اعتقادات، اعتماد به نفس، استفاده و درک فرهنگ سازمانی حرفه ای بهداشت حرفه ای و آمادگی برای EBP Health professions faculty beliefs, confidence, use, and perceptions of organizational culture and readiness for EBP: A cross-sectional, descriptive survey

1. Background Evidence based practice (EBP) is a problem-solving approach to how healthcare is delivered that integrates best available evidence with a clinicians’ expertise and patient values and preferences (Melnyk and Fineout-Overholt, 2015). EBP is the gold standard for clinical practice for health professions disciplines and has been endorsed as a core competency by the Institute of Medicine (IOM) since 2003 (Institute of Medicine, 2003). The EBP process has been associated with improved healthcare quality, reliability, patient care outcomes, and reductions in variation of care and costs (Melnyk et al., 2014). Faculty as role models for EBP across didactic and clinical courses is essential for supporting the paradigm shift from tradition based care to evidence based care (Melnyk et al., 2008). Creating a culture that uses evidence to inform clinical practice starts with faculty who use the EBP process in their teaching and academic practice (Kalb et al., 2015). Adoption of the EBP process in nursing education has been slow because of several factors (Al Hadid et al., 2011; Patterson and Klein, 2012). The majority of nurse educators are aged 46 to 60 years (63%) with 30% aged 60 and older; in contrast to the 6.7% of educators who are < 46 (Kauffman, 2010). EBP competencies were not introduced to nursing education until after 2003 (Stevens, 2013) so many of today’s nurse educators did not have EBP content in their nursing or postprofessional degree education and may lack knowledge or understanding of the EBP process (Mick, 2017). Other barriers include lack of knowledge and confidence in teaching EBP, weak information and literacy skills, no framework for curricula (Stichler et al., 2011), no time for EBP, minimal resources and support (e.g. having accessible, relevant evidence) (Stichler et al., 2011; Upton et al., 2015), and lack of cohesion between academic and clinical teaching contexts (Upton et al., 2015). These barriers are not unique to nursing and exist in other health professions disciplines (Harding et al., 2014; Manspeaker and Van Lunen, 2011). EBP is an expectation in clinical practice so health professions educators must recognize the ethical obligation to be proficient in EBP for teaching (Orta et al., 2016). An emerging body of evidence suggests that faculty proficiency in EBP is mixed. Nursing faculty in one university were found to have EBP knowledge and competence similar to that of undergraduate nursing students (Orta et al., 2016). A survey of faculty in the United States and United Kingdom revealed positive attitudes toward EBP but faculty lacked confidence in knowledge and skills (Upton et al., 2015). A survey of nurse practitioner faculty demonstrated fairly high self-reported knowledge of EBP however there were gaps in knowledge (Bernadette Mazurek Melnyk et al., 2008).