Dissertations / Theses on the topic 'Evidence-based practices (EBPs)'

The purpose of this action research project was to examine the screening and assessment behaviors of child welfare workers in the southwestern region of the United States. The study addressed whether social workers' knowledge of evidence-based practice influenced their implementation of evidence-based practice in child welfare screening and assessment, and whether the agency environment affects evidence-based practice implementation and use. The family systems theory was used to evaluate child welfare practitioner work and systems theory was used to evaluate the child welfare system in the region of the study. A focus group comprised of seven social workers practicing in the southwestern region was used to determine screening and assessment practices as well as agency factors that affect practice. Social workers' knowledge of evidence-based practices and agency environment were found to impact social workers' use of evidence-based practice. The overuse and misuse of evidence-based practice terminology confused the concept for social workers. This combined with the implementation approach in an agency setting led many of the social workers to avoid evidence-based models and revert to experiential practice knowledge. The client and agency behaviors interpreted in the findings might prompt future research and change to increase the use of evidence-based practice. Implications for social change resulting from these findings include the potential to improve evidence-based practice implementation by agencies and increase of social worker education and knowledge regarding evidence-based practice. These changes could affect greater social change with improved child welfare outcomes.

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Nowadays, there is a tendency for the Health Services to demand changes both in the professional practices and in the management in order to improve the organizational performance. In a hospital organization, the Social Service doesn`t remain free from this demand, and this scenario took us to the following question: How to adapt the Evidence-Based Practice Attitude Scale (EBPAS) to the Brazilian Health Social Service, and how to validate it? Thus, this research aims to adapt e validate the Evidence-Based Practice Attitude Scale (EBPAS) to the Brazilian Health Social Service, and it offers a version for EBPAS which can measure the social worker`s attitude related to the systematization of the professional practices; such version can be useful for future studies related to the elaboration of social protocols. The present research works based on the methodology proposed by Beaton, Bombardier, Guillemin & Ferraz (2000); Beaton, Bombardier, Guillemin & Ferraz (2007). The translation and adaptation process contains five steps: (i) translation, (ii) back translation, (iii) synthesis of the translations, (iiii) evaluation by an expert commitee and (iiiii) pretest. For the psychometric validation, the results presented suggests that the instrument presents a convergent validation, and it can be considered a useful instrument to measure the social workers` attitude related to the adoption of the Evidence Based Practice, making possible its use in the health services when the professionals` readiness related to the implementation of innovative practices has to be measured. The instrument presented easy comprehension and showed also semantic, idiomatic, experimental and conceptual validation. It is evident the need to broaden the fields of the psychometric validation, as well as to diversify the sampling plan.
Há uma tendência, nos dias atuais, dos Serviços de Saúde exigirem mudanças nas práticas profissionais e de gestão com objetivo de melhorar o desempenho organizacional. O Serviço Social, dentro de uma organização hospitalar, não fica isento dessa exigência. Este panorama levou ao questionamento: Como adaptar e validar, para o Serviço Social da saúde no Brasil, o Evidence-Based Practice Attitude Scale (EBPAS)? Sendo assim, o estudo tem como objetivo adaptar e validar o instrumento Evidence-Based Practice Attitude Scale (EBPAS) para o Serviço Social da Saúde no Brasil, propondo uma versão do EBPAS que consiga mensurar a atitude do assistente social frente à sistematização das práticas para futuros estudos na criação de protocolos sociais. O estudo assumiu a metodologia proposta por Beaton, Bombardier, Guillemin & Ferraz (2000); Beaton, Bombardier, Guillemin & Ferraz (2007), o processo de tradução e adaptação foi composto de cinco etapas, (i) tradução, (ii) retrotradução, (iii) síntese das traduções, (iiii) avaliação por um comitê de juízes e (iiiii) pré-teste. Para a validação psicométrica os resultados apresentados sugerem que o instrumento apresenta uma validação convergente, podendo ser considerado como instrumento para mensurar a atitude dos assistentes sociais na adoção de Prática Baseada em Evidências - PBE, possibilitando sua aplicação nos serviços de saúde com vista à prontidão para a implementação de práticas inovadoras. O instrumento mostrou-se de fácil compreensão, apresentando validação semântica, idiomática, experimental e conceitual. Fica claro a necessidade de ampliação de domínios na validação de psicometria, bem como diversificação do plano amostral.

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.

There has recently been an increased pressure in all-healthcare disciplines to provide interventions that are scientific, safe, efficient and cost-effective. Evidence-based practice is said to be the current best approach to address these attributes. All healthcare professionals including physiotherapists need to adopt it. Numerous physiotherapy studies have been carried out to ascertain the attitudes towards, knowledge of, engagement in as well as the barriers of evidence-based practice. These studies were mostly carried out in the developed countries and almost none in the devloping African countries. By means of an exploratory cross-sectional study, deploying both quantitative and qualitative methods, this study investigated the Tanzanian physiotherapists attitudes towards the concept of evidence-absed practice. The study also examined the knowledge that they possess, that could enable them engage in evidence-based related activities. In addition, this study explored the barriers they experience while practicing evidence-based practice.

