Capability beliefs on, and use of evidence-based practice among four health professional and student groups in geriatric care: A cross sectional study

Contextual influences on knowledge translation capacity in a nursing home organisation: A phenomenological hermeneutical study

INTRODUCTION

The demand for advanced clinical care in nursing homes (NHs) is increasing. Evidence-based practices and knowledge translation (KT) initiatives are growing to bridge the gap between what is known and what is done. However, research on contextual influence on KT has primarily focused on hospital settings.

AIM

To expand our understanding of contextual influences on KT capacity in a NH organisation.

DESIGN AND METHODS

Lindseth and Norberg's phenomenological hermeneutical method was used to explore and describe practice development nurses' experiences, perspectives and practices regarding how contextual factors influence KT capacity in NHs. Focus group interviews, participant observations, in-depth interviews and non-participant observations provided the data.

RESULTS

Two main themes and four subthemes were identified. (1) Continuous limited resources are a cultural condition that inhibits KT readiness; prioritising keeping the NH machinery running at all costs and having contrasting care philosophies undermines KT. (2) Organisational prioritisations leave KT as a missing cogwheel in the machinery; retaining a system of fragmented KT strategies and lacking a structure for collective KT effort.

CONCLUSION

The study showed that KT held a minor role in the fast-paced NH machinery. Contradicting values characterise the NH organisation, resulting in a lack of a common vision and priorities. Building a sustainable KT capacity and providing evidence-based practice necessitates explicit responsibilities, dedicated resources and robust organisational support. Management has a critical role in strengthening the position of KT. Incorporating KT in daily NH practice can help staff become adaptable and confident, capable of meeting the increasing challenges of advanced care that alleviates suffering and promote the health and well-being of NH patients.

Developing multisectoral strategies to promote evidence-based practice in rehabilitation: findings from an end-of-grant knowledge translation symposium

PURPOSE

Following a longitudinal study to understand how evidence-based practice evolves during the initial years of occupational therapy (OT) and physiotherapy (PT) practice, we held an end-of-grant symposium with representatives from education, practice, research, and policy. The objectives were to: (1) elicit feedback on the implications of the study results; and (2) co-develop a list of actionable recommendations for each sector.

METHODS

Qualitative participatory approach. The symposium was held over two half days and consisted of a presentation of study findings, a discussion on the implications of the research for each sector and future recommendations. Discussions were audio recorded, transcribed verbatim and analyzed using qualitative thematic analysis.

RESULTS

The themes related to implications of the longitudinal study included: (1) A need to rethink what evidence-based practice (EBP) really is; (2) How to practice EBP; and (3) The continuing challenge of measuring EBP. The co-development of actionable recommendations resulted in nine strategies.

CONCLUSIONS

This study highlighted how we may collectively promote EBP competencies in future OTs and PTs. We generated sector-specific avenues that may be pursued to promote EBP and argued for the importance of pooling efforts from the four sectors so that we may achieve the intended ethos of EBP.IMPLICATIONS FOR REHABILITATIONThere is a need to revisit the definition of evidence-based practice (EBP) and the traditional 3-circle model in rehabilitation to include a broader conceptualization of what constitutes evidence.We recommend using EBP measures as tools for self-reflection and professional development that can support practitioners to be reflective and accountable evidence-based practitioners.Optimal promotion of EBP competencies in occupational therapists and physiotherapists should rest upon collaborative efforts from the education, practice, research, and policy sectors.

Instruments to Assess Evidence-Based Practice Among Health Care Professionals: A Systematic Review

BACKGROUND

The use of measurement instruments to assess the use of Evidence-Based Practice by health professionals has been frequently reported in studies.

AIMS

This systematic review aimed to summarize, describe, and evaluate the measurement properties of the instruments that evaluate the use of Evidence-Based Practice in health professionals.

METHODS

The search was carried out in four databases considering three groups of search terms: evidence-based practice, evaluation, and measurement proprieties. Studies were included that described the use of instruments to assess Evidence-Based Practice in health professionals, with the full-text publication, which analyzed the measurement properties, in English. The methodological quality of the studies was evaluated using COnsensus-based Standards for the selection of health Measurement INstruments.

