Evidence-based Practice Knowledge Research Articles

Furthering Our Understanding of Therapist Knowledge and Attitudinal Measurement in Youth Community Mental Health.

Examining therapist evidence-based practice (EBP) knowledge seems an important step for supporting successful implementation. Advances in implementation science suggest a distinction between practice specific (i.e., knowing which practices are derived from the evidence base) and EBP process (i.e., integrating research evidence, clinical experience, client characteristics, and monitoring outcomes) knowledge. An examination of how these knowledge types are measured and relate to attitudes appears warranted. In our sample of 58 youth community therapists, both practice specific and EBP process knowledge accounted for EBP attitude scores, which varied by therapist demographic variables. Implications for measurement of therapist constructs and future research in identifying therapist predictors of EBP use and youth clinical improvement are discussed.

Pediatric nurses' perceived knowledge and beliefs of evidence-based practice in the care of children and adolescents with moderate-to-severe traumatic brain injury.

Pediatric nurses play a significant role in all phases of traumatic brain injury (TBI) recovery, particularly during the hospital stay. Although evidence-based nursing practice is known to improve patient outcomes, limited research exists on nurses' evidence-based perceived knowledge and beliefs specific to TBI care. As nurses' perceived knowledge and beliefs are known to guide their practice behaviors, this assessment is important to overall TBI outcomes. The purpose of this study was to evaluate pediatric nurses' evidence-based perceived knowledge and beliefs in providing care for children and adolescents with moderate-to-severe TBI. Data for this study were obtained from a larger parent study on nurses' perceptions of caring for patients of all ages with moderate-to-severe TBI. The parent study was an exploratory, cross-sectional electronic survey of registered nurses across all hospital departments within a large Midwestern health system. Only data specific to pediatric nurses (n=330) were analyzed for this study. Descriptive statistics and latent class analysis (LCA) were performed. Pediatric nurses, on average, were 38.79 years, female (90.37%), had over a decade of nursing experience (13.55 years), and practiced as a staff nurse (80.07%) on an inpatient unit (45.51%). Findings indicated pediatric nurses reported overall low levels of evidence-based perceived knowledge and had inaccurate beliefs about caring for patients with TBI. LCA indicated two distinct homogenous subgroups specific to evidence-based perceived knowledge: low (41%) and high (59%). Nurses in the low evidence-based perceived knowledge group were younger, had less nursing experience, worked primarily on an inpatient unit, and cared for patients with TBI at a higher frequency compared to high evidence-based perceived knowledge nurses. Additionally, there were significant differences in beliefs about sex-based patient differences after TBI and the role of nurses in caring for patients with TBI based on level of evidence-based perceived knowledge. Assessing nurses' perceived knowledge and beliefs of evidence-based practice is a foundational step toward implementing evidence-based care for patients with moderate-to-severe TBI. Implications of these findings indicate the need to provide additional education to increase pediatric nurses' perceived knowledge and ensure accurate beliefs about evidence-based TBI care.

The effect of a multifaceted evidence-based practice programme for nurses on knowledge, skills, attitudes, and perceived barriers: A cohort study

BackgroundThe Dutch professional nursing standard of 2012 stipulates that Dutch nursing practices are to be evidence-based. Not all practicing nurses can satisfy these requirements, therefore, an educational programme about Evidence-Based Practice (EBP) was developed for a Dutch teaching hospital. ObjectiveThe aim of this study was to measure the effects of a six month in-house EBP programme on knowledge, skills, attitudes, and perceived barriers of nurses (four European Credits equals two US Credit Hours). MethodsA multiple-cohort study was conducted with a pre-post-test design. In the period of 2011–2015, a total of 58 nurses (9 cohorts) followed the programme. Baseline and follow-up assessments consisted of three questionnaires each: the Dutch Modified Fresno, the two subscales of the McColl questionnaire, and the BARRIER scale to assess knowledge and skills, attitudes, and perceived barriers, respectively. ResultsFifty nurses completed both assessments. The results demonstrated that actual knowledge and skills significantly increased by approximately 40%. Self-perceived knowledge increased significantly, while attitudes towards EBP remained (moderately) positive. Perceived barriers did not notably change except for the Research subscale which received many “no opinion” responses prior to the programme but fewer afterwards. ConclusionsOur multifaceted in-house EBP programme led to a significant improvement of approximately 40% in EBP knowledge and skills of participating nurses. Most nurses who followed the EBP programme are currently applying their knowledge and skills in practice. Managerial support and allocated time for EBP are important facilitators for its implementation. Furthermore, to maintain and expand nurses' EBP knowledge and skills and translate them into practice, follow-up interventions, such as journal clubs, may well be beneficial. Based on the positive results of our programme, we will implement it throughout the hospital with an emphasis on training more groups of nurses.

