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  • 1.
    Neher, Margit
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Learning Challenges Associated with Evidence-Based Practice in Rheumatology2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Rheumatology is a field of practice that is undergoing many changes, leading to growing demand for rheumatology practitioners to keep up-to-date about the research developments in their field and to implement new findings and recommendations into clinical practice. Research within implementation science has shown that there are numerous barriers to the clinical use of research-based knowledge in health care. Implementation of evidencebased practice (EBP) requires a great deal of learning on the part of practitioners. It is likely that practitioners in rheumatology face similar challenges to those in other clinical fields, but there is a paucity of research concerning the implementation of EBP in rheumatology and the learning required.

    Aims: The overall aim of the research project was to generate knowledge concerning the learning challenges associated with evidence-based practice in rheumatology.

    Methods: Qualitative methods were used to explore the use of knowledge sources in rheumatology nursing and the learning opportunities in clinical rheumatology for participants belonging to five professional groups. Quantitative methods sought to examine to what extent evidence-based practice was implemented in clinical rheumatology practice and which individual and organizational factors affected research use. A theory-based study analysed the learning processes associated with achieving an evidence-based practice.

    Results: Four sources of knowledge were identified for rheumatology nursing practice: interaction with other people in the workplace (peers in particular) and previous knowledge and experience were perceived as preferred sources of knowledge, while written materials and contacts outside the workplace were less privileged. Learning opportunities occurring during daily practice were perceived by participants of all professional groups to consist predominantly of interactions with professional peers in the workplace. Participants perceived a lack of recognized learning opportunities such as continuing professional education and regular participation in rheumatology-specific courses and conferences. Participants also expressed that time for reflection and up-dating knowledge was short in everyday clinical work. The quantitative data showed that while the general interest for EBP was high in rheumatology practice, individual interest and professional self-efficacy related to EBP varied. A longer work-experience in rheumatology, better self-efficacy concerning the use research-based knowledge and more experience from research activities were positively associated with the use of research in practice. The theoretical analysis showed that challenges of implementing evidence-based practice concern not only the acquisition of research-based knowledge and the integration of this knowledge in practice, but also the abandonment of outdated practices.

    Conclusions: In this thesis, implementation of EBP in rheumatology has been shown to be a complex issue. Social, contextual and individual aspects were found to be involved in the learning processes, the use of knowledge sources and learning opportunities, as well as in the EBP-relevant behaviours that are enacted in clinical rheumatology. The thesis hopes to contribute to a better understanding of the learning challenges in connection with the implementation of EBP in rheumatology practice.

    List of papers
    1. Knowledge Sources for Evidence-Based Practice in Rheumatology Nursing.
    Open this publication in new window or tab >>Knowledge Sources for Evidence-Based Practice in Rheumatology Nursing.
    2015 (English)In: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 24, no 6, p. 661-679Article in journal (Refereed) Published
    Abstract [en]

    As rheumatology nursing develops and extends, knowledge about current use of knowledge in rheumatology nursing practice may guide discussions about future knowledge needs. To explore what perceptions rheumatology nurses have about their knowledge sources and about what knowledge they use in their practice, 12 nurses working in specialist rheumatology were interviewed using a semi-structured interview guide. The data were analyzed using conventional qualitative content analysis. The analysis yielded four types of knowledge sources in clinical practice: interaction with others in the workplace, contacts outside the workplace, written materials, and previous knowledge and experience. Colleagues, and physicians in particular, were important for informal learning in daily rheumatology practice. Evidence from the medical arena was accessed through medical specialists, while nursing research was used less. Facilitating informal learning and continuing formal education is proposed as a way toward a more evidence-based practice in extended roles.

    Place, publisher, year, edition, pages
    Sage Publications, 2015
    Keywords
    extended roles, health care, informal learning, workplace learning, qualitative
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-118283 (URN)10.1177/1054773814543355 (DOI)000364723000006 ()25059719 (PubMedID)
    Available from: 2015-05-25 Created: 2015-05-25 Last updated: 2017-12-04
    2. Learning opportunities in rheumatology practice: a qualitative study
    Open this publication in new window or tab >>Learning opportunities in rheumatology practice: a qualitative study
    2015 (English)In: Journal of Workplace Learning, ISSN 1366-5626, E-ISSN 1758-7859, Vol. 27, no 4, p. 282-297Article in journal (Refereed) Published
    Abstract [en]

    Purpose

    – This paper aims to explore what opportunities for learning practitioners in rheumatology perceive of in their daily practice, using a typology of workplace learning to categorize these opportunities.

    Design/methodology/approach

    – Thirty-six practitioners from different professions in rheumatology were interviewed. Data were analyzed using conventional qualitative content analysis with a directed approach, and were categorized according to a typology of formal and informal learning.

    Findings

    – The typology was adjusted to fit the categories resulting from the analysis. Further analysis showed that work processes with learning as a by-product in general, and relationships with other people in the workplace in particular, were perceived as important for learning in the workplace. The use of many recognized learning opportunities was lower. Barriers for learning were a perceived low leadership awareness of learning opportunities and factors relating to workload and the organization of work.

