Uptake Of Research Evidence Research Articles

The uptake of research evidence: a systematic review of nursesʼ experiences of using research evidence in their practice

Review question/objective The objective of this systematic review is to critically appraise and synthesise the best available evidence regarding the uptake of research evidence in clinical practice as experienced by nurses. This review seeks to answer the following questions: 1. What are the experiences of nurses in relation to the uptake of research into clinical practice? 2. What factors do nurses report as helpful in the uptake of research evidence into clinical practice? 3. What factors do nurses report as limiting the uptake of research evidence into clinical practice? Inclusion criteria Types of participants This review will consider qualitative studies that include all nurses working in any type of health care setting, including acute (hospitals), primary (community health), mental health and aged care. For the purpose of this review, the generic term ‘nurses’ will include registered nurses, enrolled nurses and assistants in nursing. The aim is to be as inclusive as possible and allow for global variations of nurse positions. Types of intervention(s)/phenomena of interest This review will consider studies that investigate the experience of nurses regarding the uptake of research evidence into clinical practice, including clinical decision making or clinical judgement. The term ‘clinical decision making’ for this review will describe any organisational aspects that influence decision making. The term ‘clinical judgement’ will describe the ‘different grounds for making judgements’. 20 (p. 1506) Additionally, for this review the terms research uptake or utilisations and evidence-based practice will be used interchangeably as they all represent the aspect of incorporating research evidence into clinical practice. Types of outcomes This review will consider any subjective accounts by nurses describing their experiences, either positive or negative, in relation to the uptake of research evidence into clinical practice.

Are journal clubs effective in supporting evidence-based decision making? A systematic review. BEME Guide No. 16.

Background: Journal clubs (JCs) are a common form of interactive education in health care aiming to promote the uptake of research evidence into practice, but their effectiveness has not been established.Objective: This systematic review aimed to determine whether the JC is an effective intervention in supporting clinical decision making.Methods: We searched for studies which evaluated whether clubs promote changes in learner reaction, attitudes, knowledge, skills, behaviour or patient outcomes. We included undergraduate, postgraduate and practice JCs and excluded studies evaluating video/internet meetings or single meetings.Results: Eighteen studies were included. Studies reported improvements in reading behaviour (N = 5/11), confidence in critical appraisal (N = 7/7), critical appraisal test scores (N = 5/7) and ability to use findings (N = 5/7). No studies reported on patient outcomes. Sixteen studies used self-reported measures, but only four studies used validated tests. Interventions were too heterogeneous to allow pooling. Realist synthesis identified potentially ‘active educational ingredients’, including mentoring, brief training in clinical epidemiology, structured critical appraisal tools, adult-learning principles, multifaceted teaching approaches and integration of the JC with other clinical and academic activities.Conclusion: The effectiveness of JCs in supporting evidence-based decision making is not clear. Better reporting of the intervention and a mixed methods approach to evaluating active ingredients are needed in order to understand how JCs may support evidence-based practice.

The Jamaica asthma and allergies national prevalence survey: rationale and methods

BackgroundAsthma is a significant public health problem in the Caribbean. Prevalence surveys using standardized measures of asthma provide valid prevalence estimates to facilitate regional and international comparisons and monitoring of trends. This paper describes methods used in the Jamaica Asthma and Allergies National Prevalence Survey, challenges associated with this survey and strategies used to overcome these challenges.Methods/DesignAn island wide, cross-sectional, community-based survey of asthma, asthma symptoms and allergies was done among adults and children using the European Community Respiratory Health Survey Questionnaire for adults and the International Study of Asthma and Allergies in Children. Stratified multi-stage cluster sampling was used to select 2, 163 adults aged 18 years and older and 2, 017 children aged 2-17 years for the survey. The Kish selection table was used to select one adult and one child per household. Data analysis accounted for sampling design and prevalence estimates were weighted to produce national estimates.DiscussionThe Jamaica Asthma and Allergies National Prevalence Survey is the first population- based survey in the Caribbean to determine the prevalence of asthma and allergies both in adults and children using standardized methods. With response rates exceeding 80% in both groups, this approach facilitated cost-effective gathering of high quality asthma prevalence data that will facilitate international and regional comparison and monitoring of asthma prevalence trends. Another unique feature of this study was the partnership with the Ministry of Health in Jamaica, which ensured the collection of data relevant for decision-making to facilitate the uptake of research evidence. The findings of this study will provide important data on the burden of asthma and allergies in Jamaica and contribute to evidence-informed planning of comprehensive asthma management and education programs.

