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Ghosh NR, Esmaeilinezhad Z, Zając J, Creasy RA, Lorenz SG, Klatt KC, Bala MM, Beathard KM, Johnston BC. Evidence-Based Practice Competencies among Nutrition Professionals and Students: A Systematic Review. J Nutr 2024; 154:1414-1427. [PMID: 38159813 DOI: 10.1016/j.tjnut.2023.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Evidence-based practice (EBP) promotes shared decision-making between clinicians and patients. OBJECTIVE The aim was to determine EBP competencies among nutrition professionals and students reported in the literature. METHODS We conducted a systematic review by searching Medline, Embase, CINAHL, ERIC, CENTRAL, ProQuest Dissertations and Theses Global, BIOSIS Citation Index, and clinicaltrials.gov up to March 2023. Eligible primary studies had to assess one of the 6 predefined EBP competencies: formulating clinical questions; searching literature for best evidence; assessing studies for methodological quality; effect size; certainty of evidence for effects; and determining the applicability of study results considering patient values and preferences. Two reviewers independently screened articles and extracted data, and results were summarized for each EBP competency. RESULTS We identified 12 eligible cross-sectional survey studies, comprising 1065 participants, primarily registered dietitians, across 6 countries, with the majority assessed in the United States (n = 470). The reporting quality of the survey studies was poor overall, with 43% of items not reported. Only 1 study (8%) explicitly used an objective questionnaire to assess EBP competencies. In general, the 6 competencies were incompletely defined or reported (e.g., it was unclear what applicability and critical appraisal referred to and what study designs were appraised by the participants). Two core competencies, interpreting effect size and certainty of evidence for effects, were not assessed. CONCLUSIONS The overall quality of study reports was poor, and the questionnaires were predominantly self-perceived, as opposed to objective assessments. No studies reported on competencies in interpreting effect size or certainty of evidence, competencies essential for optimizing clinical nutrition decision-making. Future surveys should objectively assess core EBP competencies using sensible, specific questionnaires. Furthermore, EBP competencies need to be standardized across dietetic programs to minimize heterogeneity in the training, understanding, evaluation, and application among dietetics practitioners. This study was registered at PROSPERO as CRD42022311916.
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Affiliation(s)
- Nirjhar R Ghosh
- Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station, TX, United States
| | - Zahra Esmaeilinezhad
- Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station, TX, United States
| | - Joanna Zając
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Rebecca A Creasy
- Department of Food Science and Technology, College of Agriculture and Life Sciences, Texas A&M University, College Station, TX, United States
| | - Saundra G Lorenz
- Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station, TX, United States
| | - Kevin C Klatt
- Department of Nutrition Sciences and Toxicology, University of California, Berkeley, CA, United States
| | - Malgorzata M Bala
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Karen M Beathard
- Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station, TX, United States
| | - Bradley C Johnston
- Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station, TX, United States; Department of Epidemiology & Biostatistics, School of Public Health, Texas A&M University, College Station, USA.
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Soguel L, Lapointe A, Burnand B, Desroches S. Descriptive and Content Analysis of Questionnaires Used to Assess Evidence-Based Practice Among Dietitians: A Systematic Review. J Acad Nutr Diet 2024; 124:80-101. [PMID: 37673334 DOI: 10.1016/j.jand.2023.08.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Evidence-based practice (EBP) is described as the integration of the following 3 main dimensions in health professionals' decision making: best currently available research evidence, professional expertise, and patient's values and circumstances. Barriers to EBP at an individual level have been assessed using questionnaires. Knowing which EBP dimensions are actually explored in these questionnaires is essential to promote EBP and its adoption. OBJECTIVE The aim of this review was to identify and describe questionnaires that have been used among dietitians to evaluate knowledge, skills, attitudes, and/or behaviors related to EBP, and to perform a content analysis of these, drawn on the EBP dimensions explored. METHODS Questionnaires were identified through a systematic review in MEDLINE, Embase and the Cumulative Index to Nursing and Allied Health Literature (last search was November 2022). Eligibility criteria were studies using, evaluating, or developing questionnaires meant to evaluate knowledge, skills, attitudes, and/or behaviors related to EBP among dietitians. The content analysis was conducted to identify the EBP dimensions explored (ie, research evidence, professional expertise, and/or patient's values and circumstances). Questionnaire items were categorized as follows: 1 sole EBP dimension, a combination of dimensions, or no identifiable dimension. RESULTS Thirty reports (25 studies) were included. The analysis of the 847 items extracted from the 25 questionnaires used showed that the main EBP dimension explored was the integration of research evidence into decision making, found in 75% of items, solely or in combination with another dimension. Professional expertise was explored in 18% of the items, patient's values and circumstances were found in 3%, and the combination of these 3 dimensions was found in <1%. CONCLUSIONS The important imbalance of explored EBP dimensions in the questionnaires used may lead to a partial and misleading evaluation that prevents efficient strategies to foster EBP. There is an important need to develop more integrative and accurate evaluations of EBP targeting dietitians to promote and develop high-quality dietetics practice.
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Affiliation(s)
- Ludivine Soguel
- School of Nutrition, Faculty of Agriculture and Food Sciences, Université Laval, Quebec City, Quebec, Canada; Nutrition and Dietetics Department, Geneva School of Health Sciences, University of Applied Sciences and Arts Western Switzerland HES-SO, Geneva, Switzerland.
| | - Annie Lapointe
- Centre Nutrition, Santé et Société, Faculty of Agriculture and Food Sciences, Université Laval, Quebec City, Quebec, Canada
| | - Bernard Burnand
- Department of Epidemiology and Health Systems, Unisanté and University of Lausanne, Lausanne, Switzerland
| | - Sophie Desroches
- School of Nutrition, Faculty of Agriculture and Food Sciences, Université Laval, Quebec City, Quebec, Canada; Centre Nutrition, Santé et Société, Faculty of Agriculture and Food Sciences, Université Laval, Quebec City, Quebec, Canada
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Van Horn LT, Wright L, Arikawa AY, Sealey-Potts C. Validity and reliability of a questionnaire measuring EBDPs among registered dietitian nutritionist. J Hum Nutr Diet 2023; 36:323-335. [PMID: 35485216 DOI: 10.1111/jhn.13024] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/15/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND There is a lack of a valid and reliable instrument that measures objective and subjective knowledge of evidence-based dietetic practices (EBDP) among registered dietitian nutritionists (RDNs). The present study aimed to develop and assess the validity and reliability of an EBDP Questionnaire (EBDPQ) with objective knowledge items (i.e., quiz items) among RDNs in the USA. METHODS Subscales from four existing evidence-based practice (EBP) instruments were combined and modified for dietetics. Content and face validity and internal consistency were used to assess the full survey. Survey responsiveness and test-retest reliability were evaluated within the objective knowledge subscale. Content experts (n = 11) and nutrition professionals (n = 16) completed validation reviews. Doctoral students enrolled in a research course (n = 12) were used to analyse survey responsiveness. Internal and test-retest relability analyses utilised RDN participants (time point 1, n = 482; time point 2, n = 335). RESULTS Content validation resulted in a 38-item questionnaire. Average percent agreement among face validity reviewers was 95.1%. Only the pre-validation version of the objective knowledge subscale resulted in significantly higher post-course scores (Mdn = 11.50) compared to the pre-course (Mdn = 9.75, p = 0.05). The validated instrument had excellent internal consistency (Cronbach's α = 0.91); however, the objective knowledge subscale was low (Cronbach's α = 0.41). A good degree of reliability was found between the two time points (intraclass correlation coefficient = 0.71). CONCLUSIONS The EBDPQ demonstrated adequate validity and reliability among RDNs. Future research should assess construct validity, with the responsiveness and objective knowledge subscale requiring additional evaluation through an EBDP course.
