Evidence-based Practice Evidence Research Articles

DEMENTIA IN INSTITUTIONALIZED ELDERLY: A NURSING TEAM’S EXPERIENCES AND PERCEPTIONS

ABSTRACT Objective: to understand nursing workers' experiences with the nursing care provided to elderly individuals with dementia living in a long-term care facility. Method: comprehensive qualitative study conducted in a long-term care facility located in Joinville, Santa Catarina, Brazil, from July to September 2018. Thirteen nursing technicians and one nurse participated. Data were collected using questionnaires, field diaries, individual interviews, and participatory observation. Thematic content analysis was used to interpret content. Results: three themes emerged from data analysis: "Knowledge acquired with practice and gap existing in the care provided to institutionalized elderly individuals with dementia"; "Individualized care provided to elderly individuals and bonding"; and "Conflicts the nursing staff faces when reconciling care needs, the time available, and the facility's routines". These themes originated the central theme: Meanings assigned to the nursing care provided to institutionalized elderly individuals with dementia. By sharing information regarding care actions that obtained positive results, the staff perceived the importance of an individualized approach and of establishing bonds as a therapeutic process. Gaps were identified in the professionals' knowledge regarding how to provide hygiene care when individuals become aggressive, agitated, or resist care. Conclusion: health workers' experience is a source of evidence for evidence-based practice and is also essential to fill in existing gaps between knowledge and care delivery.

DEMENTIA IN INSTITUTIONALIZED ELDERLY: A NURSING TEAM’S EXPERIENCES AND PERCEPTIONS

ABSTRACT Objective: to understand nursing workers' experiences with the nursing care provided to elderly individuals with dementia living in a long-term care facility. Method: comprehensive qualitative study conducted in a long-term care facility located in Joinville, Santa Catarina, Brazil, from July to September 2018. Thirteen nursing technicians and one nurse participated. Data were collected using questionnaires, field diaries, individual interviews, and participatory observation. Thematic content analysis was used to interpret content. Results: three themes emerged from data analysis: "Knowledge acquired with practice and gap existing in the care provided to institutionalized elderly individuals with dementia"; "Individualized care provided to elderly individuals and bonding"; and "Conflicts the nursing staff faces when reconciling care needs, the time available, and the facility's routines". These themes originated the central theme: Meanings assigned to the nursing care provided to institutionalized elderly individuals with dementia. By sharing information regarding care actions that obtained positive results, the staff perceived the importance of an individualized approach and of establishing bonds as a therapeutic process. Gaps were identified in the professionals' knowledge regarding how to provide hygiene care when individuals become aggressive, agitated, or resist care. Conclusion: health workers' experience is a source of evidence for evidence-based practice and is also essential to fill in existing gaps between knowledge and care delivery.

Evidence-Based Research in Nursing Science: A Reproducible Framework.

While current clinical research generally employs complex computational methods to analyze large amounts of data, reproducible research is a growing movement within the scientific community. This methodology paper consists of five sections discussing the definitions of replicability, reproducibility, and reproducible research, the current status of reproducible research in nursing science, the introduction of a reproducible framework, and the challenges and recommendations for reproducible research. To ensure the data preprocessing process and data analysis of an original study at the minimum standard, it is necessary for the study's data investigative cycle to be transparent. Most arguments for reproducible research were driven by a critical review of journal articles and conference proceedings. The suggested methodological framework capturing how scientific research generates is expected to contribute to guiding nurse scientists to conduct reproducible research. To generate high-quality scientific evidence for evidence-based practice, the reproducible framework should be integrated into nursing research.

Research utilization process model: A cyclical, spiral, and developmental process to provide conclusive research knowledge in health professions education.

Background: Research utilization plays an important role in evidence-based practice. Health professions education is a research-based discipline. Conclusive research knowledge is ranked as high level of evidence in evidence-based practice. This study was conducted to develop a model to reach conclusive research knowledge in health professions education. Methods: This study was conducted in 2 phases. In the first phase, a qualitative content analysis of the literature was performed, which provided research utilization concepts to design a model. In the second phase, a group of 5 consultants of health professions education designed a preliminary model and revised it to develop an appropriate model for research utilization in health professions education. Results: The indicators mentioned in 24 documents were extracted and later categorized into 25 items. Then, 8 concepts emerged, including problem identification, research design and implementation, research reports, research publication, presentation, research access, adoption, and research use. These concepts were arranged to design a model for research utilization in health professions education. Conclusion: This study illustrated a cyclical, spiral, and developmental model to reach conclusive research knowledge. This model emphasizes both primary and secondary research projects to reach conclusive research knowledge. Also, it distinguishes between aligned transfer and cooperative presentation in research knowledge dissemination. This model reveals the importance of the process use in health profession education. Also, it distinguishes between use and misuse of research findings.

