Perception of Spanish primary healthcare nurses about evidence-based clinical practice: a qualitative study

2014 ◽  
Vol 61 (1) ◽  
pp. 90-98 ◽  
Author(s):  
J. Pericas-Beltran ◽  
S. Gonzalez-Torrente ◽  
J. De Pedro-Gomez ◽  
J.M. Morales-Asencio ◽  
M. Bennasar-Veny
Keyword(s):  
Clinical Practice ◽  
Qualitative Study ◽  
Primary Healthcare ◽  
Evidence Based

scholarly journals Using blogging to promote clinical reasoning and metacognition in undergraduate physiotherapy fieldwork programs

2010 ◽  
Vol 26 (3) ◽  
Author(s):  
Shuyan Melissa Tan ◽  
Richard K. Ladyshewsky ◽  
Peter Gardner
Keyword(s):  
Clinical Practice ◽  
Qualitative Study ◽  
Clinical Reasoning ◽  
Education Program ◽  
Cognitive Skills ◽  
Evidence Based ◽  
Good Strategy ◽  
Web Based ◽  
The Impact ◽  
Physiotherapy Students

<span>This qualitative study investigated the impact of using blogs on the clinical reasoning and meta-cognitive skills of undergraduate physiotherapy students in a fieldwork education program. A blog is a web based document that enables individuals to enter comments and read each others' comments in a dynamic and interactive manner. In this study, final year physiotherapy students were randomly allocated to group blogs to share their reflections on their own and their peers' clinical practice. Blogging was used to help students reflect and focus on professional and evidence based practice within a supportive peer assisted learning environment. The text within each of the blogs was qualitatively analysed against concepts in the literature describing specific types of clinical reasoning and metacognition. A range of clinical reasoning typologies were found to exist in the blogs. Most notable were ethical, interactive and procedural reasoning along with evidence of metacognition. Blogging was found to be a good strategy for promoting clinical reasoning and metacognition in fieldwork education.</span>

scholarly journals Qualitative study of cardiologists’ perceptions of factors influencing clinical practice decisions

Heart ◽  
2019 ◽  
Vol 105 (10) ◽  
pp. 749-754 ◽  
Author(s):  
Veena Manja ◽  
Gordon Guyatt ◽  
John You ◽  
Sandra Monteiro ◽  
Susan Jack
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Qualitative Study ◽  
Health System ◽  
Financial Incentives ◽  
Clinical Decision Making ◽  
Health Spending ◽  
Clinical Decision ◽  
Evidence Based ◽  
The Usa

BackgroundHealthcare costs are increasing in the USA and Canada and a substantial portion of health spending is devoted to services that do not improve health outcomes. Efforts to reduce waste by adopting evidence-based clinical practice guideline recommendations have had limited success. We sought insight into improving health system efficiency through understanding cardiologists’ perceptions of factors that influence clinical decision-making.MethodsIn this descriptive qualitative study, we conducted in-depth interviews with 18 American and 3 Canadian cardiologists. We used conventional content analysis including inductive and deductive approaches for data analysis and mapped findings to the ecological systems framework.ResultsPhysicians reported that major determinants of practice included interpersonal interactions with peers, patients and administrators; financial incentives and system factors. Patients’ insurance status represented an important consideration for some cardiologists. Other major influences included time constraints, fear of litigation (less prominent in Canada), a sense that their obligation was never to miss any underlying pathology, and patient demands. The need to bring income into their health system influenced American cardiologists’ practice; personal income implications influenced Canadian cardiologists’ practice. Cardiologists reported that knowledge limitations and logistical challenges limit their ability to assist patients with cost considerations. All these considerations were more influential than guidelines; some cardiologists expressed a high level of scepticism regarding guidelines.ConclusionsClinical decision-making by cardiologists is shaped by individual, interpersonal, organisational, environmental, financial and sociopolitical influences and only to a limited extent by guideline recommendations. Successful strategies to achieve efficient, evidence-based care will require addressing socioecological influences on decision-making.

scholarly journals Factors influencing allied health professionals’ implementation of upper limb sensory rehabilitation for stroke survivors: a qualitative study to inform knowledge translation

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e042879
Author(s):  
Liana S Cahill ◽  
Leeanne M Carey ◽  
Yvonne Mak-Yuen ◽  
Annie McCluskey ◽  
Cheryl Neilson ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Qualitative Study ◽  
Knowledge Translation ◽  
Upper Limb ◽  
Occupational Therapists ◽  
Practice Change ◽  
Normalisation Process Theory ◽  
Evidence Based ◽  
Implementation Theory ◽  
Factors Influencing

ObjectivesSomatosensory loss is common after stroke with one-in-two individuals affected. Although clinical practice guidelines recommend providing somatosensory rehabilitation, this impairment often remains unassessed and untreated. To address the gap between guideline recommendations and clinical practice, this study sought to understand the factors influencing delivery of evidence-based upper limb sensory rehabilitation after stroke.DesignQualitative study involving focus groups and interviews. Data analysis used an inductive approach (thematic analysis) and deductive analysis using implementation theory (the Theoretical Domains Framework and Normalisation Process Theory).SettingEight healthcare organisations in metropolitan and regional areas of Victoria and New South Wales, Australia.ParticipantsEighty-seven rehabilitation therapists (79% occupational therapists and 21% physiotherapists) were purposively sampled and participated in a knowledge translation study with staggered recruitment from 2014 to 2018.ResultsThree types of factors influenced therapists’ delivery of upper limb somatosensory rehabilitation: individual (‘The uncertain, unskilled therapist’), patient (‘Patient understanding and priorities’) and organisational (‘System pressures and resources’). Deductive analysis using implementation theory identified key determinants of practice change, such as opportunities to consolidate new skills, the anticipated benefits of upskilling as a therapy team and the work anticipated by therapists to incorporate a new somatosensory rehabilitation approach.ConclusionsOccupational therapists and physiotherapists hold valuable insights towards practice change in somatosensory rehabilitation from the ‘frontline’. Therapists experience barriers to change including a lack of knowledge and skills, lack of resources and organisational pressures. Facilitators for change were identified, including social support and therapists’ perceived legitimacy in using new somatosensory rehabilitation approaches. Results will inform the design of a tailored implementation strategy to increase the use of evidence-based somatosensory rehabilitation in Australia.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12615000933550).

