589400 research-article2015
PRF0010.1177/0267659115589400PerfusionLong and Matthews
Original paper
Evidence-based practice knowledge and perfusionists’ clinical behavior
Perfusion 1–6 © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0267659115589400 prf.sagepub.com
Dennis M Long1 and Eric Matthews2
Abstract Introduction: Evidence-based practice (EBP) has been widely studied and adopted in allied health professions education. Current practitioners may have challenges in adopting EBP into current practice. EBP skills have not been previously assessed in perfusionists, therefore, the purpose of this study is to identify a preliminary analysis of perfusionists’ EBP knowledge and its possible relationship to clinical behavior and educational level Methods: A non-randomized convenience study using the Evidence-Based Practice Questionnaire (EBPQ) was used to measure EBP of practicing U.S. perfusionists. The EBPQ is a validated survey instrument designed to measure EBP practice, attitude and knowledge subscales. The EBPQ consisted of 24 items on a 1 to 7 Likert Scale, with higher numbers indicating frequent use of skill. Practitioner experience, educational background and employment type were also collected. Results: Two hundred and fifty-four responses met the inclusion criteria and were analyzed. The mean EBPQ score was 5.0 (SD = 0.9) with similar means for the subscales. There were important differences found in the EBPQ scores, depending on the educational level and work status. There was a positive correlation between the knowledge and practice subscales, demonstrating a relationship in the sample and a possible relationship in the population as a whole. Conclusion: The results suggest that perfusionists’ use of EBP in practice does vary, based upon educational level and employment type. The findings also demonstrated areas of lower EBP aptitude. The correlation between EBP knowledge and practice may guide educational efforts at improving EBP practice. Keywords evidence-based practice; cardiopulmonary bypass; perfusionist; cardiac surgery; evidence-based practice questionnaire; allied healthcare
Introduction Evidence-based practice (EBP) is changing the way clinicians practice medicine. EBP has been defined as taking the best available evidence from the literature and combining it with clinical knowledge to care for an individual patient;1 it is considered a core competency for those who are completing an education in the health professions.2 There has been some success with teaching classes to allied health students to improve knowledge in this subject.3 The result will allow new clinicians to be equipped with EBP knowledge when they enter practice. The increasing role of EBP in medicine has been slow to grow in the perfusion community. Recently, the American Society of Extracorporeal Technology (Am SECT), in conjunction with the International Consortium of Evidence-Based Perfusion (ICEBP), published the Standards and Guidelines of Perfusion Practice.4 This was an effort to improve the evidence base in perfusion and affect patient outcomes. Baker
et al. (2013) concede that publication of the Standards and Guidelines of Perfusion Practice alone cannot be responsible for changing the care of patients who undergo cardiopulmonary bypass. That responsibility rests with individual perfusionists and surgical teams. Perfusionists are noted to be cautious at translating research knowledge into the clinical environment where it will affect patients most.4 1Perfusion
Services, NorthShore University Health System, USA of Graduate Health Studies, A.T. Still University, Mesa, Arizona, USA
2College
Corresponding author: Dennis M Long, MS, CCP, Perfusion Services, NorthShore University Health System, 2650 Ridge Avenue, Evanston, Illinois 60201, USA. Email: [email protected] Presented at the 36th Annual Seminar of the American Academy of Cardiovascular Perfusion, San Antonio, Texas, 5-8 February 2015
Downloaded from prf.sagepub.com at COLORADO STATE UNIV LIBRARIES on July 1, 2015
2
Perfusion
Studies examining perfusionists’ knowledge of EBP or barriers to practice EBP in the field of perfusion have not been performed to date; however, there is a broad body of knowledge in other healthcare professions relative to EBP. Given the rise in EBP within healthcare, perfusionists should be situated to embrace the trend; however, that may not occur unless the knowledge of EBP in perfusion and barriers to its utilization are known. The purpose of this study was to establish a baseline assessment of knowledge and attitudes for EBP and perfusionists in the United States. The study also examined evidence-based activities that perfusionists already perform which allow them to validate or change their practice. It is hypothesized that respondents who hold an advanced degree or have attained advanced education will possess higher knowledge of, and a more positive attitude toward, EBP.
Methods Study design The study design was a descriptive, non-randomized, convenience sample. Responses were gathered using an on-line format. The EBPQ and demographic questions were transcribed from paper and uploaded to the online survey host. A web link for the survey was generated and all responses were collected through this. All potential participants were given brief information about the study. They were asked to electronically consent to participate in the study before responding to the questions. The Institutional Review Board of A.T. Still University reviewed the study and determined it to be exempt.
are scored on a 1 to 7 Likert scale with the highest score indicating frequent use of the skill. The additional demographic questions collected information to further understand perfusionist EBP practice patterns. The EBPQ was used with permission from the authors without restriction.
