiently to answer a clinical question. Also, a positive persuasion, acceptance and understanding of the usefulness of evidence-based databases is needed for nurses. All of these factors lead to the use of up-to-date and scientific evidence in clinical practice and, ultimately, to improvement in the quality of health services.

Various models and methods have been applied worldwide to investigate the factors influencing information technology adoption. Rogers’ (2003) ‘diffusion of innovations’ model is a conceptual framework that is used to identify the factors that lead to the adoption and diffusion of innovations. Rogers believes that embracing innovation requires the stages of knowledge, persuasion, decision, implementation and confirmation (see Figure 1). This process ranges from the starting point of introducing innovation to the endpoint, which is the final confirmation.

Figure 1.

Rogers’ (2003) ‘diffusion of innovations’ model.

Studies have shown that although most nurses have moderate or limited knowledge and acceptance of evidence-based practice, they have a positive attitude towards it (Al-Maskari and Patterson, 2018; Hsieh et al., 2018; Saunders et al., 2016; Shrestha et al., 2018; Zhou et al., 2016). Given the need to use evidence-based care and the importance of using evidence-based resources for valid and up-to-date research, this study was designed to determine the acceptability of evidence-based databases among nurses in educational hospitals affiliated with Shahid Beheshti University of Medical Sciences and Health Services using Rogers’ diffusion of innovations model. The findings of the study, in identifying a clear state of knowledge, attitudes and use of evidence-based databases of nurses, will help policymakers in decision-making and planning for the optimal use of these resources, and also provides suggestions to improve the current situation.

Methods

This study was a descriptive cross-sectional study, the statistical population of which comprised all matrons, clinical supervisors, educational supervisors and head nurses with at least five years of experience working in educational hospitals affiliated with Shahid Beheshti University of Medical Sciences and Health Services in 2019. The sampling method was complete. The study involved 238 individuals, 214 of whom completed the questionnaire. The model that was used to measure the acceptability of evidence-based resources was Rogers’ diffusion of innovations model. This model consists of five steps:

Knowledge: the individual seeks information to identify innovation and obtains information about how it is used and operated;

Persuasion: a positive or negative attitude towards innovation is formed in the individual’s mind;

Decision: the individual decides whether or not to accept the innovation;

Implementation: the individual implements and uses the innovation;

Final confirmation: the individual, after making their decision, seeks information to confirm their decision and wants to reinforce their decision (Rogers, 2003).

Because Rogers’ model analyses an innovation item, evidence-based databases were considered as an ‘innovation’ due to the availability of reliable clinical resources; they included the Cochrane Library, Embase, PubMed, Clinical Key for Nurses and BMJ (British Medical Journal) Clinical Evidence databases, which were accessible at the time of data-gathering. There was a limitation in this study in that we did not have access to some important databases in this field, such as the Cumulative Index of Nursing and Allied Health Literature (CINAHL).

The data collection instrument was a questionnaire based on Rogers’ diffusion of innovations model, considering the literature related to technology adoption models (Kalavani et al., 2018; Mohammadi et al., 2018). The questionnaire included questions to assess the nurses’ knowledge, persuasion and practice with regard to evidence-based nursing, as well as their acceptance of databases, and consisted of three sections. The first section included demographic information such as gender, age, education, work experience, job position and level of English proficiency. The second part addressed familiarity with the concept of evidence-based nursing and its related databases based on a six-item scale (very high = 6, high = 5, medium = 4, low = 3, very low = 2, none = 1). In the third section, the nurses’ views on evidence-based databases were evaluated based on the five components of Rogers’ model and a five-point Likert scale (very high = 5, high = 4, medium = 3, low = 2, very low = 1). The determination of the status of each component was reported based on the total mean score of that component (a score between 1 and 5). After finalizing the questionnaire, its validity and reliability were assessed. For this purpose, the opinions and suggestions of 11 experts were collected on each of the questions and the necessary corrections were made. The content validity ratio was calculated using the formula and the obtained value was confirmed as a content validity index of 0.77. To assess the reliability, the questionnaires were first distributed among 30 participants and the Cronbach’s alpha coefficient was calculated. The Cronbach’s alpha showed that the questionnaire had appropriate reliability. Table 1 reports the Cronbach’s alpha values.

