Doctor of Philosophy / Similar to their colleagues throughout the world, nurses and midwives in New South Wales (NSW), Australia, welcome evidencebased practice (EBP) as a means to improve patient or client outcomes. This thesis explores the way nurses and midwives understand evidence for EBP and aims to determine whether members of these professions currently have the knowledge and skills necessary to implement evidence‐based care. Three separate studies were conducted to explore NSW nurses’ readiness for EBP. Attitudes, knowledge and skill were investigated using an EBP questionnaire returned by 383 nurses. The views of 23 nursing opinion leaders were elicited during qualitative in‐depth interviews, and their ideas on maximising the potential for future nurses to confidently engage in EBP were explored. Current approaches to teaching EBP in undergraduate nursing programs were investigated by examining documents issued by NSW nursing education providers. The results demonstrate many differences between the ways NSW nurses currently understand evidence for EBP, and a range of approaches to teaching EBP in undergraduate nursing programs. Under current conditions, nurses graduating from universities in NSW commence practice with varying levels of preparation for EBP and enter into a professional arena that is itself struggling to cope with the concepts and language of this approach to improving healthcare. v Evidence for the effectiveness of EBP is slowly accumulating and despite some small positive signs, the collective results of this thesis suggest that current educational approaches are not capable of producing the kind of results that are both necessary and desirable for the promotion of evidence‐based nursing practice in NSW. Articulating a commitment to EBP, using a common language and a consistent approach are among the recommendations made for the future promotion of EBP in nursing education.

Doctor of Philosophy / Similar to their colleagues throughout the world, nurses and midwives in New South Wales (NSW), Australia, welcome evidencebased practice (EBP) as a means to improve patient or client outcomes. This thesis explores the way nurses and midwives understand evidence for EBP and aims to determine whether members of these professions currently have the knowledge and skills necessary to implement evidence‐based care. Three separate studies were conducted to explore NSW nurses’ readiness for EBP. Attitudes, knowledge and skill were investigated using an EBP questionnaire returned by 383 nurses. The views of 23 nursing opinion leaders were elicited during qualitative in‐depth interviews, and their ideas on maximising the potential for future nurses to confidently engage in EBP were explored. Current approaches to teaching EBP in undergraduate nursing programs were investigated by examining documents issued by NSW nursing education providers. The results demonstrate many differences between the ways NSW nurses currently understand evidence for EBP, and a range of approaches to teaching EBP in undergraduate nursing programs. Under current conditions, nurses graduating from universities in NSW commence practice with varying levels of preparation for EBP and enter into a professional arena that is itself struggling to cope with the concepts and language of this approach to improving healthcare. v Evidence for the effectiveness of EBP is slowly accumulating and despite some small positive signs, the collective results of this thesis suggest that current educational approaches are not capable of producing the kind of results that are both necessary and desirable for the promotion of evidence‐based nursing practice in NSW. Articulating a commitment to EBP, using a common language and a consistent approach are among the recommendations made for the future promotion of EBP in nursing education.

Nursing is a permanently developing field of activity. Research plays an irreplaceable role in this field. We moreover more and more often see the term Evidence Based Practice nowadays. However a lot of general nurses do not know that this term also relates to the field of nursing, where it is called Evidence Based Nursing. Quantitative research was chosen for this thesis. The research was performed in South Bohemian and Central Bohemian regions among general nurses with bachelor degree. The aim of the questionnaire research was to confirm or refute the hypotheses set for this thesis. The first goal of the thesis was to find out whether general nurses with bachelor degree were willing to participate in research in nursing. The second goal was to find out whether general nurses with bachelor degree had come across the term Evidence Based Practice. The third goal was focused on finding whether general nurses with bachelor degree knew the names of databases that might be used in planning nursing care based on evidence. The fourth goal was to find out whether general nurses with bachelor degree were willing to participate on application of research results to nursing practice. The fifth goal was to find out whether general nurses with bachelor degree had met with application of research results to nursing practice. The goals of the thesis have been met. Five hypotheses were set for achievement of the above goals. H1: General nurses with bachelor degree are willing to participate in research in nursing. H2: General nurses with bachelor degree are able to define the term Evidence Based Practice. H3: General nurses with bachelor degree know the names of databases they may use in planning nursing care based on evidence. H4: General nurses with bachelor degree are willing to participate in introduction and application of research results to nursing practice. H5: General nurses with bachelor degree meet application of research results to nursing practice. The first, second and fourth hypotheses were confirmed, the third and fifth ones were not confirmed. Although the issues of Evidence Based Practice appear more and more often in literature, and we might expect nurses with tertiary education to apply the practice based on evidence in nursing, there are still general nurses who have lack of information in this sphere. Nevertheless there are a lot of general nurses with tertiary education who would like to participate in research and application of the research results to nursing practice. A proposal for a whole-life educational course focused on application of Evidence Based Practice to nursing was elaborated upon the research results. The results may also be used in hospital seminars and in education of nursing students.

