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Koivunen K, Kaakinen P, Päätalo K, Mattila O, Oikarinen A, Jansson M, Mikkonen K, Pölkki T, Meriläinen M, Kääriäinen M, Holopainen A, Tuomikoski AM, Kanste O. Frontline nurse leaders' competences in evidence-based healthcare: A scoping review. J Adv Nurs 2024; 80:1314-1334. [PMID: 38041585 DOI: 10.1111/jan.15920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 09/11/2023] [Accepted: 10/17/2023] [Indexed: 12/03/2023]
Abstract
AIM To identify evidence on frontline nurse leaders' competences in evidence-based healthcare (EBHC) and the instruments measuring these competences. DESIGN A scoping review. DATA SOURCES The search was conducted in June 2021 and complemented in June 2022. The CINAHL, ProQuest, Medline (Ovid), Scopus, Web of Science databases and MedNar along with the Finnish database Medic were searched. REVIEW METHOD The scoping review was conducted in accordance with the Joanna Briggs institute methodology for scoping reviews. Titles, abstracts and full-text versions were screened independently by two reviewers according to the inclusion criteria. Deductive-inductive content analysis was used to synthesize data. RESULTS A total of 3211 articles published between 1997 and 2022 were screened, which resulted in the inclusion of 16 articles. Although frontline nurse leaders had a positive attitude towards EBHC, they had a lack of implementing EBHC competence into practice. Part of the instruments were used in the studies, and only one focused especially on leaders. None of instruments systematically covered all segments of EBHC. CONCLUSION There is a limited understanding of frontline nurse leaders' competence in EBHC. It is important to understand the importance of EBHC in healthcare and invest in the development of its competence at all levels of leaders. Frontline nurse leaders' support is essential for direct care nurses to use EBHC to ensure the quality of care and benefits to patients. Leaders must enhance their own EBHC competence to become role models for direct care nurses. It is also essential to develop valid and reliable instruments to measure leaders' competence covering all EBHC segments. The results can be utilized in the assessment and development of frontline nurse leaders' EBHC competence by planning and producing education and other competence development methods.
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Affiliation(s)
- Kirsi Koivunen
- University of Applied Sciences, Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
| | - Pirjo Kaakinen
- The Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Kati Päätalo
- University of Applied Sciences, Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
| | - Outi Mattila
- Lapland University of Applied Sciences, Rovaniemi, Finland
| | - Anne Oikarinen
- The Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Miia Jansson
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Kristina Mikkonen
- The Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Tarja Pölkki
- The Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Merja Meriläinen
- Wellbeing Services County of North Ostrobothnia, Oulu University Hospital, Medical Research Centre (MRC), Oulu, Finland
| | - Maria Kääriäinen
- The Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Arja Holopainen
- The Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
- Nursing Research Foundation, Helsinki, Finland
| | - Anna-Maria Tuomikoski
- The Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Wellbeing Services County of North Ostrobothnia, Oulu University Hospital, Medical Research Centre (MRC), Oulu, Finland
| | - Outi Kanste
- The Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Gallagher-Ford L, Hinkley TLT, Thomas B, Hertel R, Messinger JD, Cengiz A, Yoder LH. A Study of Medical Surgical Nurses Leaders' Evidence-Based Practice Attributes: Critical Implications for Practice. J Nurs Adm 2023; 53:460-466. [PMID: 37585493 DOI: 10.1097/nna.0000000000001316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
OBJECTIVE The purpose of this study was to determine medical-surgical nurse leaders' evidence-based practice (EBP) attributes, perceived barriers to EBP, and whether there were differences in leaders' EBP competencies and EBP implementation by demographic and organizational factors. BACKGROUND Leaders are crucial to the development of cultures that support EBP implementation, but little is known about medical-surgical nurse leaders' capacity to perform this aspect of their role. METHODS A cross-sectional design using survey methodology was used. The survey contained demographic/work setting questions and 3 instruments to measure EBP beliefs, implementation, and competencies. RESULTS Senior leaders self-reported higher EBP attributes compared with nurses in other roles; nurses with an MSN or higher reported greater frequency of EBP implementation. A regression revealed that EBP competencies, EBP beliefs, having a DNP degree, and working in an Academy of Medical-Surgical Nurses Premier Recognition In the Specialty of Med-surg unit or a Pathway to Excellence® organization had significant, positive effects on EBP implementation scores ( R2 = 0.37). CONCLUSIONS Findings demonstrate there is a range of EBP beliefs and competencies, and barriers to EBP among medical-surgical nurse leaders. Because medical-surgical nursing is the largest acute care practice specialty in the United States and many other countries, leaders fully integrating EBP into their practice would be a substantial contribution to advancing EBP in healthcare.
