Integration Of Evidence-based Practice Research Articles

Implementation of evidence-based medicine in dietetic practice: Current status and hurdles in Italy.

Background: Health professionals, including dietitians, should adapt their clinical daily practice to evidence-based practice (EBP), but this does not happen often in daily practice. The aim of this study was to investigate the current status and barriers to evidence-based practice among dietitians. Methods: This was a mixed-method, cross-sectional, national study (questionnaire and focus group) performed on working and registered dietitians, both self-employed and employed by public hospitals. The main outcomes were EBP knowledge, frequency of use, and proficiency scores. Barriers to EBP implementation were also collected, as well as qualitative information from the focus group. Results: Forty-three dietitians were enrolled from August to November 2021 in Italy. Overall, EBP knowledge was moderate/good. Younger dietitians (< 50 years old) obtained better results than their older colleagues. A similar trend was observed in terms of seniority. There was a discrepancy between EBP knowledge and perception of EBP implementation: the worst scores were obtained by participants who claimed an already complete integration of EBP. The average frequency of EBP use was moderate, with higher scores in dietitians ≥ 50 years old and with seniority ≥ 20 years. EBP proficiency instead was poor. The focus group revealed a lack of time and resistance to change as the main barriers. Conclusion: The importance of EBP is well-acknowledged, but it is not correctly implemented yet, because of identified barriers that need to be fixed. These barriers include a lack of dedicated time, inadequate EBP training, and resistance to change, especially in hierarchical environments.

Intensive care nurses’ and nurse anaesthetists’ motivation to enrol in an academic master’s program: A qualitative study

Background: Nurses worldwide are increasingly working in environments characterized by healthcare reforms, complex patient care and technological advancements that require the integration of evidence-based practice. There is also a growing need for continuous education, systematic competence research and competence assessment instruments to meet the rapid changes in critical and anaesthesia care settings. Aim: The aim of this study was to explore and describe anaesthetists’ (NAs) and intensive care nurses’ (ICNs) motivation for enrolling in an academic master’s program. Method: A qualitative study was carried out, using focus groups. Data were analysed by means of qualitative content analyses. The participants were 11 students from an academic master’s program at a Norwegian university. Findings: The participants’ motivation was linked to the theme “improving patient care through continuous learning” and supported by three categories: understanding research; learning to argue within an intraprofessional team; improving and further developing the NAs and ICNs professions. Conclusion: Continuous learning to improve patient care for the critically ill was the main motivating factor for NAs and ICNs to enrol in an academic master’s program. NAs and ICNs enrolled in the academic master’s program with little or no support from the hospitals, and they reported that, in a busy ward, the time available for learning is scarce. The finding that NAs and ICNs desire continuous learning is relevant for hospital leaders who struggle to achieve patient safety goals and retain/recruit highly competent advanced nurses.

Evidence-based practice education in physical medicine and rehabilitation residency programs: A Canadian national survey.

The current extent and quality of evidence based practice (EBP) training for physiatrists is unclear at this time. Training of EBP is also available to residents in Canada. The extent, quality and impact of the training was explored. Cohort study Results: about half of the Canadian programs reported a formal EBP curriculum. The most frequently reported method of providing EBP education were resident participation in journal club. Despite the increasing integration of EBP into residency program education, there remains a critical lack of knowledge and skills for implementation of EBP into clinical practice among Canadian PM&R residency programs.

Nurses’ perception of the hospitals’ culture and readiness of evidence-based practise integration in the hospital’s system in western Ethiopia

