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Fontaine G, Vinette B, Weight C, Maheu-Cadotte MA, Lavallée A, Deschênes MF, Lapierre A, Castiglione SA, Chicoine G, Rouleau G, Argiropoulos N, Konnyu K, Mooney M, Cassidy CE, Mailhot T, Lavoie P, Pépin C, Cossette S, Gagnon MP, Semenic S, Straiton N, Middleton S. Effects of implementation strategies on nursing practice and patient outcomes: a comprehensive systematic review and meta-analysis. Implement Sci 2024; 19:68. [PMID: 39350295 PMCID: PMC11443951 DOI: 10.1186/s13012-024-01398-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 09/13/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND Implementation strategies targeting individual healthcare professionals and teams, such as audit and feedback, educational meetings, opinion leaders, and reminders, have demonstrated potential in promoting evidence-based nursing practice. This systematic review examined the effects of the 19 Cochrane Effective Practice and Organization Care (EPOC) healthcare professional-level implementation strategies on nursing practice and patient outcomes. METHODS A systematic review was conducted following the Cochrane Handbook, with six databases searched up to February 2023 for randomized studies and non-randomized controlled studies evaluating the effects of EPOC implementation strategies on nursing practice. Study selection and data extraction were performed in Covidence. Random-effects meta-analyses were conducted in RevMan, while studies not eligible for meta-analysis were synthesized narratively based on the direction of effects. The quality of evidence was assessed using GRADE. RESULTS Out of 21,571 unique records, 204 studies (152 randomized, 52 controlled, non-randomized) enrolling 36,544 nurses and 340,320 patients were included. Common strategies (> 10% of studies) were educational meetings, educational materials, guidelines, reminders, audit and feedback, tailored interventions, educational outreach, and opinion leaders. Implementation strategies as a whole improved clinical practice outcomes compared to no active intervention, despite high heterogeneity. Group and individual education, patient-mediated interventions, reminders, tailored interventions and opinion leaders had statistically significant effects on clinical practice outcomes. Individual education improved nurses' attitude, knowledge, perceived control, and skills, while group education also influenced perceived social norms. Although meta-analyses indicate a small, non-statistically significant effect of multifaceted versus single strategies on clinical practice, the narrative synthesis of non-meta-analyzed studies shows favorable outcomes in all studies comparing multifaceted versus single strategies. Group and individual education, as well as tailored interventions, had statistically significant effects on patient outcomes. CONCLUSIONS Multiple types of implementation strategies may enhance evidence-based nursing practice, though effects vary due to strategy complexity, contextual factors, and variability in outcome measurement. Some evidence suggests that multifaceted strategies are more effective than single component strategies. Effects on patient outcomes are modest. Healthcare organizations and implementation practitioners may consider employing multifaceted, tailored strategies to address local barriers, expand the use of underutilized strategies, and assess the long-term impact of strategies on nursing practice and patient outcomes. TRIAL REGISTRATION PROSPERO CRD42019130446.
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Affiliation(s)
- Guillaume Fontaine
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Rue Sherbrooke West, 18Th Floor, Office 1812, Montréal, QC, H3A 2M7, Canada.
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital, CIUSSS West-Central Montreal, 3755 Chem. de La Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada.
- Centre for Nursing Research, Sir Mortimer B. Davis Jewish General Hospital, CIUSSS West-Central Montreal, 3755 Chem. de La Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada.
- Centre for Implementation Research, Methodological and Implementation Research Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
| | - Billy Vinette
- Faculty of Nursing, Université de Montréal, 2375 Chemin de La Côte-Sainte-Catherine, Montréal, QC, H3T 1A8, Canada
- Research Centre of the Centre Hospitalier de L'Université de Montréal, 900 Saint Denis St, Montreal, QC, H2X 0A9, Canada
| | - Charlene Weight
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Rue Sherbrooke West, 18Th Floor, Office 1812, Montréal, QC, H3A 2M7, Canada
| | - Marc-André Maheu-Cadotte
- Faculty of Nursing, Université de Montréal, 2375 Chemin de La Côte-Sainte-Catherine, Montréal, QC, H3T 1A8, Canada
| | - Andréane Lavallée
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, 3659 Broadway, New York, NY, 10032, USA
| | - Marie-France Deschênes
- Faculty of Nursing, Université de Montréal, 2375 Chemin de La Côte-Sainte-Catherine, Montréal, QC, H3T 1A8, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Institut de Réadaptation Gingras-Lindsay-de-Montréal, 6363 Hudson Rd, Montréal, QC, H3S 1M9, Canada
| | - Alexandra Lapierre
- CHU de Québec-Université Laval Research Centre, 1050 Chemin Sainte-Foy, Québec City, QC, G1S 4L8, Canada
| | - Sonia A Castiglione
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Rue Sherbrooke West, 18Th Floor, Office 1812, Montréal, QC, H3A 2M7, Canada
- Research Institute of the McGill University Health Centre, 2155 Guy St, Montreal, QC, H3H 2L9, Canada
| | - Gabrielle Chicoine
- Research Centre of the Centre Hospitalier de L'Université de Montréal, 900 Saint Denis St, Montreal, QC, H2X 0A9, Canada
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 38 Shuter St, Toronto, ON, M5B 1A6, Canada
| | - Geneviève Rouleau
- Department of Nursing, Université du Québec en Outaouais, 283, Boulevard Alexandre-Taché, Gatineau, QC, J8X 3X7, Canada
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, ON, M5G 1N8, Canada
| | - Nikolas Argiropoulos
- Centre for Nursing Research, Sir Mortimer B. Davis Jewish General Hospital, CIUSSS West-Central Montreal, 3755 Chem. de La Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada
| | - Kristin Konnyu
- Health Services Research Unit, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Health Sciences Building Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Meagan Mooney
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Rue Sherbrooke West, 18Th Floor, Office 1812, Montréal, QC, H3A 2M7, Canada
| | - Christine E Cassidy
- School of Nursing, Dalhousie University, 5869 University Ave, Halifax, NS, B3H 4R2, Canada
- IWK Health, 5980 University Ave, Halifax, NS, B3K 6R8, Canada
| | - Tanya Mailhot
- Faculty of Nursing, Université de Montréal, 2375 Chemin de La Côte-Sainte-Catherine, Montréal, QC, H3T 1A8, Canada
- Montreal Heart Institute Research Centre, 5000 Bélanger, Montréal, QC, H1T 1C8, Canada
| | - Patrick Lavoie
- Faculty of Nursing, Université de Montréal, 2375 Chemin de La Côte-Sainte-Catherine, Montréal, QC, H3T 1A8, Canada
- Montreal Heart Institute Research Centre, 5000 Bélanger, Montréal, QC, H1T 1C8, Canada
| | - Catherine Pépin
- Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, 143, Rue Wolfe, Lévis, QC, G6V 3Z1, Canada
| | - Sylvie Cossette
- Faculty of Nursing, Université de Montréal, 2375 Chemin de La Côte-Sainte-Catherine, Montréal, QC, H3T 1A8, Canada
- Montreal Heart Institute Research Centre, 5000 Bélanger, Montréal, QC, H1T 1C8, Canada
| | - Marie-Pierre Gagnon
- CHU de Québec-Université Laval Research Centre, 1050 Chemin Sainte-Foy, Québec City, QC, G1S 4L8, Canada
- Faculty of Nursing, Université Laval, Pavillon Ferdinand-Vandry, 1050, Avenue de La Médecine, Québec City, QC, G1V 0A6, Canada
| | - Sonia Semenic
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Rue Sherbrooke West, 18Th Floor, Office 1812, Montréal, QC, H3A 2M7, Canada
- Research Institute of the McGill University Health Centre, 2155 Guy St, Montreal, QC, H3H 2L9, Canada
| | - Nicola Straiton
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and the Australian Catholic University, 390 Victoria St, Level 5 deLacy Building, Darlinghurst, NSW, 2010, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and the Australian Catholic University, 390 Victoria St, Level 5 deLacy Building, Darlinghurst, NSW, 2010, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 40 Edward Street, North Sydney, Sydney, NSW, 2060, Australia
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Graverholt B, Espehaug B, Ciliska D, Potrebny T. The effectiveness of a knowledge translation intervention on the implementation of NEWS2 in nursing homes, a pragmatic cluster RCT. Implement Sci 2024; 19:64. [PMID: 39261938 PMCID: PMC11391697 DOI: 10.1186/s13012-024-01392-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 08/23/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Improving the uptake of relevant and reliable research is an important priority in long-term care to achieve sustainable and high-quality services for the increasingly older population. AIM The purpose was to assess the effectiveness of a tailored, adaptive and a multifaceted KT capacity program, relative to usual practice, on the implementation of National Early Warning Score 2 (NEWS2). METHODS This study was carried out as a pragmatic cluster-randomized controlled trial. The capacity program consisted of an educational part to address implementation capacity gaps and a facilitation-upon-implementation part to address a relevant knowledge gap in nursing homes. A collective decision was made to address the challenge of early detection of clinical deterioration among nursing home residents, by implementing the (NEWS2) as clinical innovation. Public nursing homes in a Norwegian municipality (n = 21) with a total of 1 466 beds were eligible for inclusion. The study-period spanned over a 22-month period, including a 12-month follow-up. Data was extracted from the Electronic Patient Journal system and analyzed using multilevel growth model analysis. RESULTS The intervention had a large effect on the use of NEWS2 among care staff in intervention nursing homes, compared to the control group (standardized mean difference, d = 2.42). During the final month of the implementation period, residents in the intervention group was assessed with NEWS2 1.44 times (95% CI: 1.23, 1.64) per month, which is almost four times more often than in the control group (mean = 0.38, 95% CI: 0.19, 0.57). During the follow-up period, the effect of the intervention was not only sustained in the intervention group but there was a substantial increase in the use of NEWS2 in both the intervention (mean = 1.75, 95% CI: 1.55, 1.96) and control groups (mean = 1.45, 95% CI: 1.27, 1.65). CONCLUSIONS This tailored implementation strategy had a large effect on the use of NEWS2 among care staff, demonstrating that integrated knowledge translation strategies can be a promising strategy to achieve evidence-based care in the nursing home sector. TRIAL REGISTRATION ISRCTN12437773 . Registered 19/3 2020, retrospectively.
