Evidence-based Practice Activities Research Articles

Evidence-Based Practice: Perceptions, Skills, and Activities of Pediatric Health Care Professionals

The purposes of this descriptive study were to evaluate pediatric professional staffs' perceptions of evidence-based practice (EBP), to identify individual and organizational barriers experienced when applying EBP into practice, and to determine differences in perceptions by those attending and not attending an EBP education series. A total of 486 pediatric health care professionals, 56 of whom attended all of the sessions, completed an anonymous online survey. Professional staff participated in and valued EBP activities but identified barriers to full implementation. Participants in the EBP series were significantly different in several positive ways. Implications for further education and research are delineated based on survey results.

Pilot Study to Test the Use of a Mobile Device in the Clinical Setting to Access Evidence-Based Practice Resources

To test the feasibility and acceptability of the use of a mobile device to access evidence-based practice (EBP) resources in the clinical setting. A pretest/posttest design was used with a convenience sample of 2nd- and 3rd-year preregistration undergraduate health care students in the United Kingdom. Questionnaires were used to measure (1) feasibility and acceptability of the mobile device and (2) perceptions of the development of EBP knowledge and skills. The study took place during the students' clinical practice and involved two meetings at the beginning and end of the placement period. A Web page was developed to support the process and provide links to key EBP resources. Nineteen undergraduate physiotherapy and nursing students took part in the study. The main findings indicated a generally low level of utilisation of the mobile device in the clinical setting, primarily due to practical difficulties associated with accessing the Internet and the small size of the screen. Consequently, the majority of the students used personal computers (PCs) to access EBP resources. Through the process, students reported improvements in their knowledge and skills in relation to EBP and the appraisal of clinical guidelines. Students were able to complete the EBP activity using either the mobile device or PC and reported improvements in their knowledge and skills in relation to EBP and the appraisal of clinical guidelines. Findings suggest that for undergraduate health care students, rapid access to online evidence in the clinical environment is not necessarily essential for the integration of the EBP process into practice, or for the development of EBP knowledge and skills, provided there is easy access to such evidence at some point during the placement period.

Professional nursing societies and evidence-based practice: Strategies to cross the quality chasm

The Institute of Medicine (IOM) published Crossing the Quality Chasm: A New Health Care System for the 21st Century nearly 10 years ago. Nursing societies are in a unique position to promote evidence-based practice (EBP). The purpose of this article is to describe EBP strategies that nursing societies can use to improve the quality of health care, thus decreasing the gap between research knowledge and practice. Nursing societies can take the lead in two key EBP activities: (1) development of evidence-based syntheses, systematic reviews, and guidelines for EBP; and (2) development, implementation, and testing strategies for these EBP resources to become available and used in clinical decision-making. The Oncology Nursing Society will be discussed as an exemplar of developing EBP programs and increasing knowledge of EBP and practice change resources for its members. The discussion stresses the importance of nursing society members and leaders in guiding their societies to contribute to the closing of the US health care quality chasm.

Evidence-based practice: the importance of education and leadership

To describe evidence-based practice among head nurses and to explore whether number of years of duty is associated with such activities. Further to evaluate the effects of education on evidence-based practice and perceived support from immediate superiors. Registered nurses in Sweden are required by law to perform care based on research findings and best experiences. In order to achieve this, evidence-based practice (EBP) is of key importance. All 168 head nurses at two hospitals were asked to participate. Ninety-nine (59%) completed the survey. Data were collected using a study-specific web-based questionnaire. The majority reported a positive attitude towards EBP, but also a lack of time for EBP activities. A greater number of years as a head nurse was positively correlated with research utilization. Education in research methods and perceived support from immediate superiors were statistically and significantly associated with increased EBP activities. The present study highlights the value of education in research methods and the importance of supportive leadership. Education is an important factor in the employment of head nurses. We recommend interventions to create increased support for EBP among management, the goal being to deliver high-quality care and increase patient satisfaction.

