Implementation Of Evidence-based Practices Research Articles

Barriers and enablers to implementation of evidence-based practice in nursing: A systematic review of literature

Background; Evidence-Based Practice (EBP) is an essential aspect of today’s healthcare landscape through which high-quality scientific research evidence can be obtained and translated into the best practical decisions to improve health outcomes. Nurses and midwives deliver the highest proportion of direct patient/client care, and therefore need to utilize evidence based practice to ensure quality patient care. Despite the great importance of evidence-based care, majority practices shown to be effective by research remain unused in the nursing field. Nurses and other health care providers often cite barriers that prevent its delivery. Objective: To describe barriers and enablers to, successful implementation of evidence based Practice in nursing Methods: A Systematic mixed-studies review of literature, synthesizing quantitative and qualitative research was done. The review involved a search on multiple data base engines which included COCHRANE, google scholar and PubMed. A search of the database using keywords (implementation, adoption, compliance, Evidence based practice (EBP), nurses, barrier, challenges and facilitators was conducted. Results: A total of 43 articles were reviewed. Two common themes were identified as barriers to EBP. Individual barriers and organizational barriers. Individual barriers identified include inadequate knowledge on EBP, time constraints and nurse’s attitude towards EBP. Organizational barriers were lack of administrative support and lack of autonomy in nursing. Enablers of EBP identified were administrative support, engagement of stakeholders and nurses autonomy Conclusion: The key barriers to EBP implementation in nursing are deficient knowledge on EBP, time constraints and lack of autonomy in nursing. The barriers can however be overcome by supporting an environment that prioritizes EBP. Recommendations: Addressing barriers to EBP implementation will enhance quality of nursing care leading to better patient’ outcomes. To mitigate the barriers, targeted enablers such as trainings and workshops on EBP, supportive leadership and increasing nurses autonomy ought to be put in place.

Opportunities for nursing and midwifery research in Bulgaria

Abstract Background The training of nurses and midwives today is at university level and follows established standards. The 2009 Global Standards for the basic nursing and midwifery education of the World Health Organization requires that the curricula should include basic knowledge and skills for scientific research to implement evidence-based health care. In Bulgaria, scientific research among nurses and midwives began in 2000 and has seen more serious development in the last 5 years. Methods A content analysis of normative documents was carried out, to regulate the conduct of scientific studies and the curricula for the two specialties. Results In all documents on the activities of graduate nurses and midwives, activities related to conducting scientific studies are regulated. No mandatory discipline for these competencies is included in the basic education. In Bulgaria, there is a bachelor’s and master’s program only in Health Care Management, in which sociology, statistics, and research methodology are studied. From 2000 to 2016 nurses and midwives defended doctoral dissertations in a program for medical doctors. The first doctoral program for nurses and midwives is from 2016. There are no legal norms for stimulating and provide conducting clinical research, and to ensure evidence-based practice by nurses and midwives. Conclusions The normative regulation of scientific activity among nurses and midwives in Bulgaria corresponds to international and European requirements, but the opportunities for training are limited. The responsibility of nurses and midwives to modern society is to ensure high quality in health care provided by: a. providing opportunities for clinical studies; b. implementation of evidence-based health care and practice; c. developing programs for training for research in health care. Key messages • In Bulgaria, there is a legal norms for conducting nursing research, but not for evidence-based practice. • There is a need for more opportunities to train and encourage clinical nursing research.

