This article is about social workers that assess disabled people’s needs and their abilities to implement a new way of working. The National Board of Health and Welfare (Socialstyrelsen) in Sweden are developing a new way of working in these cases and it’s supposed to make the social work more evidence based. The National Board of Health and Welfare has already developed this kind of instrument for the social workers who assess needs of children and elderly people and now it’s time for those who work with disabled people. Therefore, I have chosen to study which possibilities these social workers have to implement this new method called IBIC (Individens Behov I Centrum - The individual’s needs in focus, my translation). I have based my study on three factors that are important that the persons involved in an implementation have in order for the implementation to succeed. They are: comprehension, capability and willingness. The aim was to get an understanding based on the three factors comprehend, capability and willingness of which abilities the assessment workers have to implement IBIC and how this would affect the profession. To reach that aim I have interviewed six social workers who assess the needs of disabled persons. The social workers were chosen because of their work title and after approval by their managers. I was able to get one who has worked 22 years, two who has worked around 10 years and three who has just started working. This meant that I got a good distribution in length of experience. In my sample there is also one who has worked with the standardized work method for children that I mentioned earlier. The results show that most of the social workers comprehend IBIC but it is doubtful whether or not they have the capability and the willingness to implement it. The result also shows that an implementation of IBIC most likely would mean that the profession which now is based on occupational values would move towards organizational professionalism.

Bakgrund Evidensbaserad vård (EBV) är ett välkänt begrepp som används för att tillförsäkra patienter en säker vård som vilar på bästa tillgängliga bevis, beprövad erfarenhet och patientens individuella preferenser. Många studier har tidigare undersökt hinder för sjuksköterskor att bedriva och/eller implementera EBV för att förklara gapet som kan uppstå mellan teori och praktik. Färre studier har undersökt vilka faktorer som främjar sjuksköterskors användande av EBV. Syfte Att genom en litteraturöversikt beskriva vilka faktorer som främjar sjuksköterskors möjligheter att bedriva en evidensbaserad vård. Metod Studien genomfördes som en litteraturöversikt. Databaserna CINAHL, PubMed och Web of Science genomsöktes och 15 artiklar valdes ut (8 kvalitativa, 4 kvantitativa och 3 mixedmethod). Resultat Fem kategorier identifierades som främjande faktorer för sjuksköterskor att bedriva och/eller implementera EBV; arbetsmiljö, stöd, kunskap, sjuksköterskans inställning och organisation. Stöd i form utav underlättare var den mest framträdande faktorn. Slutsats Sjuksköterskan har ett individuellt ansvar att bedriva EBV och kan genom sin egen inställning påverka att en sådan vård bedrivs. De flesta främjande faktorer som framkom var dock tydligare kopplade till ledningen och chefens del i att främja användandet av EBV. / Background Evidence-based practice (EBP) is a well-known term used to ensure that patients receive a safe care based on the best research evidence, clinical expertise and patient individual preferences. A variety of studies have examined the barriers for nurses to conduct and/or implement EBP to explain the gap that can occur between theory and practice. Fewer studies have examined the factors facilitating nurses’ use of EBP. Aim Was to describe the factors facilitating nurses’ use of evidence-based practice through a literature review. Methods The study was conducted as a literature review. The databases searched were CINAHL, PubMed and Web of Science and 15 articles were chosen for the result (8 qualitative, 4 quantitative and 3 mixed-method). Results Five categories were identified as facilitating factors for nurses to conduct and/or implement EBP; work environment, support, knowledge, nurses’ attitude and organization. Support from facilitators were the most emerging factor. Conclusion Nurses have individual responsibility to conduct EBP and can through their attitude influence that it’s being used, though a majority of the facilitating factors identified were more direct connected to the leadership and managerial part in facilitating the use of EBP.

