Evidence-based Practice Improvement Research Articles

Fostering the discussion of planetary health in occupational therapy and physiotherapy.

Occupational therapists and physiotherapists aim to promote health, prevent various diseases and help people in their rehabilitation processes. So far, there is a paucity of understanding of the big picture of how the new paradigm of planetary health (PH) is connected to the education and practice of these professionals. This research aimed to address this gap by investigating and deploying a bibliometric analysis to elucidate the pivotal role of occupational therapists and physiotherapists in addressing PH challenges. The ultimate goal is to construct a comprehensive framework crosschecking the bibliometric analysis and the collection of 10 case studies selected by experts to outline how best practices in occupational therapy and physiotherapy, related to the three pillars of sustainability and the UN's Sustainable Development Goals (SDGs), can contribute to increasing PH. The bibliometric analysis revealed four major research strands: 1) enhancing patient care and quality of life; 2) integrating sustainability in health care and rehabilitation; 3) professional development and clinical competence; and 4) evidence-based practice and quality improvement. Moreover, further temporal analysis revealed how the topic evolved, from advancing evidence-based practice and clinical effectiveness, exploring the strengthening of health care and person-centred practices, to connecting the topic to aspects also predicted by the SDGs, such as integrating environmental and climate concerns in therapy and addressing psychological and self-care impacts on health. The case studies confirmed this trend, and a framework of PH in occupational therapy and physiotherapy through the lens of the SDGs was developed to support future research and practitioners in advancing this research field. Occupational therapists and physiotherapists are essential players in public health and can integrate sustainability at every level of practice, from using resources during therapy sessions to advocating for more sustainable lifestyles.

STUDENTS' PERSPECTIVES ON CHATGPT: AN EXPLORATION OF PERCEPTIONS

This master's thesis represents a meticulous scholarly endeavor meticulously crafted to illuminate the multifaceted perspectives of Indian students enrolled in MBA, B.Tech, BBA, and B.Com programs regarding the integration of ChatGPT within the academic landscape. Positioned at the intersection of technology and education, this research aims to provide a comprehensive understanding of students' viewpoints, experiences, and perceptions concerning ChatGPT—an advanced language model renowned for its potential to revolutionize learning environments. Adopting a meticulous mixed-methods research approach, this study embarks on a journey to delve into the intricate nuances of students' interactions with ChatGPT, encompassing facets such as usability, impact on learning experiences, and overall satisfaction. Through meticulously structured surveys and in-depth interviews meticulously tailored to capture the diverse array of perspectives held by students, the research methodically collects and analyzes data to unveil the underlying factors shaping students' perceptions. By rigorously examining the data gleaned from these methodologies, the study aspires to unravel the complexities inherent in students' engagement with ChatGPT, thereby offering invaluable insights into the implications of its integration into the Indian higher education landscape. As such, this thesis serves as a pivotal contribution to the scholarly discourse surrounding the responsible adoption and implementation of advanced language models in educational settings. In essence, this research endeavors to inform decision-makers, educators, and stakeholders about the transformative potential of ChatGPT within the realm of higher education. Through its meticulous examination of students' perspectives, the thesis seeks to facilitate informed decision- making, foster meaningful dialogue, and ultimately drive positive change in educational practices, leading to enhanced learning experiences and academic outcomes for students across diverse academic disciplines. Moreover, this study recognizes the evolving nature of educational practices in the digital age and the imperative to adapt to emerging technologies. By shedding light on students' perceptions of ChatGPT, the research not only provides insights into the current state of technological integration in education but also paves the way for future advancements and innovations in pedagogical approaches. As such, this thesis contributes to the ongoing dialogue on the intersection of technology and education, shaping the trajectory of educational practices in the digital era. Furthermore, the comprehensive nature of this research underscores its significance as a foundational resource for policymakers, educators, and researchers seeking to navigate the complex landscape of technology-enhanced learning. By synthesizing diverse perspectives and offering actionable insights, this thesis lays the groundwork for informed decision-making and strategic planning in the integration of advanced language models like ChatGPT into educational settings. In doing so, it fosters a culture of evidence-based practice and continuous improvement, driving positive change and innovation in higher education.

Clinical Inquiry and Problem Identification.

This is the second article in a new series designed to provide readers with insight into educating nurses about evidence-based decision-making. It builds on AJN's award-winning previous series-Evidence-Based Practice, Step by Step and EBP 2.0: Implementing and Sustaining Change (to access both series, go to http://links.lww.com/AJN/A133). This follow-up series will address how to teach and facilitate learning about the evidence-based practice (EBP) and quality improvement (QI) processes and how they impact health care quality. This series is relevant for all nurses interested in EBP and QI, especially DNP faculty and students. The brief case scenario included in each article describes one DNP student's journey.

