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.

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.

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.

Untreated depression has a detrimental effect in the lives of the adolescents suffering from this disorder. Depression is a multidimensional phenomenon that has been linked to biological, psychosocial and cognitive risk factors. Adolescents may be at risk for depression because adolescence is a time of physical, hormonal, emotional and intellectual changes. Depression may lead to impaired social and school performances and to poor physical health. In addition to a reduced quality of life, depression has also been linked to suicidal ideation and attempts. Suicide is the third cause of death in adolescents in the United States.The purpose of this practice inquiry was to conduct a critical review and synthesis of the literature on evidence-based treatment of unipolar depression in adolescents and to make recommendations for health care providers. This topic was chosen because of the high prevalence of depression in adolescents and because of the devastating effects of not treating this disorder.The methods used to synthesize the literature are described in the Guide for Literature Reviews by Cooper (1998). After the problem was identified, a literature search was conducted in PubMed, Cinahl, Psych Info, Complementary and Alternative Medicine and AMED. Next, the literature yielded 93 articles. The evidence from the literature was ranked according to the Oncology Nursing Society (ONS), Putting Evidence into Practice (PEP), Levels of Evidence scale. This system is an adaptation of the Rating the Quality of Evidence for Clinical Practice Guidelines developed by Hadorn and others (1996). Lastly, the recommendations for practice were made based on the ONS PEP, Weight of Evidence Classification Schema by Mitchell & Friese. Based on the evidence found in the literature, a guideline with the recommendations for practice was developed.The need for the treatment of adolescents with depression was supported in this synthesis of the literature. Future research is needed to explore treatment modalities tailored to the developmental, biological, psychosocial and cultural needs of adolescents and their families.

Asthma is a chronic disease that affects 8.4 million children in the United States (American Lung Association [ALA], 2007). Adolescents with asthma need tailored management of their care with attention given to particular developmental concerns. Standards of care, such as the National Heart, Lung, Blood Institute [NHLBI] 2007 asthma guidelines (NHLBI, 2007), exist to guide patient care and in this case, also address specific adolescent needs. Advanced practice nurses should incorporate "national standards of care as a framework for managing patient care" (American Association of Nurse Practitioners [AANP], 2007, p. 2). There is a lack of research about nurse practitioner use of standards of care, especially in caring for adolescents with asthma.The purpose of this practice inquiry was to explore patterns of practice and perceptions of practice by the nurse practitioners who care for adolescents with asthma, and to evaluate the current patterns of practice in comparison with national standards for providing care to adolescents with asthma at the Larry Combest Community Health Wellness Center [LCCHWC]. The design for this practice inquiry was descriptive retrospective, using mixed methods for process evaluation of a program through description of nurse practitioner practice at an academic nurse-managed primary care clinic.The nurse practitioners addressed all components of the process of care recommended by the AANP (2007), which includes assessment, diagnosis, development and implementation of a treatment plan, and evaluation of the patient status. However, despite comments about the importance of using evidence based practice in the form of guidelines, results from health records review indicate that nurse practitioners have not fully integrated the NHLBI 2007 asthma guidelines into providing care to adolescents with asthma. This study establishes a baseline measure of adoption of the NHLBI 2007 asthma guidelines by nurse practitioners at this clinic site. The results of this study may ultimately contribute to nurse practitioners' awareness of use of standards of care and improved quality of care for adolescents with asthma.

Inaug. rede Maastricht. / Auteursnaam op vooromslag: Hans Nelen. Titel ook te lezen als: Evidence maze. Met lit.opg.

AN ABSTRACT OF THE DISSERTATION OF MICHAEL A. STROUD, for Doctor of Philosophy degree in HEALTH EDUCATION, presented on MARCH 20, 2014, at Southern Illinois University Carbondale. TITLE: PHYSICAL THERAPISTS' CLINICAL PRACTICES REAGARDING INTRINSIC AND EXTRINSIC FALL RISK FACTORS AND THEIR ATTITUDES TOWARD THE USE OF EVIDENCE-BASED PRACTICE MAJOR PROFESSOR: Dr. Stephen Brown The phenomenon of falls among community-dwelling adults--coupled with an aging baby boomer generation and an increasing life expectancy--presents a significant concern for an increased number of unintentional deaths and injuries and their associated costs. The risk factors associated with falling are often categorized as intrinsic and extrinsic. Physical therapists have a unique opportunity to positively impact issues involving physical dysfunction and to educate their community-dwelling adult patients about the environmental risk factors and interventions that lessen their risk of falling. Abundant evidence-based research exists regarding interventions for the treatment and prevention of falls; however, this research indicates that physical therapists fail to consistently utilize evidence-based practice (EBP) in their daily clinical practices. The diffusion of innovations theory examines how innovations are adopted (Rogers, 2012). However, the innovation of EBP is not always adopted by physical therapists. Lack of time to conduct literature searches was the most common barrier noted by physical therapists for not adopting EBP (Jette et al., 2003; Fruth et al., 2010; Salbach, Jagial, Korner-Bitensky, Rappolt, & Davis, 2007). This study, which utilized a cross-sectional descriptive research design, provided insight into physical therapists' clinical practices regarding intrinsic and extrinsic fall risks in the treatment of community-dwelling adults aged 65 years and older. It examined physical therapists' attitudes and beliefs toward the use of EBP and identified the barriers to their adoption of it. The demographic data provided a descriptive overview of the study respondents. There were 3,523 potential physical therapist respondents, and the study's return rate was 9% (316 respondents. The majority of the respondents held doctoral degrees (49.4%), more than half (55.4%) worked in an outpatient physical therapy clinical setting, and approximately half indicated that they were American Physical Therapy Association (APTA)-certified instructors. The results of the study indicated that physical therapists who had more experience displayed a higher level of attention to clinical practices than those with less experience. The physical therapists who were APTA-certified clinical instructors demonstrated a higher level of attention to the intrinsic and extrinsic risks of falling than those who were not APTA-certified instructors. The physical therapists whose highest level of education was a doctorate placed greater importance on the utilization of EBP than respondents with a baccalaureate or master's degree. Although most physical therapists believe that the utilization of EBP holds significant value, they do not always access or apply it. Insufficient time for using EBP was the major barrier noted by most physical therapists. The results of this study concurred with those of previous studies regarding common barriers to physical therapists' adoption of EBP. Rehabilitation organizations may want to examine methods to promote the use of the most current physical therapy practices based on the evidence revealed in the literature and to explore options for improving staff access to and utilization of EBP research.

