What is needed for nurses to work with evidence-based practice? A qualitative study.

BACKGROUND: Transformation of healthcare is necessary to ensure patients receive high-quality care. Working with the evidence-based practice (EBP) principles enables nurses to make this shift. Although working according to these principles is becoming more common, nurses base their actions too much on traditions and intuition. Therefore, to promote EBP in nursing practice and improve related education, more insight into nurses' needs is necessary to overcome existing EBP barriers. OBJECTIVE: To identify the current needs to work with EBP principles among hospital and community care nurses and student nurses. DESIGN: A qualitative, exploratory approach with focus group discussions. METHODS: Data was collected between February and December 2020 through 5 focus group discussions with 25 nurses and student nurses from a hospital, a community care organisation, and nursing education schools (bachelor and vocational). Data were analysed using reflexive thematic analysis, and the main themes were synchronised to the seven domains from the Tailored Implementation for Chronic Diseases (TICD) checklist. RESULTS: Nurses and student nurses experience EBP as complex and require more EBP knowledge and reliable, ready-to-use evidence. They wanted to be facilitated in access to evidence, the opportunity to share insights with colleagues and more time to work on EBP. The fulfilment of these needs serves to enhance motivation to engage with evidence-based practice (EBP), facilitate personal development, and empower nurses and student nurses to take more leadership in working according to EBP principles and improve healthcare delivery. CONCLUSION: Nurses experience difficulties applying EBP principles and need support with their implementation. Nurses' and student nurses' needs include obtaining more EBP knowledge and access to tailored and ready-to-use information. They also indicated the need for role models, autonomy, incentives, dedicated time, and incorporation of EBP in daily work practice.

The Dutch version of the Oral Health Assessment Tool: Translation and inter-rater reliability among community nurses.

OBJECTIVES: Translating the Oral Health Assessment Tool (OHAT) into Dutch and assessing the inter-rater reliability among community nurses. METHODS: The original version of the OHAT was translated following the five stages of the 'Guidelines for the Process of Cross-Cultural Adaptation'. After a forward and backward translation, consensus on the pre-final version was obtained in an expert panel discussion. This version was pre-tested on its comprehensibility among 31 nurses and hereafter finalized. Then, inter-rater reliability of the OHAT-NL was determined by two trained nurses during oral assessments of 37 care-dependent community-dwelling older people. Intraclass correlation coefficient (ICC) and the Cohen's kappa statistic for individual items were estimated. RESULTS: Feedback from nurses in the pre-test did lead to minor changes of the OHAT-NL. Inter-rater reliability was good (ICC 0.79; 95% CI 0.63-0.89) on the total score. Agreement on item level ranged from fair to very good, the kappa ranged from 0.36-0.89. CONCLUSIONS: OHAT is now available in Dutch having good inter-rater reliability among trained community nurses. Future research can further validate the OHAT-NL and develop intervention according to total OHAT-NL scores.

Low-value wound care: Are nurses and physicians choosing wisely? A mixed methods study.

BACKGROUND: Choosing Wisely is an international movement that stimulates conversations about unnecessary care. The campaign created five recommendations including a statement that less wound care is sometimes better. AIMS: The study aims to evaluate nurses' and physicians' adherence to the Choosing Wisely recommendations for acute wound care in the Netherlands and the barriers and facilitators to improve this. DESIGN: This is a mixed methods study using a survey and interviews. METHODS: The survey was completed by 171 nurses and 71 physicians from November 2017 to February 2018. A total of 17 nurses and 6 physicians were interviewed. RESULTS: Awareness of the five recommendations ranged from 62% to 89% for nurses and 46% to 85% for physicians. However, up to 15% of the nurses and 28% of physicians were aware but did not adhere to the recommendations. Barriers to adhering were a lack of knowledge, the work environment and perceptions of patients' preferences. Repeated attention, cost-consciousness and an open culture facilitated the implementation. CONCLUSION: Although most nurses and physicians were aware of the recommendations, not all adhered to them. Increasing awareness is not enough for successful implementation. A tailored approach that removes the barriers is necessary, such as increasing knowledge about wounds and changing the work environment.

Identifying patients with benign chronic intestinal failure on home parenteral nutrition in whom a psychological support intervention may improve quality of life.

RATIONALE: Home parenteral nutrition (HPN) is the ultimate treatment for patients who suffering from chronic intestinal failure (CIF). We tested the feasibility and effects of Mindfulness Based Cognitive Therapy (MBCT) in patients on HPN. Because of the high dropout rate, however, we were next urged to develop and test a web-based coaching program (web-based MBCT). The aim of the present study was to compare the effects of MBCT with this web-based MBCT. METHODS: A quasi-experimental pilot study was conducted in a tertiary referral center for CIF in the Netherlands to evaluate the feasibility of both a MBCT and the internet-based MBCT intervention. In 2016 we included 17 patients in the MBCT group. These patients followed MBCT training. End of 2016 an internet-based online MBCT program was constructed for which we invited 14 patients and their caregivers. RESULTS: In the MBCT 5 out of 17 patients (29%) completed their therapy. Patients attributed positive effects to their acquired mindfulness skills and reported a better QoL. In the internet-based mindfulness therapy group 2 out of 14 patients (14%) fulfilled the training sessions. Also, six caregivers started the training in this latter group and one caregiver fulfilled the training. CONCLUSION: The study suggests that both MBCT and the internet-based MBCT are no feasible strategies to decrease disease burden and improve QoL for CIF patients and their caregivers due to the intensity of these programs on one side and the experienced physical limitations on the other. The patients who fulfilled the program were positive and use MBCT in daily practice.