ORIGINAL

Use of evidence-based practice by Nursing teachers: a survey study

Sirlene Luz Penha1, Kelli Borges dos Santos2, Caroline Campos Fonseca2, Cláudia Maria Messias3, Vilanice Alves de Araújo Püschel3

1Universidade de São Paulo, São Paulo, SP, Brazil

2Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil

3Universidade Federal Fluminense, Niterói, RJ, Brazil

ABSTRACT

Objective: To identify the use of evidence-based practice (PBE) by nursing teachers of higher education institutions in Brazil. Method: Descriptive study of quantitative approach. The data collection took place electronically using the instrument "Evidence-Based Practice Questionnaire", sent to the contact list of professors of undergraduate nursing institutions from different Brazilian states. Results: 117 professors from 17 states of Brazil participated in the study, with a response rate of 21.3%. Of the 86.3% of the respondents reported approaching PBE in nursing education, acting as a nurse previously (91.4%), and having a doctorate as a maximum level of education (57.2%). In the domains of attitudes, knowledge, and skill about PBE, a high score above 80% was obtained. Conclusion: the participants approach PBE in the teaching in which they work; they present positive attitudes and knowledge related to PBE according to the scores used.

Descriptors: Evidence-Based Practice; Nursing; Teaching.

INTRODUCTION

Every year, many investments are made in research in the health area, resulting in an increasing increase in knowledge in the scientific literature in this area. Evidence-based practice (PBE) is a topic that has shown a significant increase in recent years to integrate research into clinical practice(1).  Efforts in this direction are the result of interests arising from the health field, as well as from research centers and educational institutions(2). 

According to Sackett et al.(3), evidence-based practice is defined as “an approach that integrates the best external evidence to individual clinical experience and patient choice”(3). Considering these aspects, it should be used to substantiate nurses' decision-making, and it is indispensable in professional practice. Thus, implementing scientific knowledge in clinical practice, that is, translating scientific evidence to care practice, aims to achieve the best care for the patient with cost reduction and improve the quality of care(4). 

PBE started in the field of Medicine in 1980 through Evidence-Based Medicine and expanded in the following decades to other areas of health, including Nursing. It emerged and expanded as a latent need to improve and reduce the gaps between scientific research and professional practice(5).

In nursing, implementing PBE contributes to changing the care profile from one based on empirical knowledge and traditions to one based on scientific knowledge. Such transformation makes it possible to improve the quality of care provided and, consequently, the improvement of nursing care(6).

Despite the advancement of research in Latin America and the Caribbean compared to Anglo-Saxon countries, PBE in nursing still needs to be more widespread among teachers, professionals, and students(7-8). Its implementation in nursing care requires nurses' ability to interpret and integrate evidence from literature with practice through patient data and clinical observations. It is known that some barriers prevent its execution in the services, such as the lack of preparation of the nurse, the non-perception of the research as an integral part of his daily life, and the lack of time and organizational support(9-11). 

The study points out that the use of PBE in nursing practice is a reality it is necessary to plan changes in the educational sphere, in the training of professionals since graduation and their specializations; organizational, with the provision of time and technologies by health services; and individual, with a change in the posture and perspectives of health professionals(10). Thus, the present study aimed to identify the use of evidence-based practice by nursing professors of Brazilian public higher education institutions.

METHOD

Research design

This is a survey, exploratory and descriptive study, with a quantitative approach, carried out by electronic means. It was developed with professors of undergraduate nursing courses in Brazilian public Higher Education Institutions (HEIs).

The results are presented in tables containing the mean of the maximum score obtained according to the evidence-based practice questionnaire(12) and the mean of the scores obtained about the score on the Likert scale. The STROBE Checklist(13) was used to guide the research's development.

Selection criteria

The sample was determined due to convenience, that is, it was composed of professors interested in participating in the research. The convenience sample aims to obtain a sample of convenient and non-probabilistic individuals(14).

As inclusion criteria, it was necessary to be a graduate professor in Nursing of public HEIs in any part of the national territory.

An invitation was sent to participate in the research through the electronic addresses of the professors and graduation coordination, which were obtained at the IES websites. They were also sent an invitation through telephone contact among teachers through indication (snowball strategy) and direct mail via social media (WhatsApp).

Therefore, one professor and those who refused to respond during the data collection period were excluded from the sample where telephone contacts or emails were not found.

