How Can One Function As A Change Agent And Leadership Skills To Affect Change As A Nurse Educator

• Journal List
• BMC Med Educ
• 5.xvi; 2016
• PMC4768336

BMC Med Educ. 2016; 16: 71.

Educating change agents: a qualitative descriptive study of graduates of a Principal's program in evidence-based practice

Grete Oline Hole

Heart for Evidence-Based Do, Bergen Academy College, Bergen, Norway

Sissel Johansson Brenna

Centre for Prove-Based Do, Bergen University College, Bergen, Norway

Birgitte Graverholt

Heart for Evidence-Based Practice, Bergen University College, Bergen, Norway

Donna Ciliska

Center for Evidence-Based Practice, Bergen University College, Bergen, Norway

School of Nursing, McMaster University, Hamilton, ON Canada

Monica Wammen Nortvedt

Centre for Prove-Based Do, Bergen University College, Bergen, Norway

Received 2015 Feb 22; Accepted 2016 February 16.

Abstract

Background

Wellness care professionals are expected to build decisions upon show. This implies decisions based on the all-time available, electric current, valid and relevant evidence, informed by clinical expertise and patient values. A multi-professional master's program in show-based practice was developed and offered. The aims of this study were to explore how students in this program viewed their power to use evidence-based practise and their perceptions of what constitute necessary atmospheric condition to implement bear witness-based practice in health care organizations, one year later on graduation.

Methods

A qualitative descriptive design was chosen to examine the graduates' experiences. All students in the first two cohorts of the programme were invited to participate. 6 focus-group interviews, with a full of 21 participants, and a phone interview of ane participant were conducted. The data was analyzed thematically, using the themes from the interview guide every bit the starting point.

Results

The graduates reported that an overall necessary condition for evidence-based practice to occur is the being of a "readiness for alter" both at an individual level and at the organizational level. They described that they gained personal knowledge and skills to be "modify-agents" with "self-efficacy, "analytic competence" and "tools" to implement evidence based practice in clinical care. An organizational civilisation of a "learning organization" was as well required, where leaders take an "awareness of evidence- based do", and come across the need for creating "prove-based networks".

Conclusions

One yr afterward graduation the participants saw themselves equally "alter agents" prepared to improve clinical care within a learning organisation. The results of this report provides useful information for facilitating the implementation of EBP both from educational and health care organizational perspectives.

Keywords: Show-based practice, Graduate pedagogy, Multi-professional person education, Qualitative research, Learning organizations

Background

Wellness care professionals are expected to build decisions upon show. This requires that decisions are based on the best available, current, valid and relevant evidence from enquiry, informed by clinical expertise and patient values [1]. Prove-based practice (EBP) is seen as a cadre competence in several countries, but there are differences regarding the extent to which EBP is implemented [2].

One of the challenges in programs that teach EBP is to achieve the application of EBP skills in clinical care [3]. Integrating the didactics and learning of EBP equally close to clinical practise every bit possible is recommended to clinch sustainable learning for the participants [4, 5]. Ubbink et al. [vi] published a systematic scoping review of 31 studies and constitute that twenty years later its introduction, EBP implementation in clinical intendance is still deficient. Young et al. [iii] explored the effect of dissimilar pedagogy modalities to raise the learners' skills, cognition and attitudes, exercise and health outcomes, and in 2014 Ilic and Maloney [7] presented a review of xiv randomized trials regarding teaching EBP at different levels. Both reviews supported Horsley et al. [8] findings: the pathway from EBP education and grooming to using EBP competencies for improved clinical care is long and complex, and not well evaluated.

The effect of any postgraduate education on patient outcomes is debated [9]. Gijbels et al. [x] found low quality evidence in 61 studies of postgraduate education. Included studies measured mainly the students' self-reported view of achieved competencies, but the competencies were non clearly divers. Cotterill-Walkers [11] carried out a comprehensive review to explore if Master's education in nursing improved patient care. Participants reported constraints on their ability to practice new noesis and skills. Another systematic review of the outcome and touch of a Master's caste on health care revealed that the impact is seldom defined and mainly measured by self-reported surveys and qualitative studies [12]. There is a need for more in-depth studies of how participants in Master's programs feel the impact on their professional person practice, to ensure that the curriculum will come across the requirements from the clinical field.

