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1.
Liver Int ; 42(8): 1772-1782, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35635757

RESUMO

BACKGROUND AND AIMS: Even as several pharmacological treatments for non-alcoholic steatohepatitis (NASH) are in development, the incidence of NASH is increasing on an international scale. We aim to assess clinical practice gaps and challenges of hepatologists and endocrinologists when managing patients with NASH in four countries (Germany/Italy/United Kingdom/United States) to inform educational interventions. METHODS: A sequential mixed-method design was used: qualitative semi-structured interviews followed by quantitative online surveys. Participants were hepatologists and endocrinologists practising in one of the targeted countries. Interview data underwent thematic analysis and survey data were analysed with chi-square and Kruskal-Wallis tests. RESULTS: Most interviewees (n = 24) and surveyed participants (89% of n = 224) agreed that primary care must be involved in screening for NASH, yet many faced challenges involving and collaborating with them. Endocrinologists reported low knowledge of which blood markers to use when suspecting NASH (56%), when to order an MRI (65%) or ultrasound/FibroScan® (46%), and reported sub-optimal skills interpreting alanine aminotransferase (ALT, 37%) and aspartate aminotransferase (AST, 38%) blood marker test results, causing difficulty during diagnosis. Participants believed that more evidence is needed for upcoming therapeutic agents; yet, they reported sub-optimal knowledge of eligibility criteria for clinical trials. Knowledge and skill gaps when managing comorbidities, as well as skill gaps facilitating patient lifestyle changes were reported. CONCLUSIONS: Educational interventions are needed to address the knowledge and skill gaps identified and to develop strategies to optimize patient care, which include implementing relevant care pathways, encouraging referrals and testing, and multidisciplinary collaboration, as suggested by the recent Global Consensus statement on NAFLD.


Assuntos
Hepatopatia Gordurosa não Alcoólica , Médicos , Alanina Transaminase , Biomarcadores , Humanos , Determinação de Necessidades de Cuidados de Saúde , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Lacunas da Prática Profissional
3.
Behav Brain Sci ; 45: e11, 2022 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-35139948

RESUMO

Emphasizing the predictive success and practical utility of psychological science is an admirable goal but it will require a substantive shift in how we design research. Applied research often assumes that findings are transferable to all practices, insensitive to variation between implementations. We describe efforts to quantify and close this practice-to-practice gap in education research.


Assuntos
Lacunas da Prática Profissional , Humanos
5.
Surgery ; 171(2): 453-458, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34538340

RESUMO

BACKGROUND: The goal of this study was an assessment of availability postoperative pain management quality measures and National Quality Forum-endorsed measures. Postoperative pain is an important clinical timepoint because poor pain control can lead to patient suffering, chronic opiate use, and/or chronic pain. Quality measures can guide best practices, but it is unclear whether there are measures for managing pain after surgery. METHODS: The National Quality Forum Quality Positioning System, Agency for Healthcare Research and Quality Indicators, and Centers for Medicare and Medicaid Services Measures Inventory Tool databases were searched in November 2019. We conducted a systematic literature review to further identify quality measures in research publications, clinical practice guidelines, and gray literature for the period between March 11, 2015 and March 11, 2020. RESULTS: Our systematic review yielded 1,328 publications, of which 206 were pertinent. Nineteen pain management quality measures were identified from the quality measure databases, and 5 were endorsed by National Quality Forum. The National Quality Forum measures were not specific to postoperative pain management. Three of the non-endorsed measures were specific to postoperative pain. CONCLUSION: The dearth of published postoperative pain management quality measures, especially National Quality Forum-endorsed measures, highlights the need for more rigorous evidence and widely endorsed postoperative pain quality measures to guide best practices.


