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Joosub N, Kruger G, Basson P. A neuropsychological rehabilitation service delivery model for South African adults with acquired brain injury (RSDM-SA). FRONTIERS IN REHABILITATION SCIENCES 2024; 4:1175963. [PMID: 38681901 PMCID: PMC11045952 DOI: 10.3389/fresc.2023.1175963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 11/24/2023] [Indexed: 05/01/2024]
Abstract
In low- and- middle- income countries (LMICs) such as South Africa, a high number of Acquired Brain Injuries (ABIs) and a lack of accessibility to healthcare lead to many survivors of brain injury not receiving the level of healthcare and rehabilitation required. Further, in LMICs life-saving or acute care is prioritized with an inadequate focus on the lifelong effects of ABI. This study used Program Theory to develop a Rehabilitation Service Delivery Model for South African Adults with Acquired Brain Injury (RSDM-SA) that caters for the unique nuances of a resource-constrained and culturally diverse context. The RSDM-SA has four interdependent levels, namely (i) Integration of Relevant Aspects of Explanatory Frameworks (ii) South African Contextual Influences on the Model (iii) Systemic Role players Necessary for the Model and (iv) Evidence-Based Guidelines in a Holistic Rehabilitation Process. The Model is a valuable resource in guiding future research endeavors and its contribution lies in the Model's focus on quality, accessibility, relevance, and efficiency, all of which are needed in healthcare internationally.
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Affiliation(s)
- Noorjehan Joosub
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa
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Wallner M, Mayer H, Adlbrecht L, Hoffmann AL, Fahsold A, Holle B, Zeller A, Palm R. Theory-based evaluation and programme theories in nursing: A discussion on the occasion of the updated Medical Research Council (MRC) Framework. Int J Nurs Stud 2023; 140:104451. [PMID: 36812849 DOI: 10.1016/j.ijnurstu.2023.104451] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/13/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023]
Abstract
Developing and evaluating health interventions for the benefit of patients is notoriously difficult. This also applies to the discipline of nursing, owing to the complexity of nursing interventions. Following significant revision, the updated guidance of the Medical Research Council (MRC) adopts a pluralistic view to intervention development and evaluation, including a theory-based perspective. This perspective promotes the use of program theory, aiming to understand how and under what circumstances interventions lead to change. In this discussion paper, we reflect the recommended use of program theory in the context of evaluation studies addressing complex nursing interventions. First, we review the literature by investigating the question whether and how evaluation studies targeting complex interventions used theory and to what extent program theories may contribute to enhance the theoretical foundations of intervention studies in nursing. Second, we illustrate the nature of theory-based evaluation and program theories. Third, we argue how this may impact theory building in nursing in general. We finish by discussing which resources, skills and competencies are necessary to fulfill the demanding task of undertaking theory-based evaluations. We caution against an oversimplified interpretation of the updated MRC guidance regarding the theory-based perspective, e.g. by using simple linear logic models, rather than articulating program theories. Instead, we encourage researchers to embrace the corresponding methodology, i.e. theory-based evaluation. With the prevailing perspective of knowledge production in crisis, we might be on the verge of a paradigm shift in health intervention research. Viewed through this lens, the updated MRC guidance could lead to a renewed understanding of what constitutes useful knowledge in nursing. This may facilitate knowledge production and, thereby, contribute to improve nursing practice for the benefit of the patient.
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Affiliation(s)
- Martin Wallner
- Karl Landsteiner University of Health Sciences, Division of Nursing Science with focus on Person-Centred Care Research, Krems, Austria; University of Vienna, Vienna Doctoral School of Social Sciences, Department of Nursing Science, Vienna, Austria.
| | - Hanna Mayer
- Karl Landsteiner University of Health Sciences, Division of Nursing Science with focus on Person-Centred Care Research, Krems, Austria
| | - Laura Adlbrecht
- OST Eastern Switzerland University of Applied Sciences, Department of Health, Competence Center Dementia Care, St. Gallen, Switzerland
| | - Anna Louisa Hoffmann
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Witten, Germany; Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Anne Fahsold
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Witten, Germany; Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Bernhard Holle
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Witten, Germany; Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Adelheid Zeller
- OST Eastern Switzerland University of Applied Sciences, Department of Health, Competence Center Dementia Care, St. Gallen, Switzerland
| | - Rebecca Palm
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Witten, Germany
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Lee MR, Cha C. A Mobile Healing Program Using Virtual Reality for Sexual Violence Survivors: A Randomized Controlled Pilot Study. Worldviews Evid Based Nurs 2020; 18:50-59. [PMID: 33245631 DOI: 10.1111/wvn.12478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Many young women suffer from sexual violence, but few practice self-healing activities. AIMS This study evaluated the feasibility and preliminary effects of a mobile virtual intervention, Sister, I will tell you!©, to heal young women after sexual violence in South Korea. METHODS A mobile virtual intervention, Sister, I will tell you!©, was developed based on a literature review and preliminary studies. In collaboration with sexual violence survivors and experts, eight modules for reflective writing and six modules for mindfulness meditation were included in this 4-week mobile virtual intervention. Thirty-four female sexual violence survivors were randomly assigned to either experimental (n = 19) or control groups (n = 15). The experimental group practiced reflective writing and mindfulness meditation, guided by the mobile virtual intervention. The control group practiced audio-guided mindfulness meditation. Pretest, posttest, and post-4-week evaluations with standardized instruments measured perceived support, negative impact from sexual violence, and suicidal ideation. Descriptive and inferential statistics were used to analyze survey data and content analysis to analyze reflective writing. RESULTS Among 34 enrolled participants, 26 completed the 4-week intervention and posttest evaluations; 24 completed post-4-week evaluations. Significant improvements were found among participants in the areas of perceived support, negative impact from sexual violence, and suicidal ideation. The effect size of the intervention was moderate. Four themes that emerged from reflective writings were objectifying sexual violence, healing beginning with action, confronting issues, and sharing experiences. LINKING EVIDENCE TO ACTION The intervention showed potential for initiating young women's engagement in healing from sexual violence. A simple mobile audio intervention without human interaction could benefit sexual violence survivors.
