Component Of Evidence-based Practice Research Articles

Research Knowledge Translation in Sensory Integration-Based Therapy: Exploring Subjectivity of Clinical Expertise.

Background. Clinical expertise is the mechanism through which practitioners implement other components of evidence-based practice (EBP). Within occupational therapy practice, intervention approaches that are both closely and loosely aligned with Ayres' Theory of Sensory Integration are widespread, offering a unique opportunity to investigate the subjective nature of clinical expertise in EBP. Purpose. This qualitative study explored motivations to offer sensory integration-based interventions, and factors informing occupational therapists' clinical decision making in relation to an arguably contentious evidence base. Method. Six post-graduate sensory integration trained UK occupational therapists participated in individual semi-structured interviews. Interviews were transcribed, member-checked and analyzed using thematic coding analysis. Findings. Despite sound understanding of theory and continuous efforts to develop clinical knowledge, non-traditional hierarchies of evidence notably inform clinical decisions. The clinical expertise required for integration of patient preferences, clinical state and circumstances, and research evidence is informed by pragmatic responses to facilitators and barriers across contexts, combined with unique profession-specific identity factors. Implications. While empirical healthcare research is ideally undertaken under controlled conditions, realities of clinical practice are rarely so clear cut. Study findings highlight important subjective factors that are central to real-world research knowledge translation and further understanding of the clinical expertise component of EBP.

Patient Engagement in Evidence-Based Practice Frameworks.

Evidence-based practice (EBP) is the cornerstone of contemporary healthcare, promoting the integration of scientific evidence, clinical expertise, and patient values to inform clinical decision-making and enhance patient outcomes. While patient engagement is recognized as a critical component of EBP, the extent to which it is incorporated in various EBP frameworks is unclear. This study is a secondary analysis of a scoping review which evaluated EBP frameworks used in healthcare settings. In the current study, our objective was to assess the level of patient engagement within those frameworks. To achieve this, we employed a patient engagement framework which characterizes engagement as a continuum, spanning consultation to involvement to shared leadership/partnership, across 3 healthcare domains: direct care, organizational design and governance, and policymaking. Our analysis revealed a gap in integrating patient values and preferences within EBP frameworks. Only 3 of the assessed frameworks showed a high degree of engagement across all domains. Future research should focus on developing strategies for implementing and evaluating meaningful engagement in EBP.

Enhancing Quality of Care Through Evidence-Based Practice: Training and Supervision Experiences.

Evidence-based practice (EBP) is the preferred approach to treatment in mental health settings because it involves the integration of the best available research, clinical expertise, and patient values to optimize patient outcomes. Training on empirically supported treatments (ESTs) in mental health settings is an important component of EBP, and supervision of therapists' implementation of ESTs is critical for therapists to develop and maintain a strong EBP skill set. This study aimed to evaluate training and supervision histories of therapists in outpatient and inpatient psychiatric care settings as an essential first step in improving patient outcomes. Electronic surveys were completed by 69 therapists, most of whom had a master's degree, within a psychiatry and behavioral sciences department at an academic institution. Participating therapists were recruited from several outpatient and inpatient mental health settings serving children, adolescents, and adults. Although most therapists reported completing some form of EST-related coursework, a majority did not receive any supervision related to implementation of ESTs (51% for cognitive-behavioral therapy cases, 76% for dialectical behavior therapy cases, and 52% for other EST cases) during graduate and postgraduate training. Although research from the past decade has supported the need for improvements in training on ESTs, and especially in supervision, problems related to limited exposure to training and supervision among therapists still exist. These findings have implications for how mental health centers can evaluate staff members' EST training and supervision experiences, training needs, and associated training targets to improve the quality of routine care.

De-adopting low-value care: The missing step in evidence-based practice?

