Evidence-Based Practice and the Quadruple Aim

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Original Article

Predictors of Evidence-Based Practice Implementation, Job Satisfaction, and Group Cohesion Among Regional Fellowship Program Participants Son Chae Kim, RN, PhD • Jaynelle F. Stichler, DNS, RN, NEA-BC, FACHE, FAAN • Laurie Ecoff, RN, PhD, NEA-BC • Caroline E. Brown, DEd, CNS • Ana-Maria Gallo, PhD, CNS, RNC-OB • Judy E. Davidson, DNP, RN, FCCM

Keywords

evidence-based practice,

fellowship, EBP beliefs,

EBP implementation, job satisfaction,

group cohesion, group attractiveness

ABSTRACT Background: A regional, collaborative evidence-based practice (EBP) fellowship program utiliz- ing institution-matched mentors was offered to a targeted group of nurses from multiple local hospitals to implement unit-based EBP projects. The Advancing Research and Clinical Practice through Close Collaboration (ARCC) model postulates that strong EBP beliefs result in high EBP implementation, which in turn causes high job satisfaction and group cohesion among nurses.

Aims: This study examined the relationships among EBP beliefs, EBP implementation, job satis- faction, group cohesion, and group attractiveness among the fellowship program participants.

Methods: A total of 175 participants from three annual cohorts between 2012 and 2014 com- pleted the questionnaires at the beginning of each annual session. The questionnaires included the EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness scales.

Results: There were positive correlations between EBP beliefs and EBP implementation (r = 0.47; p <.001), as well as EBP implementation and job satisfaction (r = 0.17; p = .029). However, no statistically significant correlations were found between EBP implementation and group cohesion, or group attractiveness. Hierarchical multiple regression models showed that EBP beliefs was a significant predictor of both EBP implementation (β = 0.33; p <.001) and job satisfaction (β = 0.25; p = .011). However, EBP implementation was not a significant predictor of job satisfaction, group cohesion, or group attractiveness.

Linking Evidence to Action: In multivariate analyses where demographic variables were taken into account, although EBP beliefs predicted job satisfaction, no significant relationship was found between EBP implementation and job satisfaction or group cohesion. Further studies are needed to confirm these unexpected study findings.

BACKGROUND The adoption and implementation of evidence-based practice (EBP) in nursing and other healthcare disciplines are recog- nized as essential in ensuring optimal patient outcomes and quality of care (Aarons, Ehrhart, & Farahnak, 2014). Although EBP is considered to be the gold standard in nursing practice, the actual implementation of EBP has been inconsistent due to barriers related to nursing workload, lack of organizational support, lack of EBP knowledge and skills, and poor attitudes toward EBP (Brown et al., 2010; Ramos-Morcillo, Fernandez- Salazar, Ruzafa-Martinez, & Del-Pino-Casado, 2015; Squires, Estabrooks, Gustavsson, & Wallin, 2011). Although many hos- pitals have used professional development courses individually

to encourage nurses’ implementation of EBP through im- proved nurses’ knowledge and attitudes about EBP, successful outcomes have been elusive (Melnyk, Gallagher-Ford, Long, & Fineout-Overholt, 2014; Pryse, McDaniel, & Schafer, 2014; Underhill, Roper, Siefert, Boucher, & Berry, 2015).

A regional, collaborative EBP fellowship program, the EBP Institute, was founded in 2006 by nurse leaders from multi- ple hospitals and academia in San Diego County, California, to promote implementation of EBP by hospital nurses. The fel- lowship program utilized institution-matched mentors to assist in executing unit-based EBP projects, and included didactic as well as interactive learning experiences in six daylong educa- tional sessions over a 9-month period. A formal graduation day

Original Article completed the learning experience, with the fellows present- ing their EBP projects in poster and podium presentations. A previous report on this program showed improvements in the participants’ knowledge, attitudes, and practice associated with EBP, as well as a reduction in barriers to EBP implementation (Kim et al., 2013).