RESULTS

In total, 6,429 were found and only 92 were eligible for data analysis. Forty new instruments were identified most were developed for nursing and physical therapist. The investigators performed at least 1 type of validity test on 73% of the instruments. Reliability was tested at 90%, through internal consistency. Responsiveness was tested on less than half of the instruments (30%). Most of the instruments identified are reliable and valid to measure evidence-based practice in health professionals.

CONCLUSION

Although the Fresno Test remains the most complete instrument, and adequate for use. The COnsensus-based Standards for the selection of health Measurement INstruments checklist classified 7 (seven) instruments as suitable for the target audience.

Missed nursing care in relation to registered nurses' level of education and self-reported evidence-based practice

BACKGROUND

Patient safety is one of the cornerstones of high-quality healthcare systems. Evidence-based practice is one way to improve patient safety from the nursing perspective. Another aspect of care that directly influences patient safety is missed nursing care. However, research on possible associations between evidence-based practice and missed nursing care is lacking.

AIM

The aim of this study was to examine associations between registered nurses' educational level, the capability beliefs and use of evidence-based practice, and missed nursing care.

METHODS

This study had a cross-sectional design. A total of 228 registered nurses from adult inpatient wards at a university hospital participated. Data were collected with the MISSCARE Survey-Swedish version of Evidence-Based Practice Capabilities Beliefs Scale.

RESULTS

Most missed nursing care was reported within the subscales Basic Care and Planning. Nurses holding a higher educational level and being low evidence-based practice users reported significantly more missed nursing care. They also scored significantly higher on the Evidence-based Practice Capabilities Beliefs Scale. The analyses showed a limited explanation of the variance of missed nursing care and revealed that being a high user of evidence-based practice indicated less reported missed nursing care, while a higher educational level meant more reported missed nursing care.

LINKING EVIDENCE TO ACTION

Most missed nursing care was reported within the subscales Planning and Basic Care. Thus, nursing activities are deprioritized in comparison to medical activities. Nurses holding a higher education reported more missed nursing care, indicating that higher education entails deeper knowledge of the consequences when rationing nursing care. They also reported varied use of evidence-based practice, showing that higher education is not the only factor that matters. To decrease missed nursing care in clinical practice, and thereby increase the quality of care, educational level, use of evidence-based practice, and organizational factors must be considered.

Barriers and facilitators of evidence-based physiotherapy practice in Iran: A qualitative study

BACKGROUND

To facilitate evidence-based practice (EBP) in physiotherapy in Iran and guide future improvements, it is crucial to identify what barriers and facilitators exist in the current system from the physiotherapist's perspective. Therefore, the purpose of this study was to explore the barriers and facilitators of EBP in physiotherapy in Iran.

METHODS

This qualitative study was conducted using a phenomenological approach from January to July 2023 in Iran. The sampling process started with a purposive approach, and then an attempt was made to identify and interview more potential samples with the snowball approach. Thematic analysis was used to analyse the collected qualitative data.

RESULTS

44 individuals, including 37 physiotherapists and seven faculty members, participated in this study. Several barriers and facilitators to evidence-based physiotherapy practice in Iran were found and then put into three themes: (1) individual factors, (2) practice environment factors, and (3) extra-organisational factors. The most common barriers were time/workload pressures, financial incentives, lack of motivation, weakness in English, managers' pressures, inadequate awareness among patients, infrastructure limitations, poor economic situation, Internet restrictions, inappropriateness of the educational curriculum, difficult access to scientific research, and lack of insurance coverage for up-to-date therapies.

CONCLUSIONS

Although most of the participants had a very positive view of physiotherapy based on scientific evidence, various obstacles have prevented this approach from being well implemented in Iran. Therefore, it is necessary to move towards minimising the existing barriers at the individual, practice environment, and extra-organisational levels by adopting effective multilateral policies.

Adaptação transcultural e validação do “health sciences evidence based practice questionnaire” para o português do Brasil