Using an interprofessional flipped classroom educational strategy for developing evidence-based practice knowledge and skills

Abstract Evidence-based practice (EBP) is the standard approach used by healthcare practitioners to provide high quality, patient-centered healthcare. Given that all health professions students require education in both EBP and interprofessional collaboration, we used the advantages of a flipped classroom instructional strategy to provide an interprofessional EBP instruction program. Health professions students who had a clear understanding of their professional roles and had engaged in some clinical experience participated in this pilot program. The program consisted of three online learning modules (3.5 h) and one in-person faculty facilitated interprofessional case-based EBP learning activity (2 h). This program was designed with the following objectives (and assessments): develop students' foundational EBP knowledge and skills (module quizzes); increase students' understanding of health professionals' roles and responsibilities (module quiz); and improve students' attitudes toward interprofessional teamwork and communication (Readiness for Interprofessional Learning Scale). Program feasibility was also assessed. Student evaluations of the program indicated they learned skills they felt contributed to their successful participation in the in-person activity. Additionally, students reported a better understanding of the benefits and challenges of working in interprofessional teams. Students preferred the flipped classroom approach to a more traditional approach and favored learning in an interprofessional group. The major impact of this program is the potential for health professions students to gain foundational EBP knowledge and skills and experience in interprofessional teams by transitioning uni-professional, traditional EBP instruction to a flipped classroom educational strategy with students from multiple health professions programs.

Dietetic interns' perceptions and use of evidence-based practice: an exploratory study.

ObjectiveThis study explored dietetic interns’ perceptions and knowledge of evidence-based practice (EBP), their use and observation of EBP principles during their clinical rotations, and their intentions to use EBP in their careers.MethodsA mixed methods design combining a survey and focus group was employed. Dietetic interns (n=16) from a large Midwestern university were recruited in person and via email to participate in the survey, focus group, or both. Perceptions and experiences of EBP were analyzed through the focus group (qualitative), and EBP knowledge and clinical practice behaviors were analyzed through the survey (quantitative). The focus group discussion was recorded, transcribed, and analyzed using thematic analysis.ResultsFour major themes emerged from the focus group data: (1) observations of EBP in clinical practice, (2) use of EBP during clinical rotations, (3) barriers to EBP, and (4) perceived use of EBP as future registered dietitians. Interns considered EBP important for their profession and future careers. They struggled, however, with the discrepancies between current research and practice, and highlighted differences that they observed and barriers that they experienced across different clinical settings.ConclusionsThis exploratory study is the first to examine dietetic interns’ perceptions of and experiences with EBP in the clinical setting. Future research is needed to identify how dietetics educators, librarians, and preceptors can address the barriers that interns perceive in applying EBP in their internships.

Targeted Interventions to Advance a Culture of Inquiry at a Large, Multicampus Hospital Among Nurses.

The aim of this study is to assist nurse leaders in developing innovative structures to foster a culture of inquiry among professional nurses. Critical to nurse's engagement in evidence-based practice (EBP) is a culture of inquiry, in which nurses critically evaluate patient care activities and actively review existing evidence to address identified clinical issues. A bundle of structural interventions was implemented across a large, multisite hospital to advance a culture of inquiry. We measured the impact of these interventions on nurses' library use and on nurses' knowledge, attitudes, and practices towards EBP. Structural interventions included: 1) EBP and Research Committee meetings, in which nurses were educated on how to formulate a clinical question and critically appraise a research article; 2) Academic Partners Program, in which nurse academicians provided scholarly mentorship and guidance during monthly committee meetings; 3) hiring of clinical nurse scientists who provided 1-on-1 education and mentorship to clinical nurses in EBP and research; and 4) a Nurse Residency Program partnership, in which newly graduated nurses were required to complete an EBP project. We examined the impact of these structural interventions on nurses' use of library resources and nurses' knowledge, attitudes, and practices toward EBP. The implementation of structural interventions to support nurses' engagement in EBP was associated with a significant increase in the number of nurse-generated library consultative requests over time. Results showed high levels of nurse knowledge, attitudes, and practices in EBP. Nurse leaders may advance a culture of inquiry by providing the infrastructure to support EBP activities and by empowering nurses to question and seek answer to identified practice questions. Infrastructures should include access to scientific articles and partnerships with schools of nursing. Additional research is needed to validate nurse library use as a measure of nurse engagement in EBP.