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Affiliation(s)
- Birgitte Graverholt
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Bergen, Norway.
| | - Birgitte Espehaug
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Donna Ciliska
- Faculty of Health Sciences, McMaster University, Toronto, Canada
| | - Thomas Potrebny
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Schafthuizen L, Spruit-Bentvelzen L, van Dijk M, van Rosmalen J, Ista E. Implementation of a nursing oral health care protocol in a university teaching hospital: A cluster-randomized stepped-wedge design. Int J Dent Hyg 2024; 22:661-671. [PMID: 37722075 DOI: 10.1111/idh.12748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 01/24/2023] [Accepted: 07/30/2023] [Indexed: 09/20/2023]
Abstract
INTRODUCTION Providing oral care is an essential part of basic nursing care but receives little priority in daily practice, with a risk of adverse events. Also, nurses report many barriers to adequate provision of oral care, such as time restraints, insufficient materials, fear of causing pain, lack of knowledge and a negative attitude towards providing oral care. METHODS We performed a cluster-randomized, stepped-wedge study to explore the effect of the the implementation of a new nursing evidence-based oral care protocol on nurses' knowledge, attitude and protocol adherence. The study population included both nursing students, graduated nurses and patients in selected wards. The implementation strategy included oral and written information, instruction videos and reminders. Nurses' knowledge and attitude towards oral care were assessed at baseline and after the implementation of the protocol with a validated 47-item questionnaire with a score range of 0-100. Secondarily, nurses' protocol adherence to teeth brushing, measured in Activities of Daily Living (ADL) dependent patients, was evaluated. The Standards for Reporting Implementation Studies (StaRI) Statement was used. RESULTS At baseline, the questionnaire was completed by 226 nurses; after implementation by 283. Knowledge had significantly improved from 68.8 to 72.3. Nurses' attitude improved not significantly. Protocol adherence was assessed in 73 ADL-dependent patients at baseline, in 51 after implementation. Adherence to teeth brushing significantly decreased in patients with permanent teeth. Also, adherence to both teeth brushing and usage of soap decreased in patients with (partial) dentures. CONCLUSION Nurses' knowledge and attitude of oral care increased somewhat after the implementation of a new nursing evidence-based protocol. After implementation, there was an unexplained decreased adherence to oral care in ADL-dependent patients.
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Affiliation(s)
- Laura Schafthuizen
- Department of Internal Medicine, Section Nursing Science, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Lotte Spruit-Bentvelzen
- Department of Internal Medicine, Section Nursing Science, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Monique van Dijk
- Department of Internal Medicine, Section Nursing Science, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Erwin Ista
- Department of Internal Medicine, Section Nursing Science, Erasmus University Medical Centre, Rotterdam, the Netherlands
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Riguzzi M, Thaqi Q, Peng-Keller S, Lorch A, Blum D, Naef R. Adoption of evidence-based end-of-life and bereavement support to families in cancer care: A contextual analysis study with health professionals. J Clin Nurs 2024; 33:3599-3614. [PMID: 38291546 DOI: 10.1111/jocn.17033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/19/2023] [Accepted: 01/07/2024] [Indexed: 02/01/2024]
Abstract
AIMS To investigate the level of adoption of evidence-based family engagement and support during end-of-life cancer care and subsequent bereavement and its contextual facilitators and barriers from health professionals' perspectives, and to explore differences between professional groups. DESIGN Contextual analysis using an online cross-sectional survey. METHODS This study was conducted in four Swiss hospitals and three home care oncology and palliative care services. Non-parametric testing was used to investigate the level of adoption and differences between nurses, physicians, occupational- and physiotherapists and psychosocial professionals (chaplains, onco-psychologists and social workers). The STROBE checklist for cross-sectional studies was followed. RESULTS The majority of the 111 participating health professionals were nurses. Adoption was statistically significantly higher during end-of-life care than bereavement, with nurses and physicians reporting higher levels than the other professional groups. Guidance on end-of-life family care was available in about half of the cases, in contrast to a quarter for bereavement care. Self-perceived knowledge, skills and attitudes were moderate to high, with nurses and physicians reporting higher levels than others, except for general skills in working with families. Organisational structures were experienced as rather supportive, with the psychosocial group appraising the organisational context as significantly less conducive to fully implementing end-of-life and bereavement care than others, particularly during the end-of-life phase. CONCLUSION Evidence-based family engagement and support were better adopted during end-of-life care than bereavement. Overall, nurses and physicians felt better enabled to care for families compared to other professional groups. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. PROTOCOL REGISTRATION https://osf.io/j4kfh. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Implementation and quality improvement efforts should focus particularly on the bereavement phase and be tailored to professional groups. IMPACT The findings show that evidence-based family engagement and support practices during end-of-life were rather well adopted in contrast to subsequent bereavement care, with nurses and physicians better enabled than other professionals to provide care. A better understanding of health professionals' contributions and roles in family care is important to build interprofessional capacity for evidence-based end-of-life and bereavement support. REPORTING METHOD The STROBE checklist for reports of cross-sectional studies was followed (von Elm et al., 2007).
