Evidence-based Practice Experts Research Articles

Research Knowledge Translation in Sensory Integration-Based Therapy: Exploring Subjectivity of Clinical Expertise.

Background. Clinical expertise is the mechanism through which practitioners implement other components of evidence-based practice (EBP). Within occupational therapy practice, intervention approaches that are both closely and loosely aligned with Ayres' Theory of Sensory Integration are widespread, offering a unique opportunity to investigate the subjective nature of clinical expertise in EBP. Purpose. This qualitative study explored motivations to offer sensory integration-based interventions, and factors informing occupational therapists' clinical decision making in relation to an arguably contentious evidence base. Method. Six post-graduate sensory integration trained UK occupational therapists participated in individual semi-structured interviews. Interviews were transcribed, member-checked and analyzed using thematic coding analysis. Findings. Despite sound understanding of theory and continuous efforts to develop clinical knowledge, non-traditional hierarchies of evidence notably inform clinical decisions. The clinical expertise required for integration of patient preferences, clinical state and circumstances, and research evidence is informed by pragmatic responses to facilitators and barriers across contexts, combined with unique profession-specific identity factors. Implications. While empirical healthcare research is ideally undertaken under controlled conditions, realities of clinical practice are rarely so clear cut. Study findings highlight important subjective factors that are central to real-world research knowledge translation and further understanding of the clinical expertise component of EBP.

Clinical Inquiry in Nursing Readiness Fellowship: Increasing Air Force Nurse Corps Evidence-Based Practice Leadership Infrastructure.

Increasing demands to generate, translate, and implement evidence into practice in manpower and budget-constrained environments triggered innovative support for the nursing scientific community. The Clinical Inquiry in Nursing Readiness (CINR) fellowship is a solution to integrate readiness into clinical inquiry priorities and develop future experts in the field. This article describes the fellowship program structure, implementation, and contributions to nursing science, readiness, and professional development. We share specific recommendations based on our experiences to enhance and sustain this valuable fellowship program. Six fellows have completed the CINR fellowship since its launch in July 2019. Fellows garnered $40,000 in grant funds for five evidence-based practices, two research studies, and six clinical inquiry initiatives. So far, the fellows have produced 20 knowledge products: Three published manuscripts, three evidence-based resource toolkits, nine professional conference presentations (one international), five professional certifications, a variety of organization-wide leadership briefings, and two military decorations specific to the pandemic response. Establishing a fellowship program to develop a pipeline of readiness-focused nurse scientists and evidence-based practice experts builds future capacity for the enterprise while professionally developing individual nurses for advanced degrees and clinical inquiry leadership roles. Individuals and organizations aspiring to promote a culture of nursing inquiry may benefit from fellowships such as the CINR program.

Evidence-based practice models and frameworks in the healthcare setting: a scoping review

ObjectivesThe aim of this scoping review was to identify and review current evidence-based practice (EBP) models and frameworks. Specifically, how EBP models and frameworks used in healthcare settings align with...

An objective test to measure evidence-based practice knowledge and skill competency of acute care nurses: Apsychometric validation study.

Few objective measures of evidence-based practice (EBP) knowledge/skill exist. The Fresno Test, one objective method, was validated first with medicine, followed by versions for physical therapists, occupational therapists, speech therapists, social workers, dietitians, pediatric nurses, and health care students. The Fresno Test was adapted and tested with cohorts of acute care nurses. Six of the 14 items required revision to achieve acceptable psychometrics. The aim of this second validation study was to revise and validate a new version of the test, The Modified Fresno Test-Acute Care Nursing (MFT-ACN), to determine if it could distinguish EBP knowledge/skills among acute care nurses. A panel of eight EBP experts were engaged in multiple Delphi rounds to revise items. Individual-content validity indices (CVI) ranged from 0.83 to 1.0, with scale-CVI 0.92. Using a cohort design, a cross-sectional sample of 90 novice, master, and expert nurses were recruited via national listservs or snowball sampling to complete the revised test. Two doctorally prepared EBP experts independently scored tests using the standardized rubric. The MFT-ACN yielded strong psychometric properties (intra-class correlation coefficients > 0.80; item discrimination indices > 0.20; item-total correlations > 0.30). One poorly performing item was dropped per a priori cut-off values. The final test included 13 items, with a Cronbach's alpha=0.77. Item difficulty was moderate to high. Most items discriminated well between cohorts. Mean total scores were positively correlated with age, years since graduation, years of acute care experience, and formal EBP or research workshops or conferences or courses or immersions. Perceived level of EBP expertise was not associated with mean scores. Further research is recommended with a larger sample to assess the tests' responsiveness to change in EBP knowledge/skills over time and enhance its acceptability and feasibility. Additional research should further evaluate construct and concurrent validity against other objective assessments of EBP knowledge/skills. The validated 13-item MFT-ACN can be used to evaluate EBP competencies of acute care nurses in academic and practice settings. It can also be used by nurse scientists to build a stronger evidence base on types of educational programs that excel in advancing the critical competency of EBP among our nursing workforce.

