Evidence-based Practice Process Research Articles

Clinical Inquiry and Problem Identification.

This is the second article in a new series designed to provide readers with insight into educating nurses about evidence-based decision-making. It builds on AJN's award-winning previous series-Evidence-Based Practice, Step by Step and EBP 2.0: Implementing and Sustaining Change (to access both series, go to http://links.lww.com/AJN/A133). This follow-up series will address how to teach and facilitate learning about the evidence-based practice (EBP) and quality improvement (QI) processes and how they impact health care quality. This series is relevant for all nurses interested in EBP and QI, especially DNP faculty and students. The brief case scenario included in each article describes one DNP student's journey.

National evaluation of DNP students' use of the PICOT method for formulating clinical questions.

The intent of the PICOT (i.e., Population, Intervention, Comparison, Outcome, Time) method is to formulate focused clinical questions to facilitate the discovery of relevant evidence through systematic searching, with the components of the question serving as the foundation for the search. Doctor of Nursing Practice (DNP) graduates use evidence-based practices to institute changes in their organizations' systems and policies, thereby yielding positive effects on both patient and system outcomes. Given that the clinical question is the foundation of the evidence-based practice process, DNP graduates' competence in the PICOT method needs to be better understood. This analysis aimed to describe how DNP students used the PICOT method to ask clinical questions in their DNP projects. Project questions were retrieved from a subset (n = 129, 60.56%) of an existing national random sample of publicly available DNP projects spanning the years 2010 to 2021 from Commission on Collegiate Nursing Education-accredited schools (n = 213). Project questions using the PICOT method were further evaluated with a scoring system of 0 = no and 1 = yes for missing elements, formatting, directional outcome, and project purpose. Possible scores ranged from 0 to 8, with higher scores indicating more errors. Discussion among five researchers, until agreement was achieved, yielded consensus. Although the PICOT method was project author-identified in 66 (31.0%) projects, only four (6%) followed the PICOT method. All 66 (100%) were intervention questions. There were 2.74 (SD 1.55) mean errors, ranging from 0 to 6. No questions were missing P or O. Specific errors included missing I 3 (4.5%) or missing C 37 (56%), poor formatting 34 (51.5%), directional outcome 44 (66.7%), and project purpose 38 (57.6%). Thirty-three (50%) of the questions were missing T; however, T is not used for searching, so researchers recalculated the mean error without T (M = 2.24, SD = 1.28, range 0-5). Gaps in the accurate use of the PICOT method to construct clinical questions can lead to biased searches, inaccurate clinical problem identification, and, when used as the project purpose, jumping to non-evidence-based solutions. Academic faculty and clinical educators can mitigate these skewed outcomes and enhance their impact on quality outcomes by helping DNP-prepared nurses shore up this foundational skill.

Exploring the Evidence-Based Practice Process with Social Work Practitioners

ABSTRACT Purpose This study investigates social work practitioners’ feasibility, attitudes, and familiarity with the Evidence Based Practice (EBP) process in their work and their ability to access and integrate research into their practice. Materials and Methods Social work practitioners (N = 256) were recruited through Reddit and Facebook and completed an online survey. Participants completed demographic questions (e.g. time in practice, degree type, practice role), research-seeking behaviors, and completed three subscales of the Rubin & Parish Evidence-Based Practice Process Assessment Scale. Results The three EBP process subscales assessed participants’ familiarity, attitudes, and perceived feasibility of the EBP process. The familiarity subscale could range from zero to 40, and the mean in this sample was 26.75 (SD = 5.55). The attitudes subscale could range from 0 to 56, and the mean in this sample was 37.03 (SD = 5.49). Finally, the feasibility subscale could range from zero to 20, and the mean in this sample was 12.18 (SD = 2.81). A linear regression was run to predict familiarity, feasibility, and attitudes toward the EBP process. Those who reported seeking out research more often found the process more familiar and feasible. Those who were in practice longer found the EBP process less familiar and had more negative attitudes. Discussion Strategies to address research familiarity, feasibility, and attitudes toward the EBP process include continuing experiential learning in education, accessing research in social media, and the use of continuing education. Conclusion Continuing to address the research-practice gaps is an essential step toward delivering EBP to clients.

Cultivating an Evidence-Based Decision-Making Mindset.