    Research limitations/implications

    – The generalizability of results from all qualitative inquiries is limited by nature, and the issue of transferability to other contexts is for the reader to decide. Further studies will need to confirm the results of the study, as well as the proposed enhancement of the typology with which the results were categorized.

    Practical implications

    – The study highlights the importance of relationships in the workplace for informal learning in rheumatology practice. In the clinical context, locally adapted strategies at organizational and individual levels are needed to maximize opportunities for both professional and interprofessional informal learning, taking the importance of personal relationships into account. The findings also suggest a need for increased continuing professional education in the specialty.

    Originality/value

    – The workplace learning typology that was used in the study showed good applicability to empirical health-care study data, but may need further development. The study confirmed that informal workplace learning is an important part of learning in rheumatology. Further studies are needed to clarify how informal and formal learning in the rheumatology clinic may be supported in workplaces with different characteristics.

    Place, publisher, year, edition, pages
    Emerald Group Publishing Limited, 2015
    Keywords
    Health care, Continuing professional development, Workplace learning, Collaborative relationships
    National Category
    Chemical Sciences
    Identifiers
    urn:nbn:se:liu:diva-127494 (URN)10.1108/JWL-07-2014-0054 (DOI)
    Available from: 2016-04-28 Created: 2016-04-28 Last updated: 2017-11-30Bibliographically approved
  • 2.
    Neher, Margit
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Rehabilitation Center.
    Nygardh, Annette
    Jonkoping Univ, Sweden.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Broström, Anders
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Jonkoping Univ, Sweden.
    Johansson, Peter
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping.
    Implementing internet-delivered cognitive behavioural therapy for patients with cardiovascular disease and psychological distress: a scoping review2019In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 18, no 5, p. 346-357Article, review/survey (Refereed)
    Abstract [en]

    Background: Comorbid psychological distress (i.e. insomnia and depression) is experienced by 20-40% of patients with cardiovascular disease. This has a considerable impact on their health and quality of life, leading to frequent re-hospitalisations, higher healthcare costs and a shorter life expectancy. Internet-based cognitive behavioural therapy shows great potential for treating psychological distress in cardiovascular disease. Effective and feasible treatments can, however, only benefit patients if they are fully implemented in clinical care. Aim: This scoping review aimed to explore the literature for internet-based cognitive behavioural therapy in cardiovascular disease and for strategies to implement the intervention. Methods: We searched electronic databases, journals and internet sources to find original studies about internet-based cognitive behavioural therapy in cardiovascular disease, adhering to scoping methodology guidelines. After identifying 267 titles, we screened 40 abstracts and chose 11 full-text articles for full-text screening. The results sections in four articles were searched for outcomes that related to the effectiveness and implementation of internet-based cognitive behavioural therapy by directed qualitative content analysis using an implementation framework. Results: Three of the four articles fulfilling the inclusion criteria concerned internet-based cognitive behavioural therapy for treating mild to moderate depressive symptoms in cardiovascular disease, and none focused on insomnia. The studies showed evidence for the effectiveness of internet-based cognitive behavioural therapy, and/or described patient factors influencing clinical effectiveness. Our qualitative content analysis showed that many implementation aspects and stakeholder perspectives remain unexplored. Conclusions: Internet-based cognitive behavioural therapy promises to alleviate patient suffering in cardiovascular disease. There is, however, little research about internet-based cognitive behavioural therapy for cardiovascular disease, and about how this evidence-based intervention is implemented.

  • 3.
    Neher, Margit Saskia
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Learning opportunities in rheumatology practice: a qualitative study2015In: Journal of Workplace Learning, ISSN 1366-5626, E-ISSN 1758-7859, Vol. 27, no 4, p. 282-297Article in journal (Refereed)
    Abstract [en]

    Purpose

    – This paper aims to explore what opportunities for learning practitioners in rheumatology perceive of in their daily practice, using a typology of workplace learning to categorize these opportunities.

    Design/methodology/approach

    – Thirty-six practitioners from different professions in rheumatology were interviewed. Data were analyzed using conventional qualitative content analysis with a directed approach, and were categorized according to a typology of formal and informal learning.

    Findings

    – The typology was adjusted to fit the categories resulting from the analysis. Further analysis showed that work processes with learning as a by-product in general, and relationships with other people in the workplace in particular, were perceived as important for learning in the workplace. The use of many recognized learning opportunities was lower. Barriers for learning were a perceived low leadership awareness of learning opportunities and factors relating to workload and the organization of work.

    Research limitations/implications

    – The generalizability of results from all qualitative inquiries is limited by nature, and the issue of transferability to other contexts is for the reader to decide. Further studies will need to confirm the results of the study, as well as the proposed enhancement of the typology with which the results were categorized.

    Practical implications

    – The study highlights the importance of relationships in the workplace for informal learning in rheumatology practice. In the clinical context, locally adapted strategies at organizational and individual levels are needed to maximize opportunities for both professional and interprofessional informal learning, taking the importance of personal relationships into account. The findings also suggest a need for increased continuing professional education in the specialty.

