Evidence-based Practice Tools Research Articles

Clinical Implementation of DIGEST as an Evidence-Based Practice Tool for Videofluoroscopy in Oncology: A Six-Year Single Institution Implementation Evaluation.

Clinical implementation of evidence-based practice (EBP) tools is a healthcare priority. The Dynamic Grade of Swallowing Toxicity (DIGEST) is an EBP tool developed in 2016 for videofluoroscopy in head and neck (H&N) oncology with clinical implementation as a goal. We sought to examine: (1) feasibility of clinical implementation of DIGEST in a national comprehensive cancer center, and (2) fidelity of DIGEST adoption in real-world practice. A retrospective implementation evaluation was conducted in accordance with the STARI framework. Electronic health record (EHR) databases were queried for all consecutive modified barium swallow (MBS) studies conducted at MD Anderson Cancer Center from 2016 to 2021. Implementation outcomes included: feasibility as measured by DIGEST reporting in EHR (as a marker of clinical use) and fidelity as measured by accuracy of DIGEST reporting relative to the decision-tree logic (penetration-aspiration scale [PAS], residue, and Safety [S] and Efficiency [E] grades). Contextual factors examined included year, setting, cancer type, MBS indication, and provider. 13,055 MBS were conducted by 29 providers in 7,842 unique patients across the lifespan in diverse oncology populations (69% M; age 1-96 years; 58% H&N cancer; 10% inpatient, 90% outpatient). DIGEST was reported in 12,137/13,088 exams over the 6-year implementation period representing 93% (95% CI: 93-94%) adoption in all exams and 99% (95% CI: 98-99%) of exams excluding the total laryngectomy population (n = 730). DIGEST reporting varied modestly by year, cancer type, and setting/provider (> 91% in all subgroups, p < 0.001). Accuracy of DIGEST reporting was high for overall DIGEST (incorrect SE profile 1.6%, 200/12,137), DIGEST-safety (incorrect PAS 0.4% 51/12,137) and DIGEST-efficiency (incorrect residue 1.2%, 148/12,137). Clinical implementation of DIGEST was feasible with high fidelity in a busy oncology practice across a large number of providers. Adoption of the tool across the lifespan in diverse cancer diagnoses may motivate validation beyond H&N oncology.

Developing a storybook package for bereaved siblings: a pilot study of the effectiveness for enhancing the perceived knowledge and confidence of health and social care professionals in Hong Kong

A pilot randomized controlled trial was conducted to examine the effectiveness of a storybook package for enhancing the perceived knowledge and confidence of health and social care professionals in working with bereaved child siblings and their parents before and after the loss. Open-ended questions were asked to collect feedback, and thematic analyses were conducted to generate the themes. Quantitative findings provided preliminary but not strong evidence of its effectiveness, but qualitative findings showed that participants perceived their knowledge about supporting bereaved siblings and their parents was enhanced and considered the storybook package a useful tool for facilitating their practice. Participants also reflected on how real and specific the stories in the storybook should be. This study is the first step in developing an evidence-based practice tool for health and social care professionals. Future studies are required to further examine its effectiveness for practice.

Making evidence-based practice actionable in the social service context: experiences and implications of workplace education

PurposeResearch and experience show that evidence-based practice (EBP), i.e. using the best available knowledge in daily professional work, is difficult to achieve in social services. The purpose of this study is to understand the development of organizational EBP learning processes in daily work through workplace education for staff and managers of supported homes for people with cognitive disabilities. The authors examine how the EBP model and new knowledge are understood and made actionable in the workplace, applying theories of organizational learning.Design/methodology/approachThe authors used empirical material collected from an EBP workplace education pilot in Sweden, as well as documents on national EBP implementation in Swedish social services. Before the pilot, a focus group interview was conducted with regional senior managers. Participating managers and staff were individually interviewed two to three years after the pilot.FindingsThe study illustrates how knowledge-based action emerged from education where EBP was interpreted, understood, reflected on, and tested, supported by codified EBP tools in the work context. The participants, when supervised, and when observing and questioning their own behaviors in practice, contributed to double-loop learning (DLL) processes. Codification of EBP knowledge into useful tools and socialization processes during education and workplace meetings was crucial in developing individual and group DLL and knowledge-based actions.Originality/valueThe bottom-up approach to EBP development and the adaptive contextual learning at the workplace gave new insights into organizational learning in social service workplaces.