Assuntos
Manejo da Dor/estatística & dados numéricos , Dor Pós-Operatória/terapia , Padrões de Prática Médica/estatística & dados numéricos , Lacunas da Prática Profissional/estatística & dados numéricos , Centers for Medicare and Medicaid Services, U.S./estatística & dados numéricos , Bases de Dados Factuais/estatística & dados numéricos , Humanos , Medicare/estatística & dados numéricos , Manejo da Dor/normas , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/organização & administração , Estados Unidos , United States Agency for Healthcare Research and Quality/estatística & dados numéricos
6.
Intern Med J ; 52(2): 249-258, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32840951

RESUMO

BACKGROUND: P2Y12 inhibitor therapy is recommended for 12 months in patients hospitalised for acute myocardial infarction (AMI) unless the bleeding risk is high. AIMS: To describe real-world use of P2Y12 inhibitor therapy following AMI hospitalisation. METHODS: We used population-level linked hospital data to identify all patients discharged from a public hospital with a primary diagnosis of AMI between July 2011 and June 2013 in New South Wales and Victoria, Australia. We used dispensing claims to examine dispensing of a P2Y12 inhibitor (clopidogrel, prasugrel or ticagrelor) within 30 days of discharge and multilevel models to identify predictors of post-discharge dispensing and persistence of therapy to 1 year. RESULTS: We identified 31 848 patients hospitalised for AMI, of whom 56.8% were dispensed a P2Y12 inhibitor within 30 days of discharge. The proportion of patients with post-discharge dispensing varied between hospitals (interquartile range: 25.0-56.5%), and significant between-hospital variation remained after adjusting for patient characteristics. Patient factors associated with the lowest likelihood of post-discharge dispensing were: having undergone coronary artery bypass grafting (odds ratio (OR): 0.17; 95% confidence intervals (CI): 0.15-0.20); having oral anticoagulants dispensed 180 days before or 30 days after discharge (OR: 0.39, 95% CI: 0.35-0.44); major bleeding (OR: 0.68, 95% CI: 0.61-0.76); or being aged ≥85 years (OR: 0.68, 95% CI: 0.62-0.75). A total of 26.8% of patients who were dispensed a P2Y12 inhibitor post-discharge discontinued therapy within 1 year. CONCLUSION: Post-hospitalisation use of P2Y12 inhibitor therapy in AMI patients is low and varies substantially by hospital of discharge. Our findings suggest strategies addressing both health system (hospital and physician) and patient factors are needed to close this evidence-practice gap.


Assuntos
Infarto do Miocárdio , Intervenção Coronária Percutânea , Assistência ao Convalescente , Idoso de 80 Anos ou mais , Humanos , Armazenamento e Recuperação da Informação , Infarto do Miocárdio/induzido quimicamente , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/epidemiologia , Alta do Paciente , Intervenção Coronária Percutânea/efeitos adversos , Inibidores da Agregação Plaquetária/uso terapêutico , Cloridrato de Prasugrel/uso terapêutico , Lacunas da Prática Profissional , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Resultado do Tratamento , Vitória
7.
Rev. Esc. Enferm. USP ; 56: e20210465, 2022. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1356729

RESUMO

Abstract Objectives: To assess the actions performed by the operating room nurse during anesthesia and their behavior for patient safety regarding the reporting on adverse events, and to analyze their knowledge about anesthetic practices. Method: This is a cross-sectional study carried out using an electronic questionnaire consisting of socio-demographic, professional practice, knowledge in anesthesia, patient safety, and professional practice questions, conducted from January to March 2019 with operating room nurses. Results: One hundred nurses participated, 89 (89%) being women, with a mean age of 41.09 years (SD = 9.36), time of undergraduate completion of 14.33 years (SD = 8.34). The average attendance was 4.69 operating rooms (SD = 2.07) per nurse, with an emphasis on action before induction (49; 49%). Professionals reported performance of simultaneous activities (72; 72%) and insufficient number of employees (57; 57%) as difficulties of their daily practice. Among the participants, 77 (77%) correctly cited the periods of general anesthesia and 80.4% always reported the occurrence of an adverse event. Conclusion: Nurses identified their role in anesthesia, with limitations for assistance from multiple activities and lack of professionals.


