Evidence-based Practice Process Research Articles

Association between predoctoral evidence-based practice training and later use of peer-reviewed journals: National dental PBRN.

We examined whether evidence-based practice (EBP) during dental school was associated with the increased use of peer-reviewed literature during subsequent clinical practice for National Dental Practice-Based Research Network (PBRN) dentists. We also sought to understand whether this association was moderated by being a dental specialist. We analyzed cross-sectional data from 1228 dentists participating in the PBRN. We used logistic regression to examine the association between self-reported EBP training during dental school and the use of peer-reviewed journals in clinical practice, controlling for the number of years since dental school graduation and dental practice type. We stratified the data by dental specialists and examined effect modification using the Breslow-Day test for homogeneity of the odds ratio. The prevalence of peer-reviewed journal use by PBRN dentists in clinical practice was 87% (n=1070) with no statistical evidence of effect modification by dental specialists on the EBP peer-reviewed journal use relationship (p>0.05). After controlling for years since dental school graduation and dental practice type, dentists who self-reported EBP training during dental school had greater odds of using peer-reviewed journals in clinical practice than dentists who did not self-report EBP training during dental school (OR, 1.47; 95%CI=1.01, 2.15). The use of peer-reviewed published literature by PBRN dentists who had EBP predoctoral training is one important step in the EBP process by which practicing dentists can implement evidence-based findings, interventions, and policies into routine health care and public health settings. These findings add to the body of support for EBP curricula in dental education.

The theory of evidence-based practice among clinical teaching assistants at a college of nursing in Jeddah, Saudi Arabia

Background: Evidence-based practice (EBP) is an integration of the research evidence with clinical expertise and the values of patients to assist the health profession in clinical decision-making. Recent studies indicate that education on EBP is considered a core component in the learning curricula for all health-care professions. In addition, it has been recommended to use a variety of teaching strategies to enhance EBP knowledge and skills. Aims: The aim of this study is to develop an explanatory theory to guide the process of EBP among clinical teaching assistants (CTAs) within the Saudi context that is characterized by a multicultural environment. Setting and Design This study used grounded theory approach by Strauss and Corbin (1990), and was conducted in a college of nursing, Jeddah, Saudi Arabia. Materials and Methods: The study participants included 22 CTAs. Initially, three participants were conveniently sampled. As data collection and data analysis continued, sampling changed from conveniently to theoretical until data saturation was reached. The data collection was through in-depth interviews and was recorded with the permission of the participants. Analysis: The data were analyzed by following the coding in grounded theory, namely open, axial, and selective coding. Results: Twenty two CTAs participated in this study. The average age of participants was 46 years with average years of experience of 7.5 years. The theory that emerged from this study was the “theory of EBP among CTAs.” There were one core concept emerged from the study (confident to care) and four subconcepts (teamwork, forcing inquiry, EBP champions, and formal education). Conclusion: This study provided insight into the process of EBP among CTAs and provided a middle range theory for CTAs toward becoming confident in caring through adopting EBP approach to care.

Step 0: The Spirit of Inquiry

It stands to reason that competency in every area of practice, including the evidence-based practice process, improves through participation in the practice. But before engagement in the evidence-based practice process can occur, Melnyk and Fineout-Overholt1 assert, there must be a “spirit of inquiry.” This column describes strategies to spark and cultivate a spirit of inquiry for evidence-based practice and barriers that can dampen the spirit.

Доказательный подход в образовании: критический анализ актуальных дискуссий

The article analyzes the current discussions on how to define evidence and implement evidence-based practice in education. Despite their frequent use, the terms “evidence-based practice”, “evidence-based education” etc. remain something like “empty signs” the meaning of which still needs to be defined. The authors highlight several discussion topics regarding research for evidence-based practice and evidence-based process: hierarchical versus pluralistic conception of evidence; theoretical reasoning as evidence; top-down evidence-based practice versus bottom-up evidence-informed practitioner judgment; conception of research use as linear process of uptake or dissemination versus as bidirectional process by which research and practice mutually inform each other. It is presumed that although historically evidence-based approach was associated with an appeal to science primarily as an institution of prescription, in its actual versions the relationship between science and practice is much more complex.

