Steps Of Evidence-based Practice Research Articles

Don’t omit a urine culture when a urinalysis is suspicious for asymptomatic bacteriuria during pregnancy

Abstract Introduction/Objective Investigation of a clinical problem using steps of evidence-based practice (EBP) led to the development of a recommendation submitted for Choosing Wisely consideration. The prevalence of asymptomatic bacteriuria (ASB) in pregnancy is between 2-15%. ASB may be a concern in pregnancy because of its capacity for association with adverse outcomes, namely preterm delivery, low birthweight, and possible progression to pyelonephritis. Screening and treatment may reduce the risks of adverse outcomes, but data is not current. A point-of-care urine dipstick is low cost and commonly used at routine obstetrician clinic visits to screen for ASB. The urinalysis dipstick is associated with high false-positive and false-negative rates as compared to the gold standard urine culture. Some providers make the decision to treat ASB given a positive urinalysis screen without ordering a follow-up culture. Such practice could lead to overtreatment of the patient and poor antibiotic stewardship. Research question Is a urinalysis without culture sufficient for diagnosis and treatment of ASB during pregnancy? Methods/Case Report Laboratory Medicine Best Practices A-6 steps of Ask, Acquire, Appraise, Apply, Analyze, and Assess were utilized to develop an appropriate and relevant clinical question, collect literature, determine evidence value, assign ratings, implement into practice, and evaluate outcomes. During appraisal, six selected articles were graded according to study rating, practice, measures, and results, further including the final rating and effect size rating. Consistency and overall strength of the evidence were analyzed. Results (if a Case Study enter NA) Each evidence study demonstrated final ratings between 8 and 10, a rating of “Good,” and an effect size rating of “Substantial.” Consistency leads to a “High” overall strength among the body of evidence. Conclusion Obtain a urine culture if routine prenatal point-of-care dipstick urinalyses have findings consistent with asymptomatic bacteriuria. Urinalyses are limited as screening due to low sensitivity and specificity for bacteriuria. Positive urinalysis dipstick results should be neither the sole basis for diagnosis nor decision to treat.

Incorporating Evidence-Based Practice Learning Activities Throughout Family Nurse Practitioner Clinical Practicum Courses.

Evidence-based practice (EBP) is crucial to high-quality health care, yet nurse practitioner graduates report low levels of confidence in their EBP abilities. This may be because of limited incorporation of EBP learning opportunities outside of foundational course-work. Family nurse practitioner (FNP) program faculty incorporated EBP learning activities across the three-semester clinical year curriculum, and the activities scaffolded in complexity. Initial activities included appraisal and application of clinical practice guidelines to patient case scenarios. Later, students used the seven steps of EBP to present frequently asked patient questions and EBP clinical challenges in their clinical rotations to their peers. This innovative way to thread EBP across the clinical year allowed faculty to continue to evaluate and guide students toward EBP competency. The integration of EBP learning activities across the clinical year is a feasible strategy to further expand FNP student competency in EBP. [J Nurs Educ. 2024;63(X):XXX-XXX.].

Bottlenecks to Learning Evidence-Based Practice: Recommendations for Nursing Faculty.

Evidence-based practice (EBP) competency is an expected outcome of baccalaureate education; however, research indicates nursing graduates enter practice with competency gaps. The purpose of this study was to explore the challenges accelerated baccalaureate students experience when learning the steps of EBP. A qualitative, descriptive design was used to identify bottlenecks to student learning. Learning the steps of EBP in an accelerated format was challenging for students. Data analysis revealed 3 types of bottlenecks that stalled learning: cognitive, procedural, and emotional. Faculty build EBP competency by making explicit the steps that help students progress. Scaffolded learning, collaborative partnerships, and reflective practices are recommended to support student learning in accelerated formats.

Dissecting Through the Literature: A Review of the Critical Appraisal Process.

Critical appraisal is a crucial step in evidence-based practice, enabling researchers to evaluate the credibility and applicability of research findings. Healthcare professionals are encouraged to cultivate critical appraisal skills to assess the trustworthiness and value of available evidence. This process involves scrutinizing key components of a research publication, understanding the strengths and weaknesses of the study, and assessing its relevance to a specific context. It is essential for researchers to become familiar with the core elements of a research article and utilize key questions and guidelines to rigorously assess a study. This paper aims to provide an overview of the critical appraisal process. By understanding the main points of critical appraisal, researchers can assess the quality, relevance, and reliability of articles, thereby enhancing the validity of their findings and decision-making processes.

