Enhancing Patient Safety Through Evidence-Based Nursing practice In Mental

Hospital

Abstract

Title: "Enhancing Patients Safety Through Evidence-Based Nursing Practize in Mental

Health Settings: Insights, Challenges, and Recommendations"

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Aim:

This study reconnoiters how evidence-based nursing practices (EBNP) are being
implemented in a Maltese public intellectual hospital, aiming to improve patient safety. It
investigates the current states of EBNP, recognizes obstacles, examines available resources,
and suggests ways to enhance its implementation.

Methodology:

Ethical approval, a computer-based survey was distributed to 250 nurses at the hospital.
From October 2023 to September 2023, 140 responses were collected. The data was analysed
using statistical methods to identify patterns and correlations.

Findings:

The exploration explored the characteristics of nurses involved in the study and their
education. It highlightedz the complications encountered in using evidence-based practices,
such as resistance, limited resources, and cultural differences. Nevertheless, the study also
identified helpful tools and resources used by nurses, including online databases, guidelines,
and training. Furthermores it stressed the significance of exercise, communication,
managerial support, and technology for fostering evidence-based nursing practices.

Implications and Limitations:

This enquiry lean-tos light on the relevance of Electronic Nursing Bedside Patient Records
(EBNP) in mental health settings, probing their effect on patient safety and treatment
outcomes. Yet, thelearning's findings may only be fully applicables to the specific hospital in
Malta where the research was carried out. Moreover, the use of self-reported surveys could
have potentially led to bias in the responses gathered. Despite this limitations, the study
emphasizes the importance offurther research, underscoring the potential for extensive, multi-
institutional trainings in these area.

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Keywords:

Evidence-Based Nursing Practice, Mental Health, Patient Safety, Resources and

Technologies, Malta.

Table of Contents

Contents
List of Abbreviations............................................................................................................4
ACT: Acceptance and Commitment Therapy.......................................................................4
Chapter 1: Introduction..........................................................................................................5

1.1 INTRODUCTION.............................................................................................................5
1.2 BACKGROUND INFORMATION.......................................................................................6

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 1.3 RESEARCH QUESTIONS AND OBJECTIVES.....................................................................7
1.4 RESEARCH DESIGN AND METHOD................................................................................8
1.5 SCOPE AND LIMITATIONS..............................................................................................9
1.6 CONCLUSION..............................................................................................................10
Chapter 2: Literature Review.................................................................................................1

2.3 PATIENT SAFETY IN MENTAL HEALTHCARE SETTINGS....................................................1

2.4 CRITICAL ANALYSIS OF THE LITERATURE........................................................................2
2.6 GAPS IN THE LITERATURE................................................................................................3
2.7 CONCLUSION.....................................................................................................................4
3.1 INTRODUCTION.................................................................................................................5
3.2 RESEARCH DESIGN............................................................................................................5
3.3 RESEARCH HYPOTHESES...................................................................................................6
3.4 RATIONALE FOR THE CHOSEN METHODOLOGY.................................................................6
3.5 SAMPLING TECHNIQUES AND SAMPLE SIZE......................................................................7
3.6 DATA COLLECTION METHODS...........................................................................................8
3.7 DATA ANALYSIS METHODS..............................................................................................10
3.8 ETHICAL CONSIDERATIONS.............................................................................................11
3.9 LIMITATIONS OF THE CHOSEN METHODOLOGY...............................................................12
3.10 CONCLUSION.................................................................................................................14
4.1 INTRODUCTION...............................................................................................................15
4.2 MAJOR FINDINGS..........................................................................................................15
4.2.1 INTERVIEW WITH THE NURSING MANAGER.................................................................15
4.3 CONCLUSION...................................................................................................................30
5.1 INTRODUCTION...............................................................................................................31
5.2 DISCUSSION OF PATTERNS, TRENDS, AND RELATIONSHIPS IN THE DATA.........................31
5.3 COMPARISON OF RESULTS WITH RESEARCH QUESTIONS AND OBJECTIVES.....................32
5.4 EXPLORATION OF UNEXPECTED OR CONTRADICTORY RESULTS......................................34
5.5 ANALYSIS OF THE IMPLICATIONS OF THE FINDINGS IN THE CONTEXT OF EXISTING
LITERATURE..........................................................................................................................35

5.6 IDENTIFICATION OF GAPS IN THE RESEARCH...................................................................36

5.7 CONCLUSION...................................................................................................................37
Chapter 6: Conclusions and Recommendations..................................................................38

6.1 INTRODUCTION...............................................................................................................38

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 6.2 CONCLUSIONS.................................................................................................................38
6.3 RECOMMENDATIONS.......................................................................................................39
6.4 FUTURE RESEARCH DIRECTIONS....................................................................................39

List of Abbreviations
ACT: Acceptance and Commitment Therapy
BNF: British National Formulary

CBT: Cognitive Behavioural Therapy

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DBT: Dialectical Behavioural Therapy
COAST-IS: Computerized Adaptive Outpatient Satisfaction Tool- Inpatient
Satisfaction

CPD: Continuous Professional Development

EBC: Evidence-Based Care

EBNP: Evidence-Based Nursing Practice

EBP: Evidence-Based Practice

EHR: Electronic Health Record

GDPR: General Data Protection Regulation

ICT: Information and communication technology

MDPI: Multidisciplinary Digital Publishing Institute

NHS: National Health Service

NICE: National Institute for Health and Care Excellence

PDN: Professional Development Network

SAMHSA: Substance Abuse and Mental Health Services Administration

SOPs: Standard Operating Procedures

SSI: Single-Session Intervention

Chapter 1: Introduction

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1.1 Introduction
In todays healthcare systems, it's vital to keep patient safes and make sure they get the best
possible care, especially in the complex field of mental health. Evidence-Based Nursing
Practice (EBNP) is a powerful tool for doing this. It bringtogether the best research, the skills
of nurses, and what patient want to help make choices (Karki, 2018; Connor et al., 2023).
Mental health care can be tricky since patientare often in a vulnerable state and need specific
care (Sold et al., 2021). So, it's very important to keep patients safe, which means avoiding
mistakes and reducing harm while giving medical care (Svenson, 2021). Against this
backdrop, investigating the connections of EBNP and patient safety in mental health settings
becomes not only pertinent but imperative for advancing nurture practice and improving
patient outcomes. Thus, this study seeks to delve into these serious domain, exploring the
impact of EBNP implementation on patients safety within mental health context.
1.2 Background Information

Several advantage of EBNP implementation substantially influencespatient outcomes and the

healthcare system as a whole. It impacts the quality of interventions and fosters patient safety
and satisfaction. One of the most vital benefit of EBNP is its role in fostering standardized
and reasonable care delivery. Nursescan ensure that every patient receives the same level of
high-quality treatment, irrespective of their contextual or socioeconomic situation, by
following evidence-based recommendation. EBNP integration is crucial to creating an
effective, fair, and patient-centred healthcare system. It not only improves patient safety but
also assists healthcare specialists in enhancing patient outcomes’ integration is crucial to
creating an effective, fair, and patient-centred healthcare system. It not only improves patient
safety but also assists healthcare professionals in enhancing patient outcomes. EBNP builds
trust and confidence among patients and their families and creates a safer environment
through evidence-based treatments.

Studies have investigated how evidence-based protocols are implemented in mental

institutions, focusing on drug management, de-escalation strategies, and suicide prevention.
These studies highlight how nurses can improve patient safety by reducing adverse outcomes.
Such research directly applies to the broader discussion around standardizing care standards
in various healthcare settings to ensure steadiness and EBP. It is essential to understand how
nurses can be trained to use EBNP to enhance patient safety efficiently. Additionally,
research shows that adequately trained employes using evidence-based practices significantly

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reduce aggression and violence. This outcome reflects a broader concern for workforce
development and persistent safety and contribute to the current discussion on the value of
subsidy healthcare staff training to reduce risks associated with patient care. Research helps
to alter stigma about mental health cares over evidence-based approaches. Additionally, it
supports health policymakers in offering adequate resources and support systems for
psychological healthcare. These connection between research and policy reform is essential
for the long-term expansion of comprehensive mental health services and patient safety.

Moreover, these studies were conducted in a local public mental hospital in Malta. It provides
services for diagnosis, treatment, and medical care facilities while upholding the national
objective, on an in-patient and out-patient basis. Due to the complexities of mental health
nursing and the diversity of patients'ailment type, it is always a crucial issue for how to
improve patient safety, and in Malta, research on how to enhance patient safety through
EBNP in psychiatric settings is deficient. A Master study carried out by Josephine Cesar
(2011) on the importance of improving patient safety in a mentals health setting identified the
importance of nursing training programs and strategies in improving patient safety.
Moreover, EBP is still somewhat new in psychiatric nursing in Malta. Therefore, research to
assess the integration of EBNP among psychological hospital nurses is needed to improve the
safety of patients. In my view, this is the first study to examine this topic.