Teaching Culturally Responsive Evidence-Based Practice in Speech Language Pathology

Faculty teaching students in communication sciences and disorders to engage in evidence-based practice (EBP) must consciously work to overcome the lack of considerations for cultural and linguistic differences. Much of the literature on evidence-based treatment approaches fails to address contextual aspects of cultural-linguistic diversity or actively excludes non-white speakers of languages and dialects that are not White Mainstream American English from studies and analyses to maintain homogeneity. Cultural adaptation frameworks developed in the fields of education and psychology can provide guidance for integrating culturally responsive frameworks, tools, and strategies with EBP pedagogy. This paper provides the reader with an overview of relevant research on how cultural adaptation of evidence-based interventions is defined and how it can lead to culturally responsive, relevant, and sustaining teaching of EBP processes and procedures.

Nursing Staff Awareness about Evidence Based Practice: Facilitations, Barriers and Beliefs

Background: Today evidence-based practice (EBP) becomes one of the best ways that used for making clinical decisions and has an effect on health care outcomes as well as it improves the quality of care provided to patients. Aim: Assess nursing staff awareness about evidence based practice facilitations, barriers and beliefs at Belqas Central Hospital (BCH). Design: Cross sectional design. Settings: current study was carried out at Belqas Central Hospital (BCH), affiliated to Ministry Of Health, Dakahlia Governorate. Subjects: the study was conducted on nursing staff (228). Data collection tools: Data was collected using evidence based practice (EBP) questionnaire, Facilitators to change practice based on evidence based practice scale, barriers to find, use and review evidence scale and evidence based practice beliefs scale. Results: revealed that the highest total mean score of facilitations was related to organizational structure and health care environment while the lowest mean score was related to research information. As well as the highest total mean score of barriers was related to individual nurse characteristics while the lowest mean score was related to research information. Also 69% of nursing staff were agreeing with EBP, realizing its benefits and importance. Conclusion: nursing staff focus on their experience and ways that always used in providing nursing care as a source for their information. In addition to most of them were competent in fifinding, reviewing and using evidence in practice. Organizational structure and health care environment was perceived as a main facilitation of EBP, while individual nurse characteristics were perceived as the highest barriers of EBP. Most nursing staff had positive beliefs about EBP and realized its benefits in health care system. Recommendations: Ongoing training programs about EBP for nursing staff, maintaining adequate staffing in different shift to relieve nurses’ workload and help them to attain workshops and scientific conferences that updating and increasing their knowledge about EBP. Provide organizational support for EBP implementation. Translating the most relevant researches and distributed them for nurses to apply in practice to overcome the English language barrier. Increasing interest in the research and EBP process through integrating the EBP strategies in nursing curriculum.

KNOWLEDGE AND ADHERENCE TOWARDS EVIDENCE-BASED SPORTS PHYSIOTHERAPY STANDARDS AMONG PHYSIOTHERAPISTS IN KENYA

Background: Evidence-based practice (EBP) and evidence-based physiotherapy (EBPT) have been investigated in different physiotherapy clinical settings. However, there has been no research into knowledge and adherence in respect of evidence-based sports physiotherapy standards in Kenya. Objective: To determine the levels of knowledge and adherence towards EB sports physiotherapy standards among physiotherapists in Kenya. Method: A cross-sectional study using quantitative methods and in conjunction with a self-administered questionnaire was conducted in a population of 700 physiotherapists. Results: The response rate was (n=391; 55.9%). Involvement in structured sports physiotherapy practice accounted for (n=129; 32.9%). High levels of EBP knowledge (n=265; 67.8%) were reported. More males (n=185; 73.4%) than females (n=80; 57.5%) presented with high levels of EBP knowledge. Those with specializations (n=65; 83.3%) demonstrated higher levels of EBP knowledge than those without (n=200; 63.9%). Adherence to EBP process steps accounted for (n=143; 36.6%) of the population. More males (n=104; 41.3%) than females (n=39; 28.1%) adhered to the EBP process. Those with specializations (n=48; 61.5%) and those without (n=95; 30.4 %) adhered to the EBP process. Gender, training and specialization were found to have statistically-significant associations with knowledge and adherence (p<0.05). Conclusion: Physiotherapists in Kenya present with high levels of knowledge in EB sports physiotherapy but with lower levels of adherence to the EBP process. Clinical implications: Limited adherence to EBP standards despite high levels of knowledge points to an inferior quality of care for athletes with sports physiotherapy needs. Attention to the limiting factors to adherence may improve the quality of care. KEY WORDS: Evidence-based practice, standards, sports, physiotherapy, survey, Kenya.