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Affiliation(s)
- Marco Riguzzi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Qëndresa Thaqi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Simon Peng-Keller
- Spiritual Care, Faculty of Theology, University of Zurich, Zurich, Switzerland
| | - Anja Lorch
- Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - David Blum
- Competence Centre for Palliative Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Centre for Palliative Care, City Hospital Zurich, Zurich, Switzerland
| | - Rahel Naef
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
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Wudu MA, Tarekegn SM, Wondifraw EB, Birhanu TA, Hailu MK, Bekalu YE, Yosef ST, Belete MA. Uptake of evidence-based practice and its predictors among nurses in Ethiopia: a systematic review and meta-analysis. Front Pharmacol 2024; 15:1421690. [PMID: 39092215 PMCID: PMC11291372 DOI: 10.3389/fphar.2024.1421690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 06/17/2024] [Indexed: 08/04/2024] Open
Abstract
Background: While evidence-based practice has demonstrated its capacity to enhance healthcare quality and bolster clinical outcomes, the translation of research into clinical practice encounters persistent challenges. In Ethiopia, there remains a dearth of comprehensive and nationally representative data concerning the extent of Evidence-based practice adoption among nurses. Thus, this systematic review and meta-analysis endeavors to assess the overall prevalence of Evidence-based practice implementation and delve into its determinants among Ethiopian nurses. Methods: A systematic review and meta-analysis were conducted following the PRISMA guidelines. In order to identify pertinent studies, a search was conducted across PubMed, Scopus, Google Scholar, and EMBASE databases. A weighted inverse variance random-effects model was employed to estimate the pooled prevalence. Cochrane's Q-test and I2 statistics were calculated to assess heterogeneity among studies. Funnel plots and Egger's test were utilized to evaluate publication bias. Pooled implementation rates and meta-regression analysis were carried out using STATA 17. Results: Of the total 1,590 retrieved articles, twelve studies including 4,933 nurses were included in the final analysis. The pooled prevalence of Evidence-based practice uptake among nurses in Ethiopia is 53% (95% CI: 46%-60%). Having knowledge about Evidence-based practice (AOR = 2.29; 95% CI: 1.90, 2.69; I2 = 70.95%), holding a favorable attitude towards Evidence-based practice (AOR = 2.56; 95% CI: 1.63, 3.49; I2 = 88.39%), occupying a head nurse position (AOR = 3.15; 95% CI: 1.85, 4.46; I2 = 87.42%), possessing effective communication skills (AOR = 4.99; 95% CI: 1.47, 8.51; I2 = 99.86%), and having access to Evidence-based practice guidelines (AOR = 1.90; 95% CI: 1.55, 2.24; I2 = 57.24%) were identified as predictors of the uptake of Evidence-based practice. Conclusion: Only half of Ethiopia's nurses exhibit a strong embrace of Evidence-Based Practice within clinical settings, underscoring the urgent necessity for coordinated endeavors to cultivate this essential practice. Possessing knowledge, effective communication skills, access to updated guidelines, maintaining a positive attitude towards Evidence-Based Practice, and holding a position as head nurse emerged as predictors of successful implementation of Evidence-Based Practice. Hence, policymakers must prioritize capacity-building initiatives, disseminate the latest EBP guidelines widely, and strengthen mentorship roles for head nurses. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/#searchadvanced, identifier CRD42023488943.
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Affiliation(s)
- Muluken Amare Wudu
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Setegn Mihret Tarekegn
- Department of Pediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Endalk Birrie Wondifraw
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tarikua Afework Birhanu
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Molla Kassa Hailu
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yemane Eshetu Bekalu
- Department of Public Health, ALKAN Health Sciences and Business College, Dessie, Ethiopia
| | - Selamyhun Tadesse Yosef
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Woldiya University, Woldiya, Ethiopia
| | - Melaku Ashagrie Belete
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Wang W, Fu Q, Shen W, Xu Y, Wang L, Chun X, Shi Y, Lin J, Zhao Y, Gu Y. Using the i-PARIHS theoretical framework to develop evidence implementation strategies for central venous catheter maintenance: a multi-site quality improvement project. JBI Evid Implement 2024; 22:195-204. [PMID: 38557993 PMCID: PMC11107888 DOI: 10.1097/xeb.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Evidence-based nursing practice can reduce complications associated with central venous catheters (CVCs). In this project, the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework was considered an ideal theoretical instrument to identify facilitators and barriers to implementing evidence-based practice. METHODS The project was conducted in pediatric intensive care units in six Chinese tertiary children's hospitals. Twenty-two audit criteria were obtained from best practice recommendations, and a baseline audit was conducted to assess current practice against best practice. Next, the i-PARIHS framework was used to identify facilitators and barriers to best practice and develop improvement strategies. A follow-up audit was then conducted to measure changes in compliance with best practices. RESULTS Facilitators and barriers were identified at the innovation, recipient, and context levels. A comprehensive CVC maintenance strategy was then developed to apply the best evidence to nurses' clinical work. Of the 22 audit criteria, 17 showed significant improvement compared with the baseline audit. CONCLUSIONS The i-PARIHS framework is an effective tool for developing targeted, evidence-based improvement strategies and applying these to the clinical setting. The quality of the nurses' clinical practice improved during CVC maintenance. However, there is no certainty that these positive results can be maintained, and long-term data are needed to verify this. SPANISH ABSTRACT http://links.lww.com/IJEBH/A185.
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Affiliation(s)
- Wenchao Wang
- Emergency Department, Children's Hospital of Fudan University, Shanghai, China
| | - Qin Fu
- Nursing Department, ShenZhen Children's Hospital, Guangdong, China
| | - Weijie Shen
- Pediatric Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Yulu Xu
- Cardiac Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Linjuan Wang
- Pediatric Intensive Care Unit, Shenzhen Children's Hospital, Guangdong, China
| | - Xiao Chun
- Pediatric Intensive Care Unit, Guangzhou Woman and Children's Medical Center, Guangdong, China
| | - Yuyun Shi
- Pediatric Intensive Care Unit, Children's Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Jianping Lin
- Pediatric Intensive Care Unit, Xiamen Children's Hospital, Fujian, China
| | - Yaxun Zhao
- Pediatric Intensive Care Unit, Anhui Children's Hospital, Anhui, China
| | - Ying Gu
- Nursing Department, Children's Hospital of Fudan University, Shanghai, China
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Wendt B, Cremers M, Ista E, van Dijk M, Schoonhoven L, Nieuwboer MS, Vermeulen H, Van Dulmen SA, Huisman-de Waal G. Low-value home-based nursing care: A national survey study. J Adv Nurs 2024; 80:1891-1901. [PMID: 37983754 DOI: 10.1111/jan.15970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/13/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
AIMS To explore potential areas of low-value home-based nursing care practices, their prevalence and related influencing factors of nurses and nursing assistants working in home-based nursing care. DESIGN A quantitative, cross-sectional design. METHODS An online survey with questions containing scaled frequencies on five-point Likert scales and open questions on possible related influencing factors of low-value nursing care. The data collection took place from February to April 2022. Descriptive statistics and linear regression were used to summarize and analyse the results. RESULTS A nationwide sample of 776 certified nursing assistants, registered nurses and nurse practitioners responded to the survey. The top five most delivered low-value care practices reported were: (1) 'washing the client with water and soap by default', (2) 'application of zinc cream, powders or pastes when treating intertrigo', (3) 'washing the client from head to toe daily', (4) 're-use of a urinary catheter bag after removal/disconnection' and (5) 'bladder irrigation to prevent clogging of urinary tract catheter'. The top five related influencing factors reported were: (1) 'a (general) practitioner advices/prescribes it', (2) 'written in the client's care plan', (3) 'client asks for it', (4) 'wanting to offer the client something' and (5) 'it is always done like this in the team'. Higher educational levels and an age above 40 years were associated with a lower provision of low-value care. CONCLUSION According to registered nurses and certified nursing assistants, a number of low-value nursing practices occurred frequently in home-based nursing care and they experienced multiple factors that influence the provision of low-value care such as (lack of) clinical autonomy and handling clients' requests, preferences and demands. The results can be used to serve as a starting point for a multifaceted de-implementation strategy. REPORTING METHOD STROBE checklist for cross-sectional studies. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Nursing care is increasingly shifting towards the home environment. Not all nursing care that is provided is effective or efficient and this type of care can therefore be considered of low-value. Reducing low-value care and increasing appropriate care will free up time, improve quality of care, work satisfaction, patient safety and contribute to a more sustainable healthcare system.
