Strategic collaborative model for evidence-based nursing practice

Patient Engagement in Evidence-Based Practice Frameworks

Evidence-based practice (EBP) is the cornerstone of contemporary healthcare, promoting the integration of scientific evidence, clinical expertise, and patient values to inform clinical decision-making and enhance patient outcomes. While patient engagement is recognized as a critical component of EBP, the extent to which it is incorporated in various EBP frameworks is unclear. This study is a secondary analysis of a scoping review which evaluated EBP frameworks used in healthcare settings. In the current study, our objective was to assess the level of patient engagement within those frameworks. To achieve this, we employed a patient engagement framework which characterizes engagement as a continuum, spanning consultation to involvement to shared leadership/partnership, across 3 healthcare domains: direct care, organizational design and governance, and policymaking. Our analysis revealed a gap in integrating patient values and preferences within EBP frameworks. Only 3 of the assessed frameworks showed a high degree of engagement across all domains. Future research should focus on developing strategies for implementing and evaluating meaningful engagement in EBP.

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

OBJECTIVES

The aim of this scoping review was to identify and review current evidence-based practice (EBP) models and frameworks. Specifically, how EBP models and frameworks used in healthcare settings align with the original model of (1) asking the question, (2) acquiring the best evidence, (3) appraising the evidence, (4) applying the findings to clinical practice and (5) evaluating the outcomes of change, along with patient values and preferences and clinical skills.

DESIGN

A Scoping review.

INCLUDED SOURCES AND ARTICLES

Published articles were identified through searches within electronic databases (MEDLINE, EMBASE, Scopus) from January 1990 to April 2022. The English language EBP models and frameworks included in the review all included the five main steps of EBP. Excluded were models and frameworks focused on one domain or strategy (eg, frameworks focused on applying findings).

RESULTS

Of the 20 097 articles found by our search, 19 models and frameworks met our inclusion criteria. The results showed a diverse collection of models and frameworks. Many models and frameworks were well developed and widely used, with supporting validation and updates. Some models and frameworks provided many tools and contextual instruction, while others provided only general process instruction. The models and frameworks reviewed demonstrated that the user must possess EBP expertise and knowledge for the step of assessing evidence. The models and frameworks varied greatly in the level of instruction to assess the evidence. Only seven models and frameworks integrated patient values and preferences into their processes.

CONCLUSION

Many EBP models and frameworks currently exist that provide diverse instructions on the best way to use EBP. However, the inclusion of patient values and preferences needs to be better integrated into EBP models and frameworks. Also, the issues of EBP expertise and knowledge to assess evidence must be considered when choosing a model or framework.

Nursing Managers' Perspectives on the Facilitators and Barriers to Implementation of Evidence-Based Management

BACKGROUND

Evidence-based health management is defined as a new approach to improve the quality of hospital decisions by systematic application of the best available evidence. To use that, facilitators and barriers to implementation of evidence-based management (EBMgt) in the decision-making process need to be identified.

AIM

The purpose of this study was to assess nursing managers' perspectives on the facilitators and barriers to implementation of EBMgt in Tabriz hospitals, northwest Iran.

METHODS

A cross-sectional study design was used in 2017. The study was conducted in one state in Iran (Tabriz). A total of 276 nursing managers (e.g., matrons, supervisors, & head nurses [HNs]) were invited to participate from the Tabriz hospitals (N = 20); 212 completed and returned the survey, yielding a response rate of 76.81%. The EBMgt assessment questionnaire was used to collect data. The questionnaire consists of two parts. The first part includes barriers to EBMgt (five main domains and 46 questions). The second part includes the facilitators of EBMgt (five main domains and 42 questions). Data entry and analysis were carried out using SPSS-21 software.

RESULTS

Highest mean scores of barriers were observed for "training and research systems" (64.65 ± 12.42). "Lack of communication between knowledge producers and hospital decision-makers" (68.19 ± 17.32) had highest mean scores among all 46 barriers. Also, the results showed that mean scores for all the barriers were higher than 55. The highest mean scores were observed for "social/interpersonal factors" (65.84 ± 17.07). "Interest and willingness to scientific management principles" (68.62 ± 20.17) had highest mean scores among all 42 facilitators.

