Teaching EBP: strategies for achieving sustainable organizational change toward evidence-based practice

Implementation and sustainment strategies for open visitation in the intensive care unit: A multicentre qualitative study

Objective

Open visitation in adult intensive care units has been associated with improved family and patient outcomes. However, worldwide adoption of this practice has been slow and reasons for this are unclear. This study documents barriers and strategies for implementing and sustaining open visitation in adult intensive care units in the United States experienced by nursing leadership.

Research design

Qualitative approach using grounded theory.

Participants

Nurse leaders in adult intensive care units with open visitation.

Setting

Magnet® or Pathway to Excellence® designated hospitals in the United States.

Methods

Semi structured interviews were conducted with 19 nurse leaders from 15 geographically dispersed hospitals. Interviews were recorded, transcribed and imported into Atlas.ti qualitative software for analysis. Grounded theory constant comparison analysis was used for coding and category development.

Findings

The analysis revealed three barriers; nursing attitudes and clinical and nonclinical barriers. Strategies to overcome these barriers were empathy, evidence-based practice, models of care, shared governance, nurse discretion, security and family spaces.

Conclusion

Intensive care nursing leadership experienced distinct barriers and strategies during pre-implementation, implementation and sustainment of open visitation. Other nursing leaders interested in open visitation can use these findings as they plan this transition in their intensive care units.

Web-based experiential learning strategies to enhance the evidence-based-practice competence of undergraduate nursing students

BACKGROUND

Evidence-based practice (EBP) is considered a key competence for practicing high-quality and safe nursing. However, undergraduate nursing programs continue to provide traditional classroom teaching strategies that have limitations in facilitating the development of critical competences for engaging in EBP in real clinical contexts.

OBJECTIVE AND DESIGN

The purpose of this study was to develop a web-based experiential learning program aimed at improving the engagement and experience of nursing students in EBP. A quasi-experimental research with non-equivalent control-group with non-synchronized design was used to describe the process of program development and the innovative learning method, and discuss the outcomes of the program.

METHODS

The experimental group was exposed to a web-based experiential learning program, while the control group received traditional learning with written material. Self-reported EBP scores (knowledge and skills, attitude, and practice) and clinical-questioning confidence were evaluated to assess the effects of the program.

RESULTS

The result showed that web-based experiential learning strategies were effective in significantly improving the EBP knowledge and skills score (F = 12.29, p = .001) and the score for confidence in asking clinical questions (F = 12.14, p = .001). The attitudes toward EBP (F = 0.75, p = .389) and practice score (F = 3.22, p = .076) did not show a significant difference between the experimental group and the control group.

CONCLUSION

The web-based experiential learning was found to be an effective method for enhancing the EBP competence of nursing students. Based on the study results, we suggest using web-based experiential learning to supplement the traditional learning method or as the mainstream learning method for nursing students.

Context, complexity and process in the implementation of evidence-based innovation: a realist informed review

Background

This review of scholarly work in health care knowledge translation advances understanding of implementation components that support the complete and timely integration of new knowledge. We adopt a realist approach to investigate what is known from the current literature about the impact of, and the potential relationships between, context, complexity and implementation process.

Methods

Informed by two distinct pathways, knowledge utilization and knowledge translation, we utilize Rogers’ Diffusion of Innovations theory (DOI) and Harvey and Kitson’s integrated- Promoting Action on Research Implementation in Health Service framework (PARIHS) to ground this review. Articles from 5 databases; Medline, Scopus, PsycInfo, Web of Science, and Google Scholar and a search of authors were retrieved. Themes and patterns related to these implementation components were extracted. Literature was selected for inclusion by consensus. Data extraction was iterative and was moderated by the authors.

Results

A total of 67 articles were included in the review. Context was a central component to implementation. It was not clear how and to what extent context impacted implementation. Complexity was found to be a characteristic of context, implementation process, innovations and a product of the relationship between these three elements. Social processes in particular were reported as influential however; descriptions of how these social process impact were limited. Multiple theoretical and operational models were found to ground implementation processes. We offer an emerging conceptual model to illustrate the key discoveries.

Conclusions

The review findings indicate there are dynamic relationship between context, complexity and implementation process for enhancing uptake of evidence-based knowledge in hospital settings. These are represented in a conceptual model. Limited empiric evidence was found to explain the nature of the relationships.

