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A general education teacher will provide an intervention for students before deciding if the child needs further help such as accommodations. Interventions are steps a teacher can take to adjust the curriculum in a way that is conducive for the student's learning and strengths. Sometimes, no further accommodations are needed. However, if interventions do not work, more severe accommodations may be needed.

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One-on-one time for 30 minutes a week.

Small group instruction twice a week.

Study intervention team where students learn better study skills.

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Interventions are for any student that needs to improve and requires additional teaching and practice in order to reach their goals.

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The following link has information explaining interventions for students. Here, you will also find information about accommodations and modifications for students with disabilities.

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Educators should begin by assessing student's prior knowledge to determine where students need to improve. Once clear learning goals are identified, intervention strategies are put in place to assist the student. The student will be assessed frequently to measure effectiveness of the intervention in place before moving on to accommodations.

National Library of Medicine

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Abstract

Background: Using evidence-based practice (EBP) improves the implementation of safe, high-quality healthcare for patients, reduces avoidable costs, and plays a crucial role in bridging knowledge-action gaps and reducing health inequities. EBP combines the best available evidence in the relevant literature with patient preferences and values and healthcare professionals' (HCPs) expertise. Methods: Systematic searches of ten bibliographic databases, unpublished works, and the Grey Literature Report sought studies published up to 30 September 2022. Results: The 15 studies retained involved 2712 nurses. Three types of effective educational interventions were identified: (1) multifaceted educational strategies incorporating mentoring and tutoring; (2) single educational strategies, often delivered online; and (3) multifaceted educational strategies using the five steps of EBP. Eleven primary outcomes (EBP beliefs, EBP self-efficacy, perceived EBP implementation, EBP competencies, EBP knowledge, EBP skills, EBP attitudes, EBP behaviors, EBP desire, EBP practice, and perceptions of organizational culture and readiness) were assessed using 13 qualitative and quantitative instruments. Conclusions: Ensuring the successful implementation of EBP requires effective educational strategies. Computer-based learning seems the most cost-effective and efficient strategy, when considering caregivers' characteristics, the clinical field, and educational interventions across the pre-, peri-, and post-implementation processes.

Keywords: evidence-based practice, primary healthcare, beliefs, knowledge, implementation, nurses, interventions, education

1. Introduction

The reports "To Err is Human" (1999) [ 1] and "Crossing the Quality Chasm" (2001) [ 2] created a level of global awareness that pushed healthcare institutions to take corrective actions to promote and improve the quality of clinical care and patient safety [ 3]. According to the Institute of Medicine, quality of care is "the ability of health services to increase the likelihood of achieving desired health outcomes in accordance with current professional knowledge" [ 3]. At the same time, the concept of patient safety-defined as the prevention of harm [ 4]-emerged as a major focus of professional vigilance. Healthcare systems today face the twin challenges of implementing EBP [ 5, 6] to reduce healthcare costs [ 7] and increasing healthcare personnel's job satisfaction [ 8]. Indeed, EBP contributes to improving the quality of care and patient safety because effectiveness, safety, responsiveness, efficiency, and equity have become indicators of whether care providers are using patient-centered practices. EBP is now an established framework among healthcare professionals (HCPs) [ 9, 10, 11, 12]. As an integral part of patient-centered approaches, it involves the use of research steps to critically appraise research evidence and implement that evidence in practice [ 11, 13, 14]. In a nursing context, EBP is defined as the integration of information from various sources to aid clinical reasoning, including the best and most recent evidence, clinical expertise, personal experiences, patient preferences, and theories underpinning nursing care [ 5, 6, 15]. HCPs are expected to use EBP as a gold-standard approach to their daily practice [ 12, 16, 17, 18, 19, 20]. One might expect EBP to be well known and understood by HCPs and, equally, to be prevalent in their education programs and clinical practice [ 15]. However, the routine use of EBP remains challenging [ 11] since between 30% and 40% of patients do not receive care based on current knowledge and two-thirds of good practice implementations fail [ 17, 18, 19]. Moreover, some HCPs feel that engaging in EBP is not within their scope of practice [ 20]. Because not all HCPs have undergone training on EBP along their career trajectory, there are questions about which educational interventions are most effective at increasing EBP skills among HCPs in their daily practice [ 12, 21].

Nurses and physiotherapists are highly involved in healthcare services [ 22, 23]. Because of their close relationships with healthcare users during their daily practice, they play important decision-making roles, strengthening communication and collaborative practices between community and specialized HCPs to provide the best available overall healthcare [ 24]. Although it is generally considered that nurses and physiotherapists-like every other HCP-are accountable for providing the best available evidence-based healthcare [ 25, 26], recent research has concluded that only a tiny percentage of them consistently do so [ 13, 27]. Indeed, multiple barriers to the daily use of EBP have been reported, such as inadequate skills in EBP among clinicians, time constraints, negative attitudes, a lack of personal motivation, and professional resistance to research [ 28, 29, 30, 31, 32]. Additionally, several authors have documented administrative and organizational problems in the workplace, a lack of mentors for EBP, inadequate point-of-care resources, gaps between theory and practice, a lack of any meaningful transition between training courses on EBP and the clinical reality, and absent or insufficient basic education on the subject [ 7, 12, 18, 33, 34]. It is therefore urgent that efficient and effective educational interventions that meet HCPs' needs be identified and developed according to a well-defined implementation process that ensures that EBP's added value is felt at the patient's bedside. The importance of providing educational interventions on EBP has been recognized by the World Health Organization [ 33]. Over the last two decades, EBP in healthcare has been documented in exploratory and observational studies in different settings. Scurlock-Evans et al. [ 13] summarized attitudes, barriers, enablers, and EBP interventions among physiotherapists, although without specifying employment settings or assessing educational interventions. Melender et al. [ 34] summarized the educational interventions used to train nursing students to improve outcomes in implementing EBP. Nevertheless, to the best of our knowledge, no systematic reviews have examined the effectiveness of educational interventions to increase skills in EBP in the daily practice of nurses and physiotherapists. Furthermore, no previous international research has ever compared the outcomes of different educational interventions on EBP skills in our population of interest. While EBP is considered as a core competency needed for HCPs, evidence for how to effectively teach EBP remains suboptimal and there is an important heterogeneity of EBP education interventions. Therefore, there is a need to synthetize and evaluate the outcomes of the different EBP educational interventions proposed by the literature, and to evaluate what is the most effective to overcome the barriers cited, meet the characteristics and needs of the professionals, and make EBP a norm for al HCPs need to be identified. It is an essential process for bridging the gap between evidence and practice, for the nursing and physiotherapist professions to advance as well-informed disciplines, for the homogenization of basic education on EBP, and/or the avoidance of a lack of any meaningful transition between training courses on EBP and the clinical reality [ 35]. This review aimed to answer the questions: (a) What are the most effective educational interventions to increase skills in EBP among nurses and physiotherapists delivering primary healthcare? (b) What are the effects of these educational interventions on EBP skills among primary-care nurses and physiotherapists? We hypothesized that researchers, clinicians, healthcare system managers, healthcare institutions, healthcare policymakers, stakeholders, universities and their faculty, and healthcare professionals could identify the most effective educational interventions that would enable them to use evidence in daily practice, enable HCPs to understand EBP, promote and improve the quality of clinical care and patient safety, and improve responses to current healthcare challenges. If EBP educational interventions become an integral part of continuing HCPs education curricula, it will improve skills in EBP, facilitate its implementation, and guarantee its holistic benefits. Our second hypothesis was that the identification of these educational interventions would enable the recognition of the factors facilitating and constraining the implementation of EBP and would contribute to establishing effective implementation strategies within different healthcare settings.