BackgroundLow-value care provides little or no benefit to pediatric patients, has the potential to cause harm, waste healthcare resources, and increase healthcare costs. Nursing has a responsibility to identify and de-adopt low-value practices to help promote quality care. Purpose1) Describe the process of identifying and de-adopting low-value clinical practices guided by a conceptual model using a case study approach.2) Identify facilitators and barriers to de-adoption practices, including levels of stakeholder engagement, organizational structures, and the quality of available scientific and non-scientific evidence. MethodologyAn evidence-based practice (EBP) project investigating the efficacy of antihistamines in decreasing infusion reactions to infliximab identified a low-value practice within a pediatric infusion center. The Synthesis Model for the Process of De-adoption was then applied to guide the de-adoption of this low-value practice. Case study analysis highlighted facilitators and barriers to de-adoption efforts. ConclusionsThe process for de-adopting care is an essential component of EBP and, as such, should be explicated through robust, standardized EBP processes and education. Practice implicationsNurses are best positioned to identify, assess and prioritize low-value practices and facilitate the de-adoption of low-value practice that impact pediatric patients and families.Models to support de-adoption and a focus on site-specific practices including a prepared nursing workforce, continuous evaluation of care processes and the use of resources to assess for contextual determinants facilitates success and sustainability of this essential EBP approach.

Piloting an Evidence-Based Assessment Protocol for Incarcerated Adolescents

ABSTRACT Although evidence-based assessment is considered an essential component of evidence-based practice, few adolescents have access to evidence-based assessment. Despite experiencing high rates of mental health disorders, incarcerated justice-involved adolescents are rarely able to access evidence-based psychiatric care. In this article, we discuss the components of an evidence-based assessment protocol designed and piloted with incarcerated adolescents involved in Rhode Island’s juvenile justice system. In particular, we describe the components of our evidence-based protocol, ways in which evidence-based assessment may need to be modified when working with this population, and discuss policy and clinical implications relevant to increasing access to evidence-based assessment among incarcerated adolescents.

Use of Implementation Science to Advance Nurse-Led Evidence-Based Practices in Clinical Settings

Evidence demonstrates improved outcomes of evidence-based practice (EBP); yet routine implementation remains challenging. Implementation science provides a science-based approach to implementation, but application among nurse-led teams is sparse. This study identified difficulty/success of nursing teams implementing EBPs, and common implementation strategies. Nurses (n = 84) reported difficulty with implementation. Common strategies included engaging leadership, collaborators, highlighting advantages, diverse teams, and staff meetings. Highly successful nurse-led teams reported use of timelines, checklists, auditing/feedback, and hardwiring as effective implementation strategies. Implementation remains the most challenging component of EBP. Nurse-led teams should incorporate implementation science strategies to facilitate successful uptake of EBP in clinical settings.

Ethical Behavior Analysis: Evidence-Based Practice as a Framework for Ethical Decision Making.

As the number of applied behavior analysts continues to grow, ethical practice and decision making become increasingly important. Specifically, improving behavior analysts' ethical decision-making repertoires is critical to effective and ethical behavioral service delivery within the field of applied behavior analysis (ABA). This article proposes that the evidence-based practice (EBP) of ABA (Slocum et al., 2014) provides a framework to support fluent ethical decision making. The purpose of this article is to (a) review the importance of ethical decision making related to the practice of ABA, (b) introduce and summarize EBP of ABA, (c) review the three main components of EBP of ABA, and (d) discuss the broader role that EBP of ABA can play in the field of ABA. We tie the EBP of ABA to current Behavior Analyst Certification Board ethical standards and present actions that behavior analysts can engage in to support their ethical decision making throughout.

A systematic review of recommendations for behavioral health services for transgender and gender diverse adults: The three-legged stool of evidence-based practice is unbalanced.

