Promoting evidence-based practice through a research training program for point-of-care clinicians

Advancing evidence-based practice through the Knowledge Translation Challenge: Nurses' important roles in research, implementation science and practice change

AIM

To describe a knowledge translation capacity-building initiative and illustrate the roles of nurses in practice change using an exemplar case study.

DESIGN

The report uses observational methods and reflection.

METHODS

The Knowledge Translation Challenge program involves a multi-component intervention across several sites. The advisory committee invited eligible teams to attend capacity-building workshops. Implementation plans were developed, and successful teams receive funding for a 2 year period. Evaluation involved collecting data on program uptake and impact on practice change. Data has been collected from five cohorts. The exemplar case study employed an action-research framework.

RESULTS

Four nurse-led teams have demonstrated successful implementation of their practice change. The case study on implementing a clinical toolkit for clozapine management further illustrates a thoughtful planning process, and implementation journey and learnings by a team of nurses.

CONCLUSION

The Knowledge Translation Challenge program empowers nurses to use implementation science practices to enhance the quality and effectiveness of healthcare services. Success of this initiative serves as a model for addressing the persistent gap between knowledge and practice in clinical settings and the value of activating nurses to help close this gap.

IMPLICATIONS

As the most trusted and numerous profession, it is vital that nurses contribute to efforts to translate research evidence into clinical practice. The Knowledge Translation Challenge program supports nurses to lead practice change.

IMPACT

The Knowledge Translation Challenge program successfully equips nurses and other health care providers with the knowledge, skills and resources to implement practice improvements which enhance the quality and effectiveness of healthcare services and nursing practice.

PATIENT OR PUBLIC CONTRIBUTION

The Knowledge Translation Challenge advisory committee has three patient-public partners that support teams to develop a patient-oriented approach for their projects by providing feedback on the implementation plans. Each team was also supported to include patient-public partners on their project.

Development of an instrument to measure the competencies of health professionals in the process of evidence-based healthcare: A Delphi study

AIMS

To identify and reach consensus on dimensions and criteria of a competence assessment instrument for health professionals in relation to the process of evidence-based healthcare.

DESIGN

A two-round Delphi survey was carried out from April to June 2023.

METHODS

Consensus was sought from an expert panel on the instrument preliminarily established based on the JBI Model of Evidence-Based Healthcare and a rapid review of systematic reviews of relevant literature. The level of consensus was reflected by the concentration and coordination of experts' opinions and percentage of agreement. The instrument was revised significantly based on the combination of data analysis, the experts' comments and research group discussions.

RESULTS

Sixteen national and three international experts were involved in the first-round Delphi survey and 17 experts participated in the second-round survey. In both rounds, full consensus was reached on the four dimensions of the instrument, namely evidence-generation, evidence-synthesis, evidence-transfer and evidence-implementation. In round-one, the instrument was revised from 77 to 61 items. In round-two, the instrument was further revised to have 57 items under the four dimensions in the final version.

CONCLUSION

The Delphi survey achieved consensus on the instrument. The validity and reliability of the instrument needs to be tested in future research internationally.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Systematic assessment of nurses and other health professionals' competencies in different phases of evidence-based healthcare process based on this instrument provides implications for their professional development and multidisciplinary team collaboration in evidence-based practice and better care process and outcomes.

IMPACT

This study addresses a research gap of lacking an instrument to systematically assess interprofessional competencies in relation to the process of EBHC. The instrument covers the four phases of EBHC process with minimal criteria, highlighting essential aspects of ability to be developed. Identification of health professionals' level of competence in these aspects helps strengthen their capacity accordingly so as to promote virtuous EBHC ecosystem for the ending purpose of improving global healthcare outcomes.

REPORTING METHOD

This study was reported in line with the Conducting and REporting of DElphi studies (CREDES) guidance on Delphi studies.

PATIENT AND PUBLIC CONTRIBUTION

No patient or public contribution.

Factors that influence the scope of practice of the chiropractic profession in Australia: a thematic analysis

Scope of practice has been defined as the activities that an individual health care practitioner is allowed to undertake within a specific profession. The chiropractic profession in Australia does not currently have a documented scope of practice. Informed discussions around scope of practice are hampered by a paucity of literature in this area. Acknowledging this void in the literature, we chose to investigate the factors that influence scope of practice of the chiropractic profession. A knowledge of the factors will facilitate discussion on the topic and help the profession to work towards establishing a scope of practice.Aim The aim of this study was to identify the factors that influence scope of practice of chiropractic in Australia from the perspective of 4 stakeholder groups within the profession.Methods This study employed semi-structured, online-interviews. Open-ended questions, guided by a flexible interview protocol, and augmented by supplemental questions, probes and comments, were used to gather data on the research question. Data were analysed using reflexive thematic analysis.Results Six factors that influenced scope of practice of chiropractic were identified in this study: education, evidence (research-derived and practice-based), political influence, community expectations, entrepreneurial business models, and geographical location.Conclusion Knowledge of the factors that influence scope of practice of chiropractic in Australia is important for establishing a scope of practice for the profession. This knowledge is also of value to a range of stakeholders including patients, health care providers (within and outside the profession), professional associations, and policymakers.

Interventions to enhance the use of Evidence Based Decision Making for Quality Care among Nurses: A Systematic Review

Background

Decision-making is the cognitive process that results in the selection of a course of action from several possible alternative options. The complexity of nurses' decisions requires a broad knowledge base and access to reliable sources of information; as well as a supportive working environment therefore requiring that decision making be evidence based with robust knowledge translation platforms to disseminate the evidence. This review aimed to assess interventions for enhancing the use of evidence-based decision making for quality care among nurses.

Methods

This study followed the Preferred Reporting Items for Systematic Review and Meta-Analysis review (PRISMA 2020) checklist. This study protocol was registered with PROSPERO number CRD42021262318.

Results

The search revealed a total of 143 papers divided as follows: PubMed- 65 papers, CINAHL 25 papers and Cochrane 53 papers. In addition, references of included studies were scanned manually for potential papers and another 46 papers extracted. A total of 133 papers were chosen for detailed extraction following removal of 10 duplicate studies.

Conclusion

Results of this review revealed that the interventions that have been used to enhance the use of evidence for decision making are majorly educational. A few interventions have taken the form of modelling, guidelines and programming. Online solutions have also been seen to enhance the use of evidence for clinical practice of nurses.

Development of Research Core Competencies for Academic Practice Among Health Professionals: A Mixed-Methods Approach

BACKGROUND AND OBJECTIVES

Of the 4 pillars of academic practice for nursing and allied health, research has been the least developed and no standard competency framework exists that is embedded in health professional scopes of practice. The objective of this article is to report on the preliminary development and pilot-testing of research and academic scholarship core competencies for nonphysician health professionals working within a large urban academic health sciences center.

METHODS

We conducted an internal and external environmental scan and multiphase consultation process to develop research and academic core competencies for health professionals working within an interprofessional setting.

RESULTS

The final framework outlines 3 levels of research proficiency (novice, proficient, and advanced) and the relevant roles, specific competencies, and observable actions and/or activities for each proficiency level.

CONCLUSIONS

Organizations should consider the integration of the framework within performance management processes and the development of a road map and self-assessment survey to track progress over time and support health professionals with their academic practice goals.

Enhancing evidence-based practice into healthcare: Exploring the role of scientific skills in occupational therapists

BACKGROUND

Research utilization and evidence-based practice (EBP) in occupational therapy rely on essential scientific skills. Despite prior research exploring factors influencing EBP, a gap remains in understanding the specific scientific competencies crucial for effective EBP application.

OBJECTIVES

To (1) describe the level of scientific skills for EBP and research application, and (2) investigate the factors influencing higher scientific competence among 1159 Spanish-speaking occupational therapists.

