Evidence based practice readiness: A concept analysis

Frontline nurse leaders' competences in evidence-based healthcare: A scoping review

AIM

To identify evidence on frontline nurse leaders' competences in evidence-based healthcare (EBHC) and the instruments measuring these competences.

DESIGN

A scoping review.

DATA SOURCES

The search was conducted in June 2021 and complemented in June 2022. The CINAHL, ProQuest, Medline (Ovid), Scopus, Web of Science databases and MedNar along with the Finnish database Medic were searched.

REVIEW METHOD

The scoping review was conducted in accordance with the Joanna Briggs institute methodology for scoping reviews. Titles, abstracts and full-text versions were screened independently by two reviewers according to the inclusion criteria. Deductive-inductive content analysis was used to synthesize data.

RESULTS

A total of 3211 articles published between 1997 and 2022 were screened, which resulted in the inclusion of 16 articles. Although frontline nurse leaders had a positive attitude towards EBHC, they had a lack of implementing EBHC competence into practice. Part of the instruments were used in the studies, and only one focused especially on leaders. None of instruments systematically covered all segments of EBHC.

CONCLUSION

There is a limited understanding of frontline nurse leaders' competence in EBHC. It is important to understand the importance of EBHC in healthcare and invest in the development of its competence at all levels of leaders. Frontline nurse leaders' support is essential for direct care nurses to use EBHC to ensure the quality of care and benefits to patients. Leaders must enhance their own EBHC competence to become role models for direct care nurses. It is also essential to develop valid and reliable instruments to measure leaders' competence covering all EBHC segments. The results can be utilized in the assessment and development of frontline nurse leaders' EBHC competence by planning and producing education and other competence development methods.

Ambulance clinicians implementing evidence-based practice: mind the gap! Attitudes, perceptions and experiences of student paramedics

Background

Evidence-based practice (EBP) represents the conscientious and judicious use of the best contemporaneous evidence in partnership with patient values and clinical expertise to guide healthcare professionals. As a result, EBP is a recommended component of undergraduate education and considered fundamental for improving patient outcomes. EBP principles have thus become deeply rooted in higher education curricula, but only in recent years has this begun to permeate the world of paramedic practice. Despite this paradigm, the impact of EBP may be limited because ambulance clinicians may struggle with implementation, as a variety of barriers influence translation and application.

Methods

A survey study aimed to gain insight into the epistemological and metacognitive barriers impacting student experience in order to help improve teaching and learning practices.

Results

A sample of 64 students, across two different undergraduate paramedic science programmes, were recruited. Of these, 70% of BSc (Hons) students versus 33% of DipHE students agreed to some extent or greater that EBP represented minimal benefit in real-world practice due to Trust policy and the guidelines set out by the Joint Royal Colleges Ambulance Liaison Committee (Welch's t = 2.571, df = 26, p = 0.016 two-sided). Furthermore, 25% felt standard operating procedures negatively impacted their ability to implement EBP, and 39% reported their EBP learning had improved their ability to implement improved levels of patient care.

Conclusion

A disparity between theoretical learning and EBP implementation was identified. EBP may not dovetail with standard operating procedure within UK ambulance Trusts, resulting in confusion among student paramedics as to the true worth of EBP.

Integrating Evidence-Based Practice Into an Emergency Department Nurse Residency Program

Evidence-based practice (EBP) is a problem-solving approach that combines the best evidence and research with clinical knowledge in order to improve patient outcomes. Providing nurses with the tools for utilizing EBP is essential, especially for graduate nurses hired in an emergency department. This article describes how EBP is integrated into the curriculum of a nurse residency program. It discusses methodology of education and describes the development of an evidence-based project.

Representations of clinical practice guidelines and health equity in healthcare literature: An integrative review

AIM

This paper reports an integrative review of international health literature that discusses health equity in relation to clinical practice guidelines (CPGs).

BACKGROUND

Healthcare professionals (HCPs), policy makers, and decision makers rely on sound empirical evidence to make fiscally responsible and appropriate decisions about the allocation of health resources and health service delivery. CPGs provide statements and recommendations that aim to standardize care with an implicit goal of achieving equity of care among diverse populations. Developers of CPGs must be careful not to exacerbate inequity when making recommendations. As such, it is important to determine how equity is discussed within the context of CPGs.