Introdução: o instrumento “Health Sciences Evidence Based Practice Questionnaire” avalia as diferentes dimensões da construção da prática baseada em evidência como um processo para responder às situações decorrentes da prática clínica diária. Objetivos: adaptar culturalmente o instrumento Health Sciences Evidence Based Practice Questionnaire para a língua portuguesa do Brasil e avaliar suas qualidades psicométricas. Método: Estudo metodológico. A primeira etapa compreendeu o processo de tradução e adaptação transcultural. Na segunda etapa, o instrumento Questionário de Prática Baseada em Evidências e Efetividade Clínica foi aplicado para a validação convergente, utilizando-se o índice de correlação de Pearson, nível de significância 0,05 e realizada Análise Fatorial Confirmatória (AFC), de acordo com o modelo de equações estruturais. A confiabilidade foi avaliada pelo teste-reteste, utilizando o coeficiente de correlação r de Pearson. A consistência interna obtida por meio do coeficiente alpha de Cronbach. Resultados: validade de conteúdo obtida na terceira rodada, título final: Questionário HS-EBP- Prática Baseada em Evidência nas Ciências da Saúde, aplicado em 305 profissionais da saúde. A confiabilidade foi verificada por meio do coeficiente alfa de Cronbach (0,970), similar à versão original, e da estabilidade teste-reteste pelo índice de correlação r de Pearson (r = 0,766) que indicou uma correlação forte. Para a validação convergente foi aplicado o índice de correlação de Pearson (r = 0,683) positivo e com correlação moderada entre os instrumentos. Teste Qui-Quadrado foi significativo (<0,001) para todos os modelos obtidos, em todos os modelos testados. Conclusão: o instrumento mostrou-se válido e confiável para reprodutibilidade na versão brasileira.

Psychometric properties of questionnaires to assess evidence-based practice among occupational, physical and speech therapists: A systematic review

INTRODUCTION

Evidence-based practice (EBP) is an important aspect of healthcare work, but the clinical implementation is complex. To be able to facilitate EBP implementation, valid measurement of the "EBP status quo" is essential. Therefore, we aimed to identify valid tools for EBP status assessment among occupational, physical and speech therapists in Germany.

METHODS

The databases PubMed, Cochrane Library, PsycINFO, and CINAHL were systematically searched from August 2011 until July 2022. Methodological quality and evidence level were scored by two independent raters via: i) the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist, ii) updated criteria for good measurement properties, and iii) modified GRADE criteria.

RESULTS

Overall, 57 reports describing the development or validation of 31 EBP questionnaires were included. Six questionnaires showed "sufficient" evidence for content validity, three questionnaires showed "sufficient" evidence for reliability, two questionnaires showed "sufficient" evidence for structural validity as well as internal consistency, and nine questionnaires showed "sufficient" evidence for construct validity. Most questionnaires demonstrated moderate or low-quality evidence for the psychometric properties tested.

DISCUSSION

Overall, the present review found a lack of sufficient evidence on the psychometric properties of most questionnaires. The Evidence-Based Practice Inventory (EBPI), the Evidence-based Practice Confidence (EPIC) scale and the Health Sciences-Evidence-Based Practice (HS-EBP) questionnaire were the only questionnaires with "sufficient" content validity and, in addition, "sufficient" reliability or "sufficient" internal consistency.

CONCLUSION

Although a lack of high-quality psychometric properties of EBP tools became apparent, the EBPI, the EPIC scale and the HS-EBP questionnaire currently appear to be the best validated tools to assess EBP behavior/attitude and implementation in occupational, physical and speech therapists.

Professional knowledge development and evidence-based practice in confusing vs. supportive work organizations: A grounded theory situational analysis of Swedish elderly care

BACKGROUND

This article focuses on knowledge development and health professionals' opportunities to use evidence-based practice (EBP). We studied registered physiotherapists (PT), occupational therapists (OT) and nurses (RN) in Swedish elderly-care institutions, a sector known for high turnover and shortages of competent staff.

OBJECTIVE

To examine the perspectives of healthcare providers on professional knowledge development and EBP in their organization.

METHODS

We conducted on-site qualitative interviews with a purposive sample of PTs, OTs and RNs, in six elderly care institutions. Situational analysis was used to analyze the material.

RESULTS

Three discursive professional positions were found: 1) Professional ambition in confusing work organization; 2) Professional ambition in a knowledge-promoting work organization; and 3) Professional indifference with few aspirations for knowledge development. Professional aspirations toward knowledge development were high in two of these positions, whereas the third represents a slightly different approach with fewer aspirations for knowledge development. Linked to these professional approaches to knowledge development is a continuum of aggravating or facilitating factors within the work organization, including varying degrees of support from leadership of the organization, as well as few opportunities for rewards.

DISCUSSION AND CONCLUSIONS

It is concluded that elderly care needs to develop strategies for evidence-based practice in order for the sector to become a sustainable arena for health professionals' career development, and in order to improve the quality of care for the elderly.