MATERIAL AND METHODS

We assessed the scientific skills using the HACTO-Screen online survey. Recruitment was conducted through a non-probability convenience sampling method between April to June 2020, using social networks and email dissemination to education and professional organizations in Spain and Spanish-speaking Latin American countries.

RESULTS

Out of a total score of 115 points, participants showed a moderate level of scientific skills (mean: 62.7, SD: 21.6), with literature searching skills ranking the highest and scientific writing skills ranking the lowest. Associations were found between greater scientific competence and advanced degrees, ongoing research training, and on-the-job research.

CONCLUSIONS

Continuous research training, higher academic degrees, and active research engagement are essential for enhancing scientific competence among occupational therapists.

SIGNIFICANCE

Targeted training to enhance scientific skills and promote research utilization are crucial in advancing EBP in occupational therapy.

What scholarly practice means to respiratory therapists: An interpretive description study

RATIONALE

Engagement in scholarly practice has been associated with professional empowerment, role satisfaction and improvements in care delivery and patient outcomes across many healthcare professions. However, in evolving professions like respiratory therapy, scholarly practice is excluded from competency frameworks, resulting in a gap in education and subsequent application of this competency in practice. An exploration of scholarly practice in respiratory therapy may provide insights into evolving professions that face tensions between meeting competency requirements as outlined in frameworks and providing quality healthcare to the populations they serve.

AIMS AND OBJECTIVES

The aim of the study was to explore what scholarly practice means, and how it manifests in practice from respiratory therapists' (RTs) perspectives.

METHODS

We used interpretive description methodology. We purposively sampled participants to obtain varied perspectives of scholarly practice in respiratory therapy. We conducted 26 semistructured interviews with RTs in different roles (clinicians, educators, researchers, leaders and managers) across Canada and analysed the data using inductive analysis. Data collection and analysis proceeded concurrently.

RESULTS

We developed five main themes: (i) the identity of a scholarly practitioner in RTs; (ii) factors influencing scholarly practice; (iii) one's impression of their professional self-image; (iv) scholarly practice as a vehicle for changing practice and (v) the complex interconnections between knowledges and practices.

CONCLUSION

Scholarly practice appears to be a multifaceted phenomenon encompassing a wide range of activities and skills including conducting research, reflective practice, application of research to practice, and contributing to the advancement of the profession and healthcare. Scholarly practice is influenced by organisational context and culture, available resources, intrinsic motivation and external political context. We identified similarities between professional identity and the description of the scholarly practitioner, suggesting that these two phenomena may be interconnected. Furthermore, participants believed that scholarly practice could enhance the image, credibility, legitimacy and professionalisation of the profession.

A Psychometric Evaluation of the Nurse Practitioner Self-efficacy Scale

OBJECTIVE

In this study, a psychometric evaluation of the Nurse Practitioner Self-efficacy Scale (NPSES) was conducted.

BACKGROUND

Self-efficacy is an important concept for optimal nurse practitioner (NP) performance and retention. The NPSES may serve as a valuable instrument to support NP practice.

METHODS

This descriptive cross-sectional study evaluated the NPSES responses from 230 NPs. Confirmatory factor analysis, reliability, and t tests were used to analyze the results.

RESULTS

Confirmatory factor analysis revealed acceptable goodness of fit for an 8-factor model (root-mean-square error of approximation = 0.05, comparative fit index = 0.97, Tucker Lewis index = 0.96). Reliability estimates resulted in acceptable internal consistency (coefficient α = 0.94). The t tests comparing more and less experienced NPs resulted in higher scores in more experienced NPs.

CONCLUSION

This validation study showed that the NPSES is a psychometrically-sound instrument to assess NP self-efficacy. The NPSES is a cost-effective and convenient method to measure self-efficacy, a valuable concept for NP practice.

EBP on the Go! An Education Case Report: When Time, Budget, and a Global Pandemic Limit Your Options for Nursing Education, Create Your Own!

In an era when resources, time, and attention spans are limited, nursing education must be delivered in a manner that is economical and convenient while retaining the ability to hold consumers accountable for their learning. This article highlights one organization's solution to a gap in evidence-based practice education. Professional development practitioners utilized their own creative acumen to develop high-quality, organization-specific resources that provide education in an engaging, portable, and user-friendly format.

Frontline Clinician Appraisement of Research Engagement: "I feel out of touch with research"

BACKGROUND

Health services research can benefit from frontline clinician input across all stages of research, yet their key perspectives are often not meaningfully engaged.

OBJECTIVE

How can we improve clinician engagement in research?

DESIGN

Convenience sampling and semi-structured interviews followed by descriptive content analysis with an inductive approach, followed by group participatory listening sessions with interviewees to further contextualize findings.

PARTICIPANTS

Twenty-one multidisciplinary clinicians from one healthcare system.

KEY RESULTS

We identified two major themes: perceptions of research (how research fits within job role) and characterizing effective engagement (what works and what does not work in frontline clinician engagement). "Perceptions of Research" encompassed three subthemes: prior research experience; desired degree of engagement; and benefits to clinicians engaging in research. "Characterizing Effective Engagement" had these subthemes: engagement barriers; engagement facilitators; and impact of clinician's racial identity.

CONCLUSIONS

Investing in frontline clinicians as research collaborators is beneficial to clinicians themselves, the health systems that employ them, and those for which they care. Yet, there are multiple barriers to meaningful engagement.

Investigating attitudes, skills, and use of evidence-based practice among Norwegian chiropractors; a national cross-sectional study

BACKGROUND

Evidence-based practice (EBP) is essential in improving the quality of healthcare and of importance for all health care personnel. No study in Norway has investigated attitudes, skills and use related to EBP among chiropractors. The aim of this study was to describe Norwegian chiropractors' attitudes, skills, and use of EBP, as well as the barriers and facilitators to their use of EBP.

METHODS

A national cross-sectional survey, the online version of the Evidence Based practice Attitudes & Utilisation SurvEy (EBASE), was sent by email to 770 Norwegian practicing chiropractors, all members of the Norwegian Chiropractic Association. Three EBASE sub-scores were generated (Attitudes, Skills and Use), and the demographic characteristics of the sample were reported. Linear regression analyses were conducted to examine the association between responses of the three sub-scores and demographic characteristics. Information on main barriers and facilitators of EBP was collected and described.

RESULTS

A total of 312 (41%) chiropractors responded to the survey, and 95% agreed that EBP is necessary for chiropractic practice. While overall use of EBP activities was low participants were interested in learning and improving their skills to incorporate EBP into practice. Chiropractors' attitudes, skills, and use of EBP were positively associated with being female and having spent more than one hour per week on research, but negatively associated with having practiced more than 10 years. Main barriers of EBP were lack of skills to critically evaluate, interpret, and apply research findings to practice. Main facilitators of EBP included access to the internet and free online databases in the workplace.

CONCLUSION

Although chiropractors in Norway reported positive attitudes and moderate skills in EBP, their use of EBP activities was limited. The main barriers and facilitators to EBP were primarily related to perceived skills deficits, whilst enablers of EBP were mostly related to infrastructure requirements.

Understanding Training Needs in Pediatric Feeding for Allied Health Professionals: An Australian Perspective

PURPOSE

Clinician experience and confidence can negatively impact pediatric feeding service availability, but limited research has investigated what training allied health professionals (AHPs) need to increase these factors. This study developed and distributed a survey investigating Australian AHPs' self-reported confidence and anxiousness, training needs, factors impacting training access, and training preferences.

METHOD

This study was conducted over two phases. Phase 1 involved development and refinement of the survey, and Phase 2 involved distribution to Australian AHPs. Questions pertained to general demographics, feeding experience, feeding confidence and skills perception, and training needs. The questions were composed of multiple-choice, Likert scale, and short-response options.

