Evaluating the effectiveness of educational intervention on evidence based practice knowledge, attitudes and beliefs among vietnamese’ nurses

Evaluating the Effectiveness of Educational Intervention on Evidence-based Practice Knowledge, Attitudes and Beliefs among Vietnamese’ Nurses By Nguyen Van Giang Submitted for the degree of Doctor of Philosophy Dissertation Advisor: Dr Shu Yuan Lin School of Nursing Kaohsiung Medical University January 2021 Evaluating the Effectiveness of Educational Intervention on Evidence-based Practice Knowledge, Attitudes and Beliefs among Vietnamese’ Nurses By Nguyen Van Giang Submitted for the degree of Doctor of Philosophy Dissertation Advisor: Dr Shu Yuan Lin School of Nursing Kaohsiung Medical University January 2021 I ABSTRACT Background: Evidence-based practice (EBP) has become an important element in delivering optimal quality of care Barriers to the EBP implementation by nursing professionals include a lack of knowledge, less positive attitude and beliefs on EBP However, few studies have been conducted to evaluate the effectiveness of educational interventions to improve their knowledge, attitudes and beliefs on EBP Objectives: To evaluate the effectiveness of multiple educational strategies on EBP knowledge, attitude and beliefs among Vietnamese nurses Methods: This study was an experimental study with an experimental group and a comparison group using a pretest-posttest design Participants included head nurses, nurses and midwives who were enrolled from August to September 2020 at the national hospital in Vietnam A total of 148 participants (76 in the comparison group and 72 in the experimental group) received four weeks of educational interventions The experimental group received multiple educational strategies of EBP including face-to-face lectures, mentoring and online learning The comparison group received Incentive spirometry educational intervention on the same date and same period of intervention The effectiveness of educational interventions was evaluated at pretest and posttest using the Vietnamese version of the EBP Knowledge test, EBP Attitude scale and EBP Beliefs scale The statistical software IBM SPSS 20 was used to analyze the data Results: A total of 136 participants (66 in the comparison group and 70 in the experimental group) completed four weeks of educational interventions The attrition rate was 8% The mean age of participants was 36.76 years and more than 77 % of them were females Participants who had never participated in any EBP training course account for 72.2 % There were significant differences between the experimental group and the comparison group in participants’ EBP knowledge, attitude and beliefs at posttest Participants’ EBP knowledge, attitudes and beliefs in the experimental group were significantly improved at posttest compared to pretest II Conclusions: Multiple educational strategies of EBP interventions were effectively improved nurses’ EBP knowledge, attitude and beliefs The findings can be used as an important reference for improving EBP knowledge, attitude and beliefs on nursing students and other healthcare professionals KEYWORDS: evidence-based practice, nurses, education, mentoring, knowledge, attitude III ACKNOWLEDGMENTS I iwould ilike ito iacknowledge iseveral ipeople iwho ihave isupported ime iduring imy i doctoral ijourney iFirst, iI iwould ilike ito iexpress imy ispecial ithank ito imy iadvisor iDr iShu-Yuan i Lin iI iam igrateful ifor iher iexpertise, iwisdom iand ifriendship iwhich ihave iserved ito ikeep ime i focused, igrounded and guided the project from the beginning to the end iWithout iher isupport i and iguidance, iI icould inot ihave icompleted ithis idissertation I also would like to thank the other staff and professors at College of Nursing, Kaohsiung Medical University who provided some forms of support Second, iI iwould ilike ito iextend imy igratitude ito iDr iStevens ifor iallowing ime ito iuse ithe i Evidence-based iPractice iKnowledge itest, iDr iAarons ifor iusing ithe iEvidence-based iPractice i Attitude iand ito iDr iBernadette iMelnyk iand iDr iEllen iFineout-Overholt ifor ipermitting ime ito i use ithe iEvidence-based iPractice iBeliefs in this study Third, iI iwould ilike ito iexpress imy igratitude ito ithe iVice ipresident iof iThai iNguyen i National iHospital, iVietnam, iDr iDuong iHong iThai, iwho isupported iand iapproved imy idata i collection iHis iconnections iwith iall iclinical iunits ihelp ime ito iconduct ithe ieducational interventions iwithout icosting ime itoo imuch iThat isaved ime ia ilot iof imoney iin icompleting ithis i study Last ibut inot ileast, iI iwould ilike ito ithank iteachers, imentors iand iall iparticipants in this study iThanks iyou ifor iyour itime iand ihonest iresponses iinvolved iin ithis istudy i IV TABLE OF CONTENTS ABSTRACT II ACKNOWLEDGMENTS III TABLE OF CONTENTS V LIST OF ABBREVIATIONS VIII LIST OF TABLES IX LIST OF FIGURES X LIST OF APPENDICES XI CHAPTER ONE Introduction Background of the Study Purposes of the Study Research Questions Research Hypotheses Definitions of Variables CHAPTER TWO LITERATURE REVIEW Evidence-based Practice Developing history Definition of evidence-based practice Benefits of evidence-based practice 10 Barriers of evidence-based practice 10 Conceptual models of EBP 11 Nurses’ Knowledge of Evidence-based Practice 13 Nurses’ Attitude toward Evidence-based Practice 14 V C.33.44.55.54.78.65.5.43.22.2.4 22.Tai lieu Luan 66.55.77.99 van Luan an.