Sample methodology The study was designed to include only anonymous responses from actively employed CCPs who lived in the U.S. Incomplete responses were removed from the analysis. Responses were excluded from students or if they could be traced to an individual. Responses from outside the U.S. and from non-CCPs were disqualified from the study. Duplicate surveys were also excluded from the analysis. All study participants whose survey responses met the inclusion criteria became part of the study. The responses from individual participant surveys were transcribed from the online survey site and entered into a Microsoft Excel spreadsheet on a password-secured computer. Statistical analysis was completed using IBM Statistical Package for the Social Sciences (SPSS) Version 22 (IBM Corp., Armonk, NY, USA). Respondents’ categorical data were expressed as number and percent. The mean and standard deviations were generated for all EBPQ questions and subscales. The frequency distributions of low response questions were generated. Data was analyzed using Spearman’s correlation, the Mann-Whitney U test and the KruskalWallace analysis of variance. A p-value 30
170 84 14 50 46 90 54 224 30 30 25 140 74 3 12 152 76 11 15 27 24 29 36 42 28 68
% 66.9 33.1 5.5 19.7 18.1 35.4 21.3 88.2 11.8 100 9.8 55.1 29.1 1.2 4.7 59.8 29.9 4.3 5.9 10.6 9.4 11.4 14.2 16.5 11.0 26.8
Note: N = 254.
made up the majority of respondents (54.3%); those with less than 10 years’ experience were the minority of respondents (20.0%). A majority (59.8%) of the responses were received from hospital employees; few respondents were employed by surgeons (4.3%).
Assessment of evidence-based practice in perfusion The EBPQ was analyzed against the demographic characteristics to discover differences in EBP. The mean and standard deviation for all questions and subscales are presented in Table 2. The mean EBPQ score was 5.0 (SD = 0.9) with similar means for the practice subscale (M = 5.0, SD = 1.3), the attitudes subscale (M = 5.4, SD = 1.2) and the knowledge/practice subscale (M = 5.1 SD = 0.9). The frequency of questions scored on the EBPQ from 1–4 Likert scale were calculated and compared against
higher scores (Figure1). The lowest response questions were: converting information needs into questions (50.4%), information technology (IT) skills (45.7%), critically appraising literature (45.7%) and research skills (44.5). Cronbach’s alpha was calculated for the EBPQ and demonstrated excellent internal consistency (α = 0.927).
Factors affecting evidence-based practice behavior The relationship of EBP knowledge and the skillset of perfusionists was examined using EBPQ subscales. A Spearman’s rho correlation was performed on the EBPQ knowledge/skills and practice subscales. There was a strong positive correlation of increased EBP knowledge/ skills scores as related to practice scores (rs (252) = 0.574, p
PRF0010.1177/0267659115589400PerfusionLong and Matthews
Original paper
Evidence-based practice knowledge and perfusionists’ clinical behavior
Perfusion 1–6 © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0267659115589400 prf.sagepub.com
Dennis M Long1 and Eric Matthews2
Abstract Introduction: Evidence-based practice (EBP) has been widely studied and adopted in allied health professions education. Current practitioners may have challenges in adopting EBP into current practice. EBP skills have not been previously assessed in perfusionists, therefore, the purpose of this study is to identify a preliminary analysis of perfusionists’ EBP knowledge and its possible relationship to clinical behavior and educational level Methods: A non-randomized convenience study using the Evidence-Based Practice Questionnaire (EBPQ) was used to measure EBP of practicing U.S. perfusionists. The EBPQ is a validated survey instrument designed to measure EBP practice, attitude and knowledge subscales. The EBPQ consisted of 24 items on a 1 to 7 Likert Scale, with higher numbers indicating frequent use of skill. Practitioner experience, educational background and employment type were also collected. Results: Two hundred and fifty-four responses met the inclusion criteria and were analyzed. The mean EBPQ score was 5.0 (SD = 0.9) with similar means for the subscales. There were important differences found in the EBPQ scores, depending on the educational level and work status. There was a positive correlation between the knowledge and practice subscales, demonstrating a relationship in the sample and a possible relationship in the population as a whole. Conclusion: The results suggest that perfusionists’ use of EBP in practice does vary, based upon educational level and employment type. The findings also demonstrated areas of lower EBP aptitude. The correlation between EBP knowledge and practice may guide educational efforts at improving EBP practice. Keywords evidence-based practice; cardiopulmonary bypass; perfusionist; cardiac surgery; evidence-based practice questionnaire; allied healthcare
Introduction Evidence-based practice (EBP) is changing the way clinicians practice medicine. EBP has been defined as taking the best available evidence from the literature and combining it with clinical knowledge to care for an individual patient;1 it is considered a core competency for those who are completing an education in the health professions.2 There has been some success with teaching classes to allied health students to improve knowledge in this subject.3 The result will allow new clinicians to be equipped with EBP knowledge when they enter practice. The increasing role of EBP in medicine has been slow to grow in the perfusion community. Recently, the American Society of Extracorporeal Technology (Am SECT), in conjunction with the International Consortium of Evidence-Based Perfusion (ICEBP), published the Standards and Guidelines of Perfusion Practice.4 This was an effort to improve the evidence base in perfusion and affect patient outcomes. Baker