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Affiliation(s)
- Benjamin Wendt
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Milou Cremers
- Department of Internal Medicine, Section of Nursing Science, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Erwin Ista
- Department of Internal Medicine, Section of Nursing Science, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Monique van Dijk
- Department of Internal Medicine, Section of Nursing Science, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lisette Schoonhoven
- Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Minke S Nieuwboer
- Academy of Health and Vitality, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Hester Vermeulen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Simone A Van Dulmen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Getty Huisman-de Waal
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
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Minian N, Gayapersad A, Coroiu A, Dragonetti R, Zawertailo L, Zaheer J, O’Neill B, Lange S, Thomson N, Crawford A, Kennedy SH, Selby P. Prototyping the implementation of a suicide prevention protocol in primary care settings using PDSA cycles: a mixed method study. Front Psychiatry 2024; 15:1286078. [PMID: 38333892 PMCID: PMC10850298 DOI: 10.3389/fpsyt.2024.1286078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/04/2024] [Indexed: 02/10/2024] Open
Abstract
Introduction In Canada, approximately 4,500 individuals die by suicide annually. Approximately 45% of suicide decedents had contact with their primary care provider within the month prior to their death. Current versus never smokers have an 81% increased risk of death by suicide. Those who smoke have additional risks for suicide such as depression, chronic pain, alcohol, and other substance use. They are more likely to experience adverse social determinants of health. Taken together, this suggests that smoking cessation programs in primary care could be facilitators of suicide prevention, but this has not been studied. Study objectives The objectives of the study are to understand barriers/facilitators to implementing a suicide prevention protocol within a smoking cessation program (STOP program), which is deployed by an academic mental health and addiction treatment hospital in primary care clinics and to develop and test implementation strategies to facilitate the uptake of suicide screening and assessment in primary care clinics across Ontario. Methods The study employed a three-phase sequential mixed-method design. Phase 1: Conducted interviews guided by the Consolidated Framework for Implementation Research exploring barriers to implementing a suicide prevention protocol. Phase 2: Performed consensus discussions to map barriers to implementation strategies using the Expert Recommendations for Implementing Change tool and rank barriers by relevance. Phase 3: Evaluated the feasibility and acceptability of implementation strategies using Plan Do Study Act cycles. Results Eleven healthcare providers and four research assistants identified lack of training and the need of better educational materials as implementation barriers. Participants endorsed and tested the top three ranked implementation strategies, namely, a webinar, adding a preamble before depression survey questions, and an infographic. After participating in the webinar and reviewing the educational materials, all participants endorsed the three strategies as acceptable/very acceptable and feasible/very feasible. Conclusion Although there are barriers to implementing a suicide prevention protocol within primary care, it is possible to overcome them with strategies deemed both acceptable and feasible. These results offer promising practice solutions to implement a suicide prevention protocol in smoking cessation programs delivered in primary care settings. Future efforts should track implementation of these strategies and measure outcomes, including provider confidence, self-efficacy, and knowledge, and patient outcomes.
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Affiliation(s)
- Nadia Minian
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Allison Gayapersad
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Adina Coroiu
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rosa Dragonetti
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Laurie Zawertailo
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Juveria Zaheer
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Braden O’Neill
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Shannon Lange
- Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nicole Thomson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Allison Crawford
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sidney H. Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Arthur Sommer Rotenberg Program in Suicide Studies, Unity Health Toronto, Toronto, ON, Canada
| | - Peter Selby
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Eekholm S, Samuelson K, Ahlström G, Lindhardt T. Development of an Implementation Strategy Tailored to Deliver Evidence-Based and Person-Centred Nursing Care for Patients with Community-Acquired Pneumonia: An Intervention Mapping Approach. Healthcare (Basel) 2023; 12:32. [PMID: 38200938 PMCID: PMC10779328 DOI: 10.3390/healthcare12010032] [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: 11/10/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Community-acquired pneumonia is a serious public health problem, and more so in older patients, leading to high morbidity and mortality. However, this problem can be reduced by optimising in-hospital nursing care. Accordingly, this study describes a systematic process of designing and developing a tailored theory- and research-based implementation strategy that supports registered nurses (RNs) in delivering evidence-based and person-centred care for this patient population in a hospital setting. The implementation strategy was developed by completing the six steps of the Intervention Mapping framework: (1) developing a logic model of the problem and (2) a logic model of change by defining performance and change objectives, (3) designing implementation strategy interventions by selecting theory-based change methods, (4) planning the interventions and producing materials through a co-design approach, (5) developing a structured plan for adoption, maintenance and implementation and (6) developing an evaluation plan. This method can serve as a guide to (1) target behavioural and environmental barriers hindering the delivery of nursing care in local clinical practice, (2) support evidence uptake, (3) support RNs in the delivery of nursing care according to individual patient needs and thereby (4) optimise health-related patient outcomes.
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Affiliation(s)
- Signe Eekholm
- Department of Health Sciences, Faculty of Medicine, Lund University, Sölvegatan 19, P.O. Box 117, SE-221 00 Lund, Sweden; (K.S.); (G.A.)
- Department of Internal Medicine, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 4, 2nd. Floor, DK-2900 Hellerup, Denmark;
| | - Karin Samuelson
- Department of Health Sciences, Faculty of Medicine, Lund University, Sölvegatan 19, P.O. Box 117, SE-221 00 Lund, Sweden; (K.S.); (G.A.)
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Sölvegatan 19, P.O. Box 117, SE-221 00 Lund, Sweden; (K.S.); (G.A.)
| | - Tove Lindhardt
- Department of Internal Medicine, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 4, 2nd. Floor, DK-2900 Hellerup, Denmark;
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10
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Petry H, Ernst J, Naef R. Participatory development and implementation of a dementia care pathway with intervention bundles in acute care during the coronavirus pandemic: A process evaluation study. J Clin Nurs 2023; 32:7193-7208. [PMID: 37317613 DOI: 10.1111/jocn.16799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/13/2023] [Accepted: 05/30/2023] [Indexed: 06/16/2023]
Abstract
AIMS To explore the implementation of a dementia care pathway in an acute care setting. BACKGROUND Dementia care in acute settings is often constrained by contextual factors. We developed an evidence-based care pathway with intervention bundles, and implemented it on two trauma units, with the aim to empower staff and improve quality care. DESIGN Process evaluation using quantitative and qualitative methods. METHODS Pre-implementation, unit staff completed a survey (n = 72) assessing family and dementia care skills and level of evidence-based dementia care. Post-implementation, champions (n = 7) completed the same survey, with additional questions on acceptability, appropriateness and feasibility, and participated in a focus group interview. Data were analysed using descriptive statistics and content analysis guided by the Consolidated Framework for Implementation Research (CFIR). REPORTING GUIDELINE Standards for Reporting Qualitative Research Checklist. RESULTS Pre-implementation, staff's perceived skills in family and dementia care were moderate overall, with high skills in 'building relationships' and 'sustaining personhood'. Evidence-based interventions were delivered seldom to frequent, with 'individualized care' scoring lowest and 'assessing cognition' scoring highest. Implementation of the care pathway/intervention bundles was overshadowed by the pandemic, and failed due to major organisational- and process-related barriers. Acceptability scored highest and feasibility lowest, with concerns relating to complexity and compatibility of pathways/bundles when introduced into clinical routines. CONCLUSIONS Our study implies that organisational and process factors are the most influential determinants to the implementation of dementia care in acute settings. Future implementation efforts should draw on the evolving evidence within implementation science and dementia care research to ensure effective integration and improvement process. RELEVANCE TO CLINICAL PRACTICE Our study provides important learning around improving care for persons with dementia and their families in hospitals. PATIENT OR PUBLIC CONTRIBUTION A family caregiver was involved in the development of the education and training programme.
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Affiliation(s)
- Heidi Petry
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Jutta Ernst
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Rahel Naef
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
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11
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Fakha A, de Boer B, Hamers JP, Verbeek H, van Achterberg T. Systematic development of a set of implementation strategies for transitional care innovations in long-term care. Implement Sci Commun 2023; 4:103. [PMID: 37641112 PMCID: PMC10463528 DOI: 10.1186/s43058-023-00487-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/09/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Numerous transitional care innovations (TCIs) are being developed and implemented to optimize care continuity for older persons when transferring between multiple care settings, help meet their care needs, and ultimately improve their quality of life. Although the implementation of TCIs is influenced by contextual factors, the use of effective implementation strategies is largely lacking. Thus, to improve the implementation of TCIs targeting older persons receiving long-term care services, we systematically developed a set of viable strategies selected to address the influencing factors. METHODS As part of the TRANS-SENIOR research network, a stepwise approach following Implementation Mapping (steps 1 to 3) was applied to select implementation strategies. Building on the findings of previous studies, existing TCIs and factors influencing their implementation were identified. A combination of four taxonomies and overviews of change methods as well as relevant evidence on their effectiveness were used to select the implementation strategies targeting each of the relevant factors. Subsequently, individual consultations with scientific experts were performed for further validation of the process of mapping strategies to implementation factors and for capturing alternative ideas on relevant implementation strategies. RESULTS Twenty TCIs were identified and 12 influencing factors (mapped to the Consolidated Framework for Implementation Research) were designated as priority factors to be addressed with implementation strategies. A total of 40 strategies were selected. The majority of these target factors at the organizational level, e.g., by using structural redesign, public commitment, changing staffing models, conducting local consensus discussions, and organizational diagnosis and feedback. Strategies at the level of individuals included active learning, belief selection, and guided practice. Each strategy was operationalized into practical applications. CONCLUSIONS This project developed a set of theory and evidence-based implementation strategies to address the influencing factors, along further tailoring for each context, and enhance the implementation of TCIs in daily practice settings. Such work is critical to advance the use of implementation science methods to implement innovations in long-term care successfully.
