Understanding Of Evidence-based Practice Research Articles

Advocating for a Harm-Minimization Approach to Drug Education in Australian Schools

The concept of using a harm-minimization approach to drug education in Australian schools has existed in both national and state government policy documents for over two decades. However, this approach appears to be ineffectively and inconsistently incorporated within the curriculum. Harm minimization emphasizes strategies that reduce the harms associated with drug use and prevent related health and social problems. Traditional drug education programs that promote abstinence as the only option may not be realistic and appear to have had limited success. School nurses in the state of Victoria have a significant role in improving both the understanding and adoption of this approach through advocacy, education, and their understanding of evidence-based practice.

Occupational therapy: Depth, innovation and courage

‘We make our world significant by the courage of our questions and by the depth of our answers’ . . . Carl Sagan (1973, p. 193). Over the past two decades, occupational therapy has grown and developed rapidly. Changes include expansion in practice focus and location, increased emphasis on occupation and occupational performance, and a greater importance of accountability and measurement of therapy outcomes. Worldwide, there is substantial agreement that client-centredness, use of evidence, and occupation-based practices embody the fundamental principles of reflective occupational therapy. There are, however, significant challenges to meet such expectations. As practitioners, students, educators, researchers, and managers, how can we address these challenges? I believe that such change is grounded as much in the way we approach practice as in what we actually do. I wish to share with you some thoughts about characteristics that our profession can apply as we move forward — the ideas of depth, innovation and courage. The depth of the occupational therapy discipline reflects our ability to appreciate and understand the complexity of daily living. In times of turmoil, cultural change, globalisation, societal ageing, and increasing disability, our comprehension of the nature of people doing occupations within varied environments is fundamentally important (McColl, 2002). For effective occupational therapy, it is necessary to guide education, practice and research by broad, conceptual models. Examples include currently developed and contemporary occupational therapy models (Dunn, Brown & McGuigan, 1994; Law et al., 1996; Canadian Association of Occupational Therapists, 1997; Gibson & Strong, 2003; Strong, 2003) as well as interdisciplinary models such as the International Classification of Functioning, Disability and Health (World Health Organization, 2001). While conceptual models are not enough, they provide the foundation for occupational therapists to understand the complex relationships between persons, occupation and environment. Such models form the basis for the development of a deep appreciation of the ways in which people find meaning in their lives through occupation. As occupational therapists develop ‘best’ practice, we would be wise to seek inventive methods of assessment and intervention strategies. We are leaders in client-centred practice and forming effective partnerships with clients, families, colleagues, service providers, agencies, and government. Expanding the range of interventions and populations with whom we work will enable occupational therapy to truly explore the relationship between occupation, health and well-being for individuals and populations. In doing so, occupational therapists can bring hope to those who suffer through lack of satisfactory occupations. We also have the potential to forge a new understanding of evidence-based practice. Our profession will move forward in this way if we recognise that evidence-based practice, in its most innovative way, represents a confluence between research evidence, practice wisdom, and client values and preferences. Australian occupational therapy is one of the leaders in the world in moving evidence into practice. Resources such as OT Seeker, and Critically Appraised Papers in the Australian Occupational Therapy Journal are models for other countries to follow. Courage is not typically considered in a discussion centred on the development of a profession. However, think about the definition of courage, as ‘the state or quality of mind or spirit that enables one to face danger, fear, or vicissitudes with self-possession, confidence, and resolution’ (American Heritage Dictionary, 2000). How better to describe an occupational therapy practice centred on the needs, values and wishes of those we serve? Facing the future in developing effective practice inevitably leads us to concentrate on how we can enable change in occupation and environments rather than simply change people. In this way, we define occupational therapy in ways that are not limiting, but which are potentially more effective. We must have the courage to measure the outcomes of what we do, and to stop carrying out interventions that we learn are not effective. Occupational Therapy, whether practised in Australia, in Canada, or elsewhere, will be known by what we do to make a difference in the world. Some years ago, a parent said to me during an interview: ‘You spend their young lives trying to get them ready for the world and when the time comes, the world isn't ready for them. So we have to find a way to do it.’ Depth, innovation, and courage — these values can help us in this journey. My thanks to Linsey Howie from La Trobe University for her helpful review of this editorial.

Evidence-based Physiotherapy: Physiotherapists' attitudes and experiences in the Wessex area

Summary This study sought to explore physiotherapists' views and experiences of evidence-based practice (EBP). Focus groups and interviews were held with 56 physiotherapists of all grades, working in a variety of different NHS settings in the eastern part of the South and West Region. The aims were to identify physiotherapists' understanding of EBP and their views as to its appropriateness in physiotherapy and what factors they felt promoted or discouraged its development. Focus groups and interviews were tape-recorded and transcribed before thematic analysis. The findings were discussed at a consensus conference. Various recommendations emerged. The study found that physiotherapists' definitions of EBP varied depending on their understanding of the term ‘evidence'. Views ranged from evidence being only those facts emerging from robust research to personal or anecdotal evidence from clinical practice – with most people seeing it as a mix. Junior physiotherapists and others working within university hospital settings felt they had the skills necessary to appraise research findings prior to implementation in practice. Others, particularly senior physiotherapists working in community settings, felt they did not. Community physiotherapists also felt a lack of engagement with EBP activities such as journal clubs and development of clinical guidelines due to poor access to library facilities and difficulties in meeting with peers. All participants felt EBP to be important to the continuing development of the profession. In order to facilitate this it is important to develop a culture that promotes critical appraisal and a willingness to look further than personal experience. Physiotherapy managers and the professional body have a role to play in the development of these skills through the provision of resources and training. However, individual physiotherapists have a responsibility to provide the best treatment for their patients through reflective consideration of all available evidence.

Evidence-based practice and rural nursing: a literature review.

This literature review is an exploration of issues related to evidence-based practice and rural nursing. Given the contribution that nursing research can make to improved client care in rural areas, it is important that nurses' awareness and understanding of evidence-based practice be enhanced, and that strategies for fostering the development of clinically relevant programs of nursing research be identified for rural health services. The review highlights the deficiencies in the current metropolitan-based approaches to evidence-based practice that may disadvantage rural clients and nursing practitioners, because they do not accommodate the inherent differences in rural and metropolitan healthcare cultures. It emphasises the need to seek approaches to research-based practice that arise from the specific needs of the rural setting.