Preliminary research exists indicating the importance of counselor attitudes and organizational features as influencing use of evidence-based practices (EBPs). Conceptual models of evidence-based practice implementation posit relationships among factors theoretically associated with use of an EBP, yet little research exists that explores how a constellation of counselor characteristics relate to counselors’ use of evidence-based practices. Research is also lacking on the role of counselor characteristics in use of motivational interviewing, a specific evidence-based practice. In addition to identifying counselor characteristics associated with use of MI, this study explores how counselor characteristics directly and indirectly affect implementation relationships for MI. The study sample comes from a larger study testing how organizational facilitation influences outpatient substance abuse counselors’ use of MI, and client outcomes. Multiple regression was used to explore the contribution of counselor characteristics (amount of MI training, MI skill level, motivation to use MI, supportive attitudes toward MI, perception of organizational climate and MI skill level) on reported use of MI. Analyses with each dependent variable had different sample sizes: N=76 for relationships tested between counselor characteristics and use of MI and N=46 for relationships tested between counselor characteristics and MI skill level. Results suggest that among these characteristics, supportive attitudes related to MI and motivation to use MI significantly contribute to counselors’ use of MI with clients. Further, supportive attitudes related to MI and motivation to use MI each partially mediates the relationship between amount of MI training and counselor use of MI. But, findings are tempered by a sample comprised of relatively low levels of training and low MI skill level. Despite having very little training, and low skill levels, high usage of MI was reported by counselors. More empirical research utilizing larger samples with higher training levels is needed to better understand how counselor characteristics may affect EBPs implementation in order to promote the effective use of evidence-based practices. / text

The rising population of older people in the UK (Office for National Statistics 2010) and pressure on healthcare services to reduce costs indicate the necessity of developing strategies that enable coping and independence. Loss through death of close family members, partners and friends is a key factor that inhibits physical, emotional and social well being of older people. The research carried out for this thesis explored bereavement in healthcare settings where contacts with bereaved older people commonly occur, and used data collected to develop guidelines for practice. The guidelines provide research informed enhancement to bereavement care and develop opportunities for meaningful interactions. They complement current policy development work on bereavement in healthcare settings (The Scottish Government 2011). A qualitative design drawing on phenomenological methodology was used to explore healthcare staffs’ experiences of caring for bereaved older people, and older people’s experiences of being bereaved and bereavement care. Theoretical sampling took place to recruit staff from a range of roles in general practice and community nursing, hospital wards and care homes, as well as a small sample of bereaved older people. Thirty nine participants took part in in-depth interviews that yielded four key themes: bereavement care depends on a relationship between healthcare staff and relatives; preparation for a relative’s death may not equate to preparedness for bereavement; the ‘Open Door’ to bereavement care is only slightly ajar, and bereavement care supports progression of the ‘Rolling Ball’ of life. The themes informed development of the guidelines in terms of structure and content. Recommendation statements consider bereavement care before the death; at the time of the death; and follow up in the weeks and months afterwards. Criteria in the recommendations provide suggestions for enhancements to practice that facilitate appropriate response to bereavement in older people. Consultation on the guidelines provided positive feedback that identified the potential to promote consistent interactions with bereaved older people, respond to needs and support coping.