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Affiliation(s)
- Mi-Ran Lee
- College of Nursing, Ewha Womans University, Seoul, South Korea
| | - Chiyoung Cha
- College of Nursing, Ewha Research Institute of Nursing Science, & System Health & Engineering major in graduate school, Ewha Womans University, Seoul, South Korea
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Markle-Reid M, McAiney C, Ganann R, Fisher K, Gafni A, Gauthier AP, Heald-Taylor G, McElhaney J, Ploeg J, Urajnik DJ, Valaitis R, Whitmore C. Study protocol for a hospital-to-home transitional care intervention for older adults with multiple chronic conditions and depressive symptoms: a pragmatic effectiveness-implementation trial. BMC Geriatr 2020; 20:240. [PMID: 32650732 PMCID: PMC7350576 DOI: 10.1186/s12877-020-01638-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 07/01/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Older adults (> 65 years) with multiple chronic conditions (MCC) and depressive symptoms experience frequent transitions between hospital and home. Care transitions for this population are often poorly coordinated and fragmented, resulting in increased readmission rates, adverse medical events, decreased patient satisfaction and safety, and increased caregiver burden. There is a dearth of evidence on best practices in the provision of transitional care for older adults with MCC and depressive symptoms transitioning from hospital-to-home. This paper presents a protocol for a two-armed, multi-site pragmatic effectiveness-implementation trial of Community Assets Supporting Transitions (CAST), an evidence-informed nurse-led six-month intervention that supports older adults with MCC and depressive symptoms transitioning from hospital-to-home. The Collaborative Intervention Planning Framework is being used to engage patients and other key stakeholders in the implementation and evaluation of the intervention and planning for intervention scale-up to other communities. METHODS Participants will be considered eligible if they are > 65 years, planned for discharged from hospital to the community in three Ontario locations, self-report at least two chronic conditions, and screen positive for depressive symptoms. A total of 216 eligible and consenting participants will be randomly assigned to the control (usual care) or intervention (CAST) arm. The intervention consists of tailored care delivery comprising in-home visits, telephone follow-up and system navigation support. The primary measure of effectiveness is mental health functioning of the older adult participant. Secondary outcomes include changes in physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health and social service use and cost, from baseline to 6- and 12-months. Caregivers will be assessed for caregiver strain, depressive symptoms, anxiety, health-related quality of life, and health and social service use and costs. Descriptive and qualitative data from older adult and caregiver participants, and the nurse interventionists will be used to examine implementation of the intervention, how the intervention is adapted within each study region, and its potential for sustainability and scalability to other jurisdictions. DISCUSSION A nurse-led transitional care strategy may provide a feasible and effective means for improving health outcomes and patient/caregiver experience and reduce service use and costs in this vulnerable population. TRIAL REGISTRATION # NCT03157999 . Registration Date: April 4, 2017.
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Affiliation(s)
- Maureen Markle-Reid
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, 1200 Main Street West, HSC 3N25B, Hamilton, ON, L8S 4K1, Canada. .,Murray Alzheimer Research & Education Program (MAREP), School of Public Health and Health Systems, University of Waterloo,University of Waterloo Research Institute for Aging, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Carrie McAiney
- Murray Alzheimer Research & Education Program (MAREP), School of Public Health and Health Systems, University of Waterloo,University of Waterloo Research Institute for Aging, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Rebecca Ganann
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, 1200 Main Street West, HSC 3N25B, Hamilton, ON, L8S 4K1, Canada
| | - Kathryn Fisher
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, 1200 Main Street West, HSC 3N25B, Hamilton, ON, L8S 4K1, Canada
| | - Amiram Gafni
- Department of Health Research Methods, Evidence, and Impact; and Centre for Health Economics and Policy Analysis, McMaster University, 1200 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Alain P Gauthier
- School of Human Kinetics, Laurentian University, 935 Ramsey Lake Rd., Sudbury, ON, P3E 2C6, Canada
| | | | - Janet McElhaney
- Medical Sciences Division, Northern Ontario School of Medicine, Health Sciences North Research Institute, 41 Ramsey Lake Road, Sudbury, ON, P3E 5J1, Canada
| | - Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, 1200 Main Street West, HSC 3N25B, Hamilton, ON, L8S 4K1, Canada
| | - Diana J Urajnik
- Centre for Rural and Northern Health Research, Laurentian University, 935 Ramsey Lake Rd., Sudbury, ON, P3E 2C6, Canada
| | - Ruta Valaitis
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, 1200 Main Street West, HSC 3N25B, Hamilton, ON, L8S 4K1, Canada
| | - Carly Whitmore
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, 1200 Main Street West, HSC 3N25B, Hamilton, ON, L8S 4K1, Canada
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de Almeida Andrade F, Schlechta Portella CF. Research methods in complementary and alternative medicine: an integrative review. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2017; 16:6-13. [PMID: 29397095 DOI: 10.1016/j.joim.2017.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/01/2017] [Indexed: 11/18/2022]
Abstract
The scientific literature presents a modest amount of evidence in the use of complementary and alternative medicine (CAM). On the other hand, in practice, relevant results are common. The debates among CAM practitioners about the quality and execution of scientific research are important. Therefore, the aim of this review is to gather, synthesize and describe the differentiated methodological models that encompass the complexity of therapeutic interventions. The process of bringing evidence-based medicine into clinical practice in CAM is essential for the growth and strengthening of complementary medicines worldwide.
