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Al Mutair A, Almutairi W, Aljarameez F, Kay E, Rabanal R, Abellar K, Napaod A, Hawsawi A, Saha C, Ahmed GY. Assessment of nurses' knowledge, attitude and implementation of skin-to-skin care within the perinatal setting in Saudi Arabia: Survey study. Nurs Open 2023; 10:2165-2171. [PMID: 36354110 PMCID: PMC10006611 DOI: 10.1002/nop2.1464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 05/12/2022] [Accepted: 10/22/2022] [Indexed: 11/11/2022] Open
Abstract
AIM To evaluate knowledge, attitude and implementation of Skin-to-Skin Care (SSC) among nurses and to assess the implementation of SSC in the perinatal setting. DESIGN A cross-sectional study design was implemented utilizing survey distributed among critical care paediatric and neonatal nurses. METHODS The data collection form was pre-structured validated tool consisted of two main sections; socio-demographic characteristics and Likert scale of 20 items covering four main domains in; knowledge, attitude, education and implementation of SSC. RESULTS The vast majority of the sample 91 (98%) were females with mean age and mean years of experience 33.5 ± 6.5 and 9.7 ± 6.5 years respectively. Almost half of them 45 (48.4%) work in obstetric and labor and delivery units. Correlation coefficient revealed a significant association between the total educational years of nursing degree and SSC. The results showed nurses with bachelor or master significantly more knowledgeable and skilled in implementing SSC compared to others.
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Affiliation(s)
- Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Alhassa, Saudi Arabia.,School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia.,Medical Surgical Nursing Department, Princess Nourah Bint Abdulrhamn University, Riyadh, Saudi Arabia.,Nursing Department, Almoosa College of Health Sciences, al-Mubarraz, Saudi Arabia
| | - Wedad Almutairi
- Department of Maternity and Child Nursing, Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Faiza Aljarameez
- King Saud Bin Abdulziz University for Health Sciences, Alhasa, Saudi Arabia.,King Abdullah International Medical Research Center, Alhasa, Saudi Arabia.,Ministry of National Guard-Health Affairs, Alhasa, Saudi Arabia
| | - Elbert Kay
- Research Center, Almoosa Specialist Hospital, Alhassa, Saudi Arabia
| | - Rhea Rabanal
- Research Center, Almoosa Specialist Hospital, Alhassa, Saudi Arabia
| | - Katrina Abellar
- Research Center, Almoosa Specialist Hospital, Alhassa, Saudi Arabia
| | - Aireen Napaod
- Research Center, Almoosa Specialist Hospital, Alhassa, Saudi Arabia
| | - Abeer Hawsawi
- Department of Maternity and Child Nursing, Faculty of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Chandni Saha
- Research Center, Almoosa Specialist Hospital, Alhassa, Saudi Arabia
| | - Gasmelseed Y Ahmed
- Research Center, Almoosa Specialist Hospital, Alhassa, Saudi Arabia.,College of medicine and health sciences, Almangil University, Almangil, Sudan
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Frimpong SO, Seidu M, Hilton SK, Ransome Y, Paintsil E, Talbert-Slagle K, Dorcoo-Attipoe S, Brayne C. Development of a community-based COVID-19 intervention in rural Ghana: a document analysis. BMC Public Health 2022; 22:1920. [PMID: 36242031 PMCID: PMC9568940 DOI: 10.1186/s12889-022-14338-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 09/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has caused the loss of millions of lives and economic breakdowns in many countries across the globe. Despite the limited availability of vaccines and the challenges of poor health infrastructure, few interventions have been developed and implemented for those who live in rural areas, particularly in sub-Saharan Africa. In response, Cocoa360, a global health nonprofit in rural Ghana designed an intervention called Cocoa360's COVID-19 Preparedness and Outbreak Prevention Plan (CoCoPOPP). This paper aimed to examine the extent to which CoCoPOPP's design aligned with the Promoting Action on Research Implementation in Health Services (PARIHS) framework. METHODS We reviewed documents influencing CoCoPOPP's design between March and June 2021. A total of 11 documents were identified for analysis. Using the Promoting Action on Research Implementation in Health Services (PARIHS) framework as a guide, thematic analysis was done to analyze the extracted data. RESULTS Overall, CoCoPOPP's design aligned with the evidence, context, and facilitation domains of the PARIHS framework. It positioned CoCoPOPP as an intervention that considered the unique context of a rural Ghanaian setting. It was guided by robust and high-quality published and non-published evidence and engaged external and internal stakeholders during its implementation. CoCoPOPP's context-dependent nature positions it for potential replication in sub-Saharan Africa's rural communities with similar farming contexts. Specific areas that were less well and/or not addressed were the unintended negative consequences of community engagement, the absence of primary data in the guiding evidence, and the lack of a facilitation continuum coupled with the role of power during the facilitation process. CONCLUSION CoCoPOPP, Cocoa360's response to the COVID-19 pandemic in rural Ghana, is an evidence-driven, context-dependent public health intervention that has been designed to reduce COVID-19 infections and prevent potential deaths. This study underscores the importance of considering the unique community and cultural contexts, employing evidence, and engaging local and external actors as facilitators when designing interventions to respond to global health pandemics.
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Affiliation(s)
- Shadrack Osei Frimpong
- Cocoa360, Accra, Ghana.
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, England.
| | | | | | - Yusuf Ransome
- Department of Social and Behavioural Science, Yale School of Public Health, Yale University, New Haven, USA
| | - Elijah Paintsil
- Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, USA
- Departmemt of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, USA
| | - Kristina Talbert-Slagle
- Departmemt of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, USA
| | | | - Carol Brayne
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, England
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Ariff S, Maznani I, Bhura M, Memon Z, Arshad T, Samejo TA, Zaidi S, Umer M, Ahmed I, Habib MA, Soofi SB, Bhutta ZA. Understanding Perceptions and Practices for Designing an Appropriate Community-Based Kangaroo Mother Care Implementation Package: Qualitative Exploratory Study. JMIR Form Res 2022; 6:e30663. [PMID: 34994692 PMCID: PMC8783273 DOI: 10.2196/30663] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/15/2021] [Accepted: 10/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background Low birth weight (LBW) is a common outcome of preterm birth, which increases the risk of an infant’s morbidity and mortality. Approximately 20 million infants are born with LBW globally per year. Since a significant number of births in Pakistan take place at home, it is important to focus on the use of kangaroo mother care (KMC), the practice of skin-to-skin contact, in communities to prevent neonatal mortality and morbidity. Objective We employed a formative research approach to understand the context of communities and facilities with regard to neonatal care and KMC practice. The broader aims were to inform the design and delivery of culturally appropriate platforms to introduce KMC in communities, and develop effective recruitment and retention strategies of KMC in rural areas of the Dadu district in the Sindh province of Pakistan. Methods We conducted focus group discussions, in-depth interviews, and key informant interviews with families of LBW babies, community members, health care providers, and hospital administrators to identify barriers, enablers, and a knowledge base for KMC interventions. Results Newborn care practices in communities were found to be suboptimal. The community was generally unaware of the KMC intervention for the care of LBW babies. However, facility health care providers, the community, and family members were willing to provide KMC to improve outcomes. We found significant support from the community members and health care providers for KMC practices. Mothers were also ready to provide intermittent KMC. The administrative staff at the hospitals accepted the introduction of KMC practices for LBW babies. Conclusions KMC as a method of treating LBW babies is widely accepted in the community. This formative research provides strategically valuable information that will be helpful for developing effective implementation strategies by identifying common community practices for LBW babies, along with identifying the barriers and enablers to KMC practice.
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Affiliation(s)
- Shabina Ariff
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Ikram Maznani
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Maria Bhura
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Zahid Memon
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Tayyaba Arshad
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Tariq Ahmed Samejo
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Shujaat Zaidi
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Muhammad Umer
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Imran Ahmed
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Muhammad Atif Habib
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Sajid Bashir Soofi
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
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Bergström A, Ehrenberg A, Eldh AC, Graham ID, Gustafsson K, Harvey G, Hunter S, Kitson A, Rycroft-Malone J, Wallin L. The use of the PARIHS framework in implementation research and practice-a citation analysis of the literature. Implement Sci 2020; 15:68. [PMID: 32854718 PMCID: PMC7450685 DOI: 10.1186/s13012-020-01003-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework. METHODS This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail. RESULTS The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated. CONCLUSIONS In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.
