Evidence-based practice has resulted in better patient outcomes, higher patient satisfaction, and effective patient-centered care. Leadership of a large teaching hospital determined that new nurses lacked the education and experience to design and implement an evidence-based project at the bedside, which was an expected outcome for completion of the established nurse residency program. The purpose of this project was to develop a design-only project in which Masters of Science in Nursing-prepared mentors were added to the residency program to establish the required evidence-based project. A mentor workshop was developed to guide the mentors in this role using Benner's novice to expert theoretical model. A team of stakeholders, including an expert in the field of nursing education, provided ongoing process evaluation in the development of the outcome products including the Mentor Facilitation Guide, Mentor Workshop Curriculum, Mentoring Toolkit, Pre-and Post-Mentor Workshop Survey Assessment, and Mentor Implementation Plan. Stakeholders completed a summative evaluation on the processes, outcomes, and student leadership of the project. Findings showed that the project met 100% of the stated goals and objectives, as evidenced by the stakeholders' responses to the summative evaluation regarding the degree of effectiveness for the project, process, and leadership skills. Implementation and evaluation of the project, which was developed for use in the hospitals' existing nurse residency program, will occur post-graduation. Social change will occur if new nurses learn to use evidence-based practice to support their nursing actions, resulting in improved patient care outcomes and population health.

1 / Veronica Coriano

Doctor of Philosophy (PhD) / Introduction The aim of this study was to examine how the term “evidence” was conceived and used among academics and practitioners who teach medicine and public health. The rationale for the study was the widespread debate in the 1990s about evidence in health care. Methods Qualitative data were collected between 1996 to 1999. The core data came from unstructured interviews with researchers and practitioners linked to the Faculty of Medicine, University of Sydney. Other sources of data were: participant observation of group interactions in the Faculty of Medicine and at national and international conferences about evidence in health care; discourse in health care literature; and Internet posting to an international “evidence-based health” Email discussion list. The Grounded Theory method was adopted to analyse and interpret these data. The process involved systematic coding of the data to develop conceptual categories. These categories were employed to formulate propositions about the topic of evidence and how it was conceived and used by the study participants. Results Researchers and practitioners often discussed evidence from a “realist” view: that is they valued scientifically derived and rigorously substantiated knowledge about the natural world. Yet despite their widely shared epistemological perspectives, study participants presented several diverse concepts of evidence. Their ideas were also dynamic and evolving, and often influenced by the developing (local and international) debates and controversies about evidence-based medicine (EBM). Grounded Theory analysis leads to the selection of a core “social process”. This is a core conceptual category that draws together the ideas observed in the data, and that is adopted to present the study findings. In this study, “judgement” was identified as the core social process to underpin all examined reflections and discussions about evidence. Study participants defined the concept of evidence through a combination of description and appraisal. Evidence was described in three ways, i.e.: as a “measure of reality”, by its “functional role”, or as a “constructed product”. Evidence was also appraised on three “dimensions”, i.e.: “benchmarked”, “applied” and “social” dimensions of evidence. Participants invoked these concepts of evidence differently when forming their own judgements about medical or public health knowledge; when making decisions about clinical practice; and when using argument and persuasion to influence the judgements of others. Many researchers and practitioners also modified their judgements on evidence in the light of EBM. This was based on perceptions that EBM had become a dominant rhetoric within health care, which had the potential to channel the flow of resources. This led to an increasing consideration of the “social dimension” of evidence, and of the social construction and possible “misuse” of the term evidence. Conclusions The concept of evidence is presented in this study as a multi-dimensional construct. I have proposed that the three descriptions and three dimensions of evidence presented in this study, and recognition of the way these may be invoked when forming and influencing judgments, can be used as a basis for communicating about evidence in medicine and public health among colleagues and with students. There are significant gaps in knowledge (based on empirical research) about the social dimension of evidence. Particularly, in situations where researchers and practitioners wish to employ the concept of evidence to influence others’ medical and public health practice and wider social policy.

Child maltreatment (CM) is a major public health problem in the United States which affects millions of children each year. Because parents are responsible for the majority of substantiated CM reports, behavioral parent training is recommended as the primary prevention strategy. In recent years, researchers and clinicians have begun work examining the relevance and effectiveness of making cultural adaptations to parent training programs. The purpose of this study was to explore the need for systemic cultural adaptations to SafeCare®, an evidence-based parent-training child maltreatment prevention program. SafeCare is currently implemented in nine states and SafeCare providers are serving families representing a wide array of cultures and ethnicities. Eleven SafeCare providers, representing six states, participated in individual, semi-structured interviews to determine what, if any, cultural adaptations were in place in the field and whether there was a need for systematic culture-specific or general cultural adaptations to the SafeCare model. The interviews provided evidence that, across sites and populations, adaptations are being made when implementing SafeCare with diverse families. Providers expressed a need to make the language/reading levels of the model materials more relevant for all the populations served. Overall, however, providers found the model to be flexible and amenable to working with families of various cultures and ethnicities. Providers recommended against systematic adaptations of the model for specific ethnic groups.

Thesis (M. Med. Sc.)--University of Hong Kong, 2001. / Includes bibliographical references (leaves 47-55).

Thesis (Ph. D.)--Open University. BLDSC no. DX242927.

This study examined the impact of a full-day evidence-based practice (EBP) process continuing education training on practitioners' self-efficacy pertaining EBP, attitudes toward EBP, perceived feasibility of EBP, intentions to engage in EBP, self-reported engagement in EBP, and EBP knowledge. A secondary aim was to assess the impact of post-training coaching on the aforementioned outcomes at three-month follow up. The EBP Assessment Scale (Rubin & Parrish, in press) and 10 knowledge questions were used to measure the dependent variables in this study. A pretest-posttest follow up design was replicated four times, with two of the four groups receiving the coaching component based on a coin-toss. The results of this study support the effectiveness of this EBP training model, as there was significant change and moderate to strong effect sizes for each of the dependent variables over time in the desired direction. This study did not support the effectiveness of the coaching component. However, very few practitioners participated in the coaching, and for those who did, the dose of coaching was minimal. Major implications of this study for practice and policy include: 1) This EBP Process training model should be utilized as a part of future efforts to implement EBP within the field of social work; 2) The EBP process may enjoy greater success than past efforts to integrate research and practice in social work and the allied fields; 3) Some hypothesized barriers within the EBP literature were confirmed, while others were not; and 4) This study provides additional support for multi-faceted continuing education approaches and adult learning and diffusion of innovations theories when teaching practitioners the EBP process model. Future research should concentrate on finding ways to further increase practitioner engagement in EBP; identifying ways to improve support for the implementation of EBP at the organizational and policy levels; finding ways to address the most salient barriers to EBP, such as time and resources; and more effectively study the potential impact of coaching during the implementation of EBP. / text

published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Nursing Studies / Master / Master of Nursing