There is a growing literature of clinical recommendations for transgender and gender diverse (TGD) affirming behavioral health care, yet it is unknown to what extent these recommendations are rooted in evidence-based practice (EBP). This systematic review included 65 articles published between 2009 and 2018 with recommendations for behavioral health services with TGD adults, emphasizing general clinical care. Coded variables included type of article, participant demographics, aspects of EBP, and whether care was informed by objective assessment. Most articles did not equally draw from all components of EBP. Recommendations for specific clinical problems are increasingly available and address diversity within TGD communities. More research, including clinical trials adapting established interventions, is needed to inform state-of-the-art TGD-affirmative behavioral health care.

Evidence-Based Practice in Speech-Language Pathology: Where Are We Now?

Purpose In 2004, American Speech-Language-Hearing Association established its position statement on evidence-based practice (EBP). Since 2008, the Council on Academic Accreditation has required accredited graduate education programs in speech-language pathology to incorporate research methodology and EBP principles into their curricula and clinical practicums. Over the past 15 years, access to EBP resources and employer-led EBP training opportunities have increased. The purpose of this study is to provide an update of how increased exposure to EBP principles affects reported use of EBP and perceived barriers to providing EBP in clinical decision making. Method Three hundred seventeen speech-language pathologists completed an online questionnaire querying their perceptions about EBP, use of EBP in clinical practice, and perceived barriers to incorporating EBP. Participants' responses were analyzed using descriptive and inferential statistics. We used multiple linear regression to examine whether years of practice, degree, EBP exposure during graduate program and clinical fellowship (CF), EBP career training, and average barrier score predicted EBP use. Results Exposure to EBP in graduate school and during the CF, perception of barriers, and EBP career training significantly predicted the use of EBP in clinical practice. Speech-language pathologists identified the three major components of EBP: client preferences, external evidence, and clinical experience as the most frequently turned to sources of EBP. Inadequate time for research and workload/caseload size remain the most significant barriers to EBP implementation. Respondents who indicated time was a barrier were more likely to cite other barriers to implementing EBP. An increase in EBP career training was associated with a decrease in the perception of time as a barrier. Conclusions These findings suggest that explicit training in graduate school and during the CF lays a foundation for EBP principles that is shaped through continued learning opportunities. We documented positive attitudes toward EBP and consistent application of the three components of EBP in clinical practice. Nevertheless, long-standing barriers remain. We suggest that accessible, time-saving resources, a consistent process for posing and answering clinical questions, and on the job support and guidance from employers/organizations are essential to implementing clinical practices that are evidence based. The implications of our findings and suggestions for future research to bridge the research-to-practice gap are discussed.

Mock Nursing Research and Evidence-Based Practice Conference to Support Learning in Pre-Licensure Nursing Students.

