Indiana University-Purdue University Indianapolis (IUPUI) / The implementation of evidence into practice is a complex process. Estimates indicate that it takes seventeen years on average for research to be translated into practice. Delay in implementation of evidence-based practice (EBP) results in poor patient outcomes and negative impacts to healthcare systems. While many factors contribute to delayed implementation of evidence, organizational characteristics of healthcare institutions have a significant impact on implementation. Leaders play a critical role by influencing these organizational characteristics to support evidence-based practice implementation. A key leadership role within acute care healthcare organizations is that of the front-line nurse manager (NM). Front-line nurse managers have responsibility for nursing unit operations and clinical nurses who deliver patient care under the nurse managers supervision. The relationship between NM leadership competencies and implementation of EBP is not well understood. Therefore, there is a critical need to identify how NM leadership behaviors influence the implementation of EBP. This dissertation examined the relationship between NM leadership behaviors and implementation of EBP. Results link the role of the NM to evidence-based clinical practice, and describe competencies and education needed for NM development. With an understanding of the NM leadership behaviors associated with implementation of EBP, healthcare leaders can develop education, processes, and interventions to increase competencies on NM leadership behaviors. Better implementation support by NMs will result in an improvement in use of EBPs. To examine the NM leadership behaviors that are associated with implementation of EBP, the following activities were completed: (1) an integrative review of the literature related to NM competencies associated with implementation, (2) identification and description of nurse manager competencies associated with EBP implementation using the Delphi method, and (3) examination of NM leadership behaviors associated with implementation of EBP during the COVID-19 pandemic response through a multi-site descriptive correlational survey of NMs and their nursing staff. Results of these studies demonstrate the importance of NM leadership characteristics and behaviors on EBP implementation.

Excerpt: Nursing and nurse leaders have the opportunity to advance nursing practice and improve patient outcomes unlike any time in the past.

Evidence-based practice was originally defined by Sackett et al. (1996) as the use of current research evidence, clinical expertise and client wishes in making clinical decisions. To date, several studies have outlined facilitators and barriers to evidence-based practice implementation in mental health treatment settings. Few have studied evidence-based practice implementation in interdisciplinary mental health treatment settings. This research explored how clinicians working in interdisciplinary mental health treatment settings 1) define evidence-based practice, 2) report on factors influencing evidence-based practice implementation, and 3) perceive the promoters and barriers to evidence-based practice implementation. This research analyzed data from three studies. In the quantitative portion 233 clinicians participated in an online survey. Descriptive results indicated that clinician scores for knowledge (understanding of and confidence in evidence based-practice) and attitude (positive opinion about evidence-based practice) were high. However, descriptive results also indicated that scores for outcome (perceived impact of evidence-based practice) were moderate and scores for behaviour (frequency clinicians access research evidence) were low. Further analysis showed that nearly 50% of evidence-based practice outcome was explained by education, profession, knowledge and attitude, and approximately 15% of clinician behaviour was explained by knowledge. In the qualitative portion 8 clinicians were interviewed. The results showed that half of the clinicians defined evidence-based practice as research evidence and the other half defined it as research evidence with clinical expertise and client preferences. The interviews identified four components essential to evidence-based practice implementation: creating conditions; accessing evidence; motivating practice; reflecting critically. The interviews also uncovered four tensions clinicians experienced central to evidence-based practice: valuing research evidence vs. clinical expertise; fidelity vs. customization; defining roles vs. role sharing; implementing evidence-based practice vs. managing clinical workload pressures. The findings across the studies highlighted the importance of knowledge, evidence, access and time to optimize evidence-based practice implementation. The results showed that evidence-based practice implementation could be facilitated by a more unified definition, clearer expectations on the part of clinicians and organizations, and a shift in focus from education to behaviour change and monitoring implementation. / Thesis / Doctor of Philosophy (PhD) / Evidence-based practice involves using research evidence to make decisions about client treatment. The purpose of this project was to examine how different mental health professionals in the same setting define and implement evidence-based practice. This research was conducted using two online surveys of over two hundred clinicians and face-to-face interviews with eight clinicians. The surveys found that clinicians had an understanding of evidence-based practice and positive opinions about evidence-based practices but saw moderate impact of evidence-based practice and infrequency in searching for research evidence. The research found that reasons for impact included: education, profession, knowledge and attitude. One cause for search infrequency was knowledge. The interviews found that about half defined evidence-based practice as only research evidence and the other half as research evidence, clinician experience and client wishes. The interviews also illuminated the process of putting evidence-based practice into place and some areas of tension. Similarities across all of the research were the importance of knowledge, access to evidence and time to engage in evidence-based practice.

