Effective Evidence-based Practice Research Articles

Enhancing evidence-based practice into healthcare: Exploring the role of scientific skills in occupational therapists-

Background Research utilization and evidence-based practice (EBP) in occupational therapy rely on essential scientific skills. Despite prior research exploring factors influencing EBP, a gap remains in understanding the specific scientific competencies crucial for effective EBP application. Objectives To (1) describe the level of scientific skills for EBP and research application, and (2) investigate the factors influencing higher scientific competence among 1159 Spanish-speaking occupational therapists. Material and Methods We assessed the scientific skills using the HACTO-Screen online survey. Recruitment was conducted through a non-probability convenience sampling method between April to June 2020, using social networks and email dissemination to education and professional organizations in Spain and Spanish-speaking Latin American countries. Results Out of a total score of 115 points, participants showed a moderate level of scientific skills (mean: 62.7, SD: 21.6), with literature searching skills ranking the highest and scientific writing skills ranking the lowest. Associations were found between greater scientific competence and advanced degrees, ongoing research training, and on-the-job research. Conclusions Continuous research training, higher academic degrees, and active research engagement are essential for enhancing scientific competence among occupational therapists. Significance Targeted training to enhance scientific skills and promote research utilization are crucial in advancing EBP in occupational therapy.

Evaluation criteria of evidence-based practices in health and wellbeing promotion in Finland

Abstract Decision makers and experts have a great need to receive independent and credible knowledge about the effectiveness of evidence-based practices (EBPs) for promoting health, wellbeing, and equity. Best practice portals that evaluate EBPs have developed for this need. However, the evaluation criteria by which the portals determine the degree of effectiveness, evidence, and practical applicability of EBPs may differ between portals and need further investigation. There do not exist a single framework for evaluation criteria. Although the randomised control trials may meet a gold standard, there are alternative approaches to evaluate EBPs, considering the complexity of health promotion and wellbeing interventions. The Finnish Institute for Health and Welfare started to develop the best practice portal in health and wellbeing promotion in 2019. In this workshop, we present the evaluation criteria of EBPs in Finland and how the approach may contribute to the evaluation of EBSs, knowledge base and management in health promotion and disease prevention policy. We will also reflect on the way we capture the complexity in our criteria.

Barriers and facilitators of implementation of evidence-based interventions in children and youngpeople's mental health care - a systematic review.

Effective evidence-based practices (EBP) for children and young people's (CYP) mental health exist, however, there is low uptake in clinical practice and interventions do not always reach those in need. This review aimed to comprehensively identify and synthesise the barriers and facilitators to implementing EBP in CYP mental health care, mapped according to an implementation framework in order to make pragmatic recommendations for practitioners, commissioners and researchers. Following the PRISMA guidelines, an electronic search of PsycINFO, MEDLINE, CINAHL and Embase in 2021 yielded 1830 results. In total, 107 abstracts were screened, 57 of which were included for full-text review and 26 were included for data extraction and analysis. We identified a number of organisational and clinician-level barriers which impede the implementation of evidence in 'real world' practice. Barriers included lack of access to funding; poor access to resources; clinician attitudes and flexibility of EBP. Facilitators included targeted funding and access to resources; supportive staff and leadership committed to innovation and skills in the EBP. Although the process of translating research into practice is challenging and the solutions are not straightforward, we have identified a set of practical recommendations for ways in which implementation practices can improve. Researchers, commissioners, funders and practitioners can work together to improve the implementation of EBP in CYP mental health settings by ensuring funding is available, prioritise implementation beyond the end of trials, upskill staff on integrating EBP into care, ensure EBPs are flexible and are co-produced with service users. This review was registered on PROSPERO international prospective register of systematic reviews (CRD42021252995).

Gateway Scholars Program - reducing barriers to STEM for undergraduate students through scholarship and supportive programs.

This report presents the Gateway Scholars Program, an NSF-S-STEM supported program that recruited academically talented undergraduate students with demonstrated financial need. The objectives of our program included establishing a mentored cohort program, implementing enhanced risk-based advising, integrating evidence-based instructional practices in the curriculum, engaging students in co-curricular experiences, and generating new knowledge about the effect of activities on retention, student success, and degree attainment. Knowledge about broadening participation and effectiveness of evidence-based practices in STEM curricular and co-curricular activities and systems developed through this program have the potential to impact all STEM departments.