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Markle-Reid M, Ploeg J, Fraser KD, Fisher KA, Akhtar-Danesh N, Bartholomew A, Gafni A, Gruneir A, Hirst SP, Kaasalainen S, Stradiotto CK, Miklavcic J, Rojas-Fernandez C, Sadowski CA, Thabane L, Triscott JAC, Upshur R. The ACHRU-CPP versus usual care for older adults with type-2 diabetes and multiple chronic conditions and their family caregivers: study protocol for a randomized controlled trial. Trials 2017; 18:55. [PMID: 28166816 PMCID: PMC5294729 DOI: 10.1186/s13063-017-1795-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 01/11/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Many community-based self-management programs have been developed for older adults with type-2 diabetes mellitus (T2DM), bolstered by evidence from randomized controlled trials (RCTs) that T2DM can be prevented and managed through lifestyle modifications. However, the evidence for their effectiveness is contradictory and weakened by reliance on single-group designs and/or small samples. Additionally, older adults with multiple chronic conditions (MCC) are often excluded because of recruiting and retention challenges. This paper presents a protocol for a two-armed, multisite, pragmatic, mixed-methods RCT examining the effectiveness and implementation of the Aging, Community and Health Research Unit-Community Partnership Program (ACHRU-CPP), a new 6-month interprofessional, nurse-led program to promote self-management in older adults (aged 65 years or older) with T2DM and MCC and support their caregivers (including family and friends). METHODS/DESIGN The study will enroll 160 participants in two Canadian provinces, Ontario and Alberta. Participants will be randomly assigned to the control (usual care) or program study arm. The program will be delivered by registered nurses (RNs) and registered dietitians (RDs) from participating diabetes education centers (Ontario) or primary care networks (Alberta) and program coordinators from partnering community-based organizations. The 6-month program includes three in-home visits, monthly group sessions, monthly team meetings for providers, and nurse-led care coordination. The primary outcome is the change in physical functioning as measured by the Physical Component Summary (PCS-12) score from the short form-12v2 health survey (SF-12). Secondary client outcomes include changes in mental functioning, depressive symptoms, anxiety, and self-efficacy. Caregiver outcomes include health-related quality of life and depressive symptoms. The study includes a comparison of health care service costs for the intervention and control groups, and a subgroup analysis to determine which clients benefit the most from the program. Descriptive and qualitative data will be collected to examine implementation of the program and effects on interprofessional/team collaboration. DISCUSSION This study will provide evidence of the effectiveness of a community-based self-management program for a complex target population. By studying both implementation and effectiveness, we hope to improve the uptake of the program within the existing community-based structures, and reduce the research-to-practice gap. TRIAL REGISTRATION ClinicalTrials.gov, Identifier: NCT02158741 . Registered on 3 June 2014.
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Affiliation(s)
- Maureen Markle-Reid
- Aging, Community and Health Research Unit (ACHRU), School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Jenny Ploeg
- Aging, Community and Health Research Unit (ACHRU), School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Kimberly D. Fraser
- Faculty of Nursing, University of Alberta, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Kathryn Ann Fisher
- Aging, Community and Health Research Unit (ACHRU), School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Noori Akhtar-Danesh
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Amy Bartholomew
- Aging, Community and Health Research Unit (ACHRU), School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Amiram Gafni
- Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main Street, Hamilton, ON L8S 4K1 Canada
| | - Andrea Gruneir
- Department of Family Medicine, University of Alberta, 6-40 University Terrace, Edmonton, AB T6G 2T4 Canada
| | - Sandra P. Hirst
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4 Canada
| | - Sharon Kaasalainen
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Caralyn Kelly Stradiotto
- Aging, Community and Health Research Unit (ACHRU), School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - John Miklavcic
- Faculty of Nursing, University of Alberta, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Carlos Rojas-Fernandez
- Department of Family Medicine, McMaster School of Medicine, Principal, CRF Consulting, 763 Cedar Bend Drive, Waterloo, ON N2V 2R6 Canada
| | - Cheryl A. Sadowski
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 3-229 Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, St. Joseph’s Healthcare Hamilton, Room H-325, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Jean A. C. Triscott
- Care of the Elderly Division, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2R7 Canada
| | - Ross Upshur
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3M7 Canada
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Tielsch-Goddard A, Ridner SH. Critical Analysis of Interventional Research Designs to Promote Coping in Pediatric Patients. J Pediatr Health Care 2016; 30:424-34. [PMID: 26620103 DOI: 10.1016/j.pedhc.2015.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 10/06/2015] [Accepted: 10/23/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this article is to analyze the strengths and limitations of research designs of studies implementing coping based training interventions in adolescents. METHODS Quantitative and mixed methods studies were selected and reviewed for critical analysis of strengths, limitations, and validity concerns. RESULTS Methodological strengths and weaknesses were assessed. The major limitation to the studies reviewed is selection bias in both quasi-experimental studies and randomized controlled trials. PRACTICE IMPLICATIONS Improved coping strategies and skills were found in participants of coping skill training intervention programs. Decreased depressive symptoms and less impact of individual disease burden was found in the treatment intervention groups.
