Outcomes of a Multiprofessional Educational Intervention in Evidence-Based Practice

Background: Education is a commonly used intervention in the development of evidence-based practice (EBP). The aim of this study was to evaluate the outcome of an educational intervention on healthcare professionals’ perceived skills in finding, reviewing, and using research evidence in clinical practice. A further aim was to identify potential determinants for the outcome.Methods and Findings: A three-day course in EBP was designed for registered nurses, medical social workers, physiotherapists, occupational therapists, and dieticians. The Developing Evidence-Based Practice Questionnaire (DEBP) questionnaire was administered before and six months after the intervention (N = 274). Non-parametric statistics were used. The results showed an overall effect on ability to find research evidence (p = .0005) and ability to review research evidence (p = .0005), whereas there was no overall effect on use of research evidence in clinical practice (p = .18). However, some subgroups showed a significant improvement over time, for example, those whose profession was nursing or midwifery and those who had experience using evidence-based practice prior to the educational intervention.Conclusions: The results showed that a three-day course in EBP improved the participants’ ability to find and review research evidence, but it did not have an overall effect on the use of research evidence in clinical practice

Outcomes of a Multiprofessional Educational Intervention in Evidence-Based Practice

Background: Education is a commonly used intervention in the development of evidence-based practice (EBP). The aim of this study was to evaluate the outcome of an educational intervention on healthcare professionals’ perceived skills in finding, reviewing, and using research evidence in clinical practice. A further aim was to identify potential determinants for the outcome.Methods and Findings: A three-day course in EBP was designed for registered nurses, medical social workers, physiotherapists, occupational therapists, and dieticians. The Developing Evidence-Based Practice Questionnaire (DEBP) questionnaire was administered before and six months after the intervention (N = 274). Non-parametric statistics were used. The results showed an overall effect on ability to find research evidence (p = .0005) and ability to review research evidence (p = .0005), whereas there was no overall effect on use of research evidence in clinical practice (p = .18). However, some subgroups showed a significant improvement over time, for example, those whose profession was nursing or midwifery and those who had experience using evidence-based practice prior to the educational intervention.Conclusions: The results showed that a three-day course in EBP improved the participants’ ability to find and review research evidence, but it did not have an overall effect on the use of research evidence in clinical practice

Experienced physical functioning and effects of resistance training in patients with chronic kidney disease

Physical fitness declines as chronic kidney disease progresses, and is approximately 50% of the expected norm when starting dialysis therapy This means that physical fitness in these patients is so reduced that it impinge on their ability and capacity to perform activities of daily livings. Muscular weakness, caused by for instance abnormal protein metabolism, is one of the main reasons for this decline in physical functioning. Therefore, it was of interest to study effects of resistance training initiated already in the pre-dialysis phase in purpose of reducing the loss of physical functioning. Studies have shown that patients with chronic kidney disease have a lower ’health-related quality of life’, especially within the physical domain, compared to the general population. However, these results are based on different ‘health-related quality of life’ questionnaires, which are based on predetermined assumptions of what is important to measure, and it is not self-evident that the choice of items for measurements reflects the perspective of the individual whose ‘health-related quality of life’ is being assessed. Another limitation is that these questionnaires result in sub-scores or total scores, and therefore do not provide information about the various ways in which patients with chronic kidney disease experience their physical functioning. Therefore, it was of interest to use semi-structured interviews to study patients’ experiences of their physical functioning and to analyse the various coping strategies used in order to be able to perform physical activities in the daily living. I. Elderly patients in the pre-dialysis phase had a lower muscular strength/endurance and physical functioning compared with elderly healthy subjects, but improved both after 12 weeks of low intensive resistance training to the same extent as in elderly healthy subjects. Thus, resistance training, already in the pre-dialysis phase, may provide patients with chronic kidney disease with a physical basis for maintaining functional autonomy, also after maintenance dialysis becomes necessary. To maintain the patient’s ability to continue caring for her-/himself is of personal benefit, but also of importance to society in reducing costs for medical- and social care. II. There was no indication that the resistance training programme has disadvantage effects on muscle fibre histopathology in elderly patients in the pre-dialysis phase. Further, there were no differences in either muscle fibre areas or in muscle fibre proportions in the healthy exercise group and the CKD exercise group, respectively, following regular resistance training. Thus, a workload of 60% of one repetition maximum seems to be sufficient to increase muscular strength and endurance in elderly patients in the pre-dialysis phase, but not to increase muscle fibre area or change muscle fibre type proportions. III. Patients with chronic kidney disease experienced mental and physical fatigue, reduced physical functioning in terms of impact on performance and endurance, and they also experienced temporal stress in terms of lack of time as well as lack of peace, from the health-care system, in their daily life situation. IV. Three components of coping activities were used by patients with chronic kidney disease to be able to perform physical activities in their daily living: scheduling, adjusting pace, and avoiding. The coping activities were mainly problem-focused, and the patients use active-, avoidant- and social-support coping strategies. However, emotional and cognitive coping strategies were also used. An interesting finding was that none of the informants mentioned using physical exercise as a coping activity, despite the fact that regular physical exercise has been shown to improve psychosocial well-being as well as physical functioning in patients with chronic kidney disease