LITERATURE REVIEW The literature is replete with evidence and opinions that ef- forts to educate nurses regarding EBP have improved nurses’ knowledge and attitudes. However, these efforts have not nec- essarily resulted in actual improvements in EBP implementa- tion, nor have they changed clinical practices (Aarons et al., 2014; Melnyk et al., 2014; Pryse et al., 2014). Although barri- ers to EBP implementation have been well-documented, some authors have also cited the importance of organizational cul- ture and leadership in reducing barriers and fostering EBP implementation.

Organizational Culture and Leadership for EBP An organizational culture that emphasizes making clinical de- cisions based on evidence is critical for improving and sus- taining safe and high-quality patient care (Melnyk, Fineout- Overholt, Giggleman, & Cruz, 2010; Wallen et al., 2010). Al- though leaders influence the organizational culture, they also play an important role in supporting implementation of EBP and other innovative practices. Supportive leaders obtain fund- ing, provide resources, allow the time necessary for nurses to engage in EBP implementation, and reward those nurses who participate in evidence-based change projects in perfor- mance evaluations (Aarons et al., 2014; Ehrhart, Aarons, & Farahnak, 2015). Ehrhart, Aarons, and Farahnak (2015) have reported that clinical nurses with the greatest clinical exper- tise and EBP knowledge were most helpful in advancing EBP skills and positive EBP attitudes among their coworkers. This finding supports the importance of mentorship in improving nurses’ knowledge, attitudes, and practice of EBP (Abdullah et al., 2014; Green et al., 2014; Magers, 2014).

Furthermore, organizations that engage in the Magnet Recognition Program have been recognized for nurse engage- ment in EBP and implementation of clinical practice changes. The Magnet journey transforms organizational cultures, and ensures leadership support and resources necessary to facili- tate nurses’ engagement in EBP (American Nurses Credential- ing Center, 2014; Black, Balneaves, Garossino, Puyat, & Qian, 2015; Wilson et al., 2015).

Educational Processes to Enhance EBP in Healthcare Settings A number of studies have described the structures, processes, and outcomes of programs to enhance nurses’ appreciation, knowledge, competencies, and practice of EBP (Kim et al., 2013; Magers, 2014; Mollon et al., 2012; Ramos-Morcillo et al., 2015; Underhill et al., 2015; Wong & Myers, 2015). Although

most EBP educational programs emphasize EBP contents re- lated to asking relevant clinical questions, and searching for and appraising forms of evidence, less emphasis is put on actual EBP implementation (Wyer, Umscheid, Wright, Silva, & Lang, 2015). The Advancing Research and Clinical Practice through Close Collaboration (ARCC) model emphasizes EBP implementation as the final focal point of the entire model, through which all of the beneficial outcomes of EBP diffusion flow (Melnyk et al., 2010). These outcomes include benefits to patients with improved patient outcomes as well as bene- fits to nurses such as higher job satisfaction and group cohe- sion, along with lower nurse turnover, with the ultimate out- come of decreased hospital costs. Using the ARCC model to educate nurses, previous studies have reported that partici- pants’ beliefs about EBP were significantly correlated with perceived organizational culture for EBP, implementation of EBP, group cohesion, and job satisfaction (Melnyk et al., 2010; Wallen et al., 2010). However, there has not been a full ex- amination of the strength of relationships among EBP beliefs, EBP implementation, job satisfaction, and group cohesion that takes the demographic variables into account.

The purpose of the study was to examine the relation- ships among EBP beliefs, EBP implementation, job satisfac- tion, group cohesion, and group attractiveness among nurses participating in a regional, collaborative EBP fellowship pro- gram. The specific aims were to examine: (a) EBP beliefs as a predictor of EBP implementation; and (b) EBP beliefs and EBP implementation as predictors of job satisfaction, group cohe- sion, and group attractiveness above and beyond the influence of demographic variables.

METHODS Design and Participants Three annual cohorts of nurses attending the 9-month re- gional, collaborative EBP fellowship program in San Diego, California, from 2012 to 2014 were invited to participate in the study. The program attendees were selected nurses repre- senting each participating institution as a dyad of mentor and fellow. The fellows, in general, were staff nurses who would be implementing unit-based EBP projects under the mentorship of advanced practice nurses, nurse educators, or other nurses with experience in implementing EBP projects.

