Dat goed opgeleide verpleegkundigen nu en in de toekomst hard nodig zijn is niet nieuw. Zeker in academische ziekenhuizen, top-klinische centra en teaching hospitals is deze behoefte uitgesproken. Goed opgeleide verpleegkundigen op hbo-niveau zijn jonge professionals, die in de ogen van het werkveld en de maatschappij de juiste bagage hebben meegekregen voor een goede start en verdere groei. Wilma Scholte op Reimer legt in deze openbare les, aan de hand van een verhaal van een verpleegkundige in opleiding, uit hoe zij als lector de komende jaren hieraan een steentje wil bijdragen. Het illustreert het belang van Evidence Based Nursing en vervolgens de toepassing ervan op observeren (van kijken naar zien) en implementeren van kennis (van weten naar doen).
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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.
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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.
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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.
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Als hulpverlener en als docent is het belangrijk dat je op de hoogte bent van de laatste ontwikkelingen in je vakgebied. Het laatste decennium wordt veel aandacht besteed aan de wetenschappelijke onderbouwing van diverse beroepen in de gezondheidszorg, de zorg dient 'evidence based' te zijn. In dit artikel wordt geschetst wat de uitgangspunten van de opleidingen zijn en volgens welke methodiek de implementatie wordt aangepakt.
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Inmiddels weten we dat veel patiënten geen op onderzoeksresultaten gebaseerde zorg krijgen of zorg krijgen die overbodig of zelfs potentieel schadelijk is. Ondanks deze kennis is minder bekend hoe deze internationaal bestaande kloof tussen onderzoek en de verpleegkundige praktijk te overbruggen is. Gebruikelijke implementatiestrategieën die deze kloof proberen te dichten, zijn vaak gericht op de individuele professional en minder vaak op de sociale omgeving of de context waarin de verpleegkundige werkzaam is. In het proefschrift van Gerda Holleman probeert zij meer inzicht te krijgen in de rol die de context heeft bij het implementeren van evidence-based practice (EBP) in de verpleegkundige praktijk. Ze maakt een onderscheid tussen drie elementen in de sociale context: de professionele verpleegkundige beroepsorganisaties, de verpleegkundige opinieleider (een gerespecteerd persoon in een gezondheidszorgorganisatie die innovatiekennis heeft en gemotiveerd is implementatie tot een succes te maken) en de verpleegkundige teams.
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DOEL. Dit artikel beoogt een kritische analyse te geven van de manier waarop het begrip Evidence Based Practice in de literatuur doorgaans wordt ingevuld, waarna mogelijkheden worden geschetst de in het artikel geconstateerde bezwaren te ondervangen. METHODE. Er is literatuuronderzoek gedaan naar de manier waarop EBP in de literatuur wordt ingevuld. RESULTAAT. Hoewel in de literatuur met betrekking tot EBP wordt aangegeven dat het handelen van professionals gebaseerd zou moeten zijn op een integratie van wetenschappelijk onderzoek, klinische expertise en cliëntenvoorkeuren, krijgt de bron van het wetenschappelijk onderzoek de meeste nadruk. Binnen dit wetenschappelijk onderzoek wordt kwantitatief onderzoek bovendien doorgaans hoger gewaardeerd dan kwalitatief onderzoek. De andere kennisbronnen (deskundigheid van de cliënt en expertise van de verpleegkundige) die bij EBP worden onderscheiden, blijven veelal onderbelicht. DISCUSSIE EN CONCLUSIE. De manier waarop EBP meestal wordt ingevuld en geïmplementeerd brengt een aantal beperkingen met zich mee. Voorbeelden hiervan zijn de beperkte aandacht voor: de kern van het verplegen, de interactie tussen de cliënt en de verpleegkundige, de context of de cultuur waarin de zorgverlening plaatsvindt, het benutten van de ervaringsdeskundigheid van de cliënt en de expertise van de verpleegkundige zelf. In het artikel worden suggesties gegeven om deze beperkingen te ondervangen, zodat EBP inderdaad de integratie wordt van de verschillende kennisbronnen die in de literatuur worden onderscheiden en EBP met mogelijk meer succes kan worden geïmplementeerd.
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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.
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Nationwide and across the globe, the quality, affordability, and accessibility of home-based healthcare are under pressure. This issue stems from two main factors: the rapidly growing ageing population and the concurrent scarcity of healthcare professionals. Older people aspire to live independently in their homes for as long as possible. Additionally, governments worldwide have embraced policies promoting “ageing in place,” reallocating resources from institutions to homes and prioritising home-based services to honour the desire of older people to continue living at home while simultaneously addressing the rising costs associated with traditional institutional care.Considering the vital role of district nursing care and the fact that the population of older people in need of assistance at home is growing, it becomes clear that district nursing care plays a crucial role in primary care. The aim of this thesis is twofold: 1) to strengthen the evidence base for district nursing care; and 2) to explore the use of outcomes for learning and improving in district nursing care. The first part of this thesis examines the current delivery of district nursing care and explores its challenges during the COVID-19 pandemic to strengthen the evidence base and get a better understanding of district nursing care. Alongside the goal of strengthening the evidence for district nursing care, the second part of this thesis explores the use of patient outcomes for learning and improving district nursing care. It focuses on nurse-sensitive patient outcomes relevant to district nursing care, their current measurement in practice, and what is needed to use outcomes for learning and improving district nursing practice.
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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.
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