Norway
The four themes (and subthemes within each theme) were: 1) Interactive teaching strategies (Research utilisation, Information literacy and Assignments as learning activities); 2) Interactive and clinically integrated teaching strategies (Teaching EBP principles and Clinical integration and collaborations); 3) Learning outcomes (Enhancing analytical skills and Changing attitudes toward utilising research); and 4) Barriers (Information literacy skills and knowledge and Challenging collaboration).
An improved understanding of the differences between quantitative and qualitative methods was highlighted as an important aspect of preparation for nursing practice [ 29 – 32 , 34 ]. Interactive strategies to teach the research process, critical appraisal and development of information literacy skills were also emphasised. Interactive learning activities such as problem-based learning, sharing information, flipped classroom and virtual simulation, workshops, group work and seminars with discussions were identified [ 30 , 33 , 34 ]. In some studies, oral presentations of students’ research findings in a clinical setting were highlighted as an important part of the teaching and learning strategy [ 28 , 32 , 34 ].
Traditional teaching methods preparing students to use research were aimed at improving critical thinking skills, critically evaluating various literature sources and developing information literacy skills [ 30 – 32 , 34 ].
Group work was also identified as a teaching strategy for establishing research utilisation [ 28 , 30 , 34 ]. In the mixed-methods study [ 30 ], several workshops and monthly sessions were conducted to improve research competence among both lecturers and students.
Experiential learning was often supplemented by collaborative group learning, such as partnerships for learning course content [ 34 ]. The authors presented experiential teaching approaches as a motivational tool for improving research learning. The students used student-centred approaches and completed small group research studies. Assignments included carrying out a literature review, developing a proposal, facing a mock ethics committee, and collecting and analysing data. This student work was supported by pertinent lectures, including via ‘Blackboard’, a virtual learning platform. Finally, students presented their methodologic and analytic approaches on the virtual learning platform [ 34 ].
Teaching information literacy and interdisciplinary collaboration, especially with librarians, was emphasised as an important part of students’ learning how to find and use research [ 29 – 31 , 33 – 35 ]. In contrast, collaboration with librarians was not mentioned in Mattila and Eriksson’s [ 32 ] study.
Friberg and Lyckhage’s [ 30 ] study emphasised the significance of research utility and disseminating research results. Cader et al. [ 29 ] revealed differences in students’ knowledge of computer and information literacy skills. In one study, differences appear to have been influenced by the role of the library in supporting nursing students, curriculum content and emphasis, and interaction with lecturers and peers [ 33 ]. Nurse educators indicated a need for staff development and a progressive approach to the curriculum to ensure students’ understanding of IL and its links to learning [ 33 ].
An environment supportive of the learning process promoted change and development. Collaboration with and facilitation and guidance by academic and library staff was considered essential for a successful process and outcome [ 29 , 33 ]. It was also clear from these studies that nursing students need greater support to access, use and evaluate information fully [ 29 , 32 , 33 ].
Course assignments were included as a part of the learning process in all evaluated studies, which included activities preparing students to use research or enhance their EBP knowledge and skills. Assignments that were integrated into clinical practice were particularly emphasised in the studies that focused on teaching EBP principles [ 28 , 29 , 31 ].
An assignment focusing on analysis of health needs was undertaken to help student nurses gain an understanding of the relevance of EBP [ 29 ]. Nursing students were found to require further development of their critical appraisal skills and further improvement of the guidance from both academics and librarians was needed [ 29 ].
Friberg and Lyckhage [ 30 ] emphasised essay writing as a learning tool and used different literature-based research methods to meet this goal.
The thematic analysis identified interactive and clinically integrated teaching strategies. Interactive clinical strategies included assignments based on collaboration with health-care personnel in clinical practice. Learning activities with oral presentations of the findings from the students’ studies delivered in their clinical work settings were also mentioned [ 28 , 32 ].
A focus on teaching the six EBP steps was evident in the studies by André et al. [ 28 ], Cader et al. [ 29 ] and Malik et al. [ 31 ]. Research utilisation was emphasised in these reports. There was a vague focus on EBP principles in three of the studies [ 30 , 32 , 33 ] and integrated teaching activities to teach clinical strategies were described in four of the studies [ 28 , 29 , 31 , 32 ].
In the study by Malik et al. [ 31 ], students participated in clinical projects and analysed data with researchers. Clinical experts were also engaged in the lectures.
Cader et al. [ 29 ] emphasised the benefit of students carrying out analyses of health needs through collaboration within the clinical practice context. To this end, nursing students conducted ‘mini’ research projects including an analysis of the health needs of a particular patient group with a common problem or diagnosis. Although the nursing students found the assignment challenging and time consuming, they also considered it meaningful because accessing information about health needs made the evidence relevant.
Mattila and Eriksson [ 32 ] outlined a learning assignment conducted during a six-week clinical practice period in which students chose topics aimed at utilising research and enhancing their competence in the clinical practice context. The clinical instructor approved a selected research article that was applicable to clinical practice and the nursing students orally presented their findings to fellow students and staff at their clinical practice placement.
A Norwegian pilot study by André et al. [ 28 ] focused on participation and cooperation in clinical research projects, which nursing students specified was a motivation for learning EBP. These students strongly appreciated working with experienced nurses on their clinical projects.
Students expressed that writing assignments helped them understand the research process. Based on the nursing students’ reports, they were motivated by being able to choose topics that were of interest to them [ 29 , 32 , 34 ]. Learning outcomes from teaching strategies were presented in most of the studies we evaluated, and it was from these outcomes that the Enhancing analytical skills and Increased awareness of using research subthemes were identified.
Nursing students reported learning enhanced analytical and critical thinking skills, and some of the findings were outcomes of specific assignments and teaching strategies [ 28 – 30 , 34 ]. Students experienced learning outcomes and thus acknowledged the importance of research utilisation to their future clinical practice. It was emphasised in the reports that these students considered their key roles to be research consumers rather than producers [ 28 – 30 , 32 , 34 ]. Students also developed a greater awareness of the core role of nursing and that use of research is imperative in the nursing profession.
Based on the assignments they were given, the students in these studies reported learning outcomes such as understanding how to apply relevant evidence to everyday clinical practice. In this way, they learned to link research to health needs [ 28 – 30 ]. Mattila and Eriksson [ 32 ] reported that nursing students gained greater insight into their future profession. That academic presentations and discussions inspired them to search for research was considered ‘meaningful’.