Nurses’ implementation of evidence based practice in nursing process and its associated factors in South Wollo Zone public hospitals, Northeast Ethiopia: a mixed method study

BackgroundEvidence-based practice is clinical decision-making using the best evidence available in the context of individual patients’ preferences and clinical expertise. It is serving as a crucial instrument for the health science disciplines to minimize the theory-practice gap although the level of practice is unknown. Thus, this study aimed to assess nurses’ implementation of evidence-based practice in nursing process and its associated factors in South Wollo Zone Public Hospitals.MethodsAn explanatory sequential mixed method was employed from April 1 to May 29, 2023, among 419 nurses for the quantitative part and 15 others for the qualitative part. The data were collected using structured, pretested, self-administered questionnaires. Simple random and purposive sampling techniques were used to select participants for the quantitative and qualitative studies, respectively. The bivariable analysis was done primarily, and variables with a p-value < 0.25 were further examined using a multivariable logistic regression model to control con-founders. Then, variables having a p-value less than 0.05 with a 95% CI were used to declare significantly associated factors. The key informants were interviewed using pre-made interview guidelines, and then open code software was utilized to conduct a thematic analysis.ResultNurses who had poor implementation of evidence-based practice in the nursing process were 228 [54.42%; 95% CI: (49.8–59.3)]. Similarly, the key informants concluded that the implementation of evidence-based practice in the nursing process was low. Participants who were 31– 40 years old [AOR = 0.61, 95% CI: (0.38–0.99)], 41–50 years [AOR = 0.32, 95% CI: (0.15–0.65)], working at general hospitals [AOR = 3.37, 95% CI: (1.39–8.18)] and comprehensive specialized hospitals [AOR = 7.29, 95% CI: (3.06 − 17.31)], lack of training about evidence-based practice (AOR = 2.50, 95% CI: (1.36–4.56)], and lack of internet access [AOR = 2.46, 95% CI: (1.43–4.23)] were factors associated with poor levels of nurses’ implementation of evidence-based practice in the nursing process. The absence of computers, libraries, and updated guidelines were other factors identified on the quality analysis.ConclusionNurses’ implementation of evidence-based practice in the nursing process was low. Age, working in general hospitals, and comprehensive and specialized hospitals, lack of training, and internet access were factors that had significant associations. Hence, hospital managers should give an attention to internet access and training about utilization of evidence-based practice in nursing process, particularly for those aged above thirty years old.

Organizational evidence-based practice culture, implementation leadership, and nurses: A bidirectional mediation model.

This study aimed to explore 1) factors that influenced the evidence-based practice competencies and behaviors of clinical nurses and 2) the interaction between the organizational evidence-based practice culture, head nurses' implementation leadership, and nurses' evidence-based practice competencies and behaviors. The significance of organizational evidence-based practice culture and head nurses' implementation leadership in enhancing nurses' evidence-based practice competencies and behavior is widely recognized in healthcare settings. However, there is limited knowledge of how these factors influence nurses' evidence-based practice competencies and behavior. A cross-sectional survey was conducted at 10 hospitals in China. Data were collected via online questionnaires from October to December 2020, utilizing social characteristic questionnaires, the Evidence-Based Practice Questionnaire, the Organizational Culture and Readiness Scale for System-wide Implementation ofEvidence-Based Practice, and the Implementation Leadership Scale. All data were imported into the IBM Statistical Program for the Social Sciences (SPSS) 27.0 and PROCESS version 4.1 macro on SPSS for statistical analysis. The design and reporting of our study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist. We received 1047 (99.15%) valid questionnaires. The multiple linear regression analysis showed that significant factors were organizational evidence-based practice culture, implementation leadership, and years of experience in nursing. After controlling for the impact of the covariate (years of experience in nursing), it was found that organizational evidence-based practice culture partially mediated the relationship between head nurses' implementation leadership and nurses' evidence-based practice competencies and behaviors. Additionally, head nurses' implementation leadership partially mediated the relationship between organizational evidence-based practice culture and nurses' evidence-based practice competencies and behaviors. Organizational evidence-based practice culture, head nurses' implementation leadership, and years of experience in nursing significantly predict nurses' evidence-based practice competencies and behaviors. Organizational evidence-based practice culture and head nurses' implementation leadership mutually mediated their influence on nurses' implementation of evidence-based practice. Head nurses should proactively seek opportunities to enhance their implementation leadership, such as participating in training programs (e.g., mentoring and coaching programs) and attending conferences, workshops, or seminars on implementation leadership. Policymakers should also consider providing more policy support for implementing leadership development and cultivating a positive evidence-based practice culture.

