Identifies problem (in general and within the local context)
The EBPQI critical appraisal tool has important educational and practice implications. Educators have voiced challenges with teaching critical appraisal of evidence to students at entry and advanced nursing levels. Specifically, faculty frequently struggle to garner access to tools for appraising other types of evidence outside of research for student use, as some are proprietary. Positioned upstream to the health care system, educators must be prepared to guide students in critically appraising research and other evidence before entering the health care arena where patient care occurs.
Faculty development is also needed to prepare educators to optimally teach research, EBP, and QI and the differences and interrelatedness of these processes. 18 The Mountain Model maps to all 10 American Association of Colleges of Nursing New Essentials domains and offers a meaningful approach to faculty development and project oversight at prelicensure and advanced levels. 19 , 20
While not generalizable, findings from EBPQI initiatives may be transferable to other institutions, which may help close costly evidence-to-practice gaps. In a survey of over 2300 nurses, Melnyk and colleagues 21 found that nurses felt they were not competent in critical appraisal of evidence/published research. The newly developed EBPQI critical appraisal tool can provide needed guidance to nurses who may be unfamiliar with or unconfident in critically appraising evidence.
Indeed, many articles that directly relate to a nurse’s daily practice are EBPQI rather than formal research; as such, there is a need for a strong critical appraisal tool for this type of evidence. Critical appraisal tools and checklists are meant to assist nurses in identifying the presence of key components of a research study, or as in this case an EBPQI initiative, which if absent could jeopardize the success of the initiative. This is different from surveys or questionnaires that measure a concept or construct; therefore, expert and face validity are the primary concerns. Having access to a free, easy-to-use checklist-style tool may allow students and nurses the confidence and ability to formally appraise EBPQI, which can, in turn, help their own EBPQI initiatives to be completed with more rigor.
In an often fragmented and overburdened health care system, other types of evidence, in addition to research, hold promise to improve outcomes. While not generalizable to other settings, well-designed EBPQI initiatives may produce valuable findings that can be adapted appropriately to other settings and populations. The tool introduced in this article was designed to be accessible to health care teams and nursing students. Using a comprehensive critical appraisal tool to evaluate EBPQI initiatives provides greater confidence that the resulting recommendations are credible.
critical appraisal tool; evidence-based practice; evidence-based practice quality improvement; quality improvement
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“Each patient carries his own doctor inside him.” —Norman Cousins, Anatomy of an Illness
To improve health care outcomes, physicians must spend more time with patients. The teaching physician's interaction with the patient must be enthusiastic, motivated, and responsive to the individual patient's needs. For individual members of our society to realize the benefits of physician health education, there is a need for a robust, hearty engagement between patients and physicians.
Interventions to improve self-care have led to documented improvements in self-efficacy. Self-efficacy is defined as one's belief in one's ability to succeed in specific situations, or accomplish certain tasks. One's sense of self-efficacy plays a major role in how one approaches goals, tasks, and challenges regarding one's health. Clinical benefits have been seen in trials of lifestyle intervention within a wide range of conditions such as diabetes, coronary heart disease, heart failure, and rheumatoid arthritis ( 1 ).
In the context of escalating health care costs and shocking future cost projections, the potential for improved health outcomes through patient education and self-management programs is immense. In the early 1990s, it was estimated that 50% of the annual mortality toll in the US was premature. Tobacco use, poor diet, a lack of physical exercise, alcohol consumption, exposure to microbial agents, use of firearms, risky sexual behavior, motor vehicle accidents, and illicit drug use were the culprits causing premature death. Approximately 80% of premature deaths were due to tobacco use, dietary patterns, and a low physical activity level ( 1 ). Clearly, these are all behaviors we could modify to reverse the trends. For those individuals who do not smoke, eat healthy food, and participate in regular exercise programs, the hazard ratio for diabetes, myocardial infarction, stroke or cancer was 0.22 ( 2 ).
There is a belief in the medical community that physical activity and diet can reduce the risk of developing coronary artery disease, hypertension, diabetes, and the metabolic syndrome. A comprehensive systematic review reinforced this notion by revealing that there is irrefutable, convincing evidence for the benefit of exercise in improving clinical outcomes in metabolic disorders, coronary heart disease, and heart failure ( 3 ).
Physicians must promote patient education and engagement through improvement in patients' health literacy. Health literacy is defined as the capacity to seek, understand, and act on health information ( 4 ). The presumption has been that low health literacy means that physician communication is poorly understood, leading to incomplete self-health management and responsibility and incomplete health care utilization ( 5 ). It is the responsibility of physicians to proactively enable patients to have more accessible interactions and situations that promote health and well-being. Health literacy is the primary responsibility of physicians, given that it is physicians who determine the parameters of the health interaction, including physical setting, available time, communication style, content, modes of information provided, and concepts of sound health care decision crafting and acquiescence. There are communication methodologies and behaviors that physicians can implement to ameliorate the potential risks associated with limited patient health literacy, including avoiding medical jargon, engaging in patient questions, explaining unfamiliar forms, and using “teach back” as a method to ensure understanding ( 6 ).
