19,615 research outputs found

    At the pillar of the proverbial Golden Calf: Sacrificing the Need for ‚ÄėResponsible Knowing‚Äô on the Altar of a Compliance-Based Ethic

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    Evidence-based practice (EBP) has been promoted and adopted broadly and has led to advances in health and human services. Notwithstanding the underlying rationale of EBP philosophy to diversify the current body of information concerning evidence-based practices, this paper draws attention to critical thinking fallacies that confound non-evidence-based ‚Äútreatment as usual‚ÄĚ practice with actual EBP philosophy. Flawed belief systems about EBP, in tandem with a compliance-based culture, fail to provide structure to the possibility of evidence-based practice philosophy and proper use of EB treatment modalities. Impediments to EBP implementation are created by lack of ‚Äúresponsible knowing‚ÄĚ and this results in practitioner complacency toward means of augmenting effective treatment. However, insofar as EBP implementation confronts tension between ‚Äėresponsible knowing‚Äô and compliance-based program culture, it gives way to confusion, misdirection, and complacency towards what can be known about EBP and the information gleaned about it. Effectively limiting important aspects of being a responsible knower in terms of the ability to embody accurate knowledge and practice philosophy. Thus, the compliance-based ethic risks incompatibility with the ethical freedom necessary for responsible knowing and is in constant conflict with the proper implementation of EBP. Keywords: compliance-based ethics, evidence-based practice, fallacies, testimonial injustice, critical thinking, human service

    Aligning Evidence-Based Practice With Translational Research: Opportunities for Clinical Practice Research

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    Magnet(R) and other organizations investing resources in evidence-based practice (EBP) are ideal laboratories for translational nursing research. Translational research, the study of implementation of evidence into practice, provides a unique opportunity to leverage local EBP work for maximum impact. Aligning EBP projects with rigorous translational research can efficiently meet both EBP and research requirements for Magnet designation or redesignation, inform clinical practice, and place organizations at the leading edge of practice-based knowledge development for the nursing discipline

    Collaborative Instruction for Information Retrieval and Appraisal Skills in Evidence-Based Practice Models for Dental Hygiene Students.

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    Objectives: 1. Collaborate with VCU Dental Hygiene Program faculty to develop and evaluate a model of evidence-based practice (EBP) for students in didactic and clinical settings. 2. Describe how a course was modified to emphasize evidence-based practice. 3. Analyze course evaluations and student scholarly output. Methods/Materials: Dental educators strive to develop graduates who practice evidence-based practice and whose clinical decisions are based on current scientific research. A medical librarian was invited to assist in integrating EBP into the dentistry curriculum in 2012. To gain a better understanding of EBP in dental settings, the librarian and dental hygiene faculty attended the Forsyth ADA Evidence-Based Dentistry training in Boston, Massachusetts that same year. The collaborators revised a course to take students through the mechanics of EBP, including demonstrating transfer into the clinic setting and developing a model of real-time information retrieval useful after graduation in the ‚Äúreal world.‚ÄĚ Results: In didactic activities, students received instruction on information retrieval as well as critical appraisal skills to answer clinical questions, reinforcing the EBP model. This culminated in students creating improved literature reviews for capstone projects, posters and table clinic presentations, stronger clinical information retrieval skills, and increased publications in refereed professional journals. Interaction between students, the librarian and faculty resulted in positive outcomes in EBP concepts used for generation of decision making in clinic as well as peer presentations in local, regional and national settings. Conclusions: The collaborative effort was valuable as it strengthened the relationship between dental hygiene faculty, students and the librarian. Additionally, students‚Äô experience was enhanced as they practiced retrieval strategies and critical appraisal of research literature. This enabled them to develop as ‚Äúconsumers‚ÄĚ of current professional research literature, model evidence-based practice and publish their writing in professional journals

    Outcomes of an Evidence-Based, Data Driven-Model Fieldwork Experience for Occupational Therapy Students