Although nursing students considered themselves prepared to use research, Friberg and Lyckhage [ 30 ] emphasised that students are insufficiently skilled to assess research critically. This perspective is consistent with the findings by Cader et al. [ 29 ] that there is a need for further support for developing students’ critical evaluation skills.
Some students emphasised the importance of bringing together clinical practice, their own practical experiences and the research context. They experienced EBP as a platform to facilitate the development of their curiosity and critical reflection within clinical practice [ 28 ].
Nursing students reported research awareness as a learning outcome associated with information gathering and improved information literacy skills [ 29 , 30 ]. Despite completing acourse, students in one study stated that they had neither a comprehensive understanding of the information literacy concept nor improved skills [ 33 ]. Computer and information literacy skills apparently vary among both lecturers and students [ 33 , 35 ]. However, in several of the studies, increased awareness and understanding of research appeared to be an important learning outcome of information literacy teaching strategies for nursing students [ 29 , 30 , 32 , 34 ].
Generating an awareness of how to critically evaluate research evidence rather than producing research is necessary for implementing EBP. To obtain this awareness, it is crucial to find creative ways of guiding undergraduate nursing students to find and critically appraise research reports [ 30 ]. These studies emphasised nursing students’ increased awareness that implementing nursing research in clinical practice is a prerequisite to providing safer patient care [ 28 – 30 , 32 ].
Barriers to acquiring EBP and research utilisation skills were divided into two subthemes: i.e., information literacy skills and knowledge, and Challenging collaborations.
Discontinuity of information literacy content throughout the curriculum seems to constitute a barrier to searching for and finding research [ 33 ]. In addition, some academics reported their own limited awareness of EBP teaching strategies [ 31 ].
Nursing students reported finding it challenging to find and interpret research. They were dependent on assistance from librarians and lecturers [ 32 , 33 ]. The need for more interdisciplinary support to teach information literacy skills was also emphasised in several studies [ 29 , 32 , 33 , 35 ]. When integrating EBP, it was challenging for academic nurses to implement innovative teaching strategies because they lacked knowledge, had a large workload or had insufficient time and resources to study new strategies [ 31 ].
In one study, group work was interpreted as a barrier to learning EBP [ 34 ], which demonstrated that dysfunctional group dynamics can negatively affect the learning process. In contrast, in the same study, some students reported positive teamwork experiences that were motivating and enhanced their learning process [ 34 ]. In the study by Malik et al. [ 31 ], the academic educators reported that their students loved workshops on searching databases. Some nursing students reported that their clinical practice status made it difficult to gather the information required for their assignments [ 29 ].
The findings from this initial review demonstrate that various interactive teaching strategies have been emphasised to enhance knowledge and utilise research. However, despite being recommended strategies [ 3 , 14 , 36 ], factors such as teaching strategies that include clinical activities to develop EBP knowledge and skills seem to be given a lower priority. This review identified that self-reports and evaluations show that nursing students report development of critical thinking skills as a learning outcome of various teaching strategies [ 28 – 30 , 34 ], which is consistent with earlier studies [ 16 – 18 ]. In contrast, barriers to enhancing students’ EBP knowledge and skills included a weak understanding of information literacy and difficulties finding and interpreting research.
All analysed studies herein reported at least some use of interactive teaching strategies. Patient safety and quality of care in Western society require that future nurses have EBP knowledge, which means that they must use available research as well as patients’ preferences and their own clinical expertise in decision-making processes [ 14 , 36 ]. We identified studies that emphasised teaching strategies specifically aimed at finding research, critical appraisal and research utilisation through interactive methods [ 30 , 32 , 33 ]. However, it may be challenging for future nurses to obtain sound EBP knowledge if teaching strategies are mainly focused on research utilisation. A commission of health-care professionals and academic leaders presented their vision and common strategy toward strengthening global health-care systems, which argued that cross-professional collaboration in education is a powerful instrument for improving health-care outcomes [ 37 ]. Guiding principles, such as the code of ethics, the EHEA framework for expected learning outcomes [ 20 , 21 ] and health legislation emphasise wider use of the best research evidence in nursing practice, which may explain why teaching strategies are primarily directed at research utilisation. Information literacy skills are important to EBP; however, studies show that nurses and nursing students lack these skills [ 17 , 18 , 38 – 40 ].
In the present review, three studies [ 28 , 29 , 32 ] focused on clinically integrated teaching strategies in particular. The relationships between the clinical practice context and health needs analysis [ 29 ] were emphasised in a six-week clinical practice assignment, using oral presentation as a learning activity [ 32 ] and participation in clinical research projects [ 28 ].
Ryan [ 10 ] identified that learning EBP would have greater relevance for students if teaching strategies took place in a clinical setting. According to Llasus et al. [ 38 ], knowledge translation from education to clinical practice is challenging. These authors argue that if nursing students are expected to be able to implement EBP in clinical practice, they must have both EBP knowledge and EBP ‘readiness’, which requires strengthening their confidence in EBP.
Phillips and Cullen [ 13 ] observed that development of EBP skills for RN-to-BSN students was influenced by exposure to educational partnerships, contextual teaching and learning, and clinical practice experience. However, the findings from a Norwegian study in physiotherapy students reported a lack of both EBP culture and role models in their clinical practice [ 41 ].
A systematic review showed that EBP knowledge in medicine is increasing, irrespective of whether or not it is provided at undergraduate or postgraduate levels. Indeed, learning outcomes appear more effective if the teaching strategies are connected to clinical practice [ 42 ]. This notion was emphasised in the core clinical evaluation criteria developed in the Delphi Study by Bostwick and Linden [ 43 ]. In contrast, Ilic and Maloney [ 44 ] found no difference in learning outcomes. Despite the variety of teaching strategies across the studies we reviewed, they cumulatively show good evidence that any form of teaching EBM increases knowledge.
The findings from this review demonstrate that collaboration through clinical practice and patient care appears to be a relatively low priority. Patients’ preferences are not explicitly considered, despite an increased focus on seeing the patient as a collaborative partner in the EBP paradigm, ethical guidelines and legislation on education and health [ 2 , 3 , 20 , 21 ]. This is also contrary to recommendations about the factors that influence EBP skills, such as contextual teaching and learning and practical experience opportunities [ 13 ].
