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Evidence-based practice: how nurse leaders can facilitate innovation.

Evidence-based nursing practice (EBNP) is the wave of the future. Increasingly, EBNP is being identified as a key to quality and excellence in nursing services. Incorporating evidence into practice is necessary to deliver scientifically sound patient care. In addition, understanding the importance of evidence is crucial for meeting the excellence requirements of Magnet designation. Despite the growing popularity of EBNP and its documented significant benefits, the literature demonstrates that only 15% of the nursing workforce consistently practices within an EBNP framework. If EBNP adoption is to increase in the profession, it will require the active efforts of nurse leaders to pursue an aggressive innovation diffusion strategy. The purpose of this article is to discuss the nurse leader's role in facilitating EBNP in nursing using a theoretical framework grounded in innovation diffusion theory. The article develops 4 areas of focus. First, the components of innovation diffusion theory are discussed. Second, a pertinent empirical review of the EBNP adoption literature is presented. Third, strategies for applying innovation diffusion theory to facilitate EBNP adoption are proposed. Lastly, the article ends with a leadership call to action.

Attitude of Health Personnel↗

Caring for people with HIV in Zambia: are traditional healers and formal health workers willing to work together?

This study of traditional healers and formal health workers determined their knowledge and practices in the field of HIV/AIDS and examined their training needs and attitudes to collaboration, in preparation for planning joint training workshops. Several misconceptions concerning symptoms and transmission of HIV disease were found in both groups, particularly among traditional healers. Twenty healers (51%) and four formal health workers (15%) claimed a cure existed for AIDS. The majority of traditional healers interviewed expressed difficulties discussing a diagnosis of HIV directly with patients, mainly due to fear of the patient becoming depressed and suicidal. Most interviewees wanted more training--the majority of traditional healers in recognizing symptoms of HIV/AIDS and their treatment, and the majority of formal health workers in HIV counselling. Most were interested in supplying condoms. Almost all healers and half of the formal health workers were keen to collaborate in training and patient care. The study indicates that there is willingness amongst Zambian traditional healers and formal health workers to collaborate in training and patient care in the field of HIV/AIDS. As well as covering symptoms, transmission and prevention of HIV/AIDS, training should aim to increase ability to openly discuss HIV with patients, which many traditional healers and some formal health workers find difficult. Involving traditional healers in supplying condoms may improve acceptability and availability, particularly in rural areas.

Acquired Immunodeficiency Syndrome↗

Models, measurement, and strategies in developing critical-thinking skills.

Health care professionals must use critical-thinking skills to solve increasingly complex problems. Educators need to help nurses develop their critical-thinking skills to maintain and enhance their competence. This article reviews various models of critical thinking, as well as methods used to evaluate critical thinking. Specific educational strategies to develop nurses' critical-thinking skills are discussed. Additional research studies are needed to determine how the process of nursing practice can nurture and develop critical-thinking skills, and which strategies are most effective in developing and evaluating critical thinking.

Attitude of Health Personnel↗

Medical waste and health workers in Gaza governorates.

The study was conducted among health workers in Gaza to identify and highlight the problem of medical waste management. Data were collected through a questionnaire (given to 400 health workers), a checklist and interviews (with 16 decision-makers). Results show that there is no system for medical waste management in Gaza. Segregation is done only for sharps and there are no colour-coded bags. Medical waste is stored and disposed of with domestic waste in primary health care clinics and is incinerated in hospitals, but there are no emission control or safety measures. There are some gaps in knowledge of health care workers, and current practices are inadequate. However there is generally a positive attitude to improving medical waste management among those surveyed and interviewed. A national programme for medical waste management is essential in Palestine.

Attitude of Health Personnel↗

A principal calling: professionalism and health care services.