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Affiliation(s)
- Lynn Gallagher-Ford
- Author Affiliations: Chief Operating Officer and Clinical Core Director (Dr Gallagher-Ford), Clinical Program Manager (Thomas), and Statistician (Messinger), Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, The Ohio State University College of Nursing, Columbus; CEO (Dr Hinkley), Academy of Medical-Surgical Nurses, Sewell, New Jersey; Nursing Publishing Training Coordinator (Dr Hertel), Innovative Learning Sciences, Ascend Learning, Leawood, Kansas; and Research Associate (Dr Cengiz) and Professor (Dr Yoder), School of Nursing, University of Texas at Austin
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Chan RJ, Knowles R, Hunter S, Conroy T, Tieu M, Kitson A. From Evidence-Based Practice to Knowledge Translation: What Is the Difference? What Are the Roles of Nurse Leaders? Semin Oncol Nurs 2023; 39:151363. [PMID: 36414522 DOI: 10.1016/j.soncn.2022.151363] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Nurses, as the largest healthcare workforce, are well-positioned to apply knowledge translation. The role of nursing leadership in facilitating evidence-based practice has been extensively discussed in the literature, but this is not the case for knowledge translation. The objective of this study was to examine the potential role of nurse leaders in applying knowledge translation across health settings. DATA SOURCES We reviewed the existing literature for evidence-based practice as best practice in clinical care; examined how a complex systems approach to knowledge translation may extend beyond evidence-based practice, and considered nursing leadership approaches including transformational leadership. CONCLUSION In this discursive article, we discuss the differences between evidence-based practice and knowledge translation, highlight the promise of transformational leadership in facilitating knowledge translation through a complex systems lens, and argue for the importance of nurse leaders in facilitating and supporting complex knowledge translation across healthcare settings. IMPLICATIONS FOR NURSING PRACTICE Although future research is needed to test our ideas, we argue that the advanced conceptual understanding generated in this article should inform a roadmap toward a future in which nurse leaders initiate, participate and advocate for complex knowledge translation across healthcare settings.
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Affiliation(s)
- Raymond Javan Chan
- Director Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, SA, Australia.
| | - Reegan Knowles
- Research Fellow, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, SA, Australia
| | - Sarah Hunter
- Research Fellow, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, SA, Australia
| | - Tiffany Conroy
- Professor of Nursing, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, SA, Australia
| | - Matthew Tieu
- Research Fellow, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, SA, Australia
| | - Alison Kitson
- Vice President and Executive Dean of the College of Nursing and Health Sciences, Flinders University, SA, Australia
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Garcia AKA, Conchon MF, Pierotti I, Fonseca LF. PROCESS OF IMPLEMENTING THIRST MANAGEMENT IN SURGICAL BURNED PATIENTS, BASED ON KNOWLEDGE TRANSLATION. TEXTO & CONTEXTO ENFERMAGEM 2023. [DOI: 10.1590/1980-265x-tce-2022-0032en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
ABSTRACT Objective: to report the path taken to implement the Thirst Management Model using the Knowledge Translation Evidence-based Practice for Improving Quality intervention in a Burn unit. Method: an experience report on the implementation, which took place in two stages: Preparation; and Implementation/Change, both requiring a sequence of steps. Results: the implementation was performed in four cycles of the PDSA improvement tool. All had the same indicator collected, with increasing goals to be attained. Considering the barriers identified, multiple combined Knowledge Translation strategies were used, namely: posters; theoretical and practical training sessions, individual or in group; videos; dynamics; music; logo development for implementation visibility; audit and feedback; and didactic and illustrated clinical protocols. Conclusion: the report of the entire implementation process using the Evidence-based Practice for Improving Quality intervention, pointing out its weaknesses and strengths, proves to be useful, necessary and innovative. This study may assist in future evidence-based implementations that choose to use multifaceted interventions.