The aims of this study were to explore how two cohorts of graduates of a multi-professional Master'southward plan in EBP a) perceived their power to apply EBP one year after graduation and b) what they saw as necessary conditions to implement EBP at their workplace.

Methods

To examine the graduates experiences a qualitative descriptive design was chosen [13, 14]. Inside the businesslike framework [15] focus group interviews were conducted to capture participants' collective word and reflection, post-obit Krueger and Casey's guidance [16]. This included planning the report, development and refinement of the interview-guide ("the question route" ([16], p 41), moderating each interview, with utilize of appropriate "pauses and probes" ([sixteen], p 99), using an iterative procedure of analyses, and interpreting data and presenting findings.

Setting

Master's programs in Norway are equivalent to two years full-fourth dimension study, credited with 60 European Credit Transfer and Aggregating System (ECTS) credits each year [17]. A multi-professional person Master's program in evidence-based practice (MA-EBP) has been offered at Bergen University College, Norway since 2008. An overall aim of the program is to brainwash consumers of research who are able to initiate and comport out improvements in health care.

The programme follows a framework for EBP with a stepwise arroyo [1]. This includes utilizing evidence, knowledge from inquiry, experience-based knowledge and the users' knowledge and participation. These three sources of knowledge are used to inform clinical practice within a specific context, as presented in the model from the Norwegian Knowledge Centre for Health Services (Fig.1).

Model of testify-based practice (EBP) [51]

The MA-EBP is a part-time study programme. The beginning cohort received their 120 ECTS credits over three years. The second cohort, starting in 2009, gained the same number of credits over a four twelvemonth program. The students were employed in different wellness care settings in Kingdom of norway. They came to Bergen for week-long sessions three times each semester.

Students used their own work experiences to identify dubiousness in practice. These uncertainties served as starting points for every chore and assignments throughout the program. For their thesis, most students either conducted a systematic review or evaluated current practice equally a clinical audit.

The program itself is built upon bear witness of how to teach EBP [6, 18] and is rooted in the concepts of adult, self-directed learning inside a constructivist learning surroundings [19]. Developed learning theory is based on the premise that individuals learn what is relevant for them, building upon existing knowledge [twenty, 21]. The programme encourages knowledge-sharing, learning and change within communities of practice [22].

The teachers supported the learners in a self-directed approach, to apply their skills and knowledge when they return to their workplace. By reflecting on what needs to be changed and how, the students were challenged to learn different strategies of addressing a problem. This included identifying barriers for alter and opportunities to overcome these, and how to implement the necessary changes. Table1 gives an overview of the Master'due south program.

Table one

Overview Master's program in EBP

Semester	Topic	ECTS
1	Introduction to EBP in health care	15
2	EBP-Implementation I (clinical do)	15
3	Philosophy of scientific discipline, methodologies and methods	15
iv	EBP-Implementation 2 (organization)	15
5	Developing a research projection and in-depth research methods	15
6–viii	Master's thesis	45

Schön'southward reflection in action is an underlying concept of this educational activity modality [23]. Skilled wellness professionals build upon earlier experiences, link this to newly accomplished competencies from the programme, so use those new competencies when they return to clinical work. Assignments and exams were completed between course sessions. Social interaction and collaborative small grouping learning were promoted to foster an surround where students could discuss and debate. Study groups met regularly both in and outside class, with interaction representing approximately xl % of the learning sessions. Introductory lectures presented baseline knowledge, but these were interactive. Clinical scenarios were embedded in near learning activities.

Sample and data collection

This study was conducted with the get-go 2 graduating cohorts (30 people). The graduates were mainly health care professionals only health librarians and health journalists were also represented. All had considerable piece of work experience, and many had earned postgraduate education (Table2). While enrolled in the plan, students worked part-time and their work feel was essential for fulfilling some of the learning tasks.