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Affiliation(s)
- Amal Fakha
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands.
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands.
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium.
| | - Bram de Boer
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Jan P Hamers
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Theo van Achterberg
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
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12
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Connor L, Zadvinskis IM, Roberts H, Melnyk BM. Nurses' Perceptions of Adherence to the Central Line Maintenance Bundle: Linkages to Thoughts, Emotions, and Behavior. West J Nurs Res 2023; 45:599-606. [PMID: 36964699 DOI: 10.1177/01939459231162904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
The U.S. Centers for Disease Control established the central line maintenance care bundle in 2011, yet nurses' adherence to all seven components remains challenging. The specific aim of this study was to explore and understand intensive care nurses' perceptions and beliefs regarding central line maintenance, bundle care elements, and associated adherence. This qualitative study used a phenomenological approach. Three main themes emerged as follows: (1) thoughts about the ability to adhere to the central line bundle created feelings about central line maintenance care, (2) feelings about the nurses' ability to adhere to the central line bundle influenced behaviors, and (3) behaviors for central line bundle adherence reinforced thoughts. Each theme had several subthemes. Organizations must assess and mitigate the unique cognitive and behavioral factors that affect nurses' adherence to the central line-associated bloodstream infection (CLABSI) maintenance bundle. In addition, nursing adherence requires knowledge of CLABSI rates and direct care nurse involvement in identifying solutions.
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Affiliation(s)
- Linda Connor
- The Ohio State University College of Nursing, Columbus, OH, USA
- Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing & Healthcare, The Ohio State University College of Nursing, Columbus, OH, USA
| | - Inga M Zadvinskis
- Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing & Healthcare, The Ohio State University College of Nursing, Columbus, OH, USA
| | - Haley Roberts
- Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing & Healthcare, The Ohio State University College of Nursing, Columbus, OH, USA
| | - Bernadette Mazurek Melnyk
- Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing & Healthcare, The Ohio State University College of Nursing, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
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13
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Cabilan CJ, McRae J, Ganzon K, Appo C, Rogers S, O'Sullivan M, Eley R, Snoswell C, Johnston A. Introducing a Digital Occupational Violence Risk Assessment Tool Into an Emergency Department: A Pilot Implementation Study. J Emerg Nurs 2023; 49:360-370. [PMID: 36872199 DOI: 10.1016/j.jen.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION Occupational violence in emergency departments is prevalent and detrimental to staff and health services. There is an urgent call for solutions; accordingly, this study describes the implementation and early impacts of the digital Queensland Occupational Violence Patient Risk Assessment Tool (kwov-pro). METHODS Since December 7, 2021, emergency nurses have been using the Queensland Occupational Violence Patient Risk Assessment Tool to assess 3 occupational violence risk factors in patients: aggression history, behaviors, and clinical presentation. Violence risk then is categorized as low (0 risk factors), moderate (1 risk factor), or high (2-3 risk factors). An important feature of this digital innovation is the alert and flagging system for high-risk patients. Underpinned by the Implementation Strategies for Evidence-Based Practice Guide, from November 2021 to March 2022 we progressively mobilized a range of strategies, including e-learning, implementation drivers, and regular communications. Early impacts measured were the percentage of nurses who completed their e-learning, the proportion of patients assessed using the Queensland Occupational Violence Patient Risk Assessment Tool, and the number of reported violent incidents in the emergency department. RESULTS Overall, 149 of 195 (76%) of emergency nurses completed their e-learning. Further, adherence to Queensland Occupational Violence Patient Risk Assessment Tool was good, with 65% of patients assessed for risk of violence at least once. Since implementing the Queensland Occupational Violence Patient Risk Assessment Tool, there has been a progressive decrease in violent incidents reported in the emergency department. DISCUSSION Using a combination of strategies, the Queensland Occupational Violence Patient Risk Assessment Tool was successfully implemented in the emergency department with the indication that it could reduce the number of incidents of occupational violence. The work herein provides a foundation for future translation and robust evaluation of the Queensland Occupational Violence Patient Risk Assessment Tool in emergency departments.
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14
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Marsden DL, Boyle K, Birnie J, Buzio A, Dizon J, Dunne J, Greensill S, Hill K, Lever S, Minett F, Ormond S, Shipp J, Steel J, Styles A, Wiggers J, Cadilhac DAM, Duff J. Improving Practice for Urinary Continence Care on Adult Acute Medical and Rehabilitation Wards: A Multi-Site, Co-Created Implementation Study. Healthcare (Basel) 2023; 11:healthcare11091241. [PMID: 37174783 PMCID: PMC10178438 DOI: 10.3390/healthcare11091241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
Many adult inpatients experience urinary continence issues; however, we lack evidence on effective interventions for inpatient continence care. We conducted a before and after implementation study. We implemented our guideline-based intervention using strategies targeting identified barriers and evaluated the impact on urinary continence care provided by inpatient clinicians. Fifteen wards (acute = 3, rehabilitation = 7, acute and rehabilitation = 5) at 12 hospitals (metropolitan = 4, regional = 8) participated. We screened 2298 consecutive adult medical records for evidence of urinary continence symptoms over three 3-month periods: before implementation (T0: n = 849), after the 6-month implementation period (T1: n = 740), and after a 6-month maintenance period (T2: n = 709). The records of symptomatic inpatients were audited for continence assessment, diagnosis, and management plans. All wards contributed data at T0, and 11/15 wards contributed at T1 and T2 (dropouts due to COVID-19). Approximately 26% of stroke, 33% acute medical, and 50% of rehabilitation inpatients were symptomatic. The proportions of symptomatic patients (T0: n = 283, T1: n = 241, T2: n = 256) receiving recommended care were: assessment T0 = 38%, T1 = 63%, T2 = 68%; diagnosis T0 = 30%, T1 = 70%, T2 = 71%; management plan T0 = 7%, T1 = 24%, T2 = 24%. Overall, there were 4-fold increased odds for receiving assessments and management plans and 6-fold greater odds for diagnosis. These improvements were sustained at T2. This intervention has improved inpatient continence care.
