Praktijkonderzoek over integratie van practice based evidence en evidence based practice, nderzoeksresultaten toepassen in de praktijk,verbeteren in en door de praktijk.
DOCUMENT
We need educators to be constantly updating their skills and knowledge, and evidenced-informed practice is central to this; yet it is far from universal in our schools. Kristin Vanlommel and Chris Brown draw on their international research to show how EIP can be achieved based on three core principles. With this article, we consider the engagement by teachers and school leaders in educational practices that are ‘evidence-informed’ - across school systems and world-wide. There is a growing consensus that effective teaching and leadership is based on evidence-informed practice (or EIP), and that EIP results in improving student learning and achievement.
LINK
This thesis describes an Action Research (AR) project aimed at the implementation of Evidence Based Practice in a mental health nursing setting in the Netherlands. The main research question addressed in this thesis is: In what way is Action Research with an empowering appropriate to implement Evidence Based Practice in a mental health nursing setting in the Netherlands and what is the effect of this implementation on the care experienced by the client, the nursing interventions and the context in this setting compared to a comparative setting? To answer this main research question, the following questions derived from it were addressed: What is Evidence Based Practice? What is known about implementing evidence-based practice in nursing through Action Research? Which factors have to be dealt with in a mental health nursing setting, so the implementation of EBP with AR with an empowering intent will be more successful? Which factors have to be dealt with in a mental health nursing setting, so the implementation of EBP with AR with an empowering intent will be successful? How is EBP implemented through AR with an empowering intent and what are the outcomes for the use of evidence, the context and the facilitation in the setting? What is the effect of the implementation of EBP in mental health nursing using AR with an empowering intent on the care experienced by the client, the nursing interventions and the context compared to a comparison setting? The first two questions were answered by a search of the literature while the remaining questions were answered during the AR study conducted in two mental health organisations in the Netherlands.
DOCUMENT
Aims and objectives: To describe the process of implementing evidence-based practice (EBP) in a clinical nursing setting. Background: EBP has become a major issue in nursing, it is insufficiently integrated in daily practice and its implementation is complex. Design: Participatory action research. Method: The main participants were nurses working in a lung unit of a rural hospital. A multi-method process of data collection was used during the observing, reflecting, planning and acting phases. Data were continuously gathered during a 24-month period from 2010 to 2012, and analysed using an interpretive constant comparative approach. Patients were consulted to incorporate their perspective. Results: A best-practice mode of working was prevalent on the ward. The main barriers to the implementation of EBP were that nurses had little knowledge of EBP and a rather negative attitude towards it, and that their English reading proficiency was poor. The main facilitators were that nurses wanted to deliver high-quality care and were enthusiastic and open to innovation. Implementation strategies included a tailored interactive outreach training and the development and implementation of an evidence-based discharge protocol. The academic model of EBP was adapted. Nurses worked according to the EBP discharge protocol but barely recorded their activities. Nurses favourably evaluated the participatory action research process. Conclusions: Action research provides an opportunity to empower nurses and to tailor EBP to the practice context. Applying and implementing EBP is difficult for front-line nurses with limited EBP competencies. Relevance to clinical practice: Adaptation of the academic model of EBP to a more pragmatic approach seems necessary to introduce EBP into clinical practice. The use of scientific evidence can be facilitated by using pre-appraised evidence. For clinical practice, it seems relevant to integrate scientific evidence with clinical expertise and patient values in nurses’ clinical decision making at the individual patient level.
DOCUMENT
The aim of the research reported in this thesis was to gain knowledge about the implementation of evidence‐based practice (EBP) in nursing to find a way to integrate shared decision making (SDM) with EBP in a chronic care environment in nursing, and to develop a strategy for an integrated approach of EBP and SDM in daily nursing practice in the individual aftercare for cancer survivors.
DOCUMENT
Objectives: This study assesses social workers’ orientation toward the evidence-based practice (EBP) process and explores which specific variables (e.g. age) are associated. Methods: Data were collected from 341 Dutch social workers through an online survey which included a Dutch translation of the EBP Process Assessment Scale (EBPPAS), along with 13 background/demographic questions. Results: The overall level of orientation toward the EBP process is relatively low. Although respondents are slightly familiar with it and have slightly positive attitudes about it, their intentions to engage in it and their actual engagement are relatively low. Respondents who followed a course on the EBP process as a student are more oriented toward it than those who did not. Social workers under 29 are more familiar with the EBP process than those over 29. Conclusions: We recommend educators to take a more active role in teaching the EBP process to students and social workers.