Incorporating Evidence-Based Practice Into Informed Consent Practice

This conceptual article argues that evidence-based practice (EBP) is best understood as a component of the informed consent process preceding treatment. The legally mandated informed consent/consent to treat process requires that professionals disclose to clients the nature of services along with potential risks, benefits, and alternatives. Informed consent is a long-standing part of professional practice ethics with over a century of legal precedents. The more recent EBP process also requires discussion with the client of the best research-supported treatments, which are explored in combination with the client’s values and preferences and the professional’s expertise, to develop a treatment plan. Yet, EBP has not been clearly linked to informed consent for treatment. EBP can be usefully understood as part of the more comprehensive informed consent ethics process. New practice and ethics competencies are examined.

A Five-Step Evidence-Based Practice Primer for Perioperative RNs.

Perioperative nurses work in a complex health care setting and are well-positioned to mitigate unexpected events and promote optimal patient outcomes. Thus, perioperative nurses must adapt to rapid advances in technology, treatments, and scientific discoveries to maintain clinical competence and provide care that reflects current evidence. Evidence-based practice (EBP) is a standard of professional nursing performance and an expectation of professional nursing practice. Because EBP is foundational to health care quality and safety, perioperative nurses must understand the concepts of EBP and have the capacity to apply evidence to their clinical practice. However, some perioperative nurses struggle with EBP concepts and find it difficult to access, appraise, and apply evidence. In this article, we describe the five-step EBP process and provide valuable insights into EBP for perioperative RNs.

Digital Story-Based Education: An Innovative Way to Learn Evidence-Based Practice.

Applying evidence-based practice (EBP) to diverse clinical situations is challenging due to the complex process of EBP. Digital story-based education helps learners to understand the complex process more easily by providing contextual information. This article shares the process of development of digital story-based education to teach the steps of EBP and its implementation. A diversity of stories in real clinical situations can be used as effective learning content and to make the learning process of EBP enjoyable. [J Contin Educ Nurs. 2020;51(11):501-503.].

Determinants of an evidence-based practice environment: an interpretive description

BackgroundDespite the available research to inform nursing practice, many patients still fail to receive evidence-based care. Several evidence-based practice (EBP) models have been developed to guide nurses through the steps in the process, yet these models have not been uniformly adopted or consistently used. The original purpose of this research was to gather perspectives and experiences of nurses using the Iowa Model of EBP to help inform its introduction into other practice settings. As a more in-depth understanding was gained, the emphasis of the study shifted towards understanding the determinants of the EBP environment.MethodThe study was conducted in an 800-bed comprehensive academic medical centre in the USA with a 25-year history of using the Iowa Model of EBP. Semi-structured in-depth interviews were conducted with twelve nurses from various roles to ascertain their perspectives and experiences using the model. The interview transcripts were reviewed alongside relevant published literature and internal documents in a process of synthesising, theorising, and conceptualising. Data were collected during the first half of 2019.ResultsFour determinants of the local EBP environment were identified from the perspectives and experiences of participants: (1) the importance of a shared model to guide staff through the EBP process; (2) support for EBP in the form of education, hands-on training, and knowledge infrastructure; (3) active team facilitation by direct care nurses, nurse managers, nurse specialists, and nurse scientists; and (4) a culture and leadership that encourages EBP.ConclusionIntroducing an EBP model is an essential first step for an organisation to improve consistent and reliable evidence-based care; to be most effective, this should be done in conjunction with efforts to optimise the EBP environment.

