Evidence-based Practice Strategies Research Articles

Facilitating Evidence-Based Practice among Nurses in a Tertiary General Hospital: A Six-Year Practice of an Implementation Strategy Informed by the i-PARIHS Framework

Aims. To develop an evidence-based practice (EBP) facilitating strategy informed by the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and evaluates the strategy’s effectiveness on promoting EBP. Background. Nurses are increasingly expected to use research evidence in practice to improve patients’ outcomes, but the application of such evidence is still unsatisfactory. The facilitation of EBP in nursing needs the organization and the individual levels. Methods. Based on an analysis of EBP-promoting strategies and expert consultation, the core team of the nursing department developed an EBP group-based and project-oriented strategy under the guidance of the i-PARIHS framework. The strategy was implemented for six years and evaluated by a longitudinal design. The validated Chinese version of the self-reported Evidence Based Practice Questionnaire (EBPQ) was used to assess the attitudes, knowledge, and practice of the nurses. Results. The mean score of the total EBPQ was 4.46 (SD = 0.92) after one year of the EBP strategy, and the scores for knowledge, attitudes, and practice of EBP members were higher than those of general nurses p<0.05. After four years, EBP members’ scores continued to increase. EBP groups conducted 51 EBP projects in the areas of emergency nursing, surgical and medical nursing, critical care, and so forth. Of these, 33 projects improved nursing practice by changing nursing procedures, upgrading nursing tools, and developing nursing standards, resulting in improved patient outcomes. Conclusion. The EBP group-based and project-oriented strategy can promote EBP. The composition of the EBP group, the annual audit of EBP projects, and the roles of internal and external facilitators were key components of this EBP-facilitating strategy. Implications for Nursing Management. The strategy is an organizational-level EBP-facilitation approach which can improve nurses’ academic preparation for EBP through ongoing training and sustained EBP behavior that involves annual projects.

Enhancing Behavioral Health Implementation in a Care Coordination Program at a Federally Qualified Health Center: A Case Study Applying Implementation Frameworks.

Federally Qualified Health Centers are charged with providing comprehensive health care in traditionally underserved areas, underscoring their importance in caring for and promoting health equity for the large portion of historically marginalized communities in this setting. There is a significant need to ensure Federally Qualified Health Centers are equipped to appropriately address the immense behavioral health needs common among patients served. Care coordination is an evidence-based model that is increasingly utilized in Federally Qualified Health Centers to improve care equity and outcomes. Addressing and supporting behavioral health needs is a key aspect of such care coordination models. Context-specific considerations and programmatic supports, particularly those that address the needs of care coordinators and the complex patients they serve, are needed to ensure such models can appropriately meet and address the behavioral health concerns of the diverse populations served. The goal of this study was to present a mixed-methods case study that systematically applies implementation frameworks to conduct a needs and context assessment to inform the development and testing of evidence-based practice strategies and implementation support as part of a care coordination program within a partnered Federally Qualified Health Center.

Needlestick and Sharp Injuries among Healthcare Workers in the Operating Theatre: Why They Do Not Report Their Incidences

Introduction: Needlestick and Sharp Injuries (NSSIs) pose a significant threat to healthcare workers, particularly in Operating Theatres (OTs), where the risk of exposure is compounded by high-stress environments and the complexity of procedures. Despite the known dangers, a persistent issue of underreporting complicates efforts to safeguard worker and patient health. This paper promotes the adoption of Evidence-Based Practice (EBP) to mitigate these risks, aiming to improve reporting behaviors and, by extension, overall safety within healthcare settings. Methods: This study utilizes a qualitative research approach, combining literature review and case studies to explore the phenomena of NSSI underreporting among healthcare workers. It examines barriers to reporting within OTs, such as fear of repercussions and time constraints, and proposes interventions based on EBP. Research methodology emphasizes the application of theory to practice through multidisciplinary team involvement, workshops, and the establishment of clear, achievable goals. Results: The investigation reveals that while healthcare workers are generally aware of the protocols for reporting NSSIs, a range of barriers inhibits consistent application in practice. The study identifies effective strategies for bridging the theory practice gap, including fostering a constructive learning environment, ensuring leadership support, and promoting open communication. These strategies are shown to facilitate the practical application of theoretical knowledge, thereby improving reporting rates and enhancing safety protocols in OTs. Conclusions: Effectively addressing NSSIs in healthcare settings, particularly in Operating Theatres, requires a comprehensive approach that encompasses education, clear reporting protocols, and a culture of collective responsibility. Bridging the gap between theoretical knowledge and practical application through workshops, evidence translation, and an emphasis on interdisciplinary collaboration is key to enhancing patient and worker safety. The study underscores the necessity of understanding the multifaceted nature of behavior change in healthcare environments to implement successful EBP strategies.

