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Enhancing Evidence-Based Practice Integration Into Clinical Practice: Using Policy as a Tool for Culture Change in a Large Urban Academic Medical Center. CLIN NURSE SPEC 2023; 37:14-19. [PMID: 36508230 DOI: 10.1097/nur.0000000000000717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE This article describes how a large urban medical center was able to enhance the integration of evidence-based practice in the clinical environment by reconfiguring its approach to policy and procedures documentation. PROJECT DESCRIPTION Leaders at a large urban medical center observed that numerous nursing practice documents lacked a base of evidence. No standard process existed for building staff awareness of the evidence-based underlying practice, and there was uneven knowledge of evidence-based practice in the milieu. To address the problem, a team of Clinical Nurse Specialists developed a novel policy establishing procedures for document review, formal structures for policy assignment, and rigorous standards for the development and sharing of evidence tables. OUTCOME The proportion of nursing guidance documents connected to evidence tables increased from 45% to 77% in the first year and a half following implementation. The change has enabled streamlining and consolidation of nursing practice guidance documents and has led to significant increases in engagement with clinical inquiry at the bedside. CONCLUSION A policy specifically requiring evidence to be incorporated into nursing practice guidance documents can help enhance the understanding and uptake of evidence-based practice in a complex clinical environment. Clinical Nurse Specialists played a vital role in facilitating this organizational culture change.
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Fossum M, Opsal A, Ehrenberg A. Nurses' sources of information to inform clinical practice: An integrative review to guide evidence-based practice. Worldviews Evid Based Nurs 2022; 19:372-379. [PMID: 35244324 PMCID: PMC9790517 DOI: 10.1111/wvn.12569] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/11/2021] [Accepted: 11/21/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Evidence-based practice in nursing is challenging and relies on the sources of information used by nurses to inform clinical practice. An integrative review from 2008 revealed that nurses more frequently relied on information from colleagues than information from high-level sources such as systematic reviews and evidence-based clinical practice guidelines. AIMS To describe the information sources used by registered nurses to inform their clinical practice. METHODS An integrative review was conducted according to the PRISMA guidelines, based on empirical research studies published from January 2007 until June 2021. The included studies were appraised, following which the identified sources of information from quantitative studies were compiled and ranked. Finally, the qualitative text data were summarized into categories. RESULTS Fifty-two studies from various countries were included. The majority of studies employed a quantitative design and used original instruments. Peers were ranked as the number one source of information to inform nurses' clinical practice. However, computers and reference materials are now ranked among the top four most used information sources. LINKING EVIDENCE TO ACTION Improvement in computer and information searching skills, as well as the availability of computerized decision support tools, may contribute to nurses' frequent use of digital sources and reference material to inform clinical practice. This review shows that nurses' most frequently reported peer nurses as their source of information in clinical practice. Information sources such as computers and reference materials were ranked higher, and information from patients was ranked lower than in the 2008 review. Developing and standardizing instruments and ensuring high-quality study design is critical for further research on nurses' sources of information for clinical practice.
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Affiliation(s)
- Mariann Fossum
- Centre for Caring ResearchSouthern NorwayFaculty of Health and Sport SciencesUniversity of AgderGrimstadNorway
| | - Anne Opsal
- Department of Health and Nursing ScienceFaculty of Health and Sport SciencesUniversity of AgderKristiansandNorway
| | - Anna Ehrenberg
- School of Health and WelfareDalarna UniversityFalunSweden
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Perceived Knowledge, Attitudes, and Implementation of Evidence-Based Practice Among Jordanian Nurses in Critical Care Units. Dimens Crit Care Nurs 2021; 39:278-286. [PMID: 32740199 DOI: 10.1097/dcc.0000000000000431] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Evidence-based practice (EBP) has become of great interest to policymakers, health care practitioners, and researchers. OBJECTIVE This study aimed at assessing knowledge associated with, attitudes toward, and implementation of EBP among Jordanian registered nurses (RNs) in critical care units. METHOD A descriptive, correlational, and cross-sectional study was conducted in 5 hospitals: 3 public and 2 private. A convenience sample of 200 RNs was invited. Data were collected using a paper-based and self-administered questionnaire, in 2 sections; the first section was the demographic and contextual characteristics and the second was the Evidence-Based Practice Questionnaire (J Adv Nurs. 2006;53(4):454-458) to measure RNs' knowledge, attitudes, and EBP. RESULTS A total of 187 RNs were included in this study. Findings revealed that Jordanian RNs in critical care units perceived themselves as having a satisfactory level of knowledge and practice of evidence-based interventions. In addition, RNs strongly recognized the value of EBP. There were significant positive associations between EBP and knowledge associated with EBP (r = 0.708, P < .001) and attitude toward EBP (r = 0.490, P < .001). CONCLUSION Knowledge associated with EBP, a positive attitude toward EBP, higher educational qualifications, and training in EBP all increased the implementation of EBP. It is recommended that continuing education programs on EBP for nurses be conducted. Nursing educators in clinical settings have to consider a number of strategies to improve EBP. A qualitative research design and/or including open-ended questions are encouraged to gain more in-depth views about EBP.