Instruments EBP beliefs scale. This 16-item scale measures respondents’ beliefs about the importance of EBP and their EBP competence in a five-point Likert response format, ranging from strongly disagree ( = 1) to strongly agree ( = 5). Possible total scores range from 16 to 80, with higher scores indicating stronger EBP beliefs. The internal consistency reliability was reported as Cronbach’s alpha of 0.90, and validity testing has also been reported in the previous study (Melnyk, Fineout-Overholt, & Mays, 2008). The Cronbach’s alpha for the instrument in this study was 0.87.

Predictors of EBP Implementation, Job Satisfaction, and Group Cohesion

EBP implementation scale. This 18-item scale assesses the frequency of performing EBP-related activities in the past 8 weeks (Melnyk et al., 2008). Examples of items include gener- ating a PICO question, critically appraising research evidence, and collecting data, as well as sharing EBP guidelines with oth- ers. Response options range from 0 times ( = 0) to greater than or equal to 8 times ( = 4), and the total summation score ranges from 0 to 72, with a higher score indicating greater participa- tion in EBP-related activities. The internal consistency reliabil- ity was Cronbach’s alpha of 0.96, and validity testing was also reported. The Cronbach’s alpha in this study was 0.96.

Job satisfaction scale. Respondents are asked to rate their perception of job satisfaction in a five-point Likert response format, ranging from strongly disagree ( = 1) to strongly agree ( = 5). This scale contains four items and the total summation score ranges from 4 to 20, with a higher score indicating higher job satisfaction (Mueller, Boyer, Price, & Iverson, 1994). The Cronbach’s alpha was reported as 0.88 in the previous study and it was 0.89 in this study.

Group cohesion and attractiveness scales. These are two scales that measure group cohesion and group attractiveness in a seven-point Likert response format (Good & Nelson, 1973). The four-item Group Cohesion scale rates respondents’ percep- tion about their work group’s productivity, efficiency, feeling of belongingness, and morale from very much above average ( = 1) to very much below average ( = 7). The two-item Group Attractiveness scale assesses respondents’ perception of their enjoyment in working with the group. Responses range from like/enjoy very much ( = 1) to dislike very much ( = 7). In this study, the scores were reversed so that higher scores indicate positive perceptions. The reported split-half reliabilities were 0.77 and 0.82, whereas the Cronbach’s alphas in this study were 0.90 and 0.85, respectively.

Demographic data form. General demographic information, such as age, educational background, ethnicity, years of RN experience, and nursing position, was obtained.

Data Collection Procedures This study was approved by the institutional review boards of the participating academic and healthcare institutions. A consent letter was provided to and reviewed by all potential participants. Written documentation of consent was waived, because minimal risk was involved in this study and partici- pants’ anonymity was protected. Completion of the study ques- tionnaires indicated consent to participate in the study. The participants completed the study questionnaires at the begin- ning of each 9-month program.

Data Analyses Descriptive statistics, including mean, standard deviation, fre- quency, and percentage, were calculated. Independent t-tests were performed to compare the mean scores of EBP be- liefs, EBP implementation, job satisfaction, group cohesion,

and group attractiveness between the mentors and the fel- lows. Bivariate Pearson’s correlations were performed to exam- ine the relationships among demographic variables and other variables. To examine EBP beliefs as a predictor of EBP im- plementation, the demographic variables that had significant correlations with EBP implementation were entered in the first step of the hierarchical multiple regression model. The EBP be- liefs was then entered in the second step as a predictor of EBP implementation above and beyond the demographic variables.

