Objectives Evidence-based practice (EBP) is an approach to healthcare that combines the use of the best available evidence, the healthcare professional’s expertise, and patient preferences/values, when making healthcare decisions. Application of EBP in healthcare yields economical delivery of optimal patient outcomes, standardizes practice, enhances practitioner job satisfaction and empowerment and is therefore a particularly relevant concept in the current climate. Despite this, there is little evidence of EBP among healthcare professionals, including nurses and midwives. In the absence of EBP in healthcare, questions may arise in relation to the standard of care provided, the answers to which may not always be satisfactory or indeed defensible. It is therefore paramount that care afforded to patients is always based upon the best available evidence, in order to ensure optimal outcomes for all concerned. Integral to the success of any EBP initiative are the individual practitioners who deliver patient care and the organisations in which they work. Practitioners require relevant knowledge and skills to apply EBP to patient care delivery. This is particularly important for nurses and midwives, one of the largest groups of healthcare practitioners, and who are the key focus of this study. Furthermore, the organisational culture must be open and prepared to embrace and support EBP. In order to make EBP a reality in nursing and midwifery practice, its implementation must be tackled at organisational and individual levels within both the clinical and educational settings responsible for nurse and midwifery education. The current EBP beliefs and utilisation levels among nurses and midwives along with the organizational culture and readiness within these settings must be established in order to determine the current situation and the best way forward in the Irish context. This national study sets out to do this. Data will be collected from under-graduate nursing and midwifery students and lecturers in nine Higher Education Institutes in Ireland, along with staff nurses and midwives and nurse and midwife managers in affiliated clinical services. The findings of this study will inform the development of an implementation strategy at individual, organisational and potentially national levels to foster a sustainable culture of EBP use among nurses and midwives within the Irish healthcare system.

The objectives of this PhD study are;

1. To establish the beliefs, knowledge level and utilisation of evidence–based practice (EBP) of;

   • lecturers who teach on undergraduate, pre–registration nursing and midwifery programmes delivered in Higher Education Institutes (HEIs) in the Republic of Ireland

   • students undertaking undergraduate, pre–registration nursing or midwifery programmes delivered in these HEIs.

   • clinically–based nurses and midwives working in teaching hospitals affiliated with these HEIs?

2. To determine the culture and preparedness of the HEIs and hospitals (within which these nurses and midwives, student nurses and student midwives, nurse and midwifery lecturers work, learn and teach) for EBP?

3. To establish informed starting point from which a specifically tailored EBP education programme, underpinned with specific knowledge of the needs of the nurses and midwives, as well as the challenges and opportunities present in their workplaces, can be developed and implemented where necessary.

Method A national cross-sectional survey of three cohorts of nurses/midwives (hospital-based nurses/midwives, nurse/midwifery lecturers, and student nurses/midwives) was undertaken. This quantitative study used three EBP questionnaires that explored EBP beliefs, implementation levels, and organisational culture and readiness for EBP, respectively. One open-ended question was included on the survey which invited participants to write down in their own words, what they believe EBP to be, the purpose of which was to gain insight into participants’ knowledge and understanding of EBP. Power analysis determined adequate sample sizes fo the three cohorts, and these were achieved. Randomised sampling was used to select nine Higher Education Institutions (Schools of Nursing/Midwifery), and seven teaching hospital sites. Descriptive, correlational and inferential statistics were used to analyse the relationships among EBP attitudes and beliefs, knowledge level and utilization. Content analysis facilitated exploration of the participants’ responses to the open question on the survey.

Results Quantitative results revealed that overall, across the three cohorts of participants, there is a positive attitude towards, and belief in the potential of EBP to produce improved patient outcomes. Beliefs in practitioners’ own ability to implement EBP is not as positive. Utilisation levels of EBP are poor across all three cohorts, with clinical nurses and midwives scoring lowest in this area. Further insights that contribute to some explanation of these findings have been extrapulated from closer scrutiny of the quantitative data, but also from exploration of the qualitative data, which reveal poor knowledge and understanding of what EBP actually is, across all three cohorts. Organisational culture and readiness for EBP in the selected Schools of Nursing/Midwifery, and in the selected hospitals, was found to be moderate, but with a lot more to be done.

Conclusions The positive beliefs in EBP, and moderate organisational culture/readiness for EBP are encouraging findings. Nurses/midwives in academic and clinical settings are positively predisposed to EBP and believe their workplaces as moderately supportive of its implementation. However, the very low EBP implementation levels are concerning, both for nurse/midwifery education and practice going forward, and particularly for patient care and safety. Close scrutiny of the quantitative data reveals a substantial deficit in knowledge and understanding of EBP among nurses and midwives, and this is clearly corroborated by the qualitative data generated by the open question. These findings offer an informed starting point from which a specifically tailored education programme, underpinned with knowledge of the specific needs of nurses/midwives, as well as challenges and opportunities in their workplaces, can be developed and implemented with the aim of developing/improving EBP knowledge and skills to foster a culture of EBP.