Table 1.

Cronbach’s alpha values of five components of Rogers’ innovation-diffusion model.

Questionnaire	Cronbach’s alpha
Knowledge (8 items)	0.954
Persuasion (8 items)	0.725
Decision (3 items)	0.880
Implementation (4 items)	0.835
Final confirmation (6 items)	0.856

SPSS Version 23 was used for the data analysis. Frequency descriptive statistics and percentages, means, tables and graphs were used. Multiple regression, the Pearson correlation coefficient, an independent t-test and analysis of variance were used to test the existing relationships. The significance level was considered as 0.05.

Results

Of the 214 nurses studied, 170 (79.4%) were women and 44 (20.6%) were men; 108 (50.5%) held a Bachelor’s degree and 126 (58.9%) were head nurses. Most of the respondents had between 20 and 25 years of experience (Table 2).

Table 2.

Background information of the research participants.

Variable	Variable levels	Frequency (%)
Gender	Female	170 (79.4)
Gender	Male	44 (20.6)
Age	20–30	1 (0.5)
	31–40	42 (19.6)
	41–50	125 (58.4)
	51–60	46 (21.5)
Level of education	Bachelor’s degree	108 (50.5)
	Master’s degree	97 (45.3)
	Doctorate	9 (4.2)
Work experience	5–10 years	9 (4.2)
	10–15 years	15 (7.0)
	15–20 years	63 (29.4)
	20–25 years	91 (42.5)
	More than 25 years	36 (16.8)
Occupation	Educational supervisor	16 (7.5)
	Clinical supervisor	67 (31.3)
	Matron	5 (2.3)
	Head nurse	126 (58.9)
English-language proficiency	Very high	7 (3.3)
	High	45 (21.0)
	Medium	141 (65.9)
	Low	18 (8.4)
	Very low	3 (1.4)

The results showed that 69 (32.3%) nurses participated in evidence-based nursing classes and workshops and 145 (67.8%) were not involved in such classes and workshops. The nurses used a variety of methods to meet their information needs and answer clinical questions. The results showed that 135 (63.1%) participants reported consulting with faculty members, 122 (57%) reported using reference books and directories, and 84 (39.3%) reported using proprietary websites as the most common methods for meeting their information needs. Eighteen (8.4%) of the respondents reported the use of databases as their least used method.

The level of familiarity with the concept of evidence-based nursing was moderate for most nurses (81, 37.9%) and the level of familiarity with evidence-based databases was 2.84 (of a score between 1 and 6). This indicated that their familiarity with these resources was low. They were most familiar with PubMed, Clinical Key for Nurses and Embase (see Figure 2).

Figure 2.

Average score of nurses’ knowledge of each database.

Figure 3 shows the average score of each component of Rogers’ (2003) model. According to the findings, the level of knowledge, implementation of databases and final confirmation of the nurses were low, acceptance was moderate, and persuasion was relatively favourable.

Figure 3.

Average score of each component of Rogers’ (2003) model.

The findings showed that there was a significant positive correlation between knowledge, persuasion, implementation, final confirmation and the decision to adopt evidence-based databases (p < 0.001) (see Table 3).

Table 3.

The relationship between knowledge, persuasion, implementation, final confirmation and the decision to adopt evidence-based databases.

Components		Knowledge	Persuasion	Implementation	Final confirmation
Decision to adopt evidence-based databases	Pearson’s correlation coefficient	0.306	0.593	0.558	0.726
Decision to adopt evidence-based databases	p	< 0.001	< 0.001	< 0.001	< 0.001

The results of the regression analysis in Table 4 show that the two components of persuasion and final approval (p < 0.001), with regression coefficients of 0.551 and 0.503, respectively, had the most effect on the acceptance of databases, and as the nurses’ persuasions and final confirmation increased, average acceptance also increased.

Table 4.

Estimated regression coefficients for the relationship between knowledge, persuasion, implementation final confirmation and the decision to adopt evidence-based databases.