RESUMEN Objetivos: Evaluar las acciones realizadas por los enfermeros en el quirófano durante la anestesia y sus conductas para la seguridad del paciente en la notificación de eventos adversos, analizando sus conocimientos sobre prácticas anestésicas. Método: Estudio transversal realizado con un cuestionario electrónico compuesto por preguntas sociodemográficas, práctica profesional, conocimientos en anestesia, seguridad del paciente y cuestiones de ejercicio profesional, realizado de enero a marzo de 2019 con enfermeros de quirófano. Resultados: Participaron 100 enfermeros, 89 (89%) mujeres, con una edad media de 41,09 años (DE = 9,36), tiempo de formación de 14,33 años (DE = 8,34). La asistencia media fue de 4.69 quirófanos (DE = 2.07) por enfermero, con énfasis en la actuación antes de la inducción (49; 49%). Los profesionales informaron como limitación de su práctica diaria la ejecución de actividades simultáneas (72; 72%) y la insuficiencia de empleados (57; 57%). Entre los participantes, 77 (77%) citaron correctamente los períodos de anestesia general y el 80,4% siempre reportaron la ocurrencia de un evento adverso. Conclusión: Los enfermeros identificaron su papel en la anestesia, con limitaciones en la atención por múltiples actividades y falta de profesionales.


RESUMO Objetivos: Avaliar as ações executadas pelo enfermeiro de centro cirúrgico durante a anestesia e suas condutas para segurança do paciente quanto à notificação de eventos adversos, analisar o seu conhecimento sobre as práticas anestésicas. Método: Estudo transversal realizado com questionário eletrônico composto por perguntas sócio-demográficas, prática profissional, conhecimento em anestesia, segurança do paciente e questões de exercício profissional, conduzido de janeiro a março de 2019 com enfermeiros de centro cirúrgico. Resultados: Participaram 100 enfermeiros, sendo 89 (89%) do sexo feminino, com média de idade de 41,09 anos (DP = 9,36), tempo de formação de 14,33 anos (DP = 8,34). A média de atendimento foi de 4,69 salas operatórias (DP = 2,07) por enfermeiro, com destaque para a atuação antes da indução (49; 49%). Os profissionais relataram como limitação de sua prática diária a execução de atividades simultâneas (72; 72%) e funcionários insuficientes (57; 57%). Entre os participantes, 77 (77%) citaram corretamente os períodos da anestesia geral e 80,4% sempre notificavam a ocorrência de um evento adverso. Conclusão: Os enfermeiros identificaram seu papel na anestesia, com limitações para assistência devido a múltiplas atividades e carência de profissionais.


Assuntos
Enfermagem Perioperatória , Papel do Profissional de Enfermagem , Anestesia , Enfermagem de Centro Cirúrgico , Segurança do Paciente , Lacunas da Prática Profissional
9.
Health Psychol ; 40(10): 727-736, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34881941

RESUMO

OBJECTIVE: Health psychology, as an applied area, emphasizes bridging the gap between researchers and practitioners. While rigorous research relies on advanced statistics to illustrate an underlying psychological process or treatment effectiveness, these statistics have less immediate applicability to practitioners who require knowing the relative magnitude in practical benefits. One way to reduce this research-practice gap is to translate reported effects into nontechnical language whose focus is on the likelihood of benefiting an individual. Common Language Effect Size (CLES) indicators offer a more intuitive way to understand statistical results from research but may not be widely known to researchers. METHOD: This article synthesizes the literature of available CLES indicators and how they overcome limitations from traditional effect sizes. To promote adoption, we summarize all existing measures in a compact table, which includes their analogous effect size, context, interpretation, calculation, and citation. RESULTS: We present evidence describing the effectiveness of CLES indicators at facilitating research interpretability compared to traditional effect size indicators. We discuss some limitations of CLES indicators and reasons that they are not used in psychology. Finally, this review offers some future directions for the use and study of CLES indicators moving forward. CONCLUSIONS: In general, CLES indicators are tools that can benefit health psychology because of their shared goals to aid practitioners in understanding research findings and making informed decisions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Idioma , Lacunas da Prática Profissional , Humanos
10.
PLoS One ; 16(11): e0260075, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34843517