Barriers to Implementing Evidence-Based Practice among Primary Healthcare Nurses in Saudi Arabia: A Cross-Sectional Study.

Several studies have been conducted to investigate the barriers to implementing evidence-based practice (EBP) worldwide. In Saudi Arabia, a few studies were conducted in hospital and mental health settings, and no study has explored the topic in primary healthcare settings. This study aimed to examine the barriers perceived by primary healthcare nurses in implementing EBP. This study employed a correlational and cross-sectional design. A total of 284 nurses were surveyed using the BARRIERS scale. Regression analysis was performed to identify the effects of predictor variables on the four subscales. The overall raw score on the BARRIERS scale was 86.21 (standard deviation = 16.15). The highest mean score was reported in the organizational subscale, followed by the innovation and communication subscales, whereas the lowest mean score was reported in the adopter subscale. The findings showed that the three top-ranked barriers were: (1) results of the studies are not generalizable to nurses’ setting, (2) facilities are inadequate, and (3) physicians do not cooperate with the implementation. Findings showed that nurses encounter organizational-related barriers to a moderate extent and EBP implementation varies depending on gender, level of education, and job position. There is a need to create and implement educational interventions and programs to overcome the barriers to effective EBP implementation among primary healthcare nurses.

Testing the Usefulness of the Evidence Integration Triangle for Implementation of EIT-4-BPSD

The effectiveness of evidence-based practices, such as use of behavioral interventions, can be improved when delivered under conditions of an implementation framework. This pragmatic trial used the Evidence Integration Triangle (EIT) which is a parsimonious, community-engaged participatory framework that brings evidence and facility stakeholders together. Active engagement empowers key stakeholders to integrate evidence into practice using a simple three-pronged framework: (1) A participatory implementation process which was done via monthly meetings and weekly emails between stakeholders and a clinical expert as they worked on facility based goals; (2) Implementation of the four steps delineated in the EIT-4-BPSD; and (3) evaluation using practical progress measures. There was some evidence of implementation of the EIT-4-BPSD based on participation in Stakeholder team meetings, settings working towards goal achievement, and increased use of behavioral interventions among staff. The EIT approach is a useful implementation framework to help change staff behavior in long term care.

An Evaluation of the Practice Element Response Form in a Sample of Preservice Trainees

ABSTRACT Modal public sector in-service provider trainings tend to inadequately prepare therapists for effective evidence-based practice (EBP) delivery. To address this issue, some dissemination and implementation efforts have slowly turned to investigating and potentially improving preservice training, as doing so may provide a venue for ongoing training and competency evaluation. This investigation aimed to further study the psychometric properties of the Practice Element Response Form (PERForm), a vignette-prompted, open-ended response measure of procedural knowledge in specific EBP components, and a potential resource for clinical training programs considering modular approaches to treatment. A total of 67 clinical psychology doctoral students from three different institutions were administered the PERForm before and after participating in an in-class training on the practice elements of exposure and/or problem-solving. Results indicated good to excellent interrater reliabilities for the PERForm as well as some evidence supporting the measure’s sensitivity to instruction. Additionally, this was the first study to attempt to explore the relationships between students’ background characteristics and their procedural knowledge in the graduate school setting. Students’ year in the program, number of semesters in practicum, and group supervision hours per week were found to be associated with PERForm score changes, although these variables did not significantly predict procedural knowledge after controlling for the effect of cohort. While this investigation’s main purpose was to analyze the psychometric properties of the PERForm in a graduate school setting, the results of this study may have the potential to inform implementation and dissemination efforts in other aspects of therapist training.

Student perspectives on factors that influence the implementation of evidence-based practice in occupational therapy.

