Implementation Of Evidence-based Practices Research Articles

Exploring the Scholarly Value and Impact of DNP-Prepared Nurses Through the Lens of Nursing Leaders.

To explore organizational nursing leaders' perceptions of impact, value, and support for doctor of nursing practice (DNP)-prepared nurses engaging in practice scholarship. DNP nurses are educated to lead change at the system level and direct practice-based initiatives to enhance health outcomes. Organizational support and the value of DNP scholarship need to be better understood. An exploratory cross-sectional survey of organizational nursing leaders (N = 87) who participated in hiring or interacting with DNP-prepared nurses was implemented. More than half of the organizational nursing leaders reported that scholarship competencies were integrated into DNP-prepared nurses' job descriptions, yet almost half reported no time allotment for scholarship activities. Respondents reported that the highest impact of the DNP-prepared nurse was on the quality of care, and the greatest value reported was the implementation of evidence-based practice and quality improvement initiatives, the development of innovative roles, and as change agents. Consistent organizational support for DNP-prepared nurses to engage in practice scholarship could maximize the value and impact of these highly educated nurses on healthcare systems and health outcomes.

How valuable is an implementation toolkit for midwives? An exploratory study.

Incorporating evidence-based approaches in maternity care throughout the entire trajectory from pregnancy through to the postnatal phase is integral to good public health. Yet, despite developing theories, frameworks, and models to guide midwives' implementation efforts, implementing new evidence-based practices in midwifery practice settings remains challenging. An exploratory study design was used to conduct an initial assessment of the appeal and suitability of an implementation 'how to' Toolkit for Australian change-leader midwives. We aimed to determine the effectiveness of the intervention by evaluating midwives' experience of using the Toolkit, and report on the usability of the Toolkit in maternity care. We also sought to establish the degree to which the intervention could reach a broad cross-section of midwives, confirming the usability of the Toolkit across a range of public and private maternity services. Twenty-four midwives participated in our study. Participants provided practical Toolkit evaluation data, contextual information related to Toolkit content, their understanding of what implementation in a healthcare context is, and factors that hindered midwives' implementation efforts in clinical settings. The importance of co-design research and involving end-users in product development were also highlighted as crucial factors underpinning the effectiveness of resources like ours, particularly those designed to support specialist disciplines and the implementation challenges experienced by health practitioners in clinical environments. It is crucial to progress health care practitioners understanding of how to accelerate the implementation and sustainment of new evidence-based practices in clinical settings, including strategies to support organisational readiness, local barriers or challenges, and partnerships between researchers and end-users. Evaluation of our midwifery-specific implementation Toolkit indicates health professionals require tailored materials and information specific to their disciplines and clinical work environments; ideally, packaged in a centalised, open-access format. Future research is required to evaluate the mid-to-longterm impact of our Toolkit on implementation initiatives in midwifery contexts, and to establish the adaptability of our Toolkit in other settings, and with other disciplines.

Lessons From Implementing Research-Supported Practices to Address Psychiatric Illnesses in Two Countries.

Across the globe, psychiatric illnesses are common, painful, often disabling, and sometimes deadly. Although well-researched practices exist to address these disorders, most people with psychiatric illnesses do not have access to care that has been demonstrated to be effective. Practical clinical leadership experience and engagement in evidence-based practice (EBP) implementation research in Colombia and the United States have demonstrated that multisite EBP implementation is possible and that effective implementation improves outcomes for people who develop psychiatric illnesses. Implementation requires financial and policy support but is effective only if onsite operational leaders actively overcome practical, sometimes site-specific barriers. Operational leaders have the greatest impact when they focus on changing the flow of work to help clinicians offer the desired EBP in their day-to-day care. Discovery science may bring new solutions in the future, but implementing practices that have already been demonstrated to be effective can relieve patients' suffering now.

Experience of an advanced practice nurse in an intensive care unit.

