Implementing an Evidence-Based Feeding Protocol: Impact on Nurses' Knowledge, Perceptions, and Feeding Culture in the NICU

BACKGROUND

Evidence-based feeding practices are often variable among neonatal providers due to lack of knowledge and neonatal intensive care unit (NICU) feeding culture norms.

PURPOSE

To evaluate changes in NICU nurses' knowledge, perceptions, feeding practices and culture following education about, and implementation of, an evidence-based Infant-Driven Feeding (IDF) protocol.

METHODS

A pre-/postprospective comparative design was used to survey 120 registered nurses employed in a level 3 NICU about feeding practices, knowledge, and culture prior to IDF education and 1 to 2 months after IDF implementation.

RESULTS

The preeducation survey yielded 59 respondents; of these, 30 responded to the same survey after IDF implementation. Postimplementation responses were significant for fewer nurses making decisions to begin oral feedings ( P = .035), greater use of gestational age to increase frequency of oral feeding attempts ( P = .03), less reliance on weight loss to decrease oral feeding attempts ( P = .018), an increase in use of combination interventions to prepare infants for oral feeding ( P = .001), and greater willingness to allow a rest period or stop the feeding if an infant falls asleep after completing 70% of the feeding ( P = .03).

IMPLICATIONS FOR PRACTICE AND RESEARCH

Trends in several survey categories following the education program and implementation of IDF support the use of evidence-based practices (EBPs) such as IDF. Future research focused on nurses' perceptions of how education influences integration of specific EBPs into practice is needed. Evaluating EBP mentorship combined with education about EBPs can provide insights on how best to integrate EBPs into practice.

Evidence-Based Practice for Cardiac Intensive Care Unit Nurses: An Educational Intervention Study

BACKGROUND

This study examined the effectiveness of two educational methods on nurses' skills and commitment to implementing evidence-based practice (EBP).

METHOD

Ninety nurses were randomly assigned to three groups. Participants in the workshop group took part in a 2-day training course, participants in the multimedia group received educational content through video, and participants in the control group did not receive any training content. The nurses' skills and commitment to implement EBP were assessed at baseline and 1 month after the teaching sessions.

RESULTS

The EBP skills of nurses in the intervention groups were significantly enhanced compared with nurses in the control group (p < .05). Mean scores in the multimedia group were slightly better than in the workshop group; however, this difference was not statistically significant. Commitment to EBP implementation did not change significantly over time among the groups (p > .05).

CONCLUSION

Different methods of training can be useful in improving nurses' EBP skills; however, the participants' commitment to implement EBP did not change considerably. Because of its cost effectiveness, the multimedia method should be considered for use in nurse training. [J Contin Educ Nurs. 2020;51(4):167-173.].

Adoption of an Electronic Template to Promote Evidence-Based Practice for Policies, Procedures, Guidelines, and Directives Documents

BACKGROUND

Policies, procedures, and guidelines standardize care, meet regulatory requirements, and can promote safety in clinical practice. The existing protocols, policies, guidelines, and directives (PPGDs) at a level 1 trauma academic medical center were underused by the intensive care unit clinicians and did not always clearly represent the supporting evidence.

AIMS

The goals of this project were to update the Critical Care Practice Manual (CCPM) and to ensure that clinical practice was aligned with best evidence. The aim was to design a new PPGD template that used technology to enhance the presentation and functionality of these documents.

METHODS

Nurse project consultants reviewed every PPGD and solicited feedback from critical care nurses who consistently identified 2 barriers to utilization of CCPM: difficulty finding PPGDs and the cumbersomeness of lengthy policies. This improvement project used the principles of the Plan-Do-Study-Act cycle to test changes in real time. When 95% of the PPGDs were in the new format, a 22-question survey was created to elicit feedback from the direct care nurses who used the PPGD in the new electronic format.

RESULTS

On the basis of the survey results, nurses at the medical center accessed a PPGD at least once a month. The overall results indicated that the respondents agreed or strongly agreed that the PPGDs provided guidance (85%), reflected current practice (76%), were clear and concise (75%), and were evidence based (73%). Only 24% of those surveyed were still having difficulty finding PPGDs.

DISCUSSION/CONCLUSION

To facilitate timely modification and early adoption of the new PPGD format, the Plan-Do-Study-Act cycle was effectively used. The CCPM adopted a new electronic format that met the aims of the project. When making a commitment to develop evidence-based practice policies and guidelines, it is important to revisit the process, consider ongoing support, and educate frontline staff as applicable. The new template restored and enhanced the standardization of PPGDs. Technology can enhance usability and improve functionality, but it can also prove to be frustrating when implementing changes that use it, especially if users are not comfortable with it.