The Doctor of Nursing Practice help desk: An innovative approach to developing evidence-based practice competency and providing DNP project support.

The 2021 American Association for Colleges of Nursing (AACN) Essentials for Professional Nursing Education identifies evidence-based practice (EBP) as a core concept meant to be integrated across curricula. Integrating EBP in Doctor of Nursing Practice (DNP) programs is challenging because of barriers including persistent confusion between research, EBP, and quality improvement; low faculty confidence and competence in their EBP skills and mentoring; increased faculty workload with growing program enrollments; and limited opportunities for students and faculty to practice EBP skills. The aim of this initiative was to implement and evaluate an innovative education strategy to build DNP students' and faculty's EBP competency and confidence while mitigating barriers faced by DNP programs. A DNP Help Desk was created and implemented at a large, Midwestern college of nursing with participation and support from EBP experts. Student and faculty participation were tracked, and perceptions of the help desk were evaluated. Opportunities to evolve the help desk were identified and implemented. Outcomes included a self-reported increase in student and faculty confidence and EBP competency, increased integration, and utilization of EBP in project work, elevated DNP project quality, and decreased demands on DNP project advisors. Engaging in innovative strategies aimed at increasing EBP competency and confidence may lead to increased EBP engagement and positive outcomes for students, faculty, and DNP programs.

Evidence, expertise, and patient/family preferences to maximize health for older adults with implications for evidence-based practice.

As Americans live longer and with chronic conditions, the healthcare system, researchers, faculty, practicing providers, patients, and families must adapt to changing societal needs and goals. The aim of this commentary was to offer recommendations that align with the six vital directions to improve the health care and quality of life for older Americans. This article expands upon the six vital directions from an evidence-based practice (EBP) perspective that values the three legs of the EBP stool: (1) research evidence, (2) clinician expertise, and (3) patient preferences, values, and circumstances. The recommendations reflect the scientific literature, our expertise in EBP and research, our nursing roles and expertise, and our experiences in the care of our older parents. By sharing our experiences as nurse scientists and daughters, we offer insight to raise the healthcare bar for older adults through EBP and meaningful, person-centered care. Vital directions for improving the health care and quality of life for older Americans include promoting interprofessional education to create an adequately prepared workforce; researching and implementing pathways to minimize the social determinants of health for older adults; disseminating findings that remediate older adult health disparities; innovating approaches for managing chronic health conditions at home; and studying and implementing approaches for allocating resources for end-of-life care that are satisfying for the patients, their family, and clinicians.

Two Halves of a Greater Whole: The Human Touch of Caring and the Scientific Approach of Evidence-Based Practice.

Charlotte Sortedahl, DNP, MPH, MS, RN, CCM, is a Commissioner and former Chair of the Commission for Case Manager Certification (CCMC), the first and largest nationally accredited organization that certifies more than 50,000 professional case managers and disability management specialists. Charlotte is also a professor at the University of Wisconsin-Eau Claire where she teaches in the undergraduate and graduate programs. She has a clinical background in case management, with expertise in evidence-based practice, case management, community health, and leadership. Address correspondence to Charlotte Sortedahl, DNP, MPH, MS, RN, CCM ([email protected]). The author reports no conflicts of interest.

Evidence-Based Practice among Critical Care Nurse’s/Midwives in Qatar

Background: Successful implementation of evidence-based research into clinical practice was determined by four core elements, self-belief, the nature and level of evidence, the conductive context into which the study is to be implemented, and organizational factors facilitating the process. Aim: The current study aimed to examine barriers influencing evidence-based practice among critical care nurses in QATAR. Methods: A cross-sectional survey was utilized for the study resulting in data collected from 278 nurses during the period of Feb-2021 to March 2021 using the Barriers to Research Utilization Scale (BTRUS). The BTRUS consisted of data on various information sources utilized by nurses for support in practice, potential barriers for evidence-based practice, and perceived skills on applying research-based evidence. Result: The most significant organizational barriers were lack of time, lack of empowerment to change practice, lack of support from colleagues in implementing research evidence, and lack of access to research articles. Self-perceived barriers were irrelevance of research evidence to current practice, studies having methodological flaws, skepticism about research findings, a large amount of research evidence, and inability to understand statistics. The Nurse’s age, years of nursing practice, academic attainment, and organizational position influenced self-reported barriers and utilization of sources of Evidence. Conclusion: Organizational support, improved self-belief, and evidence-based practice expertise may reduce barriers to implementing research evidence in clinical Practice.

