Nurses' perceived knowledge, beliefs, skills, and needs regarding evidence-based practice: implications for accelerating the paradigm shift. The propensity to adopt evidence-based practice among physical therapists 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 Evaluation of an evidence-based practice initiative: outcomes, strengths and limitations of a retrospective, conceptually-based approach. Protocol: Adaptive Implementation of Effective Programs Trial (ADEPT): cluster randomized SMART trial comparing a standard versus enhanced implementation strategy to improve outcomes of a mood disorders program Strengthening organizations to implement evidence-based clinical practices. Implementation of evidence-based practice across medical, nursing, pharmacological and allied healthcare professionals: a questionnaire survey in nationwide hospital settings Evidence-based practice profiles of physiotherapists transitioning into the workforce: a study of two cohorts Knowledge and use of evidence-based practice by allied health and health science professionals in the United Kingdom. A KT intervention including the evidence alert system to improve clinician’s evidence-based practice behavior—a cluster randomized controlled trial
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 Data base of Systematic Review s and the National Guideline Clearinghouse . CONCLUSION AND IMPLICATION S 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 r and omized controlled trials are urgently needed to test the effectiveness of interventions on advancing evidence -based care Background Many authors , as well as the American Physical Therapy Association , advocate that physical therapists adopt practice patterns based on research evidence , known as evidence -based practice ( EBP ) . At the same time , physical therapists should be capable of integrating EBP within the day-to-day practice of physical therapy . The purpose of this study was to determine the extent to which personal characteristics and the characteristics of the social system in the workplace influence the propensity of physical therapists to adopt EBP . Methods The study used a 69 item mailed self-completion question naire . The question naire had four major sections . The first three sections were each drawn from a different theoretical framework and from different authors ' work . The instrument was developed to capture the propensity of physical therapists to adopt EBP , characteristics of the social system in the workplace of physical therapists , personal characteristics of physical therapists , and selected demographic variables of physical therapists . The eligible population consisted of 3,897 physical therapists licensed by the state of Georgia in the United States of America . A r and om sample of 1320 potential participants was drawn . Results 939 question naires were returned for a response rate of 73 % . 831 of the participants ' question naires were useable and became the basis for the study . There was a moderate association between desire for learning ( r = .36 , r2 = .13 ) , highest degree held ( r = .29 , r2 = .08 ) , practicality ( r = .27 , r2 = .07 ) and nonconformity ( r = .24 , r2 = .06 ) and the propensity to adopt EBP .  A negative correlation was found between age , years licensed and percentage of time in direct patient care . The findings demonstrated that the best three variables for predicting the propensity to adopt EBP  in physical therapy were : desire for learning , highest degree held , and practicality . Conclusion The study confirms there is no single factor to facilitate research evidence into day-to-day practice . Multiple practice change strategies will be needed to facilitate change in practice Although evidence -based practice ( EBP ) improves health care quality , decreases costs , and empowers nurses , there is a paucity of intervention studies design ed 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 r and omized 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 BACKGROUND AND PURPOSE Making evidence -based practice ( EBP ) a sustained reality is a difficult endeavor . This relates , among other factors , to lack of sufficient research upon which to base implementation efforts . Alternative sources of evidence therefore need to be considered , particularly where organizational level EBP is the goal . In this article a brief evaluation of a service-based initiative with the aim of obtaining insights regarding multiple types and levels of EBP-related outcomes is described . METHODS A structured , retrospective improvement evaluation was conducted . Semi-structured interviews and available documents were chosen to obtain information regarding outcomes , perceived spread of reported individual changes , and factors related to the degree of progress . Underlying the method is an evaluation model that shows a progressive set of