Elements Of Evidence-based Practice Research Articles

Nurses’ knowledge sources when making decisions involving pro re nata medication in sheltered housings for older people: A qualitative descriptive study

Although pro re nata medications (PRNM) are widely used among older patients in long-term care, current knowledge about nurses’ PRNM management is scarce. The study aim was to describe which knowledge sources nurses working in sheltered housing for older people use when making decisions regarding PRNM. This was a qualitative interview study with registered nurses ( n = 4) and assistant nurses ( n = 4) working in sheltered housings in mid and eastern Norway. Data analysis was based on qualitative and abductive content analysis, where evidence-based practice (EBP) was used in the abduction. The COREQ checklist was followed. Several knowledge sources are used when making decisions regarding PRNM, that represent the four elements of EBP. ‘Practitioner experience and judgement’ was a prominent source of knowledge among the nurses, while ‘Evaluated external evidence’ was less emphasized in PRNM decision-making. The results support previous research on EBP in nursing, and bring new knowledge regarding PRNM in the context of sheltered housing. To achieve appropriate and safe management of PRNM, there is a need to support nurses’ decision-making process, e.g. through PRNM guidelines and systems for documentation and information exchange. EBP in PRNM decision processes should be given attention, utilizing all elements including ‘Evaluated external evidence’ as a knowledge source.

Physiotherapists\u2019 perceptions of challenges facing evidence-based practice and the importance of environmental empowerment in fall prevention in the municipality \u2013 a qualitative study

BackgroundFalls in older adults are an increasingly important public-health concern. Despite abundant research, fall rates have not been reduced, because implementation of evidence-based fall-prevention measures has been slow and limited. This study aims to explore physiotherapists’ perceptions on external factors, such as public policy, organisation and leadership, regarding the relation between knowledge translation and the three elements of evidence-based practice (EBP) to effectively address barriers and facilitate the uptake of EBP in fall prevention.MethodsWe conducted semi-structured interviews with 18 physiotherapists (men = 7; women = 11) working with fall prevention in the primary healthcare system. The physiotherapists ranged in age from 27 to 60 years (median 36 years) and had worked as a physiotherapist from 1 to 36 years (median 7 years). Data are analysed using thematic analysis.ResultsThe analysis revealed one main theme and four sub-themes. The main theme was ‘Environmental empowerment enhances physiotherapists’ capabilities for using EBP’. A resourceful work environment facilitates EBP, having access to information about research-based knowledge, supportive leadership, enough human resources and opportunities to learn and grow at work. The four sub-themes were as follows: 1) ‘Tension between attributes of research-based knowledge and organisational routines and practices’; 2) ‘Evidence must be informed by policymakers—What works?’; 3) ‘Empowering culture and work environment—A steppingstone to EBP’ and 4) ‘Organisation readiness for EBP, managerial and clinical relations’. Success in environmental empowerment depends on the leader’s role in creating preconditions at the workplace that may lead to important positive personal and organisational outcomes for EBP. Two-way communication and transfer-of-information are also key factors in the development of positive work engagement when using EBP.ConclusionThe findings of this study outline tension between policy, leadership, organisational facilitators and EBP. Leadership is influenced by policy with ripple effects for the organisation and clinicians. Organisational facilitators form structural empowerment, which is the foundation for creating an EBP environment.Trial registration2018/2227/REC south-east C. Registered 19 December 2018, Norwegian Ethics Committee for Medical and Health Research Ethics.

Development, implementation and evaluation of an evidence-based practice model in a new hospital in Chile.

To describe an implementation programme for an evidence-based practice (EBP) model in a new Chilean hospital and to analyse the programme evaluation results. Evidence-based practice is key to professional nursing for improving health care safety and quality. First, a literature review was performed to develop an institutional EBP model. Second, internal and external analyses contributed to assessing facilitators for and barriers to implementation. Third, a multi-stage implementation plan was conducted. Fourth, process and outcome indicators were evaluated. The model considered the basic elements of EBP and outlined different decision-making levels in clinical practice. Several facilitators for implementation were identified. Each implementation stage included activities addressing EBP knowledge, attitude and skills. Outcome indicators showed significant improvement regarding knowledge (p=.038). Providers with formal EBP training, compared with providers without training, showed a significant difference of 8.6% (0.6 points) in the average CPBE-19 score in knowledge, attitude and application in the last evaluation (p<.01). Having an EBP programme with ongoing implementation strategies improves knowledge over time, and formal training enhances positive results. Nurse managers can build an institutional research culture to improve the quality of care using an EBP programme that fits organisational needs.

