Evidence-based Care Practices Research Articles

Using the Translating Research into Practice framework to develop a diabetes prevention intervention in primary care: a mixed-methods study

BackgroundPre-diabetes affects one-third of US adults and increases the risk of type 2 diabetes. Effective evidence-based interventions, such as the Diabetes Prevention Program, are available, but a gap remains in...

Quality improvement initiative to reduce Medical Adhesive Related Skin injury (MARSI) in very preterm babies admitted to neonatal intensive care unit

IntroductionSick preterm neonates are most vulnerable to developing skin injuries. Despite sound knowledge and application of evidence-based practices for preventing medical adhesive-related skin injury (MARSI), the incidence of MARSI was...

Survey of perioperative utilization of professional medical interpreters for limited-English proficient patients: Towards a framework for systems-level improvement

IntroductionSurgical patients in United States’ hospitals have grown more linguistically diverse. However, professional medical interpreter (PMI) utilization remains inconsistent at many healthcare institutions for limited-English proficient (LEP) patients. Numerous studies demonstrate that inadequate perioperative access to PMI leads to worse care and outcomes for LEP patients. The perioperative setting presents unique challenges for providers in caring for LEP patients including obtaining informed consent, a transient team of multi-disciplinary providers, and the time pressure of operating room practice. ObjectiveOur study is the first to assess barriers to consistent PMI use in the immediate perioperative setting and to identify system-level approaches to improve PMI use. MethodWe surveyed a multidisciplinary team of perioperative nurses, advanced practice providers, anesthesiology and surgical trainees and faculty on their personal practices and perceived barriers to PMI use. An anonymous online 13-question survey was used. Answer options included rank order, multiple choice, Likert scale, and free text. Survey data was analyzed using univariate statistics and stratified based on providers having received information on the Title VI Civil Rights Act of 1964 and their medical training status. Pearson's chi-squared test was performed and odds ratios calculated to determine if these provider characteristics were associated with increased preference for PMI over bilingual staff and patients’ family members for interpretation and with other LEP evidence-based care practices. ResultsWe received a total of 262 responses with a 28.3 % response rate. Among survey participants, 19.1 % of participants did not know where to find patients’ language preferences in the electronic health record (EHR) and 69.8 % of participants did not know how to update language preferences in the EHR. When a bilingual staff was present, 31.0 % and 24.8 % of providers would forgo using video and phone PMI, respectively. Comparatively, trainees were more likely to use PMI instead of patients’ family or bilingual staff. Providers who received training on the Title VI Civil Rights Act of 1964 were more likely to use PMI for interpretation and provide translated consent forms, and least likely to utilize patients’ families for interpretation. Barriers to PMI use included difficulty obtaining video consoles or phones, long wait times for interpreters, unavailability of language, unfamiliarity with using video consoles or accessing interpreters, poor sound quality and internet connectivity issues. As many as 26 % of respondents cited time pressure for starting a surgical case as the reason for not using an interpreter. DiscussionBased on these survey results, we developed a framework for quality improvement initiatives to effect system-level change in similar high-output perioperative settings. This framework can be categorized into (1) process refinement and harnessing the EHR for identification and documentation of LEP status, (2) interdepartmental collaboration to address workflow constraints, technical issues and supply-demand mismatch, and (3) increasing awareness among leadership and providers about interpretation laws, cost reduction and improved outcomes with PMI use.

Low back pain patients' experience and expectations: A qualitative study focusing on physiotherapist and physician care.

Low back pain (LBP) is a common and disabling musculoskeletal disorder. LBP experiences and expectations can vary from one person to another and influence their clinical outcomes. Despite the existence of numerous evidence-based treatment recommendations, LBP management in primary care remains challenging. This study aims to investigate the experiences and expectations of patients with LPB in primary care settings. A qualitative study with an inductive thematic analysis was conducted. Semi-structured interviews were performed using individuals who had experienced LBP in the past year and had consulted a family physician (FP) or a physiotherapist (PT). Ten participants with LBP were interviewed (5 women, 5 men, mean age 49±17). Five themes were identified: (1) I am always upset because I can't do anything; (2) I waited to consult; I thought it would go away; (3) I want to see what is going on with my LBP; (4) I want to see the person that will provide the right treatment; (5) I need support to get over it. Participants consulted when their pain was severe and disabling. They expected an imaging test to explain the cause of their LBP and placed more importance on the imaging test results than the FP's or PT's evaluation. Their opinions on care selection and being listened to were important for the participants. This study has highlighted the importance of the patient's point of view in their care. This consideration is important to ensure a comprehensive and collaborative approach with evidence-based practice care.