Health professions faculty beliefs, confidence, use, and perceptions of organizational culture and readiness for EBP: A cross-sectional, descriptive survey

BACKGROUND

Evidence-based practice (EBP) is an essential skill and ethical obligation for all practicing health professions clinicians because of its strong association with improved health outcomes. Emerging evidence suggests that faculty who prepare these clinicians lack proficiency to teach EBP.

OBJECTIVES

The purpose of this study was to describe; 1) health profession faculty beliefs about and confidence in their ability to teach and implement EBP, 2) use of EBP for education, 3) organizational culture and readiness for EBP; and to determine whether relationships exist among these variables.

DESIGN

This study used a cross-sectional, descriptive survey design.

SETTING AND PARTICIPANTS

College of Nursing (CON) and College of Health Professions (CHP) faculty from a university located in the Northeast, United States. Faculty were defined as anyone teaching a course for the CON or CHP during the fall of 2016.

METHODS

Faculty were invited to complete an electronic survey measuring EBP beliefs, EBP use, and EBP organizational culture and readiness. The survey was comprised of three tools developed specifically for health professions educators in 2010 by Fineout-Overholt & Melnyk.

RESULTS

Sixty-nine faculty returned usable surveys (25.5% response rate). Mean EBP beliefs score was 89.49 (SD = 10.94) indicating respondents had a firm belief in and confidence in their ability to implement and teach EBP. Mean EBP use was 32.02 (SD = 20.59) indicating that respondents taught and implemented EBP between 1 and 3 times in the last 8-weeks. Mean EBP culture and readiness score was 90.20 (SD = 15.23) indicating essential movement toward a sustainable culture of college-wide integration of EBP. Mean scores for beliefs/confidence were higher for full-time clinical faculty compared to other groups [F_{(2, 55)} = 0.075, p = 0.928; ηp² = 0.003)]. Adjunct faculty reported higher EBP behaviors expected by health profession educators in the last 8-weeks compared to other groups [F_{(2, 55)} = 0.251, p = 0.779; ηp². =0.009)]. Adjunct faculty had the highest mean scores on OCRSIEP-E followed by full-time clinical faculty. These group differences in OCRSIEP-E were statistically significant [F_{(2, 49)} = 7.92, p = 0.001; ηp² = 0.244)]. OCRSIEP-E was significantly different between full-time tenure/tenure track faculty (M = 78.0, SD = 12.58) and full-time clinical faculty (M = 91.37, SD = 14.79, p = 0.027) and between full-time tenure/tenure track faculty and adjunct faculty (M = 97.19, SD = 12.39, p = 0.001).

CONCLUSIONS

Faculty adoption of EBP as a foundational pillar of teaching is essential. Research is needed to define the scope of the problem internationally. Organizations need to set standards for faculty teaching in the health professions to be EBP proficient. Programs preparing faculty to teach in nursing and other health professions must include educator EBP competencies.

Knowledge and Competency of Nursing Faculty Regarding Evidence-Based Practice

The Institute of Medicine recommended that 90% of clinical decisions should be evidenced based by 2020. Both the IOM and the American Association of Critical-Care Nurses identified evidenced-based practice (EBP) as a core competency for practice. EBP can reduce costs, improve patient outcomes, and ensure optimal nursing interventions. Because nursing faculty may have deficits in knowledge, attitudes, and competencies to teach EBP, few nursing students conduct EBP reviews. The purpose of this project was to develop EBP educational resources to increase nursing faculty knowledge and competency of EBP in a southeastern college with both a multicultural faculty and student body. A pre- and postsurvey design using Stevens' ACE Star Model of Knowledge Transformation and Evidence Based Practice Readiness Inventory (ACE-ERI) determined the effectiveness of the educational intervention. Results indicated that faculty's self-confidence about their competency in EBP increased significantly from presurvey to postsurvey, t(17) = -2.04, p = .028, but there was no significant change from pretest to posttest, t(17) = -0.576, p =.572, for the EBP knowledge component of ACE-ERI. The results of the study suggest that educational programs for RN-to-BSN faculty are vital in increasing participant's readiness for EBP. J Contin Educ Nurs. 2016;47(9):409-419.