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Affiliation(s)
- Anna Bergström
- Department of Women’s and Children’s health, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Uppsala, Sweden
- Institute for Global Health, University College London, London, UK
| | - Anna Ehrenberg
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Ann Catrine Eldh
- Department of Medicine and Health, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kazuko Gustafsson
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- University Library, Uppsala University, Uppsala, Sweden
| | - Gillian Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Green Templeton College, University of Oxford, Oxford, UK
| | - Jo Rycroft-Malone
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancashire, UK
| | - 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
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Toivonen M, Lehtonen L, Ahlqvist-Björkroth S, Axelin A. Key factors supporting implementation of a training program for neonatal family- centered care - a qualitative study. BMC Health Serv Res 2019; 19:394. [PMID: 31217007 PMCID: PMC6585011 DOI: 10.1186/s12913-019-4256-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 06/13/2019] [Indexed: 11/12/2022] Open
Abstract
Background Traditionally, the care of infants in neonatal care units has been professionally centered, paying less attention to family support. In recent years, many interventions have been developed to improve family-centered care and thereby parent and infant outcomes. Understanding the key factors of implementation of these interventions would help improve clinical practice. The aim of this study was to describe the staff’s perceptions of the implementation of the Close Collaboration with Parents Training Program and to identify the barriers and facilitators of the implementation. Methods A descriptive qualitative interview study was conducted in eight neonatal intensive care units in Finland. Nineteen unit managers and 32 nurses were interviewed after their unit had finished the 1.5-year training program. Data were analyzed using thematic content analysis. Results Key factors facilitating the implementation of the training program were multidisciplinary commitment and the staff’s motivation to change their professional role to work as the parents’ facilitator. Observable benefits promoted the implementation, as well as experiential learning as a facilitation method. The role of mentor was remarkable as a facilitator. In addition, contextual elements such as support from leadership and proper timing were important. Conclusions Implementation of family-centered care is facilitated by staff who is prepared to accept parents as partners and adopt a new professional role. Enough time for preparation, readiness for the change, solid support from the leadership, and a multidisciplinary approach are needed as well. Mentoring was found to be one of the key factors facilitating the change. Electronic supplementary material The online version of this article (10.1186/s12913-019-4256-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mirka Toivonen
- Department of Nursing Science, University of Turku, FI-20014, Turku, Finland.
| | - Liisa Lehtonen
- Faculty of Medicine, University of Turku, Turku, Finland.,Hospital District of Southwest Finland, Department of Pediatrics Turku University Hospital, Kiinamyllynkatu 4-8, PL 52, 20521, Turku, Finland
| | - Sari Ahlqvist-Björkroth
- Department of Psychology and Speech-Language Pathology, Faculty of Social Sciences, University of Turku, FI-20014, Turku, Finland
| | - Anna Axelin
- Department of Nursing Science, University of Turku, FI-20014, Turku, Finland
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6
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Gifford WA, Squires JE, Angus DE, Ashley LA, Brosseau L, Craik JM, Domecq MC, Egan M, Holyoke P, Juergensen L, Wallin L, Wazni L, Graham ID. Managerial leadership for research use in nursing and allied health care professions: a systematic review. Implement Sci 2018; 13:127. [PMID: 30261927 PMCID: PMC6161344 DOI: 10.1186/s13012-018-0817-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 09/10/2018] [Indexed: 01/08/2023] Open
Abstract
Background Leadership by point-of-care and senior managers is increasingly recognized as critical to the acceptance and use of research evidence in practice. The purpose of this systematic review was to identify the leadership behaviours of managers that are associated with research use by clinical staff in nursing and allied health professionals. Methods A mixed methods systematic review was performed. Eight electronic bibliographic databases were searched. Studies examining the association between leadership behaviours and nurses and allied health professionals’ use of research were eligible for inclusion. Studies were excluded if leadership could not be clearly attributed to someone in a management position. Two reviewers independently screened abstracts, reviewed full-text articles, extracted data and performed quality assessments. Narrative synthesis was conducted. Results The search yielded 7019 unique titles and abstracts after duplicates were removed. Three hundred five full-text articles were reviewed, and 31 studies reported in 34 articles were included. Methods used were qualitative (n = 19), cross-sectional survey (n = 9), and mixed methods (n = 3). All studies included nurses, and six also included allied health professionals. Twelve leadership behaviours were extracted from the data for point-of-care managers and ten for senior managers. Findings indicated that managers performed a diverse range of leadership behaviours that encompassed change-oriented, relation-oriented and task-oriented behaviours. The most commonly described behavior was support for the change, which involved demonstrating conceptual and operational commitment to research-based practices. Conclusions This systematic review adds to the growing body of evidence that indicates that manager-staff dyads are influential in translating research evidence into action. Findings also reveal that leadership for research use involves change and task-oriented behaviours that influence the environmental milieu and the organisational infrastructure that supports clinical care. While findings explain how managers enact leadership for research use, we now require robust methodological studies to determine which behaviours are effective in enabling research use with nurses and allied health professionals for high-quality evidence-based care. Trial registration PROSPERO CRD42014007660 Electronic supplementary material The online version of this article (10.1186/s13012-018-0817-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wendy A Gifford
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.
| | - Janet E Squires
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Douglas E Angus
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - Lisa A Ashley
- Canadian Nurses Association, Ottawa, Ontario, Canada
| | - Lucie Brosseau
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Janet M Craik
- Canadian Association of Occupational Therapists, Ottawa, Ontario, Canada
| | | | - Mary Egan
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada.,Elisabeth Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Paul Holyoke
- SE Research Centre, SE Health, Markham, Ontario, Canada
| | - Linda Juergensen
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.,Faculty of Health, School of Nursing, York University, Toronto, Ontario, Canada
| | - Lars Wallin
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Sahlgrenska Academy, Department of Health Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing Karolinska Institutet, Stockholm, Sweden
| | - Liquaa Wazni
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Ian D Graham
- Sahlgrenska Academy, Department of Health Care Sciences, University of Gothenburg, Gothenburg, Sweden.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Cranley LA, Cummings GG, Profetto-McGrath J, Toth F, Estabrooks CA. Facilitation roles and characteristics associated with research use by healthcare professionals: a scoping review. BMJ Open 2017; 7:e014384. [PMID: 28801388 PMCID: PMC5724142 DOI: 10.1136/bmjopen-2016-014384] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/30/2016] [Accepted: 02/21/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Implementing research findings into practice is a complex process that is not well understood. Facilitation has been described as a key component of getting research findings into practice. The literature on facilitation as a practice innovation is growing. This review aimed to identify facilitator roles and to describe characteristics of facilitation that may be associated with successful research use by healthcare professionals. METHODS We searched 10 electronic databases up to December 2016 and used predefined criteria to select articles. We included conceptual papers and empirical studies that described facilitator roles, facilitation processes or interventions, and that focused on healthcare professionals and research use. We used content and thematic analysis to summarise data. Rogers' five main attributes of an innovation guided our synthesis of facilitation characteristics. RESULTS Of the 38 488 articles identified from our online and manual search, we included 195 predominantly research studies. We identified nine facilitator roles: opinion leaders, coaches, champions, research facilitators, clinical/practice facilitators, outreach facilitators, linking agents, knowledge brokers and external-internal facilitators. Fifteen facilitation characteristics were associated with research use, which we grouped into five categories using Rogers' innovation attributes: relative advantage, compatibility, complexity, trialability and observability. CONCLUSIONS We found a diverse and broad literature on the concept of facilitation that can expand our current thinking about facilitation as an innovation and its potential to support an integrated, collaborative approach to improving healthcare delivery.
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Affiliation(s)
- Lisa A Cranley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | | | | | - Ferenc Toth
- Faculty of Nursing, University of Alberta, Edmonton, Canada
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McGowan JE, Naranian T, Johnston L. Kangaroo Care in the high-technology neonatal unit: Exploring evidence-based practice, policy recommendations and education priorities in Northern Ireland. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.jnn.2017.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
The quality of care that families and infants receive during their time on the neonatal unit will be influenced by the well-being of the people who care for them. The emotional work of caring for infants and families in this demanding setting often goes unrecognized and can result in stress, burnout, and compassion fatigue, which in turn are a threat to the quality of care. Resilience and well-being can be fostered by encouraging self-maintenance, supportive systems organization, providing a healthy working environment, education, and opportunities for reflection.