Content of a wound care mobile application for newly graduated nurses: an e-Delphi study

BackgroundWound care represents a considerable challenge, especially for newly graduated nurses. The development of a mobile application is envisioned to improve knowledge transfer and facilitate evidence-based practice. The aim of this study was to establish expert consensus on the initial content of the algorithm for a wound care mobile application for newly graduated nurses.MethodsExperts participated in online surveys conducted in three rounds. Twenty-nine expert wound care nurses participated in the first round, and 25 participated in the two subsequent rounds. The first round, which was qualitative, included a mandatory open-ended question solicitating suggestions for items to be included in the mobile application. The responses underwent content analysis. The subsequent two rounds were quantitative, with experts being asked to rate their level of agreement on a 5-point Likert scale. These rounds were carried out iteratively, allowing experts to review their responses and see anonymized results from the previous round. We calculated the weighted kappa to determine the individual stability of responses within-subjects between the quantitative rounds. A consensus threshold of 80% was predetermined.ResultsIn total, 80 items were divided into 6 categories based on the results of the first round. Of these, 75 (93.75%) achieved consensus during the two subsequent rounds. Notably, 5 items (6.25%) did not reach consensus. The items with the highest consensus related to the signs and symptoms of infection, pressure ulcers, and the essential elements for healing. Conversely, items such as toe pressure measurement, wounds around drains, and frostbite failed to achieve consensus.ConclusionsThe results of this study will inform the development of the initial content of the algorithm for a wound care mobile application. Expert participation and their insights on infection-related matters have the potential to support evidence-based wound care practice. Ongoing debates surround items without consensus. Finally, this study establishes expert wound care nurses’ perspectives on the competencies anticipated from newly graduated nurses.

Ready or Not: A Conceptual Model of Organizational Readiness for Embedded Pragmatic Dementia Research.

The National Institute on Aging Alzheimer's Disease/Alzheimer's Disease and Related Dementias Research Implementation Milestones emphasize the need for implementation research that maximizes up-take and scale-up of evidence-based dementia care practices across settings, diverse populations, and disease trajectories. Organizational readiness for implementation is a salient consideration when planning and conducting embedded pragmatic trials, in which interventions are implemented by provider staff. The current article examines the conceptual and theoretical underpinnings of organizational readiness for implementation and the operationalization of this construct. We offer a preliminary conceptual model for explicating and measuring organizational readiness and describe the unique characteristics and demands of implementing evidence-based interventions targeting persons with dementia and/or their care partners. [Research in Gerontological Nursing, 17(3), 149-160.].

Reasons for performing episiotomy during ectopic deliveries: An integrative literature review

The labor process is a crucial phase in a pregnant woman's life. However, it is often perceived as a frightening experience due to routine procedures carried out without her consent and the potential for traumatic experiences that can have long-lasting effects. Nursing, particularly midwifery, is responsible for providing support and care that upholds the dignity of women. This integrative literature review aims to identify and analyze the reasons health professionals identify for the practice of episiotomy in ectopic births and the situations in which it would be appropriate to perform it. The results of this review may help identify gaps in practice and guide the improvement of the quality of obstetric care. Eight articles were selected for analysis after a detailed review of 200. The review revealed that health professionals perform episiotomies for various reasons related to the fetus, the pregnant/parent, the health professional, and the birth. The most common reasons given by the participants were physical damage and maternal physical characteristics. Results provide a better understanding of practice gaps, enlighten the need to improve knowledge and evidence-based care practices, and encourage health professionals to examine their practices.

Optimising recovery after perineal trauma: Implementation of an evidence-based patient-centred care and clinical practice guideline

