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1. Am J Nurs. 2011 Mar;111(3):54-60. Evidence-based practice, step by step: implementing an evidence-based practice change.

Gallagher-Ford L, Fineout-Overholt E, Melnyk BM, Stillwell SB. Center for the Advancement of Evidence-Based Practice at Arizona State University in Phoenix, USA. lynn.gallagher-ford@asu.edu This is the ninth article in a series from the Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values. When delivered in a context of caring and in a supportive organizational culture, the highest quality of care and best patient outcomes can be achieved.The purpose of this series is to give nurses the knowledge and skills they need to implement EBP consistently, one step at a time. Articles will appear every other month to allow you time to incorporate information as you work toward implementing EBP at your institution. Also, we've scheduled "Chat with the Authors" calls every few months to provide a direct line to the experts to help you resolve questions. Details about how to participate in the next call will be published with May's Evidence-Based Practice, Step by Step. PMID: 21346469 [PubMed - indexed for MEDLINE]

2. J Nurs Manag. 2011 Jan;19(1):109-20. doi: 10.1111/j.1365-2834.2010.01144.x. Epub 2010 Dec 13. Evidence-based practice barriers and facilitators from a continuous quality improvement perspective: an integrative review. Solomons NM, Spross JA. Arizona State University, Phoenix, AZ, USA. nan.solomons@gmail.com AIMS: The purpose of the present study is to examine the barriers and facilitators to evidence-based practice (EBP) using Shortell's framework for continuous quality improvement (CQI). BACKGROUND: EBP is typically undertaken to improve practice. Although there have been many studies focused on the barriers and facilitators to adopting EBP, these have not been tied explicitly to CQI frameworks. METHODS: CINAHL, Academic Search Premier, Medline, Psych Info, ABI/Inform and LISTA databases were searched using the keywords: nurses, information literacy, access to information, sources of knowledge, decision making, research utilization, information seeking behaviour and nursing practice, evidence-based practice. Shortell's framework was used to organize the barriers and facilitators. RESULTS: Across the articles, the most common barriers were lack of time and lack of autonomy to change practice which falls within the strategic and cultural dimensions in Shortell's framework. CONCLUSIONS: Barriers and facilitators to EBP adoption occur at the individual and institutional levels. Solutions to the barriers need to be directed to the dimension where the barrier occurs, while recognizing that multidimensional

approaches are essential to the success of overcoming these barriers. IMPLICATIONS FOR NURSING MANAGEMENT: The findings of the present study can help nurses identify barriers and implement strategies to promote EBP as part of CQI. PMID: 21223411 [PubMed - indexed for MEDLINE]

3. J Am Acad Nurse Pract. 2011 Jan;23(1):8-14. doi: 10.1111/j.1745-7599.2010.00569.x. Epub 2010 Nov 5. Family presence during cardiopulmonary resuscitation: using evidence-based knowledge to guide the advanced practice nurse in developing formal policy and practice guidelines. Doolin CT, Quinn LD, Bryant LG, Lyons AA, Kleinpell RM. Spalding University, Louisville, Kentucky, USA. PURPOSE: To provide advanced practice nurses (APNs) with the best available evidence for implementation of policies and procedures to allow family presence during cardiopulmonary resuscitation (CPR) in the acute care environment. DATA SOURCES: A comprehensive review of research-based articles from Ebsco Host, CINAHL, Pre-CINAHL, and Medline Plus, as well as statement alerts from nursing credentialing bodies, and practice guidelines were reviewed. Kolcaba's Theory of Comfort and Lewin's Three Step Change Theory provide a framework for implementation of formal policies and procedures. CONCLUSIONS: Best available evidence showed more support in favor of allowing families at the bedside during CPR. Implementation of policies and procedures allowing family presence enables facilities to change and grow in a holistic and family-oriented atmosphere. IMPLICATIONS FOR PRACTICE: With this evidence-based knowledge the APN will be able to disseminate information to facilitate collaborative change in current practices surrounding staff education, decision making, and self-governance. The APN can then address controversial changes when developing formal policies and procedures, which will increase patient satisfaction and outcomes. PMID: 21208329 [PubMed - indexed for MEDLINE]

4. Prof Inferm. 2010 Jul-Sep;63(3):161-71. [Evidence-based practice in nursing curricula: the experience of nursing degree course of Reggio Emilia. A pilot study]. [Article in Italian] Finotto S, Chiesi I, Mecugni D, Casali P, Doro LM, Lusetti S. Tutor al Corso di Laurea in Infermieristica dell'Universit degli Studi di Modena e Reggio Emilia, Azienda Ospedaliera S. Maria Nuova di Reggio Emilia. Given the lack of evidence in literature concerning the presence of Evidence-Based Practice (EBP) in nursing curricula, but considering its importance in order to educate future nurses to use critical thinking and to base their practice on scientific evidence, tutors and nursing teachers of the Nursing

Degree Course of Reggio Emilia (Universit degli Studi di Modena e Reggio Emilia), have decided to introduce a three-year laboratory of EBP. The purposes of this project are: to describe the three-year EBP laboratory of Nursing Degree, its objectives, its structure, its integration with practical training and nursing subjects and its students evaluation strategies; to get students verify the perception of the usefulness of the three-year EBP laboratory regarding the elaboration of the graduation thesis, the search for appropriatem answers for patients met during clinical trainings and the usefulness of the EBP process in view of the development of their professional career. The design of research of this pilot study is correlation-descriptive. It has been selected a sample of convenience consisting of 56 nurses graduated in the autumn session of the academic year 2007-2008. For data collection we have used an electronic questionnaire (Microsoft Word with closed fields) structured for the purpose. The laboratory has been effective in learning to use the database to search for evidences and to use the database to search for evidences related to nursing problems met in training placements. Finally, graduated nurses consider the EBP process an essential element of professional nursing luggage. Although the sample is restricted the results indicates the good educational choice made by our Nursing Degree Course of integrating the EBP Laboratory in the curriculum. PMID: 21167112 [PubMed - indexed for MEDLINE]

5. Nurs Adm Q. 2011 Jan-Mar;35(1):21-33. Fostering evidence-based practice to improve nurse and cost outcomes in a community health setting: a pilot test of the advancing research and clinical practice through close collaboration model. Levin RF, Fineout-Overholt E, Melnyk BM, Barnes M, Vetter MJ. Lienhard School of Nursing, Pace University, Tuckahoe, NY, USA. rlevin@pace.edu Although evidence-based practice (EBP) improves health care quality, decreases costs, and empowers nurses, there is a paucity of intervention studies designed to test models of how to enhance nurses' use of EBP. Therefore, the specific aim of this study was to determine the preliminary effects of implementing the Advancing Research and Clinical practice through close Collaboration (ARCC) model on nurses' EBP beliefs, EBP implementation behaviors, group cohesion, productivity, job satisfaction, and attrition/turnover rates. A 2-group randomized controlled pilot trial was used with 46 nurses from the Visiting Nurse Service of New York. The ARCC group versus an attention control group had stronger EBP beliefs, higher EBP implementation behaviors, more group cohesion, and less attrition/turnover. Implementation of the ARCC model in health care systems may be a promising strategy for enhancing EBP and improving nurse and cost outcomes. PMID: 21157261 [PubMed - indexed for MEDLINE]

6. Pain Manag Nurs. 2010 Dec;11(4):245-58. Epub 2009 Sep 18. Prior conditions influencing nurses' decisions to adopt evidence-based postoperative pain assessment practices.

Carlson CL. Northern Illinois University School of Nursing, DeKalb, Illinois 60115, USA. clcarlson@niu.edu Over the past 30 years, postoperative pain relief has been shown to be inadequate. To provide optimal postoperative pain relief, it is imperative for nurses to use evidence-based postoperative pain assessment practices. This correlational descriptive study was conducted to identify factors, termed prior conditions, that influenced nurses' decisions to adopt three evidence-based postoperative pain assessment practices. A convenience sample of nurses who cared for adult postoperative patients in two Midwestern hospitals were surveyed, and 443 (46.9%) nurses responded. The previous practice and innovativeness of nurses were supportive of adoption of the three practices. Nurses felt that patients received adequate pain relief, which is unsupportive of adoption of the three practices because there is no impetus to change. Nurses who perceived the prior conditions as being supportive of adoption of pain management practices used multiple sources to identify solutions to clinical practice problems, and those who read professional nursing journals were more likely to have adopted the three practices and were more innovative. The number of sources used to identify solutions to clinical practice problems, previous practices, and innovativeness were predictive of nurses' adoption of the three evidence-based postoperative pain assessment practices. Nurses need to be encouraged to use multiple sources, including professional nursing journals, to identify solutions to clinical practice problems. Innovative nurses may be considered to be opinion leaders and need to be identified to promote the adoption of evidence-based postoperative pain assessment practices. Further exploration of the large unexplained variance in adoption of evidence-based postoperative pain assessment practices is needed. PMID: 21095599 [PubMed - indexed for MEDLINE]

7. Nurs Educ Perspect. 2010 Sep-Oct;31(5):290-3. A constructivist model for teaching evidence-based practice. Rolloff M. Bellin College, Green Bay, Wisconsin, USA. mary.rolloff@bellincollege.edu The Institute of Medicine has reported that it takes roughly 17 years for evidence generated through research to move into clinical practice. Bridging that gap is an urgent need and will require educators to rethink how nurses are prepared for evidence-based practice. The constructivist theory for learning--in which it is assumed that students construct knowledge and meaning for themselves as they learn--may provide a framework for a redesigned baccalaureate curriculum, one that supports evidence-based practice throughout a nursing student's education. PMID: 21086866 [PubMed - indexed for MEDLINE]

8. Nurs Prax N Z. 2010 Aug;26(2):14-25. Practice nurse use of evidence in clinical practice: a descriptive survey.

Prior P, Wilkinson J, Neville S. Child and Family Service, Waitemata District Health Board, Auckland. The role of practice nurses is a specific feature of the modernisation agenda of the New Zealand health service. Increasing importance is being placed on service improvement through effective decision making and enhanced clinical performance. To contribute to the development of primary health care it is crucial that nurses have the skills to appropriately implement research based and other evidence in practice. This study involved 55 West Auckland practice nurses working in the general practice setting. The aim of the study was to describe nurses' perceptions of their use of evidence-based practice, attitudes toward evidence-based practice and perceptions of their knowledge/skills associated with evidence-based practice. An additional aim was to determine the effect of educational preparation on practice, attitudes and knowledge/skills toward evidence-based practice. A descriptive survey design was selected for this study. The results demonstrated that nurses' attitudes toward evidence-based practice, knowledge and skills relevant to the implementation of evidence-based practice and the educational preparation of the nurses were important factors influencing the effective utilisation and application of research results in practice. Educational interventions are identified as an integral aspect of implementing evidence-based practice and enhancing practice nurses' knowledge and skill relevant to the use of evidence in practice. Further research is needed to assess the contextual factors which can inhibit or promote achievement of evidence-based practice by practice nurses. PMID: 21032971 [PubMed - indexed for MEDLINE]

9. Am J Nurs. 2010 Nov;110(11):43-51. Evidence-based practice, step by step: Critical appraisal of the evidence: part III. Fineout-Overholt E, Melnyk BM, Stillwell SB, Williamson KM. Center for Advancement of Evidence-Based Practice at Arizona State University in Phoenix, USA. ellen.fineout-overholt@asu.edu This is the seventh article in a series from the Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values. When delivered in a context of caring and in a supportive organizational culture, the highest quality of care and best patient outcomes can be achieved. The purpose of this series is to give nurses the knowledge and skills they need to implement EBP consistently, one step at a time. Articles will appear every two months to allow you time to incorporate information as you work toward implementing EBP at your institution. Also, we've scheduled "Chat with the Authors" calls every few months to provide a direct line to the experts to help you resolve questions. See details below. PMID: 20980899 [PubMed - indexed for MEDLINE]

10. J Adv Nurs. 2011 Jan;67(1):33-42. doi: 10.1111/j.1365-2648.2010.05488.x. Epub 2010 Oct 25. Implementation of evidence-based nursing practice: nurses' personal and professional factors? Eizenberg MM. Department of Health Systems Management, Yezreel Valley College, Israel. michalm@yvc.ac.il Comment in J Adv Nurs. 2011 Jan;67(1):3. AIMS: This paper is a report of a study conducted to explore the relationship between nurses' personal and professional factors and evidence-based nursing practice. BACKGROUND: Like most health-related professions, nursing is shifting from the traditional intuition-based paradigm to evidence-based nursing practice. METHODS: A cross-sectional survey was conducted in 2007 with a convenience sample of 243 nurses from northern Israel, who worked in hospitals or in the community. Associations between background variables and evidence-based nursing practice were examined. For the purpose of finding factors that predicted behaviour, a logistic regression analysis was conducted. RESULTS: The self-reported professional behaviour of nurses with a degree was more evidence-based than that of those without a degree. Moreover, evidence-based nursing practice was more likely where there was access to a rich library with nursing and medical journals, and opportunities for working with a computer and for searching the Internet in the workplace. The variables emerging as predicting evidence-based nursing practice were: education, skills in locating various research sources, support of the organization for searching and reading professional literature, knowledge sources based on colleagues and system procedures (inhibiting variable), knowledge sources based on reading professional literature, and knowledge sources based on experience or intuition. CONCLUSION: The findings point to the need for research-based information, exposure to professional journals and, in particular, organizational support for evidence-based nursing practice. PMID: 20969620 [PubMed - indexed for MEDLINE]

11. Qual Manag Health Care. 2010 Oct-Dec;19(4):330-48. A baseline study of communication networks related to evidence-based infection prevention practices in an intensive care unit. Rangachari P, Rissing P, Wagner P, Rethemeyer K, Mani C, Bystrom C, Dillard T, Goins D, Gillespie W. Department of Health Informatics, Medical College of Georgia, 1120 15th Street, Augusta, GA 30912, USA. prangachari@mcg.edu This study seeks to gain a baseline understanding of the communication network structure, content of communication, and outcomes in a medical intensive care

unit experiencing higher-than-expected central line blood stream infection (CLBSI) rates. The communication network structure refers to the direction and frequency of communication on evidence-based CLBSI prevention practices across various professional subgroups and hierarchical levels in the unit, including medical faculty, nurses, residents, students, unit managers, and hospital administrators. The content of communication refers to the type of knowledge (ie, tacit vs explicit knowledge) exchanged on CLBSI prevention practices. Outcomes include (1) compliance with CLBSI prevention practices and (2) hospital-acquired CLBSI rates in the unit. Data on communication network structure and content of communication are collected using communication logs completed weekly for 4 weeks, by individual participants in each professional subgroup and hierarchical level. Outcomes are collected weekly through chart (medical record) review. Study results indicate a sparse communication network structure with minimal interaction across professional subgroups and hierarchical levels. They also indicate that primarily explicit knowledge on general infection topics is being exchanged as against tacit knowledge on specific infection prevention practices. Unit outcomes are poor, with the central line bundle score at zero during all 4 weeks. The study represents an original attempt at developing methods for measuring the communication network structure related to evidence-based infection prevention practices at the unit level. It lays a foundation for testing hypotheses related to effective communication network structures for hospital infection prevention in a larger study. More significantly, the study lays a foundation for generating concrete and context-sensitive strategies for organizational learning and improvement in the context of evidence-based practices. Such insight is critical from the perspective of evidence-based health care management. PMID: 20924254 [PubMed - indexed for MEDLINE]

12. J Clin Nurs. 2010 Jul;19(13-14):1944-51. doi: 10.1111/j.1365-2702.2009.03184.x. Multi-institutional study of barriers to research utilisation and evidence-based practice among hospital nurses. Brown CE, Ecoff L, Kim SC, Wickline MA, Rose B, Klimpel K, Glaser D. Research/Evidence-based Practice Liaison, University of California San Diego Healthcare, San Diego, CA, USA. c7brown@ucsd.edu AIMS: The study aims were to explore the relationships between perceived barriers to research use and the implementation of evidence-based practice among hospital nurses and to investigate the barriers as predictors of implementation of evidence-based practice. BACKGROUND: Evidence-based practice is critical in improving healthcare quality. Although barriers to research use have been extensively studied, little is known about the relationships between the barriers and the implementation of evidence-based practice in nursing. Cross-sectional study.DESIGN: METHOD: Data were collected between December 2006-January 2007 for this cross-sectional study using computerised Evidence-Based Practice Questionnaire and BARRIERS surveys. A convenience sample (n=1301) of nurses from four hospitals in southern California, USA, participated. Hierarchical multiple regression analyses were performed for each of the three dependent variables: practice, attitude and knowledge/skills associated with evidence-based practice. BARRIERS subscales were used as predictor variables.

RESULTS: The perceived barriers to research use predicted only 27, 24 and 45% of practice, attitude and knowledge/skills associated with evidence-based It was unexpected that the barriers to research usepractice. Conclusions. predicted such small fractions of practice, attitude and knowledge/skills associated with evidence-based practice. The barriers appear to have minimal influence over the implementation of evidence-based practice for most hospital nurses. RELEVANCE TO CLINICAL PRACTICE: In implementing evidence-based practice, the focus on barriers to research use among general nursing staff may be misplaced. Further studies are needed to identify the predictors of evidence-based practice and to identify the subset of nurses who are most amenable to adopting evidence-based practice. PMID: 20920021 [PubMed - indexed for MEDLINE]

13. J Adv Nurs. 2010 Dec;66(12):2761-71. doi: 10.1111/j.1365-2648.2010.05442.x. Epub 2010 Sep 6. Implementing evidence-based practice: effectiveness of a structured multifaceted mentorship programme. Wallen GR, Mitchell SA, Melnyk B, Fineout-Overholt E, Miller-Davis C, Yates J, Hastings C. Nursing Research and Translational Science National Institutes of Health, Clinical Center, Bethesda, Maryland, USA. gwallen@cc.nih.gov AIM: This paper is a report of the effectiveness of a structured multifaceted mentorship programme designed to implement evidence-based practice in a clinical research intensive environment. BACKGROUND: Barriers to implementing evidence-based practice are well-documented in the literature. Evidence-based practice is associated with higher quality care and better patient outcomes than care that is steeped in tradition. However, the integration of evidence-based practice implementation into daily clinical practice remains inconsistent, and the chasm between research and bedside practice remains substantial. METHODS: This quasi-experimental mixed methods study included three focused discussions with nursing leadership and shared governance staff as well as pre(N = 159) and post-intervention (N = 99) questionnaires administered between June 2006 and February 2007. Online questionnaires included measures of organizational readiness, evidence-based practice beliefs, evidence-based practice implementation, job satisfaction, group cohesion and intent to leave nursing and Participants in the evidence-based practice mentorshipthe current job. Results. programme had a larger increase in perceived organizational culture and readiness for evidence-based practice and in evidence-based practice belief scores than those who did not participate. Qualitative findings suggested that leadership support of a culture for evidence-based practice and the dedication of resources for sustainability of the initiative needed to be a priority for engaging staff at all levels. CONCLUSION: These findings corroborate other studies showing that nurses' beliefs about evidence-based practice are significantly correlated with evidence-based practice implementation and that having a mentor leads to stronger beliefs and greater implementation by nurses as well as greater group cohesion, which is a potent predictor of nursing turnover rates.

PMCID: PMC2981621 [Available on 2011/12/1] PMID: 20825512 [PubMed - indexed for MEDLINE] 14. J Nurs Adm. 2010 Sep;40(9):348-51. Evaluating the evidence in evidence-based design. Stichler JF. School of Nursing, San Diego State University, California, USA. jstichler@aol.com Evidence-based practice has become a valued process on which to base our clinical and facility design decisions, yet not all evidence is created equal. This facility design department aims to expand nurse leaders' knowledge and competencies in health facility design and enables them to take leadership roles in design efforts. This article focuses on the need to critical appraise facility design research articles and rate the strength of the evidence using a hierarchical model. PMID: 20798615 [PubMed - indexed for MEDLINE]

15. J Nurs Educ. 2010 Dec;49(12):691-5. doi: 10.3928/01484834-20100831-07. Epub 2010 Aug 31. Teaching research and evidence-based practice using a service-learning approach. Balakas K, Sparks L. Clinical Research Partnerships, Goldfarb School of Nursing, Barnes-Jewish College, St. Louis, MO 63110, USA. KaBalakas@bjc.org Because nurses are expected to engage in evidence-based practice (EBP), nursing students must learn to critically evaluate and apply research findings to prepare for professional practice. To connect research and EBP, the focus of a baccalaureate research course was changed from a traditional format to one of evidence appraisal and synthesis. Using an approach that incorporated service-learning and collaborative learning resulted in a new hybrid course that provided students with an opportunity to apply concepts in the real world. Working with a community partner, students were able to develop PICO (Population, Intervention, Comparison, and Outcome) questions and critically appraise the literature to establish the evidence base for three pediatric programs. Students reported that working with a community partner was a meaningful experience because course assignments had a direct impact on current practice. Research courses taught from an EBP perspective can provide motivation for students to incorporate research into their practice as professional nurses. PMID: 20795608 [PubMed - indexed for MEDLINE]

16. Am J Nurs. 2010 Sep;110(9):41-8. Evidence-based practice, step by step: critical appraisal of the evidence: part

II: digging deeper--examining the "keeper" studies. Fineout-Overholt E, Melnyk BM, Stillwell SB, Williamson KM. Center for Advancement of Evidence-Based Practice at Arizona State University in Phoenix, USA. ellen.fineout-overholt@asu.edu Erratum in Am J Nurs. 2010 Nov;110(11):12. This is the sixth article in a series from the Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values. When delivered in a context of caring and in a supportive organizational culture, the highest quality of care and best patient outcomes can be achieved. The purpose of this series is to give nurses the knowledge and skills they need to implement EBP consistently, one step at a time. Articles will appear every two months to allow you time to incorporate information as you work toward implementing EBP at your institution. Also, we've scheduled "Chat with the Authors" calls every few months to provide a direct line to the experts to help you resolve questions. Details about how to participate in the next call will be published with November's Evidence-Based Practice, Step by Step. PMID: 20736710 [PubMed - indexed for MEDLINE]

17. J Nurses Staff Dev. 2010 Jul-Aug;26(4):170-7. Self-efficacy-based training for research literature appraisal: a competency for evidence-based practice. Kiss TL, O'Malley M, Hendrix TJ. School of Nursing, University of Alaska Anchorage, Anchorage, AK 99701, USA. teri.kiss@bannerhealth.com Evidence-based practice requires nurses to integrate research findings into patient care. The lack of skill and confidence in effective literature appraisal remains a barrier for many nurses. The author describes a self-efficacy-based pilot project designed to enhance nurses' skill and confidence, thus increasing their ability and willingness to critically evaluate research findings. After the intervention, nurses were better prepared to critically appraise the literature and, through enhanced readiness, were more inclined to make evidence-based practice a clinical reality. This approach may be beneficial to staff development educators to develop and enhance an evidence-based practice culture. PMID: 20683302 [PubMed - indexed for MEDLINE]

18. Gastroenterol Nurs. 2010 Jul-Aug;33(4):263-6. Evidence-based practices of gastroenterology nurses.

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Baker KA, Ellett ML, Sharon DB. Texas Christian University, Fort Worth, TX 76129, USA. kathy.baker@tcu.edu Evidence-based practice (EBP) incorporates use of the best scientific knowledge, expert opinion, clinician experience, and patient preferences to facilitate the best patient outcomes in healthcare. Recent studies have suggested that nurses lack the skills and expertise to facilitate EBP in a meaningful way. This replication study (n = 225) investigated the EBPs of gastroenterology nurses in the United States. Findings generally support the previous studies that suggest nurses do not yet possess the skills or resources to implement EBP. Recommendations for addressing this deficit in the specialty of gastroenterology nursing are discussed. PMID: 20679777 [PubMed - indexed for MEDLINE]

19. J Am Geriatr Soc. 2010 Aug;58(8):1532-7. doi: 10.1111/j.1532-5415.2010.02964.x. Epub 2010 Jul 19. Knowledge of evidence-based urinary catheter care practice recommendations among healthcare workers in nursing homes. Mody L, Saint S, Galecki A, Chen S, Krein SL. Division of Geriatric Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA. lonamody@umich.edu OBJECTIVES: To assess the knowledge of recommended urinary catheter care practices among nursing home (NH) healthcare workers (HCWs) in southeast Michigan. DESIGN: Self-administered survey. SETTING: Seven NHs in southeast Michigan. PARTICIPANTS: HCWs. MEASUREMENTS: The survey included questions about respondent characteristics and knowledge about indications, care, and personal hygiene pertaining to urinary catheters. The association between knowledge measures and occupation (nurses vs aides) was assessed using generalized estimating equations. RESULTS: Three hundred fifty-six of 440 HCWs (81%) responded. More than 90% of HCWs were aware of measures such as cleaning around the catheter daily, glove use, and hand hygiene with catheter manipulation. They were less aware of research-proven recommendations of not disconnecting the catheter from its bag (59% nurses, 30% aides, P<.001), not routinely irrigating the catheter (48% nurses, 8% aides, P<.001), and hand hygiene after casual contact (60% nurses, 69% aides, P=.07). HCWs were also unaware of recommendations regarding alcohol-based hand rub (27% nurses and 32% aides with correct responses, P=.38). HCWs reported informal (e.g., nurse supervisors) and formal (in-services) sources of knowledge about catheter care. CONCLUSION: Significant discrepancies remain between research-proven recommendations pertaining to urinary catheter care and HCWs' knowledge. Nurses and aides differ in their knowledge of recommendations against harmful practices, such as disconnecting the catheter from the bag and routinely irrigating catheters. Further research should focus on strategies to enhance dissemination of proven infection control practices in NHs.