To examine EBP beliefs and EBP implementation as pre- dictors of job satisfaction, group cohesion, and group attrac- tiveness, the demographic variables that correlated with job satisfaction, group cohesion, or group attractiveness were en- tered in the first step of the hierarchical multiple regression models. This was followed by entry of the EBP beliefs and EBP implementation in the second step as predictors above and beyond the demographic variables. The assumptions of normality, linearity, and homoscedasticity in the hierarchical multiple regression models were met. SPSS version 21.0 (IBM SPSS Statistics, Armonk, NY) was used for data analyses and the level of significance was set at p < .05.

RESULTS Sample Characteristics A total of 175 participants (101 fellows and 74 mentors) from the three annual cohorts between 2012 and 2014 completed the questionnaires at the beginning of the program. The fellows comprised 57.7% of all participants. A majority of the partic- ipants were white (69.7%) and had graduate degrees (52%). The mean age was 42 years and average RN experience was 15 years (Table 1).

The mentors had statistically significant higher scores for EBP beliefs (66.6 vs. 59.3; p < .001) and EBP implementation (24.2 vs. 11.0; p < .001) in comparison with the fellows. How- ever, there were no statistically significant differences in job satisfaction, group cohesion, or group attractiveness between the mentors and the fellows (Table 2).

Bivariate Correlations among Demographics and Other Variables Table 3 shows that the demographic variables of being a mentor, clinical nurse specialist, nurse educator, or nurse practitioner, as well as having a graduate-level education, had statistically significant positive correlations with both EBP beliefs and EBP implementation. Length of RN experience also correlated with EBP implementation and having a graduate- level education was the only demographic variable that corre- lated with job satisfaction. None of the demographic variables had positive correlations with either group cohesion or group attractiveness.

For EBP implementation, positive correlations were ob- served with EBP beliefs (r = 0.47; p < .001) and job satisfaction (r = 0.17; p = .029). However, no statistically significant cor- relations were found between EBP implementation and group

Original Article Table 1. Demographic Characteristics (N = 175)

Total Fellows Mentors

Variables (N = 175) (n = 101) (n = 74) Cohorts

2012 cohort 42 (24.0) 20 (19.8) 22 (29.7)

2013 cohort 60 (34.3) 40 (39.6) 20 (27.0)

2014 cohort 73 (41.7) 41 (40.6) 32 (43.2)

Age,mean (year), range 42 (23-68) 39 (23-68) 46 (27-67)

Ethnicity

White (non-Hispanic) 122 (69.7) 66 (65.3) 56 (75.7)

Black 5 (2.9) 3 (3.0) 2 (2.7)

Hispanic 11 (6.3) 6 (5.9) 5 (6.8)

Asian/Pacific Islanders 29 (16.6) 19 (18.8) 10 (13.5)

Other 8 (4.5) 7 (6.9) 1 (1.4)

Educational level

Diploma/associate 8 (4.6) 8 (7.9) 0 (0.0)

Baccalaureate 76 (43.4) 70 (69.3) 6 (8.1)

Master/doctorate 91 (52.0) 23 (22.8) 68 (91.9)

Nursingposition

Clinical nurse 73 (41.7) 67 (66.3) 6 (8.1)

Leadnurse 20 (11.4) 13 (12.9) 7 (9.5)

Nursemanager 12 (6.9) 1 (1.0) 11 (14.9)

CNS/nurse educator/NP 64 (36.6) 15 (14.9) 49 (66.2)

Non-nursing 6 (3.4) 5 (5.0) 1 (1.4)

RNexperience,mean (year), range 15 (1, 42) 12 (1, 35) 20 (2, 42)

ANCCcertification in specialty 94 (53.7) 48 (47.5) 46 (62.2)

Note. Values are expressed as n (%) unless otherwise indicated. Percentagesmay not add up to 100% because of missing data or rounding. ANCC = American NursesCredentialingCenter; CNS = clinical nurse specialist; NP = nursepractitioner; RN = registerednurse.

cohesion or group attractiveness. For job satisfaction, there were positive correlations with EBP beliefs (r = 0.26; p = .01) and group attractiveness (r = 0.23; p = .003). There was also a positive correlation between group cohesion and group attrac- tiveness (r = 0.49; p < .001; Table 3).

