Evidence-informed practice: simplifying and applying the concept for nursing students and academics

Translation, Cross-Cultural Adaptation and Reliability and Validity Studies of the Chinese Version of the Evidence-Based Practice and Evidence-Informed Practice Questionnaire

Purpose

To translate and culturally adapt the Evidence-Based Practice and Evidence-Informed Practice Questionnaire into the Chinese version and evaluate its psychometric properties.

Methods

The process of translation and cross-cultural adaptation adhered to the established guidelines, followed by psychometric evaluation that assessed floor/ceiling effects, face validity, content validity, construct validity, internal consistency, and test-retest reliability. The evaluation engaged 5 experts and 279 students (170 undergraduates and 109 postgraduates) from Beijing Sport University. Questionnaire items were categorized according to Evidence-Based Practice (EBP) and Evidence-Informed Practice (EIP) concepts, with varying response options for degree and frequency. Forty students completed the Chinese version of the questionnaire for the second time after a two-week period.

Results

No floor or ceiling effects were observed. Following the revision of item 32 and deletion of item 14, the Item-Level Content Validity Index (I-CVI) for all other items ranged from 0.80 to 1.00, with an average scale-level CVI (S-CVI/Ave) of 0.91. The final Chinese version of the questionnaire consists of 52 items, showing adequate internal consistency, with Cronbach's alpha values of 0.78, 0.86, 0.86, and 0.89 for the EBP (degree and frequency) and EIP (degree and frequency) items, respectively. Comparison between test-retest scores produced significant differences in all items, with Spearman correlation coefficient (r) ranging from 0.33 to 0.80 (p<0.05), except for item 16 (r=0.29, p=0.065). Exploratory Factor Analysis (EFA) results indicated Kaiser-Meyer-Olkin (KMO) values for EBP degree, EBP frequency, and EIP degree items ranging from 0.78 to 0.87. Bartlett's test of sphericity yielded significant results, explaining 63.62%, 69.35%, and 70.91% of the total variance, respectively, after removing items 23 and 42-44 (cross-loading items).

Conclusion

The Chinese version of the Evidence-Based Practice and Evidence-Informed Practice Questionnaire demonstrated good psychometric properties for assessing the effectiveness of EBP and EIP educational programs tailored for physiotherapy and exercise rehabilitation students.

Cultural Stigmatization in Home Care Nursing

This concept analysis explores cultural stigmatization and its impact on home care, using Walker and Avant's eight-step method and reviewing 49 peer-reviewed articles. Cultural stigmatization is identified as a key barrier, causing discrimination and negatively affecting patient outcomes. The home care implications of addressing cultural stigmatization include interventions that address clinician biases, enhance cultural sensitivity, and reduce stereotypes to improve care quality. These implications highlight the need for targeted strategies to address cultural stigmatization in home care settings, ensuring equitable and effective services for all patients.

Factors influencing virtual reality use in paediatric acquired brain injury upper limb rehabilitation: a qualitative study

OBJECTIVE

Upper limb movement difficulties in children with acquired brain injury (ABI) result in longer recovery times compared with lower limb. Intensive neurorehabilitation promotes a good long-term functional outcome. Virtual reality (VR) and video game technologies are invaluable adjuncts to traditional neurological rehabilitation as they help to motivate, engage and gain children's compliance in goal-directed therapy. However, this technology is not routinely used in the National Health Service, UK; it requires embedding to benefit children and their families. VR implementation in rehabilitation practice requires development. The associated influencing factors require further exploration before routine use can be established. This project aimed to understand the factors influencing the use of VR in upper limb rehabilitation in children.VR implementation in rehabilitation practice requires development. The associated influencing factors require further exploration before routine use can be established. This project aims to understand the factors influencing the use of VR in upper limb rehabilitation in children.

DESIGN

An interpretative qualitative study used focus groups and 1:1 semi-structured interviews conducted in person and online to explore participants' experiences. These were analysed for inductive overarching themes, particularly focusing on the views of professionals and young people regarding the use of VR in upper limb rehabilitation.