The Influence of an Evidence-Based Practice Course on Saudi Nursing Students’ Beliefs About and Implementation of Evidence-Based Practice: A Cross-Sectional Comparative Study

The Influence of an Evidence-Based Practice Course on Saudi Nursing Students’ Beliefs About and Implementation of Evidence-Based Practice: A Cross-Sectional Comparative Study

Using Implementation Science to Implement Evidence-Based Practice: A Discursive Paper.

The purpose of this manuscript is to offer an overview of knowledge regarding Evidence-Based Practice and implementation science. It addresses the question: What are the EBP implementation models used in nursing settings? Discursive paper. The databases were searched with the following keywords: 'Nursing Faculty', 'Nurse educator', 'Academic', 'clinic', 'Evidence-based implementation', 'evidence-based practice', 'implementation', 'implementation science', 'undergraduate', 'nurse'. The search strategy aims to identify published studies. Eight databases were searched. There are specific implementation models for implementing EBP: the IOWA Model, the Stetler Model, the Johns Hopkins Nursing Evidence-Based Practice Model, the Stevens Star Model, the Promoting Action on Research Implementation in Health Services (PARIHS), the Advancing Research and Clinical practice through close collaboration (ARCC) model. They were analysed according to the Nilsen classification. An evidence-based implementation project must be structured. First, it is necessary to choose an implementation model, then identify one or more implementation strategies, and finally, plan evaluation for implementation outcome. The use of implementation science ensures successful implementation or at least highlights barriers that need adjustment. Effective utilisation of implementation science facilitates the transfer of obtained results to similar contexts. Implementation science complements the EBP process perfectly and ensures the proper implementation of evidence. EBP mentors now have the entire structure of implementation science to succeed in implementing evidence-based data in both academic and clinical settings. The discursive paper addresses the difficulties of implementing evidence in academic or clinical settings. Implementation science is the bridge between evidence and practice. Nurses now have everything they need to implement evidence-based practice successfully. There was no patient or public involvement in the design or writing of this discursive article.

Developing a Set of Standardized Core Principles and Methods Across Multiple Training and Technical Assistance Centers.

Despite a growing body of research demonstrating the value of using evidence-based programs and practices (EBPPs) to address health and education issues, the gap between research evidence and practice in education and human services continues to be a vexing problem. Technical assistance (TA) is widely accepted as a key strategy to support evidence-based programs and practices (EBPP) uptake and implementation. However, little is known about how TA practices are used in TA delivery. Moreover, little attention has been paid to building the capacity of TA providers and assessing the fidelity of the implementation of TA practices. The case example presented in this article describes one organization's efforts to develop common language and definitions of TA services, core principles, and methods, and to standardize the delivery of TA by enhancing the capacity and retention of TA providers. We conclude with recommendations about how like organizations can employ similar efforts to improve the quality and consistency of TA delivery, thereby establishing a foundation for building a strong evidence base.

Cultivating Curiosity in Midwifery Leadership

This article advocates for curiosity as a crucial element in midwifery leadership. It highlights the importance of curiosity in fostering innovation, enhancing communication and promoting a learning culture. The article emphasises that curious leaders can better navigate challenges, implement evidence-based practices and create a more supportive environment for midwives and women.