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / Trata-se de uma revisÃo integrativa da literatura, que teve como objetivo buscar e avaliar as evidÃncias disponÃveis na literatura sobre o cuidado no perÃodo perioperatÃrio prestado à paciente submetida à mastectomia. Para a seleÃÃo dos estudos, foram consultadas as bases de dados PUBMED, LILACS e CINAHL. A amostra constituiu-se de sete estudos. NÃo foi identificado nenhum estudo nas bases de dados LILACS e CINAHL, sete estudos foram provenientes do PUBMED. Houve uma prevalÃncia de seis estudos (86%) com nÃvel de evidÃncia 2 e um estudo (14%) com nÃvel de evidÃncia 3. ApÃs a anÃlise dos aspectos abordados nestes artigos, reuniu-se em uma categoria temÃtica: o manejo da dor, contendo os sete estudos. O primeiro estudo concluiu que uma dose de 600 mg de gabapentina administrada uma hora antes da cirurgia produz analgesia pÃs-operatÃria significativa apÃs a mastectomia total. O segundo estudo demonstrou que o uso do EMLA em pacientes mastectomizadas reduziu a solicitaÃÃo de analgÃsicos no pÃs-operatÃrio e uma reduÃÃo da incidÃncia e a intensidade da dor crÃnica. No terceiro estudo nÃo foram encontradas diferenÃas no manejo da dor pÃs-operatÃria entre 3,75 mg / ml de ropivacaÃna e infiltraÃÃo da ferida com soluÃÃo salina antes da mastectomia. O quarto estudo concluiu que a administraÃÃo preventiva com cetoprofeno por via endovenosa (100 mg) produz maior alÃvio da dor pÃs-operatÃria em pacientes submetidas à mastectomia. O quinto estudo evidenciou que a administraÃÃo de 8 mg de dexametasona diminui efetivamente o uso de analgÃsicos em mulheres submetidas à anestesia geral para a mastectomia. O sexto estudo nÃo demonstrou associaÃÃo entre o Ãndice de Ãxido nÃtrico e o desenvolvimento de dor crÃnica pÃs-operatÃria. O sÃtimo estudo concluiu que a administraÃÃo perioperatÃria de venlafaxina reduz significativamente a incidÃncia de sÃndrome da dor pÃs-mastectomia. O estudo apresentou como limitaÃÃes o fato de que ao longo dos 10 anos pesquisados, o Ãnico cuidado perioperatÃrio da cirurgia de mastectomia encontrado na literatura foi relacionado ao manejo farmacolÃgico da dor, ademais os estudos analisados nÃo mostraram uma associaÃÃo entre si, visto que em cada um foi avaliado uma droga diferente, dificultando o consenso e a recomendaÃÃo relacionada ao uso de fÃrmacos para o controle/minimizaÃÃo da dor. A evidÃncia nÃo apresentou um consenso para o cuidado perioperatÃrio de mastectomia, pois encontrou-se uma diversidade de uso de fÃrmacos para o controle da dor e em grande parte dos estudos existiu divergÃncias e divisÃo de opiniÃes. Contudo, observou-se a preocupaÃÃo por parte dos profissionais em minimizar/prevenir a dor prÃ, intra e pÃs-operatÃria. Desse modo, a enfermagem deve estar atenta, tanto à atualizaÃÃo dos tratamentos farmacolÃgicos no manejo da dor quanto ao desenvolvimento de futuras pesquisas relacionadas ao cuidado de enfermagem no perÃodo perioperatÃrio de mastectomia. / It is an integrative literature review, which aimed to search and evaluate the available evidence in the literature on perioperative care provided to patients undergoing mastectomy. To select the studies were consulted the databases PUBMED, LILACS and CINAHL and the sample consisted of seven studies. No study has been identified in the databases LILACS and CINAHL, and all seven studies were from the PUBMED. There was a prevalence of 6 studies (86%) with level of evidence 2 and 1 study (14%) with level of evidence 3. After analyzing the issues addressed in these articles, gathered in atopical category: pain management, containing the seven studies. The first study found that a dose of 600 mg of gabapentin administered 1 h before surgery produces significant postoperative analgesia after total mastectomy. The second study showed that use of EMLA in mastectomy patientsreduced the request of analgesics postoperatively and a reductionin the incidence and intensity of chronic pain. In the study 03 found no differences in the management of postoperative pain between 3.75 mg / ml and ropivacaine wound infiltration with saline prior to mastectomy. The fourth study found that preventive administration of ketoprofen intravenously (100 mg) produces greater relief of postoperative pain in patients undergoing mastectomy. The fifth study showed that administration of dexamethasone 8 mgeffectively decreases the use of analgesics in women undergoinggeneral anesthesia for mastectomy. The sixth study showed no association between the index of nitric oxide and the development of chronic postoperative pain. The seventh study found that perioperative administration of venlafaxine significantly reduces the incidence of pain syndromeafter mastectomy. The study had limitations the fact that over the 10 years studied, the only perioperative care of the mastectomy surgery in the literature was related to the pharmacological management of pain and the studies analyzed did not show an association between them, since in each was assessed a different drug, hindering consensus and recommendation regarding the use of drugs to control / minimize the pain. The evidence did not show a consensus for the perioperative care of mastectomy, because we found a diversity of use of drugs for pain control and in most studies there were differences and division of opinion. However, we noted the concern on the part of professionals to minimize / prevent pain before, during and after surgery, and nursing must be attentive to both the update of pharmacological treatments in pain management, for the development of future research related to the care of perioperative nursing.