DESIGN

This integrative review was conducted according to integrative review methods as outlined by Whittemore and Knafl (2005), and Toronto and Remington (2020). These authors outlined a systematic process for the identification of relevant literature across health disciplines to examine the state of knowledge pertaining to a phenomenon such as health equity.

SEARCH METHODS

The computerized databases PubMed, CINAHL, Cochrane, Embase, Medline, and Web of Science were searched using a combination of keywords. Search parameters included international peer-reviewed published, full-text, English language articles, editorials, and reports over the last decade (January 2011 to February 2022). A reference search of included articles was conducted to identify any additional articles. Dissertations and theses were not included.

SEARCH OUTCOME

A total of 139 peer-reviewed English language articles were identified.

RESULTS

The findings of this review revealed five main ways in which health equity is in context of CPGs including if they target or exacerbate inequity among disadvantaged populations, equity and CPG development, implementation, and evaluation, and checklists and tools to assist developers and users of CPG to consider equity. Although critical appraisal tools exist to assist users of CPGs assess and to evaluate how well CPGs address issues of equity, the definition of equity and how CPG development panels should incorporate and articulate it remains unclear and haphazard. As such, recommendations intended to be implemented by HCPs to optimize health equity remains diverse and unclear.

CONCLUSION

The way equity is discussed within the reviewed health literature has implications for their uptake by and utility for HCPs. The ability of HCPs to implement CPGs may be hindered without an appreciation and integration of equity considerations across the various phases of CPG conceptualization, development, implementation, and evaluation, and their relevance and appropriateness to diverse geographic and socioeconomic contexts with variable access to health human resources and services. This situation could be improved if equity were more clearly articulated within all aspects of the CPG process.

CLINICAL RELEVANCE

Understanding how equity is discussed in the literature relative to CPGs has implications for their uptake by and utility for HCPs in their goal of providing equitable health care. Successful implementation of CPGs with consideration equity could be improved if equity were more clearly articulated within all aspects of the CPG process including conceptualization, development, implementation, and evaluation.

Creencias y actitud hacia la Práctica Basada en la Evidencia de fonoaudiólogos latinoamericanos dedicados exclusivamente a la práctica clínica y educativa

La Práctica Clínica Basada en la Evidencia (PBE) sugiere al fonoaudiólogo/a la incorporación de acciones orientadas a dar respuesta a las necesidades de los usuarios en contextos específicos. Dichas acciones incluyen planteamiento de interrogantes, revisión crítica de evidencia disponible y toma de decisiones integrando la experiencia clínica, la evidencia y las preferencias del usuario. Si bien este paradigma se ha posicionado en la disciplina en la última década, resulta compleja su implementación para los profesionales que se encuentran completamente dedicados a la práctica clínica y/o educativa. El objetivo de este estudio es analizar las creencias y actitud hacia la PBE de fonoaudiólogos/as dedicados a labores clínicas y/o educativas a tiempo completo en diferentes países de Latinoamérica. Se trata de un estudio cualitativo, fenomenológico. Se realizaron entrevistas semiestructuradas a fonoaudiólogos/as residentes en Argentina, Paraguay, Chile, Perú, Colombia, Uruguay y Costa Rica. Para los análisis de resultados se contó con entrevistas a 9 profesionales. La mayoría de los encuestados considera que la PBE se limita a las publicaciones científicas y que se dificulta la implementación en su contexto laboral, principalmente por la falta de tiempo asociada a la revisión de literatura científica actualizada. Como conclusión cabe indicarse que existe una creencia errada en términos conceptuales sobre el significado de la PBE, generando actitudes ambiguas hacia dicho paradigma. En Latinoamérica se hace necesaria la reflexión respecto a la formación de fonoaudiólogos/as para que desde el pregrado puedan manejar mayores recursos para la toma de decisiones en la evaluación e intervención; y así disminuir la brecha entre los investigadores y quienes se dedican eminentemente a la práctica clínica.

Barriers to the Adoption of Evidence Based Practice in Nursing: a Focus Group Study

Background

Evidence Based Practice is considered a complex process with many factors hindering its implementation. The use of focus groups to detect barriers to its application can provide an in-depth investigation of the phenomenon.

Objective

The investigation of nurses' views regarding the obstacles connected to the implementation of Evidence Based Practice.