Multivariate Analysis: EBP Beliefs as a Predictor of EBP Implementation In the first step of a hierarchical multiple regression model, the demographic variables, including being a mentor, edu- cational level, years of RN experience, and nursing position accounted for 22.5% of the variance in EBP implementation

(R2 = 0.225; Table 4). The entry of the EBP beliefs in the second step increased the R2 by .075, indicating that the EBP beliefs explained a small fraction of the variance in the EBP implementation above and beyond the demographic variables (7.5%). Being a mentor (β = 0.27; p = .012) and EBP beliefs (β = 0.33; p < .001) were statistically significant predictors of EBP implementation.

Multivariate Analyses: Predictors of Job Satisfac- tion, Group Cohesion, and Group Attractiveness Table 5 shows that demographic variables in the first step of a hierarchical multiple regression model accounted for 6.2%

Predictors of EBP Implementation, Job Satisfaction, and Group Cohesion

Table 2. Comparison of Mean (± SD) of Variables Between Mentors and Fellows (N = 170)

P value

Fellows Mentors independent

(n = 98) (n = 72) (t test) EBPbeliefs 59.3 (6.38) 66.6 (6.91) < .001***

EBP implementation 11.0 (10.6) 24.2 (16.9) < .001***

Job satisfaction 16.6 (2.18) 17.0 (2.34) .215

Groupcohesion 20.1 (4.39) 20.6 (4.67) .479

Groupattractiveness 11.7 (1.67) 11.8 (1.83) .653

Note. ***p < 0.001. SD = standard deviation. The higher the scores, the higher the EBP beliefs, EBP implementation, job satisfaction, group cohesion, andgroupattractiveness.

of the variance in job satisfaction (R2 = 0.062). The entry of EBP beliefs and EBP implementation in the second step in- creased the R2 by 0.050, indicating that these two variables ex- plained a small fraction of the variance in job satisfaction above and beyond demographic variables (5.0%). EBP beliefs was a statistically significant positive predictor of job satisfaction (β = 0.25; p = .011), but EBP implementation was not a predictor of job satisfaction.

For group cohesion, the demographic variables in the first step explained 1.8% of the variance of group cohesion (R2 = 0.018). The EBP beliefs and EBP implementation in the second step explained 0.2% of the variance of group cohesion (R2 = 0.002), indicating that these two variables explained only a minimal fraction of variance in group cohesion above and beyond the demographic variables.

For group attractiveness, the first entry of demographic variables accounted for 1.0% of the variance of the group at- tractiveness (R2 = 0.010). The entry of EBP beliefs and EBP implementation in the second step changed the R2 by 0.038, indicating that they explained a minimal fraction of the vari- ance in group attractiveness (3.8%). EBP implementation was a statistically significant negative predictor for group attractive- ness (β = -0.22; p = .021; Table 5).

Table 3. Bivariate Correlations Among Variables

EBP beliefs

EBP implementation

Job satisfaction

Group cohesion

Group attractiveness

Mentors 0.48*** 0.43*** 0.10 0.06 0.04

Educational level

Diploma/associate −0.19* −0.03 −0.02 −0.19* 0.01 Baccalaureate −0.43*** −0.37*** −0.15* −0.002 −0.06 Master/doctorate 0.51*** 0.38*** 0.16* 0.01 0.07

Years of RNexperience 0.13 0.16* 0.02 0.04 0.04

Nursingposition

Clinical nurse −0.33*** −0.28*** 0.04 −0.01 −0.07 Leadnurse −0.02 −0.001 −0.19* −0.04 −0.02 Nursemanager 0.07 −0.02 −0.07 0.11 0.04 CNS/nurse educator/NP 0.34*** 0.32*** 0.09 −0.02 0.01

EBPbeliefs 1 0.47*** 0.26** −0.02 0.09 EBP implementation 0.47*** 1 0.17* −0.02 −0.11 Job satisfaction 0.26** 0.17* 1 0.09 0.23**

Groupcohesion −0.02 −0.02 0.09 1 0.49***

Groupattractiveness 0.09 −0.11 0.23** 0.49*** 1 Note. *p < .05; ** p < .01; *** p < .001 byPearson’s correlations.

