Practice-Based Evidence and Evidence-Based Practice: The Evidence for Outcomes Management

Organizational supported evidence-based practice (EBP) enables nurses to be change agents and impact patient outcomes. Globally, a multitude of barriers limits EBP implementation, evaluation, and dissemination, which include time constraints, staff, resource access, education, technology, and fiscal support. These barriers and other disenfranchising elements hinder nurses' ability to actualize EBP and change practice within their workplace. This study describes the EBP readiness, barriers, and facilitators reported by inpatient registered nurses (RNs) employed in a nationwide healthcare system before COVID-19. The study employed a cross-sectional descriptive survey design using the 2005 Nursing EBP Survey for RN EBP readiness. The setting included 14 hospitals in Southern California. The survey was deployed in November 2016 and closed after 23 weeks. Descriptive statistics analyzed demographics and EBP scores, with inferential statistics for associations between demographics and EBP scores. ANOVA examined differences between EBP scores, service lines, years of employment, and education level. A content approach synthesized open-ended barrier and facilitator questions into seven specific themes. Seven hundred and twenty-four nurses completed the survey. Overall, the scores of inpatient RNs were highest scores for Practice Climate, suggesting the health system fosters a climate conducive to EBP. Scores were lowest for Data Collection and Implementation. Qualitative themes were: (1) Everyone Involved in EBP Implementation, (2) Fear and Resistance to Change, (3) Protected Release Time, (4) Knowing EBP Culture Outside of Current Organization, (5) Organizational Communication and Education, (6) Management and Leadership Support, and (7) Pragmatic Solutions to Facilitate EBP. Fear and Resistance to Change cut across all themes. Nurses at all organizational levels from the C-suite to the bedside can create strategies to determine essential EBP readiness components, including EBP mentors to guide knowledge uptake activities. Pragmatic solutions for EBP capacity require frontline nurse feedback, commitment, and partnership with nursing leaders.

This cross-sectional study explored the behaviour, knowledge, skills and resources, opinion, and perceived barriers of paediatric physiotherapists practising in Saudi Arabia regarding evidence-based practice (EBP). Sixty-eight paediatric physiotherapists from Saudi Arabia participated. Data were collected by electronic questionnaire and the Likert scale was used to score knowledge, skills and resources, opinion, and barriers to EBP implementation. Approximately 78% of the participants were motivated to use EBP in their daily practise and 82.3% have reported the use of best scientific evidence in their clinical practise. Participants with higher database usage over the last 6 months showed significant association with EBP knowledge scores (t = 2.46, p = 0.01), skills and resources scores (t = 3.81, p < 0.001), and opinion scores (t = 2.43, p = 0.01). Furthermore, a higher level of education in participants was significantly associated with EBP knowledge scores (t = 2.41, p = 0.01). Most paediatric physiotherapists believed that EBP is essential in their clinical practise as it improves patient care and quality of health services. Difficulty in obtaining full-text papers and lack of time were identified as major barriers to implementing EBP followed by the lack of management support, motivation in research, and EBP training.

In active implementation science frameworks, coaching has been described as an important competency “driver” to ensure evidence-based practices are implemented as intended. Empirical evidence also has identified coaching as a promising job-embedded professional development strategy to support implementation of quality teaching practices. The purpose of the present article is to describe a coaching framework designed to support early childhood practitioners to implement evidence-based teaching practices with fidelity. We explicate the key components of the coaching framework, provide theoretical and empirical rationales for each component, and describe how it was operationalized for use as a coaching protocol in several studies. The studies focused on supporting preschool teachers of young children with or at risk for disabilities to implement social-emotional, behavioral, and instructional teaching practices with fidelity. For this special issue, we offer recommendations for future research and considerations for wider scale application and situate each article in the context of coaching and the coaching framework described in this article.