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PMCID: PMC2955179 [Available on 2011/8/1] PMID: 20662957 [PubMed - indexed for MEDLINE] 20. Nurse Educ Today. 2011 Feb;31(2):168-72. Epub 2010 Jun 29. The practical skills of newly qualified nurses. Danbjrg DB, Birkelund R. Dortheboe@gmail.com This paper reports the findings from a study of newly qualified nurses and which subjects the nurses regarded as the most important in order to be able to live up to the requirements of clinical practice, and how they experience their potential for developing practical and moral skills, after the decrease in practical training. A qualitative approach guided the research process and the analysis of the data. The data was collected by participant observation and qualitative interviews with four nurses as informants. The conclusions made in this study are based on the statements and the observations of the newly qualified nurses. Our findings are discussed in relation to the Aristotelian concept and other relevant literature. The main message is that the newly qualified nurses did not feel equipped when they finished their training. This could be interpreted as a direct consequence of the decrease in practical training. Our study also underlines that the way nursing theory is perceived and taught is problematic. The interviews revealed that the nurses think that nursing theories should be applied directly in practice. This misunderstanding is probably also applicable to the teachers of the theories. PMID: 20591541 [PubMed - indexed for MEDLINE]

21. Am J Nurs. 2010 Jul;110(7):47-52. Evidence-based practice step by step: Critical appraisal of the evidence: part I. Fineout-Overholt E, Melnyk BM, Stillwell SB, Williamson KM. Center for the Advancement of Evidence-Based Practice, Arizona State University, Phoenix, USA. ellen.fineout-overholt@asu.edu This is the fifth article in a series from the Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values. When delivered in a context of caring and in a supportive organizational culture, the highest quality of care and best patient outcomes can be achieved.The purpose of this series is to give nurses the knowledge and skills they need to implement EBP consistently, one step at a time. Articles will appear every two months to allow you time to incorporate information as you work toward implementing EBP at your institution. Also, we've scheduled "Chat with the Authors" calls every few months to provide a direct line to the experts to help you resolve questions. Details about how to participate in the next call will be published with September's Evidence-Based Practice, Step by Step.

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22. J Contin Educ Health Prof. 2010 Spring;30(2):132-8. Comparison of evidence-based practice between physicians and nurses: a national survey of regional hospitals in Taiwan. Chiu YW, Weng YH, Lo HL, Hsu CC, Shih YH, Kuo KN. Division of Health Policy Research and Development, Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli, Taiwan. INTRODUCTION: Although evidence-based practice (EBP) has been widely investigated, few studies compare physicians and nurses on performance. METHODS: A structured questionnaire survey was used to investigate EBP among physicians and nurses in 61 regional hospitals of Taiwan. Valid postal questionnaires were collected from 605 physicians and 551 nurses during February to May 2007. RESULTS: Physicians were more aware of EBP than nurses. Although both groups had high recognition of belief in and favorable attitudes toward EBP, their knowledge of and skill in EBP were relatively low. When compared with nurses, physicians were more willing to support the promotion of EBP implementations in clinical services. Physicians' knowledge and skills regarding the application of EBP principles were greater than nurses. Furthermore, physicians more often accessed the on-line evidence-retrieval databases, including the Cochrane Library. The most commonly ranked barriers to EBP applications for both groups included lack of designated personnel, lack of convenient kits, limited basic knowledge of EBP, and time. In general, nurses generated more barriers than physicians. DISCUSSION: There were significant discrepancies between physicians and nurses in their awareness of, attitude toward, knowledge of, skill in, behavior toward, and barriers regarding EBP. In implementing EBP, strategies to overcome barriers and provide on-line evidence-retrieval systems should differ for physicians and nurses. PMID: 20564703 [PubMed - indexed for MEDLINE]

23. Nurs Sci Q. 2010 Jul;23(3):226-30. The limitations of evidenced-based practice. Baumann SL. City University of New York, USA. Comment in Nurs Sci Q. 2010 Oct;23(4):354. Evidence based practice seeks to replace practice as usual, with practice guided by rigorous outcome-oriented research, ideally randomized controlled trials. It also seeks to make practice a less subjective enterprise, and to raise it to a higher level of accountability. It is associated with efforts to identify best practices in nursing and other disciplines. The limitations of evidence-based

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practice for nursing are not routinely discussed or considered by many clinicians. In this article the author raises several critical questions about the use of evidence-based practice in nursing. The author also suggests that nurses need to develop and use their own nursing perspective to help guide their synthesis of knowledge from diverse sources, which needs to be creatively and respectfully applied in each patient encounter. PMID: 20558652 [PubMed - indexed for MEDLINE]

24. Am J Nurs. 2010 May;110(5):41-7. Evidence-based practice, step by step: searching for the evidence. Stillwell SB, Fineout-Overholt E, Melnyk BM, Williamson KM. Nurse Educator Evidence-Based Practice Mentorship Program at Arizona State University in Phoenix, USA. sstillwell@asu.edu Comment in Am J Nurs. 2010 Oct;110(10):15. This is the fourth article in a series from the Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values. When delivered in a context of caring and in a supportive organizational culture, the highest quality of care and best patient outcomes can be achieved. The purpose of this series is to give nurses the knowledge and skills they need to implement EBP consistently, one step at a time. Articles will appear every two months to allow you time to incorporate information as you work toward implementing EBP at your institution. Also, we've scheduled "Chat with the Authors" calls every few months to provide a direct line to the experts to help you resolve questions. See details below. PMID: 20520115 [PubMed - indexed for MEDLINE]

25. Br J Nurs. 2010 Apr 8-21;19(7):442-7. Observations in acute care: evidence-based approach to patient safety. Preston R, Flynn D. University of Bedfordshire, UK. Both the National Patient Safety Agency and National Institute for Clinical Excellence have recommended that nurses must competently carry out observations, accurately interpret the data and make appropriate decisions on that data if unnecessary deaths are to be avoided. This review explores patient safety through a review of nurses' knowledge, skills and practices of recording observations in acute clinical settings (TPR, BP, blood glucose levels, blood oxygen saturation levels and neurological function). Findings from different research studies indicate the respiratory rate in particular is a sensitive indicator of clinical

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deterioration, but is the one observation that is poorly performed in acute care. The review also highlights the advantages and disadvantages of using electronic recording devices and using early warning systems that have been designed to identify patients at risk of deterioration. In addition to this, the review explores what nurses need to know about physiological compensatory mechanisms in order to facilitate accurate detection and reporting of clinical deterioration in acute care. Some recommendations for improving nurses' competence in doing the observations are considered. These recommend nurses should attend the ALERT course (acute life threatening events recognition and treatment), within the first eighteen months post qualifying if working in acute care. It is also recommended that further development of simulation exercises in both pre and post registration courses may help to foster 'what is best practice' for doing the observations in acute care. PMID: 20505604 [PubMed - indexed for MEDLINE]

26. J Healthc Qual. 2010 May-Jun;32(3):15-22. Evidence-based practice in healthcare: an exploratory cross-discipline comparison of enhancers and barriers. Asadoorian J, Hearson B, Satyanarayana S, Ursel J. School of Dental Hygiene, Faculty of Dentistry, University of Manitoba, Winnipeg, MB, Canada. joanna_asadoorian@umanitoba.ca In order to improve health outcomes, healthcare providers need to base practice on current evidence. The purpose of this qualitative study was to explore and compare the understanding and experiences with evidence-based practice (EBP) in three different disciplines. Researchers conducted individual interviews with psychiatrists, nurses, and dental hygienists. The majority of study participants demonstrated an understanding of EBP and were able to identify enhancers and barriers to implementing EBP. Using a grounded theory approach, several major themes acting as enhancers and barriers to EBP emerged and revealed both differences and similarities within and across the three health disciplines. While saturation was not attempted, this exploratory research is important in contributing to understanding the cultural practice milieu in relation to individual characteristics in implementing evidence into practice with the overall aim of improving healthcare delivery and outcomes. PMID: 20500776 [PubMed - indexed for MEDLINE]

27. J Nurs Manag. 2010 Jan;18(1):90-5. Evidence based practice and its critics: what is a nurse manager to do? O'Halloran P, Porter S, Blackwood B. School of Nursing and Midwifery, Queen's University Belfast, 10 Malone Road, Belfast, UK. p.ohalloran@qub.ac.uk AIM(S): The purpose is to discuss the arguments against the evidence based practice (EBP) movement and suggest how nursing management might respond.

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BACKGROUND: EBP is a pervasive approach to directing and regulating nursing care. There are, however, fierce critics who argue that it is fundamentally flawed and detrimental to patient care. EVALUATION: We consider some of the more radical criticisms of EBP, weighing the arguments and reflecting on the extent to which alleged short-comings are supported in the literature. Postmodernist critics are amongst the most vocal and are therefore our principal focus. KEY ISSUE(S): 'Best evidence' implies a hierarchical approach to knowledge which excludes other forms of evidence that are needed to understand the complexity of care. Evidence based guidelines tend to stifle critical thinking amongst nurses. CONCLUSION(S): While EBP is increasingly open to a range of research methodologies, it still largely subscribes to a hierarchy of evidence, even though this approach to addressing the complexities of healthcare is limiting. Although the EBP approach can be shown to stifle critical thinking, this is not inherent to the approach, which can lend itself to supporting professional nursing practice. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers should neither abandon EBP nor accept it uncritically. PMID: 20465734 [PubMed - indexed for MEDLINE]

28. J Nurs Manag. 2010 Jan;18(1):70-7. Evidence-based practice: the importance of education and leadership. Johansson B, Fogelberg-Dahm M, Wadensten B. Department of Oncology, Uppsala University Hospital, Uppsala, Sweden. birgitta.johansson@onkologi.uu.se AIM: To describe evidence-based practice among head nurses and to explore whether number of years of duty is associated with such activities. Further to evaluate the effects of education on evidence-based practice and perceived support from immediate superiors. BACKGROUND: Registered nurses in Sweden are required by law to perform care based on research findings and best experiences. In order to achieve this, evidence-based practice (EBP) is of key importance. METHOD: All 168 head nurses at two hospitals were asked to participate. Ninety-nine (59%) completed the survey. Data were collected using a study-specific web-based questionnaire. RESULTS: The majority reported a positive attitude towards EBP, but also a lack of time for EBP activities. A greater number of years as a head nurse was positively correlated with research utilization. Education in research methods and perceived support from immediate superiors were statistically and significantly associated with increased EBP activities. CONCLUSIONS: The present study highlights the value of education in research methods and the importance of supportive leadership. IMPLICATIONS FOR NURSING MANAGEMENT: Education is an important factor in the employment of head nurses. We recommend interventions to create increased support for EBP among management, the goal being to deliver high-quality care and increase patient satisfaction. PMID: 20465731 [PubMed - indexed for MEDLINE]

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29. J Eval Clin Pract. 2009 Dec;15(6):1159-63. Registered nurses' application of evidence-based practice: a national survey. Bostrm AM, Ehrenberg A, Gustavsson JP, Wallin L. Knowledge Utilization Studies Program, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada. anne-marie.bostrom@ualberta.ca BACKGROUND: Evidence-based practice (EBP) is a worldwide approach to improving health care. There is, however, a shortage of studies examining whether or not newly graduated health care professionals are actually applying EBP in their daily work. OBJECTIVES: To examine the application of EBP in clinical practice by registered nurses (RNs) 2 years post graduation and to explore whether the application of EBP differed with regard to the clinical settings where RNs were working. METHOD: A cross-sectional design using a national sample. Data were collected in 2007 from 987 RNs (response rate 76%). Six items measuring respondents' self-reported extent of applying EBP were used. Results Of the 987 RNs, 19% formulated questions and performed searches in data bases, 56% used other information sources, 31% appraised the literature, 30% participated in practice development and 34% participated in evaluating clinical practice. A greater proportion of the RNs working in elder care applied EBP compared with the RNs working in hospitals, psychiatric care and primary care. CONCLUSIONS: The RNs applied the components of EBP to a rather low extent 2 years post graduation despite EBP being an important objective in Swedish health care and educational programmes since the 1990s. These findings support other studies reporting the implementation of EBP in organizations as a complex and often slow process. The differences in the RNs extent of applying EBP in relation to their workplace indicate that contextual factors and the role of the RN in the organization are of importance for getting EBP into practice. PMID: 20367720 [PubMed - indexed for MEDLINE]

30. J Perianesth Nurs. 2010 Apr;25(2):64-70. Information literacy for evidence-based practice in perianesthesia nurses: readiness for evidence-based practice. Ross J. Information literacy, the recognition of information required, and the development of skills for locating, evaluating, and effectively using relevant evidence is needed for evidence-based practice (EBP). The purpose of this study was to examine perianesthesia nurses' perception of searching skills and access to evidence sources. The design was a descriptive, exploratory survey. The sample consisted of ASPAN members (n = 64) and nonmembers (n = 64). The Information Literacy for Evidence-Based Nursing Practice instrument was used. Findings were that ASPAN members read more journal articles, were more proficient with computers, and used Cumulative Index to Nursing and Allied Health Literature (CINAHL) more frequently than nonmembers. The three top barriers to use of research were: lack of understanding of organization or structure of electronic databases, lack of skills to critique and/or synthesize the literature, and difficulty in accessing research materials. In conclusion, education is needed

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for critiquing literature and understanding electronic databases and research articles to promote EBP in perianesthesia areas. PMID: 20359640 [PubMed - indexed for MEDLINE]

31. Nurs Stand. 2010 Feb 17-23;24(24):40-9; quiz 50. Caring for patients with long-term conditions and depression. Haddad M. King's College London, Institute of Psychiatry. mark.2.haddad@kcl.ac.uk Long-term conditions are an increasingly important part of healthcare activity. The prevalence of these health problems is high and their personal and social effects are extensive, requiring an approach to health care that emphasises integration, continuity and self-care. The risk of depression is significantly increased among people with chronic illnesses. Recognising and assisting in the management of this aspect of care is a crucial part of the nurse's role. To help people with long-term conditions, services need to be organised so that the assessment and recall of all patients at risk is co-ordinated, and to ensure a range of treatments, including case management, is available for those who are depressed. Nurses need to be familiar with appropriate case-finding tools, and to have knowledge of and access to evidence-based treatments ranging from guided self-help and exercise, to problem-solving, antidepressant and cognitive therapies. PMID: 20359075 [PubMed - indexed for MEDLINE]

32. Worldviews Evid Based Nurs. 2010 Dec;7(4):214-25. doi: 10.1111/j.1741-6787.2010.00188.x. Motivating nurses' organizational citizenship behaviors by customer-oriented perception for evidence-based practice. Chang CS, Chang HC. Department of Business Administration, National Cheng Kung University and Department of Medical Information Management, College of Health Science, Kaohsiung Medical University, Taiwan. arthur0660@yahoo.com.tw BACKGROUND: There is a gap in the literature about the influence of customer-oriented perception on nursing personnel's organizational citizenship behaviors. Organizational citizenship behaviors are the type of contextual behaviors that are difficult to observe and measure as such behaviors are usually generated in quite subtle and unpredictable ways. AIMS: This study tested the hypothesis: Customer-oriented perception is associated with increased organizational citizenship behaviors for nurses. If nursing personnel's customer-oriented perception can increase their willingness to display organizational citizenship behaviors, it may facilitate hospital operation and enhance organizational effectiveness. METHODS: A cross-sectional design using a questionnaire survey of nurses in 10 medical centers was used. Five hundred copies of the questionnaire were

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distributed, and 232 effective copies were retrieved, with a valid response rate of 46.4%. Structural equation modeling was performed in SPSS 11.0 and Amos 7.0 (SPSS Inc., Chicago, IL, USA) statistical software packages. RESULTS: The main finding was that favorable customer-oriented perception is associated with increased organizational citizenship behaviors for nurses. IMPLICATIONS: Extensive training and customer-oriented performance evaluation are proposed in the hope of creating customer-oriented perception among nursing personnel and subsequently inspiring the display of organizational citizenship behaviors. PMID: 20345521 [PubMed - indexed for MEDLINE]

33. Br J Nurs. 2010 Feb 11-24;19(3):186-93. Nurses' understanding of patient-centred care in Bhutan. Pelzang R, Wood B, Black S. Jigme Dorji Wangchuk National Referral Hospital, Ministry of Health, Royal Government of Bhutan, Thimphu. AIM: The purpose of the study was to explore nurses' perceptions and understanding of patient-centred care (PCC) in Bhutan. BACKGROUND: Nurses' perceptions and understanding of PCC in Bhutan are unknown. METHODS: A non-probability convenience sample was taken and a mixed method (quantitative and qualitative descriptive) used. Survey questionnaires were administered to 87 Bhutanese nurses in three types of hospitals--the National Referral Hospital, the regional referral hospital and the district hospital. Descriptive statistics including frequency distribution, mean and standard deviation (SD) were used for analysis. Spearman's correlation coefficients were used to investigate relationships between demographic variables. RESULTS: The nursing labour force in Bhutan knows which behaviours are considered necessary for practising PCC. The mean (SD) rating of behaviours considered critical for practising PCC was 4.29 (0.22), five being the highest score. Bhutanese nurses described PCC, according to qualitative descriptive analysis, as being based on individual patient assessment (22/87 or 25% of respondents), using a holistic model of care (38/87 or 44%) that was based on evidence (38/87 or 44%). A higher level of education (79/87 or 91%) was found to be the main factor that would facilitate the development of PCC, while inadequate staffing, in terms of insufficient numbers of staff and lack of advanced practitioners (56/87 or 64%), was revealed as the main factor that hinders development of PCC. CONCLUSION: Bhutanese nurses believed certain behaviours were critical to PCC. Reform of higher nursing education, putting an emphasis on PCC, would improve nursing practice and increase its scope. PMID: 20220663 [PubMed - indexed for MEDLINE]

34. Neonatal Netw. 2010 Mar-Apr 1;29(2):117-22. Importance of nursing leadership in advancing evidence-based nursing practice. Bradshaw WG.

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Veteran's Administration Medical Center in St. Louis, Missouri, USA. Our patients depend on us to do the best on their behalf. If we do not take accountability for our practice, continually examining what is the best way to deliver care, we are limiting our role to technical skills and not fully actualizing our professional role. [Evidence-based practice] is essential to practicing safely as nurses (p. 53).1. PMID: 20211834 [PubMed - indexed for MEDLINE]

35. J Pediatr Health Care. 2010 Mar-Apr;24(2):81-94. Epub 2009 May 21. Strengthening PNP curricula in mental/behavioral health and evidence-based practice. Melnyk BM, Hawkins-Walsh E, Beauchesne M, Brandt P, Crowley A, Choi M, Greenburg E. Arizona State University College of Nursing & Healthcare Innovation, Phoenix, AZ, USA. INTRODUCTION: The incidence of mental health/behavioral and developmental problems in children and teens is escalating. However, many primary care providers report inadequate skills to accurately screen, identify, and manage these problems using an evidence-based approach to care. Additionally, educational programs that prepare pediatric nurse practitioners (PNPs) have been slow to incorporate this content into their curriculums. METHODS: The purpose of this project was to implement and evaluate a strengthened curriculum in 20 PNP programs from across the United States that focused on: (a) health promotion strategies for optimal mental/behavioral health and developmental outcomes in children, and (b) screening and evidence-based interventions for these problems. An outcomes evaluation was conducted with faculty and graduating students from the participating programs along with faculty and students from 13 PNP programs who did not participate in the project. RESULTS: Participating schools varied in the speed at which components of the strengthened curriculum were incorporated into their programs. Over the course of the project, faculty from participating programs increased their own knowledge in the targeted areas and reported that their students were better prepared to assess and manage these problems using an evidence-based approach. Although reports of screening for certain problems were higher in the graduating students from the participating schools than the non-participating schools, the overall use of screening tools by students in clinical practice was low. DISCUSSION: There is a need for educational programs to strengthen their curricula and clinical experiences to prepare students to screen for, accurately identify, prevent, and provide early evidence-based interventions for children and teens with mental health/behavioral and developmental problems. This project can serve as a national model for curriculum change. PMID: 20189060 [PubMed - indexed for MEDLINE]

36. Am J Nurs. 2010 Mar;110(3):58-61. Evidence-based practice, step by step: asking the clinical question: a key step

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in evidence-based practice. Stillwell SB, Fineout-Overholt E, Melnyk BM, Williamson KM. Nurse Educator Evidence-Based Practice Mentorship Program at Arizona State University in Phoenix, USA. sstillwell@asu.edu This is the third article in a series from the Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values. When delivered in a context of caring and in a supportive organizational culture, the highest quality of care and best patient outcomes can be achieved.The purpose of this series is to give nurses the knowledge and skills they need to implement EBP consistently, one step at a time. Articles will appear every two months to allow you time to incorporate information as you work toward implementing EBP at your institution. Also, we've scheduled "Ask the Authors" call-ins every few months to provide a direct line to the experts to help you resolve questions. Details about how to participate in the next call will be published with May's Evidence-Based Practice, Step by Step. PMID: 20179464 [PubMed - indexed for MEDLINE]

37. J Prof Nurs. 2010 Jan;26(1):23-8. Part III. Reenvisioning undergraduate nursing students as opinion leaders to diffuse evidence-based practice in clinical settings. Cronje RJ, Moch SD. University of Wisconsin-Eau Claire, Scientific and Technical Writing Program, Eau Claire, WI 54702-4004, USA. Rogers's claims about the importance of social networks to the diffusion of innovations are reviewed in light of efforts to promote evidence-based practice (EBP) among nursing students and practicing nurses. We argue that nursing educators can take more deliberate advantage of the essentially social nature of the diffusion process by devising opportunities for nursing students to form meaningful social interactions with practicing nurses. We recommend curricular reforms that reenvision undergraduate nursing students as opinion leaders throughout the curriculum. Rogers's theory predicts that such ongoing interactions between nursing students and practicing nurses will better integrate EBP among both populations. PMID: 20129589 [PubMed - indexed for MEDLINE]

38. J Gerontol Nurs. 2010 Jan;36(1):41-8. doi: 10.3928/00989134-20091204-04. Epub 2010 Jan 12. Implementing evidence-based practice in Taiwanese nursing homes: attitudes and perceived barriers and facilitators.