BackgroundEvidence-based practise is a method by which healthcare professionals integrate the best available evidence, individual expertise and patient preferences to improve patient safety and utilise quality healthcare. No study was conducted in Ethiopia to assess the nurses’ perception of the hospitals’ culture and readiness for evidence-based practice integration into the hospital’s system. Hence, this study aimed to assess the perception of nurses on the hospitals’ culture and readiness of evidence-based practise integration in hospitals’ systems in Western Ethiopia.MethodsA cross-sectional study involving 412 nurses in six hospitals in western Ethiopia was conducted between December 2022 and February 2023. A 25-item Organisational Culture and Readiness of System-Wide Integration of EBP scale was used, with a Cronbach’s alpha of 0.94. While 25 is the minimum score, 125 is the maximum; higher scores indicate better hospital culture and readiness for system-wide integration of evidence-based practice. A self-administered data collection technique was used. Descriptive statistics were computed using Statistical Package for the Social Sciences version 25 software.ResultsFour hundred and twelve nurses participated in the study. The majority (85.9%) were bachelor’s degree holders and over a third (34.7%) worked in primary hospitals. Only a quarter (26.5%) had ever received mentorship from their leader on implementing evidence-based practice. The overall hospital culture and readiness score for system-wide integration of evidence-based practice among nurses in six hospitals was 70.3 ± 17.3.ConclusionThe nurses’ perception of the hospitals’ culture and readiness score for system-wide integration of evidence-based practice in six hospitals in Western Ethiopia was equivocal. There is a need to engage all resources and increase leadership commitment to make evidence-based practice a hospital culture. Further research is warranted to understand the national hospitals’ status in establishing and sustaining evidence-based practise culture.

Abstract IA019: Implementation science as an opportunity to address cancer equity

Abstract The past decade of research has continued to identify and understand health disparities for cancer prevention and control. Although emerging, progress in addressing these disparities continues to fall short achieving equity. Specifically, for cancer prevention and control, Khan and colleagues in 2021 showed a 15-year lag in implementation of evidence-based interventions (i.e., HPV vaccinations, cancer screenings, etc.). This gap highlights the lack of attention towards the implementation of scientific evidence, the complexity and fragmentation of health systems, and lays bare the structural causes of inequities that continue to persist from a population perspective. Integrating implementation science in cancer prevention and control research can provide a pathway to reduce the time to translation while addressing and advancing cancer equity. Implementation science is defined as the study of methods to promote the adoption and integration of evidence-based practices, interventions, and policies into routine health care and public health settings to improve the impact on population health. Implementation science has pushed the cancer prevention and control field to pay close attention to how we dissemination scientific information towards the adoption of interventions (i.e., dissemination research) and how we systematically study strategies (i.e., the building blocks) that aid in the implementation, scale-up, and sustainability of interventions (i.e., implementation science). With implementation research, there has been a push towards hybrid designs that considers intervention effectiveness and its implementation within the same study. Given the dearth of literature around the implementation of interventions, the science of implementation continues to build on a foundational theoretical base that further provide important opportunities for the promoting equitable outcomes for cancer prevention and control research. In this educational session, we will discuss why and how applying a health equity lens to implementation science is crucial to achieve equity in cancer prevention and control. Using ongoing and completed research studies as examples, this session will help attendees learn about core elements of implementation science including theories, models, and frameworks; implementation strategies; and focal areas of adaptations and de-implementation. Citation Format: Prajakta Adsul. Implementation science as an opportunity to address cancer equity [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr IA019.

Mechanisms of Successful Implementation of Tailored Motivational Interviewing in a Multisite Study of Youth HIV Clinics in the United States.

A recent implementation science stepped-wedge trial of motivational interviewing (MI) in adolescent HIV clinics indicated variable degrees of implementation success. The present mixed-methods study analyzed trajectories of postimplementation MI competence scores and compared postimplementation qualitative interviews among the clinics with the highest levels of provider competency and the lowest levels of competency to further understand mechanisms of successful implementation. Ten HIV clinics in the Adolescent Trials Network for HIV/AIDS Interventions. This study used a sequential explanatory mixed-methods design. Continuous MI competency data from the parent study were structured with repeated measurements nested within providers nested within 10 sites. A mixed-effects regression model rank ordered the clinics by competence scores. Key stakeholders (N = 77) at the 10 randomized clinics completed a 1-hour qualitative interview at 12-month follow-up (immediately postimplementation). Using the phases of reflexive thematic analysis, interviews from the 3 highest competence clinics and the 3 lowest competence clinics were pragmatically analyzed. Thematic analysis suggested 3 central themes that influenced successful evidence-based practice (EBP) implementation. Organizational culture included the leadership, collective effort, and resources that influenced how the organization at large responded to the implementation intervention. Staff attitudes encapsulated individual providers' mindsets and attitudes about MI and the implementation intervention. EBP integration reflected the perception and use of MI by individuals and the organization as a whole. These themes and their subthemes are interconnected and exerted an influence on each other through the implementation process. Findings suggest additional implementation strategies to improve implementation of EBPs. Such mixed-methods research is critical to understanding the mechanisms of successful implementation of EBP and improving future implementation strategies.