Orientador: Neusa Maria Costa Alexandre
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Enfermagem
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Resumo: INTRODUÇÃO: A Prática Baseada em Evidência compreende "o uso consciente, explícito e judicioso da melhor evidência atual para a tomada de decisão sobre o cuidar individual do paciente". Para a implantação da prática de enfermagem baseada em evidências, compete ao enfermeiro a busca de estratégias que permitam a utilização de pesquisa na prática. O instrumento "Evidence-based practice questionnaire" (EBPQ), avalia atitudes, conhecimento e implantação da Prática Baseada em Evidências. Utiliza Escala de Likert com pontuação de um a sete em três domínios: prática, atitudes e conhecimentos relacionados à Prática Baseada em Evidências. Mostrou-se uma ferramenta útil para mensurar a implantação desta prática com enfermeiros no Reino Unido e na Espanha. OBJETIVO: O presente estudo tem como objetivo adaptar culturalmente o instrumento EBPQ para a língua portuguesa do Brasil e avaliar suas qualidades psicométricas. METODOLOGIA: Estudo metodológico em que fizeram parte professores e alunos de uma Universidade Pública e enfermeiros de um Hospital Público. Foram seguidos os passos essenciais de adaptação cultural de instrumentos de medida: tradução do instrumento para a língua portuguesa, síntese, retro-tradução, avaliação pelo comitê de juízes e pré-teste. Foi verificada a confiabilidade por meio da avaliação da consistência interna e da estabilidade pelo teste-reteste e a validade de constructo com abordagem de grupos conhecidos, do qual fizeram parte enfermeiros com pós-graduação em Mestrado ou Doutorado e enfermeiros com graduação completa. RESULTADOS: As etapas de tradução, síntese e retro-tradução foram realizadas satisfatoriamente. A avaliação pelo comitê de juízes resultou em alterações em alguns itens, assegurando as equivalências entre as versões original e traduzida. Durante o pré-teste, foi verificada a compreensão dos itens para torná-los mais claros. Na avaliação das propriedades psicométricas, a versão brasileira do instrumento mostrou-se confiável, com Coeficiente Alfa de Cronbach satisfatório em todos os domínios (0,91 ¿ 0,68). O Coeficiente de Correlação Intraclasse, que avaliou a estabilidade do instrumento mostrou-se satisfatório para o instrumento como um todo (0,90). Na avaliação da validade de constructo, o instrumento foi capaz de demonstrar diferenças nos escores entre os grupos conhecidos, com pontuações mais elevadas no grupo de enfermeiros com Mestrado ou Doutorado. CONCLUSÃO: As etapas necessárias para a adaptação cultural de instrumentos de medida foram concluídas com sucesso. A versão brasileira obtida apresenta propriedades psicométricas confiáveis para a sua utilização nessa população
Abstract: INTRODUCTION: The Evidence-Based Practice comprehends "the conscious, explicit and judicious use of current best evidence for decision making about the individual caring of patients". To implement the evidence-based practice of nursing, the nurse is responsible for searching strategies that allow the use of research in practice. The instrument "Evidence-based practice questionnaire" (EBPQ) assesses attitudes toward, knowledge of and use of evidence-based practice. It uses Likert Scale which is a seven point scale used in three areas: practice, attitudes and knowledge related to Evidence Based Practice. It was proved to be a useful tool to measure the implementation of this practice with nurses in the United Kingdom and Spain. OBJECTIVE: This study aims to adapt culturally the tool EBPQ to the Portuguese Language and to evaluate its psychometric qualities. METHODOLOGY: For this methodological study, the participants were some teachers and students of a Public University and some nurses of a Public Hospital. The essential steps of cultural adaptation of measurement instruments were followed: instrument translation into Portuguese language, synthesis, retro-translation, evaluation by the committee of judges and pretest .The reliability was checked by means of evaluation of internal consistency and the stability by test-retest and the construct validity with known groups approach. The first group was formed by nurses with Masters' degree or PhD and the second group was formed by nurses with bachelor's degree. RESULTS: The steps of translation, retro-translation and synthesis were performed satisfactorily. The evaluation by the expert panel resulted in changes in some items, ensuring the equivalence between the original and translated versions .During the pretest, the understanding of the items was done in order to make them clearer. The Brazilian version was reliable , with satisfactory results , and it was obtained Cronbach's alpha similar to International studies for all domains ( .91 to .68 ) .The intraclass correlation coefficient , which evaluated the stability was satisfactory for the instrument as a whole ( 0,90 ) .In the assessment of construct validity , there was significant difference between groups in relation to evidence-based practice , with higher scores in the group of nurses with master's or PhD. CONCLUSION: The necessary steps for the cultural adaptation of the measurement instruments were finished successfully. The Brazilian version obtained presents reliable psychometric properties for its use in this population
Mestrado
Enfermagem e Trabalho
Mestra em Ciências da Saúde

Evidence-based practice (EBP) is a key driver of care and advancements within nursing. It is essential to emphasize EBP early in a nurse's career to promote inquisitive minds and enthusiasm for seeking evidence. The purpose of this project was to implement an EBP mobile app into a nurse residency program (NRP) to improve the process of providing EBP information and resources to new graduate nurses. The intent of the project was to leverage mobile technology to engage new graduate nurses in evidence-based practice. Roger's diffusion of innovation framework guided the project. The target audience for the project was 16 new graduate RNs participating in a health system's NRP who attend the EBP module and were required to complete an EBP project. The EBP module was provided during a classroom lecture and the mobile application was downloaded. After using the EBP module, all attendees were sent an electronic survey with open-ended questions related to the mobile application. Responses were reviewed to identify patterns. Survey responses reflected that a 50% did not utilize the mobile application. However, those that did use the mobile application (50%) found it useful and had a positive perception of the mobile application. Continued use of the mobile application and promotion of the mobile application for new graduate nurses may help with their own personal development of an EBP project. Ultimately, allowing nurses to effectively integrate nursing research into practice and impact patient care quality. This project impacted social change by empowering new nurses with knowledge and information related to evidence based practice and allowed for increased information to be accessible to a large audience of new graduate nurses.

Evidence-based practice (EBP) is well-established as the gold standard for service delivery of quality healthcare around the world, yet there remains a significant gap between best available evidence and its everyday use in maternity services. The numerous benefits of EBP are therefore never realised and although a considerable body of knowledge has evolved on how to promote the uptake of new EBPs, little is known about midwives’ experience of implementing EBP or leading practice change projects in clinical areas. The aim of this study was to work collaboratively with midwives towards the co-development of an evidence implementation resource, designed to provide clear direction and support to midwives wanting to implement new EBPs in clinical areas. This led to the design of a blueprint for an eTool(KIT) for midwives, outlining a stepby- step approach to leading practice change projects in clinical areas. A qualitative approach to the study design was adopted and critical realism employed as the philosophical underpinning for this research inquiry. Seventeen Australian midwives consented to participate in either a focus group discussion or face-to-face interview, which were audio recorded, transcribed and combined with additional field notes to provide a collection of data that was analysed and reported. Three higher order codes were synthesised from the findings to make overall meaning of the factors that contribute to the adoption of EBP in midwifery: “It’s hard to overcome the resistance towards new EBP, midwives are passionate yet reticent towards leading practice change”, “Inter-disciplinary collaboration and organisations supportive of change are key to improving implementation processes for midwives”, and “ To lead practice change initiatives, midwives require knowledge of system-level change and a clear process for evidence implementation”. The findings revealed that although midwives are passionate iv about EBP, they express reticence towards leading practice change for numerous reasons. These reasons contribute to the inconsistent and sub-optimal use of EBP in Australian maternity services. As such, this study offers a pragmatic approach to organisational change and demonstrates the potential for midwives to be leader of evidence-based change and key stakeholders in all future practice change projects in Australian maternity services.

