The majority of the public health nurses found it difficult to understand articles published in English, a problem which has also been reported in other countries where English is not the native tongue (37). This language barrier restricts the public health nurses’ opportunity to obtain and assess new evidence. Their free text comments also explain that while they focus on professional development and research, time is a restricting factor.
However, this finding does not coincide with the study that demonstrated limited understanding among other primary health care nurses of the importance of updating their professional knowledge (6). Our result may be explained by the fact that all public health nurses have specialty training, which may well influence their views on professional development.
A Master’s degree is significant
Compared with public health nurses without a Master’s degree, the odds were more than 3.5 times greater that public health nurses who hold a Master’s degree will consider themselves as being fairly good, proficient or expert at assessing research. There has been much debate about the general need for a Master’s degree programme. Arguments have been put forward both for and against the trend of introducing ever more postgraduate specialty training programmes for nurses (38–40).
Nurses agree that evidence-based practice is useful to clinical work, but they lack the skills to implement such practices (41). Like other studies, our study supports the view that public health nurses with a Master’s degree will be better equipped to assess research findings (36, 42).
The odds were 1.5 times greater that public health nurses in a full-time job will consider themselves to be fairly good, proficient or expert at assessing research-based knowledge. Other studies also show that the full-time equivalent ratio impacts on the implementation of evidence-based practice (43). It is reasonable to assume that fewer working hours result in correspondingly fewer opportunities to read up on research and other professional literature or to attend courses and medical meetings during working hours.
In order to implement evidence-based work practices, the public health nurses need to be adept at assessing multiple sources of knowledge rather than solely referring to national guidelines and local procedures. This study tells us nothing about the ways that public health nurses use the various sources of knowledge. Further research is therefore required in this area.
The study’s findings should impact on the teaching of evidence-based practice at public health nursing courses in order to build confidence in newly qualified public health nurses that they are able to access different sources of knowledge. Local authorities and university colleges should also consider introducing refresher courses for public health nurses in evidence-based practice and sources of knowledge.
The local authorities
Public health nursing is a widely scoped profession, and public health nurses work independently, which may suggest that the training programme for public health nursing should be at postgraduate level. It is also important that local authorities utilise the competence of public health nurses with a Master’s degree to develop the area’s service provision.
There is currently no body that holds an overarching responsibility for implementing national guidelines and safeguarding the quality of procedures issued by local authorities. Work has been on-going for some time to establish a national competence and development centre for services provided at community and school health centres (44–46). The Professional interest group of public health nurses (LaH) also recognises that there is a great demand for such a centre and has pushed for its establishment. This work should be intensified and may play an important role in achieving the objective of introducing evidence-based practice in the public health nursing service (47).
Strengths and weaknesses
A total of 3 130 public health nurses were invited to take part in the survey. Of these, 708 completed the questionnaire. This gives a response rate of 22.6 per cent, which matches that of other comparable studies (48). In 2014, a total of 4 368 public health nurses were working in Norway.
This study was able to obtain responses from 16.2 per cent of the entire population (15). The fact that we chose to recruit via LaH, may have introduced a bias in the sample. However, we have no data that might verify whether public health nurses outside the LaH are significantly different to those who are members of the LaH. Consequently, it is difficult to assess whether the findings are representative of the public health nurses who did not take part in the survey. Nevertheless, we hold the opinion that the results of the study provide a general indication of conditions within the service.
One of our study’s limitations, however, is that we have only established what the public health nurses report that they do, not what they are actually doing in practice. Neither can the study establish possible causes and effects; it can only describe associations between variables.
The modifications made to the original UKBP questionnaire proved to be so comprehensive that the results of this study cannot readily be compared with the results of studies that have employed the original English or Norwegian version of the questionnaire.
This study shows that national guidelines constitute the source of knowledge most frequently used by public health nurses. Public health nurses who hold a Master’s degree, and public health nurses in full-time employment, feel that they are better at assessing research-based knowledge than public health nurses without a Master’s degree, or who are in less than full-time employment.
The field of practice should consider how these resources may be better utilised. The educational institutions should also reflect on how they teach evidence-based practice and offer refresher courses for public health nurses. The establishment of a national competence and development centre for services provided at community and school health care centres will potentially have a considerable impact on the use of evidence-based practice and knowledge development in the public health nursing service.
I would like to thank Anne Dalheim for allowing me to use the Norwegian translation of the questionnaire entitled ‘Developing Evidence-Based Practice Questionnaire’ (DEBP).
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