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Pierrat V, Coquelin A, Cuttini M, Khoshnood B, Glorieux I, Claris O, Durox M, Kaminski M, Ancel PY, Arnaud C. Translating Neurodevelopmental Care Policies Into Practice: The Experience of Neonatal ICUs in France-The EPIPAGE-2 Cohort Study. Pediatr Crit Care Med 2016; 17:957-967. [PMID: 27518584 PMCID: PMC5049969 DOI: 10.1097/pcc.0000000000000914] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To describe the implementation of neurodevelopmental care for newborn preterm infants in neonatal ICUs in France in 2011, analyze changes since 2004, and investigate factors associated with practice. DESIGN Prospective national cohort study of all births before 32 weeks of gestation. SETTING Twenty-five French regions. PARTICIPANTS All neonatal ICUs (n = 66); neonates surviving at discharge (n = 3,005). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Neurodevelopmental care policies and practices were assessed by structured questionnaires. Proportions of neonates initiating kangaroo care during the first week of life and those whose mothers expressed breast milk were measured as neurodevelopmental care practices. Multilevel logistic regression analyses were used to investigate relationships between kangaroo care or breast-feeding practices and unit policies, taking into account potential confounders. Free visiting policies, bed availability for parents, and kangaroo care encouragement significantly improved between 2004 and 2011 but with large variabilities between units. Kangaroo care initiation varied from 39% for neonates in the most restrictive units to 68% in less restrictive ones (p < 0.001). Individual factors associated with kangaroo care initiation were gestational age (odds ratio, 5.79; 95% CI, 4.49-7.48 for babies born at 27-31 wk compared with babies born at 23-26 wk) and, to a lesser extent, single pregnancy, birthweight above the 10th centile, and mother's employment before pregnancy. At unit level, policies and training in neurodevelopmental care significantly influenced kangaroo care initiation (odds ratio, 3.5; 95% CI, 1.8-7.0 for Newborn Individualized Developmental Care and Assessment Program implementation compared with no training). Breast milk expression by mothers was greater in units with full-time availability professionals trained for breast-feeding support (60% vs 73%; p < 0.0001). CONCLUSIONS Dissemination of neurodevelopmental practices occurred between 2004 and 2011, but large variabilities between units persist. Practices increased in units with supportive policies. Specific neurodevelopmental care training with multifaceted interventions strengthened the implementation of policies.
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Affiliation(s)
- Veronique Pierrat
- 1Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France.2Paris Descartes University, Paris, France.3CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France.4Research Unit of Perinatal Epidemiology, Pediatric Hospital Bambino Gesù, Rome, Italy.5Department of Neonatology, Toulouse University Hospital, Toulouse, France.6Department of Neonatology, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Bron, France.7EAM 4128, Claude Bernard University Lyon 1,Villeurbanne, France.8Clinical Research Unit, Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France.9Inserm U 1027, Toulouse, France.10Paul-Sabatier University, Toulouse, France.11Purpan, Clinical epidemiology Unit, Toulouse, France
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11
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Soni A, Amin A, Patel DV, Fahey N, Shah N, Phatak AG, Allison J, Nimbalkar SM. The presence of physician champions improved Kangaroo Mother Care in rural western India. Acta Paediatr 2016; 105:e390-5. [PMID: 27111097 PMCID: PMC4982817 DOI: 10.1111/apa.13445] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 03/04/2016] [Accepted: 04/20/2016] [Indexed: 11/28/2022]
Abstract
AIM This study determined the effect of physician champions on the two main components of Kangaroo Mother Care (KMC): skin-to-skin care and breastfeeding. METHODS KMC practices among a retrospective cohort of 648 infants admitted to a rural Indian neonatal intensive care unit (NICU) between January 5, 2011 and October 7, 2014 were studied. KMC champions were identified based on their performance evaluation. We examined the effect of withdrawing physician champions on overall use, time to initiation and intensity of skin-to-skin care and breastfeeding, using separate models. RESULTS In comparison with when KMC champions were present, their absence was associated with a 45% decrease in the odds of receiving skin-to-skin care, with a 95% confidence interval (CI) of 64% to 17%, a 38% decrease in the rate of initiation skin-to-skin care (95% CI 53-82%) and an average of 1.47 less hours of skin-to-skin care (95% CI -2.07 to -0.86). Breastfeeding practices were similar across the different champion environments. CONCLUSION Withdrawing physician champions from the NICU setting was associated with a decline in skin-to-skin care, but not breastfeeding. Training health care workers and community stakeholders to become champions could help to scale up and maintain KMC practices.
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Affiliation(s)
- Apurv Soni
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Amee Amin
- Pramukhswami Medical College, Gujarat, India
| | | | | | - Nikhil Shah
- Pramukhswami Medical College, Gujarat, India
| | | | - Jeroan Allison
- University of Massachusetts Medical School, Worcester, Massachusetts
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Perception of kangaroo care in German neonatology—A nationwide survey. Eur J Integr Med 2016. [DOI: 10.1016/j.eujim.2015.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Chan GJ, Labar AS, Wall S, Atun R. Kangaroo mother care: a systematic review of barriers and enablers. Bull World Health Organ 2015; 94:130-141J. [PMID: 26908962 PMCID: PMC4750435 DOI: 10.2471/blt.15.157818] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 10/17/2015] [Accepted: 10/23/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate factors influencing the adoption of kangaroo mother care in different contexts. METHODS We searched PubMed, Embase, Scopus, Web of Science and the World Health Organization's regional databases, for studies on "kangaroo mother care" or "kangaroo care" or "skin-to-skin care" from 1 January 1960 to 19 August 2015, without language restrictions. We included programmatic reports and hand-searched references of published reviews and articles. Two independent reviewers screened articles and extracted data on carers, health system characteristics and contextual factors. We developed a conceptual model to analyse the integration of kangaroo mother care in health systems. FINDINGS We screened 2875 studies and included 112 studies that contained qualitative data on implementation. Kangaroo mother care was applied in different ways in different contexts. The studies show that there are several barriers to implementing kangaroo mother care, including the need for time, social support, medical care and family acceptance. Barriers within health systems included organization, financing and service delivery. In the broad context, cultural norms influenced perceptions and the success of adoption. CONCLUSION Kangaroo mother care is a complex intervention that is behaviour driven and includes multiple elements. Success of implementation requires high user engagement and stakeholder involvement. Future research includes designing and testing models of specific interventions to improve uptake.
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Affiliation(s)
- Grace J Chan
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Street, Boston, Massachusetts, 02115, United States of America (USA)
| | - Amy S Labar
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Street, Boston, Massachusetts, 02115, United States of America (USA)
| | - Stephen Wall
- Saving Newborn Lives, Save the Children, Washington, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Street, Boston, Massachusetts, 02115, United States of America (USA)
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Spassiani NA, Parker Harris S, Hammel J. Exploring How Knowledge Translation Can Improve Sustainability of Community-based Health Initiatives for People with Intellectual/Developmental Disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2015. [PMID: 26223553 DOI: 10.1111/jar.12202] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Community-based health initiatives (CBHI) play an important role in maintaining the health, function and participation of people with intellectual/developmental disabilities (I/DD) living in the community. However, implementation and long-term sustainability of CBHI is challenging. The Promoting Action on Research Implementation in Health Services (PARiHS) is a knowledge translation (KT) framework that is particularly relevant to intellectual/developmental disabilities research as it identifies the barriers and facilitators of implementation and action plans. This framework provides a foundation for understanding how KT can be used to aid the implementation and sustainability of CBHI for people with intellectual/developmental disabilities. The following study explores how KT - specifically the PARiHS framework - can be used to help sustain CBHI for people with intellectual/developmental disabilities.