Magister Psychologiae - MPsych
Evidence-based practice (EBP) has been internationally recognised as the gold standard for the provision of safe and compassionate health care, and entails integrating clinical expertise with the best available research evidence in order to make effective decisions about the care of patients. The adoption of EBP remains slow, and this has been identified as a significant public health concern as few people with mental disorders in South Africa are treated using evidence-based psychological treatments (EBTs). Proponents of EBP have argued that the most effective way of sustaining the use of EBTs is by adopting EBP as a guiding pedagogical principle in professional psychology training programmes. For such efforts to be successful, it is pertinent to assess the receptiveness of the target population. Attitudes towards EBP remain the top indicator of successful adoption. The current study explored the attitudes and receptiveness towards EBP among clinical and counselling psychology students (N=57) at 11 accredited institutions nationally. Participation in the study was voluntary and the procedure followed all ethical requirements. All data collection occurred online. Participants completed a general questionnaire, the Evidence-Based Practice Attitudes Scale-15 (EBPAS-15) and the Organisational Culture and Readiness for System-wide Integration of Evidence-based Practice (OCRSIEP) Scale All data collection instruments demonstrated sound psychometric properties. A major finding of this study was that clinical and counselling psychology students reported favourable attitudes and receptiveness towards the adoption of EBP. The overall score on the EBPAS-15 indicated that students were likely to adopt EBP, while results on the ORCSIEP overall score indicated that they were receptive towards EBP and were ready to adopt EBP. An exploration of the association between attitudes and receptiveness towards EBP indicated that no correlation exists. Additionally, factors such as age, gender, psychology programme enrolment and preferred therapeutic orientation were not significantly associated with attitudes and receptiveness towards EBP. In conclusion, the results of this study suggest that there is a sound foundation on which to incorporate EBP into the professional training programmes of psychology students.

The purpose of this exploratory study was to examine school psychologists' use of evidence- based practices (EBP), in general, and more specifically in the area of social skills training (SST) for students with autism spectrum disorders (ASD). Study participants, consisting of 498 school psychologists from across the nation, participated in an online survey that gathered information about their training, attitudes, and practices. The frequency with which specific EBP practices for social skills training for students with ASD was examined, as was prediction of use of these practices. Multiple-regression analyses revealed multiple independent variables that were predictors for overall use of EBP. Results indicated that over half of the participants provide SST for students with ASD. Although the majority of participants indicated that their graduate program included at least one course with information about ASD and EBP practices, in general, nearly half indicated that their coursework did not include any courses that directly addressed social skills training for students with ASD. Confirmatory factor analysis (CFA) was used to determine the extent to which the data fit the factor model. Participants' perception of the importance placed on EBP by their school district, scores on the openness subscale of the Evidence Based Practices Assessment Scale, perception of how well their graduate program prepared them in the EBP process, perception of whether they were adequately trained in the area of SST for students with ASD, and having a caseload evenly divided among settings were significant predictors of overall use of EBP.

The purpose of this study was to examine the perceptions of first-year teachers regarding the use of Evidence-Based Practices (EBPs) within their teacher training programs. Participants in this study included 35 teachers from one of the 46 rural public-school districts in south-central Missouri. The 43 EBPs outlined in Robert Marzano’s (2017) New Art and Science of Teaching: More than Fifty New Instructional Strategies for Academic Success were used to frame the research. A survey with Likert-type statements and open-ended questions regarding EBPs taught in teacher preparation programs was completed by participants. Participants were asked to identify EBP strengths and weaknesses of their preparatory programs. Data revealed participants believed four key areas needed to be covered more in-depth within instructional programs: 1) creating and utilizing assessments, 2) classroom management strategies, 3) engaging and motivating reluctant learners, and 4) time management techniques. Participants also indicated the desire to have spent more time in classrooms completing fieldwork, as they believed this to be a valuable part of the training programs. The data suggested reflective practice of theory and classroom experience should be increased in teacher preparation programs.

The purpose of this study is to examine the attitudes and beliefs of art therapists towards Evidence-Based Practices (EBP). EBP is a rising trend in healthcare that refers to the process of using empirically validated research to make clinical decisions that best meet the needs of each client (Patterson, Miller, Carnes & Wilson, 2004).The investigators used a mixed methods approach to the research topic. Part A consists of a survey distributed to graduates of the Department of Marital and Family Therapy (MFT) at Loyola Marymount University (LMU). In addition to answering questions, survey participants were asked to create an art response depicting their perspective on the relationship between art therapy and EBP. In the second phase (Part B), the researchers used an arts-based methodology to further explore the findings from Part A. Part B involved the creation of key idea cards pulled from the literature review and the findings, individual art responses by each investigator, and verbal and written analyses of the content and process. The idea that art therapists are already integrating EBP and art therapy in their practices emerged as the major finding of the research. This realization that clinicians are already at the intersection of EBP and art therapy was a contrast to the cautious divided attitudes that were discovered in the literature review. Further research could not only strengthen the evidence base of art therapy, but also illuminate how exactly therapists have managed to bridge the gap between EBP and art therapy.

This poster presents development and pilot-testing of an electronic survey evaluating behavior analysts perceptions and use of Evidence-Based Practices (EBPs). Demographic information, ratings of quality indicators (Horner et al 2005) in evaluating and choosing behavior interventions, and resources identifying EBPs were assessed. Fourteen graduate trainees in a behavior analysis certification program were participants. Test-retest intra-rater agreement was assessed approximately 2 weeks apart and varied considerably across survey items. Overall exact agreement was 71 % while agreement within 1 rating point was 91 %. The most highly rated quality indicators were clear descriptions of baseline and intervention conditions, measures of inter-observer agreement, and repeated measures of target behaviors. Lowest rated were group experimental designs, statistical analyses, and numbers of participants. Surprisingly, multiple studies with 20+ participants, integrated intervention packages, and written intervention manuals were not as highly rated. Most frequently reported EBP sources were professional society websites, university courses, practitioner journals, and professional peer-reviewed journals. Least frequently reported were webinars by private entities, non-peer-reviewed journals, and government websites (e.g., What Works Clearing House). Participants identified time constraints, difficulty finding research relevant to their current situation and technical rather than practical nature of research as impediments to keeping current with EBPs

