Evidence-based practice improves patient outcomes and healthcare system return on investment: Findings from a scoping review

Digital health competences and AI beliefs as conditions for the practice of evidence-based medicine: a study of prospective physicians in Canada

BACKGROUND

The practice of evidence-based medicine (EBM) has become pivotal in enhancing medical care and patient outcomes. With the diffusion of innovation in healthcare organizations, EBM can be expected to depend on medical professionals' competences with digital health (dHealth) and artificial intelligence (AI) technologies.

OBJECTIVE

We aim to investigate the effect of dHealth competences and perceptions of AI on the adoption of EBM among prospective physicians. By focusing on dHealth and AI technologies, the study seeks to inform the redesign of medical curricula to better prepare students for the demands of evidence-based medical practice.

METHODS

A cross-sectional survey was administered online to students at the University of Montreal's medical school, which has approximately 1,400 enrolled students. The survey included questions on students' dHealth competences, perceptions of AI, and their practice of EBM. Using structural equation modeling (SEM), we analyzed data from 177 respondents to test our research model.

RESULTS

Our analysis indicates that medical students possess foundational knowledge competences of dHealth technologies and perceive AI to play an important role in the future of medicine. Yet, their experiential competences with dHealth technologies are limited. Our findings reveal that experiential dHealth competences are significantly related to the practice of EBM (β = 0.42, p < 0.001), as well as students' perceptions of the role of AI in the future of medicine (β = 0.39, p < 0.001), which, in turn, also affect EBM (β = 0.19, p < 0.05).

CONCLUSIONS

The study underscores the necessity of enhancing students' competences related to dHealth and considering their perceptions of the role of AI in the medical profession. In particular, the low levels of experiential dHealth competences highlight a promising starting point for training future physicians while simultaneously strengthening their practice of EBM. Accordingly, we suggest revising medical curricula to focus on providing students with practical experiences with dHealth and AI technologies.

Quality care for children and young people with complex and integrated care needs: A discussion on nursing-sensitive indicators

This paper highlights the need for nursing-sensitive indicators tailored to children and young people with complex and integrated care needs. While nursing plays a pivotal role in influencing care quality for this population, current measures predominantly focus on adult populations, creating gaps that hinder the evaluation of nursing contributions across diverse settings such as acute, community, and home care. We examine the importance of quality care measurement for children and young people with complex and integrated care needs and highlight deficiencies in international measurement systems. The discussion highlights the multidimensional care needs of this vulnerable population and advocates for nursing-sensitive indicators that capture broader outcomes including physical health, functional outcomes, family experience, and family well-being. Also highlighted is, the weak evidence linking process indicators to improved patient outcomes, a focus on negative outcomes, such as mortality, and the lack of theoretical foundations for nursing-sensitive indicators. There is a lack of consensus on what components to measure, definitions of indicators, and appropriate methodologies for the development of nursing sensitive indicators. Donabedian's (1988) structures, processes, and outcomes framework is discussed as well as an overview of adaptations used to improve the quality of indicator sets in a variety of settings. By situating the discussion within the context of children's and young people's nursing, this paper aims to direct future research towards the development of comprehensive indicators that capture the full contribution of nursing to the care of children and young people with complex and integrated care needs. Ultimately, this paper advocates for a standardised, holistic approach to nursing-sensitive indicators for this vulnerable population to improve care quality and overall health and wellbeing for children, young people, and their families.

How valuable is an implementation toolkit for midwives? An exploratory study

BACKGROUND

Incorporating evidence-based approaches in maternity care throughout the entire trajectory from pregnancy through to the postnatal phase is integral to good public health. Yet, despite developing theories, frameworks, and models to guide midwives' implementation efforts, implementing new evidence-based practices in midwifery practice settings remains challenging.

METHODS

An exploratory study design was used to conduct an initial assessment of the appeal and suitability of an implementation 'how to' Toolkit for Australian change-leader midwives. We aimed to determine the effectiveness of the intervention by evaluating midwives' experience of using the Toolkit, and report on the usability of the Toolkit in maternity care. We also sought to establish the degree to which the intervention could reach a broad cross-section of midwives, confirming the usability of the Toolkit across a range of public and private maternity services.

RESULTS

Twenty-four midwives participated in our study. Participants provided practical Toolkit evaluation data, contextual information related to Toolkit content, their understanding of what implementation in a healthcare context is, and factors that hindered midwives' implementation efforts in clinical settings. The importance of co-design research and involving end-users in product development were also highlighted as crucial factors underpinning the effectiveness of resources like ours, particularly those designed to support specialist disciplines and the implementation challenges experienced by health practitioners in clinical environments.

CONCLUSIONS

It is crucial to progress health care practitioners understanding of how to accelerate the implementation and sustainment of new evidence-based practices in clinical settings, including strategies to support organisational readiness, local barriers or challenges, and partnerships between researchers and end-users. Evaluation of our midwifery-specific implementation Toolkit indicates health professionals require tailored materials and information specific to their disciplines and clinical work environments; ideally, packaged in a centalised, open-access format. Future research is required to evaluate the mid-to-longterm impact of our Toolkit on implementation initiatives in midwifery contexts, and to establish the adaptability of our Toolkit in other settings, and with other disciplines.

Living Lab Dementia: process evaluation of an academic-practice partnership in German long term care for people living with dementia - study protocol

BACKGROUND

Living Labs, as a type of academic-practice partnerships, possess the potential to transform care and research into a participatory partnership and narrow the research-practice gap to improve evidence-based and Person-centred care. Given the lack of systematic investigations of Living Labs in healthcare, we will establish a dementia-specific academic-practice partnership (Living Lab Dementia) in Germany and conduct a process evaluation. The aim of this study is to gain insights into the intervention itself (mechanisms of impact) and its implementation process (degree of implementation, barriers, and facilitators).

METHODS

This process evaluation of the multi-center research project PraWiDem (German acronym for linking professional nursing practice and research in dementia) will be conducted applying a convergent mixed methods design and will be based on the Medical Research Council (MRC) framework for the development and evaluation of complex interventions. The intervention is presented in a logic model which describes relevant basic theoretical assumptions, intervention components, implementation aspects, mechanisms of impact, relevant outcomes, and the context in which the intervention is delivered. Data will be collected before the intervention (T0), during the intervention period, and at follow-up after 18 months (T1). Qualitative data will be collected through semi-structured interviews and focus groups. Quantitative data sources will be process documents and questionnaires.

DISCUSSION

Our study will provide important insights into the Living Lab Dementia intervention and its implementation processes. The results of this evaluation will contribute to the refinement of the intervention and its implementation processes, and will enable to measure the impact of these processes in future studies.

Corpus Linguistics as a Research Method in Nursing: A Practical Approach to Analysing Language Data

AIM

To highlight the use of corpus linguistics for analysing language data and to provide a worked example of this approach in nursing research.

DESIGN

Methodology discussion paper.

METHODS

This paper introduces corpus linguistics as a distinct approach to undertaking qualitative research in nursing. Examples are provided to illustrate how corpus linguistics can be applied to explore contemporary concepts in healthcare.

CONCLUSION

Corpus linguistics offers a structured, robust alternative to traditional qualitative analysis. When combined with critical social theory, it is ideal for exploring power dynamics and discourse, making it a valuable approach for nursing and healthcare related research.

IMPLICATIONS FOR NURSING

Nurse researchers often work with large amounts of textual data. Corpus linguistics provides a rigorous framework for analysing such data sets, which can be used for various studies.

IMPACT

Corpus linguistics analytics can enhance nursing research by uncovering language use patterns that can help generate knowledge to inform nursing practice and policy development.

PATIENT OR PUBLIC CONTRIBUTION

None.

Clinicians' and Patients' Experiences and Perceptions on the Prevention and Management of Surgical Site Infections: A Mixed-Methods Systematic Review

AIM

To explore clinicians' and patients' perceptions of implementing evidence-based practice to improve clinical practice for preventing and managing surgical site infections within hospital acute care settings.

DESIGN

A convergent integrated mixed-methods systematic review using the Joanna Briggs Institute approach.

METHODS

Included studies reported (i) acute care hospital clinicians' and patients' experiences and preferences for preventing and managing surgical site infections and (ii) barriers and facilitators to implementing surgical site infection prevention and management guidelines. The Mixed Methods Appraisal Tool and the Quality Improvement Minimum Quality Criteria Set were used for critical appraisal. Quantitative data was transformed into qualitised data, then thematically synthesised with qualitative data and coded all findings into themes. Clinicians' and patients' views were also compared.