School-Based Speech-Language Pathologists' Clinical Decision-Making Process in the State of California

Purpose: The purpose of this survey study was to examine the relationships between knowledge and training in evidence-based practice (EBP) and ethical decision-making processes among school based speech-language pathologists (SLPs) in the state of California, U.S.A. The possible factors that may prevent SLPs from making ethical clinical decision were also explored.Method: An online survey collected demographic information as well as responses pertaining to school-based SLPs’ understanding and implementation of EBP and ASHA Code of Ethics, and perceptions of possible constraints to ethical decision-making.Result: All demographic factors are not related to EBP implementation and ethical decision-making. Weak positive correlations were found between ethical decision-making and the use of research evidence as well as between EBP training and understanding the role of school-based SLPs. Factors that may have a notable impact on ethical decision-making include parent’s preference, school district policies, and lack of administrator’s support while caseload, workload, and service delivery model have relatively less impact.Conclusion: School-based SLPs who had the EBP training more likely incorporated EBP components during their decision-making process. However, the lack of comprehensive understanding of EBP and explicit guidelines of applying EBP to clinical practice may limit the effective implementation of EBP.

Current scenario of evidence-based practice and rationale of preferred approach in stroke rehabilitation among physiotherapists in Saudi Arabia: A cross-sectional survey

Context: Evidence-based practice (EBP) is an integral part of stroke rehabilitation, to achieve optimal results by practicing best evidence available in the literature. Aims: A survey was conducted to find the knowledge of EBP and preferred treatment used by the physiotherapists in Saudi Arabia for stroke rehabilitation. Settings and Design: Eminent research scholars and experienced physiotherapists involved in stroke rehabilitation developed an EBP questionnaire containing 35 questions. The survey was intended to explore the current practice of stroke rehabilitation among physiotherapists. Subjects and Methods: Physiotherapists (n = 186) practicing stroke rehabilitation received online questionnaire through e-mail; only 156 complete questionnaires returned (86.2% of response rate). Statistical Analysis Used: Nonparametric tests were used to analyze data obtained from the questionnaire. Results: Physiotherapists preferred Bobath approach (77.7%) for stroke rehabilitation over newer techniques. The survey further shows that the majority of participants (59.6%) were unaware of process and implementation of EBP. Conclusions: Experienced and novice therapists showed a vast degree of variation in treatment approaches. Majority of the therapists preferred Bobath approach over newer techniques.

A Confirmatory Factor Analysis of the Student Evidence-Based Practice Questionnaire (S-EBPQ) in an Australian sample

BackgroundIt is crucial that nursing students develop skills and confidence in using Evidence-Based Practice principles early in their education. This should be assessed with valid tools however, to date, few measures have been developed and applied to the student population. ObjectiveTo examine the structural validity of the Student Evidence-Based Practice Questionnaire (S-EBPQ), with an Australian online nursing student cohort. DesignA cross-sectional study for constructing validity. Participants and MethodThree hundred and forty-five undergraduate nursing students from an Australian regional university were recruited across two semesters. Confirmatory Factor Analysis was used to examine the structural validity. ResultsConfirmatory Factor Analysis was applied which resulted in a good fitting model, based on a revised 20-item tool. ConclusionsThe S-EBPQ tool remains a psychometrically robust measure of evidence-based practice use, attitudes, and knowledge and skills and can be applied in an online Australian student context. The findings of this study provided further evidence of the reliability and four factor structure of the S-EBPQ. Opportunities for further refinement of the tool may result in improvements in structural validity.

Evidence-based practice among health professionals in hospitals of Northwest Ethiopia: a cross-sectional study.