This research was undertaken to study the impact of single and multicomponent knowledge translation interventions (KTIs) on barriers to the integration of Clinical Practice Guidelines (CPG) into Clinical Decision Making (CDM) in the context of physical therapists (PTs) and find out which of the two KTIs was more effective. A literature review showed that research knowledge (e.g. CPG) in the field of PT (Physical Therapy) is not being integrated in to clinical practice (e.g. CDM), thus leading to a research-practice (R-P) gap in other words CPG-CDM gap. It is suggested in the literature that the management and behavioural aspects of PTs might be acting as barriers hindering the integration of the research knowledge into clinical practice consequently affecting the delivery of optimum patientcare. Remedial measures, namely KTIs, are suggested to address those barriers and to bridge the R-P gap. However, the phenomenon of the R-P gap, the causes of it and the possible interventions are not well understood concepts in the literature, particularly in the context of PTs. CPG for Venous Thromboembolism (VTE) in PT was chosen as the example of research knowledge. It was argued that barriers have the potential to affect CDM which in turn can affect the CPG-CDM gap. Lack of knowledge about CPG-CDM gap is a major limitation in the literature that is affecting the integration of CPG into CDM. Other gaps found in the literature that have the potential to affect CPG-CDM gap include management and behavioural variables as probable causes of CPG-CDM gap (or barriers), use of KTIs to bridge the CPG-CDM gap and, KTIs. Furthermore, lack of knowledge about relationship between barriers and CPG-CDM gap, KTIs and barriers, KTIs and CPG-CDM gap and the impact of KTIs (effectiveness) in bridging CPG-CDM gap were the other gaps found in the literature that had potential implications to CPG-CDM gap. These gaps were addressed in this research to some extent. Relationships between the independent variables (lack of knowledge of PTs in CPG, lack of favourable attitude of PTs towards CPG and lack of self-efficacy and motivation of PTs to integrate CPG into CDM) and the dependent variables (CDM and CPG-CDM gap) were defined and models were proposed. Further, it was posited that KTIs could impact barriers based on theories and models found in the literature that provided some basis to create the linkage between KTIs and management and behavioural barriers. Education material (EM) and virtual communities of practice (VCoP) were chosen as of the KTIs in this study. The models of Cabana et al. (1999) and Fischer et al. (2016), primarily, were used to ground the conceptual models represented by figures and equations. Methodologically, a positivist approach with an objective ontological stance was employed and a deductive approach and quantitative research method were used to address the research gaps. The research design included a longitudinal element and survey questionnaire. The target population was licensed PTs in the USA. Random sampling was used. Two groups of PTs were identified namely EM-group and VCoP group. Data was collected from the groups before and after administering the KTIs. The results showed that single and multicomponent KTIs impacted barriers in different ways. EM impacted lack of favourable attitude of PTs towards CPG, and lack of self-efficacy and motivation of PTs to integrate CPG into CDM as barriers and narrow the CPG-CDM gap. VCoP was found to impact the combination of four barriers and narrow CPG-CDM gap. In addition, barriers in groups of two were also impacted by VCoP and narrowed the CPG-CDM gap. Furthermore, a CPG knowledge score card and a corresponding CDM score card developed by the researcher were used to test the change behaviour of PTs in integrating CPG into CDM. This experiment showed that barriers existed and caused CPG-CDM gap and KTIs could narrow the CPG-CDM gap. The findings indicate that this research has contributed to knowledge in many ways, including unearthing the relationship between CPG-CDM gap and barriers, better understanding of KTIs, their relationship with CPG-CDM gap and barriers, gaining knowledge about the impact of single and multicomponent KTIs on single and multiple barriers and identification of methods to bridge the CPG-CDM gap.

There has been a recent expansion of community-based coalitions to address issues related to youth substance use. Research on their overall effectiveness, however, has produced mixed results. Recommendations to improve coalition success have emphasized the high-quality implementation of evidence-based programs targeting specific community needs. Coalitions vary extensively, however, in their organization and functioning. In addition, the lack of a universally accepted theoretical framework to understand coalition functioning has led to inconsistencies in the coalition research and the specific constructs used to describe coalition functioning. Purpose of the Study: To address these gaps, the current study used a case study approach to describe the organization and functioning of four local substance abuse coalitions and to identify factors related to coalition high-quality implementation of evidence-based programs. Methods: Using constructs based on Community Coalition Action Theory, the current study used coalition member surveys and key leadership interviews to produce separate case study descriptions of four participating community substance abuse coalitions. An exploratory factor analysis was conducted to examine the structure of the survey measure. Univariate statistics were used to describe coalition functioning and attitudes toward evidence-based practice and implementation. One-way analysis of variance tests were employed to examine differences across the coalitions and Pearson's product-moment correlations were used to identify coalition characteristics associated with attitudes toward evidence-based practice. A thematic analysis of interview data was conducted for an in-depth examination of coalition functioning and perceptions of evidence-based practice. Results: Coalition members and leaders reported high levels of functioning across all of the included domains. However, several differences in coalition background and structure were discussed. Community support was described as a major functioning challenge across both surveys and interviews. Interview results also revealed several different coalition belief patterns surrounding evidence-based practice and quality implementation. Coalition members and leaders generally indicated positive attitudes toward the use of evidence-based prevention programs and strategies. However, varying levels of knowledge and experience with evidence-based practices was identified across interviews. Interviews also highlighted several factors that influence coalition decision-making and identified several perceived challenges associated with the use of evidence-based practices. Results include a discussion of coalition knowledge, perceptions, and experiences with program implementation. Conclusions and Implications: Taken together, these findings form a basis for better understanding the current environment surrounding community substance abuse coalition functioning and implementation of evidence-based practices. Several factors were shown to influence coalition decision-making processes and overall functioning. In addition, the present study highlights strengths and gaps related to coalition leadership knowledge, attitudes, and implementation of evidence-based programs and strategies. These identified relationships can be used to guide future research and community practice. With their growing popularity, it is likely that community coalitions will take on a major role in future community-based prevention efforts across the country. As such, there is a need to design substance abuse prevention programming with coalitions in mind and to identify alternative avenues to disseminate information surrounding community-focused evidence-based practices. Identifying new ways to measure and build coalition processes, leadership skills, and structures could result in greater coalition capacity to plan for and support prevention activities, including use of evidence-based practices.

