Research-informed practice is crucial to ensure best possible decisions are made during care delivery. In reality, research-based evidence often does not reach patient care due to many elements that impede the implementation process. The purpose of this phenomenological study was to discover the lived experiences of nurses involved in implementing evidence-based practice (EBP) in clinical settings within hospitals in United Arab Emirates. The theoretical and conceptual basis for the study was derived from Promoting Action on Research Implementation in Health Services framework for knowledge translation and Benner's Novice to Expert theory. Twelve nurses who had experience implementing evidence to practice were the participants of this study. Data were collected through semi-structured interviews and analyzed using a qualitative hermeneutic phenomenological approach. Three themes emerged from the study that included the significance of EBP, the process of evidence translation, and the outcome of evidence translation. Nurses in the clinical settings had basic understanding of EBP and were motivated to translate evidence, but their knowledge and skill in EBP were still limited. The implication for positive social change of this study is the recommendation that leaders in healthcare and nursing, as well as educators, and researchers to recognize the need for building EBP capabilities among nurses. Organizations must include current theories, frameworks, and tools of evidence translation to cultivate a culture of EBP as a foundation for patient care.

High quality mental health services do not reach the youth who need them, leading to efforts to implement effective treatments more broadly. One focus of these efforts concerns training the mental health workforce, of which master’s-level social workers represent a large proportion. However, the curricula of master’s in social work (MSW) programs do not often emphasize evidence-based approaches. One possible solution is Managing and Adapting Practice (MAP; PracticeWise, LLC), a system that allows clinicians to (1) identify clinically indicated evidence-based programs by searching a growing evidence-base of randomized controlled trials (RCTs) and (2) build individualized evidence-informed treatment plans by focusing on common practice elements. MAP may also address the concerns about manual-based programs (e.g., inflexibility). Although some MSW programs have integrated MAP, the benefits of MAP training within MSW education have not yet been evaluated. This project evaluated multiple mechanisms of training in a semester-long MSW-focused MAP course relative to curriculum-as-usual control at a large public university. Participants were advanced MSW students (mean age = 27, SD = 5.8; 92.3% women; 59% white) either enrolled in the MAP course (n = 17) or enrolled in curriculum-as-usual (n = 22). The MAP course was co-taught by an expert MAP trainer and a MAP-trained social worker. Pre- and post-semester, participants completed a battery that included: (1) role-plays with standardized patients that were videotaped and coded using the Therapy Observational Coding System of Child Psychotherapy – Revised Strategies scale; (2) a written task that was subsequently coded to assess participants’ clinical decision-making skills during different phases of a standardized case; and (3) attitudinal factors that may be predictive of future MAP usage, such as attitudes toward evidence-based practice and the acceptability and feasibility of MAP. Results indicate significant uptake of cognitive and behavioral therapeutic strategies in the MAP condition. Overall, participants endorsed positive attitudes toward evidence-based practice broadly and MAP specifically. Findings may be used to inform the development of more effective evidence-informed curriculum for master’s-level clinical programs and future workforce training initiatives. Methodological considerations may inform advances in instrumentation to measure multidimensional training outcomes

The push to generate professional nurses has raised questions about the competency level of the novice nurses that are entering the workforce. Utilization of simulation laboratories is being viewed as an option for bridging the gap for the shortage of nurses, nurse educators, and clinical sites. The theory of goal attainment was used to guide this project, which aimed to develop and validate an ER simulation scenario that mimics a clinical setting as a tool for measuring nursing skills. An additional purpose, to be accomplished after graduation, will be to implement a pilot project to determine the impact of the validated simulation scenario within the nursing skills laboratories on the quality of care provided by novice nurses to patients. The validation of the ER simulation scenario was completed by having 10 local experts review the developed ER simulation scenario. The experts then completed a 5-question Likert-type scale survey. Descriptive analysis was used to evaluate the results of the survey and validate the simulation scenario tool. Results revealed that all experts strongly agreed that the ER scenario was visually appealing and had enough subject content. Most experts strongly agreed that it was easy to read and follow. Post-graduation and with the assistance of the education organization, the second part of this proposal will occur with a pilot study implementation. The significance of this project to the nursing practice is to utilize simulation as a bridge to real life practice settings. This project may contribute to the American Nurses Association Standards of best practice which works to improve patient safety as well as quality nursing care.