Diclofenac diethylamine emulgel delivery via nano plum-blossom needle for acute gouty arthritis: study protocol for a single-center blind randomized controlled trial

Background Patients with acute gouty arthritis experienc severe pain and often have concomitant limited joint movement. High-dose intake of anti-inflammatory analgesics often results in adverse reactions, such as nausea, vomiting, and diarrhea, and might increase the risk of gastrointestinal bleeding. In order to reduce the adverse reactions by oral intake, local use of externally useddrugs with the same active ingredients as the oral intake is an option in clinical practice. However, externally useddrugs take effect slowly and efficacy to reduce painful feelingis unsatisfactory. Therefore, it is demanding to develop a safe and effective treatment plan. In this regard, researchers have put up a hypothesis. The skin of the human body has a dense stratum corneum, which is difficult for externally used drugs to penetrate effectively; if the keratin barrier of the skin around affected joints can be broken without further damaging the skin, externally applied drugs may safely and effectively alleviate the local symptoms of acute gouty arthritis. The nano plum blossom needle is made of a modern new material. The needle body is thin and the diameter of the needle tip is only 300 nm. The needle is used clinically to break through the keratin barrier of the human skin and promote the absorption of external medicine. Therefore, this trial was designed to preliminarily evaluate the safety and effectiveness of using the nano plum blossom needle for the introduction of diclofenac diethylamine emulgel in the treatment of acute gouty arthritis. Methods A randomized controlled trial including 83 patients with acute gouty arthritis was conducted, who was assigned to three groups, the intervention group, control group 1, and control group 2 in a ratio of 2:2:1, respectively. The nano plum blossom needle was used for the introduction of diclofenac diethylamine emulgel in the intervention group; the nano plum blossom needle was used as a placebo along with the local use of diclofenac diethylamine emulgel in control group 1; and the nano plum blossom needle was used alone in control group 2. The treatments were applied once a day until the pain was completely relieved and the course of treatment lasted up to 7 days. The primary outcome measurement was the visual analog scale for evaluating the degree of pain. The secondary outcome indicators included scoring of the symptoms and signs with comprehensive consideration of the joint skin color, local tenderness, and degree of joint motion, the time and dose of emergency medication usage during trial, and adverse events. Discussion This trial couldprovide preliminary evidence for evidence-based practice of using nano plum blossom needle transdermal drug delivery technology for diclofenac diethylamine emulgel for the treatment of acute gouty arthritis, and provide a reference for sample size calculation and experimental design of future clinical trials verifying the effectiveness and safety of such a technical scheme in a larger target population. Registration information This study has been registered in the China Clinical Trial Registry Centerwith the registration code of ChiCTR-IOR-17012154. Key words: Clinical protocols; Randomized controlled trials as topic; Arthritis, gouty; Plum blossom needle therapy; Nanotechnology

Closing the Science-Practice Gap With Technology: From Evidence-Based Practice to Practice-Based Evidence.

Closing the Science-Practice Gap With Technology: From Evidence-Based Practice to Practice-Based Evidence.

Evidence and/or Experience-Based Knowledge in Lifestyle Treatment of Patients Diagnosed as Obese?

Proceeding from a phenomenological perspective, this study investigates how physiotherapists’ experience-based knowledge acquires significance in their encounters with patients diagnosed as obese. Presenting the thematic accounts of three physiotherapists, this paper illuminates how they make use of experiences from both their own life as well as experiences from learning and doing physiotherapy. This multifaceted experience-based knowledge is significant for making individual adjustments in a group-based programme. In line with these findings, the authors question whether the therapeutic method itself can be given such a prime position in defining best evidence in evidence-based practice. In concluding, they call for a re-consideration of the term evidence. More precisely, it is argued that what will be “effective” therapy for a person diagnosed as obese cannot be reduced to external evidence.

