Table 5.
Structural incorporation of EBP at various levels as stated by the authors of the individual studies
| Level | Intervention by | Effect | Author |
|---|---|---|---|
| Worldwide | International collaboration | Expansion and acceleration of the production and maintenance of Cochrane Systematic Reviews | Oliveri |
| Global and international associations | Promotion of EBP Making EBP courses available |
Olivieri Sur |
|
| Scientific journals | Educational efforts Publishing high quality research |
Poolman, Veness Scales, Sur |
|
| National | Governmental enforcement | EBP in all undergraduate and postgraduate healthcare educational institutions | Melnyk, Ubbink |
| Installing and financing regulatory professional bodies | Quality assurance Practicing EBP Use of guidelines |
Al-Almaie Melnyk Ubbink |
|
| Installing and financing a national institute | Development of evidence based guidelines | Al-Almaie | |
| Arranging and financing | Free use of the Cochrane Library | Oliveri | |
| Policy makers, professional associations, health insurance companies and regulatory bodies | Promotion of EBP | Scales, Oliveri, Poolman, Melnyk | |
| Board of hospital directors | Incorporating EBP in strategic aims | Goals tailored on systematic evaluations Implementation of EBP and research utilisation |
Brown 2009, Ubbink |
| Installing research councils | High-quality research | Brown 2009, Melnyk | |
| Allocating budget | High-quality research | Mehrdad | |
| Performing systematic evaluations during working visits, quarterly meetings with managers | Increased hospital‘s level of EBP implementation and quality of care | Ubbink | |
| Incorporating performance of EBP activities by directors, managers and administrators in annual interviews | Increased hospital‘s level of EBP implementation and quality of care | Ubbink | |
| Providing management, administrators and directors with tools and means | Effective learning and practising EBP | Al Ohmari 2006, Lai | |
| Managers | Integrating EBP and policy setting | Evidence-based management | Al Ohmari 2009 |
| Recruitment, selection, employment of new personnel Identifying EBP role models among current personnel | EBP-minded working force | Ubbink, Brown 2010 | |
| Building an infrastructure and environment with an atmosphere that supports, promotes and embraces EBP (ie, incentives, prizes or rewards, positive attitude) | Effective tools for implementing, learning and practising EBP Knowledgeable (nurse) researchers, (nurse) specialists, master’ prepared professionals, faculty, research departments |
Al-Almaie, Al Ohmari 2006, Brown 2009, Chui, Gale, Gerrish, Melnyk, Mehrdad, Mittal, Oranta, Parahoo, Ubbink | |
| Collaborating with educators | Organisational barriers and education addressed | Brown 2009 | |
| Allocating budget | (More) dedicated EBP personnel, education, activities, computers and facilities at each point of care. Attending continuous education, (inter)national conferences | Brown 2009, Gale, Gerrish, Mehrdad, Melnyk, Lai | |
| Provide non-patient hours to personnel | Time for EBP activities and implementation, changing practice, and quality care development | Brown 2009, Gale, Mehrad, Palfeyman | |
| Regular evaluation (audit and feedback) of ward-level EBP activities, knowledge, skills, behaviour and research utilisation during annual interviews | Annual evaluation of implementing EBP-activities | Ahmandi, Al-Almaie, Al Ohmari 2009, Ubbink | |
| Educators | Incorporating and inflating time spent on EBP by refining and modifying curriculum and education style in postgraduate and undergraduate medical and nursing curricula | Each non-academic degree professional produces a Cochrane Systematic review Improved audit and feedback, systematic evaluation, and needs assessment Tiered, feasible and realistic education |
Ahmandi, Al-Almaie, Al-Ohmari 2006, Amin, Andersson, Brown 2009, Gale, Gerrish, Hadley, Kitto, Koehn, Lai, Mehrdad, Melnyk, Mittal, Nwagwu, Oliveri, Parahoo, Poolman, Scales, Sur, Ubbink, Upton |