Table 2

Demographic characteristics' of participants

Informants	Due north thirty/n 22
Historic period (mean)	29–56 (40.6)
Profession
Registered Nursea	sixteen
Physiotherapista	2
Occupational Therapista	2
Health librarian/-journalista	2
Further education
Genericb	9
Inter-professional	3

Invitations were sent by electronic mail one year after graduation. Out of 30 potential participants, 22 volunteered, 11 from each accomplice. Half dozen semi-structured focus groups discussions with 3–4 participants in each were conducted. 1 participant who could not attend the focus grouping was interviewed past phone.

The discussions were audiotaped and memos were written during the focus groups to capture the context. GOH and SJB facilitated and co-facilitated the interviews, except for one group in the second accomplice where GOH had been supervising these students. In this example SJB moderated the discussion with another co-moderator.

The focus groups/interview lasted between threescore–120 min. All professions represented in the cohorts participated in the focus groups and all participants were female. Each participant had a unique identifier, by the cohort (2008 or 2009), the sequence of the interviews (1–4) and by the number of the participants (1–4).

Data assay

The more 12 h of taped discussion were transcribed to 130 pages of text by a research banana. Interim analysis guided the planning of the next focus groups.

A thematic analysis was done with each transcript with the four themes for the semi-structured interview guide equally starting point [24]. This focused upon experiences as students, perceptions of their competencies in EBP, office performance in EBP and suggestions for improvements in the educational plan (not included in this paper every bit the purpose was feedback to the program). The analysis involved carefully reading through the transcript several times, first to get an overview over the interview and then to grouping the statements into the initial themes. When the three first interviews were grouped, a further rereading and grouping took place. The statements were and then condensed and tentative codes and subcodes were developed for each group session. Thereafter the coded statements from the offset cohort were pulled together for each initial theme. Next, statements were further grouped and condensed to new codes, where one sought to identify patterns and clarify what seemed to exist essential for the students. Matrices were used to get an overview and make comparisons [25]. Saturation was non a goal of the assay, equally all potential participants were invited at that place was no possibility of increasing the number of participants.

The assay was undertaken by GOH, but at each central step in the procedure the preliminary findings was discussed with SJB. Each session involved dialogue over the codes and how tentative findings could be interpreted. Reflection notes were written before and afterwards the meetings. Each step followed the criteria past Lincoln and Guba to ensure trustworthiness and authenticity [26]. Findings from the first cohort guided the interviews and analysis with the 2nd cohort. For the second accomplice, we sought to explore more in-depth how the students experienced the intended link betwixt the model of EBP (Fig.one), the study program and the underlying pedagogical framework. Did the program promote the defined learning outcomes? Did information technology give participants the necessary competencies to implement EBP in their clinical practice? Pocket-size adjustment of the interview guide and the introductory question were made at this point. Students' experiences were still discussed, only with a closer focus on their feedback regarding the programme rather than their personal experiences. For each theme we explored their experiences equally adult learners, tasks rooted in cerebral learning theories linked towards lifelong learning and their thoughts about using EBP in the futurity. The coding first followed the same process equally for cohort 1. Thereafter the findings from all seven data collection sessions were pulled together and further in-depth analysis was conducted with a closer focus upon the participants learning outcomes. Other authors (BG, DC and MWN) participated in analysis, discussion of the presentation of the findings and refinement of the model.

Upstanding considerations

The study was given ethical blessing by the Norwegian Data Protection Official in accordance with the Personal Data Human activity and the participants gave their written informed consent. Efforts were taken to ensure that the participants were not recognizable in the presentation of findings.

Results

The aims of this study were to explore how the graduates perceived their ability to use the principles of EBP and what they saw as necessary conditions to be able to follow the EB process in a clinical setting. Even though the report initially had focus upon the graduates' individual capabilities, during the analysis it became clear that organisational factors were crucial for former students' experiences during the MA-program and the first year after graduation. Individual factors were identified as "self-efficacy", "tools" and "analytic competence" which together constituted an "ability to be change agents". Factors related to the possibility of applying EB inside their own organisation were "leadership", an "awareness of EBP" and "EBP networks", which together provided the "ability to be a learning organization". Together, this constituted the overall condition for EBP, and is the necessity of "readiness for change", as illustrated in Fig.2. While the participants appreciated the acquired cognition and skills, organizational factors were crucial to their power to utilize these competencies. The analysis revealed that these individual and organizational factors could not be seen as separate situations, only are mutually interdependent.