Situating children in international development policy: challenges involved in successful evidence-informed policy influencing

This article presents a framework for analysing the impacts of evidence-informed policy entrepreneurship, and applies it to a longitudinal policy research project on childhood poverty in the developing world. Drawing on insights from Keck and Sikkink’s (1998) work on transnational advocacy, the discussion highlights five key dimensions of possible policy impact: framing debates and policy agenda formulation; securing discursive commitments from key policy actors; bringing about procedural changes; policy reform; and behavioural change. The analysis pays particular attention to the interplay of culture, politics and values in the uptake of research evidence in the policy process, and the challenges of cross-institutional partnership approaches to knowledge translation initiatives.

Evidence‐based practice in teaching: an information perspective

PurposeThe purpose of this research is to explore UK teachers' use of research‐based information, with a particular focus on issues relating to access to information in schools, information literacy, and the role of the school librarian and school library services.Design/methodology/approachThe study adopts a mixed methodology. In‐depth qualitative data gathered through vignette interviews (n=28), group exercises (four groups of between three and five teachers) and a discussion forum were supplemented by quantitative data gathered through surveys of teachers (n=312), head teachers (n=78), school librarians (n=78) and school library services (n=26).FindingsTeachers' professional use of research information reflects a preference for predigested information and informal sources. Although professional bodies and government departments promote the use of research by teachers and provide a range of customised web sites for information, lack of ready local access to information and lack of time were cited as major barriers to the use of research information. Teachers also revealed uncertainties and lack of confidence in their own ability to find and evaluate such information. The findings suggest scope for more targeted provision by school librarians of both information and skills to support the professional development of teachers. However, this raises issues of priorities and resources, and needs to be seen in the context of a wider change in ethos supported by senior management. The study also raises questions about teachers' own experiences and approaches to the use of information in professional learning, and how this might impact on the provision of support for their pupils and the potential for collaborative working between librarians and teachers.Research limitations/implicationsThe qualitative aspects of the study provided a rich source of data from teachers with varying levels of experience and involvement with the use of research information. However, a low response to the teacher questionnaire survey (10.9 per cent, overall, 312 teachers) resulted in a bias towards more research‐oriented teachers in that particular data set. While the data from research‐oriented teachers do appear to triangulate, it is difficult to generalise to other teachers. Therefore teacher survey data have been treated with some caution and drawn on only to aid further understanding of the issues raised in interviews and group exercises.Originality/valueIn focusing attention on teachers' information behaviour and information literacy, this paper provides a new perspective on the issues affecting the lack of uptake of research evidence within the teaching profession, contributes to the literature on information behaviour and information literacy in professional contexts, and contributes to the understanding of factors which may have a bearing on the development of student information literacy in schools.

Outcomes‐Focused Knowledge Translation: A Framework for Knowledge Translation and Patient Outcomes Improvement

Regularly accessing information that is current and reliable continues to be a challenge for front-line staff nurses. Reconceptualizing how nurses access information and designing appropriate decision support systems to facilitate timely access to information may be important for increasing research utilization. An outcomes-focused knowledge translation framework was developed to guide the continuous improvement of patient care through the uptake of research evidence and feedback data about patient outcomes. The framework operationalizes the three elements of the PARIHS framework at the point of care. Outcomes-focused knowledge translation involves four components: (a) patient outcomes measurement and real-time feedback about outcomes achievement; (b) best-practice guidelines, embedded in decision support tools that deliver key messages in response to patient assessment data; (c) clarification of patients' preferences for care; and (d) facilitation by advanced practice nurses and practice leaders. In this paper the framework is described and evidence is provided to support theorized relationships among the concepts in the framework. The framework guided the design of a knowledge translation intervention aimed at continuous improvement of patient care and evidence-based practice, which are fostered through real-time feedback data about patient outcomes, electronic access to evidence-based resources at the point of care, and facilitation by advanced practice nurses. The propositions in the framework need to be empirically tested through future research.

