Knowledge translation strategies for enhancing nurses' evidence-informed decision making: a scoping review

Evidence-based practice implementation in healthcare in China: a living scoping review

BACKGROUND

Evidence-based practice (EBP) implementation plays a crucial role in bridging the knowledge-action gaps and reducing health inequities. Little is known about its development in China. This study aims to provide an overview of the EBP implementation research progress in healthcare in China and identify gaps for future studies.

METHODS

We conducted a scoping review following the Joanna Briggs Institute scoping review methodology and the Cochrane Collaboration's guidance on living reviews. We performed a literature search in four Chinese databases (i.e., China National Knowledge Infrastructure, Wan Fang Database, The VIP Database, and China Biology Medicine) and three English databases (i.e., Ovid MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, and EMBASE), Google scholar, and Baidu scholar from 1996 to 2021. We included EBP implementation studies conducted in healthcare settings in China and were published in Chinese and English literature. The search will be run on a regular basis to monitor the development of new literature and determine when to update the review.

FINDINGS

Of the 11,276 records identified, we finally included 309 papers. The publications were on a sharp rise since 2013 and were predominantly from the nursing field (292/309, 94.50%). The commonly researched areas were symptom management (75/309, 24.27%), tube care (46/309, 14.89%), perioperative care (43/309, 13.92%), and fundamental care (43/309, 13.92%). Joanna Briggs Institute model was the most frequently used model to guide the implementation process (92/159, 59.75%). A median number of 8 people often comprised an implementation team, with 113 studies (36.57%) taking a multidisciplinary approach. 204 studies reported utilizing audit criteria to assist evaluation of evidence implementation rate with diversified methods measuring the criteria. Lack of knowledge, skills, and resources, and incomplete procedures or pathways were top barriers impeding EBP implementation. Leadership support was considered the most common facilitator. Education and training were the most frequently described implementation strategies for healthcare professionals and patients. Optimizing workflows and developing evaluation tools were the primary strategies adopted by organizations. 291 studies measured patient outcomes and 174 studies measured healthcare professional outcomes.

INTERPRETATION

To our knowledge, this scoping review is the first one to systematically examine the EBP implementation research progress in healthcare in China. Based on this review, we identified contributions that Chinese EBP implementation research made to the global community, and provided eight recommendations for Chinese researchers in conducting implementation studies in the future.

FUNDING

None.

A pre-experimental pilot study exploring EBP Beliefs and EBP Implementation among post-graduate student nurses in Saudi Arabia

AIM

This study aimed to measure the impact of a dedicated EBP module on the knowledge, skills and capability for EBP of students undertaking the inaugural MSc in Nursing: Advanced Practice programme in the KSA.

BACKGROUND

Evidence-based practice (EBP) yields multiple benefits for all key stakeholders of healthcare. Key to this are healthcare professionals armed with necessary EBP knowledge and skills. Nurses, the largest professional group in healthcare, can be instrumental in effecting sustained EBP implementation. In the Kingdom of Saudi Arabia (KSA) achieving this is hindered by a chronic shortage of nurses and a heavy reliance on expatriate nurses who are often a transient workforce, resulting in a high turnover. The Government of Saudi Arabia 2030 Vision aspires to address the indigenous nurse shortage and the quality of healthcare. In 2017 the inaugural MSc in Nursing: Advanced Practice programme was established in the KSA to prepare Saudi nurses for emerging advanced practice roles. A dedicated EBP module was a core component of the programme.

METHODS

A pre-experimental pilot study conducted over 18-months collected data from the same participants at three different points. Two validated EBP questionnaires measuring EBP Beliefs and EBP Implementation were administered to post-graduate students undertaking the MSc in Nursing: Advanced Practice programme in one Higher Education Institution in the KSA. Descriptive, inferential and correlational statistics were employed to analyse the demographic data, group mean scores and distribution on the EBP scales, as well the correlation between EBP Beliefs and EBP Implementation.

FINDINGS

Findings demonstrated that the educational intervention did improve participants' EBP beliefs and implementation. Participants reported positive beliefs about EBP at all 3 data collection points (M = 57.4 SD = 7.0; M = 62.54 SD = 7.21; M = 55.31 SD = 15.81, respectively). EBP implementation was low prior to undertaking the module but improved thereafter as illustrated across the 3 data collection points (M = 15.14 SD = 11.9; M = 27.64 SD = 14.35; M = 25.9 SD = 20.43). On both measures, higher scores indicate higher EBP beliefs and implementation.