Assessing the Feasibility of Integrating the Lethality Assessment Program into the Los Angeles Domestic Abuse Response Team

Abstract Purpose The Lethality Assessment Program (LAP) Maryland Model is an evidence-based intervention designed to prevent intimate partner homicide. It includes the lethality assessment screen, a tool used by field practitioners to assess a victim-survivor’s risk of being killed by their partner, and a referral process linking victim-survivors to community-based domestic violence services. This study aimed to evaluate the LAP's alignment with the needs of Los Angeles and its potential integration into the Los Angeles Domestic Abuse Response Team (DART) Program, which operates in all 21 divisions of the Los Angeles Police Department (LAPD). Methods Between January and May 2021, we conducted qualitative interviews with 15 law enforcement officers, domestic violence service providers, and other stakeholders involved with DART to gather information for tailoring the LAP intervention for pilot implementation in three LAPD divisions. Results Participants were positive about the LAP and its integration into the DART program but identified several gaps, such as limited staff, resources, and training. Despite these concerns, there was widespread agreement that the LAP aligned with existing DART operations, with an emphasis on the importance of obtaining buy-in from non-DART LAPD personnel. Conclusions Results suggest that it will be feasible to pilot test the LAP in Los Angeles. These efforts should include fact-based education for officers on the rationale and factors behind the screening procedures to improve acceptance and implementation of evidence-based practices.

Unit Leadership and Climates for Evidence-Based Practice Implementation in Maternal-Infant Health Units: A Cross-Sectional Descriptive Study.

To describe unit leadership and climates for evidence-based practice implementation and test for differences in unit leader and staff nurses' perceptions within maternal-infant units. A cross-sectional descriptive study. A convenience sample of maternal-infant unit leaders and nurses (labour, postpartum, neonatal intensive care, paediatrics) from four Midwestern United States hospitals completed a survey including the Implementation Leadership Scale (ILS) and Implementation Climate Scale (ICS). Descriptive statistics described items, subscales and total scores. Independent t-tests with Bonferroni correction tested for differences in perceptions. A total of 470 nurses and 21 unit leaders responded, representing 17 units. Ratings of unit leadership and climates for implementation were modest at best [ICS: M = 2.17 (nurses), 2.41 (leaders); ILS: M = 2.4 (nurses), 2.98 (leaders)]. Unit leader ratings were statistically significant and higher than nurse ratings. This study is one of the first to describe unit leadership and climates for implementation in maternal-infant health. To improve outcomes and equity in maternal-infant health, attention on leadership behaviours and unit climates for evidence-based practice implementation is needed. Nurse leaders are encouraged to evaluate their leadership behaviours and the unit climates they facilitate, and work to improve areas of concern or where staff perceptions differ. Staff nurses should work with their leaders to identify resources and rewards/recognition which support and facilitate EBP implementation. This study addressed a gap in research examining the social dynamic factors of unit leadership and climate for evidence-based practice implementation in maternal-infant units. Leadership behaviours for implementation and unit climate were rated moderately by both staff and leaders. Unit leaders rated their implementation leadership and climates higher in almost all items. This study is relevant to unit leaders and nurses in maternal-infant units in the United States. This study adhered to STROBE guidelines. No patient or public contribution.

Process mapping with failure mode and effects analysis to identify determinants of implementation in healthcare settings: a guide.

Generating and analyzing process maps can help identify and prioritize barriers to the implementation of evidence-based practices in healthcare settings. Guidance on how to systematically apply and report these methods in implementation research is scant. We describe a method combining a qualitative approach to developing process maps with a quantitative evaluation of maps drawn from the quality improvement literature called failure mode and effects analysis (FMEA). We provide an outline and guidance for how investigators can use process mapping with FMEA to identify and prioritize barriers when implementing evidence-based clinical interventions. Suggestions for methods and reporting were generated based on established procedures for process mapping with FMEA and through review of original research papers which apply both methods in healthcare settings. We provide case examples to illustrate how this approach can be operationalized in implementation research. The methodology of process mapping with FMEA can be divided into four broad phases: 1) formulating a plan, 2) generating process maps to identify and organize barriers over time, 3) prioritizing barriers through FMEA, and 4) devising an implementation strategy to address priority barriers. We identified 14 steps across the four phases. Two illustrative examples are provided. Case 1 describes the implementation of referrals to chiropractic care for adults with low back pain in primary care clinics. Case 2 describes the implementation of a family navigation intervention for children with autism spectrum disorder seeking care in pediatric clinics. For provisional guidance for reporting, we propose the REporting Process mapping and Analysis for Implementation Research (REPAIR) checklist. Process mapping with FMEA can elucidate barriers and facilitators to successful implementation of evidence-based clinical interventions. This paper provides initial guidance for more systematic applications of this methodology in implementation research. Future research should use a consensus-building approach, such as a multidisciplinary Delphi panel, to further delineate the reporting standards for studies that use process mapping with FMEA.