Neighbourhood active living environment and obesity in adolescents using the Millennium Cohort Study

ObjectivesYouth obesity has increased substantially in recent decades; however, the potential role of the built environment in mitigating these trends is unclear. This study examines whether more walkable neighbourhoods are associated with lower levels of overweight/obesity for adolescents compared to less walkable neighbourhoods, after considering the potential role of socio-economic and lifestyle characteristics.
 MethodsWe examine overweight/obesity levels for all singleton 14 years-old children living in Wales, using the UK Millennium Cohort Study. Children are classified as healthy weight, overweight and obese using international age and sex adjusted cut-offs for body mass index (BMI). The built environment is assessed using the active living environments (ALE) index for 2017-2018 classified into 5 categories (1-low walkability and 5 – high walkability). We apply regression analysis and adjust for children characteristics (e.g., physical activity), parental socio-economic circumstances and lifestyle choices (e.g., maternal education, physical activity).
 ResultsWe assess the hypothesis that the built environment is associated with adolescents’ overweight/obesity levels and examine how much of this association could be modified by parental socioeconomic circumstances and lifestyle choices. The ALE index is higher in urban compared to rural areas. To capture variations in Wales’ population, we are conducting a stratified analysis to explore any differences on the association between ALE index and adolescents’ overweight/obesity by urban and rural areas. Accounting for the potential role of lifestyle and socio-economic characteristics is key for future research, as understanding the underlying pathways of this association is necessary to design effective interventions.
 ConclusionFindings can help us develop a better understanding of associations between the built environment and overweight/obesity status to inform evidence-based planning policy and practice strategies on how to modify the built environment to promote child health in future generations by increasing better opportunities for diet and activity.

Improving the Evidence-Based Practice Skills of Entry-Level Physiotherapy Students through Educational Interventions: A Scoping Review of Literature.

Evidence-based practice (EBP) is an essential approach in healthcare, attracting growing interest among both practitioners and researchers. This scoping review aims to (1) systematically investigate the effectiveness of pedagogical methods used to facilitate learning of the EBP approach, and (2) explore the perceptions, experiences, and issues related to these learning methods. The overarching purpose is to identify the state of the art in pedagogical methods, instruments, influences, and barriers in teaching and learning EBP within entry-level physiotherapy education programs. This scoping review was conducted following PRISMA guidelines, with PubMed and Eric databases being searched for peer-reviewed original research articles using a combination of keywords. Excluding non-pertinent articles from the initial 465 identified, 12 were eligible for final inclusion (5 quantitative, 3 qualitative, and 4 mixed-methodology studies). A range of pedagogical methods and instruments for teaching EBP in physiotherapy education were detected, all of which having the capability to positively affect physiotherapy outcomes. Findings from this study support the significant influence that EBP exerts on the improving of the quality of teaching, together with the necessities that the involvement of EBP in physiotherapy education programs provide. Several barriers were identified, which should be taken into consideration when designing population-specific EBP strategies tailored to these particular needs.

Implementing Best Practices for Decreasing Nurse Hesitancy to Call the Rapid Response Team: An Evidence-Based Quality Improvement Initiative.

Nurses, regardless of experience, sometimes wait for the Modified Early Warning Score to indicate physiological decline before initiating the hospital's Rapid Response Team (RRT). The goal of this quality improvement initiative was to reduce nurse hesitancy to call the RRT, as indicated by the monthly number of proactive calls before the Modified Early Warning Score increased and triggered an automated page. Education, planned handoff communication, debriefing, and good catch emails were the educational strategies used in the implementation of the quality improvement initiatives, encouraging RRT calls sooner. Increasing RRT knowledge and communication is an evidence-based practice strategy to reduce nurse reluctance to call the RRT. After implementation, monthly proactive RRT calls increased (χ2 [1, n = 1,964] = 14.6085, p = .000159). Bedside interventions, unscheduled transfers, and Acute Physiologic and Chronic Health Evaluation scores did not differ. Education, structured handoff communication, and acknowledging good catches reduced nurses' reluctance to call the RRT proactively. [J Contin Educ Nurs. 2023;54(6):281-288.].