EBP outcomes at both individual and group levels . FINDINGS Evaluative results , although limited by several factors , provided credible and sufficient internal evidence for this organization 's leadership team to build upon past efforts and refine their approach to integrating research utilization ( RU ) throughout the department of nursing . For example , the evaluation indicated a set of RU outcomes at the individual nurse level not previously considered and also indicated limitations and challenges to full achievement of initial project-related goals . DISCUSSION AND IMPLICATION S The evaluation provided suggestive internal evidence regarding potential benefits of one component of a long-term , valued EBP initiative . However , the evaluation also raised questions regarding structural aspects of this initiative ; identified barriers to progress ; provided information for dialogue and planning ; and highlighted future needs for a proactive , systematic evaluation and a documented trail of data related to all EBP program goals . For those in setting s with similar characteristics and aims that have not built in such a prospect i ve evaluation for EBP initiatives , this evaluative project can be assessed for its applicability Background Despite the availability of psychosocial evidence -based practice s ( EBPs ) , treatment and outcomes for persons with mental disorders remain suboptimal . Replicating Effective Programs ( REP ) , an effective implementation strategy , still result ed in less than half of sites using an EBP . The primary aim of this cluster r and omized trial is to determine , among sites not initially responding to REP , the effect of adaptive implementation strategies that begin with an External Facilitator ( EF ) or with an External Facilitator plus an Internal Facilitator ( IF ) on improved EBP use and patient outcomes in 12 months . Methods / Design This study employs a sequential multiple assignment r and omized trial ( SMART ) design to build an adaptive implementation strategy . The EBP to be implemented is life goals ( LG ) for patients with mood disorders across 80 community-based outpatient clinics ( N N = 1,600 patients ) from different U.S. regions . Sites not initially responding to REP ( defined as < 50 % patients receiving ≥3 EBP sessions ) will be r and omized to receive additional support from an EF or both EF/IF . Additionally , sites r and omized to EF and still not responsive will be r and omized to continue with EF alone or to receive EF/IF . The EF provides technical expertise in adapting LG in routine practice , whereas the on-site IF has direct reporting relationships to site leadership to support LG use in routine practice . The primary outcome is mental health-related quality of life ; secondary outcomes include receipt of LG sessions , mood symptoms , implementation costs , and organizational change . Discussion This study design will determine whether an off-site EF alone versus the addition of an on-site IF improves EBP uptake and patient outcomes among sites that do not respond initially to REP . It will also examine the value of delaying the provision of EF/IF for sites that continue to not respond despite EF.Trial registration Clinical Trials.gov identifier : OBJECTIVES Despite recognition that implementation of evidence -based clinical practice s ( EBPs ) usually depends on the structure and processes of the larger health care organizational context , the dynamics of implementation are not well understood . This project 's aim was to deepen that underst and ing by implementing and evaluating an organizational model hypothesized to strengthen the ability of health care organizations to facilitate EBPs . CONCEPTUAL MODEL : The model posits that implementation of EBPs will be enhanced through the presence of three interacting components : active leadership commitment to quality , robust clinical process re design incorporating EBPs into routine operations , and use of management structures and processes to support and align re design . STUDY DESIGN In a mixed- methods longitudinal comparative case study design , seven medical centers in one network in the Department of Veterans Affairs participated in an intervention to implement the organizational model over 3 years . The network was selected r and omly from three interested in using the model . The target EBP was h and -hygiene compliance . Measures included ratings of implementation fidelity , observed h and -hygiene compliance , and factors affecting model implementation drawn from interviews . FINDINGS Analyses support the hypothesis that greater fidelity to the organizational model was associated with higher compliance with h and -hygiene guidelines . High-fidelity sites showed larger effect sizes for improvement in h and -hygiene compliance than lower-fidelity sites . Adherence to the organizational model was in turn affected