Nearly two decades of research on translating evidence-based care guidelines into practice has resulted in a considerable body of primary and secondary evidence about guideline implementation strategies and the individual, organizational and environmental challenges associated with closing the evidence to practice gap in primary care. Interventions to improve professional performance are complex and a disentangling of the various independent, intervening and constraining variables is required in order to be able to design and implement interventions that can improve primary care practice performance. The PRECEDE-PROCEED planning model (Green & Kreuter, 1999) provides a step-wise theoretical framework for understanding the complexity of causal relationships among the variables that affect the adoption of evidence-based practice and may assist in the design and implementation of practice-based interventions. Knowledge of an evidence-based practice guideline is important, but a consensus has emerged that having knowledge is rarely sufficient to change practice behaviour. Didactic education or passive dissemination strategies are ineffective, whereas interactive education, reminder systems and multifaceted interventions tailored to the needs of the practice are effective. Outreach or practice facilitation is a proven effective multifaceted approach that involves skilled individuals who enable others, through a range of tailored interventions, to address the challenges in implementing evidence-based care guidelines within the primary care setting. The challenges to implementing evidence-based chronic illness care practice guidelines are thought to be similar to the other contextual, organizational and individual behavioural challenges associated with the uptake of research findings into practice. A multifaceted guideline implementation strategy such as practice facilitation may be well-suited to improving the adoption of these guidelines within rural primary care settings. However, research has not systematically reviewed, through meta-analysis, the published practice facilitation trials to determine overall effects and an implementation research study of practice facilitation that has considered fidelity of implementation within the rural Ontario setting for a complex practice guideline such as chronic illness management has not been done. The systematic review in the thesis incorporated an exploratory meta-analysis of randomized and non-randomized controlled trials of interventions targeted towards implementing evidence-based practice guidelines through practice facilitation, and was conducted to gain an understanding of the overall effect of practice facilitation and the factors that moderate implementation success. The results were the identification of an improvement overtime in the methodological rigour of practice facilitation implementation research based on a critical appraisal of methods, a significant moderate overall effect size of 0.54 (95% CI 0.43 – 0.65) for 19 good quality practice facilitation intervention studies and several significant effect size modifiers; notably, tailoring to the needs of the practice, using multiple intervention components, extending duration, and increasing the intensity of practice facilitation were associated with larger effect sizes. As more practices were assigned to the practice facilitator, the effect diminished. A significant positive association between the number of PRECEDE predisposing, enabling and reinforcing strategies employed by the facilitator and the effect size was detected. The implementation research study utilized mixed methods for data collection as part of an embedded case study of four rural primary care practices to determine the implementation fidelity of the practice facilitation of chronic illness care planning and the factors that impeded and contributed to implementation success. The feasibility of and potential cost savings of practice facilitation via videoconferencing was also implemented for two of the practices. For those practices that successfully implemented care planning, fidelity was achieved for the implementation of care plans. On the other hand, the dosage, duration, component delivery of the practice facilitation intervention was low in comparison to other published studies, and tailoring of the intervention to the practice was inconsistent. Based on the qualitative analysis of physician interviews, the moderating factors for successful implementation were categorized into the broad themes of pessimism and tempered optimism. Pessimistic physicians were unsuccessful at implementation, lacked a willingness to engage and were uncomfortable with the patient-centred approach to chronic illness care. Optimists were positive about the psychosocial, patient-centred assessment aspects of the chronic illness care protocol and provided anecdotes of success in resolving patient problems. However, this was tempered as both pessimists and optimists reflected on the time intensive aspect of the protocol and the unlikelihood of widespread implementation without additional supports. Participating physicians were satisfied with the facilitator and the videoconferencing experience, and the intervention cost analysis revealed opportunities for cost saving via the use of videoconferenced facilitation. Improvements to the intervention suggested by participants included integrating chronic illness management with medical information systems, involving other health disciplines, and forming networks of community health resources and support services for health providers and patients. This work has demonstrated that although practice facilitation can successfully result in moderate significant improvements in practice behaviour, it is not necessarily singularly effective in all contexts or for all targeted behaviours. A complex practice guideline such as the chronic illness care management model is unlikely to be adopted in the current context of primary care in rural Ontario and as a consequence to have any impact on the health of chronically ill patients without further intervention supports, adaptation, and implementation research undertaken to demonstrate successful execution of chronic illness care management. Alternative care delivery models are required to address barriers and improve the delivery of chronic illness care management.