DATA SOURCES

English language peer-reviewed studies published from 2009 to March 2023 were identified from Medline, EMBASE, CINAHL, PsycINFO and Cochrane Central Library.

RESULTS

Thirty-seven studies (16 quantitative, 17 qualitative, 3 mixed-methods and 1 quality improvement) met the inclusion criteria. Five main themes represent key factors believed to influence the implementation of evidence-based surgical site infection prevention and management guidelines: (1) Intentional non-adherence to insufficiently detailed and outdated guidelines, (2) Knowledge deficits on evidence-based SSI care bring about inconsistent clinical practice, (3) Collaborative interdisciplinary and patient-provider relationship to enhance guideline uptake, (4) Infection surveillance to improve patient safety and quality of life and (5) Negative physical and psychological impacts on patients.

CONCLUSION

The five themes reflect a need for updated hospital guidelines as a medium to improve surgical site infection knowledge and ensure consistent and evidence-based clinical practice. This review also highlights the significance of interdisciplinary and patient-provider collaboration and infection surveillance to facilitate guideline uptake. The effectiveness of intervention bundles designed to improve these aspects of care will need to be evaluated in future research.

IMPACT

A future intervention bundle that includes (1) ensuring up-to-date hospital guidelines/policies; (2) fostering collaborative interdisciplinary teamwork culture between physicians, nurses, podiatrists, pharmacists and allied health professionals; (3) encouraging patient or carer involvement in shared decision-making and (4) implementing audit and feedback mechanism on infection surveillance is proposed to improve SSI prevention and management in acute care settings.

REPORTING METHOD

This paper followed the PRISMA 2020 checklist guideline for reporting systematic reviews.

PATIENT OR PUBLIC CONTRIBUTION

This mixed-methods systematic review collates evidence of clinicians' and patients' experiences and preferences for preventing and managing surgical site infections. The inclusion of hospital patients' perspectives supports the development of patient-centred interventions.

TRIAL REGISTRATION

The review protocol is registered on the International Prospective Register of Systematic Reviews (PROSPERO 2021 CRD42021250885). Available at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021250885.

Defining evidence-based nursing practice: An interpretative phenomenological study

BACKGROUND

Evidence-based nursing practice (EBNP) has been regarded core competencies in nursing practice and education. Defining evidence-based nursing practice and translating evidence into nursing practice by nursing students who are green to clinical practice in their education journey remain unclear.

AIM

To explore how pre-registered nursing students define and characterize evidence-based nursing practice as they participate in their clinical practicum.

DESIGN

This study used an interpretive phenomenological qualitative study design.

SETTINGS AND PARTICIPANTS

Twenty nursing students were interviewed for their clinical practicum experience from four universities, one nursing college and one hospital-based nursing school in Hong Kong.

METHODS

Data was generated through semi-structured in-depth interview and analyzed following interpretative phenomenological analysis guidelines, using a cyclical coding process.

RESULTS

Four themes emerged regarding nursing students' definition of EBNP, highlighting that EBNP is 'identifying a reliable learning source', by which they can 'rationalize their nursing practice', and enabling them to 'establish care standard through critical thinking', and eventual 'fostering their professionalism' to improve health outcomes and reduce potential harms.

CONCLUSION

Nursing students defined and characterized evidence-based nursing practice as core competencies in accompany their practicum that enables them to learn and grow professionally with a universal desire to be qualified, cope with doubt, and improve patient outcome. They recognized the challenges in identifying evidence and emphasized conservative approach to validate the evidence to avoid patient harm. Students expressed doubt towards their instructors EBNP when observing procedures untaught at school, which requires the curriculum model to foster students' skills in applying and appraising evidence and instructors' capacity to rationalize and role model EBNP.

Breast Cancer Patient Flap Management After Mastectomy: A Best Practice Implementation Project

BACKGROUND

Breast cancer is a prevalent malignancy in women, with mastectomy as the main surgery. Common postmastectomy complications are seroma (15%-81%), infections (2.9%-3.8%), and flap necrosis (10%-18%), severely impacting quality of life and costs. However, there's a lack of standardized flap care protocols and limited staff knowledge.

OBJECTIVES

This study aims to apply best evidence for flap management post-mastectomy to standardize practices, reduce complications, and enhance patient's quality of life.

METHODS

This project followed JBI PACES and GRiP principles, implementing evidence-based practices in a Chinese tertiary hospital between January and May 2023. It entailed evidence identification, integration into clinical context, protocol development, baseline audits, barrier/enabler analysis. The study compared pre- and post-evidence implementation rates of flap complications, healthcare staff's knowledge/skill scores on mastectomy flap management, and audit indicator adherence by both staff and patients.

RESULTS

After evidence application, flap ischemia/necrosis rates dropped from 8.57% to 5.56% (P < .001), wound infection rates after surgery reduced from 5.71% to 2.78% (P < .001), and seroma rates decreased from 17.14% to 2.78% (P < .001). Healthcare staff's knowledge and skill scores for flap management following mastectomy increased from 50.67 ±18.32 preimplementation to 98.33 ± 4.01 (t = -13.90, P < .001). Audit criterion compliance rates increased from 8.57% to 94.29% to between 91.67% and 100%, with statistically significant differences in all 15 criteria (P < .001).

CONCLUSIONS

Evidence-based management of flaps after mastectomy improves healthcare staff's knowledge and skills, enhances nursing quality, effectively reduces flap complications in patients, and boosts their quality of life.

Medicine Meets Science: The Imperative of Scientific Research and Publishing for Physician-Scientists

Physician-scientists serve as conduits between clinical practice and scientific research, leveraging their unique expertise to improve patient care and drive medical innovation. This article highlights the indispensable role of research and publishing in promoting evidence-based practices, facilitating professional growth, and shaping public health policy. Drawing on historical and contemporary examples, I examine the challenges faced by physician-scientists, such as ethical dilemmas and declining engagement in research, particularly in resource-constrained settings. I suggest pragmatic strategies to overcome these barriers, emphasizing the need for systemic support, ethical integrity, and the equitable dissemination of advancements. This piece aims to inspire a new generation of physician-scientists to engage deeply with both clinical and research domains, thus advancing global health equity and resilience.

Knowledge, attitudes, practice, and perceived barriers toward evidence-based practice among Palestinian nurses in intensive care units

BACKGROUND

Evidence-based practice (EBP) implementation can improve healthcare safety and patient outcomes. The significant challenge for intensive care nurses is providing safe and evidence-based care to patients with complex illnesses who are at high risk of complications and death. This study aimed to assess the knowledge, attitudes, and practice of EBP, and the perceived barriers to EBP implementation among nurses in intensive care units (ICUs) in the North West Bank hospitals.

METHODS

A cross-sectional descriptive correlational design was employed, with 154 registered nurses from governmental and private ICU hospitals in the North West Bank of Palestine participating. Data were collected using a self-reported questionnaire from December 2022 to July 2023.

RESULTS

The findings revealed that the attitudes mean was (M = 5.1 SD ± 1.1), followed by knowledge (M = 4.8, SD ± 1.4), and practice (M = 4.6, SD ± 1.2). The main barriers to EBP were insufficient time to find research reports (M = 3.5, SD ± 1.0) and inadequate time at work to implement changes in own practice (M = 3.4, SD ± 0.8). A correlation was found between knowledge, attitudes, and practice of EBP with Levels of education (t = 2.68, p < 0.01; t = 2.98, p < 0.01; t = 4.83, p < 0.01, respectively), attending EBP courses (t = 4.30, p < 0.01; t = 20.0, p < 0.01; t = 4.30, p < 0.01, respectively), and age (r = 0.159, p < 0.05; r = 0.234, p < 0.01; r = 0.289 p < 0.01, respectively). In contrast, the experience was associated with the practice of EBP (t = 1.77, p < 0.05).

CONCLUSION

The intensive care nurses had positive knowledge, attitudes, and practice of EBP, while attitudes were more favorable than knowledge and practice. Thus, the findings can assist policymakers and hospital administration in developing appropriate interventions and strategies, such as effective continuing education and developing and implementing a hospital-wide EBP culture to improve nurses' knowledge and practice of EBP.