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.22 Do an.Tai lieu Luan van Luan an Do an.Tai lieu Luan van Luan an Do an Nurses’ Beliefs about Evidence-based Practice 16 Reviews the effectiveness of EBP educational intervention 18 Procedures 18 Data extraction and synthesis 19 Main findings 21 Conclusions 22 CHAPTER THREE 23 Methodology 23 Study Design 24 Setting 24 Sampling 24 Cluster randomized design 25 EBP Educational Intervention 25 Incentive Spirometry Educational Intervention 26 Instruments 30 Demographic and work characteristics sheet 30 The V-ACE-ERI knowledge test 30 The V-EBPA 31 The V-EBPB 31 Procedures 32 Data Analysis 35 Ethical Consideration 36 CHAPTER FOUR 37 Results 37 Demographic and Work Characteristics of Participants 37 VI Stt.010.Mssv.BKD002ac.email.ninhd 77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77t@edu.gmail.com.vn.bkc19134.hmu.edu.vn.Stt.010.Mssv.BKD002ac.email.ninhddtt@edu.gmail.com.vn.bkc19134.hmu.edu.vn C.33.44.55.54.78.65.5.43.22.2.4 22.Tai lieu Luan 66.55.77.99 van Luan an.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.22 Do an.Tai lieu Luan van Luan an Do an.Tai lieu Luan van Luan an Do an Comparisons of EBP Knowledge between Two Groups 39 Comparisons of EBP Knowledge within Two Groups 39 Comparisons of the Correct Percentage of Knowledge Items between Pretest and Posttest 40 Comparisons of EBP Attitudes between Two Groups 42 Comparisons of EBP Attitudes within Two Groups 42 Comparisons of the Percent of Positive Attitude Items between Pretest and Posttest 43 Comparisons of EBP Beliefs between Two Groups 45 Comparisons of EBP Beliefs within Two Groups 45 Comparisons of the Percent of Positive Beliefs Items between Pretest and Posttest 46 CHAPTER FIVE 48 Discussion 48 Demographic and Work Characteristic of Participants 48 Comparisons in Changes of EBP Knowledge between Group and Time 49 The Correct Percentage of Knowledge Items between Pretest and Postest 50 Comparisons in Changes of EBP Attitude between Group and Time 51 The Percent of Positive Beliefs Items between Pretest and Posttest 52 Comparisons in Changes of EBP Beliefs between Group and Time 22 The Percent of Positive Beliefs Items between Pretest and Posttest 54 Effectiveness of Educational Intervention in EBP 54 Strengths of the Study 56 Limitations of the Study 57 Implications of the Study 58 CONCLUSION 60 REFERENCES 61 VII Stt.010.Mssv.BKD002ac.email.ninhd 77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77t@edu.gmail.com.vn.bkc19134.hmu.edu.vn.Stt.010.Mssv.BKD002ac.email.ninhddtt@edu.gmail.com.vn.bkc19134.hmu.edu.vn C.33.44.55.54.78.65.5.43.22.2.4 22.Tai lieu Luan 66.55.77.99 van Luan an.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.22 Do an.Tai lieu Luan van Luan an Do an.Tai lieu Luan van Luan an Do an LIST OF ABBREVIATIONS ACE-ERI Academic Center for Evidence-based Practice Readiness Inventory CFA Confirmatory Factor Analysis EBP Evidence-based Practice EBP-A Evidence-based Practice Attitude EBP-B Evidence-based Practice Beliefs EBPQ Evidence-based Practice Questionnaires EFA Exploratory Factor Analysis PCA Principal Component Analysis PICO Population, Intervention, Comparision and Outcomes V-ACE-ERI Vietnamese version of the ACE-ERI V-EBPA Vietnamese version of Evidence-based Practice Attitude V-EBPB Vietnamese version of Evidence-based Practice Beliefs VIII Stt.010.Mssv.BKD002ac.email.ninhd 77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77t@edu.gmail.com.vn.bkc19134.hmu.edu.vn.Stt.010.Mssv.BKD002ac.email.ninhddtt@edu.gmail.com.vn.bkc19134.hmu.edu.vn C.33.44.55.54.78.65.5.43.22.2.4 22.Tai lieu Luan 66.55.77.99 van Luan an.