The old practice of separating the mother-baby-dyad was without measurable benefits to mothers or their infants. Evidence has shown that skin-to-skin care (SSC) prevents hypothermia and hypoglycemia, decreases crying during painful procedures in newborns, and reduces maternal anxiety, stress, and postpartum depression. Rooming-in care (RIC) has been linked to an increase in the rate of breastfeeding and mother-infant interaction, as well as a decrease in the infant morbidity rate. This project assessed the effect of an educational intervention to increase rates of SSC and RIC in an obstetric unit, in addition to measuring nurses' attitudes and barriers in relation to SSC and RIC. The obstetric nurses received educational content related to SSC and RIC based on Kotter's model of change. A pre and postintervention evaluation showed a significant increase in the rates of SSC and RIC from pretest of 10%, to posttest of 96%; and RIC from pretest of 10% to posttest of 92%. Using a Wilcoxon test, a significant difference was found from pretest to posttest for every subscale score of the Mother-Newborn Skin-to-Skin Contact Questionnaire and Nurse Attitudes and Barriers to nonseparation Scale (p < 0.001), with the exception of belief about obstacles for SSC, which yielded a nonsignificant change (p = 0.57). This DNP project led to changes in the organization's culture, including the closure of the well-baby nursery. This project promoted social change across the organization, in that the team health care providers delivered evidence-based, standardized, unbiased, and family-centered care to the mother-baby dyad.

Translating research to practice takes 10-20 years or more and evidence-based practice (EBP) integration remains at 10%-20%, despite recommendations requiring EBP-guided decisions. EBP integration has been associated with up to 30% decreases in healthcare system spending, improved quality outcomes, and increased staff satisfaction. Nurse leaders are accountable for EBP enculturation, yet rate quality and safety as the highest priority and EBP as the lowest. This knowledge gap perpetuates low EBP integration rates and hinders EBP enculturation. Asking whether EBP facilitative interventions for nurse leaders increase scores on organizational culture and readiness, beliefs, and EBP use scales addressed the knowledge gap via this quality improvement, pre/posttest pilot project. Multiple frameworks guided the project: the nursing process, Lewin's change management model, the Johns Hopkins Nursing EBP model, and the Five Practices of Exemplary Leadership-® model. A comprehensive literature search validated the design using EBP facilitators: educational interventions, transformational leadership, strategic planning, and a systems perspective. Pre/posttest data garnered from 14 non-direct care nurse leaders on the Organizational Culture and Readiness for System-Wide Integration of EBP Scale, the EBP Beliefs Scale, and the EBP Implementation Scale was analyzed using 2-sample t tests. Individual questions on the scales revealed statistically significant differences correlating to the facilitative interventions, yet overall aggregate scores did not change significantly. The limited findings contribute to the existing body of knowledge, while positive social implications include resolving public health and safety issues, reversing fiscal irresponsibility, and overcoming resistance to change.

