Evidence based practice (EBP) is an educational paradigm that espouses that clinical decision making should be made through the judicious and conscientious use of best evidence. EBP is predicated on a fundamental principle that therapeutic knowledge is appraised and applied into practice with the ethical imperative to use such knowledge for the good of patient care. Despite the ubiquitous nature of EBP in health care little is known about how physiotherapists use this clinical decision making process and it is not clear as to which theoretical frameworks of practice and knowledge paradigms underpin physiotherapists application of EBP. Phenomenology seeks to uncover the internal consciousness of phenomena by describing and exploring the lived experience and explores the relationship between what exists in one’s consciousness and what exists in the objective world. Descriptive phenomenology was used in this thesis to gain an in depth understanding of how twelve physiotherapists applied EBP in the real and complex world of clinical practice with the objective to explore their experiences and to understand the essence of its practice. The findings in this study revealed a complex picture comprising of three separate but interrelated themes. Physiotherapists had developed a personal theory of EBP (Theme 1) that guided their behaviour and comprised of an ontological, epistemological and methodological structure. This theoretical and practice framework was uniquely individual and required a complex set of cognitive processes that included knowledge identification, transformation, translation and implementation in specific client situations and practice contexts (Theme 2: translation into practice). To add to this complexity this framework took place within intrapersonal, social and cultural milieus which influenced behaviour (Theme 3). The study concludes by conceptualising the findings and experiences of physiotherapists into models that could be used to assist educationalists, practitioners and researchers to promote evidence based practice in a pragmatic way.

Doctor of Philosophy / Aim and significance: The aim of this research was to investigate how evidence-based practice (EBP) in nursing homes is understood in the context of Taiwan, a non-Western country. There is a growing movement towards using research evidence to inform practice in the nursing profession with variable success. To date, factors that promote or inhibit implementation of EBP in health care have been investigated through research conducted in hospital settings in Western countries. Remarkably little is known about nurses’ experience and perceptions of EBP in residential aged care facilities (RACFs), especially in non-Western countries. Method: The study adopted a mixed method approach. Subjects were recruited from six nursing homes in the Hsinchu district of Taiwan. In Stage 1, 89 registered nurses completed a comprehensive questionnaire specifically developed for this project. It was designed to elicit information about (1) their experience of and attitudes towards research and EBP; (2) the barriers they perceive to its implementation; and (3) what strategies they believe would enhance its implementation in the nursing home setting. In Stage 2, six nursing managers participated in semi-structured in-depth interviews that explored the same topic areas as those in the questionnaire but used an open-ended format which allowed for new themes to emerge. Findings: The majority of nurses and nursing managers expressed positive attitudes towards research and EBP but reported relatively little experience in its implementation. Nurses relied most heavily on knowledge derived from past experience and on interactions with nursing colleagues, medical staff and patients to inform their clinical practice. They identified the main barriers to EBP as: insufficient authority to change practice, their own lack of research knowledge and insufficient time to implement new ideas in the workplace. They believed EBP would be facilitated by: improved access to computers and internet facilities in the workplace; more effective research training; collaboration with academics; and dedicated time to search for and read research articles. As anticipated, nurses viewed the issues from a practical stance in relation to their own time, resources and lack of authority to effect change. Nursing managers expressed similar views to the nurses in relation to attitudes towards EBP implementation. However, they identified barriers which related to aspects of the organizational framework. In particular, they expressed concerns about issues such as budgetary constraints, staff quality (notably the reliance on minimally trained assistants in nursing (AINs) for direct resident care), as well as factors that reflected the wider political and economic context of health care in Taiwan. Conclusion: The findings of this study have implications for research, policy and practice in both Western and non-Western countries. Further research on EBP would be beneficial if conducted in settings other than hospitals, such as RACFs. There remains also the need to examine the potential for EBP in different social-cultural contexts, such as those in non-Western countries. Nursing managers have generally been excluded in previous research but, because of their particular role, there is a need to examine their perspectives of EBP and then compare these with those of the nurses. In Taiwan specifically, policy change is needed at both government and institutional levels to encourage and support the development of protocols and procedures for the implementation of EBP. If EBP was a government requirement for accreditation and a standard for protocols in hospitals and RACFs, it would lead to improved standards of care and cost effectiveness. This study supports the findings of a number of investigations conducted in Western countries which indicate that further education and training in research for nurses may lead to higher standards of patient care, greater job satisfaction and higher staff retention rates.