2. Materials and Methods

This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations [ 36], the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) reporting proposals [ 37], and the methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions [ 38]. The research protocol for this systematic review has been published elsewhere [ 39].

2.1. Study Selection Criteria

2.1.1. Participants and Healthcare Settings

This review considers studies involving registered HCPs delivering primary healthcare, including those with bachelor's, master's, and doctoral degrees in nursing (RNs = registered nurses) and physiotherapy (physiotherapists = PTs) and nursing and physiotherapy students in their respective educational institutions. Physical therapists and physiotherapists are considered synonymous. We also include all categories of primary healthcare settings for home-dwelling adult care, such as private offices, community, and health maintenance organizations (HMO), community and private primary healthcare settings, hospital outpatient departments (OPDs), and hospital settings.

2.1.2. Types of Studies

Randomized controlled trials (RCTs), cluster randomized controlled trials (RCTs), non-randomized studies (NRSs), prospective cohort studies, case-control studies, controlled before-and-after studies, interrupted-time-series studies, quasi-experimental studies, and mixed-methods studies were included [ 40, 41, 42].

2.1.3. Types of Educational Interventions

All kinds of educational interventions to improve the EBP skills of RNs, and PTs delivering active primary healthcare were examined. These included ex cathedra, interactive, online, or individual educational sessions on the steps and components of EBP, organized journal clubs, seminars, educational meetings, the distribution of educational materials, webinars and other individual-oriented educational activities, case studies, grand rounds, and mentoring within a healthcare organization. Educational interventions were excluded if they targeted the regulatory, economic, or financial aspects of EBP, as per the Cochrane Effective Practice and Organization of Care (EPOC, 2015) taxonomy of interventions [ 43].

2.1.4. Outcome Measures

Our primary outcome was whether educational interventions increased or decreased the EBP knowledge, attitudes, beliefs, competencies, skills, self-efficacy, behavior, practice and perception of RNs, and PTs active in primary healthcare settings. This was measured using methods such as questionnaires, interviews, chart analyses, and self-reporting by RNs, and PTs, with a focus on dichotomous (yes/no), ordinal, or continuous scales or scores. Secondary outcomes explored the production of systematic reviews and numbers of journal clubs and grand rounds [ 44, 45].

2.2. Search and Process Strategies

2.2.1. Search Strategy and Identification of Relevant Studies

In collaboration with a medical librarian (PM) and using predefined search terms, we conducted a systematic literature search for published articles in the following electronic databases, from inception until 30 September 2022: Medline Ovid SP (from 1946), PubMed (NOT Medline[sb]) (from 1996), Embase.com (from 1947), CINAHL Ebesco (from 1937), the Cochrane Central Register of Controlled Trials Wiley (from 1992), PsycINFO Ovid SP (from 1806), Web of Science Core Collection (from 1900), PEDro (from 1999), the JBI Database of Systematic Reviews and Implementation Reports (from 1998), and the Trip Database (from 1997). We conducted a hand search of the bibliographies of all relevant articles and searched for unpublished studies using Google Scholar, ProQuest Dissertations and Theses dissemination, Mednar, and WorldCat. The search was completed a first time by exploring the grey literature in OpenGrey and the Grey Literature Report from inception until 31 December 2021, and a second time until 30 September 2022. We considered publications in any language.

2.2.2. Study Screening and Data Extraction

Three reviewers (OPDS, HV, RH) independently screened the titles and abstracts identified in our searches to assess which studies met our inclusion criteria. The full texts of the articles retained were read to ensure the assessments were correct. Disagreements were resolved through discussion or, if needed, a consensus was reached after discussion with the co-authors (KG, EP, FP). A flowchart of the article selection process was drawn using the PRISMA statement guidelines [ 36] ( Figure 1). Three reviewers (OPDS, EP, HV) extracted the data independently using a specially designed, standardized data-extraction form. Again, discrepancies were resolved through discussion and consultation with the co-authors if necessary. The information extracted from each study included: (1) study authors, year of publication, and country where the study was conducted; (2) study characteristics (including setting and design, duration of follow-up, and sample size); (3) participants' basic sociodemographic characteristics; (4) characteristics of interventions (description and frequency of educational interventions, healthcare professionals involved, etc.); (5) characteristics of the usual care group; and (6) outcome measures.

Figure 1.

Search strategy for the EDITcare systematic review [ 46].

2.3. Assessment of the Risks of Bias in the Studies Retained

Two reviewers (OPDS, HV) independently assessed the risks of bias in all the randomized and non-randomized studies of the interventions included. Disagreements were resolved through discussion and consultation with all the co-authors (EP, KG, RH, FP). Any disagreements in the quality assessments were resolved through discussion.

2.4. Statistical Analyses

Statistical analyses followed the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions [ 38] and the PRISMA and MOOSE statements [ 36]. Descriptive statistics were used to describe the studies and participants involved. We computed the sum of the population and the mean age of the participants in the studies retained. We used exact statistics and measures of association to report on the effectiveness of the interventions in the studies. The extreme heterogeneity of the data collected meant that we could not compute group or subgroup meta-analyses.

3. Results

3.1. Search Strategy and Results

Our literature search took place at two distinct time points, with a baseline search in 2019 and a supplementary search in December 2021: we retrieved a total of 18,299 references. The second search's goal was to complete the first one and ensure up-to-date evidence. After removing duplicates, three researchers independently analyzed the titles and abstracts of 12,948 references. In the second phase, papers' full texts were retrieved from the references and analyzed based on the inclusion and exclusion criteria. Finally, a third search was made in September 2022, during the revision process, with the objective of improving the literature review with information about the very latest research publications. Considering the importance of the topic we decided to conduct living systematic review based on the Cochrane recommendations, defined as "a systematic review that is continually updated, incorporating relevant new evidence as it becomes available" [ 59], by continual and active monitoring of the evidence, and incorporating relevant new evidence as it becomes available. Two appropriate new references were discovered. All the full texts respecting the inclusion criteria were analyzed and described in a structured reporting form ( Figure 1).

3.5. Clinical Outcomes, Instruments, and Results

3.5.1. Primary Outcomes

The 15 studies measured 11 primary outcomes-EBP beliefs, EBP self-efficacy, EBP attitudes, perceived EBP implementation, EBP competencies, EBP knowledge, EBP skills, EBP behaviors, EBP desire, EBP practice, and perceptions of organizational culture and readiness (EBP attributes)-using 15 qualitative and quantitative instruments.