BackgroundPerineal trauma and pain can affect the quality of life of women who experience vaginal birth. AimTo investigate the effect of perineal care and pain management on women’s postpartum recovery. MethodsThis was a Quasi-experimental study. In Phase 1 women were treated using our old postnatal perineal care management guideline. In Phase 2 an updated guideline was introduced (regular administration of icepacks and analgesia during the first 24–48 h postpartum). During Phase 1, pregnant women planning a vaginal birth completed a baseline questionnaire. Those who sustained perineal trauma completed a survey at 24–48 h, seven days and 12 weeks after birth. In Phase 2 we continued recruiting participants, using the same procedure, and investigated the efficacy of pain relief approaches using the new guideline. ResultsIn Phase 1, 111 women (Group 1), and Phase 2, 146 women (Group 2) were recruited. No statistically significant differences were found between the two groups in terms of the women’s pain catastrophising, their partner’s responses to pain behaviours, or birth outcomes. At 24–48 h and seven days postpartum, women in Group 2 were less likely than women in Group 1 to be bothered by back or perineal pain, headache, sleeping difficulties and dizziness (p < 0.05). More women in Group 2 received regular paracetamol and perineal icepacks during their hospital stay, with less use of oxycodone in Group 2 than Group 1. ConclusionThe implementation of the guideline’s recommendations was associated with decrease back and perineal pain, headache, sleeping difficulties and dizziness during the first seven days postpartum.

Outcomes and care practices of extremely preterm infants at 22-25 weeks' gestation age from the Chinese Neonatal Network

Objective: To describe the current status and trends in the outcomes and care practices of extremely preterm infants at 22-25 weeks' gestation age from the Chinese Neonatal Network (CHNN) from 2019 to 2021. Methods: This cross-sectional study used data from the CHNN cohort of very preterm infants. All 963 extremely preterm infants with gestational age between 22-25 weeks who were admitted to neonatal intensive care units (NICU) of the CHNN from 2019 to 2021 were included. Infants admitted after 24 hours of life or transferred to non-CHNN hospitals were excluded. Perinatal care practices, survival rates, incidences of major morbidities, and NICU treatments were described according to different gestational age groups and admission years. Comparison among gestational age groups was conducted using χ2 and Kruskal-Wallis tests. Trends by year were evaluated by Cochran-Armitage and Jonckheere-Terpstra tests for trend. Results: Of the 963 extremely preterm infants enrolled, 588 extremely preterm infants (61.1%) were male. The gestational age was 25.0 (24.4, 25.6) weeks, with 29 extremely preterm infants (3.0%), 88 extremely preterm infants (9.1%), 264 extremely preterm infants (27.4%), and 582 extremely preterm infants (60.4%) at 22, 23, 24, and 25 weeks of gestation age, respectively. The birth weight was 770 (680, 840) g. From 2019 to 2021, the number of extremely preterm infants increased each year (285, 312, and 366 extremely preterm infants, respectively). Antenatal steroids and magnesium sulfate were administered to 67.7% (615/908) and 51.1% (453/886) mothers of extremely preterm infants. In the delivery room, 20.8% (200/963) and 69.5% (669/963) extremely preterm infants received noninvasive positive end-expiratory pressure support and endotracheal intubation. Delayed cord clamping and cord milking were performed in 19.0% (149/784) and 30.4% (241/794) extremely preterm infants. From 2019 to 2021, there were significant increases in the usage of antenatal steroids, antenatal magnesium sulfate, and delivery room noninvasive positive-end expiratory pressure support (all P<0.05). Overall, 349 extremely preterm infants (36.2%) did not receive complete care, 392 extremely preterm infants (40.7%) received complete care and survived to discharge, and 222 extremely preterm infants (23.1%) received complete care but died in hospital. The survival rates for extremely preterm infants at 22, 23, 24 and 25 weeks of gestation age were 10.3% (3/29), 23.9% (21/88), 33.0% (87/264) and 48.3% (281/582), respectively. From 2019 to 2021, there were no statistically significant trends in complete care, survival, and mortality rates (all P>0.05). Only 11.5% (45/392) extremely preterm infants survived without major morbidities. Moderate to severe bronchopulmonary dysplasia (67.3% (264/392)) and severe retinopathy of prematurity (61.5% (241/392)) were the most common morbidities among survivors. The incidences of severe intraventricular hemorrhage or periventricular leukomalacia, necrotizing enterocolitis, and sepsis were 15.3% (60/392), 5.9% (23/392) and 19.1% (75/392), respectively. Overall, 83.7% (328/392) survivors received invasive ventilation during hospitalization, with a duration of 22 (10, 42) days. The hospital stay for survivors was 97 (86, 116) days. Conclusions: With the increasing number of extremely preterm infants at 22-25 weeks' gestation admitted to CHNN NICU, the survival rate remained low, especially the rate of survival without major morbidities. Further quality improvement initiatives are needed to facilitate the implementation of evidence-based care practices.