CONCLUSION

This study established the EBP Beliefs and EBP Implementation of a sample of postgraduate nursing students in the KSA. Findings revealed a substantial improvement in both EBP Beliefs and EBP Implementation following the EBP module. Findings support the use of a dedicated module to prepare nurses to use EBP and to practice at an advanced level while simultaneously preparing them for leadership roles in healthcare in KSA. In so doing, this will help to advance the healthcare goals of the KSA 2030 vision.

Naturopaths' mobilisation of knowledge and information in clinical practice: an international cross-sectional survey

BACKGROUND

The contemporary evidence-based practice model acknowledges the importance of patient preferences and clinician experience when applying evidence within a clinical setting. Knowledge mobilisation (KM) acknowledges the complexities of knowledge translation by recognising and respecting diversity in types of knowledge and how such diversity can influence health care and health care choices. While there has been considerable discussion on KM in health care, it has received little attention in the field of naturopathy. Despite naturopathy's widespread international use, it is unclear how naturopathic practitioners (NPs) use and share knowledge and information in clinical practice. This study examines the mobilisation of knowledge amongst NPs internationally.

METHODS

Online, international, cross-sectional survey of a self-selected sample of NPs from any country, that were either currently in clinical practice or had been in practice within the previous 12 months. The survey was administered in five languages (English, French, Portuguese, Spanish, German). Descriptive statistics were prepared for all survey items.

RESULTS

The survey was completed by 478 NPs who reported using an average of seven (median = 7, SD = 2.6) information sources to inform patient care. NPs also drew on knowledge gained through patients sharing their perspectives of living with their health condition (Always/Most of the time: 89.3%). They mostly sought knowledge about how a treatment might benefit a patient, as well as knowledge about treatment safety and a better understanding of a patient's health condition. NPs frequently reported sharing knowledge developed through consideration of the patient's unique needs (83.3%), and primarily shared knowledge by producing information for the public (72.6%) and for patients (72.2%).

CONCLUSIONS

Based on these findings, it may be argued that NPs practice knowledge mobilisation; employing multiple forms and sources of knowledge, and mobilising knowledge to - as well as from - others. Due to their active engagement in patient and community education, NPs also may be considered knowledge brokers. In the context of the growing understanding of the complexities of knowledge translation and mobilisation in contemporary health care - and particularly within the context of implementation science - this study provides novel insights into an under-researched element of health services accessed by the community.

Moving Evidence into Practice by Advanced Practice Nurses in Hospitalization Wards. Protocol for a Multicentre Quasi-Experimental Study in Three Hospitals in Spain

Evidence-based practice (EBP) combined with quality of care improves patient outcomes. However, there are still difficulties for its implementation in daily clinical practice. This project aims to evaluate the impact of the incorporation of the Advanced Practice Nurse (APN) role on the implementation of EBP at three levels: context, nurses' perceptions, and clinical outcomes. Mixed-methods study in two phases is proposed. Phase 1: a quasi-experimental design where five APNs are included in five hospitalization wards that are compared with another five similar wards without APNs. Variables from Practice-Environment-Scale-Nursing-Work-Index, Health-Science-Evidence-Based-Practice-Questionnaire, and Advanced-Practice-Nursing-Competency-Assessment-Instrument are used. Clinical outcomes are followed-up with monthly. A descriptive and exploratory analysis is performed. Phase 2: an exploratory qualitative design through focus groups at the intervention wards after one year of APNs implementation. Explicative data are gathered to explain the progression of change and how actors perceive and attribute triggers, barriers, and facilitators for change. An inductive thematic analysis is performed. The inclusion of APN in hospitalization context is insufficiently studied. It is hoped that these figures provide solutions to the multiple barriers in the development of EBP in these sceneries and contribute to resolve the gap between research results and healthcare practice.

Identifying relevant concepts and factors for the sustainability of evidence-based practices within acute care contexts: a systematic review and theory analysis of selected sustainability frameworks

Background

There is growing recognition among healthcare professionals that the sustainability of evidence-based practices (EBPs) within different settings is variable and suboptimal. Understanding why a particular EBP might be sustained in one setting and not another remains unclear. Recent reviews illustrate the need to identify and analyze existing frameworks/models/theories (F/M/Ts) that focus solely on the sustainability of EBPs in specific healthcare settings, such as acute care, to illuminate key determinants and facilitate appropriate selection to guide practice and research.