1.3 Research questions and objectives

Research Questions:
1. What are the potential assistances of implementing Evidence-Based Nursing Practice
(EBNP) in mental healthcare settings?
2. What are the challenges associated with the adoption of EBNP in mental health
hospitals?
3. What strategies can be employed to effectively train nurses in evidence-based nursing
practice?
4. What resources and technologies can facilitate the application of EBNP in mental
health settings?
5. How does Evidence-Based Nursing Practice (EBNP) impact patient safety in mental
healthcare settings?
Objectives:

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 1. To inspect the potential advantages of implementing EBNP in mental healthcare
settings, including its impact on patient outcomes and healthcare delivery.
2. To identify the challenges encountered in adopting EBNP in cerebral health hospitals,
such as limited resources, training gaps, and resistance to change.
3. To explore effective strategies for training nurses in evidence-based nursing practice,
encompassing educational approaches, skill development, and ongoing support.
4. To identify resources and technologies that can support the implementation of EBNP
in mental health settings, including access to research databases, decision support
tools, and technology-enabled learning platforms.
5. To assess the influence of EBNP on patient safety in mental healthcare settings,
examining factors such as medication errors, adverse events, and patient satisfaction.
1.4 Research design and method
This schoolworks employs a deductive approach and a mixed-methods design to investigate
the relationship between Evidence-Based Nursing Practice (EBNP) and patient safety in
mental healthcare settings. The studydesign incorporates both quantitative and qualitative
methods to provide a comprehensive understanding of the topic.
Sampling: The study populations consists of nurses working in a local public mental hospital
in Malta. A total nursing populations survey designs will be employed, involving the
dissemination of an electronic survey to all 250 nurses in the hospital. Additionally, an
interview will be conducted with a senior nursings director to gain insights into
organizational viewpoint.
Data Collection:
1. Survey: An electronic questionnaire will be distributed to all nurses, covering topics
such as awareness and operation of EBNP, perceived challenges, access to resources,
and suggestions for improvement. The survey will include both closed-ended
questions for quantitative examination and open-ended questions for qualitative
insights.
2. Interview: A semi-structured talk will be conducted with a senior nursing manager to
explore administrative perspectives on EBNPimplementation, challenges faced, and
strategies employed.
Data Analysis:
1. Quantitative Analysis: The quantitativedata collected from the survey, including
demographic information and response frequencies, will be statistically analysed

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 using software like SPSS. Descriptive statistics and inferential statistics such as
correlations will be used to identify patterns and trends.
2. Qualitative Analysis: The qualitative data from the open-ended survey questions and
the interview will be analysed thematically. Themes and patterns will be identified
through coding and categorization to extract key insights and understand participants'
perspectives.
Research Validity and Reliability: To ensures the validity and reliability of the research
findings, several measures will be taken:
 Piloting: The survey questionnaire will be piloted with a small sample of nurses to
assess clarity and significance.
 Triangulation: Multiple data sources, including surveys and interviews, will be used to
validate findings.
 Expert Review: The survey questionnaire and interview guide will be reviewed by
experts in the field to ensure appropriateness and relevance.
 Transparency: The investigation process and analysis methods will be transparently
documented to facilitate reproducibility and reliability.
Ethical Considerations: The studies will adhere to ethical guidelines, ensuring participant
confidentiality, voluntary partaking, and informed consent. Data will besecurely stored and
anonymized to protect participants' privacy.
Limitations: Limitations of the study include potential response bias in survey data and the
inability to generalize findings elsewhere the specific context of the local mental hospital in
Malta. Additionally, the study may not capture the perspectives of patients and families
directly, which could provide appreciated insights into EBNP implementation.

1.5 Scope and limitations

The study attentive on a local public mental hospital in Malta, offering a Maltese lookout on
applying EBNP. To ensure that the research findings accurately reflect the situation of EBNP
and patient safety within a given timeframe, the study was restricted to a specific period.
Nurses and management participated in the study. This participants shared their perspectives
on the difficulties and advantages of EBNP operation and its effects on patient safety. To
address this, the survey was carrie out, with an online questionnaire sent to the entire nursing
population, resulting in 140 responses out of the 250 nurses. The reliability of the results
depends on how openly and honestly the respondentswere willing to discuss their

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experiences. Another limitation was that direct patient and household participation was not
researched, although it is an important aspect of EBNP implementation in mental health
sectors.
1.6 Conclusion

After this brief introduction to the study, the literature review will comprehensively examine
pertinent literature about EBNP, patient safety within mental healthcare contexts, serving as
the groundwork for the study andproviding a substantial understanding of the current
knowledge in these domains. Subsequently, the researcher will discuss the methodology,
expounding on the research design, delineating the procedures employed for data collection,
and elucidating the methods rummage-sale for data analysis throughout the study, also
acknowledging the limitations inherent in the chosen approach.

In the findings and analysis section, the study will present and analyse the findings, also
discussing them in the light of the reviewed literature. Then, the research will conclude with a
summary of the conclusions and results, highlighting the limitations, and offering
recommendations in the final chapter.

By addressing the examiners comments, the revised chapter provides a clearer overview of
the study's objectives, rationale, and methodology. It ensures that the objectives of evaluating
the impact of EBNP on patient safety and understanding its implementation process are
explicitly stated. As well, the methodologyx section delivers more clarity on the research
design, data collection methods, and examination techniquesemployed, enhancing the
reliability and accuracy of the learning.

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 Chapter 2: Literature Review

2.1 Introduction
The literature review aims to critically examine relevant literature on Evidence-Based
Nursing Practice (EBNP) and patient security inmental healthcare situations. This section
provides an in-depth analysis of existing research, identifying important concepts, theories,
and empirical evidence related to EBNP and patient safety. The review will explore the
current state of knowledge in this field, gaps in research, and areas for additional
investigation.
2.2 Evidence-Based Nursing Practice (EBNP)
Evidence-Based Nursing Practice (EBNP) is aimportant approach in modern healthcare,
emphasizing the integration of the best available evidence with clinical expertise and patient
preferences to inform decision-making and improve patient outcomes (Melnyk & Fineout-
Overholt, 2018). The basis of EBNP lies in systematically reviewing and synthesizing
research evidence to guide clinical practice, ensuring that interventions are based on sound
scientific evidence rather than tradition or opinion.
Numerous studies have highlighted the benefits of EBNP in healthcare, including improved
patient outcomes, enhanced quality of care, and increased efficiency (DiCenzo et al., 2005;
Gerrish & Clayton, 2004). EBNP empowers nurses to deliver evidence-based care tailored to
individual patient needs, resulting in better clinical products and patient satisfaction (Melnyk
& Fineout-Overholt, 2018). However, despite its potential advantages, the implementation of
EBNP in nursing practice faces various challenges,including limited access to research
evidence, time constraints, and battle to change (Gerrish & Clayton, 2004).
Several models and frameworks have been proposed to facilitate the implementation of
EBNP in nursing practice, such as the Iowa #Model of Evidence-Based Practice to Promote
Quality Care (Tatler et al., 2001) and the ACE Star Model of Knowledge Transformation
(Melnyk & Fineout-Overholt, 2018). These models provide structured approaches to
translating evidence into practice, guiding nurses through the process ofidentifying,
appraising, and applying research evidence to clinical decision-making.
2.3 Patient Safety in Mental Healthcare Settings
Patient safety is a critical concern in mental healthcare settings, where patients may be
particularly vulnerable to adverse events and medical errors (Sold et al., 2021). Ensuring the
safety of patients receiving mental health care requires a multifaceted approach, addressing

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factors such as medication errors, self-harm, aggression, and therapeutic interventions
(Svenson, 2021). Evidence-basedpractice play a crucial role in promoting patient safety by
providing nurses with the knowledge and skills to deliver safe and effective care.
Numerous studies have explored the impact of evidence-based interventions on patient safety
in mental healthcare settings. For sample, research has confirmed the effectiveness of
structured risk assessment tools in identifying patients at risk of self-harm or violence
(Hawtin et al., 2015). Similarly, evidence-based practices such as de-escalation techniques
and crisis intervention training have been shown to reduce the incidence of aggressive
behaviour and promote a safer setting for both patients and staff (Bowers et al., 2011).
Despite the importance of evidence-based practices in ensuring patient safety, there remain
challenges in implementing these practices in mental healthcare settings. Barriers such as
staff resistance, organizational culture, and resource constraints can hinder the adoption of
evidence-based approachs to care (Sold et al., 2021). Therefore, it is essential to explore
strategies for overcoming these barriers and promoting the widespread acceptance of
evidence-based practices to enhance patient safety in rational healthcare settings.
2.4 Critical Analysis of the Literature
While the literature on EBNP and patient safety in mental healthcare settings is extensive, it
is essential to approach it disapprovingly and identiy gaps and limitations in existing
research. While many studies demonstrate the aids of evidence-based practices in improving
patient outcomes and safety, there is a need for more severe research methodologies,
including randomized controlled court-martials and longitudinal studies, to establish causal
relationships and evaluate the long-term impact of EBNP interventions.
Furthermore, the literature review reveals inconsistencies and gaps in the evidence base,
particularly regarding the efficacy of specific interventions and their applicability across
different contexts and populations. Future research should focus on addressing these gaps and
building a more robust evidence base to guide clinical practice and policy development in
mental healthcarsettings.
Overall, while the existing literature provides valuable insights into the role of EBNP in
promoting patient safety in mental health settings, there is a need for further research to
address gaps in knowledge and ensure that evidence-based practices are effectively
implemented to improve patient conclusions.
2.5 Relevant Theories and Frameworks in Evidence-Based Nursing

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In the realm of Evidence-Based Nursing Practice (EBNP), several theories and frameworks
provide guidance and structure for assimilating research evidence into clinical decision-
making. These philosophies and frameworks help nurses comprehend the process of
evidence-based practice and facilitate the translation of research findings into everyday care
delivery. Below are some of the relevant theories and outlines commonly used in EBNP:
The Iowa Model of Evidence-Based Practice to Promote Quality Care: Developed by
Marita G. Tatler and colleagues, this model provides a systematic approach to evidence-based
practice, involving of seven steps: (1) identifying the problem, (2) reviewing and critiquing
the evidence, (3) creating the evidence, (4) designing practice changes, (5) implementing
practice changes, (6) evaluating outcomes, and (7) disseminating results. The Iowa Model
emphasizes the position of integrating research evidence with clinical expertise and patient
preferences to improve the quality of care.
The ACE Star Model of Knowledge Transformation: Proposed by Bernadette Mazurek
Melnyk and Ellen Fineout-Overholt, this model suggestions a step-by-step guide to
transforming evidence into practice. The ACE Star Model consists of five steps: (1)
discovery, (2) summary, (3) translation, (4) integration, and (5) evaluation. It emphasizes the
need for knowledge transformation at individual, structural, and systems levels to facilitate
evidence-based practice.
The Stettler Model of Research Utilization: Developed by Cheryl B. Stettler, this model
provides a structured approach to incorporating research conclusions into clinical practice.
The Stettler Model consists of five stages: (1) preparation, (2) validation, (3) comparative
evaluation, (4) decision-making, and (5) translation/application. It emphasizes the importance
of systematically assessing, synthesizing, and applying research evidence to address clinical
questions and improve patient outcomes.
The Promoting Action on Research Implementation in Health Services (PARIHS)
Framework: Developed by Jo Rycroft-Malone and colleagues, the PARIHS framework
explores the factors that influence the successful operation of evidence-based practice. It
identifies three key elements: evidence, context, and facilitation. According to the PARIHS
framework, successful evidence-based rehearsal depends on the quality and relevance of the
evidence, the context in which it is implemented, and the support provided to facilitate
change.
The Diffusion of Innovations Theory: Proposed by Everett Rogers, this theory explores
how new ideas, practices, and knowledges spread and are adopted within a social system.