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Affiliation(s)
| | - Lauri Wright
- Brooks College of Health, University of North Florida, Jacksonville, FL, USA
| | - Andrea Y Arikawa
- Brooks College of Health, University of North Florida, Jacksonville, FL, USA
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4
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Baldwin T, Riddle E. Three Lesson Series Improves Student Confidence in Ability to Apply Evidence-Based Practice in Dietetics. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:364-370. [PMID: 34903445 DOI: 10.1016/j.jneb.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 10/20/2021] [Accepted: 10/28/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Tayler Baldwin
- State University of New York College at Oneonta, Oneonta, NY
| | - Emily Riddle
- State University of New York College at Oneonta, Oneonta, NY.
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Middeke J, Palmer K, Lövestam E, Vivanti A, Orrevall Y, Steiber A, Lyons-Wall P, Lo J, Devine A, Lieffers J, Papoutsakis C, Lang NR, Thoresen L, Lloyd L, O'Sullivan TA. Predictors of nutrition care process knowledge and use among dietitians internationally. J Hum Nutr Diet 2021; 35:466-478. [PMID: 34812563 DOI: 10.1111/jhn.12961] [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: 05/26/2021] [Accepted: 09/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The nutrition care process (NCP) and its associated standardised terminology (NCPT, referred to collectively as NCP/T) forms a problem-solving framework fundamental to dietetic practice. Global implementation would assist in confirming outcomes from dietetic care, but implementation rates have varied between countries. We investigated which factors predict NCP/T knowledge and use among dietetic professionals in an international cohort, aiming to understand how implementation can be strengthened. METHODS The validated International NCP Implementation Survey was disseminated to dietitians in 10 countries via professional networks. Implementation, attitudes and knowledge of the NCP/T along with workplace and educational data were assessed. Independent predictive factors associated with higher NCP/T knowledge and use were identified using backward stepwise logistic regression. RESULTS Data from 6149 respondents was used for this analysis. Enablers that were independent predictors of both high knowledge and frequent use of NCP/T were peer support, recommendation from national dietetic association and workplace requirements (all p < 0.001). Country of residence and working in clinical settings (p < 0.001) were demographic characteristics that were independent predictors of high knowledge and frequent use of NCP/T. A high knowledge score was an independent predictor of frequent NCP/T use (p = 0.002). CONCLUSIONS Important modifiable enablers for NCP knowledge and use rely on organisational management. National dietetic organisations and key stakeholders such as employers are encouraged to integrate active NCP/T support in their leadership initiatives. This could take the form of policies, formalised and structured training strategies, and informatics initiatives for the integration in electronic health records.
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Affiliation(s)
- Julia Middeke
- School of Medical and Health Science, Institute for Nutrition Research, Edith Cowan University, Joondalup, WA, Australia
| | - Kayla Palmer
- School of Medical and Health Science, Institute for Nutrition Research, Edith Cowan University, Joondalup, WA, Australia
| | - Elin Lövestam
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Angela Vivanti
- Research & Development Dietitian, Princess Alexandra Hospital, Brisbane, QLD, Australia.,School of Human Movement and Nutrition Studies, University of Queensland, St Lucia, Queensland, Australia
| | - Ylva Orrevall
- Department of Clinical Nutrition, Karolinska University Hospital, Stockholm, Sweden.,Department of Bioscience and Nutrition, Karolinska Institute, Stockholm, Sweden
| | - Alison Steiber
- Division of Nutrition and Dietetics, Collage of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SA, Canada
| | - Philippa Lyons-Wall
- School of Medical and Health Science, Institute for Nutrition Research, Edith Cowan University, Joondalup, WA, Australia
| | - Johnny Lo
- School of Science, Edith Cowan University, Joondalup, WA, Australia
| | - Amanda Devine
- School of Medical and Health Science, Institute for Nutrition Research, Edith Cowan University, Joondalup, WA, Australia
| | - Jessica Lieffers
- Division of Nutrition and Dietetics, Collage of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SA, Canada
| | | | - Nanna R Lang
- Department of Nutrition and Health, VIA University College, Horsens, Denmark
| | | | - Lyn Lloyd
- Auckland City Hospital, Auckland, New Zealand
| | - Therese A O'Sullivan
- School of Medical and Health Science, Institute for Nutrition Research, Edith Cowan University, Joondalup, WA, Australia
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Edwards A, Baldwin N, Findlay M, Brown T, Bauer J. Evaluation of the agreement, adoption, and adherence to the evidence-based guidelines for the nutritional management of adult patients with head and neck cancer among Australian dietitians. Nutr Diet 2021; 79:197-205. [PMID: 34528363 DOI: 10.1111/1747-0080.12702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/09/2021] [Accepted: 08/17/2021] [Indexed: 12/01/2022]
Abstract
AIM Evidence-based guideline translation to practice can improve outcomes but is often impaired by poor implementation. This project aimed to evaluate the implementation of the Evidence-based guidelines for the nutritional management of adult patients with head and neck cancer among Australian dietitians providing clinical care to this population. METHODS A questionnaire was developed, with face and content validity confirmed by an expert panel (n = 13), to gauge participant perceptions of the guidelines against an implementation evaluation framework. Dietitians were identified through Dietitians Australia and by contacting experts in the field. Eligibility was determined by questionnaire completion and prior guideline awareness. Responses were provided using a 5-point Likert scale. Results were analysed using descriptive statistics; with inferential analysis to determine if demographic information could reveal trends in guideline use and perception. RESULTS Of the 43 initial respondents, n = 28 completed the questionnaire, with n = 24/28 (86%) meeting full eligibility criteria for analysis. Median (range) scores for all four domains were high: awareness (4.0 [3.2-4.8]), agreement (4.4 [4.1-4.7]), adoption (3.5 [3.1-3.9]), and adherence (4.3 [4.1-4.9]). However, perception of guideline awareness and use among multidisciplinary team colleagues was low (mean 3.2/5.0 and 3.1/5.0, respectively). Dietitians with <10 years' experience had significantly higher perceptions of the guidelines' ability to positively influence practice; support evidence-based practice; and enhance dietitian credibility (P = 0.04) vs dietitians with ≥10 years' experience. CONCLUSION Dietitians demonstrated high rates of guideline implementation and positive perceptions for its use in clinical practice. Future implementation strategies and evaluation should expand to engage the wider multidisciplinary team and more experienced clinicians.
