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The Innovative Environment of the Engaged Nurse Scholar: Setting the Stage for a Nurse
Scholar Program

Jason Warren
Edson College of Nursing and Health Innovation, Arizona State University

Author Note
Jason Warren is a registered nurse with Dignity Health.
He has no known conflict of interest to disclose.
Correspondence should be addressed to Jason Warren, Edson College of Nursing and
Health Innovation, Arizona State University, Downtown Campus, 550 N. 3rd Street, Phoenix,
AZ 85004. Email: jrwarre6@asu.edu

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Abstract

Background: The purpose of this project was a culture assessment on nurses’ perception about
evidence-based practice (EBP) prior to creating an EBP training program. EBP improves patient
outcomes, job satisfaction and retention, and decrease healthcare costs.
Methods: A descriptive study design was used. Nurses at a hospital and outpatient cancer center
were sent a voluntary anonymous survey through work email. 630 nurses were invited to
participate, and 245 completed the survey with a response rate of 38.9%. The survey consisted of
3 instruments developed by Melnyk, along with demographic information.
Results: Most nurses surveyed answered “strongly agree” or “agree” to questions pertaining to
EBP knowledge and implementation. “I believe that EBP results in the best clinical care for
patients,” resulted in 93.9% answering “strongly agree” or “agree.” For questions referring to
the organizational culture towards EBP, the results were less positive. Only 59.6% answered,
“strongly agree” or “agree” to “My organization provides EBP mentors to assist clinicians in
implementing EBP.”
Discussion: Strengths and current EBP beliefs and practices can be identified through
organizational assessment. This project will spur further discussion and knowledge growth of
EBP practice, inspiring the nursing organization to examine current culture to create an
innovative community.
Conclusions: Along with areas of strength including a positive knowledge and use of EBP in the
organization, barriers to implementation such as leadership support were identified. These
factors will influence further development of mentors and education and the formulation and
implementation of the fellowship program.
Keywords: Evidence-based practice; research training, organizational culture, nurse scholar

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The Innovative Environment of the Engaged Nurse Scholar:
Evidence-based nursing practice refers to the use of nursing research to guide practice
and decision making (Leasure et al., 2008). The pool of evidence and research available to the
clinician continues to grow, in the form of online databases, research and guidelines (Melnyk &
Fineout-Overholt, 2019). While nurses are educated in critical thinking and skilled decision
making, the translation and utilization of new research and evidence produced takes a time and
faces many barriers. Resource utilization, cost, attitude and behavior, knowledge and
understanding of evidence-based practice (EBP), access to search engines, and other issues have
been implicated as obstacles to EBP implementation (Leasure et al., 2008). Many hospitals are
implementing research training programs with varying degrees of success in engaging nurse staff
and leadership to embrace EBP supported practice change (Black, Ali, et al., 2019; Friesen et al.,
2017a). Hospital programs can be effective in the synthesis and dissemination of evidence and
the implementation of practice changes (Jayakumar et al., 2016).
Background and Significance
Leasure et al. found that nurses do not access EBP resources routinely or effectively
(2008). While encouraged to use EBP, nurses felt that they did not have the opportunity to be
involved in research or EBP implementation projects. Bedside nurses are increasingly expected
to be able to utilize EBP to inform their own practice. Research training programs have been
created at various hospitals and educational institutions and these programs have been shown to
have an encouraging effect on practice changes and nurse engagement (Black et al., 2019).
However, nurses do not always have the opportunity or educational support to seek out new
EBP. Lack of time, cost, limited knowledge and mentorship, and lack of leadership interest are

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all barriers to nurses at the bedside translating research into practice (Koehn & Lehman, 2008).
Nurses need to be empowered to identify practice needs, study the literature, and implement
practice changes based on evidence. Climate and leadership behavior must be considered for any
EBP practice change (Shuman et al., 2019). Nurse managers and executives play a critical role
in establishing the practice environment that facilitates nursing staff empowerment towards
scholarly nursing practice (Beal et al., 2008).
Recent studies have shown that exposure of undergraduate nursing students to EBP
education had a positive effect on their understanding and attitude towards EBP practice (Reid et
al., 2017). However, master’s and doctoral prepared nurses have been shown to have a lack of
knowledge of EBP implementation and the confidence to incorporate EBP into their practice
(Moore et al., 2019). Koen and Lehman found that age and experience of nursing staff had a
profound impact on the education and acceptance of EBP, thought to be related to initial
education of EBP being absent, thus supporting the need for clinical training (2008). Lack of
time and lack of support and incentive have been found to be significant barriers to nursing
implementation of EBP (Hasanpoor et al., 2019). Both background training and facility-based
training have a positive association with nurses’ perceptions about EBP, highlighting the
importance of establishing a culture of best practice (Melnyk et al., 2008).
Purpose and Rationale
Riley and Omery submit that nursing professionals on a personal level are obligated to
participate in the “generation, utilization, and evaluation” of evidence-based practice (1996).
This engagement of the “Nurse Scholar” places the professional nurse at the forefront of nursing
as a practice discipline. Nursing scholarship benefits society through discovery, integration,
teaching, and application. (Riley & Omery, 1996).

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Nurse Scholars
Clinical nurses and nurse managers lead the charge in establishing a culture of EBP
practice and implementation. Perception, knowledge, support, and mentorship are all factors in
determining the extent to which EBP becomes a cultural norm (Koehn & Lehman, 2008; Moore
et al., 2019; Riley & Beal, 2013; Wagner AL & Seymour ME, 2007). Studying this population to
gain insight into barriers and areas in need of support will assist in creating the best environment
for EBP program implementation. Various instruments exist to examine the education and
perceptions of staff and managers and to utilize these findings to strengthen the environment to
facilitate EBP implementation (Melnyk et al., 2008).
EBP Fellowship Programs and Evaluation
Research shows that the implementation of research training programs, research
fellowship programs, mentorship programs, and EBP centers have positive effects on nursing
staff’s perception and engagement in EBP implementation (Black, et al., 2019; Friesen et al.,
2017; Jayakumar et al., 2016; Kim et al., 2016). Various measures of nurse engagement and
impact of programs can be measured using instruments such as the evidence-based practice
beliefs scale and the EBP implementation scale (Friesen et al., 2017; Melnyk et al., 2008). Some
hospitals have been able to implement EBP fellowship programs, showing success in equipping
nursing staff to become “EBP champions” and mentors for newer staff (Kim et al., 2016).
Nurses have been shown to respond well to programs that educate and promote EBP, which
utilize support and resources like mentors and library staff (Friesen et al., 2017). Nurses also
recognize that the education of the Nurse Scholar goes beyond initial education, and requires a
blend of academic and clinical experience (Riley & Beal, 2013).

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Engagement and Empowerment
Establishing an innovative practice environment encourages EBP, values nursing input,
and supports nursing educational development and the professional scholar. Multiple programs
have been shown to increase in the positive perception of EBP and implementation, resulting in
nurse scholars and nurse scientists that produce quality EBP that drives the nursing profession as
a practice doctrine (Friesen et al., 2017b; Jayakumar et al., 2016; Riley & Beal, 2013).
Innovative EBP education has become integral in the innovation and improved quality of
care given by nurses. More nurses are becoming exposed to EBP and can be involved in
educational programs. The barriers to implementing best practice fall away as more hospitals
develop avenues to support and empower Nurse Scholars to search the literature, seek out best
practices, and implement these practice changes within their units.
Internal Evidence
A large health care system in the greater Phoenix area is interested in implementing an
Evidence-Based Practice Fellowship Program (EBPFP) in their multi-hospital system. Two
initial steps are to find out the cultural acceptance of EBP in the system, and to seek out Nurse
Scholars that will actively engage with the program, and to identify managers of units that are
willing to implement EBP practice changes. The organization aims to create a dynamic
community across their system that have the skills, support, and desire to generate new
knowledge, innovation, and process improvement.
PICOT Question
This inquiry has led to the PICOT question, "Among the nursing and administrative staff
of a large hospital organization, how does the implementation of an EBP fellowship program

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(EBPFP) vs. no EBP fellowship program facilitate engagement and participation in a one-year
cycle of the program.
Evidence Synthesis
To answer this important PICOT question, a broad search of several databases was
performed. These databases included the Cumulative Index of Nursing and Allied Health
Literature (CINAHL), Medline, and PubMed, and Psycinfo. Keywords used included: nurse,
evidence-based practice, EBP implementation, and program. Expanders were used to capture
variations in “nurse,” including nursing, and nurses. The initial search of nurs* AND evidencebased practice AND EBP implementation AND program led to a total of 103 results in CINAHL,
180 results in Medline, 143 results in PubMed, and 59 results in PsycINFO. Search limits were
set to include only articles published between the years of 2016 and 2021. This narrowed the
results to 64 in CINAHL, 27 results in Medline, 79 results in PubMed, and 27 results in
PsycINFO. Further filters included the English language, peer reviewed journal articles. An
exclusion search term student was used to exclude any student-based research, focusing on
practicing clinicians in the hospital setting. These search limits produced a total of 48 results in
CINAHL, 20 results in Medline, 64 results in PubMed, and 17 results in PsycINFO for a grand
total of 149 articles. Because of the variations in terminology describing nurse scholar programs,
other search strategies were incorporated, including citation reviews.
Review of article abstracts produced an inclusion criterion of hospital based “fellowship”
or “Scholar” programs designed to educate clinicians to implement practice changes and
excluded any specific intervention related studies. 20 articles were selected, and rapid critical
analysis was done, with 10 final articles chosen for this literature review. Exclusion criteria
included articles describing specific EBP practice changes and evaluations.

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Critical Appraisal and Synthesis of Evidence

Studies were evaluated using rapid critical appraisal (RCA) as indicated in the search
strategy (Melnyk & Fineout-Overholt, 2019). Studies consisted of an equal number of pretestposttest forms and cross-sectional surveys. Although these studies indicate a lower level of
evidence, they are instrumental in measuring the attitudes, knowledge, and frequency of EBP in
the organization, along with measurement of these variables based on the integration of
educational programs implemented in the organization.
Five studies utilized the ARCC model as a guiding framework, two used the PARHIS
model, the Iowa model was used once, and two studies failed to identify a guiding framework or
model. Most studies were done in large hospital systems, with 70% of studies based in the
United States. The mean sample size was 341. The average years of experience of those sampled
was 15 years, and the average age of those sampled was 41. These studies mostly utilized widely
reliable and validated survey instruments including the Evidence Based Practice Beliefs Scale
(EBPB), Evidence Based Practice Implementation Scale (EBPI), and the Organizational Culture
and Readiness Scale for System-Wide Integration of Evidence-Based Practice Scale (OCRSIEP). The five studies utilizing pretest-posttest methods surveyed participants in programs
focused on EBP education and mentorship. Various methods were used to evaluate survey results
with an overall increase in EBP knowledge and beliefs of participants.
Conclusions from Evidence
EBP implementation has been proven to be indicated in increased positive patient
outcomes, nursing job satisfaction and retention, with a decrease in overall healthcare costs to the
system. With this evidence, innovated leaders are examining their hospital systems and utilizing
tools to assess organizational readiness for the adoption of EBP practices. As evidenced by these

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studies and others, nursing staff and leadership can increase their capacity for EBP through
education and engagement. The culture of EBP has the potential to perpetuate decreased hospital
costs, increased positive patient outcomes, and increased engagement, job satisfaction, and
retention for nursing staff.
Theoretical Framework
An underlying framework useful in the innovation of healthcare organizations is Roger’s
Diffusion of Innovation theory (Rogers, 2003). This theory suggests that innovations are
developed and adopted slowly, spreading through organizational pieces in a predictable manner.
Rogers introduces five groups of individuals that constitute an organization. The introduction of
process changes, new ideas or behaviors are initially presented and adopted by small groups of
individuals, called Innovators. The innovator in relation to my project is the CNO of the hospital
system with the vision of a EBP fellowship program, along with his team of stakeholders that
design and create the program. Early Adopters represent the second slightly larger group, called
early adopters. Within the fellowship program, this group will be represented by the participants
in the program, or “Scholars.” With training in the fellowship program, they then can utilize
their knowledge to influence the rest of the organization. The final 3 groups consist of the Early
Majority, Late Majority, and Laggards, which make up the bulk of the organization. Within my
project, these groups represent the rest of the hospital system and will benefit from the EBP
Scholars project implementation and exposure to EBP. In the hospital system, the
implementation of EBP champions, clinical mentors, and leaders will affect change through their
own EBP implementation. projects, and to inspire further EBP focus and pursuit from their peer
colleagues. This project will help to define these groups through an assessment of the culture,
beliefs, and attitudes of the nursing organization towards EBP. This assessment will help to

