Organizational Readiness for Evidence-Based Practice

Improving Capnography Use for Critically Ill Emergency Patients: An Implementation Study

OBJECTIVES

Capnography has established benefit during intubation and cardiopulmonary resuscitation (CPR). Implementation within emergency departments (EDs) has lagged. We sought to address barriers to improve documented capnography use for patients requiring intubation or CPR.

METHODS

A controlled before- and after-implementation study was performed in 2 urban EDs. The control site had an existing policy for capnography use. Interventions for the experimental site included a 5-minute informational video, placement of capnography monitors with a shortened warm-up period in all resuscitation rooms, laminated reminder cards, and feedback during staff meetings. Staff members were surveyed about knowledge before and after the intervention. Records were reviewed for documented capnography use for 3 months before and 6 months after the intervention. Change in documented use at the experimental site was compared with the control site.

RESULTS

At the experimental site, 118 providers participated and 190 records were reviewed; 544 records were reviewed from the control site. There was a significant increase in the proportion of documented capnography use at the experimental site (8% versus 19%, P = 0.04) compared with the control site (64% versus 71%, P = 0.10). However, there was no significant trend over time at the experimental site after the intervention (P = 0.86). Despite high baseline knowledge about capnography, providers had improvements in survey responses regarding indications for intubation and CPR, normal values, and minimum effective values during CPR.

CONCLUSIONS

Documented capnography use increased with simple interventions but with no positive trend. Additional work is needed to improve use, including further evaluation of capnography's implementation in the ED.

Military nurses' perspectives towards research utilization barriers

OBJECTIVES

Research utilization in nursing practice includes integrating research findings into clinical practice to guide nursing practice towards safe and effective clinical decision-making. However, nursing leaders are faced with barriers which hinder research utilization and hence create a gap between research and clinical practice. This study aimed to identify the barriers to research utilization as perceived by Jordanian Royal Medical Services nurses.

METHODS

A descriptive cross-sectional design was employed. A convenience sample of 365 nurses working with the Jordanian Royal Medical Services was recruited from three hospitals. The BARRIERS scale and a self-designed questionnaire were used for data collection, and descriptive statistics, t-tests, one way ANOVA, and Pearson's correlation were used to analyze the data.

RESULTS

The mean age of the participants was 30 years. The majority of the participating nurses were female (62.5%), and 91.8% held a bachelor's degree. Overall, the greatest barrier to research utilization was related to the setting factor (mean = 3.01), followed by the presentation of research factor (mean = 2.86). Further, lack of time to read research identified as a top-ranked barrier among the individual items (m = 3.3). In addition, there were significant differences in the participants' mean BARRIERS scale scores based on age and hospital (p value = .002 and <.0001, respectively).

CONCLUSION

The study findings highlighted the need for organizational support, recognition, and encouragement of research utilization. Continuous education for nurses that focuses on research skills, knowledge, and awareness is also crucial.

Organizational structures and processes in nurse-led, evidence-based practice projects that lead to measurable outcomes: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to describe health care organizational structures and processes that support implementation of nurse-led, evidence-based practice projects resulting in improvements in outcome measures.

INTRODUCTION

Many health care organizations claim to support evidence-based practice methodology; however, a gap exists between knowledge generation and its use in routine clinical practice. This scoping review protocol will examine the status of organizational factors impacting implementation of evidence-based practices and reported outcomes.

INCLUSION CRITERIA

This scoping review will consider all literature that includes descriptions of health care organizations' structures or support of evidence-based nursing programs or efforts that include outcomes. Health care organizations are defined as primary/secondary/tertiary, public/private, for profit/non-profit hospitals, medical centers, or multi-hospital systems. Literature will be excluded if the evidence-based practice project does not report the organizational structures that supported the implementation for the project. In addition, literature will be excluded if the program is not inclusive of nursing.

METHODS

Literature published in English from 1992 to present will be included. The databases to be searched include MEDLINE, CINAHL, Cochrane, and Embase. The search for unpublished evidence and gray literature will include ProQuest Dissertations & Theses Global, ANCC Magnet conferences, and government publications. Retrieval of full-text studies and data extraction will be performed independently by two reviewers. The extracted data will be presented in a tabular format with accompanying narrative summary.

Leveraging knowledge translation and implementation science in the pursuit of evidence informed health professions education

Evidence informed approaches to health professions education can ensure accountability to learners and society in providing meaningful and effective education and helping resource strained systems via streamlined and cost-efficient practices. Knowledge translation and implementation science are two areas of study originally developed in clinical medicine in response to concerns that health care practices were incongruent with the scientific evidence. Two decades of research have led to important advances in our understanding of the nature and magnitude of research-practice gaps, the factors that support or impede adoption of evidence in clinical decision-making, and in the design and evaluation of theory driven interventions to reduce gaps. This paper borrows concepts from knowledge translation and implementation science to further our thinking about how health professions education can 'truly' be evidence informed. The article is organised in four sections: a discussion of the impetus for the evidence informed health professions education movement; a description of the origins of knowledge translation and implementation science; a discussion on how knowledge translation and implementation science can be leveraged to advance the evidence informed health professions education agenda; and suggestions for future discussion and research. An example is used to illustrate the application of the underpinning principles of knowledge translation and implementation science. The authors suggest a theory driven, staged and systematic approach that integrates knowledge translation principles and processes and involves key stakeholders interested in promoting the application of educational research of evidence.