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Islam MM, Parkinson A, Burns K, Woods M, Yen L. A training program for primary health care nurses on timely diagnosis and management of dementia in general practice: An evaluation study. Int J Nurs Stud 2020; 105:103550. [PMID: 32145467 DOI: 10.1016/j.ijnurstu.2020.103550] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 02/06/2020] [Accepted: 02/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Primary health care nurses can play an important role in assisting the diagnosis and management of dementia. This study describes the evaluation outcome of a training program developed on the 'Four Steps to Building Dementia Practice in Primary Care'. OBJECTIVE To evaluate a training program for primary health care nurses by assessing change in current practice and future intention; and their knowledge, confidence, and perceived importance about dementia diagnosis and management. DESIGN A longitudinal survey. Participants were surveyed at three time points: pre-training, immediately post-training and six months (+/- 3 months) following their training. SETTING All states and territories in Australia. PARTICIPANTS Primary health care nurses (n = 1,290). METHODS A face-to-face and online training program on timely diagnosis and management of dementia was offered to primary health care nurses. A questionnaire was administered face-to-face and online to assess whether certain processes and services were 'currently in practice', 'working towards', or 'not in current practice' in their primary care facility. Three 10-point Likert scales were created to assess self-perceived levels of importance, knowledge and confidence about the diagnosis and management of dementia. A paired t-test was used to examine the differences between (a) post and pre-scores, and (b) follow-up and post scores. Linear regressions were used to identify the significant factors associated with pre-training scores for importance, confidence and knowledge. RESULTS Of 1290 primary health care nurses who participated in the training, 471 attended face-to-face and 819 participated online. Participants demonstrated improvements in all items in all four steps of the survey, with considerably higher improvement in the face-to-face mode. The average post-training score was significantly higher than the pre-training score for perceived importance, knowledge and confidence. The average follow-up score was significantly higher than the post-training score for perceived knowledge and confidence but not for perceived importance. Primary health care nurses who had 20 or more years of experience reported significantly more knowledge in attending patients with dementia than those with less than five years of experience (0.56, 95% CI: 0.11-1.01). CONCLUSIONS With a growing ageing population, the demand for dementia care is rising. Primary health care nurses can lead practice change and promote the timely diagnosis and management of dementia in general practice. Training programs of this kind that build knowledge, confidence, awareness and skills should be made available to the primary care nursing workforce. Further research is recommended to examine the translation of this training outcome into practice.
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Affiliation(s)
- M Mofizul Islam
- Department of Public Health, La Trobe University, Melbourne Australia.
| | - Anne Parkinson
- Department of Health Services Research and Policy, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Kelly Burns
- Centre for Dementia Learning, Dementia Australia, Melbourne, Australia
| | - Murphy Woods
- Australian Primary Health Care Nurses Association (APNA), Melbourne, Australia
| | - Laurann Yen
- Department of Health Services Research and Policy, Research School of Population Health, The Australian National University, Canberra, Australia
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Pereira F, Pellaux V, Verloo H. Beliefs and implementation of evidence-based practice among community health nurses: A cross-sectional descriptive study. J Clin Nurs 2018. [DOI: 10.1111/jocn.14348] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Filipa Pereira
- Department of Nursing Sciences; University of Applied Sciences and Arts Western Switzerland; Sion Switzerland
| | - Victoria Pellaux
- University of Applied Sciences and Arts Western Switzerland; Lausanne Switzerland
| | - Henk Verloo
- Department of Nursing Sciences; University of Applied Sciences and Arts Western Switzerland; Sion Switzerland
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Abstract
In this column, the issue of who should drive healthcare decision-making will be considered. To that end, evidence-based practice and evidence-informed practice models of care will be discussed. Problems with the use of each of these models will be brought to light followed by a presentation of a proposed model of care that puts the person at the center of healthcare decision- making.