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identify those Early Adopters, creating a fertile ground for the dissemination of EBP to the rest
of the organization.
Implementation Framework
Barriers to organizational change are well known and documented. Multiple models
exist for guidance in organizational innovation through the implementation of EBP. The
Advancing Research & Clinical Practice through Close Collaboration (ARCC) model is a wellknown and effective model that has been used extensively in the incorporation of EBP at the
organizational level (Melnyk & Fineout-Overholt, 2019). It applies not only to implementing
EBP at the clinical level, but the overarching application of the organization’s EBP culture. The
first step in the ARCC model involves assessing the organizational cultures and readiness for
system-wide change. Through assessment, strengths and barriers to EBP implementation can be
identified and addressed by the leadership. As a further step, EBP mentors are developed who
are knowledgeable and passionate about building a sustainable EBP culture. These mentors work
with staff to stimulate and educate, guiding EBP practice changes and overall EBP cultural
increase. With increased EBP, the ARCC model suggests that patient outcomes are improved,
nurse job satisfaction and turnover is improved, and these factors result in decreased healthcare
system costs. Specific barriers such as a lack of knowledge or skills, or a lack of perceived
leadership support can be identified and addressed. Strengths related to the implementation of
EBP fellowship programs, such as a high degree of EBP beliefs and support can be cultivated
and encouraged. Utilizing this data can help organizations to sustain an EBP culture that has the
potential to influence each nurse to support their own practice with EBP.

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Methods

The project design was a cross-sectional survey. Institutional Review Board approval was
obtained from the organization on September 22, 2021 and received exemption status from
Arizona State University Institutional Review Board on October 26, 2021.
The project utilized demographics and questionnaires as instruments for data gathering.
These instruments have high validity. There were three specific instruments used, each
containing three questions for total of nine questions. (Melnyk et al., 2021). The first was the
EBP Beliefs Scale – Short Version, which at the time of use had a Cronbach alpha of 0.81. The
second was the EBP Implementation Scale – Short Version with a Cronbach alpha of 0.89, and
finally the Culture and Readiness Scale – Short Version with a Cronbach alpha of 0.87. These
tools were shortened versions of similar surveys also developed by Melnyk. The shortened
versions’ convergent validity was between r = .42 and r - .72 (p < .001) which is acceptable.
Permission to utilize these instruments was obtained. Seven demographic questions were also
included, which asked age, gender, highest level of education, years of RN experience, years of
employment with the organization, type of facility employed at, and current nursing role. At the
end of the survey period, all surveys completed were collected by an employee of the
organization associated with the research team.
This project was based in a large urban hospital organization in Arizona, consisting of six
large hospitals and two surgery centers with a total of 1426 beds. This organization employs
approximately 4,400 RNs. Five of the six hospitals are Magnet accredited, and two are level one
trauma centers. Currently there are no formal training opportunities for nurses to engage in EBP
development. There are some advancement opportunities, in the form of a clinical ladder, but no
systematic or organizational focus on EBP education or implementation. To increase the amount

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of EBP development in the nursing staff of this system, the Chief Nursing Officer (CNO) of one
of the hospitals championed the development of a research program. This program was
forecasted to begin in January of 2022 and was designed be a 1-year program consisting of
didactic training with both in-person and virtual classes consisting of 4-hour sessions once per
month with assignments and work between sessions. The didactic portion focused on learning
about EBP, both research and the translation of research to practice, with additional education on
innovation, utilizing time in the ASU HEALab. In addition, the participants address specific
concerns and develop evidence-based clinical solutions to apply on their units while under the
mentorship of an experienced nurse scholar/scientists. The CNO was instrumental in garnering
support from other key leadership and obtaining the funding necessary to support for the
program. Other stakeholders include several key faculty members at an area university, which is
serving as an educational institution partner to aid in curriculum development and provide
faculty to serve as mentors to the nurses enrolled in the program. Finally, nurses associated with
the organization are important stakeholders. As the point-of-service personnel of the hospital,
nurses with increased knowledge and skill pertaining to EBP will be highly instrumental in
shifting the organizational culture to one of system-wide EBP implementation and high-quality
care delivery.
Planning the Intervention
The primary goal of this project was an organizational culture assessment on nurses’
perception about EBP. Evaluation of this system attempted to identify organizational strengths
and weakness and assist leaders in tailoring the program toward identified needs, while also
identifying potential barriers that can be addressed. Utilizing the ARCC model, this project
served as an initial inquiring into the beliefs and exposure of the nursing organization. After

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carefully examination of the literature, several survey tools were decided upon to study the
current landscape and culture. Considering that this was an initial examination, these proven
survey instruments will be able to be utilized after the fellowship program has been implemented
to assess for changes in organizational culture and RN beliefs and implementation of EBP. With
assessment of the organizational culture completed and analyzed, strengths and current EBP
beliefs and practices can be identified. The survey will also act as a catalyst for further
discussion and knowledge growth of EBP practice, inspiring the nursing organization to examine
current practices and culture and help to create an innovative community that possess the skill to
translate knowledge and innovation into practice. Also identified will be barriers to
implementation such as nursing inadequate knowledge or beliefs associated with EBP, and
support issues such as leadership resistance to change. These factors will influence further
development of mentors and education and the formulation and implementation of the fellowship
program.
Participants and Recruitment
The participants of this project include 630 registered nurses employed at one hospital in
the system and an outpatient cancer care network. Inclusion criteria included full, part-time, and
prn registered nurses and nursing leadership. Nursing personnel consisting of point of care
nurses, administrators, nurse managers, clinical nurse specialists, and advanced practice nurses.
Participants had to have the ability to read and write in English. Excluded were non-RN staff
(Nursing Assistants, pharmacy staff, doctors, ect.).
Data Collection and Outcome Measurement
Participants in this project were recruited to participate in the survey through their work
email. An information letter about the project was included with the survey with the following

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wording: "Completing the survey will be considered your consent to participate in the project."
No paper consent forms were stored. To ensure the confidentiality of participants, the
anonymous responses setting was utilized on the survey development software by disabling IP
address tracking and email address tracking. The survey did not include identifiable questions.
The survey was sent out in November with a link to an online survey built through Survey
Monkey, which was available for one week.
Results
A total of 245 participants completed the nine questions regarding EBP, with a response
rate of 39%. Between 225 and 237 participants answered the demographic questions.
225 participants answered the question of age with 20 skipping. Completed responses
indicated that 22 (9.8%) were 18 to 25, 75 (33.3%) participants were 26 to 35, 61 (27.1%)
participants were 36 to 45, 40 (17.8%) participants were 46 to 55, 24 (10.7%) participants were
56 to 75, 3 (1.3%) participants were 66 to 75, and no participants were over 76. 229 participants
completed the question of gender while 16 did not answer. Completed responses indicated that
34 (14.9%) participants were male, while 193 (84.3%) were female, and 2 (0.9%) chose “other.”
Looking at years with the organization, 230 answered and 15 skipped. Responses indicated that
77 (33.5%) had less than 1 year, 61 (26.5%) and 1 to 3 years, 26 (11.3%) had 4 to 5 years, 30
(13%) had 6 to 10 years, 20 (8.8%) had 11 to 15 years, 6 (2.6%) had 16 to 20 years, 6 (2.6%) had
20 to 25 years, and 4 (1.8%) had more than 26 years at this organization. For years of experience,
231 answered and 14 skipped. Responses indicated that 26 (11.3%) had less than 1 year, 32
(13.9%) had 1 to 3 years, 29 (12.6%) had 4 to 5 years, 52 (22.5%) had 6 to 10 years, 33 (14.3%)
had 11 to 15 years, 15 (6.5%) had 16 to 20 years, 8 (3.5%) had 20 to 25 years, and 36 (15.6%)
had more than 26 years of nursing experience. For the question “type of facility primarily

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working at,” 237 participants answered and 8 skipped. 197 (83.1%) answered “hospital,” and 40
(16.9%) answered outpatient. For participants highest level of education, 236 answered and 9
skipped. 2 (0.9%) participants reported diploma. 36 (15.3%) participants reported having a
associates degree. 162 (68.6%) reported a bachelors degree, 35 (14.8%) reported master’s
degree, and 1 (0.4%) reported a doctorate (PhD, DNP, DNSc, or other). When questioned about
their nursing role, 233 participants answered and 12 skipped. 189 (81.1%) identified as clinical
nurses. 19 (8.2%) identified as supervisors. No participants identified as advanced practice. 10
(4.3%) identified as management/leadership. 1 (0.4%) identified as an educator. 14 (16%)
answered “other.”
Interestingly, while 173 (75%) nurses who identified their years of experience had 4years
of experience or more, 138 (60%) of nurses answered that they had 3 or less years of
employment at this facility.
EBP Beliefs Scale – Short Version
For the question “I believe that EBP results in the best clinical care for patients,” 146
(59.6%) signaled that they “strongly agree,” 84 (34.3%) signaled “agree,” 12 (4.9%) chose
“neither agree nor disagree,” 1 (0.4%) chose “disagree,” and 2 (0.8%) chose “strongly disagree.”
For the question “I am sure that I can implement EBP,” 120 (49%) signaled that they “strongly
agree,” 103 (42%) signaled “agree,” 19 (7.8%) chose “neither agree nor disagree,” 2 (0.8%)
chose “disagree,” and 1 (0.4%) chose “strongly disagree.” For the question “I am sure that
implementing EBP will improve the care that I deliver to my patients,” 131 (53.5%) signaled that
they “strongly agree,” 94 (38.4%) signaled “agree,” 18 (7.4%) chose “neither agree nor
disagree,” 0 (0%) chose “disagree,” and 2 (0.8%) chose “strongly disagree.”

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EBP Implementation Scale – Short Version
For the question “I use evidence to improve patient outcomes in my healthcare setting,”
108 (44%) signaled that they “strongly agree,” 117 (47.8%) signaled “agree,” 18 (7.4%) chose
“neither agree nor disagree,” 1 (0.4%) chose “disagree,” and 1 (0.4%) chose “strongly disagree.”
For the question “I implement the steps of the EBP process in my practice,” 96 (39.2%) signaled
that they “strongly agree,” 120 (50%) signaled “agree,” 28 (11.4%) chose “neither agree nor
disagree,” 0 (0%) chose “disagree,” and 1 (0.4%) chose “strongly disagree.” For the question “I
promote the use of EBP in my healthcare setting to improve outcomes,” 106 (43.2%) signaled
that they “strongly agree,” 118 (48.2%) signaled “agree,” 19 (7.8%) chose “neither agree nor
disagree,” 1 (0.4%) chose “disagree,” and 1 (0.4%) chose “strongly disagree.”
Culture and Readiness Scale – Short Version
For the question “My organization has a culture that supports clinicians to implement
evidence-based practice,” 86 (35.1%) signaled that they “strongly agree,” 121 (49.4%) signaled
“agree,” 32 (13.1%) chose “neither agree nor disagree,” 5 (2%) chose “disagree,” and 1 (0.4%)
chose “strongly disagree.” For the question “My organization has readily available resources to
implement evidence-based practice,” 77 (31.4%) signaled that they “strongly agree,” 106
(43.3%) signaled “agree,” 47 (19.2%) chose “neither agree nor disagree,” 13 (5.3%) chose
“disagree,” and 2 (0.8%) chose “strongly disagree.” For the question “My organization provides
EBP mentors to assist clinicians in implementing EBP,” 62 (25.3%) signaled that they “strongly
agree,” 84 (34.3%) signaled “agree,” 67 (27.4%) chose “neither agree nor disagree,” 27 (11%)
chose “disagree,” and 5 (2%) chose “strongly disagree.”
Due to a variety of factors, the raw data associated with the survey was unavailable to the
author. The initial intention was to run descriptive and inferential statistical analysis on the data.