RESULTS

Overall, 198 complete responses were received. Participants reported significantly lower confidence and higher anxiousness working with infants compared to older children (p < .01). Increased frequency of service provision predicted higher self-reported confidence and lower anxiousness (p < .01). Practical training opportunities including case discussion, videos, and clinical feedback were preferred. Access facilitators were online, on-demand training; however, respondents reported preferring hands-on training opportunities. Common barriers included cost, time, competing professional development priorities, and distance/travel.

CONCLUSIONS

Findings have highlighted that recency and frequency of practice impact self-reported confidence and anxiousness, and that AHPs self-report lowest confidence and highest anxiety working with infants compared to older age groups. Overall, the findings highlight the need for flexible, practical, and remotely accessible training opportunities, as well as the need for access to regular clinical supervision and a pediatric feeding caseload.

The improvement in research orientation among clinical nurses in Qatar: a cross-sectional study

BACKGROUND

The main barrier to engaging nurses in research is the lack of research knowledge and skills.

AIM

To explore the influence of research workshops on the research orientation of nurses in a large referral hospital in Qatar.

DISCUSSION

This article describes a cross-sectional study involving 564 nurses working in 14 health facilities who attended research workshops in Qatar. The authors collected data using the Edmonton Research Orientation Survey (EROS) as well as questions considering support and barriers to research. Descriptive statistics were used to summarise and determine the sample characteristics and distribution of participants. The participants who attended the workshop were found to have a higher orientation towards the EROS sub-scales of evidence-based practice, valuing of research, involvement in research, being at the leading edge of the profession and support for research, compared to those who did not attend the workshop. There was no statistical difference between the groups in the research barrier sub-scale.

CONCLUSION

Despite significant improvements in their responses to the EROS research orientation sub-scales after attending the workshop, the nurses still reported many barriers to being actively engaged in research.

IMPLICATIONS FOR PRACTICE

Healthcare organisations should assist with integrating evidence-based practice into healthcare. There is a need for research education for clinical nurses to bring evidence into clinical practice to improve the quality of patient outcomes. Increasing the research capacity of nurses will lead to their emancipation in addressing the flaws in clinical practice and motivate them to use evidence in patient care.

Can Research Training be Improved in Health Professional Student Curricula? A Qualitative Descriptive Study of Health Students' Experiences with an Integrated Research Training Platform

INTRODUCTION

Project-based learning is currently the status quo for research training for health professional students; however, it alone is not sufficient for holistic development of research skills. One promising style of intervention that can complement project-based research training is a centralised hub of e-learning resources. Therefore, we explored the perception of health professionals in tertiary education, towards the E-learning hub named 'Health and Medical Sciences Research Modules'. Specifically, we explored (1) the role the Modules can play in supporting students in their research training courses, (2) the perception of the selection of topics and content quality and (3) student engagement with content.

METHODS

Semi-structured interviews were conducted via the online platform Zoom for University of Western Australia 3rd- and 4th-year Dental doctoral students, and 2nd-year Master of Pharmacy students. Interview transcripts were analysed using the framework method, to identify manifest and latent level themes.

RESULTS

Eleven participants completed the interview, including five dentistry and six pharmacy students. The analysis yielded numerous manifest level themes including selection and depth of topics, and four latent level themes: content volume and balance, relevance of content to project, alignment and sequencing, and interactivity.

DISCUSSION

The present study suggests the Modules content and the online platform were well received as a complementary intervention to project-based learning. However, issues such as content oversaturation emerged as topics which can be addressed to improve the learning experience. These topics should be considered when considering further implementation of e-learning hubs to complement project-based learning, across Australia and worldwide.

Systematic education has a positive impact on nurses' evidence-based practice: Intervention study results

AIMS

To evaluate how an education program on evidence-based practice (EBP) affected nurses´ knowledge, practices, and attitudes related to EBPs in patient care.

METHODS

Nurses of one Finnish university hospital participated in two separate EBP education programs in 2016-2017 and 2018-2019. Data was collected by a questionnaire given before and after each program. Reliable instruments for measuring EBP were used: The Evidence-Based Practice Questionnaire (24 items) and the Attitudes to Evidence-Based Practice Questionnaire (17 items). Means and frequencies were evaluated with the Mann-Whitney U test and linear regression.

RESULTS

Nurses reported that their EBP practice, skills and the Work based on EBPs improved substantially after the education program. We found that scores on the Work based on EBPs and the attitudes towards EBP could predict the nurses' overall self-evaluations of practices, attitudes, and skills.

DISCUSSION

EBP education affects positively on implementation of nurses' practices and skills. There is still a need to change attitudes towards evidence based practice. IMPLICATIONS FOR PRACTICE, RESEARCH, POLICY, MANAGEMENT, AND EDUCATION: Organizations need to maintain and develop efficient, attractive EBP educational programs to promote lifelong learning.

CONCLUSIONS

When designing EBP educational content, it is crucial to teach participants to develop evidence-based methods and consider how to implement them in practice.

Implementing health system improvement: resources and strategies for interprofessional teams

Health system improvement (HSI) is focused on systematic changes to organisational processes and practices to improve the efficient delivery of safe care and quality outcomes. Guidelines that specify how interprofessional teams conduct HSI and knowledge translation are needed. We address this urgent requirement providing health professional teams with resources and strategies to investigate, analyse and implement system-level improvements. HSI encompasses similar, yet different, inter-related activities across a continuum. The continuum spans three categories of activities, such as quality improvement, health management research and translational health management research. A HSI decision making guide and checklist, comprising six-steps, is presented that can be used to select and plan projects. This resource comprises six interconnected steps including, defining the activity, project outcome, aim, use of evidence, appropriate methodology and implementation plan. Each step has been developed focusing on an objective, actions and resources. HSI activities provide a foundation for interprofessional collaboration, allowing multiple professions to create, share and disseminate knowledge for improved healthcare. When planned and executed well, HSI projects assist clinical and corporate staff to make evidence-informed decisions and directions for the benefit of the service, organisation and sector.

Utilisation of research in clinical nursing and midwifery practice in Ghana: protocol for a mixed-method study. (Preprint)

BACKGROUND

The International Council of Nurses' 2021 code of ethics mandates nurses to provide evidence-informed care to patients. Globally, using research evidence has led to improvement in nursing and midwifery practice, according to the World Health Organization. A study in Ghana found that 25.3% (n=40) of nurses and midwives use research in clinical care. Research utilization (RU) increases therapeutic effectiveness, improves health outcomes, and enhances the personal and professional development of clinicians. However, it is uncertain the extent to which nurses and midwives are prepared, skilled, and supported to utilize research in clinical care in Ghana.

OBJECTIVE

This study aims to develop a conceptual framework that can facilitate RU among clinical nurses and midwives in Ghanaian health facilities.

METHODS

This will be a cross-sectional study with a concurrent mixed methods approach. It will be conducted in 6 hospitals and 4 nursing educational institutions in Kumasi, Ghana. The study has 4 objectives which will be executed in 3 phases. Phase 1 follows a quantitative approach to describe the knowledge, attitudes, and practices of clinical nurses and midwives on the use of research in their practice. Using a web-based survey, 400 nurses and midwives working in 6 health facilities will be recruited. Data analysis will be conducted using SPSS, with statistical significance set at .05. Qualitative methodology, using focus group discussions with clinical nurses and midwives, will be conducted to identify the factors influencing their RU. In phase 2, focus group discussions will be used to examine and describe how nurse educators in 4 nursing and midwifery educational institutions prepare nurses and midwives for RU during their education. Views of nurse managers on the RU in Ghanaian health care facilities will be explored in the second section of this phase through one-on-one interviews. Inductive thematic analysis will be used to analyze the qualitative data, and Lincoln and Guba's principles of trustworthiness will be applied. In phase 3, the stages of model development proposed by Chinn and Kramer; and Walker and Avant will be used to triangulate findings from all objectives and formulate a conceptual framework.