by factors in three categories : urgency to improve , organizational environment , and improvement climate . IMPLICATION S Implementation of EBPs , particularly those that cut across multiple processes of care , is a complex process with many possibilities for failure . The results provide the basis for a refined underst and ing of relationships among components of the organizational model and factors in the organizational context affecting them . This underst and ing suggests practical lessons for future implementation efforts and contributes to theoretical underst and ing of the dynamics of the implementation of EBPs Background Implementation of evidence -based practice ( EBP ) is regarded as core competence to improve healthcare quality . In the current study , we investigated the EBP of six groups of professionals : physicians , nurses , pharmacists , physical therapists , technicians , and other allied healthcare personnel . Methods A structured question naire survey of regional hospitals throughout Taiwan was conducted by post in 2011 . Question naires were mailed to all healthcare workers of 11 r and omly selected hospitals .  Linear and logistic regression models were used to examine predictors for implementing EBP . Results In total , 6,160 returned question naires , including 645 from physicians , 4,206 from nurses , 430 from pharmacists , 179 from physical therapists , 537 from technicians , and 163 from other allied healthcare professionals , were valid for the analysis . Physicians and pharmacists were more aware of EBP than were the other professional groups ( p < 0.001 ) . Positive attitudes toward and beliefs in EBP were significantly lower among nurses than in the other groups ( p < 0.001 ) . Physicians had more sufficient knowledge and skills of EBP than did the other professionals ( p < 0.001 ) ; in addition , they implemented EBP for clinical decision-making more often and perceived fewer personal barriers to EBP ( p < 0.001 ) . Multivariate logistic regression analyses showed that EBP implementation was associated with the following characteristics of participants : EBP training , having a faculty position , academic degree , one 's profession , and perceptions ( beliefs , attitudes , knowledge , skills and barriers ) . Conclusions This study depicts various levels of EBP implementation among medical , nursing , pharmacological , and allied healthcare personnel . There were significant differences in their implementation of EBP . We observed that certain factors were associated with EBP implementation , including personal background s and perceptions toward EBP . The data suggest that strategies for enhancing EBP implementation should differ for various groups of professionals Background Training in the five steps of evidence -based practice ( EBP ) has been recommended for inclusion in entry-level health professional training . The effectiveness of EBP education has been explored predominantly in the medical and nursing professions and more commonly in post-graduate than entry-level students . Few studies have investigated longitudinal changes in EBP attitudes and behaviours . This study aim ed to assess the changes in EBP knowledge , attitudes and behaviours in entry-level physiotherapy students transitioning into the workforce . Methods A prospect i ve , observational , longitudinal design was used , with two cohorts . From 2008 , 29 participants were tested in their final year in a physiotherapy program , and after the first and second workforce years . From 2009 , 76 participants were tested in their final entry-level and first workforce years . Participants completed an Evidence -Based Practice Profile question naire ( EBP2 ) , which includes self-report EBP domains [ Relevance , Terminology ( knowledge of EBP concepts ) , Confidence , Practice ( EBP implementation ) , Sympathy ( disposition towards EBP ) ] . Mixed model analysis with sequential Bonferroni adjustment was used to analyse the matched data . Effect sizes ( ES ) ( 95 % CI ) were calculated for all changes . Results Effect sizes of the changes in EBP domains were small ( ES range 0.02 to 0.42 ) . While most changes were not significant there was a consistent pattern of decline in scores for Relevance in the first workforce year ( ES -0.42 to -0.29 ) followed by an improvement in the second year ( ES + 0.27 ) . Scores in Terminology improved ( ES + 0.19 to + 0.26 ) in each of the first two workforce years , while Practice scores declined ( ES -0.23 to -0.19 ) in the first year and improved minimally in the second year ( ES + 0.04 ) . Confidence scores improved during the second workforce year ( ES + 0.27 ) . Scores for Sympathy showed little change . Conclusions During the first two years in the workforce , there was a transitory decline in the self-reported practice and sense of relevance of EBP , despite increases in confidence and