Learning Challenges Associated with Evidence-Based Practice in Rheumatology

Background: Rheumatology is a field of practice that is undergoing many changes, leading to growing demand for rheumatology practitioners to keep up-to-date about the research developments in their field and to implement new findings and recommendations into clinical practice. Research within implementation science has shown that there are numerous barriers to the clinical use of research-based knowledge in health care. Implementation of evidencebased practice (EBP) requires a great deal of learning on the part of practitioners. It is likely that practitioners in rheumatology face similar challenges to those in other clinical fields, but there is a paucity of research concerning the implementation of EBP in rheumatology and the learning required. Aims: The overall aim of the research project was to generate knowledge concerning the learning challenges associated with evidence-based practice in rheumatology. Methods: Qualitative methods were used to explore the use of knowledge sources in rheumatology nursing and the learning opportunities in clinical rheumatology for participants belonging to five professional groups. Quantitative methods sought to examine to what extent evidence-based practice was implemented in clinical rheumatology practice and which individual and organizational factors affected research use. A theory-based study analysed the learning processes associated with achieving an evidence-based practice. Results: Four sources of knowledge were identified for rheumatology nursing practice: interaction with other people in the workplace (peers in particular) and previous knowledge and experience were perceived as preferred sources of knowledge, while written materials and contacts outside the workplace were less privileged. Learning opportunities occurring during daily practice were perceived by participants of all professional groups to consist predominantly of interactions with professional peers in the workplace. Participants perceived a lack of recognized learning opportunities such as continuing professional education and regular participation in rheumatology-specific courses and conferences. Participants also expressed that time for reflection and up-dating knowledge was short in everyday clinical work. The quantitative data showed that while the general interest for EBP was high in rheumatology practice, individual interest and professional self-efficacy related to EBP varied. A longer work-experience in rheumatology, better self-efficacy concerning the use research-based knowledge and more experience from research activities were positively associated with the use of research in practice. The theoretical analysis showed that challenges of implementing evidence-based practice concern not only the acquisition of research-based knowledge and the integration of this knowledge in practice, but also the abandonment of outdated practices. Conclusions: In this thesis, implementation of EBP in rheumatology has been shown to be a complex issue. Social, contextual and individual aspects were found to be involved in the learning processes, the use of knowledge sources and learning opportunities, as well as in the EBP-relevant behaviours that are enacted in clinical rheumatology. The thesis hopes to contribute to a better understanding of the learning challenges in connection with the implementation of EBP in rheumatology practice

Preparedness to Implement Physical Activity and Rehabilitation Guidelines in Routine Primary Care Cancer Rehabilitation : Focus Group Interviews Exploring Rehabilitation Professionals Perceptions

To explore primary care professionals perceptions of physical activity and other cancer rehabilitation practice in cancer survivors, investigating the preparedness to implement guidelines regarding cancer rehabilitation. We collected qualitative data through seven semi-structured focus group interviews with 48 rehabilitation professionals, with mean 9 years of experience in primary care rehabilitation (32 physiotherapists, 15 occupational therapists, and 1 rehabilitation assistant) in a primary care setting. Data was analyzed using content analysis. Primary care rehabilitation professionals expressed limited experience of cancer survivors, experienced lack of knowledge of cancer-related disability, and had doubts concerning how to treat cancer survivors. They also experienced uncertainty about where to find collaboration and support in the healthcare system outside their own rehabilitation clinic. There is a need to combine different implementation strategies to tackle multiple barriers for effective cancer survivor rehabilitation in primary care, to boost individual rehabilitation professionals knowledge and self-efficacy, to clarify roles and responsibilities for cancer rehabilitation across levels of care, and to develop and strengthen organizational bridges to provide adequate access to rehabilitation for cancer survivors.Funding Agencies|County Council of Ostergotlands funding of research time, Local Research Council of Western County Council of Ostergotland, and Research Council of Southeast Sweden</p

