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。     

推动证据向临床转化(四)以临床转化为目的的证据资源检索

对证据临床转化时的证据检索进行阐述和总结,包括证据资源的分布与类型、以临床转化为目的的证据检索流程,旨在促进护理人员理解证据检索的原则、方法与策略,规范证据检索,促进证据实施。     

推动证据向临床转化(六)证据总结的制作与撰写

本文对证据临床转化过程中的证据总结进行阐述,包括证据总结的制作流程和撰写建议,旨在促进护理人员高效整合证据,推动证据实施。     

推动证据向临床转化 (十三)证据临床转化的研究设计

本文对证据临床转化的研究设计进行了阐述和总结,包括自身对照设计、历史对照设计、非随机同期对照设计、中断时间序列设计、阶梯试验设计,旨在促进护理人员正确理解证据临床转化,规范临床研究设计,更好地促进循证护理实践。     

推动证据向临床转化 (八)审查指标的构建

审查指标的构建是一个科学、系统的过程,审查指标应基于现有的证据并结合专业判断,并根据证据的动态发展进行持续更新和完善。本文旨在详细介绍如何构建科学的审查指标,阐述了构建审查指标的意义,描述了审查指标的内涵及类型,分析了审查指标的7大特征及审查指标构建的方法和步骤。在此基础上,提出了构建审查指标的建议。     

推动证据向临床转化(十)证据临床转化过程中的变革策略构建∗

本文详细阐述了如何根据前期障碍因素分析制定适合临床转化的变革策略。介绍了证据转化实施过程中,应从系统、实践者和患者3个层面着手,制定全方位有效的变革策略,并将有效的变革策略融入日常工作流程和制度中,以确保变革方案在实践中的整合和维持。     

推动证据向临床转化 (十四)证据临床转化的效果评价

本文从过程、结果和结构3个层面,从审查指标、系统、实践者、患者、证据转化的持续性5个方面,就证据临床转化研究的效果评价进行阐述和总结,旨在促进护理人员正确理解证据临床转化,完善效果评价,更好地反映循证护理实践在提升护理系统功效、提高护理服务质量上的作用。     

推动证据向临床转化 (七)证据的可用性评价

本文旨在详细阐述如何对证据的可用性进行评价。笔者系统回顾了证据的内涵,阐述了证据的4大特征,并详细介绍了证据可用性评价的内容和方法,指出证据可用性评价是1个结合专业判断的过程,是将证据应用于实践前的必要环节,并有助于明确证据临床转化中证据层面的障碍因素。     

推动证据向临床转化 (二)如何选择知识转化理论模式

本文作为证据临床转化方法学系列文章的第二篇,旨在详细阐述如何选择合适的知识转化理论模式,以指导和促进证据向临床的转化。本文分析了理论、模式和概念框架的内涵,并介绍了5个知识转化领域最常用的理论模式,包括KTA知识转化框架、渥太华研究应用模式、PARIHS框架、复旦循证护理路径图和基于证据的持续质量改进模式图。在此基础上,分析了在推动证据临床转化的过程中,选择合适的知识转化理论模式的重要性、依据及应注意的问题。     

推动证据向实践转化 (十五)变革维持的策略

本文旨在剖析证据临床转化过程变革维持的意义,从理论与实践的不同角度、从个体与系统的不同层面,阐述循证护理实践最具挑战的环节——变革维持可采取的策略及其方法,以推动证据向实践转化。     

推动证据临床转化(一)促进健康照护领域科学决策

阐述在知识转化模式和实施性科学框架下循证实践领域证据临床转化的背景、意义以及实施方法。分析证据临床转化的关键要素、与持续护理质量改进之间的关系。     

Collaborating on the development and implementation of evidence-based practices: Advancing science and practice

Implementation Science has recently gained considerable attention for the discipline of Communication Sciences and Disorders as a promising means for closing the research–practice gap by proactively facilitating the use of evidence-based protocols in practice. One of the pillars of Implementation Science is collaboration between researchers and stakeholders. This article describes the benefits of researcher–stakeholder collaboration, along with the challenges. Different types of collaborative approaches are provided with specific examples. Guidelines for creating and sustaining successful collaborations are provided. The article concludes with an appeal for more research that brings together the talents and expertise of researchers and other stakeholders in conducting scientifically rigorous and practically important studies in ways that improves the likelihood of adoption and sustained use of evidence-based practices.     

Barriers to evidence based practice in primary care: a review of the literature

People with health problems deserve a service that is based on best available evidence and is possible within obtainable resources. No credible health professional could deny that sound evidence should be an integral part of clinical decision making. The demand for up to date information to inform care and treatment highlights the crucial role of research and development in the modern health service. However, within primary care, practitioners have not always been able to underpin their actions with robust research findings. In addition, the research activities within primary care are limited to a small number of 'enthusiasts'. This paper aims to analyse the literature surrounding this area, highlighting the significance of United Kingdom (UK) government reports on primary care, primary care research activities and the pursuit of evidence based practice in primary care. It shows that primary care research has been the 'poor relation' in terms of research funding and this has resulted is a dearth of high quality research results to underpin practice.     