BackgroundEvidence is needed to develop effective educational programs for promoting evidence based practice (EBP) and knowledge translation (KT) in physical therapy. This study reports long-term outcomes from a feasibility assessment of an educational program designed to promote the integration of research evidence into physical therapist practice.MethodsEighteen physical therapists participated in the 6-month Physical therapist-driven Education for Actionable Knowledge translation (PEAK) program. The participant-driven active learning program consisted of four consecutive, interdependent components: 1) acquiring managerial leadership support and electronic resources in three clinical practices, 2) a 2-day learner-centered EBP training workshop, 3) 5 months of guided small group work synthesizing research evidence into a locally relevant list of, actionable, evidence-based clinical behaviors for therapists treating persons with musculoskeletal lumbar conditions--the Best Practices List, and 4) review and revision of the Best Practices List, culminating in participant agreement to implement the behaviors in practice. Therapists’ EBP learning was assessed with standardized measures of EBP-related attitudes, self-efficacy, knowledge and skills, and self-reported behavior at baseline, immediately-post, and 6 months following conclusion of the program (long-term follow-up). Therapist adherence to the Best Practice List before and after the PEAK program was assessed through chart review.ResultsSixteen therapists completed the long-term follow-up assessment. EBP self-efficacy and self-reported behaviors increased from baseline to long-term follow-up (p < 0.001 and p = 0.002, respectively). EBP-related knowledge and skills showed a trend for improvement from baseline to long-term follow-up (p = 0.05) and a significant increase from immediate-post to long-term follow-up (p = 0.02). Positive attitudes at baseline were sustained throughout (p = 0.208). Eighty-nine charts were analyzed for therapist adherence to the Best Practices List. Six clinical behaviors had sufficient pre- and post-PEAK charts to justify analysis. Of those, one behavior showed a statistically significant increase in adherence, one had high pre- and post-PEAK adherence, and four were change resistant, starting with low adherence and showing no meaningful improvement.ConclusionsThis study supports the feasibility of the PEAK program to produce long-term improvements in physical therapists’ EBP-related self-efficacy and self-reported behavior. EBP knowledge and skills showed improvement from post-intervention to long-term follow-up and a trend toward long-term improvements. However, chart review of therapists’ adherence to the participant generated Best Practices List in day-to-day patient care indicates a need for additional support to facilitate behavior change. Future versions of the PEAK program and comparable multi-faceted EBP and KT educational programs should provide ongoing monitoring, feedback, and problem-solving to successfully promote behavior change for knowledge translation.

Existing studies have identified specific factors influencing some dimensions of evidence-based practice (EBP) competence and use. However, the way these factors interact still needs to be clarified. The purpose of the study was to test a model based on the Determinant Frameworks that explain the relationships and the direct pathways between the characteristics of the nurses, the context, and the implementation strategies and the dimensions of EBP competence, attitude, knowledge, skills, and use of EBP. A cross-sectional study was carried out in Spain during January and February 2020, involving 2,370 nurses employed in public health centers across all autonomous communities within the National Health System. An online survey was administered to gather data, addressing various topics related to the nurses' characteristics, the context in which they worked, the implementation strategy, and their competence in evidence-based practice (EBP). As depicted in the conceptual framework, a structural equation model was constructed to test the hypothesized relationships among key study variables. The model obtained showed a good fit (χ 2/df = 3.20, p < 0.001; RMSEA = 0.030 [90% CI 0.025, 0.036]; CFI = 0.989; GFI = 0.990; TLI = 0.983). The context, more specifically, the dimensions of nurse participation in the center's affairs, nursing foundations for quality of care, nurse manager ability leadership and support of nurses, and implementation strategy have a direct and positive effect on EBP use. Training in EBP, reading scientific articles, and having a doctorate are associated with higher competence and knowledge in EBP. The final fit shows the #Evidencer model for the use of EBP (#EvidencerMUSEBP) with two main components: the contextual and strategic factors that influence the implementation of EBP and the characteristics of the professionals, such as their training and reading of articles, which have an impact on EBP competence. This model could guide healthcare organizations in proposing comprehensive interventions to improve EBP use and the competency of nurses.

The many meanings of theory and practice

Editorial: Introduction to Special Section on Evidence-Based Practices for Persons With Intellectual and Developmental Disabilities