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.22 Do an.Tai lieu Luan van Luan an Do an.Tai lieu Luan van Luan an Do an LIST OF TABLES Table The EBP educational intervention 28 Table Incentive spirometry educational intervention 29 Table Demographic and work characteristics of Participants 38 Table Comparisons of EBP knowledge scores between two groups 39 Table Comparisons of EBP knowledge scores within two groups 39 Table Comparisons of the correct percentage of knowledge items between pretest and posttest 41 Table Comparisons of EBP attitude scores between two groups 42 Table Comparisons of EBP attitude scores between two groups 42 Table Comparisons of the percent of positive attitude items between pretest and posttest 44 Table 10 Comparisons of EBP beliefs scores between two groups 45 Table 11 Comparisons of EBP beliefs scores between two groups 45 Table 12 Comparisons of the percent of positive beliefs items between pretest and posttest 47 IX Stt.010.Mssv.BKD002ac.email.ninhd 77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77t@edu.gmail.com.vn.bkc19134.hmu.edu.vn.Stt.010.Mssv.BKD002ac.email.ninhddtt@edu.gmail.com.vn.bkc19134.hmu.edu.vn C.33.44.55.54.78.65.5.43.22.2.4 22.Tai lieu Luan 66.55.77.99 van Luan an.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.22 Do an.Tai lieu Luan van Luan an Do an.Tai lieu Luan van Luan an Do an Wang, L.-P., Jiang, X.-L., Wang, L., Wang, G.-R., & Bai, Y.-J (2013) Barriers to and facilitators of research utilization: a survey of registered nurses in China PLoS One, 8(11) DOI: 10.1371/journal.pone.0081908 Weng, Y.-H., Chen, C., Kuo, K N., Yang, C.-Y., Lo, H.-L., Chen, K.-H., & Chiu, Y.-W (2015) Implementation of Evidence-Based Practice in Relation to a Clinical Nursing Ladder System: A National Survey in Taiwan Worldviews on Evidence-Based Nursing, 12(1), 22-30 DOI:10.1111/wvn.12076 White, K M., Dudley-Brown, S., & Terhaar, M F (2016) Translation of evidence into nursing and health care (2nd ed.) New York, NY: Springer Publishing Company Wiechula, R., Nguyen, T., & Rasmussen, P (2014) Preparedness of Vietnamese nurses to conduct evidence-based practice International Journal of Evidence-Based Healthcare, 12(3), 196 DOI: 10.1097/01.XEB.0000455195.94174.7d Wilson, M., Ice, S., Nakashima, C Y., Cox, L A., Morse, E C., Philip, G., & Vuong, E (2015) Striving for evidence-based practice innovations through a hybrid model journal club: A pilot study Nurse Education Today, 35(5), 657-662 doi:https://doi.org/10.1016/j.nedt.2015.01.026 World Health Organization (2016) Human resources for health country profiles-Vietnam Geneva, Swizterland: WHO Retrieved from https://iris.wpro.who.int/handle/10665.1/13476 Worum, H., Lillekroken, D., Ahlsen, B., Roaldsen, K S., & Bergland, A (2019) Bridging the gap between research-based knowledge and clinical practice: a qualitative examination of patients and physiotherapists’ views on the Otago exercise Programme BMC Geriatrics, 19(1), 278 doi:10.1186/s12877-019-1309-6 76 Stt.010.Mssv.BKD002ac.email.ninhd 77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77t@edu.gmail.com.vn.bkc19134.hmu.edu.vn.Stt.010.Mssv.BKD002ac.email.ninhddtt@edu.gmail.com.vn.bkc19134.hmu.edu.vn C.33.44.55.54.78.65.5.43.22.2.4 22.Tai lieu Luan 66.55.77.99 van Luan an.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.22 Do an.Tai lieu Luan van Luan an Do an.Tai lieu Luan van Luan an Do an Yoder, L., Kirkley, D., McFall, C., Kirksey, K., StalBaum, A., & Sellers, D (2014) Staff Nurses' Use of Research to Facilitate Evidence-Based Practice The American Journal of Nursing, 114 DOI:10.1097/01.NAJ.0000453753.00894.29 Yoo, J Y., Kim, J H., Kim, J S., Kim, H L., & Ki, J S (2019) Clinical nurses' beliefs, knowledge, organizational readiness and level of implementation of evidence-based practice: The first step to creating an evidence-based practice culture PLoS One, 14(12), e0226742 doi:10.1371/journal.pone.0226742 Zeleníková, R., Gurková, E., Žiaková, K., Tomagová, M., Jarošová, D., & Fineout‐Overholt, E (2016) Psychometric properties of the Slovak and Czech versions of the evidence‐ based practice beliefs and implementation scales Worldviews on Evidence‐Based Nursing, 13(2), 139-152 DOI: 10.1111/wvn.12128 Zhou, F., Hao, Y., Guo, H., & Liu, H (2016) Attitude, Knowledge, and Practice on Evidence-Based Nursing among Registered Nurses in Traditional Chinese Medicine Hospitals: A Multiple Center Cross-Sectional Survey in China Evidence-based Complementary and Alternative Medicine, 2016; 5478086-5478086 DOI:10.1155/2016/5478086 77 Stt.010.Mssv.BKD002ac.email.ninhd 77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77t@edu.gmail.com.vn.bkc19134.hmu.edu.vn.Stt.010.Mssv.BKD002ac.email.ninhddtt@edu.gmail.com.vn.bkc19134.hmu.edu.vn C.33.44.55.54.78.65.5.43.22.2.4 22.Tai lieu Luan 66.55.77.99 van Luan an.