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Castiglione SA, Frechette J, Agnihotram VR. Implementation Leadership in the Point of Care Nursing Context: A Systematic Review Comparing Two Measurement Tools. SAGE Open Nurs 2023; 9:23779608231216161. [PMID: 38033620 PMCID: PMC10683391 DOI: 10.1177/23779608231216161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/10/2023] [Accepted: 11/05/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Implementation leadership (IL) are effective point of care (POC) nursing leadership behaviors that facilitate contexts conducive to the successful implementation of evidence-based practices (EBPs). However, no systematic evaluation of IL tools validated for the nursing context existed. Aims The purpose of this systematic review was to compare iterations of two IL measurement tools, the Implementation Leadership Scale (ILS) and the iLEAD, for application in a nursing context; and to critically appraise and summarize the methodological quality of studies assessing their psychometric properties. Methods A comprehensive search was conducted in four databases. Two reviewers independently screened titles and abstracts, reviewed full-text articles, and performed extraction into data tables. Statisticians appraised the quality control aspects. Findings were narratively summarized. Results A total of 247 records were included, where 10 for the ILS (including different versions) and one for the iLEAD met the inclusion criteria. Three studies evaluated the psychometric properties of the ILS in nursing, and its translations into Chinese and Greek. Content validity was deemed to be doubtful for both tools, but the ILS had adequate rating for comprehensiveness; methodological quality was very good for structural validity, internal consistency, hypothesis testing, and responsiveness where applicable for both scales, with the exception of cross-cultural validity which had ratings of adequate and inadequate for versions of the scales. Several study findings met the criteria for good measurement properties. No studies for either tool formally assessed feasibility. Conclusion Applying validated and contextually relevant tools to evaluate the capacity of nursing leadership to engage in IL in real-world contexts are needed. The ILS shows promise but requires further validation for contexts with diverse and multiple nursing leaders at the POC. Feasibility needs to be further studied.
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Affiliation(s)
| | - Julie Frechette
- Ingram School of Nursing, McGill University, Montréal, Canada
- Professional Development Directorate, Ordre des infirmières et infirmiers du Québec, Montréal, Canada
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Garcia AKA, Conchon MF, Pierotti I, Fonseca LF. PROCESSO DE IMPLANTAÇÃO DO MANEJO DA SEDE NO PACIENTE QUEIMADO CIRÚRGICO EMBASADO NO KNOWLEDGE TRANSLATION. TEXTO & CONTEXTO ENFERMAGEM 2023. [DOI: 10.1590/1980-265x-tce-2022-0032pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
RESUMO Objetivo: Relatar o caminho percorrido para a implantação do Modelo de Manejo da Sede com o uso da intervenção de Knowledge Translation Evidence-based Practice for Improving Quality (Prática Baseada em Evidência para a Melhoria do Processo de Qualidade) em uma unidade de queimados. Método: Relato de experiência sobre a implantação que ocorreu em duas etapas: Preparação e Implantação/ mudança, ambas obedecendo uma sequência de passos para sua realização. Resultados: A implementação foi realizada em quatro ciclos da ferramenta de melhoria PDSA. Todos tiveram o mesmo indicador coletado, com metas crescentes a serem alcançadas. Considerando as barreiras identificadas, utilizaram-se múltiplas estratégias combinadas de Knowledge Translation: cartazes, capacitações teóricas e práticas, individuais ou em grupo, vídeos, dinâmicas, músicas, desenvolvimento de logo para visibilidade da implantação, auditoria e feedback, protocolos clínicos didáticos e ilustrados. Conclusão: O relato de todo o processo de implantação com o uso da intervenção Evidence-based Practice for Improving Quality, apontando suas fragilidades e fortalezas, mostra-se útil, necessária e inovador. Este estudo pode auxiliar futuras implantações de evidências que escolham utilizar intervenções multifacetadas.