It is worth mentioning that the nursing students in some of the studies included in this review increased their analytical skills because of EBP teaching strategies [ 28 – 30 , 34 ], regardless of whether the teaching focused exclusively on interactive or targeted both interactive and clinical strategies. However, research has shown that nursing students have inadequate knowledge to make them capable of judging, reflecting on and critically assessing research [ 10 ]. Becoming more analytical and changing attitudes towards utilising research in clinical situations may be essential for nurses in their future careers and could contribute to increased patient safety. These skills may lead to nurses with a higher level of analytical skills and clinical judgment, who have a greater ability to reflect and reason.
According to the review findings, a variety of course assignments promote EBP knowledge and skills. Choosing topics of interest to students motivates them to develop EBP knowledge [ 29 , 32 , 34 ]. Several studies argue that assignments are essential for self-directed, continuous learning [ 18 , 38 – 40 ].
There are some limitations to this review. We used a relatively small sample of articles and excluded non-English language studies, which may have caused us to overlook some studies on enhancing EBP skills and knowledge in nursing education. However, to ensure a systematic search process, the literature search was performed by AN, an academic librarian. In addition, our use of several databases likely decreased the possibility of selection bias. The six qualitative studies included in this study were homogeneous in terms of their qualitative research design and meeting our inclusion criteria. Qualitative data from the mixed-methods study that addressed our research question was also included. Variations such as cultural diversity and differences in participant perspectives may also have affected the analyses in these studies. Despite these limitations, we met our goal of examining teaching strategies, learning outcomes and barriers in undergraduate nursing education, from the perspectives of both educators and students.
Insufficient attention has been paid to the use of EBP principles in nursing education. The teaching strategies identified in the represented studies show that interactive teaching strategies are used alongside traditional lectures to enhance research utilisation skills in nursing education. However, collaboration with clinical practice to enhance EBP knowledge was only vaguely addressed in most of these studies. In conclusion, there is a need to improve educators’ consciousness of and competences in teaching EBP principles, which involves using interactive and clinical integrated teaching strategies. Only seven studies met criteria for inclusion in this review, indicating that further targeted qualitative research is needed.
The authors acknowledge The University of South-Eastern Norway, Faculty of Health and Social Sciences for supporting this research.
The University of South-Eastern Norway, Faculty of Health and Social Sciences supported this research.
Abbreviations.
BN | Bachelor Nurse |
CASP | Critical Appraisal Skills Programme |
EBM | Evidence-Based Medicine |
EBP | Evidence-Based Practice |
EHEA | European Higher Education Area |
IL | Information Literacy |
PICo | Population Interest Context |
PRISMA | Preferred Reporting Items for Systematic Reviews and Meta-Analysis |
RN-to-BSN | Registered Nurses and Bachelor of Science in Nursing |
UK | United Kingdom |
METH was the lead author who planned and implemented the study in close collaboration with AN, TF and ES. AN predominantly carried out the literature research. All authors collaborated on analyses. ES provided substantial support for the study as an expert in qualitative research. METH drafted the manuscript. All authors provided critical comments on the manuscript and have approved the final version.
Not applicable.
Competing interests.
The authors declare that they have no competing interests.
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May-Elin T. Horntvedt, Phone: +4731009113, Email: [email protected] .
Anita Nordsteien, Email: [email protected] .
Torbjørg Fermann, Email: [email protected] .
Elisabeth Severinsson, Email: [email protected] .
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Evidence-based practice in nursing involves providing holistic, quality care based on the most up-to-date research and knowledge rather than traditional methods, advice from colleagues, or personal beliefs.
Nurses can expand their knowledge and improve their clinical practice experience by collecting, processing, and implementing research findings. Evidence-based practice focuses on what's at the heart of nursing — your patient. Learn what evidence-based practice in nursing is, why it's essential, and how to incorporate it into your daily patient care.
Evidence-based practice requires you to review and assess the latest research. The knowledge gained from evidence-based research in nursing may indicate changing a standard nursing care policy in your practice Discuss your findings with your nurse manager and team before implementation. Once you've gained their support and ensured compliance with your facility's policies and procedures, merge nursing implementations based on this information with your patient's values to provide the most effective care.
You may already be using evidence-based nursing practices without knowing it. Research findings support a significant percentage of nursing practices, and ongoing studies anticipate this will continue to increase.
There are various examples of evidence-based practice in nursing, such as:
Improving patient care begins by asking how you can make it a safer, more compassionate, and personal experience.
Learn about pertinent evidence-based practice information on our Clinical Practice Material page .
Evidence-based nursing draws upon critical reasoning and judgment skills developed through experience and training. You can practice evidence-based nursing interventions by following five crucial steps that serve as guidelines for making patient care decisions. This process includes incorporating the best external evidence, your clinical expertise, and the patient's values and expectations.
You can compare current professional and clinical practices with new research outcomes when evaluating evidence-based research. But how do you know what's considered the best information?
Use critical thinking skills and consider levels of evidence to establish the reliability of the information when you analyze evidence-based research. These levels can help you determine how much emphasis to place on a study, report, or clinical practice guideline when making decisions about patient care.
Four primary levels of evidence come into play when you're making clinical decisions.
Implementing evidence-based practice in nursing bridges the theory-to-practice gap and delivers innovative patient care using the most current health care findings. The topic of evidence-based practice will likely come up throughout your nursing career. Its origins trace back to Florence Nightingale. This iconic founder of modern nursing gathered data and conclusions regarding the relationship between unsanitary conditions and failing health. Its application remains essential today.
Besides keeping health care practices relevant and current, evidence-based practice in nursing offers a range of other benefits to you and your patients:
When you use the principles of evidence-based practice in nursing to make decisions about your patient's care, it results in better outcomes, higher satisfaction, and reduced costs. Implementing this method promotes lifelong learning and lets you strive for continuous quality improvement in your clinical care and nursing practice to achieve nursing excellence .
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Why has research-based practice become so important and why is everyone talking about evidence-based health care? But most importantly, how is nursing best placed to maximise the benefits which evidence-based care can bring?