After the questionnaire was sent, e-mails were sent monthly to remind the professors to answer the questionnaire. The acceptance period for answers was established from January 2019 to January 2020.

Data collection

The data collection instrument used was the “Evidence-Based Practice Questionnaire” (EBPQ)(12), translated and validated into Brazilian Portuguese, with the authors' authorization for its use.

The instrument has 24 evaluation items: 6 items related to the frequency of use of PBE, 4 related to attitudes, and 14 related to knowledge and skills scored on a Likert scale, admitting from one to seven possibilities of response. The analysis of the main components comprises three areas: 1- Evidence-Based Nursing Practice that evaluates the use of PBE to fill a gap or lack of knowledge, understand the frequency that sought, evaluated, and integrated the evidence, as well as shared this knowledge among colleagues, ranging from 1 (never) to 7 (often), integrating six items or 42 points. The 2 domain is related to evidence-based practice attitudes, consisting of four questions, adding a total of 28 points, and finally, the number 3 domain evaluates knowledge and skills related to evidence-based practice, evaluating individual characteristics and capabilities that enable an effective PBE, it varies between 1 (bad) and 7 (optimal) totaling 14 items or 98 points.

In summary, the 1 domain (use of PBE) contains 6 items, totaling 42 points; the 2 domain (attitudes related to PBE) contains 4 items, totaling 28 points, and the 3 domain (Knowledge and Skills related to PBE) contains 14 items, totaling 98 points. The domains, with 168 points, were evaluated according to the average frequency of attitudes, skills, and knowledge about the PBE scored on the Likert scale, reflecting the professors' positive attitudes. Thus, the higher the score, the more positive the respondent's attitude is. 

In addition to the EBPQ, questions related to the characterization of the participants of the research were asked regarding sociodemographic aspects (sex and age); if previously acted as a nurse; maximum training; current area of activity; form of updating; time of training, professional experience and area of activity in teaching (discipline that teaches classes).

Data analysis

The collected data were automatically sent to Excel spreadsheet and then analyzed in a statistical program R version 4.0.0.

Frequency tables were performed for categorical data. For the numerical variables, means and median were evaluated. For the analysis of the questionnaire, the standards established by the authors were adopted and evaluated through the score obtained in each domain described. For bivariate analysis, a chi-square test will be performed for categorical variables and a Student T test for quantitative variables. A significance level of 5% was adopted (p< 0.05). Pearson's method was adopted for correlation(14).

Ethical aspects

The study was approved by the Research Ethics Committees (RECs) of the School of Nursing of the University of São Paulo (USP) (CAAE: 03746918.0.0000.5392) and registered under number 3.167,042.

All professors were invited by e-mail to participate in the research, and those who agreed electronically signed the Free and Informed Consent Form. The research standards regarding ethical aspects were complied with in Resolution 466 of December 12, 2012, on guidelines and standards of research involving human beings(15).

RESULTS

Questionnaires were sent to a total of 547 electronic addresses (e-mails) of nursing professors of public HEIs of the 26 states and the Federal District, with a return of 117 responses from 17 states of Brazil, including the Federal District (DF). No responses were obtained from the following states: Acre, Alagoas, Amazonas, Goiás, Mato Grosso do Sul, Rio Grande do Norte, Rondônia, Roraima, Sergipe and Tocantins. The response rate was 21.3%.

Among the respondents, 112 (95.7%) reported having acted as care nurses before their career in teaching, and 101 (86.3%) reported addressing evidence-based practice in undergraduate nursing education. The mean age of the participants was 46.7 years (maximum 67 and minimum 24 years; SD ± 10.10). The average training time was 22.8 years (maximum 44 and minimum 3 years; SD ± 10.28). The average teaching time was 14.45 (minimum less than 1 year and maximum 44 years; SD± 9.82 13), with a median of 13 years (0;44;). A total of 57.2% (=n 67) hold a doctorate.

Based on the questionnaire, the participants answered that the source of information update is primarily scientific articles (99.1%), followed by recommendations from the Ministry of Health (85.4%) and congresses (72.6%). Books and other updating forms were the most frequently searched sources (59.8% and 11.9%, respectively.

Regarding attitudes and knowledge about PBE, the respondents were close to the maximum score in each item, as seen in Table 1.

Table 1 - Description of the domains for evaluation Evidence-Based Practice (PBE). São Paulo, SP, Brazil, 2019

*Answers submitted on a Likert scale from 1 (never) to 7 (often). SD = standard deviation; Min.= minimum; Max. =maximum.