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Affiliation(s)
- Anna Edwards
- Department of Nutrition & Dietetics, Toowoomba Hospital, Darling Downs Health, Toowoomba, Queensland, Australia.,School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia.,Department of Nutrition & Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Nathan Baldwin
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Merran Findlay
- Cancer Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Teresa Brown
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia.,Department of Nutrition & Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Judy Bauer
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia.,Department of Nutrition & Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
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7
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Moullet C, Schmutz E, Laure Depeyre J, Perez MH, Cotting J, Jotterand Chaparro C. Physicians' perceptions about managing enteral nutrition and the implementation of tools to assist in nutritional decision-making in a paediatric intensive care unit. Aust Crit Care 2020; 33:219-227. [PMID: 32414683 DOI: 10.1016/j.aucc.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/08/2020] [Accepted: 03/14/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND For critically ill children hospitalised in paediatric intensive care units, adequate nutrition reduces their risk of morbidity and mortality. Barriers may impede optimal nutritional support in this population. Moreover, physicians are usually responsible for prescribing nutrition, although they are not experts. Therefore, tools may be used to assist in nutritional decision-making, such as nutrition protocols. OBJECTIVES The objective of this two-stage qualitative study was to explore the perceptions of physicians about their management of enteral nutrition in a paediatric intensive care unit and the implementation of a nutrition protocol and computerised system. METHODS This study involved semistructured interviews with physicians at the Paediatric Intensive Care Unit of Lausanne University Hospital, Switzerland. Research dietitians conducted interviews before (stage one) and after (stage two) the implementation of a nutrition protocol and computerised system. During stage one, six junior physicians and five fellows were interviewed. At stage two, 12 junior physicians, 12 fellows, and five senior physicians were interviewed. Interviews were recorded, with data transcribed verbatim before a thematic analysis using a framework method. RESULTS Three themes emerged from thematic analysis: "nutritional knowledge", "nutritional practices", and "resources to manage nutrition". During stage one, physicians, especially junior physicians, reported a lack of nutritional knowledge for critically ill children and stated that nutritional issues primarily depended on senior physicians, who themselves had various practices. All physicians were in favour of a nutrition protocol and computerised system. At stage two, interviewees stated that they used both tools regularly. They reported improved nutritional knowledge, more systematic and consistent nutritional practices, and increased attention to nutrition. CONCLUSIONS The implementation of a nutrition protocol and computerised system by a multiprofessional team helped physicians in the paediatric intensive care unit to manage nutritional support and increase their attention to nutrition.
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Affiliation(s)
- Clémence Moullet
- Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Rue des Caroubiers 25, 1227 Carouge, Geneva, Switzerland.
| | - Elodie Schmutz
- HES-SO Master, University of Applied Sciences and Arts Western Switzerland, Avenue de Provence 6, 1007 Lausanne, University of Lausanne, Switzerland.
| | - Jocelyne Laure Depeyre
- Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Rue des Caroubiers 25, 1227 Carouge, Geneva, Switzerland.
| | - Marie-Hélène Perez
- Pediatric Intensive Care Unit, Lausanne University Hospital (CHUV/UNIL), Rue Du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Jacques Cotting
- Pediatric Intensive Care Unit, Lausanne University Hospital (CHUV/UNIL), Rue Du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Corinne Jotterand Chaparro
- Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Rue des Caroubiers 25, 1227 Carouge, Geneva, Switzerland.
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8
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Gooding B, Probst Y, Houston L, Neale E. Exploring perceptions, barriers and use of systematic reviews amongst nutrition professionals and nutrition students. Nutr Diet 2019; 77:151-159. [PMID: 31854509 DOI: 10.1111/1747-0080.12598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/27/2019] [Accepted: 11/01/2019] [Indexed: 12/01/2022]
Abstract
AIM Systematic reviews (SRs) are a core component of evidence-based practice and are widely used in developing nutrition policy. This study aimed to examine nutrition professionals and students' perceptions, barriers and use of SRs. A secondary aim was to examine confidence using and conducting SRs. METHODS A self-administered online survey was developed, pilot-tested and implemented via SurveyMonkey. The survey consisted of 29 items separated into demographics, perceptions, use, and knowledge of SRs, confidence in using and conducting SRs, and barriers to use and conduct of SRs. The survey was disseminated via professional newsletters and social media. RESULTS Ninety-four nutrition professionals/students completed the survey. Survey results indicated respondents valued SRs, with SRs used most commonly to update knowledge. While most respondents (67%) were confident in using SRs, many (59%) expressed a lack of confidence in conducting a SR. In particular, few respondents (12%) reported confidence in conducting meta-analyses. The majority of respondents were aware that SRs underpinned guidelines and nutrition resources, however, few (21%) respondents identified that self-substantiation of health claims were based on SRs. Time, access to scientific database, lack of workplace support and confidence were the main barriers to SRs use. CONCLUSIONS SRs were reported as being valued by nutrition professionals and students, though time constraints, a lack of confidence and organisations which did not prioritise research were barriers to conducting SRs. The findings of this survey highlight a need for training and education as potential strategies to promote SR engagement in nutrition professionals and students.