Prevalence of autism spectrum disorder (ASD) has increased 150% over the last 20 years, affecting all communities, with future projections of further rise. This is a particular concern for the public education system, where laws mandate that schools provide meaningful education to all students. Resources must be in place to provide the level of support children with ASD require for a successful educational experience. These resources are often expensive and require specialized training to secure. Rural schools face unique barriers meeting the standards set forth through federal law. To determine the most productive use of available resources as well as to identify critical needs, a study was conducted in a rural community to assess stakeholder perceptions of students with ASD. We provided an online needs assessment questionnaire to stakeholders involved with children who have ASD in a rural school district. These stakeholders included parents, caregivers, educators, and community care providers of children with ASD. Also included were individuals 12 years and older with an ASD educational classification. In addition to the online assessment, we invited participants who wished to elaborate further on their responses for an in- person interview. We used mixed methods for analysis of the data. To determine response patterns among groups, descriptive statistics were used. Further analysis included consensual qualitative research methods to analyze open-ended questions in the survey and the in-person interviews. Results show that stakeholders perceive needs for better training, resources, and peer relationships as a focus for improvement within the rural community. The results will have greatest implications for the school district as it allocates resources to better meet the needs of students with ASD within the community. Key points of feedback to the local school district will focus on training and support resources, primarily for educators, but also for families. Accessible (e.g., free, online) training options will be the first recommendation for immediate implementation.

Evidence-based practice (EBP) in children’s mental health has the potential to treat childhood psychological concerns in a more effective and cost-efficient way. Despite the American Psychological Association’s commitment to EBP utilization, current efforts to disseminate and implement EBP into routine care have been slow. This slow uptake may adversely affect children and families by limiting their access to effective care. These consequences may be exacerbated in rural communities due to lack of qualified professionals and resources necessary to implement EBP. Previous research has identified several individual clinician factors and mental health agency characteristics that may influence the success of implementation efforts. These factors include clinician demographic variables (e.g., education level, theoretical orientation, discipline, years of clinical experience, caseload size), clinician attitudes toward EBP, clinician knowledge of EBP, agency characteristics (e.g., setting, size, supervision method, available funding), organizational culture, and organizational climate. The current study investigated how these variables are associated and affect EBP implementation in rural areas. Fifty-five rural mental health providers who provide therapy services to children completed questionnaires assessing current use of EBP, attitudes toward and knowledge of EBP, and agency culture and implementation climate. Results indicated that rural clinicians possessed relatively positive attitudes toward EBP, perceived their organization’s culture and climate as conducive to EBP use, and were just as knowledgeable about EBP as clinicians from urban and mixed rural-urban samples. However, clinician knowledge of evidence-based therapy techniques was not related to EBP utilization. Results also indicated that organizational culture was negatively associated with EBP use and suggests that further research is needed to clarify how clinician and agency variables affect EBP utilization in rural areas. These findings have important implications for EBP training programs. Specifically, extended supervision and consultation models should be incorporated into continuing education workshops and content related to organizational factors (e.g., strategies for fostering an organizational culture and climate conductive to EBP use) should be included. Findings from this study also highlight the need for more effectiveness research to be conducted in rural settings to address the unique barriers experienced by rural clinicians.