Review for librarians of evidence-based practice in nursing and the allied health professions in the United States

Walter

McCarty

et al. 2013

Context: Although evidence-based practice (EBP) has become more prevalent, athletic trainers' perceptions of importance and knowledge of these concepts and their confidence in EBP are largely unknown.Objective: To assess perceived importance and knowledge of and confidence in EBP concepts in athletic trainers in various roles and with different degree levels.Design: Cross-sectional study. Setting: Online survey instrument.Patients or Other Participants: The survey was sent to 6702 athletic training educators, clinicians, and postprofessional students. A total of 1209 completed the survey, for a response rate of 18.04%.Main Outcome Measure(s): Demographic information and perceived importance and knowledge of and confidence in the steps of EBP were obtained. One-way analysis of variance, a Kruskal-Wallis test, and an independent-samples t test were used to determine differences in scores among the demographic variables.Results: Athletic trainers demonstrated low knowledge scores (64.2% 6 1.29%) and mild to moderate confidence (2.71 6 0.55 out of 4.0). They valued EBP as moderately to extremely important (3.49 6 0.41 out of 4.0). Perceived importance scores differed among roles (clinicians unaffiliated with an education program scored lower than postprofessional educators, P ¼ .001) and highest educational degree attained (athletic trainers with terminal degrees scored higher than those with bachelor's or master's degrees, P , .001). Postprofessional athletic training students demonstrated the highest total EBP knowledge scores (4.65 6 0.91), whereas clinicians demonstrated the lowest scores (3.62 6 1.35). Individuals with terminal degrees had higher (P , .001) total knowledge scores (4.31 6 1.24) than those with bachelor's (3.78 6 1.2) or master's degrees (3.76 6 1.35). Postprofessional educators demonstrated greater confidence in knowledge scores (3.36 6 0.40 out of 4.0) than did those in all other athletic training roles (P , .001).Conclusions: Overall knowledge of the basic EBP steps remained low across the various athletic trainers' roles. The higher level of importance indicated that athletic trainers valued EBP, but this value was not reflected in the knowledge of EBP concepts. Individuals with a terminal degree possessed higher knowledge scores than those with other educational preparations; however, EBP knowledge needs to increase across all demographics of the profession.Key Words: athletic training setting, educational preparation, clinical practice Key PointsAthletic trainers valued the concept of evidence-based practice and recognized its importance to the profession. However, their level of knowledge about evidence-based practice and their level of confidence in that knowledge were both low. Evidence-based practice should be taught not only in the educational curricula for athletic training students but also to practicing clinicians.

Section: Perceived Importancesupporting

confidence: 74%

“…mendation grades in NATA position statements, [4][5][6] and a more focused emphasis on EBP in the fifth edition of the NATA Educational Competencies. 7 This focus on EBP marks a shift in thinking among health care professionals from an emphasis on decisions based on tradition and opinion to actions based on datadriven, clinically relevant research.…”

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confidence: 99%

Use of Evidence-Based Practice Among Athletic Training Educators, Clinicians, and Students, Part 1: Perceived Importance, Knowledge, and Confidence

Walter

McCarty

et al. 2013

“…The term evidence-based medicine has evolved into the term evidence-based practice (EBP) to recognize the movement into related domains such as nursing, physical therapy, and others. 3 Specifically, EBP is a 5-step process by which clinical decisions are based on research using scientific models and theoretical paradigms. 4 The Institute of Medicine's Committee on Health Profession Education has named EBP as 1 of 5 core competencies that all health care professionals should possess to meet the needs of the 21st-century health care system.…”