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Affiliation(s)
- Bethany Gooding
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Yasmine Probst
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Lauren Houston
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Elizabeth Neale
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
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Klaic M, McDermott F, Haines T. How soon do allied health professionals lose confidence to perform EBP activities? A cross-sectional study. J Eval Clin Pract 2019; 25:603-612. [PMID: 30178627 DOI: 10.1111/jep.13001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/16/2018] [Accepted: 06/18/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore if there is a relationship between allied health professionals' confidence to perform a range of evidence-based practice (EBP) activities and the time since they graduated from their entry-level degree and the presence of postgraduate qualifications. DESIGN Cross-sectional survey. SETTING Allied health professionals from two Australian public metropolitan health services, including acute, subacute, and community settings. PARTICIPANTS Sample of 288 (n = 288) allied health professionals from the disciplines of physiotherapy, occupational therapy, speech pathology, social work, dietetics/nutrition, and other. MAIN OUTCOME MEASURE Cross-sectional survey including 12 questions measuring respondents' confidence to conduct a range of EBP activities. RESULTS Allied health professionals begin to lose confidence related to EBP activities within the first 5 years of clinical practice, particularly for those activities involving critical analysis of published studies. Respondents with postgraduate qualifications were more likely to report greater confidence with EBP activities, suggesting that higher level qualifications protect against the effect of degradation of EBP skills and confidence over time. CONCLUSIONS Allied health professionals' confidence to perform EBP activities degrades over time, particularly for those individuals with no postgraduate qualifications. Registration and accreditation bodies along with allied health professional employers should explore potential strategies to preserve and enhance EBP skills, confidence, and behaviours.
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Affiliation(s)
- Marlena Klaic
- Allied Health, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Fiona McDermott
- Department of Social Work, Monash University, Melbourne, VIC, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
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10
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Soguel L, Vaucher C, Bengough T, Burnand B, Desroches S. Knowledge Translation and Evidence-Based Practice: A Qualitative Study on Clinical Dietitians' Perceptions and Practices in Switzerland. J Acad Nutr Diet 2019; 119:1882-1889. [PMID: 31296425 DOI: 10.1016/j.jand.2019.04.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/19/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Knowledge translation (KT) in health care is essential to promote quality of care and reduce the knowledge-to-practice gap. Little is known about KT among dietitians, and a better understanding of how this process pans out is fundamental to support their clinical practice. OBJECTIVE To explore clinical dietitians' perceptions and practices concerning preferences and access to information sources in clinical practice, KT activities, research in nutrition and dietetics, and evidence-based practice (EBP). DESIGN, PARTICIPANTS, AND SETTING Eight interviews and two focus groups involving a total of 15 participants were conducted in 2013 among members of the Swiss Association for Registered Dietitians in the French- and German-speaking regions of Switzerland. ANALYSIS PERFORMED Thematic analysis drawn from a constructivist grounded theory approach. RESULTS Information from colleagues and experts of the field were favored when facing unfamiliar situations in clinical practice. Critically selecting evidence-based information was considered challenging, but dietitians declared they were at ease to integrate patients' preferences and values, and their clinical expertise and judgment, in decision making, which are fundamental elements of EBP. A major reported barrier to KT was the perception that time to identify and read scientific literature was not expected during working hours and that instead, this time should be spent in clinical activities with patients. On the other hand, dietitians identified that their frequent involvement in educational activities such as knowledge dissemination or tailoring favored the integration of evidence into practice. Finally, dietitians struggled more to identify evidence-based information about counseling and communication than about biomedical knowledge. CONCLUSIONS Dietitians mentioned being involved in each step of the KT process (ie, synthesis, dissemination, exchange, and ethically sound application of knowledge). Barriers and facilitators identified in this study need to be explored in a larger population to develop strategies to facilitate KT and EBP in dietetics practice.
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Pfeifflé S, Pellegrino F, Kruseman M, Pijollet C, Volery M, Soguel L, Torre SBD. Current Recommendations for Nutritional Management of Overweight and Obesity in Children and Adolescents: A Structured Framework. Nutrients 2019; 11:nu11020362. [PMID: 30744122 PMCID: PMC6412470 DOI: 10.3390/nu11020362] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/05/2019] [Accepted: 02/05/2019] [Indexed: 01/27/2023] Open
Abstract
Nutritional management is an important component of the treatment of pediatric overweight and obesity, but clinicians struggle to keep abreast with the abundant literature. Therefore, our aim is to provide a tool that integrates the current recommendations and clinical expertise to assist dietitians and other practitioners in their decision making about the nutritional management of pediatric overweight and obesity. To construct this practice-based evidence-informed framework, we conducted a systematic review of the guidelines on nutritional management of pediatric overweight or obesity in 2 databases and in the grey literature. We analyzed and synthesized recommendations of 17 guidelines. We selected the recommendations that were common to at least 30% of the guidelines and added by consensus the recommendations relevant to clinical expertise. Finally, we structured the framework according to the Nutritional Care Process in collaboration with a specialized team of dietitians who assessed its validity in clinical practice. The framework contributes to facilitate the integration of evidence-based practice for dietitians by synthesizing the current evidence, supporting clinical expertise, and promoting structured care following Nutrition Care Process model for children and adolescents with obesity.
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Affiliation(s)
- Shawna Pfeifflé
- Department of Nutrition and Dietetics, School of Health Sciences Geneva, University of Applied Sciences and Arts Western Switzerland (HES-SO). Rue des Caroubiers 25, 1227 Carouge, Switzerland.
| | - Fabien Pellegrino
- Department of Nutrition and Dietetics, School of Health Sciences Geneva, University of Applied Sciences and Arts Western Switzerland (HES-SO). Rue des Caroubiers 25, 1227 Carouge, Switzerland.
| | - Maaike Kruseman
- Department of Nutrition and Dietetics, School of Health Sciences Geneva, University of Applied Sciences and Arts Western Switzerland (HES-SO). Rue des Caroubiers 25, 1227 Carouge, Switzerland.
| | - Claire Pijollet
- Department of Nutrition and Dietetics, School of Health Sciences Geneva, University of Applied Sciences and Arts Western Switzerland (HES-SO). Rue des Caroubiers 25, 1227 Carouge, Switzerland.
| | - Magali Volery
- CCNP-Centre de Consultations Nutrition et Psychothérapie, Rue du Vieux-Marché 8, 1207 Genève, Switzerland.
| | - Ludivine Soguel
- Department of Nutrition and Dietetics, School of Health Sciences Geneva, University of Applied Sciences and Arts Western Switzerland (HES-SO). Rue des Caroubiers 25, 1227 Carouge, Switzerland.
| | - Sophie Bucher Della Torre
- Department of Nutrition and Dietetics, School of Health Sciences Geneva, University of Applied Sciences and Arts Western Switzerland (HES-SO). Rue des Caroubiers 25, 1227 Carouge, Switzerland.