In the maximum score of the domain 1 the average was 34.52 out of a total of 42 points representing 80.9%, in the domain 2, the average was 23.83 the maximum score is 28, corresponding to 85.1%. The Domain 3 that had a maximum score of 98, and the average answers reached 79.25, that is, 80.9%. Thus, the three domains analyzed in the study reached an average score of 137.3 out of the total of 168, 81.7% representing a significantly positive frequency.

In a specific analysis of the 1 domain, corresponding to the use of PBE, Table 2 presents the items related to their attendance by the professors. It is possible to observe that the professors in their teaching practice seek evidence to remedy their doubts, associating them with their clinical practice.

Table 2 – Use of PBE by professors (n=117) according to the answers of the item of domain 1. São Paulo, SP, Brazil, 2019

* Responses to Domain 1 items. ** Mean responses scored on the Likert scale, from 1 (never) to 7 frequently. SD = standard deviation; Min. Minimum =; Max. =Maximum.

Table 3 depicts the descriptions of attitudes related to PBE, as evaluated in domain 2.  It is possible to observe that the participants scored a lower average, when compared to the others, of 5.12 (73%) of a total of 7, referring to the workload and the use of new evidences.

Table 3 - Attitudes related to PBE according to the responses (n=117) of the item in the domain 2. São Paulo, SP, Brazil, 2019

* Responses to Domain 1 items. ** Mean responses scored on the Likert scale, from 1 (never) to 7 frequently. SD = standard deviation; Min. =minimum=; Max. =maximum.

The knowledge and skills of professors to develop the PBE are presented in Table 4. It is possible to observe a mean of ≤ 5.5 in research skills, informatics and in monitoring and reviewing practices.

Table 4 – Knowledge and skills of professors (n=117) for the PBE according to the evaluation of the domain 3. São Paulo, SP, Brazil 2019

* Responses to Domain 1 items. ** Mean responses scored on the Likert scale, from 1 (never) to 7 frequently. SD = standard deviation; Min. =minimum=; Max. =maximum.

When stratified by sex or by area of activity in teaching (according to the discipline he or she teaches), no statistical difference was observed between the groups (p > 0.05 in all dimensions evaluated).

Observing a mean of ≤ 5.5 in research skills, informatics, and monitoring and reviewing practices is possible. The longer the training time and the working time as a professor, the higher the score in the domain 3 related to knowledge and skill on the PBE (p:0.012 and p:0.049, respectively). The same was observed in the total score of the instrument (p:0.003 and p:0.032).

The participants' self-perception of PBE in their teaching practice was also evaluated. It was observed that teachers understand the importance of PBE and use it as support in everyday teaching. Table 5 describes the results.

Table 5 - Self-perception on Evidence-Based Practice in taught teaching (n=117). São Paulo, SP,  Brazil, 2019

* Means of the responses scored on the Likert scale, from 1 (never) to 7 frequently. SD = standard deviation; Min. =minimum=; Max. =maximum.

DISCUSSION

As expected, survey studies have a low response rate, with an average of 20% responses. We reached a 21.3% response in the present study, similar to studies with this data collection methodology(16).

The number of respondents who reported using PBE in teaching was considered high, corresponding to 86.3%. This finding corroborates the assertion that in 2000, the undergraduate nursing curricula did not consider the teaching of PBE. However, due to numerous governmental organizations stimulating evidence-based practice teaching, studies have emerged demonstrating the teaching of PBE in graduation and, in some circumstances, its superiority over traditional teaching(17-18).

A recent study states that including PBE in the Nursing and Medicine curriculum is crucial so students can develop self-confidence, knowledge, and preparation for clinical practice, improving care and safety in patient care(17).

Several methods were pointed out among the strategies teachers use for updating, such as congresses, systematic reviews, recommendations of the Ministry of Health and current books, and scientific articles, which are the most excellent updating strategies. Thus, since scientific articles are the most frequent updating strategy, it is imagined that the teaching practice among the respondents is to search for technical, reflective, critical, and updated training(19).

The results about the frequency with which teachers use PBE to identify and respond to knowledge gaps, seek evidence in the literature, evaluate results, and share knowledge among colleagues, with a median of 5.7 on the Likert scale, leads us to infer that such teachers are based on knowledge produced for teaching and nursing care.