Methods

This is a qualitative study carried out using focus groups and constitutes the continuation of a quantitative study. Deliberate sampling was used to recruit a total of 31 nurses.

Results

The main categories that emerged regarding the obstacles in the implementation of Evidence Based Practice in nursing, concerned the lack of logistical support, the difficulty of accessing data, the insufficient knowledge of nurses as well as their attitude, the nature of the work, the decision-making process and the impossibility of safeguarding decisions made.

Conclusion

In this study, various factors were identified that affect the application of Evidence Based Practice, in the nursing environment of Cyprus. Identifying these factors can be the basis for discussions and finding ways to resolve the problems that exist by health care managers.

Nurse Leadership and Work Environment Association with Outcome Expectancy and Self-Efficacy in Evidence-Based Practice among Hospital Nurses in The Netherlands: A Cross-Sectional Study

The active participation of nurses in evidence-based practice (EBP) is challenging and topical, as shown by the worldwide calls for appropriate, accessible, affordable care and the de-implementation of unnecessary care. Nurses' perceived support from their managers and work environments may affect their self-efficacy and outcome expectancy in EBP, as well as hinder them in EBP. Associations between these issues have not yet been explored. This study examines the association of self-efficacy and outcome expectancy levels in EBP, as well as the perceived support for EBP from nurse leaders and in the working environment, among Dutch hospital nurses.

METHODS

Questionnaires measuring nurses' self-efficacy, outcome expectancy, and perceived support for EBP from nurse leaders and their work environment were completed by 306 nurses in eight hospitals between March 2021 and June 2021. We used multilevel regression analyses to determine the associations and covariates.

RESULTS

This study shows that EBP-supportive leaders and work environments positively contribute to nurses' self-efficacy and outcome expectancy in EBP, along with the covariates undertaking EBP activities and educational level.

CONCLUSIONS

To improve nurses' active participation in EBP, nurses need to increase their self-efficacy and outcome expectancy in EBP. Supportive leaders and a supportive work environment do have an impact. Hence, these factors need attention when implementing EBP among nurses.

Organizational culture and readiness for evidence-based practice in the Kingdom of Saudi Arabia: A pre-experimental study

AIM

This study aims to establish postgraduate students' perceptions of the organizational culture and readiness for evidence-based practice of their workplaces in the Kingdom of Saudi Arabia.

BACKGROUND

Nurse shortages and a reliance on a transient nurse workforce have long been a challenge in the Kingdom of Saudi Arabia. Developing a home-grown nurse workforce, a key objective of the Government of Saudi Arabia, can help to address this. Evidence-based practice offers a mechanism to address this. Evidence-based practice implementation is heavily reliant on the prevailing organizational culture. Establishing the organizational culture and readiness for evidence-based practice is crucial for sustainable evidence-based practice implementation.

METHODS

A pre-experimental pilot study collected data from the same participants at three different points. As part of this, a questionnaire measuring organizational culture and readiness for evidence-based practice was administered twice. Descriptive, inferential and correlational statistics were employed to analyse the data.

RESULTS

Results demonstrated improved participant perceptions of the organizational culture and readiness for evidence-based practice of their workplaces between the first (M = 76.58, SD = 19.2) and second (M = 92.10, SD = 23.68) data collection points, indicating moderate movement towards a culture of evidence-based practice. Strengths, challenges and opportunities for improvement were identified.

CONCLUSION

This study established participants' perceptions of the organizational culture and readiness for evidence-based practice of their workplaces, affording insight into context-specific strategies to embed evidence-based practice in health care organizations.

IMPLICATIONS FOR NURSING MANAGEMENT

Assessing an organization's culture and readiness for evidence-based practice (EBP) can afford insight on the strengths, challenges and opportunities that exist to equip nurse managers to advance evidence-based practice at individual, professional and organizational levels. This study demonstrated the importance of promoting an environment conducive to EBP and putting in place the necessary resources to support evidence-based practice implementation. Nurse managers can play a central role in this.

A Feeling of Ambiguity: A Qualitative Content Analysis of Managers' Experiences of Evidence-Based Practice in Swedish Primary Care

Background

The Primary care manager plays a vital role in promoting a research culture in the healthcare center. The position involves both the implementation of organizational directives and patient care. The research culture and use of evidence influence each individual healthcare professional and ultimately the quality of patient care.

Purpose

To describe primary healthcare managers’ understanding of evidence-based practice in the Swedish primary healthcare context and their ability to influence its implementation.