Background: Patient and clinician relationship plays a pivotal role in the progress of treatment. Evidence based practice is the key methodology which integrates the best research evidence, clinical expertise and patient need for a better outcome. To evaluate the factors that influence the application of evidence based physiotherapy in public and private sectors of Karachi, Pakistan.&#x0D; Methodology: A cross-sectional survey was conducted from July to December 2017 in major physiotherapy clinics and rehabilitation centers of Karachi covering major government, semi-government and private sectors. Data was collected from 75 practicing physiotherapists through convenience sampling technique and were asked to fill self-administered close-ended questionnaire. Data entry and analysis was done using SPSS Version 16 and chi-square test applied.&#x0D; Result: Lack of availability of resources to access information was noted to be the biggest practitioner barrier while disinterest in evidence based practice (EBP) was considered as the least important. Among various organizational barriers, lack of time provided by management and lack of support among physiotherapists were stated to be the biggest barriers. Perception of evidence based physiotherapy was noted to be generally positive among the physiotherapists. Graduates with experience of 1-5 years were found to be keener to refine their EBP skills and were more likely to agree that EBP integration with practical knowledge improved prognosis. Almost 70% well experienced (10 years +) physiotherapists were reported to have access to research publications whereas 80.4% fresh experienced said they were confident of their capability to search relevant research.&#x0D; Conclusion: Individuals and organizations should work to rectify the identified barriers from this study and express learning in a way that helps them in applying research findings to ordinary patients in ordinary clinical settings.

Health-care service delivery models have evolved from a practitioner-centered approach toward a patient-centered ideal. Concurrently, increasing emphasis has been placed on the use of empirical evidence in decision-making to increase clinical accountability. The way in which clinicians use empirical evidence and client preferences to inform decision-making provides an insight into health-care delivery models utilized in clinical practice. The present study aimed to investigate the sources of information audiologists use when discussing rehabilitation choices with clients, and discuss the findings within the context of evidence-based practice and patient-centered care. To assess the changes that may have occurred over time, this study uses a questionnaire based on one of the few studies of decision-making behavior in audiologists, published in 1989. The present questionnaire was completed by 96 audiologists who attended the World Congress of Audiology in 2014. The responses were analyzed using qualitative and quantitative approaches. Results suggest that audiologists rank clinical test results and client preferences as the most important factors for decision-making. Discussion with colleagues or experts was also frequently reported as an important source influencing decision-making. Approximately 20% of audiologists mentioned utilizing research evidence to inform decision-making when no clear solution was available. Information shared at conferences was ranked low in terms of importance and reliability. This study highlights an increase in awareness of concepts associated with evidence-based practice and patient-centered care within audiology settings, consistent with current research-to-practice dissemination pathways. It also highlights that these pathways may not be sufficient for an effective clinical implementation of these practices.

In contrast to traditional meta-analyses of research, an alternative overview and analysis of the research literature on the impact of information and communication technologies (ICT) in medical education is presented in this article. A distinction is made between studies that have been set up at the micro-level of the teaching and learning situation and studies on meso-level issues. At the micro-level, ICT is hypothesized to foster three basic information processing activities: presentation, organization, and integration of information. Next to this, ICT is expected to foster collaborative learning in the medical knowledge domain. Empirical evidence supports the potential of ICT to introduce students to advanced graphical representations but the studies also stress the importance of prior knowledge and the need for real-life tactile and practical experiences. The number of empirical studies focusing on the impact of ICT on information organization is restricted but the results suggest a positive impact on student attitudes and relevant learning gains. However, again, students need a relevant level of prior knowledge. Empirical studies focusing on the impact of ICT on information integration highlight the positive impact of ICT-based assessment and computer simulations; for the latter this is especially the case when novices are involved, and when they master the prerequisite ICT skills. Little empirical evidence is available regarding the impact of computer games. Research results support the positive impact of ICT-based collaboration but care has to be taken when skills development is pursued. At the meso-level, the available empirical evidence highlights the positive impact of ICT to promote the efficiency of learning arrangements. Research grounds the key position of ICT in a state-of-the-art medical curriculum. Recent developments focusing on repositories of learning materials for medical education have yet not been evaluated. The article concludes by stressing the need for evaluative studies, especially in the promising field of ICT-based collaborative learning. Furthermore, the importance to be attached to the position and qualifications of the teaching staff is emphasized.