Model of "Readiness for change"

The ability to be modify agents

Participants viewed themselves equally "change agents". They stated that they had adult a strong aspiration for improving clinical care, including a firm desire for motivating and supporting others towards 'all-time practise' at all levels. Nosotros must guide clinical practice towards the right way several participants expressed. The right mode meant judging every situation carefully, not slavishly follow guidelines or procedures. Three subthemes emerged inside "power to be a change agent": "cocky-efficacy", "analytic competence" and "useful tools". These will exist presented in turn.

Cocky-efficacy

"Self-efficacy" was reflected by a raised consciousness of the informants' professional standing, a firm belief in their abilities to promote best practice and an increased sensation of the importance of a reciprocal EBP-network.

Participants revealed a raised consciousness of their professional person standing as a result of the constant reflection on their own do and on the rationale behind clinical decisions, which the informants said was introduced by the program. These atomic number 82 to improved professional confidence, independence and pride, and a increased awareness of professional carry and diligent care. Statements as I have increased pride in my piece of work and I got a new view of my piece of work, it is possible to improve clinical intendance (08,2,2) indicates this. Participants described that the new cognition was utilized in clinical reasoning with other professionals, which was appreciated past colleagues. My mission is to 'sow questions' among my colleagues, - let them showtime to reflect (08,1,2). They found that leaders and colleagues recognized their new skills, which gave them a new legitimacy.

They also expressed a firm belief in their ain abilities to improve health services, and were confident that their endeavor could improve clinical care. By stating I know I can brand a difference (08,2,one) participants demonstrated how they wanted to back up their colleagues to work towards all-time do.

Analytic competence

"Analytic competence" referred to the ability to analyze a situation, describe it and argue for change. This "analytic competence" consists of both "organizational knowledge" and "awareness of the importance of relevant bear witness for clinical decisions".

The participants gave an impression of having gained theoretical and empirical understanding of the diverseness and complication of health care organizations, by statements such as Health care systems are circuitous, with different cultures, but we learned how to overcome the difficulties (08,1,1). This understanding made them able to place key persons in their organizations who could exist considered important opinion-leaders and stakeholders. I became aware of how of import it is to anchor proffer of change with the leaders (08,2,1).

A crucial part of "organizational knowledge" is the awareness of determination-making processes in health care organizations and the realization of their ain abilities to influence decisions. Participants described that they knew and could use implementation strategies, theories of change, and how to identify and overcome barriers. In improver, they had confidence in their ability to position themselves at their own workplace to promote change. Nosotros also constitute participants describing improved organizational skills, the ability to piece of work systematically and analytically, likewise every bit improved advice and dissemination skills. During the program, students enhanced their appreciation of the importance of prove-informed decisions. In line with the concept of EBP (Fig.i), the participants reported that they used evidence from all sources of noesis when discussing clinical issues. They also gained a scientific vocabulary which strengthened their ability to convince others and raised their credibility among colleagues. This was reflected in statements equally I will not merely do as someone tells me, I want to know the reason for doing that (08,ii,2) and I can argue for my stance when I hash out with doctors, and my leader (08,three,two).

Useful tools for working with EBP

Participants expressed that the hands-on manner of learning during the educational program gave them the competencies for promoting EBP. During the focus groups the graduates oft stated I have gained the necessary tools. These were tools linked to the steps of EBP: the ability to reverberate upon electric current practice, find relevant evidence from inquiry, appraise the evidence and implement what they establish.

Evaluating practise often exposed unwarranted variation and they were now able to argue for keeping or changing practice based on evidence from research and feel-based knowledge. They likewise establish the language and vocabulary employed during discussions within the multi-professional grouping fostered a common language beyond different professional cultures. This made them able to fence with evidence both within their profession and across professions. When you check what show there is, the discussions are better (08,i,1).