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)

Evidence-based practice, whose roots emanate from the mid-1960s, aims to provide fair, high-quality, and soundly researched health care with patients' best interests as a priority. Clinical practice guidelines are evidence-based and designed to assist clinicians with sound decision making. Despite the importance of evidence-based practice and the efforts invested into its development and dissemination, its uptake and implementation are poor. The disconnect between evidence-based practice and its translation into clinical practice was previously reported in low-to-middle income countries. This study investigated South African audiologists' and otorhinolaryngologists' (ear, nose and throat specialists') self-reported orientation to evidence-based practice. Second, adherence to evidence-based clinical practice guidelines was assessed with reference to the diagnosis and management of benign paroxysmal positional vertigo, a common vestibular condition for which a firm evidence base supporting treatment exists. A two-part quantitative approach was adopted. Part one surveyed South African audiologists and otorhinolaryngologists with the Evidence-Based Practice Profile Questionnaire and an additional researcher-developed questionnaire pertaining to the diagnosis and management of benign paroxysmal positional vertigo. A total of 130 survey responses were included in this study. Independent sample t-tests, one-way ANOVAs and Fisher's Exact tests were used to analyse the survey data. Part two used a retrospective record review at a tertiary academic hospital in the Western Cape of South Africa. Medical folders of patients diagnosed with benign paroxysmal positional vertigo, between 2010 – 2018 (n = 80), were analysed. The diagnosis and management strategies were recorded and compared against a gold standard evidence based guideline for congruence. Descriptive statistics were used to analyse and understand the data. Survey scores showed a positive association between increased years of experience and healthcare professionals' knowledge (p = .008) and confidence (p = .003) in evidence-based practice. Otorhinolaryngologists might be more knowledgeable than audiologists in evidence-based practice due to their increased training and exposure to evidence-based practice in their specialising years. Findings from the retrospective record review suggested adherence to the clinical practice guidelines in the diagnosis and management of posterior semi circular canal benign paroxysmal positional vertigo. The study outcomes propose that evidence-based clinical practice guidelines developed in the Global North may not be appropriate for the different health contexts that exist in low-to-middle income South Africa (e.g., rural settings). However, the benign paroxysmal positional vertigo clinical practice guidelines were adhered to at a tertiary, academic hospital in Cape Town. The results also support the notion that increased exposure to evidence-based practice reinforces its approach. Outcomes from this study raise implications for the development and dissemination of context-appropriate, evidence-based clinical practice guidelines.

Evidence-based practice (EBP) is recognized as a means for providing safe, cost-effective, and quality healthcare. Registered Nurses (RNs), like other disciplines, are accountable for providing patient care based on the best evidence. The greatest majority of RNs are employed within the acute care setting. Unknown is what type of organizational infrastructure is necessary to support RNs in EBP. The business community reports positive performance outcomes through development of learning organizations (LO). LOs are reputed to be high functioning, supportive, adaptive, and continuously learning systems, compatible with the needs reflected in today's complex, turbulent healthcare. This descriptive study used a survey methodology to identify relationships between the dimensions of a LO as perceived by RNs within the context of the acute care hospital and their beliefs about and implementation of EBP. Six hospitals, two magnet designated, two non-magnet, and two Veterans Administration Medical Centers in one southwestern state were invited to participate. Three established instruments were used. Distribution of questionnaires to 1750 RNs resulted in a return of 592, for a 34% response rate. Instruments demonstrated adequate reliability and validity for this sample. Psychometrics on the EBP Beliefs Scale resulted in the identification of four subscales that were subsequently included in the analyses. Descriptive statistics indicated differences in characteristics of nurses from the different types organizations. The VA nurse's average age was 48 years, worked 19 years as an RN and 64% reported their highest educational degree as bachelor or above. Nurses responding from the other two types of organizations, on the average, were 42 years old, had 14 years experience, and 52% reported an educational degree of bachelor or above. Relationships were identified between RNs' perceived beliefs about EBP and their reported frequency of EBP implementation. Regressing beliefs on the dependent variable of implementation with the full sample (n=543) resulted in R2=.23, p<.05. Slight variation was noted in the analysis per organizational type. Relationships among the dimensions of the learning organization and the subscales of the Belief scale were analyzed using regression analysis. Significant relationships were noted but were demonstrated differently among the three different types of organizations.

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.

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Title: Evidence based practice within social work in Sweden: a systematic literature study Aim: The aim of this study was to investigate the research concerning EBP in a Swedish context. Method: a systematic literature study, wherein 16 articles were used and assessed using thematic analysis. Results: the study further clarifies the vagueness concerning the term EBP and what it contains. The results point to several factors which facilitate as well as inhibit the implementation of EBP, and that organization and leadership pose a significant role in the development of social workers organizations. Further findings are the gap between theory and practice and the lack of research of EBP in a Swedish context. / <p>2019-06-04</p>

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.