Methods

We conducted a systematic review to extract sustainability frameworks. This involved using two available syntheses of the literature and a systematic search of four databases from January 2015 to July 2018: CINHAL, MEDLINE, Embase, and ProQuest. We included studies published in English, and if they included sustainability F/M/Ts recommended for use in acute care or an unspecified healthcare organization/setting. F/M/Ts explicitly recommended for use in public health and or community settings were excluded. We then conducted a comparative analysis of F/M/Ts using a modified theory analysis approach, to understand the theoretical underpinnings of each F/M/T, their determinants and concepts hypothesized to influence the sustained use of EBPs within an acute care context.

Results

Of 2967 identified citations from the 2 available syntheses and the systematic review, 8 F/M/Ts met the inclusion criteria. We identified 37 core factors, of which 16 were recorded as common factors (occurring within 4 or more of the 8 included F/M/Ts). All factors grouped into 7 main themes: innovation, adopters, leadership and management, inner context, inner processes, outer context, and outcomes.

Conclusions

This systematic review is the first to include a comprehensive analysis of healthcare sustainability F/M/Ts for the sustained use of EBPs in acute care settings. Findings reveal insights into sustainability as a “process or ongoing stage of use” following initial implementation, suggesting this construct should be added to the definition of sustainability. Results provide a resource of available F/M/Ts and hypothesized factors to consider for acute care team members who are planning or currently implementing EBPs with the goal of improving patient outcomes. It also provides a basis for future research on sustainability in acute care.

Children's unmet palliative care needs: a scoping review of parents' perspectives

BACKGROUND

Children with life-limiting conditions often have complex needs, making it challenging for services to provide satisfactory care. Few studies consider whether services actually meet families' needs by exploring and identifying the parents' perspectives of unmet needs.

AIM

To identify what published evidence is available on the unmet needs of children with life-limiting conditions and their families, from the perspective of parents, internationally. ELIGIBILITY CRITERIA: Inclusion criteria: papers from the perspective of parents of children aged 0-19 years, who have a life-limiting condition and are receiving palliative care. Exclusion criteria: those papers not written in English, not reporting primary research and discussing children who died from stillbirth, accidental or unexpected circumstance.

CHARTING METHODS

A scoping review was conducted in accordance with the methods of Arksey and O'Malley.

SOURCES OF EVIDENCE

The electronic databases PubMed, MEDLINE, CINAHL and PsycINFO were searched. Key terms included: parent, needs, met/unmet/satisfaction, palliative/supportive/end of life care, life-limiting/life-threatening illness, infants/children/young people.

RESULTS

Total hit indicated 5975 papers for screening. Fifty-five papers met the scoping review criteria. The majority used mixed-methods approaches inclusive of: questionnaires, self-report measures, in-depth interviews, focus groups, case record analysis and art-based workshops. Unmet needs included: respite care, coordination and organisation of care, psychological support and professional communication skills.

CONCLUSIONS

The findings suggest many unmet needs from the parent's perspective, across several aspects of the Quality Standards and Children's Palliative Care Frameworks. Further research is needed which explores the parent's unmet needs in palliative care services.

Do educational interventions aimed at nurses to support the implementation of evidence-based practice improve patient outcomes? A systematic review

BACKGROUND

Numerous articles have sought to identify the impact of educational interventions for improving evidence-based practice (EBP) amongst nurses, most of these focus on skills and knowledge acquired. No systematic review has explored whether this educational input translates into improved patient outcomes.

OBJECTIVES

To review the evidence on (1) The change in patient outcomes following educational interventions to support practising nurses in implementing EBP. (2) The instruments or methods used to determine whether EBP education improves patient outcomes.

METHODS

A systematic review following PRISMA guidance was conducted. Literature was comprehensive searched including 6 databases, journal handsearching, citation tracking, and grey literature websites. Studies were included if they reported an EBP educational intervention aimed at practising nurses and contained objective or self-reported measures of patient related outcomes. The quality of the included studies was assessed using a modified Health Care Practice R&D Unit (HCPRDU) tool. Because of the poor homogeneity of the included studies, the data were analysed by narrative synthesis.

RESULTS

Of the 4284 articles identified, 18 were included: 12 pre-post studies, three qualitative studies, and three mixed-methods study designs. The level of quality was modest in the studies. The results of the EBP educational interventions on patient outcomes were assessed using three methods: individual projects to implement an evidence-based approach, qualitative approaches, and a questionnaire survey. The majority of the articles concluded there was a positive change in patient outcomes following an educational intervention to improve EBP; a wide range of context specific outcomes were described.