Evaluating Excellence in Nursing Care: A Comprehensive Critical Review

Quality in nursing care is pivotal to patient outcomes and healthcare delivery efficiency. This critical review synthesizes current literature to evaluate the multifaceted aspects of nursing care quality, encompassing patient safety, care effectiveness, and nurse-patient ratios. It highlights the integration of evidence-based practices in enhancing care quality, addressing the challenges faced by nursing professionals, including resource limitations and burnout. The review also explores the impact of technological advancements such as electronic health records and telehealth services on nursing care. By examining these dimensions, the review identifies gaps in current practices and provides recommendations for improving nursing care quality. The findings emphasize the need for a holistic approach that includes continuous education, policy reform, and the adoption of innovative technologies in nursing practice. This comprehensive analysis aims to contribute to the ongoing discourse on nursing care excellence, offering insights for practitioners, policymakers, and researchers dedicated to advancing healthcare quality.

From barriers to boosters: initial teacher education for inclusive science education

The paper presents a literature review on current barriers and boosters in the context of initial science teacher education for inclusion. The authors argue that current science teacher education programs for prospective teachers could be improved by adopting a more conceptually grounded and sustainable approach toward inclusion. To this end, the paper proposes an approach based on inclusive values and evidence-based practices that would benefit all students. Firstly, the paper identifies several barriers that exist in current science teacher education programs, including the dominance of anadd-on approach, separate teacher education tracks, and inadequate preparation for the topic leading to decreasing self-efficacy toward inclusion. Secondly, to overcome these barriers, the paper proposes the integration of evidence-based practices, collaboration, and knowledge-transfer in science teacher education programs. These boosters can equip prospective science teachers with the necessary skills and knowledge for effective inclusive science education. Overall, the paper provides valuable insights and recommendations for improving initial science teacher education programs in the context of inclusion.

Future Prospects of Neonatal Nursing in India

In the field of neonatal nursing, this article explores the multifaceted scene encompassing advancements in care technology, specialized training programs for nurses, inherent challenges, opportunities in practice, and the integration of evidence-based practices. It also explores into the crucial policy and regulatory framework that governs neonatal nursing. Highlighting the pivotal role of neonatal nurses, the article emphasizes their contribution as pillars of strength for families. Beyond routine tasks, these professionals provide reassurance during uncertain times, celebrating even the smallest milestones. Their significance extends far beyond hospital walls, resonating in the lives of families for years. Through compassionate care, neonatal nurses not only enhance the physical health of newborns but also foster emotional resilience in the families they serve. In the dynamic and ever-changing field of neonatal nursing, professionals go beyond the duties of a traditional job, exemplifying a profound sense of duty and commitment. As advocates for the tiniest members of society, they actively contribute to the resilience of life, witnessing the fragility yet nurturing the potential and promise of each newborn. The unwavering dedication of neonatal nurses creates a beacon of hope for families, assuring them that, even in the face of challenges, their newborns are in capable and compassionate hands. This article provides a holistic view of neonatal nursing, showcasing its complexities, challenges, and the impactful role it plays in shaping the future of newborns and their families

Enhancing Evidence-Based Practice Integration Into Clinical Practice: Using Policy as a Tool for Culture Change in a Large Urban Academic Medical Center.