et al. (2013) concede that publication of the Standards and Guidelines of Perfusion Practice alone cannot be responsible for changing the care of patients who undergo cardiopulmonary bypass. That responsibility rests with individual perfusionists and surgical teams. Perfusionists are noted to be cautious at translating research knowledge into the clinical environment where it will affect patients most.4 1Perfusion
Services, NorthShore University Health System, USA of Graduate Health Studies, A.T. Still University, Mesa, Arizona, USA
2College
Corresponding author: Dennis M Long, MS, CCP, Perfusion Services, NorthShore University Health System, 2650 Ridge Avenue, Evanston, Illinois 60201, USA. Email: [email protected] Presented at the 36th Annual Seminar of the American Academy of Cardiovascular Perfusion, San Antonio, Texas, 5-8 February 2015
Downloaded from prf.sagepub.com at COLORADO STATE UNIV LIBRARIES on July 1, 2015
2
Perfusion
Studies examining perfusionists’ knowledge of EBP or barriers to practice EBP in the field of perfusion have not been performed to date; however, there is a broad body of knowledge in other healthcare professions relative to EBP. Given the rise in EBP within healthcare, perfusionists should be situated to embrace the trend; however, that may not occur unless the knowledge of EBP in perfusion and barriers to its utilization are known. The purpose of this study was to establish a baseline assessment of knowledge and attitudes for EBP and perfusionists in the United States. The study also examined evidence-based activities that perfusionists already perform which allow them to validate or change their practice. It is hypothesized that respondents who hold an advanced degree or have attained advanced education will possess higher knowledge of, and a more positive attitude toward, EBP.
Methods Study design The study design was a descriptive, non-randomized, convenience sample. Responses were gathered using an on-line format. The EBPQ and demographic questions were transcribed from paper and uploaded to the online survey host. A web link for the survey was generated and all responses were collected through this. All potential participants were given brief information about the study. They were asked to electronically consent to participate in the study before responding to the questions. The Institutional Review Board of A.T. Still University reviewed the study and determined it to be exempt.
are scored on a 1 to 7 Likert scale with the highest score indicating frequent use of the skill. The additional demographic questions collected information to further understand perfusionist EBP practice patterns. The EBPQ was used with permission from the authors without restriction.
Sample methodology The study was designed to include only anonymous responses from actively employed CCPs who lived in the U.S. Incomplete responses were removed from the analysis. Responses were excluded from students or if they could be traced to an individual. Responses from outside the U.S. and from non-CCPs were disqualified from the study. Duplicate surveys were also excluded from the analysis. All study participants whose survey responses met the inclusion criteria became part of the study. The responses from individual participant surveys were transcribed from the online survey site and entered into a Microsoft Excel spreadsheet on a password-secured computer. Statistical analysis was completed using IBM Statistical Package for the Social Sciences (SPSS) Version 22 (IBM Corp., Armonk, NY, USA). Respondents’ categorical data were expressed as number and percent. The mean and standard deviations were generated for all EBPQ questions and subscales. The frequency distributions of low response questions were generated. Data was analyzed using Spearman’s correlation, the Mann-Whitney U test and the KruskalWallace analysis of variance. A p-value 30
170 84 14 50 46 90 54 224 30 30 25 140 74 3 12 152 76 11 15 27 24 29 36 42 28 68
% 66.9 33.1 5.5 19.7 18.1 35.4 21.3 88.2 11.8 100 9.8 55.1 29.1 1.2 4.7 59.8 29.9 4.3 5.9 10.6 9.4 11.4 14.2 16.5 11.0 26.8
Note: N = 254.
made up the majority of respondents (54.3%); those with less than 10 years’ experience were the minority of respondents (20.0%). A majority (59.8%) of the responses were received from hospital employees; few respondents were employed by surgeons (4.3%).
Assessment of evidence-based practice in perfusion The EBPQ was analyzed against the demographic characteristics to discover differences in EBP. The mean and standard deviation for all questions and subscales are presented in Table 2. The mean EBPQ score was 5.0 (SD = 0.9) with similar means for the practice subscale (M = 5.0, SD = 1.3), the attitudes subscale (M = 5.4, SD = 1.2) and the knowledge/practice subscale (M = 5.1 SD = 0.9). The frequency of questions scored on the EBPQ from 1–4 Likert scale were calculated and compared against
higher scores (Figure1). The lowest response questions were: converting information needs into questions (50.4%), information technology (IT) skills (45.7%), critically appraising literature (45.7%) and research skills (44.5). Cronbach’s alpha was calculated for the EBPQ and demonstrated excellent internal consistency (α = 0.927).
Factors affecting evidence-based practice behavior The relationship of EBP knowledge and the skillset of perfusionists was examined using EBPQ subscales. A Spearman’s rho correlation was performed on the EBPQ knowledge/skills and practice subscales. There was a strong positive correlation of increased EBP knowledge/ skills scores as related to practice scores (rs (252) = 0.574, p