Learning opportunities in rheumatology practice : a qualitative study

Purpose – This paper aims to explore what opportunities for learning practitioners in rheumatology perceive of in their daily practice, using a typology of workplace learning to categorize these opportunities. Design/methodology/approach – Thirty-six practitioners from different professions in rheumatology were interviewed. Data were analyzed using conventional qualitative content analysis with a directed approach, and were categorized according to a typology of formal and informal learning. Findings – The typology was adjusted to fit the categories resulting from the analysis. Further analysis showed that work processes with learning as a by-product in general, and relationships with other people in the workplace in particular, were perceived as important for learning in the workplace. The use of many recognized learning opportunities was lower. Barriers for learning were a perceived low leadership awareness of learning opportunities and factors relating to workload and the organization of work. Research limitations/implications – The generalizability of results from all qualitative inquiries is limited by nature, and the issue of transferability to other contexts is for the reader to decide. Further studies will need to confirm the results of the study, as well as the proposed enhancement of the typology with which the results were categorized. Practical implications – The study highlights the importance of relationships in the workplace for informal learning in rheumatology practice. In the clinical context, locally adapted strategies at organizational and individual levels are needed to maximize opportunities for both professional and interprofessional informal learning, taking the importance of personal relationships into account. The findings also suggest a need for increased continuing professional education in the specialty. Originality/value – The workplace learning typology that was used in the study showed good applicability to empirical health-care study data, but may need further development. The study confirmed that informal workplace learning is an important part of learning in rheumatology. Further studies are needed to clarify how informal and formal learning in the rheumatology clinic may be supported in workplaces with different characteristics

Implementation of Evidence-Based Practice in Rheumatology: What Sociodemographic, Social Cognitive and Contextual Factors Influence Health Professionals’ Use of Research in Practice?

Objective: Research on the use of research in rheumatology practice is largely lacking. This study attempts to fill this knowledge gap by exploring the degree to which evidence-based practice (EBP) is implemented in clinical rheumatology practice and identifying individual and organizational factors that may potentially affect research use in the clinical environment. Methods: A web-based questionnaire was distributed to members of health professional groups in clinical rheumatology by way of publicly available e-mail addresses. Data were collected on sociodemographic, social cognitive, and contextual factors deemed to potentially influence the use of research in practice. The outcome measure was the EBP Implementation Scale. Results: A complex range of factors was found to influence the outcome. The factors that were most clearly associated with research use were the perception of personal ability to use research knowledge, years of experience in clinical rheumatology, and experience of research activities. Conclusions: Our study results suggest a large variation in levels of implementation of EBP across work units and individuals, and although a low general standard is indicated (even if a gold standard does not exist), there was also a great interest in working according to EBP principles. Potential for change is apparent, but it seems necessary to examine the use of research evidence in rheumatology practice at the individual and work unit levels to accommodate local and individual needs and resources. Future studies are needed to examine the influence of contextual influences by other methods

Implementation of Evidence-Based Practice From a Learning Perspective.

IntroductionFor many nurses and other health care practitioners, implementing evidence-based practice (EBP) presents two interlinked challenges: acquisition of EBP skills and adoption of evidence-based interventions and abandonment of ingrained non-evidence-based practices.AimsThe purpose of this study to describe two modes of learning and use these as lenses for analyzing the challenges of implementing EBP in health care.MethodsThe article is theoretical, drawing on learning and habit theory.ResultsAdaptive learning involves a gradual shift from slower, deliberate behaviors to faster, smoother, and more efficient behaviors. Developmental learning is conceptualized as a process in the “opposite” direction, whereby more or less automatically enacted behaviors become deliberate and conscious.ConclusionAchieving a more EBP depends on both adaptive and developmental learning, which involves both forming EBP-conducive habits and breaking clinical practice habits that do not contribute to realizing the goals of EBP.Linking Evidence to ActionFrom a learning perspective, EBP will be best supported by means of adaptive learning that yields a habitual practice of EBP such that it becomes natural and instinctive to instigate EBP in appropriate contexts by means of seeking out, critiquing, and integrating research into everyday clinical practice as well as learning new interventions best supported by empirical evidence. However, the context must also support developmental learning that facilitates disruption of existing habits to ascertain that the execution of the EBP process or the use of evidence-based interventions in routine practice is carefully and consciously considered to arrive at the most appropriate response.<br

Rapid Implementation of Telegenetic Counseling in the COVID-19 and Swedish Healthcare Context : A Feasibility Study