Praktyka oparta na dowodach w postępowaniu logopedycznym

Evidence-based practice (EBP) is supposed to integrate: Clinical Expertise, External Clinical Evidence and Patient Preferences. In the process of speech-language therapy after precise clinical assessment it refers to following steps, named in literature ‘5A’ formula: ask clinical question, acquire evidences, appraise the evidences, apply the strategy based on gathered evidenced, assess results from the incorporated strategy.The aim of the article is to describe the idea of evidence-based practice in speech-language pathology and its strengths and weaknesses in confrontation with reality. There have been essential elements of EBP presented, as well as hierarchy of evidence, sources of evidence-based publications which are important for speech-language pathology, and speechlanguage therapy steps according to EBP criteria. Conclusions for clinicians and researchers may contribute to development of evidence-based practice in Polish speech-language pathology.

Knowledge Translation and Evidence-Based Practice: A Qualitative Study on Clinical Dietitians’ Perceptions and Practices in Switzerland

BackgroundKnowledge translation (KT) in health care is essential to promote quality of care and reduce the knowledge-to-practice gap. Little is known about KT among dietitians, and a better understanding of how this process pans out is fundamental to support their clinical practice. ObjectiveTo explore clinical dietitians’ perceptions and practices concerning preferences and access to information sources in clinical practice, KT activities, research in nutrition and dietetics, and evidence-based practice (EBP). Design, participants, and settingEight interviews and two focus groups involving a total of 15 participants were conducted in 2013 among members of the Swiss Association for Registered Dietitians in the French- and German-speaking regions of Switzerland. Analysis performedThematic analysis drawn from a constructivist grounded theory approach. ResultsInformation from colleagues and experts of the field were favored when facing unfamiliar situations in clinical practice. Critically selecting evidence-based information was considered challenging, but dietitians declared they were at ease to integrate patients’ preferences and values, and their clinical expertise and judgment, in decision making, which are fundamental elements of EBP. A major reported barrier to KT was the perception that time to identify and read scientific literature was not expected during working hours and that instead, this time should be spent in clinical activities with patients. On the other hand, dietitians identified that their frequent involvement in educational activities such as knowledge dissemination or tailoring favored the integration of evidence into practice. Finally, dietitians struggled more to identify evidence-based information about counseling and communication than about biomedical knowledge. ConclusionsDietitians mentioned being involved in each step of the KT process (ie, synthesis, dissemination, exchange, and ethically sound application of knowledge). Barriers and facilitators identified in this study need to be explored in a larger population to develop strategies to facilitate KT and EBP in dietetics practice.

Getting All the Pixels: How can we Increase the Evidence?

The American Speech-Language-Hearing Association (ASHA) advocates that all Speech language pathologists must include the principles of evidence-based practice (EBP) in their clinical decisionmaking to ensure the provision of high quality interventions [1]. EBP is a trilateral construct consisting of external evidence, the clinical expertise of the clinician, and the needs of the client. Recently, consideration of the needs of the client, the so-called social evidence, has become increasingly important, especially in the discussion of quality [2]. However, when considering the three elements of EBP, the external evidence frequently receives the highest emphasis. In the context of communication disorders, randomized controlled trials (RCT), studies that are viewed as the best source of the highest level of evidence, are considered by many as the “gold standard” of treatment efficacy studies [3]. RCT studies are often difficult to conduct, as they are expensive and time-consuming. In the area of fluency disorders, there are few RCTs available, and we often have to rely on expert opinion rather than efficacy studies [4]. However, if such studies were the only evidence clinicians could rely on, it would be like having a high definition television and only receiving a limited number of pixels. Imagine the output, if all the red pixels were missing – the picture or evidence would be blurry! One option to increase the fidelity of the overall picture would be to take other evidence into account, for example a well-designed and well-reported case study. Such studies may not have the highest level of evidence, but could guide the speechlanguage pathologist when making clinical decisions. Smaller wellreported studies are not invalid and although they will not receive the highest rating of evidence they still can lead to well-informed clinical decision-making. But a far more important question is, could we widen the evidence base for these types of studies? How can the pixilation, the data sets that are available for these studies, be improved? Can the “gold standard” for lesser-investigated therapy methods be reached by increasing the data collected?