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Affiliation(s)
- Dianne Lesley Marsden
- Hunter Stroke Service, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Kerry Boyle
- Hunter Stroke Service, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Belmont Hospital, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
| | - Jaclyn Birnie
- Armidale Hospital, Hunter New England Local Health District, Armidale, NSW 2350, Australia
| | - Amanda Buzio
- Coffs Harbour Health Campus, Mid North Coast Local Health District, Coffs Harbour, NSW 2450, Australia
| | - Joshua Dizon
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Judith Dunne
- Rankin Park Centre, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
- John Hunter Hospital, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
| | - Sandra Greensill
- Rockhampton Hospital, Central Queensland Hospital and Health Service, Rockhampton, QLD 4700, Australia
| | - Kelvin Hill
- Stroke Foundation, Melbourne, VIC 3000, Australia
| | - Sandra Lever
- Ryde Hospital, Northern Sydney Local Health District, Eastwood, NSW 2122, Australia
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW 2006, Australia
| | - Fiona Minett
- Manning Hospital, Hunter New England Local Health District, Taree, NSW 2430, Australia
- Wingham Hospital, Hunter New England Local Health District, Wingham, NSW 2429, Australia
| | - Sally Ormond
- Hunter Stroke Service, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
- Calvary Mater Newcastle, Waratah, NSW 2298, Australia
| | - Jodi Shipp
- Rankin Park Centre, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
- John Hunter Hospital, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
| | - Jennifer Steel
- Port Macquarie Hospital, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia
| | - Amanda Styles
- Armidale Hospital, Hunter New England Local Health District, Armidale, NSW 2350, Australia
- Tamworth Hospital, Hunter New England Local Health District, Tamworth, NSW 2340, Australia
| | - John Wiggers
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Health Research and Translation, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
| | - Dominique Ann-Michele Cadilhac
- Stroke and Ageing Research, Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences at Monash Health, Clayton, VIC 3168, Australia
| | - Jed Duff
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4001, Australia
- Royal Brisbane and Womens Hospital, Queensland Health, Brisbane, QLD 4029, Australia
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15
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Mpasa F, van Rooyen DRM, Jordan PJ, Venter D, ten Ham-Baloyi W. Malawian critical care nurses' views on the implementation of an educational intervention to enhance sustained use of an evidence-based endotracheal tube cuff pressure management guideline: A survey study. SOUTHERN AFRICAN JOURNAL OF CRITICAL CARE 2023; 39:10.7196/SAJCC.2023.v39i1.550. [PMID: 37521961 PMCID: PMC10378196 DOI: 10.7196/sajcc.2023.v39i1.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 02/09/2023] [Indexed: 08/01/2023] Open
Abstract
Background Evidence-based guidelines can assist critical care nurses in promoting best practices, including those related to endotracheal tube cuff pressure management. However, these guidelines require tailored strategies to enhance their implementation, uptake, and sustained use in practice. Objectives To evaluate Malawian critical care nurses' views on the implementation of an endotracheal tube cuff pressure management guideline to enhance sustained guideline use. Methods An explorative-descriptive survey design was employed, using a questionnaire with closed- and open-ended questions that was distributed after implementation of an educational intervention based on an endotracheal tube cuff pressure management guideline. The questionnaire had a Cronbach's alpha score of 0.85. Results A total of 47 nurses working in four public and two private hospital intensive care units in Malawi participated. Quantitative findings showed that the majority of the participants (92%) indicated that the strategies used for the group that received the full intervention including both active (monitoring visits) and passive (a half-day educational session using a PowerPoint presentation, and a printed guideline and algorithm) strategies (intervention 1 group) were useful, clear and applicable and enhanced implementation of the guideline. These results were statistically significant (mean (standard deviation) 1.86 (0.84); t=6.07; p<0.0005). Qualitative data revealed three major themes related to recommendations for uptake and sustained use of the guideline in nursing practice: the guideline needs to be translated, updated, and made available to ICU staff; implementation strategies (continuous supervision and follow-up); and facilitating factors for successful implementation (education and training on guideline content, resources, and commitment to best practices). Conclusion The study highlighted that although the implementation strategies used were positively received by participants, they need to be further tailored to their context to enhance guideline uptake and sustained use in practice. Further study is required to ensure that tailored implementation strategies facilitate guideline uptake and sustained use, specifically in resource-constrained contexts. Contributions of the study The study findings can be used by nurses and academics when developing educational interventions for critical care units to enhance implementation of guidelines in this context.
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Affiliation(s)
- F Mpasa
- Lecturer, Department of Nursing and Midwifery Science, Faculty of Health Sciences, Mzuzu University, Luwinga, Malawi; Former PhD candidate,
Department of Nursing Science, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
| | - Dalena R M van Rooyen
- Deputy Dean, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
| | - P J Jordan
- Associate Professor and Head, Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town,
South Africa
| | - D Venter
- Consultant Statistician, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
| | - W ten Ham-Baloyi
- Research Associate, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
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16
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Bora AM, Piechotta V, Kreuzberger N, Monsef I, Wender A, Follmann M, Nothacker M, Skoetz N. The effectiveness of clinical guideline implementation strategies in oncology-a systematic review. BMC Health Serv Res 2023; 23:347. [PMID: 37024867 PMCID: PMC10080872 DOI: 10.1186/s12913-023-09189-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/15/2023] [Indexed: 04/08/2023] Open
Abstract
IMPORTANCE Guideline recommendations do not necessarily translate into changes in clinical practice behaviour or better patient outcomes. OBJECTIVE This systematic review aims to identify recent clinical guideline implementation strategies in oncology and to determine their effect primarily on patient-relevant outcomes and secondarily on healthcare professionals' adherence. METHODS A systematic search of five electronic databases (PubMed, Web of Science, GIN, CENTRAL, CINAHL) was conducted on 16 december 2022. Randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) assessing the effectiveness of guideline implementation strategies on patient-relevant outcomes (overall survival, quality of life, adverse events) and healthcare professionals' adherence outcomes (screening, referral, prescribing, attitudes, knowledge) in the oncological setting were targeted. The Cochrane risk-of-bias tool and the ROBINS-I tool were used for assessing the risk of bias. Certainty in the evidence was evaluated according to GRADE recommendations. This review was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the identification number CRD42021268593. FINDINGS Of 1326 records identified, nine studies, five cluster RCTs and four controlled before-and after studies, were included in the narrative synthesis. All nine studies assess the effect of multi-component interventions in 3577 cancer patients and more than 450 oncologists, nurses and medical staff. PATIENT-LEVEL Educational meetings combined with materials, opinion leaders, audit and feedback, a tailored intervention or academic detailing may have little to no effect on overall survival, quality of life and adverse events of cancer patients compared to no intervention, however, the evidence is either uncertain or very uncertain. PROVIDER-LEVEL Multi-component interventions may increase or slightly increase guideline adherence regarding screening, referral and prescribing behaviour of healthcare professionals according to guidelines, but the certainty in evidence is low. The interventions may have little to no effect on attitudes and knowledge of healthcare professionals, still, the evidence is very uncertain. CONCLUSIONS AND RELEVANCE Knowledge and skill accumulation through team-oriented or online educational training and dissemination of materials embedded in multi-component interventions seem to be the most frequently researched guideline implementation strategies in oncology recently. This systematic review provides an overview of recent guideline implementation strategies in oncology, encourages future implementation research in this area and informs policymakers and professional organisations on the development and adoption of implementation strategies.
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Affiliation(s)
- Ana-Mihaela Bora
- Evidence-Based Medicine, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Vanessa Piechotta
- Evidence-Based Medicine, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nina Kreuzberger
- Evidence-Based Medicine, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ina Monsef
- Evidence-Based Medicine, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Andreas Wender
- Evidence-Based Medicine, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Monika Nothacker
- Institute for Medical Knowledge Management, Association of the Scientific Medical Societies in Germany, C/O Faculty of Medicine, Philipps University Marburg, Marburg, Germany
| | - Nicole Skoetz
- Evidence-Based Medicine, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Shin HD, Durocher K, Sequeira L, Zaheer J, Torous J, Strudwick G. Information and communication technology-based interventions for suicide prevention implemented in clinical settings: a scoping review. BMC Health Serv Res 2023; 23:281. [PMID: 36959599 PMCID: PMC10037806 DOI: 10.1186/s12913-023-09254-5] [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: 07/29/2022] [Accepted: 03/07/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND A large number of information and communication technology (ICT) based interventions exist for suicide prevention. However, not much is known about which of these ICTs are implemented in clinical settings and their implementation characteristics. In response, this scoping review aimed to systematically explore the breadth of evidence on ICT-based interventions for suicide prevention implemented in clinical settings and then to identify and characterize implementation barriers and facilitators, as well as evaluation outcomes, and measures. METHODS We conducted this review following the Joanna Briggs Institute methodology for scoping reviews. A search strategy was applied to the following six databases between August 17-20, 2021: MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Library, Information Science and Technology Abstracts. We also supplemented our search with Google searches and hand-searching reference lists of relevant reviews. To be included in this review, studies must include ICT-based interventions for any spectrum of suicide-related thoughts and behaviours including non-suicidal self-injury. Additionally, these ICTs must be implemented in clinical settings, such as emergency department and in-patient units. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist to prepare this full report. RESULTS This review included a total of 75 citations, describing 70 studies and 66 ICT-based interventions for suicide prevention implemented in clinical settings. The majority of ICTs were computerized interventions and/or applications (n = 55). These ICTs were commonly used as indicated strategies (n = 49) targeting patients who were actively presenting with suicide risk. The three most common suicide prevention intervention categories identified were post-discharge follow-up (n = 27), screening and/or assessment (n = 22), and safety planning (n = 20). A paucity of reported information was identified related to implementation strategies, barriers and facilitators. The most reported implementation strategies included training, education, and collaborative initiatives. Barriers and facilitators of implementation included the need for resource supports, knowledge, skills, motivation as well as engagement with clinicians with research teams. Studies included outcomes at patient, clinician, and health system levels, and implementation outcomes included acceptability, feasibility, fidelity, and penetration. CONCLUSION This review presents several trends of the ICT-based interventions for suicide prevention implemented in clinical settings and identifies a need for future research to strengthen the evidence base for improving implementation. More effort is required to better understand and support the implementation and sustainability of ICTs in clinical settings. The findings can also serve as a future resource for researchers seeking to evaluate the impact and implementation of ICTs.