Systematic reviews and meta-analyses have been a central pillar of evidence-based practice and policy-making in healthcare over recent years. Traditionally, this has focused on effectiveness evidence from trials.. There is increasing understanding, however, that other study designs also provide essential information and this has led to interest in developing ways to review and synthesis such evidence. Qualitative research has unique potential to illuminate the patient experience. This research has three aims: 1) To review and compare the proposed methods of systematic review and synthesis of qualitative research. 2) To develop and assess two methods of systematic review and synthesis of qualitative research. 3) To compare these two methods and suggest how they might be used in a policy-making context. In addressing these aims, this thesis substantially contributes to debates about the purpose and practice of systematic review and synthesis of qualitative research, particularly in the context of health technology assessment and related pOlicy-making. I undertake a unique critical comparison of the methods suggested for reviewing and synthesising qualitative research, based on their approach to key stages of systematic review. This is used to produce a comprehensive framework for good practice~ I use the framework in two systematic reviews, one about heavy menstrual bleeding using meta-ethnography, and one about hysterectomy using meta-study. These two reviews allow a comparison of the two methods, and in particular explore the impact of expanding the meta-ethnography approach through meta-study, which adds explicit steps to assess the impact of study methodology and theory on findings. The ability of meta-study to unpack the procedures and theories that produce particular findings is key and illuminates the importance of theory in systematic reviews of qualitative research. Through the two systematic reviews, my thesis also contributes to understanding of these reproductive health topic areas through the creation of new insights and concepts from the synthesis. The synthesis of heavy menstrual bleeding studies produced a detailed patient illness model based on women's experiences. In addition, it allowed an understanding of elements that contribute to women's certainty or uncertainty about whether or not their periods could be seen as problematic and requiring medical help. This helps to establish the limitations of the medical model for doctors, as well as women who suffer from heavy menstrual bleeding. The synthesis of hysterectomy studies produced a detailed description of the journey that women make to, and through, hysterectomy, based on their experiences. I also created a theoretical framework, which shows that hysterectomy needs to be understood in the context of personal, physical experiences, together with sociocultural forces that affect the way in which hysterectomy is experienced, and that the interaction of these micro- and macro-concerns mediate through, and affect, relationships with key other people. Methodology affected the research questions posed and the conclusions of research. Comparing the two methods of review and synthesis showed the importance of taking account of the methods and theories that produce research findings. However this additional detail may be at the expense of certainty and requires additional resources.

Given the importance of client characteristics and preferences, and therapist expertise to evidence-based practice in psychology, the current study sought to contribute to the literature concerning the role of values in psychotherapy. Personal values of clients and trainee therapists in 29 dyads were examined for relationships between client and therapist values and associations with working alliance and outcomes. Although previous literature in this area has suggested that successful therapy is characterized by an increase in similarity of client and therapist values, the current study did not replicate this finding. However, client perceptions of therapist values were found to be important to working alliance and outcome. Findings are discussed in terms of suggestions for future research as well as implications for clinical practice, including the importance of discussing expectations and preferences with clients.

Submitted in partial compliance with the requirements for a Master's Degree in Technology, Durban University of Technology, Durban, South Africa, 2015. / Background The Chiropractic profession is considered a form of complementary and alternative therapy which began as a vitalistic approach to health care. Over the years research has become a main focus of the profession in order to validate its claims for its treatment modalities, with the profession having made advances in producing high quality research (Newell and Cunliffe, 2003). In an era of evidenced based practice medical professionals are required to use research findings to guide their practice therefore their perceptions towards using research are important to ascertain. Although there is some literature on Chiropractors' perception of research most studies focus on specific regional populations. Very few if any studies have assessed perceptions of research from different Chiropractic populations at the same time. The aim of this study was to determine the perception, knowledge and utilisation of research and its role in the Chiropractic profession as determined by Chiropractic delegates attending an international Chiropractic conference. In order to provide information to the profession as to how Chiropractors from varying regions perceive research and to see if the shift seen in other health care professions towards evidence based practice is seen in the chiropractic profession. Method This quantitative, cross sectional, descriptive survey was administered to Chiropractic delegates attending the World Federation of Chiropractic biennial conference 2013 in