The intensive care units structure, the technological improvement and the severity of the patients, require that there be harmony between all the actors involved in assisting the critically ill patient. Added to this context is that the current role of the supervisor involves assuming more and more management skills, without losing sight of the need to frame professional practice within the framework of a philosophy of care. Given this challenge for the supervisor, the appearance in our environment of the Advance Practice Nurse figure (APN) is an opportunity. The APN is essential to improving patient care, staff development and the implementation of evidence-based practice. This article describes how the APN works with the different members of the health team and what the results have been since their incorporation. The APN leads efforts to maintain quality of care. They use their knowledge to assess gaps in practice and between practice settings, and to design and lead evidence-based practice changes so that benchmarks can be met in the most efficient and timely manner. Additionally, it supports the organization to respond to a constantly changing healthcare environment and is instrumental in achieving its goals.

Analyzing the effectivity of evidence-based practice in health science higher education: a narrative review

ABSTRACT BACKGROUND: Although multiple strategies have been suggested for evidence-based practice educational interventions, few studies have focused on the development of abilities for evidence-based practice implementation. OBJECTIVE: To explore the effectiveness of evidence-based practice in higher education and understand its teaching methods. DESIGN AND SETTING: Narrative review was conducted at the Universidade Municipal de São Caetano do Sul, Brazil. METHODS: Narrative review included research studies that measured any type of evidence-based practice teaching method and its effectiveness. Searches included publications from inception to June 2022, conducted on MEDLINE, EMBASE, CINAHL, CENTRAL, ERIC, and the Cochrane Library. Two independent authors descriptively extracted and analyzed the data. The methodological quality of the studies was also analyzed. RESULTS: The results determined that 79.2% of the studies proved their effectiveness. Teaching methods varied according to the time period, format, and types of questionnaire. CONCLUSIONS: Most studies demonstrated the effectiveness of the chosen teaching methods. This study shows the importance of health professionals using evidence-based practice to ensure effective patient treatment.

Determinants of birth asphyxia in urban south Ethiopia

Birth asphyxia is a well-known cause of neonatal mortality, and the survivors suffer from long-lasting sequels such as seizures, intellectual disabilities, and motor disorders that are great challenges for newborns. Elucidating the determinants of birth asphyxia helps implement evidence-based practice in the local context. Thus, this study aimed at elucidating the determinants of birth asphyxia in urban south Ethiopia. A community-based unmatched nested case-control study was conducted on a cohort of 2548 pregnant women who were followed up until delivery in urban areas of Hadiya Zone, south Ethiopia. All newborns who experienced birth asphyxia (n = 118) were taken as cases. Newborns who were randomly selected from the risk-set (n = 472) were taken as controls (those without birth asphyxia). A binary logistic regression was done using R software. Induction of labor [AOR = 2.98, 95% CI: 1.20, 7.42], prolonged labor [AOR = 2.12, 95% CI: 1.02, 4.37], delivery through cesarean section [AOR = 3.81, 95% CI: 1.67, 8.72], instrumental delivery [AOR = 3.91, 95% CI: 1.72, 8.89], and low birth weight [AOR = 6.52, 95% CI: 3.40, 12.51] were determinants of birth asphyxia. Asphyxia during birth was mainly related to obstetric care and maternal nutrition, highlighting the need to pay attention during the course of labor and maternal nutrition during pregnancy. This study might have selection bias and loss of power so careful interpretation of the results is needed.

Missing Fundamental Nursing Care: What's the Extent of Missed Oral Care? A Cross-Sectional Study.

The Fundamentals of Care framework emphasizes a patient-centered approach that prioritizes the nurse-patient relationship and care environment to meet patients' basic needs, including oral hygiene. Recognized as crucial for preventing systemic health problems, oral care neglect is a global concern. Studies identify missed oral care as a widespread issue, contributing to significant patient safety risks. This study aimed at measuring missed nursing care occurrence in a Northern Italian university hospital, exploring the association between missed oral care with nursing staff characteristics and oral care policies. A single-center cross-sectional study was conducted according to the STROBE guidelines. Data collection was performed in May 2022 using the MISSCARE survey, a self-administered questionnaire sent by email to 473 nurses from all inpatient units. The degree of implementation of oral care policies was obtained by accessing the Facility Score Sheet data at the department level. Descriptive statistics, chi-square tests, and Fisher tests were conducted using SAS 9.4 and R software. Providing oral care was the third-most missed nursing care after rotating patients every two hours and walking them three times daily. The reasons for missed care included resource shortage and high patient turnover. The Facility Score Sheet data showed a low adoption of oral care policies. No significant associations were found between missed oral care and both nurses' characteristics and oral care policy at the department level. The study confirms highly missed oral care in acute care settings, emphasizing the urgent need for systemic changes via an evidence-based oral care policy and practice implementation. This study was prospectively registered under protocol 293 CE 050/2022 (8 Aril 2022).