Evidence based practice within the complementary medicine context

Evidence based practice (EBP) is a system of applying the most current and valid high quality evidence to support clinical decision making in a healthcare setting. In the twenty five years since its inception, EBP has become the accepted benchmark for excellence in healthcare. Although the system emerged within the biomedical sciences, in the years since EBP has become normative across all healthcare modalities from dentistry, allied health to complementary and alternative medicine (CAM). Practicing evidence based medicine within any modality potentially offers the patient the best available care based on high quality evidence. Yet it is the nature of the evidence that provokes some questions about the suitability of EBP across all modalities of healthcare. The meta analysis of randomized controlled trial (RCT) stands at the pinnacle of the hierarchy of evidence in EBP. This forms a challenge to CAM due to the difficulty in reducing the elementals of a holistic naturopathic assessment of a patient into an answerable question to be tested within a RCT. On one level this makes EBP paradigmatically incompatible with CAM, yet on another level it presents the opportunity to redefine the parameters of what is considered high level evidence. EBP has become a tool, and at times a weapon wielded by governments and health insurance companies to direct healthcare funding and policy. The implications of the nature of accepted evidence are becoming far reaching. The pursuit of the best available healthcare for each individual is the focus of EBP. However, the injudicious use of this system to direct health policy is fraught with biomedical bias and dominance. This issue raises the challenge to CAM to present high level evidence according to the rules of evidence, or face the annihilation of centuries of empirical knowledge.

Lab Work for the Non-PhD? Absolutely!

Lab Work for the Non-PhD? Absolutely!

Insomnia During Climacteric: an Integrative Review

Introduction: Climacteric is a stage in women's lives in which occurs the passage from reproductive period to non-reproductive, marked by menopause. This phase can be seen as something natural, free of complaints. However, some women complain with climacteric symptoms, especially with disorders that affect sleep. Objective: Identifying the factors related to insomnia during climacteric, based on the analysis of scientific production. Method: The method of integrative literature review was requested, using descriptors insomnia, climacteric, menopause ; the databases consulted were PubMed, LILACS and SciELo, from 2004 to May 2014. The results were obtained by selecting 10 articles, by means careful reading, critical and reflective of the texts, followed by the organization of synoptic charts from the data obtained. Results: The evidence were gathered and synthesized, pointing to a set of physiological changes that can affect the quality of sleep during climacteric, including vasomotor symptoms, psychogenic, hormonal changes and menopause transition. Conclusions: The methodological designs of the studies analyzed were strong evidence for evidence-based practice. However, the data can be questioned, once the insomnia was self-reported. Therefore it needs that research be conducted approaching insomnia, with assessment by examinations which allow accuracy of the findings, such as polysomnography.

Turning the tide: Putting acute aphasia management back on the agenda through evidence-based practice

Background: The role of speech pathologists working in the acute hospital setting has evolved away from service provision to people with aphasia and their families towards a stronger focus on dysphagia. Evidence-based practice (EBP) can be conceptualised as the integration of four streams of evidence: research-based clinical evidence, clinical expertise, patient preferences and values, and the practice context. EBP is an important tenet in current healthcare. However, it is not clear whether speech pathologists in the acute setting are using EBP to support their aphasia management. Not adopting evidence-based approaches to care has the potential to result in a negative impact on people with aphasia and their families, healthcare services, and speech pathologists, who experience a sense of dissonance related to their current service provision This paper explores acute aphasia management through an EBP lens in an attempt to better understand this dilemma. Aims: This paper applies the conceptual framework of EBP to acute aphasia management. An extensive, systematically conducted review of the international literature relating to health professionals was undertaken. The findings are presented as a narrative literature review. Main Contribution: This paper describes and evaluates how the different streams of research evidence, clinical expertise, patient preferences and values, and the practice context contribute to speech pathologists' management of acute aphasia. Further, the paper identifies current gaps in the literature and suggests a research agenda for the field. Conclusions: Little is known about how speech pathologists integrate and implement the different streams of evidence in EBP, and how these contribute to acute aphasia practice. Speech pathologists report that clinical guidelines containing low-level evidence are the main source of research information. Other sources of knowledge include colleagues, professional development events, and websites. Additional challenges to the management of people with aphasia in the acute hospital setting may be posed by the physical environment, the culture of the acute hospital setting, and the provision of leadership to support evidence-based approaches to care. The challenge of using a person-centred approach to care for people with aphasia is acknowledged. Further research exploring speech pathologists' perceptions of their role in acute aphasia management, the clinical decision-making process of speech pathologists in relation to acute aphasia management, and the experiences of people with aphasia and their families in the acute setting is required. This will allow for the design of patient-centred approaches to care, and enable the implementation of evidence-based acute aphasia management.