    Originality/value

    – The workplace learning typology that was used in the study showed good applicability to empirical health-care study data, but may need further development. The study confirmed that informal workplace learning is an important part of learning in rheumatology. Further studies are needed to clarify how informal and formal learning in the rheumatology clinic may be supported in workplaces with different characteristics.

  • 4.
    Neher, Margit
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Ellström, Per-Erik
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Knowledge Sources for Evidence-Based Practice in Rheumatology Nursing.2015In: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 24, no 6, p. 661-679Article in journal (Refereed)
    Abstract [en]

    As rheumatology nursing develops and extends, knowledge about current use of knowledge in rheumatology nursing practice may guide discussions about future knowledge needs. To explore what perceptions rheumatology nurses have about their knowledge sources and about what knowledge they use in their practice, 12 nurses working in specialist rheumatology were interviewed using a semi-structured interview guide. The data were analyzed using conventional qualitative content analysis. The analysis yielded four types of knowledge sources in clinical practice: interaction with others in the workplace, contacts outside the workplace, written materials, and previous knowledge and experience. Colleagues, and physicians in particular, were important for informal learning in daily rheumatology practice. Evidence from the medical arena was accessed through medical specialists, while nursing research was used less. Facilitating informal learning and continuing formal education is proposed as a way toward a more evidence-based practice in extended roles.

  • 5.
    Neher, Margit
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Festin, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Implementation of Evidence-Based Practice in Rheumatology: What Sociodemographic, Social Cognitive and Contextual Factors Influence Health Professionals’ Use of Research in Practice?2016In: Journal of rheumatic diseases and treatment, ISSN 2469-5726, Vol. 2, no 3, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Abstract

    Objective: Research on the use of research in rheumatology practice is largely lacking. This study attempts to fill this knowledge gap by exploring the degree to which evidence-based practice (EBP) is implemented in clinical rheumatology practice and identifying individual and organizational factors that may potentially affect research use in the clinical environment.

    Methods: A web-based questionnaire was distributed to members of health professional groups in clinical rheumatology by way of publicly available e-mail addresses. Data were collected on sociodemographic, social cognitive, and contextual factors deemed to potentially influence the use of research in practice. The outcome measure was the EBP Implementation Scale.

    Results: A complex range of factors was found to influence the outcome. The factors that were most clearly associated with research use were the perception of personal ability to use research knowledge, years of experience in clinical rheumatology, and experience of research activities.

    Conclusions: Our study results suggest a large variation in levels of implementation of EBP across work units and individuals, and although a low general standard is indicated (even if a gold standard does not exist), there was also a great interest in working according to EBP principles. Potential for change is apparent, but it seems necessary to examine the use of research evidence in rheumatology practice at the individual and work unit levels to accommodate local and individual needs and resources. Future studies are needed to examine the influence of contextual influences by other methods.

  • 6.
    Nilsen, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Neher, Margit
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Ellström, Per-Erik
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Gardner, Benjamin
    Institute Psychiat Psychol and Neurosci, England.
    Implementation of Evidence-Based Practice From a Learning Perspective2017In: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 14, no 3, p. 192-199Article in journal (Refereed)
    Abstract [en]

    IntroductionFor many nurses and other health care practitioners, implementing evidence-based practice (EBP) presents two interlinked challenges: acquisition of EBP skills and adoption of evidence-based interventions and abandonment of ingrained non-evidence-based practices. AimsThe purpose of this study to describe two modes of learning and use these as lenses for analyzing the challenges of implementing EBP in health care. MethodsThe article is theoretical, drawing on learning and habit theory. ResultsAdaptive learning involves a gradual shift from slower, deliberate behaviors to faster, smoother, and more efficient behaviors. Developmental learning is conceptualized as a process in the opposite direction, whereby more or less automatically enacted behaviors become deliberate and conscious. ConclusionAchieving a more EBP depends on both adaptive and developmental learning, which involves both forming EBP-conducive habits and breaking clinical practice habits that do not contribute to realizing the goals of EBP. Linking Evidence to ActionFrom a learning perspective, EBP will be best supported by means of adaptive learning that yields a habitual practice of EBP such that it becomes natural and instinctive to instigate EBP in appropriate contexts by means of seeking out, critiquing, and integrating research into everyday clinical practice as well as learning new interventions best supported by empirical evidence. However, the context must also support developmental learning that facilitates disruption of existing habits to ascertain that the execution of the EBP process or the use of evidence-based interventions in routine practice is carefully and consciously considered to arrive at the most appropriate response.

  • 7.
    Nygårdh, Annette
    et al.
    Jönköping University, Sweden.
    Neher, Margit
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Broström, Anders
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Jönköping University, Sweden.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Johansson, Peter
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Towards internet-based cognitive behavioural therapy for patients with cardiovascular disease and comorbid depression and insomnia?2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no 7, p. 565-566Article in journal (Other academic)
    Abstract [en]

    n/a

1 - 7 of 7
CiteExportLink to result list
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  • harvard1
  • ieee
  • modern-language-association-8th-edition
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  • en-GB
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