Integrating the "best" evidence into nursing of venous thromboembolism in ICU patients using the i-PARIHS framework.

OBJECTIVES: To explore how to integrate the "best" practice into nursing of venous thromboembolism (VTE) based on the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. METHODS: A mixed-methods design was used. A steering group for clinical evidence implementation (EI) was established to conduct pre-implementation baseline surveys, a thorough analysis of the evidence, and an analysis of the survey results. The hindering and enabling factors associated with the clinical implementation of the evidence were analysed based on the three core elements of i-PARIHS, to formulate the clinical implementation plan for VTE nursing evidence. On-site expert reviews and focus group interviews were used to evaluate the feasibility of the draft plan, make adjustments, and finalize the evidence-based practice plan, which was then put into practice and evaluated. RESULTS: A new nursing process, a health education manual and a nursing quality checklist on VTE has been established and proved to be appropriate through the implementation. Compliance with evidence related to VTE nursing increased significantly in the two units, with better compliance in unit B than unit A. The knowledge, attitude and behaviour scores for VTE nursing increased substantially in both nurses and patients. CONCLUSION: The EI programme of incorporating the "best" evidence on VTE nursing into clinical practice using the i-PARIHS framework demonstrated feasibility, appropriateness and effectiveness and could serve as a reference.

Aligning Organizational Culture and Infrastructure to Support Evidence-Based Practice.

Standardized nursing practice based on the foundations of evidence-based practice leads to high-quality patient care and optimal outcomes. Despite knowing the benefits of evidence-based practice, health care organizations do not consistently make it the standard of care; thus, implementation of evidence-based practice at the system level continues to be challenging. This article describes the process adopted by a facility in the Southwest that took on the challenge of changing the organizational culture to incorporate evidence-based practice. The organization met the challenges by identifying perceived and actual barriers to successful implementation of evidence-based practice. The lack of standardized practice was addressed by developing a group of stakeholders including organizational leaders, clinical experts, and bedside providers. Changing the culture required a comprehensive process of document selection and development, education, and outcome evaluation. The ultimate aim was to implement an integrated system to develop practices and documents based on the best evidence to support patient outcomes.

Tamaño del efecto para diferencia de medias: aportes complementarios / Mean difference effect size: Complementary contributions

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Nursing and midwifery use, perceptions and barriers to evidence-based practice: a cross-sectional survey.

AIM: The study aimed to explore how nurses and midwives obtain, use and embed evidence in everyday practice. METHODS: The study design was cross-sectional survey method. The setting was one local health district in metropolitan Sydney, Australia. All nurses and midwives working within the local health district, with access to an email account, were invited to participate in the study. An online survey questionnaire was distributed to explore how evidence is obtained, used and embedded within the clinical setting. The data were analysed using descriptive statistics (frequency and percentages). Pearson's Chi-square tests were used for comparison between groups. RESULTS: There were 204 survey respondents. The findings identified that the majority (n = 157; 76.96%) of respondents obtained evidence primarily from clinical practice guidelines. The majority (n = 149; 73.04%) of respondents reportedly searched databases and used evidence related to general clinical practice. There was a statistical difference (χ = 17.069; df = 8; P = 0.029) when comparing leadership positions and other registered practitioner groups in the frequency of searching for evidence. Most respondents (n = 138; 67.65%) were confident in their ability to change practice on the basis of available evidence. Thematic analysis identified four barriers to sustaining evidence-based practice, which included: the need for time; the need for organizational and management support; the need for educational opportunities and challenges to accessing evidence. CONCLUSION: The study provided an understanding of how nurses and midwives obtain, use and embed evidence into everyday practice. More importantly, the role of leadership is significant to support a process of knowledge generation, research translation and the implementation of evidence into clinical settings.

Midwifery and women's health.

EBN Perspectives bring together key issues from the commentaries in one of our nursing topic themes.

Enhancing a Culture of Inquiry: The Role of a Clinical Nurse Specialist in Supporting the Adoption of Evidence.

This article describes a Magnet®-designated, national cancer institute comprehensive cancer center's quest to restructure the organization's evidence-based practice (EBP)/performance improvement (PI) framework leveraging the role of the clinical nurse specialist (CNS) as a coach to support staff nurses in EBP/PI initiatives. The support of the CNS is essential in developing effective projects, minimizing barriers, and maintaining a level of engagement in the EBP process from problem identification through dissemination and sustainment of practice changes.

Response to "The Evidence Behind Integrating Palliative Care Into Oncology Practice"
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I am writing in response to "The Evidence Behind Integrating Palliative Care Into Oncology Practice" (Dailey, 2016). I have 16 years of oncology experience and work at the University Health Systems in San Antonio, Texas. Our facility's palliative care program holds the Advanced Certification awarded by the Joint Commission, and we have dedicated inpatient beds for palliative care patients.

Evidence based nursing and midwifery practice in a regional Australian healthcare setting: Behaviours, skills and barriers.

