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Chang, hui chen. "Evidence-based practice in nursing homes." University of Sydney, 2008. http://hdl.handle.net/2123/3572.
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Doctor of PhilosophyAim and significance: The aim of this research was to investigate how evidence-based practice (EBP) in nursing homes is understood in the context of Taiwan, a non-Western country. There is a growing movement towards using research evidence to inform practice in the nursing profession with variable success. To date, factors that promote or inhibit implementation of EBP in health care have been investigated through research conducted in hospital settings in Western countries. Remarkably little is known about nurses’ experience and perceptions of EBP in residential aged care facilities (RACFs), especially in non-Western countries. Method: The study adopted a mixed method approach. Subjects were recruited from six nursing homes in the Hsinchu district of Taiwan. In Stage 1, 89 registered nurses completed a comprehensive questionnaire specifically developed for this project. It was designed to elicit information about (1) their experience of and attitudes towards research and EBP; (2) the barriers they perceive to its implementation; and (3) what strategies they believe would enhance its implementation in the nursing home setting. In Stage 2, six nursing managers participated in semi-structured in-depth interviews that explored the same topic areas as those in the questionnaire but used an open-ended format which allowed for new themes to emerge. Findings: The majority of nurses and nursing managers expressed positive attitudes towards research and EBP but reported relatively little experience in its implementation. Nurses relied most heavily on knowledge derived from past experience and on interactions with nursing colleagues, medical staff and patients to inform their clinical practice. They identified the main barriers to EBP as: insufficient authority to change practice, their own lack of research knowledge and insufficient time to implement new ideas in the workplace. They believed EBP would be facilitated by: improved access to computers and internet facilities in the workplace; more effective research training; collaboration with academics; and dedicated time to search for and read research articles. As anticipated, nurses viewed the issues from a practical stance in relation to their own time, resources and lack of authority to effect change. Nursing managers expressed similar views to the nurses in relation to attitudes towards EBP implementation. However, they identified barriers which related to aspects of the organizational framework. In particular, they expressed concerns about issues such as budgetary constraints, staff quality (notably the reliance on minimally trained assistants in nursing (AINs) for direct resident care), as well as factors that reflected the wider political and economic context of health care in Taiwan. Conclusion: The findings of this study have implications for research, policy and practice in both Western and non-Western countries. Further research on EBP would be beneficial if conducted in settings other than hospitals, such as RACFs. There remains also the need to examine the potential for EBP in different social-cultural contexts, such as those in non-Western countries. Nursing managers have generally been excluded in previous research but, because of their particular role, there is a need to examine their perspectives of EBP and then compare these with those of the nurses. In Taiwan specifically, policy change is needed at both government and institutional levels to encourage and support the development of protocols and procedures for the implementation of EBP. If EBP was a government requirement for accreditation and a standard for protocols in hospitals and RACFs, it would lead to improved standards of care and cost effectiveness. This study supports the findings of a number of investigations conducted in Western countries which indicate that further education and training in research for nurses may lead to higher standards of patient care, greater job satisfaction and higher staff retention rates.
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Arnell, Ruth. "Conceptualising evidence-based practice in educational psychology." Thesis, University of Exeter, 2018. http://hdl.handle.net/10871/34078.
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This exploratory study describes the variation in how evidence-based practice is understood in educational psychology. The study is comprised of two phases, which were both designed, analysed and interpreted using qualitative methodology. In phase one, twenty-two semi-structured interviews were conducted with educational psychologists from eight services in England. A phenomenographic approach to analysis was applied, resulting in a conceptual framework, representing the variation in understandings of evidence-based practice of a group of educational psychologists. In phase two, two focus groups were conducted with a subset of participants from phase one to elucidate the influence of evidence-based practice on decision-making in practice. A framework approach to thematic analysis showed that practice decisions of educational psychologists are influenced by evidence-based practice according to contextual factors, training and practice experiences and personal characteristics. This study gives insight as to how educational psychologists experience and account for the role of evidence and evidence-based practice in their practice and informs how evidence-based practice might be conceptualised in educational psychology. The findings suggest that evidence-based practice is grounded on personal, internalised beliefs while being contextualised by the demands of specific circumstances. The findings have implications for providers of educational psychology training in terms of the curriculum for evidence-based practice and associated learning outcomes.
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Williams, A. Lynn. "Evidence-Based Practice for Children with Speech Sound Disorders: A Call for Practice-Based Evidence." Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/etsu-works/2016.
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Chang, Hui-Chen. "Evidence-based practice in nursing homes." Thesis, The University of Sydney, 2008. http://hdl.handle.net/2123/3572.
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Aim and significance: The aim of this research was to investigate how evidence-based practice (EBP) in nursing homes is understood in the context of Taiwan, a non-Western country. There is a growing movement towards using research evidence to inform practice in the nursing profession with variable success. To date, factors that promote or inhibit implementation of EBP in health care have been investigated through research conducted in hospital settings in Western countries. Remarkably little is known about nurses’ experience and perceptions of EBP in residential aged care facilities (RACFs), especially in non-Western countries. Method: The study adopted a mixed method approach. Subjects were recruited from six nursing homes in the Hsinchu district of Taiwan. In Stage 1, 89 registered nurses completed a comprehensive questionnaire specifically developed for this project. It was designed to elicit information about (1) their experience of and attitudes towards research and EBP; (2) the barriers they perceive to its implementation; and (3) what strategies they believe would enhance its implementation in the nursing home setting. In Stage 2, six nursing managers participated in semi-structured in-depth interviews that explored the same topic areas as those in the questionnaire but used an open-ended format which allowed for new themes to emerge. Findings: The majority of nurses and nursing managers expressed positive attitudes towards research and EBP but reported relatively little experience in its implementation. Nurses relied most heavily on knowledge derived from past experience and on interactions with nursing colleagues, medical staff and patients to inform their clinical practice. They identified the main barriers to EBP as: insufficient authority to change practice, their own lack of research knowledge and insufficient time to implement new ideas in the workplace. They believed EBP would be facilitated by: improved access to computers and internet facilities in the workplace; more effective research training; collaboration with academics; and dedicated time to search for and read research articles. As anticipated, nurses viewed the issues from a practical stance in relation to their own time, resources and lack of authority to effect change. Nursing managers expressed similar views to the nurses in relation to attitudes towards EBP implementation. However, they identified barriers which related to aspects of the organizational framework. In particular, they expressed concerns about issues such as budgetary constraints, staff quality (notably the reliance on minimally trained assistants in nursing (AINs) for direct resident care), as well as factors that reflected the wider political and economic context of health care in Taiwan. Conclusion: The findings of this study have implications for research, policy and practice in both Western and non-Western countries. Further research on EBP would be beneficial if conducted in settings other than hospitals, such as RACFs. There remains also the need to examine the potential for EBP in different social-cultural contexts, such as those in non-Western countries. Nursing managers have generally been excluded in previous research but, because of their particular role, there is a need to examine their perspectives of EBP and then compare these with those of the nurses. In Taiwan specifically, policy change is needed at both government and institutional levels to encourage and support the development of protocols and procedures for the implementation of EBP. If EBP was a government requirement for accreditation and a standard for protocols in hospitals and RACFs, it would lead to improved standards of care and cost effectiveness. This study supports the findings of a number of investigations conducted in Western countries which indicate that further education and training in research for nurses may lead to higher standards of patient care, greater job satisfaction and higher staff retention rates.
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Gillespie, Ann M. "Untangling the evidence : teacher librarians and evidence based practice." Thesis, Queensland University of Technology, 2013. https://eprints.qut.edu.au/61742/2/Ann_Gillespie_Thesis.pdf.
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The research was a qualitative study investigating the lived experiences of teacher librarians as evidence based practitioners in Australian school libraries. It addressed how teacher librarians understood, applied and implemented evidence based practice, and investigated what these teacher librarians considered to constitute evidence. Two key critical findings of this research are that evidence based practice for teacher librarians is a holistic experience and evidence for teacher librarians can take many forms, including professional knowledge, observations, statistics, informal feedback and personal reflections.
The study is significant to teacher librarians, library and information professionals, schools and school administrators, and the research field.
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Wallace, Rick L., and Nakia Carter. "Evidence Based Library and Information Practice." Digital Commons @ East Tennessee State University, 2008. https://dc.etsu.edu/etsu-works/8693.
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Evidence Based Library & Information Practice (EBLIP) is a way of using the best research to solve practical problems in the library. This session will cover the fundamentals of EBLIP, along with possible applications. “Evidence-Based Librarianship is an approach to information science that promotes the collection, interpretation and integration of valid, important and applicable user-reported, librarian observed, and research-derived evidence. The best available evidence, moderated by user needs and preferences, is applied to improve the quality of professional judgements” (Booth & Brice, 2004). Evidence-Based Library and Information Practice (EBLIP) evolved from the evidence-based medicine (EBM) movement which is a systematic way to review and apply the medical literature to medical practice. EBM began to find its way into other health disciplines and eventually was applied to health sciences librarianship and then to librarianship as a whole.
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Wallace, Rick, and Patricia M. Vanhook. "The Importance of Evidence-Based Practice." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/7417.
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Wilkinson, Joyce E. "Managing to implement evidence-based practice? : an exploration and explanation of the roles of nurse managers in evidence-based practice implementation." Thesis, St Andrews, 2008. http://hdl.handle.net/10023/560.
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Reeser, Kelly Butler. "Policy, practice and review evidence based practices in autism spectrum disorders /." Connect to Electronic Thesis (CONTENTdm), 2010. http://worldcat.org/oclc/648982148/viewonline.