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    Over the past decade, there has been an increased emphasis on evidence-based practice (EBP) and the use of outcome measurement in clinical practice, however, the implementation of evidence into practice remains challenging and irregular. During fieldwork, students often experience a disconnect between the emphasis on EBP in the classroom and lack of use in the clinic. Recognizing the need to develop high-quality, evidence-based and data-driven models of practice for student training, we partnered with local fieldwork educators to develop an innovative program that guides students and simultaneously trains fieldwork educators (FWE) in the use of a systematic data driven decision making (DDDM) process to infuse evidence into practice. Using a pre-post quasi-experimental design, we evaluated the impact of this program on students’ perceived knowledge and skills in use of EBP and DDDM. A focus group with participating fieldwork educators captured their knowledge and attitudes in the use of EBP and DDDM in their clinical sites. Eleven FWEs and twenty four students participated. Results revealed significant change in students’ knowledge and skill in use of EBP and DDDM. FWEs reported the program clarified the role of occupational therapy, enhanced communication, and validated the value of occupational therapy in their clinical site. This program serves as a model for training students to implement evidence and data driven approaches in clinical practice, thus bridging the gap between classroom and clinic

    Mentors' attitudes, beliefs and implementation of evidence based practice when mentoring student nurses in the community: a qualitative study

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    Background: Nursing practice based on evidence improves patient care. Mentors supporting student nurses are in clinical placements are in a unique position to demonstrate evidence based practice (EBP). The NMC (2008) suggest mentors must be able to identify and apply research and EBP, increase or review the evidence-base used to support practice and support student nurses in applying an evidence base to their own practice. However, there is limited literature on nurse mentor’s attitudes, beliefs and implementation of EBP when mentoring student nurses in the community. Methods Data were collected via 7 focus groups in 2015 with 33 community nurse mentors from one NHS Foundation Trust. Community settings of the mentors included: community hospital inpatients and outpatients, minor injury units, and district nurse teams including specialist teams such as long term conditions, tissue viability, respiratory and cardiac rehabilitation. The interview schedule was based on information from a pilot group and previous literature. Data was analysed using Interpretative Phenomenological Analysis (IPA). Results Emergent super-ordinate themes from community nurse mentors included: 1) implementation of EBP 2) community nursing versus acute hospital nursing 3) implications of degree entry nursing 4) bidirectional learning 5) being part of the students’ journey a role model 6) EBP versus practice based evidence 7) barriers: IT, time, student attitudes, agency staff, mentorship course, paperwork 8) facilitators: IT, time, student attitudes, resources. Discussion All nurse mentors believed their clinical practice to be informed from evidence, specifically the structure provided from guidelines and policies both nationally and locally. Reviewing guidelines occurred in job descriptions of more senior roles. Mentors invested time and energy in supporting students to implement EBP as recognised the importance of educating the next generation of nurses. Issues regarding the mentorship course arose including; accessibility, length of the course and content

    Embedded or Modular? Preliminary Findings From a Study of Pre-Registration Nursing EBP Teaching Delivery Methods.

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    Aim: This study explores the impact of teaching delivery method (embedded vs. modular) on undergraduate pre-registration nursing students’ self-reported Evidence-Based Practice (EBP) implementation, attitudes, knowledge and skills. Background: For the past 20 years EBP has been increasingly emphasised as an effective approach and goal in healthcare. Although research has identified a number of barriers to its adoption and implementation, little research has focused on nurses’ pre-registration training; particularly on the impact of teaching delivery-method EBP throughout the learning process. Method: The study represents an on-going educational audit. Two cohorts of undergraduate nursing students were recruited for a longitudinal, cross-sectional survey study: cohort one (N=57, response rate= 90.1%) were being taught EBP modularly, but cohort two (N=88, response rate= 63.8%) had EBP embedded across their modules. Data was collected using the Evidence-Based Practice Questionnaire (EBPQ; Upton & Upton, 2006), administered at six-monthly intervals across the duration of students’ courses. Results: Preliminary analysis of students’ EBP 6-months into their courses identified no statistically significant differences between the cohorts on EBP Practice (U=2,138.00, Z=-0.13, p=.894). However, statistically significant differences between the two cohorts were identified on EBP attitudes (U=1, 852.00, Z=-2.43, p=.015; embedded group Md= 5.67, modular group Md=6.33) and Knowledge/skills (U=2,802.00, Z=3.68, p<.001; embedded group Md= 4.89, modular group Md=4.29). Conclusions: Although the project is still in its infancy, preliminary findings raise important questions about the relationship between EBP attitudes, practice and skill. The embedded cohort’s lower attitude scores may reflect social-desirability effects: modules dedicated to EBP may instil greater importance of displaying positive EBP attitudes. Embedding EBP may provide an effective means of developing students’ practice, knowledge and skills, without requiring dedicated modules (thereby reducing resource demands)