Development of a Cadre of Evidence-Based Practice Mentors for Nurses: What Works?

Development of a critical mass of evidence-based practice (EBP) mentors for healthcare professionals is pivotal in facilitating and sustaining system-wide implementation of evidence-based care, especially for nurses. Empirical evidence shows that organizational factors are strongly associated with EBP. However, the understanding of organizational support to promote EBP competency is found lacking, especially in Mainland China. The purposes of this study were to (1) establish a baseline assessment of EBP nursing leadership and work environment support as well as EBP competency for EBP mentors of nurses in Western China, and (2) explore how nursing leadership and work environment impact the EBP competencies of mentors. A cross-sectional study was conducted. The study population was 286 EBP mentors for nurses from six urban general hospitals in Xi'an City, Shanxi Province. The EBP Nursing Leadership Scale and the EBP Work Environment Scale were used to evaluate their perceived organizational support. EBP competency was measured by the Evidence-Based Practice Questionnaire. There was insufficient time for EBP mentors of nurses to engage in EBP. Lack of experts in EBP and educational offerings about EBP were identified as the two lowest workplace organizational supports for EBP. The respondents reported themselves as not competent in EBP, especially for the knowledge/skills. EBP nursing leadership and work environment support were key predictors of the self-reported EBP competency in the stepwise multiple linear regression models (β=.211-.345, p<.01). It is imperative to provide EBP mentors for nurses with the knowledge and skills to achieve the expected level of EBP competency. Strategies for developing a cadre of EBP mentors for nurses who have competency in EBP need to be multipronged and target the cultivation of an organizational culture that supports EBP.

Impact of a Formal Educational Skill-Building Program Based on the ARCC Model to Enhance Evidence-Based Practice Competency in Nurse Teams.

Implementation of evidence-based practice (EBP) is necessary for healthcare systems to improve quality, safety, patient outcomes, and costs. Yet, EBP competency is lacking in many nurses and clinicians across the country. The purpose of this initiative was to determine whether nursing teams (Executive Leader, Clinical/Mid-level Leader, and Direct Care Nurse) attending a 5-day EBP continuing education skill-building program (immersion) was an effective strategy to build EBP competence, practice, and culture sustainability over time. The Advancing Research and Clinical Practice Through Close Collaboration Model was used to guide this initiative. A project team was assembled, including leaders with EBP expertise from the Air Force Medical Service and The Helene Fuld Health Trust National Institute for EBP in Nursing and Healthcare at The Ohio State University. Five survey instruments were used to evaluate outcomes, including Organizational Culture and Readiness for System-Wide Implementation of Evidence-Based Practice, Evidence-Based Practice Beliefs, Evidence-Based Practice Implementation, and Evidence-Based Practice Competencies, as well as the Knowledge Assessment Questionnaire test. Nursing teams were invited to participate and complete the program with the implementation of EBP projects over the following year. Participants' EBP knowledge, skills, competencies, and beliefs were significantly improved and sustained over 12months. A team-based EBP skill-building program was an effective strategy for building EBP competence, practice, and culture. This initiative demonstrated that the direct involvement of leadership and infrastructure to support EBP were crucial factors for building and sustaining an EBP culture.

Applied and conceptual approaches to evidence-based practice in research and academic libraries

Evidence-based practice is an approach to professional practice that involves a structured process of collecting, interpreting and applying valid and reliable research and evidence to support decision-making and continuous service improvement in professional practice. This paper reports on emerging initiatives in evidence-based practice at the University of Southern Queensland (USQ) Library, a regional multi-campus university in Australia. It demonstrates how evidence-based practice forms part of our organisational strategy to engage with our community and society. The case study describes a new model of embedding evidence-based practice through a role explicitly dedicated to developing the library’s evidence base. While other libraries may have a person responsible for assessment, performance metrics or data analysis, the Coordinator (Evidence-Based Practice) has a broader mandate – to work with library staff to develop tools, skills and expertise in evidence-based practice. The paper will describe why this role was created and how the Coordinator is working to engage with library staff to understand their business and the evidence needed to support service improvement for the Library. By doing this, USQ Library is building the capacity to demonstrate value to stakeholders, gain a deeper understanding of clients’ needs and experiences, promote robust decision-making and improve service delivery. The paper also outlines an initiative led by the Coordinator (Evidence-Based Practice) to develop a conceptual model of evidence-based practice within academic libraries at the organisational, rather than individual level. Current models of evidence-based library and information practice apply predominantly to individuals. Informed by relevant literature and 16 semi-structured interviews with library professionals from Australian and New Zealand university libraries, three themes emerged to describe how evidence-based practice might be experienced at the organisational level. The lived experience at USQ Library and our research investigations suggest that being evidence-based provides benefits to an academic library’s culture, practice and impact.