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Verhoef MJ, Vanderheyden LC, Fønnebø V. A Whole Systems Research Approach to Cancer Care: Why Do We Need It and How Do We Get Started? Integr Cancer Ther 2016; 5:287-92. [PMID: 17101757 DOI: 10.1177/1534735406295041] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Because cancer care is presently developing into a complicated network of interventions delivered at different times and places with different intentions, there is a need to consider whether the current research approaches in clinical cancer care adequately cover the ongoing treatment choices and combinations. Researchers in complementary and alternative medicine (CAM) are proposing whole systems research as an additional research approach for modern systems of care, whether they include complementary and alternative medicine or not. The current status of whole systems research methodology development is mainly theoretical. Necessary components of the methodology include focus on interventions, context, process, outcomes, and philosophy. Further development should be based on observational studies using both qualitative and quantitative approaches, often combined. Only when modern healthseeking systems of treatment behaviors are thoroughly understood should fine-tuning of hypothesis-testing research methods be continued.
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Affiliation(s)
- Marja J Verhoef
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Canada.
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Wuest J, Merritt-Gray M, Dubé N, Hodgins MJ, Malcolm J, Majerovich JA, Scott-Storey K, Ford-Gilboe M, Varcoe C. The process, outcomes, and challenges of feasibility studies conducted in partnership with stakeholders: a health intervention for women survivors of intimate partner violence. Res Nurs Health 2015. [PMID: 25594917 DOI: 10.1002/nur.2163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Feasibility studies play a crucial role in determining whether complex, community-based interventions should be subject to efficacy testing. Reports of such studies often focus on efficacy potential but less often examine other elements of feasibility, such as acceptance by clients and professionals, practicality, and system integration, which are critical to decisions for proceeding with controlled efficacy testing. Although stakeholder partnership in feasibility studies is widely suggested to facilitate the research process, strengthen relevance, and increase knowledge transfer, little is written about how this occurs or its consequences and outcomes. We began to address these gaps in knowledge in a feasibility study of a health intervention for women survivors of intimate partner violence (IPV) conducted in partnership with policy, community and practitioner stakeholders. We employed a mixed-method design, combining a single-group, pre-post intervention study with 52 survivors of IPV, of whom 42 completed data collection, with chart review data and interviews of 18 purposefully sampled participants and all 9 interventionists. We assessed intervention feasibility in terms of acceptability, demand, practicality, implementation, adaptation, integration, and efficacy potential. Our findings demonstrate the scope of knowledge attainable when diverse elements of feasibility are considered, as well as the benefits and challenges of partnership. The implications of diverse perspectives on knowledge transfer are discussed. Our findings show the importance of examining elements of feasibility for complex community-based health interventions as a basis for determining whether controlled intervention efficacy testing is justified and for refining both the intervention and the research design.
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Affiliation(s)
- Judith Wuest
- Professor Emerita, University of New Brunswick Faculty of Nursing, P.O. Box 4400, Fredericton, NB, Canada, E3B 5A3
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Wuest J, Merritt-Gray M, Dubé N, Hodgins MJ, Malcolm J, Majerovich JA, Scott-Storey K, Ford-Gilboe M, Varcoe C. The process, outcomes, and challenges of feasibility studies conducted in partnership with stakeholders: a health intervention for women survivors of intimate partner violence. Res Nurs Health 2015; 38:82-96. [PMID: 25594917 PMCID: PMC4305208 DOI: 10.1002/nur.21636] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 11/04/2014] [Accepted: 11/13/2014] [Indexed: 12/18/2022]
Abstract
Feasibility studies play a crucial role in determining whether complex, community-based interventions should be subject to efficacy testing. Reports of such studies often focus on efficacy potential but less often examine other elements of feasibility, such as acceptance by clients and professionals, practicality, and system integration, which are critical to decisions for proceeding with controlled efficacy testing. Although stakeholder partnership in feasibility studies is widely suggested to facilitate the research process, strengthen relevance, and increase knowledge transfer, little is written about how this occurs or its consequences and outcomes. We began to address these gaps in knowledge in a feasibility study of a health intervention for women survivors of intimate partner violence (IPV) conducted in partnership with policy, community and practitioner stakeholders. We employed a mixed-method design, combining a single-group, pre-post intervention study with 52 survivors of IPV, of whom 42 completed data collection, with chart review data and interviews of 18 purposefully sampled participants and all 9 interventionists. We assessed intervention feasibility in terms of acceptability, demand, practicality, implementation, adaptation, integration, and efficacy potential. Our findings demonstrate the scope of knowledge attainable when diverse elements of feasibility are considered, as well as the benefits and challenges of partnership. The implications of diverse perspectives on knowledge transfer are discussed. Our findings show the importance of examining elements of feasibility for complex community-based health interventions as a basis for determining whether controlled intervention efficacy testing is justified and for refining both the intervention and the research design.