Introducción Aunque la Práctica Basada en la Evidencia mejora la calidad de los cuidados existe una falta de implementación de la misma en el ámbito de Atención Primaria (AP). El objetivo de este estudio es explorar los factores que influyen en el uso implementación de EBE en AP de Baleares. Contenido de la investigación En una primera fase se diseñó un estudio observacional transversal multicéntrico utilizando los cuestionarios PES-NWI, que valora el entorno para una PBE, y el EBPQ que valora los conocimientos, uso y actitudes de las enfermeras hacia la PBE. Posteriormente se realizó un estudio cualitativo en el que se realizaron cinco grupos de discusión desde una perspectiva fenomenológica. Conclusión La actitud de las enfermeras de AP hacia la EBE es muy positiva pero no se sienten apoyadas por la organización, por lo que sería importante que las instituciones realizasen una gestión más profesional y menos politizada que facilitara el uso e implementación de EBE. Bibliografía Brown, C.E., Wickline, M.A., Ecoff, L., Glaser, D., 2008. Nursing practice, knowledge, attitudes and perceived barriers to evidence-based practice at an academic medical center. Journal of Advanced Nursing 65 (2), 371-381. Fineout-Overholt, E., Williamson, K.M., Gallagher-Ford, L., Melnyk, B.M., Stillwell, S.B., 2011. Evidence-Based Practice, Step By Step: Following the Evidence: Planning for Sustainable Change. AJN The American Journal of Nursing 111 (1), 54. Thompson, D.S., Estabrooks, C.A., Scott-Findlay, S., Moore, K., Wallin, L., 2007. Interventions aimed at increasing research use in nursing: a systematic review. Implementation Science 2 (1), 15. Pericàs, J., González, S., De Pedro, J., Morales, J. M., & Bennasar, M. (2014). Perception of Spanish primary healthcare nurses about evidence-based clinical practice: a qualitative study. International Nursing Review, 61(1), 90-98. doi: 10.1111/inr.12075
Introducció Encara que la Pràctica Basada en l'Evidència millora la qualitat de les cures, hi ha una manca d'implementació de la mateixa en l'àmbit d'Atenció Primària (AP). L’objectiu d’aquest estudi és explorar els factors que influeixen en l’ús i l’ implementació d’EBE en AP de Balears. Contingut de la investigació En una primera fase es va dissenyar un estudi observacional transversal multicèntric utilitzant els qüestionaris PES-NWI, que valora l'entorn per a una PBE, i el EBPQ que valora els coneixements, ús i actituds de les infermeres cap a la PBE. Posteriorment es va realitzar un estudi qualitatiu en què es van realitzar cinc grups de discussió des d'una perspectiva fenomenològica. Conclusió L'actitud de les infermeres d'AP cap a l'EBE és molt positiva però no se senten recolzades per l'organització, pel que seria important que les institucions realitzessin una gestió més professional i menys polititzada que facilités l'ús i implementació d'EBE . Bibliografia Brown, C.E., Wickline, M.A., Ecoff, L., Glaser, D., 2008. Nursing practice, knowledge, attitudes and perceived barriers to evidence-based practice at an academic medical center. Journal of Advanced Nursing 65 (2), 371-381. Fineout-Overholt, E., Williamson, K.M., Gallagher-Ford, L., Melnyk, B.M., Stillwell, S.B., 2011. Evidence-Based Practice, Step By Step: Following the Evidence: Planning for Sustainable Change. AJN The American Journal of Nursing 111 (1), 54. Thompson, D.S., Estabrooks, C.A., Scott-Findlay, S., Moore, K., Wallin, L., 2007. Interventions aimed at increasing research use in nursing: a systematic review. Implementation Science 2 (1), 15. Pericàs, J., González, S., De Pedro, J., Morales, J. M., & Bennasar, M. (2014). Perception of Spanish primary healthcare nurses about evidence-based clinical practice: a qualitative study. International Nursing Review, 61(1), 90-98. doi: 10.1111/inr.12075
Introduction Although Evidence-Based Practice improves the quality of care there is a lack of implementation in Primary Health Care (PHC) services. The aim of this study is to explore the factors that influence on the use and EBN implementation in the Balearics PHC. Research content In the first phase a multicenter cross-sectional study was designed using two questionnaires, the PES-NWI which assessed the environment for EBN, and EBPQ that values knowledge, use and attitudes of nurses towards the EBN. Subsequently, a qualitative study in which five focus groups were conducted from a phenomenological perspective, was performed. Conclusion The attitude of PHC nurses towards the EBN is very positive but they don’t feel supported by the organization, it would be important that institutions should do a more professional and less politicized management to facilitate the use and implementation of EBN. Bibliography Brown, C.E., Wickline, M.A., Ecoff, L., Glaser, D., 2008. Nursing practice, knowledge, attitudes and perceived barriers to evidence-based practice at an academic medical center. Journal of Advanced Nursing 65 (2), 371-381. Fineout-Overholt, E., Williamson, K.M., Gallagher-Ford, L., Melnyk, B.M., Stillwell, S.B., 2011. Evidence-Based Practice, Step By Step: Following the Evidence: Planning for Sustainable Change. AJN The American Journal of Nursing 111 (1), 54. Thompson, D.S., Estabrooks, C.A., Scott-Findlay, S., Moore, K., Wallin, L., 2007. Interventions aimed at increasing research use in nursing: a systematic review. Implementation Science 2 (1), 15. Pericàs, J., González, S., De Pedro, J., Morales, J. M., & Bennasar, M. (2014). Perception of Spanish primary healthcare nurses about evidence-based clinical practice: a qualitative study. International Nursing Review, 61(1), 90-98. doi: 10.1111/inr.12075

In the United States, one in every 100 adults is confined to a correctional facility. Approximately 60% of inmates have an alcohol use disorder (AUD). When compared to the general population, inmates are twice as likely to have AUD. As they are unable to readily access alcohol, inmates entering a correctional facility with AUD are at high risk for the lethal alcohol withdrawal syndrome (AWS). AWS is preventable and yet correctional nurses process new inmates without an evidence-based clinical practice guideline (CPG) to assess for AUD, the prerequisite for AWS. The purpose of this project was to develop an evidence-based CPG with implementation algorithm to guide the inmate assessment for AUD. The ACE star model of knowledge transformation guided the project, the AGREE II was used to develop the CPG, and the Delphi technique was used to evaluate the final CPG with algorithm. Nationally, 20 correctional health experts were identified and asked to participate in the Delphi expert panel, although 11 experts agreed to participate only 9 completed the evaluation. The experts were correctional health experts, nurses and physicians, from different regions of the United States. The resulting CPG satisfied all 23-items of the AGREE II. Through 2 Delphi panel rounds, all participants recommended the CPG with minor modifications (6 experts recommended as presented while the 3 recommended with modifications). At the project conclusion, all 9 experts agreed the CPG will help improve the identification, referral, and management of inmates with AUD. This project contributes to positive social change as the CPG addresses a serious problem, AUD with possible AWS, in a vulnerable population. The CPG may be generalizable for use in other correctional facilities.

Background When planning evidence‐based intervention services for children with phonology‐based speech sound disorders (SSD), speech and language therapists (SLTs) need to integrate research evidence regarding service delivery and intervention intensity within their clinical practice. However, relatively little is known about the optimal intensity of phonological interventions and whether SLTs’ services align with the research evidence. Aims The aims are twofold. First, to review external evidence (i.e., empirical research evidence external to day‐to‐day clinical practice) regarding service delivery and intervention intensity for phonological interventions. Second, to investigate SLTs’ clinical practice with children with phonology‐based SSD in Australia, focusing on service delivery and intensity. By considering these complementary sources of evidence, SLTs and researchers will be better placed to understand the state of the external evidence regarding the delivery of phonological interventions and appreciate the challenges facing SLTs in providing evidence‐based services. Methods & Procedures Two studies are presented. The first is a review of phonological intervention research published between 1979 and 2016. Details regarding service delivery and intervention intensity were extracted from the 199 papers that met inclusion criteria identified through a systematic search. The second study was an online survey of 288 SLTs working in Australia, focused on the service delivery and intensity of intervention provided in clinical practice. Main Contributions There is a gap between the external evidence regarding service delivery and intervention intensity and the internal evidence from clinical practice. Most published intervention research has reported to provide intervention two to three times per week in individual sessions delivered by an SLT in a university clinic, in sessions lasting 30–60 min comprising 100 production trials. SLTs reported providing services at intensities below that found in the literature. Further, they reported workplace, client and clinician factors that influenced the intensity of intervention they were able to provide to children with phonology‐based SSD. Conclusions & Implications Insufficient detail in the reporting of intervention intensity within published research coupled with service delivery constraints may affect the implementation of empirical evidence into everyday clinical practice. Research investigating innovative solutions to service delivery challenges is needed to provide SLTs with evidence that is relevant and feasible for clinical practice