Durban, South Africa. The questionnaire was compiled by using the available literature and validated by means of a focus group and pilot testing. The questionnaire was administered to the delegates as part of their delegate packs at the conference and was made available electronically via SurveyMonkey© after the conference. Participants were required to give written informed consent prior to partaking in the research. The research protocol was approved by the Durban University of Technology Institutional Research Ethics Committee (REC 26/13). On completion the questionnaire and the signed letter of information and consent were deposited into separate sealed containers at the conference or stored on SurveyMonkey© . When the study closed, data was coded into an excel spread sheet and imported into IBM SPSS version 21 for statistical analysis. Descriptive and inferential statistics were used to analyse the data Results A response rate of 34.48% (n = 140) was obtained. More than half of the respondents were male (52.2%), from the African region (51.1%), in possession of a master's degree in Chiropractic (51.4%), and were involved in professional chiropractic practice (60.7%). The respondents had a favourable perception towards research (51.4%), with almost all respondents perceiving that research was essential to the progression of the Chiropractic profession (97.5%). A more favourable perception of research was found in those who were from Europe as opposed to Africa (p = 0.001) and had an evidence based practice (EBP) philosophical orientation as opposed to a mixer or straight approach (p < 0.001). Overall the respondents displayed an adequate knowledge of research terminology (59.2%), with those from Europe as opposed to Africa (p = 0.001) having improved research knowledge along with those who had an EBP philosophical orientation (p < 0.001) compared to the straights and mixer approaches. In terms of research utilisation the respondents showed a high utilisation of research to improve clinical practice (88.9%), for self-development (90.1%) and to change their approach to conditions, polices and practice in their area of the Chiropractic profession (83%). There was a trend that being from Europe, North America and Australisia resulted in high research utilisation than those from Africa and Asia. The effectiveness of Chiropractic care for various musculoskeletal conditions was seen as the primary research focus area for the profession (95.1%), with 75% of the respondents wanting the profession to move in the direction of science as opposed to a philosophical focus. The respondents perceived research to play an integral role within Chiropractic by promoting its acceptance among other health care professionals (87%) and by third party payers (70%). Conclusion The respondents in this study had a favourable perception, knowledge and utilisation of research and supported the role of research and science in the future of the Chiropractic profession. Future studies should be conducted on more diverse groups of Chiropractors to see if the findings of this study are replicated, as well as investigate the disparity observed between developed and developing countries. / PDF copy unavailable. please refer to hard copy for full text information / M

The primary objective of the current study was to attempt to establish whether there is a need for a dysphagia training programme for nurses and speech-language therapists working with acute tracheostomised patients in critical care units in South Africa. The research design that was adopted for this project was within a mixed methods approach framework. An exploratory descriptive survey design using semi-structured face-to-face interviews was used. The final sample consisted of interviews with 20 speech-language therapists from eight different hospitals with critical care facilities and 12 nurses from four different hospitals with such facilities. Data from the close ended questions were analysed using descriptive statistics, while remaining data from open ended questions were thematically analysed and the constant comparison method was applied. The data demonstrated that all speech-language therapists and 10 out of the 12 nurses were in agreement that there was a need for a dysphagia training programme for nurses in critical care for tracheostomised patients presenting with dysphagia. An important and unexpected result of this study was that speech-language therapists themselves required additional training in this area. The data demonstrated that the majority of speech-language therapists and nurses were of the view that they had received minimal theoretical and practical hours on tracheostomy screening, assessment and management at an undergraduate level. Overall, the results of the current study suggested varied practices in the screening, assessment and management of tracheostomy and dysphagia, particularly with regard to blue dye testing, suctioning protocols and cuff inflation and deflation protocols. The research significance and implications of the study included the need to improve undergraduate training for speech-language therapists and nurses in the area of dysphagia and tracheostomy, to alert professional training bodies regarding institution of additional licensing and qualifications for speech-language therapists and nurses in the area of dysphagia and tracheostomy, and to thereby improve the situation of clinicians practising in dysphagia and tracheostomy management through the development of guidelines, protocols and position papers. An important implication of this research is that it established the need for a dysphagia training programme for both speech-language therapists and nurses in critical care in dysphagia and tracheostomy, and thereby monitoring the efficacy of this programme and measuring/monitoring the outcomes of multidisciplinary teamwork in the assessment and management of dysphagia and tracheostomy in critical care.