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Affiliation(s)
- Natasha A Spassiani
- Disability and Human Development, University of Illinois at Chicago, Chicago, IL, USA
| | - Sarah Parker Harris
- Disability and Human Development, University of Illinois at Chicago, Chicago, IL, USA
| | - Joy Hammel
- Departments of Occupational Therapy & Disability and Human Development, University of Illinois at Chicago, Chicago, IL, USA
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Yost J, Ganann R, Thompson D, Aloweni F, Newman K, Hazzan A, McKibbon A, Dobbins M, Ciliska D. The effectiveness of knowledge translation interventions for promoting evidence-informed decision-making among nurses in tertiary care: a systematic review and meta-analysis. Implement Sci 2015; 10:98. [PMID: 26169063 PMCID: PMC4499897 DOI: 10.1186/s13012-015-0286-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 06/30/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nurses are increasingly expected to engage in evidence-informed decision-making (EIDM) to improve client and system outcomes. Despite an improved awareness about EIDM, there is a lack of use of research evidence and understanding about the effectiveness of interventions to promote EIDM. This project aimed to discover if knowledge translation (KT) interventions directed to nurses in tertiary care are effective for improving EIDM knowledge, skills, behaviours, and, as a result, client outcomes. It also sought to understand contextual factors that affect the impact of such interventions. METHODS A systematic review funded by the Canadian Institutes of Health Research (PROSPERO registration: CRD42013003319) was conducted. Included studies examined the implementation of any KT intervention involving nurses in tertiary care to promote EIDM knowledge, skills, behaviours, and client outcomes or studies that examined contextual factors. Study designs included systematic reviews, quantitative, qualitative, and mixed method studies. The search included electronic databases and manual searching of published and unpublished literature to November 2012; key databases included MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Excerpta Medica (EMBASE). Two reviewers independently performed study selection, risk of bias assessment, and data extraction. Studies with quantitative data determined to be clinically homogeneous were synthesized using meta-analytic methods. Studies with quantitative data not appropriate for meta-analysis were synthesized narratively by outcome. Studies with qualitative data were synthesized by theme. RESULTS Of the 44,648 citations screened, 30 citations met the inclusion criteria (18 quantitative, 10 qualitative, and 2 mixed methods studies). The quality of studies with quantitative data ranged from very low to high, and quality criteria was generally met for studies with qualitative data. No studies evaluated the impact on knowledge and skills; they primarily investigated the effectiveness of multifaceted KT strategies for promoting EIDM behaviours and improving client outcomes. Almost all studies included an educational component. A meta-analysis of two studies determined that a multifaceted intervention (educational meetings and use of a mentor) did not increase engagement in a range of EIDM behaviours [mean difference 2.7, 95 % CI (-1.7 to 7.1), I (2) = 0 %]. Among the remaining studies, no definitive conclusions could be made about the relative effectiveness of the KT interventions due to variation of interventions and outcomes, as well as study limitations. Findings from studies with qualitative data identified the organizational, individual, and interpersonal factors, as well as characteristics of the innovation, that influence the success of implementation. CONCLUSIONS KT interventions are being implemented and evaluated on nurses' behaviour and client outcomes. This systematic review may inform the selection of KT interventions and outcomes among nurses in tertiary care and decisions about further research.
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Affiliation(s)
- Jennifer Yost
- School of Nursing, Faculty of Health Sciences, McMaster University, Main Street West, Hamilton, ON, Canada.
| | - Rebecca Ganann
- School of Nursing, Faculty of Health Sciences, McMaster University, Main Street West, Hamilton, ON, Canada.
| | - David Thompson
- School of Nursing, Faculty of Health and Behavioural Sciences, Lakehead University, 955 Oliver Road, Thunder Bay, ON, Canada.
| | - Fazila Aloweni
- Singapore General Hospital, 31 Third Hospital Avenue, Singapore, Singapore.
| | - Kristine Newman
- Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, 350 Victoria Street, Toronto, ON, Canada.
| | - Afeez Hazzan
- Department of Medicine, McMaster University, St. Peter's Hospital-Hamilton Health Sciences, 88 Maplewood Avenue, Hamilton, ON, Canada.
| | - Ann McKibbon
- Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Main Street West, Hamilton, ON, Canada.
| | - Maureen Dobbins
- School of Nursing, Faculty of Health Sciences, McMaster University, Main Street West, Hamilton, ON, Canada.
| | - Donna Ciliska
- School of Nursing, Faculty of Health Sciences, McMaster University, Main Street West, Hamilton, ON, Canada.
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Mörelius E, Anderson GC. Neonatal nurses’ beliefs about almost continuous parent-infant skin-to-skin contact in neonatal intensive care. J Clin Nurs 2015; 24:2620-7. [DOI: 10.1111/jocn.12877] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Evalotte Mörelius
- Department of Social and Welfare Studies; Division of Health, Activity, and Care; Linköping University; Linköping Sweden
| | - Gene Cranston Anderson
- Emeritus and Courtesy Faculty; University of Florida; Gainesville FL USA
- Case Western Reserve University; Cleveland OH USA
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Koch M, Englander M, Tegelberg Å, Wolf E. Successful clinical and organisational change in endodontic practice: a qualitative study. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2014; 18:121-127. [PMID: 24118746 DOI: 10.1111/eje.12066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/28/2013] [Indexed: 06/02/2023]
Abstract
The aim of this study was to explicate and describe the qualitative meaning of successful clinical and organizational change in endodontic practice, following a comprehensive implementation program, including the integration of the nickel-titanium-rotary-technique. After an educational intervention in the Public Dental Service in a Swedish county, thematic in-depth interviews were conducted, with special reference to the participants' experience of the successful change. Interviews with four participants, were purposively selected on the basis of occupation (dentist, dental assistant, receptionist, clinical manager), for a phenomenological human scientific analysis. Four constituents were identified as necessary for the invariant, general structure of the phenomenon: 1) disclosed motivation, 2) allowance for individual learning processes, 3) continuous professional collaboration, and 4) a facilitating educator. The perceived requirements for achieving successful clinical and organizational change in endodontic practice were clinical relevance, an atmosphere which facilitated discussion and allowance for individual learning patterns. The qualities required in the educator were acknowledged competence with respect to scientific knowledge and clinical expertise, as well as familiarity with conditions at the dental clinics. The results indicate a complex interelationship among various aspects of the successful change process.
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Affiliation(s)
- M Koch
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden; Department of Endodontics, Public Dental Service, Sörmland County Council, Eskilstuna, Sweden
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Gifford WA, Holyoke P, Squires JE, Angus D, Brosseau L, Egan M, Graham ID, Miller C, Wallin L. Managerial leadership for research use in nursing and allied health care professions: a narrative synthesis protocol. Syst Rev 2014; 3:57. [PMID: 24903267 PMCID: PMC4072612 DOI: 10.1186/2046-4053-3-57] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 05/22/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Nurses and allied health care professionals (physiotherapists, occupational therapists, speech and language pathologists, dietitians) form more than half of the clinical health care workforce and play a central role in health service delivery. There is a potential to improve the quality of health care if these professionals routinely use research evidence to guide their clinical practice. However, the use of research evidence remains unpredictable and inconsistent. Leadership is consistently described in implementation research as critical to enhancing research use by health care professionals. However, this important literature has not yet been synthesized and there is a lack of clarity on what constitutes effective leadership for research use, or what kinds of intervention effectively develop leadership for the purpose of enabling and enhancing research use in clinical practice. We propose to synthesize the evidence on leadership behaviours amongst front line and senior managers that are associated with research evidence by nurses and allied health care professionals, and then determine the effectiveness of interventions that promote these behaviours. METHODS/DESIGN Using an integrated knowledge translation approach that supports a partnership between researchers and knowledge users throughout the research process, we will follow principles of knowledge synthesis using a systematic method to synthesize different types of evidence involving: searching the literature, study selection, data extraction and quality assessment, and analysis. A narrative synthesis will be conducted to explore relationships within and across studies and meta-analysis will be performed if sufficient homogeneity exists across studies employing experimental randomized control trial designs. DISCUSSION With the engagement of knowledge users in leadership and practice, we will synthesize the research from a broad range of disciplines to understand the key elements of leadership that supports and enables research use by health care practitioners, and how to develop leadership for the purpose of enhancing research use in clinical practice. TRIAL REGISTRATION PROSPERO CRD42014007660.
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Affiliation(s)
- Wendy A Gifford
- The University of Ottawa, 451 Smyth Road, K1H 8M5 Ottawa, ON, Canada.
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Implementation of Evidence-Based Practice for a Pediatric Pain Assessment Instrument. CLIN NURSE SPEC 2014; 28:97-104. [DOI: 10.1097/nur.0000000000000032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sandström B, Willman A, Svensson B, Borglin G. Mapping attitudes and awareness with regard to national guidelines: an e-mail survey among decision makers. J Nurs Manag 2013; 22:884-93. [PMID: 23869416 DOI: 10.1111/jonm.12061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The adoption of evidence-based guidelines within the mental health field has been slow. Changing inadequate practice is therefore a formidable challenge for mental health-care managers. AIM To explore decision-makers' attitudes and awareness regarding the national guidelines for psychosocial interventions targeting people with schizophrenia. METHOD A questionnaire distributed by e-mail to 592 Swedish decision-makers was analysed using descriptive and comparative techniques. RESULTS Significantly more of the top-level mental health-care managers than politicians stated that they knew about the national guidelines (i.e. their release and content) and they considered the guidelines to be a good source of support for planning and allocating resources. CONCLUSION If those responsible for allocating resources (i.e. politicians) are unaware of the dissemination of national guidelines or their content, and they do not perceive the national guidelines to be a good source of support for planning and allocating resources, this is likely to have a negative influence on the remit of nurse managers as well as nursing practice. IMPLICATIONS FOR NURSING MANAGEMENT Top-level mental health-care managers have a vital role to play in the implementation of national guidelines. However, our findings indicate that implementing national guidelines in practice could be virtually impossible without strategic government support.