knowledge . The pattern of progression of EBP skills beyond these early professional working years is unknown Clinical  effectiveness ( CE ) and evidence -based practice ( EBP )  are the cornerstone of modern-day health care . Although many studies have explored attitudes and perceived knowledge of individual professions , few have compared these factors between professional groups , especially in the allied health professions ( AHP ) and health science services ( HSS ) . We report a study comparing the knowledge and practice of 14 different professional groups from the AHP and HSS in terms of EBP and CE . The aim was to highlight any differences between the 14 professional groups along with the needs of the groups . A postal question naire survey was completed by a r and om sample of 1,000 members of AHP and HSS across the United Kingdom . There were significant differences between professional groups with , in general , professionals from the HSS groups rating their knowledge and application of CE and EBP  as lower than members of the AHP . Differences were also noted between individual professional groups . For example , podiatrists , radiographers , and orthoptists reported having less knowledge of CE and EBP than physiotherapists , occupational therapists , dietitians , speech and language therapists , and psychologists . Barriers to implementing EBP were similar for all groups , with lack of both time and money cited as the main issues . A number of differences between professions were recorded that highlight the difference in educational and policy approach required for greater uptake of EBP Background It is difficult to foster research utilization among allied health professionals ( AHPs ) . Tailored , multifaceted knowledge translation ( KT ) strategies are now recommended but are re source intensive to implement . Employers need effective KT solutions but little is known about ; the impact and viability of multifaceted KT strategies using an online KT tool , their effectiveness with AHPs and their effect on evidence -based practice ( EBP ) decision-making behavior . The study aim was to measure the effectiveness of a multifaceted KT intervention including a customized KT tool , to change EBP behavior , knowledge , and attitudes of AHPs . Methods This is an evaluator-blinded , cluster r and omized controlled trial conducted in an Australian community-based cerebral palsy service . 135 AHPs ( physiotherapists , occupational therapists , speech pathologists , psychologists and social workers ) from four regions were cluster r and omized ( n = 4 ) , to either the KT intervention group ( n = 73 AHPs ) or the control group ( n = 62 AHPs ) , using computer-generated r and om numbers , concealed in opaque envelopes , by an independent officer . The KT intervention included three-day skills training workshop and multifaceted workplace supports to redress barriers ( paid EBP time , mentoring , system changes and access to an online research synthesis tool ) . Primary outcome ( self- and peer-rated EBP behavior ) was measured using the Goal Attainment Scale ( individual level ) . Secondary outcomes ( knowledge and attitudes ) were measured using exams and the Evidence Based Practice Attitude Scale . Results The intervention group ’s primary outcome scores improved relative to the control group , however when clustering was taken into account , the findings were non-significant : self-rated EBP behavior [ effect size 4.97 ( 95 % CI -10.47 , 20.41 ) ( p = 0.52 ) ] ; peer-rated EBP behavior [ effect size 5.86 ( 95 % CI -17.77 , 29.50 ) ( p = 0.62 ) ] . Statistically significant improvements in EBP knowledge were detected [ effect size 2.97 ( 95 % CI 1.97 , 3.97 ( p < 0.0001 ) ] . Change in EBP attitudes was not statistically significant . Conclusions Improvement in EBP behavior was not statistically significant after adjusting for cluster effect , however similar improvements from peer-ratings suggest behaviorally meaningful gains . The large variability in behavior observed between clusters suggests barrier assessment s and subsequent KT interventions may need to target subgroups within an organization . Trial registration Registered on the Australian New Zeal and Clinical Trials Registry ( ACTRN12611000529943 )
RESULTS Many physiotherapists hold positive attitudes towards EBP .
However , this does not necessarily translate into consistent , high- quality EBP .
Many barriers to EBP implementation are apparent , including : lack of time and skills , and misperceptions of EBP .
BACKGROUND Despite clear benefits of the Evidence -Based Practice ( EBP ) approach to ensuring quality and consistency of care , its uptake within physiotherapy has been inconsistent .
OBJECTIVES Synthesis e the findings of research into EBP barriers , facilitators and interventions in physiotherapy and identify methods of enhancing adoption and implementation .