Do educational interventions aimed at nurses to support the implementation of evidence-based practice improve patient outcomes? A systematic review

BACKGROUND

Numerous articles have sought to identify the impact of educational interventions for improving evidence-based practice (EBP) amongst nurses, most of these focus on skills and knowledge acquired. No systematic review has explored whether this educational input translates into improved patient outcomes.

OBJECTIVES

To review the evidence on (1) The change in patient outcomes following educational interventions to support practising nurses in implementing EBP. (2) The instruments or methods used to determine whether EBP education improves patient outcomes.

METHODS

A systematic review following PRISMA guidance was conducted. Literature was comprehensive searched including 6 databases, journal handsearching, citation tracking, and grey literature websites. Studies were included if they reported an EBP educational intervention aimed at practising nurses and contained objective or self-reported measures of patient related outcomes. The quality of the included studies was assessed using a modified Health Care Practice R&D Unit (HCPRDU) tool. Because of the poor homogeneity of the included studies, the data were analysed by narrative synthesis.

RESULTS

Of the 4284 articles identified, 18 were included: 12 pre-post studies, three qualitative studies, and three mixed-methods study designs. The level of quality was modest in the studies. The results of the EBP educational interventions on patient outcomes were assessed using three methods: individual projects to implement an evidence-based approach, qualitative approaches, and a questionnaire survey. The majority of the articles concluded there was a positive change in patient outcomes following an educational intervention to improve EBP; a wide range of context specific outcomes were described.

CONCLUSION

Educational interventions for clinical nurses to support the implementation of EBP show promise in improving patient outcomes. However, the direct impact of EBP interventions on clinical outcomes is difficult to measure. Further testing and development is needed to improve the quality of studies and evaluation instruments in order to confirm the current findings.

Effects of Education Programs on Evidence-Based Practice Implementation for Clinical Nurses

This study was conducted to identify the effectiveness of an education program for evidence-based practice (EBP) implementation of clinical nursing. EBP knowledge/skill, attitude, and belief; information search ability; and EBP implementation were significantly higher in the experimental group than in the control group. Furthermore, the effect on implementation was maintained at week 4 and week 8, indicating that the education program practically promotes the EBP implementation of nurses. Results confirm that the education program for EBP implementation is critical and the continuous education program is an essential part of EBP implementation. Also, to promote EBP implementation and disseminate it to nursing organizations, an immediate concern should be the cultivation of mentors for EBP and fortification of the belief and ability regarding EBP implementation. J Contin Educ Nurs. 2016;47(8):363-371.

Evaluating Evidence-Based Practice Knowledge and Beliefs Through the e-Learning EBP Academy

BACKGROUND

This research examined evidence-based practice (EBP) knowledge and beliefs before and after a 3-month e-learning program was implemented to build EBP capacity at a large children's hospital.

METHOD

Ten clinicians completed the development, implementation, and evaluation of the e-learning education, comprising phase one. Revision and participation by 41 clinicians followed in phase two. Participants in both phases completed the EBP Beliefs and Implementation Scales preintervention, postintervention, and 6 months after postintervention.

RESULTS

EBP beliefs and implementation increased immediately and 6 months after postintervention, with statistically significant increases in both phases. Participants in both phases applied knowledge by completing mentor-supported EBP projects.

CONCLUSION

Although EBP beliefs and implementation scores increased and e-learning provided flexibility for clinician participation, challenges arose, resulting in lower-than-expected completion. Subsequent revisions resulted in hybrid education, integrating classroom and e-learning with project mentoring. This funded e-learning research contributes knowledge to the growing specialty of professional development. J Contin Educ Nurs. 2017;48(7):304-311.

Interprofessional Evidence-Based Clinical Scholar Program: Learning to Work Together

St. Catherine University and North Memorial Medical Center conducted an Interprofessional Clinical Scholar Program (ICSP) involving five teams of staff, students, and faculty. The aim of the case study was to determine how the interprofessional teams implemented evidence-based projects. We triangulated data from interviews, field notes, and surveys to produce themes: learning to value interprofessional teams, working as a team, and being evidence-based practitioners. We found significant differences pre- and post-ICSP on the Attitudes Toward Interprofessional Teamwork and Education scale, t(14) = −5.48, p &lt; .005, and the Terminology subscale of the Evidence-Based Practice Profile, t(15) = −4.04, p = .001. We found no change in scores on the Evidence-Based Practice Belief Scale, t(14) = −1.49, p = .156. The study supported predicted patterns of benefits from ICSP. Not all participants benefited because of variability in attendance.