Today's society places greater demands on how preventative and promotional efforts should be based on evidence for optimal results. Public health workers have a great responsibility to act and support the population ahead in a positive healthy direction where evidence-based methods are to form the basis of their actions, but simultaneously they perceive high demands, lack of resources and difficulties in controlling their work situation. This leads to the purpose; how this group of workers relate to and are affected by evidence-based practices in relation to the three themes of this thesis; demands, resources and control. Eleven participants went through semi-structured interviews and a content analysis was conducted by the author on the transcribed material. Results are presented in line with the content of the three themes where demands are represented by categories named time limits, workload and responsibility; resources are represented by cooperation, adequate guidance and budget; and control is represented by context adjustments and loneliness. Public health workers are affected by evidence-based methods where perceived demands lower their ability to function efficiently, where resources are vital and where control is threatened by perceived obstacles but is longed for. Together, public health workers are pillars for raising the well-being of residents and they need attention because their actions affect us all.

Introdução: o modelo predominante de assistência ao parto no Brasil caracteriza-se pelo uso abusivo ou inadequado de intervenções e cerceamento dos direitos da parturiente (restrição à presença de acompanhante de escolha da mulher, realização de amniotomia de rotina durante o trabalho de parto, posição litotômica de rotina, infusão intravenosa de ocitocina de rotina, puxo dirigido e pressão no fundo uterino da parturiente durante a expulsão fetal) em todos os períodos clínicos do parto. Sabe-se que esse modelo pode ser modificado com a adoção das boas práticas de assistência ao parto normal preconizadas pela Organização Mundial da Saúde. Embora as melhores práticas no parto e nascimento estejam fundamentadas em evidências científicas, faltam pesquisas sobre sua implementação na prática clínica. Objetivo geral: avaliar o impacto da implementação das práticas baseadas em evidências na assistência ao parto normal. Método: estudo de intervenção quase experimental, tipo antes e depois, baseado na metodologia de implementação de evidências científicas na prática clínica do Instituto Joanna Briggs. Foi conduzido no Hospital da Mulher Mãe Luzia, maternidade pública de referência para a assistência obstétrica em Macapá, Amapá. Foram entrevistados 42 profissionais (enfermeiros e médicos obstetras e residentes das duas categorias) e 280 mulheres atendidas no trabalho de parto e parto. Também foram analisados dados de 555 prontuários de puérperas. A pesquisa foi desenvolvida em três fases: auditoria de base (fase 1), intervenção educativa (fase 2) e auditoria pós-intervenção (fase 3). A intervenção educativa consistiu em um seminário denominado Seminário de práticas baseadas em evidências científicas na assistência ao parto normal, oferecido para os profissionais. A coleta de dados ocorreu entre julho de 2015 e março de 2016. Os achados foram analisados comparando-se os dados das fases 1 e 3, adotando-se o nível de significância de 5%. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem da Universidade de São Paulo. Resultados: após a intervenção educativa, houve incremento de 8,3 p.p. na taxa de parto normal. Na entrevista com as mulheres, constatou-se aumento de 10,0 p.p. (p=0,002) da presença do acompanhante durante o trabalho de parto e de 31,4 p.p. (p<0,001) no uso da posição vertical ou cócoras. A realização de amniotomia foi reduzida em 16,8 p.p. (p=0,005), o uso de posição litotômica em 24,3 p.p. (p<0,001), a utilização de ocitocina em 17,1 p.p. (p=0,004), os puxos dirigidos em 29,3 p.p. (p<0,001) e a manobra de Kristeller em 10,7 p.p. (p=0,013). Na perspectiva dos profissionais, houve redução da prescrição ou administração de ocitocina de 29,6 p.p. (p=0,005). Na análise dos dados dos prontuários, observou-se redução significativa da taxa de amniotomia em 29,5 p.p. (p<0,001) e de posição litotômica em 1,5 p.p. (p=0,013), enquanto a taxa de posição vertical ou cócoras apresentou incremento de 2,2 p.p. (p=0,013). Conclusões: a intervenção educativa revelou impacto positivo na melhora da assistência à mulher durante o trabalho de parto e parto, com aumento da taxa de parto normal e, também, na visão