RESULTS

Data collection started in December 2022. Publication of the results will begin in April 2023.

CONCLUSIONS

RU in clinical practice has become an acceptable practice in nursing and midwifery. It is critical that nursing and midwifery professionals in sub-Saharan Africa shift their practice to embrace the global movement. This proposed conceptual framework will empower nurses and midwives to improve their practice of RU.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/45067.

Research capacity and culture in an Australian metropolitan public mental health service: scoping the skills and experience of social workers and occupational therapists

BACKGROUND

Investment in a clinical research culture appears to be associated with benefits for consumers, staff, and overall organisational performance. The validated 55-item Research Capacity and Culture (RCC) tool was developed specifically to gauge the research capacity and culture of health professionals and workplace settings within which they work. Results of some individual studies suggest that professional discipline and workplace setting may impact RCC results however it has never been used in a dedicated public mental health setting. Therefore, this study will explore the research capacity and culture of allied mental health clinicians (Part 1). Another aim is to explore potential connections between workplace settings, locations and disciplines based on published RCC-based data to help signpost potential impediments to service improvements (Part 2).

METHODS

Part 1: An RCC-based online survey canvased Australian Social Workers and Occupational Therapists (n = 59) based in a metropolitan public mental health service. Non-parametric analyses explored links between research-related experience and participant characteristics. Part 2: Comparative analyses explored the potential influence of workplace settings and professional disciplines on published RCC results.

RESULTS

Part 1: Overall, the research capacity and experiences of mental health Social Workers and Occupational Therapists seemed modest. Discipline was statistically associated with level of research-activity experience, weighted towards occupational therapy; demographic characteristics were not. Only two items in the RCC were rated high; many more items were rated low. Part 2: Published studies exploration found no link between RCC ratings and workplace location, setting, or professional discipline. Sampling biases and use of modified, non-validated RCC versions likely impacted the results.

CONCLUSIONS

Allied mental health clinicians may not be sufficiently experienced, knowledgeable, or confident with a range of research-related activities given the emphasis on workforce research capability in policy and practice nowadays. This may be commonplace across health-based organisations. We recommend the systematic implementation of research training programs in (mental) health services, and a 'whole-of-service levels' approach be used i.e., transform policy, culture and leadership as well as provide practical resources with individual training. Potential benefits include a positive impact on organisation functioning, clinicians' confidence and practice, and improved consumer outcomes.

Scholarly practice in healthcare professions: findings from a scoping review

Scholarly practitioners are broadly defined as healthcare professionals that address critical practice problems using theory, scientific evidence, and practice-based knowledge. Though scholarly practice is included in most competency frameworks, it is unclear what scholarly practice is, how it develops and how it is operationalized in clinical practice. The aim of this review was to determine what is known about scholarly practice in healthcare professionals. We conducted a scoping review and searched MEDLINE, EMBASE, CINAHL from inception to May 2020. We included papers that explored, described, or defined scholarly practice, scholar or scholarly practitioner, and/or related concepts in healthcare professionals. We included a total of 90 papers. Thirty percent of papers contained an explicit definition of scholarly practice. Conceptualizations of scholarly practice were organized into three themes: the interdependent relationship between scholarship and practice; advancing the profession's field; and core to being a healthcare practitioner. Attributes of scholarly practitioners clustered around five themes: commitment to excellence in practice; collaborative nature; presence of virtuous characteristics; effective communication skills; and adaptive change ethos. No single unified definition of scholarly practice exists within the literature. The variability in terms used to describe scholarly practice suggests that it is an overarching concept rather than a definable entity. There are similarities between scholarly practitioners and knowledge brokers regarding attributes and how scholarly practice is operationalized. Individuals engaged in the teaching, research and/or assessment of scholarly practice should make explicit their definitions and expectations for healthcare professionals.

Canadian Naturopathic Doctor Engagement, Preparedness, and Perceptions of Evidence-Based Practice: A National Cross-Sectional Study

Background: Despite the reported benefits of evidence-based practice (EBP), there are concerns that some practitioners, including naturopathic doctors (NDs), may be cautious about its use. The objective of this study was to explore Canadian ND perceptions, preparedness, and engagement in EBP, and the barriers and enablers to EBP uptake. Methods: The study was a national cross-sectional survey. NDs practicing in Canada were invited to complete the validated 84-item Evidence-Based Practice Attitudes and Utilization Survey between February and May 2020. Results: A total of 252 Canadian NDs were recruited. Participant attitudes toward EBP were predominantly positive, with three-quarters of participants indicating that >50% of their practice was informed by clinical research evidence. One-half of participants self-reported a medium-high to high level of skill across most EBP-related activities. Notable barriers to EBP uptake were lack of clinical evidence in naturopathy, and lack of time. Access to the internet and online databases were identified as useful enablers to improving EBP engagement. Conclusions: By shedding light on Canadian ND engagement with, preparedness for, and perceptions of EBP, the findings will help guide the development of strategies to support EBP uptake in NDs with the expectation of improving quality of care.

Using mixed-methods in evidence-based nursing: a scoping review guided by a socio-ecological perspective

Background

Increased pressure for evidence-based practice in nursing necessitates that researchers use effective approaches. Mixed-methods research (MMR) has potential to improve the knowledge and implementation of evidence-based nursing (EBN) by generating outcome-based and contextually-focused evidence.

Aims

To identify methodological trends in how MMR is used in EBN research.

Methods

Searches were completed in PubMed, CINAHL, and Google Scholar using the terms "nursing", "mixed-methods", and "evidence-based". Seventy-two articles using MMR to address EBN and published 2000-2021 were reviewed across content themes and methodological domains of the Socio-Ecological Framework for MMR.

Results

Mixed-methods research has been used to study how EBN strategies are perceived, developed and assessed, and implemented or evaluated. A few studies provided an MMR definition reflecting the methods perspective, and the dominant MMR rationale was gaining a comprehensive understanding of the issue. The leading design was concurrent, and half of studies intersected MMR with evaluation, action/participatory, and/or case-study approaches. Research quality was primarily assessed using criteria specific to quantitative and qualitative approaches.

Conclusions

Mixed-methods research has great potential to enhance EBN research by generating more clinically useful findings and helping nurses understand how to identify and implement the best available research evidence in practice.

Electronic nudge tool technology used in the critical care and peri-anaesthetic setting: a scoping review protocol

INTRODUCTION

Electronic clinical decision support (eCDS) tools are used to assist clinical decision making. Using computer-generated algorithms with evidence-based rule sets, they alert clinicians to events that require attention. eCDS tools generating alerts using nudge principles present clinicians with evidence-based clinical treatment options to guide clinician behaviour without restricting freedom of choice. Although eCDS tools have shown beneficial outcomes, challenges exist with regard to their acceptability most likely related to implementation. Furthermore, the pace of progress in this field has allowed little time to effectively evaluate the experience of the intended user. This scoping review aims to examine the development and implementation strategies, and the impact on the end user of eCDS tools that generate alerts using nudge principles, specifically in the critical care and peri-anaesthetic setting.

METHODS AND ANALYSIS

This review will follow the Arksey and O'Malley framework. A search will be conducted of literature published in the last 15 years in MEDLINE, EMBASE, CINAHL, CENTRAL, Web of Science and SAGE databases. Citation screening and data extraction will be performed by two independent reviewers. Extracted data will include context, e-nudge tool type and design features, development, implementation strategies and associated impact on end users.