LINKING EVIDENCE TO ACTION

The aim of EBMgt is to provide the most effective healthcare outcomes. Identifying barriers and facilitators is essential for implementing EBMgt in hospitals. Building the facilitators and eliminating barriers are foundation of EBMgt. Filling the gap between knowledge producers and nursing managers can be a starting point for improvement of the decision-making process in nursing care.

MODELOS PARA A IMPLEMENTAÇÃO DA PRÁTICA BASEADA EM EVIDÊNCIAS NA ENFERMAGEM HOSPITALAR: REVISÃO NARRATIVA

RESUMO Objetivo: identificar modelos para implementação da prática baseada em evidências na Enfermagem hospitalar. Método: Revisão narrativa da literatura. Após a identificação dos modelos, realizou-se uma busca de referências específicas sobre o tópico de interesse e procedeu-se a leitura dos artigos publicados. Resultados: são apresentados 16 modelos para a utilização de pesquisas na prática de enfermeiros hospitalares, publicadas no período de 1970 a 2015. Foram descritas as etapas para a implementação dos modelos, com ênfase nos tipos de evidências e abordagens para utilização das pesquisas. Conclusão: na análise dos pressupostos dos modelos descritos, pode-se inferir que a utilização de pesquisas na prática de enfermeiros hospitalares requer conhecimento e competências para além dos usuais no exercício cotidiano do trabalho. Desta maneira, o desafio para o cenário nacional perfaz o desenvolvimento de modelos próprios, específicos para a realidade vivenciada ou, ainda, a elaboração de iniciativas que retratem a implementação e/ou adaptação dos modelos propostos em âmbito internacional.

Self-organizing Development Teams for Innovative Nursing Care

The purpose of this study was to describe the participation of nurses and nurse leaders in self-organizing teams formed to develop innovative nursing care. The theoretical perspective combines Bondas' caritative theory on nursing leadership with Waterman's and Dolan's work on ad hoc organizations. Seven self-organizing teams participated in a 2-year action research project. Data were collected through fieldwork, formal and informal individual and group interviews, and diaries. Analytical abstraction methodology described by Miles et al was used. The metaphor "overcoming the jet lag of bureaucracy" is based on 5 themes: struggling to design the new team; investing time and self; needing research and leadership support; evolving collegial collaboration, professional growth, and pride; and growing professional security and the will to continue education as a result of learning.

Question Safari: Seeking Questions in Their Natural Habitat. A Case Report

Due to the demanding schedules of nurses, many clinical queries generated during patient care are forgotten before the nurse has time to conduct a search. This article describes a new clinical librarian service, Question Safari, created in partnership with the Nursing Research & Evidence-Based Practice initiative to help mitigate this issue and to support patient care.

How do health care organizations take on best practices? A scoping literature review

AIMS

The aims of this scoping literature review are to examine and summarize the organizational-level factors, context, and processes that influence the use of evidence-based practice in healthcare organizations.

METHODS

A scoping literature review was done to answer the question: What is known from the existing empirical literature about factors, context, and processes that influence the uptake, implementation, and sustainability of evidence-based practice in healthcare organizations? This review used the Arksey and O'Malley framework to describe findings and to identify gaps in the existing research literature. Inclusion and exclusion criteria were developed to screen studies. Relevant studies published between January 1991 and March 2014 were identified using four electronic databases. Study abstracts were screened for eligibility by two reviewers. Following this screening process, full-text articles were reviewed to determine the eligibility of the studies by the primary author. Eligible studies were then analyzed by coding findings with descriptive labels to distinguish elements that appeared relevant to this literature review. Coding was used to form categories, and these categories led to the development of themes.

RESULTS

Thirty studies met the eligibility criteria for this literature review. The themes identified were: the process organizations use to select evidence-based practices for adoption, use of a needs assessment, linkage to the organization's strategic direction, organizational culture, the organization's internal social networks, resources (including education and training, presence of information technology, financial resources, resources for patient care, and staff qualifications), leadership, the presence of champions, standardization of processes, role clarity of staff, and the presence of social capital.

