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.
Objectives: In the post-surgical setting, active involvement of family caregivers has the potential to improve patient outcomes by prevention of surgical complications that are sensitive to fundamental care. This paper describes the development of a theoretically grounded program to enhance the active involvement of family caregivers in fundamental care for post-surgical patients. Methods: We used a quality improvement project following a multi-phase design. In Phase 1, an iterative method was used to combine evidence from a narrative review and professionals’ preferences. In Phase 2, the logic model underlying the program was developed guided by four steps: (1) confirm situation, intervention aim, and target population; (2) documented expected outcomes, and outputs of the intervention; (3) identify and describe assumptions, external factors and inputs; and (4) confirm intervention components. Results: Phase 1 identified a minimum set of family involvement activities that were both supported by staff and the narrative review. In Phase 2, the logic model was developed and includes (1) the inputs (e.g. educational- and environmental support), (2) the ultimate outcomes (e.g. reduction of postoperative complications), (3) the intermediate outcomes (e.g. behavioural changes), and (4) immediate outcomes (e.g. improved knowledge, skills and attitude). Conclusions: We demonstrated how we aimed to change our practice to an environment in which family caregivers were stimulated to be actively involved in postoperative care on surgical wards, and how we took different factors into account. The description of this program may provide a solid basis for professionals to implement the family involvement program in their own setting.
In dit artikel wordt eerst beschreven wat het verschil is tussen Evidence Based Practice (EBP) en Practice Based Evidence (PBE). Vervolgens wordt ingegaan op het toepassen van EBP en PBE in de praktijk. Dit gebeurt met behulp van de begrippen normativiteit en contextualiteit. Tot slot worden, in het licht van het voorafgaande, de rollen beschreven die de professional kan innemen ten aanzien van het verbeteren en ontwikkelen van zijn handelen. Aan bod komen de 'reflective practitioner', de 'evidence based practitioner' en de 'scientist practitioner'.
Dit PD traject beoogt ontwikkeling en inbedding van learning communities voor duurzame ontwikkeling in ecosystemen van onderwijs, onderzoek en praktijk. Werken aan duurzame ontwikkelingsdoelen in de transitie naar een duurzame samenleving vraagt andere competenties van professionals, zoals kritisch bewustzijn, empathie, verantwoordelijkheid nemen, toekomstdenken en transdisciplinair werken. Deze competenties worden door hogescholen idealiter in een authentieke leeromgeving ontwikkeld, waarin vraagstukken en dilemma’s rondom duurzame ontwikkeling, kennisontwikkeling op gang brengen. Learning communities (LC’s) zijn zo’n authentieke leeromgeving: groepen waarin studenten, docenten en professionals over grenzen van praktijken heen, samen werken, leren en innoveren naar aanleiding van grote maatschappelijke vraagstukken. Ze worden in dit traject ontwikkeld als een key enabling methodology voor duurzame ontwikkeling. Bij opdrachtgever Saxion en andere hogescholen zijn experimenten gestart met LC’s, die nog niet structureel zijn ingebed in ecosystemen van onderwijs, onderzoek en praktijk. De nog zwakke afstemming van onderwijs op de praktijk van learning communities betekent voor de Nederlandse samenleving een rem op de ontwikkeling van human capital, noodzakelijk voor de transitie naar een duurzame samenleving. Belemmeringen voor de beweging naar ontwikkeling, opschaling en inbedding van LC’s zien we op vijf gebieden: • ondersteunende processen • samenwerking tussen onderwijs, onderzoek en beroepspraktijk • ervaring met ontwerp, begeleiding en evaluatie van LC’s • ervaring met education for sustainable development (ESD) • professionele rol van docenten Dit PD traject hanteert een systemische onderzoeks-en veranderaanpak. Vanuit vier rollen, professional, innovator, onderzoeker en veranderaar, werkt de PD-kandidaat samen met beginnende en best practice LC’s. Middels participatief onderzoek, kennisdeling, veranderkundige interventies, reflectie en bijstellingen, ondersteunt zij hen bij het ontwerp van evidence-informed instrumenten voor de ontwikkeling en inbedding van LC’s in het ecosysteem van hogeschool en praktijk. Het traject mondt na vijf jaar uit in een portfolio met innovatieve bijdragen aan praktijk en wetenschap en een reflectie op de ontwikkeling van de PD-kandidaat
Higher education offers great flexibility as students are largely free to decide where, when, and how to study. Being successful in such an environment requires well-developed self-regulated learning skills. However, every teacher in higher education knows that students experience ample difficulty to self-regulate their learning. They struggle to set and plan learning goals, and to gain sufficient depth in learning when preparing for exams. These struggles can negatively impact their learning, well-being, academic achievement, and professional life. On top of the existing flexibility in higher education, a need for more flexibility in what students learn is becoming evident. That is, students have room for flexible learningapproaches (i.e., deciding what learning goals or materials to study and how) and/or flexible learning trajectories (i.e.,choosing what combination of courses to take). This places an additional burden on students’ self-regulated learning skills. We posit that for students to thrive in flexible higher education, practice-oriented research on supporting students’self-regulated learning skills is required. Our collaborative consortium will i) unravel how students can be optimally scaffolded within flexible learning approaches and flexible learning trajectories, ii) examine how to optimize teacher and technological support, and iii) study how student autonomy and motivation can be guarded. We will set up a practice-oriented research program with both qualitative and quantitative methods, including design-based research, action research, pre-post comparative intervention studies, and large-scale correlational research. The findings will impact higher education through (technological) design guidelines and intervention programs for educational professionals, andsupport-modules for students.
