Background
All nurses have responsibilities to enculturate evidence‐based practice (EBP) and translate and implement research findings into nursing care, practices, and procedures.
Aims
To report ...EBP‐related findings from the national Hospital‐Based Nursing Research Characteristics, Care Delivery Outcomes, and Economic Impact Survey questionnaire.
Methods
In this cross‐sectional survey research study of 181 nursing research leaders, 127 responded to these questions: “Has your hospital adopted or does it use a model of evidence‐based practice?” “If yes, what is the name of the model and how is it used?” “Does your hospital implement (translate) findings from nursing research into clinical practice?” “Describe how your hospital implements these findings and whose responsibility it is.” “What factors do you believe facilitate the implementation of findings from nursing research into clinical practice at your hospital?” Qualitative content analyses were used.
Results
Over 90% of nursing research leaders specified that their hospital used an EBP model and implements findings into practice. The most frequently reported models were the Iowa Model of Evidence‐Based Practice, Johns Hopkins Nursing Evidence‐Based Practice Model, and Advancing Research and Clinical Practice Through Close Collaboration Model. EBP models were used most frequently for education and training, nurse residency programs, and EBP and research fellowships. Findings were implemented through policy and procedure committee processes, shared governance structures, and EBP processes. Those responsible for implementing findings were project leads, nursing professional practice councils, and clinical nurse specialists and advanced practice nurses. Implementation facilitators were nursing leadership, dissemination of findings, and engaged and educated nurses.
Linking Evidence to Action
These new findings report >90% EBP model use and implementation. All nurses, especially our leaders, have responsibilities to evaluate EBP and how nursing research findings are implemented (translated) into practice. Ideally, engaged and educated nurses who enculturate, support, and sustain EBP will facilitate advancing nursing practice to improve patient and work environment–related outcomes.
Background
Evidence‐based practice (EBP) competencies are essential for all practicing healthcare professionals to provide evidence‐based, quality care, and improved patient outcomes. The multistep ...EBP implementation process requires multifaceted competencies to successfully integrate best evidence into daily healthcare delivery.
Aims
To summarize and synthesize the current research literature on practicing health professionals’ EBP competencies (i.e., their knowledge, skills, attitudes, beliefs, and implementation) related to employing EBP in clinical decision‐making.
Design
An overview of systematic reviews.
Methods
PubMed/MEDLINE, CINAHL, Scopus, and Cochrane Library were systematically searched on practicing healthcare professionals’ EBP competencies published in January 2012–July 2017. A total of 3,947 publications were retrieved, of which 11 systematic reviews were eligible for a critical appraisal of methodological quality. Three independent reviewers conducted the critical appraisal using the Rapid Critical Appraisal tools developed by the Helene Fuld National Institute for Evidence‐Based Practice in Nursing & Healthcare.
Results
Practicing healthcare professionals’ self‐reported EBP knowledge, skills, attitudes, and beliefs were at a moderate to high level, but they did not translate into EBP implementation. Considerable overlap existed in the source studies across the included reviews. Few reviews reported any impact of EBP competencies on changes in care processes or patient outcomes. Most reviews were methodologically of moderate quality. Significant variation in study designs, settings, interventions, and outcome measures in the source studies precluded any comparisons of EBP competencies across healthcare disciplines.
Linking Evidence to Action
As EBP is a shared competency, the development, adoption, and use of an EBP competency set for all healthcare professionals are a priority along with using actual (i.e., performance‐based), validated outcome measures. The widespread misconceptions and misunderstandings that still exist among large proportions of practicing healthcare professionals about the basic concepts of EBP should urgently be addressed to increase engagement in EBP implementation and attain improved care quality and patient outcomes.