Evidence-based practice (EBP) is a problem-solving approach to patient care based on the best available and valid evidence. It is accentuated to increase the quality of care and patient safety. EBP in clinical service is low in developing countries including Ethiopia. This study aimed at assessing EBP and associated factors among health professionals in North Gondar Administrative Zone hospitals, Northwest Ethiopia. Institution-based cross-sectional study was carried out from March to May 2015 in three hospitals in North Gondar Zone. A stratified simple random sampling technique was used to select 438 respondents. Trained data collectors collected data using a pre-tested, structured and self-administered questionnaire. The questionnaire included sociodemographic characteristics, level of knowledge, attitude and organizational factors. Data were entered using Epi Info version 7.0 and analysed using SPSS version 20.0. Bivariate and multivariable logistic regression analyses were undertaken to identify the associated factors. In total, 431 returned questionnaires were valid for the analysis making a response rate of 98.4%. Almost half, 53% (228) of study participants utilized EBP. EBP utilization was significantly associated with knowledge [adjusted odds ratio (AOR): 1.612, 95% confidence interval (CI) = (1.06-2.45)], Internet access [AOR: 1.831, 95% CI = (1.191-2.816)], training [AOR: 1.906, 95% CI (1.223-2.97)], and availability of enough time to apply EBP [AOR: 1.698, 95% CI = (1.122-2.57)]. This study depicts EBP utilization was insufficient. We observed that knowledge of EBP, training, Internet access and availability of time were significantly associated with utilizing EBP. Improving facilities Internet access, giving more time for EBP, and training health professionals about search strategies would improve EBP.

The Role of Practice and Feedback for Developing Teacher Candidate’s Opportunities to Respond Expertise

A greater emphasis on measuring the outputs of teacher preparation programs such as practice-based evaluations (e.g., edTPA) has increased the need for teacher educators to examine “best practice” for developing the skill-based competencies of teacher candidates. The purpose of this study was to examine the role of practice and feedback on teacher candidates’ knowledge and skill acquisition of a specific evidence-based practice, the provision of opportunities to respond (OTRs). Using an experimental, pretest–posttest design, 48 teacher candidates in an introductory special education course (i.e., nonpracticum course) were randomly assigned to a distributed practice with feedback (experimental) condition or a massed practice with no feedback (business-as-usual) condition. Candidates in the experimental condition outperformed candidates in the business-as-usual condition on a measure of knowledge and a performance measure on the accuracy of specific OTR technique delivery. There were, however, no differences between the groups in terms of rate of OTR delivery. Implications for teacher preparation are discussed.

Integrating Evidence-Based Practice into a Lebanese Nursing Baccalaureate Program: Challenges and Successes.

Evidence-based practice (EBP) is defined as "the conscientious use of current best evidence in making clinical decisions about patient care." This paper describes how we have developed the evidence-based practice concept and integrated it into two courses at two different levels of the BSN curriculum. Students apply EBP knowledge and process by using the PICO clinical question (Population, Intervention, Comparison and Outcome), whereby they observe a selected clinical skill, and then compare their observations to hospital protocol and against the latest evidence-based practice guidelines. The assignment for the second course requires students to pick a more complex clinical skill and to support proposed changes in practice with scholarly literature. Assessment of student learning and course evaluation has shown that the overall experience of integrating EBP projects into the curriculum is fruitful for students, clinical agencies, and faculty.

Teaching evidence-based practice principles to prepare health professions students for an interprofessional learning experience.

Objective:The research assessed online learning modules designed to teach health professions students evidence-based practice (EBP) principles in an interprofessional context across two institutions.Methods:Students from nine health professions at two institutions were recruited to participate in this pilot project consisting of two online learning modules designed to prepare students for an in-person case-based interprofessional activity. Librarians and an instructional designer created two EBP modules. Students’ competence in EBP was assessed before and after the modules as well as after the in-person activity. Students evaluated the online learning modules and their impact on the students’ learning after the in-person session.Results:A total of 39 students from 8 health professions programs participated in the project. Average quiz scores for online EBP module 1 and module 2 were 83% and 76%, respectively. Following completion of the learning modules, adapted Fresno test of competence in EBP scores increased (p=0.001), indicating that the modules improved EBP skill competence. Student evaluations of the learning modules were positive. Students indicated that they acquired new information skills that contributed to their ability to develop a patient care plan and that they would use these information skills in their future clinical practice.Conclusions:Online EBP learning modules were effective in developing EBP knowledge and skills for health professions students. Using the same modules ensured that students from different health professions at different stages of their professional programs had consistent knowledge and enabled each student to fully engage in an interprofessional evidence-based activity. Student feedback indicated the modules were valued and beneficial.