Part of the difficulty is that although nurses perceive research positively, 2 they either cannot access the information, or cannot judge the value of the studies which they find. 3 This journal has evolved as a direct response to the dilemma of practitioners who want to use research, but are thwarted by overwhelming clinical demands, an ever burgeoning research literature, and for many, a lack of skills in critical appraisal. Evidence-Based Nursing should therefore be exceptionally useful, and its target audience of practitioners is a refreshing move in the right direction. The worlds of researchers and practitioners have been separated by seemingly impenetrable barriers for too long. 4
Tiptoeing in the wake of the movement for evidence-based medicine, however, we must ensure that evidence-based nursing attends to what is important for nursing. Part of the difficulty that practitioners face relates to the ambiguity which research, and particularly “scientific” research, has within nursing. Ambiguous, because we need to be clear as to what nursing is, and what nurses do before we can identify the types of evidence needed to improve the effectiveness of patient care. Then we can explore the type of questions which practitioners need answers to and what sort of research …
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Senior Lecturer, School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast
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This aim of this article is to explore the current position of evidence-based practice (EBP) in nursing. The article provides an overview of the historical context and emergence of EBP with an outline of the EBP process. There is an exploration of the current challenges facing the nursing profession as it endeavours to adopt EBP into care delivery, along with actions to address these challenges. There will also be a discussion on how to integrate EBP into undergraduate nursing curricula as academic institutions implement the Future nurse standards of proficiency from the Nursing and Midwifery Council.
It has been suggested that the idea of delivering care based on evidence had its early foundations in the 1800s with Florence Nightingale, who aimed to provide better outcomes for patients who experienced unsanitary conditions ( Mackey and Bassendowski, 2017 ). However, it is generally agreed that Professor Archie Cochrane, whose work inspired the Cochrane Collaboration ( Smith and Rennie, 2014 ; Barker and Linsley, 2016 ), is credited for being at the forefront of the modern evidence-based practice (EBP) approach. The concept of evidence-based medicine (EBM) emerged from researchers at McMaster University, Canada, who redefined the practice of medicine to move from a culture based solely on clinical experience, to one which is more inclusive of medical evidence ( International Council of Nurses, 2012 ). Smith and Rennie (2014) noted that the phrase EBM was coined by Gordon Guyatt in 1991, so has had a relatively short life span. Although a number of individuals contributed to the development of EBM, David Sackett is regarded as the father of EBM as in 1996 he distinguished EBM as one that combines research evidence with clinical skills, and patient values and preferences ( Smith and Rennie, 2014 ).
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This paper is an essay about evidence-based nursing practice, with an emphasis on evidence in the form of various types of theories developed by various modes of inquiry. The essay is the second in a series written to acknowledge the 25th anniversary of the founding of Nursing Science Quarterly.
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Reid, J., Briggs, J., Carlisle, S., Scott, D., & Lewis, C. (2017). Enhancing utility and understanding of the evidence-based practice through undergraduate nurse education. BMC Nursing, 16 (58), 1-8. Web.
The selected article offers meaningful insights that can empower nursing educationists and practitioners to embrace the power of evidence-based practice (EBP). The authors describe a new course (Evidence-Based Nursing 1) that was implemented as part of an undergraduate nursing program. The researchers observed that the targeted learners were willing to make evidence-based practices part of their nursing philosophies after completing the course. The practice can encourage practitioners to integrate EBP into their respective care delivery models (Reid, Briggs, Carlisle, Scott, & Lewis, 2017). The judicious use of emerging or current evidence in care delivery and health decision-making processes can result in improved patient outcomes and support advanced practice nursing. This article describes the meaning of EBP and how it can be implemented in nursing institutions to ensure that advanced practice nurses (APNs) are prepared to meet their patients’ health needs. The use of emerging evidence and concepts from research studies can guide nurses to offer advanced care. When APNs embrace the power of EBP, they will achieve their potential and offer quality and equitable health services.
The concept of EBP revolves around the use of best evidence to improve patient outcomes. Mackey and Bassendowski (2016) indicate that external clinical findings, results from systematic studies, and personal nursing expertise constitutes “best evidence” for EBP. Nurses should combine such concepts to develop appropriate care delivery models and make desirable decisions to support their patients. EBP is a powerful approach that can be used at the point of care. Proficient nurses can diagnose and educate patients depending on their conditions. Such practitioners will identify signs and symptoms, offer timely patient education, and empower individuals to engage in disease management practices. These tasks at the point of care will be informed by every nurse’s current evidence and information backed by the latest research findings.
Informatics can bring the best available evidence to support AGPC practice. Modern technologies empower nurses to use standardized terminologies that can result in desirable health outcomes. Digital sources of timely or latest evidence can also be used to meet patients’ needs. Practitioners can use informatics processes to acquire and apply evidence to different clinical situations (Reid et al., 2017). Informatics competencies empower nurses to minimize sentinel events and meet patients’ needs.
I am planning to embrace the future by using EBP in my practice. I will incorporate the concept using a powerful strategy. The approach will be implemented using the notion of lifelong learning. I will also undertake numerous researches and use modern informatics to improve my nursing philosophy. Unfortunately, some barriers can affect the implementation and development of an EBP culture. The first one is the existing gap in education and practice. This limitation affects nurses’ ability to use evidence accurately and efficiently. The lack of appropriate policies to support the use of EBP is the second challenge (Mackey & Bassendowski, 2016). The third obstacle is that many institutions and practitioners have failed to embrace the power of informatics. These gaps affect patients’ health outcomes negatively.
EBP is expected to impact advanced nursing practice positively. The concept can sanction practitioners to make informed decisions and offer desirable care depending on their patients’ expectations. The approach results in improved care delivery systems. It also encourages practitioners to improve their nursing philosophies using emerging ideas (or concepts) and their competencies (Reid et al., 2017). EBP empowers nurses to make informed decisions, develop superior care delivery models, and update their skills. APNs using the concept will, therefore, offer safe, affordable, and sustainable care to their patients.
Mackey, A., & Bassendowski, S. (2016). The history of evidence-based practice in nursing education and practice. Journal of Professional Nursing, 33 (1), 51-55. Web.
Reid, J., Briggs, J., Carlisle, S., Scott, D., & Lewis, C. (2017). Enhancing utility and understanding of evidence based practice through undergraduate nurse education. BMC Nursing, 16 (58), 1-8. Web.
IvyPanda. (2020, December 17). Evidence Based Practice' Impact on Nursing. https://ivypanda.com/essays/evidence-based-practice-impact-on-nursing/
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What it is and how to implement it into your professional work?
This guide is designed to help you understand and implement Evidence Based Practice in your professional work. It provides resources, tools, and information to support your research and application of EBP principles.
What is Evidence Based Practice?
Evidence Based Practice (EBP) is an approach to clinical decision-making that integrates the best available research evidence with clinical expertise and patient values. It aims to improve patient outcomes by applying the most current and relevant information to healthcare decisions.
The EBP Process
The EBP process involves five key steps:
PICO Framework
The PICO framework is a tool used to formulate clinical questions in a structured and focused way. It stands for:
Example : In patients with chronic low back pain (P), does yoga (I) compared to standard physical therapy (C) improve pain management (O)?