A survey for the readiness of Greek midwives for the adoption of evidence-based practice (EBP)

INTRODUCTION

The holistic approach of healthcare practice in midwifery demands the use of evidence-based practice (EBP) in all aspects of clinical care. Applying EBP in every day healthcare practice by midwives offers various significant benefits. The aim of the present study was to investigate and assess the knowledge and awareness of midwives in Greece with regard to EBP.

METHODS

Data collection took place from October 2012 to January 2013 among midwifery staff within two national ‘urban’ healthcare hospitals of Athens and the department of midwifery in the Athens Technological Institute. The sample consisted of 209 participants of which 109 were midwives and 100 student midwifes. Both were invited to complete a questionnaire specifically designed for the study.

RESULTS

Only 43.5% of midwives declared awareness of the term EBP, while 36.4% had to search for general evidence about twice a month in order to support their role. The first source of information to support clinical practice was found to be ‘asking colleagues’ (52.2%) followed by ‘internet search in general’ (48.8%), but not in the EBP databases. In addition, 61.2% of respondents stated that EBP would definitely contribute to the provision of better quality midwifery care.

CONCLUSIONS

For a successful implementation of EBP, it is required initially to train personnel to develop their abilities, to provide information on the way to use different data sources and encourage midwifery personnel to take initiatives and be part of the decision-making process.

Development, implementation and evaluation of an evidence-based practice model in a new hospital in Chile

AIMS

To describe an implementation programme for an evidence-based practice (EBP) model in a new Chilean hospital and to analyse the programme evaluation results.

BACKGROUND

Evidence-based practice is key to professional nursing for improving health care safety and quality.

METHODS

First, a literature review was performed to develop an institutional EBP model. Second, internal and external analyses contributed to assessing facilitators for and barriers to implementation. Third, a multi-stage implementation plan was conducted. Fourth, process and outcome indicators were evaluated.

RESULTS

The model considered the basic elements of EBP and outlined different decision-making levels in clinical practice. Several facilitators for implementation were identified. Each implementation stage included activities addressing EBP knowledge, attitude and skills. Outcome indicators showed significant improvement regarding knowledge (p = .038). Providers with formal EBP training, compared with providers without training, showed a significant difference of 8.6% (0.6 points) in the average CPBE-19 score in knowledge, attitude and application in the last evaluation (p < .01).

CONCLUSION

Having an EBP programme with ongoing implementation strategies improves knowledge over time, and formal training enhances positive results.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers can build an institutional research culture to improve the quality of care using an EBP programme that fits organisational needs.

Factors Affecting Implementation of Evidence-Based Practices in Public Health Preparedness and Response

CONTEXT

There is limited research on what factors are most salient to implementation of evidence-based practices (EBPs) among public health agencies in public health emergency preparedness and response (PHPR) and under what conditions EBP implementation will occur.

OBJECTIVE

This study assessed the conditions, barriers, and enablers affecting EBP implementation among the PHPR practice community and identified opportunities to support EBP implementation.

DESIGN

A Web-based survey gathered information from public health agencies. Data obtained from 228 participating agencies were analyzed.

SETTING

State, local, and territorial public health agencies across the United States.

PARTICIPANTS

Preparedness program officials from 228 public health agencies in the United States, including Public Health Emergency Preparedness (PHEP) cooperative agreement awardees (PHEP awardees) and a random sample of local health departments (LHDs).

RESULTS

Respondents indicated that EBP is necessary and improves PHPR functions and tasks and that staff are interested in improving skills for EBP implementation. Top system-level barriers to EBP implementation were insufficient funding, lack of EBP, and lack of clarity regarding which practices are evidence based. PHEP awardees were significantly more likely to report a lack of EBP in the field, whereas LHDs were significantly more likely to report a lack of incentives. The top organizational-level barrier was insufficient staff. Most respondents indicated their agency culture supports EBP; however, LHDs were significantly more likely to report a lack of support from supervisors and leadership. Few respondents reported individual barriers to EBP implementation.

CONCLUSIONS

Findings indicate an opportunity to improve dissemination strategies, communication efforts, and incentives to support EBP implementation in PHPR. Potential strategies include improving awareness of and accessibility to EBPs through targeted dissemination efforts; building organizational capacity to support EBP implementation, particularly staff capacity, knowledge, and skills; and identifying funding and incentives to promote EBP uptake and sustainment.

Evaluation of Facilitators and Barriers to Implementing Evidence-Based Practice in the Health Services: A Systematic Review

BACKGROUND

Evidence-based practice (EBP) is an ambition for health service administrators. We aimed to systematically review the major relevant articles in case of barriers and facilitators to implementing evidence-based practice in health services.

MATERIALS AND METHODS

The type of study was a systematic review. We searched the libraries and online sources such as PubMed, MEDLINE, Wiley, EMBASE, ISI Web of Knowledge, Scopus, Science Direct, Cochrane Library, and Google scholar. We used keywords included "Evidence-Based Practice", "Evidence-Based Management", "Healthcare", "Care Management, Evidence-Based Healthcare Management", "Health Care", Health", "Barrier", "Facilitator", policy and "Evidence-Based Healthcare".

RESULTS

In total, 12 studies were included. Several barriers and facilitators were recognized through the included papers, the factors such as organization support and a helpful education system improved skills, knowledge, and confidence to EBP. The outcomes of studies were identified as the employ of the internet as a highest-rated skill for increasing EBP quality.

CONCLUSION

Generally, the results showed health service administrators should first identify barriers of EBP then transferred them to facilitators to the implementation of proper and efficient EBP.