Components	Regression coefficient	Standard error	t	p
Knowledge	−0.052	0.048	−1.091	0.277
Persuasion	0.551	0.086	6.424	< 0.001
Implementation	0.099	0.059	1.690	0.092
Final confirmation	0.503	0.071	7.102	< 0.001

The results of the test of the relationships between the demographic variables and the mean score of each component of Rogers’ model showed that the mean scores of knowledge (p = 0.031) and persuasion (p = 0.001) were higher in men than in women. Older participants had a higher mean score of knowledge (p =0.008) and persuasion (p = 0.047). Also, participants with a higher education level had more knowledge and persuasion (p = 0.000) with regard to evidence-based databases. Educational supervisors reported more knowledge (p = 0.002), acceptance (p = 0.009) and implementation (p = 0.005). Also, those with a higher level of English proficiency had a higher mean score of knowledge (p = 0.000) and persuasion (p = 0.005). The results showed that there were no significant differences in the scores of each component for people with different work experience.

Discussion and conclusion

Nursing staff are amongst the most important factors in the provision of care in health centers and play a vital role in the promotion and maintenance of patient health. To this end, access to up-to-date scientific research, in addition to updating their knowledge and skills, helps them make the best decisions on patient care.

The Committee on the Health Professions Education Summit has reported evidence-based practice as one of the top five competencies for all health-care providers, and emphasizes its development in the belief that individuals should be professionally trained (Greiner and Knebel, 2003). Training in any profession requires reliable information sources. Evidence-based resources in the nursing profession are, in addition to providing information resources, also tools for transferring and sharing clinical experience. Killeen and Barnfather (2005) have stated that research-based-practice skills are an essential element of nurses’ competence to provide high-quality care, which requires the ability to evaluate research findings and reflect knowledge gained in clinical practice (Florin et al., 2012).

Despite the importance of databases in nursing practice, the results of this study showed that the familiarity of most nurses with the concept of evidence-based nursing and its related databases was moderate or low. Also, most of the resources they used to meet their information needs were non-evidence-based sources, and they preferred to consult their professors and colleagues. Al-Jamei et al. (2019) reported that pharmacists had very little knowledge of the PubMed database and were unfamiliar with other databases. In Kalavani et al.’s (2018) study, the use of specialized assistants with evidence-based medical databases was also reported as low. Since nurses and health-care providers always need to obtain information through formal and credible sources and channels to enhance the quality of their professional practice, it is possible to increase nurses’ awareness and encourage them to use evidence-based resources by holding evidence-based-nursing workshops and training courses.

Since evidence-based practice is considered to be an indicator of the quality of health care (Ozsoy and Ardahan, 2008), the acceptance of evidence-based databases among nurses can play an important role in the application of this practice. The findings of the present study showed that the acceptance of evidence-based databases among nurses was moderate and they had a relatively favourable attitude towards them. In the studies by Al-Maskari and Patterson (2018) and Zhou et al. (2016), nurses also had a positive attitude towards evidence-based practice. Hsieh et al. (2018) reported that most nurses had a low level of knowledge and skills and a positive attitude towards evidence-based practice. The results of the study by Alshehri et al. (2017) showed that although most of the participants had a positive attitude towards using research in practice, many were not familiar with evidence-based practice and implementation. Forming positive attitudes about evidence-based practice is one of the prerequisites for its use and acceptance. Therefore, in order to create a more desirable attitude among nurses and provide sufficient motivation to use these resources, the benefits of evidence-based care should be widely discussed.

The findings also showed that there was a significant positive correlation between the components of knowledge, persuasion, implementation, final confirmation and the decision to adopt the evidence-based databases, and the persuasion and final confirmation components had the most effect on the acceptance of these resources. In the study by Mohammadi et al. (2018), the results showed that knowledge and persuasion had a greater impact on the acceptance of evidence-based practice. Shrestha et al. (2018) stated that knowledge is the most important predictor of evidence-based nursing, which is inconsistent with the present study. If nurses have a more favourable view of evidence-based resources and the final level of confirmation is increased, their decision to adopt them will increase. This means that there is more need to strengthen nurses’ persuasions and understanding of the benefits of evidence-based approaches, and to build on the belief that they can improve their performance and skills through research findings.