A national survey evaluating the knowledge and attitude of health-care workers of Saudi Arabia about Coronavirus infection

Background and Objectives:

Health-care workers (HCWs) are playing an instrumental role in combating coronavirus infection (COVID-19). While rendering their services, they also run the risk of cross-contamination. Hence, it is important to evaluate and correlate the knowledge and attitude of HCWs of Saudi Arabia about COVID-19.

Materials and Methods:

A prospective, nationwide, questionnaire-based survey was conducted after getting the approval from the institutional ethical board. A validated and reliable questionnaire was constructed, developed on the Qualtrics software, and circulated through an electronic medium across the country. The questionnaire had a total of 29 questions regarding knowledge and attitude about COVID-19. Through convenience sampling, the data were collected from a total sample of 1553 HCWs. Based on the primary area of expertise, the sample was categorized into three study groups with 1040 medical health-care professionals (MHCPs) (Group I), 318 dental health-care professionals (DHCPs) (Group II), and 195 allied health-care professionals (AHCPs) (Group III). Univariate and multivariate logistic regression analysis was done using SPSS v. 21, where P < 0.05 was considered statistically significant.

Results:

Female HCWs (P = 0.003) were shown to have a higher (adjusted odds ratio [aOR]: 1.46; confidence interval [CI]: 1.19–1.79) risk of inadequate knowledge in comparison to male HCWs. With respect to qualification, HCWs with doctorate qualification (P = 0.005) (aOR: 0.39; CI: 0.2–0.75) had shown to have adequate knowledge compared to their counterparts. AHCPs were shown inadequate knowledge (P < 0.001; aOR: 2.36; CI: 1.65–3.38), but adequate attitude (P < 0.001; aOR: 0.13; CI: 0.09–0.2) compared to MHCPs and DHCPs.

Conclusion:

MHCPs were shown to have the most appropriate level of knowledge, whereas AHCPs outscore other counterparts of HCWs with respect to attitude toward COVID-19. Emphasis should be directed to the whole community of HCWs in enhancing their awareness and practice attitude toward the novel infection of COVID-19.

Individual and organizational factors associated with evidence-based practice among physical and occupational therapy recent graduates: A cross-sectional national study

BACKGROUND

Occupational therapy (OT) and physical therapy (PT) programs in Canada have moved to graduate-level entry education to address graduates' readiness for evidence-based practice (EBP). Whether rehabilitation professionals with advanced training in EBP are meeting their responsibilities as evidence-based professionals upon entry into practice and the factors that influence the use of evidence is unclear. The aim of this study was to examine the individual and organizational factors associated with the use of EBP and supporting evidence-based activities among graduates of professional OT and PT master's programs.

METHODS

A cross-sectional design using a survey of recent graduates of the 29 OT and PT programs in Canada. The survey measured six constructs supportive of EBP (ie, knowledge, attitudes, confidence, organizational resources, actual use of EBP, and evidence-based activities). Analyses consisted of descriptive statistics to characterize the sample and the different variables and ordinal multivariate regression analysis.

RESULTS

257 graduates (15%) completed the survey. Attitudes towards EBP was positively associated both with evidence-based activities (odds ratio = 1.36 with a 95% CI: 1.22 to 1.52) and use of EBP (odds ratio = 1.23 with a 95% CI: 1.12 to 1.36); greater confidence was related to greater use of EBP (OR = 1.12, 95% CI: 1.01 to 1.24); and working in a private practice setting was found to be related to performing more evidence-based activities (odds ratio = 3.15, 95% CI: 1.40 to 7.12).

CONCLUSIONS

Despite a greater focus on EBP knowledge in these curricula across Canada, knowledge was not related to EBP use nor evidence-based activities upon entry into practice. On the other hand, attitudes, confidence and working in private practice were. University programs should consider curricular strategies that increase the use of EBP, provide opportunities to engage in evidence-based activities with an emphasis on promoting the development of positive attitudes towards EBP and increasing learners' confidence in their ability to be evidence-based professionals.