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Adily, Armita Public Health & Community Medicine Faculty of Medicine UNSW. "Assessment of the capacity for evidence-based policy and practice in Australian population health." Publisher:University of New South Wales. Public Health & Community Medicine, 2009. http://handle.unsw.edu.au/1959.4/42888.
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Evidence-based policy and practice (EBPP) in population health in Australia has been promoted largely without sound research. In response, this thesis presents a series of studies undertaken to assess and inform enhancement of capacity for EBPP in Australia. It comprises linked studies designed to examine different yet complementary aspects of capacity for EBPP. Research was conducted at various levels of Australian health care system, from local to national, in order to better understand EBPP and to make a series of recommendations about effective and synergistic response.
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Roy-Davis, Kylie. "Sport injury-related growth : theory-to-practice." Thesis, University of Roehampton, 2017. https://pure.roehampton.ac.uk/portal/en/studentthesis/Sport-Injury-Related-Growth(2638eb76-433d-4f96-9b41-ea87fa0c32ce).html.
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This thesis explored the concept of sport injury-related growth (SIRG). Specifically, the mechanisms through which growth occurs and how it may be promoted for injured athletes. Study 1 used a grounded theory methodology to develop a context-specific theory. Aligning with a Straussian approach, data was collected using semi-structured interviews and analysed using open, axial, and selected coding. Findings revealed that the mechanisms of (a) meta-cognition, (b) positive reappraisal, (c) positive emotions, and (d) facilitative responses are what enable SIRG. These mechanisms are influenced by a combination of internal (e.g., personality) and external (e.g., received social support) factors. These factors enable injured athletes to alter their perception of their injury into an opportunity for growth, and it is by drawing upon and mobilizing a variety of these resources that athletes are able to experience SIRG. Dimensions of growth were psychosocial, physiological, and behavioral. Although this study produced a theory that explains the SIRG process, it does not propose specific techniques or therapies that encourage the development of growth. To address this issue, Study 2 aimed to investigate and identify evidence-based interventions that promote growth after experiencing adversity. To achieve this aim, a systematic review was conducted on literature pertaining to the promotion of growth for populations who have undergone a stressful experience (e.g., medical illness). In total, 34 studies were located and obtained that met the preplanned inclusion criteria. Within these 37 studies, three types of interventions were identified: emotional processing, cognitive processing, and combined techniques. The authors of the studies who successfully demonstrated the promotion of growth either identified or suggested that growth occurs through the mechanisms of cognitive restructuring and/or reappraisal. Other important considerations that were identified through this review were the duration and timing of the intervention in relation to the adverse event, and the importance of the intervention meeting the needs of the participants. Although this study offers valuable insight into how growth may be more successfully nurtured, the studies included within this review did not specifically focus on promoting growth for injured athletes. Consequently, Study 3 sought to complement this study by examining the practice-based experiential knowledge of sport psychologists who have worked with injured athletes in an applied manner. In total, 10 sport psychologists were purposively sampled and interviewed. Data was collected using a semi-structured interview guide and analysed using content analysis. Findings revealed a fluid development framework that consisted of 5 phases: (a) reactionary phase, (b) preparation phase, (c) reflection phase, (d) application phase, and (e) monitoring phase. Within each phase a set of corresponding strategies, skills, and tools were identified that the sport psychologists would utilize to match the needs of the athletes. The sport psychologists also identified a number of personal and environmental factors that either promoted or hindered the development of SIRG. Altogether, this thesis supports and extends research regarding growth and sport injury, as well as offering applied practitioners useful information for promoting SIRG.
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Smith, Luisa J. "Evidence-based medicine in equine clinical practice." Thesis, University of Glasgow, 2006. http://theses.gla.ac.uk/5004/.
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The principles of Evidence-Based Medicine (EBM) have been well documented in the medical literature, with many examples of the successful application of these principles to the clinical environment. Despite this widespread acceptance of these principles throughout the medical profession, there has been resistance to adopt such an approach in the veterinary profession. To date, there are. few examples in the literature of the application of the principles of evidence-based medicine to either clinical or scientific research. The aim of this study was to design a series of investigations of equine diseases, and implement them at three private equine hospitals. A variety of study designs were used, providing different classes of evidence when using the classification system proposed by Yusuf et al. (1998). The main focus of this investigation was to ascertain whether it was possible to apply the ethos of EBM to the veterinary profession, and provide good quality research and evidence form private practice. It was found that 85.6% of horses (95% c.l. 81.3 to 89.3) treated for septic arthritis were successfully discharged from the hospital, with 65% of these horses (95% C.l. 57.9 to 71.6) able to return to their previous level of athletic function. When considering those horses treated for septic digital tenosynovitis, 87.8% survived to be discharged from the hospital. However, the prognosis for future soundness was poorer than that achieved following resolution of septic arthritis, with only 50% of horses treated for septic digital tenosynovitis able to return to their previous level of athletic function. Racing Thoroughbreds, both neonates and mature horses, were identified as an important subset of the population. It was found that the occurrence of septic arthritis in neonatal Thoroughbreds significantly reduced the likelihood of those foals going on to make at least one start on a racecourse, with those foals being 3.5 times less likely to start on a racecourse when compared to their siblings. In contrast, when considering mature Thoroughbred racehorses it was found that the occurrence of septic arthritis did not affect the likelihood that they would make at least one start on a racecourse when compared to their siblings, or be able to achieve an Official Rating awarded by the British Horseracing Board's handicappers equal to, or higher than, either the highest rating achieved prior to the onset of sepsis in cases in which horses had raced previously, or equal to the highest rating achieved by their siblings. In a controlled, randomised trial it was found that 31.6% (95% c.l. 17.5 to 48.7) of horses wearing a belly band following an exploratory laparotomy developed incisional complications, compared with 76.6% (95% c.I. 62.0 to 87.7) of horses where no belly band was used. If a belly band was used following an exploratory laparotomy, the risk of developing post-operative incisional complications was reduced by 45% compared to those cases where no belly band was used. Following a clinical audit of elective surgical procedures at three private equine hospitals, there was found to be a higher rate of post-operative complications, when compared to results reported in both the medical and small animal veterinary literature. It was concluded that it was possible to apply the ethos of EBM to the veterinary profession, and provide good quality research and evidence from research performed in private practice. However, in order to be able to achieve sufficient case numbers to provide answers that are directly relevant to practice-based clinical situations, multi-centre studies are likely to be the best way forward.
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Williams, Katherine Sarah. "Evidence based nursing practice and continence care." Thesis, Oxford Brookes University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.325499.
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Leufer, Therese. "Tackling evidence-based practice in nursing education." Thesis, University of Bristol, 2016. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.702872.
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This study addresses the challenge of preparing undergraduate student nurses to be able to engage profitably in Evidence -based Practice. It focuses on the tension between learning about Evidence-based Practice within the Academy and the competencies and skills required to utilise it in clinical settings. Evidence-based Practice is a dynamic process which has core components and defined steps. Nurse education programmes are required by regulatory bodies to prepare nurses to utilise the best evidence to underpin their practice. However, they provide no specific guidance on how this should be organised and delivered or how it can be measured within nurse education programmes. This study evaluated a teaching module in nurse education which was re-designed to embed Evidence-based Practice into its teaching, learning and assessment strategies. The new module aimed to foster capability for Evidence-based Practice at undergraduate level through specifically modified teaching, learning and assessment strategies; and to evaluate the impact of the intervention on the attitudes, beliefs, knowledge and utilisation of Evidence-based Practice. The study was a pre-test/post-test quasi-experimental design employing two questionnaires administered to the same cohort on two separate occasions. The pre-test was administered immediately before the module commenced; the post-test was administered after the module, following a year-long placement in clinical nursing practice. Participants were also asked two free text response qualitative questions regarding their views on aspects relating to Evidence-based Practice in practice. Results indicated static levels of knowledge, attitudes and beliefs about Evidence-based Practice between pre-test and post-test phases. Declined levels of utilisation were demonstrated on post-test measurement. The findings suggest that programme-wide curricular reform coupled with a focused, structured collaboration with clinical partners is required if Evidence-based Practice is to become embedded in nurse education and practice. A number of theoretical perspectives offer real promise of greater insight and understanding of how nurses learn, know and practice and the factors that can and do affect these characteristics. Such insight could facilitate more sensitive, appropriate and targeted integration of Evidence-based Practice knowledge into practice ensuring its success and sustainability
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Leung, Kat Lai Chun. "Measurement of Competence in Evidence Based Practice." Thesis, The University of Sydney, 2016. http://hdl.handle.net/2123/16900.
