Evidence-based Practice In Clinical Settings Research Articles

Necessary prerequisites for evidence-based practice: results of investigating nurses’ informatics competency and information literacy skills

Abstract This study aimed to evaluate the correlation between nursing informatics (NI) competency and information literacy skills for evidence-based practice (EBP) among intensive care nurses. This cross-sectional study was conducted on 184 nurses working in intensive care units (ICUs). The study data were collected through demographic information, Nursing Informatics Competency Assessment Tool (NICAT), and information literacy skills for EBP questionnaires. The intensive care nurses received competent and low-moderate levels for the total scores of NI competency and information literacy skills, respectively. They received a moderate score for the use of different information resources but a low score for information searching skills, different search features, and knowledge about search operators, and only 31.5% of the nurses selected the most appropriate statement. NI competency and related subscales had a significant direct bidirectional correlation with information literacy skills for EBP and its subscales (P < 0.05). Nurses require a high level of NI competency and information literacy for EBP to obtain up-to-date information and provide better care and decision-making. Health planners and policymakers should develop interventions to enhance NI competency and information literacy skills among nurses and motivate them to use EBP in clinical settings.

Where innovation meets evidence: The cutting edge of Neurologic Music Therapy and evidence-based practice in clinical settings

Where innovation meets evidence: The cutting edge of Neurologic Music Therapy and evidence-based practice in clinical settings Charlotte Smith, Ludlow Street Healthcare, UK
 CONFERENCE DETAILS Where innovation meets evidence: The cutting edge of Neurologic Music Therapy and evidence-based practice in clinical settings 24 March 2022, UK

Interventional Therapy and Surgical Management of Lumbar Disc Herniation in Spine Surgery: A Narrative Review.

Significant advancements in lumbar disc herniation (LDH) management have been made in interventional pain therapy, operative therapy, peri-operative management, and cost analysis of various procedures. The present review aims to provide a concise narrative of all these topics, current trends, and possible future directions in the management of LDH. Interventional pain management using intradiscal injections often serves as a minimally invasive non-surgical approach. Surgical modalities vary, including traditional open laminectomy, microdiscectomy, endoscopic discectomy, tubular discectomy, percutaneous laser disc decompression, and transforaminal foraminotomy. Prevention of infections during surgery is paramount and is often done via a single-dose preoperative antibiotic prophylaxis. Recurrence of LDH post-surgery is commonly observed and thus mitigative strategies for prevention have been proposed including the use of annular closure devices. Finally, all treatments are well-associated with clear as well as hidden costs to the health system and society as described by billing codes and loss of patients' quality-adjusted life-years. Our summary of recent literature regarding LDH may allow physicians to employ up-to-date evidence-based practice in clinical settings and can help drive future advancements in LDH management. Future longitudinal and comprehensive studies elucidating how each type of treatments fare against different types of herniations are warranted.

Understanding the Barriers of Implementing a Self-Awareness Assessment in Occupational Therapy Practice within a Brain Injury Population: An Exploratory Study.

Self-awareness is seldom formally assessed by occupational therapists among individuals with traumatic brain injury (TBI). However, impaired self-awareness is prevalent and has a significant impact on rehabilitation outcomes. There is a need to understand clinician perspectives on self-awareness assessments and promote evidence-based practice in clinical settings. (1) Explore how an education session impacts knowledge and use of self-awareness assessments in occupational therapists working with people with TBI; (2) Understand the barriers that occupational therapists experience when assessing self-awareness in clinical practice. A single-group pre-post session design with an integrated knowledge translation approach was used. Occupational therapists working in neurorehabilitation were recruited from two rehabilitation centres through convenience sampling. Participants completed questionnaires before, after, and three months following an education session about the Self-Awareness of Deficits (SADI) assessment. 14 occupational therapists participated in this study. A statistically significant increase in knowledge and confidence in using the SADI was observed both post-session and at 3-month follow-up. Targeted and ongoing education promotes confidence and knowledge retention among occupational therapists. Further research should explore strategies to promote behaviour change. Significance. The barriers identified in this study can provide insights for knowledge translation across clinical contexts.

Advancing EBP culture and competencies through an academic-research partnership: Process and outcomes of an EBP scholar program.