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Affiliation(s)
- Judith Wuest
- Professor Emerita, University of New Brunswick Faculty of Nursing, P.O. Box 4400, Fredericton, NB, Canada, E3B 5A3
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Huijbregts MP, Myers AM, Streiner D, Teasell R. Implementation, Process, and Preliminary Outcome Evaluation of Two Community Programs for Persons with Stroke and Their Care Partners. Top Stroke Rehabil 2015; 15:503-20. [DOI: 10.1310/tsr1505-503] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Markle-Reid M, McAiney C, Forbes D, Thabane L, Gibson M, Browne G, Hoch JS, Peirce T, Busing B. An interprofessional nurse-led mental health promotion intervention for older home care clients with depressive symptoms. BMC Geriatr 2014; 14:62. [PMID: 24886344 PMCID: PMC4019952 DOI: 10.1186/1471-2318-14-62] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 04/24/2014] [Indexed: 11/10/2022] Open
Abstract
Background Depressive symptoms in older home care clients are common but poorly recognized and treated, resulting in adverse health outcomes, premature institutionalization, and costly use of health services. The objectives of this study were to examine the feasibility and acceptability of a new six-month interprofessional (IP) nurse-led mental health promotion intervention, and to explore its effects on reducing depressive symptoms in older home care clients (≥ 70 years) using personal support services. Methods A prospective one-group pre-test/post-test study design was used. The intervention was a six-month evidence-based depression care management strategy led by a registered nurse that used an IP approach. Of 142 eligible consenting participants, 98 (69%) completed the six-month and 87 (61%) completed the one-year follow-up. Outcomes included depressive symptoms, anxiety, health-related quality of life (HRQoL), and the costs of use of all types of health services at baseline and six-month and one-year follow-up. An interpretive descriptive design was used to explore clients’, nurses’, and personal support workers’ perceptions about the intervention’s appropriateness, benefits, and barriers and facilitators to implementation. Results Of the 142 participants, 56% had clinically significant depressive symptoms, with 38% having moderate to severe symptoms. The intervention was feasible and acceptable to older home care clients with depressive symptoms. It was effective in reducing depressive symptoms and improving HRQoL at six-month follow-up, with small additional improvements six months after the intervention. The intervention also reduced anxiety at one year follow-up. Significant reductions were observed in the use of hospitalization, ambulance services, and emergency room visits over the study period. Conclusions Our findings provide initial evidence for the feasibility, acceptability, and sustained effects of the nurse-led mental health promotion intervention in improving client outcomes, reducing use of expensive health services, and improving clinical practice behaviours of home care providers. Future research should evaluate its efficacy using a randomized clinical trial design, in different settings, with an adequate sample of older home care recipients with depressive symptoms. Trial registration Clinicaltrials.gov identifier: NCT01407926.
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Satherley P, Allen D, Lyne P. Supporting evidence-based service delivery and organisation: a comparison of an emergent realistic appraisal technique with a standard qualitative critical appraisal tool. INT J EVID-BASED HEA 2013; 5:477-86. [PMID: 21631808 DOI: 10.1111/j.1479-6988.2007.00062.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A major component of current policies aimed at promoting the delivery of an effective health service is to ensure that practitioners base their practice on research findings. Considerable attention has been focussed on the research community and developing appropriate methods and tools to support these objectives at the national and international level. The appraisal needs of individual practitioners, who might wish to inform local service delivery and organisation and who are often not methodological experts, has been hitherto ignored. This paper reports on the application and testing of a technique for the appraisal of evaluation studies, which is being developed for use by practitioners to inform local service delivery. This technique has previously been applied to a quantitative evaluation. In this paper we report on its application to the appraisal of a qualitative paper. Our aim is to compare it with a standard tool to establish which generates more meaningful information for use by practitioners for the purposes of informing service delivery and organisation. The emergent technique successfully extracted relevant methodological and contextual information, with developmental issues being identified.
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Affiliation(s)
- Philip Satherley
- Cardiff University, Nursing, Health & Social Care Research Centre, SONMS, UK
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Markle-Reid M, Browne G, Gafni A. Nurse-led health promotion interventions improve quality of life in frail older home care clients: lessons learned from three randomized trials in Ontario, Canada. J Eval Clin Pract 2013; 19:118-31. [PMID: 22029487 DOI: 10.1111/j.1365-2753.2011.01782.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This paper explores the lessons learned from a series of three randomized controlled trials that included 498 community-living frail older adults (≥65 years) using home care services in Southern Ontario, Canada. Each study was designed to evaluate the effectiveness of different multi-component nurse-led health promotion and disease prevention (HPDP) interventions. METHODS The nurse-led HPDP interventions were 6- or 12-month multi-component and evidence-based strategies targeting known risk factors for functional decline and frailty. Across the three studies, a common approach was used to measure the change in health-related quality of life (HRQOL) (SF-36) and the costs of use of health services (Health and Social Services Utilization Inventory) from baseline to the end of the intervention. RESULTS The main lesson learned from the three studies is that nurse-led HPDP interventions for frail older home care clients provide greater improvements in HRQOL compared with usual home care. Such approaches are highly acceptable to this population and can be implemented using existing home care resources. Nurse-led HPDP interventions should include multiple home visits, multidimensional screening and assessment, multi-component evidence-based HPDP strategies, intensive case management, inter-professional collaboration, providers with geriatric training and experience, referral to and coordination of community services, and theory use. CONCLUSION The results of the three trials underscore the need to reinvest in nurse-led HPDP interventions in home care to optimize HRQOL and promote ageing in place in the target population of frail older adults. More studies are needed to evaluate the effectiveness of additional nurse-led HPDP interventions in other contexts and settings.