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Evidence based practice (EBP) is a clinical decision making process which integrates the use of best available evidence, clinical expertise, with consideration of the preferences and values of the person with health concerns. The implementation of EBP is mainly through the 5-step process: asking focussed questions, acquiring research evidence, appraising the quality of evidence, applying evidence in practice and assessing the outcome of care. Although EBP has been the focus of optimal health care for more than three decades, the uptake of EBP is still influenced by a range of individual, organisational and environmental factors such as insufficient evidence appraisal skills and heavy workload. The barriers to and facilitators for successful implementation of EBP have been extensively researched, where the ultimate goal is to minimise the evidence-to-practice gap in health services. To achieve this, the initiative of knowledge translation which aimed at reducing barriers and facilitating the use of research evidence in clinical decision making, is viewed as the bridge that brings together the behaviour change of clinicians in applying evidence-based interventions to patient care. Moving evidence into practice is a persistent challenge to all health professionals, and the translation of evidence into nursing practice is no exception to other health disciplines. Research into the facilitation of EBP implementation has highlighted the critical role of clinical nurse educators (CNEs) in supporting clinicians and fostering an evidence-based learning culture in the workplace. Nevertheless, a recent systematic review has concluded that many CNEs did not perceive themselves as comfortable in engaging with EBP. This finding was however limited by the use of self-report instruments, suggesting the need for an instrument that can more objectively measure the EBP knowledge and skills of nurse clinicians. A further problem is the lack of a validated appraisal tool to assess the quality of EBP instruments using quantitative measurements. Moreover, previous reviews of such instruments have only focussed on their validity for measuring discrete elements associated with EBP such as attitudes to research utilisation and outcome-expectancy in EBP. No review has ever been conducted to identify instruments for evaluation of competence in evidence-based nursing practice.The overarching purpose of this thesis is to gain a better understanding about the EBP knowledge and skills of nurse clinicians and educators, whose role is to support and nurture an EBP learning environment in clinical settings in Australia. This thesis used a stepwise approach to address multiple issues associated with the measurement of competence in EBP. First, the development of an appraisal tool for assessing the validity of instruments (Chapter 3), then using this tool to systematically evaluate the quality of all EBP instruments used in nursing (Chapter 4). An EBP competency framework was then developed (Chapter 5) to guide the development (Chapter 6 and 7) and validation (Chapter 8 and 9) of a new EBP instrument called the Evidence-based Practice Assessment Tool (EPAT). A minimum level of competency in EBP was then determined with a group of mainly CNEs and nurse clinicians through a standard setting procedure described in Chapter 9. Finally, a factor analysis was performed with the EPAT and the final version was a 10-item assessment tool which consists of two 5-item subscales. The ‘EBP knowledge’ subscale includes five items related to EBP steps 1-3 (PICO question for which P=Patient/problem/population, I=Intervention, C=Comparison, O=Outcome; search for evidence, appraisal of treatment effect) and step 5 (evaluate quality of care) whereas another five items in the ‘Shared Decision Making (SDM) skills’ subscale are indicators for EBP steps 3 and 4 (appraise benefit and harm of treatment options, explain choices and identify values). Participants answered all questions on the EPAT related to a clinical scenario and the provided evidence summary. Using the framework of the Construct Validity Model, four types of validity were assessed to support the psychometric characteristics of the EPAT: the content validity, response process, internal structure, and relationship to other variables. The strong correlation between the two subscales confirmed unique but theoretically related constructs, which means ‘EBP knowledge’ and ‘SDM skills’ constituted to the measurement of competence in EBP (Chapter 9). The EPAT was deemed to have good content validity and response process (Chapter 8), good internal consistency and factorial validity; and there was a significant relationship to different levels of exposure in EBP education (Chapter 9). The EPAT also demonstrated good inter-rater reliability through substantial agreement among seven markers, also reflecting the reliability of criteria set for the marking guidelines. The EPAT is deemed to be a very feasible tool for use in different educational settings with an average completion time of only 33 minutes (Chapter 9). The results of participants, described in Chapter 9, demonstrated an overall low pass rate (35%) on the EPAT, which may be associated with the participant ability or the difficulty of most EPAT items. These findings are similar to other modified Fresno tests which only measure the first three steps of EBP. Moreover, this thesis provides new information in regards to the competence of nurse clinicians in applying evidence and evaluating the quality of care (EBP step 4-5). It is disappointing to see that the average pass rate for SDM skills of this cohort participant was only 24% whereas the evaluation of care was even lower at 14%, indicating the priority for future EBP education and training in nursing. Chapters 5-9 included in this thesis represent the development and validation of the first EBP instrument for measuring the actual EBP knowledge and skills in nurse clinicians, through the 5-step implementation model. The results of this thesis have provided an important contribution to the knowledge of measurement in EBP and reveal an overall low level of EBP competence among nurse clinicians. The newly developed EPAT enables a comprehensive evaluation of learner’s ability and paves the way for a more focused EBP education and training in healthcare.
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Chan, Chun-ha, and 陳春霞. "Evidence-based practice guideline for patients undergoing intermittentcatheterization procedure." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46581297.
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Smith-Keys, Sherri L. "Education and Mentoring of Staff Nurses in Evidence Based Practice." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3123.
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Current gaps in nursing practice can decrease by the translation, implementation, and dissemination of evidence-based practice (EBP). The purpose of this project was to provide staff nurses with EBP education and mentoring in identifying and addressing nursing practice issues using EBP to manage patient care. The Advancing Research & Clinical Practice through Close Collaboration (ARCC) and the social cognitive theory were used as a framework to guide this project development, which addressed if medical surgical nurses receiving education in EBP practice led to improved use, implementation, and improved best practice outcomes. Seven randomly selected medical surgical nurses from a local community 200-bed hospital were recruited to participate in this project. The participants were placed in a quiet room and asked to complete a pre ARCC EBP Beliefs Scale survey, review newly developed EBP education tool, and complete a post ARCC EBP Beliefs Scale survey. The EBP Beliefs Scale (EBPB) survey was used pre and post EBP educational tool review and consisted of 16 statements addressing nurses' beliefs about EBP knowledge. This survey also addressed the implementation of EBP into nursing practice. Descriptive statistical analysis was used to analyze the surveys. The results of the survey show a positive correlation between receiving education and mentoring with utilizing EBP in nursing practice. The results of this quality improvement project's social impact will improve collaboration in healthcare organizations and nursing staff to improve the use, translation, and dissemination of EBP projects for patient care improvements and overall improved patient care outcomes.
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Stroud, Michael Alan. "PHYSICAL THERAPISTS' CLINICAL PRACTICES REGARDING INTRINSIC AND EXTRINSIC FALL RISK FACTORS AND THEIR ATTITUDES TOWARD THE USE OF EVIDENCE-BASED PRACTICE." OpenSIUC, 2014. https://opensiuc.lib.siu.edu/dissertations/853.
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AN ABSTRACT OF THE DISSERTATION OF MICHAEL A. STROUD, for Doctor of Philosophy degree in HEALTH EDUCATION, presented on MARCH 20, 2014, at Southern Illinois University Carbondale. TITLE: PHYSICAL THERAPISTS' CLINICAL PRACTICES REAGARDING INTRINSIC AND EXTRINSIC FALL RISK FACTORS AND THEIR ATTITUDES TOWARD THE USE OF EVIDENCE-BASED PRACTICE MAJOR PROFESSOR: Dr. Stephen Brown The phenomenon of falls among community-dwelling adults--coupled with an aging baby boomer generation and an increasing life expectancy--presents a significant concern for an increased number of unintentional deaths and injuries and their associated costs. The risk factors associated with falling are often categorized as intrinsic and extrinsic. Physical therapists have a unique opportunity to positively impact issues involving physical dysfunction and to educate their community-dwelling adult patients about the environmental risk factors and interventions that lessen their risk of falling. Abundant evidence-based research exists regarding interventions for the treatment and prevention of falls; however, this research indicates that physical therapists fail to consistently utilize evidence-based practice (EBP) in their daily clinical practices. The diffusion of innovations theory examines how innovations are adopted (Rogers, 2012). However, the innovation of EBP is not always adopted by physical therapists. Lack of time to conduct literature searches was the most common barrier noted by physical therapists for not adopting EBP (Jette et al., 2003; Fruth et al., 2010; Salbach, Jagial, Korner-Bitensky, Rappolt, & Davis, 2007). This study, which utilized a cross-sectional descriptive research design, provided insight into physical therapists' clinical practices regarding intrinsic and extrinsic fall risks in the treatment of community-dwelling adults aged 65 years and older. It examined physical therapists' attitudes and beliefs toward the use of EBP and identified the barriers to their adoption of it. The demographic data provided a descriptive overview of the study respondents. There were 3,523 potential physical therapist respondents, and the study's return rate was 9% (316 respondents. The majority of the respondents held doctoral degrees (49.4%), more than half (55.4%) worked in an outpatient physical therapy clinical setting, and approximately half indicated that they were American Physical Therapy Association (APTA)-certified instructors. The results of the study indicated that physical therapists who had more experience displayed a higher level of attention to clinical practices than those with less experience. The physical therapists who were APTA-certified clinical instructors demonstrated a higher level of attention to the intrinsic and extrinsic risks of falling than those who were not APTA-certified instructors. The physical therapists whose highest level of education was a doctorate placed greater importance on the utilization of EBP than respondents with a baccalaureate or master's degree. Although most physical therapists believe that the utilization of EBP holds significant value, they do not always access or apply it. Insufficient time for using EBP was the major barrier noted by most physical therapists. The results of this study concurred with those of previous studies regarding common barriers to physical therapists' adoption of EBP. Rehabilitation organizations may want to examine methods to promote the use of the most current physical therapy practices based on the evidence revealed in the literature and to explore options for improving staff access to and utilization of EBP research.
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Wilson, Virginia. "Research in Practice: Evidence, Local Context, and the Hierarchy." Evidence Based Library and Information Practice, 2015. http://hdl.handle.net/10388/7083.
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O'Hare, Daniel Patrick. "Evidence-based practice : a mixed methods approach to understanding educational psychologists' use of evidence in practice." Thesis, University of Bristol, 2015. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.686817.
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Evidence-based practice is a term that continues to receive a great.deal of attention within the Educational Psychology (EP) profession. Publications within the EP field have suggested that evidence-based practice is unworkable due to its reliance on research evidence and have instead suggested practice, which is based primarily on practitioner experience. This study suggests that EP conceptualisations of evidence-based practice have been too narrow, and adopts a model of evidence-based practice from the field of organisational psychology. This model accepts a wide range of sources of evidence including research findings, practitioner experience and judgement, information from people directly affected by decision and information from the local context. A mixed methods approach is adopted to explore EPs understandings and use of evidence in practice. The study is comprised of three phases: an experiment, an attitude scale, and a focused ethnography with interviews. Findings for this study are mixed primarily at the level of interpretation. Findings suggest that EPs orientation towards evidence-based practice is complex. It is suggested that EPs may currently lack some of the skills to be effective evidencebased practitioners but that a wide range of evidence is already drawn on in daily practice. A major barrier to a more critical understanding and application of evidence-based practice is an underlying assumption that 'evidence' is synonymous with 'research'. An expanded model of evidence-based practice is presented which, it is suggested, will allow for EPs to critically and explicitly engage with many types of evidence within practice. An essential element of evidence-based practice for EPs is their connection and relationship with peers that allows for exposure to challenge, new ideas and ways of thinking.