Validation study and setting norms of the evidence based practice competence questionnaire for nursing students: A cross-sectional study in Poland

BackgroundAchieving high quality care through full use of potential stemming from the use of the principles of evidence based practice (EBP) requires adequate shaping of student attitudes toward EBP already at an early stage of education, as well as teaching in the scope of knowledge and skills essential to apply EBP in future professional work. Therefore, nursing educators need a tool to assess competency in EBP. This study aims to present the adaptation of the psychometric test and setting norms to the Polish version of the Evidence Based Practice Competence Questionnaire (EBP-COQ_P). MethodsPoland-wide multicentre study, cross-sectional validation design, a representative sample of 1636 nursing students. The EBP-COQ_P was validated in terms of content validity through an expert review. The EBP-COQ_P was administered to evaluate test reliability and validity. Settings norms for the Polish nurse population were also done. ResultsConfirmatory factor analysis demonstrated that 25 items are grouped into three categories which define competences related to EBP: attitude, knowledge, and skills. Cronbach's alpha was 0.856 for the entire questionnaire. EBP-COQ_P had good parameters of absolute stability. EBP-COQ_P was also characterized with external construct validity. Measurement with the use of EBP-COQ_P allowed for a good differentiation of the respondents in terms of their expertise in EBP (known-groups validity). ConclusionsIn terms of reliability and validity, EBP-COQ_P is compared with its original version. EBP-COQ_P may be used in educational practice (graduate and postgraduate education). Polish norms set for a representative group of nursing students may serve as a benchmark for the results obtained from individual and group measurements.

The Role of the Doctor of Nursing Practice in Promoting Nonpharmacologic Pain and Comfort Management.

In this article the author presents her vision for integration of nonpharmacologic treatments, many taken from whole systems of care (Verhoef et al., 2005), for both pain and comfort management. By combining the evidence-based practice expertise of the clinical nurse specialist role with the knowledge of innovation, systems thinking, health policy, and implementation science acquired in the Doctor of Nursing Practice program, she is engaging interprofessional teams to join her shared vision.

The Belgian Evidence-Based Practice Program: network governance to improve efficiency and effectiveness of evidence-based practice uptake.

In 2016, the Belgian Minister for Social Affairs and Public Health decided to set up a central governance structure for evidence-based practice (EBP). The underlying model, consisting of six EBP life cycle cells (prioritization, development, validation, dissemination, implementation and evaluation) and a bipolar governance layer was developed in 2017. Based on the characteristics of the Belgian EBP landscape, a network administrative organization was chosen to coordinate and facilitate the operational processes in the EBP life cycle and act as intermediate between the two forces: stakeholders and funders/policy makers. Scientific processes remain the responsibility of the EBP experts in the cells. As organizational change can result in resistance, building trust and consensus is a very important success factor for the setup of the network. The process is now in an advanced stage and in 2019 the EBP governance structure will be operationalized.

An undergraduate student-faculty collaborative EBP project supporting a campus-wide tobacco free campus

The purposes of this paper are to describe a student-faculty, collaborative team and the evidence-based practice (EBP) project that supported a campus-wide, tobacco-free environment. Two faculty members served as mentors and undergraduate nursing students were selected to participate in a one credit independent study course outside the threaded curricular experiences. Weekly course meetings were used to assess course goals and EBP project progress. After reviewing literature evidence, a baseline campus survey, and focus group data, the best practice strategies were selected by the student-faculty collaborative team for a 3-year plan. The strategies included an orientation session to the tobacco-free campus during student fall orientations and a marketing campaign with social norm messaging. Pre and post-EBP project surveys to determine the effectiveness of the campaign were used to evaluate the outcomes of the team’s efforts. The undergraduate nursing students were effective in planning and implementing the project, and the students reported benefits and challenges to their involvement. The collaborative team was seen as an immensely positive experience despite the increased demands on time. Findings from this EBP project were similar to other literature on smoking abstinence on a college campus. One way to help undergraduate students better appreciate and gain expertise in the EBP process is to engage them in student-faculty collaborative EBP projects within the curriculum. In addition, an emersion experience offers expanded opportunities and greater expertise in EBP to students who can meet the challenge.