This is the first article in a new series designed to provide readers with insight into educating nurses about evidence-based decision-making. It builds on AJN's award-winning previous series-Evidence-Based Practice, Step by Step and EBP 2.0: Implementing and Sustaining Change (to access both series, go to http://links.lww.com/AJN/A133). This follow-up series will address how to teach and facilitate learning about the evidence-based practice (EBP) and quality improvement (QI) processes and how they impact health care quality. This series is relevant for all nurses interested in EBP and QI, especially DNP faculty and students. The brief case scenario included in each article describes one DNP student's journey.

Development and psychometric testing of the actualisation of evidence-based nursing instrument.

To describe the development of the Actualisation of Evidence-Based Nursing instrument targeted at nurses working in clinical practice (ActEBN-nurses), meant for evaluating the actualisation of individual and organisational-level support structures for evidence-based nursing within social and healthcare organisations, and to test its validity and reliability. Cross-sectional survey. The FinYHKÄ model was used as the theoretical background of the instrument development and supplemented with the JBI Model of Evidence-Based Healthcare, previous literature and items from a previous instrument, the Evidence-Based Practice Process Assessment Scale, with permission of the copyright holders. After two rounds of expert panel and piloting, a national survey was conducted with the instrument in 2021. The target group consisted of nurses working in clinical practice. Psychometric testing included internal consistency (Omega, item analysis) confirmatory factor analysis and t-test for comparison of two groups' differences (sensitivity). A new instrument, ActEBN-nurses was developed, comprising two parts: Individual-level (32 items, 5-point Likert-scale) and Organisational-level support structures for evidence-based nursing (37 items, 5-point Likert-scale). In total, 1289 nurses participated in the survey. The ActEBN-nurses proved to have good internal consistency in both parts (Omega ω .931 and .966), structural validity and sensitivity based on the two educational levels within the sample. The structure of both parts was slightly modified, based on the CFA modification indices, considering the impact of the reverse worded items in part Individual and redundant items within both parts. The ActEBN-nurses has promising psychometrics, and it can be used for evaluating individual and organisational-level support structures for evidence-based nursing within social and healthcare organisations. Evaluation of the support structures within social and healthcare organisations is needed to recognise shortcomings in current structures and advance evidence-based nursing across different contexts. The authors state that they have adhered to relevant EQUATOR guidelines: STROBE statement for cross-sectional studies. No patient or public contribution.

Role of Magnet®-recognized hospital nurse managers in implementing evidence-based practice: A mixed-method study.

Healthcare systems recognize evidence-based practice (EBP) as the prestigious standard for providing safe and high-quality patient care, nursing excellence, and Magnet Recognition. Despite the well-documented benefits, implementation of EBP is inconsistent and remains elusive in the US and throughout the world and many patients still fail to receive evidence-based care. The literature revealed a huge gap between nursing science and practice but provided evidence that nurse managers (NMs) had a pivotal leadership role in implementing EBP. To gain a deeper understanding of Magnet-recognized hospital nurse managers' (MRHNMs) leadership roles, the influencing factors, and their experience in implementing EBP to enhance EBP initiatives and sustain Magnet recognition. This mixed-method study guided by Goodall's (Australasian Psychiatry, 2016. 24, 231) theory of expert leadership used a sequential explanatory method with a quantitative-driven design based on a national correlational survey augmented by a qualitative descriptive component using semi-structured interviews. The findings of the study demonstrated that MRHNMs had a 54.6% effective leadership role in implementing EBP and produced numerous themes indicating that MRHNMs did implement EBP with struggle. MRHNMs in this study viewed EBP as a healthcare priority and leadership of NMs is necessary to promote EBP. However, lack of knowledge, difficulties with the EBP process, time constraints, and staffing issues negatively impacted EBP. Postgraduate degree, formal EBP education, critical care units as workplace, collaboration with doctorally prepared nurses, and Magnet culture enhanced EBP among MRHNMs. EBP is essential for Magnet recognition and is a hallmark of nursing excellence, however, is a complex and challenging process. The leadership of NMs is necessary to shape evidence-based care, and NMs require EBP preparation during leadership training, necessary resources, and time to complete the EBP process. EBP cannot become a reality without leaders being engaged, supportive, and persistent.

Nurses' experiences and perspectives regarding evidence-based practice implementation in healthcare context: A qualitative study.