Evidence-Based Practices and Use among Employees and Students at an Austrian Medical University

Developed in the pre-internet era in the early 1980s, empirical medical practice, i.e., evidence-based practice (EBP) has become crucial in critical thinking and statistical reasoning at the point-of-care. As little evidence is available so far on how EBP is perceived in the Austrian academic context, we conducted a cross-sectional online survey among a nonrandom purposive sample of employees and students at the Medical University Vienna, Austria (total n = 1247, 59.8% females). The German questionnaire assessed both EBP capability beliefs and EBP use, with the respective indices both yielding good internal consistency. We conducted subgroup comparisons between employees (n = 638) and students (n = 609). In line with Bandura's self-efficacy theory, we found a correlation between EBP capability beliefs and EBP use, with higher scores reported in the employee group. The results indicated that the participants did not strictly follow the sequential EBP steps as grounded in the item-response theory. Since its emergence, EBP has struggled to overcome the dominating traditional way of conducting medicine, which is also known as eminence-based medicine, where ad hoc decisions are based upon expert opinions, and nowadays frequently supplemented by quick online searches. Medical staff and supervisors of medical students should be aware of the existing overlaps and synergies of these potentially equivalent factors in clinical care. There is a need for intensifying the public and scientific debate on how to deal with the divergence between EBP theory and EBP practice.

Examining the Association between Evidence-Based Practice and Burnout among Spanish Physical Therapists: A Cross-Sectional Study

The aim of this study was to quantify the level of burnout and competence for evidence-based practice among Spanish physical therapists and to determine if there is a relationship between these and other socio-professional factors. A cross-sectional study with 472 Spanish Physiotherapists. An electronic survey was conducted that included the Maslach Burnout Inventory, Evidence-Based Practice Questionnaire and sociodemographic data. The three subscales of the Burnout correlated with attitude and total Evidence-Based Practice Questionnaire. Attitude and practice for evidence-based practice, educational level and experience were the variables that showed the greatest influence on burnout. Burnout and the degree of evidence-based practice were identified as being discretely related. Specifically, it seems that the evidence-based practice could improve the lack of personal accomplishment, meaning that through interventions perceived as more effective and advantageous, a sense of mastery and self-efficacy is experienced.

Optimizing a knowledge translation intervention: a qualitative formative study to capture knowledge translation needs in nursing homes

Background

Knowledge translation (KT) has emerged as an important consideration to reduce knowledge-to-practice gaps in healthcare settings. Research on KT approaches in nursing homes (NHs) is lacking. There is a need to understand the challenges faced in NHs and how these can be managed. This study is part of the larger IMPAKT (IMPlementation and Action for Knowledge Translation) study which addresses KT in NHs. The aim of the study presented here was to identify crucial staff and organizational needs in order to inform the development of a KT intervention in NHs.

Methods

A multimethod qualitative approach was applied. We invited practice development nurses (PDNs) to describe current practice, and to identify problems and needs concerning KT in NHs. We followed the recommendations of the development phase of the MRC framework for developing complex interventions. Data were collected through four focus groups and participatory observations in six NHs. Analysis was conducted according to structural thematic analysis based on a phenomenological hermeneutic method.

Results

We identified three themes that expressed the PDNs’ perceived needs for successful KT implementation: (1) narrowing the PDN role, (2) developing an EBP culture and (3) establishing collaborative alliances. Nine subthemes derived from the PDNs’ experiences and current practice, illustrating needs at individual, relational and organizational levels.

Conclusions

Rigorous development of complex interventions may add relevance to the intervention, increase the likelihood of success and reduce research waste. Insight into the NH context and organization have helped us define problems and articulate needs that must be addressed when tailoring the IMPAKT intervention.

Trial registration

The IMPAKT trial was retrospectively registered in the ISRCTN Registry (Trial ID: 12,437,773) on March 19th, 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00603-5.

Student perspectives on factors that influence the implementation of evidence-based practice in occupational therapy

AIM

Evidence-based practice (EBP) is perceived as an integral component of contemporary allied health practice. While allied health clinicians (such as occupational therapists) have generally positive attitudes towards EBP, research suggests that they find its implementation consistently challenging. The professional literature increasingly suggests that more effective EBP learning takes place when social constructivist approaches to learning are adopted. The authors of this study sought to use the pre-existing knowledge and perceptions of occupational therapy students to inform a curriculum review of an EBP unit. Therefore, the aim of this content analysis study was to investigate how occupational therapy students perceive and critically analyse factors that influence the implementation of EBP, specifically strengths, weaknesses, opportunities and threats (SWOT).