Factors influencing the transition of foreign-educated nurses to the US healthcare setting: A systematic review.

This literature review examined the impact of the orientation or onboarding programs on the transition of foreign-educated nurses to a US healthcare setting and factors influencing their transition. Recruitment of foreign-educated nurses has been a solution to the ongoing nursing workforce shortage in the United States. However, they face various challenges in their transition to employment in the United States. Adequate orientation and continued support are needed for the successful transition of foreign-educated nurses. A systematic literature search was conducted in 2022 across PubMed, CINAHL, Academic Search Complete, Google Scholar, and MEDLINE databases. This review selected only articles published between 2015 and 2022 in English that addressed foreign-educated nurses' transition issues in US healthcare settings. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The quality of the articles was appraised using the John Hopkins Evidence-based Practice tool. This review of 14 articles revealed that the quality of orientation and organizational support were positively associated with foreign-educated nurses' job satisfaction and turnover. Factors influencing foreign-educated nurses' transition included peer support, job assignment and workload, credentialing, communication and cultural adjustment, psychological factors, safety perceptions, work environment, and coping strategies. There was a lack of literature that evaluated orientation or onboarding programs for foreign-educated nurses. Further research is needed to explore the effectiveness of supportive programs in promoting their smooth transition. Efficient onboarding or orientation programs and policies for foreign-educated nurses are crucial, considering the factors influencing their transition. Good programs and policies that prioritize the support, integration, and professional development of FENs will help maximize their contributions to health care.

Risk for post-operative delirium related to comorbidities in older adult cardiac patients: An integrative review.

Delirium is defined as a sudden onset of confusion due to disruption in normal brain functioning. Although it is highly prevalent in post-operative patients, most significantly the older adult population, limited information exists explaining why its onset occurs. This integrative review aimed to synthesise specific comorbidities that can contribute to the development of post-operative delirium in older adult cardiac surgical patients. PRISMA statement was used to report the identification, selection, appraisal and synthesis of articles and the PRISMA diagram reports the selection process. The Johns Hopkins Evidence-Based Practice Tools were used as guide in literature review, critical analysis, levelling of evidence and quality rating. PubMed, ProQuest, CINAHL plus, EMBASE, MEDLINE, Ovid Nursing Collection and Cochrane databases were searched from 2015 to 2020. The initial search yielded 1529 articles. Following the removal of duplicates and screening, 14 articles were included for this review. The following comorbidities were identified in the studies: Diabetes mellitus, atrial fibrillation, depression, impaired olfaction, pre-existing cerebrovascular disease, pre-existing cardiovascular disease, insomnia and frailty. There was a strong indication of the development of post-operative delirium among older adult cardiac surgical patients with comorbidities. Awareness of the impact of comorbidities in developing post-operative delirium may help healthcare providers to plan and implement proper care management among older adult cardiac surgical patients with comorbidities.

The neuron model: An educational tool for evidence-based practice and interprofessional care

Objective: The objective of the study was to assess the usefulness of the neuron model in educating how evidence-based drug information and interprofessional care interface. Methods: The Neuron model of evidence-based practice and interprofessional care was introduced in an online session to a group of healthcare professionals at a United Arab Emirates (UAE) tertiary-level care hospital in March 2021. A Google Form survey was used to assess the usefulness of the neuron model. Results: Among those who responded to the form, 90% of healthcare professionals said that the neuron model was useful. This agreement improved significantly (Wilcoxon Signed-Rank test p-value &gt; 0.05), and persisted even after six months. Conclusion: The healthcare professionals agreed that the neuron model was beneficial in visualising how evidence-based practice and interprofessional care interface with each other, integrate into the academic health system, and help identify areas of improvement for healthcare professionals.