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Only a summary of participant responses was provided as previously described. This limitation
prevented the authors from further data analysis and comparisons.
Discussion
These findings indicated that while nurses believe strongly that EBP is important in their
practice, more efforts can be made to empower staff with mentorship and resources necessary to
fully implement EBP. The culture of EBP has the potential to impact the organization through
decreased hospital costs, increased positive patient outcomes, and increased engagement, job
satisfaction, and retention for nursing staff. Assessing the organizational culture prior to the
implementation of a research program is itself based in evidence. Through this assessment, the
organization can tailor its program specifically to the barriers and facilitators that the nursing
staff identified. This will aid in a successful implementation of the program, resulting in a
greater increase in EBP practice changes that will promote lasting changes that will benefit
patient outcomes, nurse engagement and satisfaction, and the hospital system. Unfortunately,
due to several factors, the organization decided to forego the development of a scholar program
as previously designed. Instead, the organization used a program developed by a midwestern
university that performed a weeklong intensive training in EBP for their nursing and leadership.
While not the type of local and sustained program initially desired, the efforts to advance the
culture of EBP in the organization were still accomplished. This “compromise” represents the
difficulty that comes with organizational cultural change. Leadership vision, communication,
and cooperation are all vital when it comes to affecting change both at the micro and macro
level.

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Limitations
Several factors negatively affected this project and its implementation. As is the case
with all one-point-in-time surveys, participant responses are inherently biased to their situation
and specific culture. A response rate of 39% also could have contributed to sampling bias. As
this survey only examined the nursing population of one hospital and outpatient network,
generalizability is difficult. Additionally, 83% of the respondents were from an inpatient setting,
creating an imbalance of representation. During the time just prior to implementing the survey,
nursing staff had undergone a biannual system wide employee engagement survey. This could
have resulted in “survey fatigue” and have been a cause of the low response rate. The COVID-19
epidemic was in full force during this time as well, which has had well documented effects on
employee moral and engagement, thus also could have resulted in a low response rate and could
have affected responses. Finally, system wide changes including the CNO moving to a different
hospital may have affected the project.
Conclusion
EBP implementation has been proven to be indicated in increased positive patient
outcomes, nursing job satisfaction and retention, with a decrease in overall healthcare costs to the
system. With this evidence, innovative leaders are examining their hospital systems and utilizing
tools to assess organizational readiness for the adoption of EBP practices. As evidenced by these
studies and others, nursing staff and leadership can increase their capacity for EBP through
education and engagement.

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Appendix A
Synthesis Table

Evaluation Table Quantitative Studies
Citation
Theoretical/ Design/
Conceptual Purpose
Framework

Friesen et al.
(2017)
Findings from
pilot study:
EBP to the
bedside
Country:
USA
Funding:

Roger’s
Diffusion of
Innovations
Theory
ARCC
model
Ottawa
model
JHNEBPM

Design:
Pretest-post test
Purpose:
To assess the
pilot
implementation
of a EBP
exemplar model
in a large
multihospital
system

Sample/Setting

Variables

Measurement/
Data
Instrumentation Analysis

n = 57

IV EBP
competency
building
program

EBPB Scale

Demographics
M age = 42.63
BACC = 66.7%
M YE = 12.95
Setting
Multihospital
system

DV 1 - EBP
beliefs
DV 2 - EBP
implementation

EBPI Scale

Results/
Findings

Descriptive
statistics

DV 1
t = no
one sample t- statistically
significant
tests
change
(p>0.1)
DV 2
t = 1.75 (p<0.05)

Level of
Evidence;
Application
to practice/
Generalizat
ion
LOE: 3
Strengths
Extensive
study of
existing
program
Limitations
: Small pilot
study with
purposeful

Key:– ANOVA – Analysis of variance; ARCC -Advancing Research and Clinical Practice through Close Collaboration; BACC – Baccalaureate or
higher; Cα – Cronbach’s α; CAH – Critical Access Hospital; CHC – Community Health Center; CHN – Community Health Nurse; CNS – Clinical
nurse specialist; DV-dependent variable; EBMgt – Evidence Based Management; EBN – Evidence Based Nursing; EBP – Evidence Based Practice;
EBPB – Evidence Based Practice Beliefs; EBPI – Evidence Based Practice Implementation; EBPK – Evidence Based Practice Knowledge; EBPQ
– Evidence-Based Practice Questionnaire; EC – Exclusion Criteria; ESI - Effect size improvement (posttest score minus pretest score); f = female;
GR-ATTR – Group attractiveness; GR-COH – Group Cohesion; HCP – Healthcare Professionals; IC – Inclusion Criteria; ICS – Implementation
Climate Scale ILS – Implementation Leadership Scale; IV- independent variable; JS – Job Satisfaction; JHNEBPM – Johns Hopkins Nursing
Evidence-Based Practice Model; LOE – Level of Evidence; M – Mean; N- number of participants in study, n = number of participants in subset;
NA – Nurse administrator; NM - Nurse Manager; NM-EBPC - Nurse Manager Evidence Based Practice Competency Scale OCR-SIEP –
Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice; OREBP – Organizational Readiness for
Evidence Based Practice; Ottawa – Ottawa Model of Research Use; PARIHS – Promoting Action on Research Implementation in Health Services;
SN – Staff Nurse; VAP – Ventilator associated pneumonia; YE- Years of experience

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Theoretical/ Design/
Conceptual Purpose
Framework

24
Sample/Setting

Seed grant
from hospital
system

IC – nursing
staff of pilot
units

Bias:
None listed

EC – non unit
staff

Variables

Measurement/
Data
Instrumentation Analysis

Results/
Findings

Level of
Evidence;
Application
to practice/
Generalizat
ion
sampling,
may not be
generalizabl
e.
Study did
not measure
useful
information
like degree
of
participatio
n and
tracking
individuals
over time.

Key:– ANOVA – Analysis of variance; ARCC -Advancing Research and Clinical Practice through Close Collaboration; BACC – Baccalaureate or
higher; Cα – Cronbach’s α; CAH – Critical Access Hospital; CHC – Community Health Center; CHN – Community Health Nurse; CNS – Clinical
nurse specialist; DV-dependent variable; EBMgt – Evidence Based Management; EBN – Evidence Based Nursing; EBP – Evidence Based Practice;
EBPB – Evidence Based Practice Beliefs; EBPI – Evidence Based Practice Implementation; EBPK – Evidence Based Practice Knowledge; EBPQ
– Evidence-Based Practice Questionnaire; EC – Exclusion Criteria; ESI - Effect size improvement (posttest score minus pretest score); f = female;
GR-ATTR – Group attractiveness; GR-COH – Group Cohesion; HCP – Healthcare Professionals; IC – Inclusion Criteria; ICS – Implementation
Climate Scale ILS – Implementation Leadership Scale; IV- independent variable; JS – Job Satisfaction; JHNEBPM – Johns Hopkins Nursing
Evidence-Based Practice Model; LOE – Level of Evidence; M – Mean; N- number of participants in study, n = number of participants in subset;
NA – Nurse administrator; NM - Nurse Manager; NM-EBPC - Nurse Manager Evidence Based Practice Competency Scale OCR-SIEP –
Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice; OREBP – Organizational Readiness for
Evidence Based Practice; Ottawa – Ottawa Model of Research Use; PARIHS – Promoting Action on Research Implementation in Health Services;
SN – Staff Nurse; VAP – Ventilator associated pneumonia; YE- Years of experience

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Theoretical/ Design/
Conceptual Purpose
Framework

25
Sample/Setting

Variables

Measurement/
Data
Instrumentation Analysis

Results/
Findings

Level of
Evidence;
Application
to practice/
Generalizat
ion
Conclusion
s: Overall
useful study
in
examining
usefulness
of EBP
education
and the use
of the
ARCC
model for
structured
framework.
Also the
used of the
JHNEBPM

Key:– ANOVA – Analysis of variance; ARCC -Advancing Research and Clinical Practice through Close Collaboration; BACC – Baccalaureate or
higher; Cα – Cronbach’s α; CAH – Critical Access Hospital; CHC – Community Health Center; CHN – Community Health Nurse; CNS – Clinical
nurse specialist; DV-dependent variable; EBMgt – Evidence Based Management; EBN – Evidence Based Nursing; EBP – Evidence Based Practice;
EBPB – Evidence Based Practice Beliefs; EBPI – Evidence Based Practice Implementation; EBPK – Evidence Based Practice Knowledge; EBPQ
– Evidence-Based Practice Questionnaire; EC – Exclusion Criteria; ESI - Effect size improvement (posttest score minus pretest score); f = female;
GR-ATTR – Group attractiveness; GR-COH – Group Cohesion; HCP – Healthcare Professionals; IC – Inclusion Criteria; ICS – Implementation
Climate Scale ILS – Implementation Leadership Scale; IV- independent variable; JS – Job Satisfaction; JHNEBPM – Johns Hopkins Nursing
Evidence-Based Practice Model; LOE – Level of Evidence; M – Mean; N- number of participants in study, n = number of participants in subset;
NA – Nurse administrator; NM - Nurse Manager; NM-EBPC - Nurse Manager Evidence Based Practice Competency Scale OCR-SIEP –
Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice; OREBP – Organizational Readiness for
Evidence Based Practice; Ottawa – Ottawa Model of Research Use; PARIHS – Promoting Action on Research Implementation in Health Services;
SN – Staff Nurse; VAP – Ventilator associated pneumonia; YE- Years of experience

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Citation

(Hasanpoor et
al., 2019)

26

Theoretical/ Design/
Conceptual Purpose
Framework

None
provided.

Design:
Cross-sectional

Sample/Setting

N=212
f= 63%
BACC = 63%

Variables

IV – Nurse
managers of
hospital system

Measurement/
Data
Instrumentation Analysis

EBMgt
Questionnaire
(Cα .89)

Descriptive
statistics

Results/
Findings

EBMgt
Questionnaire

Level of
Evidence;
Application
to practice/
Generalizat
ion
to guide
education
will be good
to emulate.
Also
references
to the
Roger’s
theory as a
guide to
learning
theory will
be useful.
LOE: III

Key:– ANOVA – Analysis of variance; ARCC -Advancing Research and Clinical Practice through Close Collaboration; BACC – Baccalaureate or
higher; Cα – Cronbach’s α; CAH – Critical Access Hospital; CHC – Community Health Center; CHN – Community Health Nurse; CNS – Clinical
nurse specialist; DV-dependent variable; EBMgt – Evidence Based Management; EBN – Evidence Based Nursing; EBP – Evidence Based Practice;
EBPB – Evidence Based Practice Beliefs; EBPI – Evidence Based Practice Implementation; EBPK – Evidence Based Practice Knowledge; EBPQ
– Evidence-Based Practice Questionnaire; EC – Exclusion Criteria; ESI - Effect size improvement (posttest score minus pretest score); f = female;
GR-ATTR – Group attractiveness; GR-COH – Group Cohesion; HCP – Healthcare Professionals; IC – Inclusion Criteria; ICS – Implementation
Climate Scale ILS – Implementation Leadership Scale; IV- independent variable; JS – Job Satisfaction; JHNEBPM – Johns Hopkins Nursing
Evidence-Based Practice Model; LOE – Level of Evidence; M – Mean; N- number of participants in study, n = number of participants in subset;
NA – Nurse administrator; NM - Nurse Manager; NM-EBPC - Nurse Manager Evidence Based Practice Competency Scale OCR-SIEP –
Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice; OREBP – Organizational Readiness for
Evidence Based Practice; Ottawa – Ottawa Model of Research Use; PARIHS – Promoting Action on Research Implementation in Health Services;
SN – Staff Nurse; VAP – Ventilator associated pneumonia; YE- Years of experience

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Citation

Nursing
Managers’
Perspectives on
the facilitators
and barriers to
Implementation
of EBMgt
Country: Iran
Funding: None
listed
Bias: None
listed

27

Theoretical/ Design/
Conceptual Purpose
Framework

Purpose:
To assess
nursing
manager’s
perspectives on
the facilitators
and barriers to
implementation
of EBMgt in
large hospital
system in Iran.