Care, lead, and inspire: Infusing innovation into nursing research and evidence-based practice course.

Today's nursing workforce is expected to know how to identify and understand research methods and procedures and apply the most current evidence into daily practice. However, teaching evidence-based practice (EBP) in an undergraduate nursing curriculum poses unique challenges in overcoming students' perception of content relevancy to their educational experience, but also offers opportunities for innovation to facilitate critical thinking and clinical application. The aim of this article is to report on how teaching and learning innovation was infused into a research and evidence-based practice course and the effect on students' perceptions of course values and effectiveness. We used a Plan-Do-Study-Act approach to introduce innovation in an undergraduate course within a university setting. Final student course evaluations were used to measure outcomes on a 5-point Likert scale (1 = low and 5 = high) on the following dimensions: (1) value of overall educational experience, (2) relevancy of course content, (3) improvement in critical thinking, and (4) level of student-instructor interaction. Overall course evaluation scores improved greatly from 2.69 to 3.90 between Spring 2020 and Fall 2021. This finding remained relatively consistent across subsequent semesters (3.79 [Spring 2022], 3.84 [Fall 2022]). Students also reported appreciation and increased engagement and interest with the material after transitioning from examinations to a project-based assignment that allowed them to walk through the steps of EBP in class. We identified and implemented several innovative strategies to improve student outcomes and increase the relevance of the course content. These innovations can be easily incorporated at other universities to enhance delivery and student engagement in this content that is essential to advancing quality care in nursing and developing future nurse scientists and practice leaders who care, lead, and inspire.

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

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

Current Practice of Physical Therapists: An evidence-based practice survey

Background: Patient/client management is comprehensive multidirectional process. It includes patient client examination, evaluation, diagnosis, prognosis, intervention and then discharge plans from supervised treatment to follow ups. The process of examination includes comprehensive history taking, performing systemic review and special tests and measures. Aim: To investigate Pakistani physiotherapists’ current practice, skills and understanding of evidence-based practice in order to improve the utilization of the evidence base in physiotherapy in the country. Methods: This observational cross section study was done in Pakistan Institute of Medical Sciences and Islamabad Medical and Dental College, Islamabad between January 2021 and March 2021. Physiotherapists(n=369) were contacted through non-probability convenience sampling technique. Respondents were contacted at clinical facilities in the twin cities of Pakistan. The content of the questionnaire was validated using the literature and the method of Lynn MR et al. The results were extracted, conclusion was drawn, suggestions and recommendations were made. Results: The participants mean age was 27.58±7.41 years. The male/female ratio was almost same. Approximately half of the respondents 50.4% were agreed about the role of EBP in practice.57% respondents were agreed that EBP removes the art from clinical practice. 58.5% respondents were agreed about benefit of EBP and EBP improves clinical outcomes and 53.4%respondents were agreed about help of EBP in decision making. Attitude and knowledge need analysis was positive but there found compromise in utilization of this evidence-based practice, while this study showed more utilization. Conclusion: Five steps of evidence-based practice were found being infrequently practiced. Physiotherapists had good to fair understanding of evidence-based practice. Physiotherapists had fair to poor appraisal skills. Keywords: Clinician practice; Data base; Evidence-based practice; Physical therapist; Practice guideline; Patient management.