This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning and implementation of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787 Evidence-based practice (EBP) is an essential element of quality nursing care and education programs. However, nursing students do not seem to grasp the importance of learning EBP, as evidenced by a lack of competency in their clinical roles (Melnyk et al., 2018). Within the seven steps in the EBP process (Table 1), it was found that nursing students’ most needed improvement is with the competencies of “critical appraisal of published research” and “evaluation and synthesis of evidence” (Melnyk, Fineout-Overholt, Stillwell, & Williamson, 2010; Melnyk et al., 2018). One common way to teach critical appraisal skills and evaluation of evidence competencies is through the use of journal clubs (Ahmadi et al., 2012). Journal clubs are educational tools used to foster critical appraisal skills, encourage EBP, and disseminate new findings, typically through discussion of an article (Topf et al., 2017). This teaching strategy has been around since the mid-1800s and has since taken on a number of forms, ranging from face-to-face meetings to interactions via online, social media platforms (Rosenthal & Rosenthal, 2017; Topf et al., 2017). Incorporating the concepts of the journal club, this column will describe an innovating teaching strategy using a live “mock” nursing research and EBP conference in a pre-licensure nursing program. The objectives were to (a) engage students in current nursing research and EBP and (b) develop their critical appraisal and evaluation skills. Whereas traditional journal clubs discuss current, published literature (Topf et al., 2017), the mock conference included presentations on projects currently in process by PhD and DNP students. The mock conference took place during the EBP course in a pre-licensure nursing program halfway through the semester. The beginning of the semester was spent providing an overview of the EBP process using the Iowa Model of EBP as a guide (Buckwalter et al., 2017). As an integral component of EBP, much didactic time was spent reviewing non-research and research methodologies and how to critically appraise articles. Standard critical appraisal tools that also include clear descriptions and directions on how to assess an article’s level and quality were used to further guide students (Dearholt & Dang, 2012). The concepts of validity, reliability, and applicability of evidence were discussed in didactic lectures, and examples were provided by the course faculty. Course faculty served as the moderator for the conference. Each presenter had 15 min to discuss their project, with time allotted for questions. Presenters were at various stages in their projects, ranging from beginning protocol development to finalized results, with a variety of methodologies and topics presented. Brochures with presenters’ biographies and evaluation forms were distributed to students. Within the brochures, students were asked to rate presentations on a 5-point Likert scale of 1 (poor) to 5 (excellent). This provided students with experience in evaluating speakers, a component of real nursing conferences. Evaluations were provided to the presenters for feedback. To improve the students’ critical appraisal and evaluation skills, students were asked to (a) identify the methodology used, (b) describe the overall purpose, (c) describe the population and setting, and (d) describe how outcomes were measured. Lastly, students were asked to rate the overall mock conference on the same 5-point Likert scale. I thought this was super interesting and a great way to solidify some of the research concepts we have been learning! It gave us examples in what we are studying, while giving students a chance to practice presentations on their research. Great collaboration! This was a great experience. As a student interested in research, this mock conference sparked further interest into future work. The presenters’ enthusiasm for their work is contagious! This conference was helpful in demonstrating multiple facets of ‘real-world’ application of research and EBP. PhD and DNP students commented that they appreciated the opportunity to practice presenting their projects and that it gave them confidence and helpful feedback for the future. The mock conference, a new twist on the journal club, was a mutually beneficial activity that improved pre-licensure students’ critical appraisal and evaluation skills and provided a forum for PhD and DNP students to practice presenting their project. Based off of feedback from the first mock conference, a PhD and DNP student panel was added where pre-licensure students could ask questions about the two doctoral programs. Future conferences may expand to add faculty and clinicians from the health system, as well as poster presentations.

Quantitative comparison of group-based music therapy experiences in adults with substance use disorder on a detoxification unit: a three-group cluster-randomized study

ABSTRACT Background: Service users’ values and preferences are components of evidence-based practice and recovery. Methods: Adults (N = 113) with substance use disorder (SUD) on a detoxification unit were cluster-randomized to one of three group-based single-session conditions: Recreational music therapy (RMT), educational lyric analysis for illness management and recovery (ELA-IMR) or educational songwriting for illness management and recovery (ESW-IMR). Participants completed the Ferrara Group Experiences Scale after their session. Results: There were significant differences in the sharing of emotions and experiences subscale between the RMT and both the ELA-IMR and ESW-IMR conditions, with the educational conditions having higher scores. There was a significant difference in the total group experience between the RMT and ELA-IMR conditions, with the ELA-IMR condition having a higher score. Conclusions: Merging the results of previous literature with the current study, educational music therapy interventions can positively impact recovery-based objectives and the group-based experience in adults with SUD.

Caries Excavation: Evidence Gaps.

Dental caries, the most common chronic disease in the world, affects over 3 billion people globally. Its management comprises a large proportion of dental care providers' clinical responsibility, yet despite the extensive evidence base for the management of cavitated carious lesions, gaps in the evidence persist. This promotes uncertainty and debate among providers. This chapter reiterates the 3 key components of evidence-based practice (EBP): clinical expertise, an awareness and appreciation of patient values, and use of best available evidence. Secondly, we give a brief summary of current best evidence pertaining to some key areas of caries excavation in the context of lesion management, and highlight respective gaps in the evidence. Consideration is given to the state of the evidence for: how carious-lesion excavation is best achieved, the extent to which excavation should occur, contemporaneous practice, the timing of dental intervention in relation to the extent of the disease, and some areas of contention. Finally, there is discussion around how dental care providers might proceed when high-quality evidence does not exist to inform that part of the EBP collective.