A participatory approach to embedding evidence in practice to support early language and communication in a London nursery school

IOE (Institute of Education), UCL’s Faculty of Education and Society (University College London, UK) has a long tradition of engagement with schools to support young children’s learning and co-produce knowledge through research–practice partnerships. From the first demonstration schools in the early 1900s to engagement with contemporary research schools, the vital importance of linking theory and practice in education through schools has been an integral part of the IOE’s values and ethos. One way to link theory to practice is to utilise participatory research methodologies to embed evidence in practice. This article discusses the research project Manor Park Talks, undertaken in collaboration with IOE and a leading partner, a head teacher and IOE alumnus of the East London Teaching and Research School. The aim of the project was to support early language and communication in a cluster of early years settings in Newham, London, and it involved a process of co-production in the design of a systematic review to assess the evidence-based pedagogical strategies that can be used to inform teaching practices to enhance the professional development of early years education practitioners (to include teachers, classroom assistants, childcare workers and other ancillary staff). The research aimed to evaluate a community of practice for early years practitioners to support young children’s early language development and communication, and to inform an evidence-based practice tool to guide teaching practices in early years settings. A commentary on the review findings and methodological innovation of the study in using a participatory approach to review the evidence is provided in this article.

Building family connectedness—A new practice tool for social workers

Abstract Family connectedness is important for youth mental health and well-being. Social workers can help families build and maintain connections during adolescence. Evidence-based practice tools which approach youth well-being through a whole-of-family lens help legitimise social work’s person-in-environment approach to mental health. In this study, fifteen Australian social workers piloted a new practice tool to support family connectedness. The tool outlines key elements of family connectedness from the perspectives of young people and provides detailed examples to help understand and strengthen family connections. The social workers trialled the Family Connectedness Practice Tool for two months. Before the trial, participants were surveyed on which skills, theories and practice approaches they used to support family connectedness. After the trial, participants were surveyed on how they used the tool and how useful it was in their practice. The findings highlight the range of knowledge informing practice with children, youth and families. The tool was considered very useful by participants and helped with family connectedness education, assessment and intervention. The findings raise questions about how much young people’s perspectives are valued in practice and the challenges social workers face when using a whole-of-family approach.

Exploring clinicians\u2019 experiences and perceptions of end-user roles in knowledge development: a qualitative study

BackgroundEnd-user involvement in developing evidence-based tools for clinical practice may result in increased uptake and improved patient outcomes. Understanding end-user experiences and perceptions about the co-production of knowledge is useful to further the science of integrated knowledge translation (iKT) – a strategy for accelerating the uptake and impact of research. Our study had two main objectives: (1) explore end-user (clinician) experiences of co-producing an evidence-based practice tool; and (2) describe end-user perceptions in knowledge development.MethodsWe used a qualitative study design. We conducted semi-structured interviews with clinicians and used a transcendental phenomenological approach to analyze themes/phenomena. In addition, we explored the interrelated themes between the thematic maps of each objective.ResultsFour themes emerged from clinicians’ experiences in co-producing the practice tool: ease/convenience of participating, need for support and encouragement, understanding the value of participating, and individual skillsets yield meaningful contributions. Stakeholder roles in knowledge tool development and improving dissemination of evidence and knowledge tools were themes that related to clinician perceptions in knowledge development. The review of interrelated thematic maps depicts an intertwined relationship between stakeholders and dissemination.ConclusionsEnd-users provide invaluable insight and perspective into the development of evidence-based clinical tools. Exploring the experiences and perceptions of end-users may support future research endeavours involving iKT, such as the co-production of clinical resources, potentially improving uptake and patient health outcomes.

Critical Thinking Tools for Quality Improvement Projects.

This article explores the use of 4 quality improvement tools and 2 evidence-based practice tools that, when used within the nursing process, encourage critical thinking about quality issues. Patients and families expect to receive patient-centered, high-quality, and cost-effective care. Caring for critically ill patients is challenging and requires nurses to engage in quality improvement efforts to ensure that they provide evidence-based care. To explore the use of critical thinking tools and evidence-based practice tools in assessing and diagnosing quality issues in the clinical setting. The nursing process serves as the framework for problem solving. Some commonly used critical thinking tools for assessing and diagnosing quality issues are described, including the Spaghetti Diagram, the 5 Whys, the Cause and Effect Diagram, and the Pareto chart.