Doctor of Philosophy / Aim and significance: The aim of this research was to investigate how evidence-based practice (EBP) in nursing homes is understood in the context of Taiwan, a non-Western country. There is a growing movement towards using research evidence to inform practice in the nursing profession with variable success. To date, factors that promote or inhibit implementation of EBP in health care have been investigated through research conducted in hospital settings in Western countries. Remarkably little is known about nurses’ experience and perceptions of EBP in residential aged care facilities (RACFs), especially in non-Western countries. Method: The study adopted a mixed method approach. Subjects were recruited from six nursing homes in the Hsinchu district of Taiwan. In Stage 1, 89 registered nurses completed a comprehensive questionnaire specifically developed for this project. It was designed to elicit information about (1) their experience of and attitudes towards research and EBP; (2) the barriers they perceive to its implementation; and (3) what strategies they believe would enhance its implementation in the nursing home setting. In Stage 2, six nursing managers participated in semi-structured in-depth interviews that explored the same topic areas as those in the questionnaire but used an open-ended format which allowed for new themes to emerge. Findings: The majority of nurses and nursing managers expressed positive attitudes towards research and EBP but reported relatively little experience in its implementation. Nurses relied most heavily on knowledge derived from past experience and on interactions with nursing colleagues, medical staff and patients to inform their clinical practice. They identified the main barriers to EBP as: insufficient authority to change practice, their own lack of research knowledge and insufficient time to implement new ideas in the workplace. They believed EBP would be facilitated by: improved access to computers and internet facilities in the workplace; more effective research training; collaboration with academics; and dedicated time to search for and read research articles. As anticipated, nurses viewed the issues from a practical stance in relation to their own time, resources and lack of authority to effect change. Nursing managers expressed similar views to the nurses in relation to attitudes towards EBP implementation. However, they identified barriers which related to aspects of the organizational framework. In particular, they expressed concerns about issues such as budgetary constraints, staff quality (notably the reliance on minimally trained assistants in nursing (AINs) for direct resident care), as well as factors that reflected the wider political and economic context of health care in Taiwan. Conclusion: The findings of this study have implications for research, policy and practice in both Western and non-Western countries. Further research on EBP would be beneficial if conducted in settings other than hospitals, such as RACFs. There remains also the need to examine the potential for EBP in different social-cultural contexts, such as those in non-Western countries. Nursing managers have generally been excluded in previous research but, because of their particular role, there is a need to examine their perspectives of EBP and then compare these with those of the nurses. In Taiwan specifically, policy change is needed at both government and institutional levels to encourage and support the development of protocols and procedures for the implementation of EBP. If EBP was a government requirement for accreditation and a standard for protocols in hospitals and RACFs, it would lead to improved standards of care and cost effectiveness. This study supports the findings of a number of investigations conducted in Western countries which indicate that further education and training in research for nurses may lead to higher standards of patient care, greater job satisfaction and higher staff retention rates.

Proefschrift Universiteit van Amsterdam. / Met lit.opg. en een samenvatting in het Nederlands.

Proefschrift Universiteit van Amsterdam. / Met samenvatting in het Nederlands.

The purpose of this study is to explore crowdsourcing as a research paradigm for creating evidence-based practice research in the field of speech pathology. Using an Internet survey, respondents provided de-identified information about one patient with aphasia they had treated in the previous year. The respondents were then asked to rate the success of treatment. Analysis and grading of the responses was performed to identify which responses were usable for the purpose of planning a treatment for a patient with similar demographics and diagnostic make-up. Results showed that crowdsourcing is a viable research method; however, further refinements to the collection and analysis are required before it can be an effectively used. / text

In 2001 the Institute of Medicine identified a significant gap between what is known about how we care for patients and the care that they receive. This identified gap renewed interest in the development and implementation of evidence-based practice (EBP). A number of research studies have evaluated barriers to EBP yet questions still arise as to why evidence is not routinely incorporated into practice. This led to a new field of inquiry called implementation science focused on methods for translating evidence into practice. The Promoting Action on Research Implementation in Health Services (PARiHS) framework purports that successful implementation of EBP is a function of the strength of the evidence to be implemented, the quality of the context into which it will be implemented and appropriate facilitation. There currently are levels of evidence and measures of context that can be utilized but no measures of appropriate facilitation. The purpose of this research was to develop an instrument (the Facilitation Assessment Index) to measure facilitation. This methodological study was conducted to determine the psychometric properties of an investigator-developed instrument to define and measure the concept of facilitation. The instrument was distributed to1025 Registered Nurses in an Academic Medical Center. The response rate was 28%. The majority of respondents were in a staff nurse role, over age 35 and had at least a Bachelor's degree. The Facilitation Assessment Index (FAI) demonstrated adequate psychometrics. Factor analysis delineated four subscales entitled Support, Leadership, Respect and Autonomy. The overall reliability of the scale was r = .93 and the range of reliability of the subscales was r = .85-.93. The test-retest correlation for the total scale was r = .85 (p<.001). Correlations for the subscales ranged from r = .61-.85 (p<.01).Relationships between demographic variables and facilitation were evaluated. Both unit and job title variables demonstrated relationships with scale scores but group sizes were not equal. Future research is needed to strengthen the psychometric properties of the FAI. Subsequent research could focus on use in strengthening the PARiHS framework and quantifying the amount of facilitation needed to implement EBP.