Evidence-based practice (EBP) is increasingly being adopted in healthcare organizations to improve patient care and outcomes. Yet, barriers remain that prevent consistent implementation of EBP in clinical settings. To increase EBP competencies and promote practice change, a regional academic-community hospital in Los Angeles, California, jointly with a university school of nursing, developed and implemented an EBP scholar program. A multistep EBP process was delivered during monthly didactic workshops to ensure optimal delivery and acquisition of EBP core competencies. The Iowa Model of Evidence-Based Practice to Promote Quality Care was integrated into the curriculum to assist program scholar's efforts to systematically direct EBP implementation at the organizational level. Additional strategies were incorporated including one-to-one mentoring, institutional recognition, and protected time. The 13-item EBP Competency Scale for practicing registered professional nurses was used to measure EBP competency at baseline and post-program completion. Five recruited scholars completed the baseline survey and three completed the postsurvey. EBP competency increased from 52.9% to 62.75%. Scholars submitted abstracts for conference poster presentation, podium presentations, and conference poster awards. One article was submitted and accepted for journal publication. A multistep EBP process can enhance EBP delivery, improve EBP competency, and facilitate dissemination.

Measuring and Evaluating Clinical Context in Implementation Science Research.

Measuring and Evaluating Clinical Context in Implementation Science Research.

Evidence-based practice profiles of nurses: a transcultural study†

Abstract Objective To compare (i) the evidence-based practice (EBP) profiles and (ii) socio-demographic characteristics of nurses in 4 selected low-middle income countries (LMICs). Methods A cross-sectional survey was conducted among 677 nurses from 4 hospitals in 4 countries (Afghanistan, Ghana, Iran, and Uganda). Results The findings revealed that there are significant differences between the 3 EBP subscales (that is, practice/use, attitude, and knowledge/skill) across the 4 countries (P < 0.05). No significant EBP differences were identified across age groups and gender in the subscales of practice, knowledge, and attitude. Practice and knowledge subscales were significantly associated with working schedules (that is, part-time and full-time) (P < 0.05). Analyses also revealed significant differences between attitude and knowledge subscales and working experience (P < 0.05). Conclusions Nurses in the 4 countries have moderate practice, attitude, and knowledge/skills of EBP. Nurses in LMICs require continuous professional development programs and support to enhance their practice and knowledge regarding EBP in clinical settings.

Establishment of Nurse Manager Leadership Competencies to Support Clinicians in Evidence-Based Practice.

This 2-part study was conducted to validate nurse manager (NM) leadership competencies that support clinicians in using evidence-based practice (EBP). Numerous studies validate the critical need for NM support among clinicians seeking to engage in EBP. In phase 1, a Delphi study was conducted to establish the validity of a set of NM leadership competencies that support EBP. In phase 2, descriptive analyses, tests of significance, and reliability coefficients were used to assess reliability. An expert panel achieved consensus on a set of 22 NM leadership competencies that constitute effective support for EBP. Further quantitative analyses demonstrated excellent levels of internal consistency and overall consistent outcomes across time. A valid set of 22 NM leadership competencies with evidence of reliability that successfully support clinicians to engage in EBP in clinical settings was established.

Use of Implementation Science to Advance Nurse-Led Evidence-Based Practices in Clinical Settings

Evidence demonstrates improved outcomes of evidence-based practice (EBP); yet routine implementation remains challenging. Implementation science provides a science-based approach to implementation, but application among nurse-led teams is sparse. This study identified difficulty/success of nursing teams implementing EBPs, and common implementation strategies. Nurses (n = 84) reported difficulty with implementation. Common strategies included engaging leadership, collaborators, highlighting advantages, diverse teams, and staff meetings. Highly successful nurse-led teams reported use of timelines, checklists, auditing/feedback, and hardwiring as effective implementation strategies. Implementation remains the most challenging component of EBP. Nurse-led teams should incorporate implementation science strategies to facilitate successful uptake of EBP in clinical settings.

Integrating evidence-based interventions in clinical settings in Jordan: a policy brief.