Assessing the comparative effects of interventions in COPD: a tutorial on network meta-analysis for clinicians

To optimize patient outcomes, healthcare decisions should be based on the most up-to-date high-quality evidence. Randomized controlled trials (RCTs) are vital for demonstrating the efficacy of interventions; however, information on how an intervention compares to already available treatments and/or fits into treatment algorithms is sometimes limited. Although different therapeutic classes are available for the treatment of chronic obstructive pulmonary disease (COPD), assessing the relative efficacy of these treatments is challenging. Synthesizing evidence from multiple RCTs via meta-analysis can help provide a comprehensive assessment of all available evidence and a "global summary" of findings. Pairwise meta-analysis is a well-established method that can be used if two treatments have previously been examined in head-to-head clinical trials. However, for some comparisons, no head-to-head studies are available, for example the efficacy of single-inhaler triple therapies for the treatment of COPD. In such cases, network meta-analysis (NMA) can be used, to indirectly compare treatments by assessing their effects relative to a common comparator using data from multiple studies. However, incorrect choice or application of methods can hinder interpretation of findings or lead to invalid summary estimates. As such, the use of the GRADE reporting framework is an essential step to assess the certainty of the evidence. With an increasing reliance on NMAs to inform clinical decisions, it is now particularly important that healthcare professionals understand the appropriate usage of different methods of NMA and critically appraise published evidence when informing their clinical decisions. This review provides an overview of NMA as a method for evidence synthesis within the field of COPD pharmacotherapy. We discuss key considerations when conducting an NMA and interpreting NMA outputs, and provide guidance on the most appropriate methodology for the data available and potential implications of the incorrect application of methods. We conclude with a simple illustrative example of NMA methodologies using simulated data, demonstrating that when applied correctly, the outcome of the analysis should be similar regardless of the methodology chosen.

Perspectives of paediatric occupational therapists on the use of evidence-based practice in Kuwait: a qualitative study

OBJECTIVES

To investigate the perspectives of paediatric occupational therapists on factors relating to the use of evidence-based practice (EBP) in clinical practice/settings.

DESIGN

A qualitative approach entailing the use of (face-to-face) semistructured interviews. Collected data were analysed using thematic analysis.

SETTING

Governmental and private hospitals, clinics and schools in Kuwait that offered occupational therapy services.

PARTICIPANTS

10 occupational therapists with a minimum of 2 years experience working with children.

PRIMARY AND SECONDARY OUTCOME MEASURES

Occupational therapists' perspectives on the factors relating to the implementation of EBP in clinical practice.

RESULTS

Three themes emerged: (1) source of motivation towards EBP; (2) organisational support for EBP use and (3) creativity and flexibility in implementing EBP. Several motivators encouraged therapists to use EBP in their clinical practice, including their personal motivation and clients' outcomes. However, the barriers to EBP implementation are due to the lack of organisational support for EBP. Using creativity and flexibility in practice is essential to overcome challenges.

CONCLUSION

This study identified factors related to the implementation of EBP from the perspective of paediatric occupational therapists in Kuwait. It provides several implications and recommendations for occupational therapy education and practice in the region due to similarities in culture. As therapists' concerns are identified, developing the educational curricula at universities and providing continuous professional development courses in regard to EBP utilisation are important for delivering effective healthcare services.

The use of a nursing implementation framework to enhance the uptake of an evidence-based intervention

BACKGROUND

Evidence-based practices (EBPs) are instrumental in improving patient outcomes and ensuring high-quality nursing care, yet their implementation often encounters substantial barriers. The Iowa Implementation for Sustainability Framework and the Precision Implementation Approach© offer systematic strategies for overcoming barriers and enhancing EBP implementation and sustainability in health care settings.

AIM

This project aimed to use the Iowa Implementation for Sustainability Framework and the Precision Implementation Approach© to support the use of an evidence-based maternal depression intervention within Iowa's Title V Maternal Health Program that serves mothers of young children living in poverty.

METHODS

This practice-based implementation was accomplished in three steps: (1) hold intervention-focused staff meetings, (2) identify barriers to using the intervention, and (3) identify and deliver implementation strategies. Collected data included barriers identified, selected implementation strategies, and evaluation of meeting attendance and impact on confidence.

RESULTS

Four of the monthly virtual staff meetings focused on Listening Visits (LV) use. The 7 strategies comprising our approach to supporting LV use addressed three categories of identified barriers: lack of confidence, logistical issues, and not understanding intervention procedures. In the LV-focused meetings, representation of the 14 maternal health clinics was high, although attendance by individual staff was inconsistent. Post-meeting polls indicated that 40% to 65% of attendees felt more confident using intervention skills.

LINKING EVIDENCE TO ACTION

This practical nursing-implementation framework facilitated EBP adoption, and our well-structured targeted strategies effectively increased staff confidence. Nursing managers and educators should consider using this framework to enhance their organizations' capacity to implement EBPs sustainably.

Creating infrastructure for supporting nurse engagement in evidence-based practice at a Veterans Administration Hospital

BACKGROUND

Evidence-based practice (EBP) is foundational to safe and quality health care; however, barriers to nursing engagement in EBP have been well documented. To circumvent these barriers, nursing leadership must proactively implement system-level, multifaceted strategies within their organization to enhance EBP engagement. One Veterans Administration (VA) hospital has operationalized these strategies.

AIMS

To provide a description of the multifaceted strategies employed to promote a EBP culture and enhance nurses' engagement with EBP at a VA Hospital.

CONCLUSIONS

Although it takes time, nursing leadership can overcome barriers and ensure nurse engagement in EBP at their organizations through implementation of multifaceted, system-wide strategies.

Participant Experience of Taking Part in Periodontal Experimental Studies

Objective: Despite the plethora of published periodontal interventional and experimental studies, there are no reports evaluating the experience of the participants as a research subject or their willingness for repeat participation in a similar study. This study aimed to determine the participants' experience and willingness to participate again in periodontal experimental studies and to explore factors that affect the participants' research experience. Materials and Methods: Questionnaires from four completed experimental wound healing studies with 76 total participants were extracted and analyzed. The participants answered the same specific questions at their last study visit. The questions asked were "overall experience in the study" and "willingness to participate in the study again," with each question providing five levels/possible answers. Questionnaires also provided an opportunity for participants to offer open-ended comments about their participation. Frequency distribution and logistic regression analyses were performed to evaluate the association between the participant's responses and study characteristics. Results: All 76 participants answered the specific questions. Overall, 88.2% of participants had a positive experience from their research participation, and 65.8% of them would participate again in such a study. Of the 76 participants, 50 were in studies that included multiple (≥2) experimental wounds, while 26 received only a single experimental wound. Participation experience was negatively associated with the number of wounds received (p < 0.001), while willingness to participate again was positively associated with participation experience (p < 0.001). Conclusions: Within the present study limitations, volunteers participating in periodontal experimental studies have an overall positive experience and express willingness for repeat participation.

Effect of an online training intervention on evidence-based practice in clinical nurses. #Evidencer Project

BACKGROUND

Online learning is becoming increasingly essential for health professionals, and it is necessary to understand how this modality affects clinical nurses' learning of Evidence-Based Practice (EBP). For this reason, the present study sought to assess the effectiveness of an online training program in improving nurses' EBP competence.

METHODS

A quasi-experimental study with a pretest-posttest design was conducted with a control group and without randomization for a period of 6 months. The intervention was an online self-learning course based on Melnyk's seven steps of Evidence-Based Practice (EBP). The course was structured into sequential modules requiring 72 h of work, with task completions and tests necessary for progression. Participants had three months to complete the course. EBP competence was measured with the EBP-COQ Prof© questionnaire. Data analysis included percentages, means, standard deviations, chi-square tests, student's t-tests, and a two-way repeated measures analysis of covariance (ANCOVA).

RESULTS

The analysis of the changes observed in each dimension and the overall EBP competence between the intervention group (IG) and the control group (CG) showed a significant group*time interaction in three of the four dimensions of the questionnaire. The results indicated that the online Evidence-Based Practice (EBP) course significantly improved knowledge, skills, and utilization three months after its completion. In the IG, the mean score was 44.04 (standard deviation (SD) = 7), compared to 37.83 (SD = 8.5) in the CG (p < 0.001). Regarding skills, the IG had a mean score of 24.24 (SD = 3.8), while the CG scored 23.01 (SD = 3.1) (p = 0.008). For utilization, the mean score in the IG was 36.77 (SD = 6.8), and the CG was 33.12 (SD = 6.3) (p = 0.005). Overall competence also showed a statistically significant difference, with the IG achieving a mean score of 141.22 (SD = 20.0) compared to the CG with a mean score of 130.34 (SD = 16.7) (p < 0.001).

