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.

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

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.

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.