    An Evidence-Based Practice Assessment and Quality Improvement Initiative in Idaho\u27s Critical Access Hospitals

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    Background: Health care providers and systems have been challenged to discard tradition-based care and outdated practices in lieu of evidence-based practice (EBP). Yet, little is known about the state of EBP, barriers and facilitators to EBP, and organizational readiness for EBP in Idaho‚Äôs Critical Access Hospitals (CAH). To affect positive change, it was necessary to understand whether providers in Idaho‚Äôs CAHs were using evidence as a foundation for practice‚ÄĒand, if not, what challenges existed in implementing EBP. Mitigating barriers and providing EBP education by way of webinar-based online technology has been proven to be practical and feasible. Providing EBP education, employing EBP tools and techniques, and implementing an evidence-based QI initiative will bridge the gap between knowledge and practice to improve health outcomes Project Design: The aim of this project was to determine whether providers in Idaho‚Äôs CAH were using evidence as a foundation for practice. Nurse Executives (NE) from CAHs in the Northern region of Idaho answered questions about the state of evidence-based practice. One CAH volunteered to participate in an EBP continuing education program and complete a quality improvement initiative. Pre- and post-education intervention surveys were administered to measure the outcomes of this EBP continuing education program. Results: The results of the NE needs assessment indicated NEs were familiar with EBP and were willing to participate in this project. Nurse executives reported they and their staffs wanted to learn more about EBP, they were interested in participating in an online modular EBP continuing education program, and they were willing to allocate a moderate amount of education dollars to fund this program. Additionally, they were engaged in EBP activities and interested in implementing EBP to address a specific quality issue in his or her organization. However, not all NEs were able to allocate education funds for clinicians to complete the 13-hour program or implement an interdisciplinary quality improvement initiative. The resulting hybrid modular EBP continuing education program was effective in improving mean scores for EBP competency, EBP beliefs, and EBP knowledge. After five months, mean scores demonstrated additional improvements in EBP competency, EBP beliefs, and EBP implementation. Recommendations and Conclusions: Evidence-based practice improves patient care and quality outcomes. However, barriers exist and removing them can be a challenge for small and rural hospitals. The findings from this EBP assessment and quality improvement initiative demonstrate using an EBP nurse mentor to implement a hybrid modular EBP continuing education program is practical, feasible, and effective. With ongoing support from an EBP nurse mentor, interdisciplinary teams can employ EBP tools, processes, and resources to implement evidence-based quality improvement initiatives to improve patient outcomes. It is recommended this project be replicated in other CAHs in Idaho in partnership with Ohio State University‚Äôs Center for Transdisciplinary Evidence-Based Practice

    Promoting Environments that Measure Outcomes: Partnerships for Change

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    This paper describes the development of the PrEMO© (Promoting Environments that Measure Outcomes) program. PrEMO© is an innovative model promoting evidence-based practice (EBP) while developing capacity and quality of Level II fieldwork placements. The PrEMO© program is described from initiation to completion, including development of site-specific learning objectives, the twelve week schedule and the role of faculty mentorship. Occupational therapy (OT) students, and university OT program faculty including academic fieldwork coordinators, partner with fieldwork educators at the site to implement EBP using a data-driven decision making (DDDM) process to guide the development of evidence-based practices. PrEMO© appears to be a useful strategy for building Level II fieldwork capacity and enhancing student and fieldwork educators’ knowledge and skills about EBP and outcome measurement in routine OT practice
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