CONCLUSION

Educational interventions for clinical nurses to support the implementation of EBP show promise in improving patient outcomes. However, the direct impact of EBP interventions on clinical outcomes is difficult to measure. Further testing and development is needed to improve the quality of studies and evaluation instruments in order to confirm the current findings.

Improving evidence based practice in postgraduate nursing programs: A systematic review: Bridging the evidence practice gap (BRIDGE project)

BACKGROUND

The nursing profession has a significant evidence to practice gap in an increasingly complex and dynamic health care environment.

OBJECTIVE(S)

To evaluate effectiveness of teaching and learning strategies related to a capstone project within a Masters of Nursing program that encourage the development of evidence based practice capabilities.

DESIGN

Systematic review that conforms to the PRISMA statement.

SAMPLE

Master's Nursing programs that include elements of a capstone project within a university setting.

DATA SOURCES/REVIEW METHODS

MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, ERIC and PsycInfo were used to search for RCT's or quasi experimental studies conducted between 1979 and 9 June 2017, published in a peer reviewed journal in English.

RESULTS

Of 1592 studies, no RCT's specifically addressed the development of evidence based practice capabilities within the university teaching environment. Five quasi-experimental studies integrated blended learning, guided design processes, small group work, role play and structured debate into Masters of Nursing research courses. All five studies demonstrated some improvements in evidence based practice skills and/or research knowledge translation, with three out of five studies demonstrating significant improvements.

CONCLUSIONS

There is a paucity of empirical evidence supporting the best strategies to use in developing evidence based practice skills and/or research knowledge translation skills for Master's Nursing students. As a profession, nursing requires methodologically robust studies that are discipline specific to identify the best approaches for developing evidence-based practice skills and/or research knowledge translation skills within the university teaching environment. Provision of these strategies will enable the nursing profession to integrate the best empirical evidence into nursing practice.

Training Nursing Skills: A Quantitative Study of Nursing Students' Experiences before and after Clinical Practice

Introduction

Requirements for Patient Safety suggest that students encounter patients well prepared. In clinical laboratory practice (CLP), the students simulate patient situations as a preparation for internship. Various CLP models have been tried out to meet the students' prerequisites and learning strategies.

Objectives

The purpose of this study was to try out two different learning sessions related to the bed bath procedure.

Design and Methods

The study has a descriptive, quantitative design with elements from clinically controlled trials.

Sample

The population of 160 first-year students was randomly divided into two classes.

Questionnaires

Two questionnaires were answered with six-month intervals: Form 1 immediately after the first training session and Form 2 a short time after clinical practice.

Findings

A majority of the nursing students reported that the exercises in the clinical lab were a good way to prepare for the practice, although most of them did not perceive that the procedure conducted at the university resembled how it is conducted in clinical practice. Age or level of discomfort related to organization of the skills training did not have impact on the students' confidence in mastering bed bath in clinical practice. Students without previous experience were less confident to master the procedure in clinical practice, but the results evened out during the internship.

Conclusions

The results from this study could indicate that the students' age to a larger extent should be considered in the universities' facilitation of nursing students' clinical preparations, to improve the transition to “real life” as smoothly and meaningfully as possible to nursing students.

The Hope Research Community of Practice

Background

Clinical nurses have multiple challenges in conducting high-quality nursing research to inform practice. Theoretically, the development of a community of practice on nursing research centered on the concept of hope is an approach that may address some of the challenges.

Purpose

This article describes the delivery and evaluation of a hope research community of practice (HRCoP) approach to facilitate research expertise in a group of advanced practice nurses in one hospital. It addressed the question: Does the establishment of a HRCoP for master’s prepared nurses increase their confidence and competence in leading nursing research?

Method

Using interpretive descriptive qualitative research methodology, five participants were interviewed about their experiences within the HRCoP and facilitators engaged in participant observation.

Results

At 13 months, only four of the original seven participants remained in the HRCoP. While all participants discussed positive impacts of participation, they identified challenges of having protected time to complete their individual research projects, despite having administrative support to do so. Progress on individual research projects varied.

Conclusion

Nurse-led research remains a challenge for practicing nurses despite participating in an evidence-based HRCoP. Lessons learned from this project can be useful to other academic clinical partnerships.

Evidence-based nursing implementation in Mainland China: A scoping review

BACKGROUND

It is crucial to identify the challenges of evidence-based nursing implementation faced by countries in transitional stage.

PURPOSE

The purpose of this study was to identify the state of evidence on implementation in Chinese nursing contexts and to determine gaps that need to be pursued.