UNLABELLED: As heath care professionals, our "product" is clinical service. We demonstrate professionalism by attitudes, knowledge, and behaviors that reflect a multi-faceted approach to the standards, regulations, and principles underlying successful clinical practices. The issues facing practitioners who work in health care environments are complex, forming an infrastructure for conducting clinical and business operations. Issues discussed include: clinical quality and outcomes management; patient safety and medical errors; accreditation and compliance. A thorough knowledge of these topics forms the context within which we integrate our services with the larger health care community. In this age of accountability, inquiry, introspection and integrity are the keys to professionalism. LEARNING OUTCOMES: As a result of this activity, the reader will be able to: (1) discuss basic points related to the complex requirements and issues facing clinical practitioners today; (2) understand the components of "professional" practice within the health care community; (3) integrate quality management, regulatory compliance, and accreditation standards into every clinical practice. Profession: A calling requiring specialized knowledge and often long and intensive academic preparation; a principal calling, vocation, or employment. Professionalism: The conduct, aims, or qualities that characterize or mark a profession or professional person. -Webster's New Collegiate Dictionary.

Accreditation↗

A tale of two (low prevalence) cities: social movement organisations and the local policy response to HIV/AIDS.

In the field of HIV/AIDS, social movement organisations (SMOs) have been identified as powerful potential catalysts for change through their impact on formal organisational structures and the policy process. In addition, they have the capacity to be important providers of services in their own right, through the community resources they are capable of mobilising. In the United Kingdom, however, their role in policy formation is disputed. Previous studies have concluded that they have been most influential at national policy and ward level. At the level of local policy making, their influence has been found to be patchy and confined largely to securing recognition of HIV as an issue. Most previous research has, however, been conducted in high prevalence, metropolitan settings with functional SMOs. This paper presents the results of a comparative case study of two neighbouring provincial low prevalence district health authorities (HAs) in England. We describe the changing national policy context from 1986 to 1995 and use a strategic change model to analyse the local development of care and treatment services for people with HIV/AIDS, in particular the relationship between SMOs and HAs. Despite being demographically, socioeconomically and epidemiologically similar, and sharing an identical national policy framework, the two districts demonstrate completely divergent organisational responses to the HIV/AIDS epidemic. We conclude that the level of prior social movement mobilisation and the degree of receptivity for change within the HA are the key variables for explaining variations in the scale of strategic change observed in the two districts.

Adult↗

Qualitative study investigating the process of giving anti-smoking advice in general practice.

General practitioners' (GPs') anti-smoking advice promotes patients' smoking cessation but little is known about how GPs use their short consultations to give advice. We used semi-structured interviews with 27 UK GPs to investigate how GPs believe they should advise smokers to stop and the reasons underpinning these beliefs. GPs reported a limited repertoire of techniques for dealing with smokers who were not motivated to stop. They also reported using confrontational advice-giving styles with patients who continued to smoke despite suffering from smoking-related illnesses. GPs might find it easier and more rewarding to discuss smoking with patients if they possessed a greater range of skills for dealing with non-motivated smokers.

Attitude of Health Personnel↗

Ways of knowing about health: an aboriginal perspective.

Because of the questionable applicability to extant health promotion models and middle-range theories to aboriginal peoples, foundational inquiries examining the nature of cultural beliefs and ways of knowing about health within the cultures of various ethnic groups are imperative. This article describes the ways of knowing about health reported by Ojibwe people during an ethnographic inquiry in the Great Lakes region. These ways included stories from the oral tradition, authoritative knowledge of elders, "commonsense" models of illness and health, spiritual knowledge, and knowing oneself. The health-world view, a conceptual orientation for investigating health beliefs, is offered.

Attitude to Health↗

Empowerment in nursing: paternalism or maternalism?