Evidence-based practice (EBP) is perceived as an integral component of contemporary allied health practice. While allied health clinicians (such as occupational therapists) have generally positive attitudes towards EBP, research suggests that they find its implementation consistently challenging. The professional literature increasingly suggests that more effective EBP learning takes place when social constructivist approaches to learning are adopted. The authors of this study sought to use the pre-existing knowledge and perceptions of occupational therapy students to inform a curriculum review of an EBP unit. Therefore, the aim of this content analysis study was to investigate how occupational therapy students perceive and critically analyse factors that influence the implementation of EBP, specifically strengths, weaknesses, opportunities and threats (SWOT). The study sampled students in the third year of a 4-year, Bachelor level Australian Occupational Therapy Program. The students were undertaking the first of two EBP units, and data were collected from the first assignment they submitted for these units. The assignment required the students to complete a SWOT analysis of EBP in occupational therapy, and response to a statement around whether it should be mandatory. Data were collected over 2 consecutive years from a total of 64 occupational therapy students. All data collected were subjected to content analysis, with themes identified by at least 25% of students in each cohort retained for analysis and formation into overall themes. Participating occupational therapy students identified five strengths, four weaknesses, six threats but only one opportunity for EBP. Three key themes were identified within the data: first, the role and purpose of EBP; second, the resources it requires and third, factors that influence its success. The students perceived the main purpose of EBP as supporting positive practice change, and highlighted its roles in building clinician capacity and professional credibility. They also characterized EBP as a separate and specialist practice that requires specific training and resourcing to achieve, and questioned its feasibility as an integrated part of daily practice. Along with previously identified challenges around time and resourcing, the students also highlighted negative attitudes and beliefs from senior colleagues as an important negative influence on the success of EBP. The current study consolidates a growing body of international literature about the value of social constructive approaches to EBP in undergraduate education. Vertical constructive alignment that embeds EBP through undergraduate education, rather than the provision of 'EBP'-specific units, should now be considered best practice. However, this embedded approach requires the explicit and repeated communication of the presence of EBP in all learning opportunities, to enable students to recognize opportunities to deploy their existing knowledge and skills.

Building evidence-based practice competencies among rehabilitation students: a qualitative exploration of faculty and preceptors' perspectives.

Medical education literature suggests clinically-integrated teaching may be the most effective approach to teach evidence-based practice (EBP). Before implementing this educational best practice in rehabilitation curricula, it is imperative to better understand the current context, barriers and facilitators to teach EBP in rehabilitation from the academic to the clinical setting. The aim of this study was to explore faculty and preceptors' experiences and perceptions of teaching EBP in rehabilitation professions, namely occupational therapy, physical therapy and speech-language pathology. We gathered data from seven focus groups and an individual interview with a sample of 24 faculty and 15 preceptors, i.e., clinical supervisors. Data collected were subjected to inductive thematic content analysis. We identified three overarching themes and corresponding strategies. First, "Recognizing EBP as a multifaceted concept" denoted participants' lack of consensus regarding the meaning and scope of EBP, and their awareness of such discrepancies. Second, "Complexity of EBP is at the core of teaching practices and experiences" referred to participants' perception of EBP as a complex process involving high-level cognitive skills, which influenced their teaching practices and challenged students and themselves. Third, "Connections and divides between research and practice" represented the limited and delicate connection between faculty and preceptors, the factors either bridging or maintaining the gap between them, and the impacts of such connections and divides on teaching. Improving collaboration between faculty and preceptors constitutes an essential first step towards more effective EBP training programs in rehabilitation that could be facilitated through online communities of practice or integrated knowledge translation research projects.

Effectiveness of Evidence-Based Practice (EBP) Education on Emergency Nurses' EBP Attitudes, Knowledge, Self-Efficacy, Skills, and Behavior: A Randomized Controlled Trial.