Six studies [ 8, 52, 54, 60, 61, 69] used this instrument. In their longitudinal, pre-experimental study, Gallagher et al. [ 50] initially showed increasing mean scores from T0 to T1 (T0: M = 58.4 (SD = 8.7), T1: M = 68.1 (SD = 8.1)), and then decreases from T1 to T2 (M = 66.3 (SD = 9.1) and increases from T2 to T3 (M = 68.1 (SD = 7.4)). These scores were statistically significantly different between T0 and T1 ( p < 0.001), between T0 and T2 ( p < 0.001), and between T0 and T3 ( p < 0.001).

In the study by Underhill et al. [ 56], oncology RNs and advanced practice nurses completed this quantitative tool at T1 and T2. The EBP-B median at T1 was 56.5 (range = 37-77, IQR1-3 = 50-61) and at T2 was 57 (range = 38-76, IQR1-3 = 51-63). There were no significant differences between T1 and T2 implementation scores or between those who had or had not participated in the SPAWN projects ( p = 0.36). Finally, the level of nursing education was positively correlated with EBP-I (r = 0.32, p = 0.01), unlike years employed as a nurse ( p = 0.16). The study by Levin et al. [ 8] demonstrated a major effect for its IG (F[1,15] = 10.39, p = 0.006), with nurses showing better results in EBP at T3 and T4. There was also a main effect of time (F[2,30] = 5.85, p = 0.007) since those authors noted a significant increase from T1 to T3 (T1: M = 12.89 and T3: M = 28.14; F[1,15] = 12.40, p = 0.003). Finally, there was also a significant time-group status interaction (F[2,30] = 3.625, p = 0.0039) since the IC showed a higher mean score on EBP implementation than the CG (M = 15.50 versus 10.33). These results were consistent with different studies [ 57, 65]. Indeed, the CG's emergency nurses revealed constant attitudes toward EBP throughout their follow-up. Nurses from the IG showed improved attitudes toward EBP at T2, with a decrease at T3 (M = 4.3 (SD = 0.23) versus M = 4.12 (SD = 0.49)), although still higher than at T0 (M = 3.85 (SD = 0.49)).

Five studies used the EBP-I, whereas two studies used the Adapted EBP-I. In Singleton's study [ 48], DNP-FNP students showed a mean pre-intervention score of 2.68 (SD = 0.94) versus 3.61 (SD = 0.96) post intervention. Data analysis showed this to be statistically significant (t = 8.4 (52), p < 0.001), with an effect size ranging from 0.75 to 1.5 SD above the mean. Finally, gains were made by every cohort and across the curriculum (F ratio 20.01). Underhill et al. [ 56] asked oncology RNs and advanced practice nurses to complete the EBP-I at T1 and T2. No statistical differences were found between the scores of nurses who had and had not participated in SPAWN projects ( p = 0.36). However, nurse leaders had higher perceived scores ( p < 0.001). Finally, the level of nursing education was positively correlated with EBP-I (r = 0.32; p < 0.01). These results are consistent with Wan's study [ 57]. Nurses in the IG who underwent the EBP education program had lower mean rank scores than CG nurses in the pre-test but higher ones in the post-test. Their scores increased between T0 and T1 ( p = 0.025), unlike the CG ( p = 0.257). Mean scores across the 18 implementation items used by Gallagher et al. [ 50] increased over time, although no data were reported for T1 (T0: M = 15.4 (SD = 13.9), T2: M = 20 (SD = 12.7), and T3: M = 25.4 (SD = 15.6)). Statistically significant differences were found between T0 and T2 ( p = 0.0087) and between T0 and T3 ( p > 0.0001). These results are consistent with Levin et al. [ 8]. The interventional group showed significantly higher scores from T1 to T3 (T1: M = 12.89, T3: M = 28.14) (F[1,15] = 12.40, p = 0.003). However, the study by Koota et al. [ 65] revealed that the IG's emergency nurses' EBP scores had improved at T2 but had decreased again by T3. Some studies showed conflicting findings on how EBP behaviors decreased following interventions [ 54, 55], and the EBP scores of nurses in the CG had dropped below baseline levels by T3.

Gallagher et al. [ 50] assessed nurses' EBP competencies using the Evidence-Based Competencies Scale. Participants completed the scale at four time points, and mean scores for the 24 competency items increased over time (T0: M = 53.1 (SD = 18), T1: M = 75.7 (16.3), T2: M = 77.3 (SD = 17.7), and T3: M = 85 (SD = 19.9)). Statistically significant differences were found between T0 and T1, T0 and T2, and T0 and T3 ( p < 0.001).

The EBP-KAQ was developed in 2015 (Gallagher-Ford et al.) but remained unpublished. Gallagher et al. [ 50] reported mean scores for the 38 EBP-KAQ questions increasing over the four time points (T0: M = 24 (SD = 6.1), T1: M = 30.2 (SD = 3.9), T2: M = 31.2 (SD = 3.5), T4: M = 31.7 (SD = 4.2)). Statistically significant differences were found between T0 and T1, T0 and T2, and T0 and T3 ( p < 0.0001), providing strong evidence of a positive effect on participants.

Two studies used the Adapted Fresno test to evaluate the knowledge, skills, and EBP competency of nurse educators. In the study by Cardoso et al. [ 62], both the IG and the CG completed the Adapted Fresno Test at T0 and T1. The mean IG score improved from baseline (M = 6.85 (SD = 5.15)) to T1 (M = 12.47 (SD = 7.21)), as it did for the CG (T0: M = 7.25 (SD = 5.34), T1: M = 9.73 (SD = 5.56)). These improvements over time were statistically significant for both the IG and the CG (F(1.73) = 53.028, p < 0.001, and F(1.73) = 13.832, p < 0.001). Finally, students in both groups significantly improved their knowledge and skills in four items (1, 3, 4, 5), only IG improved in item 7 (Z = −2.543, p = 0.011 versus CG: Z = −1.941, p = 0.052), and only CG improved in item 7 (Z = −2.714, p = 0.007 versus IG: Z = −1.236, p = 0.216). D'Souza et al. [ 64] asked nurse educators to complete the Adapted Fresno Test at T0, T1, and T3. The mean IG score improved from T0 to T2 (M = 20.30 (SD = 13.13) to M = 103.45 (SD = 27.87)), whereas mean CG scores only improved a little (T0: M = 24.67 (SD = 11.39) and T2: M = 28.78 (SD = 10.86)). The differences between the IG and CG indicated that the EBP training program improved EBP competency (F[2,92.06] = 37.13, p < 0.05).

Koota et al. [ 65], D'Souza et al. [ 64], Wan [ 57], and Moore [ 54, 55] all used the EBPQ. Hart et al. [ 51] used the same instrument but named it the Evidence-Based Nursing Questionnaire.