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Van, Roper Stephen. "Evidence Based Practice Among Primary Care Nurse Practitioners." Diss., The University of Arizona, 2011. http://hdl.handle.net/10150/217049.
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This study describes primary care nurse practitioner (PCNP) beliefs in, knowledge, implementation and utilization of evidence based practice (EBP). Research questions answered are: 1. What are the levels of belief, implementation, knowledge and utilization of EBP among PCNPs? 2. Is there a relationship with PCNP demographics (personal, professional, and practice), belief, knowledge, implementation and utilization of EBP? 3. Do PCNP demographics (personal, professional, and practice) and scores on belief, knowledge and implementation influence EBP utilization? EBP is considered a standard of care and essential to nurse practitioner practice. The primary advantages of EBP include improved quality of care through the utilization of patient resources, provider resources and experiences, current research and scientific information. However, few studies describe nurse practitioner beliefs, knowledge in EBP and the extent to which this may affect primary care nurse practitioners' (PCNP) utilization of EBP in their practice. Four questionnaires incorporated into one survey were used to examine PCNP beliefs, knowledge, implementation and utilization of EBP. JNC7 guideline knowledge and self-reported use was used to measure EBP utilization. A convenience sample of 202 FNPs, ANPs and GNPs were obtained during the American Academy of Nurse Practitioners National Conference 2011 in Las Vegas, Nevada. PCNPs surveyed were found to have a high level of belief in EBP but did not report implementing EBP more than 3 times in the past 8 weeks. Belief was statistically higher in doctorally prepared PCNPs. Ninety-five percent of the participants were familiar with the JNC7 guideline but the group scored a mean of 69% on knowledge of JNC7 guideline specifics. Only 25% of respondents indicated they utilized guidelines in hypertension management. Future studies should include quantitative and qualitative evaluation of EBP implementation facilitators and obstacles. Findings in this study have provided initial information to better understand PCNPs and EBP.
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Waters, Donna. "Evidence : the knowledge of most worth." University of Sydney, 2006. http://hdl.handle.net/2123/1903.
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Doctor of PhilosophySimilar to their colleagues throughout the world, nurses and midwives in New South Wales (NSW), Australia, welcome evidencebased practice (EBP) as a means to improve patient or client outcomes. This thesis explores the way nurses and midwives understand evidence for EBP and aims to determine whether members of these professions currently have the knowledge and skills necessary to implement evidence‐based care. Three separate studies were conducted to explore NSW nurses’ readiness for EBP. Attitudes, knowledge and skill were investigated using an EBP questionnaire returned by 383 nurses. The views of 23 nursing opinion leaders were elicited during qualitative in‐depth interviews, and their ideas on maximising the potential for future nurses to confidently engage in EBP were explored. Current approaches to teaching EBP in undergraduate nursing programs were investigated by examining documents issued by NSW nursing education providers. The results demonstrate many differences between the ways NSW nurses currently understand evidence for EBP, and a range of approaches to teaching EBP in undergraduate nursing programs. Under current conditions, nurses graduating from universities in NSW commence practice with varying levels of preparation for EBP and enter into a professional arena that is itself struggling to cope with the concepts and language of this approach to improving healthcare. v Evidence for the effectiveness of EBP is slowly accumulating and despite some small positive signs, the collective results of this thesis suggest that current educational approaches are not capable of producing the kind of results that are both necessary and desirable for the promotion of evidence‐based nursing practice in NSW. Articulating a commitment to EBP, using a common language and a consistent approach are among the recommendations made for the future promotion of EBP in nursing education.
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Niemelä, M. (Mika). "Structured child-centred interventions to support families with a parent suffering from cancer:from practice-based evidence towards evidence-based practice." Doctoral thesis, Oulun yliopisto, 2012. http://urn.fi/urn:isbn:9789514298981.
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Abstract Several studies have highlighted the need for the provision of extra support for parenting and for the children of families with parental cancer, with particular emphasis on the need to protect the psychosocial wellbeing of these children. However despite this, child-centred work still rarely forms part of clinical practice in adult health-care settings. The aims of the present work were: 1) to calculate a population-based estimate for the number of Finnish children affected by parental cancer, 2) to investigate whether these children had used specialised psychiatric services to a greater extent than their peers, 3) to conduct a systematic review of the scientific literature regarding the current state of structured interventions directly targeted at children with parental cancer, 4) to outline the clinicians' experiences of the use of structured child centred interventions in long-term clinical practice, and 5) to assess whether the “Let’s Talk about Children” (LT) and “Family Talk Intervention” (FTI) approaches have any impact on the psychiatric symptom profile of seriously somatically ill parents and their spouses. It was found that every 15th child (6.6% of the children) had a mother or father who was treated for cancer during the years 1987 to 2008. Cases of parental cancer increased these children’s use of specialised psychiatric services significantly by comparison with their peers. A systematic review revealed that the existing number of structured child-centred interventions was small and their methodological content was highly heterogeneous. Clinicians’ long-term experiences of the use of structured child-centred interventions in everyday clinical practice highlighted: the flexible choice of interventions, the importance of taking the children’s needs into account, inter–team collaboration and the need to regard death as an essential topic when working with families with parental cancer. A significant improvement in the parent’s psychological symptoms was observed four months after the completion of the structured intervention. It can be concluded that children affected by parental cancer comprise a substantial part of the general population. Both the increased use of specialised psychiatric services by the children and the positive effect of interventions on the parents justify the pursuance of research-based child-centred workTiivistelmä Useat viimeaikaiset tutkimukset ovat suosittaneet lisätukea vanhemmuudelle ja lapsille syöpäpotilaiden lasten psykososiaalisen hyvinvoinnin turvaamiseksi. Tästä huolimatta lapsikeskeistä työtä tehdään aikuisterveydenhuollossa vähän. Tämän tutkimuksen tavoitteena oli: 1) arvioida väestötasolla niiden suomalaisten lasten lukumäärä, joilla on syöpää sairastava vanhempi, ja verrata näiden lasten psykiatrisen erikoissairaanhoidon käyttöä muihin vastaavan ikäisiin, 2) selvittää systemaattisesti olemassa oleva tutkimustieto lapsikeskeisten strukturoitujen interventioiden käytöstä syöpää sairastavien vanhempien lapsilla, 3) tutkia työntekijöiden pitkäaikaisia kokemuksia strukturoitujen lapsikeskeisten interventioiden käytöstä osana jokapäiväistä kliinistä työtä, 4) selvittää kahden strukturoidun intervention, Lapset puheeksi -keskustelun ja Beardsleen perheintervention, vaikutusta vanhempien psykiatrisiin oireisiin neljä kuukautta intervention jälkeen verrattuna tilanteeseen ennen interventiota. Tulosten mukaan Suomessa 6,6 %:lla vuonna 1987 syntyneistä lapsista oli vanhempi, jota oli hoidettu syövän takia seurantajakson 1987–2008 aikana. Syöpää sairastavien vanhempien lasten psykiatrisen erikoissairaanhoidon käyttö oli tilastollisesti merkitsevästi kohonnut verrattuna muihin samanikäisiin. Lasten tukemiseen tarkoitettujen strukturoitujen interventioiden määrä oli vähäinen ja niiden tutkimuksellinen taso oli vaihteleva. Työntekijöiden kokemukset lapsikeskeisten interventioiden toteuttamisesta potilastyössä nostivat esille useita huomioonotettavia asioita: on tärkeää voida valita interventio joustavasti perheen tarpeiden mukaan, yli sektorirajojen ulottuva yhteistyö on keskeistä, lasten yksilöllisten tarpeiden huomioiminen on tärkeää, kuoleman teema nousee usein esille perheiden kanssa työskenneltäessä. Vanhempien psyykkisten oireiden todettiin vähentyneen intervention jälkeen tehdyssä mittauksessa verrattuna ennen interventiota tehtyyn mittaukseen. Tutkimuksen tulosten perusteella voidaan päätellä, että syöpäpotilaiden lapset muodostavat merkittävän ryhmän väestössä. Syöpäpotilaiden lasten lisääntynyt psykiatrisen erikoissairaanhoidon käyttö jo yksin ja myös interventioiden myönteiset vaikutukset puoltavat lapsikeskeisen työn kehittämistä aikuisterveydenhuoltoon. Kehittämistyön pohjana voidaan käyttää tässä tutkimuksessa käytettyjä strukturoituja lapsikeskeisiä interventioita
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Edwards, D. J. A., F. M. Dattilio, and D. B. Bromley. "Developing evidence-based practice: the role of case-based research." Professional Psychology: Research and Practice, 2004. http://hdl.handle.net/10962/d1007856.
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How can practitioners engage in evidence-based practice when the evidence for effectiveness of psychological treatments comes from randomized controlled trials using patient populations different from those encountered in everyday settings and treatment manuals that seem oversimplified and inflexible? The authors argue that important evidence about best practice comes from case-based research, which builds knowledge in a clinically useful manner and complements what is achieved by multivariate research methods. A multidimensional model of the research process is provided that includes clinical practice and case-based research as significant contributors. The authors summarize the principles of case-based research and provide examples of recent technical advances. Finally, the authors suggest ways in which practitioners can apply the case-based approach in researching and publishing their own cases, perhaps in collaboration with university-based researchers.