SETTING

Two neurorehabilitation services located in two children's hospitals in England, UK.

PARTICIPANTS

Three physiotherapists, five occupational therapists, a play worker and four members from the Young Persons' Advisory Group took part. Four focus groups with 2-4 participants in each group and two 1:1 semi-structured interviews were conducted. Thematic analysis was used to create the model participants described as the factors that influenced the use of VR in neurorehabilitation.

RESULTS

Five closely related major themes and thirty associated subthemes were developed: training, knowledge, promotion, consideration of barriers and family factors. There is a lack of knowledge and understanding about the use of VR, its limitations, and the clinicians' motivation to use it. Training packages with available VR equipment, clinical indicators and scientific evidence are required. Staff need frequent training, logistics (uninterrupted Wi-Fi, software, hardware) and simple instruction manuals.

CONCLUSION

To introduce VR into the routine rehabilitation of children with ABI, investment in improving knowledge, frequent training and positive behaviour change among health professionals is needed.

Evidence-Informed Nursing Clinical Practices for Wound Debridement

ABSTRACT

Debridement, a mainstay of nursing clinical practice, refers to the removal of dead or unhealthy tissue from a wound to facilitate healing. Debridement is one component of the concept of wound bed preparation that has long guided the approach to wound management. The ability of a wound to heal must be determined prior to the initiation of any method of debridement. In areas where high-quality, comparative studies on the relative benefits of different debridement modalities are lacking, nurses should adopt an evidence-informed approach to care. To do this, nurses must understand the importance of following a comprehensive, holistic approach when treating chronic wounds. Nurses should have knowledge of inflammation and infection control and of the fundamentals of moisture management, recognize the need for debridement in healable wounds, and be familiar with different debridement options. This article provides nurses with a wound management framework, an overview of wound debridement options based on the potential for wound healing, and scope of practice considerations for developing a plan of care. A composite case is presented to illustrate the critical considerations in wound care.

Hospital design for inpatient psychiatry: A realistic umbrella review

The evaluation of the effects of architecture and design in psychiatric hospitals primarily focuses on final outcomes, such as disease progression, and is made from the perspective of evidence-based medicine. Meanwhile, the evidence-informed, realist approach addresses how the intervention works. Understanding the underlying action mechanisms of the intervention is needed to facilitate its scaling-up and adaptation in new environments. This umbrella review reports in which ways architecture and design have an effect on patients' and staff experience in inpatient psychiatric hospital. The search was constructed around three key concepts (psychiatric hospital, design, and staff and patient outcomes) and was conducted across three reference databases (Embase, Medline, and PsychINFO). Academic and gray literature was analyzed. Information on design and architectural features in psychiatric hospitals, their effects on patients and staff experience, and the acting mechanisms enabling these effects were extracted. From 951 original references, 14 full texts were included in the analysis. Design and architectural features (e.g., aesthetic appeal of places, home-like environment) in psychiatric hospitals address patients' stress, boost social interaction, foster patients' autonomy and feelings of control, ensure respect for patient's privacy and dignity, and prevent under-and overstimulation. Using theory-driven evaluation may facilitate future hospital renovation and the evaluation of its effect.

Evaluation of Evidence-Based Practice Competency among Greek Undergraduate Nursing Students