Correct patient identification and matching of adults in an ambulatory care setting: a best practice implementation project.

Ambulatory care settings are at high risk for errors when identifying patients and matching them to their intended care. The objective of this project was to improve correct and consistent patient identification and matching to their intended care by nurses in ambulatory care settings. The seven-phase JBI Evidence Implementation Framework was used to guide this project. JBI tools were used to audit current practices and implement best practices in four ambulatory care units. The implementation plan included a baseline audit and two follow-up audits. Feedback was obtained through interviews with ambulatory care nursing staff, educational sessions were conducted for nursing staff, and unit guidelines were developed. In the baseline audit, compliance with best practice criteria for patient matching and identification was below 62% for 7/13 criteria. After conducting education sessions and other strategies, 1/3 pre- and post-clinical intervention criteria improved in compliance, while 2 were unchanged. For blood product administration criteria, 2/5 improved, 1 was unchanged, and 2 were lower than baseline. Nurses' education in patient identification procedures improved (1/1) and knowing where to access relevant policies remained unchanged at 100%. Criteria for patients knowing the importance of patient identification (2/2) and the identification band following national standards (1/1) improved from baseline. The results support the use of education sessions and infrastructure changes to promote and sustain change in evidence-based practice in ambulatory care units. Not all criteria improved, and the audit team identified strategies to improve the implementation of evidence-based practice in ambulatory care units. http://links.lww.com/IJEBH/A275.

O CUIDADO DA ENFERMAGEM AO PORTADOR DA ANEMIA EM UNIDADE DE TERAPIA INTENSIVA.

The study on nursing care for patients with iron-deficiency anemia in the ICU underscores the relevance of this common and potentially serious condition, caused by insufficient iron levels in the body. This deficiency hampers hemoglobin production, resulting in symptoms such as fatigue, weakness, and difficulty concentrating. Factors such as blood loss, dietary iron deficiency, and underlying conditions contribute to the development of iron-deficiency anemia, especially in critically ill patients in the ICU. The research reviewed biochemical data for anemia in the ICU and highlighted the importance of nursing care in this context. Increased oxygen demand due to physiological stress can exacerbate symptoms of iron-deficiency anemia in critically ill patients, leading to severe complications and prolonged hospitalization. The literature review addressed the methodology used to identify best care practices, including searching electronic databases and analyzing institutional protocols. The discussion of results underscored the severity of iron-deficiency anemia in the ICU, emphasizing the need for effective interventions to improve clinical outcomes. The results and discussions highlighted the crucial role of nursing in caring for patients with iron-deficiency anemia in the ICU. From early symptom detection to appropriate treatment administration, the nursing team plays a crucial role in patient recovery. Challenges such as constant monitoring, iron supplementation administration, and blood transfusions were discussed, emphasizing the need for continuous education and specialized training of the healthcare team. Finally, the concluding remarks emphasized the importance of a coordinated and continuous approach in managing iron-deficiency anemia in the ICU. The implementation of evidence-based practices, along with continuous team training, is essential for providing high-quality care and improving outcomes for patients.

Implementing Best Practice Guidelines under the Best Practice Spotlight Organisation: Facilitators and Barriers for Nurses: A Delphi Study.

