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.

Abstract This study sought to understand the differences and similarities between social work practice and evidence-based practice (EBP). As evidence-based practice becomes popularized in areas of professional practice, challenges and tensions arise for social workers. This qualitative research study asked social workers working in the hospital setting how they define and use evidence-based practice in their work, and about the tensions they experience in using EBP. The study revealed that social workers maintain their scope of practice in areas related to advocacy, the use of systems theory and the importance of the therapeutic relationship with clients in the helping process. The social workers in the study identified that social workers understood the value of scientific research and indicated that as a profession, social work practice can use research to influence areas for social change. The participants in the study described that social work practice and evidence-based practice are distinct. Social work practice is intended to understand and respond to social problems, whereas EBP in mental health settings is designed to resolve more narrowly-defined problems of individual coping. The social workers recognized that the two practices could only really co-exist. However, they did note that social workers’ commitments to reinforce self-determination for clients have potentially important overlap with EBP’s attention to patient values and preferences. / Thesis / Master of Social Work (MSW)

This study describes primary care nurse practitioner (PCNP) beliefs in, knowledge, implementation and utilization of evidence based practice (EBP). Research questions answered are: 1. What are the levels of belief, implementation, knowledge and utilization of EBP among PCNPs? 2. Is there a relationship with PCNP demographics (personal, professional, and practice), belief, knowledge, implementation and utilization of EBP? 3. Do PCNP demographics (personal, professional, and practice) and scores on belief, knowledge and implementation influence EBP utilization? EBP is considered a standard of care and essential to nurse practitioner practice. The primary advantages of EBP include improved quality of care through the utilization of patient resources, provider resources and experiences, current research and scientific information. However, few studies describe nurse practitioner beliefs, knowledge in EBP and the extent to which this may affect primary care nurse practitioners' (PCNP) utilization of EBP in their practice. Four questionnaires incorporated into one survey were used to examine PCNP beliefs, knowledge, implementation and utilization of EBP. JNC7 guideline knowledge and self-reported use was used to measure EBP utilization. A convenience sample of 202 FNPs, ANPs and GNPs were obtained during the American Academy of Nurse Practitioners National Conference 2011 in Las Vegas, Nevada. PCNPs surveyed were found to have a high level of belief in EBP but did not report implementing EBP more than 3 times in the past 8 weeks. Belief was statistically higher in doctorally prepared PCNPs. Ninety-five percent of the participants were familiar with the JNC7 guideline but the group scored a mean of 69% on knowledge of JNC7 guideline specifics. Only 25% of respondents indicated they utilized guidelines in hypertension management. Future studies should include quantitative and qualitative evaluation of EBP implementation facilitators and obstacles. Findings in this study have provided initial information to better understand PCNPs and EBP.

This exploratory study describes the variation in how evidence-based practice is understood in educational psychology. The study is comprised of two phases, which were both designed, analysed and interpreted using qualitative methodology. In phase one, twenty-two semi-structured interviews were conducted with educational psychologists from eight services in England. A phenomenographic approach to analysis was applied, resulting in a conceptual framework, representing the variation in understandings of evidence-based practice of a group of educational psychologists. In phase two, two focus groups were conducted with a subset of participants from phase one to elucidate the influence of evidence-based practice on decision-making in practice. A framework approach to thematic analysis showed that practice decisions of educational psychologists are influenced by evidence-based practice according to contextual factors, training and practice experiences and personal characteristics. This study gives insight as to how educational psychologists experience and account for the role of evidence and evidence-based practice in their practice and informs how evidence-based practice might be conceptualised in educational psychology. The findings suggest that evidence-based practice is grounded on personal, internalised beliefs while being contextualised by the demands of specific circumstances. The findings have implications for providers of educational psychology training in terms of the curriculum for evidence-based practice and associated learning outcomes.

The central themes of this thesis are professional learning and knowledge transfer. These themes have been critically examined in the context of how social work child protection professionals learn. Traditional ways of knowing and learning are no longer adequate. Professionals are facing increasingly complex practice issues that take place within an ever-changing social and political landscape. The role of the professional social worker is under constant scrutiny, nowhere more so than in the field of child protection, where the media plays a pivotal role in setting the political agenda (McCulloch and Kelly, 2007). The nature of professional learning and in particular, child protection social work learning, has been captured at various junctures in this thesis as it grapples with the key tensions, debates and conflicts. The thesis has positioned these challenges within the context of the literature and provides an alternative theoretical lens from which to consider alternative approaches. The future of child protection social work and the protection of vulnerable children and families rely on the skills, experience and knowledge of those charged with working with them. In this thesis I posit that current methods of education and continuing professional development are failing. New methods and models of sharing knowledge between all who have a stake in child protection, need to be reconsidered. For this to occur, we need to reconceptualise the theory that underpins our current approach and recognise the barriers that prevent the effective transfer of knowledge across the domains of research, practice and service user knowledge and experience. This thesis concludes that this can only be achieved through the active and informed participation of all stakeholders.