CONCLUSION

Several gaps were identified by this review. There is a lack of research on how evidence-based practices may be sustained by organizations. Most of the research done to date has been cross-sectional. Longitudinal research would give insight into the relationship between organizational characteristics and the uptake, implementation, and sustainability of evidence-based practice. In addition, although it is clear that financial resources are required to implement evidence-based practice, existing studies contain a lack of detail about the cost of adopting and using new practices. This scoping review contains a number of implications for healthcare administrators, managers, and providers to consider when adopting and implementing evidence-based practices in healthcare organizations.

A systematic review of implementation frameworks of innovations in healthcare and resulting generic implementation framework

BACKGROUND

Implementation science and knowledge translation have developed across multiple disciplines with the common aim of bringing innovations to practice. Numerous implementation frameworks, models, and theories have been developed to target a diverse array of innovations. As such, it is plausible that not all frameworks include the full range of concepts now thought to be involved in implementation. Users face the decision of selecting a single or combining multiple implementation frameworks. To aid this decision, the aim of this review was to assess the comprehensiveness of existing frameworks.

METHODS

A systematic search was undertaken in PubMed to identify implementation frameworks of innovations in healthcare published from 2004 to May 2013. Additionally, titles and abstracts from Implementation Science journal and references from identified papers were reviewed. The orientation, type, and presence of stages and domains, along with the degree of inclusion and depth of analysis of factors, strategies, and evaluations of implementation of included frameworks were analysed.

RESULTS

Frameworks were assessed individually and grouped according to their targeted innovation. Frameworks for particular innovations had similar settings, end-users, and 'type' (descriptive, prescriptive, explanatory, or predictive). On the whole, frameworks were descriptive and explanatory more often than prescriptive and predictive. A small number of the reviewed frameworks covered an implementation concept(s) in detail, however, overall, there was limited degree and depth of analysis of implementation concepts. The core implementation concepts across the frameworks were collated to form a Generic Implementation Framework, which includes the process of implementation (often portrayed as a series of stages and/or steps), the innovation to be implemented, the context in which the implementation is to occur (divided into a range of domains), and influencing factors, strategies, and evaluations.

CONCLUSIONS

The selection of implementation framework(s) should be based not solely on the healthcare innovation to be implemented, but include other aspects of the framework's orientation, e.g., the setting and end-user, as well as the degree of inclusion and depth of analysis of the implementation concepts. The resulting generic structure provides researchers, policy-makers, health administrators, and practitioners a base that can be used as guidance for their implementation efforts.

A retrospective review of leg wound complications after coronary artery bypass surgery

Little research or attention has been paid to finding out whether wound closure with sutures or staples attains the best outcomes after saphenous vein harvest for coronary artery bypass grafting. We undertook a quality improvement project to compare the prevalence of leg wound complications (eg, infection, seroma, hematoma, dehiscence) between two types of skin closure (ie, staples, subcuticular sutures) after conventional open surgery with bridging between incisions and vein harvesting during coronary revascularization to determine the need for practice changes. We found no significant differences between patients with wound complications and those without. However, in this project, the risk for infections was greater for patients with diabetes whose wounds were closed by using subcuticular sutures. These findings have led to practice changes for reducing leg wound complications within our institution: clinicians now assess patients for increased risk of leg wound complications preoperatively and opt to close wounds with staples for patients who have diabetes.

Development and psychometric testing of the Nursing Research Self-Efficacy Scale (NURSES)

BACKGROUND AND PURPOSE

The Nursing Research Self-Efficacy Scale (NURSES) was designed to measure individual nurses' degree of research self-efficacy and their perceptions regarding their unit's collective support of research use. Development for the NURSES instrument spanned a 4-year period, which included initial development, revisions, and psychometric evaluations.

METHOD

The NURSES is a 38-item Likert-scale instrument developed through ongoing instrument validation that included content validation and exploratory and confirmatory analysis. The 5 subscales include obtaining science-based knowledge resources, critically reading and evaluating quantitative research literature, critically reading and evaluating qualitative research literature, understanding and applying theory, and collective research efficacy.