The ability to be a learning organization

Participants saw "the power to be a learning organization" as a necessary condition for the implementation of EBP. Working with EBP is time-consuming, and it is important to determine who should do what, at what level within the organization and to classify sufficient resource to achieve the use of evidence in changing practice. The participants described the necessity of a strategy for implementing EBP anchored in the organisation. Several commented that all health care workers in Norway must know about EBP, only each individual demand not follow the steps of EBP in their daily work. The implementation of EBP must have a systematic perspective, with dedicated persons promoting EBP at all levels within the organization, thereby building a learning organization. Several participants described their workplace as a learning organization, which allowed them to utilize their skills and knowledge gained during the program. Of those who did non accept such support, some volunteered to engage in work with EBP, while others plant new jobs where their new skills were more than appreciated.

The subthemes identified under the organizations' ability to be a learning organization were: "leadership", "awareness of EBP" and "EBP networks". Each will be presented below.

Leadership

The data showed the importance of support from leaders. My leader was very positive, and tasks I did according to the assignments are now implemented at my workplace (08,2,iii). This was followed by disappointment if the participants did not have such support. Not ane of my leaders was interested in my Master's study. Never! (08,2,ii). They expressed the necessity for an organizational strategy for implementing EBP: It is of import that the leaders back up the facilitation of EBP (08,2,3). Such a strategy should be overarching for the wellness care arrangement and so exist operationalized for each local workplace. Some informants perceived this where they worked. Where I piece of work all the leaders accept committed to EBP (08,i,3). But working in an EB way is time-consuming, and must be prioritized. Non all leaders recognized this. It is hard to work on EBP without added time and resources (09,1,iii).

Awareness of EBP

Even though EBP is prized inside Norwegian health care and is stated as an essential goal in several governmental papers [two], the discussion revealed that different levels of knowledge of EBP exist. Many statements indicated a lack of understanding of the concept. My leader was very positive, but she did not know how to use what I learned (08,2,1). Several of the participants used the phrase There is a need for spreading EBP within clinical practice in Norway.

The participants agreed that they used their new skills and competencies from the graduate program in their daily piece of work, but they described the organizational learning attitude and motivation every bit central to their opportunities to practice so. Some returned to their former workplace and were satisfied with their ability to use EBP, while others sought opportunities to work with EBP within their health trust. I volunteered to write guidelines, must show them what I can practice (09,one,1). Quite a few of the graduates were engaged in new jobs, where their competencies are wanted and appreciated. For example, i participants stated I now have a job where I can employ what I learned every solar day. It is similar doing my thesis once more than (09,three,2).

EBP networks

Several participants expressed a need for EBP networks where they could share and support each other towards implementing EBP. During the plan, peer students were important to them, and they wanted to proceed contact later on graduation. Statements like The discussions in our grouping were essential for my learning (08,3,ane) and There are and so many resources amidst us, there is always somebody who knows more than me about an result (09,i,one) reflect this.

Returning to work they wanted to promote EBP. Their closest leader was fundamental to success with this, just the participants also identified a demand to help their colleagues to implement EBP. People enquire me: do you know annihilation near this and that…? And it is satisfying to be able to find literature which answers the questions (08,1,iv). They raised the importance of existence a part of a reciprocal EBP network, as a community with common goals. As a student you lot could always ask someone for assist. We still need networks after graduation, as we have a responsibility for implementing EPB (08,1,one). This view was not simply related to their workplace, but expressed as a need for a national EBP network.

Discussion

The study sought to explore a) to what extent a new Master's programme in EBP gave the students the ability to promote EBP and b) what the graduates saw equally necessary conditions to implement EBP at their own workplace one year later graduation. The analysis revealed the importance of a "readiness for modify" regarding implementation of EBP, as shown in Fig.two. Participants experienced that the Master's program in EBP gave them the ability to exist a "change agent". However, the importance of the organizations' "ability to be a learning organization" was emphasized. Participants expressed that requirements for practicing their enhanced EBP skills were that the organization have "leadership which supports EBP", an "awareness of the importance of EBP" within the organisation and leaders who "support EBP networks".