CONCLUSIONS

Training through an online education platform for three months (72 h) is an effective tool for improving the competence in Evidence-Based Practice (EBP) of clinical nurses. A significant increase was observed in knowledge and moderate improvements in skills and the application of EBP. These online courses, adapted to the needs of professionals, can be an efficient way to prepare nurses and improve their application of EBP in a clinical setting.

Unveiling the Context for Implementing Evidence-Based Practice in Spanish Nursing

AIM

This study explores contextual factors affecting evidence-based practice (EBP) adoption among Spanish nurses, examining their interaction with sociodemographic and practice variables to enhance implementation strategies.

DESIGN

A national multicenter study employing a cross-sectional online survey design was conducted with an intentional sample of 934 voluntary Spanish practicing nurses.

METHODS

Participants completed the 12-item Barriers/facilitators dimension of the HS-EBP instrument, along with sociodemographic, training and practice information relevant to EBP implementation. Psychometric networks have been utilised as a novel analytical approach.

RESULTS

The HS-EBP scores confirm validity and reliability for assessing EBP barriers and facilitators among Spanish nurses. Primary barriers include inadequate EBP discussion spaces, lack of guidance, resistance to change, patient apathy, time constraints and support gaps. Key facilitators are higher academic qualifications, EBP training, professional development participation, educational institution employment and student supervision. Focus is needed on rural nurses and those with heavy clinical duties, facing major EBP barriers.

CONCLUSION

Spanish nurses encounter organisational barriers to EBP implementation, including insufficient incentives and support. Prioritising hands-on training, professional development in teaching and research and robust programs can enhance nurses' ability to advance EBP implementation.

IMPACT

The HS-EBP questionnaire is reliable in measuring organisational and contextual factors affecting EBP implementation.

IMPLICATIONS FOR THE PROFESSION

Successful implementation of evidence-based practice (EBP) in the Spanish healthcare system depends on developing an appropriate organisational culture and securing support from formal leaders. Additionally, fostering an understanding of the importance of patients and their families among Spanish nurses is crucial for promoting EBP adoption.

Effects of Work Engagement and Barriers on Evidence-Based Practice Implementation for Clinical Nurses: A Cross-Sectional Study

Background/Objectives: Implementing evidence-based practice (EBP) among healthcare professionals is a vital strategy for improving the quality of healthcare services, patient outcomes, and professional role satisfaction. In this study, we aimed to identify the effects of work engagement and barriers to EBP implementation among clinical nurses. Methods: In this cross-section study, we collected data from 184 nurses with at least 1 year of clinical experience using a questionnaire. The study was performed in three general hospitals in Korea between 17 July and 4 August 2023. Following data collection, we performed descriptive statistics, independent sample t-test, one-way analysis of variance, Scheffe's post hoc test, Pearson's correlation analysis, and multiple regression to analyze the data. Results: EBP implementation was found to be positively correlated with work engagement (r = 0.32, p < 0.001) and negatively correlated with barriers to implementing EBP (r = -0.44, p < 0.001). Factors influencing EBP implementation included work engagement (β = 0.14, p = 0.041) and barriers (β = -0.39, p < 0.001). Notably, barriers had a greater influence on EBP implementation than work engagement. Conclusions: Policy support, including performance incentives and training policies, among others, along with an organizational environment that provides necessary resources, should be established to encourage nurses' engagement, which influences their organizational performance to improve EBP. In addition, it is crucial to develop and strengthen educational and support programs for nurses regarding EBP to help identify and minimize barriers to implementing this practice.

Validity and reliability of the Turkish version of the Implementation Leadership Scale in the context of nurses

BACKGROUND

The implementation of evidence-based practices (EBPs) in healthcare is of critical importance, and nursing leadership plays a significant role in this process; however, there is a lack of validated instruments to measure the effectiveness of implementation leadership for EBPs. This study aims to evaluate the validity and reliability of the Turkish version of the Implementation Leadership Scale (ILS) within the context of nursing.

METHODS

Data were obtained through a cross-sectional study. The original ILS was first translated into Turkish and then back into English. The scale was administered to 343 nurses working in a training and research hospital in Türkiye. Content validity was assessed with input from 10 experts. The data set was randomly divided into two subsamples to evaluate the construct validity of the ILS. Exploratory factor analyse (EFA) was conducted in sub-sample 1 (n = 172) and Confirmatory factor analyse (CFA) was conducted in sub-sample 2 (n = 171). Reliability was assessed using Cronbach's alpha values, test-retest reliability, item-total statistics, and split-half reliability.

RESULTS

The content validity index was calculated to be 0.96, indicating high validity. EFA revealed that the scale consists of four factors with eigenvalues greater than 1, and these factors together explained a high proportion of the total variance (77.10%). Confirmatory factor analysis results (χ2 / df = 1.29; CFI = 0.98; GFI = 0.94; AGFI = 0.91; NFI = 0.94; RMSEA = 0.04) confirmed that the Turkish version of the ILS maintains the original four-factor structure (Proactive, Knowledgeable, Supportive, and Perseverant leadership). Cronbach's alpha values (0.80-0.88) and intraclass correlation coefficients (ICC) (0.78-0.86) were found to be high. Item-total correlations (0.38-0.63) and the Spearman-Brown coefficient (0.75) were above acceptable levels.

CONCLUSION

The findings suggest that the Turkish version of the ILS is a valid and reliable tool for assessing implementation leadership in evidence-based practice (EBP) among nurses. This version of the ILS could contribute to further research on implementation leadership in Türkiye, international comparisons of EBP leadership, and the development of EBP practices.

Preventing Spinal-induced Hypotension During Elective Cesarean Sections

PURPOSE

The purpose of this quality improvement project was to implement an evidence-based intraoperative protocol to reduce the incidence of spinal-induced hypotension during elective cesarean sections.

DESIGN

A quality improvement project.

METHODS

After receiving education, anesthesia providers implemented the intraoperative protocol for 6 weeks on elective cesarean sections. Intraoperative anesthesia records were retrospectively reviewed and evaluated preimplementation and postimplementation to determine the impact of the project on the incidence of spinal-induced hypotension.

FINDINGS

The final sample included 134 patient charts (64 preimplementation and 72 postimplementation). The incidence of hypotension 10 minutes after spinal placement was not significantly different before (n = 9) or after implementation (n = 13; χ2 = 0.4, P = .554). After project implementation, the rate of hypotension was 22% (n = 13) in patients not treated per the protocol and 0% (n = 0, χ2 = 3.5, P = .062) in patients treated per the protocol. There was a 39.4% (P < .001) reduction in the need for rescue doses of phenylephrine and a 27.8% (P = .001) reduction in the need for rescue doses of ephedrine after protocol implementation.

CONCLUSIONS

Hypotension was not significantly decreased for all patients after project implementation but was eliminated for patients in whom the protocol was used. Provider utilization of the intraoperative protocol was only 18%. It is recommended to pursue additional interventions to increase protocol utilization, accessibility of protocol components, and staff training. Future studies can investigate the impact of this protocol on maternal nausea and vomiting incidence during elective cesarean sections.

National Study Examining Excellence and Value in Physical Therapist Residency Education: Part 1-Design, Methods, and Results

OBJECTIVE

A challenge in health professions is training practitioners to navigate health care complexities, promote health, optimize outcomes, and advance their field. Physical therapist residency education offers a pathway to meet these needs in ways that "entry-level" (professional) education may not. Identifying key aspects of excellence in residency education and understanding its value in developing adaptive expertise will help devise strategies to enhance program, resident, and patient outcomes. The objective of this study was to examine current physical therapist residency education practices to identify and describe examples of excellence and value.

METHODS

A multi-site, multi-specialty qualitative case series was conducted, examining exemplary physical therapist residency programs and their contextual environments using a social constructivist theoretical lens. Six residency programs operating 20 individual residencies that were considered exemplar were selected for the study to participate in site visits. Qualitative case studies were generated from individual interviews, focus groups, review of artifacts, and field observations. The residencies were diverse in specialty area of practice, setting, and geographic location.

RESULTS

A conceptual framework was generated grounded in the domains of excellence and value. These domains were connected by 3 signature indicators: (1) atmosphere of practice-based learning, (2) embodiment of professional formation, and (3) elevated practice. These signature indicators represent the aggregate effects of the interchange between the excellence and value domains which sustain residency education.