Addiction Severity Index (ASI) är tänkt att användas både för klientarbete på individnivå och för forskning på gruppnivå. Denna studie undersöker i vilken omfattning ASI-Uppföljning genomförs samt vilka individ- och organisationsfaktorer som påverkar användningen. Studien är kvantitativ dvs presenterar statistiska analyser. Data samlades in på två sätt. Tillgång till ASI-data gjordes möjlig genom en avidentifierad fil från databasen ASI-Net och omfattade data från elva kommuner i Jönköpings län. ASI-data bestod av 1964 intervjuer från ASI-Grund och ASI-Uppföljning och behövdes för undersökningen av individfaktorerna. Data angående organisationsfaktorerna samlades in genom webbenkäter till cheferna inom Individ- och Familjeomsorg (IFO) i samma elva kommuner. Resultatet visar att andelen uppföljningsintervjuer ökar för varje år och att det föreligger stora skillnader mellan kommuner i genomförande av andelen uppföljningsintervjuer. Analysen av individfaktorerna tyder på att de äldre, med högre utbildning och ett yrke återintervjuas i högre utsträckning. Klienterna med stora problem och hjälpbehov med alkohol genomgår i högre grad en uppföljningsintervju, medan mer problem med narkotika och rättsliga problem tenderar att följas upp i mindre grad. Analysen av organisationsfaktorerna kunde ej på meningsfullt sätt signifikansprövas då populationen för webbenkäten var liten. Dock upptäcktes korrelation mellan andelen uppföljningsintervjuer för varje kommun och två organisationsfaktorer, befolkningsmängd i kommunerna samt personalomsättning. Organisationsfaktorerna visar tvärtemot förväntat att små kommuner följer upp en högre andel, och att faktorer som personalomsättning, utbildning och ärendemängd inte förklarar de skillnader som finns.  Studiens slutsats visar att andelen genomförda ASI-Uppföljning ökar kontinuerligt. Även om ASI-Uppföljning ökar så är det långt kvar till dess att ens hälften av alla ärenden med ASI-Grund återintervjuas. För att öka motivationen att genomföra uppföljningsintervjuer kan det vara viktigt att socialsekreterarna får mer tillbaka i form av sammanställningar och analyser på gruppnivå.
Addiction Severity Index (ASI) is thought to be used both for client work at the individual level and for research at a group level. This study examines the extent to which the ASI Follow-up is carried out, and the individual and organizational factors influencing the usage. The study is quantitative, i.e. presents statistical analyzes. Data were collected in two ways. Access to ASI data was made possible by an anonymous file from the database ASI-Net and included data from eleven municipalities in Jönköping County. ASI data consisted of 1,964 interviews from ASI Basic and ASI Follow-up and was needed for the investigation of individual factors. Data regarding organizational factors was collected through web surveys to managers in Individual and Family Care (IFO) in the same eleven municipalities. The result shows that the percentage of follow-up interviews is increasing every year and that there are large differences between municipalities in the usage of the percentage of follow-up interviews. The analysis of individual factors suggest that the elderly, with higher education and a profession are interviewed to a greater extent. Clients with serious problems and in need of help with alcohol also undergo follow-up interviews more frequently, while more problems with drugs and legal problems tend to be followed-up to a lesser degree. The analysis of organizational factors could not in a meaningful way be tested for significance since the population for the web survey was small, however, correlation was discovered between the percentage of follow-up interviews for each municipality and organizational factors of population in municipalities and employee turnover. Organizational factors show the contrary as expected that small municipalities follow up to higher degree, and that factors such as staff turnover, training and case quantity does not explain the existing differences. The study's conclusions are that the percentage of ASI Follow-up is continuously increasing. Although the ASI follow-up is increasing, it is a long way until the even half of all cases with ASI Basic are re-interviewed. To increase the motivation to carry out follow-up interviews, it may be important for the social workers to get back more in the form of summaries and analyzes at the group level.

Background Internationally, speech and language therapists (SLTs) are involving parents and providing home tasks in intervention for phonology-based speech sound disorder (SSD). To ensure that SLTs’ involvement of parents is guided by empirical research, a review of peer-reviewed published evidence is needed. Aims To provide SLTs and researchers with a comprehensive appraisal and analysis of peer-reviewed published intervention research reporting parent involvement and the provision of home tasks in intervention studies for children with phonology-based SSD. Methods & Procedures A systematic search and review was conducted. Academic databases were searched for peer-reviewed research papers published between 1979 and 2013 reporting on phonological intervention for SSD. Of the 176 papers that met the criteria, 61 were identified that reported on the involvement of parents and/or home tasks within the intervention. These papers were analysed using a quality appraisal tool. Details regarding the involvement of parents and home tasks were extracted and analysed to provide a summary of these practices within the evidence base. Main Contribution Parents have been involved in intervention research for phonology-based SSD. However, most of the peer-reviewed published papers reporting this research have provided limited details regarding what this involved. This paucity of information presents challenges for SLTs wishing to integrate external evidence into their clinical services and clinical decision-making. It also raises issues regarding treatment fidelity for researchers wishing to replicate published intervention research. Conclusions & Implications The range of tasks in which parents were involved, and the limited details reported in the literature, present challenges for SLTs wanting to involve parents in intervention. Further high-quality research reporting more detail regarding the involvement of parents and home tasks in intervention for SSD is needed.