Objective: Leadership is important in practice change, yet there are few studies addressing this issue in mental health and social services. This study examined the differential roles of ...transformational (i.e., charismatic) leadership and leader-member exchange (i.e., the relationship between a supervisor and their direct service providers) on team innovation climate (i.e., openness to new innovations) and provider attitudes toward adopting evidence-based practice (EBP) during a statewide evidence-based practice implementation (EBPI) of an intervention to reduce child neglect. Method: Participants were 140 case-managers in 30 teams providing home-based services to families in a statewide child-welfare system. Teams were assigned by region to EBPI or services as usual (SAU) conditions. Multiple group path analysis was used to examine associations of transformational leadership and leader-member exchange with innovation climate and attitudes toward adoption and use of EBP. Results: Transformational leadership predicted higher innovation climate during implementation, whereas leader-member exchange predicted higher innovation climate during SAU. Innovation climate was, in turn, associated with more positive attitudes toward EBP for the EBPI group. Conclusions: Strategies designed to enhance supervisor transformational leadership have the potential to facilitate implementation efforts by promoting a strong climate for EBPI and positive provider attitudes toward adoption and use of EBP. (Contains 1 table and 1 figure.)
A lack of effective therapist training is a major barrier to evidence-based intervention (EBI) delivery in the community. Systematic reviews published nearly a decade ago suggested that traditional ...EBI training leads to higher knowledge but not more EBI use, indicating that more work is needed to optimize EBI training and implementation. This systematic review synthesizes the training literature published since 2010 to evaluate how different training models (workshop, workshop with consultation, online training, train-the-trainer, and intensive training) affect therapists' knowledge, beliefs, and behaviors. Results and limitations for each approach are discussed. Findings show that training has advanced beyond provision of manuals and brief workshops; more intensive training models show promise for changing therapist behavior. However, methodological issues persist, limiting conclusions and pointing to important areas for future research.
Public Health Significance
Therapist training plays a critical role in the implementation of evidence-based interventions. This review provides an update of the past decade of literature related to therapist training in evidence-based interventions and examines five approaches to therapist training: workshops alone, workshops followed by consultation, online training, train-the-trainer, and intensive training. Results suggest that more intensive training models are most likely to facilitate clinician behavior change, although optimal dosage and training content remains unclear. Future work is needed to identify key elements of training to optimize the success of implementation efforts and ensure that treatment-seeking individuals receive effective care.
Aim
This integrative review aims to explore how nursing leadership influences evidence‐based practice in contemporary health care settings.
Background
Although managers and environmental ward culture ...have long been identified as being among the main barriers to evidence‐based practice, there is little overall conceptualization and understanding of the specific role of nurse leaders in directly influencing and supporting this.
Evaluation
The team carried out an integrative literature review (n = 28) utilizing PubMed, CINAHL and the Cochrane Library (2006–2016).
Key Issues
The key role of leadership, the methodology used, and understanding and addressing barriers to or facilitators of the implementation of evidence‐based practice emerged as key issues.
Conclusion
Nurse managers have a particular influential role on the implementation of evidence‐based practice in terms of providing a supportive culture and environment. For this they need to have an underlying knowledge but also to be aware of and address barriers to implementation, and understand the key role of nurse managers in creating and supporting the optimum environment.
Implications for Nursing Management
Nurse managers need to facilitate and enhance nurses’ use of evidence‐based practice. Both managers and nurses need to have the necessary academic preparation, support and resources required for practising using an evidence base.
ABSTRACT
Background
The Iowa Model is a widely used framework for the implementation of evidence‐based practice (EBP). Changes in health care (e.g., emergence of implementation science, emphasis on ...patient engagement) prompted the re‐evaluation, revision, and validation of the model.
Methods
A systematic multi‐step process was used capturing information from the literature and user feedback via an electronic survey and live work groups. The Iowa Model Collaborative critically assessed and synthesized information and recommendations before revising the model.
Results
Survey participants (n = 431) had requested access to the Model between years 2001 and 2013. Eighty‐eight percent (n = 379) of participants reported using the Iowa Model and identified the most problematic steps as: topic priority, critique, pilot, and institute change. Users provided 587 comments with rich contextual rationale and insightful suggestions. The revised model was then evaluated by participants (n = 299) of the 22nd National EBP Conference in 2015. They validated the model as a practical tool for the EBP process across diverse settings. Specific changes in the model are discussed.
Conclusion
This user driven revision differs from other frameworks in that it links practice changes within the system. Major model changes are expansion of piloting, implementation, patient engagement, and sustaining change.
Linking Evidence to Action
The Iowa Model‐Revised remains an application‐oriented guide for the EBP process. Intended users are point of care clinicians who ask questions and seek a systematic, EBP approach to promote excellence in health care.