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Abstract
PURPOSE The aim of this study is to describe clinical nurse specialists' characteristics, interest, confidence, motivators, and barriers in conducting research. DESIGN This study was a descriptive, multicohort design. METHODS Clinical nurse specialists were recruited electronically through national and local organizations to complete anonymous surveys 3 times, over 3 years. Comparative analyses included χ and Kruskal-Wallis tests. RESULTS Of 2052 responders (initial, n = 629; 18 months, n = 465; and 3 years, n = 958), mean (SD) participant age was 50.3 (9.3) years. Overall, 41.7% of participants were involved as principal or coinvestigators in research. Interest in conducting nursing research (on a 0-100 scale) was 61.1 (38.4) and was lowest among the 18-month time point participant group (score, 39.1 [32.2]) and highest at the 3-year time point (68.3, [30.7]; P < .001). Confidence in conducting research, discussion of statistics, and perceptions of motivators and barriers to conducting research did not differ across time period groups. Access to literature and mentors and research knowledge were the most prevalent barriers to conducting research. CONCLUSIONS Less than 42% of clinical nurse specialists conducted research and the rate did not change between different time groups. Access and knowledge barriers to conducting research were prominent. Workplace leaders need to consider resources and support of academic educational opportunities to increase research conduct by clinical nurse specialists.
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Doody O, Slevin E, Taggart L. Focus group interviews examining the contribution of intellectual disability clinical nurse specialists in Ireland. J Clin Nurs 2017; 26:2964-2975. [PMID: 27862506 DOI: 10.1111/jocn.13636] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2016] [Indexed: 01/24/2023]
Abstract
AIMS AND OBJECTIVES To explore the contribution of clinical nurse specialists in intellectual disability nursing in Ireland. BACKGROUND While clinical nurse specialists exist since the 1940s, they have only been a reality in Ireland since 2001. While the role of clinical nurse specialist has developed over the years, it still however is often seen as a complex multifaceted role that causes confusion, frustration and controversy. DESIGN A exploratory qualitative approach using focus groups with Irish intellectual disability clinical nurse specialists (n = 31). METHODS Five focus group interviews were conducted to gather qualitative data to gain insight into the attitudes, perceptions and opinions of the participants. Data were audio-recorded, transcribed and analysed using Burnard's (Vital Notes for Nurses: Research for Evidence-Based Practice in Healthcare, 2011, Blackwell Publishing, Oxford) framework. Ethical approval was gained from the researcher's university and access granted by the national council for the professional development of nursing/midwifery in Ireland. RESULTS The study highlights that intellectual disability clinical nurse specialists contribute to and support care delivery across a range of areas including client-focused and family-centred care, staff support, organisation support, community support and supporting other agencies. CONCLUSIONS Overall, the study shows the importance of intellectual disability clinical nurse specialists and their contribution across a range of services, care environments and the support they offer to clients/families/staff/multidisciplinary team members and outside agencies. RELEVANCE TO CLINICAL PRACTICE Ireland is in a unique position to develop knowledge regarding specialist care for people with intellectual disability that can be shared and adapted by other healthcare professionals in other countries that do not have specialised intellectual disability nurses.