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Academy of Nutrition and Dietetics Methodology for Developing Evidence-Based Nutrition Practice Guidelines. J Acad Nutr Diet 2017; 117:794-804. [DOI: 10.1016/j.jand.2016.07.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Indexed: 11/18/2022]
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Harper C, Maher J. Investigating Philosophies Underpinning Dietetic Private Practice. Behav Sci (Basel) 2017; 7:E11. [PMID: 28257036 PMCID: PMC5371755 DOI: 10.3390/bs7010011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/06/2017] [Accepted: 02/21/2017] [Indexed: 11/25/2022] Open
Abstract
There is limited theory or knowledge regarding dietitians' practice philosophies and how these philosophies are generated and incorporated into their professional practices. For the purposes of this study, a conceptual framework will explain and define the 'philosophies' as three different types of knowledge; episteme, techne, and phronesis. This study aimed to develop an explanatory theory of how dietitians in private practice source, utilise, and integrate practice philosophies. A grounded theory qualitative methodology was used to inform the sampling strategy, data collection, and analytical processes. Semi-structured interviews with dietitians in private practice were undertaken and data were collected and analysed concurrently. The results show that dietitians form collaborative relationships with their clients, in order to nurture change over time. They use intrinsic and intertwined forms of episteme, techne, and phronesis, which allow them to respond both practically and sensitively to their clients' needs. The learning and integration of these forms of knowledge are situated in their own practice experience. Dietitians adapt through experience, feedback, and reflection. This study highlights that private practice offers a unique context in which dietitians deal with complex issues, by utilising and adapting their philosophies.
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Affiliation(s)
- Claudia Harper
- The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School, The University of Sydney, Level 2, Charles Perkins Centre, John Hopkins Drive, Camperdown, NSW 2006, Australia.
| | - Judith Maher
- Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, 90 Sippy Downs Dr, Sippy Downs, QLD 4556, Australia.
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Schoonees A, Rohwer A, Young T. Evaluating evidence-based health care teaching and learning in the undergraduate human nutrition; occupational therapy; physiotherapy; and speech, language and hearing therapy programs at a sub-Saharan African academic institution. PLoS One 2017; 12:e0172199. [PMID: 28207842 PMCID: PMC5313131 DOI: 10.1371/journal.pone.0172199] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 02/01/2017] [Indexed: 11/18/2022] Open
Abstract
Background It is important that all undergraduate healthcare students are equipped with evidence-based health care (EBHC) knowledge and skills to encourage evidence-informed decision-making after graduation. We assessed EBHC teaching and learning in undergraduate human nutrition (HN); occupational therapy (OT); physiotherapy (PT); and speech, language and hearing therapy (SPLH) programs at a sub-Saharan African university. Methods We used methodological triangulation to obtain a comprehensive understanding of EBHC teaching and learning: (1) through a document review of module guides, we identified learning outcomes related to pre-specified EBHC competencies; we conducted (2) focus group discussions and interviews of lecturers to obtain their perspectives on EBHC and on EBHC teaching and learning; and we (3) invited final year students (2013) and 2012 graduates to complete an online survey on EBHC attitudes, self-perceived EBHC competence, and their experience of EBHC teaching and learning. Results We reviewed all module outlines (n = 89) from HN, PT and SLHT. The OT curriculum was being revised at that time and could not be included. Six lecturers each from HN and OT, and five lecturers each from PT and SLHT participated in the focus groups. Thirty percent (53/176) of invited students responded to the survey. EBHC competencies were addressed to varying degrees in the four programs, although EBHC teaching and learning mostly occurred implicitly. Learning outcomes referring to EBHC focused on enabling competencies (e.g., critical thinking, biostatistics, epidemiology) and were concentrated in theoretical modules. Key competencies (e.g., asking questions, searching databases, critical appraisal) were rarely addressed explicitly. Students felt that EBHC learning should be integrated throughout the four year study period to allow for repetition, consolidation and application of knowledge and skills. Lecturers highlighted several challenges to teaching and practising EBHC, including lack of evidence relevant to the African context and lack of time within curricula.
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Affiliation(s)
- Anel Schoonees
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anke Rohwer
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Taryn Young
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Tan SY, Hemmelgarn M, Baumgardner K, Tucker RM. Attitudes towards and experiences with research: Differences between dietetics students and professionals in Australia and the United States. Nutr Diet 2016; 74:388-395. [PMID: 28901699 DOI: 10.1111/1747-0080.12313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 07/12/2016] [Accepted: 07/19/2016] [Indexed: 11/28/2022]
Abstract
AIM Research conducted by dietitians is encouraged by national and international organisations, yet research output remains low. The attitudes towards and experiences with research and research methods course work of students and practitioners in Australia and the United States were examined. METHODS A cross-sectional online survey was conducted. Participants were contacted by email; 173 Australian (N = 50 students; 123 practitioners) and 499 US (N = 231 students; 268 practitioners) respondents completed the survey. RESULTS A smaller proportion of American students (74%) indicated that they would consider conducting research in the future compared to Australian students (84%) (P < 0.001). More Australian than American practitioners indicated interest in conducting research in their current position (87% vs 66%; P < 0.001). Research training did not increase future research plans, but respondents who had conducted research either as a student or at work responded more favourably to conducting research in the future (P < 0.001). In general, Australian respondents were more supportive of and more experienced with research. CONCLUSIONS Unlike classroom training, past research experiences supported plans for future research. Further work needs to investigate how the culture of the profession can be changed to support more dietitian-conducted research.
