Finland's Healthcare Act1 asserts that ‘healthcare shall be based on evidence and recognized treatment and operational practices’. Evidence-based practice (EBP) seeks to provide safe, high-quality services to all individuals2 by ensuring nursing interventions are effective, appropriate, feasible and meaningful.3 A key aspect of EBP is the minimization of interventions and practices subject to unjustifiable variations between different organizations or care providers.4,5 Consistent practices across organizations and health professionals increase healthcare's efficiency and quality and patient safety.2
Finland's Ministry of Social Affairs and Health published the Action Plan for Nursing6 to support implementation of EBP in healthcare. The Nursing Research Foundation (NRF) also promotes EBP in nursing at the national level. The following article is based on a previously published report7 (in Finnish), which presented a nationwide survey's results concerning EBP implementation.
The current study's aim was to describe nurses’, nurse directors’ and clinical nurse specialists’ (CNSs’) perceptions of how well EBP is being implemented in nursing in Finland.
The NRF together with the Finnish Nurses Association collected data on this topic in 2017 using e-questionnaires, one separately for nurses and the other for nurse directors and CNSs in both Finnish and Swedish. The survey was distributed to nurses, nurse directors and CNSs via e-mail after permission was received from the relevant trade unions to use their registers in the study.
The questionnaire was developed based on the Action Plan for Nursing6 and previous related research.2,8–11 Some items were based on the internationally validated Evidence-based Practice Process Assessment Scale,12 so permission to use parts of the scale was obtained from the copyright holders. The data were analysed with descriptive statistical methods (i.e. frequency and percentage) using the Statistical Package for Social Sciences Statistics for Windows version 22.0 (IBM, Armonk, New York, USA).
In total, 1063 nurses and 340 nurse directors and CNSs participated. The respondents’ characteristics are presented in Table 1.
Most nurses are confident of their competencies regarding EBP, such as how to find the best available evidence (70%, n = 730) and how to determine the need to improve current practices (76%, n = 786). Less than half of the respondents (43% of the nurses, n = 452; 49% of the nurse directors and CNSs, n = 158) reported that the requisite evidence on which to base their organizations’ clinical practices is available. Approximately one-third (37%, n = 118) of the nurse directors and CNSs asserted that availability of research evidence has been ensured. In addition, the majority of nurse directors and CNSs (63%, n = 204) perceived that their organizations consider EBPs a strategic goal.
However, most nurses (64%, n = 669) indicated that evidence is not used in clinical practices’ development. The nurses also reported that the current practices followed to disseminate evidence (65%, n = 679) and implement EBPs (66%, n = 687) are impractical.
The majority of nurses (67%, n = 702) and over half of nurse directors and CNSs (57%, n = 184) perceived that knowledge about evidence-based protocols is not circulated within their organizations.
The survey revealed variations in the nurse directors’ and CNSs’ opinions. Half of those who worked at university hospitals (50%, n = 30) and more than half of those employed by central hospitals (54%, n = 42) and primary healthcare, private or tertiary sector (62%, n = 111) asserted that knowledge about evidence-based protocols is not distributed to employees by their organizations.
Nonetheless, 39% of nurses (n = 407), and 53% of nurse directors and CNSs (n = 171) reported that they are developing clinical practices based on evidence. More than half the nurses (55%, n = 568) perceived that treatment instructions are evidence-based. Furthermore, approximately half of nurse directors and CNSs (51%, n = 163) also felt that their organization is committed to implementing evidence-based clinical guidelines.
Almost all nurse directors and CNSs (86%, n = 262), however, asserted that they do not have time to assess the implementation of EBP. Although nurses understand how to evaluate their work-related results (83%, n = 862), only a few have enough time to conduct assessments (39%, n = 412).
The results show that evidence is utilized in some form in nursing to improve current practices. The nurse professionals’ answers highlight that their attitudes towards EBP are positive, but evidence is still not sufficiently implemented. These findings are in line with previous studies.13
In addition, the results confirm the need to re-examine the practices used to ensure evidence's availability. Previous studies have also acknowledged that easily available evidence is needed.14,15 One possible solution could be to develop further information technologies supporting EBP.15
The findings indicate that nurses evaluated the implementation of EBP as weaker than nurse directors and CNSs did. However, the e-questionnaires were distributed to over 50 000 nurse professionals, so the response rate was quite low. The participating nurses, nurse directors and CNSs also were from different organizations, which may have influenced the results.
Nurse professionals in Finland have positive attitudes to EBP, although the survey's results indicate that nurses need more support to implement evidence fully to improve practices. The plan is to conduct this nationwide survey again every 2–3 years, to follow how much EBP implementation is improving.
The authors would like to thank the nurse professionals who participated in this study and the Finnish Nurses Association – especially Dr Teija Korhonen and Dr Nina Hahtela – for their collaboration throughout the research process.
Conflicts of interest
The authors report no conflicts of interest.
1. Ministry of Social Affairs and Health, Finland. Health Care Act (1326/2010). Available from: https://www.finlex.fi/en/laki/kaannokset/2010/en20101326_20131293.pdf
2. Innis J, Dryden-Palmer K, Perreira T, Berta W. How do healthcare organizations take on best practices? A scoping literature review. Int J Evid Based Healthc
3. Pearson A, Wiechula R, Court A, Lockwood C. A re-consideration of what constitutes ‘evidence’ in the healthcare professions. Nurs Sci Q
4. Newhouse RP. Examining the support for evidence-based nursing
practice. J Nurs Adm
5. Kennedy PJ, Leathley CM, Hughes CF. Clinical practice variation. Med J Aust
6. Ministry of Social Affairs and Health. Increasing the effectiveness and attraction of nursing
care by means of management. An action plan for the years 2009–2011 (in Finnish). Sosiaali- ja terveysministeriön julkaisuja
2009; 18. Available from: https://julkaisut.valtioneuvosto.fi/bitstream/handle/10024/74335/URN:NBN:fi-fe201504226780.pdf?sequence=1
7. Korhonen T, Siltanen H, Hahtela N, Holopainen A. Toteutuuko näyttöön perustuva toiminta Suomessa? Raportti nykytilasta hoitotyön edustajien kuvaamana (in Finnish). Raportti 1, Nursing
Research Foundation and Finnish Nurses Association. 2018. Available from: http://www.hotus.fi/system/files/NPT_RAPORTTI%20_DIGI_1.pdf
8. VanDeusen LC, Engle RL, Holmes SK, Parker VA, Petzel RA, Nealon SM, et al. Strengthening organizations to implement evidence-based clinical practices. Healthcare Manage Rev
9. Eizenberg MM. Implementation of evidence-based nursing
practice: nurses’ personal and professional factors? J Adv Nurs
10. Chaudoir SR, Dugan AG, Barr CH. Measuring factors affecting implementation of health innovations: a systematic review of structural, organizational, provider, patient, and innovation level measures. Implement Sci
11. May CR, Johnson M, Finch T. Implementation, context and complexity. Implement Sci
12. Rubin A, Parrish DE. Validation of the Evidence-Based Practice Process Assessment Scale. Res Soc Work Pract
13. Ubbink DT, Guyatt GH, Vermeulen H. Framework of policy recommendations for implementation of evidence-based practice: a systematic scoping review. BMJ Open
14. Straus S, Haynes RB. Managing evidence-based knowledge: the need for reliable, relevant and readable resources. CMAJ
15. Andermann A, Pang T, Newton JN, Davis A, Panisset U. Evidence for health I: producing evidence for improving health and reducing inequities. Health Res Policy Syst