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Affiliation(s)
- Owen Doody
- Department of Nursing and Midwifery, North Bank Campus, University of Limerick, Limerick, Ireland
| | - Eamonn Slevin
- Autism Initiatives, Beechill Business Park, Beechill Road, Belfast, County Antrim, Northern Ireland
| | - Laurence Taggart
- University of Ulster, Jordanstown Campus, Newtownabbey, County Antrim, Northern Ireland
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Kilpatrick K, Tchouaket E, Carter N, Bryant-Lukosius D, DiCenso A. Structural and Process Factors That Influence Clinical Nurse Specialist Role Implementation. CLIN NURSE SPEC 2016; 30:89-100. [DOI: 10.1097/nur.0000000000000182] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Perceived Outcomes of Research and Audit Activities of Clinical Specialists in Ireland. CLIN NURSE SPEC 2015; 29:100-11. [DOI: 10.1097/nur.0000000000000104] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kilpatrick K, Kaasalainen S, Donald F, Reid K, Carter N, Bryant-Lukosius D, Martin-Misener R, Harbman P, Marshall DA, Charbonneau-Smith R, DiCenso A. The effectiveness and cost-effectiveness of clinical nurse specialists in outpatient roles: a systematic review. J Eval Clin Pract 2014; 20:1106-23. [PMID: 25040492 DOI: 10.1111/jep.12219] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Increasing numbers of clinical nurse specialists (CNSs) are working in outpatient settings. The objective of this paper is to describe a systematic review of randomized controlled trials (RCTs) evaluating the cost-effectiveness of CNSs delivering outpatient care in alternative or complementary provider roles. METHODS We searched CINAHL, MEDLINE, EMBASE and seven other electronic databases, 1980 to July 2012 and hand-searched bibliographies and key journals. RCTs that evaluated formally trained CNSs and health system outcomes were included. Study quality was assessed using the Cochrane risk of bias tool and the Quality of Health Economic Studies instrument. We used the Grading of Recommendations Assessment, Development and Evaluation to assess quality of evidence for individual outcomes. RESULTS Eleven RCTs, four evaluating alternative provider (n = 683 participants) and seven evaluating complementary provider roles (n = 1464 participants), were identified. Results of the alternative provider RCTs (low-to-moderate quality evidence) were fairly consistent across study populations with similar patient outcomes to usual care, some evidence of reduced resource use and costs, and two economic analyses (one fair and one high quality) favouring CNS care. Results of the complementary provider RCTs (low-to-moderate quality evidence) were also fairly consistent across study populations with similar or improved patient outcomes and mostly similar health system outcomes when compared with usual care; however, the economic analyses were weak. CONCLUSIONS Low-to-moderate quality evidence supports the effectiveness and two fair-to-high quality economic analyses support the cost-effectiveness of outpatient alternative provider CNSs. Low-to-moderate quality evidence supports the effectiveness of outpatient complementary provider CNSs; however, robust economic evaluations are needed to address cost-effectiveness.
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Affiliation(s)
- Kelley Kilpatrick
- Canadian Centre for Advanced Practice Nursing Research, Hamilton, Ontario, Canada; Faculty of Nursing, Université de Montreal, Montreal, Quebec, Canada; Hôpital Maisonneuve-Rosemont Research Centre, Montreal, Quebec, Canada
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Current status of clinical nursing specialists and the demands of osteoporosis specialized nurses in Mainland China. Int J Nurs Sci 2014. [DOI: 10.1016/j.ijnss.2014.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Albarran JW, Jones I, Lockyer L, Manns S, Cox H, Thompson DR. Patients’ perspectives on the educational preparation of cardiac nurses. Eur J Cardiovasc Nurs 2013; 13:451-8. [PMID: 24072728 DOI: 10.1177/1474515113507166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- John W Albarran
- Centre for Health and Clinical Research, Faculty of Applied Sciences, University of the West of England, UK
| | - Ian Jones
- School of Nursing, Midwifery & Social Work, University of Salford, UK
| | - Lesley Lockyer
- Centre for Health and Clinical Research, Faculty of Applied Sciences, University of the West of England, UK
| | - Sarah Manns
- Centre for Health and Clinical Research, Faculty of Applied Sciences, University of the West of England, UK
| | - Helen Cox
- Centre for Health and Clinical Research, Faculty of Applied Sciences, University of the West of England, UK
| | - David R Thompson
- Cardiovascular Research Centre, Australian Catholic University, Australia
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Jeffs L, Beswick S, Lo J, Campbell H, Ferris E, Sidani S. Defining What Evidence is, Linking It to Patient Outcomes, and Making It Relevant to Practice: Insight from Clinical Nurses. Appl Nurs Res 2013; 26:105-9. [DOI: 10.1016/j.apnr.2013.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 03/12/2013] [Accepted: 03/15/2013] [Indexed: 11/27/2022]