Educating for the implementation of evidence-based healthcare in Brazil: the JBI methodology

To present the JBI evidence implementation methodology and report the Brazilian experience in educating health professionals. This is an experience report on professional education in the Brazilian context as per the JBI methodology. In four years, 29 clinical fellows were trained in Brazil, with technical and scientific theoretical bases and tools for evidence-based practice, focusing on the transformation of the health contexts in which they are inserted. The JBI methodology offers systems and tools to evaluate existent practices; it also reinforces and disseminates evidence-based healthcare, potentializing the achievement of effective change in healthcare.

How Does Organizational Culture Influence the Adoption of Research Evidence by Management Practitioners?

Using the best available evidence from multiple sources can lead to more effective management practice. However, management practitioners often make decisions based on limited evidence, mostly from personal experience and judgment. Values, beliefs, and practices may conflict with a manager’s ability to use research evidence in practice. This systematic review suggests that an integration of the diffusion of innovations (Rogers, 1995) and planned behavior (Ajzen, 1991) theories may be used to explain the influence of values, beliefs, and practices on the adoption of research evidence by management practitioners. These cultural influence factors may be conceptualized as moderating the effects of innovation diffusion efforts on research evidence adoption behavior. Viewing evidence-based management (EBMgt) as an innovation, organizational managers may employ innovation diffusion strategies to influence values, beliefs, and practices conducive to using research evidence in management practice. This review presents recommendations for both practitioners and scholars to facilitate EBMgt. Practitioners can promote a culture that enables evidence-based practice, use tact when presenting evidence to a skeptical audience, and form partnerships with scholars. Leaders can promote the use of evidence in their organizations, provide evidence-based practice tools and training, and use human resource practices to ensure key positions are proficient in research skills. Scholars can publish more practitioner-friendly evidence and teach business and management students research skills.

Establishing A Global EBP Tool to Measure Evidence-Based Practice Knowledge: Translating and Testing the French Version of EKAN.

Government and professional organizations around the world have issued a call for evidence-based practice (EBP), affecting nursing globally. This study aimed to establish a baseline measure of EBP knowledge in French-speaking, baccalaureate nursing students and test the psychometric performance of a newly translated instrument. For the cross-sectional, descriptive, correlational study, 103 baccalaureate nursing students from Haiti were included in the analysis. Rasch analysis showed strong evidence of validity (Weighted MS M = 984; Unweighted MS M = 1.01). Individual items showed item reliability (.94). The mean EBP knowledge score was 5.9 (SD = 1.93; Range = 2-10 points). This study provides initial psychometric evidence for an EBP knowledge measure that can be used as a catalyst for research in 29 French-speaking countries.

The impact of job satisfaction on nurses’ work lives: A literature review

ABSTRACT Many outcomes in nurses’ work lives are influenced by their job satisfaction. Background: One of the tools that measures nurses’ job satisfaction is the McCloskey/Mueller Job Satisfaction tool. Several databases were accessed to identify studies published after 2002 that measured nurses’ job satisfaction using the McCloskey/Mueller Job Satisfaction tool and identified an outcome related to work lives of nurses. Aim: The aim of this literature review was to explore the relationship between job satisfaction and outcomes related to nurses’ work lives. Methodology: The framework developed by Cronin, Ryan, and Coughlan was used for this review. Articles included in this review met the following criteria: studies that used the MMSS (McCloskey/Mueller Nurse Job Satisfaction Scale) tool, articles that were written in English, studies that focused on nurses and outcomes related to nurses’ work lives, and articles that were published in peer-reviewed journals. The exclusion criteria included articles that were not from original research, articles that were written before 2002, gray literature, and studies that did not have ethical approval. The Johns Hopkins Nursing Evidence-Based Practice Tool was used to appraise each article’s quality. Results: Eighteen articles were chosen for inclusion in this review. Nurses’ job satisfaction had several key impacts on nurses’ work lives. Five themes that reflected the outcomes of nurses’ job satisfaction were identified: commitment to the workplace, workplace environment, emotional status, career ladder, and accountability. Conclusions: The findings show that workplace commitment, workplace environment, emotional status, career ladder, and accountability contribute to nurses’ job satisfaction. These factors need to be taken into account in developing interventions to increase nurses’ job satisfaction and their work output.