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Chang HC, Russell C, Jones MK. Department of Nursing, Faculty of Health Sciences, The University of Yuanpei, Hsinchu, Taiwan. huirita@hotmail.com To date, there is a paucity of research investigating nurses' perceptions of evidence-based practice (EBP) in nursing homes, especially in non-Western countries. This descriptive, quantitative study investigated attitudes toward and perceived barriers and facilitators to research utilization among 89 Taiwanese RNs. The majority of nurses expressed positive attitudes toward research and EBP. The most frequently cited barriers were related to insufficient authority to change practice, difficulty understanding statistical analyses, and a perceived isolation from knowledgeable colleagues with whom to discuss the research. EBP facilitators included improved access to computers and Internet facilities in the workplace, more effective research training, and collaboration with academic nurses. These findings are similar to those from research conducted in Western countries and indicate that further education and training in research for nurses working in nursing homes would be beneficial. PMID: 20047246 [PubMed - indexed for MEDLINE]

39. Am J Nurs. 2010 Jan;110(1):51-3. Evidence-based practice: step by step: the seven steps of evidence-based practice. Melnyk BM, Fineout-Overholt E, Stillwell SB, Williamson KM. Arizona State University in Phoenix, AZ, USA. bernadette.melnyk@asu.edu This is the second article in a new series from the Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values. When delivered in a context of caring and in a supportive organizational culture, the highest quality of care and best patient outcomes can be achieved.The purpose of this series is to give nurses the knowledge and skills they need to implement EBP consistently, one step at a time. Articles will appear every two months to allow you time to incorporate information as you work toward implementing EBP at your institution. Also, we've scheduled "Ask the Authors" calls every few months to provide a direct line to the experts to help you resolve questions. See details below. PMID: 20032669 [PubMed - indexed for MEDLINE]

40. Worldviews Evid Based Nurs. 2010 Mar;7(1):4-15. Epub 2009 Dec 16. Supporting evidence-based practice for nurses through information technologies. Doran DM, Haynes RB, Kushniruk A, Straus S, Grimshaw J, Hall LM, Dubrowski A, Di Pietro T, Newman K, Almost J, Nguyen H, Carryer J, Jedras D.

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Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada. diane.doran@utoronto.ca PURPOSE: To evaluate the usability of mobile information terminals, such as personal digital assistants (PDAs) or Tablet personal computers, to improve access to information resources for nurses and to explore the relationship between PDA or Tablet-supported information resources and outcomes. BACKGROUND: The authors evaluated an initiative of the Nursing Secretariat, Ontario Ministry of Health and Long-Term Care, which provided nurses with PDAs and Tablet PCs, to enable Internet access to information resources. Nurses had access to drug and medical reference information, best practice guidelines (BPGs), and to abstracts of recent research studies. METHOD: The authors took place over a 12-month period. Diffusion of Innovation theory and the Promoting Action on Research Implementation in Health Services (PARIHS) model guided the selection of variables for study. A longitudinal design involving questionnaires was used to evaluate the impact of the mobile technologies on barriers to research utilization, perceived quality of care, and on nurses' job satisfaction. The setting was 29 acute care, long-term care, home care, and correctional organizations in Ontario, Canada. The sample consisted of 488 frontline-nurses. RESULTS: Nurses most frequently consulted drug and medical reference information, Google, and Nursing PLUS. Overall, nurses were most satisfied with the Registered Nurses Association of Ontario (RNAO) BPGs and rated the RNAO BPGs as the easiest resource to use. Among the PDA and Tablet users, there was a significant improvement in research awareness/values, and in communication of research. There was also, for the PDA users only, a significant improvement over time in perceived quality of care and job satisfaction, but primarily in long-term care settings. IMPLICATIONS: It is feasible to provide nurses with access to evidence-based practice resources via mobile information technologies to reduce the barriers to research utilization. PMID: 20028493 [PubMed - indexed for MEDLINE]

41. Nurs Res. 2010 Jan-Feb;59(1 Suppl):S22-31. Care of the patient with enteral tube feeding: an evidence-based practice protocol. Kenny DJ, Goodman P. TriService Nursing Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814-4799, USA. deb.kenny@us.army.mil BACKGROUND: Care of patients with enteral feeding tubes often is based on tradition and textbook guidance rather than best evidence. Care practices can vary widely both between and within institutions, and this was the case at a northeastern military medical center that served as the site for this evidence-based protocol development and implementation project. OBJECTIVES: The purpose of this study was to describe the development and implementation of an evidence-based clinical protocol for care of patients with enteral feeding tubes. METHODS: This was an evidence-based implementation project with pretest-posttest measures. Protocol data collection occurred both before and after implementation of the protocol. Data collection tools were based on the literature review and

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included three domains: (a) documentation of patient procedures, (b) nursing knowledge of each of the specific procedures, and (c) environment of care. Descriptive statistics and data were analyzed using independent samples t tests. RESULTS: Overall staff knowledge of enteral feedings and methods used to unclog both large- and small-bore feeding tubes differed significantly before and after implementation (p < .05). Staff knowledge regarding the danger of using blue dye in feeding solution was significant (p < .001). There was improvement also in administration of medications separately rather than mixed together and in head of bed elevation of patients with feeding tubes. There was a 10% improvement in documentation of patient family education and a 15% improvement in recording fluid flushes during medication administration. After implementation, environment of care data collection showed 100% of patients with head of bed elevated and with functioning suction available, an improvement over levels before implementation. DISCUSSION: Care must be taken in the interpretation of these findings because it was generally not the same nurses who answered both surveys. High staff turnover within this military hospital also affected sustainment of the protocol implementation. Maintenance activities must be constant and visible within the organization. A champion for evidence-based practice greatly enhances uptake and maintenance of nursing practice change. PMID: 20010275 [PubMed - indexed for MEDLINE]

42. Worldviews Evid Based Nurs. 2010 Mar;7(1):16-24. Epub 2009 Nov 16. Nurses' knowledge of evidence-based guidelines for the prevention of surgical site infection. Labeau SO, Witdouck SS, Vandijck DM, Claes B, Rello J, Vandewoude KH, Lizy CM, Vogelaers DP, Blot SI; Executive Board of the Flemish Society for Critical Care Nurses. Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. sonia.labeau@hogent.be BACKGROUND: Prevention of surgical site infection (SSI) is an important responsibility for nurses. Knowledge of the related evidence-based recommendations is necessary to provide high-quality nursing care. AIM: Development of an evaluation tool and subsequent evaluation of intensive care unit (ICU) nurses' knowledge of the SSI prevention guideline to identify their specific educational needs, as part of a needs analysis preceding the development of an e-learning module on infection prevention. METHODS: We developed a multiple-choice knowledge test concerning evidence-based SSI prevention. After expert assessment of its face and content validity, the test was used in a survey among 809 ICU nurses. Demographics included were gender, ICU experience, number of ICU beds, and whether respondents had obtained a specialized ICU qualification. Based on the test results, an item analysis was performed. RESULTS: Face and content validity were achieved for 9 out of 10 items of the questionnaire. From the survey, we collected 650 questionnaires (response rate 80.3%). The item analysis revealed overall good results with values for item difficulty ranging from 0.1 to 0.5 for eight questions, while one question had a value of 0.02; discriminative values ranging from 0.27 to 0.53 and values for the quality of the response alternatives between 0.1 and 0.7. Overall, these results demonstrate the questionnaire's reliability. The nurses' mean score on the

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knowledge test was 29%. Males were shown to have better scores. CONCLUSIONS: Opportunities exist to improve ICU nurses' knowledge about SSI prevention recommendations. Current guidelines should support their ongoing training and education. PMID: 19919658 [PubMed - indexed for MEDLINE]

43. Rev Esp Salud Publica. 2009 Jul-Aug;83(4):577-86. [Validation of the Spanish version of the Evidence Based Practice Questionnaire in Nurses]. [Article in Spanish] de Pedro Gmez J, Morales-Asencio JM, Abad AS, Veny MB, Roman MJ, Ronda FM. Escuela Universitaria de Enfermera y Fisioterapia, Universitat de les Illes Balears, Palma, Islas Baleares, Espaa. depedro@uib.es BACKGROUND: The lack of adequate instruments prevents the possibility of assessing the competence of health care staff in evidence-based decision making and further, the identification of areas for improvement with tailored strategies. The aim of this study is to report about the validation process in the Spanish context of the Evidence-Based Practice Questionnaire (EBPQ) from Upton y Upton. METHODS: A multicentre, cross-sectional, descriptive psychometric validation study was carried out. For cultural adaptation, a bidirectional translation was developed, accordingly to usual standards. The measuring model from the questionnaire was undergone to contrast, reproducing the original structure by Exploratory Factorial Analysis (EFA) and Confirmatory Factorial Analysis (CFA), including the reliability of factors. RESULTS: Both EFA (57.545% of total variance explained) and CFA (chi(2)=2359,9555; gl=252; p < 0.0001; RMSEA=0,1844; SRMR=0,1081), detected problems with items 7, 16, 22, 23 and 24, regarding to the original trifactorial version of EBPQ. After deleting some questions, a reduced version containing 19 items obtained an adequate factorial structure (62.29% of total variance explained), but the CFA did not fit well. Nevertheless, it was significantly better than the original version (chi(2)=673.1261; gl=149; p < 0.0001; RMSEA=0.1196; SRMR=0.0648). CONCLUSIONS: The trifactorial model obtained good empiric evidence and could be used in our context, but the results invite to advance with further refinements into the factor "attitude", testing it in more contexts and with more diverse professional profiles. PMID: 19893885 [PubMed - indexed for MEDLINE]

44. Worldviews Evid Based Nurs. 2010 Sep;7(3):135-57. Epub 2009 Sep 22. Implementation of evidence-based practice in nursing using action research: a review. Munten G, van den Bogaard J, Cox K, Garretsen H, Bongers I.

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Fontys University of Applied Science, Eindhoven, the Netherlands. a.munten@fontys.nl BACKGROUND: As is often reported in the literature exploring the research-practice gap, applying the principles of evidence-based practice is easier said than done. Action research is a methodology with an explicit intent of linking the worlds of research and practice. This review attempts to answer the question: What is known about implementing evidence-based practice in nursing through action research? APPROACH: A total of 21 action research studies have been used to answer this question. To prevent possible confusion over terminology, we used a conceptual framework that distinguishes various influencing factors in terms of four target groups (ranging from the individual end user to society as a whole) at whom the strategy is aimed and various strategies (ranging from individual feedback to contracting care providers) related to the same four target groups. FINDINGS: Studies often failed to name the implementation strategies applied, necessitating deduction from the text by the reader. In most of the studies the implementation strategy was directed at a combination of target groups. Many of the projects reviewed reported positive contextual outcomes, "knowledge improvement" among nurses, and to a lesser degree, improved "performance." Patient outcomes were the least reported outcome measure. CONCLUSION: With an element of caution, this review concludes that the implementation of evidence-based practice using action research is a promising approach. Caution is needed because of the lack of detailed descriptions of implementation strategies, and their intensity and frequency prevents us from drawing firm conclusions. These are important considerations for any action researcher intending to implement EBP using this approach. PMID: 19778316 [PubMed - indexed for MEDLINE]

45. Worldviews Evid Based Nurs. 2010 Mar;7(1):36-50. Epub 2009 Sep 9. Clinical nurse specialists' approaches in selecting and using evidence to improve practice. Profetto-McGrath J, Negrin KA, Hugo K, Smith KB. University of Alberta, Edmonton, Alberta, Canada. joanne.profetto-mcgrath@ualberta.ca ABSTRACT Background: Evidence-based practice (EBP) has become the desired standard within all health disciplines because the integration of the best evidence into clinical practice is fundamental to optimizing patient outcomes. The valuing of research and research-based knowledge as the basis for decision making is explicit in current discourse in the health sciences. Despite the desires of proponents of EBP for use of evidence derived through research, nurses prefer to use knowledge derived from experience and social interactions. The clinical nurse specialist (CNS) is in the ideal position to act as a link between evidence and practice; however, a paucity of knowledge exists on how CNSs select and use evidence in their daily practice. Purpose: The purpose of this descriptive, cross-sectional study was to examine the approaches used by CNSs to select and use evidence in their daily practice. Method: A telephone survey, developed for this study from a pilot study conducted by the principal investigator (PI), was used to elicit responses from a purposive sample of CNSs living in a western Canadian province who were willing to be contacted for

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research, and who had practiced clinically as CNSs within the past year. A response rate of 75% (n = 94) was achieved. Descriptive statistics were used to describe and compare the variables of interest. Results: Literature tailored to particular specialties and personal experiences were reported as the most frequently accessed sources of evidence. This evidence was most often used to facilitate improvements in patient care, and least often used to develop further research proposals. Conclusion: This study indicates that although CNSs select and use evidence from a wide variety of sources, further development of their capacity to retrieve and transfer knowledge may increase the uptake of research findings in nursing practice. PMID: 19744192 [PubMed - indexed for MEDLINE]

46. Am J Crit Care. 2010 May;19(3):272-6. Epub 2009 Aug 17. Critical care clinicians' knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia. El-Khatib MF, Zeineldine S, Ayoub C, Husari A, Bou-Khalil PK. Department of Anesthesiology, School of Medicine, American University of Beirut, Beirut, Lebanon. BACKGROUND: Ventilator-associated pneumonia is the most common hospital-acquired infection among patients receiving mechanical ventilation in an intensive care unit. Different initiatives for the prevention of ventilator-associated pneumonia have been developed and recommended. OBJECTIVE: To evaluate knowledge of critical care providers (physicians, nurses, and respiratory therapists in the intensive care unit) about evidence-based guidelines for preventing ventilator-associated pneumonia. METHODS: Ten physicians, 41 nurses, and 18 respiratory therapists working in the intensive care unit of a major tertiary care university hospital center completed an anonymous questionnaire on 9 nonpharmacological guidelines for prevention of ventilator-associated pneumonia. RESULTS: The mean (SD) total scores of physicians, nurses, and respiratory therapists were 80.2% (11.4%), 78.1% (10.6%), and 80.5% (6%), respectively, with no significant differences between them. Furthermore, within each category of health care professionals, the scores of professionals with less than 5 years of intensive care experience did not differ significantly from the scores of professionals with more than 5 years of intensive care experience. CONCLUSIONS: A health care delivery model that includes physicians, nurses, and respiratory therapists in the intensive care unit can result in an adequate level of knowledge on evidence-based nonpharmacological guidelines for the prevention of ventilator-associated pneumonia. PMID: 19687515 [PubMed - indexed for MEDLINE]

47. J Nurs Manag. 2009 May;17(4):510-8. The Australian experience of nurses' preparedness for evidence-based practice. Waters D, Crisp J, Rychetnik L, Barratt A.

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The College of Nursing, Burwood, Sydney, NSW 1805, Australia. dwaters@nursing.edu.au AIM: This study aimed to determine current knowledge and attitudes towards evidence-based practice (EBP) among pre- and post-registration nurses in New South Wales (NSW), Australia. BACKGROUND: Educational and clinical strategies for EBP in nursing assume a readiness to interpret and integrate evidence into clinical care despite continued reports of low levels of understanding and skill in this area. METHOD: Perceptions of EBP were examined through a self-complete, anonymous postal survey distributed to 677 (post-registration) clinical nurses and to 1134 final year (pre-registration) nursing students during 2002 and 2003. RESULTS: A completed survey was returned by 126 post-registration and 257 final year nursing students (combined 21% response rate). Both pre- and post-registration nurses had a welcoming attitude towards EBP. Pre-registration nurses expressed more confidence in their EBP skills but self-rated knowledge and skill were low to moderate in both groups. CONCLUSION: Nurses in Australia are clearly supportive of EBP but it is incorrect to assume that even recent graduates have a level of knowledge and skill that is sufficient to permit direct engagement in evidence implementation. IMPLICATIONS FOR NURSING MANAGEMENT: Among a range of clinical supports, nurse managers and leaders can contribute to evidence-based health care by understanding the EBP knowledge and skills of their workforce and demanding a more practical approach in nursing education towards evidence-based guidelines and summaries appropriate to the clinical context. PMID: 19531151 [PubMed - indexed for MEDLINE]

48. Worldviews Evid Based Nurs. 2009;6(2):93-101. Epub 2009 Apr 29. Evidence-based practice: Iranian nurses' perceptions. Adib-Hajbaghery M. Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran. adib1344@yahoo.com BACKGROUND: During the past 2 decades, evidence-based practice has increasingly been proven as a means of standard and higher-quality health care. Nurses who base their practices on scientific evidence bring their clients and organization better and more cost-effective nursing care. However, little is known about Iranian nurses' perceptions of evidence-based practice. AIMS: The present study was conducted to evaluate Iranian nurses' perceptions of evidence-based practice. METHODS: A qualitative study was conducted on 21 participants from different groups of nurses at Kashan University of Medical Sciences. Semi-structured interviews were used to gather data. Content analysis was used to analyze the data according to the Cheevakumjorn's method. FINDINGS: Two main categories, the concept of "evidence-based nursing" and "nature and the source of evidence," emerged from the data. The participants used the term "standard care" as a synonym for evidence-based practice. According to the participants, the nurses implement evidence-based practice care for clients based on their professional knowledge and the patient's needs. The participants believed "caring evidence" includes five different types of knowledge: "knowledge of patient,""knowledge of the environment,""learned (academic)

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knowledge,""practice-based knowledge," and "research-based knowledge." However, participants stated that, currently, the nursing practice is not based on scientific evidence. CONCLUSIONS: Nurses have a positive attitude concerning the use of scientific evidence to guide practice, but this evidence has little application in their current nursing practice. IMPLICATIONS: Nurses need support from both the organizational management and the educational system to help them apply evidence in practice. PMID: 19413583 [PubMed - indexed for MEDLINE]

49. J Clin Nurs. 2009 May;18(10):1442-50. What is the relationship between nurses' attitude to evidence based practice and the selection of wound care procedures? Dugdall H, Watson R. Hull & East Yorkshire Hospitals NHS Trust, Hull Royal Infirmary, Hull, UK. hayley.dugdall@hey.nhs.uk AIM: To investigate qualified nurses' attitudes to evidence-based practice and whether this influenced their selection of wound care products. BACKGROUND: The literature shows that previous studies on attitudes to evidence-based practice tended to be part of a wider study. The general consensus was that there was a positive attitude to evidence-based practice. However, there appeared to be no published studies specifically addressing nurses' attitudes to evidence-based wound care. DESIGN: Survey design using a questionnaire completed by 156 qualified nurses working in three UK National Health Trusts. RESULTS: A statistically significant difference was seen between those nurses with a tissue viability link nurse role (p = 0.002) and those without a link nurse role; those educated to first degree (p < 0.001) and those without a first degree; and those who had received formal tissue viability training (p < 0.001) and those with informal tissue viability training. There was also a highly statistically significant relationship between the clinical grade of staff and the overall attitude to evidence-based practice (p < 0.001). CONCLUSIONS: Nurses who had attained a higher level academic qualification, had a tissue viability link nurse role and those who had received formal tissue viability training scored generally higher in the wound care knowledge tests and in attitude to evidence-based practice. RELEVANCE TO CLINICAL PRACTICE: The care received by patients in relation to wound care could be dependent upon factors that are related to the individual characteristics of the nurse providing the care and these factors, in turn, are related to education and training with respect to wound care. Better general education and better specific training in wound care could lead to better wound care. PMID: 19413537 [PubMed - indexed for MEDLINE]

50. World J Surg. 2009 Jul;33(7):1348-55. Attitudes, awareness, and barriers regarding evidence-based surgery among

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surgeons and surgical nurses. Knops AM, Vermeulen H, Legemate DA, Ubbink DT. Department of Quality Assurance and Process Innovation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. a.m.knops@amc.nl BACKGROUND: Evidence-based surgery (EBS) is stressed to increase efficiency and health care quality, but not all surgeons and surgical nurses use EBS in clinical practice. To define future tailor-made interventions to improve evidence-based behavior, the aim of this study was to determine the attitude and awareness among surgeons and surgical nurses as to the paradigm of EBS and the barriers experienced when practicing EBS. METHODS: In this cross-sectional study, surgeons and surgical nurses at a university hospital in Amsterdam were invited to complete the BARRIERS scale and McColl et al. questionnaire. An evidence quiz was composed for the surgeons. RESULTS: Response rates were 67% (29/43) for surgeons and 60% (73/122) for nurses. Attitudes toward EBS were positive. Among the surgeons, 90% were familiar with EBS terms, whereas only 40% of the nurses were. Common barriers for surgeons were conflicting results (79%, 23/29) and the methodologic inadequacy of research reports (73%, 21/29); and for nurses they were unawareness of EBS (67%, 49/73) and unclear reported research (59%, 43/73). Only about half of the convincing evidence presented in the quiz was actually applied. CONCLUSIONS: Surgeons have a positive attitude toward EBS and are familiar with EBS terminology, but conflicting results and methodologic shortcomings of research reports are major barriers to practicing EBS. Continual confrontations with available evidence through frequent critical appraisal meetings or grand rounds and using more aggregate sources of evidence are advocated. Nurses can probably benefit from EBS training focusing on basic skills. Finally, collaboration is needed among surgeons and nurses with the same zest about EBS. PMCID: PMC2691930 PMID: 19412569 [PubMed - indexed for MEDLINE] 51. Br J Nurs. 2009 Apr 23-May 13;18(8):484-9. Using evidence-based practice to address gaps in nursing knowledge. Tagney J, Haines C. Bristol Royal Infirmary. Implementing evidence based-practice and research findings into nursing care has been identified as a challenge to nursing staff. This article identifies key barriers to the use of research in the international literature, however, there are limited suggestions as to how to improve this in the clinical arena. This article aims to identify how nurses could optimize the implementation of evidence and research into their clinical care and reviews barriers to implementing and undertaking nursing research, suggesting a framework for improvement. It considers the widely varied levels of knowledge of research and equally varied critical appraisal skills present both at a pre and post-registration nursing level. The authors discuss an innovative, collaborative approach that considers the role of the nurse consultant, clinical academic and research facilitator posts. To ensure quality evidence-based practice is implemented into clinical nursing care a realistic and practical structure must be applied. With the

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appropriate framework, clinical structure and organizational support, promotion of evidence-based practice and research for patient benefit can be optimized. The implications for practice are also discussed. The implementation of a realistic research framework into clinical nursing practice has the potential to influence and develop a more active nursing research culture and promote evidence-based care within the workplace. PMID: 19377394 [PubMed - indexed for MEDLINE]

52. Nurs Leadersh (Tor Ont). 2009;22(1):86-98. Nursing leaders' accountability to narrow the safety chasm: insights and implications from the collective evidence base on healthcare safety. Jeffs L, Macmillan K, McKey C, Ferris E. Nursing/Clinical Research, Scientist, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. jeffsl@smh.toronto.on.ca Challenges continue to exist in bridging the safety gap to ensure that consistent, high-quality nursing care is provided based on the best scientific knowledge available. This paper examines findings from nursing research presented at the symposium Advancing Nursing Leadership for a Safer Healthcare System, held in Toronto, Ontario in 2007. Four central themes emerged: (1) place the patient in safety; (2) generate a broader knowledge base on safety across the continuum of care; (3) create a safe culture and healthy work environment to mitigate current threats to patient safety; and (4) advance translation of evidence to practice at the organizational and clinical levels. The aim of this exchange of knowledge was to equip nursing leaders and their decision partners with evidence that can become a catalyst for mobilizing change in practice to address the safety chasm. PMID: 19289915 [PubMed - indexed for MEDLINE]

53. Perspect Infirm. 2008 Sep-Oct;5(7):36-42. [Evidence-based practice and the development of a nursing research culture]. [Article in French] Halabi-Nassif H, Hatem M. L'Institut de Gestion, L'Universit Saint-Joseph de Beyrouth. The article looks at the perceptions of nurses at the Htel-Dieu de France university hospital (CHU-HDF) in Lebanon regarding the obstacles to and potential benefits of implementing an evidence-based practice. For front-line nurses, the organization and characteristics of nurses appear to be the main obstacles to the use of research findings, along with the quality of the research and the way the findings are communicated. To ensure its credibility as a university hospital and guarantee quality care for patients, CHU-HDF authorities should clearly state their commitment and support for nurses in establishing a research unit,

