Document Type

Dissertation

Date of Degree

Spring 2-10-2023

Primary Advisor

Shelley B. Brundage, Ph.D., CCC, BCS-F, Fellow-ASHA

Keywords

evidence-based practice; clinical education; clinical supervision; healthcare; implementation science; psychological safety; scholarship of teaching and learning

DOI

https://doi.org/10.4079/THS2023.05

Abstract

Background: Evidence-based practice (EBP) was introduced to the profession of speech-language pathology in 2004. However, the limited empirical and implementation literature on EBP in speech-language pathology suggests that the field lags behind other healthcare disciplines, including physical therapy, occupational therapy, and nursing. Additionally, the limited empirical literature on EBP in speech-language pathology identified a need to know how speech-language pathologists (SLPs) in healthcare 1) defined and described their use of EBP and 2) perceived barriers and facilitators to utilizing EBP in clinical practice. While in the clinical instructor role, SLPs are expected to integrate theoretical, evidence-based knowledge in their clinical practice to facilitate novice clinicians' knowledge and skills in communication and swallowing disorders. The limited empirical literature on clinical supervision in healthcare settings identified a need to know how SLPs in healthcare 1) modeled and taught EBP in clinical supervision and 2) perceived barriers and facilitators to clinical supervision in healthcare settings

Purpose: The purpose of this study was to describe the current use of EBP by SLPs in clinical practice and novice clinicians’ training in EBP by capturing the experiences of SLPs who have worked in clinical practice and as clinical instructors for the discipline in the healthcare setting.

Method: In-depth individual semi-structured, open-ended interviews were administered to 15 experienced SLPs who have served as clinical instructors in the healthcare setting to understand their perspective of EBP in clinical practice. SLPs were asked questions regarding their description of EBP, their definition of EBP, and barriers and facilitators to EBP in clinical practice and supervision.

Results: SLPs' definitions of EBP often focused on the scientific literature (external evidence) and did not include the three components of the EBP definition – clinician expertise, client perspectives, and the evidence (external and internal). SLPs reported using EBP to guide and validate their clinical decisions. SLPs identified graduate school, continuing education, independent learning activities, and the clinician/researching relationship as sources of information. Identified barriers to EBP were accessibility, lack of clinical application and generalization, limited use of data collection and data analysis by SLPs in clinical practice, lack of skills to interpret statistical methods, cost, time, and regulations. Reported facilitators of EBP were advocacy and promotion, clinical supervision, and facilitation strategies. SLPs’ also reported incorporating EBP into clinical supervision.

Conclusion: SLPs’ definitions of EBP suggest they weighed research (external) evidence more than the other components of EBP. SLPs’ relied primarily on external evidence sources to guide and validate their clinical decisions. Professional and organizational contexts presented as barriers that need to be considered for increasing the uptake of EBP. Future facilitation strategies are provided with suggestions for implementation. Considerations for implementation science, implementation strategies, and the scholarship of teaching and learning are discussed.

Comments

©2023 by Rosalyn Anya Davis. All rights reserved.

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