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Affiliation(s)
- Hwayeon Danielle Shin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Keri Durocher
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
- School of Health, Community Service & Creative Design, Lambton College, Sarnia, Ontario, Canada
| | - Lydia Sequeira
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Juveria Zaheer
- Health Outcomes and Performance Evaluation (HOPE) Research Unit, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Gerald Sheff and Shanitha Kachan Emergency Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Gillian Strudwick
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Wayop IYA, de Vet E, Wagenaar JA, Speksnijder DC. Why Veterinarians (Do Not) Adhere to the Clinical Practice Streptococcus suis in Weaned Pigs Guideline: A Qualitative Study. Antibiotics (Basel) 2023; 12:antibiotics12020320. [PMID: 36830232 PMCID: PMC9952329 DOI: 10.3390/antibiotics12020320] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
The Netherlands has been very successful in the last decade in reducing antimicrobial use in animals. On about a quarter of farms, antimicrobial use in weaned pigs remains relatively high. As Streptococcus suis (S. suis) infections are responsible for a high consumption of antimicrobials, a specific veterinary guideline to control S. suis was developed, but seemed to be poorly adopted by veterinarians. Guided by the theoretical domains framework, the aim of this study was to identify determinants influencing veterinarians' adherence to this guideline. We interviewed 13 pig veterinarians. Interviewees described multiple approaches to managing S. suis problems and adherence to the guideline. Mentioned determinants could be categorized into 12 theoretical domains. The following six domains were mentioned in all interviews: knowledge, skills, beliefs about capabilities, beliefs about consequences, social influences, and environmental context and resources. The insights derived from this study are relevant for understanding factors influencing veterinarians' adoption of scientific evidence and guidelines and can be used to develop evidence-based implementation strategies for veterinary guidelines.
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Affiliation(s)
- Isaura Y. A. Wayop
- Department Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL Utrecht, The Netherlands
| | - Emely de Vet
- Consumption and Healthy Lifestyles Group, Wageningen University and Research, 6700 EW Wageningen, The Netherlands
| | - Jaap A. Wagenaar
- Department Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL Utrecht, The Netherlands
- Wageningen Bioveterinary Research, Houtribweg 39, 8221 RA Lelystad, The Netherlands
| | - David C. Speksnijder
- Department Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL Utrecht, The Netherlands
- University Farm Animal Clinic ULP, Reijerscopse Overgang 1, 3481 LZ Harmelen, The Netherlands
- Correspondence:
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Albasha N, Ahern L, O’Mahony L, McCullagh R, Cornally N, McHugh S, Timmons S. Implementation strategies to support fall prevention interventions in long-term care facilities for older persons: a systematic review. BMC Geriatr 2023; 23:47. [PMID: 36698065 PMCID: PMC9878796 DOI: 10.1186/s12877-023-03738-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Falls are common among older people in long-term care facilities (LTCFs). Falls cause considerable morbidity, mortality and reduced quality of life. Of numerous interventional studies of fall prevention interventions in LTCFs, some reduced falls. However, there are challenges to implementing these interventions in real-world (non-trial) clinical practice, and the implementation techniques may be crucial to successful translation. This systematic review thus aimed to synthesise the evidence on implementation strategies, implementation outcomes and clinical outcomes included in fall prevention intervention studies. METHODS A systematic search of six electronic databases (PubMed, CINAHL, EMBASE, PsycINFO, SCOPUS, Web of Science) and eight grey literature databases was conducted, involving papers published during 2001-2021, in English or Arabic, targeting original empirical studies of fall prevention interventions (experimental and quasi-experimental). Two seminal implementation frameworks guided the categorisation of implementation strategies and outcomes: the Expert Recommendations for Implementing Change (ERIC) Taxonomy and the Implementation Outcomes Framework. Four ERIC sub-categories and three additional implementation strategies were created to clarify overlapping definitions and reflect the implementation approach. Two independent researchers completed title/abstract and full-text screening, quality appraisal assessment, data abstraction and coding of the implementation strategies and outcomes. A narrative synthesis was performed to analyse results. RESULTS Four thousand three hundred ninety-seven potential papers were identified; 31 papers were included, describing 27 different fall prevention studies. These studies used 39 implementation strategies (3-17 per study). Educational and training strategies were used in almost all (n = 26), followed by evaluative strategies (n = 20) and developing stakeholders' interrelationships (n = 20). Within educational and training strategies, education outreach/meetings (n = 17), distributing educational materials (n = 17) and developing educational materials (n = 13) were the most common, with 36 strategies coded to the ERIC taxonomy. Three strategies were added to allow coding of once-off training, dynamic education and ongoing medical consultation. Among the 15 studies reporting implementation outcomes, fidelity was the most common (n = 8). CONCLUSION This is the first study to comprehensively identify the implementation strategies used in falls prevention interventions in LTCFs. Education is the most common implementation strategy used in this setting. This review highlighted that there was poor reporting of the implementation strategies, limited assessment of implementation outcomes, and there was no discernible pattern of implementation strategies used in effective interventions, which should be improved and clearly defined. TRIAL REGISTRATION This systematic review was registered on the PROSPERO database; registration number: CRD42021239604.