CONCLUSION

This study builds upon the work of the Physical Therapist Education for the 21st Century (PTE-21) study and identifies key elements of excellence in residency education, the value of such education, and related outcomes. Findings from this study substantiate the need for a postprofessional phase of physical therapist education founded in practice-based learning encapsulated in residency education.

IMPACT

Results from this study could have compelling and powerful implications on the dialogue and strategic direction in physical therapist residency education.

Clinical practice guideline-inconsistent chemotherapy-induced vomiting prophylaxis in pediatric cancer patients in community settings: A Children's Oncology Group study

BACKGROUND

This study aimed to determine the proportion of patients receiving clinical practice guideline (CPG)-inconsistent care related to chemotherapy-induced vomiting (CIV) prophylaxis, and to describe the association between CPG-inconsistent care and site size. The association between delivery of CPG-inconsistent care and patient outcomes (CIV control, admission prolongation, and unplanned healthcare visits) was also described.

METHODS

This was a retrospective study conducted at Children's Oncology Group (COG) National Cancer Institute Community Oncology Research Program (NCORP) sites. Eligible patients received highly (HEC) or moderately emetogenic chemotherapy (MEC) as inpatients from January 2014 through December 2015, and were previously enrolled in a COG study. The COG generated a patient list from which patients were randomly selected for chart review by participating sites. A central panel adjudicated CIV prophylaxis received as CPG-consistent or -inconsistent.

RESULTS

Twenty-four sites participated. Over half of patients received CPG-inconsistent CIV prophylaxis (HEC: 59/112, 52.6%; MEC: 119/215, 55.3%). The most common reasons for CPG-inconsistency were shortened duration of antiemetic administration or omission of dexamethasone. Site size was not found to be associated with CPG-inconsistent care delivery (HEC: adjusted odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.76-1.23; MEC: adjusted OR: 1.07; 95% CI: 0.92-1.24). Additionally, there was no statistically significant association between receipt of CPG-inconsistent care and patient outcomes.

CONCLUSIONS

Patients receiving MEC or HEC often received CPG-inconsistent CIV prophylaxis. Site size was not associated with receipt of CPG-inconsistent care. Future studies should evaluate strategies to improve CIV control among pediatric oncology patients including those aimed at improving CPG adherence.

Evidence-based veterinary medicine-potential, practice, and pitfalls

Understanding and incorporating evidence-based veterinary medicine (EBVM) into clinical practice and research continues to pose a challenge for our profession despite over 2 decades of increasing awareness of this concept. Reasons for this include a lack of understanding of its importance to the practice of medicine, veterinary literature that often fails to adhere to evidence-based standards, inadequate attention to teaching EBVM at the university level, and the inherent reluctance of clinicians to alter historical practice styles. For many practitioners, EBVM continues to be an abstract concept they believe requires advanced training in statistics and epidemiology resulting in them relying on less robust sources for clinical guidance. This unfortunately results in suboptimal care for our patients and delayed medical advancements for our profession. As part of the 20th anniversary of the founding of the Evidence-Based Veterinary Medicine Association (EBVMA), we are refocusing our efforts to highlight the need for dedicated teaching of EBVM at the university level, for rigorous adherence to established research reporting guidelines, for expansion of EBVM infrastructure, and for the provision of easily accessible tools that permit clinicians to incorporate EBVM into their daily practice. As the quality of veterinary literature improves, so too will development of more effective clinical practice guidelines that ultimately can be widely adopted if they are flexible enough to support the triadic relationship between veterinarians, our clients and our patients. Ultimately, EBVM is not an end unto itself, but rather a means to improve the quality of care we provide our patients.

Adding a Mobility Champion to an Existing Progressive Mobility Protocol: An Evidence-Based Initiative

PURPOSE

This evidence-based initiative assessed the effect of adding a mobility champion to an existing progressive mobility protocol on functional decline in hospitalized older adults as evidenced by recommended discharge to home versus an inpatient rehabilitation facility.

METHOD

Older adults admitted from home to a 47-bed medical-surgical telemetry unit who were assessed as ambulatory, either independently or with assistance (Level 5), and with a progressive mobility order in the electronic health record were included in the initiative. Patient care associates who volunteered to be mobility champions were trained how to safely ambulate patients.

RESULTS

Patients who worked with a mobility champion were less likely to be referred to inpatient rehabilitation post discharge for further care due to functional decline.

CONCLUSION

Mobility has a critical role in the maintenance of hospitalized older adults' functional abilities and is a determinate of their post discharge disposition. [Journal of Gerontological Nursing, 50(11), 37-43.].

Unit Leadership and Climates for Evidence-Based Practice Implementation in Maternal-Infant Health Units: A Cross-Sectional Descriptive Study

AIMS

To describe unit leadership and climates for evidence-based practice implementation and test for differences in unit leader and staff nurses' perceptions within maternal-infant units.

DESIGN

A cross-sectional descriptive study.

METHODS

A convenience sample of maternal-infant unit leaders and nurses (labour, postpartum, neonatal intensive care, paediatrics) from four Midwestern United States hospitals completed a survey including the Implementation Leadership Scale (ILS) and Implementation Climate Scale (ICS). Descriptive statistics described items, subscales and total scores. Independent t-tests with Bonferroni correction tested for differences in perceptions.

RESULTS

A total of 470 nurses and 21 unit leaders responded, representing 17 units. Ratings of unit leadership and climates for implementation were modest at best [ICS: M = 2.17 (nurses), 2.41 (leaders); ILS: M = 2.4 (nurses), 2.98 (leaders)]. Unit leader ratings were statistically significant and higher than nurse ratings.

CONCLUSION

This study is one of the first to describe unit leadership and climates for implementation in maternal-infant health. To improve outcomes and equity in maternal-infant health, attention on leadership behaviours and unit climates for evidence-based practice implementation is needed.

IMPLICATIONS FOR THE PROFESSION

Nurse leaders are encouraged to evaluate their leadership behaviours and the unit climates they facilitate, and work to improve areas of concern or where staff perceptions differ. Staff nurses should work with their leaders to identify resources and rewards/recognition which support and facilitate EBP implementation.

IMPACT

This study addressed a gap in research examining the social dynamic factors of unit leadership and climate for evidence-based practice implementation in maternal-infant units. Leadership behaviours for implementation and unit climate were rated moderately by both staff and leaders. Unit leaders rated their implementation leadership and climates higher in almost all items. This study is relevant to unit leaders and nurses in maternal-infant units in the United States.

REPORTING METHOD

This study adhered to STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Methodological quality and clinical recommendations of guidelines on the management of dyslipidaemias for cardiovascular disease risk reduction: a systematic review and an appraisal through AGREE II and AGREE REX tools

BACKGROUND

Clinical practice guidelines (CPGs) are statements to assist practitioners and stakeholders in decisions about healthcare. Low methodological quality guidelines may prejudice decision-making and negatively affect clinical outcomes in non-communicable diseases, such as cardiovascular diseases worsted by poor lipid management. We appraised the quality of CPGs on dyslipidemia management and synthesized the most updated pharmacological recommendations.

METHODS

A systematic review following international recommendations was performed. Searches to retrieve CPG on pharmacological treatments in adults with dyslipidaemia were conducted in PubMed, Scopus, and Trip databases. Eligible articles were assessed using AGREE II (methodological quality) and AGREE-REX (recommendation excellence) tools. Descriptive statistics were used to summarize data. The most updated guidelines (published after 2019) had their recommendations qualitatively synthesized in an exploratory analysis.

RESULTS

Overall, 66 guidelines authored by professional societies (75%) and targeting clinicians as primary users were selected. The AGREE II domains Scope and Purpose (89%) and Clarity of Presentation (97%), and the AGREE-REX item Clinical Applicability (77.0%) obtained the highest values. Conversely, guidelines were methodologically poorly performed/documented (46%) and scarcely provided data on the implementability of practical recommendations (38%). Recommendations on pharmacological treatments are overall similar, with slight differences concerning the use of supplements and the availability of drugs.

CONCLUSION

High-quality dyslipidaemia CPG, especially outside North America and Europe, and strictly addressing evidence synthesis, appraisal, and recommendations are needed, especially to guide primary care decisions. CPG developers should consider stakeholders' values and preferences and adapt existing statements to individual populations and healthcare systems to ensure successful implementation interventions.

