Factors Influencing Evidence-Based Decision-Making Among Specialized Nurses Working in Selected Health Facilities in Nairobi, Kenya

Abstract

Evidence-based decision-making (EBDM) and practice among nurses in Kenya, is largely unexplored. The study was designed to determine the factors influencing the utilization of evidence by nurses for decision-making and practice. In 2024, a concurrent, triangulation mixed methods study was designed, targeting nurses working in maternal and child (Reproductive) wards in selected facilities in Nairobi County with the sites being all public facilities of levels 4 and 5. A 5-point Likert scale questionnaire was administered to all nurses found working on the day the researcher visited the facility. Key informant interviews were also conducted on the same day. Ethical approval was sought from Kenya Methodist University and individual respondents completed Informed consent forms prior to participation in the study. All other ethical considerations required were adhered to. Quantitative data analysis was carried out using SPSS version 22 statistical software. Exploratory data analysis (EDA) was employed at the initial stage of analysis. Bivariate level analysis was used to assess the association of independent variables with EBDM utilization using Chi-square test and/ or Fisher’s Exact Test. All variables with a P-value < 0.25 in the bivariate analysis were subjected to multivariate analysis. Adjusted Odds Ratios (AOR) with 95% Confidence Intervals (CIs), were used to evaluate the strength of statistical association between dependent and independent variables. Qualitative data was managed using thematic analysis. Results show intuition is the most applied thought paradigm among nurses for decision making alluding to the importance of tacit knowledge in nursing. Factors that emerged as significantly associated with EBDM among reproductive nurses were individual in nature. The findings of this study are expected to inform policy and management efforts to enhance nurses’ decision making. As without nurses’ engagement with evidence and learning, EBDM contributions will continue to be negligible, it is recommend that more research be done to enhance institutional factors and the use of intuition to support EBDM. As well, strategies for harvesting tacit knowledge should be enriched.