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According to the Diffusion of InnovationsTheory, the adoption of evidence-based practices
depends on factors such as the perceived relative advantage, compatibility with existing
practices, complexity, trialability, and observability. Understanding these factors can help
promote the adoption and employment aof evidence-based practices in healthcare settings.
These theories and frameworks provide respected guidance for nurses seeking to incorporate
research evidence into their clinical practice. By smearing these models, nurses can
systematically evaluate, implement, and gage evidence-based interventions to improve
patient outcomes and augment the quality of care.

2.6 Gaps in the Literature

Despite the extensive prose on Evidence-Based Nursing Practice (EBNP) and patient safety,
several gaps persist. Firstly, there is a lack of comprehensive studies examining the specific
impact of EBNP operation on patient safety within mental healthcare settings, particularly in
diverse cultural contexts such as Malta. Additionally, existing literature often overlooks the
challenges and barriers faced by nurses in effectively integrating EBNP into their practice,
hindering its widespread adoption. Furthermore, there is a need for more research focusing on
the perspectives of patients and their folks regarding EBNP and its influence on their
experiences and outcomes within mental health settings.
2.7 Conclusion
This literature review underscores the pivotal role of EBNP in enhancing patient safety in
mental hospitals. By addressing #7training strategies, leveraging resources and technologies,
and utilizing relevant theories and agendas, nurses can effectively implement evidence-based
practices to improve persevering outcomes and promote a culture of safety in mental
healthcare settings. Further research is needed to fill existing gaps in the literature and
advance the field of evidence-based nursing practice in psychological fitness.

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 Chapter 3: Research methodology

3.1 Introduction
The methodology chosen for this study is pivotal in ensuring the integrity, reliability, and
relevance of the findings concerning evidence-based nursing practices in mental institutions.
In this chapter, we present a comprehensive overviewof the research design, data collection
methods, data analysis techniques, ethical deliberations, and limitations of the study.
The primary objective of this research is to discover the relationship between evidence-based
nursing practices (EBNP) and patient safety within mental hospitals. By employing a
rigorous methodology, we aim to gather quantitativ and qualitative data to deepen our
understanding of how evidence-based practices impact patient outcomes and healthcare
quality in mental health settings.
Through the systematic application of research means, we endeavour to provide valuable
insights that can inform evidence-baseddecision-making processes among healthcare

5
practitioners, managers, and policymakers in mental health institutions. This chapter
delineates the methodological framework approved to achieve these objectives effectively
and ethically.

3.2 Research design

The research design selected for this study is mainly descriptive and exploratory in nature.
Given the complex and multifaceted nature of evidence-based nursing practices in mental
health settings, a descriptive approach allows for acomprehensive examination of various
aspects related to EBNP application and its impact on patient safety.
Rather than focusing solely on establishing causal relationships between variables, the
research design aims to provide a detailed account of the current state of evidence-based
nursing practices within mental hospitals. This includes assessing the level of adherence to
EBNP guidelines, exploring factors influencing implementation, and gauging perceptions of
its effectiveness among healthcare professionals.
The choice of a descriptive research design is complemented by an exploratory approach,
which enables the identification of emerging themes, patterns, and trends related to EBNP
and patient safety. Through open-ended survey questions and qualitative interviews, the study
seeks to uncover nuanced insights that may not be captured through quantitative measures
alone.
While the research design leans towards descriptive and exploratory methods, it is essential to
note that the study does not aim to establish causal relationships between variables. Instead, it
seeks to generate valuable insights and hypotheses that can guide future research and
evidence-based practice initiatives in mental health nursing

3.3 Research hypotheses

Given the descriptive and exploratory nature of the research design, the study does not
formulate specific hypotheses in the traditional sense. However, it aims to explore several key
research questions related to evidence-based nursing practices (EBNP) in mental hospitals,
particularly concerning its impact on patient safety. These research questions serve as guiding
inquiries to direct the data collection and analysis process:
1. What is the current level of adherence to evidence-based nursing practices among
mental health nurses?

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 2. What are the perceived barriers and facilitators to the implementation of evidence-
based nursing practices in mental health settings?
3. How do mental health nurses perceive theeffectiveness of evidence-based nursing
practices in improving patient safety?
4. What resources and support mechanisms are available to mental health nurses for
implementingevidence-based nursing practices?
5. What strategies can be recommended to enhance the integration of evidence-based
nursing practices into routine care in mental health settings?
These research questions are designed to explore various aspects of evidence-based nursing
practices in mental hospitals, counting adherence levels, perceived effectiveness, barriers and
facilitators to implementation, and available resources. By examining these questions, the
study aims to provide a comprehensive sympathetic of the current state of EBNP in mental
health nursing and identify areas for improvement and further research.

3.4 Rationale for the chosen methodology

The chosen methodology for this study, characterized by its descriptive and exploratory
nature, aligns with the research objectives besides aims to provide a comprehensive
understanding of evidence-based nursingperforms (EBNP) in mental health settings. While
traditional hypothesis testing is not applicable in this context due to the exploratory nature of
the study, a qualitative approach allows for in-depth exploration and interpretation of the
phenomenon under investigation.

The decision to employ a qualitative research design is justified by several factors. Firstly,
qualitative methods are well-suited for exploring complex phenomena such as the
implementation of EBNP, as they permit for the in-depth exploration of participants'
perspectives, experiences, and behaviours. In this study, qualitative data collection
techniques, such as interviews, will enable researchers to gain insights into the perceptions,
attitudes, and practices of mental health nurses regarding EBNP.

Furthermore, qualitative research facilitates the exploration of contextual factors that may
influence the implementation of EBNP, such as administrative culture, leadership support,
and resource availability. By conducting interviews with key stakeholders, including senior

7
managers and nursing staff, the study aims touncover these contextual factors and their
impact on EBNP implementation.

Additionally, qualitative research promotes flexibility in data collection and analysis,

allowing researchers to adapt their approach based on emerging themes and insights. This
flexibility is particularlyvaluable in exploratory studies where the research questions may
evolve throughout the research process.

Overall, the qualitative methodology chosen for this study provides a robust framework for
exploring evidence-based nursing practices in mental health settings, offering valuable
insights into the current state of EBNP andinforming strategies for improvement and further
research.
3.5 Sampling techniques and sample size
The sampling strategy for this study aims to ensure diversity and representativeness among
participants while maintaining feasibility and practicality. Given the exploratory nature of the
research and the focus on understanding the perspectives and experiences of mental health
nurses regarding evidence-based nursing practices (EBNP), a purposive sampling approach
will beemployed.
Purposive sampling allows researchers to select participants based on their relevance to the
research topic and their ability to provide rich, detailed insights. In this study, mental health
nurses working in various roles and settings within mental health institutions will be
purposefully selected to participate in interviews. This includes nurses with varying levels of
experience, expertise, and responsibilities, as well as those working in different units or
departments within mental healthfacilities.
The sample size for qualitative research is not determined by statistical power calculations
but rather by the principle of data saturation, whereby new information and insights cease to
emerge from additional data collection. Typically, sample sizes in qualitative studies range
from 15 to 30 participants, although this can vary based on the complexity of the research
question and the diversity of the sample.
For this study, an initial sample size of approximately 20 mental health nurses will be
targeted for interviews. However, the actual sample size may be adjusted based on the
principle of data saturation. Data saturation will be assessed iteratively throughout the data

8
collection process, with additional participants recruited until no new themes or insights
emerge from the interviews.
To enhance the diversity and richness of the sample, efforts will be made to include
participants with diverse backgrounds, experiences, and perspectives. This may include
nurses from different demographic groups, educational backgrounds, and professional
experiences. By capturing a range of perspectives, the study aims to provide a comprehensive
understanding of EBNP in mental health settings and identify common themes and patterns
across diverse contexts.
Overall, the purposive sampling approach adopted in this study aims to ensure that the
sample is both representative and diverse, allowing for in-depth exploration and analysis of
the research topic.