To explore nurses' experiences and perspectives about evidence-based practice (EBP) implementation in the healthcare context. A qualitative descriptive study design using focus group discussions (FGDs). Sixty-four nurses who purposefully selected and worked at various healthcare organizations in Bisha Governorate, Saudi Arabia, were included. Eight FGDs were used to obtain data using open-ended questions. The collected data underwent inductive qualitative content analysis. Two main categories were extracted: experiences and perspectives towards EBP. The experiences category emerged into four sub-categories: familiarity with concepts and benefits, steps, dissemination sources of EBP and sources of EBP knowledge, while perspectives towards the EBP category included four sub-categories: application of EBP in clinical practice, barriers, facilitators and EBP application methods. The participants experienced being in a non-supportive and non-encouraging atmosphere which results from a lack of organizational commitment to EBP implementation and illuminates the complexities involved in the integration process. The nurses' experience with EBP indicated that there was limited support for the implementation of this approach. Furthermore, they experienced varying barriers to EBP implementation. They viewed EBP as a complex technique as they lacked knowledge and skills related to the formulation of research questions, and retrieving, applying and disseminating of EBP in clinical practice decision-making. That is due to barriers pertinent to the individual, organizational and patient factors. The key to successfully implementing an EBP in nursing practice is to promote professional development, comprehensive and continuous training, a culture of change, organizational support and motivation. Through the construction and provision of ongoing educational interventions and mentoring programmes about EBP, healthcare organizations and nursing leadership may develop a comprehensive strategy to encourage staff nurses' participation in the EBP process. This is to enhance nurses' experiences and perspectives towards the EBP approach and overcome the barriers to effective implementation. Patients or the general public were not involved in the design, analysis or interpretation of the data in this study.

Step 3: Critical Appraisal of Evidence-Expert Opinion.

Critically appraising the literature is the third step in the evidence-based practice process. The lowest level of evidence includes expert opinion and related types of literature. This column describes the appraisal of this type of literature using a specific set of questions.

Evidence-Based Practice Mission Possible: An Innovative Teaching Strategy for New Graduate Nurses.

Interactive strategies to teach nurse residents about evidence-based practice (EBP) can instill the confidence to question practice and ensure best care for patients. A nurse residency program with the Mission Possible theme transformed nurses into EBP agents that must solve the EBP process, step-by-step. Clues interspersed with didactic lessons guide the teams through the EBP mission. This creative option for teaching EBP may assist other educators in finding interactive learning opportunities for this content.

The use of the evidence-based practice process by experienced registered nurses to inform and transform clinical practice during the COVID-19 pandemic: A longitudinal national cohort study.

During the COVID-19 pandemic, many registered nurses (RNs) worked on the frontline caring for severely ill patients. They did so with limited knowledge of how to treat and prevent the disease. This extreme situation puts pressure on RNs to find evidence on which to base the care of their patients. To examine: (1) the extent to which evidence-based practice (EBP) process was applied by Swedish RN cohorts 15-19 years after graduation during the pandemic, (2) whether there was any change to their EBP process from pre-pandemic to late pandemic, (3) the relationship between RNs' use of the EBP process and the duration of exposure to work situations severely affected by the COVID-19 pandemic, and (4) whether level of education, position and care setting were associated with the extent of RNs' EBP process. In 2021, the level of EBP activities was investigated among 2237 RNs 15-19 years after graduation. The scale used to measure EBP consisted of six items of the EBP process. Unpaired t-tests or one-way analysis of variance (ANOVA) were used in the analysis. RNs used the EBP process to a moderate extent to inform and transform their clinical practice. There was a minor but significant decrease in practicing the EBP process from pre-pandemic to late in the pandemic. RNs who were most affected by the pandemic scored higher on the scale than less-affected colleagues. RNs in nonclinical positions reported more EBP activities, as did RNs in management positions. RNs working in outpatient settings reported more EBP activities than their colleagues in hospitals. It is imperative that RNs hone their skills in EBP if they are to be prepared for future healthcare crises. Healthcare providers have a duty to facilitate the development of EBP and, in this regard, RNs in clinical positions in hospitals need particular support.

SEEK™: A Program to Implement Evidence-Based Practice and Transform Oncology Nursing Practice.