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Lau, Sze-lok Alfred. "Evidence-based practice in oral and maxillofacial surgery /." View the Table of Contents & Abstract, 2005. http://sunzi.lib.hku.hk/hkuto/record/B32222154.
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Lau, Sze-lok Alfred, and 劉思樂. "Evidence-based practice in oral and maxillofacial surgery." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2005. http://hub.hku.hk/bib/B45007755.
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Chapman, Lynn. "Evidence-based practice : a trainee clinical psychologist perspective." Thesis, University of Lincoln, 2010. http://eprints.lincoln.ac.uk/17554/.
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Evidence-based practice (EBP) is now the dominant model in health care; its aim is to increase the use of research evidence to inform clinical decision making. Clinical practice guidelines are the predominant method by which research is distilled into practice recommendations. Clinical psychology has its own model which promotes the integration of research evidence with clinical expertise, the scientist practitioner model (SPM). Recent developments within the United Kingdom health service, such as the Improving Access to Psychological Therapies programme have stimulated debate about the types of evidence that is often prioritised within the EBP model. This study aimed to explore these concepts with current third year clinical trainee psychologists, with a view to seeing how they construct these models. The findings suggest that the SPM may be more accurately termed the reflective-scientist-practitioner, or the critical-reflective-scientist-practitioner; in acknowledgment of the importance placed on these skills by participants who saw them as central to their role. The current study indicates participants were unaware of the APA (2006) definition of EBP; recommendations include that clinical training courses consider including teaching around both models, exploring the complexity of the underlying debates, in doing so trainees will be more informed about the models that shape their chosen profession.
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Cheers, Deirdre Anne. "Evidence Based Practice in Out-Of-Home Care." Thesis, The University of Sydney, 2006. http://hdl.handle.net/2123/1633.
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This research is about evidence based practice, which is an area of increasing interest and emphasis in social work today. Initially apparent in medical and health care settings, evidence based practice now has widened applicability to a broad range of contexts and professional disciplines. The ways in which research evidence is translated into policy and practice is itself a topic area for social work research. The study investigates evidence based practice in child welfare, specifically the out-of-home care system. Out-of-home care provides alternative placements for children and young people who cannot live with their families because of abuse and neglect, and generally consists of placement with foster carers or in a residential/group care setting. This research is an exploratory study which investigates through individual interview how nineteen out-of-home care Senior Managers and Team Leaders in the states of New South Wales, Western Australia and the Australian Capital Territory interpret and understand evidence based practice, and the degree and depth of knowledge they transfer from research awareness into out-of-home care practice and policy development. The research has three main objectives. Firstly to investigate the understanding of out-of-home care managers of evidence based practice, secondly to determine the influence of relevant research on practice and policy in out-ofhome care, and thirdly to explore potential barriers to evidence based practice. Looking After Children, a social work case management system for children and young people in out-of-home care, provides the context for this research, in which evidence based practice is critically examined. A thematic analysis of the interview data identified five major themes. These included: the benefit of broadening definitions of evidence based practice to include a wide range of influences on practice; the value and importance of 2 considering a broad range of research approaches in connecting research with policy and practice AND the potential for influencing outcomes of social work intervention via research based and influenced guided practice systems and techniques; factors which constitute barriers and also those that enhance the implementation of evidence based practice; the potential for instigating and supporting new research via the use of evidence based practice for purposes such as data aggregation, in addition to practice development and enhancement of client outcomes. Implications and conclusions are drawn from this study in relation to out-ofhome care policy and practice, with particular reference to use of the Looking After Children case management system in the Australian context. These include the potential of a consistent system such as LAC to provide common language and assessment tools and procedures in a welfare sector that is fragmented by lack of national legislation, and the potential for development of national out-of-home care research projects as a result of cross agency LAC implementation resulting in data aggregation opportunities.
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Estrada, Nicolette Ann. "Learning Organizations and Evidence-Based Practice by RNs." Diss., The University of Arizona, 2007. http://hdl.handle.net/10150/195736.
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Evidence-based practice (EBP) is recognized as a means for providing safe, cost-effective, and quality healthcare. Registered Nurses (RNs), like other disciplines, are accountable for providing patient care based on the best evidence. The greatest majority of RNs are employed within the acute care setting. Unknown is what type of organizational infrastructure is necessary to support RNs in EBP. The business community reports positive performance outcomes through development of learning organizations (LO). LOs are reputed to be high functioning, supportive, adaptive, and continuously learning systems, compatible with the needs reflected in today's complex, turbulent healthcare. This descriptive study used a survey methodology to identify relationships between the dimensions of a LO as perceived by RNs within the context of the acute care hospital and their beliefs about and implementation of EBP. Six hospitals, two magnet designated, two non-magnet, and two Veterans Administration Medical Centers in one southwestern state were invited to participate. Three established instruments were used. Distribution of questionnaires to 1750 RNs resulted in a return of 592, for a 34% response rate. Instruments demonstrated adequate reliability and validity for this sample. Psychometrics on the EBP Beliefs Scale resulted in the identification of four subscales that were subsequently included in the analyses. Descriptive statistics indicated differences in characteristics of nurses from the different types organizations. The VA nurse's average age was 48 years, worked 19 years as an RN and 64% reported their highest educational degree as bachelor or above. Nurses responding from the other two types of organizations, on the average, were 42 years old, had 14 years experience, and 52% reported an educational degree of bachelor or above. Relationships were identified between RNs' perceived beliefs about EBP and their reported frequency of EBP implementation. Regressing beliefs on the dependent variable of implementation with the full sample (n=543) resulted in R2=.23, p<.05. Slight variation was noted in the analysis per organizational type. Relationships among the dimensions of the learning organization and the subscales of the Belief scale were analyzed using regression analysis. Significant relationships were noted but were demonstrated differently among the three different types of organizations.
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Managbanag, Jenny Ann Salve. "Evidence-Based Practice Guideline for Peripheral Artery Disease." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5570.
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The absence of a practice guideline for peripheral artery disease (PAD) in the cardiology department creates differing practice preferences among providers, leading to deviations in practice among staff. Variations in practice can affect the quality of care that is provided to patients. This project was guided by research statements indicating that there was a difference in the screening approach for PAD among health practitioners at preimplementation and postimplementation and that an 85% compliance with the guideline would signify consistency in the provision of care. Rogers' theory of diffusion of innovations was used to facilitate the adoption of the guideline. This project helped close the gap between research (adoption of a guideline) and practice (compliance in the use of evidence in clinical practice). Using random medical record reviews and pretest-posttest design, the results of the project showed that patterns of using the PAD guideline in practice at preimplementation significantly differed compared to postimplementation. The rates of screening for the compliance of the PAD guideline showed approximately an eightfold increase. The adoption of the PAD guideline has implications for policy, because adopting the PAD guideline helped standardize the care, improve effectiveness of care in nursing practice, evaluate quality through use of research, and promote social change by improving patient outcomes.
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Igo, Simon. "The essential structure of practising evidence based practice : a phenomenological description of the experiences of physiotherapists." Thesis, University of Bath, 2015. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.646146.
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Evidence based practice (EBP) is an educational paradigm that espouses that clinical decision making should be made through the judicious and conscientious use of best evidence. EBP is predicated on a fundamental principle that therapeutic knowledge is appraised and applied into practice with the ethical imperative to use such knowledge for the good of patient care. Despite the ubiquitous nature of EBP in health care little is known about how physiotherapists use this clinical decision making process and it is not clear as to which theoretical frameworks of practice and knowledge paradigms underpin physiotherapists application of EBP. Phenomenology seeks to uncover the internal consciousness of phenomena by describing and exploring the lived experience and explores the relationship between what exists in one’s consciousness and what exists in the objective world. Descriptive phenomenology was used in this thesis to gain an in depth understanding of how twelve physiotherapists applied EBP in the real and complex world of clinical practice with the objective to explore their experiences and to understand the essence of its practice. The findings in this study revealed a complex picture comprising of three separate but interrelated themes. Physiotherapists had developed a personal theory of EBP (Theme 1) that guided their behaviour and comprised of an ontological, epistemological and methodological structure. This theoretical and practice framework was uniquely individual and required a complex set of cognitive processes that included knowledge identification, transformation, translation and implementation in specific client situations and practice contexts (Theme 2: translation into practice). To add to this complexity this framework took place within intrapersonal, social and cultural milieus which influenced behaviour (Theme 3). The study concludes by conceptualising the findings and experiences of physiotherapists into models that could be used to assist educationalists, practitioners and researchers to promote evidence based practice in a pragmatic way.
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Muenchberger, Heidi. "Evidence-based Practice in Rehabilitation: A Process for Synthesising Knowledge." Thesis, Griffith University, 2007. http://hdl.handle.net/10072/365865.