RESUMO

BACKGROUND: Current data indicates 70% of adults with obesity report experiencing bias and stigmatisation when engaging with healthcare. Most studies to date, have focused on weight bias from a healthcare professional's perspective. Few have explored weight bias from the perspective of the individual living with obesity and no study has conducted this research in the Irish context. AIMS: This study explored, the lived-in experience of individuals afflicted with obesity, when interacting with the Irish healthcare system. It examined whether participants encountered weight bias and stigma, if so, how it may have impacted them and gathered their suggestions on how it could be best addressed. METHODS: Employing a phenomenological approach, purposive sampling and semi-structured interviews were conducted with 15 individuals living with class II (BMI 35.0-39.9) or III obesity (BMI ≥40kg/m2) who reported regular and consistent engagement with the Irish healthcare system. Predominant emergent themes were categorised using the interview domains; (1) experiences of obesity bias and stigma, (2) impact of this bias and stigma and (3) suggested avenues to reduce bias and stigma. FINDINGS: Participants reported experiencing high levels of weight bias and stigmatisation. Relating to experiences, three themes were identified; interpersonal communication, focus of care and physical environment. In terms of its impact, there were two emergent themes; negativity towards future healthcare and escalation of unhealthy behaviours. Suggested avenues to eliminate bias and stigma included the introduction of a timely and clear clinical pathway for obesity management and a focus on HCPs education in relation to obesity causes and complexity. CONCLUSIONS: Outside of specialist obesity tertiary care, weight bias and stigmatisation is commonly reported in the Irish healthcare system. It is a significant issue for those living with obesity, detrimental to their physiological and psychological health. A concerted effort by HCPs across clinical, research and educational levels is required to alleviate its harmful effects.


Assuntos
Atenção à Saúde/tendências , Pacientes/psicologia , Preconceito de Peso/tendências , Adulto , Feminino , Instalações de Saúde , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Obesidade , Lacunas da Prática Profissional/tendências , Estigma Social , Estereotipagem , Inquéritos e Questionários , Preconceito de Peso/psicologia
11.
J Trauma Acute Care Surg ; 91(5): 886-890, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34695065

RESUMO

BACKGROUND: Devastating injuries require both urgent assessment by a trauma service and early attention to patients' goals of care (GOC). American College of Surgeons Trauma Quality Improvement Program (TQIP) guidelines recommend an initial palliative assessment within 24 hours of admission and family meeting, if needed, within 72 hours. We hypothesize that a primary palliative care-based practice improves adherence to TQIP guidelines in trauma patients. METHODS: All adult trauma patients who died while inpatient from January 2014 to December 2018 were reviewed. Timing of GOC discussions, transition to comfort measures only (CMO), and the utilization of specialty palliative services were analyzed with univariate analysis. RESULTS: During the study period, 415 inpatients died. Median Injury Severity Score was 26 (interquartile range [IQR], 17-34), median age was 67 years (IQR, 51-81 years), and 72% (n = 299) transitioned to CMO before death. Documented GOC discussions increased from 77% of patients in 2014 to 95% of patients in 2018 (p < 0.001), and in 2018, the median time to the first GOC discussion was 15 hours (IQR, 7- 24 hours). Specialty palliative care was consulted in 7% of all patients. Of patients who had at least one GOC discussion, 98% were led by the trauma intensive care unit (TICU) team. Median time from admission to first GOC discussion was 27 hours (IQR, 6-91 hours). Median number of GOC discussions was 1 (IQR, 1-2). Median time to CMO after the final GOC discussion was 0 hours (IQR, 0-3). Median time to death after transition to CMO was 4 hours (IQR, 1-18 hours). CONCLUSION: Of those who died during index admission, we demonstrated significant improvement in adherence to American College of Surgeons TQIP palliative guidelines across the 5-year study period, with the TICU team guiding the majority of GOC discussions. Our TICU team has developed an effective primary palliative care approach, selectively consulting specialty palliative care only when needed. LEVEL OF EVIDENCE: Therapeutic/care management, level III.