Emergency care clinicians are expected to use the latest research evidence in practice. However, emergency nurses do not always consistently implement evidence-based practice (EBP). An educational intervention on EBP was implemented to promote emergency nurses' use of EBP, and the effectiveness of it was evaluated. This study aimed to evaluate the effectiveness of an EBP educational intervention on emergency nurses' EBP attitudes, knowledge, self-efficacy, skills, and behavior. The study also examined learners' satisfaction with the EBP educational intervention. A randomized controlled trial with parallel groups with evaluations before the education, immediately after it, and 6 and 12months after the education was conducted at four emergency departments in two university hospitals. The experimental group (N=40) received EBP education while the control group (N=40) completed self-directed EBP education. The primary outcomes were emergency nurses' EBP attitudes, knowledge, self-efficacy, skills, and behavior, while the secondary outcome was satisfaction with the EBP education. Thirty-five participants of an experimental and 29 participants of a control group completed the study. There were no statistically significant (p<.05) improvements and differences between groups in EBP attitude, self-efficacy, or behavior immediately after the EBP education. At the 6-month measurement point, the experimental group showed significantly better EBP attitudes, behavior, knowledge, and self-efficacy than the control group. At the 12-month measurement point, the improvements began to decrease. The groups also differed significantly in terms of participant satisfaction with how the teacher encouraged learners to ask clinical questions. The EBP educational intervention implemented in this study had a positive effect on emergency nurses' EBP attitudes, knowledge, self-efficacy, skills, and behavior. The effects of the education appeared the best 6months after the education. After this point, the results began to decrease and approached baseline levels. EBP educational interventions designed for emergency nurses should apply various teaching strategies to improve their EBP attitude, knowledge, self-efficacy, skills, behavior, and satisfaction with the education.

Introducing evidence based practice in nursing care delivery, utilizing the Iowa model in intensive care unit at Kamuzu Central Hospital, Malawi

BackgroundNowadays, having knowledge of Evidence Based Practice (EBP) and its implementation strategies are critical skills for nurses to promote delivery of safe, effective and quality care. Nursing care delivery is faced with a challenge of delivering EBP. The purpose of this study was to build the capacity of and support nurses to implement an EBP change using Iowa Model of EBP. MethodsAction research using quantitative approaches was conducted in intensive care unit at Kamuzu Central Hospital (KCH). A descriptive, pretest-posttest design using repeated measures was employed. Iowa model was used to implement change. Convenient sampling of six-co researchers and 26 patients was done, the inclusion criteria was all patients with fever. STATA 12.0 software was used to analyze data and paired t-test was used to determine the mean difference of the paired temperature observations. ResultsIowa model effectively supported and guided nurses to: identify fever as a clinical problem; select fever control interventions; implement and evaluate the evidence-based interventions; refine and integrate the evidence-based interventions in routine practice. After Paired t-tests were run; there was an insignificant mean difference for exposure 0.07 °C, t (85) = 1.4123 and the P = 0.1615. This suggest that exposure has minimal effect on temperature reduction. The mean difference for paired temperature observation for: tepid sponge bath was 0.6 °C/hour, (t (85) = 9.8427, P = <0.001.); Ice packs 0.5 °C/hour, (t (56) = 6.7854, P = <0.001); antipyretics-paracetamol 0.3 °C/hour, t (23) = 3.4371, P = <0.002) and intravascular cooling 2.4 °C/hour (t (21) = 19.8080, P = <0.001). These methods had a significant mean difference of temperature reduction. This shows that the methods are effective in reducing temperature. Then a fever guideline was developed to guide nurses in smooth integration of the evidence-based fever control intervention into routine nursing care delivery to ensure sustainability. ConclusionUsing Iowa model improves nurses' EBP capability and capacity. Increasing knowledge of key staff members, team work, availability of local resources are crucial to increase nurse’s capacity of taking their EBP role. For effective EBP initiative it is recommended to: utilize of EBP models, ensure active participation of all nurses at the unit level, have supportive leadership, communicate available EBP policies, guidelines and job description to providers, and integrate the pilot EBP innovation in routine nursing care operations.

Innovative digital tools in EBP and information literacy education for undergraduate nursing students

Background: Information literacy (IL) skills are essential for the translation of current knowledge into evidence-based practice (EBP) in healthcare, which in turn improves patient outcomes. However, students enter pre-registration nursing programs with variable IL skills, which can present challenges when preparing research-literate nursing graduates. Objectives: To develop an online module for nursing students to learn the information literacy skills they require to effectively implement EBP. Project design: A self-paced, interactive online module was developed for final year pre-registration nursing students at an Australian university and launched in late January 2019. Four different digital tools, including screen-capture videos, split-screen tutorials, e-portfolio/learning journey platforms, and digital badges, were integrated to create an interactive module on database searching and systematic reviews. A student feedback survey was added to collect information on the students’ learning experience. Results: Students reported the online module was challenging but engaging and that its self-paced interactive nature assisted their learning. Digital badges were reported as a motivating factor by students, and their attitudes toward EBP were positive. Students were able to complete the module on their own, but a handful required face-to-face assistance. Conclusion: This project successfully integrated screen-capture videos, split-screen tutorials, e-portfolios and micro-credentialing into one online learning module to assist nursing students with developing the IL skills required for effective EBP.