RESULTS

Over a 4-year period, approximately 1000 practicing nurses from multiple hospitals responded to the instrument. Exploratory and confirmatory factor analyses supported the existence of four subscales for research self-efficacy and one subscale for collective research efficacy. Reliability for the subscales was excellent, ranging from .94 to .97.

CONCLUSIONS

Hospitals may wish to use the NURSES instrument as an orientation tool, or to examine relationships between research efficacy and nurses' professional development. Health care facilities on a Magnet journey might also use the NURSES instrument to assess their nursing staff as they pursue evidence-based practice and conduct research.

Framework of policy recommendations for implementation of evidence-based practice: a systematic scoping review

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.

Framework of policy recommendations for implementation of evidence-based practice: a systematic scoping review

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.

Clinical challenges and ongoing role changes for primary health-care nurses

OBJECTIVE

To investigate the perceptions of primary health-care nurses (PHNs) about clinical demands and future challenges.

METHOD

Qualitative content-analysis of open questions from a questionnaire. A total of 121 PHNs from health-care districts in northern Sweden filled in a questionnaire during a mandatory educational day.

RESULTS

Key issues that were raised included: defending the specific professional role of the PHNs; strengthening their self-governance and authority; and ensuring adequate care in the future through education that focuses more on nursing practice than on academic work.

CONCLUSION

To ensure that the role of the PHN continues to develop, it is necessary to enable them to articulate, discuss, and evaluate their profession and to learn, in concrete forms, how to implement science in clinical practice.

Using the theory of planned behaviour to predict nurses' intention to integrate research evidence into clinical decision-making

AIMS

Using an extended theory of planned behaviour, this article is a report of a study to identify the factors that influence nurses' intention to integrate research evidence into their clinical decision-making.

BACKGROUND

Health professionals are increasingly asked to adopt evidence-based practice. The integration of research evidence in nurses' clinical decision-making would have an important impact on the quality of care provided for patients. Despite evidence supporting this practice and the availability of high quality research in the field of nursing, the gap between research and practice is still present.

DESIGN

A predictive correlational study.

METHODS

A total of 336 nurses working in a university hospital participated in this research. Data were collected in February and March 2008 by means of a questionnaire based on an extension of the theory of planned behaviour. Descriptive statistics of the model variables, Pearson correlations between all the variables and multiple linear regression analysis were performed.

RESULTS/FINDINGS

Nurses' intention to integrate research findings into clinical decision-making can be predicted by moral norm, normative beliefs, perceived behavioural control and past behaviour. The moral norm is the most important predictor. Overall, the final model explains 70% of the variance in nurses' intention.

CONCLUSION

The present study supports the use of an extended psychosocial theory for identifying the determinants of nurses' intention to integrate research evidence into their clinical decision-making. Interventions that focus on increasing nurses' perceptions that using research is their responsibility for ensuring good patient care and providing a supportive environment could promote an evidence-based nursing practice.

Clinical nurse research consultant: a clinical and academic role to advance practice and the discipline of nursing

AIMS

This article presents a proposal for the Clinical Nurse Research Consultant, a new nursing role.

BACKGROUND

Although healthcare delivery continues to evolve, nursing has lacked highly specialized clinical and research leadership that, as a primary responsibility, drives evidence-based practice change in collaboration with bedside clinicians.

DATA SOURCES

International literature published over the last 25 years in the databases of CINAHL, OVID, Medline Pubmed, Science Direct, Expanded Academic, ESBSCOhost, Scopus and Proquest is cited to create a case for the Clinical Nurse Research Consultant.

DISCUSSION

The Clinical Nurse Research Consultant will address the research/practice gap and assist in facilitating evidence-based clinical practice. To fulfil the responsibilities of this proposed role, the Clinical Nurse Research Consultant must be a doctorally prepared recognized clinical expert, have educational expertise, and possess advanced interpersonal, teamwork and communication skills. This role will enable clinical nurses to maintain and share their clinical expertise, advance practice through research and role model the clinical/research nexus.

IMPLICATIONS FOR NURSING

Critically, the Clinical Nurse Research Consultant must be appointed in a clinical and academic partnership to provide for career progression and role support.

