Systematic review of instruments for measuring nurses' knowledge, skills and attitudes for evidence-based practice

J Adv Nurs. 2014 Oct;70(10):2181-95. doi: 10.1111/jan.12454. Epub 2014 May 27.


Aim: To identify, appraise and describe the characteristics of instruments for measuring evidence-based knowledge, skills and/or attitudes in nursing practice.

Background: Evidence-based practice has been proposed for optimal patient care for more than three decades, yet competence in evidence-based practice knowledge and skills among nurse clinicians remains difficult to measure. There is a need to identify well-validated and reliable instruments for assessing competence for evidence-based practice in nursing.

Design: Psychometric systematic review.

Data sources: The MEDLINE, EMBASE, CINAHL, ERIC, CDSR, All EBM reviews and PsycInfo databases were searched from 1960-April 2013; with no language restrictions applied.

Review methods: Using pre-determined inclusion criteria, three reviewers independently identified studies for full-text review, extracting data and grading instrument validity using a Psychometric Grading Framework.

Results: Of 91 studies identified for full-text review, 59 met the inclusion criteria representing 24 different instruments. The Psychometric Grading Framework determined that only two instruments had adequate validity - the Evidence Based Practice Questionnaire measuring knowledge, skills and attitudes and another un-named instrument measuring only EBP knowledge and attitudes. Instruments used in another nine studies were graded as having 'weak' validity and instruments in the remaining 24 studies were graded as 'very weak'.

Conclusion: The Evidence Based Practice Questionnaire was assessed as having the highest validity and was the most practical instrument to use. However, the Evidence Based Practice Questionnaire relies totally on self-report rather than direct measurement of competence suggesting a need for a performance-based instrument for measuring evidence-based knowledge, skills and attitudes in nursing.

Keywords: evidence-based practice; instrument; knowledge; nursing; psychometric grading framework; psychometric systematic review; research utilization; skills and attitudes.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Evidence-Based Practice*
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Nursing Staff / psychology*
  • Psychometrics