This article describes how a large urban medical center was able to enhance the integration of evidence-based practice in the clinical environment by reconfiguring its approach to policy and procedures documentation. Leaders at a large urban medical center observed that numerous nursing practice documents lacked a base of evidence. No standard process existed for building staff awareness of the evidence-based underlying practice, and there was uneven knowledge of evidence-based practice in the milieu. To address the problem, a team of Clinical Nurse Specialists developed a novel policy establishing procedures for document review, formal structures for policy assignment, and rigorous standards for the development and sharing of evidence tables. The proportion of nursing guidance documents connected to evidence tables increased from 45% to 77% in the first year and a half following implementation. The change has enabled streamlining and consolidation of nursing practice guidance documents and has led to significant increases in engagement with clinical inquiry at the bedside. A policy specifically requiring evidence to be incorporated into nursing practice guidance documents can help enhance the understanding and uptake of evidence-based practice in a complex clinical environment. Clinical Nurse Specialists played a vital role in facilitating this organizational culture change.

Self-reported attitudes, skills and use of evidence-based practice among Swiss chiropractors: a national survey

Study ObjectivesThe high burden of disease associated with musculoskeletal disorders severely impacts patients’ well-being. As primary care providers, Swiss chiropractors ought to contribute towards identifying and using effective treatment strategies. An established approach is the full integration of evidence-based practice (EBP). This study aimed to investigate the attitudes, skills and use of EBP among Swiss chiropractors, as well as investigating potential facilitators and barriers for its adoption.Methods and materialAll 329 members of the Swiss Association of Chiropractic (ChiroSuisse) were invited in March 2021 to participate in this cross-sectional survey. Data were acquired anonymously online, using the Evidence-Based practice Attitude and utilization SurvEy (EBASE). The survey encompassed 55 questions measuring attitudes (n = 8, response range 1–5; total score range of 8–40), skills (n = 13, response range 1–5; total score range of range of 13–65) and use of EBP (n = 6, response range 0–4; total score range of 0–24).Results228 (69.3%) chiropractors returned complete EBASE questionnaires. This sample was representative of all ChiroSuisse members with respect to gender, age groups and proportion of chiropractic residents. Respondents generally held positive attitudes towards EBP, as indicated by the high mean (31.2) and median (31) attitude sub-score (range 11–40). Self-reported skills had a mean sub-score of 40.2 and median of 40 (range 13–65). Knowledge about EBP-based clinical practice had been primarily obtained in chiropractic under- or postgraduate education (33.8% and 26.3%, respectively). Use of EBP achieved a lower sub-score, with mean and median values of 7.4 and 6, respectively (range 0–24). The most commonly identified barriers preventing EBP uptake were lack of time (67.9%) and lack of clinical evidence in chiropractic/manual therapy-related health fields (45.1%).ConclusionSwiss chiropractors held favourable attitudes and reported moderate to moderate-high skill levels in EBP. Nevertheless, similar to chiropractors in other countries, the self-reported use of EBP was relatively low, with lack of time and lack of clinical evidence being the most named barriers.

Psychometric properties of the Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice.

Patient safety metrics declined due to COVID-19-related strains placed on hospitals and hospital systems. Because evidence-based practice (EBP) can improve patient outcomes and quality of care and empower clinicians, a renewed focus on organizational EBP culture is needed. The Advancing Research and Clinical practice through close Collaboration (ARCC©) Model describes how to use a system-wide approach to advance and sustain EBP in hospital systems to improve outcomes. EBP culture is a key variable that directly impacts EBP knowledge, beliefs, competency, and implementation. The ARCC© Model uses the Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice (OCRSIEP) to identify organizational characteristics that influence clinician and patient outcomes. Although the scale has been reported to have excellent reliability, a comprehensive psychometric analysis has yet to be performed that confirms its construct validity. The aim of this study was to describe the OCRSIEP's construct validity and reliability via an in-depth psychometric analysis. OCRSIEP assessment data were obtained from a prior national study with 2344 nurses from 19 hospitals and healthcare systems. Descriptive statistics summarized the sample and distributions of the 25 scale items. Construct validity was assessed via exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Cronbach's alpha assessed reliability. A one-factor model was supported by EFA with item Q17b excluded (i.e., to what extent are decisions generated from upper administration). Model fit indices for CFA indicated a good fit (CFI=0.978, TLI=0.973, RMSEA=0.077, SRMR=0.027). Cronbach's alpha was 0.96 for all items and 0.97 with item Q17b excluded, both indicating outstanding internal consistency. The OCRSIEP is valid and reliable and can be used to assess EBP culture and readiness in hospitals and healthcare systems at the organizational level.