Knowledge, skills, attitudes, beliefs, and implementation of evidence-based practice among nurses in low- and middle-income countries: A scoping review

BACKGROUND

Over the past three decades, research studies on nurses' engagement in evidence-based practice (EBP) have been widely reported, particularly in high-income countries, with studies from these countries dominating literature reviews. As low- and middle-income countries (LMICs) continue to join the EBP movement, primary research has emerged over the past decade about nurses' engagement with EBP.

AIMS

The aim of this scoping review was to identify the types and extent of published research regarding nurses' knowledge, skills, attitudes, beliefs, and implementation of EBP in LMICs.

METHODS

The JBI scoping review methodology was used. Eight databases were searched up to November 2023. The review included primary studies (quantitative, qualitative, and mixed methods) that reported the knowledge, skills, attitudes, beliefs, or implementation of EBP among nurses in LMICs. Included studies focused on registered nurses in all healthcare settings within LMICs. Studies published in English were included with no limit on publication date. Two independent reviewers screened titles, abstracts, and full-text articles of published studies. Data were analyzed quantitatively using frequencies and counts. Textual data from qualitative studies were analyzed using descriptive content analysis.

RESULTS

Fifty-three publications were included, involving 20 LMICs. Studies were published between 2007 and 2023, with over 60% published in the past 7 years. Studies that evaluated familiarity/awareness of EBP showed that in general, nurses had low familiarity with or awareness of EBP. Most studies (60%) described nurses' attitudes toward EBP as positive, favorable, or high, and 31% as moderate. However, over 60% of studies described nurses' EBP knowledge/skills as moderate, low, or insufficient. Approximately 84% of studies described EBP implementation in healthcare settings as moderate, low, poor, or suboptimal.

LINKING EVIDENCE TO ACTION

Studies on nursing EBP have been increasing in LMICs for the past two decades, with findings highlighting opportunities for advancing EBP in nursing within LMICs. Health systems and healthcare organization leaders in LMICs should equip nurses with EBP knowledge and skills while providing the needed resources and support to ensure consistent implementation of EBP to improve health outcomes.

Effects of implementation strategies on nursing practice and patient outcomes: a comprehensive systematic review and meta-analysis

BACKGROUND

Implementation strategies targeting individual healthcare professionals and teams, such as audit and feedback, educational meetings, opinion leaders, and reminders, have demonstrated potential in promoting evidence-based nursing practice. This systematic review examined the effects of the 19 Cochrane Effective Practice and Organization Care (EPOC) healthcare professional-level implementation strategies on nursing practice and patient outcomes.

METHODS

A systematic review was conducted following the Cochrane Handbook, with six databases searched up to February 2023 for randomized studies and non-randomized controlled studies evaluating the effects of EPOC implementation strategies on nursing practice. Study selection and data extraction were performed in Covidence. Random-effects meta-analyses were conducted in RevMan, while studies not eligible for meta-analysis were synthesized narratively based on the direction of effects. The quality of evidence was assessed using GRADE.

RESULTS

Out of 21,571 unique records, 204 studies (152 randomized, 52 controlled, non-randomized) enrolling 36,544 nurses and 340,320 patients were included. Common strategies (> 10% of studies) were educational meetings, educational materials, guidelines, reminders, audit and feedback, tailored interventions, educational outreach, and opinion leaders. Implementation strategies as a whole improved clinical practice outcomes compared to no active intervention, despite high heterogeneity. Group and individual education, patient-mediated interventions, reminders, tailored interventions and opinion leaders had statistically significant effects on clinical practice outcomes. Individual education improved nurses' attitude, knowledge, perceived control, and skills, while group education also influenced perceived social norms. Although meta-analyses indicate a small, non-statistically significant effect of multifaceted versus single strategies on clinical practice, the narrative synthesis of non-meta-analyzed studies shows favorable outcomes in all studies comparing multifaceted versus single strategies. Group and individual education, as well as tailored interventions, had statistically significant effects on patient outcomes.

CONCLUSIONS

Multiple types of implementation strategies may enhance evidence-based nursing practice, though effects vary due to strategy complexity, contextual factors, and variability in outcome measurement. Some evidence suggests that multifaceted strategies are more effective than single component strategies. Effects on patient outcomes are modest. Healthcare organizations and implementation practitioners may consider employing multifaceted, tailored strategies to address local barriers, expand the use of underutilized strategies, and assess the long-term impact of strategies on nursing practice and patient outcomes.

TRIAL REGISTRATION

PROSPERO CRD42019130446.

Implementing Best Practice Guidelines under the Best Practice Spotlight Organisation: Facilitators and Barriers for Nurses: A Delphi Study

The implementation and sustainability of evidence-based practice (EBP) is a complex process. Best practice guidelines (BPGs) can facilitate the translation of knowledge from theory into practice, but they require working groups to adapt recommendations and encourage adherence to them. The aim of this study was to identify facilitators and barriers of BPGs in the Registered Nurses' Association of Ontario®, within the framework of Best Practice Spotlight Organisations® (BPSOs®), in a hospital setting. Methods: This study was conducted using the modified Delphi method (two rounds) with a cohort of BPSO® Best Practice Champions. The facilitators and barriers included in the first round were identified through a bibliographic search. The degree of concordance was determined in the second round using the highest mean resulting values. Results: A total of 44 nurses responded, with a mean age of 42.57 ± 8.563. The facilitators included the following: work environment; working in a hospital that encourages research; and dedicating time to EBP (p < 0.001). The barriers included the following: excessive workload; professional mobility (p < 0.001); and lack of time (p = 0.002). Implications for practice: As such, it is necessary to approach human resource management by implementing new policies that guarantee systemic sustainability. The BPSO® programme is an excellent framework for promoting the translation of theoretical knowledge into practice and effecting institutional change.

A single-centre retrospective study of the utility of routine chest X-ray post intrathoracic drain removal in cardiothoracic surgical patients

Routine chest X-ray (CXR) post intrathoracic drain removal in cardiac surgical patients is common practice to identify the presence of a pneumothorax following drain removal. Such pneumothoraces occur infrequently and rarely require intervention. We investigated the utility of routine CXR post drain removal and hypothesised that the practice is unnecessary and a possible area for significant cost saving. We conducted a single-centre, retrospective study of 390 patients who underwent cardiac surgery over a one-year period. Routine CXR post drain removal was reviewed for the presence of a pneumothorax. Rates of intervention post routine CXR were analysed to assess for clinical benefit obtained from this practice. Potential cost savings were calculated by the cost of a mobile CXR and by considering the radiographer's time. There were 15 pneumothoraces detected on routine CXR post drain removal. All pneumothoraces detected on routine post drain removal CXR were defined as small. No patients had a clinically significant pneumothorax requiring re-insertion of a chest drain. The potential cost saved by omitting routine CXR post drain removal was estimated to be approximately A$7750 per year. This study did not detect any clinically significant pneumothoraces requiring intervention. It also suggests that routine CXR post drain removal does not provide any clinical benefit and indicates that current practice should be reviewed.

Evidence-based practice in radiography: A strategy for shifting our culture

Evidence-based practice (EBP) has a vital role to play in improving outcomes for patients, organisations and individual practitioners. Unfortunately, within diagnostic radiography, literature consistently demonstrates that positive EBP is not the norm. This editorial discusses a strategy for fostering cultural change within the profession to improve EBP.

Pharmacy practice and policy research in Türkiye: a systematic review of literature

Background

In recent decades, there has been an interest in clinical pharmacy practice in Türkiye with emerging studies in this area. Despite the recent emergence of diverse pharmacy practice studies in Türkiye, a comprehensive assessment of overall typology of studies and impact has not been conducted thus far.

Objectives

This systematic review aims to document and assess pharmaceutical policy and practice literature published within the last 5 years in Türkiye. The other aim is to summarise the expected impact of published studies on policy and practice research.

Methods

The systematic review was conducted according to the guidelines described in the PRISMA Statement. A comprehensive search approach, incorporating Medical Subject Headings (MeSH) queries and free-text terms was employed to locate pertinent literature related to pharmacy practice and policy in Türkiye. The search covered the period from January 1, 2019, to January 1, 2024, and involved electronic databases including PubMed, Medline Ovid, Scopus, ScienceDirect, Springer Link, PlosOne, and BMC.