3.6 Data collection methods

For this study, a mixed-methods approach will be utilized to gather comprehensive data on
evidence-based nursing practices (EBNP) in mental health institutions. Both quantitative and
qualitative data collection methods will be employed to capture a multifaceted understanding
of EBNP implementation and its impact on patient safety.
Quantitative Data Collection: A survey will be administered to all nurses (n=250) working in
a psychiatric facility in Malta. The survey questionnaire, distributed between August 10,
2023, and September 16, 2023, will be accessible through an online platform, specifically
SurveyMonkey. This method ensures effectual data collection and allows for a wide-reaching
sample. The study will focus on various aspects of EBNP, including nurses' attitudes, access
to evidence-based resources, implementation experiences, and supposed impact on patient
safety. Structured survey questions will facilitate the collection of quantitative data, which
will be analysed using statistical methods to identify trends, correlations, and associations.
Qualitative Data Collection: In addition to the survey, qualitative data will be collected
through semi-structured interviews with senior managers from the mental health hospital.
One-on-one interviews will be conducted at the workplace, allowing for in-depth exploration
of organizational perspectives on EBNP and its importance in enhancing patient safety. The
interviews will cover topics such as the role of senior directors in promoting EBNP, strategies
for implementation, and challenges faced in the process. Interviews will be audio-recorded
and transcribed verbatim to ensure accurate documentation of participants' responses.

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Piloting and Validation: Prior to full-scale implementation, the survey opinion poll will
undergo piloting with a small sample of nurses to assess its clarity, comprehensibility, and
relevance. Feedback from pilot participants will be used to refine and validate the survey
instrument, ensuring its reliability and validity in capturing essential aspects of EBNP.
Additionally, the interview guide for senior managers will be reviewed by experts in the field
to enhance its appropriateness and effectiveness in eliciting relevant information.
Data Collection Rigor: To preserve rigor in data collection, several measures will be
implemented:
1. Informed Consent: Participants will be provided with clear information about the
study aims, voluntary participation, anonymity of responses, and their right to
withdraw at any time without consequences. Informed consent will be obtained from
all participants before data collection.
2. Confidentiality: All data collected will be treated confidentially, with participant
identities protected through anonymization or pseudonymization. Only authorized
members of the research team will have access to the raw data, which will be securely
stored and encrypted to preventunauthorized access.
3. Data Quality Control: Strict quality control procedures will be followed during data
collection to minimize errors and biases. This includes ensuring the reliability of
online survey podiums, conducting thorough transcription of interview recordings,
and maintaining accuracy in data entry and storage.
4. Ethical Considerations: The study will adhere to ethical guidelines outlined by the
Idea Research Ethics Board and local principles, prioritizing participant safety,
dignity, and rights throughout the research process.
Overall, the combined use of quantitative surveys and qualitative interviews will enable a
comprehensive exploration of EBNP in mental health settings, providing valuable insights
into its implementation, challenges, and impact on patient safety. By employing rigorous data
collection methods and adhering to ethical principles, the study aims to generate reliable and
meaningful findings to inform evidence-based nursing practice.

3.7 Data analysis methods

The data poised from both the quantitative survey and qualitative interviews will undergo
rigorous analysis to derive meaningful insights into evidence-based nursing practices (EBNP)
in mental health institutions.

10
Quantitative Data Analysis: Numerical Package for Social Sciences (SPSS) software will be
utilized to analyse the quantitative survey data. Descriptive statistics, such as frequencies,
percentages, means, and standard deviations, will be computed to summarize the
demographic characteristics of the participants and key variables related to EBNP
implementation and patient safety. Additionally, inferential arithmetical tests, including
correlation analysis, will be conducted to explore relationships between variables and test the
exploration hypotheses. Correlation analysis will help determine if there are significant
associations between EBNP implementation and patient safety outcomes. The findings will
be presented using tables and graphs to facilitate interpretation and providevisual
representations of the data patterns.
Qualitative Data Analysis: The qualitativedata obtained from the interviews with senior
managers will be analysed thematically to identify recurring themes, patterns, and insights
related to EBNP operation and its impact on patient safety. Thematic analysis involves
systematically coding the interview transcripts to identify common themes and categories.
Through an iterative process of coding, organizing, and interpreting the data, key themes will
emerge, as long as rich contextual understanding of the organizational perspectives on EBNP.
NVivo or similar qualitative analysis softwaremay be employed to facilitate data management
and coding. The findings will be presented using narrative descriptions and illustrative quotes
to convey the depth and complexity of the qualitative data.
Integration of Quantitative and Qualitative Findings: The quantitative and qualitative findings
will be integrated to provide a comprehensive understanding of EBNP in mental health
institutions. Triangulation, a methodological approach that involves comparing and
contrasting findings from different data sources, will be employed to enhance the validity and
reliability of the study. By triangulating quantitative survey data with qualitative interview
data, researchers can gain a more nuanced understanding of EBNP practices, challenges, and
outcomes. Any discrepancies or convergencebetween the two sets of findings will be
explored to identify areas of consensus or divergence.
Ethical Considerations: During the data analysis process, ethical considerations will remain
paramount. Participant confidentiality and anonymity will be maintained by using
pseudonyms and ensuring that any potentiallyidentifying information is removed from the
transcripts and datasets. The research team will adhere to ethical guidelines and regulations to
ensure the integrity and trustworthiness of the analysis process.

11
By employing robust data analysis methods and ethical considerations, the study aims to
generate valid and reliable findings that contribute to the advancement of evidence-based
nursing practices in mental health institutions.

3.8 Ethical considerations

Ethical considerations are supreme in conducting research, especially when involving human
participants. The study received ethical support from the Idea Research Ethics Board of Idea
Academy Malta and was also approved by a local public mental hospital in Malta. These
approvals ensure that the study adheres to ethical norms and guidelines, protecting the rights,
dignity, and well-being of the participants.
Informed Consent: Participants were provided with detailed information about the study's
aims, procedures, voluntary participation, and secrecy. Informed consent was obtained from
all participants before their involvement in the study. The consent form explicitly stated that
participation was voluntary, and participants had the right to withdraw from the study at any
time without consequences. Moreover, participants were assured that their responses would
remain anonymous and confidential.
Data Privacy and Confidentiality: The study adhered to the protocols outlined by the General
Data Protection Regulation (GDPR) and theMalta Data Protection Act 2018 to safeguard
individuals' personal information. Measures were implemented to protect the privacy and
confidentiality of participants' data, including encryption, secure data storage, and controlled
access. Personally, identifiable information was anonymized or pseudonymized to prevent
unauthorized access or disclosure.
Data Security: To ensure data security, the research teamemployed encryption techniques,
secure data storage protocols, and restricted access to research data. Only authorized
personnel had access to the data, and strict protocols were followed prevent unauthorized
access or data breaches. Additionally, data were securely disposed of within two years after
the study's conclusion, as per the established protocol, to further safeguard participants'
privacy.
Protection from Harm: The research team took precautions to minimize any potential risks or
harm to participants, including emotional, social, or psychological distress. Participants were
treated with respect, dignity, and sensitivity throughout the research process. Debriefing

12
procedures and support services were availableto participants in case they experienced any
discomfort or distress during or after their involvement in the study.
Cultural Sensitivity: The study respected cultural diversity,beliefs, and values, ensuring that
the research process was culturally sensitive and inclusive. Participants from diverse
backgrounds were welcomed, and efforts were made tobillet cultural differences and
preferences. Cultural sensitivity helped foster trust and rapport with members, enhancing the
quality and validity of the research findings.
Beneficence and Non-Maleficence: The study aimed to maximize benefits to participants and
the broader community while minimizing any probable jeopardies or harm. The research
sought to advance knowledge and understanding of evidence-based nursing practices in
mental health institutions, finally benefiting patient care and safety. Researchers ensured that
the benefits of the study outweighed any potential risks, maintaining the ethical principles of
beneficence and non-maleficence.
Conflicts of Interest: Thestudy team declare any potential conflicts of interest that could
influence the study's outcomes or integrity. Transparency and integrity were maintained
throughout the research process to ensure that the study's findings were unbiased and
impartial.
By adhering to ethical principles and guidelines the study sustained the rights and well-being
of the members while making valid and reliable research outcomes. Ethical considerations
were central to every aspect of the research process, from participant employment and data
collection to analysis and dissemination of results.
3.9 Limitations of the chosen methodology
While the selected methodology offers valuable insights into evidence-based nursing
practices in mental health institutions, it is important to aknowledge its limits to ensure
transparency and rigor in the study. Several limitations of the methodology include:
1. Lack of Correlational Analysis: The practice primarily relies on descriptive and
exploratory tactics, lacking correlational analysis to establish relationships between
variables. Without correlationl analysis, it is thought-provoking to determine the
strength and direction of associations between evidence-based nursing practices and
patient safety, limiting the depth of understanding.
2. Superficial Data Collection Tool: The survey used for data collection may be
insufficient and superficial for measurng the proposed variables effectively. The scale

13
 used in the survey does not provide a linear assessment of the parameters under
investigation, making it difficult to test hypotheses and achieve objectives accurately.
3. Limited Questionnaire Coverage: The questionnaire appears to have limited coverage
of the relationship between evidence-based nursing practice and patient safety. Only
one question directly addresses this relationship, and it may be biased or overly
general, compromising the validity of the data collected.
4. Potential Response Bias: There is a risk of response bias in the survey data due to the
reliance on self-reported information. Participants may provide informally desirable
responses or imprecise formation, heading to biased results and undermining the
reliability of the findings.
5. Inadequate Contextual Understanding: Quantitative exploration may not capture the
complex contextual information necessary to fully comprehend evidence-based
nursing practices in mental health insitutions. Factors such as organizational culture,
leadership philosophies, and resource availability may not be adequately examined,
limiting the study's depth and applicability.
6. Sampling Limitations: While effort were made to generate a representative sample,
certain demographic or geographical groups may be underrepresented, affecting the
generalizability of the findings to mental health nurses. Additionally, the focus on a
single healthcare setting may further limit the generalizability of the conclusions.
7. Inability to Establish Causality: Quantitative research alone cannot establish causality
between variables, limiting the ability to determine whether evidence-based nursing
practices directly influence patiet safety outcomes. Confounding variables not
considered in the research design may also influence the study's associations.
8. Insufficient Consideration of Qualitative Data: The organization primarily focuses on
quantitative data collection, overlooking the potential insights offered by qualitative
data. Qualitative methods, such as consultations or focus groups, could provide a
deeper understanding of nurses' experiences and acuities regarding evidence-based-
follows.
Addressing these limitations requires careful consideration and potential adjustments to the
research methodology. Incorporating correlational analysis, refining the data collection tool,
enhancing procedure coverage, mitigating response bias, and integrating qualitative
approaches could strengthen the study's validity and reliability. Additionally, mounting the
sample size and considering diverse healthcare settings may enance the generalizability of the
findings.
14
 3.10 Conclusion
In this chapter, the methodology employed in the study has beenoutlined, focusing on a
quantitative tactic with descriptive and examining elements. However, limitations such as
insufficient correlational analysis, an incipients survey tool, and potential response bias were
identified. Recommendations for improvement include refining the data collection tool,
mitigating bias, and assimilating qualitative method. Addressing these confines is crucial for
enhancing the study's validity and reliability.