The aim of this article is to explore whether patient empowerment flourishes in the wake of current health reforms or if there is a power struggle between nursing and medicine as to what is in the patients' best interest. Shifting the balance of power from healthcare professionals to patients has become a key element of healthcare policy in England. The RCN's definition of nursing places patient empowerment as a central remit of nurses. However, achieving genuine patient empowerment is not easy and requires individuals and organizations to alter their beliefs, values and behaviours. To empower patients nurses must be in a position to share power and this may require a realignment of the traditional power base within health care. Although empowerment is often viewed on a one-to-one level between professionals and patients, for true patient empowerment to occur, issues of power and control must also be addressed at a national and political level.

Attitude of Health Personnel↗

Effect of service-learning on knowledge about older people and faculty teaching evaluations in a physical therapy class.

The major purpose of this study was to identify the knowledge, misconceptions, and bias regarding aging among graduate physical therapy students and to determine whether service-learning modified any of these variables. A cohort of 40 students in a graduate physical therapy program was randomly divided into an experimental (service-learning) or control (no service-learning) group. General knowledge and attitudes about aging were measured by Palmore's Facts on Aging Quiz I. The Wilson Student Evaluation of Faculty tool measured student evaluations of a faculty member at the end of the semester. Two-way analyses of variance with repeated measures revealed that all students increased their knowledge about aging, p < .05. However, students who initially had negative attitudes toward older adults significantly improved their attitudes only after the service-learning experience, p < .05. A t-test revealed that teaching evaluation scores were significantly lower in the service-learning course, p < .05. The results suggest that service-learning effectively enhanced both the knowledge and attitudes of physical therapy students toward the older adult. Although service-learning imparted better learning for the student, there was some risk to the faculty member as evidenced by lower teaching evaluations.

Adult↗

Students' and faculty members' knowledge and attitudes regarding pain management: a descriptive survey.

Many basic nursing programs spend little time educating students about pain management. Between the years of 2000 and 2002, a baccalaureate nursing program at a university in central Virginia surveyed sophomore, junior, and senior nursing students using McCaffery's Pain Knowledge and Attitude Survey at the beginning and end of each academic semester. During the same time period, faculty also completed the survey and answered open-ended questions pertaining to the inclusion of pain management in course content. The purposes of this study were to determine the baseline knowledge and attitudes of nursing students and faculty about the science of pain management and to evaluate the content of pain management material and the extent to which it is integrated into the curriculum.

Analgesia↗

[Nursing knowledge and attitude of day care personnel towards health promotion of babies].

Currently it is more acceptable that women work. Besides women who are obliged to work to contribute to the income of their families, a large number of women work due to a need for social stimulation. While their mothers are at work during the day, the babies are left in substitute care out of necessity. Health promotion of babies is necessary and is the duty of the substitute caregiver. These women, however, do not always have the knowledge of, or positive attitude towards, health promotion. The purpose of this study, was to determine the knowledge and skills that the day mother should have in order to promote the health of babies (age 0-12 month). The qualititative research approach was used, within which a descriptive study had been done. A comprehensive literature study had initially been done regarding the health promotion of babies in substitute care. A programme had been compiled regarding the knowledge and skills that a day mother must possess in order to promote the health of babies. This program was then submitted to a group of selected experts for evaluation according to the Delphi technique. According to the data, it is quite clear that the day mother should be knowledgeable and skilled in order to satisfy the baby's physiological, security and affiliation needs as well as the need for appreciation and self-actualization.

Attitude of Health Personnel↗

A comprehensive investigation of barriers to adult immunization: a methods paper.