AIM: To establish self-reported skill levels, behaviours and barriers in relation to evidence-based practice (EBP) among a representative sample of regional Australian nurses and midwives in senior roles. BACKGROUND: It has been widely established that nurses and midwives continue to face challenges in relation to putting evidence into practice on the clinical floor. Prior to conducting an EBP capacity building activity in a regional Australian Local Health District, a survey assessing needs and skill and barrier areas was conducted. METHODS: A quantitative descriptive survey which utilised the 'Developing Evidence Based Practice Questionnaire' (DEBPQ) was conducted in early 2012 among senior nurses and midwives of a regional New South Wales Local Health District (LHD). The survey results were contrasted with reported DEBPQ results from a sample of UK metropolitan nurses and a sample of Australian general practice nurses (GPNs). RESULTS: One hundred and sixty nine nurses completed the survey (response rate 42%). Survey respondents' reliance on accepted evidentiary knowledge sources was found to be low. Research literature-related knowledge sources were ranked outside of the top 10 sources, compared with numerous personalised and subjective sources, which ranked within the top 10. Access to and understanding of research material was a primary barrier to reviewing evidence in the study sample. Time-related barriers to changing practice on the basis of evidence figured prominently in the study sample and the UK and Australian GPN samples. The study sample rated their EBP skill levels significantly higher than both their UK counterparts and the Australian GPN sample (P < 0.0001). CONCLUSION: Capacity building interventions are needed among senior nurses and midwives in Australian regional LHDs, as the most prominent knowledge sources reported are non-evidentiary in nature and barriers to finding and reviewing evidence, along with barriers to making practice change, remain significant.

The impact of post-registration education on midwifery practice.

National guidelines require midwives to undertake effective post-registration education which is relevant to practice. However, there is minimal research investigating the impact of education on practice, most of which originates from nursing and allied professions. A small-scale phenomenological pilot study, involving four experienced midwives, was undertaken to explore their experiences and opinions regarding the impact of midwifery post-registration educational courses upon practice. The research highlighted two key areas: practical engagement in continuing professional development (CPD) and midwives' reasons for their educational choices. The midwives valued the practical relevance and applicability of CPD to practice and the use of interprofessional learning in narrowing the theory-practice gap; educational choices were affected by accessibility, flexibility, mandatory attendance, cost and conflict with employers' objectives. The study suggests further research into the impact of CPD upon midwifery practice and what factors would better engage and motivate midwives to undertake more clinically effective post-registration education.

A study of Iranian nurses' and midwives' knowledge, attitudes, and implementation of evidence-based practice: the time for change has arrived.

BACKGROUND: Evidence-based practice (EBP) leads to enhanced quality of care, and the individual and professional development of nurses and midwives. Therefore, it is important for nurses and midwives as well as all other healthcare providers and stakeholders to inform clinical decision-making and implement EBP. AIM: This study aimed to determine the EBP knowledge, attitudes, and practice of clinical nurses and midwives in Mashhad public hospitals in Iran. METHODS: The descriptive cross-sectional study was conducted with a stratified cluster, random sample of 240 employed nurses and midwives (response rate of 96%) in Mashhad, who held a Bachelor of Science degree and had at least 1 year of clinical experience. Two valid and reliable questionnaires were used to collect demographic and EBP data. Data were analyzed using SPSS version 11.5 software and descriptive and inferential statistics calculated. RESULTS: Participants' mean age was 31.0 (SD = 5.5) years and 80% (n = 194) were female. Most participants reported low knowledge or skills and practice of EBP, but moderate attitudes toward EBP. Significant differences between the mean scores on knowledge or skills, attitudes, and practice were identified by field of study. Nurses reported higher knowledge or skills and practice of EBP than midwives (p < .001). Nurses and midwives with master-s degrees displayed greater knowledge or skills and practice of EBP, and more positive attitudes than nurses with bachelor-s degrees (p < .001). LINKING EVIDENCE TO ACTION: Although clinical nurses and midwives apply EBP in clinical settings, it is necessary to develop their knowledge or skills and practice. The results of this study can be applied by educational planners, educational managers, and authorities to enhance the quality and consistency of EBP implementation. The results provide a base for future studies in this field.

Research midwives: look at the evidence!

Evidence based practice underpins modern healthcare and includes the use of research knowledge, consideration of an individual's circumstances and their personal preferences. Maternal and child health care interventions aim to prevent disease and disability and promote health and wellbeing. Before interventions are brought into practice the benefits and risks should be adequately evaluated to ensure clinicians and those receiving the interventions fully understand the potential effects. A multidisciplinary team approach to the development of research initiatives is advantageous. The team should include clinicians, researchers and service users working together to answer important clinical questions. It is our view that clinical research midwives are pivotal to the success of maternal and child health improvement initiatives. For example they can help reduce the gap between clinical practice and research by making research understandable to clinicians and applicable to practice by working in partnership with academics.