What Does Evidence-Based School Nursing Practice Even Mean? Get a CLUE.

Evidence-based practice (EBP) is a phrase used frequently in nursing, policy, and education. This article explains three components of EBP, why it is important for school nursing, barriers to practicing EBP, and solutions to practicing EBP. This article is the first in a series of articles for NASN School Nurse that will delve into what EBP is and how it applies to school nursing using practical examples.

Assessment of evidence-based practice among hospital pharmacists in Saudi Arabia: attitude, awareness, and practice.

Background Many studies have previously looked at the perceptions, attitude, and use of Evidence-based Practice (EBP) among healthcare providers. However, limited data is available on the implementation of EBP among pharmacists in general, and Saudi Arabia in particular. Objective To evaluate the awareness, attitude, and practice of EBP among hospital practicing pharmacists in Saudi Arabia. Setting Secondary and tertiary care hospitals in Saudi Arabia with a bed capacity of ≥200 Methods This is a cross sectional, survey-based study where a validated selfadministrated questionnaire was utilized. Pharmacists working in secondary and tertiary care hospitals with a bed capacity of ≥200 were targeted. The descriptive data consisted of percentages for discrete and medians for continuous statistics. Results The survey was distributed to a total of 1136 pharmacists. Total number of respondents is 228 which represent a response rate of 20%. Most of them (75% median score=8) have a positive attitude toward EBP. In addition to clinical expertise, only 48.6% of them were able to identify EBP resource as the second component of EBP concept, while only 1.7% of the respondents were able to identify patient preference as a third component. Lack of personal time, critical appraisal skills, and resources, (40%, 15.6% and 13.9% respectively) are considered as the major barriers to implementing EBP in pharmacy. Conclusion The majority of pharmacists in Saudi Arabia hold a positive attitude of EBP. Unfortunately, most of pharmacists do not consider patients' values as a component of EBP. The major barriers to practicing EBP are lack of personal time, critical appraisal skills, and resources availability.

Tyranny of the randomised clinical trial

Researchers and clinicians often disagree about what it means to provide the best possible care. This paper’s purpose is to propose ways of resolving the disagreements. The first is to have both groups re-examine the three equal components of evidence-based practice, a re-examination that begins with rejection of the randomised clinical trial’s tyranny. The second is for researchers to design rehabilitation research based on a biopsychosocial rather than a biomedical model. The third is for both groups to redefine translational research so that it means both translation from the laboratory to the clinic and from the clinic to the laboratory. The fourth is to advocate for a science of dissemination that is as robust as rehabilitation’s present science of discovery. Most examples are drawn from the literature on acquired neurologic speech and language disorders.

Music therapy promotes self-determination in young people with autism spectrum disorder

Self-determination leads to a higher quality of life, yet many individuals with autism spectrum disorder struggle with the component skills necessary for self-determination. Music therapy is one method of treatment for persons with autism spectrum disorder and has the ability to improve or develop skills in communication, self-awareness, socialization, and decision making. Two components of evidence-based practice (clinical expertise and scientific research) are presented in this article describing how music therapy facilitates self-determination.

Exploring the relationship between client perspectives, clinical expertise and research evidence

Purpose: This paper examines the relationship between components of evidence-based practice (clinical expertise, patient perspective and research evidence).Method: Findings are examined from two research programs: the Better Communication Research Program and Child Talk, including exploratory studies of the views of parents and children regarding speech-language pathology and studies of current practice by SLPs in England. Systematic reviews of the research literature were also undertaken. The paper analyses relationships between outcomes valued by children and parents and those reported in the literature and in practice, parents’ perspectives regarding intervention in comparison with clinicians’ reports of practice and the extent to which research evidence underpins current practice is examined.Result: Parents and children value functional outcomes and positive experiences; these are not routinely measured in research or practice. Therapy is perceived positively by most parents; however, some are ambivalent and less clear about the rationale. Commonly used interventions are supported by evidence, but there are gaps regarding some critical therapy components.Conclusion: The paper discusses four challenges to evidence-based practice: the consistency and clarity of descriptions of interventions; consensus based models of practice; understanding of the mechanisms of change; and, finally, the operationalization of client preferences within an evidence-based practice framework.