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Affiliation(s)
- Boel Sandström
- Blekinge Institute of Technology, School of Health Science, Karlskrona, Department of Health Science, Lund University, Lund and Blekinge Center of Competence, Karlskrona, Sweden
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Dogherty EJ, Harrison MB, Graham ID, Vandyk AD, Keeping-Burke L. Turning knowledge into action at the point-of-care: the collective experience of nurses facilitating the implementation of evidence-based practice. Worldviews Evid Based Nurs 2013; 10:129-39. [PMID: 23796066 PMCID: PMC3883090 DOI: 10.1111/wvn.12009] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Facilitation is considered a way of enabling clinicians to implement evidence into practice by problem solving and providing support. Practice development is a well-established movement in the United Kingdom that incorporates the use of facilitators, but in Canada, the role is more obtuse. Few investigations have observed the process of facilitation as described by individuals experienced in guideline implementation in North America. AIM To describe the tacit knowledge regarding facilitation embedded in the experiences of nurses implementing evidence into practice. METHODS Twenty nurses from across Canada were purposively selected to attend an interactive knowledge translation symposium to examine what has worked and what has not in implementing evidence in practice. This study is an additional in-depth analysis of data collected at the symposium that focuses on facilitation as an intervention to enhance evidence uptake. Critical incident technique was used to elicit examples to examine the nurses' facilitation experiences. Participants shared their experiences with one another and completed initial data analysis and coding collaboratively. The data were further thematically analyzed using the qualitative inductive approach of constant comparison. RESULTS A number of factors emerged at various levels associated with the successes and failures of participants' efforts to facilitate evidence-based practice. Successful implementation related to: (a) focus on a priority issue, (b) relevant evidence, (c) development of strategic partnerships, (d) the use of multiple strategies to effect change, and (e) facilitator characteristics and approach. Negative factors influencing the process were: (a) poor engagement or ownership, (b) resource deficits, (c) conflict, (d) contextual issues, and (e) lack of evaluation and sustainability. CONCLUSIONS Factors at the individual, environmental, organizational, and cultural level influence facilitation of evidence-based practice in real situations at the point-of-care. With a greater understanding of factors contributing to successful or unsuccessful facilitation, future research should focus on analyzing facilitation interventions tailored to address barriers and enhance facilitators of evidence uptake.
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Blomqvist YT, Ewald U, Gradin M, Nyqvist KH, Rubertsson C. Initiation and extent of skin-to-skin care at two Swedish neonatal intensive care units. Acta Paediatr 2013; 102:22-8. [PMID: 23072448 DOI: 10.1111/apa.12056] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 10/11/2012] [Accepted: 10/11/2012] [Indexed: 11/30/2022]
Abstract
AIM To describe initiation and extent of parents' application of skin-to-skin care (SSC) with their preterm infants at two Swedish neonatal intensive care units. METHODS The duration of SSC was recorded in 104 infants' medical charts during their hospital stay, and the parents answered a questionnaire. RESULTS Both parents were involved in the practice of SSC. Three infants experienced SSC directly after birth, 34 within 1 h, 85 within 24 h and the remaining 19 at 24-78 h postbirth. SSC commenced earlier (median age of 50 min) in infants whose first SSC was with their father instead of with their mother (median age of 649 min: p < 0.001). The earlier the SSC was initiated, the longer the infant was cared for skin-to-skin per day during his/her hospital stay (p < 0.001). The median daily duration of SSC was 403 min. CONCLUSION Early initiation of SSC had positive impact on the extent of parents' application of SSC. Even though the infants in this study were cared for skin-to-skin to a high extent, there is a potential for extended use of SSC in this type of hospital setting for reducing separation between infants and parents.
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Affiliation(s)
| | - Uwe Ewald
- Department of Women's and Children's Health; Uppsala University; Uppsala; Sweden
| | | | | | - Christine Rubertsson
- Department of Women's and Children's Health; Uppsala University; Uppsala; Sweden
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Mörelius E, Angelhoff C, Eriksson J, Olhager E. Time of initiation of skin-to-skin contact in extremely preterm infants in Sweden. Acta Paediatr 2012; 101:14-8. [PMID: 21732975 DOI: 10.1111/j.1651-2227.2011.02398.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To describe the time of first skin-to-skin contact in extremely preterm infants in a national perspective and to investigate possible factors affecting the time of first skin-to-skin contact. METHODS A population-based prospective descriptive study of extremely preterm infants (n = 520) in seven regional hospitals in Sweden. RESULTS Extremely preterm infants in Sweden experience first skin-to-skin contact with the parent at a median of six postnatal days (range 0-44). Low gestational age, a high score on the clinical risk index for babies, and the number of days on a ventilator tended to delay first skin-to-skin contact. A statistically significant difference was also found between regional hospitals. CONCLUSION There is a difference in the time of first skin-to-skin contact based on the infant's medical condition and the tradition in the neonatal intensive care unit at the regional hospital where the infant is born.
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Affiliation(s)
- Evalotte Mörelius
- Department of Social and Welfare Studies, Faculty of Health Science, Linköping University, Norrköping, Sweden.
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Walker R, Cooke M, Henderson A, Creedy DK. Characteristics of leadership that influence clinical learning: a narrative review. NURSE EDUCATION TODAY 2011; 31:743-756. [PMID: 21255881 DOI: 10.1016/j.nedt.2010.12.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 12/07/2010] [Accepted: 12/20/2010] [Indexed: 05/30/2023]
Abstract
Leadership has been consistently implied in fostering clinical learning. However there is a lack of clarity about the form leadership should take. Limited quantitative research indicated a narrative approach to review literature from a broad perspective. A framework to guide the synthesis was developed to ensure a rigorous review process. Preliminary reading and review of papers using search terms nursing and leadership and clinical learning and learning culture narrowed the inclusion criteria to 245 papers published between 2000 and 2010. Given the diversity of the papers' focus, aim and context, a refined screening process justified the inclusion of twenty-six papers in the review. A critical appraisal of these peer-reviewed quantitative, qualitative and commentary papers identified factors/elements integral to effective leadership. Across the literature leadership was discussed in relation to two broad themes: influence of leadership on organisational learning and development and; influence of leadership on undergraduate clinical education. The factors central to leadership emerged as transformative principles, the role of the nurse unit/ward manager, collaboration and relationship building and role-modelling. The review has raised some suggestions for future research aimed at examining the impact of a leadership capacity building intervention that supports clinical learning.
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Affiliation(s)
- Rachel Walker
- School of Nursing and Midwifery, Research Centre for Clinical & Community Practice Innovation, Griffith Institute of Health and Medical Research, Griffith University, Nathan, 4111, Queensland, Australia.
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De Pedro-Gómez J, Morales-Asencio JM, Bennasar-Veny M, Artigues-Vives G, Perelló-Campaner C, Gómez-Picard P. Determining factors in evidence-based clinical practice among hospital and primary care nursing staff. J Adv Nurs 2011; 68:452-9. [DOI: 10.1111/j.1365-2648.2011.05733.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Flacking R, Ewald U, Wallin L. Positive Effect of Kangaroo Mother Care on Long‐Term Breastfeeding in Very Preterm Infants. J Obstet Gynecol Neonatal Nurs 2011; 40:190-7. [DOI: 10.1111/j.1552-6909.2011.01226.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Abstract
BACKGROUND It has been proposed that a systematic pain assessment increases the awareness of the need to treat and prevent pain, and most international and national neonatal pain guidelines state that pain assessment should be performed in a systematic way. National surveys show a wide variation in compliance to these guidelines. METHODS A survey to all Swedish neonatal units was performed in 1993, 1998, 2003 and 2008, concerning the use of, and need for, pain assessment tools. RESULTS The number of units that tried to assess pain increased from 64% in 1993 to 83% in 2008. Forty-four per cent of these used a structured method in 2003, compared to three per cent in 1998. The most common pain indicator was facial actions. CONCLUSION The proportion of neonatal units that reported the use of a structured pain assessment tool has increased significantly from 1993 to 2008. There is a need for better evidence for the relation between the implementation of pain guidelines and the actual performance of pain assessment.
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Affiliation(s)
- Maria Gradin
- Department of Paediatrics, Örebro University Hospital, Sweden.