METHODS

We performed a scoping review on existing literature on implementation studies conducted in nursing context in Mainland China. After systematically searching eight (four Chinese and four English) databases, we extracted and analyzed data from the included studies.

RESULTS

Ninety-five articles met inclusion criteria. Publications were on the rise, with most funding from academic institutions. Most studies were quantitative, with patient outcomes as primary indicators. Eighteen studies used a theoretical framework. Frequently used strategies and barriers to evidence-based nursing implementation were mainly from the organizational level.

CONCLUSIONS

This scoping review indicates an urgent requirement of Chinese evidence-based nursing resources, more funding and support from clinical managerial level, cooperation between academic and clinical institutes, and a call for more rigorous studies of implementation science under a Chinese nursing context.

Understanding scoping reviews: Definition, purpose, and process

BACKGROUND/PURPOSE

Scoping review design represents a methodology that allows assessment of emerging evidence, as well as a first step in research development. Despite its increasing use, to date no article reflecting use of scoping review methodology has been submitted for review at JAANP. The purpose of this article is to provide detailed information on scoping reviews, including definition, related processes, and uses, and discuss the relationship to nurse practitioner (NP) practice, policy, education, and research. The longer-term goal is that NPs will understand the related techniques, consider the methodology as a viable one for NP scholarship, and bring related reports to the forefront of NP publications.

METHODS

This manuscript represents a brief report. Processes to develop the brief include detailed search and review of scoping review literature in CINAHL and PubMed. Both methodologic reports and reviews were included. Definitions and uses of scoping reviews were reviewed.

CONCLUSION

The definition and process of scoping review are evolving. Although there is controversy regarding the methodology, there is increasing visibility of scoping review methodology in the published literature since the year 2000, with over 500 published reviews currently available.

IMPLICATIONS FOR PRACTICE

A well-executed scoping review has potential to inform NP practice, policy, education, and research.

The effectiveness of knowledge translation interventions for promoting evidence-informed decision-making among nurses in tertiary care: a systematic review and meta-analysis

BACKGROUND

Nurses are increasingly expected to engage in evidence-informed decision-making (EIDM) to improve client and system outcomes. Despite an improved awareness about EIDM, there is a lack of use of research evidence and understanding about the effectiveness of interventions to promote EIDM. This project aimed to discover if knowledge translation (KT) interventions directed to nurses in tertiary care are effective for improving EIDM knowledge, skills, behaviours, and, as a result, client outcomes. It also sought to understand contextual factors that affect the impact of such interventions.

METHODS

A systematic review funded by the Canadian Institutes of Health Research (PROSPERO registration: CRD42013003319) was conducted. Included studies examined the implementation of any KT intervention involving nurses in tertiary care to promote EIDM knowledge, skills, behaviours, and client outcomes or studies that examined contextual factors. Study designs included systematic reviews, quantitative, qualitative, and mixed method studies. The search included electronic databases and manual searching of published and unpublished literature to November 2012; key databases included MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Excerpta Medica (EMBASE). Two reviewers independently performed study selection, risk of bias assessment, and data extraction. Studies with quantitative data determined to be clinically homogeneous were synthesized using meta-analytic methods. Studies with quantitative data not appropriate for meta-analysis were synthesized narratively by outcome. Studies with qualitative data were synthesized by theme.

RESULTS

Of the 44,648 citations screened, 30 citations met the inclusion criteria (18 quantitative, 10 qualitative, and 2 mixed methods studies). The quality of studies with quantitative data ranged from very low to high, and quality criteria was generally met for studies with qualitative data. No studies evaluated the impact on knowledge and skills; they primarily investigated the effectiveness of multifaceted KT strategies for promoting EIDM behaviours and improving client outcomes. Almost all studies included an educational component. A meta-analysis of two studies determined that a multifaceted intervention (educational meetings and use of a mentor) did not increase engagement in a range of EIDM behaviours [mean difference 2.7, 95 % CI (-1.7 to 7.1), I (2) = 0 %]. Among the remaining studies, no definitive conclusions could be made about the relative effectiveness of the KT interventions due to variation of interventions and outcomes, as well as study limitations. Findings from studies with qualitative data identified the organizational, individual, and interpersonal factors, as well as characteristics of the innovation, that influence the success of implementation.

CONCLUSIONS

KT interventions are being implemented and evaluated on nurses' behaviour and client outcomes. This systematic review may inform the selection of KT interventions and outcomes among nurses in tertiary care and decisions about further research.