The implementation and sustainability of evidence-based practice (EBP) is a complex process. Best practice guidelines (BPGs) can facilitate the translation of knowledge from theory into practice, but they require working groups to adapt recommendations and encourage adherence to them. The aim of this study was to identify facilitators and barriers of BPGs in the Registered Nurses' Association of Ontario®, within the framework of Best Practice Spotlight Organisations® (BPSOs®), in a hospital setting. Methods: This study was conducted using the modified Delphi method (two rounds) with a cohort of BPSO® Best Practice Champions. The facilitators and barriers included in the first round were identified through a bibliographic search. The degree of concordance was determined in the second round using the highest mean resulting values. Results: A total of 44 nurses responded, with a mean age of 42.57 ± 8.563. The facilitators included the following: work environment; working in a hospital that encourages research; and dedicating time to EBP (p < 0.001). The barriers included the following: excessive workload; professional mobility (p < 0.001); and lack of time (p = 0.002). Implications for practice: As such, it is necessary to approach human resource management by implementing new policies that guarantee systemic sustainability. The BPSO® programme is an excellent framework for promoting the translation of theoretical knowledge into practice and effecting institutional change.

Developing Evidence to Support Policy: Protocol for the StrAtegic PoLicy EvIdence-Based Evaluation CeNTer (SALIENT).

All federal agencies are required to support appropriation requests with evidence and evaluation (US Public Law 115-435; the Evidence Act). The StrAtegic PoLicy EvIdence-Based Evaluation CeNTer (SALIENT) is 1 of 6 centers that help the Department of Veterans Affairs (VA) meet this requirement. Working with the existing VA evaluation structure, SALIENT evaluations will contribute to (1) optimize policies and programs for veteran populations; (2) improve outcomes regarding health, equity, cost, and provider well-being; (3) advance the science of dissemination and knowledge translation; and (4) expand the implementation and dissemination science workforce. We leverage the Lean Sprint methodology (iterative, incremental, rule-governed approach to clearly defined, and time-boxed work) and 3 cores to develop our evaluation plans collaboratively with operational partners and key stakeholders including veterans, policy experts, and clinicians. The Operations Core will work with evaluation teams to develop timelines, facilitate work, monitor progress, and guide quality improvement within SALIENT. The Methods Core will work with evaluation teams to identify the most appropriate qualitative, quantitative, and mixed methods approaches to address each evaluation, ensure that the analyses are conducted appropriately, and troubleshoot when problems with data acquisition and analysis arise. The Knowledge Translation (KT) Core will target key partners and decision makers using a needs-based market segmentation approach to ensure that needs are incorporated in the dissemination of knowledge. The KT Core will create communications briefs, playbooks, and other materials targeted at these market segments to facilitate implementation of evidence-based practices and maximize the impact of evaluation results. The SALIENT team has developed a center infrastructure to support high-priority evaluations, often to be responsive to shifting operational needs and priorities. Our team has engaged in our core missions and operations to rapidly evaluate a high-priority areas, develop a comprehensive Lean Sprint systems redesign approach to training, and accelerate rapid knowledge translation. With an array of interdisciplinary expertise, operational partnerships, and integrated resources, SALIENT has an established and evolving infrastructure to rapidly develop and implement high-impact evaluations. Projects are developed with sustained efficiency approaches that can pivot to new priorities as needed and effectively translate knowledge for key stakeholders and policy makers, while creating a learning health system infrastructure to foster the next generation of evaluation and implementation scientists. PRR1-10.2196/59830.