Sample/Setting

M age = 41
YE = 17
Setting:
Large hospital
system in Iran
IC – nursing
managers of
hospital system
EC – Nonnursing
managers

Variables

Measurement/
Data
Instrumentation Analysis

DV1: factors
associated with
barriers to
EBMgt

1. Overall
Barriers
and sub
questions

DV2: Factors
associated with
facilitators of
EBMgt

2. Facilitators
Barriers
and sub
questions

Results/
Findings

independent t DV1
tests
(0-100)
M = 63.20
ANOVA
DV2
(0-100)
Pearson
Correlation
M = 61.72

Level of
Evidence;
Application
to practice/
Generalizat
ion
Strengths:
Large
sample size
and
response
rate
Limitations
: Only
managemen
t
perspective,
self-survey.
Conclusion
s: Nurse
managemen

Key:– ANOVA – Analysis of variance; ARCC -Advancing Research and Clinical Practice through Close Collaboration; BACC – Baccalaureate or
higher; Cα – Cronbach’s α; CAH – Critical Access Hospital; CHC – Community Health Center; CHN – Community Health Nurse; CNS – Clinical
nurse specialist; DV-dependent variable; EBMgt – Evidence Based Management; EBN – Evidence Based Nursing; EBP – Evidence Based Practice;
EBPB – Evidence Based Practice Beliefs; EBPI – Evidence Based Practice Implementation; EBPK – Evidence Based Practice Knowledge; EBPQ
– Evidence-Based Practice Questionnaire; EC – Exclusion Criteria; ESI - Effect size improvement (posttest score minus pretest score); f = female;
GR-ATTR – Group attractiveness; GR-COH – Group Cohesion; HCP – Healthcare Professionals; IC – Inclusion Criteria; ICS – Implementation
Climate Scale ILS – Implementation Leadership Scale; IV- independent variable; JS – Job Satisfaction; JHNEBPM – Johns Hopkins Nursing
Evidence-Based Practice Model; LOE – Level of Evidence; M – Mean; N- number of participants in study, n = number of participants in subset;
NA – Nurse administrator; NM - Nurse Manager; NM-EBPC - Nurse Manager Evidence Based Practice Competency Scale OCR-SIEP –
Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice; OREBP – Organizational Readiness for
Evidence Based Practice; Ottawa – Ottawa Model of Research Use; PARIHS – Promoting Action on Research Implementation in Health Services;
SN – Staff Nurse; VAP – Ventilator associated pneumonia; YE- Years of experience

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Citation

Theoretical/ Design/
Conceptual Purpose
Framework

(Kim et al,
2017)

ARCC

Design:
Pretest-posttest
Quasiexperimental

Sample/Setting

Variables

Measurement/
Data
Instrumentation Analysis

Results/
Findings

Level of
Evidence;
Application
to practice/
Generalizat
ion
t plays
important
role in
implementi
ng EBP, and
are integral
in
identifying
barriers to
implementat
ion

N=120

IV –
EBP fellowship
program

Descriptive
statistics

DV1
ESI = +5.65,
p<.001

LOE: III

Demographics:

Paired t-tests

EBPB Scale
EBPI Scale

Strengths:
Findings

Key:– ANOVA – Analysis of variance; ARCC -Advancing Research and Clinical Practice through Close Collaboration; BACC – Baccalaureate or
higher; Cα – Cronbach’s α; CAH – Critical Access Hospital; CHC – Community Health Center; CHN – Community Health Nurse; CNS – Clinical
nurse specialist; DV-dependent variable; EBMgt – Evidence Based Management; EBN – Evidence Based Nursing; EBP – Evidence Based Practice;
EBPB – Evidence Based Practice Beliefs; EBPI – Evidence Based Practice Implementation; EBPK – Evidence Based Practice Knowledge; EBPQ
– Evidence-Based Practice Questionnaire; EC – Exclusion Criteria; ESI - Effect size improvement (posttest score minus pretest score); f = female;
GR-ATTR – Group attractiveness; GR-COH – Group Cohesion; HCP – Healthcare Professionals; IC – Inclusion Criteria; ICS – Implementation
Climate Scale ILS – Implementation Leadership Scale; IV- independent variable; JS – Job Satisfaction; JHNEBPM – Johns Hopkins Nursing
Evidence-Based Practice Model; LOE – Level of Evidence; M – Mean; N- number of participants in study, n = number of participants in subset;
NA – Nurse administrator; NM - Nurse Manager; NM-EBPC - Nurse Manager Evidence Based Practice Competency Scale OCR-SIEP –
Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice; OREBP – Organizational Readiness for
Evidence Based Practice; Ottawa – Ottawa Model of Research Use; PARIHS – Promoting Action on Research Implementation in Health Services;
SN – Staff Nurse; VAP – Ventilator associated pneumonia; YE- Years of experience

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Citation

Evaluating the
effect of a
regional EBP
fellowship
program.
Country:
United States
Funding:
None listed
Bias:
None stated

29

Theoretical/ Design/
Conceptual Purpose
Framework

Purpose:
To determine
whether a EBP
Fellowship
program
improved EBP
beliefs,
implementation,
job satisfaction,
group cohesion
and group
attractiveness in
participants.

Sample/Setting

Variables

Measurement/
Data
Instrumentation Analysis

Results/
Findings

M age = 42
YE =16
BACC = 47.5%
SN = 52.5 %

DV1: EBPB
DV2: EBPI
DV3: JS
DV4: GR-COH
DV5: GRATTR
DV6:
Relationship
between
variables

Bivariate
Pearson’s
correlations

DV3
ESI = +9.84,
p<.001

Setting
Mentors (43)
and fellows (77)
of a EBP
fellowship
program based
out of a large,
multi-hospital
center with
academia
involvement.

Level of
significance
p < .05
Path analysis

JS Scale
GR-COH
Scale
GR-ATTR
Scale

DV3
ESI = +0.38,
p<.047
DV4
ESI = +1.03,
p<.014
DV5
ESI = +0.03,
p<.889 (not
significant)

Level of
Evidence;
Application
to practice/
Generalizat
ion
support
previous
studies.
Good
completion
rate
Limitations
: No
randomizati
on and
control
groups, not
generalizabl
e to nursing
staff due to

Key:– ANOVA – Analysis of variance; ARCC -Advancing Research and Clinical Practice through Close Collaboration; BACC – Baccalaureate or
higher; Cα – Cronbach’s α; CAH – Critical Access Hospital; CHC – Community Health Center; CHN – Community Health Nurse; CNS – Clinical
nurse specialist; DV-dependent variable; EBMgt – Evidence Based Management; EBN – Evidence Based Nursing; EBP – Evidence Based Practice;
EBPB – Evidence Based Practice Beliefs; EBPI – Evidence Based Practice Implementation; EBPK – Evidence Based Practice Knowledge; EBPQ
– Evidence-Based Practice Questionnaire; EC – Exclusion Criteria; ESI - Effect size improvement (posttest score minus pretest score); f = female;
GR-ATTR – Group attractiveness; GR-COH – Group Cohesion; HCP – Healthcare Professionals; IC – Inclusion Criteria; ICS – Implementation
Climate Scale ILS – Implementation Leadership Scale; IV- independent variable; JS – Job Satisfaction; JHNEBPM – Johns Hopkins Nursing
Evidence-Based Practice Model; LOE – Level of Evidence; M – Mean; N- number of participants in study, n = number of participants in subset;
NA – Nurse administrator; NM - Nurse Manager; NM-EBPC - Nurse Manager Evidence Based Practice Competency Scale OCR-SIEP –
Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice; OREBP – Organizational Readiness for
Evidence Based Practice; Ottawa – Ottawa Model of Research Use; PARIHS – Promoting Action on Research Implementation in Health Services;
SN – Staff Nurse; VAP – Ventilator associated pneumonia; YE- Years of experience

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Citation

Theoretical/ Design/
Conceptual Purpose
Framework

30
Sample/Setting

IC – program
participants
EC – nonprogram
participants

Variables

Measurement/
Data
Instrumentation Analysis

Results/
Findings

DV6
↑EBPB + ↑JS
r = .27, p=.003
↑GR-ATTR +
↑JS
r = .27, p=.003

Level of
Evidence;
Application
to practice/
Generalizat
ion
selecting
nurses
already
involved in
EBP
fellowship

Conclusion
s:
↑GR-ATTR +
Comprehen
GR-COH
sive study
r = .26, p=.005
positive
effects of an
************** EBP
No correlation
fellowship
between
program
↑EBPB + ↑EBPI with
Key:– ANOVA – Analysis of variance; ARCC -Advancing Research and Clinical Practice through Close Collaboration; BACC – Baccalaureate or
higher; Cα – Cronbach’s α; CAH – Critical Access Hospital; CHC – Community Health Center; CHN – Community Health Nurse; CNS – Clinical
nurse specialist; DV-dependent variable; EBMgt – Evidence Based Management; EBN – Evidence Based Nursing; EBP – Evidence Based Practice;
EBPB – Evidence Based Practice Beliefs; EBPI – Evidence Based Practice Implementation; EBPK – Evidence Based Practice Knowledge; EBPQ
– Evidence-Based Practice Questionnaire; EC – Exclusion Criteria; ESI - Effect size improvement (posttest score minus pretest score); f = female;
GR-ATTR – Group attractiveness; GR-COH – Group Cohesion; HCP – Healthcare Professionals; IC – Inclusion Criteria; ICS – Implementation
Climate Scale ILS – Implementation Leadership Scale; IV- independent variable; JS – Job Satisfaction; JHNEBPM – Johns Hopkins Nursing
Evidence-Based Practice Model; LOE – Level of Evidence; M – Mean; N- number of participants in study, n = number of participants in subset;
NA – Nurse administrator; NM - Nurse Manager; NM-EBPC - Nurse Manager Evidence Based Practice Competency Scale OCR-SIEP –
Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice; OREBP – Organizational Readiness for
Evidence Based Practice; Ottawa – Ottawa Model of Research Use; PARIHS – Promoting Action on Research Implementation in Health Services;
SN – Staff Nurse; VAP – Ventilator associated pneumonia; YE- Years of experience

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Citation

Theoretical/ Design/
Conceptual Purpose
Framework

(Melnyk et al.,
2017)

ARCC
model

Sample/Setting

Design
N=45
Pretest/posttest
longitudinal pre-

Variables

Measurement/
Data
Instrumentation Analysis

Results/
Findings

IV – ARCC
model

OCR-SIEP

t-tests

EBPB Scale

effect sizes

DV1
t+3.9, p = .00
effect size = .70

Level of
Evidence;
Application
to practice/
Generalizat
ion
continued
success in
improving
EMP
implementat
ion in
medical
institution.
Benefits
also show to
academia
partnership
with
institution.
LOE: 3
Strengths

Key:– ANOVA – Analysis of variance; ARCC -Advancing Research and Clinical Practice through Close Collaboration; BACC – Baccalaureate or
higher; Cα – Cronbach’s α; CAH – Critical Access Hospital; CHC – Community Health Center; CHN – Community Health Nurse; CNS – Clinical
nurse specialist; DV-dependent variable; EBMgt – Evidence Based Management; EBN – Evidence Based Nursing; EBP – Evidence Based Practice;
EBPB – Evidence Based Practice Beliefs; EBPI – Evidence Based Practice Implementation; EBPK – Evidence Based Practice Knowledge; EBPQ
– Evidence-Based Practice Questionnaire; EC – Exclusion Criteria; ESI - Effect size improvement (posttest score minus pretest score); f = female;
GR-ATTR – Group attractiveness; GR-COH – Group Cohesion; HCP – Healthcare Professionals; IC – Inclusion Criteria; ICS – Implementation
Climate Scale ILS – Implementation Leadership Scale; IV- independent variable; JS – Job Satisfaction; JHNEBPM – Johns Hopkins Nursing
Evidence-Based Practice Model; LOE – Level of Evidence; M – Mean; N- number of participants in study, n = number of participants in subset;
NA – Nurse administrator; NM - Nurse Manager; NM-EBPC - Nurse Manager Evidence Based Practice Competency Scale OCR-SIEP –
Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice; OREBP – Organizational Readiness for
Evidence Based Practice; Ottawa – Ottawa Model of Research Use; PARIHS – Promoting Action on Research Implementation in Health Services;
SN – Staff Nurse; VAP – Ventilator associated pneumonia; YE- Years of experience