Methods.

Methods.

Evidence based practice in traditional & complementary medicine: An agenda for policy, practice, education and research

ObjectiveTo develop a policy, practice, education and research agenda for evidence-based practice (EBP) in traditional and complementary medicine (T&CM). MethodsThe study was a secondary analysis of qualitative data, using the method of roundtable discussion. The sample comprised seventeen experts in EBP and T&CM. The discussion was audio-recorded, and the transcript analysed using thematic analysis. ResultsFour central themes emerged from the data; understanding evidence and EBP, drivers of change, interpersonal interaction, and moving forward. Captured within these themes were fifteen sub-themes. These themes/sub-themes translated into three broad calls to action: (1) defining terminology, (2) defining the EBP approach, and (3) fostering social movement. These calls to action formed the framework of the agenda. ConclusionsThis analysis presents a potential framework for an agenda to improve EBP implementation in T&CM. The fundamental elements of this action plan seek clarification, leadership and unification on the issue of EBP in T&CM.

Content validity of a health science evidence-based practice questionnaire (HS-EBP) with a web-based modified Delphi approach.

To develop a tool for measuring evidence-based practice (EBP) and to evaluate its content validity by Delphi technique. A five-factor/dimensions latent structure for the EBP construct was defined a priori and operationalized. Online Delphi technique. A group of 32 national EBP experts from different health professions. The experts rated the initial questionnaire items according to adequacy and relevance criteria using four-point Likert scales and including open fields for suggestions, with basic and supplementary criteria consensus established a priori. Level of consensus in the Content Validity Index Item. An EBP construct solution was designed with the elements that constitute the operationalization proposal of the EBP. This initial version consisted of 76 items, whereas the version arising from the Delphi study was made up of 73 items. In the first round, 13 items did not reach the minimum level of consensus, and 12 of these were reformulated. Three additional items were removed in the second round. A new psychometric tool forms measuring EBP with a five-factor structure, and 73 items obtained adequate content validity evidence based on expert opinion.

The place of service-user expertise in evidence-based practice

Summary This article considers the place of service-user knowledge and expertise within an evidence-based practice perspective. It makes a strong argument that client involvement is a core principle of Sackett et al.'s foundational approach in evidence-based medicine. In so doing, it draws on research on service-users' perceptions and experiences of evidence-based practice. Findings For service users, evidence-based practice lacks relevance and trustworthiness unless it explicitly factors in the expertise of service users themselves. Evidence-based practice is seen to have merit as a tool for enhancing accountability, but service users see a role for themselves at individual and representative levels in the process of evidence-based practice. They place a high value on the expertise derived from lived experience, and recognise that fluctuations in capacity and changes in circumstances of many service users require a flexible approach to their participation in decision making. A pragmatic approach to the conceptualisation of evidence is recommended, which not only maintains scientific rigour inherent in evidence-based practice but also more strongly emphasises the process of analysing evidence appropriate to a particular individual's preferences and circumstances. Applications For human service practitioners, this study emphasises the need to develop professional skills in assessing the capacities, circumstances and preferences of clients and analysing and applying evidence for practice in ways that conform to a client-centred approach. It also indicates a need for researchers and practitioners to recognise and value service-user expertise.

The development and content validity testing of the Quick-EBP-VIK: A survey instrument measuring nurses’ values, knowledge and implementation of evidence-based practice

Objective: A validated survey tool that concisely measures nurses’ values, knowledge and implementation of evidence-based practice (EBP) is needed to develop needs-based curricula for continuing nurse education. Purpose: Develop a succinct measurement instrument, the Quick-EBP-VIK, assessing nurses’ values, implementation and knowledge of EBP, to establish face and content validity. Methods: In Phase I-Review of the existing literature to establish topic domains, developed and refined questions. Phase II established face validity, and Phase III content validity using EBP experts as raters. Results and conclusions: Twenty-five questions met the clarity and relevance criteria with content validity indices of > .80. Questions were critically evaluated by EBP experts from both academic and clinical settings across the country for relevance and clarity and revised when indicated. The use of EBP experts and content validity indices resulted in a final survey instrument, measuring nurses’ values, knowledge and implementation of EBP.