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.22 Do an.Tai lieu Luan van Luan an Do an.Tai lieu Luan van Luan an Do an CHAPTER FIVE Discussion Demographic and Work Characteristic of Participants The demographic characteristics of participants in this study represented the national profile of Vietnam nursing professionals based on gender Gender indicated a higher percentage of female nurses (72.2%) than males (World Health Organization, 2016) The majority of participants were staff nurses who had worked for more than ten years which was higher than another Vietnameses study (69.8 % vs 35.2 %) (Giang et al., 2020) Besides, a higher percentage of participants had bachelor and above degrees than in Nguyen and Wilson’s (2016) study (53.7% vs 19.7%) It was possible because nurses with high education degrees were more likely to be employed in a public hospital at the provincial level such as the study hospital Sixty-four percent of the participants were not familiar with EBP The finding was consistent with previous study results (Aarons, 2004; Giang et al., 2020; Nguyen & Wilson, 2016; Thorsteinsson, 2012) that nurses were not familiar with EBP term Nguyen and Wilson (2016) reported that 70% of Vietnamese nurses were not familiar with the EBP term The American study reported mental healthcare providers rated a low level of familiarity with the term of EBP (Aarons, 2004) Thorsteinsson (2012) found that Icelandic nurses who were not familiar with EBP term rated lower scores on the EBP belief scales Less than one-fourth of the participants had received EBP training which was lower than in Giang and colleagues’ (2020) study (22.8% vs 26.6%) No significant differences were found in any demographic and work characteristics variables between the experimental group and the comparison group We hypothesized the strategy of group assignment was acceptable 48 Stt.010.Mssv.BKD002ac.email.ninhd 77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77t@edu.gmail.com.vn.bkc19134.hmu.edu.vn.Stt.010.Mssv.BKD002ac.email.ninhddtt@edu.gmail.com.vn.bkc19134.hmu.edu.vn C.33.44.55.54.78.65.5.43.22.2.4 22.Tai lieu Luan 66.55.77.99 van Luan an.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.22 Do an.Tai lieu Luan van Luan an Do an.Tai lieu Luan van Luan an Do an Comparisons in Changes of EBP Knowledge between Group and Time The hypothesis, “there were significant differences between the experimental group and comparison group in participants’ EBP knowledge at posttest”, was supported Nurses who received the EBP educational intervention in the experimental group had significantly higher EBP knowledge than those who received IS intervention in the comparison group This finding was consistent with previous findings (Ramos et al., 2015; Sim et al., 2016) that EBP knowledge in the experimental group was significantly higher than that in the comparison group at posttest Ramos and colleagues (2015) found American nurses who received multiple strategies of EBP educational intervention had significantly higher EBP knowledge than those who received no EBP education Similarly, Sim and colleagues (2016) reported Korean nurses who received a single strategy of EBP educational intervention had significantly higher EBP knowledge than those who did not receive EBP education Hence, nurses who received a single strategy or multiple strategies of EBP educational intervention had significantly higher EBP knowledge than those who did not receive EBP education This study used multiple educational strategies such as face-to-face lectures, mentoring and online learning of EBP were supported the effect of improving higher EBP knowledge compared to IS educational intervention The hypothesis, “ there were significant differences between pretest and posttest in participants’ EBP knowledge in the experimental group”, was supported Nurses’ EBP knowledge in the experimental group was significantly improved at posttest compared to pretest This finding was consistent with the previous studies (Saunders et al., 2016; Spiva et al., 2016) that nurses improved their EBP knowledge after receiving EBP educational intervention The Finland study reported that nurses’EBP knowledge was significantly improved after receiving multiple strategies of EBP educational interventions (Saunders et al., 2016) Similarly, Spiva and colleagues (2016) reported that American nurses had significantly improved their EBP knowledge after receiving multiple strategies of EBP educational intervention This study 49 Stt.010.Mssv.BKD002ac.email.ninhd 77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77t@edu.gmail.com.vn.bkc19134.hmu.edu.vn.Stt.010.Mssv.BKD002ac.email.ninhddtt@edu.gmail.com.vn.bkc19134.hmu.edu.vn C.33.44.55.54.78.65.5.43.22.2.4 22.Tai lieu Luan 66.55.77.99 van Luan an.