Health Studies / (D. Litt. et Phil. (Health Studies))

Bakgrund Utveckling av evidensbaserad omvårdnad i klinisk praxis innebär förbättring av kvalitén inom vården. Sjuksköterskestudenter påbörjar förberedelserna för evidensbaserad omvårdnad redan under sin utbildningsperiod, och nyexaminerade sjuksköterskor förväntas i hög grad tillämpa evidensbaserad omvårdnad i klinisk praxis. Syfte Syftet med denna litteraturöversikt är att beskriva nyexaminerade sjuksköterskors användning av evidensbaserad omvårdnad och vilka faktorer som har betydelse för sjuksköterskors tillämpning av evidensbaserad omvårdnad. Metod En litteraturöversikt baserad på 16 vetenskapliga artiklar som inkluderar både kvalitativa och kvantitativa studier. Resultat Utvecklingen i tillämpning av evidensbaserad omvårdnad bland nyexaminerade sjuksköterskor förefaller oförändrad eller avtagande under senaste decenniet. Mest tillämpad evidensbaserad omvårdnad är Instrumentell forskningsanvändning. Faktorer som har betydelse för sjuksköterskors tillämpning av evidensbaserad omvårdnad är: utbildning, oerfarenhet, stressiga arbetssituationer och stöd i arbetsmiljön. Slutsats Att granska i vilken utsträckning nyexaminerade sjuksköterskor tillämpar evidensbaserad omvårdnad är svårt då begreppet kan tolkas på olika sätt och det är enligt min kunskap fortfarande ett outforskat område. Nyexaminerade sjuksköterskor behöver mer stöd både före och efter examen för att utveckla sin tillämpning av evidensbaserad omvårdnad. De behöver mer stöd av lärare under utbildningsperioden och av erfarna seniora kollegor på arbetsplatsen. Därutöver krävs ett aktivt ledarskap. / Background Development of evidence-based nursing leads to improvement of the quality of care in clinical practice. Nursing students begin the preparations for evidencebased nursing already during their training period, and newly graduated nurses are highly expected to apply evidence-based nursing in clinical practice. Aim The aim of this review is to describe the newly graduated nurses' use of evidencebased nursing and the factors which are significant for the nurse´s application of evidence-based nursing. Method A literature review based on 16 articles that included both qualitative and quantitative studies. Result The development of application of evidence-based nursing among newly graduated nurses seems unchanged or decreasing in the last decade. The most applied implementation of evidence-based nursing among newly graduated nurses is Instrumental research use. The influential factors are: education, inexperience, stressful work situations and the support they perceive at their workplace. Conclusion In conclusion, this review emerged to that the whole situation of how and which extent newly graduated nurses apply evidence-based nursing is difficult to grasp within my comprehension. Since the apprehension of the concept of applying evidence-based nursing is complex, it is still an unexplored subject. Newly graduated nurses require further extensive support through their pregraduate to the post- graduate period to develop their application of evidencebased nursing. They need more guiding by the teachers, experienced senior colleagues and administrative support at their workplaces.