The aim of this study was to describe and analyze how social workers working in social services using evidence based practice with special focus on the clients’ experiences and wishes as source of knowledge in collecting information, assessment and decision. To get to the social workers experiences and descriptions we used a qualitative method with semistructured interviews. The empiric material of the study consists of eight interviews with social workers working in different social offices in different areas, in southern Sweden. The main result of this study was that social workers use clients’ experiences and wishes differently in different parts of the investigations. The client gets decreasingly space the further into the investigation process the social worker gets; the clients’ experiences and wishes are used largely in the initial phase of the investigation, when it comes to collect information, and decreases when it comes to assessment and decision. For the clients’ experiences and wishes to be a part of the investigation at all we also found out that there are some conditions that have to be fulfilled, such as a cooperative and motivated client and sufficient workplace recourses. Another finding of the study was that social workers define and use evidence based practice in different ways and a number of conditions have to be fulfilled in order to the use of evidence based practice. In a second analyze we’ve looked into the social workers competence related to the findings of the main analyze, and one of the results of that was that social workers competence matter when it comes to the use of the clients’ experiences and wishes in their work.

Against the backdrop of the transformations in the entire framing of professional work, social work has come under close scrutiny in many countries, including Sweden. Doubts have been raised about practitioners’ existing knowledge base, and the importance of practitioners engaging in learning and the renewal and extension of professional capacities has been emphasized. The present thesis concerns knowledge use and learning in the daily practices of child investigation work. The aim is to explore processes of knowledge use and learning in practice. The study is based on a mix of qualitative approaches, basically from ethnography, comprising methods such as participant observations, interviews, reflective dialogues and documentary analysis of case data. The main findings demonstrate that investigation work is characterized mainly by the use of practice-based knowledge. Research-based knowledge is predominantly used as a means of explaining a client’s situation or to underpin and legitimize one’s own beliefs and decisions made on other grounds. Professional learning is largely adaptive in character, as the social workers learn to handle tasks in a fairly routinized way on the basis of rules or procedures that draw on existing knowledge in the practice setting. Two conclusions are drawn: First, the use of knowledge in child investigation work bears little resemblance to principles of evidence-based practice. Second, the reproduction of professional knowledge is largely implicit and taken for granted. The study offers insight into the much-discussed topic of putting knowledge into practice, which is of importance to strategies for organizing profes sional learning and knowledgeable practice. / Ett i allt högre grad vetenskapsbaserat samhälle har lett till att kunskapsbasen i många verksamheter ifrågasatts, däribland socialt arbete. Avhandlingen behandlar kunskapsanvändning och lärande i utredningsarbetet inom den sociala barn- och ungdomsvården. Syfte är att öka kunskapen kring hur individer använder kunskap och lär sig i och genom sin dagliga praktik. Avhandlingen baseras på fyra delstudier som genomförts i tre svenska kommuners socialtjänst. Det empiriska materialet består av deltagande observationer, intervjuer, reflekterande dialoger och dokumentanalyser. Studien tar sin utgångspunkt i ett kognitivt perspektiv på lärande med teoretiska rötter i pragmatism. Ett grundläggande antagande bakom studien är att lärandet utgår från hur individen tolkar och förstår den situation som hen möter och därefter handlar. Resultaten visar att utredningsarbetet företrädesvis baseras på praktikbaserad kunskap som erhålls från tidigare erfarenheter och kollegor. Forskningsbaserad kunskap används huvudsakligen för att bekräfta och legitimera en uppfattning och inte för att ifrågasätta och utmana existerande åsikter och antaganden. Lärandet kan främst karaktäriseras som ett anpassningsinriktat lärande där praktikern med stöd i tidigare erfarenheter och utifrån befintlig kunskapsbas skapar rutiner för att hantera arbetet. Kunskapsanvändningen inom den sociala barn- och ungdomsvården ligger långt ifrån idealen för evidensbaserad praktik. Reproduktionen av professionell kunskap sker främst implicit och utan frågasättande. Förståelse för praktikers faktiska kunskapsanvändning och lärande har central betydelse för hur verksamheter kan organiseras för att stödja lärande i arbetet.