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.22 Do an.Tai lieu Luan van Luan an Do an.Tai lieu Luan van Luan an Do an indicates that the teaching strategy and course design applied are effective for the knowledge acquisition of EBP The environment of multiple strategies of EBP educational intervention implemented a nurse-centered design Educators who had experiences of EBP focused on guidance through interactive teaching methods which might increase learning effectiveness Nurses could utilize their time during EBP educational intervention to exchange views and solved questions via discussions with mentors and other nurses while applying new practical knowledge through activities assigned by educators, thereby improving their EBP knowledge The Correct Percentage of Knowledge Items between Pretest and Postest In the experimental group, the correct percentage of knowledge increased in all knowledge items at posttest compared to pretest Three reasons could explain our results First, there was sufficient time for nurses to increase their knowledge during four weeks of EBP educational intervention Second, the contents of the EBP educational intervention were covered questions of the ACE-ERI knowledge scale Third, nurses received multiple strategies of EBP educational interventions including face-to-face lecture, mentors’ support and online learning that may contribute to increase in their EBP knowledge In the comparison group, five items increased in the correct percentage of knowledge at posttest compared to pretest The contents of these items focused on patient preferences, knowledge from research, quality of care and the ACE star model A possible reason could explain these results There were contaminated interactions between nurses in the experimental group and those in the comparison group Nurses in both groups might contact each other and share some information about EBP educational intervention Ten items decreased in the correct percentage of knowledge after receiving IS intervention A possible explanation for this finding was that the ACE-ERI knowledge test covered a lot of EBP information They also received IS education that might have distracted 50 Stt.010.Mssv.BKD002ac.email.ninhd 77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77t@edu.gmail.com.vn.bkc19134.hmu.edu.vn.Stt.010.Mssv.BKD002ac.email.ninhddtt@edu.gmail.com.vn.bkc19134.hmu.edu.vn C.33.44.55.54.78.65.5.43.22.2.4 22.Tai lieu Luan 66.55.77.99 van Luan an.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.22 Do an.Tai lieu Luan van Luan an Do an.Tai lieu Luan van Luan an Do an their memory of EBP concepts Therefore, nurses might interpret these knowledge items in different ways Comparisons in Changes of EBP Attitude between Group and Time The hypothesis “there were significant differences between the experimental group and comparison group in participants’ EBP attitude at posttest” was supported Nurses who received EBP educational intervention had a significantly more positive EBP attitude than those who received IS education Our findings were consistent with Sim and colleagues' (2016) study, which reported that nurses who received face-to-face EBP courses had a significantly more positive EBP attitude than those who received no EBP intervention Our study indicated that multiple strategies of EBP educational intervention positively changed EBP attitudes than through IS educational intervention The hypothesis, “ there were significant differences between pretest and posttest in participants’ EBP attitudes in the experimental group”, was supported Nurses in the experimental group had significant increases in positive EBP attitude after receiving EBP educational intervention Our results were consistent with previous studies (Hart et al., 2008; Sciarra, 2011; Sim et al., 2016) that nurses improved significantly in positive EBP attitudes after receiving EBP courses Hart and colleagues (2008) found American nurses had significant increases in positive EBP attitudes after receiving 60 minutes of EBP online learning courses Similary, Sciarra (2011) found American nurses had significant increases in positive EBP attitudes after receiving 10 hours of face-to-face EBP courses Sim and colleagues (2016) reported that Korean nurses increased significantly in positive EBP attitude after receiving 24 hours of face-to-face EBP courses A possible reason may explain these results There was a positive relationship between EBP knowledge improvement and positive attitudes toward EBP (Park & Jang, 2016; Thiel & Ghosh, 2008) It is suggested that sufficient EBP knowledge could reduce the negative attitude toward EBP implementation (Sherriff, Wallis, & Chaboyer, 2007) 51 Stt.010.Mssv.BKD002ac.email.ninhd 77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77t@edu.gmail.com.vn.bkc19134.hmu.edu.vn.Stt.010.Mssv.BKD002ac.email.ninhddtt@edu.gmail.com.vn.bkc19134.hmu.edu.vn C.33.44.55.54.78.65.5.43.22.2.4 22.Tai lieu Luan 66.55.77.99 van Luan an.