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Lai J, Pilla B, Stephenson M, Brettle A, Zhou C, Li W, Li C, Fu J, Deng S, Zhang Y, Guo Z, Wu Y. Pre-treatment assessment of chemotherapy for cancer patients: a multi-site evidence implementation project of 74 hospitals in China. BMC Nurs 2024; 23:320. [PMID: 38734605 PMCID: PMC11088226 DOI: 10.1186/s12912-024-01997-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 05/07/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Chemotherapy, whilst treating tumours, can also lead to numerous adverse reactions such as nausea and vomiting, fatigue and kidney toxicity, threatening the physical and mental health of patients. Simultaneously, misuse of chemotherapeutic drugs can seriously endanger patients' lives. Therefore, to maintain the safety of chemotherapy for cancer patients and to reduce the incidence of adverse reactions to chemotherapy, many guidelines state that a comprehensive assessment of the cancer patient should be conducted and documented before chemotherapy. This recommended procedure, however, has yet to be extensively embraced in Chinese hospitals. As such, this study aimed to standardise the content of pre-chemotherapy assessment for cancer patients in hospitals and to improve nurses' adherence to pre-chemotherapy assessment of cancer patients by conducting a national multi-site evidence implementation in China, hence protecting the safety of cancer patients undergoing chemotherapy and reducing the incidence of adverse reactions to chemotherapy in patients. METHODS The national multi-site evidence implementation project was launched by a JBI Centre of Excellence in China and conducted using the JBI approach to evidence implementation. A pre- and post-audit approach was used to evaluate the effectiveness of the project. This project had seven phases: training, planning, baseline audit, evidence implementation, two rounds of follow-up audits (3 and 9 months after evidence implementation, respectively) and sustainability assessment. A live online broadcast allowed all participating hospitals to come together to provide a summary and feedback on the implementation of the project. RESULTS Seventy-four hospitals from 32 cities in China participated in the project, four withdrew during the project's implementation, and 70 hospitals completed the project. The pre-and post-audit showed a significant improvement in the compliance rate of nurses performing pre-chemotherapy assessments for cancer patients. Patient satisfaction and chemotherapy safety were also improved through the project's implementation, and the participating nurses' enthusiasm and belief in implementing evidence into practice was increased. CONCLUSION The study demonstrated the feasibility of academic centres working with hospitals to promote the dissemination of evidence in clinical practice to accelerate knowledge translation. Further research is needed on the effectiveness of cross-regional and cross-organisational collaborations to facilitate evidence dissemination.
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Affiliation(s)
- Jie Lai
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
- School of Nursing, Southern Medical University, Guangzhou, PR China
| | - Bianca Pilla
- JBI, School of Public Health, University of Adelaide, Adelaide, Australia
| | - Matthew Stephenson
- JBI, School of Public Health, University of Adelaide, Adelaide, Australia
| | - Alison Brettle
- School of Health & Society, University of Salford, Manchester, UK
| | - Chunlan Zhou
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Wenji Li
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Chaixiu Li
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
- School of Nursing, Southern Medical University, Guangzhou, PR China
| | - Jiaqi Fu
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
- School of Nursing, Southern Medical University, Guangzhou, PR China
| | - Shisi Deng
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
- School of Nursing, Southern Medical University, Guangzhou, PR China
| | - Yujie Zhang
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
- School of Nursing, Southern Medical University, Guangzhou, PR China
| | - Zihan Guo
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
- School of Nursing, Southern Medical University, Guangzhou, PR China
| | - Yanni Wu
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China.
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McNett M, Tucker S, Zadvinskis I, Tolles D, Thomas B, Gorsuch P, Gallagher-Ford L. A Qualitative Force Field Analysis of Facilitators and Barriers to Evidence-Based Practice in Healthcare Using an Implementation Framework. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2022; 2:195-208. [PMID: 35974880 PMCID: PMC9373890 DOI: 10.1007/s43477-022-00051-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/20/2022] [Indexed: 11/01/2022]
Abstract
Research has identified facilitators and barriers to implementation of evidence-based practices (EBPs). Few studies have evaluated which factors persist among healthcare clinicians with extensive education and training on EBP implementation. Therefore, the purpose of this study was to examine facilitators and barriers to EBP implementation across a national sample of specialty-prepared EBP mentors in healthcare settings. Healthcare clinicians participating in an immersive 5-day EBP knowledge and skill building program were invited to complete a follow-up survey 12 months later to report on implementation experiences. The Consolidated Framework for Implementation Research (CFIR) guided content analysis of responses. A force field analysis using Lewin’s change theory was used to assign numerical ‘weights’ to factors. Eighty-four individuals reported facilitators and barriers to implementation. The majority occurred within the inner setting of the CFIR model. Facilitators were strong leadership engagement (n = 15), positive EBP culture (n = 9), and resources (n = 4). Barriers included lack of resources (n = 21), poor leadership engagement (n = 19), implementation climate (n = 17), lack of relative priority (n = 12), and organizational characteristics (n = 9). Respondents also identified simultaneous facilitators and barriers within the process domain of the CFIR model. The construct of stakeholder engagement was a barrier when absent from the implementation process (n = 23), yet was a strong facilitator when present (n = 23). Implementation in healthcare settings appears most effective when conducted by an interprofessional team with strong leadership, resources, stakeholder engagement, and positive EBP culture. When these same factors are absent, they remain persistent barriers to implementation, even among specialty-trained healthcare clinicians.
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Latulippe K, LeBlanc A, Gagnon MP, Boivin K, Lavoie P, Dufour J, Raynard EP, Richard E, Lamontagne MÈ. Organizational knowledge translation strategies for allied health professionals in traumatology settings: realist review protocol. Syst Rev 2021; 10:255. [PMID: 34556170 PMCID: PMC8461924 DOI: 10.1186/s13643-021-01793-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 08/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Knowledge translation (KT) is an important means of improving the health service quality. Most research on the effectiveness of KT strategies has focused on individual strategies, i.e., those directly targeting the modification of allied health professionals' knowledge, attitudes, and behaviors, for example. In general, these strategies are moderately effective in changing practices (maximum 10% change). Effecting change in organizational contexts (e.g., change readiness, general and specific organizational capacity, organizational routines) is part of a promising new avenue to service quality improvement through the implementation of evidence-based practices. The objective of this study will be to identify why, how, and under what conditions organizational KT strategies have been shown to be effective or ineffective in changing the (a) knowledge, (b) attitudes, and (c) clinical behaviors of allied health professionals in traumatology settings. METHODS This is a realist review protocol involving four iterative steps: (1) Initial theory formulation, (2) search for Evidence search, (3) knowledge extraction and synthesis, and (4) recommendations. We will search electronic databases such as PubMed, Embase, CINHAL, Cochrane Library, and Conference Proceedings Citation Index - Science. The studies included will be those relating to the use of organizational KT strategies in trauma settings, regardless of study designs, published between January 1990 and October 2020, and presenting objective measures that demonstrate change in allied health professionals' knowledge, attitudes, and clinical behaviors. Two independent reviewers will select, screen, and extract the data related to all relevant sources in order to refine or refute the context-mechanism-outcome (CMO) configurations developed in the initial theory and identify new CMO configurations. DISCUSSION Using a systematic and rigorous method, this review will help guide decision-makers and researchers in choosing the best organizational strategies to optimize the implementation of evidence-based practices. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020216105.
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Affiliation(s)
- Karine Latulippe
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Pavillon Lindsay de l'IURDPM, 6363, Chemin Hudson, Montréal, Québec, H3S 1M9, Canada
| | - Annie LeBlanc
- Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Pavillon Ferdinand-Vandry, Université Laval, 1050 av. de la Médecine, Québec, Québec, G1V 0A6, Canada
| | - Marie-Pierre Gagnon
- Chaire de recherche du Canada en technologies et pratiques en santé, Faculté des sciences infirmières, Pavillon Ferdinand-Vandry, Université Laval, Canada, 1050 av. de la Médecine, Québec, Québec, G1V 0A6, Canada
| | - Katia Boivin
- Direction de l'enseignement et des affaires universitaires, CHU de Québec-Université Laval, 2705 Boulevard Laurier, Québec, Québec, G1V 4G2, Canada
| | - Pascale Lavoie
- Direction de l'enseignement et des affaires universitaires, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 525, boul. Wilfrid Hamel, Québec, Québec, G1M 2S8, Canada
| | - Joëlle Dufour
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Institut de réadaptation en déficience physique de Québec, 525 boul. Wilfrid-Hamel, Québec, Québec, G1M 2S8, Canada
| | | | - Eve Richard
- Bibliothèque de l'Université Laval, 2345, allée des Bibliothèques, Québec, Québec, G1V 0A6, Canada
| | - Marie-Ève Lamontagne
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Institut de réadaptation en déficience physique de Québec, 525 boul. Wilfrid-Hamel, Québec, Québec, G1M 2S8, Canada.
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Abuejheisheh A, Tarawneh O, Qaddumi JAS, Almahmoud O, Darawad MW. Predictors of Intensive Care Unit Nurses' Practice of Evidence-Based Practice Guidelines. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 57:46958020902323. [PMID: 32108531 PMCID: PMC7052456 DOI: 10.1177/0046958020902323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although many studies discussed evidence-based practice among general nurses, few
studies were found by the researchers among intensive care unit nurses. Also, no
study has been conducted to investigate the predictors of evidence-based
practice among intensive care unit nurses in Jordan. Therefore, this study aims
to identify the predictors of evidence-based practice among intensive care unit
nurses in Jordan. A descriptive cross-sectional design was used to conveniently
recruit 132 participants. Self-reported questionnaires were utilized including
the Evidence-Based Practice Questionnaire and Evidence-Based Practice barrier
scale. Participants’ rate of evidence-based practice was 60% (M = 4.2/7), which
was significantly correlated with their knowledge (r = 0.739,
P < .01) and attitudes (r = 0.564,
P < .01) of evidence-based practice. The results
revealed a 2-predictor model that explained 62.2% of the variance in
evidence-based practice among intensive care unit nurses. The 2 variables were
attitude (β = 0.245) and knowledge (β = 0.563). The outcomes of this study added
new information regarding the prediction of evidence-based practice among
intensive care unit nurses. An educational program for nurses regarding this
issue is crucial to improve their practice aiming at enhancing nursing care.