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Kilpatrick K, DiCenso A, Bryant-Lukosius D, Ritchie JA, Martin-Misener R, Carter N. Practice patterns and perceived impact of clinical nurse specialist roles in Canada: results of a national survey. Int J Nurs Stud 2013; 50:1524-36. [PMID: 23548169 DOI: 10.1016/j.ijnurstu.2013.03.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 02/15/2013] [Accepted: 03/08/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Clinical nurse specialists are recognized internationally for providing an advanced level of practice. They positively impact the delivery of healthcare services by using specialty-specific expert knowledge and skills, and integrating competencies as clinicians, educators, researchers, consultants and leaders. Graduate-level education is recommended for the role but many countries do not have formal credentialing mechanisms for clinical nurse specialists. Previous studies have found that clinical nurse specialist roles are poorly understood by stakeholders. Few national studies have examined the utilization of clinical nurse specialists. OBJECTIVE To identify the practice patterns of clinical nurse specialists in Canada. DESIGN A descriptive cross-sectional survey. PARTICIPANTS Self-identified clinical nurse specialists in Canada. METHODS A 50-item self-report questionnaire was developed, pilot-tested in English and French, and administered to self-identified clinical nurse specialists from April 2011 to August 2011. Data were analyzed using descriptive and inferential statistics and content analysis. RESULTS The actual number of clinical nurse specialists in Canada remains unknown. The response rate using the number of registry-identified clinical nurse specialists was 33% (804/2431). Of this number, 608 reported working as a clinical nurse specialist. The response rate for graduate-prepared clinical nurse specialists was 60% (471/782). The practice patterns of clinical nurse specialists varied across clinical specialties. Graduate-level education influenced their practice patterns. Few administrative structures and resources were in place to support clinical nurse specialist role development. The lack of title protection resulted in confusion around who identifies themselves as a clinical nurse specialist and consequently made it difficult to determine the number of clinical nurse specialists in Canada. CONCLUSIONS This is the first national survey of clinical nurse specialists in Canada. A clearer understanding of these roles provides stakeholders with much needed information about clinical nurse specialist practice patterns. Such information can inform decisions about policies, education and organizational supports to effectively utilize this role in healthcare systems. This study emphasizes the need to develop standardized educational requirements, consistent role titles and credentialing mechanisms to facilitate the identification and comparison of clinical nurse specialist roles and role outcomes internationally.
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Affiliation(s)
- Kelley Kilpatrick
- Canadian Centre for Advanced Practice Nursing Research, Faculty of Nursing, Université de Montréal, Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Hôpital Maisonneuve-Rosemont, CSA - RC - Aile bleue - Bureau F121, 5415 boul. l'Assomption, Montréal, QC, Canada H1T 2M4.
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Oude Rengerink K, Zwolsman SE, Ubbink DT, Mol BWJ, van Dijk N, Vermeulen H. Tools to assess Evidence-Based Practice behaviour among healthcare professionals. ACTA ACUST UNITED AC 2013; 18:129-38. [DOI: 10.1136/eb-2012-100969] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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McDonnell A, Gerrish K, Kirshbaum MN, Nolan M, Tod A, Guillaume L. The perceived impact of advanced practice nurses (APNs) on promoting evidence-based practice amongst frontline nurses: findings from a collective case study. J Res Nurs 2012. [DOI: 10.1177/1744987112446241] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to explore the perceived impact of advanced practice nurses in promoting evidence-based practice amongst frontline nurses. A collective instrumental case study was undertaken involving five extended case studies and eighteen short case studies in a range of hospital and primary care settings across seven Strategic Health Authorities in England. The study participants were a purposive sample of 23 advanced practice nurses selected to represent a range of settings, clinical specialities, organisational responsibilities and ways of working. In-depth interviews were undertaken with the advanced practice nurse and up to 10 interviews with health care professionals with whom they worked. For the extended case studies, non-participant observation and follow-up interviews were also undertaken. Data analysis drew on the principles of the Framework approach. From the perspectives of the participants, these advanced practice nurses enhanced the ability of frontline nurses to provide evidence-based care. They improved the competence, knowledge and skills of frontline nurses and empowered them to deliver care which they considered to be safer, holistic, more timely and of a higher standard. This is likely to have a positive effect on patient outcomes and on patient experience. However, this impact is inherently hard to capture.