Databases and Journals
Key databases for EBP include:
Search Strategies
Effective search strategies include:
Grey Literature
Grey literature refers to research that is not published in traditional journals. It includes reports, theses, conference papers, and more. Important sources of grey literature are:
Critical Appraisal Tools
Use tools like:
Levels of Evidence
Understanding the hierarchy of evidence helps in determining the strength of recommendations:
Integrating Evidence into Practice
Strategies for implementation include:
Case Studies and Examples
Explore real-world applications of EBP through case studies and examples from various healthcare settings.
Evaluating the Impact
Methods for assessing outcomes:
Continuous improvement is vital to ensure that EBP is effectively enhancing patient care and outcomes.
Websites and Online Resources
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Evidence based practice refers to all the clinical judgments that are prepared on the basis of investigation and scientific studies which facilitates in the distribution of the high quality care to the patient to make better results. Evidence-based health care practices are accessible for a number of circumstances such as diabetes, heart failure, kidney failure, and asthma.
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Research question in picot format, evaluation of research, research topic, literature review, the impact of the evidence on future nursing practice and health outcomes of patients, recommendations.
According to the Australian Institute of Health Welfare (2018), diabetes is among the primary chronic diseases that have shown a high prevalence rate and adverse complications to the patients. It is due to this concern that the National Strategic Framework for Chronic Conditions presents approaches to ensure that evidence-based practice is implemented into the clinical practice so that patients can receive appropriate and patient-centered care. Thus achieving quality lives with fewer complications (National Strategic Framework for Chronic Conditions, 2017).
Based on the National Strategic Frameworks for Chronic diseases, chronic diseases have increasingly become a common cause of death in the Australian nation. This is because of a change in lifestyle. This increasing occurrence of chronic diseases with the associated effects as are affecting individuals, families, public health and the nation at large. As such, the National Strategic Frameworks for Chronic diseases provides approaches that outline the management and care principles for the prevention and control of many conditions such as cancer and diabetes. These approaches are evidence-based practices that need to be implemented in the nursing practice to improve the patients’ outcome and the general service delivery of the healthcare sector. That will entail enhanced healthcare management under which chronic patients receive supervised, patient-centered and appropriate services (National Strategic Framework for Chronic Conditions, 2017). The National Strategic Frameworks for chronic disease ensure that the evidence-based practice will result in reduced complications and multi-morbidities.
The National Strategic Frameworks for Chronic conditions provides that evidence-based practices which are appropriate in the nursing practice will ensure patient safety and enhanced outcomes. In this case, improved outcomes for chronic conditions will include slowing the condition’s progression, practices that help to control and delay any other additional chronic disease (National Strategic Framework for Chronic Conditions, 2017). It further provides that an appropriate practice will prevent the complications and disabilities associated with the disease thus enhancing the general wellbeing and the quality of life as it has been provided in the various literature reviews regarding the use of physical exercises to control and prevent diabetes-associated complications rather than using anti-hyperglycemic therapy.
1. Alhadramy, M. (2016). Diabetes and oral therapies: A review of oral therapies for diabetes mellitus. Journal of Taibah University Medical Sciences, 11(4), 317–329. https://doi.org/10.1016/j.jtumed.2016.02.001
2. Balk, E. M., Earley, A., Raman, G., Avendano, E. A., Pittas, A. G., & Remington, P. L. (2015). Combined diet and physical activity promotion programs to prevent type 2 diabetes among persons at increased risk: a systematic review for the Community Preventive Services Task Force. Annals of Internal Medicine, 163(6), 437–451.
3. CardioSmart. (2012). Exercise and Diet Remain Important for Diabetes Prevention and Control. Retrieved August 24, 2018, from https://www.cardiosmart.org/News-and-Events/2012/10/Exercise-and-Diet-Remain-Important-for-Diabetes-Prevention-and-Control
4. Carpio, G. R. A., & Fonseca, V. A. (2014). Update on Safety Issues Related to Antihyperglycemic Therapy. Diabetes Spectrum : A Publication of the American Diabetes Association, 27(2), 92–100. https://doi.org/10.2337/diaspect.27.2.92
5. Laaksonen, D. E., Lindström, J., Lakka, T. A., Eriksson, J. G., Niskanen, L., Wikström, K., … Uusitupa, M. (2005). Physical Activity in the Prevention of Type 2 Diabetes: The Finnish Diabetes Prevention Study. Diabetes, 54(1), 158–165. https://doi.org/10.2337/diabetes.54.1.158
6. Mendham, A. E., Duffield, R., Marino, F., & Coutts, A. J. (2015). A 12-week sports-based exercise programme for inactive Indigenous Australian men improved clinical risk factors associated with type 2 diabetes mellitus. Journal of Science and Medicine in Sport, 18(4), 438–443.
7. National Strategic Framework for Chronic Conditions. (2018). National Strategic Framework for Chronic Conditions. Australian Government Department of Health. Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/content/nsfcc
8. Thent, Z. C., Das, S., & Henry, L. J. (2013). Role of Exercise in the Management of Diabetes Mellitus: the Global Scenario. PLoS ONE, 8(11). https://doi.org/10.1371/journal.pone.0080436
Impact of the problem on the patient.
People with T2DM have a higher risk of health problems such as stroke, kidney failure, and heart attack. Patients may also perceive a loss of independence and self-control. Treatment of T2D is very costly. Individuals diagnosed with T2D incur approximately $16,750 yearly in medicinal costs. Diabetes can even cause the death of a patient.
Increased hospital expenditure. About $1 in every $4 in health care is spent on patients diagnosed with T2D. Most expenses are associated with hospitalizations and medicines used to cure diabetes complications.
P – Novel DSME patient group with type 2 diabetes mellitus (T2DM)
I – Diabetes self-management education (DSME) programme
C – The traditional DSME group
O – Improved self-management behavior, social resources utilization, and hemoglobin
In the novel DSME patient group with type 2 diabetes mellitus (T2DM), what is the effectiveness of a diabetes self-management education (DSME) programme based on multi-social utilization compared to a traditional DSME group in improving self-management behavior, social resources utilization, and HbA1c levels?