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The primary aim of the research was to develop a systematic process for synthesising rehabilitation evidence that incorporates both qualitative and quantitative research and clinical experience. A second aim was to use this evidence-base to develop a coherent conceptual framework for rehabilitation that can inform future interventions. These aims were articulated through the worked example of low back injury (LBI). Evidence-based practice (EBP) has received unequivocal support as a way of ensuring best practice in health and rehabilitation. However, EBP has been interpreted in a way that demands evidence conforms with stringent empirical criteria, as would typically be applied to effectiveness studies (i.e., randomised controlled trials, (RCTs)). Consequently, qualitative research and clinical experience have largely been excluded as valuable sources of evidence. However, there is some suggestion that EBP has failed to translate into improved outcomes following LBI. This thesis has argued that the relevance of EBP will be enhanced if its conceptualisation of knowledge can shift from the stringent criteria that are often applied to evidence to a more inclusive approach. The current thesis employed a program of research comprising three separate studies that contributed to the cumulative development of a coherent evidence-base. Study One systematically explored the empirical support for return-to-work predictors in the quantitative research, using the method of Narrative Systematic Review. Study Two reviewed the clinical utility of these predictors, using a method based on practitioner consultation and consensus. Study Three reviewed the qualitative rehabilitation research using Meta-ethnography. The findings from Study One revealed 38 key predictors that were associated with return-to-work outcome following LBI. Significant empirical support was found for predictors relating to age, the subjective experience of injury and expectations of return-to-work. Trends towards significance were found in relation to workplace factors. Study Two identified nine predictors that were considered to be relevant to rehabilitation practice and, therefore, an important focus for future interventions. Study Two also demonstrated the disparity among experts in their ability to distinguish between work factors, rehabilitation processes and individual characteristics. These diverse attributions may influence practice and, therefore, outcomes. Most importantly, Study Two revealed the fact that practitioners understood predictors of outcome according to the way in which they contributed to three critical processes that underpin rehabilitation. Specifically, practitioners focused on supportive and collaborative processes that attended to issues of time, context and engagement. Study Three identified five key components that provided a framework for understanding rehabilitation as a system. Sixteen themes clustered together to form these five components, which, taken together, defined a rehabilitation system marred by tensions and multiple competing processes. Components such as policy and philosophy interacted and competed with the demands of the workplace and the individual’s personal responses. Partnerships between key stakeholders were lacking, but offered an important strategy for improving outcomes. The current thesis utilised an innovative methodology to efficiently synthesise an extensive literature base and develop clinically meaningful conclusions. This thesis has demonstrated that the knowledge cycle is an evolving process, informed by both empirical research and clinical experience, and located within broader frameworks of understanding. It has also supported the view that evidence and its interpretation must be grounded in the context of the discipline and developmental stage of knowledge-base.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Human Services
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Fennessy, Gabrielle Ann 1968. "Knowledge management in evidence based practice : study of a community of practice." Monash University, School of Information Management and Systems, 2002. http://arrow.monash.edu.au/hdl/1959.1/8023.
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Dannapfel, Petra. "Evidence-Based Practice in Practice : Exploring Conditions for Using Research in Physiotherapy." Doctoral thesis, Linköpings universitet, Avdelningen för samhällsmedicin, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-122172.
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Research developments have led to increased opportunities for the use of improved diagnostic and treatment methods in physiotherapy and other areas of health care. The emergence of the evidence-based practice (EBP) movement has led to higher expectations for a more research-informed health care practice that integrates the best available research evidence with clinical experience and patient priorities and values. Physiotherapy research has grown exponentially, contributing to an increased interest in achieving a more evidence-based physiotherapy practice. However, implementation research has identified many individual and contextual barriers to research use. Strategies to achieve a more EBP tend to narrowly target individual practitioners to influence their knowledge, skills and attitudes concerning research use. However, there is an emerging recognition that contextual conditions such as leadership and culture are critical to successfully implementing EBP. Against this background, the overall aim of this thesis was to explore conditions at different levels, from the individual level to the organizational level and beyond, for the use of research and implementation of an evidence-based physiotherapy practice. The thesis consists of four interrelated papers that address various aspects of the aim. Individual and focus group interviews were conducted with physiotherapists and managers within physiotherapy in various county councils in Sweden between 2011 and 2014. Data were analysed using qualitative content analysis, direct content analysis and hermeneutics. It was found that many different types of motivation underlie physiotherapists’ use of research in their clinical practice, from amotivation (i.e. a lack of intention to engage in research use) to intrinsic motivation (research use is perceived as interesting and satisfying in itself). Most physiotherapists tend to view research use in favourable terms. Physiotherapists’ participation in a research project can yield many individual learning experiences that might contribute to a more research-informed physiotherapy practice. However, organizational learning was more limited. Numerous conditions at different levels (individual, workplace and extra-organizational levels) provide support for physiotherapists’ use of research in their clinical practice. However, physiotherapy leaders appear to contribute to a modest degree to establishing a culture that is conducive to implementing EBP in physiotherapy practice. Instead, EBP issues largely seem to depend on committed individual physiotherapists who keep to up to date with research in physiotherapy and inform colleagues about the latest research findings.
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Brown, Bernadette. "Clinician-Led Improvement in Cancer Care (CLICC): Complementing Evidence-Based Medicine with Evidence-Based Implementation." Thesis, The University of Sydney, 2016. http://hdl.handle.net/2123/15660.
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This thesis explores whether a multifaceted intervention implemented through the NSW Agency for Clinical Innovation (ACI) Urology Clinical Network can improve the rates of referral of men with high-risk prostate cancer post-radical prostatectomy for consideration for adjuvant radiotherapy in line with clinical practice guideline recommended care. It comprises seven iterative studies that address urologists’ knowledge, attitudes and equipoise for the use of adjuvant radiotherapy for high-risk prostate cancer, the development of a clinical network embedded intervention and the evaluation of this intervention within a step-wedge cluster randomised trial ‘Clinician-Led Improvement in Cancer Care (CLICC)’ (NHMRC Partnership Grant 1011474; Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12611001251910). The thesis found some evidence that the CLICC intervention resulted in desired practice change. Results are presented within the context of the CLICC conceptual program logic framework and are interpreted in relation to knowledge, attitudes and beliefs in the wider urological community. The thesis concludes with consideration of how findings could be translated to the implementation of other clinical practice guideline recommendations.
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Göransson, Olof, and Elin Jakobsson. "Utvärdering av Belöningssystem : Vad är dess roll i företag verksamma i Sverige?" Thesis, Uppsala universitet, Företagsekonomiska institutionen, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-202222.
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Denna kvalitativa studie genomfördes för att undersöka vilken roll utvärdering av belöningssystem har i företag verksamma i Sverige. Studien utgår från teorin Evidence- Based Practice och dess underkategorier som specifikt behandlar belöningssystem. Dessa teorier applicerades på data inhämtad från intervjuer med personer ansvariga för belöningssystem på olika företag. I studien framkom, i likhet med de få tidigare studier som genomförts inom området, att utvärdering av belöningssystem inte har någon central roll hos de undersökta företagen. Anledningen till denna undanskymda roll anses dock inte vara en misstro mot behovet av det. Istället framkom att en starkt bidragande orsak till det restriktiva utförandet av utvärdering är att området anses komplext med stora problem relaterade till att identifiera lämpliga metoder för det praktiska utförandet.
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Muttiah, Nimisha. "Controversial therapy and evidence-based practice the clinicians' perspective /." Bowling Green, Ohio : Bowling Green State University, 2008. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=bgsu1206325052.
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Makic, Mary Beth Flynn. "Evidence-based practice for the prevention of pressure ulcers /." Connect to full text via ProQuest. Limited to UCD Anschutz Medical Campus, 2007.
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Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2007.Typescript. Includes bibliographical references (leaves 195-207). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;
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Reagon, Carly. "Reconfiguring evidence-based practice for use in occupational therapy." Thesis, Cardiff University, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.490116.
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Murray, Esther Louise. "Practice-based evidence : cardiac care and doctor-patient communication." Thesis, City University London, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.492344.
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Depression and anxiety are common in patients with coronary heart disease (CHD). As well as reducing health related quality of life, psychological problems can be a barrier to recovery and to making the necessary lifestyle changes to prevent worsening of cardiac health. A report on cardiac rehabilitation services in South East London (Marks & Filer, 2005) identified gaps in the services provided: not all CHD patients receive psychological support. Reviews of psycho-educational programmes in cardiac rehabilitation (Dusseldorp 1999 and Bennett & Carroll 1994) have found that group interventions can be effective in reducing emotional distress, targeting risk factors and increasing active coping. Cognitive behavioural techniques such as goal setting and evidence checking have been found to be effective when working with CHD patients (Lewin 2002). A psycho-education session based on cognitive behavioural techniques was designed and delivered to CHD patients as part of their usual Phase III cardiac rehabilitation programme in 3 hospitals in South East London. Two types of session were delivered: one individualised and interactive, the other generic and didactic in style. The format and content of the intervention is outlined in a manual and the same manual was used to deliver the session each time. All patients received a written handout summarising the session. Patients were randomly allocated to the control or intervention group. Outcomes were measured by HADS, Dartmouth COOP and a behavioural questionnaire before and after the session. Results showed high levels of patient satisfaction with the intervention in terms of usefulness and feeling comfortable and accepted in the group format. There was no significant difference in HADS scores over time, or between groups. This project is a case study for the complexities of carrying out research with limited resources in the setting of the NHS and highlights the role of practice-based evidence.
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Neher, Margit. "Learning Challenges Associated with Evidence-Based Practice in Rheumatology." Doctoral thesis, Linköpings universitet, Avdelningen för samhällsmedicin, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-127495.