Institutionalizing evidence-based practice: an organizational case study using a model of strategic change

BackgroundThere is a general expectation within healthcare that organizations should use evidence-based practice (EBP) as an approach to improving the quality of care. However, challenges exist regarding how to make EBP a reality, particularly at an organizational level and as a routine, sustained aspect of professional practice.MethodsA mixed method explanatory case study was conducted to study context; i.e., in terms of the presence or absence of multiple, inter-related contextual elements and associated strategic approaches required for integrated, routine use of EBP ('institutionalization'). The Pettigrew et al. Content, Context, and Process model was used as the theoretical framework. Two sites in the US were purposively sampled to provide contrasting cases: i.e., a 'role model' site, widely recognized as demonstrating capacity to successfully implement and sustain EBP to a greater degree than others; and a 'beginner' site, self-perceived as early in the journey towards institutionalization.ResultsThe two sites were clearly different in terms of their organizational context, level of EBP activity, and degree of institutionalization. For example, the role model site had a pervasive, integrated presence of EBP versus a sporadic, isolated presence in the beginner site. Within the inner context of the role model site, there was also a combination of the Pettigrew and colleagues' receptive elements that, together, appeared to enhance its ability to effectively implement EBP-related change at multiple levels. In contrast, the beginner site, which had been involved for a few years in EBP-related efforts, had primarily non-receptive conditions in several contextual elements and a fairly low overall level of EBP receptivity. The beginner site thus appeared, at the time of data collection, to lack an integrated context to either support or facilitate the institutionalization of EBP.ConclusionOur findings provide evidence of some of the key contextual elements that may require attention if institutionalization of EBP is to be realized. They also suggest the need for an integrated set of receptive contextual elements to achieve EBP institutionalization; and they further support the importance of specific interactions among these elements, including ways in which leadership affects other contextual elements positively or negatively.

Strengthening the Use of Evidence-Based Practice: Development of an Independent Study Packet

Based on staff nurse input, an evidence-based practice (EBP) independent study packet augmented by one-on-one mentoring was developed to support nurses in EBP activities and utilization. The strategies for developing the packet to meet American Nurses Credentialing Center requirements for continuing education credit are discussed, including review by a content expert and piloting of the packet prior to implementation. Evaluation of the independent study pilot project and plans for educational support for continuing development of EBP knowledge and skills are described.

Strategies for Starting a Successful Evidence-Based Practice Program

Today's nurses must provide care that is based on the best available evidence. Creating a program that supports the routine use of evidence-based practice (EBP) can seem complicated and time-consuming. This article provides a practical description of the critical elements to consider when starting an EBP program. A successful program includes built-in organizational supports for clinical inquiry, functional and efficient processes for EBP activities, and added details to sustain momentum and interest over time. Strategies for making EBP part of everyday care are identified, along with suggestions for overcoming barriers to change and ideas for acknowledging nurses for EBP work.

Strategies for Starting a Successful Evidence-Based Practice Program

Today’s nurses must provide care that is based on the best available evidence. Creating a program that supports the routine use of evidence-based practice (EBP) can seem complicated and time-consuming. This article provides a practical description of the critical elements to consider when starting an EBP program. A successful program includes built-in organizational supports for clinical inquiry, functional and efficient processes for EBP activities, and added details to sustain momentum and interest over time. Strategies for making EBP part of everyday care are identified, along with suggestions for overcoming barriers to change and ideas for acknowledging nurses for EBP work.

Practitioner and Organizational Barriers to Evidence-based Practice of Physical Therapists for People With Stroke

The purpose of this study was to identify practitioner barriers (education, attitudes and beliefs, interest and perceived role, and self-efficacy) and organizational barriers (perceived support and resources) to physical therapists' implementation of evidence-based practice (EBP) for people with stroke. The participants were 270 physical therapists providing services to people with stroke in Ontario, Canada. A cross-sectional mail survey was conducted. Only half of respondents had learned the foundations of EBP in their academic preparation or received training in searching or appraising research literature. Although 78% agreed that research findings are useful, 55% agreed that a divide exists between research and practice. Almost all respondents were interested in learning EBP skills; however, 50% indicated that physical therapists should not be responsible for conducting literature reviews. Average self-efficacy ratings were between 50% and 80% for searching and appraising the literature and below 50% for critically appraising psychometric properties and understanding statistical analyses. Despite Internet access at work for 80% of respondents, only 8% were given protected work time to search and appraise the literature. Lack of education, negative perceptions about research and physical therapists' role in EBP, and low self-efficacy to perform EBP activities represent barriers to implementing EBP for people with stroke that can be addressed through continuing education. Organizational provision of access to Web-based resources is likely insufficient to enhance research use by clinicians.