Lessons learned from screening literature on person-centred care: Exploration of text-mining functions for semi-automatization of study identification.

Short introduction: To develop evidence-based person-centred care practice, informed by synthesised international knowledge, there is a need to comprehensively identify relevant citations from systematic data-base searches. However, systematic searches on ‘thick’ concepts with diffuse conceptual boundaries like person-centred care will generate to many citations possible to screen and assess manually. &#x0D; Background and purpose: The implementation of person-centred care is hindered by the fact that research results are not easily accessible. Searches of databases for original studies generate at least 90,000 unique citations. In addition to this large number of publications, there is also a diversity in terminology and conceptualisations used. When decision-makers, practitioners and researchers are unable to review all existing knowledge, the obvious risk is confusion in implementation.&#x0D; As part of an ongoing project, which aims to map available international literature of centredness in healthcare, our specific purpose with this presentation is to share some lessons learned from literature screening supported by text-mining functions. This was performed by a team of researchers specialised in interprofessional person-centred care who in the larger team includes patient partners, students and project assistants. Our experience is of importance not only for researchers, but also for policy-makers, decision-makers and healthcare professionals. &#x0D; Method: The use of text-mining functions to semi-automate the process of citation screening is a way to tackle the great amount of research citations available today. Database searches for literature on person-centred care resulted in the retrieval of 94 236 unique citations. A random sample of 5455 records was screened manually by two reviewers independently against inclusion- and exclusion criteria. Results from that screening was used to build two project tailored text-mining classifier models, one built manually by a language technologist based on word frequencies, and one machine learning classifier constructed in the software EPPI-reviewer using the sci-kit-learn library. The 1000 highest-ranking records were retrieved and manually screened for both models. &#x0D; Result: In the exploration, manual screening of the first random sample of 5455 citations resulted in 3,7% of the sample to be included in the specific mapping study. When screening the 1000 highest ranked citations using the manually built classifier model 23,5% of the sample was included. . The EPPI reviewer classifier model resulted in 83,4% to be included, while applying the same criteria for inclusion. &#x0D; Discussion: For our purposes the classifier model built in EPPI-reviewer showed promise in identifying relevant citations earlier in the process as compared to a manually built classifier. Both models performed better than random manual screening. Making use of classifying model software is merited to facilitate processes of screening and sifting citations in knowledge fields that are hard to conceptually delimit in larger data bases, such as the field of person-centred care research. &#x0D;

Stigma manifestations in cardiomyopathy care impact outcomes for black patients: a qualitative study

IntroductionInequities in clinical care may contribute to racial disparities observed in studies of heart disease morbidity and cardiogenetic testing outcomes. There is a lack of research aimed at understanding the complexity of those inequities, but stigma likely contributes. This qualitative exploratory study helps close that gap in the literature by describing intersectional stigma manifestations perceived by the Black cardiomyopathy patient population at one academic medical center.MethodsQualitative interviews were conducted with 14 Black cardiomyopathy patients. Interviews aimed to elicit patients’ experiences with discrimination related to diagnosis, symptoms, genetic testing, knowledge of genetic results, genetic counseling, providers’ actions, and providers’ communication. The interview guide was informed by The Health Stigma and Discrimination Framework. Data were also collected about participant demographics, type of cardiomyopathy, age of diagnosis, documentation of relevant family history, and completion of genetic counseling and/or genetic testing.ResultsMore than half of participants reported intersectional stigma manifestations related to their race, age, and/or weight while receiving care from cardiologists, nurse practitioners, genetic counselors, or clinical support staff. Stigma manifestations included physical roughness during patient care, withholding diagnostically-relevant information from the patient, impersonal care, coercion, and use of offensive stereotyped language by providers. These stigma manifestations impacted access to care, uptake of genetic testing, timeline to diagnosis, patient emotion, patient-provider trust, and adherence to medical recommendations.ConclusionsThis study provides nuanced qualitative descriptions of stigma manifestations that affect patient and clinical outcomes in cardiology care and genetic services in one medical center in the Southeastern United States. The results of this study suggest that provider bias and stigma manifestations have an adverse effect on cardiogenetic and clinical outcomes among Black cardiomyopathy patients. Clinical interventions are suggested to assist health professionals in providing culturally-competent and respectful care. These results help inform patient-provider communication, clinical policies, and evidence-based practice in cardiology care and genetics. Continued study of this topic across more institutions and with a larger sample size is needed to confirm the generalizability of the conclusions.