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Background: Rheumatology is a field of practice that is undergoing many changes, leading to growing demand for rheumatology practitioners to keep up-to-date about the research developments in their field and to implement new findings and recommendations into clinical practice. Research within implementation science has shown that there are numerous barriers to the clinical use of research-based knowledge in health care. Implementation of evidencebased practice (EBP) requires a great deal of learning on the part of practitioners. It is likely that practitioners in rheumatology face similar challenges to those in other clinical fields, but there is a paucity of research concerning the implementation of EBP in rheumatology and the learning required. Aims: The overall aim of the research project was to generate knowledge concerning the learning challenges associated with evidence-based practice in rheumatology. Methods: Qualitative methods were used to explore the use of knowledge sources in rheumatology nursing and the learning opportunities in clinical rheumatology for participants belonging to five professional groups. Quantitative methods sought to examine to what extent evidence-based practice was implemented in clinical rheumatology practice and which individual and organizational factors affected research use. A theory-based study analysed the learning processes associated with achieving an evidence-based practice. Results: Four sources of knowledge were identified for rheumatology nursing practice: interaction with other people in the workplace (peers in particular) and previous knowledge and experience were perceived as preferred sources of knowledge, while written materials and contacts outside the workplace were less privileged. Learning opportunities occurring during daily practice were perceived by participants of all professional groups to consist predominantly of interactions with professional peers in the workplace. Participants perceived a lack of recognized learning opportunities such as continuing professional education and regular participation in rheumatology-specific courses and conferences. Participants also expressed that time for reflection and up-dating knowledge was short in everyday clinical work. The quantitative data showed that while the general interest for EBP was high in rheumatology practice, individual interest and professional self-efficacy related to EBP varied. A longer work-experience in rheumatology, better self-efficacy concerning the use research-based knowledge and more experience from research activities were positively associated with the use of research in practice. The theoretical analysis showed that challenges of implementing evidence-based practice concern not only the acquisition of research-based knowledge and the integration of this knowledge in practice, but also the abandonment of outdated practices. Conclusions: In this thesis, implementation of EBP in rheumatology has been shown to be a complex issue. Social, contextual and individual aspects were found to be involved in the learning processes, the use of knowledge sources and learning opportunities, as well as in the EBP-relevant behaviours that are enacted in clinical rheumatology. The thesis hopes to contribute to a better understanding of the learning challenges in connection with the implementation of EBP in rheumatology practice.
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Eliasson, Benitha. "Social Work Approaching Evidence-Based Practice. : Rethinking Social Work." Doctoral thesis, Luleå tekniska universitet, Arbetsvetenskap, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-18343.
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The Swedish public sector has undergone major changes over the last decades, with increased demands to be effective and perform their tasks with high quality, but also with the demand to increase the influence of users and citizens over the support given. This development has influenced how social services organise and how their work is perform, and is one motive given as to why evidence-based practice was introduced. This development can also be traced back to the manager philosophy new public management and neo-liberalism. Evidence-based practice has its origin in evidence-based medicine, which had a large impact internationally from the 1990s.Although there are different opinions concerning how evidence-based practiceshould be understood is often described on the basis of Sackett et al.’s (2000) definition which regards evidence-based practice as an integration of different knowledge sources – the best evidence, clinical or professional expertise and the values and preferences of users. The professional have the responsibility to use all these knowledge sources in the daily work.The purpose of this thesis is to describe and analyse different processes of the introduction of evidence-based practice. One aspect is what these processes have contributed to in terms of organising ways of working and management within social services; another aspect concerns what this means for social work. With a combination of new institutional organisational theory and Berger and Luckmann’s (1967) insights into the social construction of everyday life, it is possible to analyse the introduction of evidence-based practice as a process, moving between a macro, meso and micro perspective. The empirical base for this thesis is interviews with 33 personnel from different professions and organisations. Those interviewed from thesocial services include social workers within individual and family services and socialservices managers, as well as regional representatives from a Research and Development Unit. To understand the development of evidence-based practice and its proliferation into social services I also interviewed doctors from health care in a County Council.New institutional organisational theory is useful for understanding how differentways of organising activities are spread between and within organisations. With concepts used in new institutional theory, the focus is on how evidence-based practice travels from medicine to social work, and from a national level to the local social services level, via the regional level. Giddens (1990) terms ‘disemedding’ and ‘reembedding’ are used. Different isomorphic processes are recognised in these processes, as well as strategies to decouple or loosely couple evidence-based practice from social services ordinary activities as a way to gain legitimacy. The main findings in the thesis are that evidence-based practice has been introduced with evidence-based medicine as a role model, and that this has been done from different conditions. As is described in the interviews, the development of evidencebased practice has been controlled from national organisations such as the government, the National Board of Health and Welfare and in recent years also the Swedish Association of Local Authorities and Region, while the development within the medical area was governed by national organisations but performed by the medical profession, which advocated the introduction of evidence-based practice within the profession. The regional representatives largely support the myth that is presented of evidence-based practice, and have a central responsibility in the national initiativesconducted; they are intermediary between the national initiatives on development work and the local practice. When evidence-based practice is introduced in social work this has entailed loosely coupling between the myth about evidence-based practice and the ordinary activities, this strategy is especially obvious among social services managers. Furthermore, when a medical model of evidence-based practice is used, although with a broader approach, the introduction of evidence-based practice does not reflect the social workers’ education, profession and ways of working in the same way as evidence-based medicine reflects the doctors’ education, profession andway of working. The intention to analyse the introduction of evidence-based practice from a micro perspective is about understanding how evidence-based practice is received by the social worker and their managers. When the interviews with the doctors, social workers and managers are analysed there is less coherence between evidence-based practice and social workers’ work than between evidence-based medicine and doctors’ work. This means that social workers have to shape and construct their daily work anew through internalising the new habits and routines into everyday work, something that takes energy and time, which most interviewees feel does not exist.This thesis also highlights the need for social work to approach evidence-based practice both at an organisational and a structural level, and from the level where the daily work is performed by social workers. Finally, there exists among almost all interviewees a great interest in introducing evidence-based practice, especially among the social workers, but at the moment it is not re-embedded in social work.Godkänd; 2014; 20140731 (beneli); Nedanstående person kommer att disputera för avläggande av filosofie doktorsexamen. Namn: Benitha Eliasson Ämne: Arbetsvetenskap/Human Work Science Avhandling: Social Work Approaching Evidence-Based Practice Rethinking Social Work Opponent: Professor of Health Care Organisation Mike Dent, Faculty of Health Sciences, Staffordshire University, Storbritannien Ordförande: Professor Elisabeth Berg, Avd för arbetsvetenskap, Institutionen för ekonomi, teknik och samhälle, Luleå tekniska universitet Tid: Måndag den 29 september 2014, kl 13.00 Plats: A109, Luleå tekniska universitet
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Muttiah, Nimisha Anya. "Controversial Therapy and Evidence-Based Practice: The Clinicians' Perspective." Bowling Green State University / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=bgsu1206325052.
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Lee, Andrew C. K. "Developing evidence-based practice in emergency planning and management." Thesis, University of Sheffield, 2015. http://etheses.whiterose.ac.uk/11559/.
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BACKGROUND Emergency planning is essential to mitigate disasters and ensure appropriate emergency responses. However, it is imperfect and rarely ‘evidence-based’. The extent of the evidence-base and how it is utilised is also unclear. This thesis scopes the evidence-base from a health perspective, and explores the determinants of evidence-based practice in this field. METHODS Three scoping reviews of published literature including British grey literature were conducted to map the evidence-base. Two further studies involving key informant interviews in the UK and Nepal were then conducted to understand how evidence was used and identify determinants of evidence-based practice in this field. A thematic approach was then applied during data analysis for key themes. FINDINGS Many publications originate from high income countries, especially North America. Most were observational and unsystematically reported commentaries and event reports. Whilst many addressed emergency planning and response issues, few covered disaster mitigation or recovery. More disaster research especially from LMIC settings is required. The UK interviews revealed greater practitioner focus on operational aspects. Knowledge gaps included individual and organisational behaviour in emergencies, public engagement and community disaster resilience. There were issues with knowledge acquisition, dissemination and utilisation, and ascertaining the optimal system configuration. Interviews in Nepal uncovered further barriers to evidence-based practice such as contextual factors (e.g. poverty), local custom and culture, weak legislative infrastructure, and limited demand and accessibility of the evidence-base. CONCLUSIONS The validity and generalisability of existing disaster literature is unclear and little evidence synthesis has been performed to inform policy and practice. What constitutes “evidence” is also contested. Various knowledge management issues exist. Current knowledge gaps are diverse, including socio-behavioural aspects, operational processes and organisational configuration issues. Barriers to evidence-based practice include political factors especially in settings where governance, legislation and leadership are weaker. Promoting evidence-based practice will require individual, organisational and system culture change.
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Kochanowicz, Kathleen Marie. "Evaluation of Evidence-Based Practice Guideline for Pediatric Obesity." Diss., The University of Arizona, 2014. http://hdl.handle.net/10150/316778.
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Introduction: Pediatric obesity prevention and management is a high priority for pediatric providers. Pediatric providers use evidence-based clinical guidelines to integrate the best current recommendations into practice. The contention of this inquiry is that while practice guidelines and obesity programs address the "who, what, when, where, and why" of pediatric obesity interventions, the guidelines fail to address the "how" of the process that bolsters adherence and attacks the high attrition rates of obesity management. Objective: The objective of this practice inquiry is to evaluate Prevention and Treatment for Pediatric Obesity: An Endocrine Society Clinical Practice Guideline Based on Expert Opinion using the Appraisal for Guidelines and Research and Evaluation (AGREE II) instrument and to investigate techniques to improve adherence to the lifestyle changes recommended in the guideline, by synthesizing the current research for using motivational interviewing with obese pediatric patients, and propose a plan for translating the intervention to measurable outcomes. Methods: Prevention and Treatment of Pediatric Obesity: An Endocrine Society Clinical Practice Guideline Based on Expert Opinion was evaluated using the AGREE II instrument. The current recommendations are detailed based on the findings of a review of the literature. Using the RE-AIM framework, recommendations are made to determine the translation potential for the use of motivational interviewing to improve adherence to lifestyle recommendations, thus improving the current clinical practice guideline. Results: Review of the Endocrine Society's CPG using the AGREE II instrument yielded an overall guideline quality rating of 6/7. The guideline is recommended for use with modifications to improve applicability. Integration of MI to the practice guideline and the use of the RE-AIM framework to improve uptake of the intervention is proposed to address the weaknesses in applicability revealed in the guideline evaluation. Conclusion: The CPG reviewed in this PI provides quality recommendations for the treatment and prevention of pediatric obesity. By integrating MI techniques and using the RE-AIM framework, pediatric providers may be able to bolster adherence to the guideline recommendations and ultimately improve clinical outcomes and impede the rising pediatric obesity rates. Future research should include evaluation of MI interventions in the pediatric clinical setting.