Chapter 4: Findings

15
 4.1 Introduction
This chapter presents the findings derived from collected data, which includes survey
questionnaires administered to mental health nurses and an interview conducted with one of
the senior managers of a local mental hospitals. Through the presentation and analysis of
collected data, this section offers a comprehensive overview of the nursing living's diversity,
qualifications and attitudes towads Evidence-Based Nursing Practices (EBNP), aiming to
enhance patient safety.
4.2 Major findings
4.2.1 Interview with the Nursing Manager
All through the interview with one of the senior nursing managers at a local mental hospital
in Malta (Transcription provided in Appendix 9), the manager demonstrated a comprehensive
understanding of EBNP. They dscribed it as the laim of current and unbiased research
findings to guide nursing care practices. Additionally, the manager emphasized the
significant importance of EBNP inmaintaining the relevance and currency of nursing care.
Challenges such as resistance and resource constraints were acknowledged and addressed
with proactive strategies and support mechanisms, highlighting the hospital's commitment to
enhancing patient safety and care quality through evidence-based approaches. EBNP was
underscored for its role in improving patient outcomes, enhancing patient safety, reducing
healthcare costs, and advancing nursing science. The manager promoted the implementation
of EBNP among staff through various measures such as training programs, access to updated
evidence and guidelines, support for ongoing professional education, and fostering positive
staff attitudes through engagemnt and communication. These findings highlight the director's
dedication to EBNP and its substantial influence on the hospital's nursing procedures and
patient care, expressing a strong commitment to promoting the use of EBNP among the
nursing staff.

4.2.2 Presentation of collected data from questionnaire

The questionnaire (survey) is provided in Appendix 8

4.2.2.1 Demographic characteristics, educational backgrounds and working experience

of the nurses
Demographic analysis of the participants reveals a nuanced picture of the mental health
nursing workforce.

16
 Table 1: Gender Distribution

The gender distribution was reasonably balanced, with 42.86% male and 56.43% female
respondents, indicating high transparency among the respondents. Age group distribution
provided valuable insights into the generational composition of mental health nurses, with
significant representation across different age brackets. Educational backgrounds varied, with
the majority holding Bachelor's degrees, followed by Diplomas and Master's degrees.
Participants hailed from divers countries, enriching the survey data with a global perspective
on mental health nursing experiences. Nursing experience in mental health settings varied
widely among the participants, indicating a diverse range of expertise levels within the
profession.

17
 Table 2: Age Distribution

Age group distribution provided valuable insights into the generational composition of
mental health nurses. About age distribution in the Table 2, a notable 35.00% fell within the
25-34 age bracket, representing a significant portion of the workforce, the 35-44 age group
accounted for 28.57% of the respondents, highlighting a substantial mid-career presence.
Additionally, 20.00% fell within the 45-54 age range, suggesting a seasoned cadre of
professionals. The elder demoraphic, aged 55 and above, constituted 15.00% of the
participants, indicating a wealth of experience within the mental health nursing community.
Surprisingly, the youngest age group, 18-24, was the smallest, comprising only 1.43% of the
participants (2 individuals), this may further research about the factors effect newly
graduation nurses to choose mental health profession.

18
 Table 3: Rate of nurses studied abroad

Table 4: level of Education

19
The educational background of the respondents further illuminated the survey's participant
landscape. Showing in the Table 4, notably, 47.14% held Bachelor's degrees (66
participants), making them the majority, following closely, 40.00% possessed Diplomas (56
participants), showcasing the significance of practical experience in this field, and master's
degree holders constituted 12.14% of the participants (17 individuals), this reflecting a
notable presence of highly educated professionals. Intriguingly, there were no respondents
with Doctoral Degrees, suggesting potential areas for nuture academic development. One
participant (0.71%) fell under the “Other category,” indicating a unique educational
background not captured by the predefined options. This diverse demographic composition
underscores the multidimensionality of mental health nursing professionals. Educational
backgrounds varied, with the majority having Bachelor's degrees (47.14%) and Diplomas
(40.00%).

The data regarding the foreign countries where the participants have studied provides
valuable insights into the diverse educational backgrounds of the mental health nurses
surveyed. In the above Table 3, out of the 51 respondents (35.69%) who answered this
question, most hail from countries such as Pakistan and India, indicating a solid
representation from South Asia, it highlights the importance of understanding the specific
challenges and opportunities mental health nurses face in this region. Additionally, some
participants have pursued education in Romania, Bulgaria, England, and Australia,
showcasing the international aspect of mental health nursing education. Including participants
from these diverse countries enriches the survey data, offering a global pespective on the
experiences and standpoints of mental health nurses. Moreover, there are instances where
contributors pursued distance learning programs, exemplified by entries citing institutions
like the University of Derby and collaborations between Maltese organizations and English
universities like Northumbria. These facts emphasize the flexibility and accessibility of
mental health nursing education, allowing individuals to engage in learnin experiences
tailored to their specific needs and circumstances.

The ethnic group of the participants provides a fascinating glimpse into the diverse cultural
backgrounds within the mental health nursing community. Refer to question 3, Among the
140 respondents, most identified themselves as Maltese, reflecting a significant local
presence. This local dominance is highlighted by the multiple entrie from Maltese nationals
across various dates and times, indicating this group's consistent and active participation. In
20
addition to the Maltese participants, respondents from other nations, including India,
Pakistan, Romania, Bulgaria, and England, showcased the international representation within
the survey. The majority of foreign nurses are from India. A noteworthy observation is the
presence of participants with dual or multiple nationalities, exemplified by entries such as
"Maltese/Australian." This dual nationality indicates a multicultural background, adding an
intriguing layer of diversity to the survey data.

The variation in age, education, gender and nationality brings a richness of perspectives to the
study, ensuring a comprehensive understanding of evidence-based nursing practices within
the mental healthcare sector. Such dversity enriches the research findings and mirrors the
complex and multifaceted nature of mental health nursing as a profession.

Table 5: Nursing experience in mental health setting

ANSWER CHOICES RESPONSES

0-5 years 29.50% 41

6-10 years 18.71% 26

11-20 years 28.78% 40

20 years + 23.02% 32

TOTAL 139

21
The study explored the nursing experience of the participants in the mental health field to
comprehend the extent of skill exhibited by the respondents. The findings (as showed above
in Table 5) revealed a wide range of expertise levels within this particular domain. Notably, a
considerable proportion, amounting to 29.50% of the participants, indicated that they had
acquired a range of 0 to 5 years of experience in mental health nursing. This finding suggests
a cohort of individuals who are relatively new to this particular area of practice. In contrast, a
notable proportion of the particpants (18.71%) reported possessing a moderate degree of
expertise in mental health nursing, specifically encompassing a duration of 6 to 10 years. This
finding suggests a discernible advancement in their competency within the profession.
Moreover, a significant proportion of the participants (28.78%) indicated they possessed an
exceptional tenure of 11 to 20 yrs in mental health nursing. This finding highlights the
presence of a considerable and highly experinced subgroup within the surveyed population. It
is probable that this collective exhibit a comprehensive comprehension of the complexities
and difficulties entailed in providing mental healthcare. Furthermore, it is worth mentioning
that a significant amount of the participants, nmely 23.02%, reported having more than
twenty years of experience in this particular field. This conclusion highlights the presence of
a highly experienced group of professionals who have devoted a considerable portion of their
professional lives to mental health nursing.

4.2.2.2 Key Aspects of EBNP:

EBNP was characterized by informed decision-making, implementation of studied practices,
regular review of the latest research, holistic and quality care, and application in policies and
Standard Operating Procedures (SOPs). Participants emphasized the importance of
incorporating current study resultsand knowlede into routine clinical care, deviating from
conventional methodologies or individual opinions in favour of evidence-based
methodologies. The responses provided in Appendix 5 indicate that EBNP can be
summarized as follows:
 Informed Decision Making: Nurses use current, up-to-date research, clinical
judgment, and patient preferences to guide their decisions
 Application of Studied Practices: EBNP entails implementing practices that have
been studied and proven effective through scientific research.