The Adapted Fresno test for speech pathologists, social workers, and dieticians/nutritionists: validation and reliability testing

Purpose

The current versions of the Adapted Fresno test (AFT) are limited to physiotherapists and occupational therapists, and new scenarios and scoring rubrics are required for other allied health disciplines. The aim of this study was to examine the validity, reliability, and internal consistency of the AFT developed for speech pathologists (SPs), social workers (SWs), and dieticians/nutritionists (DNs).

Materials and methods

An expert panel from each discipline was formed to content-validate the AFT. A draft instrument, including clinical scenarios, questionnaire, and scoring rubric, was developed. The new versions were completed by ten SPs, 16 SWs, and 12 DNs, and scored by four raters. Interrater reliability was calculated using intraclass correlation coefficients (2,1) for the individual AFT items and the total score. The internal consistency of the AFT was examined using Cronbach’s α.

Results

Two new clinical scenarios and a revised scoring rubric were developed for each discipline. The reliability among raters was excellent for questions 1, 3, and 6 across all disciplines. Question 7 showed excellent reliability for SPs, but not for SWs and DNs. All other reliability coefficients increased to moderate or excellent levels following training. Cronbach’s α was 0.71 for SPs, 0.68 for SWs, and 0.74 for DNs, indicating that internal consistency was acceptable for all disciplines.

Conclusion

There is preliminary evidence to show that AFT is a valid and reliable tool for the assessment of evidence-based practice knowledge and skills of SPs, SWs, and DNs. Further research is required to establish its sensitivity to detect change in knowledge and skills following an educational program.

Implementation of evidence-based nursing practice for diabetic patients: an Iranian experience

Evidence-based nursing is recognized as an indicator of quality in nursing practice, a basis for accountability and the gold standard of professional nursing care. The aim of this study was to explore nurses' experiences and perceptions about evidence-based nursing practice in giving care to patients with diabetic foot ulcers. A qualitative research design was adopted, and content analysis was used to analyse data. Semistructured interviews were held with 19 bachelor-degree nurses working in a teaching hospital in an urban area of Iran. During data analysis, two main themes developed: 'structural backgrounds of the organization' and 'empowerment'. Accordingly, it was concluded that successful implementation of evidence-based nursing requires the reconfiguration of the administrative structure in the hospital. In addition, it requires the support of nurse leaders to facilitate the implementation of evidence-based nursing in the practice.

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

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

Evidence-based practice curriculum in allied health professions for teaching-research-practice nexus

Allied healthcare workers are from diverse professions and the key skill required is providing evidence-based care but this concept has not permeated enough for using it skillfully in their professions. A well structured curriculum in allied health professions is needed to strengthen concerted teaching, research, and practice to empower their professionals and make considerable differences in the lives of people by adopting evidence-based practice. Information sources for allied health professionals have relied on advice of their supervisors and colleagues, personal experiences, authoritative theory and texts for practice. Because of "research-practice" gap, often the use of evidence is not reflected in an individual day to day professional practice. Although allied health professionals work in resource and evidence challenged settings, there are certain barriers and facilitators, which need to be addressed. To implement practice-related research findings and uptake of evidence requires two essential components, namely, practical component and knowledge component. Research bench marking and research metrics for quality assurance and standardization through evidence-based practice will promote academic status and credibility of allied health profession.

Rating the level, quality, and strength of the research evidence

Improving patient safety and quality requires more consistent application of best practices based on the strongest scientific evidence available. Although evidence-based practice initiatives are increasingly being implemented in healthcare settings, clinicians may not have had the necessary preparation to accurately determine the overall strength of evidence supporting specific practice change recommendations. A particular issue is lack of clarity in use of the terms level of evidence, quality of evidence, and strength of evidence. This article clarifies the important differences among these terms.

Comparative effectiveness research in evidence-based dental practice

Will evidence-based dental practice (EBDP) benefit from the projected new drive for comparative effectiveness research (CER)? Optimists may answer Yes certainly, because CER and EBDP are intertwined, and benefit and feed on each other. Others may be more cautious. Any differences in opinion likely arise because the similarities and the differences between CER and EBDP are not clear cut.