Developing alcohol SBI policy and procedures with Alaska Public Health Nursing

Background The Institute of Medicine recommends changing organizational policy as a key element of evidence-based practice (EBP) implementation; however, policy change alone may be insufficient to change provider practice behavior [1,2]. Engaging key organizational stakeholders in the policy change process may foster buy-in, particularly if the policy is piloted and refined alongside the new practice. As part of a two-year initiative funded by CDC to implement routine alcohol screening and brief intervention (SBI) into primary care settings, the Alaska Section of Public Health Nursing (PHN) collaborated with the University of Alaska Anchorage to pilot alcohol SBI policy and procedures in three clinics prior to systemwide dissemination.

Testing the Clinical Implications of Planned Missing Data Designs.

Assessment is a core element of evidence-based practice, but thorough formal assessment can place a significant burden on clients. We evaluated the clinical viability of using planned missing data designs to reduce client burden. Data come from an archival dataset with 1342 participants. Although significant differences were found in scores with planned missing data versus real scores, the effect sizes for the differences were generally small. Scores with missing data had sensitivity and specificity scores generally above .90 when predicting real scores over clinical cutoffs and improvement in real scores. These findings offer useful information to agencies and researchers looking for ways to collect more data without losing its immediate clinical utility.

English Social Work at the Crossroads: A Critical View

At the present time, social work in England finds itself at the crossroads. Against a backdrop of economic globalisation, it has been caught up in New Labour's modernising policy discourse that has recast social justice in terms of opportunity, inclusion, and “choice”. More recently, this has been extended by the introduction of a “respect agenda”, a reaction to the loss of community cohesion and the rise in antisocial behaviour. In the present article, two alternative paradigmatic responses are explored reflecting a debate between evidence-based practice (EBP) and critical practice (CP). These may be juxtaposed because they offer different visions of what social work could become in the future while providing two important reference points against which current practice may be judged. Whereas the former has been depicted as a “search for certainty” that largely complements the modernising discourse, CP works with both certainty and uncertainty in the quest for more emancipatory change. In practice, English social workers may manage such contradictions by looking down both roads and incorporating elements of both in their practice: adopting elements of EBP to justify their interventions and become more research minded while embracing aspects of CP to engage with structural issues that lie at the root of injustice.

Identifying Common Elements of Evidence-Based Psychosocial Treatments for Children's Disruptive Behavior Problems

: Almost all of the efforts to study and implement evidence-based practice (EBP) have used individual treatments as the unit of analysis. A complementary approach using aggregated common elements of multiple individual evidence-based treatment programs has been introduced. The purpose of this article is to describe a new method for identifying common elements of EBP and to present common elements resulting from a systematic review of interventions for children with disruptive behavior problems and their parents. : We identified eight individual treatment programs with established efficacy for children ages 4 to 13 with disruptive behavior problems, reviewed all of the treatment materials thoroughly, identified core elements of each treatment, and determined which elements were common to at least half of the programs. The validity of these common core elements was confirmed through a survey of national experts using a modified Delphi technique. : We identified 21 treatment elements that were common to multiple evidence-based treatment programs. These included therapeutic content (e.g., principles of positive reinforcement, problem-solving skills training), treatment techniques (e.g., role-playing, assigning homework), aspects of the working alliance, and other parameters such as treatment duration. : Identification of common core elements of EBP has important implications for efforts to characterize practice, as well as therapist training and implementation of EBP in community-based service settings. Therapist training and ongoing supervision that builds on common elements of EBP could potentially improve the effectiveness of care overall. It could also build a strong foundation for targeted individual treatment implementation efforts by enhancing therapists' skills and attitudes about EBP.

Library Support for Problem-Based Learning: An Algorithmic Approach

ABSTRACT Academic health sciences libraries can take various approaches to support the problem-based learning component of the curriculum. This article presents one such approach taken to integrate information navigation skills into the small group discussion part of the Pathophysiology course in the second year of the Dental school curriculum. Along with presenting general resources for the course, the Library Toolkit introduced an algorithmic approach to finding answers to sample clinical case questions. While elements of Evidence-Based Practice were introduced, the emphasis was on teaching students to navigate relevant resources and apply various database search techniques to find answers to the clinical problems presented.

Implementing elements of evidence‐based practice into scientist–practitioner training at the University of Nebraska‐Lincoln

Evidence-based practice (EBP) has become the predominant model of training and is emerging as a common model of practice for many non-psychology health care professions. Recognizing the relevance of EBP to psychology, the American Psychological Association (APA) developed and endorsed an official policy statement on EBP for the practice of professional psychology. There is now a pressing need to consider ways that EBP can inform scientist-practitioner training. The present article proposes clinical competencies associated with the practice of EBP, and describes initial efforts to implement elements of EBP into training at the University of Nebraska-Lincoln. These efforts have occurred in both the classroom and practicum training experiences, and are geared toward helping students become more effective users of the evidence base through their clinical work. Challenges to the implementation of EBP in clinical psychology training are discussed as well.