22
  Regular Evaluation of Latest Research: Nurses continually review and assess the
latest research findings toguarantee their practice is based on the most recent and
reliable evidence.
 Holistic and Quality Care: EBNP emphasizes providing holistic, quality care based
on the most updated research and knowledge, moving away from traditional
methods, advice from colleagues, or personal beliefs.
 Application in Policies and SOPs: EBNP is applied in nursing policies and SOPs to
enhance the overall quality of care.
 Challenges and Considerations
 Need for Continuous Learning: Nurses must stay updated with the latest research to
ensure their practice aligns with the most recent findings.
 Cultural and Traditional Influences: EBNP might face challenges in cultures where
traditional methods are deeply rooted.
 Benefits of EBNP
 Improved Patient Outcomes: Implementing EBNP enhances patient outcomes and
ensures the delivery of effective and safe care.
 Quality Decision Making: EBNP supports nurses in making informed decisions,
leading to better patient care.
 Professional Development: EBNP encourages continuous professional development
among nurses, fostering a culture of learning and growth.
The prevailing consensus among participants was that EBNP incorporated current research
results and knowledge into routine clinical care. The nurses emphasized the importance of
deviating from conventional methodologies or individual convictions in favour of evidence-
based methodologies. This unanimity underscores a basic element of EBNP. This uses
empirical knowledge to inform nursing decisions and enhance patient outcomes.

4.2.2.3 Resources, Challenges and Suggestions

The survey investigated the extent to which participants were knowledgeable about the
existence of evidence-based resources that may assist them in their nursing practice inside a
mental healthcare facility (Refer to question 10 and 11). The findings revealed that a
significant majority, namely 87.86% of the participants, demonstrated awareness of the
mentioned resources. Conversely, a minority of 12.14% expressed a lack of awareness of
such resources.

23
Nurses were aware of various resources, based on the responses provided as indicated in
Appendix 1, these are the evidence-based resources that nurses are aware of:
 University and Library Resources

University of Malta website and databases provided by the University of Malta; and Malta
Library resources.
 Guidelines and Protocols
Various guidelines are related to specific medical conditions or treatments. Protocols and
guidelines are available online, such as the following: National Health Service (NHS)
guidelines; National Institute for Health and Care Excellence (NICE) guidelines; Substance
Abuse and Mental Health Services Administration (SAMHSA) guidelines, especially in
relation to drug dependency. Medicine guidelines and British National Formulary (BNF)
guidelines.
 Online Resources
Online books and articles; Internet resources; online databases include CINAHL, PUBMED,
Google Scholar, MDPI (Multidisciplinary Digital Publishing Institute) and psych info; open-
source full-text articles and evidence-based books on mental health from various online
sources; also, online journals and publications.
 Mobile Apps
Mobile applications related to nursing and healthcare.
 Other Sources
Audit reports related to healthcare practices; Information from literature and personal
working experiences in nursing; policy and guidelines, including Standard Operating
Procedures; clinical trials and peer-reviewed articles; Patient satisfaction levels; PDN
(Professional Development Network) and Practice Development Unit resources.
 Educational and Professional Events
Courses, seminars, conferences, and group discussions.
 Specialized Tools
Psychometric tools for assessment and evaluation.
 Miscellaneous
Web searches and Google Scholar for research purposes.
These resources cover a wide range of evidence-based materials, including guidelines,
protocols, databases, online articles, mobile applications, and educational events, enabling
nurses to access up-to-date and reliable information to inform their practice.

24
Challenges which nurse are encountered (Refer to question 12). Based on the responses
provided, as indicated in Appendix 2, nurses face several challenges when implementing
EBNP, included:
 Resistance and Negative Attitudes
Resistance from colleagues and patients; negative attitudes from colleagues and patients
hinder the implementation of EBPs; staff reluctance to change and acceptance of new
practices; resistance from management and senior staff who are accustomed to traditional
methods; outdated practices and mentalities of both patients and nurses.
 Lack of Resources
Lack of time makes investing in research and implementing new practices difficult;
Insufficient resources, both human and material, are necessary for effective implementation;
lack of access to resources such as online libraries and research materials; limited access to
online databases and research articles; lack of supportive resources and communication
within the organization; and
lack of resources for training in mental health nursing.
 Knowledge and Skill gaps
Lack of skills to find, evaluate, and manage research evidence; difficulty in understanding
and interpreting research reports; lack of confidence in judging the quality of research
reports; uncertainty about the practicality and suitability of evidence-based interventions;
difficulty finding appropriate research reports and understanding their implications for
practice.
 Cultural and Organizational Challenges
Cultural differences and lack of training sessions affect the acceptance of EBNP; differences
between practice realism and idealism pose challenges in practical implementation; lack of
power and authority to change care procedures hinders the adoption of new practices;
Interpersonal conflicts and resistance encountered when changing nursing practices.
 Time Constraints
Limited research time hinders the ability to search for and implement EBNP; the time-
consuming nature of EBNP makes it difficult to balance with regular nursing duties; high
workload leading to time constraints, preventing thorough research and implementation
efforts.
 Educational Challenges

25
Difficulty in identifying the implications of research findings for individual practice; lack of
confidence and experience, especially in mental health settings; theory-practice gap,
including the lack of essential assessment tools and knowledge gaps among peers.
 Organizational Dynamics
Resistance from management and old nursing practitioners; different agendas and priorities
within the management lead to conflicts in practice implementation.
 Patient-Related Challenges
Apathy and resistance faced by other nurses hinder change implementation, patient resistance
makes it challenging to implement evidence-based care.

Recommendations from the Questionnaire (Refer question 14). Based on the responses
provided in Appendix 3, several suggestions exist for improving the implementation of
EBNP in healthcare settings. These suggestions include:
 Continuous education and Training
Provide continuous professional development (CPD) and ongoing research courses to keep
healthcare professionals updated; organize frequent group sessions and training sessions
tackling different scenarios related to EBNP; Conduct more training sessions for healthcare
professionals about EBNP; provide access to properly written guidelines, (SOPs), and
appropriate equipment to promote EBP; organize lectures and training sessions by the
Practice Development Unit for all nurses.
 Resource Allocation
Provide more resources, including staffing, to support EBNP; Increase access to resources
such as libraries and research materials; modernize the system of work and establish clear
protocols; Allocate more staff and provide training hours and information on new studies and
research.
 Effective Communication and Support
Improve communication skills among staff to enhance collaboration and understanding of
EBNP; provide effective communication between managers, nurses, and doctors; Foster a
culture of continuous learning and creative thinking through team discussions and activities;
encourage open discussions and teambuilding activities to enhance collaboration.
 Management Support
Provide more support from management, including leadership skills training; encourage
involvement from the Practice Development Unit, providing hands-on training and support;

26
Implement changes in management style and create a better working environment; Reward
positive behaviour and avoid rewarding toxic staff members.
 Utilization of technology and Innovation
Utilize information and communication technology (ICT) systems to provide guidance and
improve research efforts; Implement a system where nurses can access recommendations and
enhance their research skills.
 Monitoring and Audit
Conduct frequent monitoring of wards to ensure nurses maintain EBNP; Implement a system
where practices are audited for effectiveness and outcomes.
 Professional Development
Encourage nurses to attend conferences and lectures to stay updated with the latest research
and EBNP; offer mandatory training by competent practitioners to maintain registration,
ensuring ongoing education.
 Organizational Restructuring
Restructure the entire system to align with EBP and improve overall efficiency.
These suggestions emphasize the importance of education, resources, communication,
management support, technology, and continuous monitoring in promoting EBNP within
healthcare settings. Addressing these areas can significantly enhance the implementation of
EBNP and ultimately improve patient outcomes.

Also, respondents highlighted the importance of management support, effective

communication, and the positive impact of evidence-based nursing practices on patient safety
and care outcomes in mental health settings. As shown in Appendix 4, (refer to question
22), the research survey concluded with an optional question where the participants were
asked to provide comments regarding enhancing patient safety through EBNP in a mental
health hospital. One Respondent emphasized the importance of management encouraging and
supporting nurses in practicing evidence-based nursing to improve patient safety. Another one
Respondent highlighted the importance of two-way communication in mental health care.
Patients should be given enough time to express their feelings, and healthcare providers
should communicate calmly, listen patiently, and provide constructive feedback and
information to the patient. Another Respondent stressed the importance of management
focusing on patient safety and positive patient outcomes when introducing and implementing
EBNP in mental health settings. Also, there are respondents acknowledged the importance of

27
EBNP and emphasized the evidence-based research would improve the continuum of care,
benefiting clients from the care and attention nurses provide. These comments reflect a range
of perspectives, with a focus on the importance of management support, effective
communication, and the potential positive impact of evidence-based nursing practices on
patient safety and care outcomes in mental health settings.

4.2.2.4 Perceptions of EBNP implementation and impact on patient safety

Participants held a favourable perception of the quality of EBNP, with the majority indicating
either good or outstanding ratings. The prevalence of employing EBNP in making patient
care choices varied among respondents, with a significant portion reporting frequent or
occasional usage. The majority of participants strongly agreed that EBNP exerts a beneficial
influence on patient safety.
Additionally, the survey included a series of inquiries about the implementation of EBNP
within the present healthcare environment as experienced by the respondents. When
participants were queried about the quality of EBNP in their healthcare context (Refer
question 8), the results are showing below in the Table 6 exhibited a somewhat even
distribution. Specifically, 2.86% of participants rated it as outstanding, 48.57% as good,
45.71% as fair, and a minor 2.86% as bad. The observed distribution indicates that many
individuals hold a favourable perception of the quality of EBNP.

Table 6: Rating of evidence-Based nursing practice quality

28
The investigation of the prevalence of employing EBNP in the context of making patient care
choices inside a mental healthcare facility revealed a range of use levels (Refer question 9).
Below In the table 7, A minority of respondents (5.00%) reported utilizing EBNP regularly,
while a significant portion (30.71%) indicated frequent usage. A substantial proportion
(38.57%) reported using EBNP sometimes, while a smaller percentage (24.29%) claimed
uncommon usage. Interestingly, just a negligible fraction (1.43%) acknowledged never
incorporating EBNP into their patient care choices.