Measuring factors associated with telehealth use by people who use mental health services: A psychometric analysis of a theoretical domains framework questionnaire.

Telehealth has the potential to improve access to mental health care, especially for people living in rural and remote regions. Yet, telehealth accessibility remains a challenge in Australia, and there is a scarcity of appropriate, psychometrically sound tools for evaluating telehealth use by mental health service users. The aim of this study was to adapt and validate a scale for measuring factors associated with mental healthcare telehealth use. A 39-item scale was adapted from the Theoretical Domains Framework questionnaire (TDFQ); a 14-domain framework for measuring implementation of evidence-based practice in health research and service delivery. Since use of the TDFQ in the service user and telehealth space is novel, we adapted and piloted the TDFQ using a rigorous and iterative consultation process and analysis. The study sample included 208 people who use mental health services (52% male). Preliminary analysis identified 32-items for inclusion in the exploratory factor analysis. Internal reliability and construct validity were also analysed. The resulting 21-item telehealth adaption of the TDFQ includes four factors, each with good internal reliability: satisfaction and habit (6 items), knowledge and training (5 items), benefit and value (6 items), and emotionality (4 items). Both the total scale and individual factors were positively associated with telehealth use. The telehealth adaption of the TDFQ is a psychometrically sound tool for assessing factors associated with the use of telehealth by people who use mental health services.

Tailored Multifaceted Strategy for Implementing Fundamental Evidence-Based Nursing Care: An Evaluation Study.

Background/Objectives: Extensive research has emphasised the persistent challenges and failures in providing hospitalised patients with fundamental evidence-based nursing care, often resulting in grave consequences for patient safety. Recommendations from implementation research indicate that a tailored theory- and research-based implementation strategy targeting contextual determinants can optimise the implementation of evidence-based clinical practice for the benefit of patients. This study evaluated the feasibility of an implementation strategy designed to improve the quality of nursing care by targeting behavioural and environmental barriers in a hospital setting. Methods: Proctor's conceptual model for implementation was applied to evaluate the strategy based on eight outcomes: adoption, acceptability, appropriateness, fidelity, feasibility, penetration, sustainability, and costs. Data collection methods included field observations, informal and focus group interviews, registrations, and audits of electronic patient records. Results: The strategy was adoptive, acceptable, appropriate, and feasible in targeting complex environmental and behavioural determinants (at the individual, team, and management level), enabling successful implementation of fundamental evidence-based nursing care. However, fidelity, feasibility, and sustainability were challenged by competing organisational demands and time constraints. Conclusions: The tailored, multifaceted strategy proved effective in addressing complex environmental and behavioural determinants across multiple levels, facilitating the implementation of fundamental evidence-based nursing care in a clinical practice. Further testing and larger-scale studies is needed to assess the strategy's transferability and its impact on nursing-sensitive patient outcomes in different clinical settings.

Determinants of implementation of evidence-based practice in clinical decision-making among nurses in primary health care facilities in Ondo State, Nigeria

Aims: To assess the determinants of implementation of evidence-based practice in clinical decision-making among nurses in primary health care facilities in Ondo State, Nigeria. Design: A cross-sectional descriptive study. Methods: A total number of 266 nurses in the primary health care facilities in Ondo State participated in the study. A structured questionnaire was to elicit responses from the respondents via an online survey platform, called Google form. Findings from this study was presented in frequency-percentage tables and inferential statistics was certified using Chi-square analysis at 5% statistical level of significance. Results: There was an association between respondents’ socio-demographic characteristics and knowledge on EBP in clinical decision-making, marital status (X²= 5.16, P=0.023) and the professional cadre, CNO (X²=17.95, P= 0.012). In addition, it was revealed from the findings of this study there is no significant relationship between knowledge and level of implementation of evidence-based practice in clinical decision-making among nurses (X²= 0.15, 0.702). The last hypothesis identified an association between respondents’ socio-demographic characteristics and level of implementation on EBP in clinical decision-making (Age: X²=11. 77, P=0.008; professional cadre; X²=31.47, P= 0.000). Conclusion: The study concluded that though nurses overall, had a good knowledge of EBP but was mostly reported amidst ward managers; this can be linked to their job responsibility. With the apex nurses having the lowest records; this may be due to the fact that they are not directly involved in patients care. Similarly, the proportion of high level of implementation was more among respondents between age 51-60years compared to those that are age 21-30years. Therefore, it is recommended that nurse administrators focus on training of newly employed nurses on EBP and its components and establishment of platforms where new ideas on evidence-based findings can be taught and shared with professional colleagues.