Assuntos
Cuidados Paliativos/organização & administração , Planejamento de Assistência ao Paciente , Melhoria de Qualidade , Ferimentos e Lesões/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/organização & administração , Masculino , Pessoa de Meia-Idade , Lacunas da Prática Profissional , Estudos Retrospectivos , Ferimentos e Lesões/mortalidade
12.
BMC Fam Pract ; 22(1): 211, 2021 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-34666702

RESUMO

BACKGROUND: It may take 15 years or longer before research evidence is integrated into clinical practice. This evidence-to-practice gap has deleterious effects on patients as well as research and clinical processes. Bringing clinical knowledge into the research process, however, has the potential to close the evidence-to-practice gap. The NEUROTRANS-Project attempts to bring research and practice together by focusing on two groups that usually operate separately in their communities: general practitioners and neuroscientists. Although both groups focus on dementia as an area of work, they do so in different contexts and without opportunities to share their expertise. Finding new treatment pathways for patients with dementia will require an equal knowledge exchange among researchers and clinicians along with the integration of that knowledge into research processes, so that both groups will benefit from the expertise of the other. METHODS: The NEUROTRANS-Project uses a qualitative, multi-stage research design to explore how neuroscientists and general practitioners (GPs) approach dementia. Using a grounded theory methodology, it analyzes semi-structured interviews, case vignettes, focus groups with GPs in Saxony-Anhalt, Germany, and informal conversations with, and observations of, neuroscientists from the German Center for Neurodegenerative Diseases in Magdeburg. RESULTS: The NEUROTRANS-Project identified a clear division of labor between two highly specialized professional groups. Neuroscientists focus abstractly on nosology whereas general practitioners tend to patient care following a hermeneutic approach integrating the patients' perspective of illness. These different approaches to dementia create a barrier to constructive dialogue and the capacity of these groups to do research together with a common aim. Additionally, the broader system of research funding and health care within which the two groups operate reinforces their divide thereby limiting joint research capacity. CONCLUSIONS: Overcoming barriers to research collaboration between general practitioners and neuroscientists requires a shift in perspective in which both groups actively engage with the other's viewpoints to facilitate knowledge circulation (KC). Bringing 'art into science and science into art', i.e. amalgamating the hermeneutic approach with the perspective of nosology, is the first step in developing joint research agendas that have the potential to close the evidence-to-practice gap.


Assuntos
Clínicos Gerais , Atitude do Pessoal de Saúde , Grupos Focais , Humanos , Conhecimento , Lacunas da Prática Profissional , Pesquisa Qualitativa
14.
J Dent ; 115: 103854, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34688779

RESUMO

OBJECTIVES: To determine whether: the evidence-practice gap (EPG) in minimal intervention dentistry (MID) can be improved by a tailored web-based intervention, and specific clinical situations might impede implementing MID. METHODS: We conducted a before-after intervention study and a qualitative study. Two web-based questionnaire surveys were conducted among 197 Japanese dentists. In the first questionnaire, a baseline EPG was measured using six questionnaire items. Subsequently, feedback material about the EPG was electronically prepared, including results of the first questionnaire, international comparisons with a previous study from the US, and a summary of recent evidence on MID. In the second questionnaire, the EPG was re-measured after participants read the material. The primary outcome was mean overall concordance between published evidence and the dentist's clinical practice for all six questions. During the second questionnaire, we performed qualitative content analysis using free-text responses to a question about difficult situations encountered when conducting MID. RESULTS: Regarding before and after comparisons of concordance between the first and second questionnaires, mean overall concordance improved significantly, from 66% to 89% (p<0.001). Qualitative content analysis identified five difficult situations: "cases where decision making for treatment and prognosis is difficult", "inadequate practice resources", "limitations on patient visit and treatment period", "discrepancy between MID and the patient's values", and "limitations on health insurance and social understanding". CONCLUSIONS: These results suggest that it is possible to reduce the EPG in MID using a web-based educational intervention among Japanese dentists. Qualitative content analysis revealed five difficult situations that might hinder implementation of MID. CLINICAL SIGNIFICANCE: Although this intervention demonstrated educational effects, perfect concordance was not achieved by all participants. This is possibly associated with the five situations that participants reported facing when conducting MID. Creating an environment to improve these situations may facilitate a reduction in the EPG.