Critically Ill Adults With Coronavirus Disease 2019 in New Orleans and Care With an Evidence-Based Protocol

BackgroundCharacteristics of critically ill adults with coronavirus disease 2019 (COVID-19) in an academic safety net hospital and the effect of evidence-based practices in these patients are unknown.Research QuestionWhat are the outcomes of critically ill adults with COVID-19 admitted to a network of hospitals in New Orleans, Louisiana, and what is an evidence-based protocol for care associated with improved outcomes?Study Design and MethodsIn this multi-center, retrospective, observational cohort study of ICUs in four hospitals in New Orleans, Louisiana, we collected data on adults admitted to an ICU and tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between March 9, 2020 and April 14, 2020. The exposure of interest was admission to an ICU that implemented an evidence-based protocol for COVID-19 care. The primary outcome was ventilator-free days.ResultsThe initial 147 patients admitted to any ICU and tested positive for SARS-CoV-2 constituted the cohort for this study. In the entire network, exposure to an evidence-based protocol was associated with more ventilator-free days (25 days; 0-28) compared with non-protocolized ICUs (0 days; 0-23, P = .005), including in adjusted analyses (P = .02). Twenty patients (37%) admitted to protocolized ICUs died compared with 51 (56%; P = .02) in non-protocolized ICUs. Among 82 patients admitted to the academic safety net hospital’s ICUs, the median number of ventilator-free days was 22 (interquartile range, 0-27) and mortality rate was 39%.InterpretationCare of critically ill COVID-19 patients with an evidence-based protocol is associated with increased time alive and free of invasive mechanical ventilation. In-hospital survival occurred in most critically ill adults with COVID-19 admitted to an academic safety net hospital’s ICUs despite a high rate of comorbidities.

Promotion of Evidence-Based Practice Skill and Attitude Among Advanced Nurses

In response to the call by both the Institute of Medicine and Centers for Medicare and Medicaid Services for increased evidence-based practice (EBP) competence and activity by nurses, healthcare institutions worldwide face the challenge of including quality educative content for effective EBP training (Llasus et al., 2014). The purpose of this evidence-based improvement project is to investigate and address current levels of EBP skill and attitude among nursing professional development specialists in a Magnet hospital and provide data for continued improvement of EBP promotion initiatives for nurses. Conclusions synthesized from a review of literature highlight common barriers and facilitators to EBP implementation among nursing professionals and point to the importance of continued efforts to provide EBP instruction to nurses at all levels, emphasizing a need for institutional support and development of advanced nurses as EBP champions.Keywords: Evidence-based practice, EBP, EBP knowledge, EBP attitudes, EBP instruction

Más Allá De Las Barreras: Competency and Practice Considerations in Language, Cultural, and Social Issues When Delivering Group CPT to Hispanic Immigrants

ABSTRACTHigh rates of underassessed trauma and psychiatric disorders, particularly post-traumatic stress disorder (PTSD) have been reported among Hispanic immigrants, especially as related to immigration trauma. Multiple studies have shown group cognitive processing therapy (CPT) to be an effective evidence-based practice (EBP) for treatment of PTSD across a number of clinical populations. To date, however, no studies have examined important competency and practice issues in linguistic, cultural, and ethical areas that group CPT providers should consider when delivering group CPT to Hispanic immigrants. This article aims to outline these and provide future directions for research.

Decision-based models of the implementation of interventions in systems of healthcare: Implementation outcomes and intervention effectiveness in complex service environments.