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Pearson, Mindy Judd. "The Group Readiness Questionnaire: A Practice-Based Evidence Measure?" BYU ScholarsArchive, 2017. https://scholarsarchive.byu.edu/etd/6485.
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In recent decades, psychologists have increasingly turned to evidence-based practice (EBP) to guide their treatments with clients. Practice-based evidence (PBE) is one type of EBP that allows clinicians to treat their clients in a flexible, but effective way. PBE treatments are those that use information gathered about the client through measures or questionnaires to inform the clinical decisions therapists make in the process of treating the client. The use of PBE in group psychotherapy is increasing and there are many measures that can potentially be used to aid therapists by gathering client information or feedback in the areas of group selection and pre-group preparation, group process, and outcome. The Group Readiness Questionnaire (GRQ) is one measure that was created in the hopes that it could predict which potential group members would benefit from group psychotherapy. The GRQ was designed to capture a potential group member's expectations regarding the helpfulness of group therapy as well as positive and negative interpersonal skills that could affect process within the group. This study tests the ability of the GRQ to predict group process and outcome during the early, middle, and late stages of group while taking the interdependent nature of group data into account through multilevel analysis in an effort to establish the GRQ as a PBE measure. Clients who perceived themselves to be less inclined to participate actively in group settings felt less connected to their groups during the early stage of group, but began to feel more bonded to other group members during the middle stage of group. Group members who had lower expectations of group therapy being helpful to them initially felt less connected to their groups and perceived more conflict within their groups after the initial session. Group members who were less prepared in general for group therapy tended to feel more gradually connected to other group members during the middle stage of group. Group members who were less inclined to participate and self-disclose in group settings as well as ones who were overall less prepared for group tended to be experiencing greater initial distress before starting group therapy. Implications of these findings as well as directions for future research are discussed.
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Theriaque, Tina June. "Educational Training of Staff Nurses for Evidence-Based Practice." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5275.
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Translating research into practice takes 10 to 20 years or more. Evidence-based practice (EBP) integration remains at 10% to 20%, despite recommendations requiring EBP-guided decisions. Up to 30% decreases in health care system spending, improved quality outcomes, and increased staff satisfaction result from EBP integration. Nurse leaders, who rate quality and safety as the highest priority but EBP as the lowest, are accountable for EBP enculturation; a desire to support bedside registered nurses in EBP exists, yet this EBP use knowledge gap supersedes this goal. The purpose of this project was to provide an EBP education program introducing the use of evidence to guide nursing practice. The project question addressed whether an education program for staff nurses on introduction to EBP would increase nursing staff perception of the value of EBP and their interest in implementing EBP. Knowles's theory of adult learning and the nursing process guided this project. The 36 participants completed the16-question EBP Beliefs Scale before and after the education program on introduction to EBP. Results from the paired samples t tests showed there was a significant difference in each response on the survey, indicating an increased understanding of the fundamental value of EBP, as well as the participant's individual ability to implement EBP within clinical practice. The limited findings contribute to the existing body of knowledge, while positive social change implications include resolving public health and safety issues, reversing fiscal irresponsibility, and overcoming resistance to change, which is at the heart of implementing and enculturating EBP.
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Peterson, George. "An Evidence-Based Clinical Practice Guideline for Childhood Obesity." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/6092.
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Childhood obesity is a national problem in the United States and has known implications as a potential cause of chronic illnesses as the child transitions into adulthood. A primary care clinic in the southwestern United States had a high percentage of obese Hispanic children within its population; therefore, the nurses and the pediatrician needed an evidence-based clinical practice guideline (CPG) to manage Hispanic children with a body mass index greater than the 95th percentile for their age. The purpose of the project was to develop a culturally competent CPG to manage childhood obesity in this primary care practice. The social cognitive theory provided the framework to develop the CPG. The final project resulted in an evidence-based CPG that was validated by an expert physician panel. The implication of this project is that nurses and providers can provide culturally competent education to the parent and child to reduce obesity among the pediatric Hispanic population. This project may create positive social change by modifying unhealthy cultural practices and behaviors, preventing chronic diseases, and reducing health care costs for the children within the selected practice.
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Osop, Hamzah Bin. "A practice-based evidence approach for clinical decision support." Thesis, Queensland University of Technology, 2018. https://eprints.qut.edu.au/123320/2/Hamzah%20Bin%20Osop%20Thesis.pdf.
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This thesis studies the conceptualisation and evaluation of a Practice-Based Evidence approach to decision making in healthcare. It examines the existing ICT architecture of a public hospital in Singapore to design a decision support system that leverages practical clinical evidence meaningfully captured in electronic health records. In doing so, healthcare professionals are supported in decision making through findings from past similar patients that can be generalised to the current patient population.
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Baatiema, Leonard. "The knowledge-practice gap: Evidence-based practice for acute stroke care in Ghana." Thesis, Australian Catholic University, 2018. https://acuresearchbank.acu.edu.au/download/b5a2ef6ecac7825df17579a882a4330952b0767ef154f1a1fd16c6f9100beaea/5467471/BAATIEMA_2018_The_Knowledge_practice_gap_evidence_based_practice_for.pdf.
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A critical global health concern in the last few decades is the widened gap between what we recognized scientifically as best practice interventions and what patients actually receive in clinical settings. Despite the fact that the past two decades has witnessed a preponderance of new and more effective interventions for acute stroke care globally, uptake of such interventions is inadequate and remains largely inaccessible to stroke patients. To be specific, uptake rates in low-middle income countries (LMICs) is pervasively slow, notwithstanding the fact that these countries bear a greater proportion of the global stroke burden. Yet, research on the application of contemporary interventions for acute stroke care in these contexts has been limited. Contextualizing this from the theoretical standpoints of evidence-based practice and knowledge translation, the overall purpose of this thesis was to advance understandings on the extent to which proven interventions for acute stroke care are implemented in standard practice in Ghanaian hospital settings This thesis aimed to 1) examine hospital-based services for acute stroke care and the extent to which such services are consistent with international best practice guidelines for acute stroke care; 2) evaluate in-hospital mortality outcomes among acute stroke patients in Ghanaian hospitals; and 3) explore acute stroke care professionals’ views on the practical barriers to the provision of evidence-based care for acute stroke patients. This thesis comprised three separate but interlinked studies. The first was a multi-site, hospital based survey conducted in 11 referral hospitals (regional and tertiary/teaching hospitals) in Ghana among neurologists, physician specialists and general medical officers. A structured questionnaire was used to gather data on available hospital-based acute stroke services, which were then analysed descriptively. The second study was a retrospective cohort study which evaluated in-hospital mortality outcomes among consecutive acute stroke patients admitted to six referral hospitals, comprising a sample of 300 participants selected randomly, representing about 50 patients from each site. Both descriptive and inferential statistics were used to conduct the analysis. The final study involved a multisite in-depth, semi-structured interview conducted in the retrospective study sites, comprising a purposive sample of 40 acute stroke care professionals (neurologists, emergency physician specialist, non-specialist medical doctors, nurses, physiotherapists, clinical psychologists and dietitian) to explore potential barriers to acute stroke care. Thematic and grounded theory approaches were employed to analyse the data. Overall, the findings showed the availability of evidence-based services for acute stroke care were limited. Only one tertiary-teaching hospital had a stroke unit. Although aspirin therapy was administered in all hospitals, none of the hospitals surveyed offered thrombolytic therapy (thrombolysis). Although eight study sites reported having a brain computed tomographic (CT) scanning, only 7 were functional. Magnetic resonance imaging (MRI scan) services were also limited to only 4 hospitals (only functional in three) within the sample hospitals. Acute stroke care specialists, especially neurologists, were available in 4 of the study hospitals whilst none of the study hospitals had an occupational or speech therapists. The results further highlight inadequate health policy priority towards acute stroke care across the sample hospitals. Evidence from the retrospective study revealed that the delivery of acute stroke care remained variable and patient outcomes, mainly in-hospital mortality, were also higher and varied across the study sites by international comparisons. However, patients provided with aspirin recorded less in-hospital mortality. There was also insignificant variance in-hospital mortality across admitting wards. Hypertension was identified as a significant risk factor for in-hospital mortality. The qualitative interviews also identified four key potential barriers impeding the implementation of evidence-based acute stroke care. These included barriers at the patient (financial constraints, delays, socio-cultural or religious practices, discharge against medical advice, denial of stroke), health system (inadequate medical facilities, lack of stroke care protocol, limited staff, inadequate staff development opportunities), health professionals (poor collaboration, limited knowledge of stroke care interventions) and broader national health policy (lack of political will) levels. Perceived barriers varied across professional disciplines and hospitals. In summary, the findings highlight evidence of only limited application of contemporary acute stroke care interventions, and relatively high in-hospital mortality and morbidity rates, which may be due to multiple barriers to provision of acute stroke care. Decisive and critical decisions are thus required to increase political support for acute stroke care by developing relevant policy to support well-targeted interventions that improve uptake of new treatment options for excellent clinical outcomes, with the ultimate goal of closing the current evidence-practice gap in Ghana and potentially other LMICs.