Orta and collaborators affirm that, despite the benefits of using PBE, nurses and professors present difficulties in both knowledge and attitudes and ability to teach about PBE(20). The authors claim that professors emphasize teaching the research method rather than allowing students to connect scientific knowledge to clinical practice(21).

In the present study, the positive skills of teachers to review their practices, apply knowledge to individual cases, identify gaps, and share information among colleagues. However, it is possible to identify fewer positive skills on the part of teachers regarding the use of informatics and monitoring and review of practices(21). Thus, when analyzed from a current perspective, a barrier is that internet use is increasingly frequent, and studies(21-22) portray it as an essential tool to facilitate the search for evidence..

In addition, participants need more ability to develop research and knowledge on how to raise evidence. Another study, however, carried out only with nurses, identified some deficit in knowledge or ability to apply the PBE(22) .

Although the score reached regarding knowledge and ability to identify the main types and sources of information existing is 5.56, studies show that this is one of the main barriers to implementing PBE. The integrative review identified that the stage of identifying the best evidence to be applied in practice and how to make the transition process between theoretical and practical knowledge is one of the most significant barriers, as evidenced in another primary study(22).

Another integrative review(21) that shows the barriers to the implementation of PBE, it was identified that the stage of knowing how to identify the best evidence to be applied in practice and how to make the transition process between theoretical and practical knowledge is one of the most significant barriers, which is also evidenced in another primary study(22).

Another study(2) also points out that professionals find it challenging to search for scientific evidence, have few basic skills in formulating research questions, and need help understanding the statistical terms used and critically evaluating the literature(24). However, this barrier was not identified in the present study. Professors of public HEIs are constantly developing research in their respective areas of knowledge and, consequently, exhibit smaller gaps in knowledge, skills, and attitudes about the knowledge produced. The research question formulation has yet to be identified as a problem.

The present study did not evaluate whether the teacher can critically evaluate a scientific article, only if the same is considered able to do it. This ability to critically analyze evidence against established standards reached 5.64. Critically analyzing evidence is paramount to substantiate/discern the best evidence and assist decision-making in nurse practice. Selecting and reading scientific articles is not enough to determine the change in clinical practice; however, evaluating the quality of the article is a fundamental step in identifying whether a practice should be changed from new evidence. Professors who develop themselves and stimulate critical thinking in students conduct better results in practice(25) skill, which is essential for the critical analysis of a scientific article. Most of the evaluated (57.2%) have a doctorate; that is, they should be trained for research and consequently have developed the ability to perform the critical evaluation of the scientific article.

Regarding the attitudes of defining a time to update new evidence, participants scored an average of 5.12. The workload of professors and lack of time among nursing professionals were considered barriers to PBE(21-22). However, professors presented positive attitudes when their practice was questioned, recognized that PBE is necessary, and changed their practices due to new evidence.

When analyzing variables such as sex, time of graduation, area of activity, and the correlation with the domains of EBPQ, only statistical difference was observed about the time of graduation, suggesting that the longer the time of graduation and work, the greater the use, the attitude, the knowledge, and skill of the PBE described by the respondent.

One study found higher EBPQ scores among nurses with master's or doctorate degrees, nurses who were also educators, and lower scores among the instrument domains for nurses with only one undergraduate degree(26). In another study, the authors identified that the level of master’s and doctoral training improves the disposition of the use of PBE in the care practice(27).  

The realization of the PBE requires both teaching/research and professional development through pedagogical preparation, developing constant skills among those who need to teach and those who apply PBE, without separating research from professional practice and the institutional context. Combining these factors is challenging for constructing evidence-based quality teaching(19).

Therefore, inserting the PBE since the students' graduation is relevant and contributes to the graduation of professionals better prepared to consume and implement scientific evidence in professional practice. In this perspective, professors need to be involved in the real scenarios of assistance so that the teaching of the PBE is carried out in a responsible and committed way to integrate theory with practice, research, and clinical assistance. Students will be able to articulate their knowledge to solve real health problems, with professionals who work in care contributing to an interprofessional education(25). 

When students are inserted into the care reality, they may develop questions arising from clinical practice/care or doubt in the classroom, the search for the best available evidence, the evaluation of the evidence, and the attempt to implement/transform the reality that is, using the PBE allows different teaching methodologies, thinking and acting, in addition to the early stimulation of students with care practices and use of research to improve customer care(23).

