The ICER Model© measure of an evidence-based nursing culture

Abstract

Evidence-based practice (EBP) is defined as the use of current best evidence in making decisions about the care of individual patients. The magnitude of emphasis on EBP within the healthcare industry is articulated in the Institute of Medicine's (IOM) agenda that by 2020, 90% of clinical decisions will be supported by accurate and up-to-date clinical information that reflects the best available evidence. In contrast, medical practice based on best evidence may be as low as 25-50% and even lower within the nursing profession. The importance of objective measures toward fully achieving an evidence-based culture is supported in the IOM's call for the development of measures to "track and stimulate progress" of the EBP quest and in the Magnet Recognition Program® inclusion of empirical outcomes as the foundation of their model for exemplary nursing practice. Yet, no sufficiently comprehensive scales for measuring an evidence-based healthcare or nursing culture are available. Hence, the objective of this study was to develop a reliable and valid measure of the intrapersonal, interpersonal, and organizational predictors (i.e., attitudes, knowledge, social norms, and organizational controls) of the behaviors necessary for achieving an evidence-based nursing culture (EBNC). Using a modified version of the Theory of Planned Behavior, survey statements were developed to represent the predictors associated with each of four essential behaviors embedded within the ICER Model for Achieving an Evidence-Based Healthcare Culture©. Following pilot testing at a medical center, the survey was disseminated electronically to approximately 1500 nurses working at a larger health system. Structural equation modeling analyses conducted on survey responses from 559 nurse participants were used to establish a scale with acceptable internal structure and psychometric properties. This measure offers a diverse range of applications that includes evaluating progress toward achieving, and the accuracy and efficiency of interventions designed to promote, an EBNC.