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simplifying access to resources (e.g. the Internet) and to scientific articles, and recognizing teams that support such a practice. It would also be a good idea to develop nurses' knowledge of research methodology and back them up in their initial research work. Lastly, nursing management must reconsider nurses' workload, to allow them time to consult research findings. PMID: 19266791 [PubMed - indexed for MEDLINE]

54. J Nurs Adm. 2009 Feb;39(2):91-7. Organizational readiness for evidence-based practice. Gale BV, Schaffer MA. Hennepin County Medical Center, Minneapolis, Minnesota 55415, USA. Barbara.Gale@hcmed.org OBJECTIVE: This study explored factors that affect the adoption or rejection of evidence-based practice (EBP) changes and differences in nurse manager and staff nurse perceptions about those factors. BACKGROUND: Roger's Diffusion of Innovations Theory explains relevant organizational strategies for guiding practice change. METHODS: The primary author developed the Evidence-Based Practice Changes Survey consisting of 12 items, completed by 92 nurses at a level 1 trauma center. RESULTS: Top barriers to EBP were insufficient time, lack of staff, and not having the right equipment and supplies. Top reasons to adopt EBP were having personal interest in the practice change, avoiding risk of negative consequences to the patient, and personally valuing the evidence. Several statistically significant differences emerged for demographic variables. CONCLUSION: Planning for EBP change must address barriers and facilitators to practice change and emphasize the benefit for patients and value of the practice change to nurses. PMID: 19190426 [PubMed - indexed for MEDLINE]

55. J Am Acad Nurse Pract. 2008 Dec;20(12):585-9. Saying "no" to professional recommendations: client values, beliefs, and evidence-based practice. Michaels C, McEwen MM, McArthur DB. College of Nursing, University of Arizona, Tucson, AZ 85721, USA. cathym@nursing.arizona.edu PURPOSE: The purpose of this article is to explore the phenomenon of saying "no" to secondary prevention recommended by healthcare providers. DATA SOURCES: Extracted findings from two qualitative studies in which participants have said "no" to provider recommendations for secondary prevention, specifically screening mammograms or treatment for latent tuberculosis infection, are discussed. CONCLUSIONS: Although these two studies focus on different aspects of secondary prevention, both studies emphasize how client values and beliefs impact health

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decisions. In evidence-based practice (EBP), both scientific evidence and client values and beliefs must be considered. Nurse practitioners (NPs) have the skill set and are in a position to assist clients to mediate between their values and beliefs and current scientific evidence. IMPLICATIONS FOR PRACTICE: Several findings from the two qualitative studies are relevant for practice: qualitative studies provide information about values and beliefs for EBP, and findings from these particular qualitative studies demonstrated that women were protective about their health even though their values and beliefs did not align with current scientific evidence. Through client narratives, NPs can facilitate clients aligning personal values and beliefs with current scientific evidence in relationship to caring for self. PMID: 19120589 [PubMed - indexed for MEDLINE]

56. J Adv Nurs. 2008 Dec;64(6):632-43. Development and testing of four instruments to assess prior conditions that influence nurses' adoption of evidence-based pain management practices. Carlson C. Northern Illinois University, DeKalb, USA. clcarlson@niu.edu AIM: This paper is a report of the development and testing of the psychometric properties of a set of four instruments measuring prior conditions influencing nurses' decisions to adopt evidence-based pain management practices. BACKGROUND: Nurses do not use evidence-based pain management practices consistently. Their adoption of pain management practices depends on several prior conditions. Prior conditions are factors that influence the need to learn more about an innovation and begin the adoption process. METHOD: Four instruments were developed, collectively known as Carlson's Prior Conditions Instruments, to assess the four theoretically-derived prior conditions of previous practice, felt needs/problems, innovativeness and norms of the social system that influence nurses' decisions to adopt evidence-based pain management practices. Item-to-total correlations and Cronbach's alpha were used to determine internal consistency reliability. Construct validity was examined through principal components factor analysis with varimax rotation. Data were collected as part of a larger study in 2005. RESULTS: Content validity of the four instruments was supported through review by experts. The instruments were distributed to nurses (n = 187). Each instrument demonstrated internal consistency (alpha range = 0.731-0.825). Factor analysis demonstrated that the Felt Needs/Problems and Norms of the Social System Instruments were unidimensional, with six and seven items respectively. The Previous Practice Instrument (11 items, three factors) and Innovativeness Instrument (six items, two factors) were multidimensional. CONCLUSION: Initial psychometric testing revealed adequate estimates of reliability and validity for Carlson's Prior Conditions Instruments. Further research is needed using the tools with nurses in different countries and cultures to test and confirm the constructs. PMID: 19120578 [PubMed - indexed for MEDLINE]

57. Worldviews Evid Based Nurs. 2008;5(4):193-204.

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Ventilator-associated pneumonia bundled strategies: an evidence-based practice. O'Keefe-McCarthy S, Santiago C, Lau G. CIHR/CHSF FUTURE Program for Cardiovascular Nurse Scientists, University of Toronto, Ontario, Canada. s.okeefe.mccarthy@utoronto.ca BACKGROUND: Ventilator-associated pneumonia (VAP) is an ongoing challenge for critical care nurses as they use current evidence-based strategies to decrease its incidence and prevalence. Mechanical intubation negates effective cough reflexes and impedes mucociliary clearance of secretions, causing leakage and microaspiration of virulent bacteria into the lungs. VAP is responsible for 90% of nosocomial infections and occurs within 48 hours of intubation. VAP is a major health care burden in terms of mortality, escalating health care costs, increased length of ventilator days and length of hospital stay. AIM: (1) To provide a review of the literature on VAP bundle (VAPB) practices. (2) To describe the etiology and risk factors and define bundled practices. (3) To discuss an explanatory framework that promotes knowledge translation of VAPBs into clinical settings. (4) To identify areas for further research and implications for practice to decrease the incidence of VAP. METHODS: Electronic searches in MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Collaboration were conducted using keywords specific to VAP. The inclusion criteria were: (1) Studies were original quantitative research published in an English peer-reviewed journal for the years 1997 to 2007. (2) Each study included an examination of bundled practices. (3) The clinical outcomes of critically ill adults with VAP were assessed. The studies were identified from the bibliographies of key references. Six studies were accepted based on the inclusion criteria. Each contributing author conducted the review and analysis of selected studies independently. The findings were compared and contrasted by all authors to establish consensus. RESULTS: Evidence shows that VAPB practices decrease VAP rates. Bundled practices result in decreased ventilator days, intensive care unit length of stay, and mortality rates. A strong association was seen, with an increased clinician compliance with VAPB protocols with decreased VAP rates. CONCLUSIONS AND IMPLICATIONS: Methodologically robust randomized controlled trials are required to examine the efficacy of VAPBs and determine causality between VAPBs and clinical outcomes. Organizational commitment is needed to adopt a conceptual framework that promotes effective knowledge translation, incorporating factors of evidence, context, and facilitation of VAPBs into clinical settings. Instituting nurse-led intervention champion leaders to facilitate reliable and consistent implementation of VAPBs into practice is warranted. PMID: 19076920 [PubMed - indexed for MEDLINE]

58. Worldviews Evid Based Nurs. 2008;5(4):182-92. Determining registered nurses' readiness for evidence-based practice. Thiel L, Ghosh Y. University of Detroit Mercy, Detroit, Michigan, USA. thiellm@udmercy.edu BACKGROUND: As health care systems worldwide move toward instituting

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evidence-based practice (EBP), its implementation can be challenging. Conducting a baseline assessment to determine nurses' readiness for EBP presents opportunities to plan strategies before implementation. Although a growing body of research literature is focused on implementing EBP, little attention has been paid to assessing nurses' readiness for EBP. OBJECTIVE: The purpose of this study was to assess registered nurses' readiness for EBP in a moderate-sized acute care hospital in the Midwestern United States before implementation of a hospital-wide nursing EBP initiative. DESIGN AND METHODS: A descriptive cross-sectional survey design was used; 121 registered nurses completed the survey. The participants (n= 121) completed the 64-item Nurses' Readiness for Evidence-Based Practice Survey that allowed measurement of information needs, knowledge and skills, culture, and attitudes. Data were analyzed using descriptive statistics and a post hoc analysis. RESULTS: The majority (72.5%) of respondents indicated that when they needed information, they consulted colleagues and peers rather than using journals and books; 24% of nurses surveyed used the health database, Cumulative Index to Nursing & Allied Health Literature (CINAHL). The respondents perceived their EBP knowledge level as moderate. Cultural EBP scores were moderate, with unit scores being higher than organizational scores. The nurses' attitudes toward EBP were positive. The post hoc analysis showed many significant correlations. CONCLUSIONS AND IMPLICATIONS: Nurses have access to technological resources and perceive that they have the ability to engage in basic information gathering but not in higher level evidence gathering. The elements important to EBP such as a workplace culture and positive attitudes are present and can be built upon. A "site-specific" baseline assessment provides direction in planning EBP initiatives. The Nurses' Readiness for EBP Survey is a streamlined tool with established reliability and validity. PMID: 19076919 [PubMed - indexed for MEDLINE]

59. J Adv Nurs. 2009 Feb;65(2):371-81. Epub 2008 Nov 27. Nursing practice, knowledge, attitudes and perceived barriers to evidence-based practice at an academic medical center. Brown CE, Wickline MA, Ecoff L, Glaser D. UCSD Medical Center, University of California, San Diego, USA. cbrown@mail.sdsu.edu AIM: This paper is a report of a study to describe nurses' practices, knowledge, and attitudes related to evidence-based nursing, and the relation of perceived barriers to and facilitators of evidence-based practice. BACKGROUND: Evidence-based practice has been recognized by the healthcare community as the gold standard for the provision of safe and compassionate healthcare. Barriers and facilitators for the adoption of evidence-based practice in nursing have been identified by researchers. Healthcare organizations have been challenged to foster an environment conducive to providing care based on evidence and not steeped in ritualized practice. METHODS: A descriptive, cross-sectional research study was conducted in 2006-2007 with a convenience sample of 458 nurses at an academic medical center in California (response rate 44.68%). Two reliable and valid questionnaires were electronically formatted and administered using a secured website. Relationships between responses to the two instruments were examined and results compared with previously published data.

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RESULTS: Organizational barriers (lack of time and lack of nursing autonomy) were the top perceived barriers. Facilitators were learning opportunities, culture building, and availability and simplicity of resources. Statistically significant correlations were found between barriers and practice, knowledge and attitudes related to evidence-based practice. CONCLUSION: Similar barriers to the adoption of evidence-based practice have been identified internationally. Educators must work with managers to address organizational barriers and proactively support evidence-based practice. PMID: 19040688 [PubMed - indexed for MEDLINE]

60. J Adv Nurs. 2009 Feb;65(2):337-47. Epub 2008 Nov 6. How evidence-based is venous leg ulcer care? A survey in community settings. Van Hecke A, Grypdonck M, Beele H, De Bacquer D, Defloor T. Department of Public Health-Nursing Science, Faculty of Medicine and Health Sciences, Ghent University, Belgium. ann.vanhecke@ugent.be Republished in Nurs Times. 2009 Mar 3-9;105(8):24. AIM: This paper is a report of a study to describe venous leg ulcer care regarding compression, pain management and lifestyle advice in community settings and to identify factors that predict the provision of lifestyle advice by nurses. BACKGROUND: Incongruence between evidence and practice in leg ulcer care has been reported. Little is known about predictive factors related to the provision of lifestyle advice. METHOD: Two focus interviews and a Delphi procedure were used to develop a self-administered questionnaire based on the Graham questionnaire. Nurses employed by community healthcare organizations and independent nurses in private practices participated (n = 789). The data were collected in 2006. FINDINGS: Compression was applied in 58.7% of patients with venous ulcers. Pain was present in 82.9%. A third of patients with pain received analgesics, but half of these patients (52.1%) took analgesics as prescribed. Half of the nurses (50.8%) gave lifestyle advice related to the leg ulcer. It was mainly instructions about leg elevation (68.3%), promoting physical activity (39.8%) and optimizing nutrition (16.7%) that were provided. Nurses who perceived themselves to have adequate leg ulcer knowledge and skills were 3.75 times more likely to provide lifestyle advice compared with those lacking such knowledge and skills. Nurses who found leg ulcer care not rewarding, rarely successful or difficult gave statistically significantly less lifestyle advice than those who found it rather rewarding, successful and not difficult. CONCLUSION: Patients with leg ulcers receive less than optimum care and patient education. A particular challenge lies in leg ulcer education programmes and pain management. PMID: 19016923 [PubMed - indexed for MEDLINE]

61. J Nurs Adm. 2008 Nov;38(11):494-503. Nurses' skill level and access to evidence-based practice.

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Cadmus E, Van Wynen EA, Chamberlain B, Steingall P, Kilgallen ME, Holly C, Gallagher-Ford L. Organization of Nurse Executives of New Jersey, Englewood Hospital and Medical Center, New Jersey, USA. edna.cadmus@ehmc.com Integrating evidence-based practice into the culture of an acute care hospital requires assessment, planning, and intervention by nursing leadership. The authors discuss a statewide study that assessed the skill level of nurses in obtaining evidence for their nursing practice, using computers and databases, as well as evaluating the perceived availability of resources in their hospitals to access evidence. PMID: 18997555 [PubMed - indexed for MEDLINE]

62. Nurs Econ. 2008 Sep-Oct;26(5):319-22. Resourcing evidence-based practice in ambulatory care nursing. Haas SA. Niehoff School of Nursing, Loyola University, Chicago, IL, USA. Ambulatory care nurses may benefit from not only developing knowledge and skills in evidence-based practice (EBP), but also in identifying and providing sufficient resources for EBP to be implemented and sustained. Organizations should select one of the five conceptual models available in the literature to guide development and implementation of EBP. Costs of implementing and sustaining EBP include expert consultation, facilitators, staff time, informatician time, and data management. Benefits of EBP include improvements in patient care quality and safety, as well as regulatory compliance and risk management. Resources supporting EBP include professional literature available via the Internet and databases or agencies, such as ARHQ, professional organizations, and funding through grants. PMID: 18979697 [PubMed - indexed for MEDLINE]

63. N Z Med J. 2008 Oct 3;121(1283):51-8. Evidence-based resource use by practice nurses in the Greater Auckland region of New Zealand. Hoare KJ, Steele J, Ram FS, Arroll B. Goodfellow Unit, School of Nursing, ProCare Department of General Practice and Primary Health Care, School of Population Health, The University of Auckland, Private Bag 92019, Auckland, New Zealand. k.hoare@auckland.ac.nz AIM: To determine self-reported use of New Zealand's Guidelines Group (NZGG) and BPAC resources by practice nurses (PNs) in the Greater Auckland area of New Zealand. METHOD: A postal survey of all PNs registered on the University of Auckland's

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Department of General Practice and Primary Health Care's database. RESULTS: A total of 419 of 917 (46%) PNs working in 280 general practices returned completed questionnaires. The majority of PNs did not use either the NZGG (53%) or BPAC guidelines (57%) and 35% did not use any evidence resources. The main reason these resources were not used was lack of knowledge about them, one-third of PNs had never heard of NZGG guidelines and 42% had never heard of BPAC guidelines. Of those who knew of NZGG guidelines, 74% found them useful, (a 'fair amount' or 'very') and 94% found BPAC guidelines useful (a 'fair amount' or 'very'). When PNs knew of these resources, 74% used NZGG guidelines and 69% used BPAC guidelines for patient care. CONCLUSION: PNs who knew of New Zealand Guidelines and BPAC found them useful in patient management. Practice nurses are not routinely on the mailing list of these two organisations. Strategies to increase PN awareness of these publicly funded evidence-based resources may increase their use and thus contribute to the reduction in health inequalities between ethnic groups in New Zealand. PMID: 18841185 [PubMed - indexed for MEDLINE]

64. J Nurs Manag. 2008 Sep;16(6):682-91. Achieving evidence-based nursing practice: impact of the Caledonian Development Model. Tolson D, Booth J, Lowndes A. School of Nursing, Midwifery & Community Health, Glasgow Caledonian University, Glasgow, UK. d.tolson@gcal.ac.uk AIM: To determine the impact of the Caledonian Development Model, designed to promote evidence-based practice. BACKGROUND: The model features practice-development activities, benchmarking, knowledge pooling and translation through membership of a community of practice and a virtual college. METHODS: Twenty-four nurses, from 18 practice sites formed three communities of practice, each selecting evidence-based guidance to implement. A modified group supervision framework empowered nurses to champion local implementation. Outcomes were determined at 6 months. RESULTS: Eighty per cent of the patient-related criteria and 35% of the facilities criteria were achieved. The Revised Nursing Work Index indicated these nurses experienced greater autonomy (P = 0.019) and increased organizational support (P = 0.037). Focus groups revealed a deepening organizational support for the initiative over time, illuminated work-based learning challenges and overall enthusiasm for the approach. CONCLUSION: Implementation of the model effectively promoted evidence-based practice, most notably at the level of the individual patient. IMPLICATIONS FOR NURSING MANAGEMENT: Time and budgetary constraints necessitate smart, value for money approaches to developing evidence-based practice and improved care standards. This work demonstrates an effective model that strikes a balance between individual and group learning, virtual and real-time activities, coupled with resource pooling across organizations and sectors. PMID: 18808462 [PubMed - indexed for MEDLINE]

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65. J Contin Educ Nurs. 2008 Sep;39(9):402-6. Advancing evidence-based practice: a program series. Soukup M, McCleish J. Mercy Medical Center-The Iowa Heart Hospital, Des Moines, Iowa 50314, USA. The call to evidence-based practice (EBP) is evolving and empowers nurses to form innovative learning partnerships with colleagues to nourish wisdom, strengthen critical thinking, integrate research knowledge, and celebrate contributions in leading best practice. Based on clinician interest, Advancing Evidence-Based Practice: A Program Series was designed for nurses to showcase initiatives using Mercy Nursing's EBP Model. Mentoring guides their efforts. This opportunity creates learning partnerships that encourage participants to reflect about their practice and network with colleagues about what is important for clinical excellence. It also nurtures professional growth in research development and formal presentations. PMID: 18792605 [PubMed - indexed for MEDLINE]

66. J Hosp Infect. 2008 Oct;70(2):180-5. Epub 2008 Aug 23. Evidence-based guidelines for the prevention of ventilator-associated pneumonia: results of a knowledge test among European intensive care nurses. Labeau S, Vandijck D, Rello J, Adam S, Rosa A, Wenisch C, Bckman C, Agbaht K, Csomos A, Seha M, Dimopoulos G, Vandewoude KH, Blot S; EVIDENCE study investigators. Collaborators: Adam S, Agbaht K, Bckman C, Blot S, Borg M, Csomos A, Dimopoulos G, Dumpis U, Fawcett J, Gastmeier P, Geffers C, Harden S, Ioanna S, Jaklic A, Jurca T, Kasanen A, Kolar M, Labeau S, Luiking ML, Macor A, Mkel T, Manno EP, Marianthi G, Norrenberg M, Parkel A, Piner AR, Pujate E, Rello J, Ritmala-Castrn M, Rosa A, Seha M, Sierra R, Slje P, Katsioulas T, Vandewoude K, Vandijck D, Vosylius S, Wenisch C, Xuereb D, Zahorec R. Faculty of Healthcare, University College Ghent, Ghent, Belgium. sonia.labeau@hogent.be As part of a needs analysis preceding the development of an e-learning platform on infection prevention, European intensive care unit (ICU) nurses were subjected to a knowledge test on evidence-based guidelines for preventing ventilator-associated pneumonia (VAP). A validated multiple-choice questionnaire was distributed to 22 European countries between October 2006 and March 2007. Demographics included nationality, gender, ICU experience, number of ICU beds and acquisition of a specialised degree in intensive care. We collected 3329 questionnaires (response rate 69.1%). The average score was 45.1%. Fifty-five percent of respondents knew that the oral route is recommended for intubation; 35% knew that ventilator circuits should be changed for each new patient; 38% knew that heat and moisture exchangers were the recommended humidifier type, but only 21% knew that these should be changed once weekly; closed suctioning systems were recommended by 46%, and 18% knew that these must be changed for each new patient only; 51% and 57%, respectively, recognised that subglottic drainage and kinetic beds reduce VAP incidence. Most (85%) knew that semi-recumbent

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positioning prevents VAP. Professional seniority and number of ICU beds were shown to be independently associated with better test scores. Further research may determine whether low scores are related to a lack of knowledge, deficiencies in training, differences in what is regarded as good practice, and/or a lack of consistent policy. PMID: 18723247 [PubMed - indexed for MEDLINE]

67. Can J Nurs Res. 2008 Jun;40(2):94-114. Implementation of a two-part unit-based multiple intervention: moving evidence-based practice into action. Rashotte J, Thomas M, Grgoire D, Ledoux S. Children's Hospital of Eastern Ontario, Ottawa, Canada. rashotte@cheo.on.ca This study examined the impact of a 2-part unit-based multiple intervention on the use by pediatric critical care nurses of best practice guidelines for pressure-ulcer prevention. A total of 23 nurses participated in a repeated-measures design pre- and post-intervention to address 2 questions: Is there a difference in nurses' evidence-based practices following implementation of an educational intervention only versus implementation of both an educational and an innovative intervention? Are the changes sustained 6 months after completion of the intervention? A significant change occurred in the implementation of 2 of 11 recommended practices following both interventions: assessment of risk of pressure ulcers using an age-appropriate tool (p < or = 0.001), and the documentation of same (p < or = 0.001). These changes may have been sustained. The findings bring to light the real challenges encountered when attempting to implement and evaluate multiple knowledge translation strategies associated with complex best practice guidelines in clinical practice. PMID: 18714900 [PubMed - indexed for MEDLINE]

68. Nurse Res. 2008;15(4):51-67. Evidence-based nursing practice: what US nurse executives really think. Sredl D. University of Missouri at St Louis, St Louis, MO, USA. This article by Darlene Sredl considers qualitative statements from US nurse executives about their belief in and implementation of evidence-based nursing practice. Their statements suggest uncertainty about the way forward. PMID: 18700660 [PubMed - indexed for MEDLINE]

69. AMIA Annu Symp Proc. 2007 Oct 11:423-7. Clinician adoption patterns and patient outcome results in use of evidence-based

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nursing plans of care. Kim TY, Lang NM, Berg K, Weaver C, Murphy J, Ela S. University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA. Delivery of safe, effective and appropriate health care is an imperative facing health care organizations globally. While many initiatives have been launched in a number of countries to address this need from a medical perspective, a similar focus for generating evidence-based nursing knowledge has been missing. This paper reports on a collaborative evidence-based practice (EBP) research initiative that adds nursing knowledge into computerized care protocols. Here, a brief overview of the study's aims, purpose and methodology is presented as well as results of data analysis and lessons learned. The research team examined nurses' adoption patterns of EBP recommendations with respect to activity tolerance using four-month patient data collected from a pilot hospital. Study findings indicate a need for more focus on the system design and implementation process with the next rollout phase to promote evidence-based nursing practice. PMCID: PMC2655848 PMID: 18693871 [PubMed - indexed for MEDLINE] 70. J Nurses Staff Dev. 2008 Jul-Aug;24(4):E13-9. Increasing knowledge level of evidence-based nursing through self-directed learning: lessons learned for staff development. Zadvinskis IM. Riverside Methodist Hospital, Columbus, Ohio 43214, USA. izadvins@ohiohealth.com Recent literature and Magnet standards emphasize the promotion of evidence-based practice in nursing. Nurses prepared over 5 years ago may not necessarily have received education regarding the principles of evidence-based practice. Therefore, an independent study was developed to educate staff nurses regarding the basics of evidence-based practice. The development of a self-directed independent study is described, including the rationale, benefits, course content, and lessons learned when teaching evidence-based practice through self-directed learning. PMID: 18685469 [PubMed - indexed for MEDLINE]

71. Worldviews Evid Based Nurs. 2008;5(2):75-84. Effectiveness of a computer-based educational program on nurses' knowledge, attitude, and skill level related to evidence-based practice. Hart P, Eaton L, Buckner M, Morrow BN, Barrett DT, Fraser DD, Hooks D, Sharrer RL. Clinical Onboarding, Organizational Learning, Wellstar Health System, 2000 Park Place, Atlanta, GA, USA. tricia.hart@wellstar.org

