A Cross Sectional Study of Nurses’ and Nurse Educators’ Perceptions of Evidence-Based Practice in Kazakhstan

Research Article

Ann Nurs Res Pract. 2017; 2(1): 1016.

A Cross Sectional Study of Nurses’ and Nurse Educators’ Perceptions of Evidence-Based Practice in Kazakhstan

Heikkila J¹*, Hopia H¹, Hasselberg J², Tiittanen H³ and Baighorzina Z4

¹Department of Research and Development, JAMK University of Applied Sciences, Finland

²Health and Sports, Laurea University of Applied Sciences, Finland

³Faculty of Social and Health Care, Lahti University of Applied Sciences, Finland

4Republican Center of Health, The Ministry of Health Care and Social Development of the Republic of Kazakhstan, Kazakhstan

*Corresponding author: Heikkila Johanna, Department of Research and Development, School of Health and Social Studies, JAMK University of Applied Sciences, Piippukatu 2, 40100Jyvaskyla, Finland

Received: January 25, 2017; Accepted: February 22, 2017; Published: February 24, 2017


Kazakhstan is one of the countries in which the development of nursing and nursing education is currently progressing quickly. However, there is limited knowledge about the barriers to and facilitators of evidence-based practice in post-Soviet countries. The purpose of this study was to describe and compare the current state of evidence-based practice from the point of view of Kazakh nurses and nurse educators. The aim was to produce research-based information that could be used in the reform and development of nursing in Kazakhstan.

A quantitative, cross-sectional study was conducted to describe the current state of evidence-based practice in Kazakhstan. The Perceptions of Nurses of Evidence-Based Practice questionnaire was employed to collect the data. In total, 113 nurses and nurse educators responded to the questionnaire between 2013 and 2015.

The results show that only 24, 5% of the respondents understood the definition and meaning of the concept of evidence-based practice. Several statistically significant differences were found between the groups in perceptions, attitudes and knowledge regarding evidence-based practice as well as promoters of and barriers to adopting evidence-based practice. The least frequently used print and electronic information sources were journal articles and medical and nursing libraries, respectively. All activities associated with evidence based approach practices were assessed as being important.

Understanding the concept and implementation of evidence-based practice are necessary competencies in nursing education not only for students but also for educators. More focused research is needed related to the implementation of evidence-based approach to nursing education, nursing practice and management in Kazakhstan.

Keywords: Evidence-based practice; Nursing management; Nursing education


EBP: Evidence-Based Practice


Challenges in healthcare in Kazakhstan

Kazakhstan has undertaken major efforts to reform its post- Soviet healthcare system. It became independent with the dissolution of the Union of Soviet Socialist Republics in 1991. After gaining its independence, Kazakhstan began to promote evidence-based medicine and develop new national guidelines [1]. Despite current healthcare reform initiatives, Katsaga et al. [1] argued that key components of Kazakhstan’s healthcare system still need improvement. Increasing healthcare utilization and improving health outcomes are among the most challenging aspects of healthcare in the country. In alignment with the changes in healthcare, the role and value of nursing care specialists as well as their organizational authority and responsibility for work results are essentially increasing. At the same time, Kazakhstan is undergoing widespread changes in nursing higher education [2]. Kazakhstan joined the European Higher Education Area in 2011. Although Kazakh universities are trying to harmonize the higher educational system with the Bologna Process, challenges in the integration process remain [3]. However, Kazakhstan strives to be one of the 30 most developed states of the world for 2020 and describes the need for a training system of specialists in nursing care at all levels (from technical education to PhD) in accordance with European directives [4]. Nevertheless, the first steps have been taken towards advancing nursing education into higher education, which would be comparable to European nursing education standards.

Implementation of evidence-based practice

Factors affecting the implementation of Evidence-Based Practice (EBP) have been studied extensively, predominantly in Anglo-American countries, over recent decades. However, limited research has been conducted in post-Soviet countries. Thus, nursing researchers are becoming increasingly aware of barriers to and facilitators of EBP and its level of implementation in diverse healthcare settings. Many researchers have stated that poor English skills, a heavy workload, a lack of internet access and insufficient time among nurses to read research or implement new ideas in the workplace are the main barriers to implementation of EBP [5-7]. On the other hand, Thorsteinsson and Sveinsdottir [8] noted that even if nurses have internet access at work and, therefore, access to several academic databases, most of them turn to their colleagues for information needed at work. Similarly, Baird and Miller [9] found that evidence from research and nursing journals continued to be the least accessed source of knowledge on EBP among Canadian nurses and in a Norwegian study by Dalheim et al. [10].