Background: Evidence-based nursing practice (EBNP) is considered a major and very important global paradigm shift. Unfortunately, most healthcare providers and researchers embrace the concept of evidence-based practice (EBP) without integrating this concept in clinical settings. The current situation of EBP and new practice guidelines utilization in Jordan are scarce. This policy brief aimed to discusses the process of utilizing nursing EBP in clinical settings in Jordan. Methods: The authors adopted an action plan utilizing a systematic approach to develop and implement specific strategies and policies to integrate EBP in clinical settings in Jordanian hospitals. We present an experience of one country in terms of introducing a policy brief to establish an EBP policy accompanied by developing an EBP unit in the hospital's country. Results: A comprehensive description of this policy is provided with reference to the eminent steps of policy analysis and evaluation. In fact, EBP policies and clinical practice guidelines should keep a live document and revise regularly or as needed. Overall, the authors suggest the development of a unit for EBP to deal with issues related to clinical practice guidelines. Conclusions: Expected outcomes for the introduction of the EBP unit and its policy include increase research utilization and accelerated adoption of new evidence, increase the quality of care provided, increase patient, staff, and managers satisfaction, and decrease staff workload by reducing complications associated with medical errors and outdated interventions.

Beliefs and implementation of evidence-based practice among nurses in the nursing homes of a Swiss canton: An observational cross-sectional study.

Aims and objectivesExamine beliefs about EBP and its level of implementation among nurses working in nursing homes in a bilingual canton of Switzerland and explore associations between these aspects and nurses’ sociodemographic and professional characteristics.BackgroundAlthough evidence‐based practice (EBP) is recognised as an effective strategy for improving the quality and safety of care, little is known about its use in nursing homes. Nurses’ beliefs about EBP and their implementation of it in Switzerland’s nursing homes have never been explored.DesignAn observational cross‐sectional study.MethodsBeliefs about and implementation of EBP were evaluated using validated French‐ and German‐language versions of the EBP Beliefs Scale and the EBP Implementation Scale, developed by Melnyk and Fineout‐Overholt (Melnyk, Fineout‐Overholt, & Mays, 2008, Worldviews on Evidence‐Based Nursing, 5, 208). The STROBE checklist for cross‐sectional studies was used in reporting this study.ResultsThe participation rate was 40.6% (N = 194). Most participants stated that they had some knowledge of EBP and held favourable beliefs about it. Nevertheless, 37.1% of participants found the concept complicated and 36.1% found it time‐consuming. Participants were more likely to implement stages in the EBP process linked to direct clinical practice rather than those which required scientific knowledge and skills.ConclusionMost participants had favourable beliefs about EBP, but the level of implementation of EBP among nurses in their daily clinical practice was sub‐optimal.Relevance to clinical practiceA greater emphasis should be put on fostering the use of EBP among nurses working in nursing homes. This could be achieved via training and the development of individual, institutional and contextual strategies promoting the integration of EBP in clinical settings.

Promoting Evidence-Based Practice in Clinical Education at a Hospice Designated Education Unit.

Integration of palliative care principles into undergraduate nursing curriculum is essential to prepare students to provide supportive care services across the continuum of care for individuals with serious illness. Baccalaureate nursing curricula emphasize development and application of evidence-based practice (EBP); however, development of nursing skills often overshadows teaching students how to deliver care or facilitate practice changes based on evidence in clinical education. Problems revealed in clinical practice are a valuable tool for improving student use and appreciation of EBP in clinical settings. The EBP project presented in this article provides a process to promote palliative and end-of-life EBP in clinical education. This project highlights the proposed American Association of Colleges of Nursing hospice/palliative/supportive care sphere of care in a hospice dedicated education unit following The Seven Steps of EBP. Students participating in the project developed core skills to search, appraise, and translate evidence and the ability to lead EBP projects guided by the dedicated education unit model. Dedicated education units serve as ideal clinical education sites to develop student EBP competencies and support transition to practice through collaboration with practice partner stakeholders.

An integrative review to identify evidence of nurse practitioner-led changes to health-care delivery and the outcomes of such changes.

This study aimed to identify evidence of nurse practitioner-led changes to health-care delivery and the outcomes of such changes. Changing health-care delivery is synonymous with the nurse practitioner role. The literature is critical of the lack of research by nurse practitioners, reporting the effects of a change to health-care delivery. This study used a systematic integrative review by using Torraco's approach. Databases Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Web of Science and SCOPUS were searched for peer-reviewed publications from 2000 to 2019. A systematic approach was used to screen and analyse the literature. Inclusion/exclusion criteria were applied, and quality appraisal was undertaken by two reviewers. Eighteen articles were selected. The research projects were across the community and acute care settings. Research methodologies varied including preintervention and postintervention studies, evaluation of quality improvement projects, randomized controlled trial and descriptive studies. Multiple data collection tools were used. Two major themes were identified including evidence-based practice champions and improved patient outcomes. The nurse practitioner role is pertinent toward improving evidence-based practice in clinical settings. Positive patient outcomes and praise for clinical leadership are evident in the literature. Research by nurse practitioners to date has focused on individual services.