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PURPOSE: To conduct a baseline assessment of nurses' perceptions of knowledge, attitude, and skill level related to evidence-based practice (EBP) and research utilisation; determine the level of organisational readiness for implementing EBP and research; and examine the effectiveness of a computer-based educational program on nurses' perceptions of knowledge, attitude, and skill level related to EBP and research utilisation. DESIGN: A descriptive, quasi-experimental design with a one-group, pre-intervention survey, intervention, and post-intervention survey method was used. A convenience sample of 744 nurses working in an integrated health care system was recruited. The study was conducted from May 2006 through November 2006. METHODS: Data collection instruments were a demographic data questionnaire and the Evidence-Based Nursing Questionnaire. An education intervention on principles of EBP and research utilisation was conducted via three computer-based learning modules. FINDINGS: Statistically significant differences in perceptions of knowledge, attitude, and skill level, as well as beliefs about organisational readiness were found after nurses participated in the computer-based education intervention. Although nurses indicated having positive attitudes about using research to support best nursing practice, gaps in knowledge and skills in retrieving research publications, evaluating the evidence, and incorporating the evidence into practice remain. Nurses rated their managers, senior nursing administrators, and staff nurses on their unit higher than hospital managers in supporting changes to practice based on research. CONCLUSIONS: Nurses in clinical settings need to be able to use research findings and incorporate EBP into their nursing practice to promote positive patient outcomes. Appropriate organisational infrastructures are essential for promoting EBP and research utilisation in clinical settings. Diverse and effective methods are essential in educating and engaging nurses in EBP and research utilisation. Computer-based education is an effective approach that can be used by nursing leaders in health care organisations to educate and engage nurses in EBP initiatives and research utilisation. PMID: 18559020 [PubMed - indexed for MEDLINE]

72. Dimens Crit Care Nurs. 2008 Mar-Apr;27(2):74-82; quiz 83-4. Barriers and facilitators to the use of evidence-based best practices. Leasure AR, Stirlen J, Thompson C. University of Oklahoma College of Nursing, USA. Renee-leasure@ouhsc.edu The continued use of healthcare interventions without an evidence base increases healthcare costs without positively impacting patient care outcomes. Reports disseminated by bodies such as the Institute of Medicine and initiatives such as the Institute for Health Care Improvement's 5 Million Lives Campaign have increased emphasis on improving outcomes. Results of a descriptive correlational study indicated that 64% of the nurses surveyed read 7 or more specialty journals, 53% read 1 or more general nursing journal, 20% did not regularly read any professional journal, and none of the nurses surveyed read a journal that was primarily dedicated to the publication of original research. Almost half of the nurses indicated that the hospital library was the nearest location to conduct searches, and 34% indicated that they did not know what literature-searching capabilities were available to them. Although knowledge in itself is not

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sufficient for behavior change, it is an essential prerequisite. Regular reading of journals either through personal subscriptions or access through facility libraries can encourage the adoption of new evidence through lifelong learning. Modeling and skill building in use of readily available Internet resources can serve as a mechanism to increase awareness of and skill in accessing current information. Evidence-based changes can then be empirically examined, implemented, and evaluated in examining nursing's contribution to the daily operation of the healthcare organization. PMID: 18510185 [PubMed - indexed for MEDLINE]

73. J Clin Nurs. 2008 Jun;17(12):1652-9. Defining an evidence-based work environment for nursing in the USA. Kotzer AM, Arellana K. The Children's Hospital, Aurora, and University of Colorado at Denver and Health Sciences Center, School of Nursing, Aurora, CO, USA. kotzer.annemarie@tchden.org AIMS: To describe and compare staff nurses' perceptions of their real and ideal work environment in a tertiary paediatric facility; to provide administrators with research evidence for identifying areas for improvement. BACKGROUND: The workforce shortage of hospital nurses is a global problem having an impact on the financial resources and efficient operations of an organisation and the quality of care delivered to patients. A direct relationship exists between job satisfaction, retention, turnover and elements of the nurses' work environment. Research identifying specific elements of the current work setting that are in conflict with nurses' views of their preferred practice milieu can help define an evidence-based work environment for nursing. DESIGN AND METHODS: Using a descriptive survey design, a convenience sample of 385 nurses on five inpatient units and the float team completed two forms (real and ideal) of the work environment scale. The work environment scale consists of 10 subscales within three dimensions: relationship, personal growth and system maintenance and change. RESULTS: A consistent pattern was seen across all units with reported high levels of involvement, peer cohesion, task orientation and managerial control. Scores for work pressure and autonomy were moderate-high and physical comfort, supervisor support, clarity and innovation were moderate. Overall, highest scores were reported for involvement and lowest for physical comfort. Significant differences were found between real and ideal subscale scores suggesting that staff were able to identify areas for improvement. CONCLUSIONS: Despite moderate work pressure, staff affirmed a highly positive work environment on their units. Specific areas in their current work setting that were not congruent with their preferred work environment were identified and targeted for change. RELEVANCE TO CLINICAL PRACTICE: Understanding dimensions of the nurses' work environment needing improvement and involving staff in making and evaluating change supports an evidence-based environment to attract and retain qualified staff. PMID: 18482126 [PubMed - indexed for MEDLINE]

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74. Orv Hetil. 2008 May 18;149(20):929-34. [Intensive care nurses' knowledge about the evidence-based guidelines of preventing central venous catheter related infection]. [Article in Hungarian] Csoms A, Orbn E, Konczn Rti R, Vass E, Darvas K. Semmelweis Egyetem, Altalnos Orvostudomnyi Kar I. Sebszeti Klinika Budapest Ulloi t 78. 1082. csomos@seb1.sote.hu OBJECTIVES: To determine intensive care unit (ICU) nurses' knowledge of evidence-based guidelines for preventing central venous catheter (CVC) related infection. METHOD: We used a validated multiple-choice questionnaire which was distributed to intensive care units between October and December 2006. We collected demographic data, like gender, years of ICU experience, number of ICU beds and whether respondents hold a special degree in intensive care. RESULTS: We collected 178 questionnaires from 11 intensive care units; the mean score was 3.66 on 10 questions (37%). Eighteen per cent knew that CVCs should be replaced on indication only, and 61% knew that this recommendation concerns also replacement over a guidewire. Recommendations for replacing pressure transducers and tubing every 4 days, and for using coated devices in patients requiring a CVC < 5 days in settings with high infection rates were recognized only by 48% and 66%, respectively. Regarding CVC dressings, 15% knew that these should be changed only when indicated and at least once weekly, and 35% recognized that both poly-urethane and gauze dressings can be recommended. Only 20% checked 2% aqueous chlorhexidine as recommended disinfection solution; 14% knew antibiotic ointments are not recommended because they trigger resistance. The recommendation to replace administration sets within 24 hours after administering lipid emulsions was recognized by 85%, but it was known by 5% only that these sets should be replaced every 96 hours when administering neither lipid emulsions nor blood products. Professional seniority and the number of intensive care beds in the ICU where nurses work showed not to be associated with better scores on the test. DISCUSSION: Knowledge regarding CVC-related infection is poor among Hungarian nurses. Prevention guidelines should be included in the nurse education curriculum as well as in continuing refresher nursing education programs. PMID: 18467262 [PubMed - indexed for MEDLINE]

75. J Contin Educ Nurs. 2008 Apr;39(4):166-72. Nurses reclaiming ownership of their practice: implementation of an evidence-based practice model and process. Reavy K, Tavernier S. Boise State University, Department of Nursing, Boise, Idaho 83725-1840, USA. This article describes a new model and process to implement evidence-based practice. This model builds on concepts from the Iowa Model of Evidence-Based Practice, the Stetler model, and Rosswurm and Larrabee's model. The new model focuses on the centrality and involvement of staff nurses in making evidence-based practice clinical changes. Two figures illustrate the model and

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the implementation process. A detailed case study based on the model is included. Barriers identified in the literature review are addressed in the case study. Implementation of this model creates opportunities for staff nurses to recognize ownership of their practice and their role in changing the practice setting to a culture of evidence-based practice. PMID: 18429370 [PubMed - indexed for MEDLINE]

76. Int J Palliat Nurs. 2008 Jan;14(1):45-7. A question of evidence: decision-making in palliative care nursing. Murray MA. University of Ottawa, Ottawa, Ontario, Canada. maryannmurray@rogers.com Nurses are urged to integrate research evidence into their practice. Current perspectives of evidence-based practice promote a hierarchy of empirical evidence. Notwithstanding the contribution of empirical knowledge, this approach constrains our understanding of the value and contribution of other forms of knowledge. Shifting to a model of 'evidence informed practice', where multiple forms of knowledge are considered and valued, may better reflect the complexities of end-of-life care and offer a fuller understanding of palliative care nursing best practice. PMID: 18414332 [PubMed - indexed for MEDLINE]

77. J Nurs Manag. 2008 May;16(4):440-51. Tensions and contradictions in nurses' perspectives of evidence-based practice. Rolfe G, Segrott J, Jordan S. School of Health Science, Swansea University, UK. AIM: To explore nurses' understanding and interpretation of evidence-based practice (EBP). BACKGROUND: EBP has been welcomed into the nursing lexicon without a critical examination of its interpretation by practitioners. The literature suggests that there is a great deal of confusion and contradiction over the meaning and application of EBP. Although work has been conducted on how EBP might be implemented, the general issue of how nurses understand and use EBP is largely unexplored. This paper seeks to examine in depth the understandings of EBP, to enable managers, educationalists and policy makers to implement it more effectively. METHODS: All registered nurses, midwives and health visitors in one UK National Health Service (NHS) Trust were asked to complete a questionnaire in October 2006. RESULTS: Despite a disappointing response rate (8.9%, 218/2438), the survey revealed interesting tensions and contradictions in nurses' understanding of EBP. National and local guidelines, practitioners' own experience and patients' preferences were the main influences on nurses' practice. Published research had relatively little impact, particularly among nurses graded E, F and G and those

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who had not attended a study day on EBP. CONCLUSIONS: The hierarchies of evidence propounded in local and national guidelines are not adopted by practising nurses, who use other sources of evidence, such as reflection on their own experiences, when making clinical decisions. However, subsuming published evidence to clinical judgement does not contradict the original tenets of EBP. IMPLICATIONS FOR NURSING MANAGEMENT: Unless it is incorporated into national or local guidelines, research has relatively little impact on practice. To develop nursing practice and nursing knowledge, nurse leaders need to foster the synthesis of experiential knowledge and published research, in accordance with the founding principles of the EBP movement. PMID: 18405261 [PubMed - indexed for MEDLINE]

78. J Adv Nurs. 2008 Apr;62(2):209-15. Nurses' perceptions of evidence-based nursing practice. Koehn ML, Lehman K. School of Nursing, Wichita State University, Wichita, Kansas, USA. mary.koehn@wichita.edu AIM: This paper is a report of a study to investigate Registered Nurses' perceptions, attitudes and knowledge/skills associated with evidence-based practice. BACKGROUND: Evidence-based practice has emerged as a marker for healthcare quality. Previous studies have primarily used researcher-developed descriptive surveys to examine nurses' perceptions, as well as facilitators and barriers, related to evidence-based practice. Research suggests the value of understanding the organizational context prior to taking steps to implement evidence-based practice. METHODS: This study, conducted in 2006, had a descriptive, cross-sectional survey design using a psychometrically-validated measure of evidence-based practice. All Registered Nurses (n = 1031) employed by a large medical centre in the United States of America were asked to complete the questionnaires. The final response rate was 40.9% (n = 422). FINDINGS: Participants had moderate scores on practice and attitudes towards evidence-based practice. The knowledge/skills mean scores were somewhat lower. Statistically significant differences were found for attitudes between those with baccalaureate and higher education compared to those with associate and diploma education. The two most cited barriers to implementing evidence-based practice were time and knowledge. CONCLUSION: The findings suggest the value of a methodical assessment when developing a systematic plan for implementing an institutional culture of evidence-based practice. PMID: 18394033 [PubMed - indexed for MEDLINE]

79. Crit Care Nurs Q. 2008 Apr-Jun;31(2):150-60. An evidence-based evaluation of tracheostomy care practices.

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Dennis-Rouse MD, Davidson JE. Emergency Department, Palomar Pomerado Health, Escondido, California 92025, USA. melissarousern@aol.com Adverse outcomes related to tracheal occlusion and peritracheal skin breakdown stimulated a review of tracheostomy care. An evidence-based practice approach was taken to evaluate the problem. Organizational tracheostomy care policies were reviewed. Subcategories related to tracheostomy care were queried including securing devices, sutures and their removal, type and choice of dressings, prevention of skin breakdown, frequency of care and role delineation, and suctioning. A literature review was done. National experts were surveyed. A geographical survey was taken and vendors of tracheostomy products were interviewed. Collected evidence was scored along a continuum. Costs of supplies were evaluated. Physicians, staff, and patients were interviewed. Skin maceration on the neck was found on multiple audits. The type of tie was identified as a problem. Nurses and respiratory therapists reported difficulty providing tracheostomy care due to suturing technique and securing methods. The stocked dressing was too large to fit under sutures. Several conflicting policies existed regarding tracheostomy care, none of which identified responsibility for performing care: respiratory versus nursing or time standards for care. New supplies were trialed. A list of practice changes were agreed upon by respiratory, nursing, and medical staff. Primary responsibility for tracheostomy care was shifted to the registered nurse. PMID: 18360145 [PubMed - indexed for MEDLINE]

80. J Adv Nurs. 2008 Apr;62(1):62-73. Developing evidence-based practice: experiences of senior and junior clinical nurses. Gerrish K, Ashworth P, Lacey A, Bailey J. Centre for Health & Social Care Research, Sheffield Hallam University/Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. k.gerrish@shu.ac.uk AIM: This paper is a report of a study to compare factors influencing the development of evidence-based practice identified by junior and senior nurses. BACKGROUND: Assessing factors influencing the achievement of evidence-based practice is complex. Consideration needs to be given to a range of factors including different types of evidence, the skills nurses require to achieve evidence-based practice together with barriers and facilitators. To date, little is known about the relative skills of junior and senior clinical nurses in relation to evidence-based practice. METHOD: A cross-sectional survey was undertaken at two hospitals in England, using the Developing Evidence-Based Practice Questionnaire administered to Registered Nurses (n = 1411). A useable sample of 598 (response rate 42%) was achieved. Data were collected in 2003, with comparisons undertaken between junior and senior nurses. FINDINGS: Nurses relied heavily on personal experience and communication with colleagues rather than formal sources of knowledge. All respondents demonstrated confidence in accessing and using evidence for practice. Senior nurses were more confident in accessing all sources of evidence including published sources and the Internet, and felt able to initiate change. Junior nurses perceived more

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barriers in implementing change, and were less confident in accessing organizational evidence. Junior nurses perceived lack of time and resources as major barriers, whereas senior nurses felt empowered to overcome these constraints. CONCLUSION: Senior nurses are developing skills in evidence-based practice. However, the nursing culture seems to disempower junior nurses so that they are unable to develop autonomy in implementing evidence-based practice. PMID: 18352965 [PubMed - indexed for MEDLINE]

81. J Prof Nurs. 2008 Jan-Feb;24(1):7-13. Nurse practitioner educators' perceived knowledge, beliefs, and teaching strategies regarding evidence-based practice: implications for accelerating the integration of evidence-based practice into graduate programs. Melnyk BM, Fineout-Overholt E, Feinstein NF, Sadler LS, Green-Hernandez C. Arizona State University College of Nursing & Healthcare Innovation, Phoenix, AZ 85004, USA. bernadette.melnyk@asu.edu The paradigm shift to evidence-based practice (EBP) in the United States has been slow. Evidence has supported that one barrier to accelerating this paradigm shift is that many nurses have negative attitudes toward research, in large part due to the manner in which they were taught research in their educational programs. The primary aims of this study were to (a) describe nurse educators' knowledge, beliefs, and teaching practices regarding EBP; (b) determine whether relationships exist among these variables; and (c) describe major barriers and facilitators to the teaching of EBP in nurse practitioner curriculums. A descriptive survey was conducted with a sample of 79 nurse practitioner educators who are members of the Association of Faculties of Pediatric Nurse Practitioners (AFPNP) and the National Organization of Nurse Practitioner Faculties (NONPF). The 25 AFPNP participants completed the survey while attending a national conference in Orlando, FL. The remaining 54 NONPF randomly selected participants responded to an e-mail version of the survey. Participants' self-reported knowledge and beliefs about the benefits of EBP and the need to integrate it into academic curricula were strong, although their responses indicated a knowledge gap in EBP teaching strategies. Few academic programs offered a foundational course in EBP. Significant relationships were found among educators' knowledge of EBP and (a) their beliefs that EBP improves clinical care, (b) beliefs that teaching EBP will advance the profession, (c) how comfortable they feel in teaching EBP, and (d) whether EBP clinical competencies are incorporated into clinical specialty courses. CONCLUSION AND IMPLICATIONS: Graduate programs need to offer a foundational course in EBP and integrate EBP throughout clinical specialty courses in order for advanced practice nurses to implement this type of care upon entry into practice. There is a need to educate faculty to become proficient in EBP as knowledge of EBP is highly related to its teaching and incorporation into graduate education. Further research is needed to describe the knowledge and state of teaching EBP in graduate faculty who are not active in clinical practice. PMID: 18206837 [PubMed - indexed for MEDLINE]

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82. Am J Crit Care. 2008 Jan;17(1):65-71; quiz 72. Critical care nurses' knowledge of evidence-based guidelines for preventing infections associated with central venous catheters: an evaluation questionnaire. Labeau S, Vereecke A, Vandijck DM, Claes B, Blot SI; executive board of the Flemish Society for Critical Care Nurses. Faculty of Healthcare, Ghent University College, Ghent, Belgium. BACKGROUND: Lack of adherence to recommended evidence-based guidelines for preventing infections associated with use of central venous catheters may be due to nurses' lack of knowledge of the guidelines. OBJECTIVE: To develop a reliable and valid questionnaire for evaluating critical care nurses' knowledge of evidence-based guidelines for preventing infections associated with central venous catheters. METHODS: A total of 10 nursing-related strategies were identified from current evidence-based guidelines for preventing infections associated with use of central venous catheters. Face and content validation were determined for selected interventions and multiple-choice questions (1 question per intervention). The test results of 762 critical care nurses were evaluated for item difficulty, item discrimination, and quality of the response alternatives or options for answers (possible responses). RESULTS: All 10 items had face and content validity. Values for item difficulty ranged from 0.1 to 0.9. Values for item discrimination ranged from 0.05 to 0.41. The quality of the response alternatives (0.0-0.8) indicated widespread misconceptions among the critical care nurses in the sample. CONCLUSION: The questionnaire is reliable and has face and content validity. Findings from surveys in which this questionnaire is used can lead to better educational programs for critical care nurses on infections associated with use of central venous catheters. PMID: 18158392 [PubMed - indexed for MEDLINE]

83. J Contin Educ Nurs. 2007 Nov-Dec;38(6):262-70. The role of the clinical nurse specialist in promoting evidence-based practice and effecting positive patient outcomes. LaSala CA, Connors PM, Pedro JT, Phipps M. Massachusetts General Hospital, Patient Care Services, Boston, Massachusetts 02114, USA. Clinical nurse specialists (CNSs) are vital members of the healthcare delivery leadership team. The knowledge and expertise of the CNS is germane to the quality of care a patient receives. More than 50 CNSs practice at Massachusetts General Hospital (the state's first Magnet hospital), where they share their clinical skills, mentor staff through difficult situations, identify learning needs, and implement innovative approaches to patient care. This article presents a brief history of the CNS role and describes how the CNS role is operationalized at Massachusetts General Hospital and its impact on unit-based and organizational outcomes. In addition, several programs and interventions identified by the CNSs in response to results of the Staff Perception of the Professional Practice Environment Survey are discussed. How the CNS influences the professional

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development of staff and potential implications for the future role of the CNS are described. An exemplar is included depicting a typical work day of a CNS on an acute adult medical unit. PMID: 18050983 [PubMed - indexed for MEDLINE]

84. J Nurses Staff Dev. 2007 Nov-Dec;23(6):293-7. The moved to evidenced-based practice from a clinical nursing question. Heinzer MM, Bish C, Detwiler R. Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio 44106-4904, USA. marjorie.heinzer@case.edu Registered nurses on a medical unit questioned whether current practice adequately met the emotional needs of patients with chronic obstructive pulmonary disease hospitalized for acute dyspnea. The unit's education committee surveyed nursing staff regarding priority nursing activities during dyspneic episodes. After discussion with staff development educators, several registered nurses met with the center's nurse researcher, formed a research team, and designed a descriptive study. Findings of the study gave evidence for clinical practice change and revision of care guidelines. PMID: 18043339 [PubMed - indexed for MEDLINE]

85. Int J Nurs Pract. 2007 Dec;13(6):363-9. Nurses' attitudes to and perceptions of knowledge and skills regarding evidence-based practice. Sherriff KL, Wallis M, Chaboyer W. Nursing Education ans Research Unit, Gold Coast Health Services District, Southport, Queensland, Australia. karen_sheriff@health.qld.gov.au The study evaluated the effect of an evidence-based practice (EBP) educational programme on attitudes and perceptions of knowledge and skills, of registered nurses, towards EBP. The study was conducted using a quasiexperimental interrupted time series design. Participants were clinical nurses in educational and leadership roles within a Health Service District in south-east Queensland. The data were collected using a self-administered questionnaire at three points. Nurses' belief in the value of EBP for practice was high prior to the programme and did not change subsequently. There was an improvement following the intervention in nurses' attitudes to organizational support for EBP and their perceptions of their knowledge and skills in locating and evaluating research reports. Providing educational courses in a clinical setting is useful in improving clinicians' attitudes to and perceptions of knowledge and skills related to EBP. PMID: 18021165 [PubMed - indexed for MEDLINE]

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86. Nurs Leadersh (Tor Ont). 2007;20(3):86-97. Using Appreciative Inquiry to promote evidence-based practice in nursing: the glass is more than half full. Marchionni C, Richer MC. McGill University Health Centre, Montreal, QC. caroline.marchionni@mcgill.ca It is now understood that successful implementation of evidence-based practice (EBP) requires a focus on the context of the care setting. While the focal point of many reports is the limitations and barriers, this paper proposes a new approach to "making EBP happen." Appreciative Inquiry (AI), both a method of social research and an organizational development or change intervention, is a novel means to elicit enthusiasm and support for EBP in nursing. Readers will be introduced to the theoretical foundations and assumptions as well as the "4-D Model" of AI. It is proposed that the advanced practice nurse (APN) is in a key position to introduce and support this intervention in healthcare organizations to promote the successful implementation of EBP. PMID: 17987829 [PubMed - indexed for MEDLINE]

87. Rehabil Nurs. 2007 Sep-Oct;32(5):203-9. Evidence-based practice in rehabilitation nursing. Pierce LL. The University of Toledo, College of Nursing, Health Science Campus, OH 43614-2598, USA. l.pierce@utoledo.edu How to use research is a learned skill. With this skill rehabilitation nurses can help ensure that their practice is based on the best evidence available. Evidence-based practice is a balance of using external research-based clinical evidence and clinical expertise. The purpose of this article is to show rehabilitation nurses how to build the skills for using evidence, rather than just doing research. This involves asking questions, finding and appraising relevant data, and putting that information into everyday practice. When evidence-based practice is merged into a clinician's daily routine, the result is a more analytical and, ultimately, effective clinical practice. PMID: 17899991 [PubMed - indexed for MEDLINE]

88. Am J Nurs. 2007 Oct;107(10):50-8; quiz 58-9. Motivational interviewing: an evidence-based approach to counseling helps patients follow treatment recommendations. Levensky ER, Forcehimes A, O'Donohue WT, Beitz K. New Mexico Veterans Affairs Medical Center, Albuquerque, NM, USA. elevensky@comcast.net

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Motivational interviewing is an evidenced-based counseling approach that health care providers can use to help patients adhere to treatment recommendations. It emphasizes using a directive, patient-centered style of interaction to promote behavioral change by helping patients explore and resolve ambivalence. This article will help nurses learn how to use motivational interviewing to encourage patients to adhere to treatment recommendations. The basic theoretical underpinnings, principles, and methods of motivational interviewing are discussed, with an emphasis on acting in accordance with the "spirit" of the approach. PMID: 17895731 [PubMed - indexed for MEDLINE]

89. J Adv Nurs. 2007 Oct;60(2):162-71. Barriers to evidence-based nursing: a focus group study. Hannes K, Vandersmissen J, De Blaeser L, Peeters G, Goedhuys J, Aertgeerts B. Belgian Centre for Evidence-Based Medicine, Belgian Branch of the Cochrane Collaboration, Leuven, Belgium. Karin.hannes@med.kuleuven.be AIM: This paper reports a study to explore the barriers to evidence-based nursing among Flemish (Belgian) nurses. BACKGROUND: Barriers obstructing the call for an increase in evidence-based nursing have been explored in many countries, mostly through quantitative study designs. Authors report on lack of time, resources, evidence, authority, support, motivation and resistance to change. Relationships between barriers are seldom presented. METHODS: We used a grounded theory approach, and five focus groups were organized between September 2004 and April 2005 in Belgium. We used purposeful sampling to recruit 53 nurses working in different settings. A problem tree was developed to establish links between codes that emerged from the data. FINDINGS: The majority of the barriers were consistent with previous findings. Flemish (Belgian) nurses added a potential lack of responsibility in the uptake of evidence-based nursing, their 'guest' position in a patient's environment leading to a culture of adaptation, and a future 'two tier' nursing practice, which refers to the different education levels of nurses. The problem tree developed serves as (1) a basic model for other researchers who want to explore barriers within their own healthcare system and (2) a useful tool for orienting change management processes. CONCLUSION: Despite the fact that the problem tree presented is context-specific for Flanders (Belgium), it gives an opportunity to develop clear objectives and targeted strategies for tackling obstacles to evidence-based nursing. PMID: 17877563 [PubMed - indexed for MEDLINE]

90. Collegian. 2007 Apr;14(2):20-5. Evidence-based management practice: reducing falls in hospital. McKinley C, Fletcher A, Biggins A, McMurray A, Birtwhistle S, Gardiner L, Lampshire S, Noake N, Lockhart J.