Syftet med studien var att kartlägga vilka förutsättningar boendestödjare i Värmland och Dalsland har att hantera sina arbetsuppgifter utifrån kompetens och evidens. Vi använde oss av en kvantitativ metod och gruppenkäter för att kunna göra denna kartläggning. Studien riktade sig till enhetschefer inom socialpsykiatrin samt dess personal som jobbar inom boendestöd mot brukare med egen bostad. Två enkäter gjordes varav den ena riktades mot enhetscheferna och den andra mot personal. Totalt tillfrågades 23 kommuner att delta i studien och av de svarade 17 kommuner på enkäterna vilket ger en svarsfrekvens på 74 %. Svarsfrekvensen bland boendestödjarna var 63 %. Studien ger en överblick hur verksamheterna inom boendestöd i Värmland och Dalsland arbetar med kompetens och evidens. Studiens resultat visade att majoriteten av personal inom boendestöd i Värmland och Dalsland hade den utbildning som fanns att tillgå för att jobba inom socialpsykiatrin, vilket är vård- och omsorgsutbildning. För att få reda på hur det ser ut med kompetensutveckling i kommunerna slogs tre frågor samman och bildade ett index. De flesta kommuner i studien hade kompetensutvecklingsplaner och studien visade ingen skillnad mellan stora och små kommuner. Personalen hade en positiv attityd till hur genomförandeplaner används. När det gäller att arbeta med ny forskning bör det enligt studiens resultat ske en förändring då det var få som hade en positiv attityd till hur ny forskning tas in i arbetet. / The purpose of the study was to identify preconditions for housing support within competence and evidence- based work in Värmland and Dalsland. We used a quantitative method with questionnaires. The study was directed to unit managers in social psychiatry and its staff working in housing support for clients in their own homes. Two questionnaires were maid, one which was directed to unit managers and the other towards staff. A total of 23 municipalities were asked to participate in the study and of the 17 municipalities that responded to the questionnaire giving a response rate of 74%. The response among using support was 63%. The study provides an overview how competence and evidence- based work are used of housing support in Värmland and Dalsland. The results of the study show that the majority of staff in housing support in Värmland and Dalsland has the education that is available to work in social psychiatry, which is health and social care education. Most municipalities in the study has development plans, and there is no difference between large and small municipalities. The test gave a positive result showing a high reliability value. The staff had a positive attitude towards the execution plans used in work. When it comes to working with new research a change should take place according to the result of the study because the attitude was not positive how new research are used in work.

The feedback is a central component of medical education. Unfortunately, medical teachers often believe that provide adequate feedback to students. But several studies show confl icting results. The aim of this paper is to review the main concepts associated to feedback in clinical education as part of the teaching–learning process. / Revisión por pares

Evidensbaserat förhållningssätt har varit högt prioriterat i svensk sjuksköterskeutbildning de senaste decennierna. Trots det är det endast en låg andel av nyutexaminerade sjuksköterskor som uppger att de använder forskning i sin vardag. Avsaknaden av ett evidensbaserat förhållningssätt i den verksamhetsförlagda utbildningen har på senare år visat sig vara en av anledningarna till att sjuksköterskestudenter inte upplever sig utveckla ett evidensbaserat förhållningssätt. Syftet var att beskriva sjuksköterskors uppfattning av att handleda studenter i evidensbaserat förhållningssätt inom kommunal hälso- och sjukvård. Fenomenografisk ansats användes till analys av två fokusgruppsintervjuer med sjuksköterskor från två olika kommunala sjuksköterskeenheter. Det framkom fyra huvuduppfattningar som resulterade i beskrivningskategorier; 1) vetenskaplig kommunikation, 2) vara med, 3) bygga av erfarenhet och 4) begränsas av tid. Det gemensamma temat som framkom var att förstå kontexten. Med hjälp av handledarledd reflektion kunde studentens kliniska kompetens och helhetsyn utvecklas, vilket möjliggjorde en förståelse för kontexten. Först då var det möjligt för studenten att sammanfoga de tre delarna i evidensbaserat förhållningssätt: klinisk kompetens, bästa tillgängliga kunskap och patientens situation och önskemål. Resultatet visar på ett behov av samarbete mellan det kliniska och det teoretiska i sjuksköterskeutbildningen. För att möjliggöra en god handledning i evidensbaserat förhållningsätt skulle det vara värdefullt att utforska hur samarbetet mellan högskolan och den kliniska verksamheten kan stärkas. / Evidence-based practice has been highly prioritized in Swedish nursing education in recent decades. Nevertheless, only a low percentage of newly graduated nurses report that they use research in their daily work. The lack of evidence-based practice in the clinical education has been proven to be one of the reasons that nursing students’ did not develop competence in evidence-based practice. The purpose was to describe nurses' perceptions as preceptors teaching evidence-based practice in municipal health care. Phenomenological approach was used to analyze two focus group interviews at two municipal health care units. The data analysis resulted in four description categories; 1) scientific communication 2) be involved, 3) build through experience and 4) limited by time. Understanding of the context emerged as the common theme. With the help of preceptor-led reflection, the student's clinical skills and holistic view of the patient could be developed, which enabled an understanding of the context. Only then it was possible for the student to merge the three parts of evidence-based practice; clinical expertise, best available knowledge and patient's situation and preference. The result shows a need for cooperation between the clinical and theoretical part of nursing education. To develop a good preceptorship in teaching evidence based care it would be valuable to explore how cooperation between the university and the clinical settings can be improved.