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Affiliation(s)
- Sze-Yen Tan
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Megan Hemmelgarn
- Food and Nutrition Program, Department of Public and Allied Health, Bowling Green State University, Bowling Green, Ohio, USA
| | - Kelli Baumgardner
- Food and Nutrition Program, Department of Public and Allied Health, Bowling Green State University, Bowling Green, Ohio, USA
| | - Robin M Tucker
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, Michigan, USA
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Miller J, Thomas J, Miller M. Predictors of publication by dietitians from conference abstracts presented at national conferences 2006-2009. Nutr Diet 2015. [DOI: 10.1111/1747-0080.12159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jacqueline Miller
- Nutrition and Dietetics; Flinders University; Adelaide South Australia Australia
| | - Jolene Thomas
- Nutrition and Dietetics; Flinders University; Adelaide South Australia Australia
| | - Michelle Miller
- Nutrition and Dietetics; Flinders University; Adelaide South Australia Australia
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Sheard JM, Ash S. Current practice in nutrition diagnosis and intervention for the management of Parkinson's disease in Australia and Canada. Nutr Diet 2015. [DOI: 10.1111/1747-0080.12118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jamie M. Sheard
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Kelvin Grove Qld 4059 Australia
- School of Exercise and Nutrition Sciences; Queensland University of Technology; Kelvin Grove Qld 4059 Australia
| | - Susan Ash
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Kelvin Grove Qld 4059 Australia
- School of Exercise and Nutrition Sciences; Queensland University of Technology; Kelvin Grove Qld 4059 Australia
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Harding KE, Porter J, Horne-Thompson A, Donley E, Taylor NF. Not enough time or a low priority? Barriers to evidence-based practice for allied health clinicians. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2014; 34:224-231. [PMID: 25530292 DOI: 10.1002/chp.21255] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Evidence-based practice (EBP) is a key principle in the delivery of effective and high-quality health care. Existing research suggests that allied health professionals are generally supportive of EBP but rarely participate in activities associated with EBP. METHODS This mixed-method study used 8 focus groups of allied health professionals and managers and a questionnaire of all participants to explore the attitudes and barriers to EBP in a large metropolitan health service. Qualitative data were analyzed using a thematic analysis of focus group transcriptions. Questionnaire data were analyzed descriptively. RESULTS Fifty clinicians and 10 managers across 7 allied health disciplines participated in the study. The questionnaire identified that clinicians have a positive attitude but low participation in EBP. Qualitative data revealed that EBP was not highly valued by clinicians and managers or viewed as a core component of clinical care, with activities directly related to maintaining patient flow viewed as higher priorities. Lack of skills and resources and difficulty associated with implementing evidence into practice were further barriers. DISCUSSION Achieving higher uptake of EBP among allied health clinicians requires a cultural shift, placing higher value on these activities despite the challenging context of constant pressures to increase patient flow. Addressing EBP through small group projects rather than considering it to be an individual responsibility may be more acceptable to both clinicians and managers, with added benefits of peer support for both evaluating evidence and translation into practice.
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Perceptions, Attitudes, Knowledge, and Clinical Use of Evidence-Based Practice Among US Registered Dietitians. TOP CLIN NUTR 2013. [DOI: 10.1097/tin.0b013e31829dee5e] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Oude Rengerink K, Zwolsman SE, Ubbink DT, Mol BWJ, van Dijk N, Vermeulen H. Tools to assess Evidence-Based Practice behaviour among healthcare professionals. ACTA ACUST UNITED AC 2013; 18:129-38. [DOI: 10.1136/eb-2012-100969] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hall-McMahon EJ, Campbell KL. Have Renal Dietitians Successfully Implemented Evidence-Based Guidelines Into Practice? A Survey of Dietitians Across Australia and New Zealand. J Ren Nutr 2012; 22:584-91. [DOI: 10.1053/j.jrn.2011.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 09/19/2011] [Accepted: 09/20/2011] [Indexed: 01/04/2023] Open
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Orazio LK, Murray EM, Campbell KL. Guideline use: a survey of dietitians working with adult kidney transplant recipients. Nephrology (Carlton) 2012; 17:508-13. [PMID: 22369343 DOI: 10.1111/j.1440-1797.2012.01590.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To establish current service provision as well as barriers and enablers to guideline implementation in the Nutritional Management of Adult Kidney Transplant Recipients (KTR). METHODS Fifteen primary renal transplant centres (15/17; 88% response rate) and 21 secondary renal transplant centres (21/24; 88% response rate) responded to an online survey addressing key questions investigating their current practice in the nutritional management of adult KTR. RESULTS Referral from primary to secondary sites was limited with only two sites (9%) routinely receiving referrals. Allocated funding for KTR at secondary sites was low (n = 4, 14%). Many primary sites received nil or <0.5 full-time equivalent (FTE) funding for inpatient (n = 8, 53%); and nil or ≤0.2 FTE funding for outpatient services (n = 9, 60%). In sites reporting FTE hours, the average dietitian-to-patient ratio was 1 FTE dietitian for every 383 (range 50-1280) annually transplanted patients. Major barriers identified in delivering nutrition services at primary sites included time/lack of resources and limitations with systems to identify or track transplant recipients. CONCLUSION Dietitian-to-patient ratios in the management of KTR at primary sites are inconsistent and likely to be inadequate at secondary transplant sites to implement guideline recommendations, especially for weight management. Investigations into the effectiveness of innovative interventions such as groups or telehealth are warranted, which may assist practitioners to achieve guideline recommendations in an environment of limited resources.
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Affiliation(s)
- Linda K Orazio
- Department of Nutrition, Princess Alexandra Hospital, Woollongabba, Brisbane, QLD 4102, Australia
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Bowden FM, Lordly D, Thirsk J, Corby L. Phase II Practice-based Evidence in Nutrition (PEN) evaluation: interviews with key informants. CAN J DIET PRACT RES 2012; 73:e233-40. [PMID: 22397961 DOI: 10.3148/73.1.2012.e233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE Dietitians of Canada has collaborated with experts in knowledge translation and transfer, technology, and dietetic practice to develop and implement an innovative online decision-support system called Practice-based Evidence in Nutrition (PEN). A study was conducted to evaluate the perceived facilitators and barriers that enable dietitians to use or prevent them from using PEN. METHODS As part of the overall evaluation framework of PEN, a qualitative descriptive research design was used to address the research purpose. Individual, semi-structured telephone interviews with 17 key informants were completed, and the interview transcripts underwent qualitative content analysis. RESULTS Respondents identified several facilitators of and barriers to PEN use. Facilitators included specificity to dietetics, rigorous/expert review, easy accessibility, current content, credible/secure material, well-organized/easy-to-use material, material that is valuable to practice, and good value for money. Barriers included perceived high cost, fee structuring/cost to students, certain organizational aspects, and a perceived lack of training for pathway contributors. CONCLUSIONS This formative evaluation has indicated areas in which PEN could be improved and strategies to make PEN the standard for dietetic education and practice. Ensuring that PEN is meeting users' knowledge needs is of the utmost importance if dietitians are to remain on the cutting edge of scientific inquiry.
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Affiliation(s)
- Fran Martin Bowden
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS, Canada
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Hemming J, Lordly D, Glanville NT, Corby L, Thirsk J. Developing an interview guide to evaluate practice-based evidence in nutrition: use of the delphi technique. CAN J DIET PRACT RES 2011; 72:186-90. [PMID: 22146118 DOI: 10.3148/72.4.2011.186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
An interview guide was created for qualitative evaluation of the impact of Practice-based Evidence in Nutrition (PEN) on dietetic practice, and its success as a medium for knowledge translation and transfer (KTT). The Delphi technique was used to bring together a diverse group of experts (n=7) with extensive knowledge in KTT and evidence-based practice (EBP); these experts developed the interview guide content. The technique is an effective means of gathering expert input to inform evaluation tool development, particularly in the absence of accepted evaluation guidelines or pre-existing evaluation tools. Although challenges exist with the Delphi technique, it is an adaptable method that can be modified to meet a variety of needs. During this project, the technique was modified to meet specific needs, including participants' partial anonymity and starting material to reduce the number of required rounds. The resulting interview guide contained open-ended questions focused on respondents' understanding of EBP and PEN, use of PEN by dietitians in other disciplines, perceptions of the quality/usefulness of PEN, and barriers to and facilitators of PEN use.