Where do psychologists turn to inform clinical decisions? Audience segmentation to guide dissemination strategies.

Audience segmentation is an analysis technique that can identify meaningful subgroups within a population to inform the tailoring of dissemination strategies. We have conducted an empirical clustering audience segmentation study of licensed psychologists using survey data about the sources of knowledge they report most often consulting to guide their clinical decision-making. We identify meaningful subgroups within the population and inform the tailoring of dissemination strategies for evidence-based practice (EBP) materials. Data come from a 2018-2019 web-based survey of licensed psychologists who were members of the American Psychological Association (APA; N = 518, response rate = 29.8%). Ten dichotomous variables assessed sources that psychologists regularly consult to inform clinical decision-making (e.g., colleagues, academic literature, and practice guidelines). We used latent class analysis to identify segments of psychologists who turn to similar sources and named each segment based on the segment's most salient characteristics. Four audience segments were identified: the No-guidelines (45% of psychologists), Research-driven (16%), Thirsty-for-knowledge (9%), and No-reviews (30%). The four segments differed not only in their preferred sources of knowledge, but also in the types of evidence-based posttraumatic stress disorder (PTSD) treatments they provide, their awareness and usage intention of the APA PTSD clinical practice guideline, and attitudes toward clinical practice guidelines. The results demonstrate that licensed psychologists are heterogeneous in terms of their knowledge-seeking behaviors and preferences for knowledge sources. The distinctive characteristics of these segments could guide the tailoring of dissemination materials and strategies to subsequently enhance the implementation of EBP among psychologists.

Evidence-Based Practice (EBP) - A Core Concept in Achieving High -Quality Nursing Care

In the 1980s, the phrase "evidence-based medicine" was coined to represent a process of determining the best treatment based on scientific evidence. The evidence-based practise movement emerged in England in the early 1990s. The deliberate application of the best available evidence in making decisions about a patient's care is known as evidence-based medicine (EBM) or evidence-based practise (EBP). Evidence-based practise is a concept as well as a method. The idea is founded on the ethical principle that customers have the right to get the most effective interventions available. The EBP strategy describes how we go about locating and implementing interventions.

Exploring the implementation of evidence-based optimisation strategies: A qualitative study of the experience of diagnostic radiographers

IntroductionRadiographers are responsible for ensuring safe and effective use of ionising radiation. Through evidence-based practice (EBP), valuable optimisation strategies can be implemented to fulfil these responsibilities. This study aimed to explore radiographers' attitudes, perceptions, and experience of using evidence-based optimisation strategies. MethodsA Grounded Theory approach using in-depth interviews. UK-based radiographers were recruited. Discussions focused on (1) the role of evidence-based optimisation strategies in daily practice, (2) assistance in implementing evidence-based optimisation strategies, and (3) the role of EBP and optimisation strategies in the future. Interviews were transcribed verbatim and analysed using open and axial coding. ResultsParticipants (n = 13) stated that EBP is not frequently used to implement optimisation strategies. Participants relied on the knowledge taught in education settings and their professional skills to optimise in daily practice, alongside departmental protocols. Barriers identified as affecting the implementation of optimisation strategies related to reluctance to change, a lack of support from superiors, and a lack of resources to engage with EBP. Some participants expected the use of optimisation strategies to become unnecessary due to technology advancements. ConclusionThe results indicate that effective operationalisation of EBP is not part of daily practice among radiographers to implement valuable optimisation strategies in daily practice. Implications for practiceThe potential barriers to implementing evidence-based optimisation strategies highlighted in this study suggest that improving access to resources and empowerment of individual radiographers is required to enable radiographers to implement optimisation strategies.

How to Build Declarative and Procedural Fluency Simultaneously Using Complementary Independent Practice Strategies

Fluency in math facts and procedures is critical for math achievement overall and often challenging for students with emotional and behavioral disorders to develop. This article describes how to implement two complementary and evidence-based practice strategies, incremental rehearsal and Cover-Copy-Compare, to build declarative and procedural fluency in tandem. How-to steps, example materials, and additional resources are provided.