Evidence-based practices in nursing improve patient outcomes, decrease healthcare costs, and can be implemented with policies and procedures. However, there is limited literature describing how nurses acquire policy knowledge, the dissemination of which may require a significant investment of resources by a hospital. The purpose of this study was to learn more about how nurses obtain policy knowledge. Rogers's diffusion of innovations theory guided the examination of communication channels and how they relate to the formation of policy knowledge. The research questions were designed to gather information on the relationship of policy communication channels, demographic factors, and the frequency of document access in policy knowledge formation. This correlational study, using select subscales of the Policy Communication Index, was conducted to examine how nurses create and communicate policy knowledge. The sample included 22 nurses who practice at the bedside in a small hospital. Data sources included an anonymous online survey and frequency of policy access data. Data analyses included multiple regression, Pearson's r correlation, and Spearman's correlation of the data. The results showed that nurses report meeting discussions are the primary source of policy knowledge rather than written documents. A subset of participants who supplied an employee identification number showed a strong correlation with electronically distributed. Based on these results, nursing leaders can concentrate policy knowledge dissemination through meetings and safety huddles. The positive social change implication of this study includes better practices to convey evidence-based policy knowledge to nurses practicing at the bedside.

Background: As the number of older adults in Thailand continues to increase, along with increased incidence of surgical intervention that causes pain, the quality of pain care in older adults is needed. Nurses are primarily responsible for assessing and managing pain in older adults (Jose Closs, 2008; Prowse, 2007). The use of evidence-based practices (EBPs) improves quality of care and saves healthcare cost. However, in Thailand where empirical study of using EBP related to pain in older adults is limited, research to understand how Thai nurses use EBP acute pain in older adults is needed.Purpose:The purpose of this study is to describe current practices, perceived barriers and perceived facilitators of Thai nurses on using EBP for assessing and managing acute pain in postoperative older adults.Method:A descriptive exploratory survey was conducted in 8 mid and large-size hospitals in Thailand. The Acute Pain EBP Questionnaire (APEBPQ) (Suwanraj, 2009) was distributed to 240 Thai nurses. 236 questionnaires were returned with the response rate of 98.3 percent. Open-ended questions related to barriers and facilitators of using EBPs were coded to identify major themes. MANOVA was performed to explore the differences between years of nursing experience on perceived barriers and facilitatorsResultsThe majority of participants are female (96.8%) with mean age 35.5 years (range=23-54). Thai nurses reported using 51/53 recommendations from EBPG Acute Pain most of the time/always (95%). Using an equianalgesic table (1.80±1.16) and assessing MMSE in older adults with postoperative pain (1.74±1.15) were occasionally used. Research reports published in English was the greatest barriers. Nurses perceived greatest support from a Head ward than other colleagues. Nurses with 11-20 years of nursing experience had higher reported barriers than those with 1-10 years of nursing experience.Practice Implications: This study will provide important information on barriers and facilitators of using EBPs related to pain assessment and pain management in Thailand. The results of the study will be used to develop strategies to promote the use of EBPs acute pain among Thai nurses who provide nursing care for postoperative older adults.

Master of Social Work / This research is about evidence based practice, which is an area of increasing interest and emphasis in social work today. Initially apparent in medical and health care settings, evidence based practice now has widened applicability to a broad range of contexts and professional disciplines. The ways in which research evidence is translated into policy and practice is itself a topic area for social work research. The study investigates evidence based practice in child welfare, specifically the out-of-home care system. Out-of-home care provides alternative placements for children and young people who cannot live with their families because of abuse and neglect, and generally consists of placement with foster carers or in a residential/group care setting. This research is an exploratory study which investigates through individual interview how nineteen out-of-home care Senior Managers and Team Leaders in the states of New South Wales, Western Australia and the Australian Capital Territory interpret and understand evidence based practice, and the degree and depth of knowledge they transfer from research awareness into out-of-home care practice and policy development. The research has three main objectives. Firstly to investigate the understanding of out-of-home care managers of evidence based practice, secondly to determine the influence of relevant research on practice and policy in out-ofhome care, and thirdly to explore potential barriers to evidence based practice. Looking After Children, a social work case management system for children and young people in out-of-home care, provides the context for this research, in which evidence based practice is critically examined. A thematic analysis of the interview data identified five major themes. These included: the benefit of broadening definitions of evidence based practice to include a wide range of influences on practice; the value and importance of 2 considering a broad range of research approaches in connecting research with policy and practice AND the potential for influencing outcomes of social work intervention via research based and influenced guided practice systems and techniques; factors which constitute barriers and also those that enhance the implementation of evidence based practice; the potential for instigating and supporting new research via the use of evidence based practice for purposes such as data aggregation, in addition to practice development and enhancement of client outcomes. Implications and conclusions are drawn from this study in relation to out-ofhome care policy and practice, with particular reference to use of the Looking After Children case management system in the Australian context. These include the potential of a consistent system such as LAC to provide common language and assessment tools and procedures in a welfare sector that is fragmented by lack of national legislation, and the potential for development of national out-of-home care research projects as a result of cross agency LAC implementation resulting in data aggregation opportunities.