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Affiliation(s)
- Janet Hemming
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS
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Doody CM, Doody O. Introducing evidence into nursing practice: using the IOWA model. ACTA ACUST UNITED AC 2011; 20:661-4. [DOI: 10.12968/bjon.2011.20.11.661] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Owen Doody
- Department of Nursing and Midwifery, University of Limerick, Ireland
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Leach MJ, Gillham D. Are complementary medicine practitioners implementing evidence based practice? Complement Ther Med 2011; 19:128-36. [PMID: 21641517 DOI: 10.1016/j.ctim.2011.04.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 04/04/2011] [Accepted: 04/09/2011] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Over the past few decades the health professions have witnessed increasing pressure to shift from a culture of delivering care based on tradition and intuition, to a situation where decisions are guided and justified by the best available evidence. While there are concerns that many complementary and alternative medicine (CAM) practitioners may be cautious about embracing such an approach, no studies to date have effectively tested this assumption. OBJECTIVE To identify the skills, attitude, training and use of evidence-based practice (EBP) amongst CAM practitioners. DESIGN Descriptive survey, using the evidence-based practice attitude and utilisation survey (EBASE). SUBJECTS Randomly selected nationwide sample of system-based, non-medically qualified CAM practitioners practicing in a clinical capacity within Australia. MAIN OUTCOME MEASURES Practitioner skill, attitude, training and use of EBP. RESULTS Of the 351 questionnaires successfully dispatched, 126 were returned (36%). Most practitioners believed EBP was useful (92%) and necessary (73%) in CAM practice. While the majority of clinicians (>74%) reported participation in EBP activities, albeit infrequently, only a small to moderate proportion of decisions were based on evidence from clinical trials, with most practitioners relying on traditional knowledge, textbooks and clinical practice guidelines. Lack of available evidence, time, industry support and skills were perceived as barriers to EBP uptake. CONCLUSIONS While the small response rate limits the generalisability of these findings, the sample was considered representative of Australian CAM practitioners. What this study shows is that even though CAM practitioners may be supportive of EBP, education and training is needed to further improve clinician understanding and application of evidence-based practice.
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Affiliation(s)
- Matthew J Leach
- Health Economics & Social Policy Group, Sansom Institute, University of South Australia, Adelaide, SA, Australia.
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Leach MJ, Gillham D. Evaluation of the Evidence-Based practice Attitude and utilization SurvEy for complementary and alternative medicine practitioners. J Eval Clin Pract 2008; 14:792-8. [PMID: 19018912 DOI: 10.1111/j.1365-2753.2008.01046.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
RATIONALE This paper describes the development of the Evidence-Based practice Attitude and utilization SurvEy (EBASE), which was designed to measure complementary and alternative medicine (CAM) practitioner attitude to and utilization of evidence-based practice (EBP). AIM The aim of this study was to evaluate the validity and reliability of the EBASE as a measure of CAM practitioner skill, attitude and use of EBP in order to adequately inform clinicians and researchers about this comprehensive survey tool. METHODS EBASE and the clinical effectiveness and EBP questionnaire (EBPQ) were distributed to nine experts in CAM education, research, questionnaire design and/or EBP. Responses to these questionnaires were used to evaluate the content validity, convergent validity, test-retest reliability and internal consistency of EBASE. RESULTS EBASE has found to have good internal consistency (Cronbach's alpha = 0.84) and acceptable test-retest reliability (ICC = 0.578-0.986). The instrument also demonstrated good content validity (CVI = 0.899), and adequately measured practitioner skill and utilization of EBP when compared to the EBPQ. CONCLUSION The current study supports the validity and reliability of EBASE as a measure of CAM practitioner skill, attitude, experience and training in, as well as barriers and facilitating factors of EBP.
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Affiliation(s)
- Matthew J Leach
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia.
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Shakeshaft AM. A study of the attitudes and perceived barriers to undertaking clinical governance activities of dietitians in a Welsh National Health Service trust. J Hum Nutr Diet 2008; 21:225-38. [PMID: 18477178 DOI: 10.1111/j.1365-277x.2008.00868.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies of National Health Service (NHS) employees have identified barriers to undertaking clinical governance activities. Little of this research has investigated dietitians; however, where dietitians were included, generally positive attitudes towards research and evidence-based practice were reported alongside the identified barriers. METHODS A quantitative, whole population census was undertaken via a questionnaire distributed to 54 dietitians employed by Gwent Healthcare NHS Trust. RESULTS Dietitians reported positive attitudes towards clinical governance; however, barriers to undertaking clinical governance activities were identified. The main barriers included lack of time, inadequate funding, the view that direct patient care should always be prioritised over clinical governance activities and inadequate research and critical evaluation skills. CONCLUSIONS Findings were similar to those reported in previous studies of NHS staff. Where comparison was possible, all of the barriers identified were reported at lower levels than in previous studies. As the study was purely quantitative in nature, no understanding was gained regarding the nature of identified barriers or what factors influenced the dietitians' attitudes and perceptions. For further in-depth analysis of these factors, a qualitative study is recommended. As the study comprised a whole population census, the findings cannot be generalized to the dietetic profession as a whole, or to other staff groups within or outside of the study Trust.
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Affiliation(s)
- A M Shakeshaft
- Department of Nutrition and Dietetics, Royal Gwent Hospital, Cardiff Road, Newport, Gwent, UK.