Evidence-Based Assessment Meets Evidence-Based Treatment: An Approach to Science-Informed Case Conceptualization

Though case conceptualization is considered to be a component of evidence-based practice, the case conceptualization process is not always guided by scientific findings. Case conceptualization is a collaborative process of generating hypotheses about causes, antecedents, and maintaining influences for an individual client’s problems within a biopsychosocial context. We argue that adopting a scientific approach to case conceptualization informed by research findings and evidence-based assessment tools can help inform clinical decision-making from intake to treatment termination. Our approach to case conceptualization involves 5 stages. In the first stages, a clinician synthesizes and integrates research evidence from various literatures to identify presenting problems and casual and maintaining factors (Stage 1), to classify diagnoses (Stage 2), to inform the development of hypotheses about variables contributing to a client’s problems (Stage 3), and to select a treatment approach and plan (Stage 4). In the final stage, the clinician takes a scientific approach to developing individualized assessment methods that can be used to test and revise hypotheses through the treatment process and to measure outcomes (Stage 5). A case example illustrating practical use of these steps is presented.

Science and Practice Aligned Within Nursing

Science and Practice Aligned Within Nursing (SPAWN) is an innovative method developed to guide the implementation of evidence-based practice (EBP) by oncology nurses in direct patient care settings. Science and Practice Aligned Within Nursing actualizes and addresses the important and essential practice component of EBP in oncology nursing. This article describes the development of SPAWN infrastructure, phases of the process, implementation, outcome evaluation, key insights, and lessons learned.

Registered nurses’ evidence-based practice: A longitudinal study of the first five years after graduation

BackgroundThe capacity to provide evidence-based practice is one of five core competencies that it is proposed all healthcare professions should possess to meet the needs of the 21st century healthcare system. New nurses are faced with a challenging work environment which, combined with shortcomings in undergraduate education and their limited clinical experience, may affect their evidence-based practice. ObjectiveThe aim of this study was to prospectively examine the extent of Swedish nurses’ evidence-based practice during the first five years of professional life. DesignAn observational longitudinal study, with yearly data collections over the course of five years. SettingsData was collected in two national cohorts (named EX2004 and EX2006) of Swedish registered nurses. Nurses in EX2006 were followed yearly during the first three years after graduation and nurses in EX2004 yearly three to five years after graduation. They had completed a three year academic nursing program and mainly worked in in-patient care settings. ParticipantsParticipants were recruited while studying at any of the 26 universities in Sweden. A total of 2107 (EX2006) and 2331 (EX2004) nursing students were eligible. 1207 and 1227 nurses were included in the current longitudinal samples. The nurses had a mean age of 31.2/33.9years old and a majority were female. The cohorts were representative of the general nursing population. MethodsData was self-reported and collected through annual postal surveys. Evidence-based practice was conceptualized as a process and measured with an instrument including six items. Data was analyzed using latent growth curve modeling. ResultsThe extent of evidence-based practice was stable, between the two cohorts and over time. Individual differences existed and remained stable over time. However, the extent of practicing the different components of evidence-based practice on a monthly basis varied considerably, from 10% of the nurses (appraising research reports) to 80% (using information sources other than databases to search for knowledge). ConclusionThe extent of evidence-based practice remained unchanged during the first five years of professional life. It appears important to enhance both the contribution of undergraduate education and the contextual conditions in work life, in order to improve evidence-based practice among newly graduated nurses.