This study reports the process and preliminary findings of rapid implementation oftelegenetic counseling in the context of Swedish healthcare and COVID-19 pandemic,from both a patient and a provider perspective. Fourty-nine patients and 6 healthcareprofessionals were included in this feasibility study of telegenetic counseling in aregional Department of Clinical Genetics in Sweden. Telegenetic counseling is heredefined as providing genetic counseling to patients by video (n =30) or telephone (n= 19) appointments. Four specific feasibility aspects were considered: acceptability,demand, implementation, and preliminary efficacy. Several measures were used includingthe Genetic Counseling Outcome Scale 24 (collected pre- and post-counseling); theTelehealth Usability Questionnaire; a short study specific evaluation and Visiba Careevaluations, all collected post-counseling. The measures were analyzed with descriptivestatistics and the preliminary results show a high level of acceptance and demand, fromboth patients and providers. Results also indicate successful initial implementation in theregional Department of Clinical Genetics and preliminary efficacy, as shown by significantclinically important improvement in patients’ empowerment levels

How Healthcare Professionals in Cardiac Care Address Depressive Symptoms : Experiences of Patients With Cardiovascular Disease

BACKGROUND: Depressive symptoms are common in patients with cardiovascular disease (CVD) and are associated with a poorer quality of life and prognosis. Despite the high prevalence and negative consequences, the recognition of depressive symptoms is low. More knowledge about patients' perceptions of how depressive symptoms are addressed by healthcare professionals is therefore needed. OBJECTIVES: The aim of this study was to explore the experiences of patients with CVD of how healthcare professionals address and manage depressive symptoms in clinical cardiac care encounters. METHODS: A qualitative, semistructured interview study was performed. Data were analyzed using inductive thematic analysis. RESULTS: In total, 20 patients with CVD previously treated for depressive symptoms were included (mean age, 62 [range, 34-79] years; 45% women). Three main themes emerged: (1) "not being seen as a whole person," (2) "denying depressive symptoms," and (3) "being provided with help." The patients perceived that healthcare professionals mainly focused on somatic symptoms and disregarded their need for help for depressive symptoms when patients raised the issue. Some patients stated that they received help for depressive symptoms, but this depended on the patients' own ability to communicate their needs and/or having social support that could alert them to the importance of doing so. Patients also described that they downplayed the burden of depressive symptoms and/or did not recognize themselves as having depressive symptoms. CONCLUSION: Depressive symptoms were overlooked in patients with CVD, and psychological needs had not been met. A good ability to address needs and having good social support were useful for receiving help with depressive symptoms

Views on oral health determinants as described by persons with continuous positive airway pressure-treated obstructive sleep apnoea: a qualitative study

Abstract Background Oral diseases have been associated with cardiovascular diseases, and persons with continuous positive airway pressure [CPAP]-treated obstructive sleep apnoea [OSA] have an increased risk for negative consequences for both oral and general health. CPAP treatment is often life-long and adherence to treatment is essential. Xerostomia is a common side-effect which can lead to treatment abandonment. Oral health is a changeable part of our general health and well-being and exploring the views of oral health determinants from persons with experience of CPAP-treatment is important to prevent adverse oral health outcomes. The purpose of this study was to explore what persons with experience of CPAP-treated OSA view as determinants for their oral health. Methods Eighteen persons with long-term experience of CPAP-treated OSA were purposively selected. Data were collected by semi-structured individual interviews. A code book based on the World Dental Federation’s [FDI] theoretical framework for oral health was developed and used to analyse the data using directed content analysis. The domains in the framework’s component driving determinants were used as pre-determined categories. Using the description of driving determinants as a guide, meaning units were extracted from the interview transcripts through an inductive approach. Then, by employing a deductive approach the code book was used to categorise the meaning units into the pre-determined categories. Findings The views on oral health determinants described by the informants were compatible with the five domains in the component driving determinants in the FDI’s theoretical framework. Ageing, heredity, and salivation (biological and genetic factors), influences from family and the wider society (social environment), location and re-localisation (physical environment), oral hygiene habits, motivation, willingness to change, professional support (health behaviours), and availability, control, finances, and trust (access to care) were viewed as important oral health determinants by the informants. Conclusion The study points to a variety of individual oral health-related experiences that oral healthcare professionals could consider when designing interventions to reduce xerostomia and prevent adverse oral health outcomes for persons undergoing long-term CPAP-treatment