The effectiveness of the self-management programme based on multilevel social resources utilization in diabetes mellitus patients
Diabetes mellitus (DM) is among the most common chronic illnesses, whereby 90% of the affected individuals experience type 2 diabetes mellitus (T2DM) (Zhang et al., 2023). Most healthcare organizations have considered T2D diabetes self-management education effective in helping them live optimally in terms of health. Studies report that DSME is designed to reduce the inception and advancement of complications resulting from DM, to enhance lifestyle behaviors (like healthy eating and conducting more regular physical activities, to improve associated diabetes self-effectiveness), to facilitate healthy coping, to reduce undesirable emotions like depression and anxiety, and to mend the quality of life. Such benefits are particularly the outcome of diabetes self-management behavior gained through DSME. While researchers formally recognize the significance of DSME, it fails to assure long-standing effective DM self-management. At the same time, the management behavior level has proved to diminish after six months of the intervention.
The study employed a randomized control trial. The authors recruited 118 participants suffering from T2DM from two different communities through a randomized sampling randomly assigned to the novel and the traditional DSME groups. The study implemented DSME focused on multilevel social resource use in the novel DSME group. The authors collected data at the baseline (T 0 ), at the intervention’s end (T 1 ), and three months after the intervention ended (T 2 ).
The level of evidence for the research-based article is Level I (higher quality of evidence). It is a high-quality randomized trial, testing previously developed diagnostic criteria on sensible costs, consecutive patients, and values acquired in various studies with a multi-sensitivity analysis.
The study performed data analysis using the IBM SPSS version. The authors conducted descriptive statistics to obtain a summary of the demographic and medical variables. The baseline characteristics of the participants were compared by employing an unpaired t-test. For ranked or categorical variables, the study used Person’s X2. The overall linear model with repetitive ANOVA measures investigated the impact of groups, variations with time, diabetes self-management tendency, DM self-management SRU, and hemoglobin levels.
The ethical considerations in the research-based article involved guaranteeing the participant’s safety, accurately and honestly reporting the results, and adhering to the accepted protocols. In addition, the study sought approval from the Institutional Review Board (IRB) at West China Hospital of Sichuan University. Every participant gave informed written consent.
The quality rating for this research-based article was Grade A. The certainty of evidence for the effectiveness of treatment is very high. The study’s high level of proof reflects the degree to which confidence in estimating the effect is satisfactory in supporting the recommendations.
The novel DSME program focusing on multilevel social resource use can efficiently enhance self-management behaviors, social resource use, and lower levels of HbA1c T2DM among patients. More significantly, the effect can last longer.
The results or conclusions of the study demonstrated that in the novel DSME patient group with type 2 diabetes mellitus (T2DM), the diabetes self-management education (DSME) programme based on multi-social utilization is effective compared to traditional DSME group in improving self-management behavior, social resources utilization and HbA1c levels.
Influence of the Model of Care on the Outcomes of Diabetes Self-Management Education Program
Diabetes mellitus is among the most chronic infections globally and is the fifth leading cause of death in many developed nations and, hurriedly, becoming the most significant health issue. Type 2 diabetes accounts for about 95% of cases of diabetes (Kumah et al., 2021). The increasing T2DM prevalence has emphasized the need for evidence-based procedures for effective management, prevention, and treatment. Diabetes self-management education (DSME) can generate positive outcomes on a patient’s behavior in the status of their health.
The type of evidence used in the non-research-based article was a systematic review.
Due to its risk of bias because of increased heterogeneity, the evidence level in the non-research article was moderate.
The quantity of rating in the non-research-based article was Grade B.
The author’s recommendation in the non-research-based article was to consider patient’s routine medical care providers throughout the design and application of DSME interventions. Researchers should also evaluate the effectiveness of DSME intervention to consider care providers’ potential influence on the policy effects.
Based on the research and the non-research-based articles, a practice change recommendation to improve self-management behavior, social resource use, and hemoglobin Alc (HbA1c) levels in patients with T2DM is that professionals must pay attention to the social resources use education to improve and solidify the self-management behavior of diabetic patients additionally. Particularly in regions with a large number of people and minimal medical help, encouraging patients to proactively tap and use potential and available resources to self-manage themselves would be effective and economical.
As suggested by the research and the non-research article, the key stakeholders in improving self-management behavior, social resource use, and reducing hemoglobin Alc (HbA1c) levels in patients with T2DM include patients, clinicians, policymakers, doctors, healthcare managers, and the community.
A potential barrier to implementing the practice change recommendations is that there needs to be uniform and accepted common patient education perceived as effective for all individuals. There may also be a limited collaboration level between caregivers and patients and self-management educators, which might not allow for a comprehensive analysis of the effect of care providers’ engagement in SME interventions on the program outcome.
The articles suggest various strategies to overcome implementation barriers, such as health education programs, capacity building, and advocacy, which are key to overcoming the barrier to implementing the DSME program.
Various indicators will show positive outcomes of implementing the DSME policy on T2DM patients. Some of them would be improved self-management behavior, utilization of social resources, and optimum glucose control.
Kumah, E., Afriyie, E. K., Abuosi, A. A., Ankomah, S. E., Fusheini, A., & Otchere, G. (2021). Influence of the model of care on the outcomes of diabetes self-management education program: a scoping review. Journal of Diabetes Research , 2021 , 1-12.
Zhang, F., Fu, L., Wang, L., Xing, L., Liu, K., & Jiang, X. (2023). The effectiveness of the self-management programme based on multilevel social resources utilization in diabetes mellitus patients: A randomized controlled study. International Journal of Nursing Practice , e13138.
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Watchman vs. amulet for left atrial appendage closure: current evidence and future perspectives.
2. device specification, 3. periprocedural outcomes, 4. drt and pdls, 5. long-term outcomes, 6. anti-thrombotic therapy, 7. ongoing trials and future directions, 8. conclusions, author contributions, conflicts of interest.