Also, nursing schools should update their curricula to explain the importance of
evidence-based practice and to enhance students’ competencies in research
utilization and statistical skills.
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Lamontagne ME, Best KL, Clarke T, Dumont FS, Noreau L. Implementation Evaluation of an Online Peer-Mentor Training Program for Individuals With Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2020; 25:303-315. [PMID: 31844382 DOI: 10.1310/sci19-00002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Community-based spinal cord injury (SCI) associations play a critical role in successful community integration of individuals having experienced an SCI, with knowledge translation being increasingly important for the process. The implementation of a new online peer-mentor training program was perceived as being useful in improving and standardizing training practices for peer mentors across Canada. It was also seen as an opportunity to explore the context, process, and influence of a formal implementation process in SCI community-based associations that are corporate members of SCI Canada with a view to informing future implementation efforts. Objectives: The objectives of this study were to (a) explore the context in which the implementation process will be conducted, (b) identify barriers and facilitators that influence the implementation process, and (c) measure the influence of the implementation process on service delivery. Methods: A sequential cross-sectional design was used with SCI Canada provincial member associations. SCI Canada's purpose is to support collaboration among provincial corporate members. SCI Canada enlisted the participation of several employees from the provincial associations to assess the implementation context using the Evidence-Based Practice Attitude Scale and the Organizational Readiness to Change Assessment and to identify barriers to and facilitators of the implementation of an evidence-based practice through an open-ended questionnaire based on the Consolidated Framework for Implementation Research. A pre-post design was used to evaluate the influence of the implementation process on peer-mentors using the Determinants of Implementation Behavior Questionnaire. Results: Participants reported an overall positive attitude toward evidence-based practice and a positive perception of the organizational readiness to change. The relevance of the practice chosen was a facilitator because peer support is central to the mission of SCI Canada and this type of practice is in line with the organization' culture and values. Equally important, but as an obstacle, is the scarcity of existing resources within the association in general and specifically resources devoted to the implementation of the program. Finally, the implementation process seems to influence half of the implementation determinant types on potential peer mentors. Conclusion: Community-based organizations, such as the provincial association members of SCI Canada, show positive context for the implementation of evidence-based practices. However, successful implementation of online peer-mentor training will require specific consideration of financial and human resources.
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Affiliation(s)
| | - Krista L Best
- Department of Rehabilitation, Université Laval, Quebec City, Quebec, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
| | | | - Frederic S Dumont
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
| | - Luc Noreau
- Department of Rehabilitation, Université Laval, Quebec City, Quebec, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
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Knowledge, attitude and practice regarding nursing interruptions among Chinese nurses: A nationwide cross-sectional survey. Int J Nurs Sci 2019; 7:66-73. [PMID: 32099862 PMCID: PMC7031111 DOI: 10.1016/j.ijnss.2019.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 11/26/2019] [Accepted: 12/10/2019] [Indexed: 11/20/2022] Open
Abstract
Objectives To explore the knowledge, attitude and practice of Chinese nurses regarding nursing interruptions and related factors. Methods A total of 6,400 nurses from 31 hospitals in China were investigated by using the Knowledge, Attitude and Practice (KAP) Questionnaire of Nursing Interruptions. The questionnaire consists of three dimensions, knowledge, attitude and practice, containing 10, 9 and 7 items, with full score of 50, 45 and 28, respectively. Results The mean overall KAP score regarding nursing interruptions of Chinese nurses was 74.05 ± 16.65 (range: 26–123), with scores for the knowledge, attitude, and practice component being 21.74 ± 9.80, 34.83 ± 6.98, and 17.49 ± 4.97, respectively. Among the nurses, 70.8% of them experienced an average level of KAP toward nursing interruptions while 15.5% were at a poor level. The knowledge, attitude, and practice of nursing interruptions were better in chief nurses, managers, nurses with a master degree or above, nurses ever received training, and nurses with a strong agreement to leadership compared to nurses in other groups (P < 0.05). In addition, employment type, professional title, position, standardized training and leaders’ attention were predictors of KAP in nurses. Conclusion Chinese nurses have a moderate level of KAP regarding nursing interruptions. Leaders’ attention, standardized training, position, professional title and employment type could predict nurses’ KAP state of nursing interruptions. Thus, a targeted training program should be implemented for clinical nurses by nursing leaders, with a particular focus on feasibility and professionalism.
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Lavallée JF, Gray TA, Dumville J, Cullum N. Preventing pressure ulcers in nursing homes using a care bundle: A feasibility study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e417-e427. [PMID: 30919525 PMCID: PMC6618244 DOI: 10.1111/hsc.12742] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 01/16/2019] [Accepted: 02/18/2019] [Indexed: 06/03/2023]
Abstract
Pressure ulcers can be painful and negatively affect health-related quality of life and healthcare costs. Many people living in nursing homes are at risk of developing a pressure ulcer. Nursing home staff, tissue viability nurses and researchers have co-designed the first theory and evidence-informed care bundle specifically for nursing homes, which consists of three prevention practices (skin inspection, support surfaces, repositioning) and a range of behaviour change techniques to promote these practices. We conducted a mixed methods feasibility study of the use of this care bundle in one nursing home in the North of England using an uncontrolled, before-and-after study design. We collected quantitative data on pressure ulcer prevention behaviours of the nursing home staff and pressure ulcer incidence rates for 5 weeks prior to implementing the bundle. Data collection continued for a further 9 weeks during the bundle implementation phase. We explored adherence to the bundle and participants' experiences of using it. The Conceptual Framework for Implementation Fidelity and the Theoretical Domains Framework informed the semi-structured interviews. Quantitative and qualitative data were analysed using descriptive statistics and deductive framework analysis respectively. We collected data for 462 resident bed days prior to implementing the bundle; five new pressure ulcers were recorded and repositioning was the only documented pressure ulcer prevention behaviour. We collected data for 1,181 resident bed days during the intervention phase; no new pressure ulcers developed and the documented prevention behaviours included repositioning, skin inspection and checking support surfaces. Participants reported that the bundle enhanced the care they delivered and offered suggestions for future improvements. Our findings have highlighted a number of feasibility issues surrounding recruitment and retention, collecting data and implementation fidelity. A pressure ulcer prevention bundle specifically designed for nursing homes was acceptable. The feasibility work has highlighted the potential for the intervention and the areas that require development and refinement.
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Affiliation(s)
- Jacqueline F. Lavallée
- Division of Nursing, Midwifery and Social WorkUniversity of Manchester, Manchester Academic Health Science CentreManchesterUK
- Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater ManchesterManchesterUK
| | - Trish A. Gray
- Division of Nursing, Midwifery and Social WorkUniversity of Manchester, Manchester Academic Health Science CentreManchesterUK
- Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater ManchesterManchesterUK
| | - Jo Dumville
- Division of Nursing, Midwifery and Social WorkUniversity of Manchester, Manchester Academic Health Science CentreManchesterUK
- Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater ManchesterManchesterUK
| | - Nicky Cullum
- Division of Nursing, Midwifery and Social WorkUniversity of Manchester, Manchester Academic Health Science CentreManchesterUK
- Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater ManchesterManchesterUK
- Research and Innovation DivisionManchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUK
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Renolen Å, Hjälmhult E, Høye S, Danbolt LJ, Kirkevold M. Evidence-based practice integration in hospital wards-The complexities and challenges in achieving evidence-based practice in clinical nursing. Nurs Open 2019; 6:815-823. [PMID: 31367404 PMCID: PMC6650761 DOI: 10.1002/nop2.259] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 12/20/2018] [Accepted: 01/30/2019] [Indexed: 12/30/2022] Open
Abstract
AIM Exploring the processes involved in two different strategies to integrate evidence-based practice into nursing practice. DESIGN Classical grounded theory methodology was used. METHODS Data were collected through 90 hr of observation and 4 focus groups among clinical nurses in two different hospital wards. RESULTS We identified a multidimensional evidence-based practice integration framework that illuminates the complexities involved in the integration process. The dimensions were approaches to evidence-based practice, positions of evidence-based practice and levels of evidence-based practice. The interactions between the dimensions gave five combinations; an explicit evidence-based practice performed as a parallel to daily work at the systems level, an implicit evidence-based practice integrated into daily work at the systems level, an explicit evidence-based practice integrated into daily work at the individual level, an explicit evidence-based practice integrated into daily work at the systems level and an implicit evidence-based practice integrated into daily work at the individual level.
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Affiliation(s)
- Åste Renolen
- Institute of Health and SocietyUniversity of OsloOsloNorway
- Department of MedicineInnlandet Hospital TrustLillehammerNorway
| | - Esther Hjälmhult
- Centre for Evidence‐Based PracticeWestern Norway University of Applied SciencesBergenNorway
| | - Sevald Høye
- Faculty of Public HealthInland Norway University of Applied SciencesElverumNorway
| | - Lars Johan Danbolt
- Centre of Psychology of ReligionInnlandet Hospital TrustOttestadNorway
- Norwegian School of TheologyOsloNorway
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Pétré B, Gillain N, Jacqmin N, Adriaenssens J, Vandenbosch K, Gillet P, Vander Stichele R, Thienpont G, Guillaume M. Perception of Belgian nurses about evidence-based clinical practice implementation: a focus group study. Acta Clin Belg 2018; 73:110-118. [PMID: 28768464 DOI: 10.1080/17843286.2017.1355428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND/OBJECTIVES Despite recommendations to integrate evidence-based practice into nursing care, evidence-based nursing (EBN) implementation is generally lacking. Strategies for developing an EBN implementation plan require an evaluation of nurses' needs and expectations. The aim of this study was to evaluate how Belgian nurses perceive EBN. METHODS Descriptive qualitative data were obtained via focus groups. Fifty-six nurses took part in the study and were assigned to one of seven focus groups based on their work setting and the local language. RESULTS The main results revealed little familiarity with the EBN concept. There were a number of reported barriers to integrating EBN into practice: lack of time; lack of skills needed to find, process, and apply information; lack of support from management; and lack of recognition of the nursing profession. CONCLUSION Participants identified four strategies for facilitating EBN development: specific staff dedicated to supporting EBN implementation; an interactive web-based platform to help nurses find, select, and interpret relevant scientific sources; an electronic tool to help nurses in clinical decision-making based on patients' clinical data; and a change in clinical culture to include EBN in decision-making processes.