Original Article Table 4. Multivariate Analysis: Predictors of EBP Im- plementation

EBP implementation

Predictors B β

Step 1

Constant demographic variables a 15.4

R2 = 0.225***

Step2

Constant −27.0 Mentor 8.25* 0.27*

EBPbeliefs 0.66*** 0.33***

R2 � = 0.075***

F� (1, 160) = 17.22***

Note. *p < 0.05; *** p < 0.001. aDemographic variables of being amen- tor, educational level, years of RN experience, and nursing position were entered.

DISCUSSION The study findings indicate that EBP beliefs had a signifi- cant correlation with EBP implementation in bivariate anal- ysis, and was a positive predictor of EBP implementation in multivariate analysis. In addition, EBP beliefs showed a signif-

icant correlation with job satisfaction in bivariate analysis and was also a positive predictor of job satisfaction in multivariate analysis. These results are consistent with previous findings and support the ARCC model, which postulates that strong EBP beliefs result in high levels of EBP implementation (Melnyk et al., 2010).

Although these study findings indicate that EBP implemen- tation has some correlation with job satisfaction in a bivariate analysis, the multivariate analysis showed a surprising finding that EBP implementation was not a predictor of job satisfac- tion. In addition, EBP implementation was not a significant predictor of group cohesion or group attractiveness in mul- tivariate analyses. Furthermore, EBP implementation was a significant negative predictor of group attractiveness, indicat- ing that high levels of EBP implementation are associated with lower group attractiveness. These unexpected findings from multivariate analyses appear to conflict with the ARCC model, which postulates that high levels of EBP implementation re- sult in high job satisfaction as well as high group cohesion (Melnyk et al., 2010). However, these findings are consistent with a previous report showing no statistically significant cor- relations between EBP implementation and job satisfaction or group cohesion (Melnyk et al., 2010). Also, an interventional study of implementing the ARCC model showed no signifi- cant effect on job satisfaction, in spite of improvements in EBP implementation (Levin, Fineout-Overholt, Melnyk, Barnes, & Vetter, 2011). It is possible that these findings showing no significant relationship between EBP implementation and job satisfaction or group cohesion are due to small sample sizes, which could have prevented detection of small effects. Further studies are needed to confirm this study findings.

Table 5. Multivariate Analyses: Predictors of Job Satisfaction, Group Cohesion, and Group Attractiveness

Job satisfaction Groupcohesion Groupattractiveness

Predictors B β B β B β

Step 1

Constant 17.0 19.3 12.1

demographic variables a

R2 = 0.062 R2 = 0.018 R2 = 0.010 Step2

Constant 12.2 20.9 10.2

EBP implementation 0.01 0.06 −0.01 −0.03 −0.03* −0.22 EBPbeliefs 0.07* 0.25* −0.02 −0.04 0.04 0.16

R2 � = 0.050* R2 � = 0.002 R2 � = 0.038*

F� (2, 157) = 4.47* F� (2, 162) = 0.16 F� (2, 157) = 3.12*

Note. *p < 0.05. aDemographic variables of being amentor, educational level, years of RNexperience, andnursingpositionwere entered.

Predictors of EBP Implementation, Job Satisfaction, and Group Cohesion

It was not surprising that mentors, given their longer years of RN experience, higher levels of education, and nursing positions as advanced practice nurses (clinical nurse special- ists, nurse educators, or nurse practitioners), had significantly stronger EBP beliefs and greater EBP implementation. These findings are consistent with previous reports showing that higher levels of education correlated with higher EBP be- liefs and EBP implementation (Underhill et al., 2015). It is interesting that the mentors did not have higher job satis- faction, group cohesion, or group attractiveness, in spite of having higher EBP implementation. This is consistent with the aforementioned findings from this study, as well as previ- ous reports that EBP implementation is not necessarily asso- ciated with higher job satisfaction or group cohesion (Melnyk et al., 2010).