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.22 Do an.Tai lieu Luan van Luan an Do an.Tai lieu Luan van Luan an Do an Our finding reflects that the EBP interventions used in this study were effective in improving EBP knowledge and change in positive EBP attitudes The Percent of Positive Attitude Items between Pretest and Posttest In the experimental group, the percent of positive attitude in all EBP attitude items increased at posttest compared to pretest Two possible reasons may explain these findings First, there was sufficient time for nurses to change their EBP attitude during four weeks of EBP educational intervention Second, nurses received an effective EBP educational intervention in this study which made nurses understand EBP values as a new therapy that could be implemented to improve quality of care In the comparison group, seven items increased in the percent of positive EBP attitude at posttest compared to pretest A possible explanation was due to nurses might consider IS device as a new therapy that could apply to improve patients' outcomes and improve their attitudes toward new therapy So, it made nurses positively changed their attitudes toward EBP Seven items decreased the percent of positive EBP attitude at posttest compared to pretest The contents of these items focused on evidence-based treatment, the value of research, manualized therapy and enough training to use EBP A possible reason for this finding was due to nurses might not understand the value and the benefits of EBP if they had never received EBP training Therefore, they had a less positive attitude toward EBP Our findings are supported by previous studies (Park & Jang, 2016; Thiel & Ghosh, 2008) that insufficient EBP knowledge could lead to less positive attitudes toward EBP implementation (Park & Jang, 2016; Thiel & Ghosh, 2008) Comparisons in Changes of EBP Beliefs between Group and Time The hypothesis, “there were significant differences between the experimental group and the comparison group in participants’ EBP beliefs at the posttest” , was supported Nurses in the experimental group who received EBP educational intervention had significantly more positive 52 Stt.010.Mssv.BKD002ac.email.ninhd 77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77t@edu.gmail.com.vn.bkc19134.hmu.edu.vn.Stt.010.Mssv.BKD002ac.email.ninhddtt@edu.gmail.com.vn.bkc19134.hmu.edu.vn C.33.44.55.54.78.65.5.43.22.2.4 22.Tai lieu Luan 66.55.77.99 van Luan an.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.22 Do an.Tai lieu Luan van Luan an Do an.Tai lieu Luan van Luan an Do an EBP beliefs than those in the comparison group who received IS education Our results were similar to previous studies (Levin et al., 2011; Sim et al., 2016) that EBP beliefs in the experimental group were significantly more positive than the comparison group at posttest Levin and colleagues (2011) reported that American nurses who received EBP workshops and mentors’ support significantly had more positive EBP beliefs than those who did not receive EBP intervention Similarly, a Korean study found nurses who received face to face EBP courses significantly had more positive EBP beliefs than those who did not receive EBP intervention The hypothesis, “ there were significant differences in participants’ EBP beliefs between pretest and posttest in the experimental group”, was supported Nurses in the experimental group had significant increases in positive EBP beliefs after receiving EBP educational intervention These results were similar to the previous studies (Green et al., 2017; Kim et al., 2017; Melnyk et al., 2017) that positive EBP beliefs were significantly increased after receiving EBP courses Green and colleagues (2017) found American nurses had significant increases in positive EBP beliefs after receiving three months of multiple strategies of EBP intervention including face-to-face, mentors and online learning A Korean study reported that nurses had significant increases in positive EBP beliefs after receiving six days of multiple strategies of EBP intervention including face-to-face lectures and flipped classrooms (Kim et al., 2017) Similarly, Melnyk and colleagues (2017) found American nurses had significant increases in positive EBP beliefs after receiving 12 months of multiple strategies of EBP intervention such as workshops and mentoring Nurses’ EBP beliefs could improve positively through multiple strategies of EBP intervention (Ilic, Hart, Fiddes, Misso, & Villanueva, 2013) Therefore, multiple strategies of EBP educational interventions such as face-to-face lectures, mentoring and online learning used in this study were able to change EBP beliefs among nurses 53 Stt.010.Mssv.BKD002ac.email.ninhd 77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77t@edu.gmail.com.vn.bkc19134.hmu.edu.vn.Stt.010.Mssv.BKD002ac.email.ninhddtt@edu.gmail.com.vn.bkc19134.hmu.edu.vn C.33.44.55.54.78.65.5.43.22.2.4 22.Tai lieu Luan 66.55.77.99 van Luan an.