In Moore's studies [ 54, 55], RNs rated themselves moderate in attitudes to EBP (M = 5.28 (SD = 1.02)) and low in use (M = 4.80 (SD = 1.23)) and knowledge and skills (M = 4.83 (SD = 0.99)). Koota et al. [ 65] used the EBPQ to assess behaviors, attitudes, knowledge, and skills at four time points. At T2, the IG showed statistically significant improvements in EBP attitudes ( p = 0.019) and knowledge ( p = 0.005). Meanwhile, EBP behaviors had decreased among the CG. At T3, there was a statistically significant difference between the groups' EBP attitudes ( p = 0.010). EBP attitudes remained constant for the CG across the whole follow-up period, with an improvement at T2 but then a decrease at T3. The IG showed statistically significant improvements in their knowledge of EBP at every time point ( p < 0.001, p < 0.001, and p < 0.001). Finally, the two CGs showed lower scores for EBP behaviors, whereas they improved at T2 and then decreased at T3 for the IG. Finally, the IG's EBP skills showed a minor improvement at T2 (T0: M = 4.64 (SD = 0.76), T2: M = 5.05 (SD = 0.42)). In the study by Wan, the IG had lower mean ranks for attitudes to EBP than the CG in the pre-test scores but higher ones in the post-test. The IG did not increase attitude scores between T0 and T1, as CG did. D'Souza et al. [ 64] used the EBPQ to assess knowledge and use of EBP. Both groups' knowledge increased gradually from T1 to T2. The 30 h EBP training intervention was effective in improving nurse educators' knowledge (F[2,91.65] = 4.11, p < 0.05). After T1, the IG showed a greater increase in EBP use scores than the CG. IG nurse educators showed statistically significant improvements in their EBP use scores (F[2,94.88] = 6.21, p < 0.05). RNs in the Hart et al. [ 51] study completed the Evidence-Based Nursing Questionnaire before and after computer-based education sessions. Statistically significant pre- and post-intervention differences were found for knowledge of EBP (t (0.05, 312) = -2.296, p = 0.022), attitudes to EBP (t (0.05, 313) = -4.750, p < 0.001), skills in EBP (t (0.05, 313) = -4.322, p < 0.001), and organizational readiness for EBP (t (0.05, 313) = -8.601, p < 0.001) and its use in research.

Mena-Tudela et al. [ 53] used the EBP-COQ to evaluate self-perceived levels of EBP competence among Spanish nursing students. Nearly all the items showed significant differences between the three measurement points, except for item 1 ( p = 0.099), item 4 ( p = 0.051), item 7 ( p = 0.055), item 10 ( p = 0.065), and item 11 ( p = 0.441). Finally, statistically significant overall differences between the three time points were measured ( p < 0.001), between T0 and T1 ( p < 0.001) and between T0 and T2 ( p < 0.001).

Hsieh and Chen [ 52] used the SNEBP at three different time points. Knowledge section scores had increased by an average of 0.75 at post-training ( p < 0.001) and by 0.37 at follow-up ( p < 0.001). Self-efficacy section scores had increased by an average of 0.3 at post-training ( p < 0.001) and 0.13 at follow-up ( p < 0.001). Skills section scores significantly increased from baseline (M = 3.73; SD = 0.58) to post-training (M = 3.80; SD = 0.62) ( p < 0.001), but they then significantly decreased (by an average of 0.1) between post-training and follow-up ( p > 0.005). Finally, attitude section scores made no statistically significant changes over time.

Gallagher et al. [ 50] used the Organization Culture and Readiness for System-Wide Integration of Evidence-Based Practice Scale. This assesses cultural factors that can influence system-wide implementation of EBP and overall perceived readiness for EBP integration. The mean score for the 24 competency items increased across the three time points as no values were reported for T1 (immediately after the intervention) (T0: M = 77 (SD = 16.1), T1: M = 75.7 (16.3), T2: M = 80.4 (SD = 15.4), or T3: M = 84.6 (SD = 15.9)). Statistically significant differences between T0 and T2 ( p = 0.0041) and between T0 and T3 ( p > 0.0001) were described.

D'Souza et al. [ 64] developed a 21-item for their study in order to respond to the particularities of their population and assess their attitudes to EBP. Attitude scores were higher in the IG across time points T1 and T2. Significant changes in the attitudes of the IG nurse educators (F[2,91.07] = 3.55, p < 0.05) were described.

Chao et al. [ 60] used a 30-item questionnaire adapted from Lee et al.'s (2011) study [ 79]. It included the three dimensions of knowledge, attitudes, and practice. For the knowledge subscale, there was no significant difference in the two groups' mean scores at T1 and T2 ( p = 1.00 and p = 0.702). Both groups showed improved knowledge after the intervention. Both groups' attitude scores (CG: p = 0.000; IG: p = 0.000) and practice scores (CG: p = 0.000; IG: p = 0.000) also improved after the intervention, and there were no differences between the two groups at the three different time points (T1: p = 0.573; T2: p = 0.792; T3: p = 0.153).

Waltz et al. [ 61] used HEAT to measure self-perceived competencies in EBP, including understanding, ability, desire, frequency, and barriers before and after the intervention. This consisted of an interactive workshop of 1.5 h each. The pre-test and post-test scores showed improvements for the EBP subscales of frequency (except for "Used research findings in practice": p = 0.179), ability (except for "Participate in a research project": p = 0.066), desire, and barriers (only "I have difficulty finding research or library materials with my searches" and "I have difficulty understanding research articles" were statistically significant; p = 0.019 and p = 0.035, respectively).

Cardoso et al. [ 62] qualitatively analyzed 18 students' monographs using an evaluation form with 11 guiding criteria (review questions, inclusion and exclusion criteria, methodology, the presentation of results, and the congruence between the review questions and the conclusion's answers). The CG's monographs were of a lower quality than the IG's since the CG displayed difficulties synthesizing the data and providing clear answers to the review questions.

Underhill et al. [ 56] aimed to explore barriers to and facilitators of implementing EBP. The most common barriers experienced by participants were a lack of time, knowledge, and access to online journals or databases. That is why oncology nurses requested more time, resources, education, and awareness about EBP. On the other hand, the facilitating factors identified were nursing leadership and leaders from nursing research. Chao et al. [ 60] also used a questionnaire to discover levels of satisfaction with the learning process and course, with ratings from 1 (strongly disagree) to 5 (strongly agree). Higher scores indicated greater satisfaction in the learning process and course. There were no significant differences in the scores between the two groups ( p = 0.001; CG: M = 38.49, SD = 0.99 and IG: M = 44.24, SD = 0.60). The IG showed significantly higher scores for each item and overall satisfaction than the CG. The item with the lowest score for the CG was "I could understand EBP through the course content" (M = 3.75, SD = 1.15), and the highest score was for the item "Practical experience improved my ability to search for empirical literature" (M = 3.96, SD = 0.96). The item with the lowest score for the CG was "The workshop helped me complete the EBP 5As and apply them to clinical care" (M = 4.35, SD = 0.52). The most favorably rated items were "I could understand EBP through the course content" (M = 4.46, SD = 0.66) and "The course strengthened my ability to search for empirical literature (M = 4.46, SD = 0.50).