International Comparison of Professional Competency Frameworks for Advanced Practice Nurses

Abstract Background Advanced Practice Nurses (APNs) have become established professionals in many healthcare systems. APNs combine nursing with medical expertise, bridging the boundaries of traditional professions in nursing and medicine. This study focuses on the content of professional competency frameworks for APNs in different countries to determine (1) how these frameworks define the competencies of APNs and (2) address the division of tasks between APNs and physicians. Methods An inductive content analysis is conducted of the competency frameworks for APNs in Belgium, Canada, the Netherlands, the United Kingdom, and the United States. Results In Belgium, the Netherlands and the US, the framework is based on an existing model, while in Canada and UK, frameworks do not refer to a model. The analysis revealed twelve generic competency domains for APNs: 1. Clinical Care in Practice, 2. Independent Practitioner, 3. Professional Attitude, 4. Scientific Research &amp; Evidence-Based Practice Care, 5. Leadership, 6. Health Promotion and Public Healthcare, 7. Communication and Collaboration, 8. Organisation of Care and Policy, 9. Support of Self-Management and Patient Empowerment, 10. Quality and Safety of Care, 11. Teaching and (continuing) Education, 12. Technology and E-Health. There are some differences in explicitly to which high-risk procedures are described per country. The frameworks provide limited descriptions of task division and delegation from physicians to APNs, except for the frameworks from Belgium and the Netherlands. Conclusions Despite variations in the basis of professional competency frameworks per country and country-specific influences, twelve generic competency domains with similar competencies were identified. It is recommended to stimulate the development of a global standardised competency framework for APNs, including clear descriptions of task division and delegation, to optimise their role in delivering high-quality healthcare services. Key messages • Similar APN competency expectations suggest the need for an international competency framework, including roles and tasks for APNs, to function as a basis for individual country frameworks. • Nursing associations can use this study to learn from other countries and enhance their development of country-specific competency frameworks for advanced practice nurses.

Evidence-based maintenance care among chiropractors in Norway: a cross-sectional survey in the Nordic maintenance care program

BackgroundChiropractors use a treatment strategy called maintenance care with the intent of secondary and tertiary prevention. The Nordic Maintenance Care Program provides evidence of when and for whom maintenance care should be offered. Dissemination has occurred through articles, workshops, social media, conference in Europe and internationally. However, little is known about chiropractors’ awareness and use of this evidence. This study explores chiropractors’ attitudes, skills, and use of evidence on maintenance care, as well as study their association with general evidence-based practice and demographic characteristics. Moreover, barriers and facilitators of evidence access are also examined.MethodsQuestions pertaining our research aim were included in the anonymous and digital Evidence-Based practice Attitude and utilization SurvEy, which was distributed to all members (n = 770) of the Norwegian chiropractic association in the fall of 2021.ResultsThe response rate was 41% (n = 312). Regarding attitudes towards evidence-based maintenance care, 26% agreed they needed tools to recommend this care to patients. Approximately half (57%) believed they had skills to identify suitable patients, and 45% had used published information in the past month. Strong alignment was observed between Norwegian chiropractors’ attitudes, skills, and utilization of evidence-based maintenance care and general evidence-based practice. Maintenance care skills were significantly associated with age (those between 40 and 59 years being less likely to report having high skills), clinical setting (those working with conventional health care providers being less likely to report having high skills) and country of education (those educated in the US and Australia being more likely to report having high skills). Moreover, maintenance care use was significantly associated with country of education (those educated in Australia were less likely to have used published information regarding patient selection for maintenance care). Access to resources was a barrier, whereas knowledge of patient suitability facilitated evidence-based maintenance care.ConclusionsNorwegian chiropractors had neutral attitudes towards maintenance care, but generally reported moderate skills. Most had not used evidence about maintenance care in the previous month. Access to useful resources about the evidence regarding maintenance care was a barrier, and knowledge of who responds to maintenance care was a facilitator.