Click here to enlarge figure
Trial | Design and Patient Selection | Patients | Key Findings |
---|---|---|---|
PROTECT AF | WATCHMAN vs. warfarinNon-inferiority Key Inclusion Criteria: risk factors; | Control (n = 244) Device (n = 463) | |
PREVAIL | WATCHMAN vs. warfarin Non-inferiority Key Inclusion Criteria: | Control (n = 138) Device (n = 269) | |
PRAGUE-17 | LAAC device vs. DOAC Non-inferiority Key Inclusion Criteria: Nonvalvular AF and one of the following: DS -VASc score ≥ 3; | Control (n = 201) Device (n = 201) | = 0.44; p = 0.004 for non-inferiority) |
AMULET IDE | AMULET vs. WATCHMAN Non-inferiority Key Inclusion Criteria: DS -VASc score of ≥3; | Amulet (n = 934) Watchman (n = 944) |
Parameter | Amulet | Watchman FLX | Watchman FLX Pro |
---|---|---|---|
Construct of the device | Self-expanding nitinol device with a distal lobe and a proximal disc | Self-expanding nitinol frame with PET with distal fluoroscopic marker | Self-expanding nitinol frame with HEMOCOAT technology covering |
Anchor mechanism | Stabilizing wires | Dual-row anchors | Dual-row anchors with three radiopaque markers |
Available sizes | 8 | 5 | 6 |
Size range | 16 mm, 18 mm, 20 mm, 22 mm, 25 mm, 28 mm, 31 mm, 34 mm | 20 mm, 24 mm, 27 mm, 31 mm, 35 mm | 20 mm, 24 mm, 27 mm, 31 mm, 35 mm, 40 mm |
Ostium coverage | 11–31 mm | 14–31.5 mm | 14–36 mm |
Sealing mechanism | Dual seal mechanism (disc and lobe) | Single seal mechanism (single lobe) | Single seal mechanism (single lobe) |
Access system |
Amulet | Watchman |
---|---|
Confirm proper device placement before release using echocardiography and fluoroscopy following CLOSE criteria C—At least 2/3 of the device lobe should be distal to the left Circumflex artery on echocardiography; L—The device Lobe should be slightly compressed and have good apposition to the left atrial appendage wall; O—The Orientation of the device lobe must be in line with the axis of the intended landing zone in the left atrial appendage; S—The disc must be Separated from the lobe; E—The disc will have a concave elliptical shape. | All criteria must be met prior to device release PASS criteria Position—Device is at the ostium of the LAA with the exclusion of all pectinate muscle; Anchor—Secure fixation anchors confirming device stability; Size—Device is compressed 10–30% of the original size; Seal—Effective sealing without peri-device leaks ledetected by color Doppler and/or angiographic assessment. |
Trial | Sample | Objective | Intervention | Control | Primary Outcomes | Follow-Up |
---|---|---|---|---|---|---|
CHAMPION-AF (NCT04394546) | 3000 | Evaluate LAAC with Watchman/FLX in NVAF patients eligible for long-term DOAC | Watchman/FLX | Long-term DOAC | Composite endpoint of ischemic stroke or SE; composite endpoint of ischemic stroke, SE, or CV death (tested for NI); nonprocedural major bleeding (tested for S) | 3 y |
CATALYST (NCT04226547) | 2650 | Evaluate LAAC with Amulet in patients with NVAF eligible for long-term DOAC | Amulet | Long-term DOAC | Composite endpoint of ischemic stroke or SE; composite endpoint of ischemic stroke, SE, or CV death (tested for NI); nonprocedural major bleeding (tested for S) | 3 y |
OCCLUSION-AF (NCT03642509) | 750 | Evaluate Amulet or Watchman in patients with NVAF and prior ischemic stroke or TIA eligible for long-term DOAC | Amulet or Watchman | Long-term DOAC | Composite endpoint of stroke, SE, all-cause mortality, and major bleeding | 5 y |
CLOSURE-AF (NCT03463317) | 1512 | Evaluate LAAC in patients with NVAF at high bleeding risk or contraindication to OAC | LAAC devices with CE approval | DOAC or VKA | Composite endpoint of stroke, SE, CV, or unexplained death and major bleeding | 2 y |
STROKECLOSE (NCT02830152) | 750 | Evaluate LAAC in patients with NVAF and ICH within 12 months | Amulet | Medical therapy | Composite endpoint of stroke, SE, all-cause mortality, and major bleeding | 5 y |
CLEARANCE (NCT04298723) | 550 | Evaluate LAAC in NVAF patients with a previous ICH | Watchman FLX | Medical therapy | Composite endpoint of stroke, SE, CV, or unexplained death and major bleeding | 2 y |
COMPARE-LAAO (NCT04676880) | 609 | Evaluate LAAC in patients with NVAF and contraindications for OAC | Watchman FLX or Amulet | Antiplatelets or no therapy | Time to first stroke event; time to first stroke, TIA or SE event; procedural complications | 5 y |
OPTION (NCT03795298) | 1600 | Evaluate LAAC with Watchman FLX vs. OAC in patients with NVAF undergoing catheter ablation for NVAF | Watchman FLX | DOAC or VKA | Composite endpoint of stroke, SE, or death; no procedure-related major bleeding | 3 y |
ASAP-TOO (NCT02928497) | 481 | Evaluate LAAC in patients with NVAF and contraindications for OAC | Watchman | Single antiplatelet or no therapy | Time to the first occurrence of ischemic stroke and SE; 7-day combined rate of death, ischemic stroke, SE, and complications requiring major CV or endovascular intervention | 5 y |
LAAOS 4 (NCT05963698) | 4000 | Assess whether LAAC prevents ischemic stroke or systemic embolism in patients with NVAF, at high risk of stroke, despite receiving ongoing treatment with oral anticoagulation | Watchman plus OAC | OAC | Time to the first occurrence of ischemic stroke and SE | 4 y |
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Frazzetto, M.; Sanfilippo, C.; Costa, G.; Contrafatto, C.; Giacalone, C.; Scandura, S.; Castania, G.; De Santis, J.; Sanfilippo, M.; Di Salvo, M.E.; et al. Watchman vs. Amulet for Left Atrial Appendage Closure: Current Evidence and Future Perspectives. J. Clin. Med. 2024 , 13 , 4651. https://doi.org/10.3390/jcm13164651
Frazzetto M, Sanfilippo C, Costa G, Contrafatto C, Giacalone C, Scandura S, Castania G, De Santis J, Sanfilippo M, Di Salvo ME, et al. Watchman vs. Amulet for Left Atrial Appendage Closure: Current Evidence and Future Perspectives. Journal of Clinical Medicine . 2024; 13(16):4651. https://doi.org/10.3390/jcm13164651
Frazzetto, Marco, Claudio Sanfilippo, Giuliano Costa, Claudia Contrafatto, Chiara Giacalone, Salvatore Scandura, Giuseppe Castania, Jessica De Santis, Maria Sanfilippo, Maria Elena Di Salvo, and et al. 2024. "Watchman vs. Amulet for Left Atrial Appendage Closure: Current Evidence and Future Perspectives" Journal of Clinical Medicine 13, no. 16: 4651. https://doi.org/10.3390/jcm13164651
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IMAGES
COMMENTS
The importance of evidence based practice is to enable nurses to provide high quality care, improve outcomes for patient and families and to run a more efficient health service. Therefore other agencies within the health service will benefit when interventions and care is based on research (Burns & Grove 2007).