Table 7: Range of use EBNP levels

29
Very Frequently

Frequently

Occasionally

Rarely

Never

0% 10 % 20 % 30 % 40 % 50 % 60 % 70 % 80 % 90 % 100 %

ANSWER CHOICES RESPONSES

Very Frequently 5.00% 7

Frequently 30.71% 43

Occasionally 38.57% 54

Rarely 24.29% 34

Never 1.43% 2

TOTAL 140

Moreover, refer to question 15, showing at below Table 8, a significant proportion of

participants, namely 81.43%, express a strong consensus in favour of the notion that EBNP
exerts a beneficial influence on patient safety. Furthermore, a notable proportion of
respondents, namely 17.14%, expressed their concurrence with the statement mentioned

30
above, signifying a robust endorsement of the notion that EBNP plays a constructive role in
enhancing patient safety. Merely a minute fraction, around 1.43%, maintained a neutral
stance on this subject, with no participants expressing any opposition.

Table 8: Rate of EBNP impact on patient safety

ANSWER CHOICES RESPONSES

Strongly agree 81.43% 114

Agree 17.14% 24

Neutral 1.43% 2

Disagree 0.00% 0

Strongly disagree 0.00% 0

TOTAL 140
4.3 Conclusion

The survey results indicate that the nursing workforce is diverse in terms of experience and
education. The majority of the respondents had a positive perception of EBNP. Respondents
highlighted the significance of training, organizational support, and continuous professional
development in promoting the adoption of EBNP. The findings emphasize the intricate nature
of nursing and the importance of EBNP in enhancing patient outcomes. And researcher will
analysis and discuss the findings in next chapter (5).

31
 Chapter 5: Analysis

5.1 Introduction
This chapter will analysis and discuss the research findings from collected data. Identify the
patterns, trends, and relationships in the data, analysis the implications of the findings in the
context of existing literature, and identify the similarities and gaps of the research.
5.2 Discussion of patterns, trends, and relationships in the data

5.2.1 questionnaire to the nurses

The survey showcased a diverse representation of mental health nurses across various
demographic characteristics, including age, educational backgrounds, and nationalities (Refer
to Table 2). This diversity underscores the multifaceted nature of mental health nursing
professionals and emphasizes the importance of a comprehensive approach to evidence-based
nursing practices. The inclusion of nurses from different cultural backgrounds highlights the
global applicability of evidence-based methods in mental healthcare, aligning with previous
literature (Cranage and Foster, 2022). However, a deeper analysis of correlations, such as
those related to years of experience and nationality, would provide further insights into the
nuances of EBNP adoption among mental health nurses.
While the survey revealed a solid understanding of EBNP among mental health nurses, it also
identified noteworthy challenges hindering its implementation. These challenges include
resistance, resource shortages, cultural influences, and instructive gaps (Refer to Appendix
2). Addressing these obstacles requires a comprehensive strategy industrial integration,
encompassing education, resource allocation, managerial support, and organizational culture
change (Cardoso et al., 2021). However, it is essential to note that the data collection tool
used may have limitations in capturing the depth of these challenges, warranting further
investigation.

5.2.2 Interview with the senior manager

The interview findings with the senior manager provided valuable insights into the alignment
between EBNP and improved patient safety. The director's emphasis on the importance of
evidence-based resources in enhancing nursing practice and patient outcomes reinforces the
literature's assertions regarding the positive relationship between EBNP and patient safety.

32
However, furtherexploration of senior managers' perspectives from different healthcare
settings could offer a more comprehensive understanding of administrative support for EBNP.

5.3 Comparison of outcomes with research questions and objectives

While the review data addressed the research questions and objectives to some extent, there
are gaps in the depth of analysis, mainly regarding correlations and the robustness of the data
collection tool. The study primarily assessed nurses' knowledge and interest in EBNP, but a
more comprehensive evaluation of factors influencing EBNP adoption is needed to generate
conclusive insights. Moreover, the position between the study's deductions and the presented
results may require further scrutiny to ensure objectivity.
Research Question 1: What are the Demographic Characteristics of Mental Health Nurses
concerning EBNP?
Objective 1: To understand the demographic composition of mental health nurses
participating in the survey and its relation to their awareness and implementation of EBNP.
The survey revealed diverse demographics, including age groups, educational backgrounds,
and nationalities. The variation in demographics highlighted the multidimensional nature of
mental health nursing professionals, emphasizing the need for a comprehensive approach to
EBNP education and implementation.
Research Question 2: What are the Key Aspects and Definitions of EBNP Among Mental
Health Nurses?
Objective 2: To explore mental health nurses' understanding of EBNP, including its core
components and applications in healthcare.
Mental health nurses demonstrated a comprehensive understanding of EBNP, encompassing
informed decision-making, implementation of studied practices, regular review of the latest
research, and its application in policies and SOPs. This aligns with the objective, indicating a
solid grasp of the core aspects of EBNP among the surveyed professionals.

Research Question 3: What Challenges Do Mental Health Nurses Face in Implementing

EBNP?
Objective 3: To identify mental health nurses' barriers and challenges when integrating
EBNP into their daily practice.
Mental health nurses face various challenges, including resistance and negative attitudes, lack
of resources, knowledge and skills gaps, cultural and organizational challenges, time

33
constraints, educational challenges, organizational dynamics, and patient-related challenges.
These findings confirm the multifaceted challenges hindering the seamless implementation of
EBNP in mental healthcare settings.

Research Question 4: What Resources and Support Systems are Mental Health Nurses
Aware of in the Context of EBNP?
Objective 4: To assess mental health nurses' awareness of available resources and support
systems facilitating EBNP implementation.
Mental health nurses demonstrated awareness of diverse resources, including university and
library resources, guidelines and protocols, online resources, mobile apps, specialized tools,
and educational and professional events. This highlights a range of accessible resources,
although disparities in resource accessibility were also noted.

Research Question 5: What Suggestions Do Mental Health Nurses Have for Improving the
Implementation of EBNP in Mental Healthcare Settings?
Objective 5: To gather mental health nurses' suggestions for enhancing the implementation of
EBNP, including educational, managerial, and infrastructural improvements.
Mental health nurses provided numerous suggestions, including continuous education and
training, resource allocation, improved communication and support, enhanced management
support, utilization of technology, monitoring and audit mechanisms, and organizational
restructuring. These suggestions align with the objective, offering a comprehensive roadmap
for improving EBNP implementation in mental healthcare settings.

As a result, the survey data satisfactorily addressed all of the research questions and
objectives. They thoroughly analysed the demographics, perceptions of EBNP, difficulties
encountered, knowledge of available services, and recommendations for improvement among
mental health nurses. The findings closely match the goals and questions of the study. When
making decisions and providing high-quality care, mental health nurses emphasize how
important EBNP is to their profession. However, they encounter considerable obstacles that
prevent the proper implementation of EBNP, such as resistance and a lack of resources. The
above resources represent the variety of tools and materials that mental health nurses use to
guide their work. The results provide a comprehensive picture of EBNP's current situation in
mental healthcare settings, enabling well-informed plans to optimize its application and, as a
result, increase patient outcomes and safety.
34
 5.4 Exploration of unexpected or contradictory results
The survey results thoroughly overview the mental health nurses' attitudes toward EBNP.
However, they may also offer unexpected or conflicting findings that warrant further
investigation:
 The low representation of mental health nurses in the older age groups (55 and over) was
a surprise discovery. Given these experts' wealth of expertise, their under representation
may raise concerns regarding their participation in the poll or their views on EBNP.
 It is noteworthy that there were no respondents who held doctoral degrees. In the context
of a profession that frequently promotes advanced education, it is unexpected.
Investigating the causes of this absence, such as the accessibility of doctoral programs or
the professional pathways taken by mental health nurses, could yield insightful
information.
 Even though cultural effects were identified as a problem, the precise methods by which
cultural norms affect the execution of the EBNP have been thoroughly examined.
Nuanced insights could be gained by delving deeper into these cultural facets and their
contradictory effects on evidence-based procedures. While some respondents underlined
the necessity for management support, others pointed out organization opposition as a
problem. Examining these opposing viewpoints can show the various experiences mental
health harbors have with various management values within the same healthcare
environment (Cardoso et al., 2021).
 The respondents' varied educational backgrounds, which include degrees, diplomas, and
master's degrees, may have caused them to hold divergent opinions on how well various
educational paths concoct nurses for evidence-based practices. Unexpected insights could
be gained by investigating how nurses with these various educational backgrounds view
and use EBNP.
 Some responders recognized patient resistance as a problem, but better patient outcomes
were mentioned as an advantage of EBNP. Probing the relationship between patient
resistance and the final success of evidence-based interventions may reveal surprising
patterns or nursing coping mechanisms (Karki, 2018). Others renowned specific
databases and guidelines, while some respondents mentioned the resources' restricted
access. Investigating differences in resource accessibility between various healthcare
organizations or locations could reveal how erratically the EBNP is implemented.

35
 Researchers can develop a more nuanced understanding of the difficulties underlying
EBNP in mental healthcare settings by tunneling further into these surprising or
contradicting data, enabling targeted interventions and improvements innursing practices
and patient outcomes.