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Affiliation(s)
- Benoit Pétré
- Département des Sciences de la Santé publique, Nutrition, Environnement et Santé, Quartier Hôpital, Université de Liège, Liège, Belgium
| | - Nicolas Gillain
- Département des Sciences de la Santé publique, Nutrition, Environnement et Santé, Quartier Hôpital, Université de Liège, Liège, Belgium
| | | | | | | | | | - Robert Vander Stichele
- Research in Advanced Medical Informatics and Telematics (RAMIT) vzw, Ghent University, Gent, Belgium
| | - Geert Thienpont
- Research in Advanced Medical Informatics and Telematics (RAMIT) vzw, Ghent University, Gent, Belgium
| | - Michèle Guillaume
- Département des Sciences de la Santé publique, Nutrition, Environnement et Santé, Quartier Hôpital, Université de Liège, Liège, Belgium
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Smith SK, Ashby SE, Thomas L, Williams F. Evaluation of a multifactorial approach to reduce the prevalence of pressure injuries in regional Australian acute inpatient care settings. Int Wound J 2018; 15:95-105. [PMID: 29115004 PMCID: PMC7949924 DOI: 10.1111/iwj.12840] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 09/02/2017] [Accepted: 09/08/2017] [Indexed: 11/29/2022] Open
Abstract
The aim of the study was to compare the changes in the prevalence of pressure injuries from 2008 to 2014 in relation to staff behaviour in acute/subacute inpatient care settings. In 2008, the large regional health district Hunter New England Local Health District implemented an initiative called the Crystal Model which resulted in changes in their policy and an e-learning education program for all nursing staff. A retrospective cross sectional study compared data from the 2008, 2010 and 2014 point prevalence surveys of PI in acute services. These were collected as part of an annual pressure injury prevention and management quality audit for adult inpatients. The total number of participants included 1407 participants in 2008, 1331 participants in 2010 and 1199 participants in 2014. From 2008 to 2014 there was a 15.7% decrease in percentage of patients with hospital-acquired pressure injuries and the percentages of each stage of pressure of injury 1-4 decreased. From 2008 to 2014 the completion and documentation of risk assessment, the documentation of repositioning and the implementation of pressure-relieving equipment increased. A multifactorial model can reduce the prevalence of pressure injuries in acute inpatient settings. The theories of knowledge translation and the modified Theory of Planned Behaviour can be utilised to analyse changes in health professionals habituated pressure injury prevention practice.
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Affiliation(s)
| | - Samantha E Ashby
- School of Health SciencesUniversity of NewcastleCallaghanNSWAustralia
| | - Lynette Thomas
- Professional DevelopmentNursing and Midwifery Services, Hunter New England Local Health DistrictNewcastleNSWAustralia
| | - Felicity Williams
- Professional DevelopmentNursing and Midwifery Services, Hunter New England Local Health DistrictNewcastleNSWAustralia
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Harris C, Allen K, Waller C, Dyer T, Brooke V, Garrubba M, Melder A, Voutier C, Gust A, Farjou D. Sustainability in Health care by Allocating Resources Effectively (SHARE) 7: supporting staff in evidence-based decision-making, implementation and evaluation in a local healthcare setting. BMC Health Serv Res 2017. [PMID: 28637473 PMCID: PMC5480160 DOI: 10.1186/s12913-017-2388-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND This is the seventh in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE Program was a systematic, integrated, evidence-based program for resource allocation within a large Australian health service. It aimed to facilitate proactive use of evidence from research and local data; evidence-based decision-making for resource allocation including disinvestment; and development, implementation and evaluation of disinvestment projects. From the literature and responses of local stakeholders it was clear that provision of expertise and education, training and support of health service staff would be required to achieve these aims. Four support services were proposed. This paper is a detailed case report of the development, implementation and evaluation of a Data Service, Capacity Building Service and Project Support Service. An Evidence Service is reported separately. METHODS Literature reviews, surveys, interviews, consultation and workshops were used to capture and process the relevant information. Existing theoretical frameworks were adapted for evaluation and explication of processes and outcomes. RESULTS Surveys and interviews identified current practice in use of evidence in decision-making, implementation and evaluation; staff needs for evidence-based practice; nature, type and availability of local health service data; and preferred formats for education and training. The Capacity Building and Project Support Services were successful in achieving short term objectives; but long term outcomes were not evaluated due to reduced funding. The Data Service was not implemented at all. Factors influencing the processes and outcomes are discussed. CONCLUSION Health service staff need access to education, training, expertise and support to enable evidence-based decision-making and to implement and evaluate the changes arising from those decisions. Three support services were proposed based on research evidence and local findings. Local factors, some unanticipated and some unavoidable, were the main barriers to successful implementation. All three proposed support services hold promise as facilitators of EBP in the local healthcare setting. The findings from this study will inform further exploration.
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Affiliation(s)
- Claire Harris
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. .,Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC, Australia.
| | - Kelly Allen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC, Australia
| | - Cara Waller
- Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC, Australia
| | - Tim Dyer
- Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC, Australia
| | - Vanessa Brooke
- Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC, Australia
| | - Marie Garrubba
- Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC, Australia
| | - Angela Melder
- Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC, Australia
| | - Catherine Voutier
- Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC, Australia
| | - Anthony Gust
- Clinical Information Management, Monash Health, Melbourne, VIC, Australia
| | - Dina Farjou
- Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC, Australia
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12
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Mekki TE, Øye C, Kristensen B, Dahl H, Haaland A, Nordin KA, Strandos M, Terum TM, Ydstebø AE, McCormack B. The inter-play between facilitation and context in the promoting action on research implementation in health services framework: A qualitative exploratory implementation study embedded in a cluster randomized controlled trial to reduce restraint in nursing homes. J Adv Nurs 2017; 73:2622-2632. [PMID: 28513876 DOI: 10.1111/jan.13340] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2017] [Indexed: 11/29/2022]
Abstract
AIM To explore the inter-play between external facilitation and nursing home contexts relative to intervention outcomes. BACKGROUND The Promoting Action on Research Implementation in Health Services framework is frequently used to theoretically inform implementation and research in nursing and recent reviews indicate high face validity for health services. However, the inter-play and relationship between framework sub-elements of evidence, context and facilitation and the prospective utility in non-English speaking contexts warrant further illumination. DESIGN In an overarching single-blind cluster-randomized controlled trial, we applied participatory action research and ethnography from August 2011-June 2015 to evaluate a standardized education intervention to reduce restraint and agitation in nursing home residents living with dementia. The trial results are published elsewhere. METHODS Prospectively informed by the PARIHS framework, a research team and eight facilitators participating in dual roles as action researchers designed, implemented, and evaluated the intervention. How contextual factors influenced the facilitation processes were explored in focus group interviews (1), reflection notes (84) written by the facilitators' after each education session, ethnographic field studies (6 homes), and co-analysis workshops (5). Directed content analysis was used to analyse data. RESULTS Clinical leaders taking roles of internal facilitator influenced the success of implementation, while complex and fluctuating context elements determined whether restraint use was reduced- or not. The PARIHS framework was found to be relevant in a non-English nursing home setting, albeit some elements merit further conceptualization. CONCLUSIONS Our findings confirm the prospective utility of the PARIHS framework for implementation in a non-English context, particularly the notion of implementation processes as dynamic and multifaceted.
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Affiliation(s)
- Tone Elin Mekki
- Center for Care Research, Western Norway University of Applied Sciences, Bergen, Norway
| | - Christine Øye
- Center for Care Research, Western Norway University of Applied Sciences, Bergen, Norway
| | - Bodil Kristensen
- Center for institutional and home care services, Hordaland, Norway
| | - Helen Dahl
- Center for Care Research, Western Norway University of Applied Sciences, Bergen, Norway
| | - Astrid Haaland
- Center for institutional and home care services, Haugesund, Norway
| | - Kristin Aas Nordin
- SESAM, Regional centre for geriatric medicine and collaboration, Helse Stavanger HF, Norway
| | - Marta Strandos
- Center for institutional and home care services, Sogn og Fjordane, Norway
| | - Toril Marie Terum
- Center for Care Research, Western Norway University of Applied Sciences, Bergen, Norway
| | - Arnt Egil Ydstebø
- Developing Center for institutional and Home Care Services, Rogaland, Norway
| | - Brendan McCormack
- Department of Nursing, Queen Margaret University, Edinburgh, UK.,Drammen, University College of Southeast Norway, Norway
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Lunden A, Teräs M, Kvist T, Häggman-Laitila A. A systematic review of factors influencing knowledge management and the nurse leaders' role. J Nurs Manag 2017; 25:407-420. [PMID: 28580645 DOI: 10.1111/jonm.12478] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 12/01/2022]
Abstract
AIM To describe factors facilitating or inhibiting the development of registered nurses' competency and nurse leader's role in knowledge management. BACKGROUND Nurses' competency directly influences patient safety and the quality and effectiveness of patient care. Challenges of nurse leaders in knowledge management include acquiring, assessing and utilising current knowledge and assessing and enhancing competency. EVALUATION A systematic search was conducted in PubMed, CINAHL, SCOPUS and ERIC databases in April 2015. The search identified 18 relevant research articles published between 2009 and 2015. The quality of the studies was appraised in accordance with study designs. KEY ISSUE Knowledge management is facilitated by an organisation culture that supports learning, sharing of information and learning together. Leader commitment and competency were factors related to leadership facilitating knowledge management. CONCLUSION Nurse leaders need evidence-based interventions to support shared learning and to create infrastructures that facilitate competence development. Future research is especially needed to evaluate connections between knowledge management and patient outcomes. IMPLICATIONS FOR NURSING MANAGEMENT AND LEADERSHIP The results of this review can be utilised in enhancing factors to facilitate knowledge management in clinical practice and identifying nurse leaders' role in strengthening nurses' competency.