Understanding the research agenda within renal nursing: an ANNUK project

Journal of Kidney CareVol. 8, No. 2 Society UpdateUnderstanding the research agenda within renal nursing: an ANNUK projectSarah BrandSarah BrandEmail: E-mail Address: [email protected]Assistant Divisional Nurse, CAS; Senior Research Nurse, Renal and Transplant UnitSearch for more papers by this authorSarah BrandPublished Online:21 Mar 2023https://doi.org/10.12968/jokc.2023.8.2.91AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References AbuRuz ME, Hayeah HA, Al-Dweik G, Al-Akash HY. Knowledge, attitudes, and practice about evidence-based practice: a Jordanian study. Health Science Journal. 2017;11(2):1. https://doi.org/10.21767/1791-809X.1000489 Google ScholarEmpranza JL, Cabello JB, Burls AJ. Does evidence-based practice improve patient outcomes? An analysis of a natural experiment in a Spanish hospital. J Eval Clin Pract. 2015;21(6):1059–1065. https://doi.org/10.1111/jep.12460 Google ScholarMelnyk BM, Fineout-Overhold E, Stillwell SB, Williamson KM. Evidence-based practice: step by step: igniting a spirit of inquiry. Am J Nurse. 2009;109(11):49–52. https://doi.org/10.1097/01/NAJ.0000363354.53883.58 Google ScholarMelnyk BM, Fineout-Overhold E, Stillwell SB, Williamson KM. Evidence-based practice: step by step: the seven steps of evidence-based practice. Am J Nurse. 2010;110(1):51–53. https://doi.org/10.1097/01.NAJ.0000366056.06605.d2 Google ScholarPowers J. Increasing capacity for nursing research in magnet-designated organizations to promote nursing research. Appl Nurs Res. 2020;55(1):1–6. https://doi.org/10.1016/j.apnr.2020.151286 Google ScholarSmyth A, Carter V, Dube A, Cannaby AM. How a better understanding of nursing research roles may help to embed research into clinical structures. Br J Nurs. 2022;31(17):1–7. https://doi.org/10.12968/bjon.2022.31.17.902 Google ScholarStraus SE, Glasziou P, Richardson WS, Haynes RB. Evidence-based medicine: how to practice and teach it. Edinburgh: Churchill Livingstone Elsevier; 2011 Google Scholar FiguresReferencesRelatedDetails 2 March 2023Volume 8Issue 2ISSN (print): 2397-9534ISSN (online): 2397-9542 Metrics History Published online 21 March 2023 Published in print 2 March 2023 Information© MA Healthcare LimitedKeywordssupportcollaborative workingspeacial interest groupsspecialist nursesPDF download

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

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

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

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

Effectiveness of Educational Interventions to Increase Skills in Evidence-Based Practice among Nurses: The EDITcare Systematic Review.

Using evidence-based practice (EBP) improves the implementation of safe, high-quality healthcare for patients, reduces avoidable costs, and plays a crucial role in bridging knowledge-action gaps and reducing health inequities. EBP combines the best available evidence in the relevant literature with patient preferences and values and healthcare professionals' (HCPs) expertise. Systematic searches of ten bibliographic databases, unpublished works, and the Grey Literature Report sought studies published up to 30 September 2022. The 15 studies retained involved 2712 nurses. Three types of effective educational interventions were identified: (1) multifaceted educational strategies incorporating mentoring and tutoring; (2) single educational strategies, often delivered online; and (3) multifaceted educational strategies using the five steps of EBP. Eleven primary outcomes (EBP beliefs, EBP self-efficacy, perceived EBP implementation, EBP competencies, EBP knowledge, EBP skills, EBP attitudes, EBP behaviors, EBP desire, EBP practice, and perceptions of organizational culture and readiness) were assessed using 13 qualitative and quantitative instruments. Ensuring the successful implementation of EBP requires effective educational strategies. Computer-based learning seems the most cost-effective and efficient strategy, when considering caregivers' characteristics, the clinical field, and educational interventions across the pre-, peri-, and post-implementation processes.

Strategies to Sustain Quality Interventions: Case Examples of Chlorhexidine Gluconate Bathing.

Strategies to Sustain Quality Interventions: Case Examples of Chlorhexidine Gluconate Bathing.

Hierarchy of Evidence Within the Medical Literature.

The quality of evidence from medical research is partially deemed by the hierarchy of study designs. On the lowest level, the hierarchy of study designs begins with animal and translational studies and expert opinion, and then ascends to descriptive case reports or case series, followed by analytic observational designs such as cohort studies, then randomized controlled trials, and finally systematic reviews and meta-analyses as the highest quality evidence. This hierarchy of evidence in the medical literature is a foundational concept for pediatric hospitalists, given its relevance to key steps of evidence-based practice, including efficient literature searches and prioritization of the highest-quality designs for critical appraisal, to address clinical questions. Consideration of the hierarchy of evidence can also aid researchers in designing new studies by helping them determine the next level of evidence needed to improve upon the quality of currently available evidence. Although the concept of the hierarchy of evidence should be taken into consideration for clinical and research purposes, it is important to put this into context of individual study limitations through meticulous critical appraisal of individual articles.