Implementation is a crucial component for the success of interventions in health service systems, as failure to implement well can have detrimental impacts on the effectiveness of evidence-based practices. Therefore, evaluations conducted in real-world contexts should consider how interventions are implemented and sustained. However, the complexity of healthcare environments poses considerable challenges to the evaluation of interventions and the impact of implementation efforts on the effectiveness of evidence-based practices. In consequence, implementation and intervention effectiveness are often assessed separately in health services research, which prevents the direct investigation of the relationships of implementation components and effectiveness of the intervention. This article describes multilevel decision juncture models based on advances in implementation research and causal inference to study implementation in health service systems. The multilevel decision juncture model is a theory-driven systems approach that integrates structural causal models with frameworks for implementation. This integration enables investigation of interventions and their implementation within a single model that considers the causal links between levels of the system. Using a hypothetical youth mental health intervention inspired by published studies from the health service research and implementation literature, we demonstrate that such theory-based systems models enable investigations of the causal pathways between the implementation outcomes as well as their links to patient outcomes. Results from Monte Carlo simulations also highlight the benefits of structural causal models for covariate selection as consistent estimation requires only the inclusion of a minimal set of covariates. Such models are applicable to real-world context using different study designs, including longitudinal analyses which facilitates the investigation of sustainment of interventions.

High-leverage social, emotional and behavioural practices for students with disabilities in inclusive settings

ABSTRACT The use of evidence-based practices (EBPs) is a tenant of effective instruction for students with disabilities in general and special education classrooms. In fact, it is essential that teachers use EBPs across content areas as they would benefit all students and maximise opportunities for those with special needs. Often, students with disabilities have difficulty meeting the academic, social, emotional, and behavioural demands of inclusive classroom settings when effective EBPs are not consistently implemented. In 2017, the Council for Exceptional Children and the CEEDAR Center at the University of Florida identified a set of evidence-based, high-leverage practices (HLPs) with the goal to guide teacher educators and professional development providers in the task of teacher preparation. This article discusses the application of four HLPs related to social, emotional, behavioural and instructional practices for students with disabilities in inclusive settings. The four HLPs addressed in this article are connected to the teachers’ ability to integrate multifaceted learning goals into instructional planning and delivery to create effective learning environments that may improve learning outcomes for students with (and perhaps without) disabilities across settings and content areas.

121 The Cumulative Effect of Evidence-Based Practices on Outcomes of Preterm Infants Born &lt;29 Weeks

121 The Cumulative Effect of Evidence-Based Practices on Outcomes of Preterm Infants Born &lt;29 Weeks

Effectiveness of Evidence-Based Practice (EBP) Training Program on the Level of Competencies of Faculty Members in a School of Nursing

The vision for the future of nursing has led to convergence of knowledge, quality, and new functions in nursing that require new competencies beyond evidence-based practice (EBP). However, the success of teaching and implementing EBP rely on the competencies of nursing educators. This study aimed to determine the effectiveness of the Evidence-Based (EBP) Training Program in enhancing the EBP competencies of faculty members. An EBP Training Program was conducted among 13 nurse educators. The participants cognitive and psychomotor competencies were measured before and after the EBP Training Program using a self-made cognitive and psychomotor competency questionnaire. Pre-test and post-test scores were then analyzed using RM-MANOVA. Results revealed that the EBP Training Program caused a large improvement in the cognitive competency in EBP of nurse educators. However, the training program was not sufficient to cause a significant effect on the psychomotor competency of the nurse educators.

Effectiveness of Evidence-Based Practice (EBP) Training Program on the Level of Competencies of Faculty Members in a School of Nursing

The vision for the future of nursing has led to convergence of knowledge, quality, and new functions in nursing that require new competencies beyond evidence-based practice (EBP). However, the success of teaching and implementing EBP rely on the competencies of nursing educators. This study aimed to determine the effectiveness of the Evidence-Based (EBP) Training Program in enhancing the EBP competencies of faculty members. An EBP Training Program was conducted among 13 nurse educators. The participants cognitive and psychomotor competencies were measured before and after the EBP Training Program using a self-made cognitive and psychomotor competency questionnaire. Pre-test and post-test scores were then analyzed using RM-MANOVA. Results revealed that the EBP Training Program caused a large improvement in the cognitive competency in EBP of nurse educators. However, the training program was not sufficient to cause a significant effect on the psychomotor competency of the nurse educators.