| Formulating the curriculum and educating in collaboration with healthcare professionals | EBP integration | Al-Almaie, Al Ohmari 2006, Brown 2009, Gale, Gerrish, Lai | |
| Interactive, face-to-face education in clinical practice and at the bed side | EBP integration | Ahmandi, Al-Almaie, Amin, Al Ohmari 2006, Kitto, Melnyk, Poolman | |
| Interactive education | E-learning modules | Kitto, Poolman, Ubbink | |
| EBP internship programme In-service training |
Extended EBP education | Brown 2009 Gerrish |
|
| Accessing, appraising and interpreting guidelines, research and protocols, basic statistical analysis, research training, IT-technology, quality development, change management, being a role model, English language | Optimum content of education | Al Ohmari 2006, Andersson, Gerrish, Lai, Mehrdad, Mittal, Nwagwu, Oranta, Parahoo | |
| Educating all educators in EBP | Well-equipped educators | Oranta | |
| Emphasising professionals’ own responsibility | Professional skills and competencies maintained | Oranta | |
| Evaluating effectiveness of EBP teaching | Optimum EBP education | Ulvenes, Veness | |
| Faculty and researchers | Documenting, analysing and interpreting the effectiveness of actions undertaken | EBP implementation | Brown 2009 |
| Support professionals in clinical setting by simple and clear (written) communication | EBP implementation | Mehrdad, Brown 2009 | |
| Using a variety of strategies | Dissemination of research findings Valorisation of results in practice |
Brown 2009 Melnyk |
|
| Close collaboration with practicing professionals | Shared language and understanding of concepts Actual relevant clinical questions are addressed |
Oranta | |
| Being a role model | Real-life discussions about patients | Poolman | |
| Performing and promoting research | Well-designed high quality research | Scales, Sur | |
| Services | Medical library facilities | Service for searching databases Clinical letters, journals and guidelines |
Al Ohmari 2006, Melnyk, Mittal, Parahoo, Ubbink, Al Ohmari 2006, |
| Computer and internet facilities at point of care, ward, or in EBP suites | Liberal access to databases Tailored to EBP level of professionals |
Al Ohmari 2006, Gale, Lai, Mehrdad, Nwagwu, Chui, Melnyk, Ubbink | |
| Content management system allowing access to guidelines, protocols, critically appraised topics and condensed recommendations | User-friendly and reliable, readable and pre-appraised information Provide work-based information |
Al Ohmari 2009, Gerrish, Lai, Ubbink | |
| Computer based decision support system with priority to systematic reviews | Computer-based guideline implementation Alerts and reminders |
Al-Almaie, Al Ohmari 2009 | |
| Accessible critical appraisal committee | Easy assessment of relevant literature | Mehrdad | |
| Implementation guidance | Overcomes obstacles to implement EBP or recommendation Change in practice |
Chui, Mehrdad | |
| Local workplace | Journal clubs, grand rounds, handovers, regular (research) meetings | EBP implementation | Oranta, Poolman, Ubbink |
| Dedicated time and personnel for EBP activities | Individual support at the units | Andersson, Ubbink | |
| Easy access to EBP mentors, change mentors, innovators and educators, computers, databases and relevant EBP websites or links | EBP implementation | Al-Almaie, Chui, Gale, Lai, Mehrdad, Ubbink, Veness | |
| Culture | Emphasis on EBP in day-to-day practice | Amin | |
| Emphasis on patient benefit of EBP | Gale, Melnyk | ||
| Sharing experience, knowledge and support | Andersson | ||
| Activating autonomy and empower nurses to influence change | Brown 2009, Gerrish | ||
| Shared governance structures | Brown 2009 | ||
| Engaging in research | Gerrish | ||
| Willingness to facilitate the process of implementing | Koehn | ||
| Innovative strategies including a culture of research implementation | Mehrdad | ||
| Displaying interest and belief in value of research utilization | Mittal | ||
| Enlightening professionals to use EBP in decision making | Nwagwu | ||
| Supportive culture to research | Parahoo |
EBP, evidence-based practice.