Methodology

Qualitative content analysis of data collected in individual interviews.

Results

In general, managers expressed a positive view toward the use of evidence in daily practice. However, they were sometimes hesitant about fully implementing evidence-based results. This was mostly attributed to the struggle of balancing finances and allocating sufficient time for staff to keep up with and engage in evidence-based practice.

Conclusion

The organizational culture impacts the mind-set of all co-workers including managers. Those managers influenced by traditions and norms may fall into the trap of devaluing the benefit of research and evidence. The inherent feeling of being alone and without guidance in some matters related to evidence-based practice inevitably leads to inconsistency and ambiguity. The use of clinical pathways that constitute one form of evidence has become a substitute for proper, careful, individual investigation, implementation, and evaluation of each patient case. This means that managers experience moral and physical stress when trying to meet organizational, staff, and patient demands.

Practice Implication

Awareness of managers’ influence and experience of working according to evidence-based practice is valuable to gain an insight into how Swedish primary healthcare functions at local level. Illuminating and discussing evidence-based practice is an assurance of quality that contributes to many aspects of the overall safety of care.

To Explore the Application Effect and Value of Evidence-Based Nursing in Patients with Pregnancy-Induced Hypertension Syndrome

Objective

The objective is to explore the nursing methods of evidence-based nursing in preventing serious complications in patients with pregnancy-induced hypertension.

Methods

A total of 80 patients with pregnancy-induced hypertension from April 2020 to April 2022 were selected and randomly divided into a control group and a research group, with 40 cases in each group. The blood pressure, Self-Efficacy Scale score, Disease Uncertainty Scale score, the incidence of maternal and infant complications, the improvement of mental state, and the patients' satisfaction with the nursing program were observed and compared between the two groups.

Results

Compared with before the intervention, the self-efficacy scores of the two groups were significantly improved, and the blood pressure, disease uncertainty score, SAS, and SDS scores were significantly decreased, and the indicators in the study group were better than those before the intervention. In the control group, the difference was statistically significant (P < 0.05). After the intervention, among the 40 patients in the study group, 10 cases (25.00%) of cesarean section were significantly lower than 19 cases (47.50%) in the control group, and the nursing work satisfaction in the study group was significantly higher than that in the control group (P < 0.05).

Conclusion

The application of evidence-based nursing interventions and smart medical nursing interventions to patients with pregnancy-induced hypertension syndrome has significant effect and can effectively improve the blood pressure control effect of patients during pregnancy.

Effects of an evidence-based nursing intervention on prevention of anxiety and depression in the postpartum period

Postpartum depression has been one of the most common psychological disorders in patients during postpartum period. The constant anxiety and depression during this period seriously affect the physiological and psychological health of both the mother and infant. Evidence-based nursing has been widely applied in clinical practice and has achieved remarkable results. However, the effect of evidence-based nursing on postpartum depression remains unclear. Pregnant women who were not diagnosed with postpartum depression during hospitalisation (Edinburgh Postpartum Depression Scale [EPDS] ≤ 13 points) but prone to postpartum depression (EPDS scores of 9-13) were recruited into the study. They were randomly divided into the Intervention group (N = 60) and Control group (N = 60). Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), EPDS and Pittsburgh Sleep Quality Index (PSQI) were used to investigate the psychological outcomes of puerperae during and after the 6-week intervention. Both the intention-to-treat and per-protocol analyses showed that 6 weeks of evidence-based nursing intervention significantly reduced the incidence of postpartum depression. The application of the evidence-based nursing also improved the patients' satisfaction degree and effectively alleviated their anxiety according to both the intention-to-treat and per-protocol analyses. Evidence-based nursing intervention had positive effects against anxiety and depression in the postpartum period.

Application of Traditional Chinese Medical Science Characteristic Nursing Mode Based on Evidence-Based Medicine to Puerperal Breast Tenderness and Pain

Objective

To explore the effects of traditional Chinese medicine (TCM) characteristic nursing mode based on evidence-based medicine on parturients with breast tenderness and pain.