Translation of Evidence-Based Practice: Quality Improvement and Patient Safety

Using knowledge gained from the disciplines of nursing, medicine, health care management, and medical and health services research, the quality improvement movement attempts to mobilize people within the health care system to work together in a systematic way using evidence based strategies and tactics to improve the care they provide. In this valuable work, discipline-specific knowledge is combined with experiential learning and discovery to make improvements. Quality improvement provides a knowledge-based framework and methods for the change agent to work toward a more predictable, effective, efficient, reliable, equitable, patient-centered care health care system.

Improving the accuracy of fluid intake charting through patient involvement in an adult surgical ward: a best practice implementation project

OBJECTIVES

The main objective of this evidence-based utilization project was to improve the accuracy of fluid intake charting through patient involvement.

INTRODUCTION

The accurate documentation and maintenance of fluid balance charts constitute an integral part of nursing care. However, inaccuracies in fluid balance charting by nurses often occur. Inaccurate charting can result in delayed interventions, affecting the safety of patients. It has been found that fluid intake charting in an acute surgical inpatient ward is highly inaccurate. Many expressions of dissatisfaction are evident among medical healthcare professionals and patients regarding the accurate updating of the charts. Therefore, evidence-based measures need to be implemented in order to improve the safety of patient care through accurate recording of patients' fluid intake.

METHODS

The project took place in a 21-bed acute surgical ward which had 30 patients. The Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI-PACES) and Getting Research into Practice (GRiP) tools were used to implement the evidence-based project. A pre- and post- audit methodology congruent with the framework was applied. The project was implemented in three phases from April to September 2016. The audit criteria obtained from JBI-PACES were used. The project's primary focus was to harness patient involvement in improving the accuracy of fluid intake charting.

RESULTS

Criteria 1 and 2 revealed low levels of compliance during the pre-implementation audit, 3% and 10%, respectively. There were significant improvements one month post-implementation for both Criteria 1 and 2, 100% and 87%, also respectively. Fisher's exact test was carried out and the statistical significance of the results was achieved (p < 0.001), compared to the pre-implementation audit. At six months post-implementation, the audit found that both criteria were adequately sustained as a practice in the ward (Criterion 1: 100%, Criterion 2: 83%).

CONCLUSIONS

This project has demonstrated the effectiveness of improving the accuracy of fluid intake charting through patient involvement. The use of JBI-PACES and GRiP has allowed the effective utilization of evidence in practice. It has also provided evidence that effective engagement of the ground nurses and stakeholders coupled with the commitment of change champions and ground nurses can contribute to improving practice in a highly demanding acute care setting and lead to healthcare success.

The role of organizational context in the implementation of a statewide initiative to integrate mental health services into pediatric primary care

BACKGROUND

Although there is evidence that mental health services can be delivered in pediatric primary care with good outcomes, few changes in service delivery have been seen over the past decade. Practices face a number of barriers, making interventions that address determinants of change at multiple levels a promising solution. However, these interventions may need appropriate organizational contexts in place to be successfully implemented.

PURPOSE

The objective of this study was to test whether organizational context (culture, climate, structures/processes, and technologies) influenced uptake of a complex intervention to implement mental health services in pediatric primary care.

METHODOLOGY/APPROACH

We incorporated our research into the implementation and evaluation of Ohio Building Mental Wellness Wave 3, a learning collaborative with on-site trainings and technical assistance supporting key drivers of mental health care implementation. Simple linear regression was used to test the effects of organizational context and external or fixed organizational characteristics on program uptake.

RESULTS

Culture, structure/processes, and technologies scores indicating a more positive organizational context for mental health at the project's start, as well as general cultural values that were more group/developmental, were positively associated with uptake. Patient-centered medical home certification and use of electronic medical records were also associated with greater uptake. Changes in context over the course of Building Mental Wellness did not influence uptake.

CONCLUSION

Organizational culture, structures/processes, and technologies are important determinants of the uptake of activities to implement mental health services in pediatric primary care. Interventions may be able to change these aspects of context to make them more favorable to integration, but baseline characteristics more heavily influence the more proximal uptake of program activities.

PRACTICE IMPLICATIONS

Pediatric primary care practices would benefit from assessing their organizational context and taking steps to address it prior to or in a phased approach with mental health service implementation.

Best Practices in the Management of Central Vascular Access Devices: An Observational Study in Areas With a High Prevalence of Trained Nurses

Since 2009, the Department of Continuing Education at the Orthopedic and Trauma Center Hospital in Turin, Italy, has provided a training course for nurses in the management of central vascular access devices (CVADs). The course focuses on dressing and flushing procedures, as well as compliance with other CVAD guidelines. An observational study was conducted among nurses to determine the level of best practices in areas with a high prevalence of nurses trained in the management of CVADs. A correlation was observed between best practices and having attended the course, but other variables also influenced best practices.

Health care professionals' readiness for an interprofessional orthogeriatric unit: A cross-sectional survey

An assessment of readiness for change can set the stage for the implementation by providing information regarding staff members' beliefs and attitudes prior to an organizational change. We conducted a cross-sectional survey to assess readiness for change (N = 113 employees) in a hospital on the verge of implementing an interprofessional, co-managed orthogeriatric unit. Staff members from three departments with roles related to orthogeriatric patients were invited to answer a web-based questionnaire. Our survey demonstrates that health care professionals are confident that interprofessional collaboration will be promoted by the implementation of orthogeriatric care. We found they were knowledgeable about the proposed orthogeriatric collaboration model and ready to engage in its implementation. Their concerns pertained to various practical aspects; those voiced by the nursing staff related to work strain and the work-related interests of their professional group whereas the physicians' reservations concentrated on the planning of the change. The exploration of readiness for organizational change among health care professionals offers managers an understanding of their motivations and concerns and provides a useful tool for the planning and implementation of a new interprofessional collaboration model.