Registered Nurses' Evidence-Based Practice Revisited: A Longitudinal Study in Mid-Career.

BackgroundTo improve patient outcomes and patient safety and to reduce costs in health care, the implementation of evidence‐based practice (EBP) is crucial.AimsTo examine the use of the EBP process in Swedish health care. Specifically, to examine whether professional career development (years of experience, years in current position, specialist education, care setting) is associated with RNs’ practice of EBP activities and changes in the extent of practicing the EBP process between early and mid‐career.MethodsIn this observational longitudinal study, the extent of EBP activities was investigated in three national cohorts of 2,474 RNs. Nurses rated their own EBP levels 11–15 and three years after graduation. Six items measured the respondents’ extent of practicing the EBP process. Comparisons of EBP levels between subgroups were tested using unpaired t‐tests or one‐way ANOVAs.ResultsOn average, RNs used the EBP process occasionally every half year. RNs with specialist education reported a higher extent of EBP activities as did RNs who worked in outpatient and home care settings. There was a significant increase in the extent of EBP activities 11 to 13 years after graduation compared to three years after graduation.Linking Evidence to ActionThe findings raise some central questions for practice: How well equipped are RNs to practice the EBP process? What is needed to facilitate EBP in clinical settings? Building on the findings of this study, managers in clinical practice need to develop supportive organizational structures that facilitate EBP. This study suggests that mid‐career RNs increased the extent of practicing the EBP process over time compared to previous reported practice in their first years as RNs. However, the level of EBP activities was low to moderate, and this modest increase took 11 to 13 years to achieve. To enhance the practice of EBP in nursing care, educational and organizational factors need to be considered.

Empowering Nurses with an Online Roadmap for Evidence-Based Practice

ABSTRACT Nurses are involved in an increasingly complex and changing health care environment. To be effective, nurses must have the skills to effectively engage in evidence-based practice (EBP) to improve patient care. In preparing for Magnet reaccreditation, an interdisciplinary team in one academic medical center recognized that there was variability in nurses’ understanding of the EBP process. This left nurses hesitant to engage in the process and resulted in the uneven quality of EBP project outputs. This article details a project lead by a health sciences librarian in collaboration with nurses to create and implement an online resource and reshape EBP instruction. This project aimed to increase the EBP knowledge of bedside nurses, increase overall nurse engagement with EBP, and bring uniformity to the EBP activities of nurses in the organization. The implementation plan, evaluation, and next steps for this project are shared to show the key role health sciences librarians can play in improving EBP in a health care organization.

COVID-19: Impact for Pediatric Research, Evidence-Based Practice and Quality Processes and Projects

Pediatric hospitals have not experienced the increase in patient volumes or received the same media attention as adult hospitals. Yet, the impact has been equally and significantly palpable. The Department of Nursing Research and EBP continues to be available for consultation and mentoring of staff, as staff use current evidence to drive continued practice changes and consider new projects. Alternative processes for research methods will enable the continuation of important nursing research.

An exploration of evidence-based practice work files for occupational therapy students during clinical placements: a descriptive cross-sectional study

BackgroundBachelor students of occupational therapy are expected to work in accordance with evidence-based practice (EBP). The EBP work file, a learning tool in a Word document format, covering all steps in the EBP process, is an approach to teaching and learning EBP. The aim of this study was to examine the attitudes and behaviours of occupational therapy students’ in relation to applying evidence-based practice during their second-year clinical placement. We compared cohorts who received training in EBP work files with those who did not receive such training.MethodsA descriptive, cross-sectional comparative study was conducted. Five cohorts of second-year occupational therapy students took part in the study. The students answered two questionnaires, the EBP Beliefs Scale and the EBP Implementation Scale, after completing their second-year clinical placement. The analysis was based on descriptive statistics and calculation of the frequencies, percentages, mean and standard deviations of all participating students’ scores across both questionnaires. ANOVA with Bonferroni correction was conducted to analyse the differences between the mean totals of the questionnaires.ResultsIn this study, 126 occupational therapy students participated (response rate = 57.3%). The students reacted positively to EBP, although few were practicing EBP. The students believed that EBP resulted in the best clinical care for patients, but they lacked confidence in their own ability to apply EBP. The students in Cohort 5, who received extra instruction and assignments via the EBP work file, rated their EBP behaviour statistically lower than the students in Cohort 1, who did not receive extra training on the EBP work file.ConclusionsAdditional EBP work file assignments were insufficient in terms of supporting students in the implementation of EBP during clinical placements. It is, therefore, important to facilitate the learning strategies of EBP skills and demonstrate how students can practise this competency during clinical placements. Including clinical instructors in EBP teaching and learning seems essential.