Leveraging EBP to Establish Best Practices, Achieve Quality Outcomes, and Actualize High Reliability: Building EBP Competency Is Not Enough

Health care in the United States has been in a critical state for decades and the recent pandemic has added additional stress to a system that is underpinned by widespread variation in practice and care. Evidence-based practice (EBP) is a methodological, problem-solving approach to identify best practices that, when implemented and sustained, leads to quality outcomes, and actualization of true high reliability. To reap the benefits of EBP, however, leaders must do more than simply build EBP competencies. This article provides clarity, guidance, and resources for leaders who are beginning or advancing integration of EBP in their organizations.

Social Workers’ Attitudes toward Evidence-Based Practice: The Mediating Role of Work-Related Self-Efficacy

AbstractThe aim of the current study was to explore the mediating role of work-related self-efficacy in the association between organizational context variables (workplace social support, accessibility of work-related data and information resources, and role ambiguity) and social workerss’ attitudes toward adoption of evidence-based practice (EBP). For the purpose of the study, 559 social workers were sampled by means of structured questionnaires. Structural equation modeling was conducted to examine the proposed model. Accessibility of data and information resources and workplace social support were positively associated with self-efficacy, and role ambiguity was negatively associated with self-efficacy, which was in turn positively related to social workerss’ attitudes toward EBP. The findings of the current study may assist policymakers and professional supervisors in developing interventions designed to promote more positive attitudes toward EBP among social workers. In the effort to promote the integration of EBP in social services settings, the impact of organizational factors on social workerss’ work-related self-efficacy should be taken into account.

Using Implementation Science to Understand Teledermatology Implementation Early in the COVID-19 Pandemic: Cross-sectional Study.

BackgroundImplementation science has been recognized for its potential to improve the integration of evidence-based practices into routine dermatologic care. The COVID-19 pandemic has resulted in rapid teledermatology implementation worldwide. Although several studies have highlighted patient and care provider satisfaction with teledermatology during the COVID-19 pandemic, less is known about the implementation process.ObjectiveOur goal was to use validated tools from implementation science to develop a deeper understanding of the implementation of teledermatology during the COVID-19 pandemic. Our primary aims were to describe (1) the acceptability and feasibility of the implementation of teledermatology and (2) organizational readiness for the implementation of teledermatology during the COVID-19 pandemic. We also sought to offer an example of how implementation science can be used in dermatologic research.MethodsAn anonymous, web-based survey was distributed to Association of Professors of Dermatology members. It focused on (1) the acceptability, feasibility, and appropriateness of teledermatology and (2) organizational readiness for implementing teledermatology. It incorporated subscales from the Organizational Readiness to Change Assessment—a validated measure of organizational characteristics that predict implementation success.ResultsOf the 518 dermatologists emailed, 35 (7%) responded, and all implemented or scaled up teledermatology during the pandemic. Of the 11 care providers with the highest level of organizational readiness, 11 (100%) said that they plan to continue using teledermatology after the pandemic. Most respondents agreed or strongly agreed that they had sufficient training (24/35, 69%), financial resources (20/35, 57%), and facilities (20/35, 57%). However, of the 35 respondents, only 15 (43%) agreed or strongly agreed that they had adequate staffing support. Most respondents considered the most acceptable teledermatology modality to be synchronous audio and video visits with supplemental stored digital photos (23/35, 66%) and considered the least acceptable modality to be telephone visits without stored digital photos (6/35, 17%). Overall, most respondents thought that the implementation of synchronous audio and video with stored digital photos (31/35, 89%) and telephone visits with stored digital photos (31/35, 89%) were the most feasible. When asked about types of visits that were acceptable for synchronous video/audio visits (with stored digital photos), 18 of the 31 respondents (58%) said “new patients,” 27 (87%) said “existing patients,” 19 (61%) said “medication monitoring,” 3 (10%) said “total body skin exams,” and 22 (71%) said “lesions of concern.”ConclusionsThis study serves as an introduction to how implementation science research methods can be used to understand the implementation of novel technologies in dermatology. Our work builds upon prior studies by further characterizing the acceptability and feasibility of different teledermatology modalities. Our study may suggest initial insights on how dermatology practices and health care systems can support dermatologists in successfully incorporating teledermatology after the pandemic.