OBJECTIVE: Immunization rates for influenza and pneumococcal vaccines among the elderly (especially minority elderly) are below desired levels. We sought to answer 4 questions: (1) What factors explain most missed immunizations? (2) How are patient beliefs and practices regarding adult immunization affected by racial or cultural factors? (3) How are immunizations and patient beliefs affected by physician, organizational, and operational factors? and (4) Based on the relationships identified, can typologies be created that foster the tailoring of interventions to improve immunization rates? STUDY DESIGN: A multidisciplinary team chose the PRECEDE-PROCEED framework, the Awareness-to-Adherence model of clinician response to guidelines, and the Triandis model of consumer decision making as the best models to assess barriers to and facilitators of immunization. Our data collection methods included focus groups, face-to-face and telephone interviews, self-administered surveys, site visits, participant observation, and medical record review. POPULATION: To encounter a broad spectrum of patients, facilities, systems, and interventions, we sampled from 4 strata: inner-city neighborhood health centers, clinics in Veterans Administration facilities, rural practices in a network, and urban/suburban practices in a network. In stage 1, a stratified random cluster sample of 60 primary care clinicians was selected, 15 in each of the strata. In stage 2, a random sample of 15 patients was selected from each clinician's list of patients, aiming for 900 total interviews. CONCLUSIONS: This multicomponent approach is well suited to identifying barriers to and facilitators of adult immunizations among a variety of populations, including the disadvantaged.

Aged↗

Do medical students have the knowledge needed to maximize organ donation rates?

INTRODUCTION: The chronic shortage of organs for donation could be improved by increasing the numbers of potential and actual donors. Physicians can play a key role in solving this problem but may miss opportunities because they lack knowledge about organ donation to answer questions or concerns. Education of physicians early in their careers may lead to better procurement rates for donor organs. We carried out a study at Queen's University in Kingston, Ont., to determine whether medical students have sufficient knowledge of topics shown to affect organ donation rates. METHODS: Medical students from years 1-4 completed a self-administered questionnaire. Section 1 tested general knowledge about organ donation; section 2 tested the students' ability to identify potential donors; and section 3 dealt with the approach to the potential donor's family. Univariate predictors of mean test scores were assessed using the t-test. RESULTS: Of 322 medical students who received the questionnaire, 260 (81%) responded. The mean age of the students was 25 years and 54% were men. The mean knowledge score was 6.7 out of a possible score of 14. Third-year students had the best knowledge scores (7.6), followed by fourth- (7.4), second- (6.6) and first-year students (5.7). Teaching about organ donation and a student's comfort with approaching a family for organ donation were also predictive of higher knowledge scores. There was no correlation between knowledge score and age, gender or whether the student was carrying a signed donor card. Knowledge scores were low in all 3 sections. Thirty-six percent of students did not know that brain death means that the patient is dead rather than in a coma. Half the medical students believed that people of certain religious groups should not be approached about organ donation. CONCLUSIONS: Medical students possess limited knowledge about organ donation topics important for maximizing procurement rates. A teaching intervention designed to target these shortcomings may be beneficial.

Adult↗

An international physician education program to support the recent introduction of family medicine in Egypt.

BACKGROUND AND OBJECTIVES: There are few reports of systematic international physician development programs to create family medicine as a new specialty in a developing nation. This paper describes the process and outcomes of a large-scale effort to initiate new family medicine training through the Egyptian Ministry of Health and Population (MOHP) using a 12-week US-based program at the University of California, Irvine (UCI). METHODS: Generalist physicians (n=134) with 1 year of internship training, currently working under the MOHP in Egypt, were competitively selected to participate in a training program at UCI between 1998 and 2002. Participants were assessed before, during, and after the program using multiple measures of competencies in family medicine topics, practice, and teaching. Aggregate participant data, post-program quality surveys, and follow-up surveys of the program's influence on practice behaviors comprised the main measures used for program evaluation. RESULTS: Participants showed improvement in knowledge and skills for family medicine practice and teaching for topics covered in the program. After returning to Egypt, 98% reported continued use of their newly acquired skills and knowledge. Participants reported that the program advanced their careers, they taught family medicine to other physicians, and they were likely to pursue certification under a newly established Family Medicine Board of Egypt. Self-reported practice in family medicine increased to 69% after the program versus 16% before. CONCLUSIONS: Overseas training programs are a viable method of introducing family medicine as a new clinical specialty. Ingredients for successful implementation and barriers are discussed.

Clinical Competence↗