Facilitators and barriers to evidence-based practice: perceptions of nurse educators, clinical coaches and nurse specialists from a descriptive study

BACKGROUND

Implementation of evidence-based practice (EBP) is a major initiative within health care settings to ensure clinical and policy decisions incorporate best available evidence.

AIMS

This paper reports findings from a descriptive study exploring nurse educators', clinical coaches' and nurse specialists' perceptions of factors associated with using EBP.

METHODS

Data was collected from a senior group of nurses working in a tertiary health care network in Victoria, Australia by employing a questionnaire that was distributed to a total of 435 people, of whom 135 responded.

DATA ANALYSIS

Descriptive statistics for each questionnaire item were determined using SPSS (Statistical Package for Social Sciences version 17). Thematic analysis was performed for the qualitative part of the questionnaire. Results Findings revealed that organisational support, sufficient resources, and access to continuing education were perceived as factors promoting acceptance of EBP. Barriers to such acceptance in health care settings were identified as lack of knowledge and skills, poor time allowance, limited support, and insufficient resources.

CONCLUSION

The reported findings create evidence-based information for organisational strategic planning. Organisations need to develop educational programs to promote EBP and employ strategies to overcome barriers to implementation.

The evidence-based practice readiness survey: a structural equation modeling approach for a Greek sample

The present study reports on the translation, cultural adaptation and validation of the Evidence-Based Practice Readiness Survey into the Greek language. Back-translation strategy for cross-cultural research was used to translate the questionnaire into Greek. The psychometric measurements that were performed included: reliability coefficients and explanatory factor analysis using a Varimax Rotation and Principal Components Method. In a further step, confirmatory analysis of the principal components was conducted. The internal consistency of the Greek Evidence-Based Practice Readiness Survey version, as assessed by the Cronbach's alpha coefficient, showed satisfactory results. The value for alpha was found equal to 0.85. The explanatory and confirmatory factor analysis demonstrated a four-factor structure of the tool.

Barriers to Implementing Evidence-Based Intrapartum Care: A Descriptive Exploratory Qualitative Study

BACKGROUND

Evidence based practice is an effective strategy to improve the quality of obstetric care. Identification of barriers to adaptation of evidence-based intrapartum care is necessary and crucial to deliver high quality care to parturient women.

OBJECTIVES

The current study aimed to explore barriers to adaptation of evidence-based intrapartum care from the perspective of clinical groups that provide obstetric care in Iran.

MATERIALS AND METHODS

This descriptive exploratory qualitative research was conducted from 2013 to 2014 in fourteen state medical training centers in Iran. Participants were selected from midwives, specialists, and residents of obstetrics and gynecology, with a purposive sample and snowball method. Data were collected through face-to-face semi-structured in-depth interviews and analyzed according to conventional content analysis.

RESULTS

Data analysis identified twenty subcategories and four main categories. Main categories included barriers were related to laboring women, persons providing care, the organization environment and health system.

CONCLUSIONS

The adoption of evidence based intrapartum care is a complex process. In this regard, identifying potential barriers is the first step to determine and apply effective strategies to encourage the compliance evidence based obstetric care and improves maternity care quality.

Educational Intervention for an Evidence-Based Nursing Practice of Skin-to-Skin Contact at Birth

This article presents the development and evaluation of an educational intervention aiming at an evidence-based practice of skin-to-skin contact at birth among nurses of a maternity care unit. Based on the Iowa Model of Evidence-Based Practice to Promote Quality Care, four educational sessions were developed according to an active-learning pedagogy. Even if the nurses' practice did not fully meet the recommendations for skin-to-skin contact, a pre- and postintervention evaluation showed some positive results, such as a longer duration of skin-to-skin contact immediately after birth, delivery of some routine care directly on mothers' chest, and improved parent education. The educational intervention seems to have enacted some evidence-based nursing practice changes regarding skin-to-skin contact at birth.

Adjusting Bowel Regimens When Prescribing Opioids in Women Receiving Palliative Care in the Acute Care Setting

In palliative medicine, constipation is the third most common symptom after pain and anorexia, causing some patients to discontinue opioid therapy. Women experience higher incidence of constipation than men. The prevalence of infrequent bowel movements (<3 times/wk) and adherence to an established bowel regimen among women receiving opioids were studied. Referral to the palliative care team decreased the prevalence of infrequent bowel movements from 72% to 45%, and algorithm adherence increased from 38% to 78%. Education of oncology nurses decreased the prevalence of infrequent bowel movements among patients with cancer from 71% to 60%, and algorithm adherence increased from 0% to 10%. Patients benefit from stool softeners and stimulants when receiving opioids.

Factors influencing evidence-based practice for community nurses

Factors influencing the development of evidence-based nursing practice (EBNP) were examined in Prince Edward Island, Canada. An adapted electronic questionnaire was distributed to practicing registered nurses and nurse practitioners (n=68). An analysis of variance revealed a significant difference between nurses' clinical practice setting and the EBNP scale. Significant differences were also found between age and education level when compared with the EBNP subscales where novice nurses were less likely to rely on experience and intuition, and expert nurses with a higher level of education reported being more skilful at synthesising and applying information from research findings into their nursing practice.