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Adams S, Cullen L. EBP: Evidence to Practice Implementation. J Perianesth Nurs 2011; 26:35-7. [DOI: 10.1016/j.jopan.2010.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 11/22/2010] [Indexed: 11/28/2022]
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Abstract
AIMS To characterise the first infants receiving continuous Kangaroo Mother Care from birth to discharge in a Swedish neonatal intensive care unit and to investigate their mothers' experiences of this model of care. BACKGROUND Admission of a newborn infant to a neonatal intensive care unit commonly implies separation of the new mother from her infant. Kangaroo Mother Care is a model of neonatal care which supports the parental role as primary care-giver and contributes to minimising the separation between the infant and parents. DESIGN A retrospective survey design. METHOD A purposive sample consisting of 23 mother-infant pairs. Relevant infant data were obtained from their medical records. A questionnaire with questions about the infant's care and regarding Kangaroo Mother Care was designed for this study. RESULTS The infants were born at a gestational age of 31-41 weeks, birth weight ranging from 1715-3700 g. The mothers of these moderately preterm and ill newborn infants showed good acceptance of the idea of providing their infants with continuous Kangaroo Mother Care during their stay at the neonatal intensive care unit. The mothers' evaluations of this method were predominantly positive. Negative comments concerned lack of information about practical application of the method, and some mothers perceived their infants' care during the night as exhausting. No mother would have preferred not to perform continuous Kangaroo Mother Care or to terminate Kangaroo Mother Care earlier than they did. CONCLUSIONS These mothers accepted this model of care very well, provided that they received the help and support they required. RELEVANCE TO CLINICAL PRACTICE Mothers whose infants are admitted to an neonatal intensive care units in settings similar to the study setting should be offered opportunities to be present and provide Kangaroo Mother Care for their infants, to the extent that they are able and willing to do so and as permitted by the infant's medical condition and care.
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Helfrich CD, Damschroder LJ, Hagedorn HJ, Daggett GS, Sahay A, Ritchie M, Damush T, Guihan M, Ullrich PM, Stetler CB. A critical synthesis of literature on the promoting action on research implementation in health services (PARIHS) framework. Implement Sci 2010; 5:82. [PMID: 20973988 PMCID: PMC2988065 DOI: 10.1186/1748-5908-5-82] [Citation(s) in RCA: 185] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 10/25/2010] [Indexed: 12/01/2022] Open
Abstract
Background The Promoting Action on Research Implementation in Health Services framework, or PARIHS, is a conceptual framework that posits key, interacting elements that influence successful implementation of evidence-based practices. It has been widely cited and used as the basis for empirical work; however, there has not yet been a literature review to examine how the framework has been used in implementation projects and research. The purpose of the present article was to critically review and synthesize the literature on PARIHS to understand how it has been used and operationalized, and to highlight its strengths and limitations. Methods We conducted a qualitative, critical synthesis of peer-reviewed PARIHS literature published through March 2009. We synthesized findings through a three-step process using semi-structured data abstraction tools and group consensus. Results Twenty-four articles met our inclusion criteria: six core concept articles from original PARIHS authors, and eighteen empirical articles ranging from case reports to quantitative studies. Empirical articles generally used PARIHS as an organizing framework for analyses. No studies used PARIHS prospectively to design implementation strategies, and there was generally a lack of detail about how variables were measured or mapped, or how conclusions were derived. Several studies used findings to comment on the framework in ways that could help refine or validate it. The primary issue identified with the framework was a need for greater conceptual clarity regarding the definition of sub-elements and the nature of dynamic relationships. Strengths identified included its flexibility, intuitive appeal, explicit acknowledgement of the outcome of 'successful implementation,' and a more expansive view of what can and should constitute 'evidence.' Conclusions While we found studies reporting empirical support for PARIHS, the single greatest need for this and other implementation models is rigorous, prospective use of the framework to guide implementation projects. There is also need to better explain derived findings and how interventions or measures are mapped to specific PARIHS elements; greater conceptual discrimination among sub-elements may be necessary first. In general, it may be time for the implementation science community to develop consensus guidelines for reporting the use and usefulness of theoretical frameworks within implementation studies.
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Affiliation(s)
- Christian D Helfrich
- Northwest HSR&D Center of Excellence, VA Puget Sound Healthcare System, Seattle, Washington, USA.
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Gathwala G, Singh B, Singh J. Effect of Kangaroo Mother Care on physical growth, breastfeeding and its acceptability. Trop Doct 2010; 40:199-202. [DOI: 10.1258/td.2010.090513] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to determine whether the implementation of Kangaroo Mother Care (KMC) to low birth weight infants would improve physical growth, breastfeeding and its acceptability. A randomized controlled trial was performed over 16 months in which 110 neonates were randomized into a KMC group and a control group using a random number table. The KMC group was subjected to KMC for at least 6 h per day. The babies also received KMC after moving from the neonatal intensive care unit and at home. The control group received standard care (incubator or open care system). Weight, length and occipitofrontal circumference (OFC) were measured weekly for three months. The acceptability of KMC by mothers and nursing staff was assessed on day 7 after the start of KMC using a questionnaire incorporating the Likert scale. Breastfeeding rates were calculated based on history at end of three months. The mean gestational age was 35.48 ± 1.20 weeks in the KMC group and 35.04 ± 1.09 weeks in the control group ( P > 0.05). KMC was initiated at a mean age of 1.72 ± 0.45 days and the duration of KMC was 9.74 ± 1.48 h/day. The mean birth weight was 1.69 ± 0.11 kg in the KMC group compared to 1.69 ± 0.12 kg in the control group ( P > 0.05). The mean weight gain in gm/day in the KMC group was 21.92 ± 1.44 compared to 18.61 ± 1.28 in the control group ( P < 0.05). The mean length gain in cm/week was 1.03 ± 0.5 in the KMC group compared to 0.74 ± 0.05 in the control group ( P < 0.05). The mean OFC gain in cm/week was 0.59 ± 0.04 in the KMC group compared to 0.47 ± 0.03 in the control group ( P < 0.05). The exclusive breast-feeding rate at end of three months was 88% in the KMC group compared to 72% in the control group ( P < 0.05). KMC improved physical growth, breastfeeding rates and was well accepted by both mothers and nursing staff.
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Affiliation(s)
- Geeta Gathwala
- Department of Pediatrics, Pt BD Sharma Post Graduate Institute of Medical Sciences, University of Health Sciences, Rohtak-124001, Haryana, India
| | - Bir Singh
- Department of Pediatrics, Pt BD Sharma Post Graduate Institute of Medical Sciences, University of Health Sciences, Rohtak-124001, Haryana, India
| | - Jagjit Singh
- Department of Pediatrics, Pt BD Sharma Post Graduate Institute of Medical Sciences, University of Health Sciences, Rohtak-124001, Haryana, India
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Nyqvist KH, Anderson GC, Bergman N, Cattaneo A, Charpak N, Davanzo R, Ewald U, Ludington-Hoe S, Mendoza S, Pallás-Allonso C, Peláez JG, Sizun J, Widström AM. State of the art and recommendations. Kangaroo mother care: application in a high-tech environment. Acta Paediatr 2010; 99:812-9. [PMID: 20219028 DOI: 10.1111/j.1651-2227.2010.01794.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
UNLABELLED Since Kangaroo Mother Care (KMC) was developed in Colombia in the 1970s, two trends in clinical application emerged. In low income settings, the original KMC model is implemented. This consists of continuous (24 h/day, 7 days/week) and prolonged mother/parent-infant skin-to-skin contact; early discharge with the infant in the kangaroo position; (ideally) exclusive breastfeeding; and, adequate follow-up. In affluent settings, intermittent KMC with sessions of one or a few hours skin-to-skin contact for a limited period is common. As a result of the increasing evidence of the benefits of KMC for both infants and families in all intensive care settings, KMC in a high-tech environment was chosen as the topic for the first European Conference on KMC, and the clinical implementation of the KMC model in all types of settings was discussed at the 7th International Workshop on KMC. Kangaroo Mother Care protocols in high-tech Neonatal Intensive Care Units (NICU) should specify criteria for initiation, kangaroo position, transfer to/from KMC, transport in kangaroo position, kangaroo nutrition, parents' role, modification of the NICU environment, performance of care in KMC, and KMC in case of infant instability. CONCLUSION Implementation of the original KMC method, with continuous skin-to-skin contact whenever possible, is recommended for application in high-tech environments, although scientific evaluation should continue.