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Peel Health Campus, Mandurah, Western Australia. This paper reports on a falls prevention and management program at one regional Western Australian hospital. The report focuses on the processes and outcomes of a quality management initiative to reduce falls in hospital to illustrate the nexus between research and quality improvement in clinical practice. The Falls Prevention program was based on statistical evidence of the level of risk in the hospital and development of an evidence-based multidimensional, multidisciplinary program to reduce the risks of falling and the number of falling events. Evaluative data demonstrate the effectiveness of the program in terms of a substantial reduction in falls. The program illustrates the value of evidence-based practice, particularly in relation to evidence-based management practice. It supports the merits of creating an organisational climate where all clinicians are encouraged to use research data to plan strategies for quality improvement and risk management and, in the process, advance clinical nursing knowledge development. PMID: 17679264 [PubMed - indexed for MEDLINE]

91. Med J Aust. 2007 Jul 16;187(2):108-10. Practice nurses in Australia: current issues and future directions. Keleher H, Joyce CM, Parker R, Piterman L. School of Primary Health Care, Monash University, Melbourne, VIC, Australia. helen.keleher@med.monash.edu.au Almost 60% of general practices now employ at least one practice nurse. Australian Government initiatives to support the expansion of practice nursing are not consistently based on strong evidence about effectiveness, outcomes or efficiencies. Reviews from other countries suggest that practice nurses can achieve good health outcomes, but there is little information about the Australian practice-nurse workforce, funding models to support their work, scope of their practice, or its outcomes. Australian practice nursing lacks a career structure and an education framework to advance nurses' skills and knowledge. To maximise the contribution of nurses in primary care, a more systematic approach is needed, with a stronger evidence base for policy to support effective outcomes. PMID: 17635095 [PubMed - indexed for MEDLINE]

92. Am J Crit Care. 2007 Jul;16(4):371-7. Critical care nurses' knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia: an evaluation questionnaire. Labeau S, Vandijck DM, Claes B, Van Aken P, Blot SI; executive board of the Flemish Society for Critical Care Nurses. Faculty of Healthcare, Ghent University College, Ghent, Belgium.

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Comment in Am J Crit Care. 2007 Nov;16(6):532-3. BACKGROUND: Nurses' lack of knowledge may be a barrier to adherence to evidence-based guidelines for preventing ventilator-associated pneumonia. OBJECTIVE: To develop a reliable and valid questionnaire for evaluating critical care nurses' knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia. METHODS: Ten nursing-related interventions were identified from a review of evidence-based guidelines for preventing ventilator-associated pneumonia. Selected interventions and multiple-choice questions (1 question per intervention) were subjected to face and content validation. Item difficulty, item discrimination, and the quality of the response alternatives or options for answers (possible responses) were evaluated on the test results of 638 critical care nurses. RESULTS: Face and content validity were achieved for 9 items. Values for item difficulty ranged from 0.1 to 0.9. Values for item discrimination ranged from 0.10 to 0.65. The quality of the response alternatives led to the detection of widespread misconceptions among critical care nurses. CONCLUSION: The questionnaire is reliable and has face and content validity. Results of surveys with this questionnaire can be used to focus educational programs on preventing ventilator-associated pneumonia. PMID: 17595369 [PubMed - indexed for MEDLINE]

93. J Neurosci Nurs. 2007 Jun;39(3):190-1. The role of the nurse academician in promoting evidence-based practice in a brain injury rehabilitation unit. Gebhardt MC, Testani-Dufour L. Byrdine F. Lewis School of Nursing, Georgia State University, Alpharetta, GA, USA. mgebhardt@gsu.edu There are many rehabilitation teams and rehabilitation consultants. The team presented here involved the unique collaboration of university nursing scholars and clinicians from a local rehabilitation hospital. The melding of these two groups is providing new opportunities for staff nurses, administrators, and faculty members to work together and use nursing research to provide the base of evidence necessary to enhance rehabilitation nursing knowledge in the brain injury setting. PMID: 17591415 [PubMed - indexed for MEDLINE]

94. J Nurs Care Qual. 2007 Jul-Sep;22(3):234-8. Optimizing nursing care by integrating theory-driven evidence-based practice. Pipe TB. Nursing Administartion, Mayo Clinic Arizona, Phoenix, AZ 85054, USA. Pipe.teri@mayo.edu

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An emerging challenge for nursing leadership is how to convey the importance of both evidence-based practice (EBP) and theory-driven care in ensuring patient safety and optimizing outcomes. This article describes a specific example of a leadership strategy based on Rosswurm and Larrabee's model for change to EBP, which was effective in aligning the processes of EBP and theory-driven care. PMID: 17563592 [PubMed - indexed for MEDLINE]

95. Worldviews Evid Based Nurs. 2007;4(2):86-96. Clinical nurse specialists' use of evidence in practice: a pilot study. Profetto-McGrath J, Smith KB, Hugo K, Taylor M, El-Hajj H. Faculty of Nursing, Knowledge Utilization Studies Program (KUSP), and Centre for Knowledge Transfer, University of Alberta, Edmonton, Alberta, Canada. joanne.profetto-mcgrath@ualberta.ca BACKGROUND: The interest in finding ways to bridge the gap between nursing research and implementation of findings into practice has been increasing. Clinical nurse specialists (CNSs) may be a bridge between frontline nurses and current developments in practice. While several researchers have studied the use of evidence by nurses in general, no known studies have been focused specifically on the use of evidence by CNSs. PURPOSE: The purpose of this pilot study was to develop an understanding of the sources, nature, and application of evidence used by CNSs in practice and to investigate the feasibility of conducting a qualitative study focused on the CNS role in relation to evidence use in practice. METHODS: This pilot study is a descriptive exploratory design in the qualitative paradigm. Seven CNSs from a large Western Canadian health region were interviewed. Interview transcripts were reviewed for recurrent themes about sources of evidence, evidence use, and barriers and facilitators to evidence use. FINDINGS: CNSs access and use evidence from a variety of sources. All CNSs indicated that research literature was a primary source of evidence and research was used in decision-making. Peers and experience were also important sources of evidence. CNSs used the Internet extensively to consult research databases, online sources of evidence, and to contact peers about current practice. CNSs also gathered evidence from frontline nurses, healthcare team members, and families before decision-making. The choice of evidence often depended upon the type of question they were attempting to answer. Barriers cited by CNSs support previous research and included lack of time, resources, and receptivity at clinical and organizational levels. Facilitators included peers, organizational support, and advanced education. DISCUSSION: CNSs in Canada have advanced education and clinical expertise and many are employed in roles that permeate organizational management and clinical nursing care. It is suggested that qualitative research in naturalized settings that investigates the role of CNSs in relation to the dissemination of evidence in nursing practice needs attention. PMID: 17553109 [PubMed - indexed for MEDLINE]

96. Intensive Care Med. 2007 Aug;33(8):1463-7. Epub 2007 Jun 1.

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Evidence-based guidelines for the prevention of ventilator-associated pneumonia: results of a knowledge test among intensive care nurses. Blot SI, Labeau S, Vandijck D, Van Aken P, Claes B; Executive Board of the Flemish Society for Critical Care Nurses. Department of Intensive Care, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. stijn.blot@UGent.be OBJECTIVE: To determine intensive care nurses' knowledge of evidence-based guidelines for the prevention of ventilator-associated pneumonia (VAP). DESIGN: A survey using a validated multiple-choice questionnaire, developed to evaluate nurses' knowledge of VAP prevention. The questionnaire was distributed and collected during the annual congress of the Flemish Society for Critical Care Nurses (Ghent, November 2005). Demographic data included were gender, years of intensive care experience, number of critical beds, and whether respondents hold a special degree in emergency and intensive care. MAIN RESULTS: We collected 638 questionnaires (response rate 74.6%). Nineteen percent of the respondents recognized the oral route as the recommended way for intubation. It was known by 49% of respondents that ventilator circuits should be changed for each new patient. Heat and moisture exchangers were checked as the recommended type of humidifier by 55% of respondents, but only 13% knew that it is recommended to change them once weekly. Closed suctioning systems were identified as recommended by 17% of respondents, and 20% knew that these must be changed for each new patient only. Sixty percent and 49%, respectively, recognized subglottic drainage and kinetic beds to reduce the incidence of VAP. Semi-recumbent positioning is well known to prevent VAP (90%). The average knowledge level was higher among more experienced nurses (> 1 year experience) and those holding a special degree in emergency and intensive care. CONCLUSION: Nurses lack knowledge regarding recommendations for VAP prevention. Nurses' schooling and continuing education should include support from current evidence-based guidelines. PMID: 17541752 [PubMed - indexed for MEDLINE]

97. J Emerg Nurs. 2007 Jun;33(3):202-7. Epub 2006 Dec 22. Emergency nurses' knowledge of evidence-based ischemic stroke care: a pilot study. Harper JP. QM&I and Per Diem Clinical Educator, Taylor Hospital, Ridley Park, PA, USA. harpjp2@verizon.net INTRODUCTION: The purpose of this pilot study was to assess emergency nurses' knowledge of evidence-based ischemic stroke care. DESIGN AND METHODS: A descriptive, correlational design was used. Emergency nurses (N = 20) working in 2 hospitals in the Mid-Atlantic region completed a 10-item multiple choice test on evidence-based ischemic stroke care. RESULTS: Test scores ranged from 30% to 90%, with a mean of 53% (SD = 12.93) on a scale of 0 to 100%. Forty-five percent (N = 9) of respondents indicated that they read literature on evidence-based ischemic stroke care within the previous 12 months. Respondents who read literature on evidence-based ischemic stroke care

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had a significantly higher mean test score (P = .04) than did respondents who did not read any literature on evidence-based ischemic stroke care. Only 15% (N = 3) of respondents reported that they had participated in continuing education on evidence-based ischemic stroke care within the previous 12 months. In addition, there was a significant correlation (P = .02) between number of years worked in emergency nursing as a registered nurse and test scores. Nurses with more years experience in emergency nursing had higher test scores. DISCUSSION: Overall, emergency nurses demonstrated a knowledge deficit in evidence-based ischemic stroke care. The majority of nurses had not participated in continuing education on evidence-based ischemic stroke care within the previous 12 months. Nurses should be provided with evidence-based education on ischemic stroke care and opportunities to participate in continuing education. PMID: 17517264 [PubMed - indexed for MEDLINE]

98. J Clin Nurs. 2008 Jan;17(2):214-23. Epub 2007 Apr 5. A review of evidence-based practice, nursing research and reflection: levelling the hierarchy. Mantzoukas S. Institute of Health & Human Sciences, Thames Valley University, London, UK. smantzoukas@hotmail.com AIM: This paper examines the evidence-based practice movement, the hierarchy of evidence and the relationship between evidence-based practice and reflective practice. BACKGROUND: Evidence-based practice is equated with effective decision making, with avoidance of habitual practice and with enhanced clinical performance. The hierarchy of evidence has promoted randomized control trials as the most valid source of evidence. However, this is problematic for practitioners as randomized control trials overlook certain types of knowledge that, through the process of reflection, provide useful information for individualized and effective practice. METHOD: A literature search was undertaken using CINAHL, medline and Ovid electronic databases in early 2006. The search terms used were: evidence-based practice, research evidence, evidence for practice, qualitative research, reflective practice, reflection and evidence. Other sources included handpicking of books on evidence-based practice, reflection and research. Only material written in English was included. FINDINGS: The hierarchy of evidence that has promoted randomized control trials as the most valid form of evidence may actually impede the use of most effective treatment because of practical, political/ideological and epistemological contradictions and limitations. Furthermore, evidence-based practice appears to share very similar definitions, aims and procedures with reflective practice. Hence, it appears that the evidence-based practice movement may benefit much more from the use of reflection on practice, rather than the use of the hierarchical structure of evidence. CONCLUSION: Evidence-based practice is necessary for nursing, but its' effective implementation may be hindered by the hierarchy of evidence. Furthermore, evidence-based practice and reflection are both processes that share very similar aims and procedures. Therefore, to enable the implementation of best evidence in practice, the hierarchy of evidence might need to be abandoned and reflection to become a core component of the evidence-based practice movement. RELEVANCE TO CLINICAL PRACTICE: Provides an elaborated analysis for clinical

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nurses on the definition and implementation of evidence in practice. PMID: 17419779 [PubMed - indexed for MEDLINE]

99. J Nurs Manag. 2007 Mar;15(2):230-43. Building the capacity for evidence-based clinical nursing leadership: the role of executive co-coaching and group clinical supervision for quality patient services. Alleyne J, Jumaa MO. Healthcare and Nursing Management, School of Health and Social Sciences, Middlesex University, London, UK. joalleyne1@aol.com AIM: The general aims of this article were to facilitate primary care nurses (District Nurse Team Leaders) to link management and leadership theories with clinical practice and to improve the quality of the service provided to their patients. The specific aim was to identify, create and evaluate effective processes for collaborative working so that the nurses' capacity for clinical decision-making could be improved. BACKGROUND: This article, part of a doctoral study on Clinical Leadership in Nursing, has wider application in the workplace of the future where professional standards based on collaboration will be more critical in a world of work that will be increasingly complex and uncertain. This article heralds the type of research and development activities that the nursing and midwifery professions should give premier attention to, particularly given the recent developments within the National Health Service in the United Kingdom. The implications of: Agenda for Change, the Knowledge and Skills Framework, 'Our Health, Our Care, Our Say' and the recent proposals from the article 'Modernising Nursing Career', to name but a few, are the key influences impacting on and demanding new ways of clinical supervision for nurses and midwives to improve the quality of patient management and services. METHOD: The overall approach was based on an action research using a collaborative enquiry within a case study. This was facilitated by a process of executive co-coaching for focused group clinical supervision sessions involving six district nurses as co-researchers and two professional doctoral candidates as the main researchers. The enquiry conducted over a period of two and a half years used evidence-based management and leadership interventions to assist the participants to develop 'actionable knowledge'. Group clinical supervision was not practised in this study as a form of 'therapy' but as a focus for the development of actionable knowledge, knowledge needed for effective clinical management and leadership in the workplace. FINDINGS: 1. Management and leadership interventions and approaches have significantly influenced the participants' capacity to improve the quality of services provided to their patients. 2. Using various techniques, tools, methods and frameworks presented at the sessions increased participants' confidence to perform. 3. A structured approach like the Clinical Nursing Leadership Learning and Action Process (CLINLAP) model makes implementing change more practical and manageable within a turbulent care environment. The process of Stakeholder Mapping and Management made getting agreement to do things differently much easier. Generally it is clear that many nurses and midwives, according to the participants, have to carry out management and leadership activities in their day-to-day practice. The traditional boundary between the private, the public and the voluntary sector management is increasingly becoming blurred.

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CONCLUSION: It is conclusive that the district nurses on this innovative programme demonstrated how they were making sense of patterns from the past, planning for the future and facilitating the clinical nursing leadership processes today to improve quality patient services tomorrow. Their improved capacity to manage change and lead people was demonstrated, for example, through their questioning attitudes about the dominance of general practitioners. They did this, for example, by initiating and leading case conferences with the multi-disciplinary teams. It became evident from this study that to use group clinical supervision with an executive co-coaching approach for the implementation and to sustain quality service demand that 'good nursing' is accepted as being synonymous with 'good management'. This is the future of 'new nursing'. PMID: 17352707 [PubMed - indexed for MEDLINE]

100. Arch Psychiatr Nurs. 2007 Feb;21(1):12-6. Evidence-based nursing: effects of a structured nursing program for the health promotion of Korean women with Hwa-Byung. Choi YJ, Lee KJ. University of Maryland School of Nursing, Baltimore, MD 21201-1579, USA. ychoi003@umaryland.edu The objectives of this study were to develop a culturally tailored nursing program for patients with Hwa-Byung (HB) and to test the effects of the nursing intervention. The structured nursing intervention program was based on a transcultural theoretical framework in which patients with HB received therapies consisting of music therapy, drama, and group therapy. Hwa-Byung is a culture-bound syndrome, literally translated as anger syndrome, attributed to the suppression of anger. Individuals experience a decrease in quality of life as a result of insufficient treatment. Current health care programs do not meet the needs of these individuals, who still need nursing interventions. A culturally tailored therapy is effective and appropriate for patients with illnesses related to their cultural background. Evidence-based nursing is a crucial approach in verifying the effects of nursing care and in enhancing the body of knowledge on nursing science. A nonequivalent, nonsynchronized, and controlled study design was applied to experimental and control groups of an even number of women. The nursing program was generally effective in the mental health condition test; the mental health condition of the experimental group was significantly more improved as compared with that of the control group. The program was particularly effective in the categories of somatization, depression, psychoticism, and hostility. The data indicate that the mental health of patients with HB could be improved with the use of nursing intervention programs. Nurses need to understand the cultural background of patients and provide culture-sensitive interventions for effective patient-oriented care. PMID: 17258104 [PubMed - indexed for MEDLINE]

101. J Adv Nurs. 2007 Feb;57(3):328-38. Factors influencing the development of evidence-based practice: a research tool.

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Gerrish K, Ashworth P, Lacey A, Bailey J, Cooke J, Kendall S, McNeilly E. Nursing Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK. AIM: The paper reports a study to develop and test a tool for assessing a range of factors influencing the development of evidence-based practice among clinical nurses. BACKGROUND: Achieving evidence-based practice is a goal in nursing frequently cited by the profession and in government health policy directives. Assessing factors influencing the achievement of this goal, however, is complex. Consideration needs to be given to a range of factors, including different types of evidence used to inform practice, barriers to achieving evidence-based practice, and the skills required by nurses to implement evidence-based care. METHODS: Measurement scales currently available to investigate the use of evidence in nursing practice focus on nurses' sources of knowledge and on barriers to the use of research evidence. A new, wider ranging Developing Evidence-Based Practice questionnaire was developed and tested for its measurement properties in two studies. In study 1, a sample of 598 nurses working at two hospitals in one strategic health authority in northern England was surveyed. In study 2, a slightly expanded version of the questionnaire was employed in a survey of 689 community nurses in 12 primary care organizations in two strategic health authorities, one in northern England and the other in southern England. FINDINGS: The measurement characteristics of the new questionnaire were shown to be acceptable. Ten significant, and readily interpretable, factors were seen to underlie nurses' relation to evidence-based practice. CONCLUSION: Strategies to promote evidence-based practice need to take account of the differing needs of nurses and focus on a range of sources of evidence. The Developing Evidence-Based Practice questionnaire can assist in assessing the specific 'evidencing' tendencies of any given group of nurses. PMID: 17233652 [PubMed - indexed for MEDLINE]

102. J Nurs Manag. 2007 Jan;15(1):107-13. Challenges for new nurses in evidence-based practice. Ferguson LM, Day RA. College of Nursing, University of Saskatchewan, 107 Wiggins Road, Saskatoon, Saskatchewan, Canada. linda.ferguson@usask.ca AIM: The purpose of this article was to examine issues that new nurses encounter as they enter nursing practice, particularly in an evidence-based practice environment. BACKGROUND: These issues are not new. In part, these issues arise from our failure to acknowledge the developmental issues that new nurses experience on entry to practice and the lack of role models in evidence-based practice and holistic care. EVALUATION: This article synthesizes research reported over the last decade to delineate the issues of transition to practice and strategies that have proven effective in addressing them. KEY ISSUES: The key issues relate to the need to support new nurses in

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evidence-based and holistic practice, the strategies needed to do so, and the nurse manager's role in this process. CONCLUSIONS: We must invest resources in assisting new nurses into practice, which may have benefits in terms of both recruitment and retention of new nurses in practice. PMID: 17207014 [PubMed - indexed for MEDLINE]

103. Worldviews Evid Based Nurs. 2004;1(4):215-23. Promoting evidence-based practice: an internship for staff nurses. Cullen L, Titler MG. Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, Iowa City, IA 52242-1009, USA. laura-cullen@uiowa.edu Implementing evidence-based practice is a complex but valued process that requires support for nurses to make it a reality in care delivery. To address this, an Evidence-Based Practice Staff Nurse Internship was developed at the University of Iowa Hospitals and Clinics in the United States. PROGRAM OVERVIEW: The objective of this internship is to promote use of evidence by staff nurses to improve patient outcomes. Through a competitive application process, six nurses are accepted in each cohort. The program provides didactic content and dedicated work time on topics interns select (e.g., family pet visitation, sedation management, bowel sounds assessment, guided imagery, family transition to pediatric floor). Interns receive paid clinical release time for participating. ROLES AND RESPONSIBILITIES: Teams include the staff nurse, the nurse manager, and an advanced practice nurse. Responsibilities for each step are assigned to the person with the appropriate expertise. EVALUATION: Interns report understanding the process, appreciate the opportunity for professional growth, and report their objectives are being met. Participants evaluated the program very positively and also provided recommendations for revision (e.g., revising class content). The program resulted in improved quality of care such as increased patient and family satisfaction, decreased length of stay, and cost savings. IMPLICATIONS: Programs that support practitioners through the evidence-based practice process are needed for use in a variety of settings internationally. This unique program supports staff nurses in making evidence-based practice a reality for their work and patients and might be transferable across settings. PMID: 17166151 [PubMed - indexed for MEDLINE]

104. Worldviews Evid Based Nurs. 2004;1(3):185-93. Nurses' perceived knowledge, beliefs, skills, and needs regarding evidence-based practice: implications for accelerating the paradigm shift. Melnyk BM, Fineout-Overholt E, Fischbeck Feinstein N, Li H, Small L, Wilcox L, Kraus R. Center for Research & Evidence-Based Practice, University of Rochester School of Nursing, NY 14642, USA. Bernadette_Melnyk@urmc.rochester.edu