Adoption of Evidence-Based Health Promotion Programs: Perspectives of Early Adopters of Enhance(®)Fitness in YMCA-Affiliated Sites

Purpose

To identify facilitators and barriers among early adopters of Enhance^®Fitness (EF), in Young Men’s Christian Association-affiliated (Y-affiliated) sites from the perspective of program staff. EF is an evidence-based group exercise program for seniors.

Methods

This qualitative study used semi-structured phone interviews with 15 staff members representing 14 Y-affiliated sites. Interviews were digitally recorded, transcribed, and analyzed using qualitative content analysis informed by the RE-AIM framework.

Findings

Staff were, on average, 48.7 years old (SD 13.5) and had been involved with EF for 5.2 years (SD 3.1). Key themes related to facilitating adoption of EF were: match with the Y mission, support from different organizational levels, match between the target population need and EF, initial and on-going financial support, presence of champions, novelty of EF, an invitation to partner with a community-based organization to offer EF, and program-specific characteristics of EF. Key themes related to barriers interfering with EF adoption included competing organizational programs and space limitations, limited resources and expertise, and costs of offering the program.

Implications

Our findings identify the types of organizational support needed for adoption of evidence-based health promotion programs like EF. Recommendations for practice, research, and policy based on the findings, including assessing organizational readiness, researching late adopters, and developing revenue streams, may help facilitate program adoption. Packaging and sharing these practical recommendations could help community-based agencies and nationally networked organizations facilitate adoption of EF and other evidence-based programs.

Evaluation of graduate nursing students' information literacy self-efficacy and applied skills

Maintaining evidence-based nursing practice requires information literacy (IL) skills that should be established prior to completing an undergraduate nursing degree. Based on Bandura's social cognitive theory, this cross-sectional descriptive correlational study assessed the perceived and applied IL skills of graduate nursing students from two family nurse practitioner (FNP) programs in the midwestern United States. Results showed that although the 26 newly admitted FNP students demonstrated a high level of confidence in their IL skills, the students did not perform well in the actual IL skills test. According to Bandura, the students' confidence in their IL knowledge should allow students to be engaged in course activities requiring IL skills. Nurse educators teaching in undergraduate or graduate programs are in key positions to incorporate IL experiences into class activities to allow for skill assessment and further practice. Further research is needed on nursing students' IL self-efficacy and performance.

What are the factors of organisational culture in health care settings that act as barriers to the implementation of evidence-based practice? A scoping review

BACKGROUND

The responsibility to implement evidence-based practice (EBP) in a health care workplace does not fall solely on the individual health care professional. Organisational barriers relate to the workplace setting, administrational support, infrastructure, and facilities available for the retrieval, critique, summation, utilisation, and integration of research findings in health care practices and settings.

OBJECTIVE

Using a scoping review approach, the organisational barriers to the implementation of EBP in health care settings were sought.

METHOD

This scoping review used the first five of the six stage methodology developed by Levac et al. (2010). The five stages used are: 1) Identify the research question; 2) identify relevant studies; 3) study selection; 4) charting the data; and 5) collating, summarising and reporting the results. The following databases were searched from January 2004 until February 2014: Medline, EMBASE, EBM Reviews, Google Scholar, The Cochrane Library and CINAHL.

RESULTS

Of the 49 articles included in this study, there were 29 cross-sectional surveys, six descriptions of specific interventions, seven literature reviews, four narrative reviews, nine qualitative studies, one ethnographic study and one systematic review. The articles were analysed and five broad organisational barriers were identified.

CONCLUSIONS

This scoping review sought to map the breadth of information available on the organisational barriers to the use of EBP in health care settings. Even for a health care professional who is motivated and competent in the use of EBP; all of these barriers will impact on their ability to increase and maintain their use of EBP in the workplace.

Implementation of newly adopted technology in acute care settings: a qualitative analysis of clinical staff

Technologies are not always successfully implemented into practice. This study elicited experiences of acute care providers with the introduction of technology and identified barriers and facilitators in the implementation process. A qualitative study using one-on-one interviews among a purposeful sample of 19 physicians and nurses within 10 emergency departments and intensive care units was performed. Grounded theory, iterative data analysis and the constant comparative method were used to inductively generate ideas and build theories. Five major categories emerged: decision-making factors, the impact on practice, technology's perceived value, facilitators and barriers to implementation. Barriers included negative experiences, age, infrequent use and access difficulties. A positive outlook, sufficient training, support staff and user friendliness were facilitators. This study describes strategies implicated in the successful implementation of newly adopted technology in acute care settings. Improved implementation methods and evaluation of implementation processes are necessary for successful adoption of new technology.

Perceived knowledge, skills, attitude and contextual factors affecting evidence-based practice among nurse educators, clinical coaches and nurse specialists

Evidence-based practice (EBP) in the clinical setting is recognized as an approach that leads to improved patient outcomes. Nurse educators (NEs), clinical coaches (CCs) and nurse specialists are in key positions to promote and facilitate EBP within clinical settings and have opportunities to advance practice. Therefore, it is important to understand their perceptions of factors promoting EBP and perceived barriers in facilitating EBP in clinical settings, before developing educational programmes. This paper reports findings from a study that aimed to explore NEs' , CCs' and nurse specialists' knowledge, skills and attitudes associated with EBP. This study used a questionnaire containing quantitative and a small number of qualitative questions to capture data collected from NEs, CCs and nurse specialists working at a tertiary health-care facility in Victoria, Australia. The questionnaire was distributed to a total of 435 people, of whom 135 responded (31%). Findings revealed that the three senior nurse groups relied heavily on personal experience, organizational policies and protocols as formal sources of knowledge. Furthermore, they had positive attitudes towards EBP. However, participants demonstrated lack of knowledge and skills in appraising and utilizing evidence into practice. They indicated a desire to seek educational opportunities to upskill themselves in the process of EBP.