The effectiveness of ERAS guidelines in reducing postoperative pain

AbstractBackgroundPoorly controlled acute postsurgical pain can promote chronic opioid use and misuse long after the initial surgical procedure. Enhanced recovery after surgery (ERAS) guidelines have shown promise in reducing opioid exposure and minimizing opioid‐related side effects.AimsThe aims of this evidence‐based practice (EBP) project were to assess the ERAS literature to guide postoperative pain management practice change at an adult colorectal surgical unit, evaluate the practice change outcomes, and disseminate the findings.MethodsA Population, Intervention, Comparison, Outcome, and Time (PICOT) question was established to guide an ERAS literature search. Found articles were critically appraised using the FULD Critical Appraisal Tool. Following the critical appraisal, the steps of EBP were utilized to implement an ERAS guideline for adult colorectal surgical patients in a 281‐bed medical center. Outcomes of the practice change were evaluated by comparing multimodal analgesic, regional anesthesia, and opioid pain medication use before and after guideline implementation.ResultsFive articles were critically appraised for guideline development. After implementation, data demonstrated an increase in the use of multimodal analgesics and regional anesthesia and a decrease in the use of opioid pain medication. These findings were disseminated through multiple venues within the hospital, including a presentation to the stakeholders.Linking Evidence to ActionEvidence‐based strategies to reduce postoperative pain are achievable while reducing perioperative opioid consumption. Engagement of key stakeholders and timely rollout of EBP changes are important for successful implementation. ERAS guidelines with a multimodal analgesia pathway are an effective way to reduce postoperative pain and perioperative opioid consumption.

Using Lean Principles as an Implementation Strategy within the EBP Process

Evidence-based practice (EBP) is the cornerstone of nursing practice. While allowing the evidence to guide the design of an EBP protocol, it is important to consider the potential impact on the cognitive workload of busy clinicians. The Iowa Model includes developing a localized protocol as a part of the Design & Pilot step of EBP.1 This step in the EBP process is the ideal time to address potential workflow concerns related to the localized protocol, by including clinician and patient feedback into the design process and midstream corrections that are anticipated.

Teaching evidence-based practice: Knowledge to implementation in a BSN program, part 1.

Despite increased recognition for the importance of evidence-based practice (EBP), nurses still identify a need for more education and skill-building in the process used to provide evidence-based care. Nurse educators play a vital role in addressing these needs. This article is part 1 of a two-part series. To describe an interactive learning process regarding EBP taught over two courses that allow students to not only appraise evidence but also implement evidence on a clinical unit. Part 1 focuses on course one, Evidence-Based Practice, which takes place during junior year. In course one, students learn about EBP steps 1-3. Faculty assign students to teams of three to four for an evidence-based project. Project scenarios are written ahead of time by faculty, and student teams are given class time for project completion. After course completion, an anonymous survey was distributed to measure the student perceived achievement for the EBP learning objectives. Students responded to statements using a 5-point Likert scale for level of agreement (1 = strongly disagree to 5 = strongly agree) regarding achieving course objectives. The evidence-based project culminated with a PowerPoint presentation to the class with recommendations for nursing practice based on the best evidence for the scenario they were provided. Eighty students responded to the evaluation survey, and mean scores were 4.0 or higher. This finding indicates that students had a high degree of perceived achievement. Interactive learning in teams promotes discussion and understanding of EBP and mimics real-life EBP implementation. Implementing EBP steps should be tied to clinical scenarios or clinical situations to enhance student learning.

Teaching evidence-based practice: Knowledge to implementation in a BSN program, part 2.

Nursing education at the undergraduate level has started teaching the process of research integration through evidence-based practice (EBP) implementation rather than solely focusing on teaching nursing research. This is Part 2 of a two-part series. To discuss strategy on how to teach undergraduate nursing students the process of implementing EBP over two courses and to assess their learning outcomes. This article focuses on Course 2, Leadership and Management, which takes place during senior year and builds on student learning from their junior year through application of an EBP capstone project. The American Association of Colleges of Nursing's Essentials of Baccalaureate Education for Nursing Practice (2008) was used to guide the discussion and course development. An anonymous survey was used to measure the level of student perceived achievement of the learning objectives related to EBP. Students responded to statements using a 5-point Likert scale for level of agreement (1=strongly disagree to 5=strongly agree). In Course 2, Leadership and Management, senior year students focused on the remaining EBP steps (four through six) and completed an EBP capstone project with a nurse manager. A total of 83students responded to the anonymous evaluation survey, and mean learning objective scores were 4.0 or above, indicating a high degree of perceived level of achievement. Teaching the EBP process with active learning strategies over two courses enhances student learning.