EBP 2.0: Implementing and Sustaining Change: Implementing Improved Central Line Flushing Practices.

This is the eighth article in a series about evidence-based practice (EBP) that builds on AJN's award-winning previous series-Evidence-Based Practice, Step by Step-published between 2009 and 2011 (to access the series, go to http://links.lww.com/AJN/A133). This follow-up series features exemplars illustrating the various strategies that can be used to implement EBP changes-one of the most challenging steps in the EBP process.

Cultivating evidence-based practice through mentorship

BackgroundNurses' use of evidence-based practice (EBP) improves patient outcomes through provision of optimal patient care. AimThe Evidence-Based Practice Mentorship Program (EBPMP) is a self-directed, year-long immersion program implemented for staff nurses to experience the EBP process with close mentor support. The aim of this program is to bolster a culture of EBP at a single large pediatric quaternary care hospital in the Northeast. ResultsA total of 81 nurses across 4 cohorts participated in this organization wide program from 2016 to 2019. To date the program has produced 46 internally and externally disseminated EBP projects. Of the graduates, 7-nurse mentees have become formal EBPMP mentor's, 3 have applied and been accepted into the organizational based Nursing Science Fellowship to carry out clinical inquiry projects to fill important literary gaps, and 6 have received promotions or career advancements. Most importantly, graduates have anecdotally reported that program participation inspired deeper critical reflection of patient care. SummaryUtilizing mentorship to facilitate EBP was a key educational strategy for the busy mentors and mentees, as many of the nurse participants were direct care providers. This self-directed program resulted in a high project completion rate leading to continued organizational support for the program, which is now in its fourth year.

A Pancreatic Enzyme Medication Self-Management Initiative.

This is the seventh article in a new series about evidence-based practice (EBP) that builds on AJN's award-winning previous series-Evidence-Based Practice, Step by Step-published between 2009 and 2011 (to access the series, go to http://links.lww.com/AJN/A133). This follow-up series features exemplars illustrating the various strategies that can be used to implement EBP changes-one of the most challenging steps in the EBP process.

Implementation of Open Visitation in an Adult Intensive Care Unit: An Evidence-Based Practice Quality Improvement Project.

Implementation of Open Visitation in an Adult Intensive Care Unit: An Evidence-Based Practice Quality Improvement Project.

Teaching evidence-based practice: A comparison of two disciplines

ABSTRACTThe increasing emphasis on research supported treatments in behavioral health requires clinicians to develop knowledge and skills for evidence-based practice. Graduate professional degree programs must address this in preparation for the emerging workforce. In this paper, we synthesize results from two related studies that examined the extent to which master’s level professional degree programs prepare future practitioners to deliver a process of evidence-based practice or specific evidence-based treatments. We compare these results with a previous study of North American administrators and supervisors who hire graduates from Master's level professional degree programs. The first study explored the Masters in Social Work curricula, and the second study examined Marriage and Family Therapy programs. Professionals with these graduate degrees are primary providers of behavioral health treatment. Results demonstrate how both disciplines are changing and offer both rationale and concerns voiced by program deans and directors. Compared with a study of provider perspectives, the collective results indicate institutions of higher education are providing at least modest levels of training in evidence-based treatments. We conclude with suggestions for university partnership with behavioral health and social service programs.