The Mountain Model for Evidence-Based Practice Quality Improvement Initiatives.

This article introduces the Mountain Model, the first conceptual model for evidence-based practice quality improvement (EBPQI) initiatives. The Mountain Model merges modern evidence-based practice (EBP) and quality improvement (QI) paradigm principles into a unified conceptual framework with the goal of disseminating and sustaining EBPQI projects across health care and related settings. The model was developed within the nursing discipline, but is designed for transdisciplinary implementation through interprofessional teams.

DNP-Authored Articles in Peer-Reviewed Journals 2011-2021.

With an increasing number of doctor of nursing practice (DNP) graduates, the volume of peer-reviewed journal publications among DNP-prepared nurses is rising. The primary aim of this study was to quantify, analyze, and categorize DNP-authored peer-reviewed journal publications. A descriptive research design was used to analyze DNP-authored peer-reviewed journal publications in the WorldCat, EBSCO Discovery Service, and PubMed databases from 2011 through 2021. The 3839 journal publications included at least one DNP-prepared nurse author. There were 2495 (65%) publications with a DNP first author, 921 (24%) with a DNP solo author, and 2918 (76%) included publication collaboration. The majority of publications were practice- (40%), nursing- (17%), and education-focused (15%). Science translation in evidence-based practice and quality improvement publications accounted for 24%. This study demonstrates the proliferation of DNP-authored peer-reviewed journal publications, which may indicate an increase in the number of nursing care quality initiatives occurring in the clinical setting.

Preparing practice-ready family nurse practitioners using technology-based, high-fidelity pediatric telehealth simulations: A curricular quality improvement initiative

BackgroundThe SARS-CoV-2 pandemic accelerated the change in delivery of pediatric primary care services from in-person to telehealth to curb the spread of the SARS-CoV-2 virus, creating an urgent need to prepare competent, practice-ready Family Nurse Practitioner (FNP) graduates able to deliver high-quality pediatric telehealth services. The aim of this curricular quality improvement initiative was to develop preclinical telehealth competence through implementation of an innovative, technology-based, high-fidelity pediatric telehealth simulation educational intervention. The initiative was set in a private, urban university with a state-of-the art simulation center. Participants included FNP students, FNP faculty, and simulation faculty. MethodsThe Evidence Based Practice Improvement (EBPI) Model is the framework that was used for this initiative. A curricular gap analysis was conducted by faculty, results guiding the development of a high-fidelity, pediatric telehealth simulation educational intervention. Baseline measurements included student demographics, knowledge of essential pediatric telehealth concepts, and perceptions of self-efficacy in conducting telehealth visits. Knowledge assessment and self-efficacy were again measured after completion of a pre-briefing, pediatric telehealth asynchronous learning module, and self-efficacy for a third time after completion of the entire simulation intervention. Written, semi-structured qualitative questionnaires were also completed at the end of the intervention. ResultsKnowledge assessment scores significantly increased from baseline after completion of the asynchronous learning module (P < 0.001). Pediatric telehealth self-efficacy scores also showed significant improvements from baseline after completion of the asynchronous learning module (P < 0.001) and again after completion of the simulation intervention (P < 0.001). Qualitative themes supported quantitative findings. ConclusionHigh-fidelity, pediatric telehealth simulation is an effective educational intervention to develop pre-clinical, telehealth competence in FNP students prior to pediatric clinical rotations and provide them with the skills to be practice-ready upon graduation.

Translating Inquiry Into Clinical Practice: Opportunities and Barriers for Oncology Nursing.

As our scientists, researchers, and evidence-based practitioners continue to conduct multiple forms of inquiry including research, evidence-based practice (EBP), and quality improvement studies, the corpus of literature is in.

Safewards in acute medical/surgical care wards: Capability, Opportunity, Motivation and Behaviour model and Theoretical Domains Framework analysis