Impact of a journal club on the self-efficacy, expectations, and intentions of nursing students toward evidence-based results

Nursing associations require that nurses develop the skills to integrate evidence into practice to support the quality of care. Lack of self-confidence in the operational steps of evidence-based practice was identified as a barrier to integrating evidence into nursing practice. To assess the effect of a journal club (JC) on nursing students' self-efficacy (SE), expectations, and intentions to use evidence. Quasi-experimental, longitudinal approach with a non-randomized comparison group. The development of SE toward the use of evidence-based practices favored students who participated in the JC (n=48) compared to students who received a conventional educational modality (CEM) (n=50). However, there was no significant group x time interaction effect on expectations or intentions. The significant positive changes beyond the CEM may be explained by the fact that the JC incorporated modes of influence on SE. The positive effect associated with the JC on SE is difficult to sustain without continued practice. It is important to maintain high outcome expectations within nursing training.

Evidence-Based Practices and Use among Employees and Students at an Austrian Medical University.

Developed in the pre-internet era in the early 1980s, empirical medical practice, i.e., evidence-based practice (EBP) has become crucial in critical thinking and statistical reasoning at the point-of-care. As little evidence is available so far on how EBP is perceived in the Austrian academic context, we conducted a cross-sectional online survey among a nonrandom purposive sample of employees and students at the Medical University Vienna, Austria (total n = 1247, 59.8% females). The German questionnaire assessed both EBP capability beliefs and EBP use, with the respective indices both yielding good internal consistency. We conducted subgroup comparisons between employees (n = 638) and students (n = 609). In line with Bandura’s self-efficacy theory, we found a correlation between EBP capability beliefs and EBP use, with higher scores reported in the employee group. The results indicated that the participants did not strictly follow the sequential EBP steps as grounded in the item-response theory. Since its emergence, EBP has struggled to overcome the dominating traditional way of conducting medicine, which is also known as eminence-based medicine, where ad hoc decisions are based upon expert opinions, and nowadays frequently supplemented by quick online searches. Medical staff and supervisors of medical students should be aware of the existing overlaps and synergies of these potentially equivalent factors in clinical care. There is a need for intensifying the public and scientific debate on how to deal with the divergence between EBP theory and EBP practice.

French speech-language therapy students' interest in evidence-based practice: A survey.

Taking into account international studies interested in the development of evidence-based practice (EBP) in the speech and language therapy field, this survey investigated key issues with regard to students' perception of EBP. To determine how final-year students in France conceive EBP; to know if they feel competent in this area; to investigate any barriers to the use of EBP; and to assess their intention of using the EBP approach in their professional practice after graduating. Between January and April 2019, 182 advanced French students from 15 French speech-language university training centres (SLUTC) completed an online survey addressing these questions. The results show that 68.7% of students in the sample had a positive perception of the EBP. Between 54.9% and 73.6% of students felt rather competent to apply part of the approach, and 17% were sure to implement it in their own practice later on. Step 3 'Critically evaluating the evidence' was the most difficult. Regardless of the different EBP steps, the most important barrier for students who felt competent was the lack of practice; for students who did not feel competent, the major barriers were both the lack of theoretical knowledge and the lack of practice. A total of 61% of students reported not seeing EBP being practised by their clinical practice placements supervisors; 55% reported never having used their EBP knowledge during their clinical practice placements. The students interviewed had a positive perception of EBP. Nevertheless, these results demonstrate a need to improve the EBP curricula and to include EBP in clinical education, under the guidance of clinical practice placements supervisors. What is already known on the subject Despite the fact that EBP is widespread, previous studies have shown that it is not sufficiently used in the practice of speech and language therapists (SLT) and that young professionals tend to seek advice from experienced professionals rather than use EBP. Some students, despite their programme, do not feel competent enough to implement EBP. What this study adds to the existing knowledge French SLT students had a positive opinion of EBP despite barriers to implementation in their future professional practice, especially regarding the critical analysis of evidence. Moreover, the study reveals a need to practise EBP during clinical practice placements, and to create specific pedagogical framework for EBP. What are the potential or actual clinical implications of this work? The potential implication of this study is the use of the questionnaire to investigate the students' perception of EBP from a theoretical and a practical point of view, in collaboration with clinical practice placement supervisors, with the aim of promoting the task value and the self-efficacy as the two best factors to enhance students' motivation in favour of EBP.