Critical to any educational process is time. The development of patient health literacy is crucial to our proven health prevention measures of exercise and diet. Patients must have a deep understanding of the impact healthy interventions can have on their present and long-term health. Physicians will need to spend time and energy educating patients to see behavioral change that results in improved health outcomes and reduced morbidity and mortality due to preventable chronic diseases such as diabetes, obesity, and coronary and cerebrovascular disease. As physicians, we will know when we have reached the threshold of being an excellent teacher by observing responsible patients.
The partnership between a physician and patient requires dual responsibility. Physicians have a duty to inform patients how to achieve health and wellness, and patients have a responsibility to act on the information provided in their best health interest. Medical informed consent is essential to the physician's ability to diagnose and treat patients, as well as the patient's right to accept or reject clinical evaluation, treatment, or both.
Medical informed consent should be an exchange of ideas that buttresses the patient-physician relationship. The consent process should be the foundation of the fiduciary relationship between a patient and a physician. Physicians must recognize that informed medical choice is an educational process and has the potential to affect the patient-physician alliance to their mutual benefit. Physicians must give patients equality in the covenant by educating them to make informed choices. Patients must use the educational process to make rational health choices.
When physicians and patients take medical informed consent seriously, the patient-physician relationship becomes a true partnership with shared decision-making authority and responsibility for outcomes. Physicians need to understand informed medical consent from an ethical foundation, as codified by statutory law in many states, and from a generalized common-law perspective requiring medical practice consistent with the standard of care. It is fundamental to the patient-physician relationship that each partner understands and accepts the degree of autonomy the patient desires in the decision-making process ( 7 ).
IMAGES
COMMENTS
To improve the physical and psychosocial wellbeing of a patient, personalized patient education handouts, in addition to verbal education by the HCPs, augment the betterment of patient care via shared decision making and by improving patient satisfaction and health literacy. Keywords: electronic health record, quality improvement, plan-do-study ...
The first category that emerged from the data was "developing motivational factors" for patient education, with the following subcategories: "supervising patient education and providing constructive feedback" and "empowering the nursing profession.". 1. Supervising patient education and providing constructive feedback.
The patient education process has 4 equal components to be addressed by the nurse: assessment, planning, implement, and evaluation. Excellent patient education is an "art" and "science" using nuances and evidence-based strategies to effectively educate. The assessment and evaluation components often …
Fifty-two studies were included in the review. Forty-six (88.5%) reported rates of patient utilization of educational resources in the patient portal. Thirty (57.9%) shared patients' perceptions of the usefulness of the education materials. Twenty-one (40.4%) reported changes in health outcomes following educational interventions through the ...
Patient education is a key role of nurses' practice, but how nurses support people's learning, the distinctions between teaching and learning and the use learning principles are not well understood. ... Journal of Nursing Education and Practice, 8 (11) (2018), pp. 92-101. Google Scholar. Carnegie Mellon University Eberly Centre, 2019 ...
Executing excellent patient education is an "art" and "science"—nuanced and evidence based. A knowledgeable and skilled nurse uses the patient education process that mirrors the nursing process: assessment, planning, implementation, and evaluation. 1. This process provides the foundation for any form of patient education (verbal ...
1. Introduction. Patient education is a patient's right [] and is essential for supporting the empowerment of people in promoting their health and managing their health problems.Patient education is both an "art" and a "science," meaning it is nuanced and evidence-based, and a component of high-quality care [].Even though education is considered a core activity of nursing, executing ...
Patient Education and Counseling (PEC) is the Official journal of EACH, the International Association for Communication in Health Care and ACH, the Academy of Communication in Healthcare.As an interdisciplinary journal for clinicians, the PEC aims to provide a forum for fundamental and applied research, as well as to promote the study of processes affecting clinical communication, patient ...
Chronic kidney disease (CKD) is a top public health priority yet broadly under-recognized.1-3 The ninth leading cause of death in the United States, CKD currently affects 37 million Americans.2,3 On average, patients with CKD face higher risk for kidney failure, cardiovascular disease, and mortality than patients without CKD, but individual risks vary.4 Patient education is widely recognized ...
Patient education can now be delivered in standard formats (eg, articles, written messages) as well a wide array of multimedia (video, audio, interactive games, etc), which may be more appropriate for certain topics and learning styles. ... Western Journal of Nursing Research. Apr 2014. Open Access. Physician attitudes towards—and adoption of ...
The learning process within nursing is overshadowed by explanations of teaching strategies, determinants of learning and the learning principles of one specific theorist. The principles of cognitive learning and their role in patient- and family-education are poorly described and possibly poorly understood. This creates a fundamental knowledge ...
Background: Patient education is a crucial element within health care. It is a known predictor for increased engagement in shared decision making, improved medication and treatment adherence, higher levels of satisfaction, and even better treatment outcomes. Unfortunately, often patients only remember a very limited amount of medical information.