Healthy Workplaces for Health Workers in Canada: Knowledge Transfer and Uptake in Policy and Practice

The World Health Report launched the Health Workforce Decade (2006-2015), with high priority given for countries to develop effective workforce strategies including healthy workplaces for health workers. Evidence shows that healthy workplaces improve recruitment and retention, workers' health and well-being, quality of care and patient safety, organizational performance and societal outcomes. Over the past few years, healthy workplace issues in Canada have been on the agenda of many governments and employers. The purpose of this paper is to provide a progress update, using different data-collection approaches, on knowledge transfer and uptake of research evidence in policy and practice, including the next steps for the healthy workplace agenda in Canada. The objectives of this paper are (1) to summarize the current healthy workplace initiatives that are currently under way in Canada; (2) to synthesize what has been done in reality to determine how far the healthy workplace agenda has progressed from the perspectives of research, policy and practice; and (3) to outline the next steps for moving forward with the healthy workplace agenda to achieve its ultimate objectives. Some of the key questions discussed in this paper are as follows: Has the existing evidence on the benefits of healthy workplaces resulted in policy change? If so, how and to what extent? Have the existing policy initiatives resulted in healthier workplaces for healthcare workers? Are there indications that healthcare workers, particularly at the front line, are experiencing better working conditions? While there has been significant progress in bringing policy changes as a result of research evidence, our synthesis suggests that more work is needed to ensure that existing policy initiatives bring effective changes to the workplace. In this paper, we outline the next steps for research, policy and practice that are required to help the healthy workplace agenda achieve its ultimate objectives.

Commentary on Irvine (2005) Exploring district nursing competencies in health promotion: the use of the Delphi technique. Journal of Clinical Nursing 14, 1–11

Commentary on Irvine (2005) Exploring district nursing competencies in health promotion: the use of the Delphi technique. <i>Journal of Clinical Nursing</i> 14, 1–11

Space, Place, and the Evidence Base: Part II—Rereading Nursing Environment Through Geographical Research

This, the second and final article in the short health geography series, articulates how, moving beyond the models and assumptions associated with the metaparadigm of Nursing Environment, as a focused subdisciplinary approach, health geography might provide unique insights into nursing. A case study of a fictional yet somewhat typical children's hospital is presented and demonstrates some wide-ranging geographical issues and research questions (and hence potential geographical data) pertaining to nursing and the allied health professions. Indeed, this broad-brush approach is purposeful to make as many connections as possible to readers with varied theoretical, methodological, empirical, and practice expertise. In addition to the case study, to indicate further how geographical inquiry might locate quite comfortably in nursing research, the article also makes some initial and tentative connections between geography and an established nursing framework for the uptake of research evidence for practice. Although it is acknowledged that geographical inquiry should certainly never have the first call on researching the relationships between nurses and their environments, it is argued that its conceptual focus on space and place provides dedicated and detailed attention and a sound basis for a reformed, "spatialized" route to a more comprehensive understanding. Moreover, it is argued that it also demonstrates great versatility in terms of the scales and the subject matter with which it might engage. Some important issues certainly remain with respect to what might be the correct form of engagement between geographical and nursing research, but arguably, as a reformed disciplinary approach, health geography has the potential to provide a wealth of focused evidence for nursing practice.