Health Studies / (D. Litt. et Phil. (Health Studies))

Introduktion En stor del av distriktsköterskans arbetstid utgörs av sårvård. Cirka två procent av befolkningen drabbas någon gång av svårläkta bensår vilket orsakar stort fysiskt och psykiskt lidande för dessa personer. Studier på andra sårtyper visar att användning av antiseptiska och mikrobreducerande förband har en positiv effekt på sårläkning. Denna studie sammanställer studier om effekten av förband med honung, silver, jod, PHMB och DACC på svårläkta bensår. Syfte Att sammanställa studier som undersöker effekten hos antiseptiska och mikrobreducerande förband som används i dagens sjukvård för att behandla svårläkta bensår. Metod Systematisk litteraturstudie. Sökningar gjordes i databaserna PubMed, Cinahl och Cochrane, samt i referenslistor till review studier som framkom vid sökningarna. Efter en urvalsprocess hittades 15 studier som besvarade syftet.   Resultat De inkluderade studierna gav inget entydigt resultat. Honungsförband förbättrade läkningen eller var likvärdigt med standardbehandling i de inkluderade studierna Silverförband hade en positiv effekt på läkningen i övervägande del av de inkluderade studierna. I en studie var ett annat antiseptiskt ämne bättre än silver och i en studie visade sig silverförband vara likvärdigt med standardbehandling. Jodförband visade sig vara likvärdigt med silverförband i fråga om läkning och PHMB-förband var likvärdigt med standardbehandling Slutsats Majoriteten av de inkluderade studierna tyder på att antiseptiska förband har en positiv effekt på sårläkningen hos svårläkta bensår. Då ingen av studierna visade att de undersökta förbanden var sämre än standardbehandling, eller hade negativa effekter på sårläkningen, så är det förenligt med evidensbaserad omvårdnad att använda förbanden på patienter med svårläkta bensår utan risk för att fördröja eller försämra läkningen. / Introduction A considerable part of the district nurse's working time consists of wound care. Approximately two percent of the population will sometime be affected by hard to heal leg ulcers which is the cause of physical as well as psychic suffering for these people. Studies of other wound types shows that the usage of antiseptic and microbe reducing wound dressings have a positive effect on wound healing. This study review studies about the effect of wound dressings with honey, silver, iodine, PHMB and DACC on hard to heal leg ulcers.   Aim To review studies that examines the effect of antiseptic and microbe reducing wound dressings that are being used in today’s health care to treat hard to heal leg ulcers. Method Systematic review. Searches were made in databases Pubmed, Cinahl and Cochrane as well as manually among references in review articles that were found through the searches. After a selection process 15 studies were found which proved to be relevant to the study’s aim.   Results The included studies gave no coherent result. Honey dressings improved healing or were equivalent to standard care in the included studies. Silver dressings had a positive effect on wound healing in the predominant proportion of the included studies. In one study, another antiseptic substance had better results than silver, in another study silver dressings turned out to be equivalent to standard care. Iodine dressings turned out to be equivalent to silver dressings in the case of healing and PHMB dressings were equivalent to standard care. Conclusion The majority of the included studies indicates that antiseptic wound dressings have a positive effect on healing of hard to heal leg ulcers. None of the included studies showed that the examined wound dressings were less effective than standard care or had any negative effects on wound healing. Therefore, it can be considered safe and compatible with evidence-based nursing to use the antiseptic dressings on hard to heal leg ulcers.