Educating change agents: a qualitative descriptive study of graduates of a Master's program in evidence-based practice

BACKGROUND

Health care professionals are expected to build decisions upon evidence. This implies decisions based on the best available, current, valid and relevant evidence, informed by clinical expertise and patient values. A multi-professional master's program in evidence-based practice was developed and offered. The aims of this study were to explore how students in this program viewed their ability to apply evidence-based practice and their perceptions of what constitute necessary conditions to implement evidence-based practice in health care organizations, one year after graduation.

METHODS

A qualitative descriptive design was chosen to examine the graduates' experiences. All students in the first two cohorts of the program were invited to participate. Six focus-group interviews, with a total of 21 participants, and a telephone interview of one participant were conducted. The data was analyzed thematically, using the themes from the interview guide as the starting point.

RESULTS

The graduates reported that an overall necessary condition for evidence-based practice to occur is the existence of a "readiness for change" both at an individual level and at the organizational level. They described that they gained personal knowledge and skills to be "change-agents" with "self-efficacy, "analytic competence" and "tools" to implement evidence based practice in clinical care. An organizational culture of a "learning organization" was also required, where leaders have an "awareness of evidence- based practice", and see the need for creating "evidence-based networks".

CONCLUSIONS

One year after graduation the participants saw themselves as "change agents" prepared to improve clinical care within a learning organization. The results of this study provides useful information for facilitating the implementation of EBP both from educational and health care organizational perspectives.

Perceived outcomes of web-based modules designed to enhance athletic trainers' knowledge of evidence-based practice

CONTEXT

The release of evidence-based practice (EBP) Web-based learning modules to the membership of the National Athletic Trainers' Association has provided athletic trainers (ATs) the opportunity to enhance their knowledge of the various EBP concepts. Whereas increasing the knowledge of EBP among ATs is important, assessing whether this newfound knowledge is being translated into clinical practice and didactic education is crucial.

OBJECTIVE

To explore the effectiveness of an educational intervention regarding EBP on the didactic instruction patterns of athletic training educators and the clinical practice behaviors of clinicians.

DESIGN

Qualitative study.

SETTING

Individual telephone interviews.

PATIENTS OR OTHER PARTICIPANTS

A total of 25 ATs (12 educators, 13 clinicians; experience as an AT = 16.00 ± 9.41 years) were interviewed.

DATA COLLECTION AND ANALYSIS

We conducted 1 individual telephone interview with each participant. After transcription, the data were analyzed and coded into common themes and categories. Triangulation of the data occurred via the use of multiple researchers and member checking to confirm the accuracy of the data.

RESULTS

Participants perceived the EBP Web-based modules to produce numerous outcomes regarding education and clinical practice. These outcomes included perceived knowledge gain among participants, an increase in the importance and scope of EBP, a positive effect on educators' didactic instruction patterns and on instilling value and practice of EBP among students, and an enhanced ability among clinicians to implement EBP within clinical practice. However, some clinicians reported the Web-based modules had no current effect on clinical practice.

CONCLUSIONS

Although the EBP Web-based modules were successful at enhancing knowledge among ATs, translation of knowledge into the classroom and clinical practice remains limited. Researchers should aim to identify effective strategies to help ATs implement EBP concepts into didactic education and clinical practice.

Future directions of evidence-based practice in athletic training: perceived strategies to enhance the use of evidence-based practice

CONTEXT

The shift to a culture of evidence-based practice (EBP) in athletic training is a necessary step in both the optimization of patient care and the advancement of athletic trainers (ATs) as health care professionals. Whereas individuals have gained knowledge in this area, most ATs still are not practicing in an evidence-based manner. Exploring perceived strategies to enhance the use of EBP will help to determine the best approaches to assist ATs in applying EBP concepts to practice to improve patient care.

OBJECTIVE

To explore beneficial strategies and techniques ATs perceived would promote successful implementation of EBP within athletic training education and clinical practice.

DESIGN

Qualitative study.

SETTING

Individual telephone interviews.

PATIENTS OR OTHER PARTICIPANTS

Twenty-five ATs (12 educators, 13 clinicians; athletic training experience = 16.00 ± 9.41 years) were interviewed.

DATA COLLECTION AND ANALYSIS

One phone interview was conducted with each participant. After the interview was transcribed, the data were analyzed and coded into common themes and categories. Triangulation of the data occurred via the use of multiple researchers and member checking to confirm the accuracy of the data.

