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.
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.
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.
The project aims to improve palliative care in China through the competence development of Chinese teachers, professionals, and students focusing on the horizontal priority of digital transformation.Palliative care (PC) has been recognised as a public health priority, and during recent years, has seen advances in several aspects. However, severe inequities in the access and availability of PC worldwide remain. Annually, approximately 56.8 million people need palliative care, where 25.7% of the care focuses on the last year of person’s life (Connor, 2020).China has set aims for reaching the health care standards of the developed countries by 2030 through the Healthy China Strategy 2030, where one of the improvement areas in health care includes palliative care, thus continuing the previous efforts.The project provides a constructive, holistic, and innovative set of actions aimed at resulting in lasting outcomes and continued development of palliative care education and services. Raising the awareness of all stakeholders on palliative care, including the public, is highly relevant and needed. Evidence based practice guidelines and education are urgently required for both general and specialised palliative care levels, to increase the competencies for health educators, professionals, and students. This is to improve the availability and quality of person-centered palliative care in China. Considering the aging population, increase in various chronic illnesses, the challenging care environment, and the moderate health care resources, competence development and the utilisation of digitalisation in palliative care are paramount in supporting the transition of experts into the palliative care practice environment.General objective of the project is to enhance the competences in palliative care in China through education and training to improve the quality of life for citizens. Project develops the competences of current and future health care professionals in China to transform the palliative care theory and practice to impact the target groups and the society in the long-term. As recognised by the European Association for Palliative Care (EAPC), palliative care competences need to be developed in collaboration. This includes shared willingness to learn from each other to improve the sought outcomes in palliative care (EAPC 2019). Since all individuals have a right to health care, project develops person-centered and culturally sensitive practices taking into consideration ethics and social norms. As concepts around palliative care can focus on physical, psychological, social, or spiritual related illnesses (WHO 2020), project develops innovative pedagogy focusing on evidence-based practice, communication, and competence development utilising digital methods and tools. Concepts of reflection, values and views are in the forefront to improve palliative care for the future. Important aspects in project development include health promotion, digital competences and digital health literacy skills of professionals, patients, and their caregivers. Project objective is tied to the principles of the European Commission’s (EU) Digital Decade that stresses the importance of placing people and their rights in the forefront of the digital transformation, while enhancing solidarity, inclusion, freedom of choice and participation. In addition, concepts of safety, security, empowerment, and the promotion of sustainable actions are valued. (European Commission: Digital targets for 2030).Through the existing collaboration, strategic focus areas of the partners, and the principles of the call, the PalcNet project consortium was formed by the following partners: JAMK University of Applied Sciences (JAMK ), Ramon Llull University (URL), Hanze University of Applied Sciences (HUAS), Beijing Union Medical College Hospital (PUMCH), Guangzhou Health Science College (GHSC), Beihua University (BHU), and Harbin Medical University (HMU). As project develops new knowledge, innovations and practice through capacity building, finalisation of the consortium considered partners development strategy regarding health care, (especially palliative care), ability to create long-term impact, including the focus on enhancing higher education according to the horizontal priority. In addition, partners’ expertise and geographical location was also considered important to facilitate long-term impact of the results.Primary target groups of the project include partner country’s (China) staff members, teachers, researchers, health care professionals and bachelor level students engaging in project implementation. Secondary target groups include those groups who will use the outputs and results and continue in further development in palliative care upon the lifetime of the project.
Examining in-class activities to facilitate academic achievement in higher educationThere is an increasing interest in how to create an effective and comfortable indoor environment for lecturers and students in higher education. To achieve evidence-based improvements in the indoor environmental quality (IEQ) of higher education learning environments, this research aimed to gain new knowledge for creating optimal indoor environmental conditions that best facilitate in-class activities, i.e. teaching and learning, and foster academic achievement. The academic performance of lecturers and students is subdivided into short-term academic performance, for example, during a lecture and long-term academic performance, during an academic course or year, for example. First, a systematic literature review was conducted to reveal the effect of indoor environmental quality in classrooms in higher education on the quality of teaching, the quality of learning, and students’ academic achievement. With the information gathered on the applied methods during the literature review, a systematic approach was developed and validated to capture the effect of the IEQ on the main outcomes. This approach enables research that aims to examine the effect of all four IEQ parameters, indoor air quality, thermal conditions, lighting conditions, and acoustic conditions on students’ perceptions, responses, and short-term academic performance in the context of higher education classrooms. Next, a field experiment was conducted, applying the validated systematic approach, to explore the effect of multiple indoor environmental parameters on students and their short-term academic performance in higher education. Finally, a qualitative case study gathered lecturers’ and students’ perceptions related to the IEQ. Furthermore, how these users interact with the environment to maintain an acceptable IEQ was studied.During the systematic literature review, multiple scientific databases were searched to identify relevant scientific evidence. After the screening process, 21 publications were included. The collected evidence showed that IEQ can contribute positively to students’ academic achievement. However, it can also affect the performance of students negatively, even if the IEQ meets current standards for classrooms’ IEQ conditions. Not one optimal IEQ was identified after studying the evidence. Indoor environmental conditions in which students perform at their best differ and are task depended, indicating