ETHICS AND DISSEMINATION

This scoping review will synthesise published literature therefore ethical approval is not required. Review findings will be published in topic relevant peer-reviewed journals and associated conferences.

Questioning the ethics of evidence-based practice for Indigenous health and social settings in Australia

Australian government planning promotes evidence-based action as the overarching goal to achieving health equality for Aboriginal and Torres Strait Islander populations. However, an inequitable distribution of power and resources in the conduct of evidence-based practice produces a policy environment counterintuitive to this goal. This context of contemporary evidence-based practice gives legitimacy to ‘expert practitioners’ located in Australian governments and universities to use Western guidelines and tools, embedded in Western methodology, to make ‘evidence’ informed policy and programming decisions about Aboriginal and Torres Strait Islander populations. This method for decision making assumes a positional superiority that can marginalise the important perspectives, experiences and knowledge of Aboriginal Community Controlled Organisations and their processes for decision making. Here we consider the four steps of an evidence review: (1) developing a review question; (2) acquiring studies; (3) appraising the evidence and (4) assessing the evidence, as components of wider evidence-based practice. We discuss some of the limitations across each step that arise from the broader context within which the evidence review is produced. We propose that an ethical and just approach to evidence-based review can be achieved through a well-resourced Aboriginal community controlled sector, where Aboriginal organisations generate their own evidence and evidence is reviewed using methods and tools that privilege Aboriginal and Torres Strait Islander ways of knowing, doing and being.

Research education and training for nurses and allied health professionals: a systematic scoping review

BACKGROUND

Research capacity building (RCB) initiatives have gained steady momentum in health settings across the globe to reduce the gap between research evidence and health practice and policy. RCB strategies are typically multidimensional, comprising several initiatives targeted at different levels within health organisations. Research education and training is a mainstay strategy targeted at the individual level and yet, the evidence for research education in health settings is unclear. This review scopes the literature on research education programs for nurses and allied health professionals, delivered and evaluated in healthcare settings in high-income countries.

METHODS

The review was conducted systematically in accordance with the Joanna Briggs Institute scoping review methodology. Eleven academic databases and numerous grey literature platforms were searched. Data were extracted from the included full texts in accordance with the aims of the scoping review. A narrative approach was used to synthesise findings. Program characteristics, approaches to program evaluation and the outcomes reported were extracted and summarised.

RESULTS

Database searches for peer-reviewed and grey literature yielded 12,457 unique records. Following abstract and title screening, 207 full texts were reviewed. Of these, 60 records were included. Nine additional records were identified on forward and backward citation searching for the included records, resulting in a total of 69 papers describing 68 research education programs. Research education programs were implemented in fourteen different high-income countries over five decades. Programs were multifaceted, often encompassed experiential learning, with half including a mentoring component. Outcome measures largely reflected lower levels of Barr and colleagues' modified Kirkpatrick educational outcomes typology (e.g., satisfaction, improved research knowledge and confidence), with few evaluated objectively using traditional research milestones (e.g., protocol completion, manuscript preparation, poster, conference presentation). Few programs were evaluated using organisational and practice outcomes. Overall, evaluation methods were poorly described.

CONCLUSION

Research education remains a key strategy to build research capacity for nurses and allied health professionals working in healthcare settings. Evaluation of research education programs needs to be rigorous and, although targeted at the individual, must consider longer-term and broader organisation-level outcomes and impacts. Examining this is critical to improving clinician-led health research and the translation of research into clinical practice.

From Evidence Synthesis to Transfer: Results from a Qualitative Case Study with the Perspectives of Participants

The increase in health research brings challenges to the production, synthesis, and use of research findings in clinical practice. In the case of undergraduate training in nursing, it is necessary to think about the curricular contents and create opportunities to develop skills for learning evidence-based practice. The objective of this study was to analyze nurses’ perspectives regarding the effects of their participation in a project of translation of knowledge into clinical practice during undergraduate nursing education, specifically involving knowledge, attitudes, and competencies related to the use of evidence. This is a qualitative case study grounded in the knowledge-to-action theoretical framework. The participants were 13 nurses who were involved in a project about the translation of knowledge into clinical practice during the last term of their undergraduate course. The data were collected by applying interviews between December 2020 and April 2021. Content analysis was carried out by using the qualitative data analysis software tool webQDA^®. The following categories emerged from the content analysis carried out on the material gathered during the interviews: understanding evidence; learning how to use evidence; transferring evidence; adjusting to the context; and observing the advantages of evidence-based practice. Extracurricular activities were perceived as an opportunity to understand what evidence is and observe in loco the advantages of health care for clients, teams, and services. During the project, the participants developed cross-sectional competencies and envisaged changes to their professional activity as a result of changes in their attitude regarding evidence and its use. We concluded that the opportunity to develop evidence-related activities allows for the development of skills and influences the attitude towards evidence-based practice and knowledge use.

Implementing a novel programme for nurses and allied health professionals to develop capacity for evidence-informed clinical practice

Background

Nurses and allied health professionals (AHPs) require skills and support to access, appraise, interpret and use research evidence in clinical practice. We describe the process of designing and implementing the Evidence in Practice (EiP) programme at a UK hospital.

Methods

Key stakeholders were engaged to identify learning needs and priorities in appraising and implementing research evidence. To address these, we designed a multi-strategy bespoke programme of activities.

Results

The programme comprised the development of (a) a visual summary of a research paper, (b) five skills development masterclasses and (c) a six-month mentoring scheme to develop and implement plans for translating evidence into practice.

Discussion

The programme overcame many of the traditional barriers (lack of access, skills and time) to increase engagement of nurses and AHP staff in accessing, reviewing and using evidence in clinical practice.

Conclusion

With clinical leadership support, it is feasible to use a multi-strategy approach to promote and enable nurses and AHPs to use evidence in clinical practice.

Effect of an evidence-based poster on the knowledge of delirium and its prevention in student nurses: A quasi-experimental study

BACKGROUND

A major barrier to nurses adopting evidence-based practice (EBP) has been the limited awareness of evidence underpinning clinical practice, often due to poor access and understanding of the literature base. To address this, we piloted the development of educational posters summarizing the evidence base around clinical practices to see if they help nurses better understand the rationale behind their care. Our first poster focused on the evidence supporting the management of delirium in older persons, specifically delirium identification and its prevention.

OBJECTIVE

To examine the effect of an evidence-based poster education on the delirium knowledge of student nurses.

DESIGN

A prospective two-armed quasi-experimental study.

METHODS

188 student nurses were recruited in December 2017. Participants were alternated to receive either an evidence-based poster education session or a reflective education session as a control. Both groups were assessed on their general knowledge on delirium, knowledge on delirium detection and knowledge on delirium prevention. This was conducted both before exposure to either the intervention or control, and one week after exposure. Unpaired t-tests with 95% confidence intervals (CI) were applied to compare the mean change in pre-test and post-test delirium knowledge. We used the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) checklist to report our methods and findings.

RESULTS

Students in the poster education group reported greater improvements in mean scores of delirium identification (Mean increase =1.0, p = 0.007, 95% CI: 0.3-1.6), delirium prevention (Mean increase =1.6, p < 0.001, 9% CI: 1.0-2.2) and overall delirium knowledge (Mean increase = 2.7, p < 0.001, 95% CI: 1.5-3.8) than students in the control.

CONCLUSION

Summarised research evidence within a poster format can increase student nurses' access to the evidence base. This has shown to increase their knowledge to guide their clinical practice.

IMPACT STATEMENT

Exposure to poster summaries of research evidence underpinning delirium care increases student nurses' clinical knowledge of delirium identification and prevention.