RESULTS

Participants identified several components they perceived as essential for enhancing the use of EBP within the athletic training profession. These components included the need for more EBP resources, more processed information, focused workshops, peer discussion and mentorship, and continual repetition and exposure. Participants also indicated that ATs need to accept their professional responsibilities to foster EBP in their daily practices.

CONCLUSIONS

The proper shift to a culture of EBP in athletic training will take both time and a persistent commitment by ATs to create strategies that will enhance the implementation of EBP across the profession. Researchers should focus on continuing to identify effective educational interventions for ATs and to determine successful strategies to implement EBP into didactic curricula and clinical practice. Additional focus should be given to which strategies most effectively produce changes in clinical practice.

Implementation Interventions Used in Nursing Homes and Hospitals: A Descriptive, Comparative Study between Austria, Germany, and The Netherlands

Translating guidelines into nursing practice remains a considerable challenge. Until now, little attention has been paid to which interventions are used in practice to implement guidelines on changing clinical nursing practice. This cross-sectional study determined the current ranges and rates of implementation-related interventions in Austria, Germany, and The Netherlands and explored possible differences between these countries. An online questionnaire based on the conceptual framework of implementation interventions (professional, organizational, financial, and regulatory) from the Cochrane Effective Practice and Organization of Care (EPOC) data collection checklist was used to gather data from nursing homes and hospitals. Provision of written materials is the most frequently used professional implementation intervention (85%), whereas changes in the patient record system rank foremost among organisational interventions (78%). Financial incentives for nurses are rarely used. More interventions were used in Austria and Germany than in The Netherlands (20.3/20.2/17.3). Professional interventions are used more frequently in Germany and financial interventions more frequently in The Netherlands. Implementation efforts focus mainly on professional and organisational interventions. Nurse managers and other responsible personnel should direct their focus to a broader array of implementation interventions using the four different categories of EPOC's conceptual framework.

Teaching a systematic and evidence-based approach in an ambivalent context: a case example from Israel

Systematically planned intervention (SPI) and evidence-based practice (EBP) have become widely known and influential concepts in Israeli social service administration and provision. Nevertheless, the lack of success in implementing SPI and EBP in the social work field has returned the discussion regarding its importance and development to social work scholars and educators. The following article presents a case example describing an attempt to build social workers' capacity to use SPI and EBP among graduate (Master level) Israeli social work students in a university-based practical workshop. A detailed description of contextual considerations and manifestations, alongside main teaching challenges and responses, general assessment of the attainment of the workshop's goals, concluding comments, and recommendations for SPI and EBP capacity builders are offered.

Icelandic nurses' beliefs, skills, and resources associated with evidence-based practice and related factors: a national survey

BACKGROUND

Evidence-based practice (EBP) is essential to the improvement of patient outcomes and the quality of care. Nurses' use of evidence in practice, however, remains limited. Assessing nurses' readiness for EBP where it is not as prominent as in countries leading EBP research was of particular interest.

PURPOSE

To determine Icelandic registered nurses' (RNs') ability to provide care based on evidence as measured by their beliefs, perception of skills, and access to resources associated with EBP.

METHODS

A descriptive survey was used in which a random sample of 540 Icelandic RNs completed the translated and modified version of the Information Literacy for Evidence-Based Nursing Practice and the translated EBP Beliefs Scale. Descriptive statistics, correlations, chi-square tests, t tests and one-way ANOVAs were used to analyze the data.

RESULTS

Participants strongly believed in the value of EBP for patient care, but were less confident regarding their own knowledge and skills needed for EBP. Most (82%) of the respondents (i.e., RNs) turned to peers when in need of information, rather than peer-reviewed resources. Although over half of the RNs (54%) had received instructions in the use of electronic databases, only a third indicated success in using them. They considered "lack of search skills" as the primary barrier to use of research in practice. Using research findings in practice was associated with positive EBP beliefs, familiarity with EBP and other EBP-related activities. Clinical RNs were found to be at a disadvantage when it came to access to EBP-related resources and participated less frequently in EBP-related activities other than using research in practice.

CONCLUSION AND IMPLICATIONS

Icelandic RNs' beliefs regarding EBP are similar to those of RNs in other countries. Their access to EBP resources is generally good, but they lack the skills and knowledge needed for EBP. Strategies aimed at changing the organizational and practice context need to be developed.