Method

100 parturients with postpartum breast pain treated at Taizhou First People's Hospital from January 2020 to December 2021 were selected. Among them, 51 cases received routine nursing intervention (general group, GG) and 49 cases received TCM characteristic nursing based on evidence-based medicine (comprehensive group, CG). The pain number (NRS) score, lactation effect, breastfeeding self-efficacy (BSES-SF) score, anxiety and depression, and nursing satisfaction of the two groups were compared. In addition, the pregnant women were followed up after discharge to investigate the rate of exclusive breastfeeding.

Result

Three days after intervention, NRS score, SAS score, and SDS score in the CG were significantly lower than those in the GG. The level of serum prolactin and total breast lactation yield in the GG were better than those in the CG. BSES-SF score, nursing satisfaction, and exclusive breastfeeding rate in the CG were higher than those in the GG.

Conclusion

Evidence-based TCM care can significantly reduce postpartum breast tenderness, increase milk production, improve exclusive breastfeeding, and help relieve emotional distress.

Barriers and facilitators to implementation of the Accountable Health Communities (AHC) Model: Findings from a between-site qualitative assessment of implementation strategies

Introduction

A multitude of HRSN interventions are undergoing testing in the U.S., with the CMS Accountable Health Communities (AHC) Model as the largest. HRSN interventions typically include screening for social needs, referral to community resources, and patient navigation to ensure needs are met. There is currently a paucity of evidence on implementation of HRSN interventions. The Consolidated Framework for Implementation Research (CFIR) is a determinant framework widely used to plan and assess implementation. To the authors knowledge, there are no published studies assessing CFIR constructs for HRSN intervention implementation in the U.S. In the Assessment step of the Strengthening Peer AHC Navigation (SPAN) model, a between-site qualitative assessment methodology was used to examine implementation within and between AHC bridge organizations (BOs) within six ERIC implementation strategies identified by the authors based on AHC Model requirements.

Objective

Our aim was to identify and present between-site barriers and facilitators to AHC Model implementation strategies.

Design

A multi-site qualitative analysis methodology was used. CFIR determinants were linked to six Expert Recommendations for Implementing Change (ERIC) strategies: staff training, identify and prepare champions, facilitation, community resource engagement (alignment through advisory boards and working groups), data systems, and quality monitoring and assurance. Interviews were analyzed using thematic content analysis in NVivo 12 (QSR International).

Setting

Five health-related bridge organizations participating in the AHC Model.

Results

Fifty-eight interviews were completed with 34 staff and 24 patients or patient proxies. Facilitators were identified across five of the six ERIC strategies. Barriers were identified across all six. While organizations found the AHC Model compatible and facilitators to implementation included previous experience, meeting patient needs and resources, and leadership engagement and support, a number of barriers presented challenges to implementation. Issues with adequate staff training, staff skills to resolve HRSN, including patient communication and boundary spanning, setting staff goals, beneficiary caseloads and measurement of progress, data infrastructure (including EHR), available resources to implement and differences in perceptions between clinical delivery site (CDS), and CSP of how to measure and resolve HRSN.

Conclusions and relevance

The conduct of a pre-implementation readiness assessment benefited from identifying CFIR determinants linked to various ERIC implementation strategies.

Mapping the evidence-based practice research field in nursing from 1995 to 2021: A bibliometric analysis

BACKGROUND

Evidence-based nursing and its practices are increasing rapidly in the health and nursing literature. A holistic image of evidence-based nursing research is needed to address evidence-based studies and available information on nursing.

AIM

The aim of this study was to evaluate evidence-based nursing-related research with bibliometric analysis in order to provide a structured macroscopic overview of its features and advances.

METHODS

A bibliometric analysis of 4,159 publications from 1995 to 2021 was performed to map the literature of evidence-based nursing studies and assess the structure of the scientific community. The studies' publication output and growth trend, authors and collaborations, publishing journals, terms, current trends, subject categories, global distribution and collaboration, and the authors' average number of citations were all assessed.

RESULTS

It was found that the number of evidence-based nursing publications increased until 2016, reaching the publication peak (n = 369), after which they began to decline. Most studies on the topic (n = 543) have been published in the journal Worldviews on Evidence-Based Nursing. Evidence-based knowledge, dissemination, implementation, implementation barriers, and implementation and training curricula in particular fields have all evolved over time as the key concepts of research. The United States (6,218), Australia (1,247), and England (790) are the three nations with the highest number of publications. On the other hand, it is seen that the subject has yet to be discussed in a few developing or underdeveloped countries.