METHODS

The study sampled students in the third year of a 4-year, Bachelor level Australian Occupational Therapy Program. The students were undertaking the first of two EBP units, and data were collected from the first assignment they submitted for these units. The assignment required the students to complete a SWOT analysis of EBP in occupational therapy, and response to a statement around whether it should be mandatory. Data were collected over 2 consecutive years from a total of 64 occupational therapy students. All data collected were subjected to content analysis, with themes identified by at least 25% of students in each cohort retained for analysis and formation into overall themes.

RESULTS

Participating occupational therapy students identified five strengths, four weaknesses, six threats but only one opportunity for EBP. Three key themes were identified within the data: first, the role and purpose of EBP; second, the resources it requires and third, factors that influence its success. The students perceived the main purpose of EBP as supporting positive practice change, and highlighted its roles in building clinician capacity and professional credibility. They also characterized EBP as a separate and specialist practice that requires specific training and resourcing to achieve, and questioned its feasibility as an integrated part of daily practice. Along with previously identified challenges around time and resourcing, the students also highlighted negative attitudes and beliefs from senior colleagues as an important negative influence on the success of EBP.

CONCLUSION

The current study consolidates a growing body of international literature about the value of social constructive approaches to EBP in undergraduate education. Vertical constructive alignment that embeds EBP through undergraduate education, rather than the provision of 'EBP'-specific units, should now be considered best practice. However, this embedded approach requires the explicit and repeated communication of the presence of EBP in all learning opportunities, to enable students to recognize opportunities to deploy their existing knowledge and skills.

Factor structure and short version of the modified Fresno test to assess the use of the evidence-based practice in physiotherapists

BACKGROUND

The Modified Fresno Test has been used to evaluate the use of the Evidence-Based Physiotherapy (EBP). So far, none of the versions of the Fresno Test were subjected to analysis of the factorial structure. The objective of the study was to describe the exploratory and confirmatory factor structure of the Modified Fresno Test adapted to the Portuguese-Brazilian and analyze the statistical feasibility for the elaboration of a short version.

METHODS

The questionnaire was applied with a convenience sample of 57 physiotherapists, being 36 professionals (13 of these also professors) and 21 students from the last semester of the physiotherapy course. Exploratory Factor Analysis (EFA) was performed by the method of principal components. Confirmatory Factor Analysis (CFA) was performed by the method of maximum likelihood. The total score of the answers in the test and retest was evaluated, totalling 228 observations. Reliability was assessed by means of internal consistency, using Cronbach's alpha coefficient.

RESULTS

Reliability was satisfactory (α 0.81) for all questions of the instrument. The coefficient α calculated for the corrected item-total showed values higher than 0.20 except for item 9. Preliminary tests for Exploratory Factor Analysis showed acceptable values with Kaiser-Meyer-Olkin (KMO = 0.80) and Bartlett's test of sphericity [chi-square (78) = 1149.615, p < 0.001], indicating that the correlations were sufficient for analysis. The analysis revealed the presence of 3 factors (eigenvalues> 1), which explains 60.9% of the instrument's total variance. In Confirmatory Factor Analysis, none of the indices came close to an acceptable level (≥ 0.90), however, the second model which tested a three-factor structure provided a better fit to the data. From the results of this study the Modified Fresno Test short version was drawn.

CONCLUSION

The analysis showed good factor validity and adequate internal consistency for the use of the instrument consisting of 13 questions and 3 factors. This model proved to be better than the original model. The short version consisting of 9 questions may be an appropriate alternative for use in the population of interest.

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.

Capability beliefs and the intention to adopt evidence-based practices in the future among nursing students: An international study

BACKGROUND

Capability beliefs and the intention to adopt EBP in future nursing practice have been identified as strong antecedents of subsequent utilization of EBP. Despite this, a multicountry comparison may yield interesting findings that can be useful in designing empirically based and culturally tailored strategies to facilitate and enhance students' capability beliefs as well as their intentions to integrate evidence into nursing practice.

AIMS AND OBJECTIVES

This report sought to compare capability beliefs and intentions to adopt EBP in the future among student nurses from four countries-specifically, Oman, India, Nigeria, and Saudi Arabia-and to identify specific variables that predict the intention to adopt EBP.

METHODS

This study employed a descriptive, cross-sectional, comparative research design to gather data from a convenience sample of 1387 nursing students from four countries using self-report questionnaires that captured their EBP capability beliefs and their intention to adopt EBP in clinical practice upon graduation. This study adhered to STROBE guideline for cross-sectional studies.

