产后盆底康复护理管理循证实践方案的构建

目的:整合现有证据,基于我国国情和临床现况构建产后盆底康复护理管理的循证实践方案.方法:以知识转化模型为理论指导,成立循证实践研究小组,通过文献研究及临床现况调查确定研究问题,检索、评鉴、整合相关的证据,进行临床适用性评价,明确证据转化的阻碍因素,制定相应的行动策略,完成产后盆底康复护理管理循证实践方案的构建.结果:共...     

学术速递

1.推动证据临床转化系列目前,知识转化已经成为全球卫生保健关注的热点。但如何开展循证实践,促进高质量证据向临床的转化成为困扰护理人员的关键问题,尤其是关于证据实施的方法学,一直处于不断发展和完善中。复旦大学护理学院从2010年开始致力于推动证据向临床的转化与应用,开展了多项课题,推出了多个本土化证据实施模式,在多年教育、研究积累的基础上,梳理和分析了在证据实施方面的资源、理论与方法。     

推动证据向临床转化(五)证据临床转化研究中的文献质量评价

循证实践是对公开报道的研究进行组织、整理、评价、整合、分类、遴选和有效利用的过程,以促进证据向临床转化,促进护理实践水平的提高。在证据临床转化的四个阶段中,文献质量评价是证据准备阶段的关键环节。本文将详细介绍对指南、专家共识、系统评价和原始研究的文献质量评价的原则和方法,为研究者进一步梳理可用的证据,开展后续临床转化环节提供依据。     

COVID-19证据现状对快速建议指南制订的启示与思考

随着新型冠状病毒肺炎在全球暴发及快速传播,大量相关研究证据迅速产生.然而,因证据质量参差不齐、证据转化质量不佳、证据转化速度较慢等问题,卫生决策者、临床医生及患者如何作出正确决策面临巨大挑战.基于快速系统评价证据,快速建议指南可及时、有效地将当前最新证据转化为指导临床实践的推荐意见.面对全球突发公共卫生事件,通过构建新...     

医疗大数据时代下的Meta分析

循证医学在大数据时代迎来了绝佳的发展机遇。Meta分析作为循证医学的高级别证据,其写作方法应为临床医师熟练掌握。完成一篇高质量的Meta分析需要全面了解其方法流程,根据研究的临床问题选择合适的分析类型,从构建临床问题到数据分析撰写,皆需遵循国际通用的规范和指南要求。精准选题,严守规范,用心琢磨,方能为临床决策提供高级别的医学证据。     

护理证据转化中的问题与对策

知识转化是全球卫生保健关注的热点,但证据和临床护理实践存在差距。如何推动证据向临床护理实践转化、规范护理行为、促进公立医院高质量发展是临床护理实践亟待解决的问题。该文聚焦证据、实践者、环境、评价等护理证据转化的关键环节,分析我国临床护理证据转化中存在的问题并探讨改进对策,为科学、优质、高效的循证护理实践提供参考。     

基于指南的糖尿病高危足患者足部护理教育循证实践方案的构建

目的探讨基于《糖尿病高危足患者健康教育临床护理实践指南》的糖尿病高危足患者足部护理教育的循证实践方案的构建。方法本研究以KTA证据转化模式为指导,通过明确研究问题,将证据引入临床情境、评估障碍因素和构建循证实践方案3个阶段,构建《糖尿病高危足患者足部护理教育的循证实践方案》。结果本研究依据《糖尿病高危足患者健康教育临床护理实践指南》中的15条推荐意见构建的《糖尿病高危足患者足部护理教育的循证实践方案》,主要包括《糖尿病高危足患者足部护理教育最佳实践手册》和《糖尿病高危足患者足部自我护理健康教育台历》,其中《糖尿病高危足患者足部护理教育最佳实践手册》主要包含实践背景、证据来源、证据等级系统、糖尿病高危足患者足部护理教育证据摘要、实践流程、实践工具和评估表、实践内容、参考文献共8个部分。结论本方案基于我国特定临床情境及专业人员的判断和患者意愿构建而成,可为临床糖尿病高危足患者足部护理教育提供参考,为下一步证据转化于临床提供重要保障。     

护理研究

正护理科研的选题选题是指选择、形成和确定一个需要研究和解决的科学问题。它是开展科研工作的首要步骤。1研究问题的来源护理研究的范围涉及与护士或护理工作相关的一系列问题和现象,目的是构建护理学科的知识体系以指导护理工作实践。所以,护理选题的范围与护理     