Evidence-based practice (EBP) is used worldwide to improve the quality of patient care to provide cost-effective care. EBP is a mandate for nursing practice combining individual clinical judgment with available expertise to generate a positive outcome for the patient. Investigators have documented that nurses have varying degrees of confidence and knowledge about EBP. The purpose of this project was to improve knowledge of EBP among registered nurses (RNs). The ACE Star Model of Knowledge transformation was used as the conceptual model. The key project question was to assess the level of knowledge and confidence about EBP among RNs in a cardio-thoracic (CT) intensive care unit (ICU) before and after viewing a computer-based EBP educational module. The quasi-experimental project used a 1 group pretest-posttest design. In the pretest, a convenience sample (n = 29) completed ACE-ERI competencies to self-assess confidence in EBP and an EBP Knowledge Test. The participants then viewed an EBP educational module based on major steps in EBP practice. Afterward, they repeated both tests. As a group, the paired t test showed a significant increase in scores for the ACE-ERI competencies between pretest and posttest scores. Using the Wilcoxon Signed Rank Test, knowledge scores increased but were not statistically significant. These findings suggested that there was improvement in both confidence and knowledge supporting the use of the educational module. In order to effectively implement EBP, nurses require knowledge to assess the quality and evidence for improved patient outcome. These results can guide administrators and educators to enhance RN EBP by the use of educational modules to improve the quality of patient care creating positive social change.

Autism Spectrum Disorder (ASD) is a low-incidence disorder with high impacts on individuals, families, and society. School-based speech-language pathologists (SLPs) have tremendous responsibilities toward individuals with ASD, but pre-service SLPs are not adequately trained to fulfill these expectations. In order to reduce the widespread financial and social impact of ASD, school-based SLPs need to complete effective training to prepare them for the selection of established social-communication practices. One framework for the selection of individualized intervention is the Ziggurat Model (Aspy & Grossman, 2008). The following study used mixed methods to investigate the research question: “Does the ASD knowledge base of ASHA-certified school-based SLPs change when they complete an online training module based upon Aspy and Grossman’s Ziggurat Model? If so, what are those changes?” A pre-test post-test control group design demonstrated a significant difference in the experimental group’s and the control group’s pre-test post-test change scores, as demonstrated by an independent samples t-test (p=.039, 18df). Qualitative data analysis resulted in six themes. While the online training of Aspy and Grossman’s Ziggurat Model used in this study was an effective method with which to train school-based SLPs in using a comprehensive framework, more rigorous research is needed on this model relative to the selection of intervention.

There is an identified problem with patients receiving suboptimal pain management at a hospice agency in the northwestern United States. At this agency, undertreatment of pain is prevalent. Evidence indicates that this may be a result of a lack of guidelines, education, and knowledge of appropriate prescribing. Known barriers to the correct prescription and administration of potent opioids in the hospice setting include prevailing beliefs, knowledge, skills, and attitudes, all of which can impact care negatively. Contextually, hospice principles mandate patient comfort and caregiver involvement in continuous quality improvement, which includes adequate and informed pain management. Moreover, hospice metrics demand requisite knowledge, skills, and attitudes for optimal care, including pain management at the end of life. The Academic Center for Evidence-Based Practice (ACE) star model was used to guide the development of an evidence-based, guideline-supported educational program that will improve pain management at the hospice agency when implemented. The purpose of this project was to use transdisciplinary expertise and team collaboration to develop the program and then to conduct a formative and summative evaluation utilizing experts to prepare the guidelines and process for implementation. Ten experts reviewed the guideline, the educational materials, the process, and the evaluation plan and conducted reviews using the AGREE II tool. The panel of experts agreed within the 6 AGREE domains. Future implementation of this guideline, translation process, and evaluation tool will impact social change through the empowerment of the clinical staff, patients, and caregivers to provide the best pain control and comfort at end of life, a vulnerable time for all patients.