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Affiliation(s)
- Anne Lunden
- City of Helsinki, Department of Social Services and Health Care, Department of Nursing Science, University of Eastern Finland, Helsinki, Finland
| | - Marianne Teräs
- Department of Education, University of Stockholm, Stockholm, Sweden
| | - Tarja Kvist
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Arja Häggman-Laitila
- City of Helsinki, Department of Social Services and Health Care, Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
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Harris C, Allen K, Brooke V, Dyer T, Waller C, King R, Ramsey W, Mortimer D. Sustainability in Health care by Allocating Resources Effectively (SHARE) 6: investigating methods to identify, prioritise, implement and evaluate disinvestment projects in a local healthcare setting. BMC Health Serv Res 2017; 17:370. [PMID: 28545430 PMCID: PMC5445482 DOI: 10.1186/s12913-017-2269-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 04/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This is the sixth in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE program was established to investigate a systematic, integrated, evidence-based approach to disinvestment within a large Australian health service. This paper describes the methods employed in undertaking pilot disinvestment projects. It draws a number of lessons regarding the strengths and weaknesses of these methods; particularly regarding the crucial first step of identifying targets for disinvestment. METHODS Literature reviews, survey, interviews, consultation and workshops were used to capture and process the relevant information. A theoretical framework was adapted for evaluation and explication of disinvestment projects, including a taxonomy for the determinants of effectiveness, process of change and outcome measures. Implementation, evaluation and costing plans were developed. RESULTS Four literature reviews were completed, surveys were received from 15 external experts, 65 interviews were conducted, 18 senior decision-makers attended a data gathering workshop, 22 experts and local informants were consulted, and four decision-making workshops were undertaken. Mechanisms to identify disinvestment targets and criteria for prioritisation and decision-making were investigated. A catalogue containing 184 evidence-based opportunities for disinvestment and an algorithm to identify disinvestment projects were developed. An Expression of Interest process identified two potential disinvestment projects. Seventeen additional projects were proposed through a non-systematic nomination process. Four of the 19 proposals were selected as pilot projects but only one reached the implementation stage. Factors with potential influence on the outcomes of disinvestment projects are discussed and barriers and enablers in the pilot projects are summarised. CONCLUSION This study provides an in-depth insight into the experience of disinvestment in one local healthcare service. To our knowledge, this is the first paper to report the process of disinvestment from identification, through prioritisation and decision-making, to implementation and evaluation, and finally explication of the processes and outcomes.
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Affiliation(s)
- Claire Harris
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. .,Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC, Australia.
| | - Kelly Allen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC, Australia
| | - Vanessa Brooke
- Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC, Australia
| | - Tim Dyer
- Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC, Australia
| | - Cara Waller
- Centre for Clinical Effectiveness, Monash Health, Melbourne, VIC, Australia
| | - Richard King
- Medicine Program, Monash Health, Melbourne, VIC, Australia
| | - Wayne Ramsey
- Medical Services and Quality, Monash Health, Melbourne, VIC, Australia
| | - Duncan Mortimer
- Centre for Health Economics, Monash University, Melbourne, VIC, Australia
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15
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Harris C, Allen K, Waller C, Green S, King R, Ramsey W, Kelly C, Thiagarajan M. Sustainability in Health care by Allocating Resources Effectively (SHARE) 5: developing a model for evidence-driven resource allocation in a local healthcare setting. BMC Health Serv Res 2017; 17:342. [PMID: 28486973 PMCID: PMC5424307 DOI: 10.1186/s12913-017-2208-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 03/31/2017] [Indexed: 11/10/2022] Open
Abstract
Background This is the fifth in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. This paper synthesises the findings from Phase One of the SHARE Program and presents a model to be implemented and evaluated in Phase Two. Monash Health, a large healthcare network in Melbourne Australia, sought to establish an organisation-wide systematic evidence-based program for disinvestment. In the absence of guidance from the literature, the Centre for Clinical Effectiveness, an in-house ‘Evidence Based Practice Support Unit’, was asked to explore concepts and practices related to disinvestment, consider the implications for a local health service and identify potential settings and methods for decision-making. Methods Mixed methods were used to capture the relevant information. These included literature reviews; online questionnaire, interviews and structured workshops with a range of stakeholders; and consultation with experts in disinvestment, health economics and health program evaluation. Using the principles of evidence-based change, the project team worked with health service staff, consumers and external experts to synthesise the findings from published literature and local research and develop proposals, frameworks and plans. Results Multiple influencing factors were extracted from these findings. The implications were both positive and negative and addressed aspects of the internal and external environments, human factors, empirical decision-making, and practical applications. These factors were considered in establishment of the new program; decisions reached through consultation with stakeholders were used to define four program components, their aims and objectives, relationships between components, principles that underpin the program, implementation and evaluation plans, and preconditions for success and sustainability. The components were Systems and processes, Disinvestment projects, Support services, and Program evaluation and research. A model for a systematic approach to evidence-based resource allocation in a local health service was developed. Conclusion A robust evidence-based investigation of the research literature and local knowledge with a range of stakeholders resulted in rich information with strong consistent messages. At the completion of Phase One, synthesis of the findings enabled development of frameworks and plans and all preconditions for exploration of the four main aims in Phase Two were met. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2208-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Claire Harris
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia. .,Centre for Clinical Effectiveness, Monash Health, Victoria, Australia.
| | - Kelly Allen
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Centre for Clinical Effectiveness, Monash Health, Victoria, Australia
| | - Cara Waller
- Centre for Clinical Effectiveness, Monash Health, Victoria, Australia
| | - Sally Green
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Richard King
- Medicine Program, Monash Health, Victoria, Australia
| | - Wayne Ramsey
- Medical Services and Quality, Monash Health, Victoria, Australia
| | - Cate Kelly
- Medical Services, Melbourne Health, Victoria, Australia
| | - Malar Thiagarajan
- Ageing and Aged Care Branch, Department of Health and Human Services, Victoria, Australia
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Organizational Strategies for Building Capacity in Evidence-Based Oncology Nursing Practice. Nurs Clin North Am 2017; 52:149-158. [DOI: 10.1016/j.cnur.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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17
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De Angelis G, Davies B, King J, McEwan J, Cavallo S, Loew L, Wells GA, Brosseau L. Information and Communication Technologies for the Dissemination of Clinical Practice Guidelines to Health Professionals: A Systematic Review. JMIR MEDICAL EDUCATION 2016; 2:e16. [PMID: 27903488 PMCID: PMC5156823 DOI: 10.2196/mededu.6288] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/09/2016] [Accepted: 11/22/2016] [Indexed: 05/18/2023]
Abstract
BACKGROUND The transfer of research knowledge into clinical practice can be a continuous challenge for researchers. Information and communication technologies, such as websites and email, have emerged as popular tools for the dissemination of evidence to health professionals. OBJECTIVE The objective of this systematic review was to identify research on health professionals' perceived usability and practice behavior change of information and communication technologies for the dissemination of clinical practice guidelines. METHODS We used a systematic approach to retrieve and extract data about relevant studies. We identified 2248 citations, of which 21 studies met criteria for inclusion; 20 studies were randomized controlled trials, and 1 was a controlled clinical trial. The following information and communication technologies were evaluated: websites (5 studies), computer software (3 studies), Web-based workshops (2 studies), computerized decision support systems (2 studies), electronic educational game (1 study), email (2 studies), and multifaceted interventions that consisted of at least one information and communication technology component (6 studies). RESULTS Website studies demonstrated significant improvements in perceived usefulness and perceived ease of use, but not for knowledge, reducing barriers, and intention to use clinical practice guidelines. Computer software studies demonstrated significant improvements in perceived usefulness, but not for knowledge and skills. Web-based workshop and email studies demonstrated significant improvements in knowledge, perceived usefulness, and skills. An electronic educational game intervention demonstrated a significant improvement from baseline in knowledge after 12 and 24 weeks. Computerized decision support system studies demonstrated variable findings for improvement in skills. Multifaceted interventions demonstrated significant improvements in beliefs about capabilities, perceived usefulness, and intention to use clinical practice guidelines, but variable findings for improvements in skills. Most multifaceted studies demonstrated significant improvements in knowledge. CONCLUSIONS The findings suggest that health professionals' perceived usability and practice behavior change vary by type of information and communication technology. Heterogeneity and the paucity of properly conducted studies did not allow for a clear comparison between studies and a conclusion on the effectiveness of information and communication technologies as a knowledge translation strategy for the dissemination of clinical practice guidelines.