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Affiliation(s)
- Ann McDonnell
- Reader, Centre for Health and Social Care Research, Sheffield Hallam University, UK
- Information Specialist, School of Health and Related Research, University of Sheffield, UK
| | - Kate Gerrish
- Specialist Practitioner District Nursing. Professor of Nursing, Centre for Health and Social Care Research, Sheffield Hallam University and Sheffield Teaching Hospitals NHS Foundation Trust, UK
- Information Specialist, School of Health and Related Research, University of Sheffield, UK
| | - Marilynne N. Kirshbaum
- Reader in Nursing, School of Human and Health Sciences, University of Huddersfield, UK
- Information Specialist, School of Health and Related Research, University of Sheffield, UK
| | - Mike Nolan
- Professor of Gerontological Nursing, Sheffield Institute for Studies in Ageing, University of Sheffield, UK
- Information Specialist, School of Health and Related Research, University of Sheffield, UK
| | - Angela Tod
- Reader, Centre for Health and Social Care Research, Sheffield Hallam University, UK
- Information Specialist, School of Health and Related Research, University of Sheffield, UK
| | - Louise Guillaume
- Information Specialist, School of Health and Related Research, University of Sheffield, UK
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Groot ED, Jaarsma D, Endedijk M, Mainhard T, Lam I, Simons RJ, Beukelen PV. Critically reflective work behavior of health care professionals. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2012; 32:48-57. [PMID: 22447711 DOI: 10.1002/chp.21122] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Better understanding of critically reflective work behavior (CRWB), an approach for work-related informal learning, is important in order to gain more profound insight in the continuing development of health care professionals. METHODS A survey, developed to measure CRWB and its predictors, was distributed to veterinary professionals. The authors specified a model relating CRWB to a Perceived Need for Lifelong Learning, Perceived Workload, and Opportunities for Feedback. Furthermore, research utilization was added to the concept of CRWB. The model was tested against the data, using structural equation modeling (SEM). RESULTS The model was well represented by the data. Four factors that reflect aspects of CRWB were distinguished: (1) individual CRWB; (2) being critical in interactions with others; (3) cross-checking of information; and (4) openness to new findings. The latter 2 originated from the factor research utilization in CRWB. The Perceived Need for Lifelong Learning predicts CRWB. Neither Perceived Workload nor Opportunities for Feedback of other practitioners was related to CRWB. DISCUSSION The results suggest that research utilization, such as cross-checking information and openness to new findings, is essential for CRWB. Furthermore, perceptions of the need for lifelong learning are more relevant for CRWB of health care professionals than qualities of the workplace.
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Gerrish K, Nolan M, McDonnell A, Tod A, Kirshbaum M, Guillaume L. Factors Influencing Advanced Practice Nurses’ Ability to Promote Evidence-Based Practice among Frontline Nurses. Worldviews Evid Based Nurs 2011; 9:30-9. [DOI: 10.1111/j.1741-6787.2011.00230.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Marshall AP, West SH, Aitken LM. Preferred information sources for clinical decision making: critical care nurses' perceptions of information accessibility and usefulness. Worldviews Evid Based Nurs 2011; 8:224-35. [PMID: 21649854 DOI: 10.1111/j.1741-6787.2011.00221.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Variability in clinical practice may result from the use of diverse information sources to guide clinical decisions. In routine clinical practice, nurses privilege information from colleagues over more formal information sources. It is not clear whether similar information-seeking behaviour is exhibited when critical care nurses make decisions about a specific clinical practice, where extensive practice variability exists alongside a developing research base. PURPOSE This study explored the preferred sources of information intensive care nurses used and their perceptions of the accessibility and usefulness of this information for making decisions in clinically uncertain situations specific to enteral feeding practice. METHODS An instrumental case study design, incorporating concurrent verbal protocols, Q methodology and focus groups, was used to determine intensive care nurses' perspectives of information use in the resolution of clinical uncertainty. FINDINGS A preference for information from colleagues to support clinical decisions was observed. People as information sources were considered most useful and most accessible in the clinical setting. Text and electronic information sources were seen as less accessible, mainly because of the time required to access the information within the documents. DISCUSSION When faced with clinical uncertainty, obtaining information from colleagues allows information to be quickly accessed and applied within the context of a specific clinical presentation. Seeking information from others also provides opportunities for shared decision-making and potential validation of clinical judgment, although differing views may exacerbate clinical uncertainty. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The social exchange of clinical information may meet the needs of nurses working in a complex, time-pressured environment but the extent of the evidence base for information passed through verbal communication is unclear. The perceived usefulness and accessibility of information is premised on the ease of use and access and thus the variability in information may be contributing to clinical uncertainty.