Despite the various types of reported barriers, most nurses studied in different countries expressed a positive attitude toward EBP. For example, in the studies of Majid et al. [11] and Weng et al. [12], a majority of the Singaporean and Taiwanese nurses and healthcare personnel studied had favorable beliefs about and attitudes toward EBP. Given the positive attitudes that some of the healthcare professionals seem to have toward EBP, researchers have pondered what reasons might explain the slow development of the implementation of evidence-based nursing. For example, Wilson et al. [13] argued that one main reason might be nurses’ subordinate role in many healthcare organizations. They further stated that if nurses are not empowered and positioned to take action, they cannot use their professional skills and capabilities to the fullest extent in practice. In addition, nurse educators have a pivotal role in supporting students in accessing, understanding, and appraising research and encouraging its utilization in practice. Kalb et al. [14] studied nursing education faculty members in the United States. The authors found that some of them indicated that they were familiar with EBP but were not aware of evidence-based teaching practice or the need to apply evidence in their teaching responsibilities. The authors reached the conclusion that this lack of awareness has significant implications for the preparation of new nurse faculty members and the professional development of current faculty members [14].

Although the factors influencing the implementation of evidencebased nursing in Western countries are well-reported, there are still countries in which EBP is in its infancy. In these countries, barriers to and facilitators of EBP need to be studied and documented for further use. Kazakhstan is one of the countries in which the development of nursing and nursing education is currently underway. Thus, it is justified to study the perceptions and implementation of EBP from Kazakh health professionals’ point of view.

Purpose and Aim

The purpose of this study was to describe and compare the current state of EBP from the point of view of Kazakh nurses and nurse educators. The aim was to produce research-based information that could be used in the reform and development of nursing in the Republic of Kazakhstan. Specifically, the objectives were to seek information about nurses’ and nurse educators’ awareness of, knowledge of, and attitudes toward EBP and to explore the factors that influence the adoption of EBP in Kazakhstan.

Design and Methods

A quantitative, cross-sectional study was employed to describe the current state of EBP in Kazakhstan. Permission to use the Perceptions of Nurses of Evidence-Based Practice questionnaire developed by Majid et al. [11] was obtained from the original authors. The Cronbach alpha of the questionnaire was in their study between 0.681 to 0.9458 [11]. The questionnaire consisted of three sections. The first section included seven questions regarding the respondents’ demographic characteristics. The second section contained seven questions that focused on the respondents’ perceptions, attitudes and knowledge relating to EBP. Furthermore, the promoters of factors and barriers to adopting EBP were studied. The third section included two questions surrounding the sources of information used by the respondents to support their clinical work and decision making. The respondents were also asked to express their wishes regarding the contents of EBP-related training. Three of the questions concerning the literature searching skills in the original questionnaire were removed, since that was not the purpose of this study. The original questionnaire was translated into Russian using a standardized forward-backward linguistic translation method [15].

Convenience sampling [16] was used and data were collected during five one week in service trainings in Astana, the capital the Republic of Kazakhstan for practicing nurses with a bachelor’s degree who graduated from all medical universities (three trainings) and nurse educators from six medical colleges (two trainings) in autumn 2013, spring 2014 and 2015. The number of the bachelor degree nurses from the six medical universities was at the time of data collection less than 150. There are 29 state medical colleges in Kazakhstan, the nurse educators in this study represent six state medical colleges from six geographically different parts of Kazakhstan, and therefore can be considered representing the nurse educators target group extensively. All participants who were present on the last day of training were included in the study.

Ethical Issues and Approval

Permission to conduct the study was granted by a representative of the Ministry of Healthcare and Social Development of the Republic of Kazakhstan. All participants were informed that their participation was voluntary. They indicated their informed consent to participate in the study by completing the questionnaire. Their responses were kept anonymous. The identity of the respondents was not disclosed at any stage when reporting the results [17].

Statistical Analysis

The data were analyzed using SPSS V23.0. The demographic data were dichotomized to allow the comparison between the groups. Division to nurse educator or not was made. In addition, age was divided to 30 and less years, and older than 30 years. The highest educational degree was divided to nursing degree and to medical or other degree and the work experience was divided to 0-9 years and 10 or more years. Descriptive statistics were used to describe the demographic data. The responses, which were given on a five-point Likert scale, were presented as frequencies, percentages, means and standard deviations. One-way ANOVA was performed to determine if there were differences between the groups. Significance was defined as p<0.05.



The questionnaire was completed by 113 participants of the inservice trainings (Table 1). A majority of the respondents were female. More than half of them (60.2%) had attained a nursing degree and 70% of them had fewer than 10 years of work experience in nursing. Most of the nursing educators (n=52) were doctors or had non nursing degree (n=45). Half of the respondents worked in a hospital, primary healthcare facility or outpatient clinic, whereas the other half were employed as nurse educators at a medical university or college.