The primary purpose of this longitudinal, quasi-experimental study was to investigate the effects of a bipartite, standardized case conceptualization training among participants in comparison to those who were exposed to both the training and deliberate practice coaching. The secondary purpose of this study was to examine the relationship of the training and aspects of deliberate practice, along with participants’ attitudes toward evidence-based practice (EBP). A total of 84 counselor trainees were recruited from two South Florida universities. Participants in both the experimental group (n = 35) and comparison group (n = 49) received two, three-hour training lectures, which explained the integrative case conceptualization model developed by Dr. Len Sperry in 1989. Over a period of eight weeks, the lectures were separated by approximately four weeks in order to assess whether the training effects persist over time. As measured by the Views About Case Conceptualization (VACC) instrument, the first training lecture effectively reduced case conceptualization myths for both groups by approximately 4 points (out of 25), t (83) = -8.53, p < .001. Repeated measures MANOVA showed that the training had a significant impact on the entire sample. As measured by the Case Conceptualization Evaluation Form (CCEF) 2.0, the comparison group’s overall mean score improvement was approximately 40 points (out of 100) and the experimental group’s overall mean score improvement was approximately 63 points (out of 100), F (4.256, 348.974) = 32.102, p < .001. The results reveal that the training and coaching had a significant effect on counselor trainees’ ability to write effective case conceptualizations with a partial eta-squared effect size of .281. Using both the Evidence-Based Practice Attitude Scale (EBPAS) and Moulaert Questionnaire, this study also examined the influence of attitudes toward EBP and aspects of deliberate practice on trainees' case conceptualization competence. Paired samples t-tests and correlation analysis revealed that participants became more “open” to EBP, t (83) = -5.280, p < .001. However, it was determined that coaching did not act as a mediating or moderating variable. Overall, the findings support that case conceptualization training and deliberate practice coaching increase counselor competence, and that the effects persist over time. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2019. / FAU Electronic Theses and Dissertations Collection

The uptake of evidence in practice remains a challenge for healthcare professionals including nurses and providers. Increased use of evidence-based practices in healthcare settings may improve patient conditions such as pain and decrease the cost of healthcare. A wealth of literature can be found describing barriers and facilitators of evidence-based practice (EBP), and a movement in research has begun to focus on what influences the use of EBP. This study explored the relationships of context including the elements of individual, unit, and hospital and the use of evidence-based nonpharmacological pediatric pain management practices (EBNPP) using an existing data set of nurses and providers caring for children in the Emergency Department. Initial analysis found several significant correlations with individual, unit, and hospital context elements and EBNPP. A significant correlation was not found between evaluation and EBNPP and Magnet Status and EBNPP for nurse or providers. Nurse regression analyses showed knowledge and continuing education were significant predictors of EBNPP. Overall context was a significant predictor of EBNPP for both the nurse and provider models. A pooled regression analysis with Registered Nurses and Providers found nurses had a significant increased use of EBNPP when compared to providers. Regression analyses found that while overall context is a significant predictor of EBNPP, no single element was significant when all three were added to the model. The effect of context on EBNPP did not differ by profession in this sample. Results of this study indicate that while context is important in the uptake of EBNPP, one area does not have more influence than another. The variables explored in this study account for 13% of the variance in EBNPP. Future research should focus on the overall influence of context on EBP and consider other factors that may play a role in the uptake of EBP.

Evidence-based policy and practice (EBPP) in population health in Australia has been promoted largely without sound research. In response, this thesis presents a series of studies undertaken to assess and inform enhancement of capacity for EBPP in Australia. It comprises linked studies designed to examine different yet complementary aspects of capacity for EBPP. Research was conducted at various levels of Australian health care system, from local to national, in order to better understand EBPP and to make a series of recommendations about effective and synergistic response.

Organizational theory can assist in better understanding how changes made in clinical practice can be sustained in healthcare organizations. Organizational learning and knowledge transfer theories were used to develop and test a theoretical model, “Sustaining in Memory” (SIM) model, to explore how organizations disperse or distribute newly transferred knowledge in knowledge reservoirs situated in the organization. Three hypotheses were generated from the theoretical model and tested with data from a cross sectional postal survey of 148 patient/resident care units in one large Canadian province where a CPG on prevention of falls was widely disseminated. Findings confirmed that fall prevention practice knowledge was transferred and embedded in all six knowledge reservoirs; however, there were three specific knowledge reservoirs that were found to be significant predictors of perceived CPG adherence (activities consistent with the CPG recommendations). These were staff, policy and role expectation knowledge reservoirs. There was variation in the adherence to the eight CPG recommendations with greater adherence to recommendations that were mandatory. Additionally, findings showed that the relationship between staff knowledge reservoir and CPG adherence was the only relationship moderated by the practices that helped to prevent/address knowledge loss through various activities designed for reviewing and updating practice knowledge. Interestingly, although CPG adherence was reported significantly greater in LTC resident care units, its association with patient outcomes was much weaker than in hospital patient care units. Hospital units had significantly greater correlation between perceived CPG adherence and all four of the falls prevention outcomes reported by study participants. Lastly, quality management culture as managed by senior leaders in the organization was also found to be a significant predicator of adherence to the CPG. The research study validated key assumptions made in the theoretical model while helping to clarify the distinct influence of different knowledge reservoirs. The SIM model provided an alternate perspective within which to study knowledge transfer and sustainability of clinical practices and has potential to apply to other change initiatives. This study answered the call for greater theoretically driven studies of CPG implementation as well as attention on the organizational influences of CPG implementation and sustainability.