Therefore, it is essential to integrate discussions and actions in the nursing teaching scenario based on the concepts of PBE to build a teaching practice mediating stimuli to the critical-reflective graduation of the student(18). Therefore, it is necessary to develop prospective studies that evaluate the impact of incorporating PBE in curricular disciplines and activities that approach the world of work to measure the impact of this nurse training on the quality of care in the health field.

As limitations of the study, we consider the low number of questionnaire responses, although adequate according to studies that evaluate survey responses in which the response rate may vary between 20 and 80%(28) and have no response from teachers from most of the northern states of Brazil and some northeastern states.

CONCLUSION

Most of the teachers interviewed consider using the PBE in the higher education scenario in which the same operates and presents skills, attitudes, and knowledge related to PBE. In a self-perception, the professors understand that PBE is essential for the development of undergraduate education since the same supports care practices based on scientific evidence. Most respondents acted as nurses before teaching, and most have a doctorate.

Studies that evaluate knowledge about the use of PBE may be complementary to the present study in the validation of the findings.

CONFLICT OF INTERESTS

The authors have declared that there is no conflict of interests.

REFERENCES

1. Degu AB, Yilma TM, Beshir MA, Inthiran A. Evidence-based practice and its associated factors among point-of-care nurses working at the teaching and specialized hospitals of Northwest Ethiopia: A concurrent study. PLoS One. 2022;5;17(5):e0267347. https://doi.org/10.1371/journal.pone.0267347  

2. Lehane E, Leahy-Warren P, O'Riordan C, Savage E, Drennan J, O'Tuathaigh C, et al. Evidence-based practice education for healthcare professions: an expert view. BMJ Evid Based Med. 2019;24(3):103-108. https://doi.org/10.1136/bmjebm-2018-111019

3. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996;312(7023):71-72. https://doi.org/10.1136/bmj.312.7023.71

4. Jordan Z, Lockwood C, Munn Z, Aromataris E. The updated Joanna Briggs Institute Model of Evidence-Based Healthcare. Int J Evid Based Healthc. 2019;17(1):58-71. https://doi.org/10.1097/xeb.0000000000000155

5. Saunders H, Vehviläinen-Julkunen K. Nurses' Evidence-Based Practice Beliefs and the Role of Evidence-Based Practice Mentors at University Hospitals in Finland. Worldviews Evid Based Nurs. 2017;14(1):35-45. https://doi.org/10.1111/wvn.12189

6. Camargo FC, Iwamoto HH, Monteiro DAT, Goulart MB, Garcia LAA, Augusto ALDS, et al. Techniques undertaken to disseminate the evidence-based practice among hospital nurses. Rev Min Enferm [Internet]. 2017 [cited 2021 dez 04];21:e-1003. Available from: http://www.reme.org.br/artigo/detalhes/1139  

7. Camargo FC, Goulart MB, Iwamoto HH, Araújo MRN, Contim D. Apprehensions of nurse managers on evidence-based practice. Rev Esc Anna Nery. 2018;22(1):e20170109. https://doi.org/10.1590/2177-9465-EAN-2017-0109

8. Ruzafa-Martinez M, Lopez-Iborra L, Moreno-Casbas T, Madrigal-Torres M. Development and validation of the competence in evidence based practice questionnaire (EBP-COQ) among nursing students. BMC Med Educ. 2013;13:19. https://doi.org/10.1186/1472-6920-13-19

9. Iradukunda F, Mayers PM. Rwandan nursing students' knowledge, attitudes and application of evidence-based practice. Curationis. 2020;43(1):e1-e7. https://doi.org/10.4102/curationis.v43i1.2005

10. Püschel VA de A. ¿Como formar o enfermeiro para a prática baseada em evidências? Rev Iberoam Educ Invest Enferm [Internet]. 2018 [cited 2021 dez 04];8(3):4-6. Available from: https://www.enfermeria21.com/revistas/aladefe/articulo/281/como-formar-o-enfermeiro-para-a-pratica-baseada-em-evidencias/

11. Mackey A, Bassendowski S. The History of Evidence-Based Practice in Nursing Education and Practice. J Prof Nurs. 2017;33(1):51-55. https://doi.org/10.1016/j.profnurs.2016.05.009  

12. Rospendowiski K, Alexandre NMC, Cornelio ME. Adaptação cultural ao Brasil e desempenho psicométrico do “Questionário de Práticas Baseadas em Evidências”. Acta paulista de enfermagem. Acta Paul Enferm. 2014;27(5):405-411. http://dx.doi.org/10.1590/1982-0194201400068

13. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344-9. https://doi.org/10.1016/j.jclinepi.2007.11.008

14. Marconi MA, Lakatos EM. Técnicas de pesquisa: planejamento e execução de pesquisas, amostragens e técnicas de pesquisas, elaboração, análise e interpretação de dados. 5 ed. São Paulo: Atlas; 2002. 282 p.