For several years, the global scientific community has accepted and recognized the importance of evidence-based practice for nursing science. The main factor for the implementation of evidence-based practice is the competence of undergraduate nursing students towards evidence-based practice, so that they as active nurses are ready for its application in their clinical practice, in order to provide better care for their patients. The aim of the present study is to examine the level of evidence-based practice competency evaluated with the self-reported Evidence-Based Practice Competence Questionnaire. It is important to mention that such a study has not been conducted on nursing students in Greece, but only on registered nurses. A quantitative study based on cross-sectional design was conducted from February to June 2022 in a convenience sample of Greek undergraduate nursing students. The SPSS 26.0 program was used to perform descriptive, bivariate, and multivariate analyses. A total of 175 undergraduate students participated at the Hellenic Mediterranean University Department of Nursing (Greece), specifically from the 2nd and 3rd academic years. The mean score of the Evidence-Based Practice Competence Questionnaire for nursing undergraduate students was 3.03 ± 0.26, indicating moderate evidence-based practice. Among the Evidence-Based Practice Competence Questionnaire dimensions, mean scores of 3.03 ± 0.32 for attitude toward evidence-based practice, 3.01 ± 0.49 for skills in evidence-based practice, and 3.03 ± 0.49 for knowledge in evidence-based practice were obtained. Significant differences among participants' mean Evidence-Based Practice Competence Questionnaire scores regarding gender (p = 0.766), age (p = 0.400), academic year (p = 0.153), and training in the field of research methodology (p = 0.538) were not found. It appears that the level of readiness towards evidence-based practice is mediocre among undergraduate nursing students at a university in Greece. Therefore, it is necessary to carry out new studies in the future, so that there is a correct approach of all the elements that contribute to the readiness of nursing undergraduate students regarding evidence-based practice.

Vertebral Subluxation and Systems Biology: An Integrative Review Exploring the Salutogenic Influence of Chiropractic Care on the Neuroendocrine-Immune System

In this paper we synthesize an expansive body of literature examining the multifaceted influence of chiropractic care on processes within and modulators of the neuroendocrine-immune (NEI) system, for the purpose of generating an inductive hypothesis regarding the potential impacts of chiropractic care on integrated physiology. Taking a broad, interdisciplinary, and integrative view of two decades of research-documented outcomes of chiropractic care, inclusive of reports ranging from systematic and meta-analysis and randomized and observational trials to case and cohort studies, this review encapsulates a rigorous analysis of research and suggests the appropriateness of a more integrative perspective on the impact of chiropractic care on systemic physiology. A novel perspective on the salutogenic, health-promoting effects of chiropractic adjustment is presented, focused on the improvement of physical indicators of well-being and adaptability such as blood pressure, heart rate variability, and sleep, potential benefits that may be facilitated through multiple neurologically mediated pathways. Our findings support the biological plausibility of complex benefits from chiropractic intervention that is not limited to simple neuromusculoskeletal outcomes and open new avenues for future research, specifically the exploration and mapping of the precise neural pathways and networks influenced by chiropractic adjustment.

Promoting evidence-based practice and nursing excellence: How involvement in a Magnet4Europe® research study led to development of critically appraised topics sessions for health care staff

BACKGROUND

Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) is actively participating in the Magnet4Europe® research study, which aims to advance nursing excellence and promote evidence-based practice.

OBJECTIVES

As part of this initiative, the Nursing, Allied Health Professional and Midwifery Research Council at GHNHSFT has been actively engaging colleagues in evidence-based practice and research.

METHODS

This has been achieved through the development of sessions using the Critically Appraised Topics (CATs) framework, where clinical questions and relevant research articles are discussed.

RESULTS AND DISCUSSION

This article describes the collaborative approach between the Lead Nurse for Continual Professional Development and the Deputy Manager of the Library and Knowledge Services to develop and run the sessions.

CONCLUSION

Collaboration between clinical staff and library and knowledge teams can be useful in encouraging healthcare professionals' engagement with the evidence base in order to consider changes to practice.

Exploring the potential impact of applying web-based training program on nurses' knowledge, skills, and attitudes regarding evidence-based practice: A quasi-experimental study

Evidence-based practice (EBP) has gained significant importance in clinical practice worldwide, including in nursing. This study aimed to explore the potential impact of applying a web-based training program on nurses' knowledge, skills, and attitudes regarding EBP. A quasi-experimental pretest-posttest research design was utilized with a purposive sample of 64 professional nurses who agreed to participate. The study took place in different hospitals and primary healthcare centers in the Bisha Governorate, Aseer region, Saudi Arabia. A four-week standardized web-based training program was implemented using an online learning approach. Nurses were provided with an online self-rated data collection tool through the Google Forms platform. The findings indicated a highly significant difference in the total knowledge and EBP skills mean scores of the post-intervention (53.08±15.9) and (66.03±8.95), respectively compared to pre-intervention (P<0.05). Additionally, there was marked improvement in the mean scores of the positive attitude of the training sessions post-intervention compared to pre-intervention. The program was also well-received by the nurses in terms of quality and usability. The program has the potential to enhance nurses' knowledge, skills, and attitudes toward EBP. Therefore, healthcare organizations may consider adopting web-based training as a means of continuing professional education to promote EBP competencies among nurses.

