Zoekresultaten

The challenges of evidence-based prehabilitation in a real-life context for patients preparing for colorectal surgery - a cohort study and multiple case analysis

Background: Multimodal prehabilitation programs are effective at reducing complications after colorectal surgery in patients with a high risk of postoperative complications due to low aerobic capacity and/or malnutrition. However, high implementation fidelity is needed to achieve these effects in real-life practice. This study aimed to investigate the implementation fidelity of an evidence-based prehabilitation program in the real-life context of a Dutch regional hospital.Methods: In this observational cohort study with multiple case analyses, all patients who underwent colorectal surgery from January 2023 to June 2023 were enrolled. Patients meeting the criteria for low aerobic capacity or malnutrition were advised to participate in a prehabilitation program. According to recent scientific insights and the local care context, this program consisted of four exercise modalities and three nutrition modalities. Implementation fidelity was investigated by evaluating: (1) coverage (participation rate), (2) duration (number of days between the start of prehabilitation and surgery), (3) content (delivery of prescribed intervention modalities), and (4) frequency (attendance of sessions and compliance with prescribed parameters). An aggregated percentage of content and frequency was calculated to determine overall adherence.Results: Fifty-eight patients intended to follow the prehabilitation care pathway, of which 41 performed a preoperative risk assessment (coverage 80%). Ten patients (24%) were identified as high-risk and participated in the prehabilitation program (duration of 33-84 days). Adherence was high (84-100%) in five and moderate (72-73%) in two patients. Adherence was remarkably low (25%, 53%, 54%) in three patients who struggled to execute the prehabilitation program due to multiple physical and cognitive impairments.Conclusion: Implementation fidelity of an evidence-based multimodal prehabilitation program for high-risk patients preparing for colorectal surgery in real-life practice was moderate because adherence was high for most patients, but low for some patients. Patients with low adherence had multiple impairments, with consequences for their preparation for surgery. For healthcare professionals, it is recommended to pay attention to high-risk patients with multiple impairments and further personalize the prehabilitation program. More knowledge about identifying and treating high-risk patients is needed to provide evidence-based recommendations and to obtain higher effectiveness.

De rol van de organisatorische context en individuele kenmerken van verpleegkundigen bij het verklaren van variatie in het gebruik van informatietechnologie in Evidence Based Practice

Onderzoek naar het gebruik van digitale informatie door verpleegkundigen op de werkvloer.

Shared decision making in chronic care in the context of evidence based practice in nursing

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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Enhancing students' argumentation skills, content knowledge, and Nature of Science understanding through a web-based educational instrument in the context of socio-scientific issues

Using socio-scientific issues as a learning context is an effective approach to achieve an important goal in science education, which is to enhance scientific literacy. It involves strengthening skills such as argumentation while also improving an understanding of the Nature of Science and imparting content knowledge. The present study evaluates the impact of a web-based educational instrument consisting of a unique combination of features designed to promote students’ development of skills and knowledge as well as to address the challenges faced by teachers in teaching socio-scientific issues. Participants included 423 students in secondary education. Students in the experimental condition received a three-lesson intervention with the educational instrument, and students in the control condition followed their regular science lessons. Findings indicated that the instrument proves effective in fostering learning outcomes while teachers benefit from the shift of managing classroom discussion to individual guidance of students. Applying the educational instrument in the classroom demonstrates promise in improving student engagement and their comprehension of socio-scientific issues.

Implementatie van EBP: professionals in een context

De implementatie van zowel evidence-based behandelingen als het evidence-based gedachtegoed verloopt vaak moeizaam. Om het primaire proces te veranderen wordt veel inspanning gericht op de professional. Dat blijkt niet voldoende te zijn. Is die professional zo onwillig? Nee, de professional handelt in een context die minstens zo belangrijk is in implementatieprocessen. Het implementeren van evidence-based practice (EBP) valt nog niet mee. Er is veel geschreven over de kloof tussen praktijk en wetenschap en over het beperkte gebruik van wetenschappelijke kennis door verpleegkundigen. Verpleegkundigen gebruiken de kennis die ze in hun mbo- of hbo-opleiding hebben geleerd. Als ze in de praktijk tegen een probleem of kennistekort aanlopen, vragen ze eerder een collega dan te rade te gaan bij de wetenschappelijke literatuur. Ook als het gaat om concrete interventies of handelingen zijn tradities zeer sterk. Zelfs als er stevige implementatieprojecten worden ingezet, lijkt het niet altijd te lukken. Het resultaat van een serie goed begeleide doorbraakprojecten in de geestelijke gezondheidszorg bleek bijvoorbeeld zeer teleurstellend.