das mulheres, que alegaram ter mais acompanhantes de sua escolha, poder adotar mais posições verticalizadas no período expulsivo, utilizar menos ocitocina, puxos dirigidos e manobra de Kristeller. Esses resultados conferem em parte com o dos profissionais, que citaram realizar menos orientação de puxos dirigidos e prescreverem menos ocitocina. Também coincidem parcialmente com as anotações dos prontuários, que incluem aumento das posições verticais e redução da posição litotômica e da prática de amniotomia. No entanto, verificou-se que os profissionais continuam empregando práticas como posição litotômica de rotina, puxos dirigidos e manobra de Kristeller, no período expulsivo. Conclui-se que houve um impacto positivo na proposta conduzida, mas mostra que o processo de implementação de evidências científicas na assistência ao parto normal adotado não foi capaz de obter sucesso completo na mudança das práticas obstétricas dos profissionais participantes. / Background: the predominant model of childbirth care in Brazil is characterized by abusive or inappropriate use of interventions and parturient\'s rights disrespect (such as restriction of presence of the chosen companion of the woman, routine amniotomy, routine lithotomy position, routine oxytocin intravenous infusion, directed pushing, and fundal pressure during second stage of labour) in all clinical periods of the childbirth. This model of care could be modified adopting good practices on maternal health recommended by World Health Organization. Despite the evidence-based best practices in childbirth, there is a lack of research on its implementation into clinical practice. Aim: to evaluate the impact of the implementation of evidence-based practices on normal birth. Method: before and after quasi-experimental study based on Joanna Briggs Institute Evidence Implementation method. It was conducted at Mãe Luzia Women\'s Hospital, a reference maternity hospital for maternity care in Macapá, Amapá, Brazil. Interview of 42 professionals (nurses, obstetricians and residents of both categories) and 280 women who were attended during labour and birth. Data from 555 puerperium records were also analysed. The research was developed in three phases: baseline audit (phase 1), educational intervention (phase 2) and post-intervention audit (phase 3).The educational intervention was a seminar named \"Scientific evidence-based practices on normal childbirth seminar\", attended by the professionals. Data were collected from July 2015 to March 2016. The findings were analysed comparing the data from phases 1 and 3, adopting a level of significance of 5%. There search was approved by the Research Ethics Committee from School of Nursing of University of Sao Paulo. Results: after the educational intervention, there was an increase of 8.3 p.p. in normal birth rate. According to the interviewed women, there was an increase of 10.0 p.p. (p = 0.002) in the presence of companion during labour and of 31.4 p.p. (p <0.001) in the adoption of vertical or squatting position to give birth. The amniotomy was reduced by 16.8 p.p. (p = 0.005), lithotomy position by 24.3 p.p. (p<0.001), oxytocin infusion by 17.1 p.p. (p = 0.004), directed pushing by 29.3 p.p. (p <0.001) and Kristeller maneuver by 10.7 p.p. (p = 0.013). In the professionals\' perspective, it was found a reduction in oxytocin prescription (29.6 p.p.; p = 0.005). In medical records data analysis there was a reduction on amniotomy rate (29.5 p.p.; p<0.001) and lithotomy position (1.5 p.p.; p = 0.013), while vertical or squatting position had increased in 2.2 p.p. (p = 0.013). Conclusions: the educational intervention showed a positive impact improving women´s care during labour and birth, increasing normal birth rate. Also in the women´s view, having more companions of their choice, they were able to adopt vertical positions in the second stage of labour and had less oxytocin infusion, directed pushing and Kristeller maneuver. These results confer in part with these of the interviews with professionals, who have cited performing less direct pushing and prescribed less oxytocin infusion. These results are also similar with the medical records, which include increase in the adoption of vertical positions and the reduction of lithotomic position and amniotomy. However, it was verified that professionals still practice lithotomic position, directed pushing and Kristeller maneuver in the second stage of labour. The educational intervention had a positive impact, but did not have complete success in changing professional practices.