3.5.2. Secondary Outcomes

Only two studies evaluated secondary outcomes, but they used eight instruments. Levin et al. [ 8] used a qualitative and/or quantitative approach to deepen their investigation of five secondary outcomes: group cohesion, job satisfaction, nurse productivity, nurse attrition/turnover, and professionalism and leadership. Finally, Koota et al. [ 65] examined learner satisfaction using instruments developed by those authors specifically for their study.

Levin et al. [ 8] used the Group Cohesion Scale developed by Good and Nelson in 1973 [ 80]. Scores for group cohesion were examined according to time point and group as well as time point-group interactions. No main effects were identified for group (F[1,16] = 0.016, p = 0.502), time point (F[2,32] = 2.50, p = 0.098), or time point-group interactions (F[2,32] = 0.824, p = 0.448). However, the IG did report better group cohesion at T3 than at T1 (F[1,21] = 5.580, p = 0.028).

Levin et al. [ 8] use the IWS to measure work satisfaction according to time point, group, and time point-group interaction. Statistical analyses showed no main effects for group (F[1,22] = 0.057, p = 0.814) or time point-group status interaction (F[1,31] = 0.392, p = 0.537). However, it did show a main effect for time (F[1,22] = 0.016, p = 0.900).

Levin et al. [ 8] assessed the nurse productivity of the VNSNY. No main effects for group (F[3,52] = 0.422, p = 0.738) or time point (F[1,52] = 2.799, p = 0.100) were described. The overall mean productivity rate at T1 (M = 4.59) did not differ significantly from the rate at T3 (M = 4.59 versus M = 4.77). Finally, no significant time point-group status interaction (F[3,52] = 0.243, p = 0.866) was reported.

Levin et al. [ 8] used the VNSNY-Human Resources database to evaluate nurse attrition. In the IG, attrition rates decreased from 11% ( n = 5) in 2004 to 5.7% ( n = 3) in 2005, whereas the attrition rate in the CG was 35%.

Levin et al. [ 8] conducted focus groups to explore nurse managers' and visiting staff nurses' professionalism and leadership. No more details were given. These exchanges with study participants highlighted their greater sense of professionalism and increased ability to see managers as colleagues.

Levin et al. [ 8] compared the intervention's learning effects on the IG and the CG at T1 and T2 via a learning questionnaire. The IG answered more EBP questions correctly than the CG, but differences were not statistically significant.

Koota et al. [ 65] developed these instruments because they could find no validated tools appropriate for their study. Groups differed significantly in their satisfaction with the teacher's ability to encourage nurses to ask clinical questions (IG: M = 2.98 (SD = 0.62) versus CG: M = 2.75 (SD = 0.93)) ( p > 0.001). In addition, groups significantly differed in their satisfaction with the usefulness of considering research evidence in nursing practice (IG: M = 3.65 (SD = 1.06) versus CG: M = 2.94 (SD = 0.83)) ( p = 0.01).

4. Discussion

In increasingly complex healthcare systems, and given the inherent challenges of healthcare environments, it is becoming essential for nurses to have a solid foundation in EBP because of its proven links to improved patient and organizational outcomes [ 61]. This systematic review identified and summarized the most effective educational interventions to increase skills in EBP among nurses. It identified three types of key educational interventions: multifaceted educational strategies incorporating mentoring and tutoring, single educational strategies (often delivered online), and multifaceted educational strategies using the five basic steps of EBP. These pertinent findings will provide tangible support to researchers, clinicians, healthcare system managers, healthcare institutions, health policymakers, stakeholders, universities and their faculty members, and healthcare professionals because they reveal an assessment of the effectiveness of different educational interventions on eleven primary outcomes. The review covered studies involving 2712 RNs and licensed practical nurses (LPNs), bachelor's degree students, Ph.D. students in Nursing Practice-Family Nurse Practice, nurse educators, emergency nurses, nurse managers, and visiting staff nurses.

EBP educational interventions should be a standard part of nurses' professional development in clinical settings. Healthcare systems and nurses have been encouraged to adopt the principles of EBP in order to improve the delivery of safe, high-quality healthcare to patients. We might expect EBP to be well known and understood by nurses-and equally prevalent in their education programs and clinical practice-but although they generally have positive beliefs about EBP, many individual and organizational barriers remain [ 48], impeding them from turning their beliefs into action. These barriers include the lack of time, deficiencies in knowledge about EBP, access to evidence, autonomy, empowerment to change practice, resistance from colleagues or managers [ 57, 60, 68], and even inadequate numbers of EBP mentors [ 50]. To ensure EBP is used daily, it is necessary to identify the most efficient and effective EBP educational program to improve EBP beliefs, EBP self-efficacy, perceived EBP implementation, EBP competencies, EBP knowledge, EBP skills, EBP attitudes, EBP behaviors, EBP desire, EBP practice, and perceptions of organizational culture and readiness, to allow individuals, leaders, and healthcare organizations to build a culture and environment of EBP, and to make EBP's adoption sustainable [ 35].

"EBP knowledge and skills can be acquired through formal and continuing education and self-paced online tutorials" [ 81]. Indeed, the 15 studies included in this systematic review present different strategies to implement the interventions described. Although the three different types of interventions identified had significant positive impacts on the 11 outcomes mentioned above, EBP cannot occur in isolation: it requires early adopters, champions, and teamwork. According to our findings, the best way to increase EBP skills among nurses and facilitate EBP implementation in their daily practice seems to be the use of a variety of educational strategies that integrate multiple learning pathways and techniques with regular follow-up and feedback from mentors and/or leaders. Computer-based education (CBE) currently appears to be the most cost-effective and efficient strategy, providing reliable, consistent delivery of information and the flexibility for caregivers to choose where and when to access the intervention. This type of educational strategy ensures that EBP's adoption by nurses is sustainable in their daily practice.

Not all RNs have undergone training on EBP during their educational or career trajectory. Thus, it is important to develop educational strategies for both stages so as to standardize and homogenize EBP knowledge and skills: (1) during their student curricula, and (2) regularly, on site, where they practice. Indeed, mere theoretical input is not enough, and educational interventions in clinical settings are essential to promoting the use of EBP. The literature concludes that nurses' EBP competencies are only low to moderate internationally, particularly in terms of their EBP knowledge, EBP skills, and their confidence in employing EBP. One potential explanation is the heterogeneity in the quality and content of EBP teaching programs in students' curricula [ 29]. It is therefore important to homogenize nurses' knowledge and skills while they are still in training. Only once nurses are competent in EBP will they be more likely to engage in EBP in their daily practice [ 11].

