A cobrança da sociedade pela melhoria da qualidade dos serviços de saúde implica na busca de ações pela enfermagem, para a implementação da Prática Baseada em Evidências (PBE), uma vez que a assistência, pautada em evidências geradas por meio de métodos científicos, pode contribuir para aumentar os resultados do cuidado de saúde. A utilização de resultados de pesquisas na prática clínica é um dos componentes da PBE, entretanto, ainda, é desafio para a enfermagem. Assim, dentre as ações que podem minimizar a lacuna entre o conhecimento produzido e sua aplicação, está a identificação de barreiras que impedem a interdependência entre pesquisa e prática. O presente estudo teve como objetivos gerais: realizar a adaptação cultural do instrumento The Barriers to Research Utilization Scale e analisar as propriedades métricas de validade e confiabilidade do instrumento The Barriers Scale, versão para o português brasileiro. Trata-se de pesquisa metodológica conduzida por meio das seguintes etapas: processo de adaptação cultural - tradução e retrotradução; validade de face e conteúdo - Comitê de Juízes; validade de construto - dimensionalidade e grupos conhecidos e análise de confiabilidade - teste-reteste. The Barriers Scale possui 29 itens distribuídos em quatro fatores, a saber: Fator 1 - Enfermeiro, Fator 2 - Organização, Fator 3 - Pesquisa e Fator 4 - Comunicação, com valores de respostas que variam de 1 (inexistente) a 4 (enorme), sendo que os valores maiores refletem maiores barreiras para utilização de resultados de pesquisas na prática. Os dados foram coletados em dois hospitais, por meio da aplicação de um instrumento para caracterização sociodemográfica e profissional dos enfermeiros e The Barriers Scale - versão para o português brasileiro, no período de outubro de 2014 a junho de 2015, com a participação de 335 enfermeiros. O nível de significância foi de 0,05. Os resultados evidenciaram que a maioria dos participantes era do sexo feminino (88,7%), com idade média de 33,9 anos, solteiros, mestres, com um único vínculo empregatício e em regime celetista. A maioria dos enfermeiros não havia realizado curso sobre a utilização de resultados de pesquisas, na prática clínica (85,1%), e desenvolvia ou já tinha conduzido pesquisas em enfermagem (68,4%). Na avaliação das propriedades métricas, a análise fatorial confirmatória demonstrou que a versão para o português brasileiro, composta por quatro fatores, está adequadamente ajustada à estrutura dimensional, originalmente proposta pela autora principal. A validade de construto foi determinada por grupos conhecidos, os resultados demonstraram diferenças estatisticamente significativas, sendo que os enfermeiros que atuavam em instituição, com cultura organizacional direcionada para a PBE, eram mestres ou doutores, tinham características favoráveis à PBE e identificaram menores barreiras para a implementação de resultados de pesquisas, na prática clínica. A confiabilidade, avaliada em intervalo de sete dias, indicou valores apropriados para o Coeficiente de Correlação Intraclasse, entre 0,75 e 0,84, e com diferença estatisticamente significativa. A avaliação da consistência interna demonstrou valor adequado para a versão para o português brasileiro de The Barriers Scale (? de Cronbach=0,92). Concluiu-se que The Barriers Scale, versão para o português brasileiro, é válida e confiável na amostra estudada / The society\'s demand to improve the quality of health services implies the search for nursing actions for the implementation of Evidence-Based Practice (EBP), since care guided by evidence generated through scientific methods can help increase health care results. The use of research results in clinical practice is one of the EBP components; however, it is still a challenge for the nursing team. Thus, one of the actions that can minimize the gap between the knowledge produced and its application is the identification of barriers that prevent the interdependence between research and practice. This study\'s overall objectives were: to perform the cultural adaptation of The Barriers to Research Utilization Scale and analyze the metric properties of validity and reliability of the instrument The Barriers Scale - Brazilian Portuguese version. A methodological study was conducted through the following steps: cultural adaptation process - translation and back-translation; face and content validity - expert committee; construct validity - dimensionality and known groups and reliability analysis - test-retest. The Barriers Scale consists of 29 items distributed into four factors, namely: Factor 1 - Nurse, Factor 2 - Organization, Factor 3 - Research, and Factor 4 - Communication. The response values range from 1 (nonexistent) to 4 (massive), wherein the highest values reflect greater barriers to using research results in practice. Data were collected at two hospitals, through the application of an instrument for sociodemographic and professional characteristics of the nurses and The Barriers Scale - Brazilian Portuguese version, from October 2014 to June 2015, with the participation of 335 nurses. Significance was set at 0.05. The results showed that most participants were women (88.7%), with a mean age of 33.9 years, bachelors, masters, with a single job and under the Consolidation of Brazilian Labor Laws (CLT regime). Most nurses had not taken a course on the use of research results in clinical practice (85.1%) and were developing or had already conducted studies in nursing (68.4%). In the evaluation of the metric properties, the confirmatory factor analysis demonstrated that the Brazilian Portuguese version of scale, consisting of four factors, is properly adjusted to the dimensional structure originally proposed by the main author. Construct validity was determined by known groups. Results showed statistically significant differences, and the nurses working in an institution with organizational culture directed to the EBP were either masters or doctors, had favorable characteristics to the EBP and identified lower barriers to the implementation of research results in clinical practice. The reliability, evaluated in seven-day intervals, indicated appropriate values for the intraclass correlation coefficient, between 0.75 and 0.84, with a statistically significant difference. The evaluation of the internal consistency demonstrated appropriate values for the Brazilian Portuguese version of The Barriers Scale (Cronbach\'s ? = 0.92). In conclusion, The Barriers Scale - Brazilian Portuguese version is valid and reliable as per the studied sample