For many years, Sweden has had a reputation for having a comprehensive and women friendly welfare state. However, as in many other European countries during the past few decades, the organization and governing of welfare has undergone profound changes. Through interviews with social workers and the application of theories of governmentality, this thesis analyzes the expressions and consequences of such current organization and governing. One result is that the introduction of meticulous documentation practices of social workers contact with clients, regulate their interaction and constitute a control over both client and social worker. Another result is that the current organization fragments labor and awards more authority to managers, which functions to produce loyalty to the organization and management, rather than clients. This is expressed in demands not to voice protest, as it is said to create a bad mood. It is also expressed in demands to spend as little as possible on clients; short duration of treatment, preference for outpatient treatment and by making it difficult to receive financial support. This austerity is legitimized through the intermeshing of different ideals; budget awareness, evidence that supports short and outpatient treatment and that clients in order to change their course of life should to be allowed or coerced into taking individual responsibility. Another important finding is that the current governing and organization of social work produce distance and detachment, and thus discourage caring subjects. This is a complex process in which an assemblage of different techniques and rationalities undermines the cultivation of a relationship between social worker and client. 1) The ideal of evidence-based practice favors rigid methods over a flexible and holistic approach. 2) Ideals of rationality, closely connected to notions of masculinity and professionalism, value objectivity and devalue and deter the surfacing of emotions. 3) Meticulous practices of documentation reduce the amount of time available to meet clients. 4) Ideals and particular methods designed to promote individual responsibility in clients legitimize social workers distancing themselves from clients’ dependency and needs. 5) A division of labor, in either assessment or treatment, reduces time spent with clients for those who work with assessment and ultimately engage in the rationing of resources. 6) Standardized digital templates, installed to aid in assessments, regulate and proceduralize interactions with the client. 7) Austerity, heavy workloads, individualized responsibility and stress further accentuate distance, as detachment becomes a means to cope with arduous working conditions. The transformation of social work described above produces alienation and a fragmentation of social workers’ collective subjects. Simultaneously, an ethos of caring makes some social workers work extra hard to provide for clients, which ultimately covers for flaws in the system. Although such an ethos of caring allows for the further exploitation of social workers, it is also understood as a means of resistance, which in turn also forms the basis for organized resistance.
Sverige har ett internationellt rykte för att ha en omfattande och kvinnovänlig välfärd. Även om riktigheten i en sådan uppfattning sedan länge ifrågasatts har på senare år, likt i många andra Europeiska länder, det svenska välfärdssystemet genomgått en omfattande förändring i avseende på dess räckvidd, men också dess organisering och styrning. Fokus för denna studie är just denna organisering och styrning, och mer specifikt, hur detta påverkar ett av välfärdens kanske mest centrala område: socialt arbete. Genom att intervjua socialarbetare undersöks i denna studie uttryck för och konsekvenser av en sådan förändring, bland annat genom att undersöka hur könsbundna föreställningar och förväntningar är sammanflätade med det sociala arbetets organisering och styrning. I studien konstateras att socialarbetare erfar att deras arbete genomgått omfattande förändringar, vilket kopplas ihop med både organiseringen och styrningen av det sociala arbetet. Detta uttrycks både i de ideal som kringgärdar arbetet men också i dominerande arbetssätt. En sådan förändring är införandet av  omfattande dokumentationsprocedurer av socialarbetarens arbete och kontakt med klienter, vilket medför att kontakten med klienterna blir ytligare. Dokumentationsprocedurerna utgör också en sorts kontroll av både klienterna och socialarbetarna själva. En annan förändring som konstateras är att nya organisationsmodeller och en förändrad ledarskapskultur skapar förväntningar på socialarbetarna att vara lojala med organisationen och ledningen snarare än klienterna. Bland annat utrycks detta genom förväntningar att inte protestera och skapa dålig stämning på arbetsplatsen, men också genom uttalade krav att spendera så lite resurser som möjligt på klienterna; korta behandlingstider, öppenvårdsalternativ och orimligt hårda krav för att få ekonomiskt bistånd. Detta legitimeras genom sammanväxningen av flera olika ideal; budgetmedvetenhet, att klienter inte mår bra av långa institutionsvistelser, men också att klienterna ska tillåtas eller bör tvingas att klara att sig själva. Ett av studiens huvudresultat är att den nuvarande organiseringen och styrningen av socialt arbete skapar avstånd och likgiltighet. Genom flera sammankopplade ideal och arbetssätt styrs dagens socialarbetare till att bry sig mindre om de klienter de möter. På så sätt undermineras förutsättningarna för framväxten av en djup relation mellan socialarbetare och klient; 1) Idealet och kravet att socialarbetare ska arbeta utifrån evidens, det vill säga metoder och förhållningssätt som i speciellt utformade utvärderingsmodeller visat sig ha effekt, gör att väl strukturerade och rigida metoder ges företräde. Denna instrumentalisering underminerar ett flexibelt, relationsorienterat och helhetsfokuserat sätt att arbeta. Dessutom gör evidensidealets fokus på enskilda individer och avgränsade utvärderingstider att mer samhällsinriktat kritiskt och långsiktigt inriktat arbete undermineras. 2) Ett rationalitetsideal, tätt sammanbundet med föreställningar om professionalitet och maskulinitet, värderar objektivitet och förmågan att frikoppla socialarbetarens egna känslor från sitt arbete. Detta maskuliniserade professionsideal innebär att empati och solidaritet med klienten undergrävs. 3) Omfattande krav på olika former av dokumentation av det sociala arbetet gör att tiden som socialarbetaren har till sitt förfogande för att besöka och att ha möten med klienten blir knapp. 4) Ett allmänt samhällsideal kring individuellt ansvar och en särskild arbetsmetod (motiverande samtal) som många socialarbetare förväntas lära sig, framhäver klientens eget ansvar för och vilja till förändring. Detta legitimerar ett avståndstagande från klientens behov av hjälp och stöd enligt logiken  ”du måste klara detta själv”. 5) En vanligt förekommande uppdelning av socialarbetarnas arbetsuppgifter i en så kallad beställar-utförarmodell gör att vissa socialsekreterare arbetar med hjälp och stöd, medan andra arbetar med bedömningar av klienters behov. De senare, som också har inflytande över resurstilldelning, blir med en sådan organisering av arbetet alltmer frikopplade från den stödjande och hjälpande verksamheten och kontakten med klienten. 6) Standardiserade digitala bedömningsinstrument, skapade för att på ett likvärdigt sätt bedöma klienters behov och dokumentera det sociala arbetet, reglerar och instrumentaliserar kontakten med klienter. 7) Tunga arbetsbördor, individualiserat ansvar och stress, bidrar ytterligare till att skapa avstånd och likgiltighet eftersom det för vissa utgör ett sätt att genomleva en ohållbar arbetssituation. En allmän åtstramning av socialtjänstens resurstilldelning förstås som en viktig orsak till behovet av att skapa ovan distansmekanismer. Men distansen hänger också ihop med en tendens till ett återupplivande av en tidigare dominerande förståelse av marginalisering och sociala problem; där människors nöd ses som ett utslag av dålig karaktär och ett resultat av dåliga individuella val. De förändringar av det sociala arbetets premisser som beskrivits ovan gör att socialarbetarna alltmer görs främmande inför sitt arbete – de alieneras. Detta främmandegörande uttrycks genom att inte kunna identifiera sig med arbetet självt, sina kollegor eller med sig själv. Ett sådant främmandegörande underminerar, eller fragmentiserar, både relationen till klienten, men också en känsla av gemenskap med andra socialarbetare. En gemenskap som kan utgöra ett ”vi” och ligga till grund för att ställa krav, protestera och göra motstånd mot avhumaniserande ideal och reformer. På så vis är främmandegörandet inte bara en konsekvens av dagens organisering och styrning, utan också något som fyller en viktig funktion för en sådan styrning och organisering, och genomförandet av en allmän åtstramning i socialpolitiken. Samtidigt som dagens organisering och styrning av socialt arbete är främmandegörande, slår vissa socialarbetare knut på sig själva och arbetar extra hårt för att täcka upp för systemets brister och krympande resurser, för att trots det svåra läget ändå försöka ge det stöd som de upplever att klienten behöver. Ett sådant historiskt förankrat femininiserat omsorgsideal, dvs känslor av ansvar och empati inför behövande och en ilska inför oförrätter, utgör därmed på samma gång grund för en fördjupad exploatering av socialarbetarna, och ett vardagligt motstånd mot rådande system. I ett läge när flera upplever att kollegialiteten som grund för motstånd på arbetsplatserna underminerats, utgör ett sådant omsorgsideal samtidigt också grunden för organiserat motstånd utanför arbetsplatsen, bortom chefernas insyn, kontroll och härskartekniker. Medan nuvarande styrningssystem underminerar ett visst sorts motstånd, uppstår samtidigt grunden för nya.

Text in English
The inception of psychology as a practicing profession in 1938 brought with it a continuing scientific struggle geared towards cementing its place as a value-adding health service in the form of psychotherapy. Concepts such as Empirically Supported Treatments (ESTs), Evidence Based Treatments (EBTs) and Evidence Based Practice in Psychology (EBPP) arose out of research attempts to scientifically prove the efficacy of psychological treatment versus psychiatric medications or versus no treatment. This focus on evidence in psychotherapy partly stems from, but also influences public policy in the form of practice and training mandates as well as government and insurance funding policies for psychotherapy. At present ESTs, EBTs and EBPP are the source of polarisation among psychologists who argue for either sides of this controversy, raising questions on a practical/policy level as well as an epistemological level. This thesis differentiates between ESTs, EBTs and EBPP as well as the Common Factors approach and continues to critically investigate the advantages, practical/policy implications and epistemological critiques against these approaches. Some of the identified shortfalls resulting from unwarranted epistemological (empirical) assumptions are addressed by proposing a social constructionist model of therapeutic factors based on social constructionist- and eco-systemic theories. The proposed model allows therapists to employ EBT’s in conjunction with various other (excluded) approaches that are available in their arsenal of treatments. Clinical case studies are used to illustrate the model’s practical operation in therapeutic contexts.
Psychology
Ph.D. (Psychology)