Exploring factors associated with nurses' adoption of an evidence-based practice to reduce duration of catheterization

Hospitalized adult patients are at increased risk for adverse outcomes, particularly when undergoing invasive procedures that include indwelling urinary catheterization. This study identified factors associated with nurses' adoption of an evidence-based practice to reduce the duration of catheterization and potential for catheter-associated urinary tract infections in hospitalized adults.

Evidence utilisation project: Management of inadvertent perioperative hypothermia. The challenges of implementing best practice recommendations in the perioperative environment

AIMS

The prevention of inadvertent perioperative hypothermia (IPH) remains an important issue in perioperative healthcare. The aims of this project were to: (i) assess current clinical practice in the management of IPH and (ii) promote best practice in the management of IPH in adult operating theatres.

METHODS

This project from August 2010 to March 2012 utilised a system of audit and feedback to implement best practice recommendations. Data were collected via chart audits against criteria developed from best practice recommendations for managing IPH. Evidence-based best practices, such as consistent temperature monitoring and patient warming, were implemented using multifaceted interventions.

RESULTS

Perioperative records for 73 patients (baseline) and 72 patients (post-implementation) were audited. Post-implementation audit showed an increase in patients with temperatures >36°C admitted to the post-anaesthetic care unit (PACU) (8%) and discharged from PACU (28%). The percentage of patients receiving preoperative temperature monitoring increased (38%); however, low levels of intraoperative monitoring remained (31% of patients with surgery of 30 min or longer duration). Small increases were found in patient warming of 5% intraoperatively and 8% postoperatively. Preoperative warming was not successfully implemented during this phase of the project.

CONCLUSION

Temperature monitoring, warming and rates of normothermia improved; however, barriers to best practice of IPH management were experienced, which negatively impacted on the project. Further stages of implementation and audit were added to further address IPH management in this department.

Evidence based practice beliefs and implementation among nurses: a cross-sectional study

Background

Having a positive attitude towards evidence-based practice and being able to see the value of evidence-based practice for patients have been reported as important for the implementation of evidence-based practice among nurses.

The aim of this study was to map self-reported beliefs towards EBP and EBP implementation among nurses, and to investigate whether there was a positive correlation between EBP beliefs and EBP implementation.

Method

We carried out a cross-sectional study among 356 nurses at a specialist hospital for the treatment of cancer in Norway. The Norwegian translations of the Evidence-based Practice Belief Scale and the Evidence-based Practice Implementation Scale were used.

Results

In total, 185 nurses participated in the study (response rate 52%). The results showed that nurses were positive towards evidence-based practice, but only practised it to a small extent. There was a positive correlation (r) between beliefs towards evidence-based practice and implementation of evidence-based practice (r = 0.59, p = 0.001).

There was a statistical significant positive, but moderate correlation between all the four subscales of the EBP Beliefs Scale (beliefs related to: 1) knowledge, 2) resources, 3) the value of EBP and 4) difficulty and time) and the EBP Implementation Scale, with the highest correlation observed for beliefs related to knowledge (r = 0.38, p < .0001). Participants who had learned about evidence-based practice had significantly higher scores on the Evidence-based Practice Belief Scale than participants who were unfamiliar with evidence-based practice. Those involved in evidence-based practice working groups also reported significantly higher scores on the Evidence-based Practice Belief Scale than participants not involved in these groups.

Conclusion

This study shows that nurses have a positive attitude towards evidence-based practice, but practise it to a lesser extent. There was a positive correlation between beliefs about evidence-based practice and implementation of evidence-based practice. Beliefs related to knowledge appear to have the greatest effect on implementation of evidence-based practice. Having knowledge and taking part in evidence-based practice working groups seem important.

Increasing the practice of questioning among pediatric nurses: "The Growing Culture of Clinical Inquiry" project

This paper describes an innovative methodology implemented in an acute care pediatric setting to build nurses' confidence and competence in questioning practice. The Growing Culture of Clinical Inquiry (GCCI) project was composed of several evidence-based strategies to attain and maintain a spirit of clinical inquiry. These strategies included PowerPoint presentations, evidence-based practice (EBP) unit champions, patient-intervention-comparison-outcome (PICO) boxes, Clinical Inquiry Posters, summaries of evidence (SOE), layman's SOE, medical librarian in-services, and journal clubs. After 1 year of implementation, the GCCI project was evaluated and found to be a promising methodology for fostering a culture of inquiry among pediatric nurses.

An outcome of evidence-based practice education: sustained clinical decision-making among bedside nurses

This research described factors related to incorporating evidence-based practice for clinical decision-making by staff nurses who completed an evidence-based practice (EBP) scholars program. A phenomenological approach was used with focus groups to collect data. A semi-structured questionnaire and field notes comprised study instruments. Audio tapes were transcribed and semantic content analysis was used to code data. Programs to teach bedside nurses how to incorporate EBP into care delivery not only result in better outcomes for patients but also greatly contribute to the sustained enculturation of EBP as a foundation for nursing practice.