5.5 Analysis of the implications of the findings in the context of existing literature
Analysing the implications of the findings within the context of existing literature, it becomes
evident that the study's results contribute suggestively to the ongoing discourse on Evidence-
Based Nursing Practice (EBNP) and patient safety in mental healthcare settings. The findings
align with preceding research highlighting the importance of EBNP in improving patient
outcomes and reducing medical errors. Moreover, they underscore the necessity for tailored
training programs to equip nurses with the skills and knowledge required for effective EBNP
implementation. Additionally, the findings stress the crucial role of administrative support
and access to resources in simplifying EBNP adoption. Overall, the study's allegations
reinforce the existing literature's assertions regarding the essentiality of EBNP in enhancing
patient safety and excellence of care.
The results of this study shed light on how mental health nurses perceive, face, and use
resources concerning EBNP in mental healthcare settings.
 In line with previous literature highlighting the value of EBNP in healthcare settings,
mental health nurses see EBNP as indispensable for well-informed decision-making,
high-quality care, and policy implementation. The study's assumptions are more
credible because they align with current literature. It confirms the EBNP's widely
recognized importance in improving nurse practice, patientm safety and patient
outcomes.
 In line with previous research on obstacles to EBNP implementation, mental health
nurses mustcontend with issues like resistance, a lackof resources, knowledge gaps,
cultural barriers, time restraints, and patient-related difficulties (Dane and Be shah,
2021). These difficulties illustrate enduring obstacles that mental health nurses must
overcome, highlighting the demand for focused interventions and organizational
support. It is consistent with earlier exploration that stressed how crucial it was to
overcome obstacles to apply the EBNP successfully.
 In addition to guidelines, online databases, mobile apps, audit reports, and patient
satisfaction scores, mental health nurses also use various other tools (Dane and Be
shah, 2021). The range of resources used emphasizes how crucial it is for EBNP to

36
 have readily available and varied resources. It is steady with research highlighting the
importance of having a wide range of resources available to enhance evidence-based
practice among healthcarepractitioners.
 The problems experienced by mental health nurses, such as opposition and a lack of
resources, directly impression patient treatment and may result in gaps in the
provision of evidence-based therapy. The study emphasizes the need to remove these
obstacles quickly by highlighting their actual effects on patient care. It is consistent
with the body of research showing that overcoming obstacles directly impacts the
standard and security of patient care.
 For the EBNP to be implemented successfully, organizational support, training
programs, and ongoing professional development are essential components. The focus
on organizational support is consistent with lit,erature highlighting the importance of
leadership, education, and welcoming work settings in creating an EBNP culture. It
emphasizes the necessity of funding initiatives for continual training and nurse
education.
 Cultural effects make it difficult for people to adopt EBNP methods, consistent with
research that has already acknowledged the importance of cultural beliefs on medical
procedures (Karki, 2018). Culturally sensitive methods of implementing the EBNP
are necessary to address cultural factors. The literature now in circulation emphasizes
the necessity for culturally competent nursing practices, which proposes adapting
techniques to particular cultural situations.

The study's conclusions have several real-world consequences for delivering mental
healthcare. They offer practical advice that may be used to rise the standard of care, improve
patient outcomes, and foster a supportive work environment for mental health nursing
specialists.
5.6 Identification of gaps in the research
The study effectively filled the knowledge gap about the wide-ranging demographic makeup
of mental health nursing professionals. The research gave a thorough picture of the workforce
by analysing variables including age, education, gender, and nationality, emphasizing the
diversity of mental health nursing. The survey participants had a significant international
representation, according to the study.
 The study offered a worldwide perspective b capturing the experiences and difficulties
experienced by mental health nurses in various cultural contexts by integrating

37
 comments from nurses with various educational backgrounds from nations included
Maltese, Pakistan, India, Romania, Bulgaria, and England.
 Based on participant replies, the study successfully identified important facets of
EBNP. These features—such as making well-informed decisions, putting studied
approaches into practice, regularly reviewing the most recent research, providing
holistic and high-quality care, and using these features in policies and SOPs—clearly
grasp what EBNP in the mental healthcare field comprises.
 The study emphasized the advantages of EBNP, such as better patient outcomes, high-
calibre choices, and ongoing professional growth. The study highlighted the excellent
effects of EBNP on patients and healthcare professionals by highlighting these
advantages and the significance of its implementation.
 The investigation successfully located numrous evidence-based tools used by mental
health nurses. These sources gave a thorough overview of the materials available to
nurses for evidence-based practices, including university and library resources,
guidelines and protocols, online resources,mobile apps, educational and professional
events, specialized tools, and various other sources.
 The study successfully identified obstacles mental health nurses had when adopting
EBNP, such as opposition, a lack of resources, knowledge and skill gaps,
organizational and cultural issues, time restraints, educational difficulties, and patient-
related difficulties.
In order to fill in the knowledge vacuum on prospective answers and techniques to deal with
these difficulties, the study also gathered insightful comments from participants. By filling up
these gaps, the sudy offered a nuanced and thorough examination of EBNPs in settings for
mental healthcare, providing insightful information for further interventions and
advancements in the area.

5.7 Conclusion
This chapter analysed and discussed the results of the current study in a local mental hospital
in Malta. This analysis examines the important findings that contribute to our understanding
of the impact of EBNP on patient safety. Additionally, some recommendations will be
discussed in the next and finalchapter (6).

38
 Chapter 6: Conclusions and Recommendations

6.1 Introduction
This final chapter encapsulates the essence of the study by summarizing its key findings and
identifying study limitations. As well, itproffers recommendations for pretty healthcare
practices, shaping policies, and guiding future research endeavours.
6.2 Conclusions
6.2.1 Summarizing the Key Research Findings
This study meaningfully enhances understanding of the challenges associatedwith adopting
Evidence-Based Nursing Practice (EBNP) inmental healthcare settings by thoroughly
assessing resources, techniques, and tasks related to EBNP.

 The study confirms the crucial role of EBNP in reducing medical errors and
improving patient outcomes.
 It provides important insights into the diverse experiences and viewpoints within the
mental health nursing workforce, essential for creating inclusive EBNP policies.
 Awareness of available tools and platforms supporting EBNP is raised, empowering
nurses to choose beneficial resources.
 The study fosters a culture of growth within the nursing profession, emphasizing
continual learning and professional development.

In deduction, this study substantially contributes to nursing and mental healthcare fields by
addressing issues, fostering inclusivity, and providing a comprehensive perspective on
EBNP. Its remarks and recommendations are invaluable for healthcare investors, leading to
beneficial improvements in mental healthcare services.
Additionally, the study successfully spoke research questions and objectives by offering in-
depth insights into mental health nurses' sentiments, difficulties, and resource usage related to
EBNP. The results lay the underpinning for additional study and interventions to boost EBNP

39
adoption amongst mental health nurses, ultimately ornamental patient safety and care
outcomes.
6.2.2 Limitations
Limitations of this study include its single-site nature, which may limit findings' applicability
to other hospitals. Furthermore, the self-reported survey format may have introduced
response bias. Also, the study did not explore perspectives of people by mental illnesses,
focusing solely on healthcare specialists.
6.3 Recommendations
Realizing the following recommendations can enhance EBNP adoption in intellectual
healthcare settings:

 Establish dedicated research departments to facilitate EBNP.

 Allocate resources for comprehensive EBNP training programs.
 Advocate for EBNP integration in nursing policies and protocols.
 Integrate patients' perspectives into EBNP practices.
 Encourage international exposure for nurses to gain diverse insights.

These endorsements align with the evolving healthcare landscape, emphasizing the
importance of evidence-based practices in transporting high-quality, patient-centred mental
healthcare services.
6.4 Future Research Directions
Future research should include longitudinal studies to examine long-term effects of EBNP on
patient safety outcomes and healthcare personnel competence and happiness. Additionally,
studies can explore how cultural influences affect EBNP adoption and efficacy. Future
research could also investigate the effects of EBNP on outcomes for specific patient
populations or mental health disorders, ultimately aiming to improve patient lives.

References

40
Abu-Baker, N., Do sari, M., & Alta Mimi, S. (2021). The role of nursing education in
enhancing nurses' knowledge and practice of evidence-based nursing in Saudi Arabia: A
qualitative study. Nurse Education Today, 97, 104708.
Cardoso, G. B., Pereira, A. M., Santos, R. L., & Teixeira, M. C. (2021). Implementation of
evidence-based nursing practices in the care of children with cancer: an integrative review.
Revisit Brasilia de Enfleurage, 74(1), e20190545.
Dane, K., & Be shah, D. T. (2021). Assessment of knowledge, attitude, and practice of
evidence-based nursing practice and associated factors among nurses working in selected
governmental hospitals in Addis Ababa, Ethiopia. Journal of Nursing & Patient Care, 6(2),
13-21.
Duff, L., Banda, S., & Kalimba, F. W. (2020). Factors influencing the adoption of evidence-
based nursing practices among nurses: A cross-sectional study. Nursing Open, 7(5), 1419-
1427.
Flaubert, J., Deryck, H., Vandenbossche, P., & Grypdonck, M. (2021). Factors influencing
nurses' use of evidence-based practice: A qualitative study. Journal of Clinical Nursing, 30(1-
2), 251-261.
Green, L. V., Saving, S., & Lu, Y. (2019). Primary care physician shortages could be
eliminated through training interventions, but would result in significant reductions in
burnout. Health Affairs, 38(10), 1717-1724.
Million, J. S., & Brooke, J. (2016). An integrative review of the factors influencing nurses'
knowledge and practice of evidence-based pain management in children. Journal of
Paediatric Nursing, 31(6), 596-607.
Omiya, J. M., & Ago, D. I. (2020). Effects of evidence-based nursing practice in health care
delivery: A systematic review. Nursing & Health, 8(2), 12-24.
Varcarolis, E. M., & Fibre, A. B. (2020). Dissemination and utilization of evidence-based
practices in psychiatry: Understanding provider preferences and practices. Issues in Mental
Health Nursing, 41(9), 796-802.
Akiba, S. (2019). Nurses' perceptions of barriers and facilitators and evidence-based practice
in a Kenyan hospital. Journal of Nursing Scholarship, 51(1), 86-94.

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