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Citation

ARCC model
Improves
implementation
of EBP,
culture, and
patient
outcomes
Country
USA
Funding: None
listed
Bias: None
stated

32

Theoretical/ Design/
Conceptual Purpose
Framework

experimental
design
Purpose
To examine
impact of
ARCC model
on
organizational
culture,
clinicians’ EBP
beliefs and
implementation,
and patient
outcomes at one
health-care
system

Sample/Setting

No
Demographics
given

Variables

Measurement/
Data
Instrumentation Analysis

DV 1
Organization
EBPI Scale
Culture
DV 2
Sample:
Individual nurse
Interprofessional beliefs and
HCPs
DV 3
Convenience
Implementation
Setting
341 bed hospital
in San Francisco
Bay area
IC –
Participants in

p .05

Results/
Findings

DV2
t = 4.2, p= .00,
effect size 0.62
DV 3
t = 12.9, p= .00,
effect size = 2.3

Level of
Evidence;
Application
to practice/
Generalizat
ion
Strong
findings
towards
effectivenes
s of ARCC
model
Limitations
: Not much
tabulated
information
about study
Little
demographi
c
information

Key:– ANOVA – Analysis of variance; ARCC -Advancing Research and Clinical Practice through Close Collaboration; BACC – Baccalaureate or
higher; Cα – Cronbach’s α; CAH – Critical Access Hospital; CHC – Community Health Center; CHN – Community Health Nurse; CNS – Clinical
nurse specialist; DV-dependent variable; EBMgt – Evidence Based Management; EBN – Evidence Based Nursing; EBP – Evidence Based Practice;
EBPB – Evidence Based Practice Beliefs; EBPI – Evidence Based Practice Implementation; EBPK – Evidence Based Practice Knowledge; EBPQ
– Evidence-Based Practice Questionnaire; EC – Exclusion Criteria; ESI - Effect size improvement (posttest score minus pretest score); f = female;
GR-ATTR – Group attractiveness; GR-COH – Group Cohesion; HCP – Healthcare Professionals; IC – Inclusion Criteria; ICS – Implementation
Climate Scale ILS – Implementation Leadership Scale; IV- independent variable; JS – Job Satisfaction; JHNEBPM – Johns Hopkins Nursing
Evidence-Based Practice Model; LOE – Level of Evidence; M – Mean; N- number of participants in study, n = number of participants in subset;
NA – Nurse administrator; NM - Nurse Manager; NM-EBPC - Nurse Manager Evidence Based Practice Competency Scale OCR-SIEP –
Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice; OREBP – Organizational Readiness for
Evidence Based Practice; Ottawa – Ottawa Model of Research Use; PARIHS – Promoting Action on Research Implementation in Health Services;
SN – Staff Nurse; VAP – Ventilator associated pneumonia; YE- Years of experience

NURSE SCHOLAR
Citation

Theoretical/ Design/
Conceptual Purpose
Framework

33
Sample/Setting

12-month EBP
workshop
EC –
nonparticipants

Variables

Measurement/
Data
Instrumentation Analysis

Results/
Findings

Level of
Evidence;
Application
to practice/
Generalizat
ion
Narrow
research
findings
No
limitations
discussed,
Conclusion
s: Study
focused on
the results
of a specific
program
implementat
ion at one
hospital.
Generalizati

Key:– ANOVA – Analysis of variance; ARCC -Advancing Research and Clinical Practice through Close Collaboration; BACC – Baccalaureate or
higher; Cα – Cronbach’s α; CAH – Critical Access Hospital; CHC – Community Health Center; CHN – Community Health Nurse; CNS – Clinical
nurse specialist; DV-dependent variable; EBMgt – Evidence Based Management; EBN – Evidence Based Nursing; EBP – Evidence Based Practice;
EBPB – Evidence Based Practice Beliefs; EBPI – Evidence Based Practice Implementation; EBPK – Evidence Based Practice Knowledge; EBPQ
– Evidence-Based Practice Questionnaire; EC – Exclusion Criteria; ESI - Effect size improvement (posttest score minus pretest score); f = female;
GR-ATTR – Group attractiveness; GR-COH – Group Cohesion; HCP – Healthcare Professionals; IC – Inclusion Criteria; ICS – Implementation
Climate Scale ILS – Implementation Leadership Scale; IV- independent variable; JS – Job Satisfaction; JHNEBPM – Johns Hopkins Nursing
Evidence-Based Practice Model; LOE – Level of Evidence; M – Mean; N- number of participants in study, n = number of participants in subset;
NA – Nurse administrator; NM - Nurse Manager; NM-EBPC - Nurse Manager Evidence Based Practice Competency Scale OCR-SIEP –
Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice; OREBP – Organizational Readiness for
Evidence Based Practice; Ottawa – Ottawa Model of Research Use; PARIHS – Promoting Action on Research Implementation in Health Services;
SN – Staff Nurse; VAP – Ventilator associated pneumonia; YE- Years of experience

NURSE SCHOLAR

34

Citation

Theoretical/ Design/
Conceptual Purpose
Framework

(Mudderman et
al., 2020)
Effect of EBP
Program on
knowledge,
practice, and
attitudes
toward EBP in
rural hospital

Iowa Model
Revised

Country: USA

Sample/Setting

Design
N=9
pretest-posttest
nonexperimental Demographics:
nursing – 7
Purpose
non-nursing – 2
Determine the
effect of an EBP Nurses’ highest
education and
education
mentoring
ASSC: 44%
program on the
BACC: 33%
knowledge,

Variables

Measurement/
Data
Instrumentation Analysis

Results/
Findings

Level of
Evidence;
Application
to practice/
Generalizat
ion
on suffers.
And that the
way the
cookie
crumbles.

IV: EBP
education and
mentoring
program

EBPQ
(Cα .87)

Descriptive
Statistics

DV1
↑ +1.38, p=.011

LOE – III

EBPQ
subscales:

Wilcoxon
matchedpairs tests
(small
sample size)

DV2
↑ +1.3+, p=.008

DV1:
Total EBPQ
Score
DV1:
EBP knowledge
DV2:

EBPQ
knowledge
(Cα .91)
EBPQ practice

DV3
↑ +2.16, p=.015
DV4
↑ +1.00, p=.106*

Strengths:
results agree
with similar
studies
Limitations
: Very small
study,
convenience

Key:– ANOVA – Analysis of variance; ARCC -Advancing Research and Clinical Practice through Close Collaboration; BACC – Baccalaureate or
higher; Cα – Cronbach’s α; CAH – Critical Access Hospital; CHC – Community Health Center; CHN – Community Health Nurse; CNS – Clinical
nurse specialist; DV-dependent variable; EBMgt – Evidence Based Management; EBN – Evidence Based Nursing; EBP – Evidence Based Practice;
EBPB – Evidence Based Practice Beliefs; EBPI – Evidence Based Practice Implementation; EBPK – Evidence Based Practice Knowledge; EBPQ
– Evidence-Based Practice Questionnaire; EC – Exclusion Criteria; ESI - Effect size improvement (posttest score minus pretest score); f = female;
GR-ATTR – Group attractiveness; GR-COH – Group Cohesion; HCP – Healthcare Professionals; IC – Inclusion Criteria; ICS – Implementation
Climate Scale ILS – Implementation Leadership Scale; IV- independent variable; JS – Job Satisfaction; JHNEBPM – Johns Hopkins Nursing
Evidence-Based Practice Model; LOE – Level of Evidence; M – Mean; N- number of participants in study, n = number of participants in subset;
NA – Nurse administrator; NM - Nurse Manager; NM-EBPC - Nurse Manager Evidence Based Practice Competency Scale OCR-SIEP –
Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice; OREBP – Organizational Readiness for
Evidence Based Practice; Ottawa – Ottawa Model of Research Use; PARIHS – Promoting Action on Research Implementation in Health Services;
SN – Staff Nurse; VAP – Ventilator associated pneumonia; YE- Years of experience

NURSE SCHOLAR
Citation

Funding: none
listed
Bias: none
listed

35

Theoretical/ Design/
Conceptual Purpose
Framework

practice, and
attitudes toward
EBP among
staff nurses and
clinicians in a
rural CAH.

Sample/Setting

Variables

Measurement/
Data
Instrumentation Analysis

Setting
25 bed CAH in
Midwest

EBP Practice
DV 3:
EBP attitudes

(Cα .85)
EBPQ attitudes
(Cα .75)

Results/
Findings

*not significant

Level of
Evidence;
Application
to practice/
Generalizat
ion
sample,
change in
mentors
during
study, cited
costs
Conclusion
s: EBP
programs in
rural and
small
settings
shown to
increase
nurse EBP
knowledge

Key:– ANOVA – Analysis of variance; ARCC -Advancing Research and Clinical Practice through Close Collaboration; BACC – Baccalaureate or
higher; Cα – Cronbach’s α; CAH – Critical Access Hospital; CHC – Community Health Center; CHN – Community Health Nurse; CNS – Clinical
nurse specialist; DV-dependent variable; EBMgt – Evidence Based Management; EBN – Evidence Based Nursing; EBP – Evidence Based Practice;
EBPB – Evidence Based Practice Beliefs; EBPI – Evidence Based Practice Implementation; EBPK – Evidence Based Practice Knowledge; EBPQ
– Evidence-Based Practice Questionnaire; EC – Exclusion Criteria; ESI - Effect size improvement (posttest score minus pretest score); f = female;
GR-ATTR – Group attractiveness; GR-COH – Group Cohesion; HCP – Healthcare Professionals; IC – Inclusion Criteria; ICS – Implementation
Climate Scale ILS – Implementation Leadership Scale; IV- independent variable; JS – Job Satisfaction; JHNEBPM – Johns Hopkins Nursing
Evidence-Based Practice Model; LOE – Level of Evidence; M – Mean; N- number of participants in study, n = number of participants in subset;
NA – Nurse administrator; NM - Nurse Manager; NM-EBPC - Nurse Manager Evidence Based Practice Competency Scale OCR-SIEP –
Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice; OREBP – Organizational Readiness for
Evidence Based Practice; Ottawa – Ottawa Model of Research Use; PARIHS – Promoting Action on Research Implementation in Health Services;
SN – Staff Nurse; VAP – Ventilator associated pneumonia; YE- Years of experience

NURSE SCHOLAR
Citation

Theoretical/ Design/
Conceptual Purpose
Framework

(Pereira, et al.
ARCC
2018)
Beliefs and
Implementation
of EBP among
CHN working
in CHC
Country:
Switzerland
Funding:
Bias:

36

Design:
Cross-Sectional
Descriptive
Purpose:
Describe beliefs
about EBP and
record levels of
implementation.

Sample/Setting

Variables

Measurement/
Data
Instrumentation Analysis

Results/
Findings

Level of
Evidence;
Application
to practice/
Generalizat
ion

N=100

IV – CHN
DV1 – EBPB

DV1
M = 53.11

LOE – III

f= 88%
M age = 45
YE = 20.3
BACC = 57%

EBPB Scale
(range 16-80)
(Cα = .84)

IC – Nursing
staff in regional
CHC
EC – Students,
contracted RNs,
>3 months
experience.