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Xiao L, Yu Y, Ratcliffe J, Milte R, Meyer C, Chapman M, Chen L, Ullah S, Kitson A, De Andrade AQ, Beattie E, Brodaty H, McKechnie S, Low LF, Nguyen TA, Whitehead C, Brijnath B, Sinclair R, Voss D. Creating 'Partnership in iSupport program' to optimise family carers' impact on dementia care: a randomised controlled trial protocol. BMC Health Serv Res 2022; 22:762. [PMID: 35689281 PMCID: PMC9185883 DOI: 10.1186/s12913-022-08148-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/01/2022] [Indexed: 12/03/2022] Open
Abstract
Background The majority of people with dementia are cared for by their family members. However, family carers are often unprepared for their caring roles, receiving less education and support compared with professional carers. The consequences are their reduced mental and physical health and wellbeing, and that of care recipients. This study protocol introduces the ‘Partnership in iSupport program’ that includes five interventional components: managing transitions, managing dementia progression, psychoeducation, carer support group and feedback on services. This health services research is built on family carer and dementia care service provider partnerships. The aims of the study are to evaluate the effectiveness, cost-effectiveness and family carers’ experiences in the program. Methods A multicentre randomised controlled trial will be conducted with family carers of people living with dementia from two tertiary hospitals and two community aged care providers across three Australian states. The estimated sample size is 185 family carers. They will be randomly assigned to either the intervention group or the usual care group. Outcomes are measurable improvements in quality of life for carers and people with dementia, caregiving self-efficacy, social support, dementia related symptoms, and health service use for carers and their care recipients. Data will be collected at three time points: baseline, 6 months and 12 months post-initiation of the intervention. Discussion This is the first large randomised controlled trial of a complex intervention on health and social care services with carers of people living with dementia in real-world practice across hospital and community aged care settings in three Australian states to ascertain the effectiveness, cost-effectiveness and carers’ experiences of the innovative program. We expect that this study will address gaps in supporting dementia carers in health and social care systems while generating new knowledge of the mechanisms of change in the systems. Findings will strengthen proactive health management for both people living with dementia and their carers by embedding, scaling up and sustaining the ‘Partnership in iSupport program’ in the health and social care systems. Trial registration The Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12622000199718. Registered February 4th, 2022. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08148-2.
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Affiliation(s)
- Lily Xiao
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia.
| | - Ying Yu
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Julie Ratcliffe
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Rachel Milte
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Claudia Meyer
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia.,Bolton Clarke Research Institute, Melbourne, VIC, Australia.,Adjunct Research Fellow; Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Australia.,Honorary Associate, Centre for Health Communication and Participation, La Trobe University, Melbourne, Australia
| | | | - Langduo Chen
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia.,Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Shahid Ullah
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Andre Queiroz De Andrade
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Elizabeth Beattie
- Queensland Dementia Training Study Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Sue McKechnie
- Community Services, Resthaven Incorporated, Wayville, South Australia, Australia
| | - Lee-Fay Low
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Tuan Anh Nguyen
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Australia
| | - Craig Whitehead
- Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Bianca Brijnath
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Australia.,School of Allied Health, Curtin University, Bentley, West Australia, Australia
| | - Ronald Sinclair
- Faculty of Sciences, University of Adelaide, Adelaide, Australia
| | - Diana Voss
- Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
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Williams S, Keogh S, Herd D, Riggall S, Glass R, Douglas C. Building effective engagement for implementation with i-PARIHS: a collaborative enquiry into paediatric pain care in the emergency department. BMC Health Serv Res 2022; 22:330. [PMID: 35279137 PMCID: PMC8916941 DOI: 10.1186/s12913-022-07740-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/03/2022] [Indexed: 11/21/2022] Open
Abstract
Background Pain is a central and distressing experience for children in the emergency department (ED). Despite the harmful effects of pain, ED care often falls short of providing timely and effective pain relief. Knowledge translation research targeting systems of care holds potential to transform paediatric pain care. This article reports on the first stages of an implementation project aimed at embedding effective and sustainable practice change in an Australian children’s hospital ED. Methods The integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework underpinned a cooperative process of engagement to establish a practitioner-led, interprofessional research collaborative. The Kids Pain Collaborative (KPC) aimed to co-design innovation in paediatric ED pain care, facilitating an extensive reconnaissance of research evidence, clinician and family experiences, and local evaluation data. This critical appraisal of the context and culture of pain management generated foci for innovation and facilitation of implementation action cycles. Results Engaging in a complex process of facilitated critical reflection, the KPC unpacked deeply embedded assumptions and organisational practices for pain care that worked against what they wanted to achieve as a team. A culture of rules-based pain management and command and control leadership produced self-defeating practices and ultimately breakdowns in pain care. By raising a critical awareness of context, and building consensus on the evidence for change, the KPC has established a whole of ED shared vision for prioritising pain care. Conclusions In-depth key stakeholder collaboration and appraisal of context is the first step in innovation of practice change. The KPC provided a space for collaborative enquiry where ED clinicians and researchers could develop context-specific innovation and implementation strategy. We provide an example of the prospective application of i-PARIHS in transforming ED pain care, using a collaborative and participatory approach that has successfully enabled high levels of departmental engagement, motivation and ownership of KPC implementation as the facilitation journey unfolds. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07740-w.