Bakgrund: Efter kirurgiska ingrepp förekommer postoperativt ileus (POI) som ett normalfysiologiskt tillstånd. POI definieras som ett avvikande mönster av gastrointestinal motilitet med karakteristiska symtom som illamående och kräkningar, uppspänd buk, samt utebliven gasavgång eller avföring. POI har påvisats påverka den postoperativa återhämtningen negativt. Syfte: Syftet med studien var att kartlägga interventioner som används för att minska durationen av postoperativt ileus vid svenska kirurgiska vårdavdelningar. Design: Enkätbaserad tvärsnittsstudie. Metod: Internetbaserad enkät skickades till vårdenhetschefer vid 86 kirurgiskt inriktade vårdavdelningar på fem universitetssjukhus i södra och mellersta Sverige. Resultat: Totalt 21 kirurgiska vårdavdelningar besvarade enkäten. Kunskaper kring innebörden och handläggningen av POI angavs som måttliga till goda. Den mest frekvent föreslagna interventionen inom omvårdnad var mobilisering och laxantia i olika former var den vanligaste farmakologiska interventionen. Konklusion: Omvårdnads- och farmakologiska interventioner av varierande evidensgrad används på svenska kirurgiska vårdavdelningar. Det tycks finnas ett behov av utbildning om och implementering av vetenskapliga kunskaper inom området för bedömning och handläggning av POI. / Background: Postoperative ileus (POI) occurs as a normal reaction to all forms of surgery. POI is defined as a deviant pattern of gastrointestinal motility with characteristic symptoms such as nausea and vomiting, abdominal distension and lack of gas or stool. Postoperative ileus has been shown to affect the postoperative recovery in a negative way. Aim: The aim of this study was to investigate the current use of interventions aimed to reduce the duration time of postoperative ileus in Swedish surgical wards. Design: A cross-sectional study. Method: A web-based survey was administered to matrons at 86 surgical wards in five university hospitals in the mid- and south of Sweden. Results: In total, 21 wards responded. The knowledge about the meaning and management of POI was perceived as moderate to good. The most frequent used nursing intervention was mobilization, and the most common pharmacological action proposed was laxatives of various sorts. Conclusion: Both nursing and pharmacological interventions with various grades of evidence are used in Swedish surgical wards. There are indications of a need for education and implementation of science-based knowledge within the area of assessing and managing POI.

The purpose of this study was to evaluate student outcomes following implementation of a clinical scholar model of clinical education in one of four placement sites of a college of nursing grounded in a caring philosophy. The question guiding the study was to determine if the clinical scholar model has an influence on student perceptions and outcomes when used with second-degree accelerated BSN students. Watson's Human Caring theory, based on ten caritas processes, serves as the theoretical framework for this study (Watson, 2007). A sequential mixed-methods approach that combined quantitative and qualitative data collection techniques was implemented using a pre-experimental, post-test only design with non-equivalent groups to determine differences between the Traditional Model (TM) and Clinical Scholar Model (CSM) in clinical nursing education... Limitations of this study include low sample size and are partially due to limitations of the class size and low survey participation. Additionally, only CSM students attended a focus group, which prevented comparisons of qualitative feedback between groups. Even with these limitations, CSM students scored as well or better than TM students, indicating that the CSM could be a viable model for nursing clinical education. / by Kathryn Arnold. / Thesis (Ph.D.)--Florida Atlantic University, 2013. / Includes bibliography. / Mode of access: World Wide Web. / System requirements: Adobe Reader.

Background: The nurses’ responsibility is to give good and safe health care based on nursing science and proved practice, and also keeping up to date with the latest nursing science. The most common use of research utilization is instrumental, which is nursing science directly applied when caring for patients. By acquiring and utilizing new nursing science, the nurse is able to develop safe care for patients.  Aim: The aim of this review was to describe nurses’ perceptions of implementing research science in clinical practice. Method: A literary review based on studies acquired from the database CINAHL Complete and Academic Search Complete  Result: The impact of nursing science describes that nurses believe nursing science as important for the evolvement and quality of the profession, but perceives it to be too complex to utilize. Nurses’ perceptions of barriers and facilitators towards research utilization in nursing science describe what organizational factors affect nurses´ perceptions of research utilization in nursing care. Nurses also describe that they want to utilize research, but they lack the skill to critically appraise scientific literature. Lack of time and low research availability are described as barriers towards research, and support and engagement from nursing administrators are considered a facilitator towards better research utilization. Discussion: Despite having a positive attitude towards nursing science, the result shows that the nurses today find it difficult to implement it in a clinical practice. The results indicate that there needs to be support from the management to facilitate research utilization in a clinical practice.