RESULTS

Overall, nursing students reported a high intent to adopt EBP in their future nursing practice; however, the exact rate varied according to the country of origin. Students' gender, student track, education, country of origin, access to the internet, and capability beliefs were seen as important in explaining the likelihood of future implementation of evidence in clinical nursing practice. Capability beliefs among students were moderate, with large differences observed between countries.

CONCLUSIONS

Although the surveyed nursing students reported moderate capability beliefs, their intention to adopt and integrate EBP in their future nursing practice was relatively high.

RELEVANCE TO CLINICAL PRACTICE

The findings of this study highlight the critical role of nurse educators and nurse administrators in fostering EBP capability beliefs and future intentions to adopt among students through curricular review, implementation of evidence-based strategies, and the promotion of EBP culture within the clinical learning sites.

A Countrywide Survey in Saudi Arabia Regarding the Knowledge and Attitude of Health Care Professionals about Coronavirus Disease (COVID-19)

Coronavirus disease (COVID-19) has emerged as a pandemic. The updated knowledge and a positive attitude of health care professionals (HCPs) towards fighting any pandemic is the key to success. Thus, the present study aims to assess the knowledge and attitude of HCPs towards COVID-19 in the Kingdom of Saudi Arabia (KSA). A cross-sectional study was conducted across the KSA, covering its five geographical regions with a non-probability quota sample. Twenty-nine, close-ended questions evaluating the knowledge and attitude domain were included in the questionnaire. It was developed with the help of Qualtrics software and circulated among the HCPs through the electronic mode. We analyzed data from about 1040 HCPs using the statistical package of social sciences (SPSS) v.21. All variables were presented in number and percentages. Univariate and multivariate logistic regression was performed to explore the odds ratio (OR) and adjusted odds ratio (aOR) of independent variables for inadequate knowledge and attitude. Considering the "good" level of the respective domain, the HCPs have displayed better knowledge (48.2%) over attitude (33.8%). Female (aOR: 1.55; 95% CI: 1.15-2.09; p = 0.004), Diploma degree (aOR: 2.51; 95% CI: 1.64-3.83; p < 0.001), 7-10 years' experience (aOR: 1.47; 95% CI: 1.01-2.15; p = 0.045) were at higher risk of having inadequate knowledge compared to their contemporaries. Among the sources, the Ministry of Health (MOH) website was the most popular source of information (76%). The knowledge and attitude of HCPs regarding COVID-19 was similar across all the regions of KSA. However, the continuing education program is warranted to fill the potential gap in knowledge for HCPs in higher-risk groups.

Self-Reflection as a Support to Evidence-Based Practice: A Grounded Theory Exploration

The purpose of this study was to explore how reflective practice is experienced by occupational therapists. Thirty participants were purposefully sampled to explore reflective practice experiences using a critical reflection inquiry model as a theoretical framework. Grounded theory using a constant comparative analysis method was used to analyze interview data. Three categories emerged: triggers to reflection, depth of reflection, and actions taken. The frequency of statements compared across survey groups showed that participants with high reflection behaviors made more critical reflections, used steps of the EBP cycle, and took actions to correct practice. Results inform practice in three ways: (1) practitioner experiences were analyzed through the complete reflective practice construct, (2) findings indicated that greater depth of reflective thinking promotes EBP use and actions taken to correct practice, and (3) narrative content analysis was found to be a credible method of assessing reflection within practice narratives, suggesting it as useful for education and promoting continuing competency.

Occupational Therapists' Implementation of Evidence-Based Practice: A Cross Sectional Survey

Evidence-based practice (EBP) implementation has been associated with quality health care outcomes, yet only a small proportion of occupational therapists implement EBP. We conducted a cross-sectional survey measuring EBP implementation, skill and knowledge, self-reflection behavior, and practice demographics to clarify implementation of EBP and factors acting as supports. A random sample of occupational therapists practicing in the U.S. was invited to participate; 578 surveys were included in the final analysis. Participants implemented EBP less than 1 time over the previous 8 weeks; EBP use was highest in those with a doctorate (p = .002) and high self-reflection behavior (p = .001); EBP use was marginally higher in those with organizational support (p = .008; p = .009), time for EBP (p = .009), and access to full text articles (p = .006). Further investigation of how reflective practice and levels of doctoral education support EBP use are recommended.