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BACKGROUND: The paradigm shift to evidence-based nursing practice in the United States has been slow. Although multiple barriers to evidence-based practice (EBP) have been identified through prior studies, there is a gap in the literature specifically identifying key variables (e.g., belief that EBP produces quality outcomes) that are correlated with the extent to which nurses engage in EBP. AIM: The primary aims of this study were to (1) describe nurses' knowledge, beliefs, skills, and needs regarding EBP; (2) determine whether relationships exist among these variables; and (3) describe major barriers and facilitators to EBP. METHODS: A descriptive survey was conducted with a convenience sample of 160 nurses who were attending EBP conferences or workshops in four states located within the Eastern Region of the United States. RESULTS: Although participant beliefs about the benefit of EBP were high, knowledge of EBP was relatively low. Significant relationships were found between the extent to which the nurses' practice is evidence-based and (1) nurses' knowledge of EBP, (2) nurses' beliefs about the benefits of EBP, (3) having an EBP mentor, and (4) using the Cochrane Database of Systematic Reviews and the National Guideline Clearinghouse. CONCLUSION AND IMPLICATIONS: Health care systems need to implement interventions that not only increase nurses' EBP knowledge and skills, but also strengthen their beliefs about the benefit of evidence-based care. EBP mentors may be key in accelerating a more rapid shift toward evidence-based nursing practice. Theoretically driven randomized controlled trials are urgently needed to test the effectiveness of interventions on advancing evidence-based care. PMID: 17163896 [PubMed - indexed for MEDLINE]

105. Worldviews Evid Based Nurs. 2004;1(1):60-8. Strategic collaborative model for evidence-based nursing practice. Olade RA. College of Nursing, University of Nebraska Medical Center, Omaha 68198-5330, USA. rolade@unmc.edu PURPOSE: To describe a model that has been developed to guide nurses and other health professionals in collaborative efforts toward evidence-based nursing practice. METHOD: A review of literature was conducted using MEDLINE and CINAHL to search for articles on research utilization for evidence-based practice in health care delivery. Empirical studies; reviews; and theoretical, opinion, and information articles were included in the review in order to provide a more comprehensive view of the state of evidence-based nursing internationally. FINDINGS: Findings revealed a number of barriers to evidence-based nursing practice, which have persisted over the last two decades, including inadequate knowledge of research among practicing nurses, lack of administrative support for research activities in clinical settings, lack of empowerment of nurses, and lack of needed mentoring from nursing research consultants. CONCLUSIONS: Barriers in the areas of nursing education and administrative support appear to be major. A need was identified for a pragmatic model that encourages cooperation and collaboration between educators/researchers in academia and the administrative leaders in the clinical facilities if evidence-based nursing practice is to become the norm. FRAMEWORK OF MODEL: The Tyler Collaborative Model is based on an eclectic approach to planned change for

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creating evidence-based practice. This model identifies a step-by-step process for change, while allowing for the opportunity to integrate any of the previously available methods of critical appraisal to determine the best evidence for practice in each clinical setting. PMID: 17147759 [PubMed - indexed for MEDLINE]

106. Worldviews Evid Based Nurs. 2004;1(1):9-17; discussion 18-9. Fortuitous phenomena: on complexity, pragmatic randomised controlled trials, and knowledge for evidence-based practice. Thompson C. Centre for Evidence-Based Nursing, University of York, UK. cat4@york.ac.uk CONTEXT: Many of the interventions that nurses develop and implement are in themselves complex and have to operate in situations of irreducible complexity and uncertainty. MAIN ARGUMENT: This article argues that the primary means of generating knowledge for the evidence-based deployment of complex interventions should be the pragmatic randomised controlled trial. Randomised controlled trials represent the only research design to adequately deal with that which we know and (far more importantly) that which we do not. LITERARY METHOD: Using the example of practice development as an exemplar for complexity, and drawing on the objections often voiced as a response to calls to make use of randomised controlled trials in nursing and nursing research, the article presents a developmental framework and some methodological solutions to problems often encountered. CONCLUSION: Randomised controlled trials, whilst undoubtedly methodologically and strategically challenging, offer the most robust basis for developing primary research knowledge on the effects of complex interventions in nursing and their active components. PMID: 17147754 [PubMed - indexed for MEDLINE]

107. Minerva Anestesiol. 2007 Mar;73(3):129-34. Epub 2006 Nov 20. Nurses' knowledge and application of evidence-based guidelines for preventing ventilator-associated pneumonia. Biancofiore G, Barsotti E, Catalani V, Landi A, Bindi L, Urbani L, Desimone P, Stefanini A, Sansevero A, Filipponi F. Transplant and Postsurgical Intensive Care Unit, Anesthesia and Critical Care Medicine Unit 1, Cisanello Hospital, Pisa, Italy. g.biancofiore@med.unipi.it AIM: The aim of the study was to evaluate the nurses' knowledge and to highlight the causes that hinder guidelines implementation. METHODS: Experimental design: descriptive study. Setting and participants: 106 nurses working in the ICUs of a major Italian hospital of national importance. Intervention: administration of a questionnaire listing 21 non-pharmacological strategies considered the most useful in the literature. RESULTS: Eighty-four nurses responded to the questionnaire. Only 19 (22.6%) declared that their knowledge of ventilation associated pneumonia (VAP) and the

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strategies used to prevent it were satisfactory, whereas 46 (54.8%) declared that they were poorly informed; 68 nurses (80.9%) said that they applied one or more strategies, and 15 (17.9%) that they applied none. The reasons given for not applying the strategies were: method not foreseen in Department protocols (31.5%), lack of the necessary resources (14.3%), disagreement with the method (3.2%), high costs (2.6%), the possibility of causing discomfort (1%) or side effects (0.6%). CONCLUSIONS: In our experience, VAP preventive strategies are widely applied by nurses, but not in a responsible and informed manner. It is important to ensure that nurses receive continuous training and are involved in drawing up and updating Departmental protocols and guidelines for care and behaviour. PMID: 17115016 [PubMed - indexed for MEDLINE]

108. J Wound Ostomy Continence Nurs. 2006 Nov-Dec;33(6):610-8. Nursing staff beliefs and expectations about continence care in nursing homes. Resnick B, Keilman LJ, Calabrese B, Parmelee P, Lawhorne L, Pailet J, Ouslander J. University of Maryland School of Nursing, Baltimore, MD, USA. barbresnick@aol.com OBJECTIVE: The purpose of this qualitative study was to consider the current beliefs of nursing assistants and directors of nursing about management of urinary incontinence (UI) among the residents in nursing homes. DESIGN: This was a qualitative study using purposive sampling and a focus group methodology. SETTING AND SUBJECTS: Three focus groups including 38 participants were held in 2 different regions. Two of the focus groups comprised nursing assistants and 1 comprised directors of nursing. METHOD: The focus groups were facilitated by 2 different advanced practice nurses (BR and LJK), and 2 similar interview guides were used: 1 for the nursing assistants and 1 for the nurses. The interviews were tape recorded and transcribed verbatim; data were analyzed via content analysis. RESULTS: Ten themes were identified from the data; 3 focused on resident factors that influence UI, 4 related to staff and family contributors to UI, and 3 focused on recommendations to improve UI management in the nursing home setting. CONCLUSIONS: The findings from this study can be used to guide interventions to decrease or eliminate barriers to continence care and thereby facilitate the implementation of clinical practice guidelines and evidence-based interventions to improve urinary continence among nursing home residents. PMID: 17108770 [PubMed - indexed for MEDLINE]

109. Stud Health Technol Inform. 2006;124:651-6. Evidence-based practice in primary health care. De Smedt A, Buyl R, Nyssen M. Vrije Universiteit Brussel, Brussels, Belgium.

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This study aims to describe primary care professionals' self-reported attitudes towards evidence-based practice (EBP), attention to information sources, perceptions of the barriers to EBP and strategies to improve insight in EBP and patient care. An e-mail invitation with link to an Internet-based survey was sent to Belgian medical doctors (MDs), nurses and paramedics. Under paramedics, we've included emergency medical technicians, firemen and medical volunteers (Red Cross). In general, respondents were supportive towards EBP and agreed that this concept improves patient care, but still, physicians claim that only 50% of their practice is evidence-based and nurses and paramedics spend respectively 59% and 54% of their time to EBP. Doctors depend mostly on clinical guidelines, the Internet and textbooks, while nurses prefer conferences and protocols and paramedics rely on courses and their own judgement. All respondents strongly rely on experimental knowledge gained through interaction with colleagues, although the majority reported that colleagues are often not supportive towards EBP. Lack of time, the overwhelming mass of literature, difficulties with implementation of evidence in to practice are the most common barriers. Nurses show lack of critical appraisal of research results and paramedics have difficulties understanding research and have limited access to computer facilities and their working environment. Communication in group and workshops are very highly valued. Nurses and paramedics are less reluctant towards the opinion of senior colleagues, audits on clinical practice and individual feedback than doctors. EBP generally enjoys a positive attitude at every level of the health care system, but still many obstacles have to be overcome to conquer 'experience-based practice'. The most appropriate method for actual implementation of evidence-based practice at all levels of health care is to provide summaries of evidence, easily understandable protocols and web-based databases accessible from the working environment. Students should not only learn the skills related to EBP, but should be able to integrate knowledge effectively in the clinical setting and routine care. Above all, their supervisors themselves need to evolve from 'experience-based' to evidence-based practice'. PMID: 17108590 [PubMed - indexed for MEDLINE]

110. Nurse Educ Today. 2007 Aug;27(6):518-28. Epub 2006 Oct 24. Preparing for professional practice: how well does professional training equip health and social care practitioners to engage in evidence-based practice? Caldwell K, Coleman K, Copp G, Bell L, Ghazi F. School of Health and Social Sciences, Middlesex University, The Archway Campus, Highgate Hill, London N19 5LW, United Kingdom. k.caldwell@mdx.ac.uk This paper reports on the findings of a study that aimed to explore how relevant initial training is in relation to evidence-based practice, and explore the perceptions of recently qualified practitioners about their confidence to engage in evidence-based practice. A cross-sectional postal survey was used to ascertain the views of nurses, social workers, occupational therapists and physiotherapists who had been qualified no longer than two years prior to the survey, and had qualified at one of three London Universities. Fifty questionnaires were sent out to each professional group (a sample of 200 overall) and there was a 43% response rate achieved. The results show a clear discrepancy between what are generally positive attitudes towards evidence-based practice and the value of research evidence and the infrequency with which they actually do make use of research resources and engage in evidence-based practice. A number of constraints to

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engagement in accessing and utilising evidence were identified. PMID: 17064821 [PubMed - indexed for MEDLINE]

111. Hu Li Za Zhi. 2006 Oct;53(5):52-7. [An experience promoting evidence-based nursing at a medical center in central Taiwan]. [Article in Chinese] Huang CY, Huang ST, Lee YW, Liao YC, Chang SC. Department of Nursing, Changhua Christian Hospital. In the 21st Century, evidence-based nursing (EBN) may provide a mechanism by which nurses can manage the explosion in published information in the literature, introduce new techniques, effectively control healthcare costs, and increase attention on nursing quality and health outcomes. The objective of this paper is to share the experience implementing evidence-based nursing. We had applied strategies to implement evidence-based nursing care in our hospital since 2002. Over a more than three-year period (January 2002 to October 2005), we held 46 basic course sessions (around 1,840 attendees) and 58 advanced course sessions (around 500 attendees). There are 445 clinical questions with answered reports, Most questions related to foley care, central vein care and peripheral intravenous injection. Our nursing department revised three guidelines on nursing care skills related to suction and foley and nasal-gastric feeding to meet local conditions. Based on our subjective experience, promotion and implementation of EBN is feasible and helpful to update knowledge and decrease variance in clinical nursing care. However, further outcome research is needed in the future in order to obtain more objective evidence. PMID: 17004207 [PubMed - indexed for MEDLINE]

112. J Clin Nurs. 2006 Oct;15(10):1287-98. Determining factors that have an impact upon effective evidence-based pain management with older people, following colorectal surgery: an ethnographic study. Brown D, McCormack B. Royal Hospitals Trust, Belfast, UK. donna.brown@royalhospitals.n-i.nhs.uk AIM: The aim of this project was to examine pain management practices with older people admitted to the colorectal unit of an acute hospital trust. BACKGROUND: Although pain assessment and management are judged to be a priority, little research has examined the care older people receive in the acute surgical setting. Thus, pain in older people (65 years and over) can be under recognized and unrelieved. With the number of older people requiring surgery increasing, it is important to identify factors in the practice context that enhance or inhibit effective pain management. DESIGN: The project drew upon an in-depth ethnographic approach.

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METHOD: Sixty-two hours of around the clock, non-participant observation of nursing practice was completed. Thirty-nine (78%) nurses and forty-six (42%) patients were observed. Seven (6%) additional patients participated in pre- and postoperative interviews and 35 (90%) nurses completed the Nursing Work Index--Revised Questionnaire. FINDINGS: Holistic pain assessment for older people was found to be deficient in the acute surgical setting. Nurses appeared unaware of the importance of addressing the particular pain needs of older patients. Inflexible analgesic prescriptions provided the mainstay treatment of pain, with minimal consideration given to non-pharmacological strategies. Older people wanted to be active participants in their care. However, existing pain management practices disempowered older patients, making them reluctant or unable to discuss their pain with ward staff. CONCLUSION: Comprehensive pain assessment, improved documentation and proficient communication, inclusive of older patients, are necessary to improve pain management practices. It is imperative that patients, nurses, doctors and Acute Pain Service work in collaboration to challenge pain management practices and implement change. RELEVANCE TO CLINICAL PRACTICE: The project demonstrated some of the multiple and complex factors that affect the older persons' pain experience and identified three action research cycles for further development work. PMID: 16968433 [PubMed - indexed for MEDLINE]

113. Nurs Adm Q. 2006 Jul-Sep;30(3):291-4. Evidence-based practice: how nursing administration makes IT happen. Simpson RL. Nursing Informatics, Cerner Corporation, Kansas City, MO 64117, USA. rsimpson@cerner.com As the voice of and advocate for nurses, nursing administration should assume the leadership position in the development of evidence-based practice models. One of its most important tasks is to advocate for ubiquitous information technology (IT) to support these models. This article examines evidence-based nursing and the importance of IT to its development and growth. It explains the role of nursing administration in guiding IT implementation, as well as key issues that must be examined in system selection and development. PMID: 16878015 [PubMed - indexed for MEDLINE]

114. Nurs Adm Q. 2006 Jul-Sep;30(3):252-65. Evidence-based practice: how nurse leaders can facilitate innovation. Shirey MR. Shirey & Associates, Evansville, IN, USA. mrs@mail2maria.com Evidence-based nursing practice (EBNP) is the wave of the future. Increasingly, EBNP is being identified as a key to quality and excellence in nursing services.

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Incorporating evidence into practice is necessary to deliver scientifically sound patient care. In addition, understanding the importance of evidence is crucial for meeting the excellence requirements of Magnet designation. Despite the growing popularity of EBNP and its documented significant benefits, the literature demonstrates that only 15% of the nursing workforce consistently practices within an EBNP framework. If EBNP adoption is to increase in the profession, it will require the active efforts of nurse leaders to pursue an aggressive innovation diffusion strategy. The purpose of this article is to discuss the nurse leader's role in facilitating EBNP in nursing using a theoretical framework grounded in innovation diffusion theory. The article develops 4 areas of focus. First, the components of innovation diffusion theory are discussed. Second, a pertinent empirical review of the EBNP adoption literature is presented. Third, strategies for applying innovation diffusion theory to facilitate EBNP adoption are proposed. Lastly, the article ends with a leadership call to action. PMID: 16878011 [PubMed - indexed for MEDLINE]

115. Nurs Adm Q. 2006 Jul-Sep;30(3):236-42. Diffusion of innovation: the leaders' role in creating the organizational context for evidence-based practice. Crow G. Tim Porter-O'Grady Associates, San Francisco, CA, USA. greg31@pacbell.net Successfully leading change represents one of the most, if not the most, challenging aspects of a leader's role. The traditional top-down command and control structures and processes present in healthcare institutions and nursing are the enemies of effective change. Transitioning from traditional structures to structures that are more of a partnership between point-of-service staff and administrators is the foundation for creating an evidence-based practice culture. PMID: 16878009 [PubMed - indexed for MEDLINE]

116. Nurs Adm Q. 2006 Jul-Sep;30(3):193-202. Quantifying patient care intensity: an evidence-based approach to determining staffing requirements. Beglinger JE. St. Marys Hospital Medical Center, Madison, WI 53715, USA. Joan_Beglinger@ssmhc.com Over the course of the past decade, the intensity of patient care requirements has increased because of an aging patient population with increasingly complex care requirements and declining length of stay. At the same time, the reimbursement pressure in hospitals continues. The nursing organization of St. Marys Hospital Medical Center in Madison, Wis, recognized that increasing the hours of nursing care in some areas would be essential to maintaining an environment in which the nurses could deliver on the promise of the

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organization's mission: exceptional healthcare. The nursing organization undertook the challenge of quantifying the increasing intensity to enable a rigorous, evidence-based approach to the 2006 staffing budget. The compelling results enabled the nurses to successfully negotiate the necessary increases in staffing, despite the financial pressures prevalent throughout acute care today. PMID: 16878004 [PubMed - indexed for MEDLINE]

117. Int J Nurs Pract. 2006 Aug;12(4):232-40. Analysis of the impact of a national initiative to promote evidence-based nursing practice. Ring N, Coull A, Howie C, Murphy-Black T, Watterson A. Department of Nursing and Midwifery, University of Stirling, Stirling, UK. nicola.ring@stir.ac.uk Best Practice Statements (BPS) are designed to facilitate evidence-based practice. This descriptive, exploratory study evaluated the impact of five of these statements in Scotland. A postal survey of 1,278 registered nurses was undertaken to determine use of these statements and their perceived benefits (response rate: 42%). Use of the BPS differed across clinical sites and some statements were more likely to be used than others. Identified barriers and drivers to their use were similar to factors known to encourage or hinder evidence-based practice generally. Although approximately 25% of clinical respondents reported using the BPS, most respondents reported perceived benefits to patients usually through quality improvement. Results highlight the importance of facilitation and supportive contexts in encouraging clinical use of these statements. Findings suggest that variation in clinical implementation of the BPS need to be addressed locally and nationally if their benefits are to be maximized. PMID: 16834584 [PubMed - indexed for MEDLINE]

118. J Adv Nurs. 2006 Mar;53(6):702-9. Promotion of evidence-based practice by professional nursing associations: literature review. Holleman G, Eliens A, van Vliet M, van Achterberg T. Centre for Quality of Care Research, Nursing Science Section, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. g.holleman@levv.nl AIM: This paper reports a literature review examining the activities of professional nursing associations in the promotion of evidence-based practice. BACKGROUND: Professional nursing associations can play a role in the implementation and achievement of evidence-based practice as such associations aim to develop and further educate nurses professionally, build professional networks representing the interests of nurses and the nursing profession, influence the government and policymakers, and support and protect the basic values of nurses. The exact role of professional nursing associations in the

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promotion of evidence-based practice is as yet unclear, along with just how the role of such associations can be expanded and which strategies can be used to promote evidence-based practice among members. METHOD: A literature and Internet search was undertaken using the PUBMED, CINAHL, SCIRUS, INVERT, and the Cochrane databases using the terms evidence-based practice(s)* or EBP*, which were then combined with Nursing Society*, Nursing Organization*, Nursing Organisation*, Nursing Association* or Nursing Council*. Other sources included a Google search of the Internet, and the sites of various members of the International Council of Nurses. Publications in English, French or German from 1993 to 2004 were used, and the Internet search was conducted on 17 July 2003. RESULTS: Sixty nursing associations described the dissemination of evidence-based practice using one or more types of activities (179 activities in total). All of these activities were of a voluntary nature, with a predominant focus (132/179 activities) on intrinsic motivation of nurses. More specifically, most of the activities were aimed at nurses' competences and attitudes in relation to evidence-based practice. CONCLUSION: Professional nurses' associations are active in promoting evidence-based practice among their nurse members, but only those focusing on changing competences and attitude by addressing intrinsic motivation are well used. Other types of activities deserve to be explored, including behaviour-oriented approaches, approaches using structural, social or financial influence measures and perhaps methods based on 'involuntary involvement'. PMID: 16553678 [PubMed - indexed for MEDLINE]

119. J Adv Nurs. 2006 Feb;53(4):454-8. Development of an evidence-based practice questionnaire for nurses. Upton D, Upton P. Psychology Division, University of Worcester, Worcester, UK. d.upton@worc.ac.uk AIM: The aim of this paper is to report the development and validation of a self-report measure of knowledge, practice and attitudes towards evidence-based practice (EBP). BACKGROUND: Evidence-based practice has become increasingly important in health care since the mid-1990s as it provides a framework for clinical problem-solving. However, to date no means exist to quantify the extent to which barriers, such as lack of time in the working day, lack of appropriate skills and negative attitudes, may prevent greater uptake of EBP. METHODS: Questionnaire development was based on established psychometric methods. Principal component factor analysis was used to uncover the underlying dimensions of the scale. Internal consistency of the scale was assessed by Cronbach's alpha. Finally, construct validity was assessed via convergent and discriminant validity. RESULTS: The final questionnaire comprised three distinct scales (EBP, attitudes towards EBP and knowledge of EBP), which had robust validity and internal reliability. CONCLUSION: This tool can be used to measure the implementation of EBP. PMID: 16448488 [PubMed - indexed for MEDLINE]

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120. Soc Sci Med. 2006 Jun;62(11):2681-93. Epub 2005 Dec 27. The contextual influence of professional culture: certified nurse-midwives' knowledge of and reliance on evidence-based practice. Bogdan-Lovis EA, Sousa A. Center for Ethics and Humanities in the Life Sciences, Michigan State University, East Lansing, USA. libby.bogdan-lovis@ht.msu.edu This paper reports research undertaken to assess US certified nurse-midwives' (CNMs) knowledge of, access to, and use of evidence-based medicine (EBM). Findings are presented in the context of interprofessional, institutional, and popular culture. The descriptive study follows concepts of diffusion of innovation, evidence-based patient choice, and authoritative knowledge to analyse incentives and barriers to the implementation of evidence-based midwifery care. Structured interviews were conducted with practicing CNMs in an urban practice site and a regional teaching centre. The analysis of responses explored congruence between practitioner knowledge, professed practice, and published professional as well as hospital-based internal practice guidelines, for two specific interventions for which there is ample systematic review, epidural and episiotomy. The CNMs demonstrated enthusiasm for their own individual understanding of EBM, but responses to specific questions about EBM-supported practice indicate that many had an incomplete understanding of the concept. Furthermore, in those cases where CNMs demonstrated accurate knowledge of EBM, practice protocols followed subspecialty dictates, thereby preventing their knowledge from translating into adherence to EBM-guided clinical practice guidelines. Finally, patient expectations for technological intervention appeared to influence CNMs' care decisions, even when those expectations lacked sound supporting evidence. If, as conceived by its originators and champions, EBM is to be widely adopted, then practitioners such as CNMs need to accurately understand its concepts and also to be afforded the opportunity to exercise professional control over its implementation. Central to an epistemically balanced EBM is the need to ensure that midwifery knowledge contributes in a robust and ongoing fashion to EBM's scientific research base. Lastly, EBM advocates must identify balanced strategies to both rationally and fairly address consumerist pressures for aggressive health care consumption. PMID: 16377047 [PubMed - indexed for MEDLINE]

121. J Prof Nurs. 2005 Nov-Dec;21(6):364-71. Critical thinking and evidence-based practice. Profetto-McGrath J. Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada. joanne.profetto-mcgrath@ualberta.ca Critical thinking (CT) is vital to evidence-based nursing practice. Evidence-based practice (EBP) supports nursing care and can contribute positively to patient outcomes across a variety of settings and geographic locations. The nature of EBP, its relevance to nursing, and the skills needed to support it should be required components of baccalaureate education and must be introduced

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early in students' development as independent, self-directed learners and as professional nurses. Among the knowledge, skills, and processes needed to support EBP, CT is paramount. The development of CT can prepare nurses with the necessary skills and dispositions (habits of mind, attitudes, and traits) to support EBP. The intents of this study were to explore the importance of CT as an essential skill to support EBP and to describe some of the strategies and processes considered key to the ongoing development of CT. PMID: 16311232 [PubMed - indexed for MEDLINE]