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Affiliation(s)
- Gino De Angelis
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Barbara Davies
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Judy King
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Jessica McEwan
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Sabrina Cavallo
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Laurianne Loew
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - George A Wells
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lucie Brosseau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
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18
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Sving E, Högman M, Mamhidir AG, Gunningberg L. Getting evidence-based pressure ulcer prevention into practice: a multi-faceted unit-tailored intervention in a hospital setting. Int Wound J 2016; 13:645-54. [PMID: 25060416 PMCID: PMC7950133 DOI: 10.1111/iwj.12337] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 06/18/2014] [Accepted: 06/25/2014] [Indexed: 12/01/2022] Open
Abstract
The aim of the study was to evaluate whether a multi-faceted, unit-tailored intervention using evidenced-based pressure ulcer prevention affects (i) the performance of pressure ulcer prevention, (ii) the prevalence of pressure ulcers and (iii) knowledge and attitudes concerning pressure ulcer prevention among registered and assistant nurses. A quasi-experimental, clustered pre- and post-test design was used. Five units at a hospital setting were included. The intervention was based on the PARIHS framework and included a multi-professional team, training and repeated quality measurements. An established methodology was used to evaluate the prevalence and prevention of pressure ulcers. Nurses' knowledge and attitudes were evaluated using a validated questionnaire. A total of 506 patients were included, of whom 105 patients had a risk to develop pressure ulcer. More patients were provided pressure ulcer prevention care (P = 0·001) and more prevention care was given to each patient (P = 0·021) after the intervention. Corresponding results were shown in the group of patients assessed as being at risk for developing pressure ulcers. Nurses' knowledge about pressure ulcer prevention increased (P < 0·001). Positive attitudes towards pressure ulcer prevention remained high between pre- and post-test surveys. This multi-faceted unit-tailored intervention affected pressure ulcer prevention. Facilitation and repeated quality measurement together with constructed feedback of results seemed to be the most important factor for pressure ulcer prevention.
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Affiliation(s)
- Eva Sving
- Clinical Training Centre, County Council of Gävleborg, Gävle, Sweden.
- Centre for Research & Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden.
- Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Gävle, Sweden.
| | - Marieann Högman
- Centre for Research & Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
- Department of Medical Sciences, Lung Medicine and Allergology, Uppsala University, Gävle, Sweden
| | - Anna-Greta Mamhidir
- Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Gävle, Sweden
- Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Gävle, Sweden
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Hoben M, Estabrooks CA, Squires JE, Behrens J. Factor Structure, Reliability and Measurement Invariance of the Alberta Context Tool and the Conceptual Research Utilization Scale, for German Residential Long Term Care. Front Psychol 2016; 7:1339. [PMID: 27656156 PMCID: PMC5013130 DOI: 10.3389/fpsyg.2016.01339] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/22/2016] [Indexed: 11/13/2022] Open
Abstract
We translated the Canadian residential long term care versions of the Alberta Context Tool (ACT) and the Conceptual Research Utilization (CRU) Scale into German, to study the association between organizational context factors and research utilization in German nursing homes. The rigorous translation process was based on best practice guidelines for tool translation, and we previously published methods and results of this process in two papers. Both instruments are self-report questionnaires used with care providers working in nursing homes. The aim of this study was to assess the factor structure, reliability, and measurement invariance (MI) between care provider groups responding to these instruments. In a stratified random sample of 38 nursing homes in one German region (Metropolregion Rhein-Neckar), we collected questionnaires from 273 care aides, 196 regulated nurses, 152 allied health providers, 6 quality improvement specialists, 129 clinical leaders, and 65 nursing students. The factor structure was assessed using confirmatory factor models. The first model included all 10 ACT concepts. We also decided a priori to run two separate models for the scale-based and the count-based ACT concepts as suggested by the instrument developers. The fourth model included the five CRU Scale items. Reliability scores were calculated based on the parameters of the best-fitting factor models. Multiple-group confirmatory factor models were used to assess MI between provider groups. Rather than the hypothesized ten-factor structure of the ACT, confirmatory factor models suggested 13 factors. The one-factor solution of the CRU Scale was confirmed. The reliability was acceptable (>0.7 in the entire sample and in all provider groups) for 10 of 13 ACT concepts, and high (0.90-0.96) for the CRU Scale. We could demonstrate partial strong MI for both ACT models and partial strict MI for the CRU Scale. Our results suggest that the scores of the German ACT and the CRU Scale for nursing homes are acceptably reliable and valid. However, as the ACT lacked strict MI, observed variables (or scale scores based on them) cannot be compared between provider groups. Rather, group comparisons should be based on latent variable models, which consider the different residual variances of each group.
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Affiliation(s)
- Matthias Hoben
- Knowledge Utilization Studies Program, Faculty of Nursing, University of AlbertaEdmonton, AB, Canada; Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University of Halle-WittenbergHalle, Germany; Network Aging Research, Heidelberg UniversityHeidelberg, Germany
| | - Carole A Estabrooks
- Knowledge Utilization Studies Program, Faculty of Nursing, University of Alberta Edmonton, AB, Canada
| | - Janet E Squires
- Faculty of Health Sciences, School of Nursing, University of OttawaOttawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa HospitalOttawa, ON, Canada
| | - Johann Behrens
- Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University of Halle-Wittenberg Halle, Germany
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Zabaleta-del-Olmo E, Subirana-Casacuberta M, Ara-Pérez A, Escuredo-Rodríguez B, Ríos-Rodríguez MÁ, Carrés-Esteve L, Jodar-Solà G, Lejardi-Estevez Y, Nuix-Baqué N, Aguas-Lluch A, Ondiviela-Cariteu À, Blanco-Sánchez R, Rosa García-Cerdán M, Contel-Segura JC, Jurado-Campos J, Juvinyà-Canal D. Developing Evidence-Based Practice questionnaire for community health nurses: reliability and validity of a Spanish adaptation. J Clin Nurs 2016; 25:505-17. [DOI: 10.1111/jocn.13078] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Edurne Zabaleta-del-Olmo
- Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol; Barcelona Spain
- Universitat Autònoma de Barcelona; Bellatera Spain
- Universitat de Girona; Girona Spain
| | | | - Ana Ara-Pérez
- Department of Justice; Generalitat de Catalunya; Centre d'Estudis Jurídics i Formació Especialitzada; Barcelona Spain
| | | | | | - Lourdes Carrés-Esteve
- Primary Care Team Sant Martí Provençals Sud; Institut Català de la Salut; Barcelona Spain
| | - Glòria Jodar-Solà
- Primary Care Team Sant Andreu de la Barca; Institut Català de la Salut; Sant Andreu de la Barca Spain
| | | | - Núria Nuix-Baqué
- Department of Health; Generalitat de Catalunya; Institutional Relations Office; Barcelona Spain
| | - Asunción Aguas-Lluch
- Assessment Unit; Sistemes d'Informació i Qualitat; Primary Care Services; City of Barcelona; Institut Català de la Salut; Barcelona Spain
| | | | - Rafaela Blanco-Sánchez
- Department of Nursing; Faculty of Medicine; Universitat Autònoma de Barcelona; Bellaterra Spain
| | | | - Juan Carlos Contel-Segura
- Department of Health; Generalitat de Catalunya; Programa Prevenció i Atenció a la Cronicitat; Pla Interdepartamental d'atenció i interacció social i sanitaria; Barcelona Spain
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Marie Modeste RR, Adejumo O. Validation of the integration of HIV and AIDS related nursing competencies into the undergraduate nursing curriculum in South Africa. Curationis 2015; 38:1521. [PMID: 26842097 PMCID: PMC6091595 DOI: 10.4102/curationis.v38i2.1521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 09/29/2015] [Accepted: 09/30/2015] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Being in its fourth decade, HIV remains an epidemic that requires combined efforts for the global fight. The strategies planned and implemented in the fight against HIV include reversing and halting the spread of HIV, increasing health care access, and strengthening the health care system. South Africa has made the fight one of its top priorities, and has developed plans to increase the role of nurses in the management of HIV, demonstrating its willingness, commitment and progress in the fight against HIV. OBJECTIVE This article presents the validation process conducted to confirm the integration and mapping of the HIV and AIDS related nursing competencies into the four-year Bachelor of Nursing programme at a university in South Africa. METHODS This study adopted a constructivist paradigm, using a qualitative approach, applyingthe design step of the process model of curriculum development, to validate the inte gration of the mapped HIV and AIDS related nursing competencies into the undergraduate nursing curriculum. RESULTS For each competency, outcomes were developed for each year. Participants confirmed completeness of outcomes and appropriateness of the mapping of the HIV and AIDS related outcomes into the nursing curriculum, as well as the feasibility and practicability of the integration. CONCLUSION Required resources for integration of HIV and AIDS related nursing competencies, such as human resources and nurse educators' continued personal development were identified, as well as barriers to integration, and measures to eliminate them were discussed. The importance of integration of HIV and AIDS nursing competencies into the curriculum was reiterated.
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Fleiszer AR, Semenic SE, Ritchie JA, Richer MC, Denis JL. An organizational perspective on the long-term sustainability of a nursing best practice guidelines program: a case study. BMC Health Serv Res 2015; 15:535. [PMID: 26634343 PMCID: PMC4669651 DOI: 10.1186/s12913-015-1192-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 11/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many healthcare innovations are not sustained over the long term, wasting costly implementation efforts and often desperately-needed initial improvements. Although there have been advances in knowledge about innovation implementation, there has been considerably less attention focused on understanding what happens following the early stages of change. Research is needed to determine how to improve the 'staying power' of healthcare innovations. As almost no empirical knowledge exists about innovation sustainability in nursing, the purpose of our study was to understand how a nursing best practice guidelines (BPG) program was sustained over a long-term period in an acute healthcare centre. METHODS We conducted a qualitative descriptive case study to examine the program's sustainability at the nursing department level of the organization. The organization was a large, urban, multi-site acute care centre in Canada. The patient safety-oriented BPG program, initiated in 2004, consisted of an organization-wide implementation of three BPGs: falls prevention, pressure ulcer prevention, and pain management. Data were collected eight years following program initiation through 14 key informant interviews, document reviews, and observations. We developed a framework for the sustainability of healthcare innovations to guide data collection and content analysis. RESULTS Program sustainability entailed a combination of three essential characteristics: benefits, institutionalization, and development. A constellation of 11 factors most influenced the long-term sustainability of the program. These factors were innovation-, context-, leadership-, and process-related. Three key interactions between factors influencing program sustainability and characteristics of program sustainability accounted for how the program had been sustained. These interactions were between: leadership commitment and benefits; complementarity of leadership actions and both institutionalization and development; and a reflection-and-course-correction strategy and development. CONCLUSIONS Study findings indicate that the successful initial implementation of an organizational program does not automatically lead to longer-term program sustainability. The persistent, complementary, and aligned actions of committed leaders, in a variety of roles across a health centre department, seem necessary. Organizational leaders should consider a broad conceptualization of sustainability that extends beyond program institutionalization and/or program benefits. The development of an organizational program may be necessary for its long-term survival.