Exploring the transformative role of 3D printing in advancing medical education in Africa: a review

With the increasing demand for quality healthcare and the scarcity of resources, medical education in Africa faces numerous challenges. Traditional teaching methods often need help to adequately prepare medical students for the complex and diverse healthcare scenarios they will encounter in practice. 3D printing technology holds significant promise in addressing these challenges by providing innovative solutions for medical education. This review examines the various applications of 3D printing in medical education, focusing on its potential to enhance anatomy education, surgical training and medical device development. It explores how 3D printing can offer realistic and customisable anatomical models, enabling students to understand human anatomy better and improve their surgical skills through realistic simulations. Furthermore, this paper discusses the potential of 3D printing in developing low-cost medical devices, prosthetics and surgical instruments, which can significantly benefit resource-limited settings in Africa. It explores the concept of distributed manufacturing, where 3D printing can decentralise the production of essential medical equipment, reducing reliance on external suppliers and improving access to healthcare. The review also highlights the challenges and limitations associated with implementing 3D printing in medical education in Africa, such as limited infrastructure, high costs and the need for specialised training. However, it presents successful initiatives and collaborations that have overcome these obstacles, demonstrating the feasibility and potential impact of integrating 3D printing into medical education in Africa.

Sustainment of diverse evidence-informed practices disseminated in the Veterans Health Administration (VHA): initial development and piloting of a pragmatic survey tool

BACKGROUND

There are challenges associated with measuring sustainment of evidence-informed practices (EIPs). First, the terms sustainability and sustainment are often falsely conflated: sustainability assesses the likelihood of an EIP being in use in the future while sustainment assesses the extent to which an EIP is (or is not) in use. Second, grant funding often ends before sustainment can be assessed. The Veterans Health Administration (VHA) Diffusion of Excellence (DoE) program is one of few large-scale models of diffusion; it seeks to identify and disseminate practices across the VHA system. The DoE sponsors "Shark Tank" competitions, in which leaders bid on the opportunity to implement a practice with approximately 6 months of implementation support. As part of an ongoing evaluation of the DoE, we sought to develop and pilot a pragmatic survey tool to assess sustainment of DoE practices.

METHODS

In June 2020, surveys were sent to 64 facilities that were part of the DoE evaluation. We began analysis by comparing alignment of quantitative and qualitative responses; some facility representatives reported in the open-text box of the survey that their practice was on a temporary hold due to COVID-19 but answered the primary outcome question differently. As a result, the team reclassified the primary outcome of these facilities to Sustained: Temporary COVID-Hold. Following this reclassification, the number and percent of facilities in each category was calculated. We used directed content analysis, guided by the Consolidated Framework for Implementation Research (CFIR), to analyze open-text box responses.

RESULTS

A representative from forty-one facilities (64%) completed the survey. Among responding facilities, 29/41 sustained their practice, 1/41 partially sustained their practice, 8/41 had not sustained their practice, and 3/41 had never implemented their practice. Sustainment rates increased between Cohorts 1-4.

CONCLUSIONS

The initial development and piloting of our pragmatic survey allowed us to assess sustainment of DoE practices. Planned updates to the survey will enable flexibility in assessing sustainment and its determinants at any phase after adoption. This assessment approach can flex with the longitudinal and dynamic nature of sustainment, including capturing nuances in outcomes when practices are on a temporary hold. If additional piloting illustrates the survey is useful, we plan to assess the reliability and validity of this measure for broader use in the field.