Studenterfaringer med veiledning og læring knyttet til deltagelse i et kvalitetsforbedringsprosjekt på sykehus med kunnskapsbasert praksis som arbeidsform, -en beskrivende og utforskende studie

Student experiences with supervision and learning through participation in a quality improvement evidence-baced practice project in a hospital, -a descriptive and explorative study&#x0D; A significant part of health care students’ education is provided through clinical placement supervised by practitioners with required education and experience. This study has been conducted to increase knowledge of students’ experiences with supervision and learning related to participation in a quality improvement project in a hospital using evidence-based practice tools. A descriptive and exploratory design with focus group interviews. Data was analysed using qualitative content analysis. Three main themes emerged: changed student role, understanding the importance of keeping professional knowledge updated and need for the facilitation of the clinical placement period. The study showed that supervision helped students become equals of their supervisors and part of the community of practice. The project contributed to students`' coping skills. Integrating evidence-based practice into practice taught students a method of professional knowledge updating and quality improvement.

Perspective: The Evidence-Based Framework in Nutrition and Dietetics: Implementation, Challenges, and Future Directions.

Decision making in nutrition is based on current available scientific evidence. However, we are currently living in a time of highly accessible information, and with the increase in accessibility has come a concomitant increase in misinformation and pseudoscience relating to nutrition. This presents a challenge to the nutrition research community, practitioners, and consumers, and highlights a need to critically examine the current evidence-based framework in nutrition, and identify strategies for future improvements. This narrative review outlines the current evidence-based framework and approaches to evidence-based practice in the nutrition field, focusing on policy and guideline development. Within the framework, systematic reviews are an important tool for evidence-based practice, underpinning translation guidelines and other implementation documents. Recommendations for consumption of nutrients, foods, and whole diets are required to guide consumers and practitioners; however, these resources must be updated regularly to remain timely and accurate. In turn, clinical practice guidelines guide practitioners in how to implement the evidence base for patients and clients, supporting practitioners to be positioned as a key conduit between scientific evidence and the public. In contrast, health claims may support marketing of food products, but require consideration of the strength and quality of the evidence to support health claims, with external oversight required to ensure claims are appropriate. Collecting, synthesizing, and translating the evidence base in nutrition remains an ongoing challenge, particularly in the current context of increased information availability. To address growing challenges in combating pseudoscience, nutrition researchers, policy makers, and practitioners must work together, and the role of practitioners in translating the evidence base and personalizing it to individual patients must be emphasized. Continuing to address current challenges, including increasing the timeliness and consistency of the approach to the evidence base, is required to ensure informed and robust nutrition policy, research, and practice into the future.

Multilevel National Analysis of Nursing Students’ Perceived Opportunity to Access Evidence‐Based Tools During Their Clinical Learning Experience

Easy-to-access tools have been demonstrated to improve evidence-based practice (EBP) competences among nursing students. However, students' perception of access to EBP tools (e.g., clinical practice guidelines [CPGs], protocols) is unknown. To explore: (1) nursing students' opportunity to access EBP tools during their education, and (2) associated factors. A national cross-sectional study including all Italian nursing programs. Nursing students were deemed eligible according to the following inclusion criteria: Those who (1) were attending or just ended their practical rotation lasting at least 2weeks at the time of the survey, and (2) expressed through written informed consent their willingness to take part in the study. Participants were asked about their perceived opportunity to access EBP tools during their most recent clinical learning experience (from 0 - not at all to 3 - always). A set of explanatory variables was collected at the individual, nursing program, and regional levels by using a questionnaire. Nine thousand six hundred and seven (91.6%) out of 10,480 nursing students took part in the study. Overall, 4,376 (45.6%) students perceived not at all or only a small opportunity to access EBP tools during their most recent clinical rotation. In the multilevel analysis, factors promoting access were mainly set at the clinical learning environment level (high safety and nursing care quality, high self-directed learning opportunities, high quality of the learning environment, and being supervised by a clinical nurse). In contrast, male gender and lower academic class were associated with a lower perception of accessibility to EBP tools. A consistent variability in the perceived opportunity to access EBP tools emerged across regions. Evidence-based decision-making is increasingly expected from nurses. Therefore, nursing faculties should safeguard and continuously improve students' competence regarding EBP, by implementing strategies mainly at the nursing program and regional levels.