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Affiliation(s)
- Maureen Markle-Reid
- School of Nursing and Associate Member, Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
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Grossman M, Agulnik J, Batist G. The Peter Brojde lung cancer centre: a model of integrative practice. ACTA ACUST UNITED AC 2012; 19:e145-59. [PMID: 22670104 DOI: 10.3747/co.19.929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The generally poor prognosis and poor quality of life for lung cancer patients have highlighted the need for a conceptual model of integrative practice. Although the philosophy of integrative oncology is well described, conceptual models that could guide the implementation and scientific evaluation of integrative practice are lacking. PURPOSE The present paper describes a conceptual model of integrative practice in which the philosophical underpinnings derive mainly from integrative oncology, with important contributions from Traditional Chinese Medicine (TCM) and the discipline of nursing. The conceptual model is described in terms of its purpose, values, concepts, dynamic components, scientific evidence, clinical approach, and theoretical underpinnings. The model argues that these components delineate the initial scope and orientation of integrative practice. They serve as the needed context for evaluating and interpreting the effectiveness of clinical interventions in enhancing patient outcomes in lung cancer at various phases of the illness. Furthermore, the development of relevant and effective integrative clinical interventions requires new research methods based on whole-systems research. An initial focus would be the identification of interrelationship patterns among variables that influence clinical interventions and their targeted patient outcomes.
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Affiliation(s)
- M Grossman
- McGill School of Nursing, McGill University, Montreal, QC.
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Markle-Reid MF, McAiney C, Forbes D, Thabane L, Gibson M, Hoch JS, Browne G, Peirce T, Busing B. Reducing depression in older home care clients: design of a prospective study of a nurse-led interprofessional mental health promotion intervention. BMC Geriatr 2011; 11:50. [PMID: 21867539 PMCID: PMC3184267 DOI: 10.1186/1471-2318-11-50] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 08/25/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Very little research has been conducted in the area of depression among older home care clients using personal support services. These older adults are particularly vulnerable to depression because of decreased cognition, comorbid chronic conditions, functional limitations, lack of social support, and reduced access to health services. To date, research has focused on collaborative, nurse-led depression care programs among older adults in primary care settings. Optimal management of depression among older home care clients is not currently known. The objective of this study is to evaluate the feasibility, acceptability and effectiveness of a 6-month nurse-led, interprofessional mental health promotion intervention aimed at older home care clients with depressive symptoms using personal support services. METHODS/DESIGN This one-group pre-test post-test study aims to recruit a total of 250 long-stay (> 60 days) home care clients, 70 years or older, with depressive symptoms who are receiving personal support services through a home care program in Ontario, Canada. The nurse-led intervention is a multi-faceted 6-month program led by a Registered Nurse that involves regular home visits, monthly case conferences, and evidence-based assessment and management of depression using an interprofessional approach. The primary outcome is the change in severity of depressive symptoms from baseline to 6 months using the Centre for Epidemiological Studies in Depression Scale. Secondary outcomes include changes in the prevalence of depressive symptoms and anxiety, health-related quality of life, cognitive function, and the rate and appropriateness of depression treatment from baseline to 12 months. Changes in the costs of use of health services will be assessed from a societal perspective. Descriptive and qualitative data will be collected to examine the feasibility and acceptability of the intervention and identify barriers and facilitators to implementation. DISCUSSION Data collection began in May 2010 and is expected to be completed by July 2012. A collaborative nurse-led strategy may provide a feasible, acceptable and effective means for improving the health of older home care clients by improving the prevention, recognition, and management of depression in this vulnerable population. The challenges involved in designing a practical, transferable and sustainable nurse-led intervention in home care are also discussed. TRIAL REGISTRATION ClinicalTrials.gov: NCT01407926.
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Abstract
OBJECTIVE To compare a specialized interprofessional team approach to community-based stroke rehabilitation with usual home care for stroke survivors using home care services. METHODS Randomized controlled trial of 101 community-living stroke survivors (<18 months post-stroke) using home care services. Subjects were randomized to intervention (n=52) or control (n=49) groups. The intervention was a 12-month specialized, evidence-based rehabilitation strategy involving an interprofessional team. The primary outcome was change in health-related quality of life and functioning (SF-36) from baseline to 12 months. Secondary outcomes were number of strokes during the 12-month follow-up, and changes in community reintegration (RNLI), perceived social support (PRQ85-Part 2), anxiety and depressive symptoms (Kessler-10), cognitive function (SPMSQ), and costs of use of health services from baseline to 12 months. RESULTS A total of 82 subjects completed the 12-month follow-up. Compared with the usual care group, stroke survivors in the intervention group showed clinically important (although not statistically significant) greater improvements from baseline in mean SF-36 physical functioning score (5.87, 95% CI -3.98 to 15.7; p=0.24) and social functioning score (9.03, CI-7.50 to 25.6; p=0.28). The groups did not differ for any of the secondary effectiveness outcomes. There was a higher total per-person costs of use of health services in the intervention group compared to usual home care although the difference was not statistically significant (p=0.76). CONCLUSIONS A 12-month specialized, interprofessional team is a feasible and acceptable approach to community-based stroke rehabilitation that produced greater improvements in quality of life compared to usual home care. Clinicaltrials.gov identifier: NCT00463229.