Access Is Key: Teaching Students and Physical Therapists to Access Evidence, Expert Opinion, and Patient Values for Evidence-Based Practice

Background and Purpose. Access to literature that supports evidence-based practice (EBP), including identification and retrieval, is essential to implementation of EBP in physical therapy. This article will discuss importance of teaching access to EBP resources, discuss resources to identify and retrieve evidence-based literature, and outline strategies for teaching access of EBP literature in physical therapy education. With rapid growth in physical therapy articles, access to literature is essential, including a significant role for electronic access. Methods and Materials. A review of physical therapy and rehabilitation literature was completed with an informal listserv survey to characterize common methods and strategies used to teach access to EBP information in physical therapy education programs. Summary of Literature. The importance of teaching access to EBP information is discussed. A variety of sources that can be used to identify applicable articles are summarized. Options for retrieval of those articles including specific search strategies are discussed as well as barriers to access. Specific strategies and instructional activities for teaching access to EBP information and teaching resources are described. Discussion and Conclusion. Tremendous potential exists for improved patient care as students and physical therapists are instructed in EBP. Access to evidence-based literature is a foundational prerequisite for application of EBP and will result in optimal clinical outcomes. Key Words: Evidence-based practice, Education, Teaching, Literature, Access. INTRODUCTION To be able to consistently apply evidence basis to their daily physical therapy practice, each physical therapist (PT) must learn to effectively access and apply appropriate, scientifically sound information whenever available. Access to evidence-based information includes at least two components: 1) identifying and locating information and 2) retrieval of article or manuscript. Access truly is key, as expressed by Farmer and Richardson1 who stated Perhaps single most important thing policy makers could do to encourage evidence-based practice among health professionals would be to provide good access to information professionals and information resources. 1(p98) Information professionals, particularly medical librarians, are experts who can guide physical therapists to quality information and can educate them in effective search strategies. Evidence-based practice (EBP) is the conscientious, explicit, and judicious use of current best evidence in making decisions about care of individual patients2 and involves three elements, the integration of best research evidence with clinical expertise and patient values.3(p1) Therefore, students and therapists must he taught to identify, access, and apply information. Attention to information from these three elements-best research evidence, clinical expertise, and patient values-will enable one to make sound clinical decisions, ie, evidence-based decision making (EBDM). While best research evidence is found in recent, relevant, peer-reviewed research publications, as addressed in other articles in this issue, students should be taught to pay attention to type, quality, and rigor of each study as they access evidence. Students searching for best research evidence must be equipped to recognize relative strength of conclusions drawn from any particular stud4,5 and relative importance of all three elements of EBP. Clinical expertise includes use of clinical skills and past experience of health care provider,3(p1) but can often be found in form of published clinical practice guidelines6 or intervention guidelines, usually developed by agencies or professional groups for specific problems. Such guidelines, ideally based on recent research evidence,6 are often developed with no uniformity in methodology7 and are usually available in print or on government or organization Web sites, for example, www. …

Evidence‐Based Practice in Rural and Remote Clinical Practice: Where is the Evidence?

To critically review the evidence regarding barriers to implementing research findings in rural and remote settings, and the ways those barriers have been addressed. A systematic review that included searching several electronic databases, Internet sites and reference lists of relevant articles, assessment of methodological quality of the studies, and data extraction and analysis where possible. Eligibility for the review was not limited by study design. Studies that reported on: (1) barriers to the implementation of evidence by health professionals in rural and remote areas, or (2) interventions for implementing evidence-based practice or an element of evidence-based practice in rural and remote areas. There were no experimental data available on the implementation of research findings in rural and remote clinical settings. The small amounts of empirical research undertaken (surveys) showed that some of the problems experienced by general practitioners were exacerbated by rural and remote location, particularly with relation to isolation, lack of time and locum cover, and poor information technology infrastructure. There is a paucity of empirical literature on implementing evidence-based practice in rural and remote settings. This is in contrast to the large amount of literature available on implementing evidence in other clinical settings. A clear finding from the literature was that getting evidence into practice needs to be context-specific and yet very little research has been conducted into the rural and remote context. Research is needed into how evidence can be implemented in contextually specific ways in rural and remote areas.