In addition to using the different strategies mentioned above, researchers must also examine the variables that might support or hinder the implementation of EBP, using reliable and valid measures [ 7, 82]. In this context, the Consolidated Framework for Implementation Research (CFIR), developed by Damschroder et al. [ 82, 83], sheds light on a wide range of factors that can support or hinder implementation. The CFIR is itself the result of a literature review; it synthesizes all the existing implementation models, bringing together the elements facilitating or constraining the implementation of new practices described in the literature. It is subdivided into five areas: (i) the external environment, which analyzes, among other things, cosmopolitanism; (ii) the internal environment, which looks at structural characteristics and culture; (iii) the personal characteristics that influence the course of a project; (iv) the characteristics of the intervention; and (v) the implementation process, at both the individual and organizational levels. According to its developers, the CFIR can be used at three time points. Firstly, during pre-implementation, to conduct a baseline survey (nurses' sociodemographic characteristics, such as level of education, were positively correlated with EBP-I (r = 0.32, p = 0.01) in the studies by Gallagher et al. [ 50], Underhill et al. [ 56], and Wan [ 57]) including the medical specialty's specific culture, leadership style, openness to change, learning climate, communication about the project, and an identification of its implementation process. Educational interventions are only one part of advancing EBP. Indeed, implementing EBP is also affected by nurses' demographic characteristics, such as age [ 84], marital status [ 85], years of work experience, or educational level [ 86], as well as their learning environment [ 87], staffing levels, and leadership styles [ 88]. Secondly, during peri-implementation, CIFR can be used to enable monitoring (assessing the characteristics of an intervention, such as its clarity or adaptability, adapting the implementation process through PDSA cycles, regular communication, and feedback, responding to the specialty's needs, and mobilizing the right leadership style). Thirdly, it can be used post implementation to ensure sustainability-including continuous adaptation based on feedback and active involvement from the specialty, regular communication, and the identification of mentors and/or opinion leaders [ 7, 17]-and avoid a drop in buy-in as was observed in the study by Koota et al. [ 65]. In addition to the CFIR, there are other models that can guide the implementation of EBPs, such as Promoting Action on Research In Health Services Framework (PARiHS) [ 89], the Iowa Model of Evidence-Based Practice to Promote Quality Care [ 90], Advancing Research and Clinical practice through close Collaboration (ARCC) model [ 91], the JBI Model of Evidence-Based Healthcare [ 92], Johns Hopkins Nursing Evidence-Based Practice, or even the Clinical Scholar Model [ 93].

4.1. The Review's Limitations

There are some limitations to this review that should be considered. First, despite a thorough literature search using recognized methodological guidelines and recommendations, and the use of many different terms to describe EBP, our review may have missed some studies that met all the selection criteria, either due to study search errors or investigators' mistakes. Second, language and publication bias may be present despite the review's scope being worldwide. Third, the effects of different types of healthcare system, systems of professional training, urban or rural settings, and socioeconomic factors, among others, were not analyzed. Finally, this review originally aimed to answer the question, "How effective are educational interventions to increase skills in EBP among nurses and physiotherapists delivering primary healthcare?" Despite a literature search that took place at three distinct time points (2019, 2021, and 2022), no relevant studies involving PTs were found. The study's results can therefore only be generalized in relation to our sample's heterogeneous nursing characteristics (RNs, LPNs, bachelor's degree students, Ph.D. students in Nursing Practice-Family Nurse Practice, nurse educators, emergency nurses, nurse managers, and visiting staff nurses). However, the Gallagher-Ford et al. study goes beyond this sample to include 23 healthcare professionals [ 52]. Nevertheless, one of the review's strengths is that it included four RCTs, despite their poor methodological quality, eight quasi-experimental studies, and one cohort study, all of which used validated instruments when measuring study outputs. Furthermore, we used highly recommended methodological norms and guidelines, which render our findings extremely reliable.

4.2. Recommendations

In view of the small number of studies published in our field of interest to date, future research should consider whether the present findings are applicable to other samples. Indeed, there is a need to include other primary HCPs to identify which interprofessional educational interventions will ensure that they too can provide the best available evidence-based healthcare. With a view to ensuring continuous improvements in safe, high-quality healthcare for patients, more research data on the most efficient, effective educational interventions for meeting HCPs' needs and ensuring that EBP's added value is delivered at the patient's bedside also need to be collected. More data will also help to establish guidelines for EBP implementation. Finally, evidence from more high-quality studies involving larger sample sizes of HCPs would be welcome to test education interventions on EBP.

Our recommendations for implementing EBP in clinical practice and ensuring that implementation succeeds require a consideration of the specific characteristics and needs of the caregivers involved, as well as the uniqueness of the clinical setting, medical specialty, and the educational intervention before, during, and after implementation. Indeed, effective implementation of EBP comes through repeated exposure to and practice of EBP. This systematic review's findings emphasize that strategic leadership, communication, and teaching strategies for EBP should rely heavily on the added value created by the mentors/tutors who informally and/or hierarchically take clinical leadership among their peers. However, there is a need to clearly identify the facilitators of and barriers to implementing educational interventions in healthcare settings. Our recommendations for future research also include analyzing and comparing the factors facilitating and constraining the pre-, peri-, and post-implementation phases of an educational intervention about EBP. This will help RNs, other HCPs, and nurse educators to adjust and improve their knowledge of implementation processes. That future research should use the CFIR during all three phases. It would also be important to consider whether different types of professional training, urban or rural settings, or socioeconomic factors had any impact on the effectiveness of educational interventions. This could be carried out during the CFIR's pre-implementation phase.

5. Conclusions

To the best of our knowledge, this systematic review is the first on this topic to combine samples of RNs and LPNs, bachelor's degree students, Ph.D. students in Nursing Practice-Family Nurse Practice, nurse educators, emergency nurses, nurse managers, and visiting staff nurses. Nurses corroborated the importance of evidence-based practice (EBP), but very few of them were able to implement it due to personal (lack of confidence, knowledge, and time, plus heavy workloads) and organizational (lack of material, human resources, support from the hierarchy, and implementation models) barriers. Systematically integrating best evidence into daily practice is challenging due to the inherent complexity of the EBP implementation process.

In conclusion, promoting the appropriate organizational culture and continuously developing the infrastructure, resources, and administrative support needed to advance the use of EBP is itself a process of moving from evidence to practice. However, this is not enough. Indeed, this paper highlighted the significant influence that educational strategies can have on the ability to master and implement EBP. The findings demonstrated that appropriate educational strategies could help EBP become a standardized part of the nursing student curriculum and of RNs' daily practice. The most efficient, effective educational interventions will meet professionals' needs and ensure that EBP's added value is delivered at the patient's bedside. These ongoing interventions seem to be relevant to continuing education based on multifaceted learning strategies with regular follow-up and feedback from mentors and/or leaders. Computer-based education is the most cost-effective and efficient strategy.

Acknowledgments

Collaboration with Tschopp Marielle, physiotherapist.

Author Contributions

Study design and concept: H.V., O.P.D.S., F.P., R.H., K.G. and E.P.; writing the study protocol: all authors; data acquisition: O.P.D.S., P.M., H.V. and F.P.; data analysis and interpretation: O.P.D.S. and H.V.; manuscript drafting: all authors; critical revisions of the manuscript for important intellectual content: all authors; statistical analysis: O.P.D.S. and H.V. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Conflicts of Interest

The authors declare no conflict of interest. The funder was not involved in protocol design or the plan of analyses, nor will it be involved in the interpretation or publication of the systematic review's results.

Funding Statement

This systematic review is funded by the Health Institute of the University of Applied Sciences and Arts Western Switzerland (funding reference number: Sagex 89265). This funding will support data collection and analysis.