Costs and intermediate outcomes for the implementation of evidence-based practices of midwifery under a MIDWIZE framework in an urban health facility in Nairobi, Kenya

BackgroundThree evidence-based midwife-led care practices: dynamic birth positions (DBP), immediate skin-to-skin contact (SSC) with zero separation between mother and newborn, and delayed cord clamping (DCC), were implemented in four sub-Saharan African countries after an internet-based capacity building program for midwifery leadership in quality improvement (QI). Knowledge on costs of this QI initiative can inform resource mobilization for scale up and sustainability. MethodsWe estimated the costs and intermediate outcomes from the implementation of the three evidence-based practices under the midwife-led care (MIDWIZE) framework in a single facility in Kenya through a pre- and post-test implementation design. Daily observations for the level of practice on DBP, SSC and DCC was done at baseline for 1 week and continued during the 11 weeks of the training intervention. Three cost scenarios from the health facility perspective included: scenario 1; staff participation time costs ($515 USD), scenario 2; staff participation time costs plus hired trainer time costs, training material and logistical costs ($1318 USD) and scenario 3; staff participation time costs plus total program costs for the head trainer as the QI leader from the capacity building midwifery program ($8548 USD). ResultsAt baseline, the level of DBP and SSC practices per the guidelines was at 0 % while that of DCC was at 80 %. After 11 weeks, we observed an adoption of DBP practice of 36 % (N = 111 births), SSC practice of 79 % (N = 241 births), and no change in DCC practice. Major cost driver(s) were midwives’ participation time costs (56 %) for scenario 1 (collaborative), trainers’ material and logistic costs (55 %) in scenario 2(collaborative) and capacity building program costs for the trainer (QI lead) (94 %) in scenario 3 (programmatic). Costs per intermediate outcome were $2.3 USD per birth and $0.5 USD per birth adopting DBP and SSC respectively in Scenario 1; $6.0 USD per birth adopting DBP and $1.4 USD per birth adopting SSC in Scenario 2; $38.5 USD per birth adopting DBP and $8.8 USD per birth adopting SSC in scenario 3. The average hourly wage of the facility midwife was $4.7 USD. ConclusionImproving adoption of DBP and SSC practices can be done at reasonable facility costs under a collaborative MIDWIZE QI approach. In a programmatic approach, higher facility costs would be needed. This can inform resource mobilization for future QI in similar resource-constrained settings.

Embracing Challenges for Population Aging in China: Building Scientific Evidence to Inform Long-Term Care Policymaking and Practice

ABSTRACT In China, rapid aging of the population is driving up demand for healthcare and long-term care services for older adults. This special issue of the Journal of Aging & Social Policy features a collection of studies that provided timely analyses and fresh insights into a wide range of policy relevant topics concerning long-term care for older adults in China. In this introductory article, we orient readers to these studies organized under four themes: migration, caregiving, and elder care challenges; long-term care service users, frontline workers, and workforce challenges; unmet needs across the care span in healthcare, long-term care, and end of life care; and long-term care financing. We highlight major findings and contributions of each study and provide perspectives on key issues within China’s evolving healthcare and social policy contexts. Collectively, these studies contribute to building scientific evidence where it is lacking and supporting evidence-based long-term care policymaking and practice to meet the mounting challenges of population aging in China.

Staying Informed of Best Evidence to Guide Practice

Staying Informed of Best Evidence to Guide Practice

Tuberculosis in older adults: case studies from four countries with rapidly ageing populations in the western pacific region

BackgroundThe Western Pacific Region has one of the fastest-growing populations of older adults (≥ 65 years) globally, among whom tuberculosis (TB) poses a particular concern. This study reports country case studies from China, Japan, the Republic of Korea, and Singapore reflecting on their experiences in managing TB among older adults.FindingsAcross all four countries, TB case notification and incidence rates were highest among older adults, but clinical and public health guidance focused on this population was limited. Individual country reports illustrated a range of practices and challenges. Passive case finding remains the norm, with limited active case finding (ACF) programs implemented in China, Japan, and the Republic of Korea. Different approaches have been trialled to assist older adults in securing an early diagnosis, as well as adhering to their TB treatment. All countries emphasised the need for person-centred approaches that include the creative application of new technology and tailored incentive programs, as well as reconceptualisation of how we provide treatment support. The use of traditional medicines was found to be culturally entrenched among older adults, with a need for careful consideration of their complementary use. TB infection testing and the provision of TB preventive treatment (TPT) were underutilised with highly variable practice.ConclusionOlder adults require specific consideration in TB response policies, given the burgeoning aging population and their high TB risk. Policymakers, TB programs and funders must invest in and develop locally contextualised practice guidelines to inform evidence-based TB prevention and care practices for older adults.

Evidence-based intrapartum care practice and associated factors among obstetric care providers working in hospitals of the four Wollega Zones, Oromia, Ethiopia.