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Staff perception one year after implementation of the the newborn individualized developmental care and assessment program (NIDCAP). J Pediatr Nurs 2010; 25:89-97. [PMID: 20185059 DOI: 10.1016/j.pedn.2009.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) was piloted at one NICU. Staff perception of impact and the feasibility of applying the program was explored in a survey and a focus group interview. NIDCAP was perceived to impact positively on infant well-being and parents' way of caring. Although the influence of NIDCAP on staff working conditions and job perfomance was overall positive, their perceptions varied. Presence of the NIDCAP observer and empowerment of parents was challenging to some nurses, especially in terms of decision making in care. Conflicts of interest occurred between staff member need of light and infant need of light reduction.
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Dogherty EJ, Harrison MB, Graham ID. Facilitation as a role and process in achieving evidence-based practice in nursing: a focused review of concept and meaning. Worldviews Evid Based Nurs 2010; 7:76-89. [PMID: 20180826 DOI: 10.1111/j.1741-6787.2010.00186.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Facilitation is proposed as an important strategy to assist practitioners to implement evidence into practice. However, from a front-line nursing perspective, what is actually involved in facilitation, particularly in regards to research utilization, is poorly understood. AIM To examine the current state of knowledge surrounding the concept of facilitation as a role and process in the implementation of research findings within the nursing context. Building on a previous concept analysis, we examined how facilitation has evolved over the last decade, particularly focusing on the practical elements (e.g., what it entails to operationalize and implement facilitation in nursing). METHODS A systematic search of electronic databases identified theory and research-based nursing papers explicitly focused on facilitation in research utilization. Through a content analysis, we examined how the concept is being used, described, and applied within nursing. RESULTS Facilitation continues to be described as supporting and enabling practitioners to improve practice through evidence implementation. Certain aspects of the role and the strategies being employed to promote change are more evident. It was possible to formulate these into a taxonomy. Key findings include: * facilitation is now being viewed as an individual role as well as a process involving individuals and groups; * project management/leadership are important components; * no matter which approach is selected, tailoring facilitation to the local context is critical; * there is a growing emphasis on evaluation, particularly linking outcomes to nursing actions. CONCLUSIONS Further understanding of what facilitators are actually doing to enable changes in nursing practice based on research findings will provide the groundwork for the design and evaluation of practical strategies for evidence-based practice in nursing. Research is needed to clarify how facilitation may be used to implement change in nursing practice along with evaluation of the effectiveness of various approaches.
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Wallin L. Knowledge translation and implementation research in nursing. Int J Nurs Stud 2009; 46:576-87. [DOI: 10.1016/j.ijnurstu.2008.05.006] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2008] [Revised: 05/20/2008] [Accepted: 05/20/2008] [Indexed: 10/21/2022]
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McInnes RJ, Chambers J. Infants admitted to neonatal units--interventions to improve breastfeeding outcomes: a systematic review 1990-2007. MATERNAL AND CHILD NUTRITION 2009; 4:235-63. [PMID: 18811790 DOI: 10.1111/j.1740-8709.2008.00150.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This review aimed to identify interventions to promote breastfeeding or breast milk feeding for infants admitted to the neonatal unit. The medical electronic databases were searched for papers listed between 1990 and June 2005 which had breastfeeding or breast milk as an outcome and which targeted infants who had been admitted to a neonatal unit, thus including the infant and/or their parents and/or neonatal unit staff. Only papers culturally relevant to the UK were included resulting in studies from the USA, Canada, Europe, Australia and New Zealand. This search was updated in December 2007 to include publications up to this date. We assessed 86 papers in full, of which 27 ultimately fulfilled the inclusion criteria. The studies employed a range of methods and targeted different aspects of breastfeeding in the neonatal unit. Variations in study type and outcomes meant that there was no clear message of what works best but skin-to-skin contact and additional postnatal support seemed to offer greater advantage for the infant in terms of breastfeeding outcome. Galactogogues for mothers who are unable to meet their infants' needs may also help to increase milk supply. Evidence of an effect from other practices, such as cup-feeding on breastfeeding was limited; mainly because of a lack of research but also because few studies followed up the population beyond discharge from the unit. Further research is required to explore the barriers to breastfeeding in this vulnerable population and to identify appropriate interventions to improve breastfeeding outcomes.
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Bahtsevani C, Willman A, Khalaf A, Ostman M. Developing an instrument for evaluating implementation of clinical practice guidelines: a test-retest study. J Eval Clin Pract 2008; 14:839-46. [PMID: 18331325 DOI: 10.1111/j.1365-2753.2007.00916.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
RATIONALE AND AIMS This study focuses on the development of an instrument for the evaluation of clinical practice guidelines and is one part of a research project about the implementation and use of such guidelines among hospitals in the southern region of Sweden. The aim of the present paper was to investigate the test-retest reliability of a questionnaire. METHOD A questionnaire was designed to gather data about guidelines that have been implemented as well as information about factors, which, according to the Promoting Action on Research Implementation in Health Services (PARIHS)-model, influence the success of implementation. Thirty-nine health professionals at one of the hospitals included in the survey completed the questionnaire on two occasions within a mean time of 5.5 weeks. The test-retest reliability was analysed by means of Cohen's Kappa and percentage concordance. RESULTS Eight items had good agreement in terms of strength and high percentage concordance. With regard to the Kappa values, 13 items show moderate and two fair agreement. CONCLUSIONS The test-retest reliability scores show mainly acceptable results indicating a reasonable stability, thus suggesting the possibility of further developing the instrument. The factors described in the PARIHS-model seem relevant for use in evaluating implementation and use of guidelines. The instrument could benefit from a revision of the language in order to enhance clarity and make it less abstract.
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Hunt F. The importance of kangaroo care on infant oxygen saturation levels and bonding. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.jnn.2007.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Affiliation(s)
- Shannon D Scott
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada.
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Toma TS, Venâncio SI, Andretto DDA. Percepção das mães sobre o cuidado do bebê de baixo peso antes e após implantação do Método Mãe-Canguru em hospital público da cidade de São Paulo, Brasil. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2007. [DOI: 10.1590/s1519-38292007000300009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVOS: aumentar a compreensão sobre os diferentes modos que as famílias de baixa renda lidam com o nascimento de um bebê pré-termo, com vistas a aprimorar a implantação do Método Mãe-Canguru (MMC). MÉTODO: estudo qualitativo realizado em São Paulo, estado de São Paulo, em 2004, no qual foram entrevistadas 19 mães antes e 22 mães após implantação do MMC. O roteiro de entrevistas incluía questões abertas, das quais emergiram as informações sobre como as mães cuidaram de seus bebês de baixo peso, os arranjos domésticos e outras medidas a que recorreram. Para análise utilizou-se a abordagem da Grounded Theory. RESULTADOS: a necessidade de cuidar de outros filhos parece ser um dos principais limitadores para a opção ao MMC. Em comparação às mães entrevistadas antes da implantação do programa, as mães-cangurus eram mais jovens, mais escolarizadas, sem outros filhos, recebiam mais ajuda nas tarefas domésticas e relataram menos dificuldades na amamentação. CONCLUSÕES: a oferta do MMC em uma maternidade da periferia de São Paulo sugere efeitos positivos sobre a amamentação. A tendência à conformação de famílias nucleares dificulta a participação das mulheres no programa. Conhecer as limitações e possibilidades de cada família pode contribuir para o aperfeiçoamento do processo de implantação.
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Wallin L, Profetto-McGrath J, Levers MJ. Implementing nursing practice guidelines: a complex undertaking. J Wound Ostomy Continence Nurs 2007; 32:294-300; discussion 300-1. [PMID: 16234720 DOI: 10.1097/00152192-200509000-00004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Clinical practice guidelines have been proposed to significantly reduce the gap between available scientific evidence and clinical practice. Evidence-based guidelines are also being produced at an ever-increasing pace. However, guidelines do not implement themselves, and the research to support implementation does not provide straightforward answers. What works in one setting does not necessarily work in another. In short, guideline implementation and change of practice is complex and messy. The purpose of this article is to discuss the implementation of clinical practice guidelines using the Promoting Action on Research Implementation in Health Services framework. More specifically, 3 key components are highlighted: (1) the evidence base for guideline recommendations, (2) the clinical context where guidelines are to be implemented, and (3) the nature of facilitation needed to ensure a successful change process. An overview of the literature in the field is provided, and the authors' experiences are shared, and a few recommendations are tentatively provided.
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Affiliation(s)
- Lars Wallin
- Faculty of Nursing, University of Alberta, Edmonton, Canada.