Texture analysis of the developing human brain using customization of a knowledge-based system

Background:Pattern recognition software originally designed for geospatial and other technical applications could be trained by physicians and used as texture analysis tools for evidence-based practice, in order to improve diagnostic imaging examination during pregnancy.Methods:Various machine-learning techniques and customized datasets were assessed for training of an integrable knowledge-based system (KBS) to determine a hypothetical methodology for texture classification of closely related anatomical structures in fetal brain magnetic resonance (MR) images. Samples were manually categorized according to the magnetic field of the MRI scanner (i.e., 1.5-tesla [1.5T], 3-tesla [3T]), rotational planes (i.e., coronal, sagittal, and axial), and signal weighting (i.e., spin-lattice, spin-spin, relaxation, and proton density). In the machine-learning sessions, the operator manually selected relevant regions of interest (ROI) in 1.5/3T MR images. Semi-automatic procedures in MaZda/B11 were performed to determine optimal parameter sets for ROI classification. Four classes were defined: ventricles, thalamus, gray matter, and white matter. Various texture analysis methods were tested. The KBS performed automatic data preprocessing and semi-automatic classification of ROI.Results:After testing 3456 ROI, statistical binary classification revealed that the combination of reduction techniques with linear discriminant algorithms (LDA) or nonlinear discriminant algorithms (NDA) yielded the best scoring in terms of sensitivity (both 100%, 95% CI: 99.79–100), specificity (both 100%, 95% CI: 99.79–100), and Fisher coefficient (≈E+4 and ≈E+5, respectively).Conclusions:LDA and NDA in MaZda can be useful data mining tools for screening a population of interest subjected to a clinical test.

Texture analysis of the developing human brain using customization of a knowledge-based system

Background: Pattern recognition software originally designed for geospatial and other technical applications could be trained by physicians and used as texture-analysis tools for evidence-based practice, in order to improve diagnostic imaging examination during pregnancy.Methods: Various machine-learning techniques and customized datasets were assessed for training of an integrable knowledge-based system (KBS), to determine a hypothetical methodology for texture classification of closely-related anatomical structures in fetal brain magnetic resonance (MR) images. Samples were manually categorized according to the magnetic field of the MRI scanner (i.e. 1.5-tesla (1.5T), 3-tesla (3T)), rotational planes (i.e. coronal, sagittal and axial), and signal weighting (i.e. spin-lattice, spin-spin, relaxation, proton density). In the machine-learning sessions, the operator manually selected relevant regions of interest (ROI) in 1.5/3T MR images. Semi-automatic procedures in MaZda/B11 were performed to determine optimal parameter sets for ROI classification. Four classes were defined: ventricles, thalamus, grey matter, and white matter. Various textures analysis methods were tested. The KBS performed automatic data pre-processing and semi-automatic classification of ROIs.Results: After testing 3456 ROIs, statistical binary classification revealed that combination of reduction techniques with linear discriminant algorithms (LDA) or nonlinear discriminant algorithms (NDA) yielded the best scoring in terms of sensitivity (both 100%, 95% CI: 99.79-100), specificity (both 100%, 95% CI: 99.79-100) and Fisher coefficient (≈E+4, ≈E+5, respectively). Conclusions: LDA and NDA in MaZda can be useful data mining tools for screening a population of interest subjected to a clinical test.

The Role of Systematic Review in the Practice of Toxicology and Risk Assessment An Appreciation for the Primary Tool in Evidence-Based Practice

Use of systematic reviews (SRs) as a tool to facilitate evidence-based toxicology (EBT) assessments is increasing, though the field has yet to develop an appreciation of the rigor required to appropriately utilize this tool. Toxicologists should recognize the weight of the term, understanding that a systematic review involves far more than conducting elements of a review systematically. Key aspects that appear to be currently underappreciated include development and publication of a protocol, the level of documentation involved in the conduct of a SR, and the overall level of effort required to maintain standards of SR. As many regulatory agencies and health organizations integrate systematic review into their procedures, it is clear that there is a need to develop best-science practices in EBT, as the methods developed for evidence-based medicine (EBM) do not always provide the best platform for evaluation of toxicological data. Such efforts are particularly needed for evidence integration, methods which allow for integration of multiple types of data, as well as application of the SR in both qualitative and quantitative hazard or risk assessments. Nonetheless, use of systematic review is advancing the field of toxicology, providing objectivity and transparency in evidence-based assessments.