Orientador: Wilza Carla Spiri / Resumo: Introdução: a Liderança Transformacional (LT) é um processo em que o líder é capaz de compreender a importância do seu papel como agente de mudanças e transformação nas organizações. Conduz a equipe na realização de mudanças positivas e na forma como desempenham suas atividades. Assume responsabilidades, oferece aos liderados conhecimento e fortalecimento, conduzindo-os na motivação, empoderamento, busca de desafios, visibilidade e desenvolvimento de forma a modificar comportamentos, formando profissionais e pessoas focados para melhores resultados por meio de seus próprios exemplos e atitudes. Objetivo: compreender o significado de LT e propor um ambiente de aprendizagem por meio de uma intervenção educativa com discussão de temas sobre liderança. Método: Realizado em duas etapas. Na primeira etapa adotou-se a análise de conteúdo como estratégia metodológica, segundo o referencial de Graneheim e Ludman. A segunda etapa utilizou a pesquisa-ação como estratégia de construção coletiva de uma intervenção educativa para a reflexão sobre a prática gerencial e sua interface com a liderança transformacional. O cenário da pesquisa foi a rede de urgência e emergência de um município paulista. Os participantes foram os nove enfermeiros que ocupavam a posição de gerentes, três desses eram enfermeiros assistenciais que substituem os gerentes das unidades de Pronto Atendimento e do Pronto Socorro Municipal. Todos os participantes eram do sexo feminino, com tempo na função variando de três... (Resumo completo, clicar acesso eletrônico abaixo) / Doutor

Introduction Nursing is a independent scientific discipline with one main aim: maintain and support health of population. Nursing care is performed by skilled nurse using nursing techniques. Particular nursing techniques are always modified by current state of health and needs of patient. Together with other disciplines, also nursing must refect changes of the modern age. Nursing practice and theory lead to qualitative changes by implementing of evidence-based practice. Evidence-based practice in nursing is process connecting best nursing experience and expertise of nurses, which together determine the optimal care. Goals of the thesis To complete this thesis, three goals were determined. Firts goal was to find out, what was the source of particular nursing techniques performed by nurses. Second goal was to find out, if "good practise" was used when performing particular nursing techniques. Last goal was to fin out, what was the general knowedge of the "evidence based practise" phrase among nurses. Materials and methods Research investigation of the thesis was performed using the methods of qualitative and quantitative research. Quantitative research was perfefomed using the questionnaires distributed among general nurses working at inpatient wards. Results of research were evaluated using graphs and tables. Pearson´s chi square test was used for statistical processing. Qualitative research was executed using the direct observation method. Six different categories were set. Data were colected to record form, which was later on used for analysis of observed figures. Observation was focused on comprehensive hygienic care, divided into following categories: oral hygiene, care of hospital clothing, bathing of not self-sufficient patient, care of nails, skin and washing the hair. Results Results of the thesis allowed to clarify links between performing the hygiene care and evidence-based practise / good practise. These results can also be used as a contribution on coferences regarding this topic and as a material in teaching the nursing. Using the statistically preocessed data, hypotehsis were evaluated. H1: General nurses perform particular nuring techniques more based on habitual practise of their department than on local professional health care standards. H1 was confirmed. H2: General nurses perform particular nursing techniques more based on habitual practise of their department then on EBN. H2 was confirmed. H3: General nurses with the bachelors or masters degree have better awareness of EBN than nurses witout university degree. H3 was confirmed. Research question was asked - What is the role of EBN in particular nursing techniques? Observation study revealed that EBN is not of high importance in performing nursing hygiene care. Conclusion Thesis could highlight weaknesses in providing hygienic care and evidenced based nursing. It could also inspire all who perform their job with joy and respect and wish all the best for their patients. Last but not least, thesis could inspire all who want to provide fist-rate and safe care and leave the work with self-satisfaction.