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Affiliation(s)
| | - Sonia E Semenic
- Ingram School of Nursing, McGill University, Montreal, Canada.
- McGill University Health Centre (MUHC), Montreal, Canada.
| | | | - Marie-Claire Richer
- Ingram School of Nursing, McGill University, Montreal, Canada.
- McGill University Health Centre (MUHC), Montreal, Canada.
| | - Jean-Louis Denis
- École nationale d'administration publique (ENAP), Montreal, Canada.
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Archambault PM, Turgeon AF, Witteman HO, Lauzier F, Moore L, Lamontagne F, Horsley T, Gagnon MP, Droit A, Weiss M, Tremblay S, Lachaine J, Le Sage N, Émond M, Berthelot S, Plaisance A, Lapointe J, Razek T, van de Belt TH, Brand K, Bérubé M, Clément J, Grajales Iii FJ, Eysenbach G, Kuziemsky C, Friedman D, Lang E, Muscedere J, Rizoli S, Roberts DJ, Scales DC, Sinuff T, Stelfox HT, Gagnon I, Chabot C, Grenier R, Légaré F. Implementation and Evaluation of a Wiki Involving Multiple Stakeholders Including Patients in the Promotion of Best Practices in Trauma Care: The WikiTrauma Interrupted Time Series Protocol. JMIR Res Protoc 2015; 4:e21. [PMID: 25699546 PMCID: PMC4376233 DOI: 10.2196/resprot.4024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 11/24/2014] [Indexed: 11/30/2022] Open
Abstract
Background Trauma is the most common cause of mortality among people between the ages of 1 and 45 years, costing Canadians 19.8 billion dollars a year (2004 data), yet half of all patients with major traumatic injuries do not receive evidence-based care, and significant regional variation in the quality of care across Canada exists. Accordingly, our goal is to lead a research project in which stakeholders themselves will adapt evidence-based trauma care knowledge tools to their own varied institutional contexts and cultures. We will do this by developing and assessing the combined impact of WikiTrauma, a free collaborative database of clinical decision support tools, and Wiki101, a training course teaching participants how to use WikiTrauma. WikiTrauma has the potential to ensure that all stakeholders (eg, patients, clinicians, and decision makers) can all contribute to, and benefit from, evidence-based clinical knowledge about trauma care that is tailored to their own needs and clinical setting. Objective Our main objective will be to study the combined effect of WikiTrauma and Wiki101 on the quality of care in four trauma centers in Quebec. Methods First, we will pilot-test the wiki with potential users to create a version ready to test in practice. A rapid, iterative prototyping process with 15 health professionals from nonparticipating centers will allow us to identify and resolve usability issues prior to finalizing the definitive version for the interrupted time series. Second, we will conduct an interrupted time series to measure the impact of our combined intervention on the quality of care in four trauma centers that will be selected—one level I, one level II, and two level III centers. Participants will be health care professionals working in the selected trauma centers. Also, five patient representatives will be recruited to participate in the creation of knowledge tools destined for their use (eg, handouts). All participants will be invited to complete the Wiki101 training and then use, and contribute to, WikiTrauma for 12 months. The primary outcome will be the change over time of a validated, composite, performance indicator score based on 15 process performance indicators found in the Quebec Trauma Registry. Results This project was funded in November 2014 by the Canadian Medical Protective Association. We expect to start this trial in early 2015 and preliminary results should be available in June 2016. Two trauma centers have already agreed to participate and two more will be recruited in the next months. Conclusions We expect that this study will add important and unique evidence about the effectiveness, safety, and cost savings of using collaborative platforms to adapt knowledge implementation tools across jurisdictions.
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Affiliation(s)
- Patrick M Archambault
- Département de médecine familiale et médecine d'urgence, Université Laval, Québec, QC, Canada.
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Abstract
OBJECTIVES: The purpose of this study was to evaluate the effect of a research training program on clinicians’ knowledge, attitudes, and practices related to research and evidence-based practice (EBP). BACKGROUND: EBP has been shown to improve patient care and outcomes. Innovative approaches are needed to overcome individual and organizational barriers to EBP. METHODS: Mixed-methods design was used to evaluate a research training intervention with point-of-care clinicians in a Canadian urban health organization. Participants completed the Knowledge, Attitudes, and Practice Survey over 3 timepoints. Focus groups and interviews were also conducted. RESULTS: Statistically significant improvement in research knowledge and ability was demonstrated. Participants and administrators identified benefits of the training program, including the impact on EBP. CONCLUSIONS: Providing research training opportunities to point-of-care clinicians is a promising strategy for healthcare organizations seeking to promote EBP, empower clinicians, and showcase excellence in clinical research.
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Sun C, Larson E. Clinical nursing and midwifery research in African countries: a scoping review. Int J Nurs Stud 2015; 52:1011-6. [PMID: 25707997 DOI: 10.1016/j.ijnurstu.2015.01.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/22/2015] [Accepted: 01/23/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Globally, the nursing shortage has been deemed a crisis, but African countries have been hit hardest. Therefore, it is of utmost importance nurses use the best available evidence and that nursing research is targeted to address gaps in the evidence. To achieve this, an understanding of what is currently available and identification of gaps in clinical nursing research is critical. OBJECTIVES We performed a scoping review of existing literature to assess clinical nursing research conducted in all African countries over the past decade, identify gaps in clinical nursing and midwifery research, determine whether they match with health priorities for countries, and define priorities for regional clinical nursing research agendas to improve health outcomes. DESIGN This is a scoping review of published clinical nursing research conducted in African countries. DATA SOURCES Systematic searches of literature published between January 01, 2004 and September 15, 2014 were performed in PubMed, Medline, CINHAL, and Embase. REVIEW METHODS Research was included if it was conducted by nurses, included data obtained in African countries or regions within the African continent, published in a peer-reviewed journal with an abstract, and included patient outcomes. Abstracts were independently reviewed for inclusion by two authors. The following data were extracted: countries of publication and study, study type and design, journal, language, and topics of research. Gaps in the literature were identified. RESULTS Initially, 1091 papers were identified with a final sample of 73 articles meeting inclusion criteria. Studies used 12 designs, were published in 35 journals published in five countries (including two African countries); 29% of the research was published in a single journal (Curatonis). Research was mostly qualitative (57%) and included twenty countries in Africa (38%). There were 12 major topics of study, most often midwifery/maternal/child health (43%), patient experiences (38%), and human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) (36%). CONCLUSIONS Areas most often studied were associated with funding sources (e.g., a large influx of funds for HIV-related research). Major and common health care problems in African countries (e.g. infectious disease other than HIV, and noncommunicable diseases such as malnutrition, diarrheal disease, hypertension and diabetes) were not subjects of the published literature, indicating a clear gap between health care needs and problems and the focus of the majority of clinical nursing research. Additionally, the shortage of doctorally prepared nurses may contribute to the lack of clinical nursing and midwifery research in African countries.
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Affiliation(s)
- Carolyn Sun
- Columbia University School of Nursing, 617 West 168th Street, New York, NY, United States.
| | - Elaine Larson
- Columbia University School of Nursing, 617 West 168th Street, New York, NY, United States; Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, United States.
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Williams B, Perillo S, Brown T. What are the factors of organisational culture in health care settings that act as barriers to the implementation of evidence-based practice? A scoping review. NURSE EDUCATION TODAY 2015; 35:e34-e41. [PMID: 25482849 DOI: 10.1016/j.nedt.2014.11.012] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 10/31/2014] [Accepted: 11/12/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND The responsibility to implement evidence-based practice (EBP) in a health care workplace does not fall solely on the individual health care professional. Organisational barriers relate to the workplace setting, administrational support, infrastructure, and facilities available for the retrieval, critique, summation, utilisation, and integration of research findings in health care practices and settings. OBJECTIVE Using a scoping review approach, the organisational barriers to the implementation of EBP in health care settings were sought. METHOD This scoping review used the first five of the six stage methodology developed by Levac et al. (2010). The five stages used are: 1) Identify the research question; 2) identify relevant studies; 3) study selection; 4) charting the data; and 5) collating, summarising and reporting the results. The following databases were searched from January 2004 until February 2014: Medline, EMBASE, EBM Reviews, Google Scholar, The Cochrane Library and CINAHL. RESULTS Of the 49 articles included in this study, there were 29 cross-sectional surveys, six descriptions of specific interventions, seven literature reviews, four narrative reviews, nine qualitative studies, one ethnographic study and one systematic review. The articles were analysed and five broad organisational barriers were identified. CONCLUSIONS This scoping review sought to map the breadth of information available on the organisational barriers to the use of EBP in health care settings. Even for a health care professional who is motivated and competent in the use of EBP; all of these barriers will impact on their ability to increase and maintain their use of EBP in the workplace.