Evidence-based practice (EBP) uses current and best evidence, clinical expertise, and patient values to drive clinical decisions. Organizations struggle with building and sustaining an EBP-focused culture. This article shares the development and implementation of SEEK™ (Spirit of Inquiry, Expanding EBP Knowledge), an educational initiative on how to apply EBP processes at a Magnet®- and National Cancer Institute- designated comprehensive cancer center. Participants learned principles of the EBP process using didactic sessions, small group exercises, and article critiques. With mentor guidance, participants searched for and appraised evidence, proposed interventions, designed an implementation plan, and developed metrics to measure results. To date, 56 SEEK projects are in various stages of development and implementation. Based on postprogram survey results, SEEK participants and mentors demonstrated increased EBP knowledge.

Step 3: Critically Appraising Evidence: Case-Control Studies.

Critical appraisal of the evidence is the Step 3 in the evidence-based practice (EBP) process. This column, the fourth in a multipart series to describe the critical appraisal process, focuses on the critical appraisal of a case-control study.

Environmental evidence in action: on the science and practice of evidence synthesis and evidence-based decision-making

In civil society we expect that policy and management decisions will be made using the best available evidence. Yet, it is widely known that there are many barriers that limit the extent to which that occurs. One way to overcome these barriers is via robust, comprehensive, transparent and repeatable evidence syntheses (such as systematic reviews) that attempt to minimize various forms of bias to present a summary of existing knowledge for decision-making purposes. Relative to other disciplines (e.g., health care, education), such evidence-based decision-making remains relatively nascent for environment management despite major threats to humanity, such as the climate, pollution and biodiversity crises demonstrating that human well-being is inextricably linked to the biophysical environment. Fortunately, there are a growing number of environmental evidence syntheses being produced that can be used by decision makers. It is therefore an opportune time to reflect on the science and practice of evidence-based decision-making in environment management to understand the extent to which evidence syntheses are embraced and applied in practice. Here we outline a number of key questions related to the use of environmental evidence that need to be explored in an effort to enhance evidence-based decision-making. There is an urgent need for research involving methods from social science, behavioural sciences, and public policy to understand the basis for patterns and trends in environmental evidence use (or misuse or ignorance). There is also a need for those who commission and produce evidence syntheses, as well as the end users of these syntheses to reflect on their experiences and share them with the broader evidence-based practice community to identify needs and opportunities for advancing the entire process of evidence-based practice. It is our hope that the ideas shared here will serve as a roadmap for additional scholarship that will collectively enhance evidence-based decision-making and ultimately benefit the environment and humanity.

The Design and Validation of a Self-Assessment Questionnaire of Critical Appraisal of Medical Literature Skills in Medical Students.

Critical appraisal of medical literature is a challenging step of the evidence-based medicine practice. Many assessment questionnaires have been published in the literature, but they have mainly focused on all the evidence-based medicine practice process. The authors aimed to develop and validate a questionnaire assessing the critical appraisal skills of medical students from the same Faculty. The questionnaire was developed by item generation through a review of the literature and an expert committee. The questionnaire was validated in terms of content validity and construct validity. Fitness of data for analysis was checked through Kaiser-Meyer-Olkin (KMO) and Bartlett's sphericity. Construct validity was carried out using a principal axis exploratory factor analysis (EFA) with 'varimax' rotation to study the internal structure of the questionnaire and to extract the test major factors. The questionnaire was administrated to a cohort of under and postgraduate medical students (n=84) to evaluate the test reliability and select the best items. The reliability of the questionnaire was assessed by Cronbach's alpha coefficient to evaluate the internal consistency. The correlations between the self-confidence and satisfaction dimension score, the critical thinking dimension score, the learning style dimension score, the Fresno-adapted test scores and the total score were assessed using the Spearman's correlation test. The questionnaire consisted of 31 items. A factorial analysis grouped the items into 3 dimensions that consisted of the self-confidence and satisfaction dimension, the critical thinking dimension and the learning style dimension. Cronbach's alpha accounted for 0.95, CI95% [0.9-1] for the entire questionnaire. The factor analysis explained 79.51% of the variance. The external validity assessment based on a Spearman's correlation study highlighted a weak correlation between the total scores and the critical thinking dimension and the self-perception and satisfaction dimension. In spite of the limitations of this study, mainly the small number of the students recruited, the questionnaire seems to measure with adequate reliability the competences of under and postgraduate medical students.