Determinants of Implementation of Evidence-Based Practice in Clinical Decision-Making among Nurses in Primary Health Care Facilities

Background. Healthcare workers and institutions often face a lack of evidence-based and cost-effective care, which, if addressed, could improve practice and outcomes. Aim. To assess the determinants of implementation of evidence-based practice (EBP) in clinical decision-making (CDM) among nurses in primary health care facilities. Methods. The study utilized a descriptive cross-sectional design involving 266 nurses from primary healthcare facilities in Ondo State. Data were collected through a structured questionnaire administered via the online survey platform Google Forms. Findings are presented in frequency and percentage tables, and inferential statistics were analyzed using Chi-square tests at a 5% level of statistical significance. Results. Knowledge has been identified as a key determinant in the implementation of Evidence-Based Practice (EBP) in Chronic Disease Management (CDM) among nurses in primary healthcare facilities. The study revealed that 73.7% of respondents demonstrated a strong knowledge of EBP in CDM, with the highest levels reported among ward managers. Additionally, access to EBP resources and consistent support from employers were major factors influencing successful EBP implementation, with 86% of respondents affirming the importance of these supports. Regarding implementation levels, 53.4% of respondents reported high implementation of EBP in CDM, while the remaining 46.6% indicated low implementation. Conclusions. The study concluded that while nurses generally possessed good knowledge of Evidence-Based Practice, the highest levels of expertise were observed among ward managers. Key barriers to Evidence-Based Practice implementation in Chronic Disease Management were also identified, including limited network accessibility and inconsistent electricity supply. Keywords: determinants; implementation; evidence-based practice; clinical decision-making; nurses.

Perspectives of paediatric occupational therapists on the use of evidence-based practice in Kuwait: a qualitative study

ObjectivesTo investigate the perspectives of paediatric occupational therapists on factors relating to the use of evidence-based practice (EBP) in clinical practice/settings.DesignA qualitative approach entailing the use of (face-to-face) semistructured interviews....

Parental perspectives on experiences of provision of education for children with intellectual disabilities in Lesotho

The education law and policies in Lesotho assert that all children have a right to education, however, the application of these frameworks have been slow when it comes to education provision for children with intellectual disabilities. This study explores parental perspectives on experiences of provision of education for children with intellectual disabilities in Lesotho. Data was collected using semi-structured interviews with parents of children with intellectual disabilities. The findings indicate that parents immensely valued education for its advantages, however, they were aware of and disappointed with the inequitable provision of education children with intellectual disabilities were offered, leading to lack of participation and dropouts. The study therefore highlights the need to amplify implementation of evidence-based practices that ensure effective access and provision of quality and equitable education for children with intellectual disabilities. Keywords: intellectual disabilities, provision of education, education experiences, parental perspectives, Lesotho

Factors Influencing Physiotherapists' Use of Non-Academic Sources for Technical Information in Brazil.