Top 5 Benefits To The Nurse. 1. Evidence-based practice in nursing provides nurses with scientifically supported research to help them make well-educated decisions. 2. EBP in nursing helps nurses stay up-to-date about new nursing interventions and protocols used in patient care. 3.
The nursing evidence-based practice topics listed above provide a starting point for further exploration and investigation. By studying the effectiveness of various nursing interventions and techniques, we can continue to improve patient outcomes and deliver better care. ... Top Nursing Argumentative Essay Topics: Engage in Thought-Provoking ...
Results. Nurses and midwives perceived that implementation of evidence-based practice is the use of research findings, guidelines, hospital protocols, books, and expert experience in clinical decision-making practice. However, there was limited support for the implementation of evidence-based practice by nurses and midwives.
Teaching strategy: writing Bachelor's degree, essays and establishing teaching modules related to the research process (concept analysis, identifying evidence-based quantitative and qualitative research, critical assessment, identifying discourses in documents and practical implications of research). ... Evidence-based practice in nursing and ...
5 min read • June, 01 2023. Evidence-based practice in nursing involves providing holistic, quality care based on the most up-to-date research and knowledge rather than traditional methods, advice from colleagues, or personal beliefs. Nurses can expand their knowledge and improve their clinical practice experience by collecting, processing ...
Table 1: Developing evidence‐based practice guidelines and a nursing illustration (adapted from Proctor and Rosen, 2004) Step Illustration Step 1: Locate evidence‐based interventions relevant to the outcomes of interest. The nurse is interested in helping patients to manage their asthma better. Three
Evidence-Based Nursing should therefore be exceptionally useful, and its target audience of practitioners is a refreshing move in the right direction. The worlds of researchers and practitioners have been separated by seemingly impenetrable barriers for too long. 4. Tiptoeing in the wake of the movement for evidence-based medicine, however, we ...
The problems with the uptake and effective implementation of EBP led to the emergence of the EIP concept. This concept is based on the premise that healthcare practice should, as a matter of principle, be informed by, rather than based on, evidence (Nevo and Slonim-Nevo, 2011). This implies that other forms of evidence (for example, patient experiences, the nurse's expertise and experiences ...
It has been suggested that the idea of delivering care based on evidence had its early foundations in the 1800s with Florence Nightingale, who aimed to provide better outcomes for patients who experienced unsanitary conditions (Mackey and Bassendowski, 2017).However, it is generally agreed that Professor Archie Cochrane, whose work inspired the Cochrane Collaboration (Smith and Rennie, 2014 ...
Evidence-based practice (EBP) is firmly established as an essential component of nursing practice. Despite being present in some form in all nursing roles, its presence is arguably more prominent in professional nursing settings (RN). The RN's responsibilities include planning patients' care, analyzing their medical history, and ...
The essay is the second in a series written to acknowledge the 25th anniversary of the founding of Nursing Science Quarterly. This paper is an essay about evidence-based nursing practice, with an emphasis on evidence in the form of various types of theories developed by various modes of inquiry.
These gaps affect patients' health outcomes negatively. EBP is expected to impact advanced nursing practice positively. The concept can sanction practitioners to make informed decisions and offer desirable care depending on their patients' expectations. The approach results in improved care delivery systems.
Foundations of clinical research : applications to evidence-based practice by Leslie Gross Portney "The text of this fourth edition has maintained its dual perspectives. It is designed for those who do research to generate new knowledge and examine theories and for those who want to be critical consumers of evidence to inform clinical decision-making.
Evidence-based practice, in the most common definition, refers to the judicious and explicit use of evidence drawn from literary sources to make healthcare decisions. According to Frewin and Court (2009), evidence-based practice is a systematic research that envisages the integration of external clinical evidence in exercising individual ...
Evidence-based clinical practice or evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients" (Sackett et al., 1996). The beginning of Evidence-Based Practice (EBP), formerly known as evidence-based medicine, was initiated by Archie Cochrane in ...
Rigour is important for selecting quality data sources as quality clinical decisions are made based on quality evidence (Polit and Beck, 2010). Evidence-based nursing is about making clinical decisions using the best available research evidence (Ellis, 2019). This is found in well conducted, peer reviewed studies, published in respectable journals.
Evidence Based Practice Impact Of Nurses Nursing Essay. Evidence-based practice (EBP) is widely recognised within the role of nursing. Its implementation and purpose in the delivery of care is seen as an important driver for nursing practice and clinical outcomes (Cullen & Adams 2010). It has been defined as the:
What Are Evidence Based Practice Essays? Evidence papers accumulate nursing knowledge, work experience, and observation of numerous specialists. These docs describe the most effective methods of treatment and rehabilitation of patients, which are encouraged by practitioners. Research and evidence based practice essay is a kind of bridge between ...
Section 1: Nursing research is a systematic inquiry aimed at developing trustworthy evidence to create rationale for evidence-based practice (EBP); EBP is using the best evidence to make patient-care decisions and underpins nursing practice (Polit and Beck, 2018). In order to deliver high-quality care in an ever-changing society, nurses are ...
Evidence-based nursing practice essay for free ️️2245 words sample for your inspiration Get free high-quality examples from NursingPaper database. ... Framework for Chronic Conditions, 2017). The National Strategic Frameworks for chronic disease ensure that the evidence-based practice will result in reduced complications and multi ...
EBP and Quadruple Aim. EBP, or evidence-based practice, is a methodical strategy for making healthcare decisions incorporating the best available evidence, clinical knowledge, and patient values and preferences (Jolley, 2020). It displays the application of scientific ideas to improve healthcare productivity and offer high-quality services.
Recommended Practice Change. Based on the research and the non-research-based articles, a practice change recommendation to improve self-management behavior, social resource use, and hemoglobin Alc (HbA1c) levels in patients with T2DM is that professionals must pay attention to the social resources use education to improve and solidify the self ...
Left atrial appendage closure (LAAC) is a crucial intervention for stroke prevention in patients with non-valvular atrial fibrillation who are unsuitable for long-term anticoagulation. Amulet and Watchman are the most implanted devices worldwide for performing LAAC, and the aim of this review is to provide a comprehensive comparison focusing on their efficacy, safety, and short- and long-term ...