Barriers and enablers to the use of venous leg ulcer clinical practice guidelines in Australian primary care: A qualitative study using the theoretical domains framework

BACKGROUND

Venous leg ulcers represent the most common chronic wound problem managed in Australian primary care. Despite the prevalence of the condition, there is an evidence-practice gap in both diagnosis and management of venous leg ulcers.

OBJECTIVE

We used the Theoretical Domains Framework to identify barriers and enablers perceived by primary care practitioners in implementing venous leg ulcer guidelines in clinical practice.

DESIGN

We collected data to explore the experiences of practice nurses and general practitioners related to their use of clinical practice guidelines in management of venous leg ulcers.

SETTING(S)

We recruited participants from primary care settings located in metropolitan and rural areas across Victoria, Australia.

PARTICIPANTS

We recruited general practitioners (15) and practice nurses (20).

METHODS

We conducted 35 semi-structured face-to-face and telephone interviews. Content analysis of health practitioners' statements was performed and barriers to implementing clinical practice guidelines were mapped across the Theoretical Domains Framework theoretical domains.

RESULTS

Six main domains from the Theoretical Domains Framework (Environmental context and resources, Knowledge, Skills, Social influences, Social/Professional Role and Identity and Belief about Capabilities) best explained these barriers and enablers. Many participants were not aware of venous leg ulcer clinical practice guidelines. Those that were aware, stated that finding and accessing guidelines was challenging and most participants relied on other sources of information. Venous leg ulcer management was greatly influenced by professional experience and suggestions from colleagues. Other barriers included busy clinical practice, absence of handheld Doppler ultrasonography, insufficient skills and a lack of confidence related to the use of technology to rule out arterial involvement prior to compression application, a particular skill related to venous leg ulcer management that will impact on healing outcomes.

CONCLUSIONS

We identified a number of barriers and the lack of enablers that influence the uptake of venous leg ulcer clinical practice guidelines in primary care. This paper adds a theoretically sound, systematic approach for understanding and addressing the behaviour change required to improve translation of venous leg ulcer clinical practice guidelines in clinical practice. Tweetable abstract: The need to optimise venous leg ulcer clinical practice guidelines (CPG) has never been greater as the current estimate of health cost is AUD3billion and increasing due to rising epidemics of diabetes and obesity. We found most primary care health practitioners are unaware of CPG and this will impact on health and healing outcomes in Australian primary care.

Knowledge and use of evidence-based medicine in daily practice by health professionals: a cross-sectional survey

OBJECTIVES

Healthcare professionals are expected to firmly ground their practice in sound evidence. That implies that they know and use evidence-based medicine (EBM). In this study, our aim was to know how often health professionals actually made use of EBM in their daily practice.

DESIGN

A questionnaire survey of healthcare professionals.

PARTICIPANTS

Healthcare professionals who attended six university postgraduate courses. 226 answered the questionnaire (144 physicians, 64 nurses and 24 pharmacists; response rate 63.3%).

SETTING

56.5% of respondents worked in hospitals (mostly non-teaching), 25.0% in nursing homes and 10.2% in primary care. All participants were French-speaking and lived in France or Switzerland.

MEASURES

Declared degree of knowledge and use of EBM, use of EBM-related information sources.

RESULTS

Overall, 14.2% of respondents declared to use EBM regularly in their daily practice and 15.6% declared to use EBM only occasionally. The remaining respondents declared they: knew about EBM but did not use it (33.1%), had just heard about EBM (31.9%) or did not know what EBM is (4.0%). Concerning the use of EBM-related information sources, 83.4% declared to use at least monthly (or more often) clinical guidelines, 47.1% PubMed, 21.3% the Cochrane Library and 6.4% other medical databases.Fewer pharmacists (12%) declared to use EBM in their practice than nurses (22%) or doctors (36%). No difference appeared when analysed by gender, work setting or years after graduation. The most frequent obstacles perceived for the practice of EBM were: lack of general knowledge about EBM, lack of skills for critical appraisal and lack of time.

CONCLUSIONS

Only a minority of health professionals-with differences between physicians, nurses and pharmacists-declare to regularly use EBM in their professional practice. A larger proportion appears to be interested in EBM but seems to be deterred by their lack of knowledge, skills and personal time.