The integration of evidence-based practice (EBP) into clinical decision-making is crucial for ensuring optimal patient care. However, there are various factors influencing the utilization of academic sources among physiotherapists, highlighting the need for a deeper understanding of these dynamics. The present study aimed to investigate the association between personal factors (age, time since graduation, number of patients, and education level), barriers to EBP implementation and perceptions about EBP, and physiotherapists' preference for using non-academic sources when seeking technical information about physiotherapy. This was a cross-sectional study involving 610 physiotherapists. Participants completed an online questionnaire covering demographic characteristics, sources of information, barriers to EBP implementation, and perceptions regarding the importance of scientific information in clinical practice. Logistic regression was used to investigate the factors associated with the preference for non-academic sources of information. Nearly a quarter of the sample exhibited a preference for non-academic sources, with age over 34years, perceived lack of abilities to apply scientific findings, and understanding issues related to EBP being significant associated with the preference of this types of sources of information. Physiotherapists with these characteristics were twice as likely to prefer non-academic sources when compared to physiotherapists who do not have these characteristics. These findings underscore the importance of enhancing professional competencies in EBP and fostering confidence in utilizing academic sources. While efforts have been made to incorporate EBP promotion in academic curricula, further initiatives are needed to bridge the gap between established knowledge and the competencies required for daily practice. Future studies should continue to explore the role of age in EBP applicability and the adoption of scientific knowledge, aiming to inform targeted interventions and educational programs tailored to the evolving needs of physiotherapy professionals.

Effect of Providing Evidence-Based Mental Health Treatment on Retention in Care Among Medicaid-Enrolled Youths.

Youths who start behavioral health treatment often stop before completing a therapeutic course of care. To increase treatment engagement and quality of care, the Evidence-Based Practice and Innovation Center in Philadelphia has incentivized use of evidence-based practices (EBPs) for mental health care of youths. The authors aimed to compare treatment outcomes between youths who received EBP care and those who did not. Using EBP-specific billing codes and propensity score matching, the authors compared treatment retention among youths who received trauma-focused cognitive-behavioral therapy (TF-CBT; N=413) or parent-child interaction therapy (PCIT; N=90) relative to matched samples of youths in standard outpatient therapy (N=503). Youths with a minimum of one session of TF-CBT or PCIT attended a second session at higher rates than did youths in the matched control group (TF-CBT: 96% vs. 68%, p<0.01; PCIT: 94% vs. 69%, respectively, p<0.01). On average, these returning youths attended more sessions in the EBP groups than in the control group (TF-CBT: 15.9 vs. 11.5 sessions, p<0.01; PCIT: 11.2 vs. 6.9 sessions, p<0.01). These findings indicate that, in addition to improving quality of care, EBP implementation helps address the major challenge that most youths who engage with treatment are not retained long enough for care to have therapeutic effects. Future research should examine the mechanisms through which EBPs can improve treatment retention.

Advancing the Science and Practice of Training and Technical Assistance to Improve the Equitable Implementation of Evidence-Based Practices.

Health inequities in the US are greater than those in other industrialized countries and have shown little improvement over the past 20 years. Training and technical assistance centers (TTACs) could be a potential mechanism to address inequities, but to date, have lacked an explicit equity-focus. In this paper we describe how to apply equitable implementation strategies when using an evidence-based training and technical assistance process (Getting To Outcomes®) and offer the Health Equity Interactive Systems Framework to support the dissemination and implementation of readily applicable equitable implementation strategies. Proposed improvements to implementation strategies' equity focus could provide a scalable way for TTACs to promote implementation strategies that are equity-focused. Findings could also inform continuous quality improvement frameworks used by TTACs to close the research to practice gap and make progress towards reducing health inequities.

Knowledge, Attitudes and Practices Regarding Evidence-Based Practice: A Cross-Sectional Study of Nurses at Sultan Ahmad Shah Medical Centre @IIUM (SASMEC @IIUM), Kuantan, Pahang, Malaysia

Background: The aim of this study was to assess the knowledge, attitudes and practices (KAP) related to evidence-based practice (EBP) among nurses at Sultan Ahmad Shah Medical Centre (SASMEC) and to examine the relationship between these factors and socio-demographic characteristics. Methods: A cross-sectional survey was conducted from April to May 2022 among 122 nurses using a structured questionnaire, including the Evidence-Based Practice Questionnaire (EBPQ). The data were analysed using SPSS version 23. Results: The majority of nurses demonstrated moderate EBP knowledge (63.9%), positive attitude (96.7%), and moderate practice level (50%). A significant correlation was found between EBP knowledge and participation in EBP-related programs (p &lt; 0.05). Conclusion: While most nurses at SASMEC have moderate EBP knowledge and practice, their attitudes towards EBP are overwhelmingly positive. It is recommended to improve EBP implementation through continuous education and targeted interventions.