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.

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.

Background Evidence-based practice has increasingly been recognized as a priority by professional physiotherapy organizations and influential researchers and clinicians in the field. Numerous studies in the past decade have documented that physiotherapists hold generally favorable attitudes to evidence-based practice and recognize the importance of using research to guide their clinical practice. Research has predominantly investigated barriers to research use. Less is known about the circumstances that actually support use of research by physiotherapists. This study explores the conditions at different system levels that physiotherapists in Sweden perceive to be supportive of their use of research in clinical practice. Methods Patients in Sweden do not need a referral from a physician to consult a physiotherapist and physiotherapists are entitled to choose and perform any assessment and treatment technique they find suitable for each patient. Eleven focus group interviews were conducted with 45 physiotherapists, each lasting between 90 and 110 minutes. An inductive approach was applied, using topics rather than questions to allow the participants to generate their own questions and pursue their own priorities within the framework of the aim. The data were analyzed using qualitative content analysis. Results Analysis of the data yielded nine favorable conditions at three system levels supporting the participant’s use of research in clinical practice: two at the individual level (attitudes and motivation concerning research use; research-related knowledge and skills), four at the workplace level (leadership support; organizational culture; research-related resources; knowledge exchange) and three at the extra-organizational level (evidence-based practice guidelines; external meetings, networks, and conferences; academic research and education). Conclusions Supportive conditions for physiotherapists’ use of research exist at multiple interdependent levels, including the individual, workplace, and extra-organizational levels. Research use in physiotherapy appears to be an interactive and interpretative social process that involves a great deal of interaction with various people, including colleagues and patients.

Denna kvalitativa studie genomfördes för att undersöka vilken roll utvärdering av belöningssystem har i företag verksamma i Sverige. Studien utgår från teorin Evidence- Based Practice och dess underkategorier som specifikt behandlar belöningssystem. Dessa teorier applicerades på data inhämtad från intervjuer med personer ansvariga för belöningssystem på olika företag. I studien framkom, i likhet med de få tidigare studier som genomförts inom området, att utvärdering av belöningssystem inte har någon central roll hos de undersökta företagen. Anledningen till denna undanskymda roll anses dock inte vara en misstro mot behovet av det. Istället framkom att en starkt bidragande orsak till det restriktiva utförandet av utvärdering är att området anses komplext med stora problem relaterade till att identifiera lämpliga metoder för det praktiska utförandet.