Nurse mentored, student research in undergraduate nursing education to support evidence-based practice: A pilot study

OBJECTIVE

The aim was to investigate if an extracurricular research skills development program builds the knowledge, attitudes, and skills (KAS) to support evidence-based practice (EBP).

METHODS

Twenty nursing students and six mentors in four teams completed small, student-led research projects over 1 year. Using a mixed-methods design, the knowledge, attitudes, and practice (KAP) survey was administered at three-time points, followed by qualitative interviews. A linear mixed-effects regression model was used to analyze survey data and thematic analysis for qualitative data.

RESULTS

The change from the KAP survey from the first to the third time point showed a statistically significant difference following engagement in the program. Qualitative data indicated benefits and challenges to participation for both students and mentors. Mentorship provided students with improved relationships, collaboration, and leadership skills. Students believed the program enhanced their understanding of research and reported increased confidence in using EBP.

CONCLUSION

Offering students innovative first-hand experiences with research develops research KAS to support EBP.

Supporting Discovery and Inquiry: A Canadian Hospital's Approach to Building Research and Innovation Capacity in Point-of-Care Health Professionals

BACKGROUND AND OBJECTIVES

Building capacity for research and innovation among point-of-care health professionals can translate into positive outcomes from the organization, staff, and patient perspective. However, there is not a widely accepted framework in place across academic hospitals to guide this work and measure impact. This article outlines one Canadian hospital's approach and provides a blueprint with appropriate indicators as a starting point and guide for organizations looking to develop and implement a practice-based research and innovation strategy.

METHODS

An adapted framework was utilized to measure and track progress toward achievement of research and innovation strategic goals. The framework outlines key domains for research and capacity development and appropriate metrics. Data are reported from a 4-year period (2014-2018).

RESULTS

The evaluation of the practice-based research and innovation portfolio identified several important factors that contribute to the success of embedding this strategy across a large academic teaching institution. These include using a collaborative leadership model, leveraging linkages, partnerships, and collaborations, and recognizing the academic contributions of health professionals engaging in research and innovation.

CONCLUSIONS

Engaging those who provide care directly to patients and families in research and innovation is critical to ensuring high-quality health outcomes and patient experience. Creative and innovative funding models, collaborative leadership, and partnerships with key stakeholders to support research and innovation are needed to ensure sustainability.

Long-Term Outcomes of a Collaborative Regional Evidence-Based Practice Fellowship

Academic-practice partnerships provide a model for sharing resources, increasing professional knowledge and skills, improving patient outcomes, and strengthening organizational cultures of quality and safety. This article describes the long-term outcomes of a regional collaborative evidence-based practice fellowship. Results reveal the fellowship had a measurable positive impact on fellows' evidence-based practice knowledge and practice, project outcomes, professional growth, and the culture of excellence within partner organizations.

Building Capacity in Health Professionals to Conduct Quality Improvement: Evaluation From a Collaborative Interorganizational Program

BACKGROUND

The Toronto Academic Health Sciences Network Health Professions Innovation Fellowship Program began in 2014 as a pilot initiative among 4 academic teaching hospitals in Toronto, Ontario. The purpose of the Program was to cultivate applied leadership, interprofessional collaboration, and quality improvement capacity among health professionals.

PURPOSE

This article reports on the evaluation findings from the initial year as well as an update on current program status and sustainability.

METHODS

A formative evaluation was conducted focused on the impact on clinical practice, participant skill development, participant experience, and cross-organizational partnerships. Data were collected through a focus group, interviews, and pre- and postsurveys.

RESULTS

Data from the initial pilot showed increases in leadership practices, project management, and quality improvement knowledge, with changes in leadership practices being significant. Positive changes in clinical practice at both the individual and unit/team levels and capacity for building relationships were also reported. Since the pilot, more than 160 participants from 15 health professions and 9 organizations have participated. Several graduates have taken on leadership roles since their participation in the Program.

CONCLUSIONS

Health care organizations wishing to advance academic practice may benefit from implementing a similar collaborative program to reap benefits beyond organizational silos.

Building capacity for implementation-the KT Challenge

BACKGROUND

The KT Challenge program supports health care professionals to effectively implement evidence-based practices. Unlike other knowledge translation (KT) programs, this program is grounded in capacity building, focuses on health care professionals (HCPs), and uses a multi-component intervention. This study presents the evaluation of the KT Challenge program to assess the impact on uptake, KT capacity, and practice change.

METHODS

The evaluation used a mixed-methods retrospective pre-post design involving surveys and review of documents such as teams' final reports. Online surveys collecting both quantitative and qualitative data were deployed at four time points (after both workshops, 6 months into implementation, and at the end of the 2-year funded projects) to measure KT capacity (knowledge, skills, and confidence) and impact on practice change. Qualitative data was analyzed using a general inductive approach and quantitative data was analyzed using non-parametric statistics.

RESULTS

Participants reported statistically significant increases in knowledge and confidence across both workshops, at the 6-month mark of their projects, and at the end of their projects. In addition, at the 6-month check-in, practitioners reported statistically significant improvements in their ability to implement practice changes. In the first cohort of the program, of the teams who were able to complete their projects, half were able to show demonstrable practice changes.

CONCLUSIONS

The KT Challenge was successful in improving the capacity of HCPs to implement evidence-based practice changes and has begun to show demonstrable improvements in a number of practice areas. The program is relevant to a variety of HCPs working in diverse practice settings and is relatively inexpensive to implement. Like all practice improvement programs in health care settings, a number of challenges emerged stemming from the high turnover of staff and the limited capacity of some practitioners to take on anything beyond direct patient care. Efforts to address these challenges have been added to subsequent cohorts of the program and ongoing evaluation will examine if they are successful. The KT Challenge program has continued to garner great interest among practitioners, even in the midst of dealing with the COVID-19 pandemic, and shows promise for organizations looking for better ways to mobilize knowledge to improve patient care and empower staff. This study contributes to the implementation science literature by providing a description and evaluation of a new model for embedding KT practice skills in health care settings.

Addressing barriers to the conduct and application of research in complementary and alternative medicine: a scoping review

BACKGROUND

Over the past few decades, the popularity of complementary and alternative medicine (CAM) has grown considerably and along with it, scrutiny regarding its evidence base. While this is to be expected, and is in line with other health disciplines, research in CAM is confronted by numerous obstacles. This scoping review aims to identify and report the strategies implemented to address barriers to the conduct and application of research in CAM.

METHODS

The scoping review was undertaken using the Arksey and O'Malley framework. The search was conducted using MEDLINE, EMBASE, EMCARE, ERIC, Scopus, Web of Science, The Cochrane Library, JBI and the grey literature. Two reviewers independently screened the records, following which data extraction was completed for the included studies. Descriptive synthesis was used to summarise the data.

RESULTS

Of the 7945 records identified, 15 studies met the inclusion criteria. Using the oBSTACLES instrument as a framework, the included studies reported diverse strategies to address barriers to the conduct and application of research in CAM. All included studies reported the use of educational strategies and collaborative initiatives with CAM stakeholders, including targeted funding, to address a range of barriers.

CONCLUSIONS

While the importance of addressing barriers to the conduct and application of research in CAM has been recognised, to date, much of the focus has been limited to initiatives originating from a handful of jurisdictions, for a small group of CAM disciplines, and addressing few barriers. Myriad barriers continue to persist, which will require concerted effort and collaboration across a range of CAM stakeholders and across multiple sectors. Further research can contribute to the evidence base on how best to address these barriers to promote the conduct and application of research in CAM.

Nursing educators' and undergraduate nursing students' beliefs and perceptions on evidence-based practice, evidence implementation, organizational readiness and culture: An exploratory cross-sectional study

AIMS

To describe the undergraduate nursing students' and nursing educators' evidence-based practice beliefs, their extent of evidence-based practice implementation and their perspectives regarding organizational culture for evidence-based practice. To identify any relationship between the mentioned variables.