BackgroundA primary barrier to the implementation of evidence based practice (EBP) in physical therapy is therapists’ limited ability to understand and interpret statistics. Physical therapists demonstrate limited skills and report low self-efficacy for interpreting results of statistical procedures. While standards for physical therapist education include statistics, little empirical evidence is available to inform what should constitute such curricula. The purpose of this study was to conduct a census of the statistical terms and study designs used in physical therapy literature and to use the results to make recommendations for curricular development in physical therapist education.MethodsWe conducted a bibliometric analysis of 14 peer-reviewed journals associated with the American Physical Therapy Association over 12 months (Oct 2011-Sept 2012). Trained raters recorded every statistical term appearing in identified systematic reviews, primary research reports, and case series and case reports. Investigator-reported study design was also recorded. Terms representing the same statistical test or concept were combined into a single, representative term. Cumulative percentage was used to identify the most common representative statistical terms. Common representative terms were organized into eight categories to inform curricular design.ResultsOf 485 articles reviewed, 391 met the inclusion criteria. These 391 articles used 532 different terms which were combined into 321 representative terms; 13.1 (sd = 8.0) terms per article. Eighty-one representative terms constituted 90 % of all representative term occurrences. Of the remaining 240 representative terms, 105 (44 %) were used in only one article. The most common study design was prospective cohort (32.5 %).ConclusionsPhysical therapy literature contains a large number of statistical terms and concepts for readers to navigate. However, in the year sampled, 81 representative terms accounted for 90 % of all occurrences. These “common representative terms” can be used to inform curricula to promote physical therapists’ skills, competency, and confidence in interpreting statistics in their professional literature. We make specific recommendations for curriculum development informed by our findings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0641-1) contains supplementary material, which is available to authorized users.

This study explores the influence of managerial support on the attitudes of highly educated (BSc, MSc, and PhD) millennials in Serbia, focusing on job satisfaction, turnover intention, and job stress. Understanding this relationship is crucial for enhancing employee retention and organisational efficiency given the evolving workplace dynamics. Managerial support, encompassing emotional, instrumental, and informational assistance, is hypothesised to positively impact job satisfaction while reducing turnover intention and job stress. Data were collected through an online survey from 367 respondents in two waves (the first wave in January 2024 and the second in July 2024) and analysed using partial least squares structural equation modeling. The findings confirm that managerial support significantly enhances job satisfaction and mitigates turnover intention and job stress, aligning with existing literature. This research provides empirical evidence on the direct effects of managerial support in Serbia, offering valuable insights for organisations aiming to improve employee well-being and optimise leadership strategies. By emphasising the role of managerial support, the study highlights its significance in fostering a healthier work environment, increasing employee engagement, and enhancing overall organisational sustainability.

Thank you for the opportunity to respond to Hu and Gifford's comments (Hu & Gifford, 2018). We appreciated their acknowledgement of our findings about the factors influencing the successful implementation of evidence-based practice (EBP). The authors described leadership behaviours as having a significant role in implementing evidence-based practice. Although we did not specifically discuss leadership in the previous paper (Cheng, Broome, Feng, & Hu, 2017a), we agree and acknowledge the importance of leadership during evidence implementation. It was interesting to read about Hu and Gifford's work in progress related to the study of leadership behaviours in EBP. In subsequent papers, we have further explicated the role of leaders in EBP and therefore wish to offer further insights in this commentary. Hu and Gifford (2018) described two measures (i.e., O-MILe and ILS) that have been developed and validated to assess leadership in the EBP context based on the literature. These measures will be very important to scholars of EBP implementation. In our work, three questions arose related to leadership in this context and go beyond just the behaviours evidenced by leaders: (a) Who are the leaders for evidence implementation; (b) what is essential preparation for the leaders; and (c) how do the leaders manifest their roles during the implementation. By reviewing the 24 implementation projects, we found many formal leaders, for example, nurse managers, staff nurses and faculty members. Their leadership is exemplified and differentiated by the implementation approaches they take, for example, top-down, bottom-up and outsider-in (Cheng, Broome, Feng, & Hu, 2017b). Meanwhile, informal leader that might complement the formal project leaders’ role during evidence implementation was also evident. For instance, staff nurse champions emerged in some projects to assist the leaders in educating colleagues, auditing actual performance and solving problems. Some staff nurses who were informal leaders also expressed their wiliness to become a formal leader to fill a new “gap” which became evident during implementation. This pattern of formal and informal leadership intertwined together to make the evidence “take root” in nursing practice. Thus, there is a need to prepare evidence implementation leadership at all levels of the health system. Although there had not been any formal requirements, we did find some common characteristics among those “successful/effective” formal and informal leaders. First, the leaders had a passion about looking for the latest evidence to solve patient care problems in nursing practice. They were aware of the needs of clinical settings and knew exactly what the gaps were. Second, they shared and exchanged their views with stakeholders across disciplines, for example, administrators, medicine, nursing, pharmacy, physiotherapy, logistics and information systems. Sometimes, they took on the informal role of “knowledge broker” as part of the leadership role, by identifying key attributes of the evidence that might be used and analysed the context and achieve the census among the stakeholders on implementation plans. Third, during the implementation, the leaders wisely allocated resources and struck a common ground where each stakeholder would be able to understand and achieve their own goal. In order to move the projects forward, they had to keep alert constantly to align the overlapping goals between person and system. Finally, leaders were able to foresee the proximal and long-term outcomes, as well as tangible and intangible impacts from evidence implementation. This vision lay behind their every act (even sacrificing personal time) and kept them persisting on this evidence implementation leadership journey. We realise that some of these behaviours are measured in Ottawa Model of Implementation Leadership (Gifford, Graham, Ehrhart, Davies, & Aarons, 2017). However, the qualitative approach that we took enabled us to paint a better picture of the “process of leadership” versus just the isolated behaviours evidenced by leaders as measured by quantitative scales. We found that leaders were often formally appointed by the hospitals, while other times they naturally took the lead. However, in either situation, they engaged in a variety of behaviours designed to keep “the projects moving.” For example, they responded to a particular clinical context, worked in a collective manner, engaged in strategic planning and functional management, exhibiting multifaceted behaviours at multiple levels. Support from higher administration was critical for the leaders fully play out their roles, especially for the bottom-up and outsider leaders. In a more recently published paper in the Journal of Nursing Management (Cheng, Feng, Hu, & Broome, 2018), we further analysed data from the previous study and provided exemplars for a better understanding of the nurse managers’ leadership role during evidence implementation. We found it important to consider “hierarchy and obedience” as important concepts in the mainstream culture of the Chinese existing health care system, and suggest enhancing managerial support with recognition of their efforts and preparation of the leaders as facilitators to integration of the best available evidence into nurses’ workflow. As Hu and Gifford pointed out in their commentary, leadership is much more than a role, position or status. Their work, as well as ours and others, has begun to build a more comprehensive picture of leadership and provide a deeper and broader understanding of how evidence-based practice can be achieved. However, the leadership for evidence implementation needs further exploration from the perspectives of staff nurse leaders, outsider leaders as well as the informal nursing leaders in various levels that assisted in compensating the formal leadership of nursing managers. None. None to declare.

