Validación de versión brasileña de la <i>Evidence-based Practice Knowledge Assessment in Nursing</i> (EKAN)

Nick, Jan M.; Durkin, Adelaide Caroci; Caroci-Becker, Adriana; Cruz, Diná de Almeida Lopes Monteiro da; Zorzim, Vivian Inacio; Wonder, Amy H.

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Revista da Escola de Enfermagem da USP

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Sumário

ORIGINAL ARTICLE • Rev. esc. enferm. USP 55 • 2021 • https://doi.org/10.1590/S1980-220X2020012003768 copiar

Validación de versión brasileña de la Evidence-based Practice Knowledge Assessment in Nursing (EKAN)

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo

La Evidence-based Practice Knowledge Assessment in Nursing (EKAN) es una medida objetiva del conocimiento sobre práctica basada en la evidencia (PBE). Los objetivos del proyecto fueron traducir el EKAN al portugués brasileño, testear sus propiedades psicométricas y documentar una evaluación de línea de base del conocimiento de estudiantes sobre la PBE.

Método

El EKAN-Versión Brasileña fue aplicado a estudiantes de dos programas de licenciatura en enfermería, los datos fueron sometidos a análisis de Rasch.

Resultados

Participaron 123 estudiantes (87%-edades entre 19-25 años; 60%-primer año; 38% sin contacto previo con material sobre PBE). Índices de validez: dificultad promedio = -2,48 a 2,07; Infit (WMS) promedio = 0,985 (SD = 2,13); Outfit (UMS) promedio = 0,975 (SD = 0,17). Los índices de confiabilidad mostraron índice de separación suficiente (4,47); de separación de persona moderado (0,47); alta confiabilidad de ítems (0,95); baja confiabilidad de personas (0,18). El puntaje promedio en la EKAN (máximo = 20) fue 7,6 (SD = 2,13).

Conclusión

El estudio produjo evidencias de validez y confiabilidad de la EKAN-Versión Brasileña; la confiabilidad de personas mostró necesidad de incorporar conceptos y contenidos sobre PBE en los programas de enfermería.

Práctica Clínica Basada en la Evidencia; Conocimientos, Actitudes y Práctica en Salud; Estudio de Validación; Psicometría

Characteristics	Institution A (n = 77)	Institution B (n = 46)	Total (N = 123)
Age
19-25 26-30 31-35 36-40	63 (82.0%) 6 (8.0%) 6 (8.0%) 2 (2.0%)	44 (96.0%) 2 (4.0%) - -	107 (87.0%) 8 (6.0%) 7 (6.0%) 2 (1.0%)
Gender
Female Male	66 (86.0%) 11 (14.0%)	39 (85.0%) 7 (15.0%)	105 (85.0%) 18 (15.0% )
Progression in nursing program
5^th semester 7^th semester 9^th semester	37 (48.0%) 17 (22.0%) 23 (30.0%)	37 (80.0%) 9 (20.0%) -	74 (60.0%) 26 (21.0%) 23 (19.0%)
Country of origin
Brazil Angola South Korea	74 (96.1%) 2 (2.6%) 1 (1.3%)	46 (100.0%) - -	120 (97.6%) 2 (1.6%) 1 (0.8%)
Exposure to statistics course
Completed Enrolled Have not taken	25 (32.0%) 16 (21.0%) 36 (47.0%)	46 (100.0%) - -	71 (58.0%) 16 (13.0%) 36 (29.0%)
Perceived exposure to EBP content (number of days for EBP content exposition)*
Not taken any content < one 1-2 > 2 Took a whole course	15 (19.5%) 3 (4.0%) 5 (6.5%) 8 (10.0%) 46 (60.0%)	32 (69.5%) 5 (11.0%) - - 9 (19.5%)	47 (38.0%) 8 (6.5%) 5 (4.0%) 8 (6.5%) 55 (45.0%)
Self-rated confidence in providing EBP care
Strongly agree Agree Neither agree or disagree Disagree Strongly disagree	29 (38.0%) 41 (53.0%) 6 (8.0%) - 1 (1.0%)	4 (9.0%) 1 8 (39.0%) 20 (43.0%) 4 (9.0%) -	33 (27.0%) 59 (48.0%) 26 (21.0%) 4 (3.0%) 1 (< 1.0%)