Evidence-based practice strategies for faculty professional development in clinical translational research at Institutional Development Award (IDeA) state institutions in the Mountain West.

The Mountain West Clinical Translational Research - Infrastructure Network (MW CTR-IN), established in 2013, is a research network of 13 university partners located among seven Institutional Development Award (IDeA) states targeting health disparities. This is an enormous undertaking because of the size of the infrastructure network (encompassing a third of the US landmass and spanning four time zones in predominantly rural and underserved areas, with populations that have major health disparities issues). In this paper, we apply the barriers, strategies, and metrics to an adapted educational conceptual model by Fink (2013). Applying this model, we used four tailored approaches across this regional infrastructure network to: (1) assess individual faculty specific needs, (2) reach out and engage with faculty, (3) provide customized services to meet the situational needs of faculty, and (4) utilize a "closed communication feedback loop" between Professional Development (PD) core and MW CTR-IN faculty within the context of their home institutional environment. Summary statement results from participating faculty show that these approaches were positive. Grounded in best educational practice approaches, we have an opportunity to refine and build from this sound foundation with implications for future use in other CTR-IN networks and institutions in the IDeA states.

Restorative treatment decisions for carious lesions: Do Russian dentists and dental students apply minimal intervention dentistry?

BackgroundThe concept of minimal intervention dentistry (MID) includes both delayed restorative treatment and conservative caries removal, and is now recognised as an evidence-based approach for dental caries management. In order to determine if dental professionals in Russia are incorporating this concept into their clinical practice, we investigated the restorative treatment decisions of Russian dentists and dental students, and the factors associated with these decisions.MethodsWe included 171 general dental practitioners and dental therapists (collectively referred to here as “dentists”) from North-West Russia, and 76 dental undergraduate students from the Northern State Medical University in Arkhangelsk (response rate of 11.5% and 67.9%, respectively). Participants completed a questionnaire, which collected background information (sex, region of work, place of dental school graduation, practice type, years of working experience, working in an urban or rural area, and specialisation in restorative dentistry) and information on restorative treatment decisions for proximal and occlusal carious lesions of permanent teeth. Treatment options in accordance with MID were defined as intervention at dentin level and minimally invasive cavity preparation. Multinomial logistic regression was used for statistical analysis.ResultsFor the proximal carious lesion, 9.4% of participants said they would employ both MID treatment options; 60.7% said they would choose only one; and 29.9% said they would use neither option. For the occlusal carious lesion, the corresponding figures were 37.2%, 52.1%, and 10.7%. No differences in restorative treatment options were observed among general dental practitioners, dental therapists, and dental students. For the proximal carious lesion, dentists from regions outside Arkhangelsk had 4.15 (95% confidence interval [CI] 1.13–15.27) times higher odds of following one versus both MID treatment options. For the occlusal carious lesion, working experience above 15 years was associated with higher odds of using only one versus both MID treatment options (adjusted odds ratio = 3.04, 95% CI 1.33–6.91). Almost all respondents preferred tooth-coloured materials for restorations; more than 75% chose resin-based composite.ConclusionsThe majority of Russian dentists and dental students do not apply the MID concept when treating dental caries in permanent teeth. Clinical protocols on dental caries treatment and dental school curriculums should be updated to place an enhanced focus on evidence-based practice and preventive strategies. Further studies with larger samples of Russian dentists and dental students and alternative methods of recruitment are needed to validate our results.

Occupational Therapy for the Long Haul of Post-COVID Syndrome: A Case Report

Abstract Prolonged symptoms from the novel coronavirus disease 2019 (COVID-19), otherwise known as long COVID, postacute sequelae of COVID-19 (PASC), or post-COVID syndrome, are affecting an increasingly high number of patients after severe, moderate, and mild acute COVID-19 infections. Using evidence-based practice strategies, this case report describes occupational therapy evaluation and treatment approaches, plan of care, and associated outcomes for one client experiencing long COVID symptoms in the outpatient setting.