The Issue: The integration of evidence into practice is a complex process. Facilitation is a strategy that may assist practitioners with enhancing evidence uptake in nursing practice. However, the concept is not well understood from a front-line nursing perspective. Thesis Objectives: To describe facilitation in moving evidence into nursing practice and determine the nature of the facilitator role and the process of facilitation in theory and from actual experience to develop a conceptual framework to guide practitioners. Methods: A descriptive design utilizing mixed methods was employed: 1) Focused review of the literature that synthesized the current state of knowledge on facilitation as role and process in the implementation of evidence-based practice (EBP) in nursing. 2) Case audit and focus group interview with facilitators of cases involved in adapting guidelines and planning for implementation. A provisional framework was developed based on the literature review which guided the case audit and focus group interview. The data from the literature was integrated with data from those actively involved in facilitation to refine the framework. Results: Focused literature review: A final set of 39 papers were identified. Facilitation is described as supporting and enabling practitioners to improve practice through evidence implementation. Certain aspects of the role and the strategies being employed to promote change are evident. Current literature reveals that facilitation is viewed as an individual role as well as a process involving individuals and groups. Case audit and focus group interview: Forty-six discrete, practical facilitation activities discovered in the literature were in large part found as occurring within the cases. An additional 5 new, distinct activities related to facilitation were found in the case documentation. Findings suggest that facilitation is a multifaceted process and a team effort. Communication and relationship-building are key elements. Conclusion: The transparency and detail displayed in the revised framework may contribute to systematically developing, implementing, and testing facilitation interventions in nursing contexts. Facilitation is clearly an important strategy to advance EBP and the improved understanding of facilitation offered in this thesis provides a guiding framework for future investigations of evidence implementation where facilitation is a key element. / Thesis (Master, Nursing) -- Queen's University, 2009-07-30 15:13:59.116

Proefschrift Universiteit van Amsterdam. / Met samenvatting in het Nederlands.

Background: Moving the latest evidence from research into nursing practice remains a challenge. We are only beginning to recognize the processes involved and little is known as to which approaches are effective in different contexts. Facilitation is an intervention that involves helping practitioners recognize what it is they need to change in practice and how to make these changes to incorporate evidence into practice. Objective: To describe the role, function, and practice of facilitation in moving evidence into nursing practice. A secondary element is to determine if a provisional facilitation framework, developed to reflect the concept in guideline adaptation and the early stages of implementation, accurately depicts facilitation in the context of actual implementation. Methods: The thesis employs an emergent mixed-methods design and is composed of two phases each with multiple components. The first phase explores the conceptual, theoretical, and experiential foundations of facilitation and examines: (1) how the concept has evolved over 16 years in a comprehensive literature review, (2) facilitation as described by experienced nurses in guideline implementation, and (3) how facilitation relates to other guideline implementation interventions in a review of studies included in an existing systematic review. The second phase describes the practical foundations of facilitation and follows the facilitation occurring naturally over time in a guideline implementation involving front-line nurses at the point of care. Results: The comprehensive review provides a description of how facilitation has evolved and presents a current synopsis of the state of knowledge regarding facilitation. The conceptual, theoretical, and empirical understandings of the concept were integrated with the practical foundations to confirm and refine the framework to reflect facilitation across the continuum from guideline adaptation to implementation. The revised framework is displayed and represents a comprehensive view and understanding of facilitation of evidence-based practice in nursing from multiple perspectives. Conclusions: The detail in the revised framework provides a useful guide for practitioners and organizations in planning for change. Further testing is required to determine its applicability and usability in the practice setting. / Thesis (Ph.D, Nursing) -- Queen's University, 2013-09-29 23:34:20.869