Evaluating the effectiveness of Facebook to impact the knowledge of evidence-based employment practices by individuals with traumatic brain injury: A knowledge translation random control study.

Individuals with traumatic brain injury (TBI) experience difficulty with obtaining and maintaining employment post-injury. Although vocational rehabilitation (VR) can be one option to provide individuals with TBI support and services to lead to successful employment outcomes, information about these services can be difficult and confusing to navigate. Providing information on evidence-based employment practices to individuals with TBI through social media could be an effective approach. The objective of this study was to compare the effect of a knowledge translation (KT) strategy and the use of a secret Facebook group, on the knowledge of evidence-based employment research by individuals with traumatic brain injury (TBI). The study used a randomized pretest-posttest control group design. Sixty individuals with TBI were recruited through clubhouse programs in the state where the authors resided as well as through support groups nationally for individuals with TBI, and were randomly assigned to one of two groups. Both groups received information on evidence-based employment practices for individuals with traumatic brain injury (TBI) over a three month period. One group received the information via participation in a secret Facebook group while the comparison group received information as an "e-news" email blast. Participants were assessed pre- and post-intervention with a Likert-scale instrument designed to measure knowledge of evidenced-based employment information for TBI. Both groups gained a significant amount of knowledge between baseline and post-intervention. However, there were no significant differences between groups in knowledge gained at post-intervention. While the study did not identify the most effective means of delivering information to individuals with TBI, it does provide some guidance for future KT research.

Evidence-Based Practice in Clinical Nursing Education: A Scoping Review.

Nursing students require education that integrates evidence-based practice (EBP) knowledge across classroom and clinical settings. This study was conducted to identify and examine the literature related to nursing students' use of evidence in clinical education and to identify associated research gaps. A scoping review describing the extent, range, and nature of the research activity focused on students' use of evidence in clinical education. Included studies (N = 37) describe the barriers and facilitators to nursing students' EBP and describe the evaluation of strategies that support nursing students' engagement in EBP. Most commonly identified barriers include a lack of knowledge and skills for EBP; negative attitudes toward EBP in students, faculty, and nurses; and lack of support in the clinical setting. Evaluated strategies included educational sessions and EBP projects, either alone or in combination, as well as other stand-alone interventions. All but two of the intervention studies reported positive subjective or objective outcomes. On the basis of these results, educators can engage in combined educational strategies that focus on addressing described barriers. [J Nurs Educ. 2017;56(9):534-541.].

Development and Testing of the Nurse Manager EBP Competency Scale.

The purpose of this study was to develop and evaluate the validity and reliability of an instrument to measure nurse manager competencies regarding evidence-based practice (EBP). The Nurse Manager EBP Competency Scale consists of 16 items for respondents to indicate their perceived level of competency on a 0 to 3 Likert-type scale. Content validity was demonstrated through expert panel review and pilot testing. Principal axis factoring and Cronbach's alpha evaluated construct validity and internal consistency reliability, respectively. Eighty-three nurse managers completed the scale. Exploratory factor analysis resulted in a 16-item scale with two subscales, EBP Knowledge ( n = 6 items, α = .90) and EBP Activity ( n = 10 items, α = .94). Cronbach's alpha for the entire scale was .95. The Nurse Manager EBP Competency Scale is a brief measure of nurse manager EBP competency with evidence of validity and reliability. The scale can enhance our understanding in future studies regarding how nurse manager EBP competency affects implementation.

Evidence-Based Practice and School Nurse Practice: A Review of Literature.