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Wallin L, Ewald U, Wikblad K, Scott-Findlay S, Arnetz BB. Understanding work contextual factors: a short-cut to evidence-based practice? Worldviews Evid Based Nurs 2007; 3:153-64. [PMID: 17177929 DOI: 10.1111/j.1741-6787.2006.00067.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND It has become increasingly clear that workplace contextual factors make an important contribution to provider and patient outcomes. The potential for health care professionals of using research in practice is also linked to such factors, although the exact factors or mechanisms for enhancing this potential are not understood. From a perspective of implementing evidence-based nursing practice, the authors of this article report on a study examining contextual factors. AIM The objective of this study was to identify predictors of organizational improvement by measuring staff perceptions of work contextual factors. METHOD The Quality Work Competence questionnaire was used in a repeated measurement survey with a 1-year break between the two periods of data collection. The sample consisted of 134 employees from four neonatal units in Sweden. FINDINGS Over the study period significant changes occurred among staff perceptions, both within and between units, on various factors. Changes in staff perceptions on skills development and participatory management were the major predictors of enhanced potential of overall organizational improvement. Perceived improvement in skills development and performance feedback predicted improvement in leadership. Change in commitment was predicted by perceived decreases in work tempo and work-related exhaustion. CONCLUSIONS AND IMPLICATIONS These findings indicate the potential for organizational improvement by developing a learning and supportive professional environment as well as by involving staff in decision-making at the unit level. Such initiatives are also likely to be of importance for enhanced use of research in practice and evidence-based nursing. On the other hand, high levels of work tempo and burnout appear to have negative consequences on staff commitment for improving care and the work environment. A better understanding of workplace contextual factors is necessary for improving the organizational potential of getting research into practice and should be considered in future implementation projects.
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MESH Headings
- Adult
- Attitude of Health Personnel
- Burnout, Professional/prevention & control
- Burnout, Professional/psychology
- Clinical Competence/standards
- Decision Making, Organizational
- Evidence-Based Medicine/education
- Evidence-Based Medicine/organization & administration
- Feedback, Psychological
- Female
- Health Knowledge, Attitudes, Practice
- Humans
- Intensive Care Units, Neonatal/organization & administration
- Interprofessional Relations
- Linear Models
- Male
- Middle Aged
- Motivation
- Neonatal Nursing/education
- Neonatal Nursing/organization & administration
- Nursing Methodology Research
- Nursing Staff, Hospital/education
- Nursing Staff, Hospital/organization & administration
- Nursing Staff, Hospital/psychology
- Organizational Culture
- Organizational Innovation
- Self Efficacy
- Social Support
- Surveys and Questionnaires
- Sweden
- Workplace/organization & administration
- Workplace/psychology
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Affiliation(s)
- Lars Wallin
- CRU, Karolinska University Hospital, Stockholm, Sweden.
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Stetler CB, Legro MW, Rycroft-Malone J, Bowman C, Curran G, Guihan M, Hagedorn H, Pineros S, Wallace CM. Role of "external facilitation" in implementation of research findings: a qualitative evaluation of facilitation experiences in the Veterans Health Administration. Implement Sci 2006; 1:23. [PMID: 17049080 PMCID: PMC1635058 DOI: 10.1186/1748-5908-1-23] [Citation(s) in RCA: 254] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2006] [Accepted: 10/18/2006] [Indexed: 11/22/2022] Open
Abstract
Background Facilitation has been identified in the literature as a potentially key component of successful implementation. It has not, however, either been well-defined or well-studied. Significant questions remain about the operational definition of facilitation and about the relationship of facilitation to other interventions, especially to other change agent roles when used in multi-faceted implementation projects. Researchers who are part of the Quality Enhancement Research Initiative (QUERI) are actively exploring various approaches and processes, including facilitation, to enable implementation of best practices in the Veterans Health Administration health care system – the largest integrated healthcare system in the United States. This paper describes a systematic, retrospective evaluation of implementation-related facilitation experiences within QUERI, a quality improvement program developed by the US Department of Veterans Affairs. Methods A post-hoc evaluation was conducted through a series of semi-structured interviews to examine the concept of facilitation across several multi-site QUERI implementation studies. The interview process is based on a technique developed in the field of education, which systematically enhances learning through experience by stimulating recall and reflection regarding past complex activities. An iterative content analysis approach relative to a set of conceptually-based interview questions was used for data analysis. Findings Findings suggest that facilitation, within an implementation study initiated by a central change agency, is a deliberate and valued process of interactive problem solving and support that occurs in the context of a recognized need for improvement and a supportive interpersonal relationship. Facilitation was described primarily as a distinct role with a number of potentially crucial behaviors and activities. Data further suggest that external facilitators were likely to use or integrate other implementation interventions, while performing this problem-solving and supportive role. Preliminary Conclusions This evaluation provides evidence to suggest that facilitation could be considered a distinct implementation intervention, just as audit and feedback, educational outreach, or similar methods are considered to be discrete interventions. As such, facilitation should be well-defined and explicitly evaluated for its perceived usefulness within multi-intervention implementation projects. Additionally, researchers should better define the specific contribution of facilitation to the success of implementation in different types of projects, different types of sites, and with evidence and innovations of varying levels of strength and complexity.
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Affiliation(s)
| | - Marcia W Legro
- VA Puget Sound Health Care System, Health Services Research & Development, Met Park West, 1100 Olive Way, Suite 1400, Seattle, WA 98101 USA
| | - Joanne Rycroft-Malone
- Reader in Health Services Research, Centre for Health-Related Research, University of Wales, Bangor, UK
| | - Candice Bowman
- VA San Diego Healthcare System, QUERI-HIV, Health Services Research & Development, 3350 La Jolla Village Drive (111N-1), San Diego, CA 92161 USA
| | - Geoffrey Curran
- Central Arkansas Veterans Healthcare System, Center for Mental Healthcare & Outcomes Research, 2200 Fort Roots Drive, Building 58 (152/NLR), North Little Rock, AR 72114 USA
| | - Marylou Guihan
- Midwest Center for Health Services and Policy Research, Edward Hines, Jr. VA Hospital (151-H) Hines, IL 60141 USA
| | - Hildi Hagedorn
- Minneapolis VA Medical Center, One Veterans Drive, Minneapolis, MN 55417 USA
| | - Sandra Pineros
- VA Puget Sound Health Care System, Health Services Research & Development, Met Park West, 1100 Olive Way, Suite 1400, Seattle, WA 98101 USA
| | - Carolyn M Wallace
- VA Puget Sound Health Care System, Health Services Research & Development, Met Park West, 1100 Olive Way, Suite 1400, Seattle, WA 98101 USA
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Wallin L, Estabrooks CA, Midodzi WK, Cummings GG. Development and validation of a derived measure of research utilization by nurses. Nurs Res 2006; 55:149-60. [PMID: 16708039 DOI: 10.1097/00006199-200605000-00001] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Theoretical models are needed to guide strategies for the implementation of research into clinical practice. To develop and test such models, including analyses of complex theoretical constructs and causal relationships, rich datasets are needed. Working with existing datasets may mean that important variables are lacking. OBJECTIVE The aim of this study was to derive a nursing research utilization variable and validate it using the Promoting Action on Research Implementation in Health Services (PARIHS) conceptual framework on research implementation. METHODS This study was based on data from two surveys of registered nurses. The first survey (1996; N = 600) contained robust research utilization variables but few organizational variables. The second (1998; N = 6,526) was rich in organizational variables but contained no research utilization variables. A linear regression model with predictors common to both datasets was used to derive a research utilization variable in the 1998 dataset. To validate these scores, four separate procedures based on the hypothesis of a positive relationship between context and research utilization were completed. Mutually exclusive groups reflecting various levels of context were created to accomplish these procedures. RESULTS The derived research utilization variable was successfully mapped onto the cases in the 1998 dataset. The derived scores ranged from 0.21 to 21.40, with a mean of 10.85 (SD = 3.23). The mean score per subgroup ranged from 8.28 for the lowest context group to 12.75 for the highest context group. One of the validation procedures showed that significant differences in mean research utilization existed only among four conceptually unique context groups (p < .001). These groups showed a positive incremental relationship in research utilization (p < .001; the better the context, the higher the research utilization score). The validity of the derived variable was supported by using the three remaining validation procedures. DISCUSSION The successful creation and validation of a derived research utilization variable will enable advanced modeling of the relationships between research utilization and individual and organizational characteristics. The findings also support the construct validity of the context element of the PARIHS theoretical framework.
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Affiliation(s)
- Lars Wallin
- Faculty of Nursing and Knowledge Utilization Studies Program, University of Alberta, Edmonton, Canada
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Rick SL. Developmental care on newborn intensive care units: Nurses’ experiences and neurodevelopmental, behavioural, and parenting outcomes. A critical review of the literature. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.jnn.2006.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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