15. Conselho Nacional de Saúde (BR). Resolução 466/12, de 12 de setembro de 2012. Aprova diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos. Diário Oficial da União [Internet]. 2012 [cited 2021 dez 04]. Available from: https://conselho.saude.gov.br/resolucoes/2012/Reso466.pdf

16. Ponto J. Understanding and Evaluating Survey Research. J Adv Pract Oncol [Internet]. 2015 [cited 2022 jan 10];6(2):168–171. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4601897/

17. Ferraz L, Schneider LR, Pereira RPG, Pereira AMRC. Ensino e aprendizagem da prática baseada em evidências nos cursos de Enfermagem e Medicina. Rev Bras Estud Pedagog. 2020;101(257):237-249. https://doi.org/10.24109/2176-6681.rbep.101i257.4424

18. McCurry MK, Martins DC. Teaching undergraduate nursing research: a comparison of traditional and innovative approaches for success with millennial learners. J Nurs Educ. 2010;49(5):276-9. https://doi.org/10.3928/01484834-20091217-02

19. Galvão M, Ricarte I. Revisão Sistemática da Literatura:  conceituação, produção e publicação. Logeion. 2019;6(1):57-73. https://doi.org/10.21728/logeion.2019v6n1.p57-73

20. Orta R, Messmer PR, Valdes GR, Turkel M, Fields SD, Wei CC. Knowledge and Competency of Nursing Faculty Regarding Evidence-Based Practice. J Contin Educ Nurs. 2016;1;47(9):409-19. https://doi.org/10.3928/00220124-20160817-08

21. Camargo FC, Iwamoto HH, Galvão CM, Pereira GA, Andrade RB, Masso GC. Competences and Barriers for the Evidence-Based Practice in Nursing: An Integrative Review. Rev Bras Enferm. 2018;71(4):2030-8. http://dx.doi.org/10.1590/0034-7167-2016-0617

22. Pérez-Campos MA, Sánchez-García I, Pancorbo-Hidalgo PL. Knowledge, Attitude and Use of Evidence-Based Practice among nurses active on the Internet. Invest Educ Enferm. 2014;32(3):451-460. https://doi.org/10.17533/udea.iee.v32n3a10

23. Camargo FC, Iwamoto HH, Monteiro DAT, Lorena LT, Pereira G de A. Avaliação de intervenção para difusão da enfermagem baseada em evidências em hospital de ensino. Rev Gaúcha Enferm. 2016;37(esp):e68962:1-9. http://dx.doi.org/10.1590/1983-1447.2016.esp.68962   

24. Schneider LR, Pereira RPG, Ferraz L. Prática baseada em evidências e a análise sociocultural na atenção primária. Physis: Revista Saúde Colet. 2020;30(02):e300232. https://doi.org/10.1590/S0103-73312020300232

25. Kim JS, Gu MO, Chang H. Effects of an evidence-based practice education program using multifaceted interventions: a quasi-experimental study with undergraduate nursing students. BMC Med Educ. 2019;19(71). https://doi.org/10.1186/s12909-019-1501-6

26. Eizenberg MM. Implementation of evidence-based nursing practice: nurse´s personal and professional factors?. J Adv Nurs. 2011;67(1):33-42. https://doi.org/10.1111/j.1365-2648.2010.05488.x

27. Pitsillidou M, Roupa Z, Farmakas A, Noula M. Factors Affecting the Application and Implementation of Evidence-based Practice in Nursing. Acta Inform Med. 2021;29(4):281-287. https://doi.org/10.5455/aim.2021.29.281-287

28. Mineiro M. pesquisa de survey e amostragem: aportes teóricos elementares. REED. 2020;1(2):284-306. https://doi.org/10.22481/reed.v1i2.7677

Submission: 11/02/2022

Approved: 11/21/2023