Stakeholders' Perceptions of Hospital-Based Early Childhood Parenting Education Services: A Thematic Analysis

BACKGROUND: Postnatal parental education is deficient yet necessary to enhance the implementation of evidence-based newborn care practices among families. Educating both mother and father is crucial for optimal childhood development, and interventions targeting families can improve childcare practices. Implementing these interventions through systematic policies and protocols in LMIC hospitals is essential. This study explores the perceptions of pregnant women, parents, and healthcare workers regarding parenting education in a tertiary care hospital in Karachi, Pakistan. METHODS: In a qualitative study conducted in a tertiary care hospital in Karachi, Pakistan, participants included pregnant women, parents, and healthcare workers. The study used in-depth interviews with purposively selected participants, consisting of two individuals from each category. Interviews were conducted using a prepared guide, and data collection was performed by trained staff. Interviews were conducted until data saturation was achieved. The interviews were conducted in Urdu, transcribed, and translated into English. Thematic analysis was carried out manually. RESULTS: The analysis of pregnant women's experiences identified themes of personal pregnancy experiences, support systems, and hospital facilities. Women discussed physical, emotional, and financial challenges during pregnancy. They valued support from family and physicians but expressed a need for better educational resources in hospitals. For parents with children under one-year-old, themes included personal experiences, hospital experiences, and educational resources. Parents faced emotional changes, financial challenges, and desired improved work-life balance. They appreciated outpatient care but found lacking in inpatient experiences, particularly in the NICU. Healthcare workers emphasized the role of parents, families, and hospitals, highlighting the importance of teaching and understanding family dynamics. Also suggested improvement in holistic approaches, mandatory educational programs, and integrating parenting readiness into primary care. CONCLUSION: Hospital-based postpartum parenting education enhance overall baby care. Expanding literature emphasizes the importance of high-quality parenting for lifelong development. Identifying efficient programs and resources to enhance parental abilities and foster positive child growth is increasingly important.

Testing an Organizational Implementation Process Model Related to Teachers' Implementation-Related Attitudes and Behaviors: a Multilevel Mediation Analysis.

The effectiveness of school-based universal prevention programs is frequently diminished due to low-quality implementation. Organizational factors support high-quality implementation because of their broad influence across implementers. Conceptually, implementation leadership (i.e., behaviors that prioritize, reward, and support evidence-based practice [EBP] implementation) works to embed a favorable implementation climate (i.e., implementers' collective perceptions that their organization prioritizes, rewards, and support EBP implementation) leading to improved implementation citizenship behavior and attitudes toward EBP. This organizational implementation process model has some empirical support but has not been tested in a multilevel framework or related to hypothesized attitudinal and behavioral outcomes. The sample included 319 teachers across 39 US public elementary schools; all were implementing Schoolwide Positive Behavior Interventions and Supports. Multilevel mediation (level 1 = teacher, level 2 = school) was used to test the indirect association of implementation leadership on implementation-related attitudes and behaviors via implementation climate across two time points (fall and spring). At the school level, the organizational implementation process model was validated related to implementation citizenship behavior, but not attitudes toward EBP. At the teacher level, the process model was validated related to both outcomes, and there was a significant direct effect of implementation leadership on attitudes toward EBP. Developing strong leaders for implementation seems key to achieving high-quality EBP implementation. Implications for schools, principal training, and research are discussed.

Evaluation of Evidence-Based Practice Competency among Greek Undergraduate Nursing Students.