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.22 Do an.Tai lieu Luan van Luan an Do an.Tai lieu Luan van Luan an Do an The Percent of Positive Beliefs Items between Pretest and Posttest In the experimental group, most belief items increased in the percent of positive EBP beliefs at posttest compared to pretest The contents of the top five belief items increased in the percent of positive beliefs at posttest were related to positive beliefs in EBP steps, critical appraisal skills, ability to implement EBP and ability to overcome EBP barriers A possible reason could explain our findings Nurses received effective EBP interventional intervention which may have resulted to the increase of their positive beliefs In the comparison group, ten items increased the percents of positive EBP beliefs at posttest compared to pretest The contents of these items were related to belief in the value of EBP A possible explanation was that nurses might have considered the IS device as a clinical practice guideline and as a method to improve patient care So, perhaps this makes nurses think that IS has a similar effect as that of EBP This maybe makes nurses improve their trust beliefs about EBP Five items in the comparison group decreased in the percent of positive EBP beliefs at posttest compared to pretest The contents of these items were related to nurses’ abilities to EBP implementation, searching skills and critical appraisal skills A possible explanation for this result was that nurses were trained in IS intervention instead of EBP intervention They may not fully understand the search skills and appraisal skills of EBP Therefore, they had less positive beliefs about EBP Effectiveness of Educational Intervention in Evidence-based Practice This study demonstrated that multiple strategies of EBP educational interventions effectively improved knowledge attitude and beliefs on EBP among nurses We educated nurses with multiple strategies of EBP educational interventions including face-to-face lectures, mentor support, group discussions and online learning These multiple strategies approach may enable nurses to interact with educators and mentors and engage in problem- 54 Stt.010.Mssv.BKD002ac.email.ninhd 77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77t@edu.gmail.com.vn.bkc19134.hmu.edu.vn.Stt.010.Mssv.BKD002ac.email.ninhddtt@edu.gmail.com.vn.bkc19134.hmu.edu.vn C.33.44.55.54.78.65.5.43.22.2.4 22.Tai lieu Luan 66.55.77.99 van Luan an.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.22 Do an.Tai lieu Luan van Luan an Do an.Tai lieu Luan van Luan an Do an solving activities A systematic review found that multiple strategies of EBP education including face-to-face lectures, group discussion, mentoring, hand-on practice and group presentation were the most frequent methods used to improve clinical nurses’ knowledge, attitude and beliefs of EBP (Haggman-Laitila et al., 2016) In terms of mentoring, among the different strategies in conducting EBP educational intervention, mentoring was a method that demonstrated a better result in improving nurses’ knowledge and capabilities in implementing EBP (Spiva et al., 2017; Wallen et al., 2010) Nurses perceive mentoring as a better model, so involving mentorship in the learning of evidence-based practice may promote nurses' knowledge, attitude, beliefs in the implementation of EBP (Friesen, Brady, Milligan, & Christensen, 2017) A previous study has indicated that EBP mentors were key in strengthening nurses’ beliefs about EBP and their ability to implement it (Melnyk & Fineout-Overholt, 2002) Furthermore, the use of technology to promote EBP education intervention through mobile devices, simulation, and the web is on the rise Web-based educational platforms have been demonstrated as an effective method to deliver EBP educational content to nurses (Leasure, Davis, & Thievon, 2000; Long et al., 2016) As technology advances in the education system, EBP education is no longer limited to face to face courses or textbooks The updated information and resources may be accessed easily through online learning platforms without the limitation of space and time (Fulton, Meek, & Walker, 2014; Long et al., 2016) Online learning using smartphone/laptop computers can break the time barriers and enable nurses to access more information at any time and place Moreover, online learning would increase communication and information exchanges among learners or between learners and teachers (Kyriakoulis et al., 2016; Rosas et al., 2014) 55 Stt.010.Mssv.BKD002ac.email.ninhd 77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77t@edu.gmail.com.vn.bkc19134.hmu.edu.vn.Stt.010.Mssv.BKD002ac.email.ninhddtt@edu.gmail.com.vn.bkc19134.hmu.edu.vn C.33.44.55.54.78.65.5.43.22.2.4 22.Tai lieu Luan 66.55.77.99 van Luan an.