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Affiliation(s)
- Brett Williams
- Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia.
| | - Samuel Perillo
- Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia
| | - Ted Brown
- Department of Occupational Therapy, Monash University, Victoria, Australia
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Lockwood C, Aromataris E, Munn Z. Translating Evidence into Policy and Practice. Nurs Clin North Am 2014; 49:555-66. [DOI: 10.1016/j.cnur.2014.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Das JK, Kumar R, Salam RA, Lassi ZS, Bhutta ZA. Evidence from facility level inputs to improve quality of care for maternal and newborn health: interventions and findings. Reprod Health 2014; 11 Suppl 2:S4. [PMID: 25208539 PMCID: PMC4160922 DOI: 10.1186/1742-4755-11-s2-s4] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Most of the maternal and newborn deaths occur at birth or within 24 hours of birth. Therefore, essential lifesaving interventions need to be delivered at basic or comprehensive emergency obstetric care facilities. Facilities provide complex interventions including advice on referrals, post discharge care, long-term management of chronic conditions along with staff training, managerial and administrative support to other facilities. This paper reviews the effectiveness of facility level inputs for improving maternal and newborn health outcomes. We considered all available systematic reviews published before May 2013 on the pre-defined facility level interventions and included 32 systematic reviews. Findings suggest that additional social support during pregnancy and labour significantly decreased the risk of antenatal hospital admission, intrapartum analgesia, dissatisfaction, labour duration, cesarean delivery and instrumental vaginal birth. However, it did not have any impact on pregnancy outcomes. Continued midwifery care from early pregnancy to postpartum period was associated with reduced medical procedures during labour and shorter length of stay. Facility based stress training and management interventions to maintain well performing and motivated workforce, significantly reduced job stress and improved job satisfaction while the interventions tailored to address identified barriers to change improved the desired practice. We found limited and inconclusive evidence for the impacts of physical environment, exit interviews and organizational culture modifications. At the facility level, specialized midwifery teams and social support during pregnancy and labour have demonstrated conclusive benefits in improving maternal newborn health outcomes. However, the generalizability of these findings is limited to high income countries. Future programs in resource limited settings should utilize these findings to implement relevant interventions tailored to their needs.
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Affiliation(s)
- Jai K Das
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Rohail Kumar
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Rehana A Salam
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Zohra S Lassi
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
- Program for Global Pediatric Research, Hospital For Sick Children, Toronto
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Mark DD, Latimer RW, White JP, Bransford D, Johnson KG, Song VL. Hawaii's statewide evidence-based practice program. Nurs Clin North Am 2014; 49:275-90. [PMID: 25155528 DOI: 10.1016/j.cnur.2014.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Hawaii's innovative statewide evidence-based practice program facilitates practice change across multiple health care systems. The innovation eliminated duplicative efforts and provided resources, was compatible with the values of health care organizations, and had experience with a pilot program. Interpersonal and mass media communication promoted and embedded the practice change. Users included nurse champions with multidisciplinary team members. The rate of adoption varied across projects and, although resources seemed to be a major determinant of successful institutionalization, there does not seem to be a predictable pattern of successful project implementation.
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Affiliation(s)
- Debra D Mark
- Hawai'i State Center for Nursing, University of Hawai'i School of Nursing & Dental Hygiene, 2528 McCarthy Mall, Webster Hall 402, Honolulu, HI 96822, USA.
| | - Rene'e W Latimer
- Queen Emma Nursing Institute, The Queen's Medical Center, 1301 Punchbowl Street, Honolulu, HI 96813-2499, USA
| | - Joan P White
- Hawai'i State Center for Nursing, 2528 McCarthy Mall, Webster Hall 402, Honolulu, HI 96822, USA
| | - Deborah Bransford
- The Queen's Medical Center, 1301 Punchbowl Street, Honolulu, HI 96813-2499, USA
| | - Katherine G Johnson
- The Queen's Medical Center, 1301 Punchbowl Street, Honolulu, HI 96813-2499, USA
| | - Valerie L Song
- Hawai'i State Center for Nursing, 2528 McCarthy Mall, Webster Hall 402, Honolulu, HI 96822, USA
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Implementing national guidelines for person-centered care of people with dementia in residential aged care: effects on perceived person-centeredness, staff strain, and stress of conscience. Int Psychogeriatr 2014; 26:1171-9. [PMID: 24576607 DOI: 10.1017/s1041610214000258] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Person-centeredness has had substantial uptake in the academic literature on care of older people and people with dementia. However, challenges exist in interpreting and synthesizing the evidence on effects of providing person-centered care, as the person-centered components of some intervention studies are unclear - targeting very different and highly specific aspects of person-centeredness, as well as not providing empirical data to indicate the extent to which care practice was actually perceived to become more person-centered post-intervention. METHODS The study employed a quasi-experimental, one-group pre-test-post-test design with a 12-month follow-up to explore intervention effects on person-centeredness of care and the environment (primary endpoints), and on staff strain and stress of conscience (secondary endpoints). RESULTS The intervention resulted in significantly higher scores on person-centeredness of care at follow-up, and the facility was rated as being significantly more hospitable at follow-up. A significant reduction of staff stress of conscience was also found at follow-up, which suggests that, to a larger extent, staff could provide the care and activities they wanted to provide after the intervention. CONCLUSIONS The results indicated that an interactive and step-wise action-research intervention consisting of knowledge translation, generation, and dissemination, based on national guidelines for care of people with dementia, increased the staff self-reported person-centeredness of care practice, perceived hospitality of the setting, and reduced staff stress of conscience by enabling staff to provide the care and activities they want to provide.
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Fridman M, Frederickson K. Oncology Nurses and the Experience of Participation in an Evidence-Based Practice Project. Oncol Nurs Forum 2014; 41:382-8. [DOI: 10.1188/14.onf.382-388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gifford WA, Holyoke P, Squires JE, Angus D, Brosseau L, Egan M, Graham ID, Miller C, Wallin L. Managerial leadership for research use in nursing and allied health care professions: a narrative synthesis protocol. Syst Rev 2014; 3:57. [PMID: 24903267 PMCID: PMC4072612 DOI: 10.1186/2046-4053-3-57] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 05/22/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Nurses and allied health care professionals (physiotherapists, occupational therapists, speech and language pathologists, dietitians) form more than half of the clinical health care workforce and play a central role in health service delivery. There is a potential to improve the quality of health care if these professionals routinely use research evidence to guide their clinical practice. However, the use of research evidence remains unpredictable and inconsistent. Leadership is consistently described in implementation research as critical to enhancing research use by health care professionals. However, this important literature has not yet been synthesized and there is a lack of clarity on what constitutes effective leadership for research use, or what kinds of intervention effectively develop leadership for the purpose of enabling and enhancing research use in clinical practice. We propose to synthesize the evidence on leadership behaviours amongst front line and senior managers that are associated with research evidence by nurses and allied health care professionals, and then determine the effectiveness of interventions that promote these behaviours. METHODS/DESIGN Using an integrated knowledge translation approach that supports a partnership between researchers and knowledge users throughout the research process, we will follow principles of knowledge synthesis using a systematic method to synthesize different types of evidence involving: searching the literature, study selection, data extraction and quality assessment, and analysis. A narrative synthesis will be conducted to explore relationships within and across studies and meta-analysis will be performed if sufficient homogeneity exists across studies employing experimental randomized control trial designs. DISCUSSION With the engagement of knowledge users in leadership and practice, we will synthesize the research from a broad range of disciplines to understand the key elements of leadership that supports and enables research use by health care practitioners, and how to develop leadership for the purpose of enhancing research use in clinical practice. TRIAL REGISTRATION PROSPERO CRD42014007660.
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Affiliation(s)
- Wendy A Gifford
- The University of Ottawa, 451 Smyth Road, K1H 8M5 Ottawa, ON, Canada.
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Bruheim M, Woods KV, Smeland S, Nortvedt MW. An educational program to transition oncology nurses at the Norwegian Radium Hospital to an evidence-based practice model: development, implementation, and preliminary outcomes. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:224-232. [PMID: 24197689 DOI: 10.1007/s13187-013-0575-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Increasingly, nurses are expected to systematically improve their practice according to principles of evidence-based practice (EBP). In 2009, the Norwegian Radium Hospital, inspired by the EBP nursing model at its sister institution, The University of Texas MD Anderson Cancer Center, began transitioning its oncology nurses to an EBP model. Norwegian Radium Hospital nursing leaders selected an EBP expert to design an EBP educational program. The program consisted of a 1-semester, 15-credit-hour postgraduate EBP course followed by a clinical practicum during which selected nurses worked in groups to apply principles of EBP to challenging clinical questions. As of this writing, 60 staff nurses have completed the program. Nurses participating in the EBP program have developed 13 evidence-based clinical guidelines, evidence-based clinical procedures, and patient information documents, 9 of which have been adopted as national standards. Participants have demonstrated increased confidence in providing the best available patient care, deeper reflection about their practice, and a sense of being valued by their nurse and physician colleagues. At the institutional level, the EBP project has resulted in higher confidence that patients are receiving patient-centered care based on the best scientific evidence. The project has also resulted in increased collaboration between nurses and other practitioners within multidisciplinary clinical problem-solving teams. This successful EBP program could serve as a model for other cancer hospitals desiring to move to an EBP patient-care model, not only for nursing practice but also, more broadly, for delivery of cancer care by diverse multidisciplinary teams.