Knowledge translation and improving practices in neurological rehabilitation: managers' viewpoint

BACKGROUND

Studies in neurological rehabilitation have been undertaken in recent years to improve knowledge transfer. The manager is an important player in the health care system, yet few studies have examined their role in knowledge transfer. The main objective was to explore the importance of knowledge transfer and improving practices from the viewpoint of managers of neurological rehabilitation programs.

METHODS

An exploratory qualitative research design was used. Three case studies were conducted by way of semi-structured one-on-one interviews with neurological rehabilitation program managers. To be eligible, managers had to give their informed consent and have had responsibilities directly related to the coordination of clinicians working in neurological rehabilitation for at least a year. Data collected were recorded and transcribed. Each interview was synthesized and its content was carefully analysed.

RESULTS

The three managers' experience in neurology varied from a year to several decades. They believe that knowledge transfer is important but it appears to be less of a priority because of their numerous other responsibilities. Participants said they perceived their role in this process as being a coach, facilitator, motivator, organizer, guide and ambassador. They mentioned reacting to the needs expressed by the clinicians but, when asked, said they would like to be more proactive and structured in their approach.

CONCLUSIONS

This study points up the lack of organizational structure fostering uniform knowledge translation across all clinicians, although the managers expect it to happen in the near future or would like to see it in an ideal world.

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

OBJECTIVES

Evidence-based practice (EBP) may help improve healthcare quality. However, not all healthcare professionals and managers use EBP in their daily practice. We systematically reviewed the literature to summarise self-reported appreciation of EBP and organisational infrastructure solutions proposed to promote EBP.

DESIGN

Systematic review. Two investigators independently performed the systematic reviewing process.

INFORMATION SOURCES

MEDLINE, EMBASE and Cochrane Library were searched for publications between 2000 and 2011.

ELIGIBILITY CRITERIA FOR INCLUDED STUDIES

Reviews and surveys of EBP attitude, knowledge, awareness, skills, barriers and facilitators among managers, doctors and nurses in clinical settings.

RESULTS

We found 31 surveys of fairly good quality. General attitude towards EBP was welcoming. Respondents perceived several barriers, but also many facilitators for EBP implementation. Solutions were proposed at various organisational levels, including (inter)national associations and hospital management promoting EBP, pregraduate and postgraduate education, as well as individual support by EBP mentors on the wards to move EBP from the classroom to the bedside.

CONCLUSIONS

More than 20 years after its introduction, the EBP paradigm has been embraced by healthcare professionals as an important means to improve quality of patient care, but its implementation is still deficient. Policy exerted at microlevel , middlelevel and macrolevel, and supported by professional, educational and managerial role models, may further facilitate EBP.

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

OBJECTIVES

Evidence-based practice (EBP) may help improve healthcare quality. However, not all healthcare professionals and managers use EBP in their daily practice. We systematically reviewed the literature to summarise self-reported appreciation of EBP and organisational infrastructure solutions proposed to promote EBP.

DESIGN

Systematic review. Two investigators independently performed the systematic reviewing process.

INFORMATION SOURCES

MEDLINE, EMBASE and Cochrane Library were searched for publications between 2000 and 2011.

ELIGIBILITY CRITERIA FOR INCLUDED STUDIES

Reviews and surveys of EBP attitude, knowledge, awareness, skills, barriers and facilitators among managers, doctors and nurses in clinical settings.

RESULTS

We found 31 surveys of fairly good quality. General attitude towards EBP was welcoming. Respondents perceived several barriers, but also many facilitators for EBP implementation. Solutions were proposed at various organisational levels, including (inter)national associations and hospital management promoting EBP, pregraduate and postgraduate education, as well as individual support by EBP mentors on the wards to move EBP from the classroom to the bedside.

CONCLUSIONS

More than 20 years after its introduction, the EBP paradigm has been embraced by healthcare professionals as an important means to improve quality of patient care, but its implementation is still deficient. Policy exerted at microlevel , middlelevel and macrolevel, and supported by professional, educational and managerial role models, may further facilitate EBP.

Evidence-based practice models for organizational change: overview and practical applications

AIM

To provide an overview, summary of key features and evaluation of usefulness of six evidence-based practice models frequently discussed in the literature.

BACKGROUND

The variety of evidence-based practice models and frameworks, complex terminology and organizational culture challenges nurses in selecting the model that best fits their practice setting.

DATA SOURCES

The authors: (1) initially identified models described in a predominant nursing text; (2) searched the literature through CINAHL from 1998 to current year, using combinations of 'evidence', 'evidence-based practice', 'models', 'nursing' and 'research'; (3) refined the list of selected models based on the initial literature review; and (4) conducted a second search of the literature on the selected models for all available years to locate both historical and recent articles on their use in nursing practice.

DISCUSSION

Authors described model key features and provided an evaluation of model usefulness based on specific criteria, which focused on facilitating the evidence-based practice process and guiding practice change.

IMPLICATIONS FOR NURSING

The evaluation of model usefulness can be used to determine the best fit of the models to the practice setting.

CONCLUSION

The Johns Hopkins Model and the Academic Center for Evidence-Based Practice Star Model emphasize the processes of finding and evaluating evidence that is likely to appeal to nursing educators. Organizations may prefer the Promoting Action on Research Implementation in Health Services Framework, Advancing Research and Clinical Practice Through Close Collaboration, or Iowa models for their emphasis on team decision-making. An evidence-based practice model that is clear to the clinician and fits the organization will guide a systematic approach to evidence review and practice change.