Knowledge translation (KT) in healthcare is a complex process. Building the KT capacity of the workforce is fundamental to closing the gaps between research and evidence-based practice. This evaluation aimed to describe the impact of a KT capacity building program (Allied Health Translating Research into Practice, AH-TRIP) on allied health professionals and health services and systems, with the secondary aim of identifying barriers and enablers to program impact. Multi methods evaluation using online surveys and semi-structured interviews with 20 program participants and their managers. The interview guide was underpinned by the Framework to Assess the Impact from Translational health research (FAIT). Deductive content analysis was used to categorise impact against FAIT, with barriers and enablers mapped to an implementation framework. Six domains of impact were identified: Individual Capacity Building, Workforce Capacity Building, Enhanced Networks, Clinical Practice Change, Patient/Community Benefits, and Economic Benefits. Enablers of impact were program design (flexibility, access to mentors, funding opportunities), local contexts supporting research (manager support, access to local experts), and previous exposure to KT. Consistent barriers included a lack of clinician time and confidence in KT, staff turnover (particularly in regional/rural areas), lack of organisational research culture, and short-term funding cycles. Using FAIT methodology, we have demonstrated significant impact achieved by a KT capacity building program for individual health professionals and the broader allied health workforce and health services and systems. Impact could be further optimised by strategies targeted at managers to create supportive contexts for KT through improving research literacy in health decision and policy contexts and innovative workforce planning.

Recently there has been renewed interest in basing teachers’ professional learning on medically derived models. This interest has included clinical practice models and evidencebased teaching as well as the use of various forms of ‘Rounds’ which claim to derive from medical rounds. However, many arguing for these approaches may not have a detailed knowledge of the actuality of professional learning in medicine but may be basing their ideas on idealised models drawn from popular conceptions. In addition, the model used by some calling for medically derived teacher learning is biomedicine, an area in which parallels with Education are difficult. This paper argues that mental health and public health provide a better analogue for Education than biomedicine. It considers some of the lessons that can be drawn from research on evidence-based practice in these areas. The paper concludes that a way forward is neither uncritically to assume the superiority of medical models of professional learning nor to rely only on empirical evidence from Education but to enter into dialogue with colleagues in mental and public health about shared concerns and experiences in professional learning.