The nursing practice of monitoring patients in the post-operative (PO) phase upon returning to the general ward setting has traditionally consisted of the systematic collection of vital signs and observation of other aspects of the patient's recovery. For the most part the primary focus of this monitoring has been the detection of post-operative complications. There is a need for more substantive evidence to support an appropriate frequency of post-operative observation. The aim of this research was to identify if the current practice of PO vital sign collection detects PO complications in the first 24 hours after the patient has returned to the general ward setting. Due to the complex world in which nurses practice the research was undertaken using a combination of methods within a triangulated approach to collect data. A survey of 75 hospitals providing a surgical service enabled a description of the current models of PO monitoring as found in policy documents to be made. The majority of hospitals (91%) described a variety of regulated regimens for the collection of PO observations, with the most common for vital sign collection (27%) as hourly for the first four hours and then four hourly. An observation of 282 patient hours in two surgical wards identified the current practice of PO monitoring involved nurses collecting vital signs hourly for the first four hours, three hourly for the next eight hours and then every four hours. This was despite the existence of different models being described in the policies. The records of 144 patients were audited to identify what, if any, nursing interventions detected changes in a patient's recovery and to determine whether a relationship existed between vital sign collection and the detection of complications. It was found that the complications that occurred were minor in nature, occurred infrequently, and did not have a relationship with changes in vital signs. This research found that there was no relationship between the frequency of the collection of vital signs and the occurrence or detection of complications. PO observations were collected by nurses based on traditional patterns, were collected routinely, were ritualised and were not determined by individual clinician expertise or the needs of the individual patient. Recommendations are made regarding the need for a systematic program of research and alternative models of patient observation that focus on patient need rather than organisational need and that provide more efficient and effective practice in monitoring PO patient progress. / Thesis (Ph.D.)--School of Medicine, 2003.

The present study is an empirical phenomenological investigation of the influence of peer group Focusing practice (Gendlin, 1981) on doctoral psychology students' senses of their developing clinical expertise. Focusing, a therapeutic bodily awareness and symbolization practice, was proposed as a method that would support the development of student self-reflection, self-assessment, and self-care. The present study investigates the experiences of three female doctoral students who participated in a peer-initiated and peer-run Focusing group for five semesters. The methodological procedures for a reflective empirical phenomenological study as articulated by Giorgi and Giorgi (2003), Robbins (2006), and Wertz (1984) were followed. Procedures adapted from Walsh (1995) to ensure phenomenological researcher reflexivity and to explicate the researcher's approach to the phenomenon were also used. All participants provided data via audiotaped individual interviews, read provisional interpretations and provided written and verbal feedback to the researcher. The interpretive analyses of these texts indicated that all participants found their participation in the peer Focusing group to enhance some aspects of their clinical expertise. The findings support the idea that peer group Focusing is a helpful method for directly training psychology graduate students in self-reflection, self-assessment, and self-care. Relationships between these findings and research on the use of mindfulness meditation in graduate psychology training are discussed. Implications for curriculum development, including a discussion of the relationship between the findings and the training concepts of personal professional development and professional development are explored. / McAnulty College and Graduate School of Liberal Arts / Clinical Psychology / PhD / Dissertation