For several years, the global scientific community has accepted and recognized the importance of evidence-based practice for nursing science. The main factor for the implementation of evidence-based practice is the competence of undergraduate nursing students towards evidence-based practice, so that they as active nurses are ready for its application in their clinical practice, in order to provide better care for their patients. The aim of the present study is to examine the level of evidence-based practice competency evaluated with the self-reported Evidence-Based Practice Competence Questionnaire. It is important to mention that such a study has not been conducted on nursing students in Greece, but only on registered nurses. A quantitative study based on cross-sectional design was conducted from February to June 2022 in a convenience sample of Greek undergraduate nursing students. The SPSS 26.0 program was used to perform descriptive, bivariate, and multivariate analyses. A total of 175 undergraduate students participated at the Hellenic Mediterranean University Department of Nursing (Greece), specifically from the 2nd and 3rd academic years. The mean score of the Evidence-Based Practice Competence Questionnaire for nursing undergraduate students was 3.03 ± 0.26, indicating moderate evidence-based practice. Among the Evidence-Based Practice Competence Questionnaire dimensions, mean scores of 3.03 ± 0.32 for attitude toward evidence-based practice, 3.01 ± 0.49 for skills in evidence-based practice, and 3.03 ± 0.49 for knowledge in evidence-based practice were obtained. Significant differences among participants' mean Evidence-Based Practice Competence Questionnaire scores regarding gender (p = 0.766), age (p = 0.400), academic year (p = 0.153), and training in the field of research methodology (p = 0.538) were not found. It appears that the level of readiness towards evidence-based practice is mediocre among undergraduate nursing students at a university in Greece. Therefore, it is necessary to carry out new studies in the future, so that there is a correct approach of all the elements that contribute to the readiness of nursing undergraduate students regarding evidence-based practice.

Tracking implementation strategies in real-world settings: VA Office of Rural Health enterprise-wide initiative portfolio.

To use a practical approach to examining the use of Expert Recommendations for Implementing Change (ERIC) strategies by Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) dimensions for rural health innovations using annual reports on a diverse array of initiatives. The Veterans Affairs (VA) Office of Rural Health (ORH) funds initiatives designed to support the implementation and spread of innovations and evidence-based programs and practices to improve the health of rural Veterans. This study draws on the annual evaluation reports submitted for fiscal years 2020-2022 from 30 of these enterprise-wide initiatives (EWIs). Content analysis was guided by the RE-AIM framework conducted by the Center for the Evaluation of Enterprise-Wide Initiatives (CEEWI), a Quality Enhancement Research Initiative (QUERI)-ORH partnered evaluation initiative. CEEWI analysts conducted a content analysis of EWI annual evaluation reports submitted to ORH. Analysis included cataloguing reported implementation strategies by Reach, Adoption, Implementation, and Maintenance (RE-AIM) dimensions (i.e., identifying strategies that were used to support each dimension) and labeling strategies using ERIC taxonomy. Descriptive statistics were conducted to summarize data. A total of 875 implementation strategies were catalogued in 73 reports. Across these strategies, 66 unique ERIC strategies were reported. EWIs applied an average of 12 implementation strategies (range 3-22). The top three ERIC clusters across all 3 years were Develop stakeholder relationships (21%), Use evaluative/iterative strategies (20%), and Train/educate stakeholders (19%). Most strategies were reported within the Implementation dimension. Strategy use among EWIs meeting the rurality benchmark were also compared. Combining the dimensions from the RE-AIM framework and the ERIC strategies allows for understanding the use of implementation strategies across each RE-AIM dimension. This analysis will support ORH efforts to spread and sustain rural health innovations and evidence-based programs and practices through targeted implementation strategies.

Determinants and facilitators of community coalition diffusion of prevention efforts

This study examines how individual characteristics and network features of coalition participation in an intervention predict coalition members’ diffusion of Knowledge and Engagement in childhood obesity prevention. The study involved six communities in the U.S. measured across two to five time points from 2018 to 2021. Each community participated in the Stakeholder-driven Community Diffusion theory-informed intervention, a three-phase intervention that employs group model building and technical assistance with convened stakeholders to build Knowledge, Engagement, and utilize research evidence in community-led, childhood obesity prevention actions. Findings indicate that key individual-level characteristics (e.g., years of experience, gender, eigenvector centrality) and network-level features (e.g., hierarchy, clustering) are associated with higher increases in intervention outcomes of Knowledge and Engagement in childhood obesity prevention. We attend to issues of perceived influence and power in community coalitions, finding that younger, less experienced women who are not well connected to other well-connected coalition members experience smaller increases in intervention outcomes. Our discussion focuses on how individual- and network-level characteristics are associated with coalition support for evidence-based practice adoption and implementation.