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Whelan K, Thomas JE, Madden AM. Student Research Projects: The Experiences of Student Dietitians, University Faculty Members, and Collaborators. ACTA ACUST UNITED AC 2007; 107:1567-74. [PMID: 17761233 DOI: 10.1016/j.jada.2007.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Indexed: 11/24/2022]
Abstract
Two universities in the United Kingdom made systematic attempts to increase the number of student dietitians' research projects that are supervised by university faculty members in conjunction with external collaborators (collaborative projects), rather than by faculty alone (faculty-only projects). A questionnaire survey was used to evaluate the experiences of student dietitians (n=110), university faculty members (n=38), and collaborators (n=31) involved in a student research project, comparing those involved in a faculty-only project with those involved in a collaborative project. Students undertaking collaborative projects reported greater involvement in most areas of the research process and greater skill development in obtaining research ethics approval (P=0.005), data collection (P=0.05), and statistical analysis (P=0.004) than students undertaking faculty-only projects. In addition, collaborative projects were more frequently considered to produce results that would change dietetics practice than faculty-only projects by both student dietitians (60% vs 30%, P=0.01) and university faculty members (62% vs 19%, P<0.001). The collaborators also considered that in the majority of instances (61%) their involvement helped them to organize their own time to do research. The type of project did not appear to influence student's expectations of future involvement in research and audit. In general, both types of projects resulted in positive experiences for student dietitians, university faculty members, and collaborators. We recommend that those involved in dietetics education, practice, and management consider the potential value of senior-level student dietitian involvement in collaborative research projects.
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Affiliation(s)
- Kevin Whelan
- Nutritional Sciences Division, King's College London, 150 Stamford St, London, UK SE1 9NH.
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Byham-Gray LD, Gilbride JA, Dixon LB, Stage FK. Evidence-based practice: what are dietitians' perceptions, attitudes, and knowledge? ACTA ACUST UNITED AC 2005; 105:1574-81. [PMID: 16183358 DOI: 10.1016/j.jada.2005.07.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this study was to measure dietitians' perceptions, attitudes, and knowledge of evidence-based practice (PAK score), and to determine whether antecedent factors (eg, sociodemographic characteristics, education and training, professional experiences, and employment setting) predicted PAK score. DESIGN This cross-sectional, descriptive study used the Dietitian Research Involvement Survey following the Tailored Design Method. SUBJECTS/SETTING This study surveyed 500 randomly selected registered dietitians from seven dietetic practice groups of the American Dietetic Association. STATISTICAL ANALYSES PERFORMED Bivariate relationships were examined between antecedent factors and PAK score. Multiple linear regression analyses were conducted to test whether these factors predicted PAK score. RESULTS Higher PAK scores were associated with registered dietitians who completed more years of education (r=0.28, P<.0005), had taken a research course (r=0.28, P<.0005), frequently read research articles (r=0.41, P<.0005), earned an advanced-level board certification (r=0.18, P=.004), worked full-time (r=0.26, P<.0005), or belonged to professional organizations (r=0.18, P=.003). The strongest predictors for PAK score were "last time read research" (beta=.33, P<.0005), work status (beta=.20, P<.0005), level of education (beta=.19, P=.001), and association memberships (beta=.14, P=.01). CONCLUSIONS Results indicated that dietitians' ability to incorporate an evidence-based approach is largely determined by their education and training, work experience, and professional association involvement. This study identified a need to integrate concepts and principles of evidence-based practice into dietetics curriculums so that practitioners are able to routinely apply research findings to clinical practice.
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Affiliation(s)
- Laura D Byham-Gray
- Department of Primary Care, University of Medicine and Dentistry of New Jersey, Stratford 08084, USA.
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Hise ME, Kattelmann K, Parkhurst M. Evidence-based clinical practice: dispelling the myths. Nutr Clin Pract 2005; 20:294-302. [PMID: 16207666 DOI: 10.1177/0115426505020003294] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Evidence-based practice merges the best and most relevant clinical research data with clinician experience, pathophysiology of disease state, and the specifics of individual patient care. Currently, there is a significant gap between the best research evidence in healthcare and application of this evidence to clinician practices. Consistent with this finding, nutrition support is not always applied effectively or consistently, despite available scientific evidence that could be used to enhance a given treatment protocol. Cited obstacles that prevent the incorporation of research evidence into daily practice include lack of time, inadequate research skills, and information overload. Identification and application of the most valid primary research and evidence summaries (clinical guides to practice and meta-analyses) should, however, be an integral part of appropriate nutrition care. Consequently, it is important that clinicians develop and improve upon the basic skills required to allow efficient and accurate searches and evaluations of the literature. This review describes the basic and practical components of evidence-based medicine and provides tools to determine whether current nutrition practices are based upon an analysis of valid clinical evidence or anecdotal nutrition traditions and myths.
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Affiliation(s)
- Mary E Hise
- The University of Kansas Medical Center, Department of Dietetics and Nutrition, Kansas City, KS 66160-7250, USA.
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Helman AD. Arbor Clinical Nutrition Updates: evidence-based clinical nutrition education using the Internet. Eur J Clin Nutr 2005; 59 Suppl 1:S117-20; discussion S121. [PMID: 16052179 DOI: 10.1038/sj.ejcn.1602184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Arbor Clinical Nutrition Updates (ACNU) is a weekly electronic nutrition journal for health professionals. Each issue summarises several recent clinical research papers appearing in the general medical and nutrition literature and which deal with a common nutrition topic. A commentary is added on how this research fits in with previous work, and what it all means for the practising clinician. ACNU is the world's most widely read electronic nutrition publication, with over 100,000 largely health-professional readers in 186 countries. It is published in nine languages and distributed by email without charge in both plain text and Acrobat formats. ACNU utilises a number of the Internet's unique characteristics to facilitate broad reach, currency and active reader feedback. This, together with its brevity and summarising format, helps to maintain its relevance to the nutrition education needs of health professionals, particularly those in clinical practice, and to overcome the factors most commonly reported by health professionals as obstacles to their greater adoption of evidence-based medicine. ACNU is intended to be a collaboration with the primary research journals to extend the reach of new nutrition research findings to a wider community of researchers, academics and clinicians than each journal might otherwise reach individually. As such, ACNU utilises the Internet to promote the goals of open-access publishing and evidence-based medicine.
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Affiliation(s)
- A D Helman
- Royal Australian College of General Practitioners, Edgecliff, New South Wales, Australia.
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Gagan M, Hewitt-Taylor J. The issues for nurses involved in implementing evidence in practice. ACTA ACUST UNITED AC 2005; 13:1216-20. [PMID: 15580091 DOI: 10.12968/bjon.2004.13.20.17013] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Evidence-based practice (EBP) is currently high on political and professional agendas. However, there is a suggestion that despite apparent enthusiasm for EBP, it is not becoming a reality. A variety of reasons for evidence not being implemented in practice exist, including the way in which evidence is communicated, how staff are involved in changes in practice, the availability of resources, patient expectations and the priority afforded to EBP by individuals and organizations. These issues must be addressed if EBP is to succeed.
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Affiliation(s)
- Mark Gagan
- Institute of Health and Community Studies, Bournemouth University, UK
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