Discussion Guide for the Sinvani Article

Discussion Guide for the Sinvani Article

Harmonizing evidence-based practice, implementation context, and implementation strategies with user-centered design: a case example in young adult cancer care

BackgroundAttempting to implement evidence-based practices in contexts for which they are not well suited may compromise their fidelity and effectiveness or burden users (e.g., patients, providers, healthcare organizations) with elaborate strategies intended to force implementation. To improve the fit between evidence-based practices and contexts, implementation science experts have called for methods for adapting evidence-based practices and contexts and tailoring implementation strategies; yet, methods for considering the dynamic interplay among evidence-based practices, contexts, and implementation strategies remain lacking. We argue that harmonizing the three can be facilitated by user-centered design, an iterative and highly stakeholder-engaged set of principles and methods.MethodsThis paper presents a case example in which we used a three-phase user-centered design process to design and plan to implement a care coordination intervention for young adults with cancer. Specifically, we used usability testing to redesign and augment an existing patient-reported outcome measure that served as the basis for our intervention to optimize its usability and usefulness, ethnographic contextual inquiry to prepare the context (i.e., a comprehensive cancer center) to promote receptivity to implementation, and iterative prototyping workshops with a multidisciplinary design team to design the care coordination intervention and anticipate implementation strategies needed to enhance contextual fit.ResultsOur user-centered design process resulted in the Young Adult Needs Assessment and Service Bridge (NA-SB), including a patient-reported outcome measure and a collection of referral pathways that are triggered by the needs young adults report, as well as implementation guidance. By ensuring NA-SB directly responded to features of users and context, we designed NA-SB for implementation, potentially minimizing the strategies needed to address misalignment that may have otherwise existed. Furthermore, we designed NA-SB for scale-up; by engaging users from other cancer programs across the country to identify points of contextual variation which would require flexibility in delivery, we created a tool intended to accommodate diverse contexts.ConclusionsUser-centered design can help maximize usability and usefulness when designing evidence-based practices, preparing contexts, and informing implementation strategies—in effect, harmonizing evidence-based practices, contexts, and implementation strategies to promote implementation and effectiveness.

Academic-clinical nursing partnership use an evidence-based practice model.

The purpose of this study was to compare the experience of a new clinical model with traditional clinical teaching and examine the effects of evidence-based practice strategies among staff and student nurses. This provides an innovative approach to nursing student clinical learning that emphasised the academic-clinical partnership with the use of a new model called the Evidence-based Clinical Academic Partnership (ECAP) model. The model incorporates three main components (a) unit transformation into an innovative hybrid version of a dedicated education unit (hDEU); (b) Evidence-in-Action (EIA) rounding; and (c) the cognitive apprenticeship theoretical framework. This pilot study used a mixed-method, quasi-experimental design. The quantitative portion included a pre-test, post-test non-randomised quasi-experimental design using self-reported survey data. The qualitative methodology used was a hermeneutic phenomenological approach to data interpretation of three focus groups with staff nurses and unit leaders. SQUIRE 2.0 guidelines were followed (Ogrinc et al., 2016). The themes that emerged emphasised relationships and the partnership with this innovative approach to clinical teaching. The staff nurses emphasised the need for a collaborative approach and having the presence of the academic faculty member as a way to support the teaching and learning aspects with students. This study did provide significant contributions to the development of an innovative clinical model and highlighted the importance of the academic-clinical partnership with the education of undergraduate nursing students. The study results provided insight to the ways the hDEU framework may be strengthened, such as increased communication and partnership in the implementation of the ECAP model. Implementing curricular change to include innovative clinical models within a nursing programme is vital in this time of healthcare transformation.

Lesbian, Gay, Bisexual, Transgender, Queer Cultural Competency Training to Improve the Quality of Care: An Evidence-based Practice Project