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Nurse unit managers’ work and impacts on clinical leadership: A cross-sectional study. Collegian 2022. [DOI: 10.1016/j.colegn.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Tektiridis JH, Heredia NI, Morgan RO, Mikhail OI, Risendal BC, Kegler MC, Fernandez ME. Practice change in community health centers: A qualitative study of leadership attributes. FRONTIERS IN HEALTH SERVICES 2022; 2:934688. [PMID: 36925826 PMCID: PMC10012757 DOI: 10.3389/frhs.2022.934688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022]
Abstract
Introduction This paper explores leadership attributes important for practice change in community health centers (CHCs) and assesses attributes' fit with the Full-Range Leadership Theory (FRLT). Methods We conducted four focus groups and 15 in-depth interviews with 48 CHC leaders from several U.S. states using a modified appreciative inquiry approach. Thematic analysis was used to review transcripts for leadership concepts and code with a priori FRLT-derived and inductive codes. Results CHC leaders most often noted attributes associated with transformational leadership as essential for practice change. Important attributes included emphasizing a collective sense of mission and a compelling, achievable vision; expressing enthusiasm about what needs to be done; and appealing to employees' analytical reasoning and challenging others to think creatively to problem solve. Few expressions of leadership fit with the transactional typology, though some did mention active vigilance to ensure standards are met, clarifying role and task requirements, and rewarding followers. Passive-avoidant attributes were rarely mentioned. Conclusions Our results enhance understanding of leadership attributes supportive of successful practice change in CHCs.
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Affiliation(s)
| | - Natalia I Heredia
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Robert O Morgan
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Osama I Mikhail
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Betsy C Risendal
- Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, United States
| | - Michelle C Kegler
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Maria E Fernandez
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
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Garcia AKA, Conchon MF, Pierotti I, Zampar EF, Fonseca LF. Barriers and facilitators in the management of preoperative thirst of the burned patient in the light of Knowledge Translation. Rev Esc Enferm USP 2021; 55:e03764. [PMID: 34320114 DOI: 10.1590/s1980-220x2020039803764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/19/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To explore the perception of health care professionals about barriers and facilitators, and coping strategies for the implementation of the Thirst Management Model in the preoperative period of the burned patient. METHOD This is a qualitative study, anchored in the conceptual framework Knowledge Translation. The focus group technique was chosen for data collection, composed by eight key professionals, to identify barriers and facilitators in evidence implementation and to point out coping strategies for the critical nodes found. Thematic Content Analysis technique was used to evaluate the data. RESULTS Five categories emerged: Physical structure, environment and supplies; Particularities of the burned patient; Human Resources; Team attitude; Team training and education. Coping strategies were raised for each barrier identified. CONCLUSION The main barriers identified were found in the Human Resources and Team Attitude categories. The main facilitators were Particularities of the burned patient and Team training and education. The identification allowed planning coping strategies for critical nodes, providing support for scientific evidence in clinical practice.