BackgroundSafewards is an evidence-based practice improvement model to minimise conflict in inpatient mental health units. There is limited published research on implementing Safewards in acute medical/surgical care wards. ObjectiveTo identify, from nurses' perspectives, barriers, and facilitators to implement four Safewards interventions in acute medical/surgical care wards. MethodsThis article reports qualitative findings from a funded mixed-method evaluation of the Safewards Acute Care Pilot Project. Six focus group interviews comprising 35 nursing staff from four hospitals in Victoria, Australia were completed between April and October 2022. The semi-structured interview guide included questions developed using the Capability, Opportunity, Motivation and Behaviour model. Data was thematically analysed and mapped to a matrix combining Capability, Opportunity, Motivation and Behaviour model and the Theoretical Domains Framework to elucidate barriers and facilitators to implementing four Safewards interventions in acute medical/surgical care wards. ResultsThree components in the Capability, Opportunity, Motivation and Behaviour model and three Theoretical Domains Framework domains were identified as barriers to the adoption of Safewards in acute medical/surgical care wards. Specific barriers included physical opportunity challenges related to the environmental context and resources domains. The key themes included time constraints and competing priorities; lack of physical space and infrastructure; and poor patient uptake due to lack of understanding. Gaps emerged as a psychological capability barrier within the Theoretical Domains Framework knowledge domain. Additionally, resistance to practice changes was associated with the motivation component of the Capability, Opportunity, Motivation and Behaviour model. Conversely, six TDF domains were relevant to facilitating the implementation of the Safewards interventions: memory, attention, and decision processes; physical skills; social influences; social/professional role and identity; goals; and beliefs about consequences. Key facilitators included the Safewards interventions serving as reminders to focus on compassionate nursing care; nursing staff possessing the skillset for interventions; peer pressure and mandated change; supportive and passionate leadership; presence of champions to drive momentum; belief in nursing staff ownership and expertise for leading implementation; personal commitment to improve work environments and care quality; and the belief that Safewards would improve ward culture. ConclusionsAddressing barriers and leveraging facilitators can inform strategies for enhancing staff capability to implement Safewards in acute care wards. Specifically, a tailored, multilayered approach focusing on leadership support, training, resources, patient input, and feedback can promote effective adoption of the Safewards model and adaptation of discrete interventions. Tweetable abstractSafewards adaptation: Addressing barriers like resources, space, and patient awareness; leveraging peer modelling and leadership strategies for success.

Cultivating an Evidence-Based Decision-Making Mindset.

This is the first article in a new series designed to provide readers with insight into educating nurses about evidence-based decision-making. It builds on AJN's award-winning previous series-Evidence-Based Practice, Step by Step and EBP 2.0: Implementing and Sustaining Change (to access both series, go to http://links.lww.com/AJN/A133). This follow-up series will address how to teach and facilitate learning about the evidence-based practice (EBP) and quality improvement (QI) processes and how they impact health care quality. This series is relevant for all nurses interested in EBP and QI, especially DNP faculty and students. The brief case scenario included in each article describes one DNP student's journey.

Opportunities to improve high-risk behavior screenings during well-child examinations.

Nurse practitioners serve an essential role in the completion of age-appropriate adolescent high-risk behavior screenings including tobacco/nicotine, alcohol, illicit drug use, and sexual activity during well-child examinations (WCEs). Midwestern adolescents demonstrate a suboptimal rate of engaging in annual preventative medical visits in comparison to national data. This mixed-methods quality improvement pilot sought to evaluate health care providers' beliefs, general clinic processes, and the overall quality of WCEs among adolescents aged 11-17 years in two midwestern primary care clinics. Quantitative data were obtained through queried reports and manual electronic health record chart audits. Qualitative data were obtained through focus group interviews. Interventional strategies included providing education to key stakeholders regarding data analysis findings indicating process deficiencies regarding adolescent WCEs. Project members championed integration of advanced practice nurses as leaders of change within urban, multisite tertiary health care systems. Results demonstrate that the lack of standardized assessment during an adolescent WCE can lead to fragmentation of high-risk behavior screenings. This quality improvement pilot demonstrates the need for nurse practitioners to be at the forefront of interprofessional committees advancing the implementation of evidence-based guidelines and practice improvement initiatives. Standardization of high-risk behavior screening as part of the WCE in adolescence provides the foundation for health promotion and chronic disease prevention spanning into adulthood.

Project to Publication-A Writing Mentorship Program.

Evidence is required to inform effective interventions promoting publication among clinical nurses. This study examined the effect of a mentored writing program on clinical nurse perceptions of writerly self-efficacy and publication. A mixed-methods, pretest-posttest study design with an education intervention was implemented. The Revised for Nursing Practice - Postsecondary Writerly Self-efficacy Scale (RNP-PSWSES) measured perception of writerly self-efficacy before and after intervention. Manuscripts submitted for publication were counted. The purposive, convenience sample included registered nurses with completed research, evidence-based practice, or quality improvement projects. Subjects participated in a 3-month structured mentored writing program and completed the RNP-PSWSES survey before and after program completion. A Wilcoxon signed rank test was performed to determine the significance of difference between the pretest and posttest, and the number of published manuscripts was reported. The RNP-PSWSES items identified pretest-posttest Cronbach's α (.728, .818). Posttest RNP-PSWSES scores were statistically significantly higher than pretest scores (z = -1.96, P = .050) with a large effect size of r = 0.69. Two manuscripts were accepted for publication, and 1 manuscript was withdrawn after the third request for revisions. In this study, mentored writing workshops improve nurses' perceptions of writing ability and increase publications. Generalization of findings is limited by small sample size. Clinical nurse specialists are critical to champion writing and publication.