Assuntos
Intervenção Baseada em Internet , Lacunas da Prática Profissional , Odontologia , Humanos , Inquéritos e Questionários
15.
BMC Med Educ ; 21(1): 490, 2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34517861

RESUMO

BACKGROUND: The theoretical knowledge of nursing underpins the practice, while the practice environment determines the circumstances within which the theoretical knowledge is applied. The biggest challenge facing nursing as an academic field is the theory-practice gap, which is a universal issue in nursing. This study aimed to raise solutions to close the gap between theory and practice in nursing education through the eyes of nursing students in UAE. METHODS: A qualitative descriptive approach was followed; whereby 25 Emirati nursing students were interviewed. RESULTS: Two main themes are discussed in this study: 'Clinical Culture Creation' and 'Curriculum Content Reformation'. The students suggested to decreased the loud and stress on their clinical educators. They also suggested creating synchronization between what is taught in classrooms and labs and what is offered in the clinical training. Moreover, some of the students expected to have more benefit if they get their clinical training in health institutions owned by their college. On the other side, many of the participants suggested to move from the integration system to the block system. Another interesting suggestion includes having the same college staff to teach the theory and the clinical. The final suggestion includes decreasing the paper work during clinical training. CONCLUSIONS: This study explored the solutions to bridge the theory-practice gap in nursing education in the UAE. The study has implications for nursing education and practice within the UAE and is imperative for graduating workplace ready professional nurses within the country.


Assuntos
Bacharelado em Enfermagem , Educação em Enfermagem , Estudantes de Enfermagem , Currículo , Humanos , Lacunas da Prática Profissional , Pesquisa Qualitativa
16.
Dermatol Surg ; 47(8): 1079-1082, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34397542

RESUMO

BACKGROUND: Dermatologists specialize in treating conditions of the skin, hair, and nails; however, it is our experience that the field of nail diseases is the least discussed facet of dermatology. Even less acknowledged is the complexity of nail procedures and how best to accurately code for these procedures. OBJECTIVE: To convene a panel of experts in nail disease to reach consensus on the most accurate and appropriate Current Procedural Terminology (CPT) codes associated with the most commonly performed nail procedures. METHODS: A questionnaire including 9 of the most commonly performed nail procedures and potential CPT codes was sent to experts in the treatment of nail disease, defined as those clinicians running a nail subspecialty clinic and performing nail procedures with regularity. A conference call was convened to discuss survey results. RESULTS: Unanimous consensus was reached on the appropriate CPT codes associated with all discussed procedures. LIMITATIONS: Although this article details the most commonly performed nail procedures, many were excluded and billing for these procedures continues to be largely subjective. This article is meant to serve as a guide for clinicians but should not be impervious to interpretation in specific clinical situations. CONCLUSION: Billing of nail procedures remains a practice gap within our field. The authors hope that the expert consensus on the most appropriate CPT codes associated with commonly performed nail procedures will aid clinicians as they diagnose and treat disorders of the nail unit and encourage accurate and complete billing practices.


Assuntos
Current Procedural Terminology , Procedimentos Cirúrgicos Dermatológicos/economia , Dermatologia/normas , Doenças da Unha/economia , Lacunas da Prática Profissional/estatística & dados numéricos , Consenso , Procedimentos Cirúrgicos Dermatológicos/normas , Dermatologistas/estatística & dados numéricos , Dermatologia/economia , Humanos , Doenças da Unha/cirurgia , Unhas/cirurgia , Lacunas da Prática Profissional/economia , Inquéritos e Questionários/estatística & dados numéricos
17.
Nurse Educ Today ; 106: 105095, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34388539