Results

In the final grouping, 73 articles met the inclusion criteria and were selected for this review. Among the quantitative studies, majority studies were cross-sectional survey studies. Through the rigorous thematic content analysis seven research domains were developed from the selected literature: drug utilisation and rational drug use, the emerging role of pharmacist, access to medicines and generic medicines, community pharmacy practice, pharmacovigilance/adverse drug reactions, and pharmacoeconomic studies.

Conclusions

The pharmacist role is evolving; however, several challenges remain in fully realising the potential of pharmacists. These include regulatory barriers, limited public awareness of pharmacists' expanded roles, workforce capacity issues, and the need for ongoing professional development and training. Research studies are needed in the areas of generic prescribing, medicine adherence, intervention studies in community and hospital pharmacy practice, and on pharmacoeconomics and pharmacovigilance.

The Mediating Role of Students' Health Information Literacy Skills: Exploring the Relationship Between Web Resource Utilization and Health Information Evaluation Proficiency

BACKGROUND

In an increasingly digital age, students rely heavily on web resources to access health information. However, evaluating the reliability and relevance of such information is crucial for informed decision-making. This study examines the importance of students' health information literacy skills (HILS) as mediators, particularly their ability to utilize web resources and successfully evaluate health information.

OBJECTIVES

This research investigates the mediating role of students' HILS in the relationship between their utilization of web resources and their proficiency in evaluating health information.

METHOD

An online survey was distributed to current students at a public university in Bangladesh as part of the data collection process for this study. Using Google Forms, the authors created a structured questionnaire. The survey was distributed through Messenger groups, Facebook pages and email invitations to reach the target audience effectively. The researchers thoroughly analysed the gathered data using structural equation modelling (SEM) techniques and SmartPLS-4 software to look for correlations between the variables.

RESULT

The study revealed that among the 122 participants, a significant number (N = 47) accessed internet health information on an occasional basis, whereas 30 individuals reported using it infrequently. The data revealed that 58 individuals, accounting for 47.5% of the sample, possessed the necessary abilities to access and assess online health information. Additionally, 57 participants, representing 46.7% of the sample, demonstrated proficiency in conducting online health information searches. The measurement model demonstrated good convergent validity, as evidenced by composite reliability (CR) scores and Cronbach's ⍺ values over 0.700 and an average extracted variance (AVE) of 0.500. The structural model demonstrated R2 values exceeding 0.1, thus validating its dependable forecasting capability. Notable effects were seen, with f2 values of 0.335 and 0.317 for the challenges in accessing and evaluating health information (CAEHI) to health information evaluation (HIE) and CAEHI to HILS relationships, respectively. The mediation analysis found that HILS act as a mediator between types of web resources (TWRs) and HIE, with TWR having an indirect impact on HIE through HILS.

DISCUSSION

The result supports all hypotheses. Therefore, it is evident that students' HILS mediate the relationship between utilization of web resources and their proficiency in evaluating health information.

CONCLUSION

This study's findings could significantly impact instructional practices meant to raise students' health information literacy. This initiative seeks to enable students to make informed decisions about their health by providing them with the necessary tools to analyse and evaluate health-related information.

PATIENT OR PUBLIC CONTRIBUTION

Research on health information literacy can assist patients and the general public by instructing them on how to assess trustworthy online health resources. Students gave insightful feedback that assisted in shaping the study and guaranteeing its relevancy. If they better comprehend health information literacy, patients and the general public can use web-based resources and critically evaluate health information more accurately.

Door to needle time trends after transition to tenecteplase: A Multicenter Texas stroke registry

BACKGROUND

Tenecteplase (TNK) is considered a promising option for the treatment of acute ischemic stroke (AIS) with the potential to decrease door-to-needle times (DTN). This study investigates DTN metrics and trends after transition to tenecteplase.

METHODS

The Lone Star Stroke (LSS) Research Consortium TNK registry incorporated data from three Texas hospitals that transitioned to TNK. Subject data mapped to Get-With-the-Guidelines stroke variables from October 1, 2019 to March 31, 2023 were limited to patients who received either alteplase (ALT) or TNK within the 90 min DTN times. The dataset was stratified into ALT and TNK cohorts with univariate tables for each measured variable and further analyzed using descriptive statistics. Logistic regression models were constructed for both ALT and TNK to investigate trends in DTN times.

RESULTS

In the overall cohort, the TNK cohort (n = 151) and ALT cohort (n = 161) exhibited comparable population demographics, differing only in a higher prevalence of White individuals in the TNK cohort. Both cohorts demonstrated similar clinical parameters, including mean NIHSS, blood glucose levels, and systolic blood pressure at admission. In the univariate analysis, no difference was observed in median DTN time within the 90 min time window compared to the ALT cohort [40 min (30-53) vs 45 min (35-55); P = .057]. In multivariable models, DTN times by thrombolytic did not significantly differ when adjusting for NIHSS, age (P = .133), or race and ethnicity (P = .092). Regression models for the overall cohort indicate no significant DTN temporal trends for TNK (P = .84) after transition; nonetheless, when stratified by hospital, a single subgroup demonstrated a significant DTN upward trend (P = 0.002).

CONCLUSION

In the overall cohort, TNK and ALT exhibited comparable temporal trends and at least stable DTN times. This indicates that the shift to TNK did not have an adverse impact on the DTN stroke metrics. This seamless transition is likely attributed to the similarity of inclusion and exclusion criteria, as well as the administration processes for both medications. When stratified by hospital, the three subgroups demonstrated variable DTN time trends which highlight the potential for either fatigue or unpreparedness when switching to TNK. Because our study included a multi-ethnic cohort from multiple large Texas cities, the stable DTN times after transition to TNK is likely applicable to other healthcare systems.

Assessing the incorporation of the 'Five Moments for Hand Hygiene' into nursing procedure textbooks

AIM

Our aim was to conduct a thorough comparison between the hand hygiene information included in international nursing textbooks and the Slovenian nursing textbook's equivalent content as it relates to nursing procedures.

BACKGROUND

Hand hygiene practices are crucial in preventing healthcare-associated infections, which affect millions of patients annually. The idea behind "Five Moments for Hand Hygiene" is to encourage assessing success and boosting self-efficacy.

DESIGN

Comparison of hand hygiene content in international nursing textbooks with the content in a Slovenian nursing textbook.

METHODS

A study was conducted between March 2023 and March 2024 to compare hand hygiene content in international nursing textbooks. The study included textbooks from the USA and UK, as well as Slovenian (SI) textbooks. The final phase involved comparing hand hygiene performance practices against the WHO Five Moments for Hand Hygiene.

RESULTS

The study reviewed 470 nursing procedures across three textbooks, identifying four common ones: female indwelling urinary catheterisation, small-bore feeding tube insertion, enema administration and subcutaneous injections. The USA textbook had the highest number of steps, while the UK textbook had the lowest. Clean protective gloves are not recommended for all nursing procedures, only for small-bore feeding tube insertion and enema administration. The US textbook omitted 12 steps for the female indwelling urinary catheter procedure, while the UK textbook included 10 steps. The SI textbook omitted 8 steps.

CONCLUSIONS

Hand hygiene is crucial for healthcare infections prevention and control. The study found differences in the frequency of hand hygiene in these nursing procedures. WHO's Five Moments for Hand Hygiene guidelines are not universally accepted, with inadequate hygiene often observed before patient contact. Future research should review foreign textbooks and update existing ones.

Evidence-based practice knowledge, attitude, practice and barriers as predictors of stay intent among Jordanian registered nurses: a cross-sectional study

AIM

This study aimed to identify factors influencing stay intent among Jordanian registered nurses, with a specific focus on the role of evidence-based practice (EBP) knowledge, attitudes, practices and barriers.

METHODS

A descriptive cross-sectional study of 311 nurses from 5 hospitals was conducted from January 2022 to June 2022. Participants completed data about stay intent and knowledge, attitude, practice and barriers of EBP. Data were analysed using SPSS program V.24.

FINDINGS

EBP attitudes, practices, knowledge and barriers significantly predicted stay intent, controlling for participants and workplace characteristics. Private hospitals (t=-4.681, Β=-0.287, p<0.001), having a library in the healthcare institution (t=-2.018, Β=-0.118, p<0.001) and adopter barriers (t=-1.940, Β=-0.105, p=0.05) were significantly associated with stay intent.

CONCLUSION

Our findings show that EBP influences Jordanian nurses' intent to stay. It highlights the importance of addressing EBP barriers, especially in private hospitals as well as library access issues, in enhancing nurse retention and healthcare outcomes in Jordan.

