Evidence based practice: a survey of physiotherapists' current practice

Backgound and Purpose . Evidence‐based practice is the explicit use of current best evidence in making decisions about the care of individual patients and is a concept of growing importance for physiotherapy. The aim of the present study was to investigate Australian physiotherapists' self‐reported practice, skills and knowledge of evidence‐based practice and to examine differences between recent and experienced graduates, physiotherapists with low and high levels of training and physiotherapists working in private practice and hospital settings. Method . A survey was sent to 230 physiotherapists working in hospitals and in private practice. One hundred and twenty‐four were completed and returned. Results . Although 69.4% of respondents said they frequently (at least monthly) read research literature, only 10.6%, 15.3% and 26.6% of respondents, respectively, searched PEDro, Cochrane and Medline or Cinahl databases frequently, and only 25.8% of respondents reported critically appraising research reports. Recent graduates rated their evidence‐based practice skills more highly than more experienced graduates, but did not perform evidence‐based practice tasks more often. Physiotherapists with higher levels of training rated their evidence‐based practice skills more highly, were more likely to search databases and to understand a range of evidence‐based practice terminology than those with lower levels of training. Private practice and hospital physiotherapists rated their evidence‐based practice skills equally and performed most evidence‐based practice activities with equal frequency. Conclusions . Respondents had a positive attitude toward evidence‐based practice and the main barriers to evidence‐based practice were time required to keep up to date, access to easily understandable summaries of evidence, journal access and lack of personal skills in searching and evaluating research evidence. Efforts to advance evidence‐based practice in physiotherapy should focus on reducing these barriers. Copyright © 2006 John Wiley & Sons, Ltd.     

Evidence-based practice in rehabilitation nursing.

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.     

An evaluation of a teaching intervention to improve the practice of endotracheal suctioning in intensive care units

Endotracheal suctioning is a frequently performed procedure that has many associated risks and complications. It is imperative that nurses are aware of these risks and are able to practise according to current research recommendations. This study was designed to examine to what extent intensive care nurses' knowledge and practice of endotracheal suctioning is based on research evidence, to investigate the relationships between knowledge and practice, and to evaluate the effectiveness of a research-based teaching programme. This quasi-experimental study was a randomized, controlled, single-blinded comparison of two research-based teaching programmes, with 16 intensive care nurses, using non-participant observation and a self-report questionnaire. Initial baseline data revealed a low level of knowledge for many participants, which was also reflected in practice, as suctioning was performed against many of the research recommendations. Following teaching, significant improvements were seen in both knowledge and practice. Four weeks later these differences were generally sustained, and provide evidence of the effectiveness of the educational intervention. The study raised concern about all aspects of endotracheal suctioning and highlighted the need for changes in nursing practice, with clinical guidelines and focused practice-based education.     

Developing practice in mental health settings

If practice development (PD) is to be implemented in diverse mental health‐care settings, it is important that managers, researchers, and policy makers are all clear about the nature of the processes involved. The authors draw on the literature to broadly set out local strategies, practicalities, and issues that should be considered and addressed by those planning to undertake PD projects in mental health. Before implementing PD projects, pre‐existing requirements should be recognized and expedited. All aspects of who does what, when, and how should be widely communicated so that continuous evaluation and improvements are generated. Staff need to be adult learners, be aware of their practice values, be able to access supervision, and confront contradictions and tensions between values and practice. PD programmes that are effective are built into mainstream activities, considered core business, utilize existing resources to build sustainable and realistic improvements, take direction from practitioners, and incorporate client needs.     

Using theory and evidence to drive measurement of patient,nurse and organizational outcomes of professional nursing practice

An evolving body of literature suggests that the implementation of evidence based clinical and professional guidelines and strategies can improve patient care. However, gaps exist in our understanding of the effect of implementation of guidelines on outcomes, particularly patient outcomes. To address this gap, a measurement framework was developed to assess the impact of an organization‐wide implementation of two nursing‐centric best‐practice guidelines on patient, nurse and organizational level outcomes. From an implementation standpoint, we anticipate that our data will show improvements in the following: (i) patient satisfaction scores and safety outcomes; (ii) nurses ability to value and engage in evidence based practice; and (iii) organizational support for evidence‐informed nursing care that results in quality patient outcomes. Our measurement framework and multifaceted methodological approach outlined in this paper might serve as a blueprint for other organizations in their efforts to evaluate the impacts associated with implementation of clinical and professional guidelines and best practices.     

Redescribing reflective practice and evidence-based practice discourses

This paper provides an analysis on the discourses of reflective practice and evidence-based practice. It commences by examining the role of discourse in describing and defining our beliefs and attitudes. Consequently, it argues that each discourse is based on a certain epistemology, which in effect are language constructs that create realities and like all language constructs, the epistemology of each discourse is open to the possibility of being restructured. Sequentially, any discourse can (re)describe a different type of reality by providing a set of different words, values and beliefs. Eventually, by exposing the language play and the engineered binary of the reflective practice and the evidence-based practice discourses it is concluded that these discourses are not mutually exclusive as they have been portrayed by most of the literature, but complementary ones. Finally, reflective practice and evidence-based practice are re-described as supplementary discourses and practitioners can simultaneously utilize both through the process of critical reflexivity.     

Achieving evidence-based nursing practice: impact of the Caledonian Development Model

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.     

Fitness to practice and feedback to students: A literature review

In the United Kingdom (UK), the Nursing and Midwifery Council (NMC) stipulate that practice experience makes up 50% of the nursing curricula. We argue that mentors play a pivotal role in this experience, being the main practitioner responsible for supporting learning in practice, and the NMC's framework to support learning and assessment in practice establishes the knowledge and skills that mentors must apply in practice with students. This framework acts as a resource guide to mentors on how to successfully facilitate students clinical learning experiences, ensuring that students are “fit to practice” at the point of registration. It is recognised, therefore, that it is the mentor's responsibility, once in practice, to bridge the gap between that which students are taught in the classroom, and their actual application to practice. This paper aims to undertake an analysis of the available literature on how effective feedback from mentors to students can help to ensure this fitness to practice.     

Supporting students in practice

This article reports a project aiming to assess the effectiveness of clinical nurses employed in support roles for students in clinical practice in one UK higher education institution and its linked NHS Trusts. Focus groups and telephone interviews were used to collect data from the clinical support nurses themselves, senior nurse managers and pre- and post-registration students. Findings show that personal commitment to the role was high and that these support staff made a valuable contribution to up-to-date clinical input into classroom teaching. Managers also valued the university-clinical link role fulfilled by these staff. Students had mixed opinions, pre-registration students having had little exposure to this kind of support and post-registration students often not regarding clinical support as necessary because of their own existing clinical experience and expertise. For clinical support staff themselves, the role was a busy one and they often experienced conflict and role overload in balancing the education and clinical sides of their work. Necessary improvements for functioning of the roles were identified, including having regular meetings between university and NHS managers and support teachers for liaison purposes, joint appraisal, and formal support mechanisms for role occupants. The overall conclusion drawn is that the roles were successful in bridging the theory-practice gap for the University and NHS Trust managers, but less so for students, and that they did this at some personal cost for role holders.