Editors’ Note and Prologue

Editors’ Note and Prologue

Enhancing Evidence-Based Practice and Critical Thinking Skills of Nursing Students: Lessons from the Review of the Bachelor of Science in Nursing Curriculum of the University of Zambia

Background: Making changes in the existing curriculum aims, objectives, course contents learning outcomes and assessment strategies have become a fact of life for nurse educators. Purpose: To enhance the existing Bachelor of Science (BSc) in nursing curriculum through integration of evidence-based practice (EBP) and teaching of critical thinking skills. Materials and Methods: A needs analysis was conducted using a five-phased approach to review the BSc in nursing Curriculum. Kern’s six-step model was adapted and introduced through a series of workshop exercises that highlighted the application of each step: 1) Desk review of the BSc curriculum offered globally; 2) Administration of the needs assessment questionnaire to key informants; 3) Strengths, weakness, opportunities and threat analysis; 4) Consultative meeting with major stakeholders; 5) Curriculum review. Results: The five-phased approach established some gaps in existing curricula, and identified critical core competences and best practices in integrating EPB and critical thinking in the BSc undergraduate curriculum and some “A” level content that was not in tandem with the practice of nurses. New courses were developed to support students in academic writing and enhance professionalism and duration of training was reduced from 5 to 4 years. Conclusion: The process demonstrated that BSc curriculum review, in fact, should be thoroughly scrutinized to encourage positive changes to the curriculum, provide opportunities for team building and the development of leadership skills and a whole-of course perspective on the curriculum.

Beliefs, Attitudes, and Behaviors of Saudi Physiotherapists Toward Evidence-Based Practice: A Multicenter, Cross-Sectional Study.

BackgroundEvidence-based practice (EBP) has gained significant importance in clinical practice worldwide, including physiotherapy, but there are limited studies that have assessed the knowledge, attitude, and behaviors of Saudi physiotherapists toward EBP.Objective:To determine the beliefs, attitudes, knowledge, and experience of Saudi physiotherapists in public hospitals of the Eastern Province of Saudi Arabia toward EBP as well as identify barriers that limit the integration of EBP in clinical practice.Materials and Methods:This cross-sectional design included all Saudi physiotherapists working in four major tertiary hospitals in the Eastern Province of Saudi Arabia. The Evidence-Based Practice Questionnaire was used to elicit responses. The association between attitudes, awareness, and knowledge scores and the demographic data such as age group, years of experience, and level of education was assessed.Results:The questionnaire was distributed to a total of 171 physiotherapists, of which 118 (69%) responded. About 90% of the participants agreed or strongly agreed that EBP is necessary for clinical practice. However, about 25%, 19%, and 18% of the participants reported that EBP does not consider clinical limitations, support physiotherapy intervention, or consider patients' physiotherapy preferences, respectively. The most common barrier in the implementation of EBP in daily clinical practice was insufficient time (>50%), followed by self-efficacy in retrieving evidence from the literature and translating research findings into clinical practice. Years of experience, age, and gender were significant factors associated with physiotherapists' beliefs and attitudes toward implementing EBP.Conclusions:Although EBP was favored, several barriers exist that hinder its adoption by physiotherapists. Institutional support and research skill development may help accelerate EBP adoption levels and should be considered by policymakers.