BACKGROUND

The integration of evidence-based practice in nursing curricula is crucial to educate nursing students to incorporate evidence-based practice in their future clinical practice. Therefore, to promote its integration within nursing education, it is important to deeply understand how prepared academic institutions are for teaching about and supporting evidence-based practice integration.

DESIGN

Cross-sectional study.

METHODS

Nursing educators and undergraduate nursing students from nine Portuguese nursing schools were invited to participate in this study through an electronic survey comprising socio-demographic questions and the scales.

RESULTS

Sixty-eight nursing educators replied to the survey. Most were female, have PhD and have evidence-based practice training. They showed mean scores of 88.92 ± 8.18 for evidence-based practice beliefs, 40.20 ± 18.93 for evidence-based practice implementation and 80.59 ± 17.52 for evidence-based practice organizational culture and readiness. Concerning nursing educator sample, there were moderate and statistically significant relationship between: evidence-based practice beliefs and implementation; and evidence-based practice beliefs and organizational culture and readiness for school-wide integration of evidence-based practice. Between evidence-based practice implementation and organizational culture and readiness for school-wide integration of evidence-based practice, there was a small relationship. One hundred and sixty-seven undergraduate nursing students answered the survey. Mostly, they were female and were in third or fourth year of their nursing degree. Similarly, to educators, students showed mean scores of 58.69 ± 6.92 for evidence-based practice beliefs, 32.37 ± 16.97 for evidence-based practice implementation and 84.20 ± 23.48 for evidence-based practice organizational culture and readiness. Regarding undergraduate nursing student sample, there were moderate and statistically significant relationship between the different variables.

CONCLUSIONS

Both nursing educators and undergraduate nursing students had strong evidence-based practice beliefs, but low levels of evidence-based practice implementation. In nursing educators' and undergraduate nursing students' perspectives, there were opportunities in their schools for the development of an evidence-based practice culture. Based on results, support for development and testing of interventions, specifically tailored for promoting evidence-based practice implementation in nursing educational contexts, is recommended.

Knowledge, attitude, and practice toward COVID-19 vaccination in Kazakhstan: a cross-sectional study

Background: There are several COVID-19 vaccines available and many are under different stages of development. However, vaccine hesitancy, including vaccination delays and refusals, represents a major hurdle for achieving herd immunity. The current study aims to evaluate COVID-19 vaccine hesitancy and the associated factors.Method: This is a cross-sectional survey-based study that was conducted between Aug and Nov 2020.Results: There were 417 respondents with nearly 61% females, more than 65% fall between the ages of 18 and 29 years, three-quarters holding a university degree, with more than 63% identified as single, and those who have no children represented more than 67% of the respondents. More than 36% of the respondents considered themselves COVID-19 vaccine hesitant. COVID-19 vaccine hesitancy appeared to be high among female respondents (p = .02), aged 30 years old and above (p < .001), widowed or divorced (p < .001) and those who have a child (p < .001). One of the most vaccine hesitancy influencing factors is the vaccines' country of origin.Conclusion: There appears to be a high COVID-19 vaccine hesitancy among the participants with several associated factors. The current finding provides a knowledge base for policymakers for communication improvement and confidence-building in relation to COVID-19 vaccines and vaccination.

Perceived barriers to evidence-based practice in stroke management among physiotherapists in a developing country

BACKGROUND OF STUDY

Like most healthcare disciplines, the physiotherapy profession has embraced the concept of evidence-based practice (EBP) worldwide. However, there is a discrepancy between the amount of research evidence that exists and its use in clinical decision making.

AIMS

To investigate the barriers physiotherapists in Nigeria encounter in implementing EBP in stroke management.

METHODS

This was a cross-sectional survey involving consecutively recruited 170 physiotherapists (mean age = 29.92 ± 5.72 years) from conveniently sampled centres in the six geopolitical zones in Nigeria. The Practitioner and Organizational Barriers to Evidence-based Stroke Rehabilitation Questionnaire was used to collect data on EBP among the physiotherapists. Data was summarized using frequency, percentage, mean, and SD and analysed using Spearman rank order, Kruskal-Wallis and Mann-Whitney U tests at alpha level of 0.05.

RESULTS

Insufficient time (47.6%), lack of information resources (42.9%), lack of organizational mandate (42.9%), lack of research skills (30.6%), and poor ability to critically appraise literature (29.4%) were the mostly reported barriers. Most participants had received formal training about EBP, had positive attitude and beliefs about EBP, were highly confident in their abilities to implement EBP, were aware of their roles in EBP, and were interested in acquiring and improving the skills necessary to implement EBP. There was unavailability of resources and support to promote evidence-based practice. EBP uptake was significantly facilitated by having more education on EBP, higher academic degree, less daily workload, more years of experience in stroke rehabilitation, more participation time in research and teaching, and belonging to professional association (P < .05).

CONCLUSION

Insufficient time, lack of organizational mandates, lack of research skills, poor ability to critically appraise literature and unavailability of resources and organizational support are key barriers to EBP among Nigerian physiotherapists. Nigerian physiotherapists, their regulatory board, and Government need to work in tandem to improve EBP among Nigerian physiotherapists.

Training needs assessment of intensive care nurses in Zabol University of Medical Sciences' Hospitals

BACKGROUND

The improvement of the knowledge, skill, and attitude of nurses working at the intensive care unit (ICU) through implementing training need assessment and holding continuous in-service training courses are of main requisites for providing better health services to the community. Based on this, in the present work, we are looking for the identification and prioritization of the training need of intensive care nurses in the Zabol University of Medical Sciences' hospitals.

MATERIALS AND METHODS

As a cross-sectional, descriptive study, including two phases of identification and prioritization of training needs of ICU nurses, it was conducted by a close-ended researcher-made questionnaire for collecting the data on training needs from the viewpoint nursing officials, supervisors, and head nurses of the ICU wards in the first phase and a multiple-choice scientific test plus a checklist for measuring the knowledge and skill of the nurses in the ICU in the second phase. In both phases, census method was used for collecting the data. The validity and reliability of data-gathering tools, mentioned above, were tested and verified before gathering data. Data were analyzed with the descriptive statistics.

RESULTS

The results indicated that ventilator setting according to arterial blood gas sampling and interpretation (77.81), cardiac monitoring, detecting dysrhythmia and taking immediate intervention (73.04), ventilator setting according to patient's respiratory status (68.61), airway management, oxygenation and intubation (64.39), and adults cardiopulmonary resuscitation (61.77) were the high-priority training needs of the nurses successively.

CONCLUSION

To improve the quality of training programs and upgrading the knowledge, skill, and attitude of nurses working at ICU, the significance and the weight of each training titles should be determined according to the standards and the continuous in-service training plan along with nurses' training needs and duties.

Fresno test to measure evidence-based practice knowledge and skills for Portuguese undergraduate nursing students: A translation and adaptation study

BACKGROUND

The Fresno Test was originally identified as an instrument to assess evidence-based practice knowledge and skills through cognitive testing and performance assessment in medical students. Further studies have been recommended to establish the measurement properties of the Fresno Test in different learner populations.

OBJECTIVES

To perform a cross-cultural adaptation of the Fresno Test for Portuguese undergraduate nursing students and to analyze the interrater reliability.

DESIGN

Cross-cultural adaptation study with interrater reliability assessment carried out in two phases during 2017-2018.

SETTINGS

One of the main nursing schools, Portugal.

PARTICIPANTS

Fourth year undergraduate nursing students.

METHODS

The study was performed in two phases, firstly the cross-cultural adaptation (performed in five stages) and secondly the analysis of interrater reliability.