Conceptions of evidence, evidence‐based medicine, evidence‐based practice and their use in nursing: independent nurse prescribers’ views

The purpose of this study was to explore nurses' conceptions of evidence and evidence-based practice, whether there are differences between evidence-based practice and evidence-based medicine and to identify the uptake of research evidence in the workplace. The use and comprehension of the term 'evidence-based practice' in relation to nursing shows remarkable variation. Numerous definitions are provided, some tend to be closely related to the concept 'evidence-based medicine'. Independent nurse prescribers need to be able to understand the concept of evidence-based practice to utilize and apply this concept in order to provide adequate medication management of their patients. Data were generated by focus group interview and open question questionnaire and analysed by analytical abstraction. Nurses offered a variety of views on the use and uptake of evidence in the workplace. Some nurses acknowledged that they did not read research papers but were aware that they used a lot of evidence in their practice. Nurses had difficulty differentiating evidence-based practice from evidence-based medicine. Nurses were familiar with the research process but not the canons of evidenced-based practice. The data generated indicate different levels of evidence are used by nurses. This may be a reflection of the level of intrigue of the nurses involved. The education and training of independent nurse prescribers should include the exploration of evidence from randomized controlled trials and from naturalistic studies and their contribution to evidenced-based practice and evidence-based medicine. Both concepts need to be explored in relation to the medication management of patients.

Seeking evidence from medical research consumers as part of the medical research process could improve the uptake of research evidence.

Concerns have been expressed about gaps between available medical research evidence and current medical practice. These gaps have been attributed to process problems with the implementation of evidence previously judged to be appropriate, rather than to problems with the appropriateness of the evidence provided for implementation. Two such 'appropriateness' problems are the applicability of research evidence to an individual patient, and the acceptability to an individual patient of a proposed treatment. Part of both these problems is due to the pre-eminence of the scientific paradigm within the medical research domain, and of the randomized controlled clinical trial within that domain. However, there is an opportunity beneficially to address both these problems by supporting reciprocal communication between medical research 'producers' and medical research 'consumers'--both practising clinicians and patients' representatives--in the setting of research priorities, selection of topics for research, development of research questions and study designs, in-progress reviewing, and final reporting of medical research projects. Such communication could allow researchers to understand, and respond to, clinicians' and patients' inputs concerning the applicability, utility and acceptability issues that will ultimately affect whether, and how, medical research findings can be applied. Such communication could also assist with some post-research implementation issues: integration of appropriate evidence into everyday practice; access to appropriate information sources; and a critical lack of necessary time.

Promoting Evidence-Based Health Policy, Programming, and Practice for Seniors: Lessons from a National Knowledge Transfer Project

ABSTRACTIn response to Canada's pressing need for effective evidence-based policy, services, and practices specific to seniors, national leaders representing all concerned stakeholders designed and implemented a National Consensus Process to promote spread, exchange, choice, and uptake of research evidence on social and health issues associated with an aging population. This article presents the innovative methods and evaluation of this three-year project, illuminating for all constituencies the challenges and opportunities associated with promoting seniors' independence through collaborative knowledge transfer efforts. A total of 198 organizations and 65 individuals were surveyed at baseline, throughout the intervention, immediately post-intervention, and one year post-intervention. Knowledge from 783 studies was spread to 63,387 people, 90 per cent of whom reported knowledge exchange. Over 50 per cent of stakeholders reported using the research evidence, although processes for facilitating knowledge choice did not achieve consensus. Significant knowledge uptake occurred in two of the four research theme areas.

The role of research evidence in pharmaceutical policy making: evidence when necessary but not necessarily evidence.

The use of research evidence in policy making at the legislative and administrative levels would appear to be very selective. Focusing on pharmaceutical policy, this paper argues that research evidence is only one ingredient leading to a policy decision and that any examination of research transfer into policy must take into account the many other factors which impact on decision making. The paper describes the policy making process, barriers to the uptake of research evidence into policy and ways of improving research uptake into policy making. Examples are given from drug licensing, remuneration policies, post-marketing surveillance and product withdrawal from the market.

Using anecdotal information in evidence-based health care: Heresy or necessity?

Anecdotes are powerful tools that humans use to make decisions. Despite their power and influence, they are sometimes misused, and sometimes undervalued. Ignoring or under-estimating the role of anecdotal information in health care decisions is likely to hinder communication among decision makers, and to retard their uptake of research evidence. Anecdotal information should not be considered as a replacement for, but as a complement to formal research evidence. If evidence-based health care is to meet its potential, the important role of anecdotes must be acknowledged, studied and utilized.