Even though Evidence-Based Practice (EBP) is a key component of quality of Intrapartum care and links to improved health care outcomes, consistent application of EBP in patient care remains a challenge for health care providers. In the study area, there are no previous studies conducted on evidence-based Intrapartum care practice among obstetric care providers. Therefore, this study was aimed to assess the magnitude of evidence based intra-partum care practice and its associated factors among obstetric care providers working in hospitals of Wollega zones, Oromia Region, West Ethiopia, 2022. An institution-based cross-sectional study using quantitative method was conducted from January to April/2022 in 11 hospitals of the four Wollega zones. All obstetric care providers (278) who were practicing intrapartum care in the selected hospitals were included. The data was collected using structured self-administered questionnaire and observational checklist. Data was entered via Epi-Data version 3.1 and analyzed by SPSS version 25 statistical software. To see the association between the independent variables and evidence based Intrapartum care practice, multivariable logistic regression analysis was done. The statistical significance of association was declared at p-value ≤ 0.05. Tables, figures and charts were also used in descriptive statistics. The overall magnitude of evidence-based Intrapartum care practice was found to be 63.7% [95% CI (59.7, 67.7)]. There was a statistically significant association between evidence-based Intrapartum care practice and having good knowledge about Intrapartum care practice [AOR = 2.95; 95% CI (1.52,5.73)], positive attitude towards Intrapartum care practice [AOR = 3.13; 95% CI (1.59,6.16)], availability of updated Intrapartum care guideline [AOR = 2.88; 95% CI (1.46,5.70)], number of obstetric care providers per a shift (≥5 care providers) [AOR = 2.31; 95% CI (1.01,5.29)], number of deliveries within a day (<10 deliveries) [AOR = 4.61; 95% CI (2.28,9.31)], educational level (MSc and above) [AOR = 5.75; 95% CI (2.23,14.84)] at p-value ≤ 0.05. Our study revealed that, magnitude of evidence-based Intrapartum care practice was found to be low according to the WHO recommendation. These findings indicate that additional attention and monitoring is required to implement current Intrapartum care practices with the WHO guidelines.

Implementation of Evidence-Based Practice in Peripheral Intravenous Catheter Care.

Inserting a peripheral intravenous (PIV) catheter is a common health care procedure; however, risks include phlebitis, extravasation, and accidental dislodgement. Using evidence-based practices (EBPs) can reduce these risks. The purpose of this study was to implement an evidence-based PIV catheter care bundle and a decision-making algorithm. A quasi-experimental study design was used. A care bundle and an evidence-based decision-making algorithm were implemented on a medical unit. Outcomes included length of PIV catheter dwell time, phlebitis and other complications, and health professionals' adherence to the interventions. A total of 364 PIV catheters were assessed. PIV catheter dwell time decreased from 3.6 to 2.9 days ( P < .001), and phlebitis rates decreased from 14.8% to 4.9% ( P < .05). Health professionals' adherence increased from 84.3% to 91.8%. Implementing EBPs can improve care provided to patients with PIV catheters.

Hemşirelik Son Sınıf Öğrencilerinin Klinik Ortamda Kanıta Dayalı Uygulamalara İlişkin Deneyim, Görüş ve Düşünceleri: Fenomenolojik Bir Araştırma

Objective: This study was aimed at evaluating the experiences, views, and opinions of senior nursing students on evidence-based practices for the clinical environment just before graduation. Material and Methods: The research was performed in the interpretive paradigm using a hermeneutic phenomenological approach. Data were collected from 15 students who were going to graduate from the nursing department of an eastern Türkiye university from May 2019-July 2019. The data were collected by the first researcher using the individual, face-to-face interview method. The data were collected through detailed individual interviews, using the ''Personal Information Form'' and the ''Semi-Structured Interview Form.'' The Personal Information Form included questions on the participants'' age, year at school, sex, academic achievement, information about evidence-based practices, and reading status. Results: The opinions of the nursing undergraduate students on evidence-based practices were analysed, and 8 themes were created in 4 categories. Data analyses yielded the following 3 categories: ''scientific product'', ''vital for the quality of patient care and the professionalization of nurses'', ''applicability in patient care'' and ''the power to referral evidence-based practice in patient care.'' Conclusion: It was determined that some of the nursing students did not learn evidence-based practices at all, and the most important reason for this was the students'' indifference, and clinical nurses'' lack of knowledge and the academic nurses'' lack of attention regarding evidence-based learning.