Background and Significance
Evidence‐based practice (EBP) is a systematic problem‐solving approach to the delivery of health care that improves quality and population health outcomes as well as ...reduces costs and empowers clinicians to fully engage in their role, otherwise known as the quadruple aim in health care. The Helene Fuld Health Trust National Institute for Evidence‐based Practice in Nursing and Healthcare at The Ohio State University College of Nursing has been offering 5‐day EBP immersion programs since 2012. The goal of the program is for the participants to acquire EBP competence (e.g., knowledge, skills, and attitude) and sustain it over time.
Purpose and Aims
The purpose of this study was to evaluate the effects of the 5‐day EBP immersion (i.e., an education and skills building program) on EBP attributes and competence over time.
Method and Design
A longitudinal pre‐experimental study was conducted that gathered data with an anonymous online survey from 400 program attendees who attended 16 5‐day immersions between September 2014 and May 2016. Participants completed five valid and reliable instruments at four points over 12 months, including EBP beliefs, implementation, competency, knowledge, and perception of organizational readiness and culture.
Results
Findings indicated statistically significant improvements in EBP attributes and competency over time. The results of this study support the hypotheses that EBP competency and attributes can be significantly improved and sustained by attending an intensive 5‐day EBP educational and skills building program such as the one described in this study. This study can help leaders and organizations to mitigate many of the traditional barriers to EBP.
Linking Evidence to Action
The results of this study indicate that EBP attributes and competencies can be improved and sustained by attending an intensive 5‐day EBP immersion, regardless of clinicians’ prior educational preparation.
Interventions based on applied behaviour analysis are considered evidence based practice for autism spectrum disorders. Due to the shortage of highly qualified professionals required for their ...delivery, innovative models should be explored, such as telehealth. Telehealth utilises technology for remote training and supervision. The purpose of our study was to systematically review the literature researching telehealth and ABA. We analysed intervention characteristics, outcomes and research quality in 28 studies and identified gaps. Intervention characteristics were: (1) research design (2) participants (3) technology (4) dependent variables (5) aims. Outcomes were favourable with all studies reporting improvements in at least one variable. Quality ratings were significantly low. Implications for future research and practice are discussed in light of identified methodological downfalls.
Clin Psychol Sci Prac 17: 1–30, 2010
Evidence‐based practice (EBP), a preferred psychological treatment approach, requires training of community providers. The systems‐contextual (SC) perspective, a ...model for dissemination and implementation efforts, underscores the importance of the therapist, client, and organizational variables that influence training and consequent therapist uptake and adoption of EBP. This review critiques the extant research on training in EBP from an SC perspective. Findings suggest that therapist knowledge improves and attitudinal change occurs following training. However, change in therapist behaviors (e.g., adherence, competence, and skill) and client outcomes only occurs when training interventions address each level of the SC model and include active learning. Limitations as well as areas for future research are discussed.
•Economic considerations influence implementation of evidence-based mental health practices.•Decision makers and other stakeholders need cost information to make implementation decisions.•Economic ...evaluation of implementation strategies differs from traditional economic evaluation.•Economic evaluation of implementation is critical for efficient use of organizational resources.
Implementation researchers have made notable progress in developing and testing implementation strategies (i.e., highly-specified methods used to help providers improve uptake of mental health evidence-based practices: EBPs). Yet, implementation strategies are not widely applied in healthcare organizations to improve delivery of EBPs. Economic considerations are a key factor influencing the use of implementation strategies to deliver and sustain mental health evidence-based practices, in part because many health care leaders are reluctant to invest in ongoing implementation strategy support without knowing the return-on-investment. Comparative economic evaluation of implementation strategies provides critical information for payers, policymakers, and providers to make informed decisions if specific strategies are an efficient use of scarce organizational resources. Currently, few implementation studies include implementation cost data and even fewer conduct comparative economic analyses of implementation strategies. This summary will introduce clinicians, researchers and other health professionals to the economic evaluation in implementation science. We provide an overview of different economic evaluation methods, discuss differences between economic evaluation in health services and implementation science. We also highlight approaches and frameworks to guide economic evaluation of implementation, provide an example for a cognitive-behavioral therapy program and discuss recommendations.
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