Using Diffusion of Innovations Theory to implement the confusion assessment method for the intensive care unit

Routine screening of mechanically ventilated patients for delirium is essential for prompt recognition and management; however, this represents a change in practice. Rogers' Diffusion of Innovations Theory can be useful as a strategy to facilitate adoption of a practice change. This case study describes the effectiveness of identifying barriers to a change in practice and developing strategies, specific to Rogers' innovation decision process, for implementing the Confusion Assessment Method for the intensive care unit.

Leadership facilitation strategies to establish evidence-based practice in an acute care hospital

AIM

To assess the impact of leadership facilitation strategies on nurses' beliefs of the importance and frequency of using evidence in daily nursing practice and the perception of organizational readiness in an acute care hospital.

BACKGROUND

Integrating evidence in practice is a prominent issue for hospital nursing as knowledge and skills, beliefs, organizational infrastructure and nursing leadership must all be addressed.

DESIGN

Prospective, descriptive comparative.

METHOD

Three surveys were used in this prospective descriptive comparative study. Evidence-Based Practice Beliefs Scale, the Implementation Scale and Organizational Culture & Readiness for System-Wide Integration Survey measured change before and after facilitating strategies for evidence-based practice enculturation. Data were collected in December 2008 (N = 427) and in December 2010 (N = 469).

RESULTS

Leadership facilitated infrastructure development in three major areas: incorporating evidence-based practice outcomes in the strategic plan; supporting mentors; and advocating for resources for education and outcome dissemination. With the interventions in place, the total group scores for beliefs and organizational readiness improved significantly. Analyses by job role showed that direct care nurses scores improved more than other role types. No differences were found in the implementation scores.

CONCLUSION

Successful key strategies were evidence-based practice education and establishing internal opportunities to disseminate findings. Transformational nursing leadership drives organizational change and provides vision, human and financial resources and time that empowers nurses to include evidence in practice.

Implementation of national comprehensive cancer network evidence-based guidelines to prevent and treat cancer-related infections

Clinical practice guidelines are an important result of evidence-based research. However, current clinical practice remains out of step with the rapid pace of research advancements. Often, decades pass before research is translated into clinical practice. The National Comprehensive Cancer Network (NCCN) has created evidence-based clinical guidelines to promote effective clinical practice. Formerly, the NCCN established guidelines to reduce cancer-related infections only for neutropenic patients; however, they have expanded their guidelines beyond neutropenia to prevent and treat cancer-related infections. Implementing scientific evidence into clinical practice is challenging and complex, and healthcare professionals should understand barriers to implementing clinical practice guidelines to ensure successful translation into practice. This article provides a brief review of NCCN guidelines and describes common barriers encountered during implementation. In addition, a conceptual framework is offered to help identify and address potential concerns before and after adoption of guidelines.

Exploring the interpersonal-, organization-, and system-level factors that influence the implementation and use of an innovation-synoptic reporting-in cancer care

Background

The dominant method of reporting findings from diagnostic and surgical procedures is the narrative report. In cancer care, this report inconsistently provides the information required to understand the cancer and make informed patient care decisions. Another method of reporting, the synoptic report, captures specific data items in a structured manner and contains only items critical for patient care. Research demonstrates that synoptic reports vastly improve the quality of reporting. However, synoptic reporting represents a complex innovation in cancer care, with implementation and use requiring fundamental shifts in physician behaviour and practice, and support from the organization and larger system. The objective of this study is to examine the key interpersonal, organizational, and system-level factors that influence the implementation and use of synoptic reporting in cancer care.

Methods

This study involves three initiatives in Nova Scotia, Canada, that have implemented synoptic reporting within their departments/programs. Case study methodology will be used to study these initiatives (the cases) in-depth, explore which factors were barriers or facilitators of implementation and use, examine relationships amongst factors, and uncover which factors appear to be similar and distinct across cases. The cases were selected as they converge and differ with respect to factors that are likely to influence the implementation and use of an innovation in practice. Data will be collected through in-depth interviews, document analysis, observation of training sessions, and examination/use of the synoptic reporting tools. An audit will be performed to determine/quantify use. Analysis will involve production of a case record/history for each case, in-depth analysis of each case, and cross-case analysis, where findings will be compared and contrasted across cases to develop theoretically informed, generalisable knowledge that can be applied to other settings/contexts. Ethical approval was granted for this study.

Discussion

This study will contribute to our knowledge base on the multi-level factors, and the relationships amongst factors in specific contexts, that influence implementation and use of innovations such as synoptic reporting in healthcare. Such knowledge is critical to improving our understanding of implementation processes in clinical settings, and to helping researchers, clinicians, and managers/administrators develop and implement ways to more effectively integrate innovations into routine clinical care.

A practical communication strategy to improve implementation of evidence-based practice

OBJECTIVE

The purpose of this study was to determine if a consistent communication strategy for implementation of evidence-based practice (EBP), developed with input from staff nurses, improved staff nurse satisfaction with communication of practice changes.

BACKGROUND

Integration of EBP knowledge into clinical practice supports optimal nursing care. Awareness of a practice change and the ability to reference the information may be problematic.

METHODS

A quasi-experimental single group before-after design was used to survey all RNs of a level III neonatal ICU for satisfaction before and after implementation of the EBP communication strategy.

RESULTS

Registered nurse satisfaction improved regarding the amount of communication (P < .001), frequency of communication (P < .014), method of communication (P < .001), and ease of finding information (P < .001).

CONCLUSION

A consistent strategy can improve nurse satisfaction with communication of EBP changes.