Footnotes

Publisher's Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

Articles from Healthcare are provided here courtesy of Multidisciplinary Digital Publishing Institute (MDPI)

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Effectiveness of Educational Interventions to Increase Skills in Evidence-Based Practice among Nurses: The EDITcare Systematic Review

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Background: Using evidence-based practice (EBP) improves the implementation of safe, high-quality healthcare for patients, reduces avoidable costs, and plays a crucial role in bridging knowledge-action gaps and reducing health inequities. EBP ...

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Differentiation ensures that teachers are using various teaching methods to reach all levels of disabilities and learning abilities.

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Giving students the option to choose between individual work or group work

Giving students a creative assignment instead of a typical book report to assess their comprehension of a text

Having students lead group discussions with peers so teach can gauge understanding of content

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All students can benefit from differentiation. Different teaching styles can engage each student differently. What style of instruction that works for one may not work for all students. Changing instructional style is important in making sure each student is getting what they need academically.

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Teachers can differentiate materials used during instruction. For example, instead of using the dry erase board to teach, teachers can become fluent in technology and incorporate new ways to teach.

Teachers can also differentiate the materials students use in their classroom, such as colored pencils and highlighters for annotating articles instead of a pencil.

Teachers should have a steady pace when teaching the curriculum, ensuring skills are being built upon.

Teachers can challenge students who are ahead of the content knowledge and give them assignments to further their own understanding.

IRIS Center

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This module discusses the importance of differentiating three aspects of instruction: content, process (instructional methods), and product (assessment). It explores the student traits-readiness level, interest, and learning preferences-that influence learning (est. completion time: 3 hours).

Work through the sections of this module in the order presented in the STAR graphic above.

Related to this module

Copyright 2022 Vanderbilt University. All rights reserved.

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Differentiated Instruction: Maximizing the Learning of All Students

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This module discusses the importance of differentiating three aspects of instruction: content, process (instructional methods), and product (assessment). It explores the student traits-readiness level, interest, and learning preferences-that influence learning (est. completion time: 3 hours). Work through the sections of this module in the order presented in the STAR graphic above.

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Explore more about Differentiated Instruction!

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Explore more about Differentiated Instruction!

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This article expresses ways that teachers can differentiate instruction. Using differentiated instruction allows students to show what they know in a variety of ways.

Understood

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At a glance

Differentiated instruction is a teaching approach that tailors instruction to students' different learning needs.

It lets students show what they know in different ways.

It doesn't replace the goals in a child's IEP or 504 plan.

Differentiated instruction is a teaching approach that tailors instruction to all students' learning needs. All the students have the same learning goal. But the instruction varies based on students' interests, preferences, strengths, and struggles.

Instead of teaching the whole group in one way (like a lecture), a teacher uses a bunch of different methods. This can include teaching students in small groups or in one-on-one sessions.

Students have "multiple options for taking in information, making sense of ideas, and expressing what they learn," says Carol Ann Tomlinson, an educator who has done innovative work in this area.

According to Tomlinson, there are four areas where teachers can differentiate instruction:

1. Content: Figuring out what a student needs to learn and which resources will help

2. Process: Activities that help students make sense of what they learn

3. Projects: Ways for students to "show what they know"

4. Learning environment: How the classroom "feels" and how the class works together

This approach works well with the response to intervention (RTI) process used in some schools. The goal of RTI is to address learning struggles early. Students get extra support before they fall behind their peers.

About the author

About the author

Geri Coleman Tucker is a freelance writer and editor and a former deputy managing editor for

Reviewed by

Reviewed by

Kylah Torre is an instructor in the department of special education at Hunter College.

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Differentiated instruction is a teaching approach that tailors instruction to all students' learning needs. Read about how differentiated instruction works.

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Accommodations allow students to complete the same assignments as their peers, just in a different way such as additional time during tests and quizzes.

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additional testing time

having the test read aloud

preferential seating

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Students who have been evaluated will then receive an IEP plan written if needed. If an IEP is written, accommodations will automatically be put in that IEP.

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Accommodations do not change the curriculum or content for the student, but it allows the student to complete their assignments and tests at a pace suitable for them. This article will further explain accommodations for students with disabilities.

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Evidence-Based Practices for Students with Accommodations

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Evidence-Based Practices for Students with Accommodations

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Noted within the article, a few evidence-based accommodations that have worked for students is integrated learning, choice making, and use of multiple environments used for learning.

The Journal of Special Education, Vol. 37

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Adaptations are changes in the way the curriculum is taught in order for students to receive an equal opportunity in learning and achieve the desired learning outcome.

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flexible seating choices

giving students with trouble concentrating a seat closer to the board

using media devices for content delivery

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Which students will need adaptations in the classroom?

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Which students will need adaptations in the classroom?

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Students that are in an inclusive classroom but need the curriculum taught in a different way than the typical student is used to, can benefit from adaptations in the classroom. Adaptations can benefit all students, not just the ones with learning disabilities.

Brookes Blog

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In past posts, we've talked about universal design for learning (UDL) as a highly effective framework for teaching all students. As author Whitney Rapp says in her book Universal Design for Learning in Action:

"An environment that is universally designed for learning includes everyone and prepares everyone to be inclusive and think inclusively. It shows students that everyone is different, everyone has strengths, and everyone has needs, and that is okay. It shows students there are multiple ways to be successful, multiple ways to solve problems, and multiple ways to learn from mistakes."

Part of teaching and planning with a UDL lens is recognizing what each of your learners needs to be successful. That means adapting and customizing aspects of your activities and lessons-and offering multiple ways for students to learn and show what they know.

Today's post brings you five approaches for adapting instruction in your inclusive classroom, so students with and without disabilities can participate and learn academic content. Adapted from Rachel Janney & Martha Snell's practical guide to these strategies can be used in any combination to best meet the needs of your individual learners. Try these in your classroom, and let us know which adaptations have worked best for your students!

Alter the instructional arrangement

Groups of the same size don't always work for all students. Keep an eye on what types of arrangements different learners respond to best. Here are some options for adapting the arrangement of students during classtime:

Let your student work in a group of three when most of her classmates work in groups of four or five.

Have your student team up with a peer partner when most of his classmates are working individually.

Add variety to small-group work: when most classmates are working in student-directed small groups, have the student and a few selected classmates work in a small group that you sit with and help support.

Alter the physical or social environment

A student's surroundings can have a huge impact on how he or she learns. Be mindful of and responsive to students with sensory and attention issues, and make changes to the learning environment to meet their needs. Some examples:

Give your student the choice to sit at a table instead of a desk (or vice versa).

Get your student a larger (or smaller) desk, depending on her preference.

Let students with sound sensitivities work in a particular part of the classroom, such as a "quiet space" or study carrel.

Give easily distracted students the option of sitting at a desk closer to the board. You could even arrange for the student to complete certain tasks in another part of the school campus, such as the media center or outdoors.

Alter your methods and materials

Multiple means of engagement and representation are two pillars of the UDL framework. When you teach a new lesson, offer your learners many different ways to engage with and absorb the content. For example:

Incorporate more visuals to present content in different ways, such as maps, pictures, drawings, objects, or videos.