效果-实施双轨设计的分类和应用

将证据转化为卫生保健服务,需要经过3个转化过程“临床前研究-临床研究-实施性研究”,耗时漫长且常常出现转化不足。为加快证据转化为日常医疗实践和卫生政策的进程,融合了临床有效性研究和实施性研究的“效果-实施双轨设计”应运而生。本文介绍效果-实施双轨设计的概念、分类及其应用,为研究人员应用此方法开展研究提供参考。     

概念图在证据转化与应用项目中的研究进展

如何识别利益相关者观点一直是证据转化与临床应用的重要议题,概念图为解决利益相关者相关研究问题提供了框架。该文介绍了概念图的概念、实施步骤及其在证据转化与应用项目中的应用方向,包括明确研究问题和需求,探索证据实施的障碍和促进因素,选择和剪裁实施策略,开发概念框架和测量工具等方面,总结了概念图的应用前景,以期促进概念图在国内证据转化研究中的应用。     

Detecting deterioration in patients with chronic disease using telemonitoring: navigating the 'trough of disillusionment'

Objectives To examine the evidence base for telemonitoring designed for patients who have chronic obstructive pulmonary disease and heart failure, and to assess whether telemonitoring fulfils the principles of monitoring and is ready for implementation into routine settings. Design Qualitative data collection using interviews and participation in a multi‐path mapping process. Participants Twenty‐six purposively selected informants completed semi‐structured interviews and 24 individuals with expertise in the relevant clinical and informatics domains from academia, industry, policy and provider organizations and participated in a multi‐path mapping workshop. Results The evidence base for the effectiveness of telemonitoring is weak and inconsistent, with insufficient cost‐effectiveness studies. When considered against an accepted definition of monitoring, telemonitoring is found wanting. Telemonitoring has not been able so far to ensure that the technologies fit into the life world of the patient and into the clinical and organizational milieu of health service delivery systems. Conclusions To develop effective telemonitoring for patients with chronic disease, more attention needs to be given to agreeing the central aim of early detection and, to ensure potential implementation, engaging a wide range of stakeholders in the design process, especially patients and clinicians.     

An exploration of the factors that influence the implementation of evidence into practice

Background. The challenges of implementing evidence‐based practice are complex and varied. Against this background a framework has been developed to represent the multiple factors that may influence the implementation of evidence into practice. It is proposed that successful implementation is dependent upon the nature of the evidence being used, the quality of context, and, the type of facilitation required to enable the change process. This study sets out to scrutinize the elements of the framework through empirical enquiry. Aims and objectives. The aim of the study was to address the following questions:
? What factors do practitioners identify as the most important in enabling implementation of evidence into practice?
? What are the factors practitioners identify that mediate the implementation of evidence into practice?
? Do the concepts of evidence, context and facilitation constitute the key elements of a framework for getting evidence into practice? Design and methods. The study was conducted in two phases. Phase 1: Exploratory focus groups (n = 2) were conducted to inform the development of an interview guide. This was used with individual key informants in case study sites. Phase 2: Two sites with on‐going or recent implementation projects were studied. Within sites semi‐structured interviews were conducted (n = 17). Results. A number of key issues in relation to the implementation of evidence into practice emerged including: the nature and role of evidence, relevance and fit with organizational and practice issues, multi‐professional relationships and collaboration, role of the project lead and resources. Conclusions. The results are discussed with reference to the wider literature and in relation to the on‐going development of the framework. Crucially the growing body of evidence reveals that a focus on individual approaches to implementing evidence‐based practice, such as skilling‐up practitioners to appraise research evidence, will be ineffective by themselves. Relevance to clinical practice. Key elements that require attention in implementing evidence into practice are presented and may provide a useful checklist for future implementation and evaluation projects.     

Connecting Kids to Care: Developing a School-Based Telehealth Program

School-based telehealth is an efficient and effective way to overcome barriers to care and improve health equity for children in rural and underserved communities. Empowering health care providers, such as nurse practitioners, to develop successful, sustainable programs may contribute to improved access to care and improved health outcomes for the children served. Using a structured framework for program development is essential to successful implementation when connecting school-age children to care through a school-based telehealth program. The Telehealth Service Implementation Model provides a robust structure with requisite components to develop and implement a successful school-based telehealth program.     