DV2 – EBPI
DV3 –
Association
between EBPB
and EBPI

EBPI Scale
(range 0-68)
(Cα = .92)

Descriptive
Statistics

Kolmogorov- DV2
Smirnov test M = 12.51
for equality
of variances DV3
(ρ=.764, p<.001)
Spearman
correlation
coefficient

Strengths:
Findings
similar to
other
studies.
Limitations
:
Geographic
ally limited,
not
generalizabl
e, smaller
response

Key:– ANOVA – Analysis of variance; ARCC -Advancing Research and Clinical Practice through Close Collaboration; BACC – Baccalaureate or
higher; Cα – Cronbach’s α; CAH – Critical Access Hospital; CHC – Community Health Center; CHN – Community Health Nurse; CNS – Clinical
nurse specialist; DV-dependent variable; EBMgt – Evidence Based Management; EBN – Evidence Based Nursing; EBP – Evidence Based Practice;
EBPB – Evidence Based Practice Beliefs; EBPI – Evidence Based Practice Implementation; EBPK – Evidence Based Practice Knowledge; EBPQ
– Evidence-Based Practice Questionnaire; EC – Exclusion Criteria; ESI - Effect size improvement (posttest score minus pretest score); f = female;
GR-ATTR – Group attractiveness; GR-COH – Group Cohesion; HCP – Healthcare Professionals; IC – Inclusion Criteria; ICS – Implementation
Climate Scale ILS – Implementation Leadership Scale; IV- independent variable; JS – Job Satisfaction; JHNEBPM – Johns Hopkins Nursing
Evidence-Based Practice Model; LOE – Level of Evidence; M – Mean; N- number of participants in study, n = number of participants in subset;
NA – Nurse administrator; NM - Nurse Manager; NM-EBPC - Nurse Manager Evidence Based Practice Competency Scale OCR-SIEP –
Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice; OREBP – Organizational Readiness for
Evidence Based Practice; Ottawa – Ottawa Model of Research Use; PARIHS – Promoting Action on Research Implementation in Health Services;
SN – Staff Nurse; VAP – Ventilator associated pneumonia; YE- Years of experience

NURSE SCHOLAR
Citation

Theoretical/ Design/
Conceptual Purpose
Framework

37
Sample/Setting

Variables

Measurement/
Data
Instrumentation Analysis

Results/
Findings

Level of
Evidence;
Application
to practice/
Generalizat
ion
rate, Lack
of
understandi
ng resulted
in decreased
participatio
n in survey,
Conclusion
s: Found a
positive
correlation
between
nurses EBP
beliefs and
implementat
ion. Nurses

Key:– ANOVA – Analysis of variance; ARCC -Advancing Research and Clinical Practice through Close Collaboration; BACC – Baccalaureate or
higher; Cα – Cronbach’s α; CAH – Critical Access Hospital; CHC – Community Health Center; CHN – Community Health Nurse; CNS – Clinical
nurse specialist; DV-dependent variable; EBMgt – Evidence Based Management; EBN – Evidence Based Nursing; EBP – Evidence Based Practice;
EBPB – Evidence Based Practice Beliefs; EBPI – Evidence Based Practice Implementation; EBPK – Evidence Based Practice Knowledge; EBPQ
– Evidence-Based Practice Questionnaire; EC – Exclusion Criteria; ESI - Effect size improvement (posttest score minus pretest score); f = female;
GR-ATTR – Group attractiveness; GR-COH – Group Cohesion; HCP – Healthcare Professionals; IC – Inclusion Criteria; ICS – Implementation
Climate Scale ILS – Implementation Leadership Scale; IV- independent variable; JS – Job Satisfaction; JHNEBPM – Johns Hopkins Nursing
Evidence-Based Practice Model; LOE – Level of Evidence; M – Mean; N- number of participants in study, n = number of participants in subset;
NA – Nurse administrator; NM - Nurse Manager; NM-EBPC - Nurse Manager Evidence Based Practice Competency Scale OCR-SIEP –
Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice; OREBP – Organizational Readiness for
Evidence Based Practice; Ottawa – Ottawa Model of Research Use; PARIHS – Promoting Action on Research Implementation in Health Services;
SN – Staff Nurse; VAP – Ventilator associated pneumonia; YE- Years of experience

NURSE SCHOLAR

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Citation

Theoretical/ Design/
Conceptual Purpose
Framework

(Spiva et al.,
2017)

None stated

Sample/Setting

Design: 2 group n = 66 mentors
pre-test-posttest, n = 367 nurses

Variables

Measurement/
Data
Instrumentation Analysis

Results/
Findings

IV1:
Formalized

Evidence-Based
Nursing

DV1:

Descriptive
and

Level of
Evidence;
Application
to practice/
Generalizat
ion
report
positive
feelings
about EBP,
but
implementat
ion remains
low. Culture
and
opportunity
are essential
for more
EBP
focused
care.
LOE: III

Key:– ANOVA – Analysis of variance; ARCC -Advancing Research and Clinical Practice through Close Collaboration; BACC – Baccalaureate or
higher; Cα – Cronbach’s α; CAH – Critical Access Hospital; CHC – Community Health Center; CHN – Community Health Nurse; CNS – Clinical
nurse specialist; DV-dependent variable; EBMgt – Evidence Based Management; EBN – Evidence Based Nursing; EBP – Evidence Based Practice;
EBPB – Evidence Based Practice Beliefs; EBPI – Evidence Based Practice Implementation; EBPK – Evidence Based Practice Knowledge; EBPQ
– Evidence-Based Practice Questionnaire; EC – Exclusion Criteria; ESI - Effect size improvement (posttest score minus pretest score); f = female;
GR-ATTR – Group attractiveness; GR-COH – Group Cohesion; HCP – Healthcare Professionals; IC – Inclusion Criteria; ICS – Implementation
Climate Scale ILS – Implementation Leadership Scale; IV- independent variable; JS – Job Satisfaction; JHNEBPM – Johns Hopkins Nursing
Evidence-Based Practice Model; LOE – Level of Evidence; M – Mean; N- number of participants in study, n = number of participants in subset;
NA – Nurse administrator; NM - Nurse Manager; NM-EBPC - Nurse Manager Evidence Based Practice Competency Scale OCR-SIEP –
Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice; OREBP – Organizational Readiness for
Evidence Based Practice; Ottawa – Ottawa Model of Research Use; PARIHS – Promoting Action on Research Implementation in Health Services;
SN – Staff Nurse; VAP – Ventilator associated pneumonia; YE- Years of experience

NURSE SCHOLAR
Citation

Effectiveness
of an EBP
nurse mentor
training
program
Country: USA
Funding: none
listed
Bias: none
listed

39

Theoretical/ Design/
Conceptual Purpose
Framework

quasiexperimental,
interventional

Sample/Setting

Demographics:
Mentor subset
M age: 42.9
Purpose:
Y Exp: 15.9
1. To investigate BACC: 71%
the effectiveness
sofa mentor
Nurse subset
training
M age 45.9
program on
M YE: 19
mentor’s
BACC: 54%
perception of
EBP and
No statistical
research
differences
utilization
found in
2. To investigate demographics.
the effectiveness

Variables

Measurement/
Data
Instrumentation Analysis

Results/
Findings

Mentor and
nurse training
program for
EBP

Questionnaire
(nurses and
mentors)

inferential
statistics

t = -8.64;
p=<.001

Paired t-tests

DV2:
t=-6.36; p=<.001

DV1: Mentors
knowledge
DV2: Mentors
confidence
DV3: Nurses
knowledge

Confidence
Scale (mentors)
Barriers to
Research
Utilization Scale
(nurses)
EBP Nurse
Leadership
(nurses)

Frequencies,
percentages,
means,
standard
deviations.

DV3:
t = -19.12;
p=<.001
DV4:
t = 20.86;
p=<.001
DV5:
t = -20.18;
p=<.001

Level of
Evidence;
Application
to practice/
Generalizat
ion
Strengths:
Good
retention of
mentor
group,
Findings are
similar to
other
studies
Limitations
: Nonrandomized.
Some delay
in nurse
training
resulted in

Key:– ANOVA – Analysis of variance; ARCC -Advancing Research and Clinical Practice through Close Collaboration; BACC – Baccalaureate or
higher; Cα – Cronbach’s α; CAH – Critical Access Hospital; CHC – Community Health Center; CHN – Community Health Nurse; CNS – Clinical
nurse specialist; DV-dependent variable; EBMgt – Evidence Based Management; EBN – Evidence Based Nursing; EBP – Evidence Based Practice;
EBPB – Evidence Based Practice Beliefs; EBPI – Evidence Based Practice Implementation; EBPK – Evidence Based Practice Knowledge; EBPQ
– Evidence-Based Practice Questionnaire; EC – Exclusion Criteria; ESI - Effect size improvement (posttest score minus pretest score); f = female;
GR-ATTR – Group attractiveness; GR-COH – Group Cohesion; HCP – Healthcare Professionals; IC – Inclusion Criteria; ICS – Implementation
Climate Scale ILS – Implementation Leadership Scale; IV- independent variable; JS – Job Satisfaction; JHNEBPM – Johns Hopkins Nursing
Evidence-Based Practice Model; LOE – Level of Evidence; M – Mean; N- number of participants in study, n = number of participants in subset;
NA – Nurse administrator; NM - Nurse Manager; NM-EBPC - Nurse Manager Evidence Based Practice Competency Scale OCR-SIEP –
Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice; OREBP – Organizational Readiness for
Evidence Based Practice; Ottawa – Ottawa Model of Research Use; PARIHS – Promoting Action on Research Implementation in Health Services;
SN – Staff Nurse; VAP – Ventilator associated pneumonia; YE- Years of experience

NURSE SCHOLAR
Citation

40

Theoretical/ Design/
Conceptual Purpose
Framework

of creating a
structure to
enculturate EBP
to prepare
nurses to
incorporate EBP
into practice
.

Sample/Setting

Variables

Measurement/
Data
Instrumentation Analysis

Results/
Findings

Setting:
Convenience
sample of
registered nurses
and nurse
mentors in a
hospital system
in the southeast

DV4: Nurses
perceived
barriers

EBP Work
Environment
Scale
(nurses)

DV6:
t = -16.50;
p=<.001

DV5: Nurse
EBP work
environment
DV6: EBP
Nurse
leadership

Level of
Evidence;
Application
to practice/
Generalizat
ion
high
attrition of
nurse group
Conclusion
s:
A
mentorship
program
was
effective in
improving
EBP
knowledge,
attitude,
skill, and
confidence

Key:– ANOVA – Analysis of variance; ARCC -Advancing Research and Clinical Practice through Close Collaboration; BACC – Baccalaureate or
higher; Cα – Cronbach’s α; CAH – Critical Access Hospital; CHC – Community Health Center; CHN – Community Health Nurse; CNS – Clinical
nurse specialist; DV-dependent variable; EBMgt – Evidence Based Management; EBN – Evidence Based Nursing; EBP – Evidence Based Practice;
EBPB – Evidence Based Practice Beliefs; EBPI – Evidence Based Practice Implementation; EBPK – Evidence Based Practice Knowledge; EBPQ
– Evidence-Based Practice Questionnaire; EC – Exclusion Criteria; ESI - Effect size improvement (posttest score minus pretest score); f = female;
GR-ATTR – Group attractiveness; GR-COH – Group Cohesion; HCP – Healthcare Professionals; IC – Inclusion Criteria; ICS – Implementation
Climate Scale ILS – Implementation Leadership Scale; IV- independent variable; JS – Job Satisfaction; JHNEBPM – Johns Hopkins Nursing
Evidence-Based Practice Model; LOE – Level of Evidence; M – Mean; N- number of participants in study, n = number of participants in subset;
NA – Nurse administrator; NM - Nurse Manager; NM-EBPC - Nurse Manager Evidence Based Practice Competency Scale OCR-SIEP –
Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice; OREBP – Organizational Readiness for
Evidence Based Practice; Ottawa – Ottawa Model of Research Use; PARIHS – Promoting Action on Research Implementation in Health Services;
SN – Staff Nurse; VAP – Ventilator associated pneumonia; YE- Years of experience

NURSE SCHOLAR
Citation

41

Theoretical/ Design/
Conceptual Purpose
Framework

(Shuman et al., PARHIS
2018)
framework
Unit leadership
and climates
for EBP
Implementation

Design
cross-sectional
Purpose
1. Describe
NMs self-

Sample/Setting

Variables

Measurement/
Data
Instrumentation Analysis

Results/
Findings

N = 310
n = 23 (NM)
n = 287 (SN)