122. J Adv Nurs. 2005 Nov;52(4):432-44. Barriers to evidence-based practice in primary care nursing--why viewing decision-making as context is helpful. Thompson C, McCaughan D, Cullum N, Sheldon T, Raynor P. Department of Health Sciences, University of York, York, UK. cat4@york.ac.uk AIM: This paper reports a study examining the barriers associated with research knowledge transfer amongst primary care nurses in the context of clinical decision-making. BACKGROUND: The research literature on barriers to nurses' use of research knowledge is characterized by studies that rely primarily on self-report data, making them prone to reporting biases. Studies of the barriers to evidence-based practice often fail to examine information use and behaviour in the context of clinical decision-making. METHODS: A multi-site, mixed method, case study was carried out in 2001. Data were collected in three primary care organizations by means of interviews with 82 primary care nurses, 270 hours of non-participant observation and 122 Q-sorts. Nurses were selected using a published theoretical sampling frame. Between-methods triangulation was employed and data analysed according to the principles of constant comparison. Multiple linear regression was used to explore relationships between a number of independent demographic variables (such as length of clinical experience) and the dependent variable of nurses' perspectives on the barriers to their use of research knowledge. RESULTS: Three perspectives on barriers to research information use emerged: the need to bridge the skills and knowledge gap for successful knowledge transfer; information formats need to maximize limited opportunities for consumption; and limited access in the context of limited time for decision-making and information consumption. Demographic variables largely failed to predict allegiance to any of the perspectives identified. CONCLUSIONS: Researchers should consider using decision-making as a contextual backdrop for exploring information use and behaviour, avoid relying solely on self-reported behaviour as data, and use a variety of research methods to provide a richer picture of information-related behaviour. Practice developers need to recognize that understanding the decisions to which research knowledge is to be applied should be a characteristic of any strategy to increase research uptake by nurses. PMID: 16268847 [PubMed - indexed for MEDLINE]

123. Contemp Nurse. 2005 Jul-Aug;19(1-2):96-104.

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Clinical nurses' knowledge of evidence-based practice: constructing a framework to evaluate a multifaceted intervention for implementing EBP. Mott B, Nolan J, Zarb N, Arnison V, Chan R, Codner T, Casey T, Jenkins B, Ulrych G, Blackburn C, Glanfield L, Halcomb E, Davidson PM. Blacktown Mt Druitt Health, Sydney, New South Wales. Critical reflection upon nursing practice is pivotal in achieving optimal patient outcomes. Implicit in this statement is knowledge about and an understanding of the implementation of evidence-based practice (EBP). This study sought to evaluate baseline knowledge in order to assess and inform a multifaceted intervention to promote EBP in a multi-site facility in Western Sydney, Australia. On two consecutive days in February 2003, a convenience sample of 229 nurses were surveyed using a five-item, investigator developed, written survey tool. Data were analysed using descriptive statistics. Although the majority of respondents (n = 143: 62%) stated that they were aware of EBP, a considerable number (n = 86: 38%) stated they had not previously heard of the term. Of concern, 43% (n = 99) of respondents were unable to identify a source of information and resources about EBP. The results of this observational, descriptive survey underscore the importance of ongoing strategic interventions to improve knowledge, access and implementation of EBP amongst clinical nurses. This study also provides baseline data upon which to evaluate local interventions to promote knowledge of EBP amongst clinicians. PMID: 16167439 [PubMed - indexed for MEDLINE]

124. Am J Nurs. 2005 Sep;105(9):40-51; quiz 52. Readiness of U.S. nurses for evidence-based practice. Pravikoff DS, Tanner AB, Pierce ST. Online Journal of Clinical Innovations, Glendale, CA, USA. dpravikoff@cinahl.com Comment in Am J Nurs. 2005 Sep;105(9):11. Evidence-based practice is a systematic approach to problem solving for health care providers, including RNs, characterized by the use of the best evidence currently available for clinical decision making, in order to provide the most consistent and best possible care to patients. Are RNs in the United States prepared to engage in this process? This study examines nurses' perceptions of their access to tools with which to obtain evidence and whether they have the skills to do so. Using a stratified random sample of 3,000 RNs across the United States, 1,097 nurses (37%) responded to the 93-item questionnaire. Seven hundred sixty respondents (77% of those who were employed at the time of the survey) worked in clinical settings and are the focus of this article. Although these nurses acknowledge that they frequently need information for practice, they feel much more confident asking colleagues or peers and searching the Internet and World Wide Web than they do using bibliographic databases such as PubMed or CINAHL to find specific information. They don't understand or value research and have received little or no training in the use of tools that would help them find evidence on which to base their practice. Implications for nursing and nursing

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education are discussed. PMID: 16138038 [PubMed - indexed for MEDLINE]

125. J Adv Nurs. 2005 Sep;51(5):465-73. Evidence-based practice among Danish cardiac nurses: a national survey. Egerod I, Hansen GM. University Hospitals Centre for Nursing and Care Research, University Hospital, Copenhagen, Denmark. ie@ucsf.dk AIMS: This paper presents a survey of evidence-based practice among cardiac nurses exploring nurses' attitudes towards evidence-based practice and the types of knowledge they employ in clinical practice. BACKGROUND: Research utilization and evidence-based practice are required at hospitals around the world, although the definition of evidence-based practice is still unclear. An ongoing debate exists about the sources of knowledge and the hierarchy of research evidence in clinical practice, and nursing research has been threatened by the dominance of randomized controlled trials. Evidence-based practice has been described as a new paradigm, which promotes patient-centred care by integrating external evidence and patient preferences. METHODS: The study was a cross-sectional survey with a descriptive and comparative design, using self-administered postal questionnaires. The questionnaires were sent to 33 head nurses and 51 bedside nurses representing one or two units in each cardiac department in Denmark (n = 28). The final response rate was 81%. The study was carried out in 2004. RESULTS: Respondents had a positive attitude towards evidence-based practice, although they relied upon personal clinical experience. Head nurses were statistically significantly more familiar with the concept of evidence-based practice than bedside nurses, and read scientific journals more frequently. Introductory courses to evidence-based practice are rare and seldom mandatory, and the data suggest that respondents lacked knowledge of the finer points of evidence-based practice and equated the concept with research utilization. CONCLUSIONS: Barriers to evidence-based practice are inadequate education, unfamiliarity with English, and low organizational position. Facilitators include the implementation of guidelines, provision of continuing education, and an increase in the accountability of bedside nurses. PMID: 16098163 [PubMed - indexed for MEDLINE]

126. Nurs Stand. 2005 Jun 15-21;19(40):48-53. Evidence-based practice: compatibility with nursing. Dale AE. Faculty of Health and Sciences, Staffordshire University, Stafford. a.e.dale@staffs.ac.uk This article explores the compatibility of evidence-based practice with nursing. The generation of relevant research evidence in nursing and determining best

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evidence are discussed. The article concludes that different forms of research, other than randomised controlled trials, are valid and in many cases more applicable to nursing practice, and that nurses need to determine what constitutes relevant and best evidence for the profession. PMID: 15977490 [PubMed - indexed for MEDLINE]

127. Br J Nurs. 2005 Mar 10-23;14(5):284-8. Nurses' attitudes to evidence-based practice: impact of a national policy. Upton D, Upton P. University of Wales Institute, Cardiff. Clinical effectiveness and evidence-based practice should be key cornerstones of current nursing practice. This study used postal questionnaires to explore the impact of a national initiative on nurses' attitudes, knowledge and practice relating to these twin concepts. Results indicated that attitudes can be influenced by national policy initiatives. Influencing behaviour, however, appears to be more difficult; no change was seen in reported application of evidence-based practice. Nurses did, however, report a desire to increase their implementation of evidence-based practice; reasons for not doing so included lack of the necessary skills and time in the working day. It is recommended that these education and training needs must be addressed by allocating sufficient protected learning time and funds. A more difficult issue relates to the burden of clinical work, which may also be preventing greater uptake of evidence-based practice. PMID: 15902044 [PubMed - indexed for MEDLINE]

128. J Clin Nurs. 2005 Apr;14(4):411-7. Conceptions of evidence, evidence-based medicine, evidence-based practice and their use in nursing: independent nurse prescribers' views. Banning M. Faulty of Health, Department of Nursing, Canterbury Christ Church University College, Canterbury, UK. mb104@canterbury.ac.uk AIM: The purpose of this study was to explore nurses' conceptions of evidence and evidence-based practice, whether there are differences between evidence-based practice and evidence-based medicine and to identify the uptake of research evidence in the workplace. BACKGROUND: The use and comprehension of the term 'evidence-based practice' in relation to nursing shows remarkable variation. Numerous definitions are provided, some tend to be closely related to the concept 'evidence-based medicine'. Independent nurse prescribers need to be able to understand the concept of evidence-based practice to utilize and apply this concept in order to provide adequate medication management of their patients. METHOD: Data were generated by focus group interview and open question questionnaire and analysed by analytical abstraction. RESULTS: Nurses offered a variety of views on the use and uptake of evidence in

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the workplace. Some nurses acknowledged that they did not read research papers but were aware that they used a lot of evidence in their practice. Nurses had difficulty differentiating evidence-based practice from evidence-based medicine. CONCLUSIONS: Nurses were familiar with the research process but not the canons of evidenced-based practice. The data generated indicate different levels of evidence are used by nurses. This may be a reflection of the level of intrigue of the nurses involved. RELEVANCE TO CLINICAL PRACTICE: The education and training of independent nurse prescribers should include the exploration of evidence from randomized controlled trials and from naturalistic studies and their contribution to evidenced-based practice and evidence-based medicine. Both concepts need to be explored in relation to the medication management of patients. PMID: 15807747 [PubMed - indexed for MEDLINE]

129. J Adv Nurs. 2005 Apr;50(2):124-33. Progressing evidence-based practice: an effective nursing model? Tolson D, McAloon M, Hotchkiss R, Schofield I. School of Nursing, Midwifery and Community Health, Glasgow Caledonian University, Govan Mbeki Building, Cowcaddens Road, Glasgow G4 0BA, Scotland, UK. d.tolson@gcal.ac.uk AIMS: This paper presents findings from telephone interviews completed with link nurses 2 years into the project to explore how participation progressed achievement of evidence-based practice where the link nurses worked. BACKGROUND: In 2001, an innovative practice development initiative was launched in Scotland. A national network of experienced nurses from across the country was recruited to form the inaugural Community of Practice. This involved describing gerontological nursing, pioneering a nurse-sensitive methodology to craft care guidance that reflects the agreed practice model, and constructing a virtual college based on a situated learning model. METHODS: A volunteer sample of link nurses took part in telephone interviews exploring experiences of using the virtual college and the extent to which the description of gerontological nursing and the first best practice statement on nutrition had influenced practice. FINDINGS: Five components (themes) were identified as facilitating the attainment of evidence-based practice. These focussed on confidence-building and the positive benefits of achieving vision and clarity for gerontological nursing. Membership of a national Community of Practice afforded status and strengthened sense of professional identity. The inclusive knowledge synthesis methodology used to prepare, pilot and support implementation of the best practice statement was highly valued. Progress towards evidence-based practice in all affiliated areas was reported. Major challenges for nurses in participating in the virtual college included the absence of a learning-at-work culture, lack of time and doubts about the legitimacy of internet-based learning. CONCLUSION: The evaluation indicates the potential merits of e-practice development, particularly for nurses who feel geographically and professionally isolated or disenchanted with available continuing professional development opportunities. Participation in the virtual college appeared to enrich practice and foster a culture of change.

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PMID: 15788076

[PubMed - indexed for MEDLINE]

130. Nurs Leadersh (Tor Ont). 2004 Nov;17(4):64-75. Setting the climate for evidence-based nursing practice: what is the leader's role? Udod SA, Care WD. Faculty of Nursing, University of Manitoba, Winnipeg, MB. sonia_udod@umanitoba.ca Nurses are being challenged today to justify their practice. Many clinical and policy decisions in nursing are based upon isolated, ritualistic and unsystematic forms of clinical practice. The growing movement towards establishing evidence-based nursing practice (EBNP) is situated in a systematic appraisal of the best evidence available. Nurse leaders have an obligation to cultivate sound clinical and economic practices leading to quality patient care and positive work life environments for nurses. PMID: 15656249 [PubMed - indexed for MEDLINE]

131. J Nurs Adm. 2005 Jan;35(1):35-40. Evidence-based practice: a practical approach to implementation. Newhouse R, Dearholt S, Poe S, Pugh LC, White KM. Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, USA. Organizations often do not have processes in place to support nurses through a systematic approach for developing and evaluating nursing interventions, protocols, critical pathways, and policies that are derived from scientific evidence. The development of a framework to guide inquiry will have a positive impact on patients. This process may foster a higher level of professional engagement by nurses that may, in the long-term, help improve nurse retention and recruitment. The authors discuss a nursing evidence-based practice model and guidelines that were developed by a team of hospital and academic nurse leaders and is practical and easy to use. This model has been successfully implemented across the department of nursing as a strategic initiative. Results of the implementation have shown that staff nurses can effectively use this model with the help of knowledgeable mentors. PMID: 15647668 [PubMed - indexed for MEDLINE]

132. Br J Nurs. 2004 Nov 11-24;13(20):1216-20. The issues for nurses involved in implementing evidence in practice. Gagan M, Hewitt-Taylor J. Institute of Health and Community Studies, Bournemouth University, UK.

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Evidence-based practice (EBP) is currently high on political and professional agendas. However, there is a suggestion that despite apparent enthusiasm for EBP, it is not becoming a reality. A variety of reasons for evidence not being implemented in practice exist, including the way in which evidence is communicated, how staff are involved in changes in practice, the availability of resources, patient expectations and the priority afforded to EBP by individuals and organizations. These issues must be addressed if EBP is to succeed. PMID: 15580091 [PubMed - indexed for MEDLINE]

133. Appl Nurs Res. 2004 Nov;17(4):239-47. Implementing evidence-based practice: walking the talk. Thurston NE, King KM. Faculty of Nursing, University of Calgary, Alberta, Canada. Russworm and Larrabee's (1999) six-step model for evidence-based practice (EBP) was used by 10 nursing teams to seek answers to clinical questions. These teams, primarily composed of staff nurses, participated in a health region-wide EBP program over 1 year. Overall, the model served as a useful mechanism for examining practice-derived questions. However, additional strategies needed to be incorporated by the project teams. These included making decisions about change/no change at an earlier stage than was suggested by the model; seeking additional evidence including survey data to benchmark "best" practices; and ensuring colleagues' and managers' input, support, and involvement. Four project teams (three of which addressed nursing procedural questions) found insufficient empirical evidence on which to base change; the outlook for directing evidence-based practice was promising for the remaining six projects. The EBP program was judged to be highly satisfactory to participants and their managers. PMID: 15573332 [PubMed - indexed for MEDLINE]

134. J Nurs Scholarsh. 2004;36(3):220-5. Evidence-based practice and research utilization activities among rural nurses. Olade RA. University of Nebraska Medical Center, College of Nursing, 985330 Nebraska Medical Center, Omaha, NE 68198-5330, USA. rolade@unmc.edu Comment in J Nurs Scholarsh. 2005;37(1):3. PURPOSE: To identify the extent to which rural nurses utilize evidence-based practice guidelines from scientific research in their practice; to describe both previous and current research utilization activities in which they have participated, and to identify the specific barriers they face in their practice settings. DESIGN AND METHODS: Data for this descriptive study were collected through

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questionnaires with open-ended questions focused on (a) current utilization of nursing research findings, (b) previous involvement in nursing research activities, and (c) participation in medical research activities. The participants were 106 nurses from various practice areas in six rural counties of a southwestern state in the United States. FINDINGS: Results revealed that only 20.8% of the participants stated they were currently involved in research utilization, and they were mostly nurses with bachelor's degrees. The two most common areas of current research utilization were pain management and pressure ulcer prevention and management. Barriers to research utilization, such as rural isolation and lack of nursing research consultants, were identified. CONCLUSIONS: The types of research utilization activities identified by these nurses indicate how much the facilities in which these nurses work in the rural areas are striving with the utilization of available scientific evidence. Rural nurses face unique barriers related to situational and geographic factors, with implications for nursing administrators, researchers, and educators. PMID: 15495490 [PubMed - indexed for MEDLINE]

135. J Eval Clin Pract. 2004 May;10(2):197-205. Attitudes and knowledge of primary care professionals towards evidence-based practice: a postal survey. O'Donnell CA. University of Glasgow, UK. Kate.O'Donell@clinmed.gla.ac.uk OBJECTIVES: To describe the attitudes, awareness and use of evidence across key professional groups working in primary care. METHODS: A postal questionnaire was sent to all lead/chairs, general managers, clinical governance leads, lead nurses, lead pharmacists and public health practitioners working in local health care cooperatives in Scotland. RESULTS: 289 (66.1%) health care professionals responded, ranging from 51% of general managers to 80% of lead nurses. All professional groups supported evidence-based practice. General practitioners (GPs) were less likely to agree that they had the skills to carry out literature reviews or appraise evidence compared to nurses and public health facilitators (36% vs. 75% vs. 80%; 51% vs. 64% vs. 70%). Access to the internet and bibliographic databases was good for all groups but GPs used a narrower spectrum of evidence-based journals, relying mainly on medical literature. Only nurses and public health practitioners appeared to have any understanding of qualitative research terms. Public health practitioners were also least likely to view guidelines or protocols developed by others as the best source of evidence for primary care. The major perceived barrier to practising evidence-based practice was time. Consequently the most important facilitator was protected time, but increased resources (financial and staff) and training were also cited. Professional groups other than GPs perceived inter-professional boundaries as a barrier and suggested multi-professional teamworking and learning as potential supports for evidence-based practice. CONCLUSIONS: While all professional groups welcome and support evidence-based practice, there are clear differences in the starting point and perspectives across the groups. These need to recognized and addressed to ensure that learning the skills of evidence-based practice and implementing evidence are effective. This will also enhance the ability of primary care organizations to develop robust mechanisms for supporting key aspects of clinical governance.

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PMID: 15189386

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136. J Eval Clin Pract. 2004 May;10(2):177-86. Nursing based evidence: moving beyond evidence-based practice in mental health nursing. Geanellos R. University of Western Sydney, School of Nursing, Family & Community Health, Hawkesbury Campus, NSW, Australia. r.geanellos@uws.edu.au Various authors suggest mental health nursing is dominated by knowledge borrowed from psychiatry, pharmacology and the behavioural sciences. These disciplines favour knowledge developed using quantitative methodologies so they and evidence-based practice (EBP) and evidence-based nursing (EBN), increasingly called for in mental health nursing, fit seamlessly together. Nevertheless, as these movements dismiss qualitative approaches to knowledge (evidence) development, I argue against the move toward EBP/EBN in mental health nursing. This is because the specialty's primary interests - human experiences of illness/health care and human relationships, often do not lend themselves to being quantitatively researched. Using nursing examples, I demonstrate how qualitative research, wholly unacceptable in relation to EBP/EBN quality of evidence scales, is indispensable to mental health nursing. The need for evidence arising from qualitative research in no way precludes the need for quantitatively derived evidence. Indeed, the specialty's twofold interest - the work of nurses with clients and the explication of phenomena which inform practice, require diverse knowledge and thus, diverse research approaches. This twofold interest defines the area of mental health nursing practice, and knowledge informing it is referred to as nursing based evidence (NBE). Because it values multiple approaches to knowledge development, NBE provides a way to articulate the specialty's distinct contribution to the health care of people experiencing mental illness and advances mental health nursing. PMID: 15189384 [PubMed - indexed for MEDLINE]

137. Br J Nurs. 2004 Feb 26-Mar 10;13(4):211-6. Evidence-based practice is a time of opportunity for nursing. Tod A, Palfreyman S, Burke L. Sheffield Teaching Hospitals NHS Trust, and Department of Acute and Critical Care, University of Sheffield, Sheffield, UK. The debate regarding evidence-based practice (EBP) continues to rage within nursing. This article reviews the existing situation regarding policy and the ability of nurses to engage with EBP. Recommendations are made regarding moving the debate away from a focus on barriers to EBP towards seizing it as an opportunity. The article suggests that a fundamental change in attitude is required by nurses in order for the nursing profession to progress. There is a need to recognize that the nature of health services are changing and that nurses

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need to grasp the opportunities this makes available, but in order to do this nurses need support. PMID: 15039620 [PubMed - indexed for MEDLINE]

138. J Nurses Staff Dev. 2003 Nov-Dec;19(6):279-85; quiz 286-7. Evidence-based practice. The role of staff development. Krugman M. University of Colorado Hospital, Denver, CO, USA. mary.krugman@uch Knowledge and use of evidence-based practice are essential to ensure best practices and safe patient outcomes. Staff development specialists must be leaders in this initiative to support clinical nurses toward improved practice outcomes. This article describes the background for understanding the historical evolution from research utilization to evidence-based practice, defines some key concepts related to evidence-based practice, and suggests essential components for building evidence-based practice programs in healthcare institutions. PMID: 15027342 [PubMed - indexed for MEDLINE]

139. Am J Obstet Gynecol. 2004 Feb;190(2):413-21. Implementing evidence-based practice: evaluation of an opinion leader strategy to improve breast-feeding rates. Sisk JE, Greer AL, Wojtowycz M, Pincus LB, Aubry RH. Department of Health Policy, Mount Sinai School of Medicine, New York, NY, USA. OBJECTIVE: The objective was to evaluate the effectiveness of opinion leaders in raising breast-feeding rates. STUDY DESIGN: A randomized controlled trial of an opinion leader strategy in 18 hospitals in Central New York State compared mothers' intention to breast-feed during baseline and study years. Multivariate logistic regression with a mixed model analyzed the effects on breast-feeding exclusively and on breast- and formula-feeding combined. RESULTS: Obstetric clinicians had a high degree of knowledge about breast-feeding benefits and of perceived responsibility to recommend breast-feeding. Obstetricians, family practitioners, and midwives agreed on the person identified as the opinion leader, in each case an obstetrician who was chief of obstetrics or obstetrics-gynecology. Breast-feeding rates in hospitals with the opinion leader intervention did not differ significantly from those in control-group hospitals during the study year. CONCLUSION: The opinion leader strategy in this case did not improve breast-feeding rates during the study year. Opinion leader strategies may make assumptions about clinician control that are not justified in situations such as breast-feeding. PMID: 14981383 [PubMed - indexed for MEDLINE]

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140. J Adv Nurs. 2004 Jan;45(2):178-89. Barriers to evidence-based practice in primary care. McKenna HP, Ashton S, Keeney S. Head of School of Nursing, University of Ulster, Ulster, UK. BACKGROUND: Evidence-based practice is one of the most important underlying principles in modern health care. In the United Kingdom, successive governments have highlighted the fact that a quality health service is built upon the use of best evidence. Health professionals are becoming more accountable within clinical governance structures for the care they provide. The need to use robust research findings effectively is a critical component of their role. However, studies show that a number of barriers prevent the effective use of best available evidence. AIM: This study aimed to identify barriers to evidence-based practice in primary care. METHOD: A specially designed questionnaire was used to gather respondents' perceptions of the barriers to evidence-based practice. Data were collected in 2000/2001. FINDINGS: Findings show that general practitioners (GPs) ranked barriers differently to community nurses. GPs believed that the most significant barriers to using evidence in practice were: the limited relevance of research to practice, keeping up with all the current changes in primary care, and the ability to search for evidence-based information. In contrast, the most significant barriers to the identified by community nurses were poor computer facilities, poor patient compliance and difficulties in influencing changes within primary care. This suggests that these two groups may require different strategies for barrier removal. CONCLUSIONS: Identifying barriers is just the first step to addressing issues surrounding the use of evidence-based practice. Extra resources will be needed if these barriers are to be tackled. However, if the resultant change improves the health and wellbeing of people and communities, then the extra costs would be offset by more efficient use of services. PMID: 14706003 [PubMed - indexed for MEDLINE]

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