Item and Content Description	Difficulty (SE)	Infit		Outfit
Item and Content Description	Difficulty (SE)	WMS	SWMS	UMS	SUMS
1. Purpose of regression versus other tests	1.57 (0.29)	0.92^a	-0.31^b	0.79	-0.79^b
2. Sampling and study design	0.37 (0.21)	0.97^a	-0.30^b	0.98^a	-0.14^b
3. Purpose of Institutional Review Board	0.01 (0.19)	0.97^a	-0.47^b	0.96^a	-0.46^b
4. Distinguishing measures of central tendency	0.01 (0.19)	0.97^a	-0.50^b	0.96^a	-0.45^b
5. Distinguishing validity, reliability, and generalizability	0.64 (0.22)	0.96^a	-0.30 ^b	0.91^a	-0.61^b
6. Proper use of pre-appraised evidence	0.25 (0.20)	0.99^a	-0.07^b	0.99^a	-0.04^b
7. Role of judgement in EBP decision making	-0.27 (0.19)	1.01^a	0.17^b	1.02^a	0.41 ^b
8. Steps of the EBP process	-2.48 (0.26)	0.99^a	0.02^b	1.05^a	0.31^b
9. Facilitating EBP in practice settings	1.67 (0.30)	0.97^a	-0.08^b	1.02^a	0.18^b
10. Interpreting odds ratio	-0.05 (0.19)	1.01^a	0.10^b	1.00^a	0.08^b
11. Understanding credibility and bias	-0.74 (0.19)	0.94^a	-1.23^b	0.95^a	-0.89^b
12. Identifying steps in plan-do-study-act cycle for quality improvement	0.11 (0.20)	1.10^a	1.48^b	1.10^a	1.06^b
13. Priority of evidence, patient values, and clinical judgement in EBP decision making	0.01 (0.19)	1.01^a	0.16^b	1.05^a	0.67^b
14. Distinguishing causation from correlation in regression	0.10 (0.20)	0.97^a	-0.49^b	0.97^a	-0.36^b
15. Ranking of evidence quality (hierarchy)	-1.11 (0.19)	1.07^a	1.08^b	1.06^a	0.78^b
16. Strength of measurement approaches	-0.76 (0.19)	0.96^a	-0.84^b	0.94^a	-0.98^b
17. Role of PICOT question in evidence searching	0.15 (0.20)	0.96^a	-0.58^b	0.93^a	-0.76^b
18. Nurse-sensitive quality indicators	2.07 (0.35)	0.92^a	-0.19^b	0.87^a	-0.27^b
19. Understanding effect sizes	-0.23 (0.19)	1.05^a	0.90^b	1.03^a	0.48^b
20. Statistical v. clinical significance	-1.33 (0.20)	0.92^a	-1.02^b	0.93^a	-0.80^b

Rasch Validity Indices	EKAN-Brazilian Portuguese	*EKAN-English	Benchmark
Difficulty index range θ (in logits)	-2.48 to 2.07	-2.00 to 2.8	-3.0 to 3.0
Infit Weighted MS Mean (SD)	.985 (2.13)	1.01
Infit Weighted MS Range	0.69 - 1.43	-0.7 – 1.6	0.7 to 1.3**
Infit Weighted MS Interquartile Range	0.23
Outfit Unweighted MS Mean (SD)	.975 (0.17)	1.02
Outfit Unweighted MS range	0.57 - 2.11	0.93 – 1.14	0.7 to 1.3**
Outfit Unweighted MS Interquartile Range	0.34
Rasch Reliability Indices	EKAN-Brazilian Portuguese	*EKAN-English	Benchmark
Item Separation Index (ISI)	4.47	7.05	> 2***
Person Separation Index (PSI)	.47	1.66	> 2
Item Reliability (IR)	.95	.98	>.80
Person Reliability (PR)	.18	.66	>.80

Statistics	Site A (n = 77)	Site B (n = 46)	Combined Sites (N = 123)	*EKAN-English
Mean (SD)	6.8 (2.09)	8.6 (1.92)	7.6 (2.13)	10.4 (2.13)
Median	6	9	8	*
Min - Max	3–13	5 - 13	3 - 13	5
Inter-quartile range	3.0	3.0	3.0	*

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Diná de Almeida Lopes Monteiro da Cruz Alameda Franca, 732 ap. 111 CEP 01422-002 – São Paulo, SP, Brazil dinamcruz@usp.br