Development of a position statement for Australian critical care nurse education

Position statements are used by large organisations such as the Australian College of Critical Care Nurses to publically present an official philosophy or beliefs and to propose recommendations. Position statements are increasingly used by health departments and healthcare facilities to allocate resources and to guide and audit nursing practice, yet there are limited resources on the process of their development. A position statement should help readers better understand the issue, communicate solutions to problems, and inform decision-making. It should be supported by the highest level of evidence available and reflect the organisation's governing objectives and goals. In this article, we describe the structured approach used to develop a position statement for Australian critical care nurse education. The formation of an expert advisory panel, synthesis of available evidence using Whittemore and Knafl's integrative review methodology, use of Donabedian's structure-process-outcomes quality framework as a theoretical approach, and multiple layers of consensus building and consultation enabled the development of an important critical care document and informed an implementation plan. The framework and processes we have outlined in this discussion article may provide a useful starting point for other professional organisations wishing to develop similar position statements.     

E‐portfolios and Entrustable Professional Activities to support competency‐based education in dietetics

The concept of Entrustable Professional Activities, recently pioneered in medical education, has emerged to support the implementation of competency‐based education. Although competency‐based frameworks are widely used in healthcare professional education to develop outcomes‐based curricula, assessment of student competency in professional placement settings remains challenging. The novel concept of Entrustable Professional Activities together with established methods of competency assessment, namely e‐portfolios and self‐assessment, was implemented in the “[La Trobe University Dietetic program in 2015–2016. This study aimed to appraise the e‐portfolio and evaluate the use of Entrustable Professional Activities to assess competence. A mixed‐methods evaluation, using qualitative and quantitative surveys with follow‐up structured consultations, was conducted with final year dietetics students and their supervisors. Dietetics students were comfortable with Entrustable Professional Activities and competency‐based assessment, whereas supervisors preferred Entrustable Professional Activity based assessment. All stakeholders valued student self‐assessment and the ongoing use of structured e‐portfolios to develop and document competency. The use of structured e‐portfolios, student self‐assessment, and the emerging concept of Entrustable Professional Activities are useful tools to support dietetics student education in professional placement settings.     

Improving the quality of community placements for nursing students

This article explores the development and implementation of a structured framework to enable adult branch nursing students to undertake delegated care activities independently while working in community practice placements and aligned to district nursing teams. A working group comprising academic staff from De Montfort University, Leicester, and practice colleagues from Leicestershire Partnership Trust collaborated to develop the framework and accompanying guidelines.     

The effect of evidence-based practice perception,information literacy self-efficacy,and academic motivation on nursing students' future implementation of evidence-based practice

BackgroundEvidence-based practice (EBP) in nursing is an important tool for promoting quality care and improving patient outcomes. Global evidence suggests that the rate of EBP implementation among nurses and nursing students is low. The effects of EBP perception, information literacy self-efficacy, and academic motivation on nursing students' future implementation of EBP have not been fully explored.PurposeTo examine the effect of EBP perception, information literacy self-efficacy, and academic motivation on future implementation of EBP among pre-registration nursing students.MethodA cross-sectional study used a self-administered structured questionnaire and analyzed data from 148 pre-registration nursing students at a university in central Israel. A hierarchical forced steps regression analysis was conducted to predict future implementation of EBP.ResultsInformation literacy self-efficacy, EBP perception, and intrinsic academic motivation to experience stimulation, may predict EBP future implementation. The model explained 46.3% of the variance.ConclusionThe results indicate the importance of information literacy skills and positive attitudes to EBP, as well as of intrinsic academic motivation, for enhancing future implementation of EBP among nursing students.     

The value of mentoring: a strategic approach to retention and recruitment

The issues of recruitment, training, and retention of experienced nursing staff remains an ongoing business strategy of nursing service in many health care facilities. The implementation of a structured mentoring program recognizes the need to develop and maintain relationships between the new and the experienced nurses. The terms of mentor and mentee are defined within a structured orientation program, highlighting specific roles and responsibilities of each. The use of other staff as preceptors and resources is discussed as a mechanism to enhance diversity in skill and knowledge development. The value of clinical tracking forms, planning calendars, and feedback mechanisms are stressed to ensure success in monitoring this program in a longitudinal way. Problems associated with the assignment of mentors are addressed as an area for future investigation in different care settings.