RESULTS

Stages I, II, III and IV of the cross-cultural adaptation proceeded smoothly and the expert panel produced and agreed upon the pre-final version of Adapted Fresno Test. In stage V (the pre-test stage), students reported a general understanding of the items, but they reported a lack of knowledge to answer the test. An expert panel subsequently agreed that modifications were needed to ensure the test was within the student's competency level and to decrease risk of assessment bias. For phase II, 50 complete questionnaires were randomly selected to be rated by three independent nurses using the modified rubric to score the test. The overall interrater reliability was 0.826 with a range from 0.271 to 1.000 for each item.

CONCLUSIONS

The Adapted Fresno Test presented in this paper is the first instrument translated for European Portuguese and adapted specially for undergraduate nursing students. Despite good interrater reliability, further validation studies with more robust samples are suggested to definitively establish psychometric properties beyond the interrater reliability.

The Effectiveness of an Evidence-Based Practice (EBP) Educational Program on Undergraduate Nursing Students' EBP Knowledge and Skills: A Cluster Randomized Control Trial

Evidence-based practice (EBP) prevents unsafe/inefficient practices and improves healthcare quality, but its implementation is challenging due to research and practice gaps. A focused educational program can assist future nurses to minimize these gaps. This study aims to assess the effectiveness of an EBP educational program on undergraduate nursing students’ EBP knowledge and skills. A cluster randomized controlled trial was undertaken. Six optional courses in the Bachelor of Nursing final year were randomly assigned to the experimental (EBP educational program) or control group. Nursing students’ EBP knowledge and skills were measured at baseline and post-intervention. A qualitative analysis of 18 students’ final written work was also performed. Results show a statistically significant interaction between the intervention and time on EBP knowledge and skills (p = 0.002). From pre- to post-intervention, students’ knowledge and skills on EBP improved in both groups (intervention group: p < 0.001; control group: p < 0.001). At the post-intervention, there was a statistically significant difference in EBP knowledge and skills between intervention and control groups (p = 0.011). Students in the intervention group presented monographs with clearer review questions, inclusion/exclusion criteria, and methodology compared to students in the control group. The EBP educational program showed a potential to promote the EBP knowledge and skills of future nurses.

Step 0: The Spirit of Inquiry

It stands to reason that competency in every area of practice, including the evidence-based practice process, improves through participation in the practice. But before engagement in the evidence-based practice process can occur, Melnyk and Fineout-Overholt¹ assert, there must be a "spirit of inquiry." This column describes strategies to spark and cultivate a spirit of inquiry for evidence-based practice and barriers that can dampen the spirit.

Promoting cardiovascular nursing practice and research: A model for a university joint appointment

BACKGROUND

University joint appointments promote continuity of academic leadership and the acceleration of nurses' impact on improved outcomes and health service delivery. The role of university-appointed and hospital-located nurse scientists is of growing interest in the academic and clinical settings, and within the nursing profession. There is a pressing need to describe and study models of appointments, responsibilities and contributions to strengthen the integration of this boundary-crossing role across the continuum of the nursing profession.

AIMS AND OBJECTIVES

We report on the implementation of the inaugural St. Paul's Hospital and Heart & Stroke Professorship in Cardiovascular Nursing at the University of British Columbia, Vancouver Canada.

DISCUSSION

This model was based on recommendations provided by nursing to provincial government policy-makers, co-created and co-funded by academic and practice partners. Appointed by the university, the role is primarily located in the hospital, with the target of contributing 75% of time and focus on clinical research and leadership. The position is facilitated by its academic affiliation and the provision of university research and teaching infrastructure. In clinical practice, the role benefits from integration and visibility in the cardiac programme and leadership team, collaboration with advanced practice and multidisciplinary research groups, and access to office and human resources located on the clinical unit. Deliverables centre on achieving adjusted indicators of university performance to support academic promotion, and delivery of a practice-close research programme that prioritises improved patient outcomes, multidisciplinary practice and improved outcomes.

RELEVANCE TO CLINICAL PRACTICE

The dual appointment aims to provide tangible benefits to both the university and the hospital that match each organisation's needs; this requires sustained senior leadership engagement and support, and modification of conventional indicators of impact and success. Its ongoing evaluation will elucidate required modifications and future strategies required to strengthen nurses' academic and clinical leadership.

Best practice for chronic oedema in community settings: what can we learn?

There are various opportunities and challenges in the delivery of care to those diagnosed with chronic oedema/lymphoedema. Service provision is not consistent within the UK, and non-specialist nurses and other health professionals may be called on to fill the gaps in this area. The latest best practice guidance on chronic oedema is directed at community services that care for people within their own homes in primary care. This guide was developed in order to increase awareness, knowledge and access to an evidence base. Those involved in its creation cross specialist fields (lymphoedema and tissue viability), resulting in the document covering a number of areas, including an explanation of chronic oedema, its assessment and management and the association between chronic oedema and wet legs. The document complements existing frameworks on the condition and its management and also increases the available tools within chronic oedema management in the community. The present article provides an overview of the guidance document and discusses its salient features.

Actual and perceived knowledge of research ethics guidelines in a sample of public health clinicians

BACKGROUND

The conduct of research by clinicians is vital to maintain evidence-based practice and currency of clinician knowledge. However, the ability to conduct valid research is contingent on several factors including the knowledge of research ethics guidelines applicable within the researcher's location.

AIMS

To compare the actual and perceived knowledge of research ethics guidelines in a sample of healthcare clinicians in a public health service.

METHODS

A prospective cross-sectional design utilising an anonymous online survey.

RESULTS

Of the 432 valid responses, 8% were totally well calibrated on perceived and actual knowledge. A further 9% were totally miscalibrated on all items. The remaining 83% of respondents were variously miscalibrated on 1-4 items. The majority of miscalibrated responses represented overconfidence.

CONCLUSIONS

Clinicians are not as knowledgeable as they think about research ethics. This has implications for help-seeking behaviours within this population and highlights challenges for stakeholders in the provision of research support and education.

Implementing a pediatric oncology nursing multisite trial

PURPOSE/BACKGROUND

The Parent Educational Discharge Support Strategies (PEDSS) nursing study includes 16 magnet pediatric oncology institutions across the United States and one in Saudi Arabia, evaluating a nurse-led parent educational discharge support strategy for families experiencing a child newly diagnosed with cancer.

METHODS

During the first 3 months of the study, a research implementation survey was administered electronically to each site principal investigator to evaluate facilitators and barriers in the research process for this multisite nurse-led pediatric oncology study.

RESULTS

Facilitators included nursing leadership support and commitment from the nursing staff. Common barriers reported were the Institutional Review Board process, the consent process, the timing of the intervention, data collection, as well as nursing time for the study. Results from the survey suggest nurse-led research teams were motivated and felt the intervention was easy to deliver.

PRACTICE IMPLICATIONS

Nursing practice is enhanced when nurses participate in research and generate evidence regarding best practices within pediatric oncology nursing care.

CONCLUSION

Nursing research endeavors focusing on collaborative approaches for implementation can lead to successful nursing studies with careful planning, training and administrative support.

Identifying international barriers and facilitators to research utilization

PURPOSE

To define research utilization (RU) and identify barriers and facilitators to RU in nursing practice.

METHODS

An international integrative review of 42 studies was conducted related to barriers and facilitators of RU.

RESULTS

Following a review of the research that met the inclusion criteria, the author identifies common themes related to the implementation of research into clinical practice and the challenges surrounding RU.

CONCLUSION

Despite consistently perceived barriers to research among nurses from different geographic, cultural, and clinical backgrounds, practice changes are typically out of their hands. Further research is necessary to gauge perception among the nursing associations, regulatory bodies, healthcare organizations, policy makers, and managers responsible for implementing these changes.