IV:
NMs and SNs

NM- EBPC

Descriptive
Statistics

DV1 (0-3)
M=1.62

independent
t-tests with

DV2 (0-4)
M = 2.88 (SN)
M = 2.73 (NM)

Demographics

DV1: EBP
Competency

ILS
ICS

Level of
Evidence;
Application
to practice/
Generalizat
ion
levels
nurses
training to
be mentors.
A culture of
EBP is
assisted by
welleducated
mentors.
Feasibility
LOE: III
Strengths:
Multiple
units in

Key:– ANOVA – Analysis of variance; ARCC -Advancing Research and Clinical Practice through Close Collaboration; BACC – Baccalaureate or
higher; Cα – Cronbach’s α; CAH – Critical Access Hospital; CHC – Community Health Center; CHN – Community Health Nurse; CNS – Clinical
nurse specialist; DV-dependent variable; EBMgt – Evidence Based Management; EBN – Evidence Based Nursing; EBP – Evidence Based Practice;
EBPB – Evidence Based Practice Beliefs; EBPI – Evidence Based Practice Implementation; EBPK – Evidence Based Practice Knowledge; EBPQ
– Evidence-Based Practice Questionnaire; EC – Exclusion Criteria; ESI - Effect size improvement (posttest score minus pretest score); f = female;
GR-ATTR – Group attractiveness; GR-COH – Group Cohesion; HCP – Healthcare Professionals; IC – Inclusion Criteria; ICS – Implementation
Climate Scale ILS – Implementation Leadership Scale; IV- independent variable; JS – Job Satisfaction; JHNEBPM – Johns Hopkins Nursing
Evidence-Based Practice Model; LOE – Level of Evidence; M – Mean; N- number of participants in study, n = number of participants in subset;
NA – Nurse administrator; NM - Nurse Manager; NM-EBPC - Nurse Manager Evidence Based Practice Competency Scale OCR-SIEP –
Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice; OREBP – Organizational Readiness for
Evidence Based Practice; Ottawa – Ottawa Model of Research Use; PARIHS – Promoting Action on Research Implementation in Health Services;
SN – Staff Nurse; VAP – Ventilator associated pneumonia; YE- Years of experience

NURSE SCHOLAR
Citation

Country: USA
Funding: None
stated
Bias: None
stated

42

Theoretical/ Design/
Conceptual Purpose
Framework

perceptions of
EBP
competency
2. Describe
NMs EBP
leadership
behaviors as
perceived by
self and SNs
3. Describe SNs
and NM’s
perception of
unit climate for
EBP

Sample/Setting

Variables

f = 87%(NM),
84% (SN)
BACC =
52%(NM), 59%
(SM)
M Age = 42
(NM), 35 (SN)
YE = 16 (NM),
8 (SN)

DV2:
Leadership
behaviors

Sample
Convenience
sample of 24
units of 7
hospitals in
Midwest and
Northeast.

DV3: Climate
perception

Measurement/
Data
Instrumentation Analysis

Bonferroni
correction

Results/
Findings

DV3 (0-4)
M = 2.24 (SN)
M = 2.16 (NM)

Level of
Evidence;
Application
to practice/
Generalizat
ion
multiple
hospitals
Limitations
:
Convenienc
e sample,
not
generalizabl
e, only adult
med-surg,
some
subscales
(ILS) had
low
reliability

Key:– ANOVA – Analysis of variance; ARCC -Advancing Research and Clinical Practice through Close Collaboration; BACC – Baccalaureate or
higher; Cα – Cronbach’s α; CAH – Critical Access Hospital; CHC – Community Health Center; CHN – Community Health Nurse; CNS – Clinical
nurse specialist; DV-dependent variable; EBMgt – Evidence Based Management; EBN – Evidence Based Nursing; EBP – Evidence Based Practice;
EBPB – Evidence Based Practice Beliefs; EBPI – Evidence Based Practice Implementation; EBPK – Evidence Based Practice Knowledge; EBPQ
– Evidence-Based Practice Questionnaire; EC – Exclusion Criteria; ESI - Effect size improvement (posttest score minus pretest score); f = female;
GR-ATTR – Group attractiveness; GR-COH – Group Cohesion; HCP – Healthcare Professionals; IC – Inclusion Criteria; ICS – Implementation
Climate Scale ILS – Implementation Leadership Scale; IV- independent variable; JS – Job Satisfaction; JHNEBPM – Johns Hopkins Nursing
Evidence-Based Practice Model; LOE – Level of Evidence; M – Mean; N- number of participants in study, n = number of participants in subset;
NA – Nurse administrator; NM - Nurse Manager; NM-EBPC - Nurse Manager Evidence Based Practice Competency Scale OCR-SIEP –
Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice; OREBP – Organizational Readiness for
Evidence Based Practice; Ottawa – Ottawa Model of Research Use; PARIHS – Promoting Action on Research Implementation in Health Services;
SN – Staff Nurse; VAP – Ventilator associated pneumonia; YE- Years of experience

NURSE SCHOLAR
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43

Theoretical/ Design/
Conceptual Purpose
Framework

4. Compare SN
and NMs
perceptions of
EBPI leadership
behavior and
climate

Sample/Setting

IC – adult care
units, have
eligible nurse
manager
EC – motherbaby, pediatric,
neonatal,
psychiatric, and
ICU unit RNs

Variables

Measurement/
Data
Instrumentation Analysis

Results/
Findings

Level of
Evidence;
Application
to practice/
Generalizat
ion
Conclusion
s:
Nurse
managers
play a vital
role in EBP
implementat
ion. Unit
climate,
leadership
EBP
competency
needs to
improve.

Key:– ANOVA – Analysis of variance; ARCC -Advancing Research and Clinical Practice through Close Collaboration; BACC – Baccalaureate or
higher; Cα – Cronbach’s α; CAH – Critical Access Hospital; CHC – Community Health Center; CHN – Community Health Nurse; CNS – Clinical
nurse specialist; DV-dependent variable; EBMgt – Evidence Based Management; EBN – Evidence Based Nursing; EBP – Evidence Based Practice;
EBPB – Evidence Based Practice Beliefs; EBPI – Evidence Based Practice Implementation; EBPK – Evidence Based Practice Knowledge; EBPQ
– Evidence-Based Practice Questionnaire; EC – Exclusion Criteria; ESI - Effect size improvement (posttest score minus pretest score); f = female;
GR-ATTR – Group attractiveness; GR-COH – Group Cohesion; HCP – Healthcare Professionals; IC – Inclusion Criteria; ICS – Implementation
Climate Scale ILS – Implementation Leadership Scale; IV- independent variable; JS – Job Satisfaction; JHNEBPM – Johns Hopkins Nursing
Evidence-Based Practice Model; LOE – Level of Evidence; M – Mean; N- number of participants in study, n = number of participants in subset;
NA – Nurse administrator; NM - Nurse Manager; NM-EBPC - Nurse Manager Evidence Based Practice Competency Scale OCR-SIEP –
Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice; OREBP – Organizational Readiness for
Evidence Based Practice; Ottawa – Ottawa Model of Research Use; PARIHS – Promoting Action on Research Implementation in Health Services;
SN – Staff Nurse; VAP – Ventilator associated pneumonia; YE- Years of experience

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Citation

Theoretical/ Design/
Conceptual Purpose
Framework

(Warren et al.,
2016)
No space
Strengths and
Challenges of
Implementing
EBP in
Healthcare
Systems

PARIHS

Country:
Funding:
Bias:

Dillman’s

Sample/Setting

Design
N= 1608
Cross-Sectional
Survey design
Demographics
f = 92%
Purpose
YE= 17
To describe
BACC = 52%
RN’s attitudes,
beliefs, and
Setting
perceptions
Large hospital
about EBP and
system in
examine
Northeast
differences in
demographics,
IC –RNs in
professional
hospital system
characteristics,
and leadership
EC – non-RNs
differences

Variables

Measurement/
Data
Instrumentation Analysis

Results/
Findings

IV: RNs in
large hospital
system

EBPB Scale
(Cα .90)

Descriptive
Statistics

EBPI Scale
(Cα .95)

ANOVA
Levene’s test

DV1:
Know how to
use EBP to make
practice changes
(41%)

OCRSIEP Scale
(Cα .95)

Tukey HSD

DV1: EBP
Beliefs
DV2: EBP
Implementation
DV3:
Organizational
Culture survey

Welch
ANOVA
GamesHowell post
hov

DV2:
Access to EBP
resources - 49%
DV3:
Little to no
readiness - 64%

Level of
Evidence;
Application
to practice/
Generalizat
ion
LOE – III
Strengths:
Findings
consistent
with other
studies,
large
sample
despite low
response
rate
Limitations
: Low
response
rate, self-

Key:– ANOVA – Analysis of variance; ARCC -Advancing Research and Clinical Practice through Close Collaboration; BACC – Baccalaureate or
higher; Cα – Cronbach’s α; CAH – Critical Access Hospital; CHC – Community Health Center; CHN – Community Health Nurse; CNS – Clinical
nurse specialist; DV-dependent variable; EBMgt – Evidence Based Management; EBN – Evidence Based Nursing; EBP – Evidence Based Practice;
EBPB – Evidence Based Practice Beliefs; EBPI – Evidence Based Practice Implementation; EBPK – Evidence Based Practice Knowledge; EBPQ
– Evidence-Based Practice Questionnaire; EC – Exclusion Criteria; ESI - Effect size improvement (posttest score minus pretest score); f = female;
GR-ATTR – Group attractiveness; GR-COH – Group Cohesion; HCP – Healthcare Professionals; IC – Inclusion Criteria; ICS – Implementation
Climate Scale ILS – Implementation Leadership Scale; IV- independent variable; JS – Job Satisfaction; JHNEBPM – Johns Hopkins Nursing
Evidence-Based Practice Model; LOE – Level of Evidence; M – Mean; N- number of participants in study, n = number of participants in subset;
NA – Nurse administrator; NM - Nurse Manager; NM-EBPC - Nurse Manager Evidence Based Practice Competency Scale OCR-SIEP –
Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice; OREBP – Organizational Readiness for
Evidence Based Practice; Ottawa – Ottawa Model of Research Use; PARIHS – Promoting Action on Research Implementation in Health Services;
SN – Staff Nurse; VAP – Ventilator associated pneumonia; YE- Years of experience

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Theoretical/ Design/
Conceptual Purpose
Framework

45
Sample/Setting

Variables

Measurement/
Data
Instrumentation Analysis

Results/
Findings

Level of
Evidence;
Application
to practice/
Generalizat
ion
reported
data. Not
generalizabl
e.
Conclusion
s: EBP
culture
assessment
prior to
program
implementat
ion can
identify
baseline
culture.
Mentorship

Key:– ANOVA – Analysis of variance; ARCC -Advancing Research and Clinical Practice through Close Collaboration; BACC – Baccalaureate or
higher; Cα – Cronbach’s α; CAH – Critical Access Hospital; CHC – Community Health Center; CHN – Community Health Nurse; CNS – Clinical
nurse specialist; DV-dependent variable; EBMgt – Evidence Based Management; EBN – Evidence Based Nursing; EBP – Evidence Based Practice;
EBPB – Evidence Based Practice Beliefs; EBPI – Evidence Based Practice Implementation; EBPK – Evidence Based Practice Knowledge; EBPQ
– Evidence-Based Practice Questionnaire; EC – Exclusion Criteria; ESI - Effect size improvement (posttest score minus pretest score); f = female;
GR-ATTR – Group attractiveness; GR-COH – Group Cohesion; HCP – Healthcare Professionals; IC – Inclusion Criteria; ICS – Implementation
Climate Scale ILS – Implementation Leadership Scale; IV- independent variable; JS – Job Satisfaction; JHNEBPM – Johns Hopkins Nursing
Evidence-Based Practice Model; LOE – Level of Evidence; M – Mean; N- number of participants in study, n = number of participants in subset;
NA – Nurse administrator; NM - Nurse Manager; NM-EBPC - Nurse Manager Evidence Based Practice Competency Scale OCR-SIEP –
Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice; OREBP – Organizational Readiness for
Evidence Based Practice; Ottawa – Ottawa Model of Research Use; PARIHS – Promoting Action on Research Implementation in Health Services;
SN – Staff Nurse; VAP – Ventilator associated pneumonia; YE- Years of experience