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confidence: 99%

Athletic Trainers' Beliefs About and Implementation of Evidence-Based Practice

Keeley

Walker

et al. 2016

Context:Understanding the beliefs about and use of evidence-based practice (EBP) among athletic trainers (ATs) will help to determine appropriate strategies to improve implementation.Objective: To examine the ATs' beliefs about and use of EBP.Design: Cross-sectional study. Setting: Online survey instrument. Patients or Other Participants: A total of 467 ATs responded to the survey request, a response rate of 11.67%. A total of 385 (9.6%) completed the EBP Beliefs Scale and 342 (8.5%) completed the EBP Implementation Scale.Main Outcome Measure(s): The EBP Beliefs Scale and EBP Implementation Scale were administered. The surveys collected demographic information in addition to information about participants' beliefs regarding EBP and implementation of EBP in clinical practice.Results: The ATs demonstrated a level of neither agree nor disagree (56.00 6 7.86) on the EBP Beliefs Scale. Belief scores were higher among those ATs required to document for thirdparty reimbursement (P ¼ .001), those with access to current research through professional journals other than the Journal of Athletic Training (P ¼ .02), and those with a doctoral degree (P ¼ .01). A low level of implementation (9.00 6 11.38), representing the implementation of EBP approximately 0 times in the previous 8 weeks, was found on the EBP Implementation Scale. Implementation scores were higher among preceptors (P ¼ .01), those required to document for third-party reimbursement (P , .001), those with access to current research through professional journals (P ¼ .002), and those with a doctoral degree (P ¼ .01).Conclusions: Participants had a positive attitude toward EBP; however, they were not implementing EBP concepts when providing patient care. This suggests that additional information and EBP resources are needed so ATs can better implement EBP in practice. To provide the best patient care and to promote EBP within the profession, clinicians should make EBP a priority and advocate for EBP implementation.Key Words: evidence-based medicine, clinical practice, survey research Key PointsOverall, athletic trainers were neutral toward evidence-based practice but believed it results in the best clinical care for patients and is important to the credibility of the profession. Athletic trainers' level of implementation of evidence-based practice was low. Additional information and resources are needed so athletic trainers can better implement evidence-based practice. To provide the best patient care, promote evidence-based practice within the profession, and gain credibility with other health care professions, athletic trainers should become advocates for evidence-based practice and make it a priority.

“…2,[5][6][7][8] In athletic training education, the fifth edition of the Athletic Training Educational Competencies, 9 released in the spring of 2011 by the National Athletic Trainers' Association, includes a great emphasis on EBPrelated skills and concepts that are aimed at improving patient care. The inclusion of EBP in educational competencies, the increased continuing education opportunities in EBP, 10 and the inclusion of Cochrane evidencebased grading 11 of National Athletic Trainers' Association position statements 12 have continued to move athletic training toward greater emphasis within this area.…”

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confidence: 99%

Perceptions of Approved Clinical Instructors: Barriers in the Implementation of Evidence-Based Practice

Lunen

2013

Context: As evidence-based practice (EBP) becomes prevalent in athletic training education, the barriers that Approved Clinical Instructors (ACIs) experience in implementing it with students need to be understood.Objective: To investigate barriers ACIs face when implementing EBP concepts in clinical practice and in teaching EBP to professional athletic training students and to investigate the educational emphases to improve the barriers.Design: Qualitative study. Setting: Telephone interviews.Patients or Other Participants: Sixteen ACIs (11 men, 5 women; experience as an athletic trainer ¼ 10 6 4.7 years, experience as an ACI ¼ 6.81 6 3.9 years) were interviewed.Data Collection and Analysis: We interviewed each participant by telephone. Interview data were analyzed and coded for common themes and subthemes regarding barriers and educational emphases. Themes were triangulated through multipleanalyst triangulation and interpretive verification.Results: Barriers to EBP incorporation and educational emphasis placed on EBP were the main themes reported. Resources, personnel, and student characteristics were subthemes identified as barriers. Resource barriers included time, equipment, access to current literature, and knowledge. Coworkers, clinicians, and coaches who were unwilling to accept evidence regarding advancements in treatment were identified as personnel barriers. Programmatic improvement and communication improvement were subthemes of the educational emphasis placed on EBP theme. The ACIs reported the need for better integration between the clinical setting and the classroom and expressed the need for EBP to be integrated throughout the athletic training education program.Conclusions: Integration of the classroom and clinical experience is important in advancing ACIs' use of EBP with their students. Collaborative efforts within the clinical and academic program could help address the barriers ACIs face when implementing EBP. This collaboration could positively affect the ability of ACIs to implement EBP within their clinical practices.Key Words: education, curricular integration, collaboration Key PointsResources, opportunities, and integration should be provided to Approved Clinical Instructors (ACIs) to help create an educational program that focuses on valuing the best evidence, patient values, and clinical expertise. A culture of evidence-based practice (EBP) needs to be promoted in clinical practice. Understanding the barriers that ACIs face while implementing EBP within their clinical practices and with students can help athletic training education programs better prepare ACIs to incorporate EBP. Collaboration between the clinical and academic programs could help ACIs address barriers and improve their abilities to implement EBP in their clinical practices.