CONCLUSIONS

In the last 12 years, evidence-based nursing has been a comprehensive area of research. In comparison with the research areas in its field, it can be speculated that it has a more practical focus. It was determined that the authors' keywords primarily began with research implementation, practice development, and knowledge utilization over time, and then evolved to specific areas, educational areas, process applications, and important current topics such as Covid19.

Exploring readiness for implementing best practices: A mixed methods study

RATIONALE

Evidence-based practice (EBP) can improve health care in underprivileged countries. Bolivia's EBP movement is nascent and the factors contributing to better implementation in nursing are unknown.

AIM

To explore Bolivian nurses' readiness to engage in EBP while highlighting the facilitators and barriers for pursuing EBP.

METHOD

The study used a sequential explanatory mixed methods study. First, general trends were disclosed via a survey of 170 nurses in La Paz, Bolivia, holding at least a baccalaureate regarding their perceived beliefs about EBP. The survey identified facilitators and barriers for implementing EBP in acute and ambulatory settings. Second, qualitative data was gathered via a focus group of nine nurses with the purpose of enhancing the survey results.

RESULTS

The survey results showed that nurses believe that engaging in EBP can improve their clinical practice. However, the nurses' research behaviors were found to be infrequent. Lack of support from the nurses' clinics and hospitals and from non-nursing professionals were identified as barriers for engaging in EBP. The qualitative results revealed underlying limitations to nurses' clinical practice, including "feeling undervalued".

CONCLUSIONS

There is a dearth of EBP knowledge among Bolivian nurses stemming from a lack of preparation in EBP environments, including EBP training opportunities. This situation affects nurses' professional dimensions of relational work, power, and collaboration. Collaborative research among educators, professional nursing societies, and local and international organizations could provide initiatives for implementing EBP, based on local health profiles.

Differences in beliefs on and implementation of evidence-based practice according to type of health care institution-A national cross-sectional study among Slovenian nurses

AIM

To explore the differences in beliefs on and implementation of evidence-based practice in nurses working in different types of health care institutions.

BACKGROUND

Optimal organizational context and knowledge are essential to support evidence-based practice and sustain the use of evidence in professional nursing practice.

METHOD

A cross-sectional study was conducted. A total of 1,014 nurses from 20 Slovenian hospitals and 29 primary health care centres participated. Variables included the following: Evidence-Based Practice Beliefs and Implementation Scale, educational and training activities, job satisfaction, job training, perceived research and evidence-based practice knowledge, and access to databases.

RESULTS

Beliefs on evidence-based practice were explained by evidence-based practice (β = 0.249) and research (β = 0.162) knowledge, length of employment (β = 0.124), job satisfaction (β = 0.117), training in evidence-based practice (β = -0.092) and holding a master's degree (β = 0.077). Implementation of evidence-based practice depended on beliefs (β = 0.306) and the type of health care institution (β = 0.132). The highest implementation result was seen in primary health care centres (<0.001).

CONCLUSION

Training in evidence-based practice and perceived knowledge of evidence-based practice significantly influence the beliefs on and implementation of evidence-based practice. Nurses employed at primary health care centres who had completed a task-shifting training programme achieved significantly better results for implementation of evidence-based practice.

IMPLICATIONS FOR NURSING MANAGEMENT

The indirect effects of development training programmes for the implementation of EBP have not yet been studied. Development activities and change implementation processes in nursing foster education and training opportunities, which have significantly influenced the implementation of EBP.

Examining the association between evidence-based practice and the nurse-patient therapeutic relationship in mental health units: A cross-sectional study

AIMS

To examine the relationship between the dimensions of evidence-based practice and the therapeutic relationship and to predict the quality of the therapeutic relationship from these dimensions among nurses working in mental health units.

DESIGN

A cross-sectional design.

METHODS

Data were collected between February-April 2018 via an online form completed by nurses working at 18 mental health units. Multiple linear regressions were used to examine the relationship between the dimensions of evidence-based practice and therapeutic relationship. Questionnaires were completed by 198 nurses.

RESULTS

Higher levels of evidence-based practice were a significant predictor of a higher-quality therapeutic relationship (β: 2.276; 95% CI: 1.30-3.25). The evidence-based practice factor which most influenced an improved therapeutic relationship was the nurses' attitude (β: 2.047; 95% CI: 0.88-3.21). The therapeutic relationship dimension which was most conditioned by evidence-based practice dimensions was agreement on tasks, which was most favourable with a better attitude (β: 0.625; 95% CI: 0.09-1.16) and greater knowledge and skills for evidence-based practice (β: 0.500; 95% CI: 0.08-0.93).