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Kossman S, Hsieh Y, Peace J, Valdez R, Severtson L, Burke L, Brennan PF. A theory-based problem-solving approach to recruitment challenges in a large randomized field trial. Appl Nurs Res 2010; 24:179-87. [PMID: 20974068 DOI: 10.1016/j.apnr.2009.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Revised: 05/26/2009] [Accepted: 06/03/2009] [Indexed: 10/20/2022]
Abstract
Despite best-laid plans, recruitment problems arise in large field trials. Research teams must work hard on problem solving and push comfort zones to sustain recruitment and accrual levels. A systematic theory-based problem-solving approach helped us look deeply for challenges and implement strategies continuously to sustain accrual to our target enrollment.
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Affiliation(s)
- Susan Kossman
- Mennonite College of Nursing, Illinois State University, Normal, USA.
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Shanti C, Johnson J, Meyers AM, Jones GR, Fitzgerald C, Lazowski DA, Stolee P, Orange JB, Segall N, Ecclestone NA. Evaluation of the Restorative Care Education and Training Program for Nursing Homes. Can J Aging 2010; 24:115-26. [PMID: 16082615 DOI: 10.1353/cja.2005.0065] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
ABSTRACTRestorative care attempts to break the cycle of dependency and functional decline in nursing homes by addressing individual resident needs. The Restorative Care Education and Training (RCET) Program consists of a five-week workshop and resource manual for both supervisory and direct care staff. This paper describes the RCET approach and presents the implementation, process, and quasi-experimental outcome evaluation findings with 42 residents from six intervention sites and six “wait-list” facilities who received usual care. Baseline data supported the fact that staff primarily targeted residents with substantial functional impairments. Over four months, residents who received restorative care improved significantly on several functional outcome indicators, while the comparison sample declined in several areas of functioning. Interviews with facility directors and participating staff provided direction for modifying the RCET and insight regarding opportunities and challenges when implementing restorative care activities in nursing homes.
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Affiliation(s)
- C Shanti
- Canadian Centre for Activity and Aging, University of Western Ontario, London, ON, Canada
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The Efficacy of a Motivational Nursing Intervention Based on the Stages of Change on Self-care in Heart Failure Patients. J Cardiovasc Nurs 2010; 25:130-41. [DOI: 10.1097/jcn.0b013e3181c52497] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Developing an electronic nursing record system for clinical care and nursing effectiveness research in a korean home healthcare setting. Comput Inform Nurs 2009; 27:234-44. [PMID: 19574749 DOI: 10.1097/ncn.0b013e3181a91b75] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Increased accountability requirements for the cost and quality of healthcare force nurses to clearly define and verify nursing's contributions to patient outcomes. This demand necessitates documentation of nursing care in a precise manner. An electronic nursing record system is considered a key element that enhances nurses' ability not only to record nursing care provided to patients but also to measure, report, and monitor quality and effectiveness. Home care is a growing field as nurses attempt to meet the demand for long-term care. The development of an electronic record system for home care nursing was the immediate focus of this study. We identified the nursing content required for home care nursing using standardized nursing languages and designed linkages among medical diagnoses, nursing diagnoses, nursing interventions, and nursing-sensitive outcomes within the system. Equipping an electronic nursing record system with nursing standards is particularly critical for enhancing nursing practice and for creating refined data to verify nursing effectiveness.
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Sidani S, Epstein DR, Bootzin RR, Moritz P, Miranda J. Assessment of preferences for treatment: validation of a measure. Res Nurs Health 2009; 32:419-31. [PMID: 19434647 PMCID: PMC4446727 DOI: 10.1002/nur.20329] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Systematic measurement of treatment preferences is needed to obtain well-informed preferences. Guided by a conceptualization of treatment preferences, a measure was developed to assess treatment acceptability and preference. The purpose of this study was to evaluate the psychometric properties of the treatment acceptability and preferences (TAP) measure. The TAP measure contains a description of each treatment under evaluation, items to rate its acceptability, and questions about participants' preferred treatment option. The items measuring treatment acceptability were internally consistent (alpha > .80) and demonstrated validity, evidenced by a one-factor structure and differences in the scores between participants with preferences for particular interventions. The TAP measure has the potential for the assessment of acceptability and preferences for various behavioral interventions.
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Affiliation(s)
- Souraya Sidani
- School of Nursing, Ryerson University, 350 Victoria Street, Toronto, Ontario, Canada M5B 2K3
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Thorne S. The role of qualitative research within an evidence-based context: can metasynthesis be the answer? Int J Nurs Stud 2008; 46:569-75. [PMID: 18617173 DOI: 10.1016/j.ijnurstu.2008.05.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 05/14/2008] [Accepted: 05/20/2008] [Indexed: 02/08/2023]
Abstract
The increasing emphasis on evidence in the health care planning and policy context has fuelled considerable discussion and debate in nursing circles on the appropriate place of the less favourably placed knowledge forms within the conventional evidentiary hierarchy. In this paper, nursing's affinity for qualitative methods, and the species of knowledge they generate, are considered within the context of this evolving evidence-based practice movement. Noting conceptual and terminological confusions around the notion of evidence such as have arisen within the nursing literature, the author argues for clarity in our collective thinking about the role of research in a nursing or any other applied practice discipline. Toward this end, she points to some of the newer approaches to research synthesis and integration that may hold particular promise for enhancing our confidence about what might properly constitute a qualitatively-derived evidentiary knowledge claim. Such approaches may assist nurses to work more comfortably within the evidence-based movement, assured that reliance upon scientifically sound reference points need not compromise the complexity, richness and diversity they recognize as inherent in practice context excellence.
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Affiliation(s)
- Sally Thorne
- University of British Columbia School of Nursing, T201-2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5.