How to undertake a scoping review

RATIONALE AND KEY POINTS

Scoping reviews have become a popular approach for exploring what literature has been published on a particular field of interest. They can enable nurses to gain an overview of the contemporary evidence base relating to a practice area, treatment or specific patient demographic, for example. This article provides a concise guide for nurses planning to undertake a scoping review, explaining the various steps involved. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when undertaking a scoping review.• How you could use this information to educate nursing students and colleagues on the appropriate techniques and evidence base required for scoping the literature.

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

AIMS

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

DESIGN

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

METHODS

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

RESULTS

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

CONCLUSION

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

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

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

IMPACT

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

REPORTING METHOD

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

PATIENT AND PUBLIC CONTRIBUTION

No patient or public contribution.

Empowering nursing council implementation science: An appeal to action

BACKGROUND

In most hospitals, nursing councils are responsible for EBP implementation and evaluation. To enhance the perceived value of council participation by frontline nurses, administrators must promote the impact of council projects on healthcare outcomes.

PURPOSE

The purposes of this appeal to action are to describe the role of nursing councils in promoting IS and EBP, and to provide recommendations that enhance the value of IS and/or EBP councils to frontline nurses, thereby incentivizing participation on these councils.

METHODS

Nurse researchers from three metropolitan hospitals partnered with a medical librarian to recommend six strategies aimed at enhancing the perceived value of council participation. An argumentative review was conducted to support these strategies.

DISCUSSION

Recommendations are inclusion of methods experts on councils; support from nursing administrators in the development, implementation, and evaluation of projects; formation of partnerships with nursing academic departments; expansion of publication opportunities and availability; and connection of projects to measurable quality indicators.

CONCLUSION

Enhancing the perceived value of nursing councils by providing tools that optimize time and resource management can result in greater council participation and broader dissemination of IS evidence.

Heideveld-Chevalking A, Kristensen K, Huibertina Davida van Tuyl L, Põlluste K, Weynants C, Garel P, Sousa P, Talving P, Marx D, Žaludek A, Romero E, Rodríguez A, Orrego C. Improving quality and patient safety in surgical care through standardisation and harmonisation of perioperative care (SAFEST project): A research protocol for a mixed methods study

INTRODUCTION

Adverse events in health care affect 8% to 12% of patients admitted to hospitals in the European Union (EU), with surgical adverse events being the most common types reported.

AIM

SAFEST project aims to enhance perioperative care quality and patient safety by establishing and implementing widely supported evidence-based perioperative patient safety practices to reduce surgical adverse events.

METHODS

We will conduct a mixed-methods hybrid type III implementation study supporting the development and adoption of evidence-based practices through a Quality Improvement Learning Collaborative (QILC) in co-creation with stakeholders. The project will be conducted in 10 hospitals and related healthcare facilities of 5 European countries. We will assess the level of adherence to the standardised practices, as well as surgical complications incidence, patient-reported outcomes, contextual factors influencing the implementation of the patient safety practices, and sustainability. The project will consist of six components: 1) Development of patient safety standardised practices in perioperative care; 2) Guided self-evaluation of the standardised practices; 3) Identification of priorities and actions plans; 4) Implementation of a QILC strategy; 5) Evaluation of the strategy effectiveness; 6) Patient empowerment for patient safety. Sustainability of the project will be ensured by systematic assessment of sustainability factors and business plans. Towards the end of the project, a call for participation will be launched to allow other hospitals to conduct the self-evaluation of the standardized practices.

DISCUSSION

The SAFEST project will promote patient safety standardized practices in the continuum of care for adult patients undergoing surgery. This project will result in a broad implementation of evidence-based practices for perioperative care, spanning from the care provided before hospital admission to post-operative recovery at home or outpatient facilities. Different implementation challenges will be faced in the application of the evidence-based practices, which will be mitigated by developing context-specific implementation strategies. Results will be disseminated in peer-reviewed publications and will be available in an online platform.

Factors Associated with Evidence-Based Practice Competencies among Taiwanese Nurses: A Cross-Sectional Study

Evidence-based practice (EBP) is an essential component of healthcare practice that ensures the delivery of high-quality care by integrating the best available evidence. This study aimed to explore factors influencing EBP among nursing professionals in Taiwan. A cross-sectional survey study was conducted with 752 registered nurses and nurse practitioners recruited from a regional teaching hospital in southern Taiwan. EBP competency was evaluated using the Taipei Evidence-Based Practice Questionnaire (TEBPQ). The results showed that participation in evidence-based courses or training within the past year had the strongest association with EBP competencies (Std. B = 0.157, p < 0.001). Holding a graduate degree (Std. B = 0.151, p < 0.001), working in gynecology or pediatrics (Std. B = 0.126, p < 0.001), searching the literature in electronic databases (Std. B = 0.072, p = 0.039), and able to read academic articles in English (Std. B = 0.088, p = 0.005) were significantly associated with higher TEBPQ scores. Younger age (Std. B = -0.105, p = 0.005) and male gender (Std. B = 0.089, p = 0.010) were also identified as factors contributing to higher EBP competencies. The study highlights the importance of ongoing professional development, including EBP training and language proficiency, in enhancing EBP competencies among nursing professionals in Taiwan.

Assessing Priorities in a Statewide Cardiovascular and Diabetes Health Collaborative Based on the Results of a Needs Assessment: Cross-Sectional Survey Study

BACKGROUND

The Ohio Cardiovascular and Diabetes Health Collaborative (Cardi-OH) unites general and subspecialty medical staff at the 7 medical schools in Ohio with community and public health partnerships to improve cardiovascular and diabetes health outcomes and eliminate disparities in Ohio's Medicaid population. Although statewide collaboratives exist to address health improvements, few deploy needs assessments to inform their work.

OBJECTIVE

Cardi-OH conducts an annual needs assessment to identify high-priority clinical topics, screening practices, policy changes for home monitoring devices and referrals, and preferences for the dissemination and implementation of evidence-based best practices. The results of the statewide needs assessment could also be used by others interested in disseminating best practices to primary care teams.

METHODS

A cross-sectional survey was distributed electronically via REDCap (Research Electronic Data Capture; Vanderbilt University) to both Cardi-OH grant-funded and non-grant-funded members (ie, people who have engaged with Cardi-OH but are not funded by the grant).

RESULTS

In total, 88% (103/117) of Cardi-OH grant-funded members and 8.14% (98/1204) of non-grant-funded members completed the needs assessment survey. Of these, 51.5% (53/103) of Cardi-OH grant-funded members and 47% (46/98) of non-grant-funded members provided direct clinical care. The top cardiovascular medicine and diabetes clinical topics for Cardi-OH grant-funded members (clinical and nonclinical) were lifestyle prescriptions (50/103, 48.5%), atypical diabetes (38/103, 36.9%), COVID-19 and cardiovascular disease (CVD; 38/103, 36.9%), and mental health and CVD (38/103, 36.9%). For non-grant-funded members, the top topics were lifestyle prescriptions (53/98, 54%), mental health and CVD (39/98, 40%), alcohol and CVD (27/98, 28%), and cardiovascular complications (27/98, 28%). Regarding social determinants of health, Cardi-OH grant-funded members prioritized 3 topics: weight bias and stigma (44/103, 42.7%), family-focused interventions (40/103, 38.8%), and adverse childhood events (37/103, 35.9%). Non-grant-funded members' choices were family-focused interventions (51/98, 52%), implicit bias (43/98, 44%), and adverse childhood events (39/98, 40%). Assessment of other risk factors for CVD and diabetes across grant- and non-grant-funded members revealed screening for social determinants of health in approximately 50% of patients in each practice, whereas some frequency of depression and substance abuse screening occurred in 80% to 90% of the patients. Access to best practice home monitoring devices was challenging, with 30% (16/53) and 41% (19/46) of clinical grant-funded and non-grant-funded members reporting challenges in obtaining home blood pressure monitoring devices and 68% (36/53) and 43% (20/46) reporting challenges with continuous glucose monitors.

CONCLUSIONS

Cardi-OH grant- and non-grant-funded members shared the following high-priority topics: lifestyle prescriptions, CVD and mental health, family-focused interventions, alcohol and CVD, and adverse childhood experiences. Identifying high-priority educational topics and preferred delivery modalities for evidence-based materials is essential for ensuring that the dissemination of resources is practical and useful for providers.