Support is often provided by nurses, but how nurses facilitate each patient's and their family's learning, using cognitive learning principles, seems invisible in the nursing literature. Aim: This discussion paper examines the important role of cognitive learning within nurses' patient- and family-education practice.
Patients often have difficulty comprehending or recalling information given to them by their healthcare providers. Use of 'teach-back' has been shown to improve patients' knowledge and self-care abilities, however there is little guidance for healthcare services seeking to embed teach-back in their setting. This review aims to synthesize evidence about the translation of teach-back into ...
The learning process within nursing is overshadowed by explanations of teaching strategies, determinants of learning and the learning principles of one specific theorist. The principles of cognitive learning and their role in patient- and family-education are poorly described and possibly poorly understood. This creates a fundamental knowledge ...
Nurses should also give patients phone numbers of people they can contact if they have questions. It is also helpful if patients have a family member with them, so someone else can help re-educate the patient if needed. 6. Promote Health by Continuously Educating Patients.
Effective communication was identified to be a multifactorial concept and defines as a mutual agreement between nurses and patients. This influences the nursing process, clinical reasoning and decision-making. Consequently, promotes high-quality nursing care, positive patient outcome and patient's and nurse's satisfaction of care.
Patient education was above all developed through internal courses, such as motivational interviewing: "Nurses stay at a conference hotel for a couple of days and 'live with patient education.' ... A critical review of the evidence for nurses as information providers to cancer patients. Journal of Clinical Nursing, 19, 749-765. doi: 10. ...
Purpose of Study: Nursing students must be able to provide holistic, patient-centered, compassionate care upon entering professional practice despite the stress and psychological challenges of the healthcare environment. The purpose of this study was to explore the relationship between self-compassion, as a promoter, predictor and protector of psychological health, and perceived readiness for ...
Patient education in HF is an essential component of care, which has been shown to improve patient engagement, understanding of the disease process, and self-care. ... Aug 13, 2024 | Journal Scan Health Coaching Improves Outcomes of Caregivers of Adults With HF . Aug 13, 2024 | Clinical Trial ...
Journal of Cancer Education, 2011,26(1), 175-182. View Article Google Scholar 50. Diaz S., & Goyal D. Caring for the Deaf and hard of hearing: Nursing Students' Knowledge and Awareness. Nursing Education Perspectives, 2021,42(4), 241-242. View Article Google Scholar
ions of nurses to improve patient education. Methods: This research followed a qualitative exploratory design with a qualitative content analysis approach. The study participants, including eight head nurses and 16 staff nurses, were selected through purposive sampling. The data were collected through semistructured interviews, focus group sessions, and observations during 2016. Results ...
Patient safety is a global challenge in healthcare, with adverse events representing a significant concern. The integration of patient safety education in undergraduate curricula is crucial in developing a culture of safety and safe practices among future professionals. However, there is a gap in research assessing the levels of knowledge and attitudes about patient safety among undergraduate ...
This selection of papers, published between 2018 and 2019 in JAN, shows some of the challenges related to medication and patient safety that are causing slow improvement in this field. It also describes nurses' important and manifold roles as team players in patients' medication processes in changing health care environments.
Heyn LG, Brembo EA, Eide H, Hafskjold L, Sundling V. Older persons' expressed worries during nursing care at home: do health complexity and nature of nursing care in the visit matter? Patient Educ Couns. 2021;104:2418-2424.
rently available EBP or QI critical appraisal tools can be challenging for students learning the critical appraisal process and for practicing clinicians who desire access to a standardized EBPQI approach to inform health care decision-making. The currently available tools are incomplete, too brief, or too complicated for ease of use in education and practice. Approach: This article introduces ...
Nurses' patient education is important for building patients' knowledge, understanding, and preparedness for self-management. ... (2010). A critical review of the evidence for nurses as information providers to cancer patients. Journal of Clinical Nursing, 19, 749-765. Crossref. PubMed. Web of Science. Google Scholar. Lamiani G., Furey A ...
In the context of escalating health care costs and shocking future cost projections, the potential for improved health outcomes through patient education and self-management programs is immense. In the early 1990s, it was estimated that 50% of the annual mortality toll in the US was premature. Tobacco use, poor diet, a lack of physical exercise ...
The Journal of Surgical Oncology publishes research in the field of surgical oncology from leading surgeons, cancer specialists, and clinical oncologists worldwide. Abstract Online patient education materials (PEMs) on lymphedema surgery were assessed for quality, readability, and content. A total of 37 PEMs were identified, primarily authored ...
Read the latest articles of Nurse Education Today at ScienceDirect.com, Elsevier's leading platform of peer-reviewed scholarly literature ... Receive an update when the latest issues in this journal are published. Sign in to set up alerts. ... select article Nursing students' perceptions of a good death: A mixed method study. https://doi.org ...