Use graphic organizers to arrange key points in a way students can easily grasp.

Provide additional models or demonstrations for students who need extra support during the lesson.

Select concrete materials instead of symbolic representations, or illustrate symbolic representations with concrete examples.

Make the most of whatever technology is available to you-enhance your lesson with whiteboards, streaming videos, or remote clickers.

Check for understanding more frequently, using methods that require active responses from your students. For example, try asking questions about the lesson material and have your class vote on the answers.

Provide students with differentiated reading material based on their reading level and/or interests.

Make content easier to learn by giving your student enhanced texts in which key parts are highlighted, pictures or symbols are added, and/or text is enlarged.

Alter the process or task

For some learners, you may want to modify or reduce the requirements of assignments. And be sure to give all your learners multiple means of action and expression (the third pillar of the UDL framework). Let them show what they know in a variety of innovative ways, depending on how they best express themselves. Some examples:

Have your student follow written, pictorial, or audio-recorded task steps instead of giving them oral instructions.

Modify essay assignments-instead of writing an essay, your student could demonstrate understanding of the content by completing a chart, developing a text-to-speech presentation, or creating an outline.

Reduce the number of items students are expected to complete. For example, your student can receive the same math worksheet as the rest of the class, but you can ask him to complete only the odd-numbered items.

Give your student the option of using the same materials as the rest of the class, but in a different way. On a math worksheet, she could locate and mark certain numerals instead of completing problems.

Suggest note-taking helpmates such as guided notes or a slot-note note format, so students can more easily record and recall key information.

Allow for more creative ways for students to show what they know. Artistic students might build a model, create a poster, or draw a map a in place of a written assignment.

Alter the level of personal assistance

For learners who need extra support with some tasks, enlist helpers such as peers, a special educator, or a paraprofessional. They can provide assistance in a variety of ways, depending on the learner's needs:

Have the helper model the steps of a task before the student performs them on her own.

Encourage helpers to provide additional prompts (verbal, gestural, or partial physical) when students need them.

Assign the helper to complete some of the task steps with or for the student.

Ask the helper to give the student immediate feedback and additional encouragement to reinforce successes.

What are your favorite strategies for adapting materials, tasks, assignments, and the learning environment? Share your ideas in the comments below!

For more guidance on check out the book (free excerpt at the link!)

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5 Types of Instructional Adaptations for Your Inclusive Classroom - Brookes Blog

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In past posts, we've talked about universal design for learning (UDL) as a highly effective framework for teaching all students. As author Whitney Rapp says in her book Universal Design for Learning in Action: "An environment that is universally designed for learning includes everyone and prepares everyone to be inclusive and think inclusively.

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What other adaptations are there in the classroom?

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What other adaptations are there in the classroom?

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There are many ways a teacher can adapt their lessons and teachings to help a student understand the material better. Shorter assignments, verbal and emotional support, and paying attention to skill level (making sure an assignment is not too challenging or easy for a student) are all ways a teacher can adapt lessons to assist students.

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There are so many different ways to adapt and modify a lesson or activity to make it appropriate for your students. As teachers, we often fall into a rut where we find our favorite adaptations and stick with them. It is fine to have favorites, but it is also important to look at the big ...

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High-Leverage Practices for Adaptations in the Classroom

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High-Leverage Practices for Adaptations in the Classroom

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There are 22 HLPs in Special Education. This video discusses different ways teachers can use HLPs in the classroom to uphold students with disabilities to the same standard as the other students, just with more supports put in place.

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Introduction and definition of each HLP

Brief review of the research

Several brief videos of general education and special education teachers implementing the practice

What the videos are:

A resource to augment training/professional learning

A demonstration of HLP practice across degrees of intensity

A portrayal of teachers' implementation of an HLP

A demonstration of practices that can be used with all students, not only those with disabilities

What the videos are not:

A complete resource for training/professional learning

A demonstration of each tier across various settings

A depiction of all features of quality instruction/student engagement

Promoting the use of practices that would replace the need for intense, data-driven decisions and interventions provided by special educators or other specialists

This content was produced under U.S. Department of Education, Office of Special Education Programs, Award No. H325A170003 & S283B120021-12A . David Guardino serves as the project officer. The views expressed herein do not necessarily represent the positions or policies of the U.S. Department of Education. No official endorsement by the U.S. Department of Education of any project, commodity, service, or enterprise mentioned in this website is intended or should be inferred.

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Introduction and definition of each HLP Brief review of the research Several brief videos of general education and special education teachers implementing the practice What the videos are: A resource to augment training/professional learning A demonstration of HLP practice across degrees of intensity A portrayal of teachers' implementation of an

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Modifications are different ways to engage students in learning and processing information. For example, some students may require more stretch breaks in class than other students so they can concentrate better.

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breaks between tasks/transitions

Creative assignments instead of book reports

Multiple choice questions instead of written-response questions

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Modifications are for students with disabilities that need either the curriculum or assignments to be modified for their understanding.

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There are many different types of modifications. Modifications are put in place to allow students to learn material differently than the average student, meaning they may need more breaks during class or different assignment stipulations like outlining instead of writing an essay.

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High-Leverage Practice for Students with Modifications

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High-Leverage Practice for Students with Modifications

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This video discusses HLPs in modifications for students. Modifications include changing the curriculum to fit the needs of the students so they can make meaningful progress in their learning.

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Welcome to our new series on High-Leverage Practices

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Specially Designed Instruction is a teaching style that caters specifically to the needs of the student. Teachers will work with the student in a one-on-one environment or small group to specially teach a lesson that was otherwise taught differently to student without disabilities.

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Examples of Specially Designed Instruction

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Examples of Specially Designed Instruction

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speech and language therapy

vocational education

adaptive physical education

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Who needs Specially Designed Instruction?

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Who needs Specially Designed Instruction?

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Students who may struggle with paying attention or even understanding the material may need SDI. Teachers can adjust the assignments and the way content is taught in order to benefit the learning needs of the student(s).

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This link follows a few ways to specially design instruction for students! Students may need a direct approach to instruction or even the use of an interpreter. There are many ways a teacher can use specially designed instruction in the Gen Ed classroom.

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This tool is intended to be used by instructional leaders and those in coaching capacities to look for the presence of SDI in co-taught classrooms during formal observations. The list is not exhaustive, and questions may be presented in multiple ways to help uncover the various factors that contribute to the implementation of SDI and the variety of SDI one might see. An administrator or observer may only see 1 or 2 observable behaviors in an observation. This tool is intended to promote conversation between the observer and the observed.

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This tool is intended to be used by instructional leaders and those in coaching capacities to look for the presence of SDI in co-taught classrooms during formal observations. The list is not exhaustive, and questions may be presented in multiple ways to help uncover the various factors that contribute to the implementation of SDI and the variety of SDI one might see.

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SDI is tailored to a specific student. Using SDI in beneficial in assisting students in learning the curriculum in a way that is conducive to them.

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It addresses their Individualized Education Program (IEP) goals; accounts for their disability; provides modifications or adaptations to content; and encourages access to the general education curriculum.