A comparison of scalable routine clinical materials and observer ratings to assess CBT fidelity

Decades of research have demonstrated the efficacy of cognitive behavioral therapies (CBTs) for a wide variety of psychiatric diagnoses, resulting in the inclusion of CBT as a first-line evidence-based practice (EBP) in treatment guidelines for mood and anxiety disorders. However, some research suggests that many providers do not implement EBPs as intended. Ongoing quality monitoring is needed to support EBP implementation and sustainability, but “gold standard” fidelity monitoring (e.g. observer ratings) is time-consuming, requires extensive training, and may feel intrusive to providers and clients. In the current study, we aimed to develop a scalable method of assessing CBT fidelity that leverages information generated in routine clinical care (e.g. session worksheets and clinician checklists). Ratings of adherence based on worksheets were not correlated with ratings of adherence based on observer ratings. However, ratings of competence based on worksheets were significantly correlated with observer ratings of competence. Ratings of adherence based on clinician checklist ratings were also significantly correlated with observer-rated adherence. Results did not indicate a strong relationship between adherence or competence measured by worksheet ratings or observer and symptom change. However, adherence as measured by clinician checklists were associated with subsequent depression symptom change. Findings have a strong potential to impact fidelity monitoring strategies for a variety of CBTs. Given the limited resources and time to do full audio review in routine care settings, findings suggest that using routine materials generated in session to assess therapist competence may be a feasible alternative to the “gold standard” audio review. The trial is registered at ClinicalTrials.gov, number NCT03479398.

Project Coordinate: Impact of Content-Focused Lesson Study on Teacher Knowledge, Collaboration, and MTSS Instruction

General and special educators often do not have the needed knowledge and skills or collaborative opportunities to implement coordinated, evidence-based instruction within a multi-tiered systems of support (MTSS) framework. As such, the authors used a randomized control design to examine the impact of Project Coordinate (PC), a professional development approach incorporating online content modules and lesson study, on fourth-grade general and special education teachers’ knowledge, collaborative planning, and instructional practice in reading. The authors used multilevel modeling, analysis of covariance (ANCOVA), and multivariate analysis of variance (MANOVA) analyses to examine differences in teacher knowledge, changes in the frequency of tiered instruction, teachers’ perceptions of collaborative planning, changes in treatment teachers’ use of evidence-based practices (EBPs), and effective implementation of EBPs. Results showed that PC teachers did not make significant gains in knowledge; however, these teachers did make significant gains on collaborative and instructional practice though findings are complex. The authors discuss the implications of findings for future research and practice.

Sleep deprivation in dementia comorbidities: focus on cardiovascular disease, diabetes, anxiety/depression and thyroid disorders.

Sleep disturbances are a significant concern in individuals with dementia, affecting their overall health and quality of life, as well as that of their family members and caregivers. Dementia, a progressive neurodegenerative condition marked by cognitive decline, often coexists with various comorbidities such as cardiovascular disease, diabetes, obesity, anxiety/depression and thyroid disorders. These comorbidities can further impair cognitive function and complicate the clinical management of dementia, making it essential to address them in a holistic manner. This review critically examines the complex interplay between dementia and its associated comorbidities, with a special focus on the prevalence and impact of sleep disturbances. Sleep problems in dementia patients are not only common but also contribute to a faster progression of cognitive decline and increased burden on caregivers. The article explores the mechanisms by which these comorbidities, including cardiovascular conditions and metabolic disorders, exacerbate sleep disturbances and cognitive impairment in dementia patients. By synthesizing recent research findings, the review highlights the importance of identifying and managing modifiable risk factors for sleep disturbances in dementia. Integrated treatment approaches that address both cognitive and sleep-related challenges are essential for improving patient outcomes. The review also underscores the need for further research to develop targeted interventions that can effectively manage sleep disturbances in dementia, thereby enhancing the quality of life for both patients and caregivers. Understanding the relationship between dementia, comorbidities, and sleep disturbances is crucial for the development of comprehensive care strategies. This review aims to inform healthcare professionals about the current state of knowledge and encourage the implementation of evidence-based practices in dementia care.