A survey of the uptake and implementation of research evidence by South Australian acupuncturists in clinical practice: attitudes and associated predictive factors

OBJECTIVE: To examine South Australian acupuncturists' attitudes towards the use of research evidence and concurrently identify predicative factors associated with the uptake and implementation of research evidence. METHODS: Questionnaires were mailed out to the entire South Australian acupuncturist population (n=94). The population was divided into two groups, medical acupuncturists (general practitioners or other medical specialists) and non-medical acupuncturists, as previous studies have suggested that clinicians' attitudes to EBP are particular to the clinical setting. RESULTS: The total response rate to the survey was 76.6% (n=72). The difference in response rates between non-medical acupuncturists (90.9%, n=60) and medical acupuncturists (42%, n=12) was significant (p<0.0001). Over half of all respondents had both prior research training and previous research experience. Both groups held positive attitudes to research utilization, the use of research information was considered to be an important component of their professional practice, although they prioritized patient care over both reading research evidence and undertaking primary research. There was no significant difference in research interest between groups. The only predicative factor that influenced research utilization was related to the non-medical acupuncturists period of time in practice; non-medical acupuncturists interest in research (rho=-0.29, p=0.036) declined as they accrued clinical experience. No predictive factors were identified for the medical acupuncturist group. CONCLUSION: South Australian acupuncturists hold favorable views towards research utilization and consider the integration of research evidence into clinical practice as an important component of professional development. Professional associations should implement strategies which capitalize on the respondents' positive attitudes in order to ensure high quality evidence-based care for patients seeking acupuncture.     

护生自由选择临床带教老师的实践

目的:营造和谐的临床带教氛围,提高教学质量。方法:让护生根据带教老师书写的"个人带教风格"进行选择;检验开展的效果,进行绩效考评奖励。结果:护生对带教老师"个人带教风格"相符性的综合评价优良率达98.86%;科室对带教老师"个人带教风格"落实的综合评价优良率达96.25%;护生出科考核综合成绩优良率达96.66%;护生对带教老师满意度由82%上升到98%,带教老师对护生的满意度由80%上升到96%。结论:自由选择带教老师是营造和谐的临床带教氛围,融洽师生关系,提高护理临床教学质量,实现教、学、护相长的有效措施。     

Nursing science: the transformation of practice

World-wide transformations in nursing practice are evolving as more nurses are embracing extant nursing theories and frameworks in order to fortify their unique contributions to the healthcare system. This article specifies the importance of and the ethical considerations arising when using nursing knowledge from within the school of thought of the discipline to guide practice. The ideas set forth are in stark contrast to the general nursing process with its medical model-driven diagnostic systems now proliferating in nursing practice in the global healthcare community. Both challenges and opportunities are present in the transformation of practice to a nursing knowledge base.     

Creating an environment to implement and sustain evidence based practice: A developmental process

Background

Elements of evidence based practice (EBP) are well described in the literature and achievement of EBP is frequently being cited as an organisational goal. Despite this, the practical processes and resources for achieving EBP are often not readily apparent, available or successful.

Purpose

To describe a multi-dimensional EBP program designed to incorporate evidence into practice to lead to sustainable improvement in patient care and ultimately patient outcome.

Implementation strategies

A multi-dimensional EBP program incorporating EBP champions and mentors, provision of resources, creation of a culture to foster EBP and use of practical EBP strategies was implemented in a 22-bed intensive care unit (ICU) in a public, tertiary hospital in Brisbane, Australia. The practical EBP strategies included workgroups, journal club and nursing rounds.

Achievements

The multi-dimensional EBP program has been successfully implemented over the past three years. EBP champions and mentors are now active and two EBP workgroups have investigated specific aspects of practice, with one of these resulting in development of an associated research project. Journal club is a routine component of the education days that all ICU nurses attend. Nursing rounds is now conducted twice a week, with between one and seven short-term issues identified for each patient reviewed in the first 12 months.

Conclusions

A multi-dimensional program of practice change has been implemented in one setting and is providing a forum for discussion of practice-related issues and improvements. Adaptation of these strategies to multiple different health care settings is possible, with the potential for sustained practice change and improvement.     

发热管理在儿科急诊中的最佳证据应用

目的探讨发热管理在儿科急诊中的最佳证据应用。方法依据JBI临床证据实践应用系统(JBIPACES)的标准程序,基于临床问题,通过JBI在线临床治疗及护理证据网络(CONNECT+)数据库获取儿童发热管理的相关证据并制定相应审查标准,经证据应用前基线审查、实践变革、证据应用后变革效果的再审查,将证据推广到特定的临床环境中去。证据应用前后各有50名发热患儿家属及35名护士纳入研究,采用现场观察法、访谈、查阅相关护理文书收集资料,以护士对于每条标准执行的依从性、家属及护士对基于循证的发热知识的掌握度来评价证据应用前后的有效性。结果证据应用后,5条标准的依从性可达到98%~100%。儿科急诊护士的发热知识问卷均分由67.6分上升到90.3分,发热患儿家属的均分由54.5分上升到83.7分。结论儿童发热管理最佳证据的应用,利于护理人员及患儿家属对发热管理进一步的认识,在规范发热处理流程的同时,提升了护理质量。