scholarly journals Evidence-based medicine and prejudice-based medicine: the case of homeopathy

2014 ◽  
Vol 30 (11) ◽  
pp. 2368-2376 ◽  
Author(s):  
Nelson Filice de Barros ◽  
Alessandra Rodrigues Fiuza
Keyword(s):  
Clinical Practice ◽  
Qualitative Study ◽  
Medical Curriculum ◽  
Scientific Evidence ◽  
Allopathic Medicine ◽  
Evidence Based ◽  
The Core ◽  
Personal Opinion ◽  
The University ◽  
Based Medicine

In recent decades an important social movement related to Complementary and Alternative Medicine has been identified worldwide. In Brazil, although homeopathy was recognized as a specialist medical area in 1980, few medical schools offer courses related to it. In a previous study, 176 resident doctors at the University of Campinas Medical School were interviewed and 86 (49%) rejected homeopathy as a subject in the core medical curriculum. Thus, this qualitative study was conducted to understand their reasons for refusing. 20 residents from 15 different specialist areas were interviewed. Very few of them admitted to a lack of knowledge for making a judgment about homeopathy; none of them made a conscientious objection to it; and the majority demonstrated prejudice, affirming that there is not enough scientific evidence to support homeopathy, defending their position based on personal opinion, limited clinical practice and on information circulated in the mass media. Finally, resident doctors’ prejudices against homeopathy can be extended to practices other than allopathic medicine.

Meeting the Best Practice for Hearing Aid Verification in Children: Challenges and Future Directions

2019 ◽  
Vol 28 (4) ◽  
pp. 877-894
Author(s):  
Nur Azyani Amri ◽  
Tian Kar Quar ◽  
Foong Yen Chong
Keyword(s):  
Clinical Practice ◽  
Hearing Aids ◽  
Best Practice ◽  
Hearing Aid ◽  
Evidence Based ◽  
Future Directions ◽  
Major Barrier ◽  
Klang Valley ◽  
Age Range ◽  
Fitting Hearing Aids

Purpose This study examined the current pediatric amplification practice with an emphasis on hearing aid verification using probe microphone measurement (PMM), among audiologists in Klang Valley, Malaysia. Frequency of practice, access to PMM system, practiced protocols, barriers, and perception toward the benefits of PMM were identified through a survey. Method A questionnaire was distributed to and filled in by the audiologists who provided pediatric amplification service in Klang Valley, Malaysia. One hundred eight ( N = 108) audiologists, composed of 90.3% women and 9.7% men (age range: 23–48 years), participated in the survey. Results PMM was not a clinical routine practiced by a majority of the audiologists, despite its recognition as the best clinical practice that should be incorporated into protocols for fitting hearing aids in children. Variations in practice existed warranting further steps to improve the current practice for children with hearing impairment. The lack of access to PMM equipment was 1 major barrier for the audiologists to practice real-ear verification. Practitioners' characteristics such as time constraints, low confidence, and knowledge levels were also identified as barriers that impede the uptake of the evidence-based practice. Conclusions The implementation of PMM in clinical practice remains a challenge to the audiology profession. A knowledge-transfer approach that takes into consideration the barriers and involves effective collaboration or engagement between the knowledge providers and potential stakeholders is required to promote the clinical application of evidence-based best practice.

What Does Evidence-Based Practice Mean to You? A Follow-Up Study Examining School-Based Speech-Language Pathologists' Perspectives on Evidence-Based Practice

2020 ◽  
Vol 29 (2) ◽  
pp. 688-704
Author(s):  
Katrina Fulcher-Rood ◽  
Anny Castilla-Earls ◽  
Jeff Higginbotham
Keyword(s):  
Clinical Practice ◽  
Research Evidence ◽  
Evidence Based Practice ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Speech Language Pathologists ◽  
School Based ◽  
Research Findings ◽  
Ebp Implementation

Purpose The current investigation is a follow-up from a previous study examining child language diagnostic decision making in school-based speech-language pathologists (SLPs). The purpose of this study was to examine the SLPs' perspectives regarding the use of evidence-based practice (EBP) in their clinical work. Method Semistructured phone interviews were conducted with 25 school-based SLPs who previously participated in an earlier study by Fulcher-Rood et al. 2018). SLPs were asked questions regarding their definition of EBP, the value of research evidence, contexts in which they implement scientific literature in clinical practice, and the barriers to implementing EBP. Results SLPs' definitions of EBP differed from current definitions, in that SLPs only included the use of research findings. SLPs seem to discuss EBP as it relates to treatment and not assessment. Reported barriers to EBP implementation were insufficient time, limited funding, and restrictions from their employment setting. SLPs found it difficult to translate research findings to clinical practice. SLPs implemented external research evidence when they did not have enough clinical expertise regarding a specific client or when they needed scientific evidence to support a strategy they used. Conclusions SLPs appear to use EBP for specific reasons and not for every clinical decision they make. In addition, SLPs rely on EBP for treatment decisions and not for assessment decisions. Educational systems potentially present other challenges that need to be considered for EBP implementation. Considerations for implementation science and the research-to-practice gap are discussed.

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