RESUMO

BACKGROUND: The ultimate value of learning lies in the transfer of knowledge to real-life settings. The gap between knowledge and practice can be described as the disconnection between acquired knowledge, the skills learned in nursing school, and those skills needed to practice safely and independently. This is a concerning issue that needs to be investigated deeply to address all the circumstances and factors contributing to the gap. OBJECTIVES: To reveal the full range of factors leading to the knowledge-practice gap in nursing by means of a thorough survey of the most recent evidence and updates. METHODS: An integrative review design was selected. Three data bases (MEDLINE, CINAHL Plus and ERIC) were searched electronically for research articles from 2009 up to June 2020 on the gap between knowledge and practice. The 406 articles that appeared were appraised for inclusion or exclusion using the JBI Critical Appraisal Checklist for qualitative research. RESULT: Eight qualitative studies were included in the review, which identified three major themes and subthemes. The first theme is personal factors, with the following subthemes: internal motivation, learning style and attitude. The second theme is educational structure, with the following subthemes: clinical instructor role, preceptor effect and curriculum. The third theme is organisational characteristics, with the following subthemes: resources, clinical setting features and staffing. CONCLUSION: The review revealed that the knowledge-practice gap has deep roots in multiple factors. Considering all dimensions of these factors is the key to bridging the knowledge-practice gap.


Assuntos
Lacunas da Prática Profissional , Estudantes de Enfermagem , Currículo , Humanos , Aprendizagem , Pesquisa Qualitativa
18.
J Perianesth Nurs ; 36(5): 559-563, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34404604

RESUMO

PURPOSE: Preoperative fasting is a necessary experience for pediatric patients undergoing elective surgery. The American Society of Anesthesiologist guideline shows that preoperative fasting times were reduced and safe (no solid food up to 8 hours, no fluid or formula up to 6 hours, no breast milk up to 4 hours, and no clear fluids up to 2 hours before surgery). However, preoperative fasting is usually more prolonged than the suggested time. This study aimed to investigate the duration of preoperative fasting for elective surgery at a pediatric hospital in Shanghai, China, and compare it with the evidence from guidelines. DESIGN: The study used a descriptive cross-sectional design. METHODS: A total of 211 children under anesthesia in a Shanghai's pediatric hospital were included in the study. The preoperative fasting status was assessed using a self-administered record card of preoperative fasting developed by Chinese researchers. FINDINGS: The results indicated that the length of time fasted preoperatively was longer for all participants than that recommended by the American Society of Anesthesiologists. With the long length of fasting time, it is evident that the majority of children experienced hunger (17.5%), thirst (19.4%), and anxiety (16.1%) as indicated with 8 points of the Likert 10-point scale. The degrees of these experiences were relevant to the length of preoperative fasting time. CONCLUSIONS: A big gap was revealed between the recommendation and actual practice, and children underwent an uncomfortable experience before the surgery. These results suggest that evidence-based clinical improvement is required, and the recommended preoperative fasting instruction transform into clinical practice should be promoted.


Assuntos
Jejum , Hospitais Pediátricos , Criança , China , Estudos Transversais , Humanos , Cuidados Pré-Operatórios , Lacunas da Prática Profissional
20.
J Clin Psychol ; 77(12): 2765-2780, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34273910

RESUMO

OBJECTIVE: Exposure therapies (e.g., prolonged exposure [PE]), are first-line interventions for posttraumatic stress disorder but remain underutilized, partially due to providers' negative beliefs about these interventions. We examined two experimental strategies aimed at enhancing beliefs towards PE and subsequent utilization. METHOD: Clinicians (N = 155) were randomized to one of three conditions presenting a PE rationale: basic, empirically-based, or emotionally-based description. Participants were rerandomized to write or not write arguments for utilizing PE. Before and after PE rationales and 1-month later, participants completed questions about PE beliefs and utilization. RESULTS: Participants reported small yet durable belief change across all rationale conditions, with greatest change following the empirically-based description. Across conditions, belief change was not impacted by writing condition or associated with utilization. CONCLUSION: Addressing negative beliefs with empirical information may be a brief, cost-effective strategy to improve clinicians' beliefs toward PE. Complementary strategies that leverage belief modification to increase utilization are needed.


Assuntos
Terapia Implosiva , Transtornos de Estresse Pós-Traumáticos , Humanos , Lacunas da Prática Profissional , Transtornos de Estresse Pós-Traumáticos/terapia
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