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46

Theoretical/ Design/
Conceptual Purpose
Framework

(Yoo et al.
ARCC
2019)
model
Clinical nurses’
beliefs,
knowledge,
organizational
readiness, and

Design:
Descriptive and
cross-sectional
design
Purpose

Sample/Setting

N= 521
Demographics:
M age = 31.69
M YE = 9.0
years
f = 93.3%

Variables

Measurement/
Data
Instrumentation Analysis

IV: Clinical
EBP Knowledge
nurses in
Questionnaire
hospital system
EBP Beliefs tool
DV1:
EBP knowledge OROC-SIEP

Results/
Findings

Inferential
statistics

DV1
52.5/98

Descriptive
Statistics

DV2
51.7/80
DV3

Level of
Evidence;
Application
to practice/
Generalizat
ion
and support
from nurse
leaders are
critical to
successful
integration
of an EBP
culture.
Feasibility
LOE – III
Strengths –
Large
sample,
good power,

Key:– ANOVA – Analysis of variance; ARCC -Advancing Research and Clinical Practice through Close Collaboration; BACC – Baccalaureate or
higher; Cα – Cronbach’s α; CAH – Critical Access Hospital; CHC – Community Health Center; CHN – Community Health Nurse; CNS – Clinical
nurse specialist; DV-dependent variable; EBMgt – Evidence Based Management; EBN – Evidence Based Nursing; EBP – Evidence Based Practice;
EBPB – Evidence Based Practice Beliefs; EBPI – Evidence Based Practice Implementation; EBPK – Evidence Based Practice Knowledge; EBPQ
– Evidence-Based Practice Questionnaire; EC – Exclusion Criteria; ESI - Effect size improvement (posttest score minus pretest score); f = female;
GR-ATTR – Group attractiveness; GR-COH – Group Cohesion; HCP – Healthcare Professionals; IC – Inclusion Criteria; ICS – Implementation
Climate Scale ILS – Implementation Leadership Scale; IV- independent variable; JS – Job Satisfaction; JHNEBPM – Johns Hopkins Nursing
Evidence-Based Practice Model; LOE – Level of Evidence; M – Mean; N- number of participants in study, n = number of participants in subset;
NA – Nurse administrator; NM - Nurse Manager; NM-EBPC - Nurse Manager Evidence Based Practice Competency Scale OCR-SIEP –
Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice; OREBP – Organizational Readiness for
Evidence Based Practice; Ottawa – Ottawa Model of Research Use; PARIHS – Promoting Action on Research Implementation in Health Services;
SN – Staff Nurse; VAP – Ventilator associated pneumonia; YE- Years of experience

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level of
implementation
of EBP: The
first step to
creating an
EBP culture
Country:
South Korea
Funding:
Research fund
from Chosun
University
Bias: none
listed

47

Theoretical/ Design/
Conceptual Purpose
Framework

1. To identify
nurses’ EBP
knowledge,
beliefs,
organizational
readiness, and
EBP
implementation
levels
2. Examine
relationship
between EBP
knowledge
beliefs,
organizational
readiness, and

Sample/Setting

Variables

Measurement/
Data
Instrumentation Analysis

Results/
Findings

BACC = 65.7%
SN = 80.1%

DV2:
EBP beliefs

EBP
Implementation
tool

76.4/120

DV3:
Organizational
readiness and

Setting
Convenience
sample of nurses DV4:
at large hospital EBP
in South Korea
implementation.
IC – Clinical
RNs, CNSs,
NM, NA
EC – part time
RNs, training

Hierarchical
multiple
regression
independent
t-tests
ANOVA
Scheffe Test
Effect size of
0.02;
significance
level of 0.05,
and test
power of
0.80

DV4
15.0/72
EBK, EBPB, OR
significantly
correlated with
EBPI, rated as
major predictors

Level of
Evidence;
Application
to practice/
Generalizat
ion
Limitations
- One
hospital,
convenience
sample; not
generalizabl
e,
Conclusion
– Level of
OREBP
shown to be
greatest
factor in
EBPI.

Key:– ANOVA – Analysis of variance; ARCC -Advancing Research and Clinical Practice through Close Collaboration; BACC – Baccalaureate or
higher; Cα – Cronbach’s α; CAH – Critical Access Hospital; CHC – Community Health Center; CHN – Community Health Nurse; CNS – Clinical
nurse specialist; DV-dependent variable; EBMgt – Evidence Based Management; EBN – Evidence Based Nursing; EBP – Evidence Based Practice;
EBPB – Evidence Based Practice Beliefs; EBPI – Evidence Based Practice Implementation; EBPK – Evidence Based Practice Knowledge; EBPQ
– Evidence-Based Practice Questionnaire; EC – Exclusion Criteria; ESI - Effect size improvement (posttest score minus pretest score); f = female;
GR-ATTR – Group attractiveness; GR-COH – Group Cohesion; HCP – Healthcare Professionals; IC – Inclusion Criteria; ICS – Implementation
Climate Scale ILS – Implementation Leadership Scale; IV- independent variable; JS – Job Satisfaction; JHNEBPM – Johns Hopkins Nursing
Evidence-Based Practice Model; LOE – Level of Evidence; M – Mean; N- number of participants in study, n = number of participants in subset;
NA – Nurse administrator; NM - Nurse Manager; NM-EBPC - Nurse Manager Evidence Based Practice Competency Scale OCR-SIEP –
Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice; OREBP – Organizational Readiness for
Evidence Based Practice; Ottawa – Ottawa Model of Research Use; PARIHS – Promoting Action on Research Implementation in Health Services;
SN – Staff Nurse; VAP – Ventilator associated pneumonia; YE- Years of experience

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48

Theoretical/ Design/
Conceptual Purpose
Framework

EBP
implementation

Sample/Setting

RNs, non-direct
patient care RN

Variables

Measurement/
Data
Instrumentation Analysis

Results/
Findings

Level of
Evidence;
Application
to practice/
Generalizat
ion

3. To Identify
the factors that
affect EBP
implementation

Key:– ANOVA – Analysis of variance; ARCC -Advancing Research and Clinical Practice through Close Collaboration; BACC – Baccalaureate or
higher; Cα – Cronbach’s α; CAH – Critical Access Hospital; CHC – Community Health Center; CHN – Community Health Nurse; CNS – Clinical
nurse specialist; DV-dependent variable; EBMgt – Evidence Based Management; EBN – Evidence Based Nursing; EBP – Evidence Based Practice;
EBPB – Evidence Based Practice Beliefs; EBPI – Evidence Based Practice Implementation; EBPK – Evidence Based Practice Knowledge; EBPQ
– Evidence-Based Practice Questionnaire; EC – Exclusion Criteria; ESI - Effect size improvement (posttest score minus pretest score); f = female;
GR-ATTR – Group attractiveness; GR-COH – Group Cohesion; HCP – Healthcare Professionals; IC – Inclusion Criteria; ICS – Implementation
Climate Scale ILS – Implementation Leadership Scale; IV- independent variable; JS – Job Satisfaction; JHNEBPM – Johns Hopkins Nursing
Evidence-Based Practice Model; LOE – Level of Evidence; M – Mean; N- number of participants in study, n = number of participants in subset;
NA – Nurse administrator; NM - Nurse Manager; NM-EBPC - Nurse Manager Evidence Based Practice Competency Scale OCR-SIEP –
Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice; OREBP – Organizational Readiness for
Evidence Based Practice; Ottawa – Ottawa Model of Research Use; PARIHS – Promoting Action on Research Implementation in Health Services;
SN – Staff Nurse; VAP – Ventilator associated pneumonia; YE- Years of experience

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Appendix B
Synthesis Table

Table A2
Study
(Author, year)
Design
LOE

Freisen,
2017
PretestPosttest
III

Hasanpoo
r,
2019
CrossSectional
III

57
43
67
13
USA

212
41
63
17
Iran

120
42
48
16
USA

45
USA

Multihospital
system
Roger’s
DOI
ARCC
Ottawa
JHNEBP
M

Multihospital
system
--

Multihospital
system
ARCC

Single
hospital
(341 bed)
ARCC

X

X

Sample
n subjects
mean age
% with BACC
YE
Country
Setting
Model

Intervention
Tools Used
EBPB

X

Kim,
2017

Melnyk,
2017

PretestPosttest
Quasiexperimen
tal
III

PretestPosttest
Longitudi
nal
III

Mudderm
an,
2020
PretestPosttest
III

9
33
USA
Rural
CAH
(25)
Iowa
Model

Pereira,
2018

Spiva,
2017

Shuman,
2018

Warren,
2016

Yoo,
2019

CrossSectional
Descriptiv
e
III

2 group
Pretestposttest
Quasiexperimental
III

CrossSectional
III

Crosssectional
Survey
III

CrossSectional
III

100
45
57
20
Switzerlan
d
Communit
y Health
Center
ARCC

433
44
63
18
USA

310
39
56
12
USA

1608
52
17
USA

521
32
66
9
S Korea

Multihospital
system
---

Multiple
Hospitals

Multihospital
system
PARHIS
Dillman’
s

Single
Hospital

X

X

X

PARHIS
framework

ARCC

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(Author, year)
EBPI
OCR-SIEP
EBMgt Q
JS
GR-COH
GR-ATTR
EBPQ
Confidence
Scale
Barriers to
Research
Utilization
Scale
EBP Work
Environment
Scale
EBP Nurse
Leadership
NM- EBPC
ILS
ICS
EBP Knowledge
Questionnaire
Associated with
Research/mento
ring Program
How long was
the program?
Assessment of
Nursing Staff
Assessment of
Managers

50
Freisen,
2017
X

Hasanpoo
r,
2019
X

Kim,
2017

Melnyk,
2017

X

X
X

X
X
X

Mudderm
an,
2020

Pereira,
2018

Spiva,
2017

Shuman,
2018

X

X

Warren,
2016

Yoo,
2019

X
X

X
X

X

X
X
X

X

X

X

X
X

X

X

X
X

X

X
X
X

X

X

X

X

X

X

X

X

X

X

X

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Study
(Author, year)

51
Freisen,
2017

Hasanpoo
r,
2019

Kim,
2017

Melnyk,
2017

Mudderm
an,
2020

Pereira,
2018

Spiva,
2017

Shuman,
2018

Warren,
2016

Yoo,
2019

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Appendix C
Roger’s Diffusion of Innovation Model: Adopter Categories on the Basis of Innovation

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Appendix D

The Advancing Research & Clinical practice through close Collaboration Model

The ARCC© Model
Potential Strengths
� Philosophy of EBP (paradigm
is system-wide)
� Presence of EBP Mentors &
Champions
� Administrator/LeaderSupport

Assessment of
Organizational
Culture &
Readiness for
EBP*

Identification of
Strengths &
Maj or Barriers
to EBP
Implementation

Potential Barriers
*Valid and
Reliable Scale
Developed
+ Based on the
EBP paradigm &
using the EBP
process

� Lack of EBP
Mentors &
Champions
� Inadequate EBP
Knowledge & Skills
� Low Beliefs about
the Value of EBP &
the Ability to
Implement it

 EBP knowledge*
 Beliefs about the
Value of EBP & Ability
to Implement the EBP
Process*

Use of EBP
Mentors;
Perceiv ed
EBP
Mentorship*

Implementation
of ARCC
Strategies,
including
Interactive EBP
Education and
Skills Building
Workshops
EBP Rounds &
Journal Clubs

 EBP
Implementation*+



Job
Satisfaction



Group
Cohesion
Intent to
Leav e
Turnov er




Decreased
Healthcare
System
Costs

Higher Quality
Healthcare and
Improved Patient
Outcomes
© Melnyk & Fineout-Ov erholt 2005;
Rev ised, 2017
ARCC © = Adv ancing Research &
Clinical practice through close
Collaboration