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.22 Do an.Tai lieu Luan van Luan an Do an.Tai lieu Luan van Luan an Do an Strengths of the Study Strengths of this study were listed as follows: The design and contents of the EBP educational intervention in this study were developed based on expert recommendations and systematic reviews Multiple strategies of EBP educational intervention such as face-to-face lectures, mentoring and online learning were acceptable and feasible methods used to improve EBP knowledge, attitude and beliefs Therefore, EBP educational intervention may be appropriate for Vietnamese nurses This experimental study is a pioneer work on testing the effectiveness of EBP educational intervention in Vietnam 56 Stt.010.Mssv.BKD002ac.email.ninhd 77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77t@edu.gmail.com.vn.bkc19134.hmu.edu.vn.Stt.010.Mssv.BKD002ac.email.ninhddtt@edu.gmail.com.vn.bkc19134.hmu.edu.vn C.33.44.55.54.78.65.5.43.22.2.4 22.Tai lieu Luan 66.55.77.99 van Luan an.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.22 Do an.Tai lieu Luan van Luan an Do an.Tai lieu Luan van Luan an Do an Limitations of the Study Limitations were listed as follows: The participants were recruited in only one hospital It makes the findings unable to generalize the Vietnam nurses’ population Nurses in the comparison group received IS educational intervention The contents of IS education may enable nurses to be aware of the EBP value Therefore, the effect of IS education may impact the EBP knowledge, attitude and beliefs among nurses At four weeks, the follow-up period for this study may have been too short to detect long-term outcomes A longer follow-up period after receiving EBP educational intervention which may help establish the impact of time on the effectiveness of EBP educational intervention 57 Stt.010.Mssv.BKD002ac.email.ninhd 77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77t@edu.gmail.com.vn.bkc19134.hmu.edu.vn.Stt.010.Mssv.BKD002ac.email.ninhddtt@edu.gmail.com.vn.bkc19134.hmu.edu.vn C.33.44.55.54.78.65.5.43.22.2.4 22.Tai lieu Luan 66.55.77.99 van Luan an.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.22 Do an.Tai lieu Luan van Luan an Do an.Tai lieu Luan van Luan an Do an The Implications of the Study This study has implications for nursing education, practice and future research Education Leaders and administrators in hospitals should implement multiple strategies of EBP educational intervention to improve their nurses’ EBP knowledge, attitude and beliefs To implement EBP within the organizations, leaders and administrators in hospitals need to provide adequate time and resources for nurses It is necessary to consider that this EBP educational intervention can be used as reference for improving nursing students in the university They need to be equipped with adequate EBP knowledge and a positive attitude and beliefs on EBP before doing internships in the hospitals and become nurse professionals Relevant authorities in the nursing school should therefore address this issue by designing a series of training programs that are suitable for the nursing education system and facilitating the implementation of EBP in the nursing school environment Practice Leaders and administrators in hospitals need to increase nurses’ EBP activities such as EBP journal club, EBP group discussion and EBP poster presentation at their units They must initiate to guide and support these activities for nurses Establishing champions or mentors within the organizations would be beneficial to increase nurses’ evidence-based and better healthcare practice Research Future studies may apply longitudinal studies to evaluate the long-term effect of EBP educational intervention The contents of EBP educational intervention need to cover five EBP steps (Ask, Acquire, Appraise, Apply and Assess) It is recommended that the sample should be recruited from more hospitals or multiple health centers and a random sample 58 Stt.010.Mssv.BKD002ac.email.ninhd 77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77t@edu.gmail.com.vn.bkc19134.hmu.edu.vn.Stt.010.Mssv.BKD002ac.email.ninhddtt@edu.gmail.com.vn.bkc19134.hmu.edu.vn C.33.44.55.54.78.65.5.43.22.2.4 22.Tai lieu Luan 66.55.77.99 van Luan an.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.22 Do an.Tai lieu Luan van Luan an Do an.Tai lieu Luan van Luan an Do an should be used in future studies Future studies need to conduct a randomized controlled trial with the contents implementing in the control group, which will not affect or change EBP outcomes 59 Stt.010.Mssv.BKD002ac.email.ninhd 77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77t@edu.gmail.com.vn.bkc19134.hmu.edu.vn.Stt.010.Mssv.BKD002ac.email.ninhddtt@edu.gmail.com.vn.bkc19134.hmu.edu.vn C.33.44.55.54.78.65.5.43.22.2.4 22.Tai lieu Luan 66.55.77.99 van Luan an.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.22 Do an.Tai lieu Luan van Luan an Do an.Tai lieu Luan van Luan an Do an Stt.010.Mssv.BKD002ac.email.ninhd 77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77t@edu.gmail.com.vn.bkc19134.hmu.edu.vn.Stt.010.Mssv.BKD002ac.email.ninhddtt@edu.gmail.com.vn.bkc19134.hmu.edu.vn