Midwifery leaders’ views on the factors considered crucial to implementing evidence-based practice in clinical areas

ProblemThe evidence-to-practice gap continues to persist in healthcare and midwives report limited knowledge and use of effective intervention strategies to support the implementation of new evidence-based practices in clinical settings. BackgroundDespite ongoing development and dissemination of high quality research findings, the translation of latest research evidence by midwives into new evidence-based practices remains sub-optimal. This inefficiency places consumers at risk of obsolete or potentially dangerous healthcare interventions. AimTo explore midwifery leaders’ views on what information and support midwives require to lead practice change initiatives in clinical areas. MethodsThe study formed part of a broader Participatory Action Research (PAR) project designed to improve the processes by which midwives implement evidence-based practice change in clinical settings. The study employed a qualitative design and was guided by the methodological underpinnings of Action Research (AR). FindingsOne core finding emerged to fulfil the aim and objectives of the study. To lead implementation of evidence-based practices, midwives need practical solutions and a map of the process, packaged into a centralised web-based resource. DiscussionThe findings reported in this study provide valuable insight into the specific needs of midwives wanting to improve the uptake and longevity of new evidence based practices in clinical areas. This includes information specific to evidence implementation, support networks and knowledge of Implementation Science. ConclusionTo lead practice change initiatives, midwives require a web-based resource that standardises the process of evidence implementation, while providing midwives with clear direction and the support needed to confidently champion for evidence base change in clinical areas.

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.

Safety Planning to Manage Suicide Risk with Older Adults: Case Examples and Recommendations

ABSTRACTAdults age 65 and older have high rates of suicide, despite recent efforts to reduce the suicide rate in this population. One suicide prevention strategy with burgeoning empirical support is safety planning; however, there is a lack of information and resources on safety planning for older adults to support uptake of this evidence-based practice in clinical settings where older adults are commonly seen. Safety plans can address risk factors for suicide in older adults, including social isolation, physical illness, functional limitations, and use of highly lethal means. Safety plans also promote relevant protective factors, including increasing use of coping strategies, social support, and help-seeking. Clinicians may encounter challenges and barriers to safety planning with older adults. This paper describes a collaborative, creative approach to safety planning that is relevant and useful for this vulnerable population. Using two case examples, we illustrate how to engage older adults in safety planning, including ways to minimize barriers associated with the aging process.

Assessing Attitudes towards Knowledge and use of Evidence-Based Practice among Nurses Working in a Teaching Hospital in Kuala Lumpur

Evidence-based practice provides the most effective care that is available with the aim of improving clients’ outcome. However, despite existing policies related to encouragement to or requirement of evidence-based practice (EBP), results of reviewed studies show nurses do not generally incorporate research evidence in their daily practice. This study aimed to assess nurses’ attitudes towards knowledge and use of EBP in a teaching hospital in Kuala Lumpur. This study used descriptive cross-sectional survey among 265 nurses (out of 851), working in the different adult medical-surgical wards, who were selected through the quota sampling. Participants in this study, reported positive attitudes towards EBP, good knowledge of EBP, but poor utilization of evidence in their practice. Results of this study affirmed the findings of previous researches, showed despite having positive attitude and perception of good knowledge/skill regarding EBP; nurses did not incorporate evidence into practice. Application of EBP in clinical setting increases the quality of patient care, clients’ outcome and nurses’ job satisfaction and retention. In this regard, nursing managers and authorities have an important role in providing supports, facilities and persuading environment to focus nurses on evidence-based practice. It is recommended that the effect of personal and professional agents on actual EBP activities among nurses should be assessed through the observational studies rather than self-report questionnaire.