Advocating for Access to Evidence for Evidence-Based Practice in School Health

Advocating for Access to Evidence for Evidence-Based Practice in School Health

Measures of Evidence in Evidence-Based Practice

Measures of Evidence in Evidence-Based Practice

Is There Enough Evidence for Evidence-Based Practice in Occupational Therapy?

Is There Enough Evidence for Evidence-Based Practice in Occupational Therapy?

Evaluation of Evidence in Evidence-Based Practice and How Library Science Can Help

Abstract In this article, we describe how collaboration with our university librarian at San Francisco State University led to the integration of information literacy competency standards within our curriculum, as outlined by the American Library Association (ALA). The ALA standards are related to the evaluation of evidence, a key component of evidence-based practice and these were infused across four courses in the communicative disorders program focused on language development and disorders. In particular, ALA Standard 3 stipulates that the student who is information literate evaluates information and its sources critically and incorporates selected information into his or her knowledge base and value system. The integration of Standard 3 within language disorders courses is described in detail. We anticipate that the infusion of information literacy skills related to the evaluation of evidence during academic training will make such skills an integral part of the clinical process for future clinicians.

School Libraries Worldwide as a Source of Evidence for Evidence-Based Practice, 1995-2006

The theme for this issue of School Libraries Worldwide is evidence-based practice. As I reflected on the articles that make up this issue, I was reminded of the research done by Laurel A. Clyde over the past five years or so on research and researchers in school librarianship (see Clyde, 2001, for a description of that program of research).

Editorial: The evidence for evidence‐based practice

Editorial: The evidence for evidence‐based practice

The Future of Evidence in Evidence-based Practice

Summary: This article considers factors important to the broad-scale adoption of an evidence-based approach to social work practice (EBP). Elements of the EBP framework, and particularly directions for future research, are examined in terms of a number of criticisms voiced in the literature.Findings: Scholars in social work and allied disciplines have emphasized the implications of evidential hierarchies, and particularly the questionable clinical relevance of randomized controlled trials. While offering important considerations, arguments in opposition of EBP can be misconceived. Evidence-based practice is not merely a ‘best practice’ orientation, but a heuristic framework intended to foster explicit and accountable decisional capacities. Where EBP is limited highlights empirical questions that remain unanswered. Future directions for the approach will require the participation of both practitioners and researchers.Applications: The article delineates the role of operationalized clinical decision-making, local clinical research, and the unique utilities of evaluation methodologies in building knowledge for a more clinically relevant evidence-base for social work practice.

Evidence-based practice in a small community hospital: A beginning

Evidence-based practice (EBP) immediately conjures up the use of research-based findings or related guidelines. This connotation, of course, is an essential part of best practice, but there is more to the evidence in EBP than research; 1–4 an additional or internal type of evidence also can be used to help achieve the goal of best practice. This evidence consists of locally collected assessment, planning, quality, and evaluation data, as will be illustrated with the example of Cooley Dickinson Hospital (CDH).

A State-of-the-Art Conference on Implementing Evidence in Health Care.

In the late summer of 2004, the Veterans Health Administration (VHA) convened an invitational symposium, one in a series of state-of-the-art (SOTA) conferences. VHA's SOTAs are high-level “think tank” sessions with a defined agenda focusing on a specific health care topic. The theme of this SOTA conference was “Implementing the Evidence: Transforming Practices, Systems, and Organizations.” About 100 individuals from across North America, not just from within VHA, gathered for 2 days in the Nation's capital. These were the perceived thought leaders in the implementation sciences, enriched by a few influential “movers” within the largest single health care system in the United States (the VHA). To maximize the yield of the 2 days of SOTA conference brainstorming, VHA commissioned papers to be circulated in draft form before the SOTA, with the intent of priming the pump for discussions organized into specific work groups. This issue of the Journal presents these commissioned papers, revised after the conference, selected and refined through peer review, and augmented by additional manuscripts from SOTA participants and their collaborators who responded to a thematic solicitation.