Using Implementation Science Strategy Mapping on the Age-Friendly Health System's 4Ms Journey

Background: Implementation science is the study of methods to promote the adoption and integration of evidence-based practices into routine health care to improve the quality of care. The purpose of this study was to use Implementation Mapping to guide the implementation of The John A. Hartford evidence-based Age-Friendly Health Systems (AFHS) 4Ms Framework: What Matters, Medications, Mentation, and Mobility. Methods: Implementation Mapping, a systematic process for planning implementation strategies, guided the 9-month integration of the 4Ms Framework in the 1,100 MinuteClinics across the US. Implementation Mapping includes five tasks: (1) conduct an implementation needs assessment and identify program adopters and implementers; (2) state adoption and implementation outcomes and performance objectives, identify determinants, and create matrices of change objectives; (3) choose theoretical methods (mechanisms of change) and select or design implementation strategies; (4) produce implementation protocols and materials; and (5) evaluate implementation outcomes. Results: The implementation plan, developed by the implementation mapping method, was carried out over 9-months. Seven implementation strategies were identified from the Expert Recommendations for Implementing Change (ERIC) project including the provision of education, electronic health record integration, internal champion facilitation, cues to action, and a dashboard to monitor progress. To date, the implementation mapping has resulted in the adoption of the 4Ms by 1145 providers (37%). Monitoring of the adoption of the 4Ms Framework and consideration of future implementation strategies is ongoing. Conclusions: Implementation Mapping provided a systematic process to develop strategies to improve the adoption, implementation, sustainment, and scale-up of the evidence-based 4Ms Framework.

Evidence-Based Practice Beliefs, Implementation, and Organizational Culture and Readiness for EBP Among Nurses, Midwives, Educators, and Students in the Republic of Ireland.

Evidence-based practice (EBP) is an approach to health care that combines best available evidence, healthcare professionals' expertise, and patient preferences, yielding benefits for patients, healthcare professionals, and organizations. However, globally, EBP implementation remains inconsistent among nurses. Exploring this in an Irish context will establish a national baseline from which progress can be made on system-wide integration of EBP in nurse and midwife (i.e., clinician) practice, nursing/midwifery education, and the Irish healthcare system. To establish clinician, educator, and student's EBP beliefs, knowledge, and implementation, and the organizational culture of the clinical and educational settings within the Republic of Ireland. Using a descriptive study design, a national survey with demographic questions, uniquely focused EBP scales, and an open-ended question were administered to clinicians, nursing/midwifery educators, and students. Ethical review was obtained. Descriptive and inferential statistics were used to analyze the quantitative data. Clinicians, educators, and students reported positive beliefs about EBP (M=59.98, SD 8.68; M=87.72, SD = 10.91; M=55.18, SD = 10.29, respectively). Beliefs regarding their ability to implement EBP were lower overall. EBP implementation was low across all groups (clinicians: M=12.85, SD = 14; educators: M=31.09, SD = 16.54; students: M=16.59, SD = 12.11). Clinicians, educators, and students reported varying perceptions of organizational support and readiness for EBP (M=74.07, SD = 19.65; M=86.43, SD = 15.01; M=93.21, SD = 16.21, respectively). Across all measures, higher scores indicated higher beliefs, implementation, and organizational culture and readiness for EBP. Clinicians have a unique opportunity to facilitate system-wide integration of EBP. Furthermore, given the variable EBP knowledge, beliefs, and implementation, opportunities to enhance these attributes abound, particularly when supported by their organizations. This study established a contemporary baseline in Ireland from which to engage the identified strengths, challenges, and opportunities required to craft an organizational culture and environment that supports and advances an EBP approach to nursing and midwifery practice and education.