CONCLUSION

The creation of the Clinical Nurse Research Consultant will advance nursing practice and the discipline of nursing.

From workshop to work practice: An exploration of context and facilitation in the development of evidence-based practice

BACKGROUND

This article examines the process of translating evidence into practice using a facilitation model developed by the Western Australian Centre for Evidence Based Nursing and Midwifery.

AIMS

Using the conceptual framework Promoting Action on Research Implementation in Health Services (PARIHS), the aims of the study were (1) to explore the relative and combined importance of context and facilitation in the successful implementation of a new evidence-based clinical practice protocol and (2) to examine the establishment of more lasting change to individuals and organizations that resulted in greater incorporation of the principles of evidence-based practice (EBP).

METHODS

A pre-workshop, semi-structured telephone survey with 16 nurse managers in six rural hospitals; a summative evaluation immediately post-workshop with 54 participants; and follow-up, semi-structured interviews with 23 workshop participants.

FINDINGS

The contexts in each of the participating hospitals were very different; of the six hospitals, only one had not implemented the new protocol. Five had reviewed their practices and brought them in line with the protocol developed at the workshop. The rate of adoption varied considerably from 2 weeks to months. The participants reported being better informed about EBP in general and were positive about their ability to improve their practice and search more efficiently for best practice information. Underlying motivations for protocol development should be included in the PARIHS framework. IMPLICATIONS FOR EDUCATION: Good facilitation appears to be more influential than context in overcoming the barriers to the uptake of EBP.

Brief Reports for Disseminating Systematic Reviews to Nurses

Much has been written about the importance of using research findings to guide nursing practice. How to best disseminate those findings to nurses remains a challenge. In many clinical settings, nurses interested in research utilization and evidence-based practice retrieve, review, and integrate knowledge from research reports to guide decisions about best practices. Major barriers to this approach, however, are staff nurses' lack of time, expertise, and resources for this process. One approach to overcoming these barriers is to disseminate the results of systematic research reviews directly to nurses in the form of brief reports, written in an easy-to-understand style, and sent via e-mail. This article describes the development of brief reports as a strategy for disseminating the results of systematic reviews to staff nurses. To demonstrate the use of brief reports for this purpose, we chose a systematic review published in the Cochrane Database of Systematic Reviews.

Implementing practice guidelines: a workshop on guidelines dissemination and implementation with a focus on asthma and COPD

The present supplement summarizes the proceedings of the symposium "Implementing practice guidelines: A workshop on guidelines dissemination and implementation with a focus on asthma and COPD", which took place in Quebec City, Quebec, from April 14 to 16, 2005. This international symposium was a joint initiative of the Laval University Office of Continuing Medical Education (Bureau de la Formation Médicale Continue), the Canadian Thoracic Society and the Canadian Network for Asthma Care, and was supported by many other organizations and by industrial partners. The objectives of this meeting were to examine the optimal implementation of practice guidelines, review current initiatives for the implementation of asthma and chronic obstructive pulmonary disease (COPD) guidelines in Canada and in the rest of the world, and develop an optimal strategy for future guideline implementation. An impressive group of scientists, physicians and other health care providers, as well as policy makers and representatives of patients' associations, the pharmaceutical industry, research and health networks, and communications specialists, conveyed their perspectives on how to achieve these goals. This important event provided a unique opportunity for all participants to discuss key issues in improving the care of patients with asthma and COPD. These two diseases are responsible for an enormous human and socioeconomic burden around the world. Many reports have indicated that current evidence-based guidelines are underused by physicians and others, and that there are many barriers to an effective translation of recommendations into day-to-day care. There is therefore a need to develop more effective ways to communicate key information to both caregivers and patients, and to promote appropriate health behaviours. This symposium contributed to the initiation of what could become the "Canadian Asthma and COPD Campaign", aimed at improving care and, hence, the quality of life of those suffering from these diseases. It is hoped that this event will be followed by other meetings that focus on how to improve the transfer of key recommendations from evidence-based guidelines into current care, and how to stimulate research to accomplish this.