that classrooms should facilitate multiple indoor environmental conditions. Furthermore, the evidence provides practical information for improving the design of experimental studies, helps researchers in identifying relevant parameters, and lists methods to examine the influence of the IEQ on users.The measurement methods deduced from the included studies of the literature review, were used for the development of a systematic approach measuring classroom IEQ and students’ perceived IEQ, internal responses, and short-term academic performance. This approach allowed studying the effect of multiple IEQ parameters simultaneously and was tested in a pilot study during a regular academic course. The perceptions, internal responses, and short-term academic performance of participating students were measured. The results show associations between natural variations of the IEQ and students’ perceptions. These perceptions were associated with their physiological and cognitive responses. Furthermore, students’ perceived cognitive responses were associated with their short-term academic performance. These observed associations confirm the construct validity of the composed systematic approach. This systematic approach was then applied in a field experiment, to explore the effect of multiple indoor environmental parameters on students and their short-term academic performance in higher education. A field study, with a between-groups experimental design, was conducted during a regular academic course in 2020-2021 to analyze the effect of different acoustic, lighting, and indoor air quality (IAQ) conditions. First, the reverberation time was manipulated to 0.4 s in the intervention condition (control condition 0.6 s). Second, the horizontal illuminance level was raised from 500 to 750 lx in the intervention condition (control condition 500 lx). These conditions correspond with quality class A (intervention condition) and B (control condition), specified in Dutch IEQ guidelines for school buildings (2015). Third, the IAQ, which was ~1100 ppm carbon dioxide (CO2), as a proxy for IAQ, was improved to CO2 concentrations under 800 ppm, meeting quality class A in both conditions. Students’ perceptions were measured during seven campaigns with a questionnaire; their actual cognitive and short-term academic performances were evaluated with validated tests and an academic test, composed by the lecturer, as a subject-matter-expert on the taught topic, covered subjects discussed during the lecture. From 201 students 527 responses were collected and analyzed. A reduced RT in combination with raised HI improved students’ perceptions of the lighting environment, internal responses, and quality of learning. However, this experimental condition negatively influenced students’ ability to solve problems, while students' content-related test scores were not influenced. This shows that although quality class A conditions for RT and HI improved students’ perceptions, it did not influence their short-term academic performance. Furthermore, the benefits of reduced RT in combination with raised HI were not observed in improved IAQ conditions. Whether the sequential order of the experimental conditions is relevant in inducing these effects and/or whether improving two parameters is already beneficial, is unknownFinally, a qualitative case study explored lecturers’ and students’ perceptions of the IEQ of classrooms, which are suitable to give tutorials with a maximum capacity of about 30 students. Furthermore, how lecturers and students interact with this indoor environment to maintain an acceptable IEQ was examined. Eleven lecturers of the Hanze University of Applied Sciences (UAS), located in the northern part of the Netherlands, and twenty-four of its students participated in three focus group discussions. The findings show that lecturers and students experience poor thermal, lighting, acoustic, and IAQ conditions which may influence teaching and learning performance. Furthermore, maintaining acceptable thermal and IAQ conditions was difficult for lecturers as opening windows or doors caused noise disturbances. In uncomfortable conditions, lecturers may decide to pause earlier or shorten a lecture. When students experienced discomfort, it may affect their ability to concentrate, their emotional status, and their quality of learning. Acceptable air and thermal conditions in classrooms will mitigate the need to open windows and doors. This allows lecturers to keep doors and windows closed, combining better classroom conditions with neither noise disturbances nor related distractions. Designers and engineers should take these end users’ perceptions into account, often monitored by facility management (FM), during the renovation or construction of university buildings to achieve optimal IEQ conditions in higher education classrooms.The results of these four studies indicate that there is not a one-size fits all indoor environmental quality to facilitate optimal in-class activities. Classrooms’ thermal environment should be effectively controlled with the option of a local (manual) intervention. Classrooms’ lighting conditions should also be adjustable, both in light color and light intensity. This enables lecturers to adjust the indoor environment to facilitate in-class activities optimally. Lecturers must be informed by the building operator, for example, professionals of the Facility Department, how to change classrooms’ IEQ settings. And this may differ per classroom because each building, in which the classroom is located, is operated differently apart from the classroom location in the building, exposure to the environment, and its use. The knowledge that has come available from this study, shows that optimal indoor environmental conditions can positively influence lecturers’ and students’ comfort, health, emotional balance, and performance. These outcomes have the capacity to contribute to an improved school climate and thus academic achievement.
The aim of the ProInCa project was to develop the sustainable innovation capacity of Kazakhstan’s Medical Universities for the modernization of nursing. The project was coordinated by JAMK University of Applied Sciences and consisted of a consortium of five Kazakhstani medical universities and four European higher education institutions. The project was co-funded by the Erasmus+ Capacity Building in the Field of Higher Education programme and supported by the Ministry of Education and Science and the Ministry of Healthcare of the Republic of Kazakhstan during 15.10.2017 – 31.01.2021.he wider objective of the ProInCa project is to develop the sustainable innovation capacity of Kazakhstan’s Medical Universities for the modernization of nursing. This wider objective is divided into four specific objectives, which are:1. Development of mechanisms for collaboration and knowledge sharing between academic national and international nursing community and society.2. To learn from best practices on implementing evidence-based nursing in nursing research, education and practice to promote the efficiency and quality of health care.3. Strengthen higher education institutes’ role in building evidence-based nursing research activities in health services to promote quality and safety of health care system.4. Promote the capacity and system of nursing leadership and management in health care transition to improve the quality of health care system