CONCLUSION

In mental health settings, the therapeutic nurse-patient relationship is positively enhanced by evidenced-based practice and the nurse's level of experience, with a great influence on shared decision-making.

IMPACT

This research sought to examine the relationship between the evidence-based practice and the therapeutic relationship in mental health nursing. This study demonstrates that an improved attitude and knowledge of evidence-based practices of mental health nurses increases shared decision-making with patients, which is a basic requirement for person-centred care. Because the therapeutic relationship is considered the backbone of nursing practice in mental health units, this research will have an impact on both mental health nurses and mental health unit managers.

Use of Evidence-Based Practice Among Healthcare Professionals After the Implementation of a New Competency-Based Curriculum

BACKGROUND

Although evidence-based practice (EBP) has been spreading since the 1990s, it has not yet been sufficiently implemented.

AIM

Following the reform of initial training for healthcare professions in France 2012, we sought to determine whether the new curriculum was associated with more frequent use of EBP.

METHODS

We performed an online, cross-sectional survey of nurses, occupational therapists, and podiatrists (divided into pre- and post-reform groups) in June 2018. The questionnaire covered demographic data, use of EBP, and the perception of EBP. As holding a master's degree may enhance knowledge and use of EBP, we adjusted for this variable. Categories to analyze qualitative data were created regarding the five steps in EBP and its definition.

RESULTS

The total sample was N = 595 (pre-reform group n = 301; post-reform group n = 294). The proportion of respondents who frequently read the professional literature was lower in the post-reform group than in the pre-reform group (33% vs. 54%, respectively; OR [95% CI] = .52 [.37-.73]; p < .001). The main stated reasons for reading the professional literature were "keeping up to date with practice" and "making clinical decisions." Respondents in both groups mentioned a lack of time as the most frequent barrier to reading the literature (82%), a lack of access to bibliographical resources, and that EBP was not encouraged. Most professionals limited their definition of EBP to reading the literature and implementing research results.

LINKING EVIDENCE TO ACTION

There is a need to teach the five steps of EBP more explicitly and to embed its position into daily practice, for example, through reflective analysis practice. Professional trainings about EBP should be offered on a regular basis. Guidance coming from the healthcare directorate should include expected daily practice time for reading and journal club and giving more access to international healthcare literature.

Bridging the gap between research-based knowledge and clinical practice: a qualitative examination of patients and physiotherapists' views on the Otago exercise Programme

Background

Falls and fall-related injuries exacerbate the health problems of older adults, and they are a public health concern. Despite an abundance of research, the implementation of evidence-based fall prevention programs has been slow and limited, additionally and these programs have not reduced the incidence of falling. Therefore, the primary objective of the present study was to examine patients and physiotherapists’ views on the factors that influence the implementation of the community- and evidence-based Otago Exercise Programme for fall prevention.

Methods

We conducted eight in-depth interviews with physiotherapists and patients, and a focus group interview with 12 physiotherapists and authority figures who represented local hospitals and municipalities. The resultant qualitative data were subjected to thematic analysis.

Results

The analysis yielded two main themes: the researcher’s role and position in the implementation process and the tension between research-based knowledge and clinical practice. The participants believed that research-based knowledge can address the challenges of clinical practice. Further, the patients reported that the fall prevention program made them feel safe and enhanced their ability to cope with daily life. The physiotherapists also observed that research findings do not readily translate into clinical practice. Further, they contended that research-based knowledge is not universal and that it cannot be generalized across different contexts; instead, it must be adapted and translated into a user-friendly language. The findings suggest that the application of research-based knowledge does equate to filling up empty jars and that research-based knowledge does not flow from the expert to the non-expert as water through a tube. Indeed, physiotherapists and patients are not tabula rasa. Additionally, the participants believed that researchers and stakeholders must think critically about who has the power and voice to create a common understanding.

Conclusions

Our findings delineate the means by which the gap between research and practice regarding the Otago fall prevention program can bridged. The program can guide clinical work and provide important information that can be used to improve the quality of other fall prevention programs. However, the research-based knowledge that it confers must be adapted for use in clinical contexts.