Patients’ perspectives on the implementation of intra-dialytic cycling—a phenomenographic study

Abstract Background Adults undergoing haemodialysis have significantly reduced physical capacity and run a high risk of developing cardiovascular complications. Research has shown that intra-dialytic cycling has many evidence-based health effects, but implementation is rare within renal clinical practice. This may be due to several causes, and this study focuses on the patients’ perspective. This perspective has seldom been taken into account when aiming to assess and improve the implementation of clinical research. The aim of this study was to describe how adults undergoing in-centre haemodialysis treatment experienced an implementation process of intra-dialytic cycling. It aimed to identify potential motivators and barriers to the implementation process from a patient perspective. Methods Maximum-variation purposive sampling was used. Data were collected until saturation, through semistructured interviews, which were analysed using phenomenography. Results The implementation of intra-dialytic cycling was experienced as positive, as it had beneficial effects on physical and psychological well-being. It was easy to perform and did not intrude on patients’ spare time. These factors increased the acceptance of the implementation and supported the maintenance of intra-dialytic cycling as an evidence-based routine within their haemodialysis care. The patients did, however, experience some barriers to accepting the implementation of intra-dialytic cycling. These barriers were sometimes so strong that they outweighed the participants’ knowledge of the advantages of intra-dialytic cycling and the research evidence of its benefits. The barriers sometimes also outweighed the participants’ own wish to cycle. The barriers that we identified concerned not only the patients but also the work situation of the haemodialysis nurses. Conclusions Consideration of the motivators and barriers that we have identified can be used in direct care to improve the implementation of intra-dialytic cycling.</p

Health-related quality of life in different stages of chronic kidney disease and at initiation of dialysis treatment

<p>Abstract</p> <p>Objectives</p> <p>To evaluate health-related quality of life (HRQoL) in patients in different stages of chronic kidney disease (CKD) up to initiation of dialysis treatment and to explore possible correlating and influencing factors.</p> <p>Methods</p> <p>Cross-sectional design with 535 patients in CKD stages 2–5 and 55 controls assessed for HRQoL through SF-36 together with biomarkers.</p> <p>Results</p> <p>All HRQoL dimensions deteriorated significantly with CKD stages with the lowest scores in CKD 5. The largest differences between the patient groups were seen in ‘physical functioning’, ‘role physical’, ‘general health’ and in physical summary scores (PCS). The smallest disparities were seen in mental health and pain. Patients in CKD stages 2–3 showed significantly decreased HRQoL compared to matched controls, with differences of large magnitude - effect size (ES) ≥ .80 - in ‘general health’ and PCS. Patients in CDK 4 demonstrated deteriorated scores with a large magnitude in ‘physical function’, ‘general health’ and PCS compared to the patients in CKD 2–3. Patients in CKD 5 demonstrated deteriorated scores with a medium sized magnitude (ES 0.5 – 0.79) in ‘role emotional’ and mental summary scores compared to the patients in CKD 4. Glomerular filtration rate <45 ml/min/1.73 m², age ≥ 61 years, cardiovascular disease (CVD), diabetes, C-reactive protein (CRP) ≥5 mg/L, haemoglobin ≤110 g/L, p-albumin ≤ 35 g/L and overweight were associated with impaired HRQoL. CRP and CVD were the most important predictors of impaired HRQoL, followed by reduced GFR and diabetes.</p> <p>Conclusions</p> <p>Having CKD implies impaired HRQoL, also in earlier stages of the disease. At the time for dialysis initiation HRQoL is substantially deteriorated. Co-existing conditions, such as inflammation and cardiovascular disease seem to be powerful predictors of impaired HRQoL in patients with CKD. Within routine renal care, strategies to improve function and well-being considering the management of co-existing conditions like inflammation and CVD need to be developed.</p