BackgroundOne evidence-based practice strategy to improve the provision of care for the lesbian, gay, bisexual, transgender, queer population is providing cultural competency training. The aim of this evidence-based practice project was to improve Knowledge and Skills, Openness and Support, and Oppression Awareness for emergency nurses when providing care to the lesbian, gay, bisexual, transgender, queer population in the military health system. MethodsThe single-unit, educational intervention posttest compared with unit personnel historical controls project took place in an emergency department within the military health system. The participants included registered nurses or licensed practical nurses working in the emergency department. The Ally Identity Measure tool was administered to an unmatched convenience sample of emergency nurses in a military health system pre- and postintervention to assess the intervention’s effectiveness. Descriptive statistics and group difference testing (t test) were used. ResultsThe mean Knowledge and Skills subscale score was improved between the pre- and postintervention groups (t(70) = –3.33, P = .001). The mean Openness and Support subscale score was improved between the pre- and postintervention groups (t(70) = –2.06, P = .04). The mean Oppression Awareness subscale demonstrated no significant difference between the pre- and postintervention groups (t(70) = –0.93, P = .36). ConclusionThis project illustrated the feasibility of an educational intervention to promote culturally competent care in the ED environment for the lesbian, gay, bisexual, transgender, queer population. The results illustrated that emergency nurses in this military health system were aware of the oppression that this vulnerable population faces.

Using Organizational Theory to Explain ‘How’ EBP Implementation Occurs in HCOs

Despite increasing use of theory in the field of implementation science over the past decade, the literature has largely focused on using deterministic frameworks to retrospectively understand ‘what’ factors are essential for effective implementation of evidence-based practices (EBPs). On the other hand, gaps remain in using organizational theory to prospectively understand ‘how’ successful EBP implementation occurs in healthcare organizations (HCOs). This paper discusses the theoretical and empirical contributions of two selected recent exploratory research works, which provide a starting point for addressing the identified gaps in the literature, with the purpose of deriving implications for theory, practice, and research in implementation science. The selected works used the theory of ‘effective knowledge sharing network structures in professional complex systems (PCS),’ developed through an integration of organizational theories, to design prospective interventions for enabling EBP implementation in HCOs. In doing so, these studies have helped explain ‘how’ inter-professional knowledge exchange and collective learning occurred, to enable successful EBP implementation in HCOs. Correspondingly, the selected works have served a dual purpose in 1) identifying evidence-based management practice strategies for successful EBP implementation, while 2) further developing the theoretical literature on ‘effective knowledge sharing networks in PCS.’ Importantly, by addressing the identified gaps in the literature, the selected works serve to either complement or supplement existing theoretical approaches in implementation science. To this effect, they provide unique insights for theory, practice, and research in implementation science, including insights into a potential ‘dual-role’ for the future implementation researcher—one of advancing implementation science, while working to strengthen implementation practice. Based on these contributions, it could be argued that the selected works provide a starting point for a new research stream that has potential to occupy a distinct position in the taxonomy of theoretical approaches used in implementation science.

Therapist-Observer Concordance in Ratings of EBP Strategy Delivery: Challenges and Targeted Directions in Pursuing Pragmatic Measurement in Children's Mental Health Services.

Pragmatic measures of therapist delivery of evidence-based practice (EBP) are critical to assessing the impact of large-scale, multiple EBP implementation efforts. As an initial step in the development of pragmatic measurement, the current study examined the concordance between therapist and observer ratings of items assessing delivery of EBP strategies considered essential for common child EBP targets. Possible EBP-, session-, and therapist-levels factors associated with concordance were also explored. Therapists and independent observers rated the extensiveness of therapist (n = 103) EBP strategy delivery in 680 community psychotherapy sessions in which six EBPs were used. Concordance between therapist- and observer-report of the extensiveness of therapist EBP strategy use was at least fair (ICC ≥ .40) for approximately half of the items. Greater therapist-observer concordance was observed in sessions where a structured EBP was delivered and in sessions where therapists reported being able to carry out planned activities. Findings highlighted conditions that may improve or hinder therapists' ability to report on their own EBP strategy delivery in a way that is consistent with independent observers. These results can help inform the development of pragmatic therapist-report measures of EBP strategy delivery and implementation efforts more broadly.

Writing intervention: A comprehensive program for primary school children

AbstractThis article describes an intervention program to improve writing skills, intended to be a useful tool for everyday remedial work in primary school. The design was based on an initial review of the approaches most often used for writing intervention and identification of the main concerns for such intervention; namely, the use of direct and explicit instructions, the importance of feedback, recommended levels of intervention, the main content to consider, and use of motivating activities to get the student engaged or even to enjoy the intervention. All these considerations guided decision making about the appropriate features that would ensure an effective intervention in children with general and specific writing difficulties. The intervention program follows evidence-based practice strategies and may be useful for educational professionals in primary school, acknowledging that the program needs to be experimentally evaluated.