Compared to results of other studies within health [10, 12] it seems that participants in our report acquired more hands-on skills in promoting EBP and used their new skills to support a learning arrangement. While Cotteril-Walker's review [11] clearly showed the constraints the students felt using new knowledge and skills, our informants confidently expressed that they could utilize what they learned during the Master's program in their daily work. This might be due to how the Main's program is constructed, leading students through the steps of EBP [1] inside the framework of different sources of knowledge for decision- making (Fig.one), and requiring them to use content related to organizational change and barriers for implementation. When planning the program, emphasis was put upon giving the students hands-on experience with implementation processes [27–29] during the plan. In addition, one of the learning outcomes was that the students should become familiar with implementation strategies.

Several program characteristics may accept contributed to the empowerment of the participants. In 2006, Khan and Coomarasamy [iv] demonstrated the importance of interactive and clinically integrated educational activity of EBP, and several others have shown the need for using unlike instruction modalities to stimulate the learning process [3]. The program construction, with assignments anchored in clinical issues from students' ain workplace, provided fertile learning with relevant and applicable knowledge. The participants felt this more strongly ane twelvemonth after graduation.

At that place were no traditional exams testing knowledge. Habitation-based assignments were constructed stepwise following the procedure of EBP [1], making room for cumulative learning over weeks. Discussion and collaboration between students was encouraged in a constructivists learning environment. Being one of the get-go Master's programs for health professionals at that academy college site, students had waited for some time for the initiation of the program and were highly motivated. Several participants stated that the assignments made them reflect upon why and how this had become the common way of working at their workplace. Reflection and discussions encouraged them to use information from all sources of knowledge (Fig.1). They became more in bear upon with their tacit knowledge and learned to limited what they knew from former experiences in a way other professions could understand. This is in accordance with the skill acquisition and joint of embedded knowledge in expertise [30] and what is known of the development of professional person practice [31], and conspicuously counters the traditional critiques of EBP as a cookbook-like do where one slavishly follows instructions and procedures [32]. It seems like the easily-on training linked to the steps of EBP and the abiding utilise of evidence from different sources gave the former students a solid foundation for practicing their noesis and skills after graduation.

The curriculum is advisedly created to enhance the students' abilities to detect and employ testify from research in clinical practice. How participants described the part as change amanuensis has as well been labelled equally "noesis brokers" [33], as they were able to understand the clinical questions, find and critique relevant research and implement the findings when appropriate to their clinical unit. Cognition brokers are one of many noesis translation (KT) strategies used during the final decade [34]. A randomized trial of iii levels of KT intervention intensity [35] revealed the importance of knowledge brokers to promote evidence into do, peculiarly when the organizational civilization for research utilise was low, which has been the instance in many Norwegian wellness care institutions.

To retain staff with these skills, it was important that the health care services were learning organizations. Learning organizations accept been described in the leadership literature over the last decades as important for innovation and change. A learning system is structured to facilitate cosmos besides equally sharing of noesis amidst members or employees, and to foster individual skills equally an of import part of the system'southward collective competence [22]. In Great britain it was considered an of import role of the new strategy for the National Health Service [36–38] as well as a necessary status to address the 'knowing-doing gap' when promoting EBP [39]. A systematic review summarizing how to spread and sustain innovations in health services commitment emphasised the demand for a knowledge-based approach to innovations in organizations, according to the goals and values of a learning arrangement [28]. In our study, leadership was considered an important factor for the implementation of EBP in learning organizations, equally leaders were able to conspicuously prioritize and mobilize resources.

The necessity of leadership and resources allotment was too found in a case written report by Peirson et al. [40], who studied a public health unit's long-term strategic initiative to build organizational and staff capacity for evidence informed decision-making. The leaders at the highest levels were the ones who "stimulate and propel alter" ([40], p nine). Leaders with vision and mission were essential in setting the course of modify. It is of import that both leaders and the structure of the organization make room for knowledge brokers to practise their piece of work, and allow time for participation in supportive networks. This is consequent with findings from Melnyk et al. [41, 42]; which emphasized the potent demand for incorporating organizational change as well as leadership when planning the implementation of EBP.

Participants reported that their role as "change agents" became an of import role of the organizational network supporting EBP, where new individual skills contributed to the enhanced competencies in the organization. This is in line with findings from other studies pointing at the importance of the civilization of the system [22, 28, 35, 37, 39], and is further supported by Michie et al. [27] with the identification of different domains within psychological theories. The domains of "environmental context and resource" and "social influences" ([27], p 30) demonstrate the importance of of the civilisation of the organization when implementing EBP.