The purpose of this study was to explore and describe the knowledge that a cohort of 40 intensive care unit nurses had of evidence-based practice. It was assumed that they lacked the knowledge to locate, evaluate understand and apply research findings. Quantitative, non-experimental descriptive research was conducted to explore their knowledge and to formulate recommendations for promoting it. Data collection involved administering a structured questionnaire administered to the cohort in an intensive care unit. The findings revealed that, although they were familiar with the basic concept of evidence-based practice, they were reluctant and lacked the skills to adopt it in their practice. It is recommended that they be trained and empowered to develop research expertise from within their own ranks. Finally it is recommended that nursing management should play a more proactive role in identifying cost-effective strategies in overcoming barriers to finding, promoting and integrating evidence-based practice / Health Studies / M.A. (Health Studies)

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2018. / Background ABSTRACT In the chiropractic profession, it has been an established goal to utilise evidence-based practice (EBP) in clinical practice in order to empower chiropractors to develop effective treatment protocols. However, the extent to which chiropractors are utilising EBP, and the factors associated with its implementation in practice is unknown. The lack of research in this regard suggests that further studies need to be undertaken within the chiropractic profession in South Africa in order to fully understand the relationship of factors which contribute to the adoption and application of EBP by chiropractors in clinical practice. Therefore, the aim of this study was to investigate the knowledge of, attitudes towards, perceptions of and perceived barriers towards EBP by chiropractors within the eThekwini municipality. Method A pre-validated cross sectional descriptive survey was administered to chiropractors practicing within the eThekwini municipality (n = 101) by hand delivery. The questionnaire was validated by means of a focus group and pilot testing. Participants gave informed consent prior to participation. Data were analysed using using SPSS Statistics 24.0 and Statgraphics Centurion 15.1 (2006) to determine the descriptive and inferential statistics while the open- ended questions were analysed qualitatively using manifest coding. Results A response rate of 51% (n=51) was obtained. The majority of respondents were male (51%), mean age of 37.8 years, practicing for less than 19 years, working in full time practice (76.5%) between 40 and 49 hours per week (45.1%). The majority of the respondents had a positive attitude and perception towards EBP with respondents showing a willingness to improve skills (72.6%) and utilisation (52.9%) of EBP. Respondent 15 explained that “it is very important to have the skills in order to utilise EBP. Once you have the skills, utilising EBP becomes easy”. Responses highlighted that respondents are engaging with scientific literature when necessary and possess the skills necessary to utilise EBP. The majority of respondents believe that they had a strong academic foundation in their knowledge and skills related to accessing and interpreting information, yet 47.1% reported not having received formal training in search strategies to access literature. However, most felt confident about their knowledge and skills to utilise EBP. Insufficient time (66.7%), lack of generalisability of the literature findings to their patient population (49.0%) and the inability to apply research findings to individual patients with unique characteristics (45.1%) were the three top barriers identified. Respondent 12 described: “most articles are vague or time consuming and searching for relevant, up to date and reliable articles is a difficult process that can take a lot of time” as a possible barrier to utilising EBP. Conclusion The respondents in this study had a favourable attitude towards, and perception of, EBP and its usefulness to chiropractic practice. However, like other healthcare professionals they felt that they had insufficient time to utilise EBP. This study also highlighted the importance of academic institutions providing the necessary skills required to utilise EBP. It is recommended that workshops focusing on EBP principles and training are arranged to assist practitioners in integrating EBP into practice / M