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Affiliation(s)
| | - Marilia Ferrari Conchon
- Universidade Estadual de Londrina, Programa de Pós-graduação em Enfermagem, Londrina, PR, Brasil
| | - Isadora Pierotti
- Universidade Estadual de Londrina, Programa de Pós-graduação em Enfermagem, Londrina, PR, Brasil
| | | | - Lígia Fahl Fonseca
- Universidade Estadual de Londrina, Programa de Pós-graduação em Enfermagem, Londrina, PR, Brasil
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Clavijo-Chamorro MZ, Romero-Zarallo G, Gómez-Luque A, López-Espuela F, Sanz-Martos S, López-Medina IM. Leadership as a Facilitator of Evidence Implementation by Nurse Managers: A Metasynthesis. West J Nurs Res 2021; 44:567-581. [PMID: 33853443 DOI: 10.1177/01939459211004905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Evidence-based practice is often not implemented in nursing for reasons relating to leadership. This article aims to cast light on the factors that facilitate nursing evidence implementation perceived by nurse managers in their practical experiences of this implementation. It is a qualitative, narrative metasynthesis of primary studies on nurse managers' leadership-related facilitation experiences, following the Joanna Briggs Institute meta-aggregative approach and the Promoting Action on Research Implementation in Health Services (PARiHS) model. Eleven primary studies were included and three general categories were identified as leadership-related factors facilitating evidence implementation: teamwork (communication between managers and staff nurses), organizational structures (strategic governance), and transformational leadership (influence on evidence application and readiness for change among leaders). Nurse managers act as facilitators of evidence-based practices by transforming contexts to motivate their staff and move toward a shared vision of change. Always providing support as managers and colleagues, sharing their experience in the clinic environment.
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Affiliation(s)
- María Zoraida Clavijo-Chamorro
- Department of Nursing, Faculty of Nursing and Occupational Therapy, University of Extremadura, Cáceres, Extremadura, Spain
| | - Gema Romero-Zarallo
- Department of Nursing, Internal Medicine Unit, Llerena General Hospital, Badajoz, Extremadura, Spain
| | - Adela Gómez-Luque
- Department of Nursing, Faculty of Nursing, University of Extremadura, Plasencia, Extremadura, Spain
| | - Fidel López-Espuela
- Department of Nursing, Faculty of Nursing and Occupational Therapy, University of Extremadura, Cáceres, Extremadura, Spain
| | - Sebastián Sanz-Martos
- Department of Nursing, Faculty of Health Sciences, University of Jaén, Andalusia, Spain
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Hølge-Hazelton B, Kjerholt M, Rosted E, Thestrup Hansen S, Zacho Borre L, McCormack B. Improving Person-Centred Leadership: A Qualitative Study of Ward Managers' Experiences During the COVID-19 Crisis. Risk Manag Healthc Policy 2021; 14:1401-1411. [PMID: 33854389 PMCID: PMC8039537 DOI: 10.2147/rmhp.s300648] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/24/2021] [Indexed: 12/22/2022] Open
Abstract
Purpose In order to provide guidance and prepare ward managers for future crisis situations similar to the COVID-19 pandemic, the aim of this study was to reflect and learn how person-centred nursing leadership may be strengthened in such situations. Background The pandemic has forced nurse leaders to face new challenges. Knowledge about their experiences may contribute to advancing leadership practices in times of future crises. Methods A qualitative directed content analysis was chosen. The theoretical perspective was person-centred leadership. Thirteen ward managers from a Danish university hospital were included and interviewed using telephone interviews three months after the first national COVID-19 case was confirmed. Findings The main findings of the study revealed that the ward managers often experienced a lack of timely, relevant information, involvement in decision-making and acknowledgement from the head nurse of department and the executive management. This was caused by the existing organizational cultures and the traditional hierarchy of communication. This meant that the ward managers' sense of own competences and leadership values and beliefs came under high pressure when they had to balance different stakeholders' needs. Conclusion When the experience of ward managers results in them being unable to lead authentically and competently in a crisis like the COVID-19 pandemic, lack of engagement can occur, with serious consequences for patients, staff and the ward managers themselves. Traditional organizational cultures that are hierarchical and controlling needs to be challenged and reoriented towards collaborative, inclusive and participative practices of engagement and involvement. Leadership development must be an established and integrated component of organizations, so that ward managers are able to sustain person-centred ways of being and doing in times of crisis.