Step 3: Critically Appraising Evidence: Systematic Review or Metasynthesis of Qualitative Studies.

Critical appraisal of the evidence is the third step in the evidence-based practice (EBP) process. Many questions in nursing cannot be answered using quantitative methods. We often desire a better understanding of people's lived experiences. In the NICU, these questions may be related to the experiences of families or staff. Qualitative research can provide a deeper understanding of lived experiences. This column, the fifth in a multipart series describing the critical appraisal process focuses on the critical appraisal of a systematic review of qualitative studies.

Predictors of Social Work Practitioner Engagement in Evidence-Based Practice: A Cross-Sectional Survey

ABSTRACT Purpose : There has been a sustained effort to integrate the evidence-based practice (EBP) process within social work over the past few decades, yet it is unclear whether these efforts have increased the adoption of this process in social work practice. This study describes predictors of master’s level social work practitioners’ engagement in the EBP process. Method : A cross-sectional survey with NASW-Texas members (N = 258) was conducted to assess social workers’ understanding, attitudes, and implementation (and perceived difficulty) of the EBP process. Results : Most respondents endorsed the multistep process definition of EBP, were favorable to EBP and viewed its application as easy or very easy. However, only 27% of the respondents reported engaging in all the steps of the EBP process often or very often. Greater years as a licensed practitioner, more positive attitudes about and less perceived difficulty with EBP predicted increased engagement. Discussion : While it appears progress may have been made compared to prior Texas NASW samples regarding views of and engagement in EBP, the discrepancy between higher engagement in specific EBP steps and engagement in the entire process is recommended for future research.

De-adopting low-value care: The missing step in evidence-based practice?

BackgroundLow-value care provides little or no benefit to pediatric patients, has the potential to cause harm, waste healthcare resources, and increase healthcare costs. Nursing has a responsibility to identify and de-adopt low-value practices to help promote quality care. Purpose1) Describe the process of identifying and de-adopting low-value clinical practices guided by a conceptual model using a case study approach.2) Identify facilitators and barriers to de-adoption practices, including levels of stakeholder engagement, organizational structures, and the quality of available scientific and non-scientific evidence. MethodologyAn evidence-based practice (EBP) project investigating the efficacy of antihistamines in decreasing infusion reactions to infliximab identified a low-value practice within a pediatric infusion center. The Synthesis Model for the Process of De-adoption was then applied to guide the de-adoption of this low-value practice. Case study analysis highlighted facilitators and barriers to de-adoption efforts. ConclusionsThe process for de-adopting care is an essential component of EBP and, as such, should be explicated through robust, standardized EBP processes and education. Practice implicationsNurses are best positioned to identify, assess and prioritize low-value practices and facilitate the de-adoption of low-value practice that impact pediatric patients and families.Models to support de-adoption and a focus on site-specific practices including a prepared nursing workforce, continuous evaluation of care processes and the use of resources to assess for contextual determinants facilitates success and sustainability of this essential EBP approach.

Effect of a Nursing Research Council on System-Wide Practice Changes: An Evidence-Based Practice Process Improvement

Ensuring that evidence-based practice is adopted across hospital systems is difficult. A system-wide Nursing Research Council in a large academic health care system in Maryland implemented a unique strategy to support the evidence-based practice process by collaborating with other system-wide councils. As a result, new system-wide evidence-based practices were adopted and improved organizational outcomes were seen. [J Contin Educ Nurs. 2023;54(1):25-31.].

Implementation Science Toolkit for Clinicians: Improving Adoption of Evidence in Practice.

Clinicians are often familiar with quality improvement (QI) and evidence-based practice (EBP) processes, which provides guidance into what evidence should be implemented; however, these processes do not address how to successfully implement evidence. Clinicians would benefit from a deeper understanding of implementation science, along with practical tools for how to use these principles in QI and EBP projects. We provide a brief background of the principles of implementation science, an overview of current implementation science models and a toolkit to facilitate choosing and using common implementation science strategies. In addition, the toolkit provides guidance for measuring the success of an implementation science project and a case study showing how implementation science strategies can be used successfully in clinical practice. Using an implementation science toolkit for designing, conducting, and evaluating a QI or EBP project improves the quality and generalizability of results.

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.