Evidence-Based Practice-A Key to Quality Patient Care

In all parts of the world, nursing has experienced a profound culture change over the past few decades. Nurses are increasingly expected to understand and conduct research, and to base their professional practice on emerging evidence from research-that is to adopt an Evidence Based Practice (EBP). Evidence-based practice is a conscientious, problem-solving approach to clinical practice that incorporates the best evidence from well-designed studies, patient values and preferences, and a clinician's expertise in making decisions about a patient's care. EBP implements the most up to date methods of providing care, which have been proven through appraisal of high quality studies and statistically significant research findings. The seven steps of EBP are-Cultivate Spirit of Inquiry, Ask Clinical Question, search for and collect relevant evidence, critically appraise the evidence, integrate the evidence, evaluate the outcome and disseminate the outcome. CINHAL, MEDLINE (PubMed), evidence base. abstraction journals ect are few resources to avail best evidences for practice. After appraising the evidence, it is necessary to integrate it with the provider's expertise and patient's preferences. The patient is encouraged to practice autonomy and participate in the decision-making process. Adequate knowledge, attitude, skill and support are key to apply Evidence in to practice. There are so many professional and individual barriers which are needed to be overcome in order to implement EBP in clinical setting in order to achieve quality of nursing care.

Increasing the impact of randomized controlled trials: an example of a hybrid effectiveness-implementation design in psychotherapy research.

Randomized controlled trials (RCTs) are the gold standard for clinical research. However, significant delays between completion of RCTs and adoption of evidence-based practices into clinical settings remain. Engagement of stakeholders and implementation-focused outcomes to augment traditional RCTs hold the potential to increase the impact of RCT outcomes for clinical practice and more rapidly lead to the adoption of evidence-based practices in clinical settings. The purpose of this study is to discuss hybrid effectiveness-implementation designs and use a project example to highlight important methodological considerations to enhance the impact of RCTs. A hybrid effectiveness-implementation study assessed the effectiveness and implementation potential of brief cognitive behavioral therapy (bCBT) for rural Veterans. A patient-randomized trial (bCBT vs. enhanced usual care) explored the impact on depression symptoms. Implementation elements included engagement of stakeholders and a multifaceted provider training and support program to increase bCBT use by providers in Veterans Health Administration (VA) community-based outpatient clinics. Implementation outcomes included the number of providers who adopted bCBT, provider fidelity, and delivery outcomes (e.g., use of measurement-based care, treatment engagement, and completion). Hybrid designs offer opportunities to improve the alignment between research and practice, potentially improving dissemination of evidence-based interventions and reducing known delays in the translation from research to practice. Expansion of traditional RCTs through collaborative stakeholder contributions and stakeholder/consumer-informed implementation approaches is critical to improve adoption postproject. Although hybrid designs offer significant benefits related to generalizability and adoption, these approaches involve complex procedures and processes and often come at the cost of reduced internal study controls.

A Focused Review on the Treatment of Pediatric Patients with Atypical Antipsychotics.

The use of atypical antipsychotic medications in pediatric patients has become more prevalent in recent years. The purpose of this review is to provide a clinically relevant update of recent selected key publications regarding the use of atypical antipsychotics in this population. Studies reviewed included randomized, double-blind, placebo-controlled medication trials conducted within the past 5 years. A PubMed search was conducted for each of the 11 second-generation antipsychotic medications currently approved by the Food and Drug Administration for use in the United States: clozapine, risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, paliperidone, asenapine, iloperidone, lurasidone, and cariprazine. Trials published in English with subjects 18 years of age and younger were included in this review. Additional studies, chosen for their significance to clinical practice, were also included at the discretion of the authors. This review demonstrates that more empiric data are available regarding both the acute efficacy and, to a lesser extent, the longer-term efficacy and tolerability for several of the considered antipsychotic medications. The clinical conditions for which these medications have been studied include schizophrenia, bipolar disorder, Tourette's disorder, and autism spectrum disorder. They have also been used as an adjunctive treatment for disruptive behavior disorders with aggression, which have not responded to treatment with stimulants. Evidence regarding the efficacy and tolerability of antipsychotic medications for mental health disorders in children and adolescents has expanded exponentially in recent years. However, more information is needed so that evidence-based comparisons between medications can be made. In the future, data enabling the selection of medications based upon individual patient characteristics could potentially lead to greater efficacy and efficiency in treating what are frequently debilitating medical conditions. Maladaptive aggression in children, often treated with antipsychotics, is one such area in which there is a dearth of actual information available to the clinician. It is to be hoped that additional, longer-term studies of these medications will further inform evidence-based practice in clinical settings.