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Affiliation(s)
- Bibi Hølge-Hazelton
- Research Support Unit, Zealand University Hospital, Roskilde, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Mette Kjerholt
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | - Elizabeth Rosted
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
| | - Stine Thestrup Hansen
- Department of Plastic Surgery and Breast Surgery, Zealand University Hospital, Roskilde, Denmark
| | - Line Zacho Borre
- Research Support Unit, Zealand University Hospital, Roskilde, Denmark
| | - Brendan McCormack
- Centre for Person-Centred Practice Research, Queen Margaret University Edinburgh, Musselburgh, East Lothian, UK
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Kitson AL, Harvey G, Gifford W, Hunter SC, Kelly J, Cummings GG, Ehrenberg A, Kislov R, Pettersson L, Wallin L, Wilson P. How nursing leaders promote evidence-based practice implementation at point-of-care: A four-country exploratory study. J Adv Nurs 2021; 77:2447-2457. [PMID: 33626205 DOI: 10.1111/jan.14773] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/18/2020] [Accepted: 01/20/2021] [Indexed: 12/18/2022]
Abstract
AIMS To describe strategies nursing leaders use to promote evidence-based practice implementation at point-of-care using data from health systems in Australia, Canada, England and Sweden. DESIGN A descriptive, exploratory case-study design based on individual interviews using deductive and inductive thematic analysis and interpretation. METHODS Fifty-five nursing leaders from Australia, Canada, England and Sweden were recruited to participate in the study. Data were collected between September 2015 and April 2016. RESULTS Nursing leaders both in formal managerial roles and enabling roles across four country jurisdictions used similar strategies to promote evidence-based practice implementation. Nursing leaders actively promote evidence-based practice implementation, work to influence evidence-based practice implementation processes and integrate evidence-based practice implementation into everyday policy and practices. CONCLUSION The deliberative, conscious strategies nursing leaders used were consistent across country setting, context and clinical area. These strategies were based on a series of activities and interventions around promoting, influencing and integrating evidence-based practice implementation. We conjecture that these three key strategies may be linked to two overarching ways of demonstrating effective evidence-based practice implementation leadership. The two overarching modes are described as mediating and adapting modes, which reflect complex, dynamic, relationship-focused approaches nursing leaders take towards promoting evidence-based practice implementation. IMPACT This study explored how nursing leaders promote evidence-based practice implementation. Acknowledging and respecting the complex work of nursing leaders in promoting evidence-based practice implementation through mediating and adapting modes of activity is necessary to improve patient outcomes and system effectiveness.
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Affiliation(s)
- Alison L Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Gillian Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, SA, Australia
| | - Wendy Gifford
- Faculty of Heaslth Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Sarah C Hunter
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Janet Kelly
- Adelaide Nursing School, University of Adelaide, Adelaide, SA, Australia
| | | | - Anna Ehrenberg
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
| | - Roman Kislov
- Faculty of Business and Law, Manchester Metropolitan University and School of Health Sciences, The University of Manchester, Manchester, UK
| | - Lena Pettersson
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
| | - Lars Wallin
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden.,Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Paul Wilson
- Schoolf of Health Sciences, The University of Manchester, Manchester, UK
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15
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Virdun C, Luckett T, Davidson PM, Phillips J. Strengthening palliative care in the hospital setting: a codesign study. BMJ Support Palliat Care 2020:bmjspcare-2020-002645. [PMID: 33115832 DOI: 10.1136/bmjspcare-2020-002645] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To identify actions required to strengthen the delivery of person and family centred hospital-based palliative care so that it addressed the domains of care identified as important for inpatients with palliative care needs and their families. METHODS A codesign study involving a workshop with palliative care and acute hospital policy, consumer and clinical representatives in Australia. A modified nominal group process generated a series of actions, which were thematically analysed and refined, before being circulated to participants to gain consensus. RESULTS More than half (n=30, 58%) of the invited representatives (n=52) participated in the codesign process. Nine actions were identified as required to strengthen inpatient palliative care provision being: (a) evidence-informed practice and national benchmarking; (b) funding reforms; (c) securing executive level support; (d) mandatory clinical and ancillary education; (e) fostering greater community awareness; (f) policy reviews of care of the dying; (g) better integration of advance care planning; (h) strengthen nursing leadership; and (i) develop communities of practice for improving palliative care. CONCLUSIONS Changes to policy, practice, education and further research are required to optimise palliative care within hospital settings, in accordance with the domains inpatients with palliative care needs and their families consider to be important. Achieving these changes will require a whole of sector approach and significant national and jurisdictional leadership.
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Affiliation(s)
- Claudia Virdun
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, New South Wales, Australia
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, New South Wales, Australia
| | - Patricia M Davidson
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, New South Wales, Australia
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jane Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, New South Wales, Australia
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