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Reed D, Titler MG, Dochterman JM, Shever LL, Kanak M, Picone DM. Measuring the dose of nursing intervention. ACTA ACUST UNITED AC 2008; 18:121-30. [PMID: 17991139 DOI: 10.1111/j.1744-618x.2007.00067.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To increase awareness of the many issues involved in measuring the dose of nursing intervention in nursing interventions effectiveness research. METHODS Identify critical issues in measurement of the dose of nursing intervention and discuss decisions regarding dosage measurement made in a study of the effectiveness of nursing interventions. FINDINGS A single method can be applied to resolve two critical issues in intervention dosage measurement. CONCLUSIONS Those conducting nursing interventions effectiveness research must think explicitly about how intervention dosage will be measured and reported so that dosage can be replicated in research and practice. PRACTICE IMPLICATIONS Measuring and reporting the dose of nursing intervention in research is essential to the development of an evidence base adequate to support practice.
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Affiliation(s)
- David Reed
- Office for Nursing Research, University of Iowa College of Nursing, Iowa City, IA, USA.
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Huijbregts MPJ, Kay T, Klinck B. Theory-based programme development and evaluation in physiotherapy. Physiother Can 2008; 60:40-50. [PMID: 20145741 DOI: 10.3138/physio/60/1/40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Programme evaluation has been defined as "the systematic process of collecting credible information for timely decision making about a particular program." Where possible, findings are used to develop, revise, and improve programmes. Theory-based programme development and evaluation provides a comprehensive approach to programme evaluation. SUMMARY OF KEY POINTS In order to obtain meaningful information from evaluation activities, relevant programme components need to be understood. Theory-based programme development and evaluation starts with a comprehensive description of the programme. A useful tool to describe a programme is the Sidani and Braden Model of Program Theory, consisting of six programme components: problem definition, critical inputs, mediating factors, expected outcomes, extraneous factors, and implementation issues. Articulation of these key components may guide physiotherapy programme implementation and delivery and assist in the development of key evaluation questions and methodologies. Using this approach leads to a better understanding of client needs, programme processes, and programme outcomes and can help to identify barriers to and enablers of successful implementation. Two specific examples, representing public and private sectors, will illustrate the application of this approach to clinical practice. CONCLUSIONS Theory-based programme development helps clinicians, administrators, and researchers develop an understanding of who benefits the most from which types of programmes and facilitates the implementation of processes to improve programmes.
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Affiliation(s)
- Maria P J Huijbregts
- Maria P.J. Huijbregts , BScPT, PhD: Director of Clinical Evaluation, Baycrest, Toronto; Assistant Professor (status only), Department of Physical Therapy, University of Toronto, Toronto, Ontario; Adjunct Professor, Master of Public Health Department, Lakehead University, Thunder Bay, Ontario
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Supporting evidence-based service delivery and organisation. INT J EVID-BASED HEA 2007. [DOI: 10.1097/01258363-200712000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Verhoef M, Weeks L, Brazier A, Leis A. Evaluating supportive cancer care: are we missing an opportunity? Support Care Cancer 2007; 15:905-7. [PMID: 17609993 DOI: 10.1007/s00520-007-0289-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Accepted: 06/07/2007] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Cancer care can be described as a system or complex network of interventions delivered at various times and places with different intentions. CANCER CARE AS A SYSTEM Cancer care can include medical treatments, psychosocial care, complementary and alternative medicine, self-care, as well as the process of healing and the context in which care is delivered. EVALUATING CANCER CARE Whereas evaluating individual cancer treatments can be difficult, evaluating cancer care is even more challenging and requires a research framework that relies on methodologies capable of addressing its holistic, individualized, and complex nature. IN SUMMARY We suggest that research frameworks focused on studying complex or whole systems are a promising evaluation approach and an opportunity for further exploration.
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Sidani S, Epstein D, Miranda J. Eliciting Patient Treatment Preferences: A Strategy to Integrate Evidence-Based and Patient-Centered Care. Worldviews Evid Based Nurs 2006; 3:116-23. [PMID: 16965313 DOI: 10.1111/j.1741-6787.2006.00060.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The integrated patient-centered evidence-based approach to care is integral to guide practice and enhance the quality of care. In this paper, a strategy to operationalize the integrated approach is described. DESCRIPTION OF STRATEGY The strategy flows from the processes used to synthesize the best available evidence for interventions that address a clinical problem, and to elicit patient preferences for treatment options, which is an important step in patient-centered care. The strategy consists of three phases: (1) synthesis of evidence about the effectiveness and relevance of interventions derived from research and practice; (2) generation of written material describing the nature, dose, effectiveness, and risks associated with the evidence-based interventions; and (3) using the written descriptions to elicit patient preferences. Examples from an ongoing study are presented to illustrate the implementation of the strategy within the context of research. IMPLICATIONS Nurses are invited to apply the strategy in practice and to evaluate its feasibility and utility in enhancing the quality of care.
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Affiliation(s)
- Souraya Sidani
- Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
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Abstract
In the current research environment the design and management of control groups is becoming more complex. The selection of a control group design is dependent on study goals, presence and quality of existing interventions, urgency of the problem or issue being addressed by the intervention, and factors related to the study site. The purpose of the presentation is to identify various approaches to the design of control groups in experimental studies and to identify their strengths, limitations, and applications. A case study exemplifies the issues associated with control group selection and design.
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Affiliation(s)
- Sandra Ward
- University of Wisconsin-Madison, School of Nursing, Madison, WI 53792, USA
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