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Affiliation(s)
- Marie Bruheim
- Division of Cancer, Surgery and Transplantation, Oslo University Hospital, The Norwegian Radium Hospital, Ullernchausseèn 70, 0310, Oslo, Norway
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Indicadores sensibles a la práctica enfermera: una oportunidad para medir la contribución de las enfermeras. ENFERMERIA CLINICA 2014; 24:142-7. [DOI: 10.1016/j.enfcli.2013.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 06/19/2013] [Accepted: 07/03/2013] [Indexed: 11/22/2022]
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Pericas-Beltran J, Gonzalez-Torrente S, De Pedro-Gomez J, Morales-Asencio J, Bennasar-Veny M. Perception of Spanish primary healthcare nurses about evidence-based clinical practice: a qualitative study. Int Nurs Rev 2014; 61:90-8. [DOI: 10.1111/inr.12075] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J. Pericas-Beltran
- Nursing Department, Evidence, Lifestyles and Health Research Group Members; Universitat de les Illes Balears; Palma Spain
| | | | - J. De Pedro-Gomez
- Nursing Department, Evidence, Lifestyles and Health Research Group Members; Universitat de les Illes Balears; Palma Spain
| | - J.M. Morales-Asencio
- Faculty of Nursing, Physiotherapy, Podology and Occupational Therapy; University of Malaga; Malaga Spain
| | - M. Bennasar-Veny
- Nursing Department, Evidence, Lifestyles and Health Research Group Members; Universitat de les Illes Balears; Palma Spain
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Gifford WA, Graham ID, Davies BL. Multi-level barriers analysis to promote guideline based nursing care: a leadership strategy from home health care. J Nurs Manag 2013; 21:762-70. [DOI: 10.1111/jonm.12129] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Wendy A. Gifford
- Faculty of Health Sciences; School of Nursing; University of Ottawa; Ottawa Ontario Canada
- Saint Elizabeth; Markham Ontario Canada
| | - Ian D. Graham
- Faculty of Health Sciences; School of Nursing; University of Ottawa; Ottawa Ontario Canada
| | - Barbara L. Davies
- Faculty of Health Sciences School of Nursing; Co-Director Nursing Best Practice Research Center; University of Ottawa; Ottawa Ontario Canada
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English M. Designing a theory-informed, contextually appropriate intervention strategy to improve delivery of paediatric services in Kenyan hospitals. Implement Sci 2013; 8:39. [PMID: 23537192 PMCID: PMC3620707 DOI: 10.1186/1748-5908-8-39] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 03/21/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND District hospital services in Kenya and many low-income countries should deliver proven, effective interventions that could substantially reduce child and newborn mortality. However such services are often of poor quality. Researchers have therefore been challenged to identify intervention strategies that go beyond addressing knowledge, skill, or resource inadequacies to support health systems to deliver better services at scale. An effort to develop a system-oriented intervention tailored to local needs and context and drawing on theory is described. METHODS An intervention was designed to improve district hospital services for children based on four main strategies: a reflective process to distill root causes for the observed problems with service delivery; developing a set of possible intervention approaches to address these problems; a search of literature for theory that provided the most appropriate basis for intervention design; and repeatedly moving backwards and forwards between identified causes, proposed interventions, identified theory, and knowledge of the existing context to develop an overarching intervention that seemed feasible and likely to be acceptable and potentially sustainable. RESULTS AND DISCUSSION In addition to human and resource constraints key problems included failures of relevant professionals to take responsibility for or ownership of the challenge of pediatric service delivery; inadequately prepared, poorly supported leaders of service units (mid-level managers) who are often professionally and geographically isolated and an almost complete lack of useful information for routinely monitoring or understanding service delivery practice or outcomes. A system-oriented intervention recognizing the pivotal role of leaders of service units but addressing the outer and inner setting of hospitals was designed to help shape and support an appropriate role for these professionals. It aims to foster a sense of ownership while providing the necessary understanding, knowledge, and skills for mid-level managers to work effectively with senior managers and frontline staff to improve services. The intervention will include development of an information system, feedback mechanisms, and discussion fora that promote positive change. The vehicle for such an intervention is a collaborative network partnering government and national professional associations. This case is presented to promote discussion on approaches to developing context appropriate interventions particularly in international health.
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Affiliation(s)
- Mike English
- KEMRI-Wellcome Trust Research Programme, PO Box 43640, Nairobi 00100, Kenya.
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Ubbink DT, Guyatt GH, Vermeulen H. Framework of policy recommendations for implementation of evidence-based practice: a systematic scoping review. BMJ Open 2013. [PMID: 23355664 DOI: 10.1136/bmjopen‐2012‐001881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Evidence-based practice (EBP) may help improve healthcare quality. However, not all healthcare professionals and managers use EBP in their daily practice. We systematically reviewed the literature to summarise self-reported appreciation of EBP and organisational infrastructure solutions proposed to promote EBP. DESIGN Systematic review. Two investigators independently performed the systematic reviewing process. INFORMATION SOURCES MEDLINE, EMBASE and Cochrane Library were searched for publications between 2000 and 2011. ELIGIBILITY CRITERIA FOR INCLUDED STUDIES Reviews and surveys of EBP attitude, knowledge, awareness, skills, barriers and facilitators among managers, doctors and nurses in clinical settings. RESULTS We found 31 surveys of fairly good quality. General attitude towards EBP was welcoming. Respondents perceived several barriers, but also many facilitators for EBP implementation. Solutions were proposed at various organisational levels, including (inter)national associations and hospital management promoting EBP, pregraduate and postgraduate education, as well as individual support by EBP mentors on the wards to move EBP from the classroom to the bedside. CONCLUSIONS More than 20 years after its introduction, the EBP paradigm has been embraced by healthcare professionals as an important means to improve quality of patient care, but its implementation is still deficient. Policy exerted at microlevel , middlelevel and macrolevel, and supported by professional, educational and managerial role models, may further facilitate EBP.
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Affiliation(s)
- Dirk T Ubbink
- Department of Quality Assurance & Process Innovation, Academic Medical Center, Amsterdam, The Netherlands
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Ubbink DT, Guyatt GH, Vermeulen H. Framework of policy recommendations for implementation of evidence-based practice: a systematic scoping review. BMJ Open 2013; 3:bmjopen-2012-001881. [PMID: 23355664 PMCID: PMC3563143 DOI: 10.1136/bmjopen-2012-001881] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Evidence-based practice (EBP) may help improve healthcare quality. However, not all healthcare professionals and managers use EBP in their daily practice. We systematically reviewed the literature to summarise self-reported appreciation of EBP and organisational infrastructure solutions proposed to promote EBP. DESIGN Systematic review. Two investigators independently performed the systematic reviewing process. INFORMATION SOURCES MEDLINE, EMBASE and Cochrane Library were searched for publications between 2000 and 2011. ELIGIBILITY CRITERIA FOR INCLUDED STUDIES Reviews and surveys of EBP attitude, knowledge, awareness, skills, barriers and facilitators among managers, doctors and nurses in clinical settings. RESULTS We found 31 surveys of fairly good quality. General attitude towards EBP was welcoming. Respondents perceived several barriers, but also many facilitators for EBP implementation. Solutions were proposed at various organisational levels, including (inter)national associations and hospital management promoting EBP, pregraduate and postgraduate education, as well as individual support by EBP mentors on the wards to move EBP from the classroom to the bedside. CONCLUSIONS More than 20 years after its introduction, the EBP paradigm has been embraced by healthcare professionals as an important means to improve quality of patient care, but its implementation is still deficient. Policy exerted at microlevel , middlelevel and macrolevel, and supported by professional, educational and managerial role models, may further facilitate EBP.
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Affiliation(s)
- Dirk T Ubbink
- Department of Quality Assurance & Process Innovation, Academic Medical Center, Amsterdam, The Netherlands
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Gordon H Guyatt
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
| | - Hester Vermeulen
- Department of Quality Assurance & Process Innovation, Academic Medical Center, Amsterdam, The Netherlands
- Amsterdam School of Health Professions, University of Amsterdam, Amsterdam, The Netherlands
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Dalheim A, Harthug S, Nilsen RM, Nortvedt MW. Factors influencing the development of evidence-based practice among nurses: a self-report survey. BMC Health Serv Res 2012; 12:367. [PMID: 23092366 PMCID: PMC3557178 DOI: 10.1186/1472-6963-12-367] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 10/15/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health authorities in several countries have decided that the health care services should be evidence-based. Recent research indicates that evidence-based practice may be more successfully implemented if the interventions overcome identified barriers. AIMS The present study aimed to examine factors influencing the implementation of evidence-based practice among nurses in a large Norwegian university hospital. METHODS Cross-sectional data was collected from 407 nurses during the period November 8 to December 3, 2010, using the Norwegian version of Developing Evidence-based Practice questionnaire (DEBP). The DEBP included data on various sources of information used for support in practice, on potential barriers for evidence-based practice, and on self-reported skills on managing research-based evidence. The DEBP was translated into Norwegian in accordance with standardized guidelines for translation and cultural adaptation. RESULTS Nurses largely used experienced-based knowledge collected from their own observations, colleagues and other collaborators for support in practice. Evidence from research was seldom used. The greatest barriers were lack of time and lack of skills to find and manage research evidence. The nurse's age, the number of years of nursing practice, and the number of years since obtaining the last health professional degree influenced the use of sources of knowledge and self-reported barriers. Self-reported skills in finding, reviewing and using different sources of evidence were positively associated with the use of research evidence and inversely related to barriers in use of research evidence. CONCLUSION Skills in evidence-based practice seem to reduce barriers to using research evidence and to increase use of research evidence in clinical practice.
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Affiliation(s)
- Anne Dalheim
- Centre for Evidence-Based Practice, Bergen University College, Postbox 7030, Bergen, N-5020, Norway
- Department of Research and Development, Patient Safety Unit, Haukeland University Hospital, Jonas Liesvei 65, Bergen, N-5021, Norway
| | - Stig Harthug
- Department of Research and Development, Patient Safety Unit, Haukeland University Hospital, Jonas Liesvei 65, Bergen, N-5021, Norway
- Institute of Medicine, University of Bergen, Postbox 7804, Bergen, N-5020, Norway
| | - Roy M Nilsen
- Department of Research and Development, Patient Safety Unit, Haukeland University Hospital, Jonas Liesvei 65, Bergen, N-5021, Norway
- Centre for Clinical Research, Haukeland University Hospital, Jonas Liesvei 65, Bergen, N-5021, Norway
| | - Monica W Nortvedt
- Centre for Evidence-Based Practice, Bergen University College, Postbox 7030, Bergen, N-5020, Norway
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