Facilitating a Culture of Evidence-Based Practice and Quality Improvement Excellence: Streamlining Processes to Improve Care.

This article defines evidence-based practice (EBP) and quality improvement (QI) and examines the positive impact on patient care when they are in place, as well as the barriers to their implementation. An effective tool, Ovid Synthesis, was created to enable clinicians and administrators to streamline the processes for EBP and QI, provide oversight on the initiatives underway, and enable clinical educators to help nursing staff develop the necessary competencies and successfully execute their EBP and/or QI projects.

Implementation Science for the Practice-Oriented Nurse Leader.

Senior nurse leaders are accountable for improving patient outcomes efficiently and cost-effectively. Nurse leaders often find heterogeneous patient outcomes across comparable nursing units in the same enterprise, presenting a challenge for nurse leaders tasked with making system-wide quality improvements. Implementation science (IS) offers a promising new approach to guide nurse leaders in understanding why certain implementation efforts meet with success or failure and the barriers faced in making practice changes. Knowledge of IS builds upon evidenced-based practice and quality improvement knowledge, adding to the armamentarium of tools at nurse leaders' disposal for improving nursing and patient outcomes. In this article, we demystify IS, differentiate it from evidence-based practice and quality improvement, describe IS concepts every nurse leader should be familiar with, and outline nurse leaders' role in building IS in their organizations.

Research, Evidence-Based Practice, and Quality Improvement Simplified

Is the research process different than evidence-based practice and quality improvement, or is it the same? Scattered evidence and misperceptions regarding research, evidence-based practice, and quality improvement make the answer unclear among nurses. This article clarifies and simplifies the three processes for frontline clinical nurses and nurse leaders. The three processes are described and discussed to give the reader standards for differentiating one from the other. The similarities and differences are highlighted, and examples are provided for contextualization of the methods. [J Contin Educ Nurs. 2023;54(1):40-48.].

Evidence-based Practice and Quality Improvement in Allied Healthcare Education

Evidence-based practice (EBP) is acknowledged as a fundamental component of training for healthcare professionals, including respiratory therapists and other allied healthcare professionals. Understanding the key similarities, advantages and differences between it and quality improvement (QI) can help to advance allied healthcare education (AHE) and clinical practice. However, the differences between ”best EBP” and actual clinical care show how difficult it is to become competent in this field. Professional education to support EBP continues to be a significant and pressing concern. The importance of QI in medical education is becoming more widely recognized, which is also equipping allied health professionals with the knowledge and abilities to improve patient experiences and outcomes, population health, and monitoring and managing per capita healthcare costs. All frontline healthcare providers, including AHPs and RTs, should possess the fundamental capability to implement EBP and QI. Integrating EBP and QI into AHE improves the ability of AHPs to engage in safe clinical practice, which in turn increases the quality of patient care.

Strategies for successfully completing a DNP final project.

Completion of a final project is an essential component of Doctor of Nursing Practice programs. Strategies for successful project planning, implementation, and evaluation are outlined, from identifying an evidence-based practice or quality improvement project, advisor, and practice mentor through completion, presentation, and dissemination of your work.

RN Residents improving geriatric depression screening at Phelps hospital

We discuss how we integrated the Nurses Improving Care for Healthsystem Elders (NICHE) and RN Residency programs at the Phelps Hospital, Northwell Health to educate a new generation of staff nurses on the principles of geriatric nursing and evidence-based practice to care for older adults. We discuss how the recent cohort of nurse residents are leading efforts to improve geriatric depression screening on a NICHE unit through designing an evidence-based practice improvement project. This initiative reinforces and extends our work in geriatric nursing excellence. We hope others will learn from our experience to offer opportunities for new graduates to lead improvement efforts within existing NICHE programs.

Delphi survey on the application of advanced practice nursing competencies: Strong points and unfinished business in cancer care.