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Affiliation(s)
- Andrea P Marshall
- Sydney Nursing School (MO2), The University of Sydney, Sydney, NSW, Australia.
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Gerrish K, McDonnell A, Nolan M, Guillaume L, Kirshbaum M, Tod A. The role of advanced practice nurses in knowledge brokering as a means of promoting evidence-based practice among clinical nurses. J Adv Nurs 2011; 67:2004-14. [PMID: 21507046 DOI: 10.1111/j.1365-2648.2011.05642.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To identify approaches used by advanced practice nurses to promote evidence-based practice among clinical nurses. BACKGROUND Barriers encountered at individual and organizational levels hinder clinical nurses in their ability to deliver evidence-based practice. Advanced practice nurses are well placed to promote evidence-based practice through interactions with clinical nurses. However, little is understood about how advanced practice nurses might realize this potential. METHOD A multiple instrumental case study of 23 advanced practice nurses from hospital and primary care settings across seven Strategic Health Authorities in England was undertaken in 2006. Data collection comprised interviews and observation of advanced practice nurses and interviews with clinical nurses and other healthcare professionals. Data were analysed using the Framework approach. FINDINGS Advanced practice nurses acted as knowledge brokers in promoting evidence-based practice among clinical nurses. Knowledge management and promoting the uptake of knowledge were key components of knowledge brokering. Knowledge management involved generating different types of evidence, accumulating evidence to act as a repository for clinical nurses, synthesizing different forms of evidence, translating evidence by evaluating, interpreting and distilling it for different audiences and disseminating evidence by formal and informal means. Advanced practice nurses promoted the uptake of evidence by developing the knowledge and skills of clinical nurses through role modelling, teaching, clinical problem-solving and facilitating change. CONCLUSION The role of advanced practice nurses in knowledge brokering is complex and multi-faceted. It extends beyond the knowledge management, linkage and capacity building identified in the literature to include active processes of problem-solving and facilitating change.
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Affiliation(s)
- Kate Gerrish
- Centre for Health and Social Care Research, Sheffield Hallam University and Sheffield Teaching Hospitals NHS Foundation Trust, UK.
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Gerrish K, Guillaume L, Kirshbaum M, McDonnell A, Tod A, Nolan M. Factors influencing the contribution of advanced practice nurses to promoting evidence-based practice among front-line nurses: findings from a cross-sectional survey. J Adv Nurs 2011; 67:1079-90. [DOI: 10.1111/j.1365-2648.2010.05560.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Solomons NM, Spross JA. Evidence-based practice barriers and facilitators from a continuous quality improvement perspective: an integrative review. J Nurs Manag 2010; 19:109-20. [PMID: 21223411 DOI: 10.1111/j.1365-2834.2010.01144.x] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS The purpose of the present study is to examine the barriers and facilitators to evidence-based practice (EBP) using Shortell's framework for continuous quality improvement (CQI). BACKGROUND EBP is typically undertaken to improve practice. Although there have been many studies focused on the barriers and facilitators to adopting EBP, these have not been tied explicitly to CQI frameworks. METHODS CINAHL, Academic Search Premier, Medline, Psych Info, ABI/Inform and LISTA databases were searched using the keywords: nurses, information literacy, access to information, sources of knowledge, decision making, research utilization, information seeking behaviour and nursing practice, evidence-based practice. Shortell's framework was used to organize the barriers and facilitators. RESULTS Across the articles, the most common barriers were lack of time and lack of autonomy to change practice which falls within the strategic and cultural dimensions in Shortell's framework. CONCLUSIONS Barriers and facilitators to EBP adoption occur at the individual and institutional levels. Solutions to the barriers need to be directed to the dimension where the barrier occurs, while recognizing that multidimensional approaches are essential to the success of overcoming these barriers. IMPLICATIONS FOR NURSING MANAGEMENT The findings of the present study can help nurses identify barriers and implement strategies to promote EBP as part of CQI.
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