The growing focus on quality in health services link EBP as a necessary premise and tool for ensuring best practices. Equally early on equally in 2001 it was i of the 10 recommendations in Institute of Medicine' seminal report "Crossing the Quality Chasm: A New Health System for the 21^st Century" [43]. The qualities of learning organizations, lifelong learning, leadership and structural components to support EBP are seen every bit crucial components to heighten quality of care in the Magnet Infirmary Recognition Program [44–47]. Our written report results show that participants discovered the same factors to be important in their ability to employ EBP. The close interplay between individual and organizational factors which constitutes a "Readiness for modify" are in line with facilitators presented elsewhere [48, 49]. As demonstrated by Melnyk et al. [41, 42], every bit well as findings from Williamson et al. [50], these factors are very important when planning educational interventions to promote EBP and supporting clinical leaders.

Force, limitations and inquiry implications

The present study is a small study with simply 2 cohorts and 22 participants. However, there was a high participation rate from the total of 30 potential participants. The focus groups triggered reflections of learning, and perceptions of their ability to EBP in the work situation. We sought to avoid the domination of any few participants with the use of a co-moderator to ensure that all participants could take part in the discussion. The interview guide worked well. Later on each interview the interim analysis started, and tentative findings guided the adjacent interviews. A follow-up study with in-depth interviews with the graduates would be useful to explore how they overcame barriers to implementing EBP, how they contributed to building a learning organization; and what divergence the implementation of EBP made on clinical outcomes.

Conclusion

Our findings demonstrated that one year later graduation, the participants reported that the Primary'due south program of EBP had given them applicable knowledge they found useful in their daily work. Together with the caused organizational noesis and analytic competencies, they saw themselves as "change agents", prepared to improve clinical intendance within a learning organisation.

If dedicated professionals are to succeed in improving patients' outcomes', both organizational and individual factors must be addressed. The findings from our study indicate that the Main'due south programme led to the intended learning outcomes and gave the graduates the necessary competencies to implement EBP in their own workplace if the factors important for creating a "readiness for change" are present. This knowledge may prove valuable for facilitating EBP in health care, and can exist guidance to the developers of EBP curriculum.

Acknowledgements

We want to thank the former students who participated in the study, and the staff at Centre for Evidence-Based Practice at Bergen Academy College for their support, specially Katrine Aaseskjaer for assisting as co-moderator at one of the focus group, and K. Hedvig H. Myklebust for graphical design. We also give thanks Janet Harris who led the Chief's plan the commencement year, and for her contribution in the study.

Funding

GOH had release time for research from Bergen Academy College. The University Higher had no influence over the design, data drove, analysis, interpretation, or writing of the manuscript.

Abbreviations

EB	prove-based
EBP	bear witness-based exercise
ECTS	European Credit Transfer and Accumulation System
KT	knowledge translation
MA-EBP	Master's program in evidence-based do

Footnotes

Competing interests

All authors are associated with the Master's programme described in this report and all are or have been employed by the Heart for Evidence-Based Do where this Principal'due south program is offered. Intendance was taken to go on analysis and estimation truthful to the information.

Authors' contributions

GOH and MWN planned and designed the study. GOH and SJB conducted the focus-groups/interview and the initial analysis. All authors; GOH, SJB, BG, DC and MWN participated in the analysis and the writing of the manuscript. All authors read and approved the final manuscript.

Contributor Data

Grete Oline Hole, Email: on.bih@eloH.enilO.eterG.

Sissel Johansson Brenna, Email: on.bih@annerB.nossnahoJ.lessiS.

Birgitte Graverholt, E-mail: on.bih@tlohrevarG.ettigriB.

Donna Ciliska, Email: air conditioning.retsamcm@aksilic.

Monica Wammen Nortvedt, Electronic mail: on.bih@tdevtroN.nemmaW.acinoM.

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Articles from BMC Medical Instruction are provided hither courtesy of BioMed Primal

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4768336/

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