This study assessed the application of advanced practice nursing competencies in cancer care to identify obstacles to their full implementation. Internationally, the implementation of advanced practice nursing roles depends on the context and environment, which shape the definition, scope and competencies associated with these roles. Nurses participated in two rounds of an online Delphi survey about the competencies of advanced practice oncology nurses. The threshold for expert consensus was set at 75%. Eleven competency domains were proposed; all yielded consensus of over 75%. However, for 57.8% of the specific competencies proposed in round 1 and for 62.2% in round 2, there was no consensus on which were applied in practice. There was more agreement on the competencies applied in the domains of direct clinical practice, consultation and collaboration and interprofessional relations than in dimensions such as health care promotion, quality improvement, evidence-based practice and research. Barriers related to unimplemented competencies were identified. The competencies applied in advanced practice nursing reflect incomplete development of these roles. Domains related to direct clinical practice, consultation and collaboration and interprofessional relations are relatively well developed, whereas those related to leadership, research, evidence-based practice and quality improvement are not. The identified barriers hindering implementation of some competencies can inform strategies to develop this role in cancer care. Hospital administrators and nurse managers should reflect and be mindful of the development of advanced practice nurse (APN) competencies along with the challenges associated with implementing advanced practice roles.

Evaluation of research capacity and culture of hospital pharmacists and pharmacy technicians in a state-wide Australian public health service: A cross-sectional survey.

Integrating research with clinical practice is essential for evidence-based practice and continuous improvement in health care. Little is known about the research capacity and culture of the Australian hospital pharmacy workforce, particularly in rural areas and for pharmacy assistants/technicians. This paper aims to characterise the research capacity and culture of a state-wide public-hospital pharmacy service at organisation, team and individual levels, and to explore variables which influence research confidence and success. An online, anonymous, cross-sectional survey using the validated Research Capacity in Context tool was emailed to all pharmacists, pharmacy assistants/technicians and non-clinical staff employed by a statewide pharmacy service in South Australia. Respondent characteristics and organisation, team and individual scores of research skill/success were summarised using descriptive statistics. T-tests compared results for pharmacists and pharmacy assistants/technicians and metropolitan-based and non-metropolitan-based staff. Regression analyses explored predictors of pharmacists individual research skill/success scores. A response rate of 43.4% (n=278/641, 19 sites) was obtained. Respondents were primarily pharmacists (68%) and pharmacy assistants/technicians (28%); 91% were practicing in a metropolitan setting. 47% reported no research experience. Highest scores for research skill/success were observed at the organisational level (mean score 6.0/10) vs. team (mean score 5.6/10) and individual levels (mean score 5.1/10). Within each level specific items that scored poorly were identified. Individual research skills/success scores were higher in pharmacists vs. pharmacy assistants/technicians (mean score 5.2/10 vs. 4.2/10, p<0.01), and were not different between staff in metropolitan vs. non-metropolitan settings (mean scores 5.2 vs. 5.0, p=0.77). For pharmacists, undertaking undergraduate or internship research projects or postgraduate research training were associated with higher individual scores of research skills and success. This research extends understanding of hospital pharmacy research capacity and culture, describes research skills and success in hospital pharmacy technicians/assistants for the first time and highlights low-scoring areas; these could be targeted to improve research capacity and culture at an individual, team and organisational levels.

Research Priorities in Psychiatric Mental Health Nursing: Funding Availability, Recently Published Work, and Future Directions for Advancing Our Science.

Identifying and sharing psychiatric mental health (PMH) research priorities can help identify gaps in the literature, determine training needs for nurses, and assist investigators in locating funding. The aims for this project included: (1) identify PMH nursing specialty research priorities from large, public funding entities; (2) compare the identified research priorities and scholarly articles published in 2020; and (3) outline future directions for advancing the science of PMH nursing. Strategic plans of funding entities for PMH research were reviewed for research priorities. Summarized priorities were then compared with publications from peer-reviewed PMH nursing journals. Work conducted in the United States was extracted and categorized as original research, evidence-based practice (EBP), or quality improvement (QI), then design and population. Priorities from 13 funding entities comprised three domains (education, research, and practice), with nine areas, 30 topics, and subtopics. Eight journals produced 432 articles with 99 (23%) conducted in the United States. Among these journals, publications fitting research priorities ranged from 1 to 33 articles. Of the 99 articles, 85% were original research and 15% were either EBP or QI. Descriptive articles comprised 64% and 23% tested interventions. Populations studied included workforce; adults; infants, children, and adolescents; and parents. All published articles by the U.S. PMH nurses matched the funding priorities, but not all funding priorities were addressed by 2020 publications. The majority of work was conducted outside of the United States and most published from the United States was descriptive, contrary to many United States funders' priorities for interventional research.