Since its inception in 2006, our regional collaborative EBP fellowship program has been in continuous operation, and has successfully educated more than 400 nurses and nurse lead- ers from 12 local hospitals to date. With solid and consistent organizational support from local hospitals and academic insti- tutions, the fellowship program has been able to pool resources and expertise from these organizations to empower participat- ing nurses to execute unit-based EBP projects (Kim et al., 2013). The fellows and mentors, equipped with EBP knowledge and skills, along with strong EBP beliefs, become EBP champi- ons in their own hospital units and serve as role models for their colleagues (Melnyk, 2007). We believe that our regional EBP fellowship program in Southern California can serve as a template for other regional organizations to come together and collaborate in fostering EBP implementation across mul- tiple hospitals in their own regions, with the ultimate aim of improving quality of care and patient outcomes.

Limitations There are several limitations to this study. First, the study find- ings of EBP beliefs as a significant predictor of EBP implemen- tation and job satisfaction should not be taken as cause-and- effect relationships in this descriptive cross-sectional study. Second, the subjective self-reporting methods of the study questionnaire may have overestimated respondents’ percep- tions about their beliefs in the value of EBP, EBP implemen- tation, and job satisfaction. Third, the fellowship participants were selected from a group of staff nurses who had already demonstrated high motivation for EBP adoption. Due to the potential sample selection bias, the study findings may not be generalizable to other nursing staff. Fourth, although the in- struments used in this study have been validated previously, the items may not have fully captured the intended concepts. Further refinements of the instruments could show differ- ent results. Finally, even though the study population came from multiple institutions, the findings are from one region in Southern California and may not be generalizable to other regions.

Future studies are needed to conduct an interventional study to evaluate the beneficial effects of regional fellowship

programs on EBP beliefs, EBP implementation, job satisfac- tion, and group cohesion. There is a need for further empir- ical research evidence to support relationships in the ARCC model.

CONCLUSIONS The baseline data collected from the participants of a regional collaborative fellowship program involving multiple local hos- pitals and academic institutions over a 3-year period indicated that strong EBP beliefs was a positive predictor of EBP imple- mentation and job satisfaction. However, no significant rela- tionships were found between EBP implementation and job satisfaction or group cohesion when demographic variables were taken into account. Further studies are needed to evalu- ate the impact of regional collaborative fellowship programs on EBP beliefs, EBP implementation, job satisfaction, and group cohesion among the participants, as well as to generate addi- tional evidence for the ARCC model. WVN

LINKING EVIDENCE TO ACTION

� A regional, collaborative EBP fellowship program utilizing institution-matched mentors should be encouraged to advance EBP because such pro- grams may be effective in improving EBP beliefs, EBP implementation, and job satisfaction.

� Support from participating institutions is essential for the success of a regional, collaborative EBP fellowship program.

� Strong beliefs in the value of EBP appear to be associated with high levels of EBP implementation and job satisfaction among the fellowship program participants.

� No significant relationship was found between EBP implementation and job satisfaction or group cohesion when demographic variables were taken into account; further studies are needed to confirm these unexpected study findings.

Author information

Son Chae Kim, Professor, St. David’s School of Nursing, Texas State University, Round Rock, TX; Jaynelle F. Stichler, Pro- fessor Emerita, San Diego State University; Consultant, Re- search and Professional Development, Sharp Memorial Hos- pital and Sharp Mary Birch Hospital for Women & Infants, San Diego, CA; Laurie Ecoff, Director of Research, Education, and Professional Practice, Sharp Memorial Hospital, San Diego, CA; Caroline E. Brown, Research Consultant, Bonita Springs, FL; Ana-Maria Gallo, Director of Nursing Education, Research and Professional Practice, La Mesa, CA; Judy E. Davidson,

Original Article EBP/Research Nurse Liaison, University of California San Diego Health System, San Diego, CA

Address correspondence to Dr. Son Chae Kim, Professor, St. David’s School of Nursing, Texas State University, 1555 Univer- sity Blvd., Round Rock, TX 78665; [email protected]

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