The Magnet Recognition Program and Evidence-Based Practice

From the original Magnet study (1981) to now, health care organizations have begun to embrace the Magnet Recognition Program in record numbers. A visit to the Magnet web site (http://nursingworld.org/ancc/magnet.html) listed 186 Magnet hospitals, with many more healthcare facilities currently under review. As the Magnet Recognition Program has grown, so has the development of evidence-based practice (EBP). In fact, EBP is one of the cornerstones of the Magnet Recognition Program, as well as the involvement of staff nurses in research and/or EBP activities. This article will give a brief introduction of the Magnet Recognition Program and suggest activities that will involve staff nurses in EBP.

The development and validation of a knowledge, attitude and behaviour questionnaire to assess undergraduate evidence-based practice teaching and learning.

Most evidence-based practice (EBP) educational assessment tools evaluated to date have focused on specific knowledge components or technical skills. Other important potential barriers to the adoption of EBP, such as attitudinal, perceptual and behavioural factors, have yet to be studied, especially in the undergraduate setting. Therefore, we developed and validated a knowledge, attitude and behaviour questionnaire designed to evaluate EBP teaching and learning in an undergraduate medical curriculum. We derived the questionnaire from a comprehensive literature review, informed by international and local experts and a Year 5 student focus group. We determined its factor structure and refined and validated the questionnaire according to the responses of a cohort of Year 5 and a combined group of Years 2 and 3 students using principal components factor analysis with varimax rotation. Factor reliability was computed using Cronbach's alpha coefficient. We assessed construct validity by correlating the factors with other measures of EBP activity and examined responsiveness through paired t-test of the pre/post factor mean scores. A 43-item questionnaire was developed. Four factors were identified from both student groups. The overall questionnaire as well as each factor had high construct validity (Cronbach's alpha > 0.7 for each scale). No significant correlations were found between the 4 factors, confirming their orthogonality. Positive correlations, however, resulted between factor mean scores and other EBP activities. The responsiveness of the questionnaire was satisfactory. A reliable knowledge, attitude and behaviour measure of EBP teaching and learning appropriate for undergraduate medical education has been developed and validated.

Support for evidence-based practice.

To discuss examples of the process for evidence-based practice (EBP) and suggest helpful mechanisms for its support. Published review and research articles, textbooks, guidelines, and web sites. Evidence-based practice requires a step by step process. Obtaining resources for EBP is essential to identifying and implementing and/or sustaining clinical care based on the best evidence available. Finding resources to conduct EBP activities is one of the more challenging aspects of this approach to maintaining and improving quality of clinical care. However, nurses have found creative ways to obtain needed resources to implement EBP.

Evidence-based Physiotherapy: Physiotherapists' attitudes and experiences in the Wessex area

Summary This study sought to explore physiotherapists' views and experiences of evidence-based practice (EBP). Focus groups and interviews were held with 56 physiotherapists of all grades, working in a variety of different NHS settings in the eastern part of the South and West Region. The aims were to identify physiotherapists' understanding of EBP and their views as to its appropriateness in physiotherapy and what factors they felt promoted or discouraged its development. Focus groups and interviews were tape-recorded and transcribed before thematic analysis. The findings were discussed at a consensus conference. Various recommendations emerged. The study found that physiotherapists' definitions of EBP varied depending on their understanding of the term ‘evidence'. Views ranged from evidence being only those facts emerging from robust research to personal or anecdotal evidence from clinical practice – with most people seeing it as a mix. Junior physiotherapists and others working within university hospital settings felt they had the skills necessary to appraise research findings prior to implementation in practice. Others, particularly senior physiotherapists working in community settings, felt they did not. Community physiotherapists also felt a lack of engagement with EBP activities such as journal clubs and development of clinical guidelines due to poor access to library facilities and difficulties in meeting with peers. All participants felt EBP to be important to the continuing development of the profession. In order to facilitate this it is important to develop a culture that promotes critical appraisal and a willingness to look further than personal experience. Physiotherapy managers and the professional body have a role to play in the development of these skills through the provision of resources and training. However, individual physiotherapists have a responsibility to provide the best treatment for their patients through reflective consideration of all available evidence.

Is the practice of psychological therapists evidence-based?

An interview-based survey of evidence-based practice (EBP) and the research, continuing professional development (CPD) and audit activity that support it was conducted in the North East of England amongst a representative sample of NHS clinical psychologists and counsellors (n = 30). It profiled their participation in EBP activities over the past year and their intentions for the next year. The findings suggest that the sample had used guidelines and protocols on 56 per cent of occasions, had on average drawn on research, CPD and audit approximately half of the time, but had been only minimally influenced by research, CPD or audit. It is concluded that EBP has occurred in all defined areas and that the conditions for an increased degree of EBP are promising.