DOCUMENT
As is often reported in the literature exploring the research-practice gap, applying the principles of evidence-based practice is easier said than done. Action research is a methodology with an explicit intent of linking the worlds of research and practice. This review attempts to answer the question: What is known about implementing evidence-based practice in nursing through action research? APPROACH: A total of 21 action research studies have been used to answer this question. To prevent possible confusion over terminology, we used a conceptual framework that distinguishes various influencing factors in terms of four target groups (ranging from the individual end user to society as a whole) at whom the strategy is aimed and various strategies (ranging from individual feedback to contracting care providers) related to the same four target groups. FINDINGS: Studies often failed to name the implementation strategies applied, necessitating deduction from the text by the reader. In most of the studies the implementation strategy was directed at a combination of target groups. Many of the projects reviewed reported positive contextual outcomes, "knowledge improvement" among nurses, and to a lesser degree, improved "performance." Patient outcomes were the least reported outcome measure. CONCLUSION: With an element of caution, this review concludes that the implementation of evidence-based practice using action research is a promising approach. Caution is needed because of the lack of detailed descriptions of implementation strategies, and their intensity and frequency prevents us from drawing firm conclusions. These are important considerations for any action researcher intending to implement EBP using this approach.
LINK
The aim of applying science into practice is to deliver high-quality health care.Thinking about teaching the necessary accompanying skills, a distinction can bemade between using evidence for individual patient care and using scientificknowledge for the development of protocols or guidelines for groups of patients orprofessionals. In this paper, these two ways of applying science into practice arebeing considered. We plea for explicating the differences between the individualpatient and a group of patients or professionals when applying scientific knowledgein the decision-making process. The acknowledgment of these differences facilitates the teaching of the accompanying competences and different CanMEDS roles.
DOCUMENT
In the decision-making environment of evidence-based practice, the following three sources of information must be integrated: research evidence of the intervention, clinical expertise, and the patient’s values. In reality, evidence-based practice usually focuses on research evidence (which may be translated into clinical practice guidelines) and clinical expertise without considering the individual patient’s values. The shared decision-making model seems to be helpful in the integration of the individual patient’s values in evidence-based practice. We aim to discuss the relevance of shared decision making in chronic care and to suggest how it can be integrated with evidence-based practice in nursing. We start by describing the following three possible approaches to guide the decision-making process: the paternalistic approach, the informed approach, and the shared decision-making approach. Implementation of shared decision making has gained considerable interest in cases lacking a strong best-treatment recommendation, and when the available treatment options are equivalent to some extent. We discuss that in chronic care it is important to always invite the patient to participate in the decision-making process. We delineate the following six attributes of health care interventions in chronic care that influence the degree of shared decision making: the level of research evidence, the number of available intervention options, the burden of side effects, the impact on lifestyle, the patient group values, and the impact on resources. Furthermore, the patient’s willingness to participate in shared decision making, the clinical expertise of the nurse, and the context in which the decision making takes place affect the shared decision-making process. A knowledgeable and skilled nurse with a positive attitude towards shared decision making – integrated with evidence-based practice – can facilitate the shared decision-making process. We conclude that nurses as well as other health care professionals in chronic care should integrate shared decision making with evidence- based practice to deliver patient-centred care.
DOCUMENT
Humidification is not a common procedure in many buildings in the Netherlands. An exception are buildings used for healthcare, especially hospitals. There, e.g. in operating theatres, relative humidity (RH) generally is controlled stringently at levels around 50%. From an energy point-of-view humidification is an energy-intensive activity. Currently, more than 10% of the total energy used in healthcare buildings is spent on humidification. The basis for an RH of around 50%, however, is not clear. Therefore, we pursued a scoping review to find evidence for specific RH thresholds in such facilities. In addition, an inventory was made of the current practice in the Netherlands. After analyzing the title and abstracts, the remaining references were read by two persons and scored on several topics. Guidelines and current practice were analyzed by referring to existing (inter)national guidelines and standards, and by contacting experts from Dutch hospitals through a survey and semi-structured interviews. Outcomes from the literature review were grouped into four different topics: 1) micro-organisms and viruses, 2) medical devices, 3) human physiology and 4) perception. No scientific evidence was found for the currently generally applied RH set-point of ~50%. Some studies suggest a minimum RH of 30% but the evidence is weak, with exception of medical devices if specifications require it. A lack of research that addresses more long-term exposure (a couple of days) and includes frail subjects, is noted. It was found that RH requirements are strictly followed in all hospitals consulted, some only focusing on the hot zones, but in many cases extended to the whole hospital. Steam humidification is mostly applied for hygienic reasons. but is quite energy-intensive. The conclusion t is that there is no solid evidence to support the RH-setpoints as currently applied in the Netherlands. It merely appears a code of practice. Therefore, there appears room for quick and significant energy savings, and CO2 emission reductions, when considering control at lower RH values or refraining from humidification at all, while still fulfilling the indoor environment requirements and not negatively influencing the health risk. This outcome can be applied directly in current practice with the available techniques.
LINK