Investigating the relationship between the demographic variables and the mean score of each of the components of Rogers’ (2003) model also revealed that men had a higher mean score on knowledge and persuasion than women, which contradicts the results of the study by González-Torrente et al. (2012). Also, the knowledge and persuasion scores were higher in respondents with a higher level of education and age. It can be said that the study groups with higher scores, using their clinical experience and scientific knowledge, and with more opportunities for in-service training, had better knowledge and persuasion towards evidence-based nursing.

Typically, having more work experience leads to improved education and skills status. However, the present study showed that there were no significant differences between the work experience variable and the mean scores for each of the components in Rogers’ model. These findings are consistent with the results of the study by Kalhor et al. (2017). The results of the study by González-Torrente et al. (2012) showed that there was a significant difference between nurses’ work experience and the mean scores of knowledge, persuasion, and application of evidence-based practice. In their study, the nurses with less work experience scored better. In Zhou et al.’s (2016) study, the findings showed that nurses with more work experience had more knowledge about evidence-based nursing. Ammouri et al. (2014) reported that nurses who had more work experience utilized more evidence-based practice, which contradicts the present study.

The findings of the present study showed that the acceptance of evidence-based databases among educational supervisors was greater than for the other participants, and they demonstrated more knowledge and application of these resources. These professionals are more involved in learning and acquiring skills because of the types of activities they undertake. Their responsibility is to monitor and manage academic progress and improve the educational status of clinical nurses and trainees, and they have acquired the necessary knowledge and skills to do this (School of Medicines Optimisation, 2017). Educational supervisors can, therefore, play an effective role in teaching evidence-based approaches to other nurses and promoting a positive view of using evidence-based databases. Based on the findings of this study, more work needs to be done to foster positive attitudes and understanding of the benefits of evidence-based approaches among nurses, and to build on the belief that they can update their knowledge and skills by using research findings. Nursing managers in hospitals also need to have comprehensive support for using databases and implementing evidence-based processes; provide the necessary facilities; and reinforce the importance of this issue for nurses over time. In addition, by incorporating courses in this area and providing facilities for relevant training, enriching the libraries of colleges and hospitals with computer equipment, and the active presence of medical librarians for effective database-search training, nursing education policymakers can take effective steps to develop desirable attitudes, raise awareness and acceptance of these resources among nurses, and implement evidence-based practice.

Footnotes

Acknowledgements

This article is part of a Master’s thesis in Medical Librarianship and Information Science at Shahid Beheshti University of Medical Sciences (ethics code: IR.SBMU.RETECH.REC.1398.085).

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

ORCID iDs

Najme Dehghan Salmasi

Maryam Kazerani

Author biographies

Najme Dehghan Salmasi has a Master’s degree in Medical Library and Information Science from Shahid Beheshti University of Medical Sciences, Tehran, Iran. She is a librarian in a main academic library. Her areas of interest are evidence-based studies, reference services in medical library and information centers, educational content creation, etc.

Maryam Kazerani presently works as assistant professor in the Department of Medical Library and Information Science, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. She has more than 40 research papers to her credit. Evidence-based studies, scientific evaluations of thesauri, research methodology in librarianship and information science, health literacy, information literacy and bibliometrics are among her research interests. She is the executor of the national research project in Iran named the Persian Medical Thesaurus.

Maryam Shekofteh has a PhD in Medical Library and Information Science from Iran. She is associate professor and the head of the Department of Medical Library and information Science in Shahid Beheshti University of Medical Sciences, Tehran, Iran. She has published more than 40 papers in various journals. Her areas of interest are scientometrics, altmetrics, scientific communication, etc.

Sara Jambarsang is an assistant professor in the Department of Biostatistics and Epidemiology, School of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Her areas of interest include the application of statistical models in medical data. She is the statistical analyst of the data in this study and also has revised this manuscript.

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