School nurses report that evidence-based practice (EBP) is not a part of their daily practice, and most have had no formal education regarding EBP or its implementation. The purpose of this review is to identify what strategies might be effective to educate school nurses about EBP as a first step toward establishing EBP in school nurse practice. Three scientific databases were searched, and eight pertinent manuscripts were identified. A review of the manuscripts indicates that EBP learners should be addressed in terms of the level of education needed (EBP "user" vs. "practitioner") and that a multifaceted approach to learning that addresses EBP knowledge, skill, and attitude is most effective. School nurse leaders and educators should work to provide learning opportunities to develop school nurses knowledge and skill using various learning modalities and delivery methods. EBP mentor relationships should be developed to bridge knowledge into practice.

The relationship between consumer, clinician, and organizational characteristics and use of evidence-based and non-evidence-based therapy strategies in a public mental health system

We investigated the relationship between consumer, clinician, and organizational factors and clinician use of therapy strategies within a system-wide effort to increase the use of cognitive-behavioral therapy. Data from 247 clinicians in 28 child-serving organizations were collected. Clinicians participating in evidence-based practice training initiatives were more likely to report using cognitive-behavioral therapy when they endorsed more clinical experience, being salaried clinicians, and more openness to evidence-based practice. Clinicians participating in evidence-based practice initiatives were more likely to use psychodynamic techniques when they had older clients, less knowledge about evidence-based practice, more divergent attitudes toward EBP, higher financial strain, and worked in larger organizations. In clinicians not participating in evidence-based training initiatives; depersonalization was associated with higher use of cognitive-behavioral; whereas clinicians with less knowledge of evidence-based practices were more likely to use psychodynamic techniques. This study suggests that clinician characteristics are important when implementing evidence-based practices; and that consumer, clinician, and organizational characteristics are important when de-implementing non evidence-based practices. This work posits potential characteristics at multiple levels to target with implementation and deimplementation strategies.

Beliefs, Knowledge, Implementation, and Integration of Evidence-Based Practice Among Primary Health Care Providers: Protocol for a Scoping Review.

BackgroundThe adoption of evidence-based practice (EBP) is promoted because it is widely recognized for improving the quality and safety of health care for patients, and reducing avoidable costs. Providers of primary care face numerous challenges to ensuring the effectiveness of their daily practices. Primary health care is defined as: the entry level into a health care services system, providing a first point of contact for all new needs and problems; patient-focused (not disease-oriented) care over time; care for all but the most uncommon or unusual conditions; and coordination or integration of care, regardless of where or by whom that care is delivered. Primary health care is the principal means by which to approach the main goal of any health care services system: optimization of health status.ObjectiveThis review aims to scope publications examining beliefs, knowledge, implementation, and integration of EBPs among primary health care providers (HCPs).MethodsWe will conduct a systematic scoping review of published articles in the following electronic databases, from their start dates until March 31, 2017: Medical Literature Analysis and Retrieval System Online (MEDLINE) via PubMed (from 1946), Embase (from 1947), Cumulative Index to Nursing and Allied Health Literature (CINAHL; from 1937), the Cochrane Central Register of Controlled Trials (CENTRAL; from 1992), PsycINFO (from 1806), Web of Science (from 1900), Joanna Briggs Institute (JBI) database (from 1998), Database of s of Reviews of Effects (DARE; from 1996), Trip medical database (from 1997), and relevant professional scientific journals (from their start dates). We will use the predefined search terms of, “evidence-based practice” and, “primary health care” combined with other terms, such as, “beliefs”, “knowledge”, “implementation”, and “integration”. We will also conduct a hand search of the bibliographies of all relevant articles and a search for unpublished studies using Google Scholar, ProQuest, Mednar, and WorldCat. We will consider publications in English, French, Spanish, and Portuguese.ResultsThe electronic database searches were completed in April 2017. Retrieved articles are currently being screened, and the entire study is expected to be completed by November 2017.ConclusionsThis systematic scoping review will provide a greater understanding of the beliefs, knowledge, implementation, and integration of EBPs among primary HCPs. The findings will inform clinical practice and help to draw a global picture of the EBP research topics that are relevant to primary care providers.

Instruments for measuring undergraduate nursing students' knowledge, attitudes and skills in evidence-based practice: a systematic review protocol.

The objective of this systematic review is to identify and assess the properties of instruments for measuring undergraduate nursing students' knowledge, attitudes and skills in evidence-based practice (EBP).More specifically, the review questions are as follows.