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Affiliation(s)
- Neah Albasha
- grid.7872.a0000000123318773Center for Gerontology and Rehabilitation, School of Medicine, University College Cork, St Finbarr’s Hospital, The Bungalow, Block 13, Douglas Road, Cork City, Ireland ,grid.449346.80000 0004 0501 7602Rehabilitation Department, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Leanne Ahern
- grid.7872.a0000000123318773School of Clinical Therapies, University College Cork, Cork City, Ireland
| | - Lauren O’Mahony
- grid.7872.a0000000123318773Center for Gerontology and Rehabilitation, School of Medicine, University College Cork, St Finbarr’s Hospital, The Bungalow, Block 13, Douglas Road, Cork City, Ireland
| | - Ruth McCullagh
- grid.7872.a0000000123318773School of Clinical Therapies, University College Cork, Cork City, Ireland
| | - Nicola Cornally
- grid.7872.a0000000123318773School of Nursing and Midwifery, University College Cork, Cork City, Ireland
| | - Sheena McHugh
- grid.7872.a0000000123318773School of Public Health, University College Cork, Cork City, Ireland
| | - Suzanne Timmons
- grid.7872.a0000000123318773Center for Gerontology and Rehabilitation, School of Medicine, University College Cork, St Finbarr’s Hospital, The Bungalow, Block 13, Douglas Road, Cork City, Ireland
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Peters S, Sukumar K, Blanchard S, Ramasamy A, Malinowski J, Ginex P, Senerth E, Corremans M, Munn Z, Kredo T, Remon LP, Ngeh E, Kalman L, Alhabib S, Amer YS, Gagliardi A. Trends in guideline implementation: an updated scoping review. Implement Sci 2022; 17:50. [PMID: 35870974 PMCID: PMC9308215 DOI: 10.1186/s13012-022-01223-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background Guidelines aim to support evidence-informed practice but are inconsistently used without implementation strategies. Our prior scoping review revealed that guideline implementation interventions were not selected and tailored based on processes known to enhance guideline uptake and impact. The purpose of this study was to update the prior scoping review. Methods We searched MEDLINE, EMBASE, AMED, CINAHL, Scopus, and the Cochrane Database of Systematic Reviews for studies published from 2014 to January 2021 that evaluated guideline implementation interventions. We screened studies in triplicate and extracted data in duplicate. We reported study and intervention characteristics and studies that achieved impact with summary statistics. Results We included 118 studies that implemented guidelines on 16 clinical topics. With regard to implementation planning, 21% of studies referred to theories or frameworks, 50% pre-identified implementation barriers, and 36% engaged stakeholders in selecting or tailoring interventions. Studies that employed frameworks (n=25) most often used the theoretical domains framework (28%) or social cognitive theory (28%). Those that pre-identified barriers (n=59) most often consulted literature (60%). Those that engaged stakeholders (n=42) most often consulted healthcare professionals (79%). Common interventions included educating professionals about guidelines (44%) and information systems/technology (41%). Most studies employed multi-faceted interventions (75%). A total of 97 (82%) studies achieved impact (improvements in one or more reported outcomes) including 10 (40% of 25) studies that employed frameworks, 28 (47.45% of 59) studies that pre-identified barriers, 22 (52.38% of 42) studies that engaged stakeholders, and 21 (70% of 30) studies that employed single interventions. Conclusions Compared to our prior review, this review found that more studies used processes to select and tailor interventions, and a wider array of types of interventions across the Mazza taxonomy. Given that most studies achieved impact, this might reinforce the need for implementation planning. However, even studies that did not plan implementation achieved impact. Similarly, even single interventions achieved impact. Thus, a future systematic review based on this data is warranted to establish if the use of frameworks, barrier identification, stakeholder engagement, and multi-faceted interventions are associated with impact. Trial registration The protocol was registered with Open Science Framework (https://osf.io/4nxpr) and published in JBI Evidence Synthesis. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01223-6.
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Salma I, Waelli M. Mapping research findings on change implementation in nursing practice: A scoping literature review. Nurs Open 2022; 10:450-468. [PMID: 36112719 PMCID: PMC9834520 DOI: 10.1002/nop2.1369] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/20/2022] [Accepted: 08/30/2022] [Indexed: 01/16/2023] Open
Abstract
AIMS The aim of this study was to map the diverse factors impacting change implementation in nursing practices and investigate different implementation strategies. DESIGN Scoping literature review following PRISMA-ScR extension. METHODS Data were collected from PubMed, Ebsco, Scopus and ScienceDirect databases from 1990 onwards. Only English peer-reviewed studies reporting an implementation of change in nursing practice were included. Of 9,954 studies, 425 abstracts were scanned and 98 full-text articles were screened. Finally, 28 studies were selected. RESULTS A multifaceted approach, with a tailored intervention, was the most effective implementation strategy. Most identified factors were considered systematic, for example resource availability, leadership and knowledge. However, others related to local social and material context were identified in fewer number of studies. These seem to be operational elements for implementation processes. Both types of factors are essential and must be considered for successful implementation. CONCLUSION We advocate the development of framework including systematic factors and which capture the local context flexibility.
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Affiliation(s)
- Israa Salma
- École des Hautes Etudes en Santé PubliqueInserm U 1309‐RSMS, CNRS UMR 6051 ‐ ARENESRennesFrance
| | - Mathias Waelli
- École des Hautes Etudes en Santé PubliqueInserm U 1309‐RSMS, CNRS UMR 6051 ‐ ARENESRennesFrance,Global Health InstituteGeneva UniversityGeneveSwitzerland
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Thürlimann E, Verweij L, Naef R. The Implementation of Evidence-Informed Family Nursing Practices: A Scoping Review of Strategies, Contextual Determinants, and Outcomes. JOURNAL OF FAMILY NURSING 2022; 28:258-276. [PMID: 35707895 PMCID: PMC9280703 DOI: 10.1177/10748407221099655] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
There is a lack of knowledge about the successful implementation of family nursing practices. This scoping review maps current knowledge about the implementation of evidence-informed family nursing practices across settings and populations. A systematic search (CINAHL, PubMed, Medline) identified 24 publications, published between 2010 and 2020. We found nurses' implementation experience to be one of disruption, learning, and moving to new ways of practicing. The implementation resulted in benefits to families and self but was marked by fluctuation and partial integration of evidence-informed family nursing practices into care delivery. Uptake was shaped by various contextual determinants, with barriers mainly at the team and organizational levels. We identified low-quality, tentative evidence that capacity-building strategies coupled with dissemination-educational strategies may enable family nursing practice skills and increase the quality of family care. More rigorous research is needed to build further knowledge about effective implementation. Future implementation endeavors should utilize the evolving knowledge base in family nursing and tailor implementation strategies to contextual barriers.
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Affiliation(s)
- Eva Thürlimann
- University of Zurich, Institute for Implementation Science in Health Care, Switzerland
| | - Lotte Verweij
- University of Zurich, Institute for Implementation Science in Health Care, Switzerland
- University Hospital Zurich, Center of Clinical Nursing Science, Switzerland
| | - Rahel Naef
- University of Zurich, Institute for Implementation Science in Health Care, Switzerland
- University Hospital Zurich, Center of Clinical Nursing Science, Switzerland
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Scheffler B, Schimböck F, Schöler A, Rösner K, Spallek J, Kopkow C. Tailored GuideLine Implementation in STrokE Rehabilitation (GLISTER) in Germany. Protocol of a Mixed Methods Study Using the Behavior Change Wheel and the Theoretical Domains Framework. Front Neurol 2022; 13:828521. [PMID: 35968277 PMCID: PMC9363877 DOI: 10.3389/fneur.2022.828521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Evidence-based guidelines are important for informing clinical decision-making and improving patient outcomes. There is inconsistent usage of guidelines among physical therapists involved in stroke rehabilitation, suggesting the existence of a gap between theory and practice. Addressing the German guideline "evidence-based rehabilitation of mobility after stroke (ReMoS)," the aims of this project are (1) to describe the current physical therapy practice within the context of stroke rehabilitation in Germany, (2) to evaluate barriers and facilitators of guideline usage, (3) to develop, and (4) to pilot test a theory-based, tailored implementation intervention for the benefit of guideline recommendations. Materials and Methods This study uses a stepwise mixed methods approach for implementing a local guideline. A self-reported online questionnaire will be used to survey the current physical therapy practice in stroke rehabilitation. The same survey and systematic-mixed methods review will be used to evaluate the barriers and facilitators of guideline usage quantitatively. Semi-structured interviews will add a qualitative perspective on factors that influence ReMoS guideline implementation. The Behavior Change Wheel and Theoretical Domains Framework will be used to support the development of a tailored implementation intervention which will be pilot tested in a controlled study. Patient and physical therapy-related outcomes, as well as the appropriateness, such as acceptance and feasibility of the tailored implementation intervention, will be analyzed. Conclusion This will be the first endeavor to implement a guideline in German stroke rehabilitation with a focus on changing care provider behavior based on the knowledge of current practice and determining factors using a tailored and theory-based intervention.
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Affiliation(s)
- Bettina Scheffler
- Department of Therapy Sciences I, Brandenburg University of Technology Cottbus—Senftenberg, Senftenberg, Germany
| | - Florian Schimböck
- Department of Nursing Sciences and Clinical Nursing, Brandenburg University of Technology Cottbus—Senftenberg, Senftenberg, Germany
| | - Almut Schöler
- Department of Therapy Sciences I, Brandenburg University of Technology Cottbus—Senftenberg, Senftenberg, Germany
| | - Katrin Rösner
- Department of Health Sciences, University of Lübeck, Lübeck, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology Cottbus—Senftenberg, Senftenberg, Germany
| | - Christian Kopkow
- Department of Therapy Sciences I, Brandenburg University of Technology Cottbus—Senftenberg, Senftenberg, Germany
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Breneol S, Curran JA, Marten R, Minocha K, Johnson C, Wong H, Langlois EV, Wozney L, Vélez CM, Cassidy C, Juvekar S, Rothfus M, Aziato L, Keeping-Burke L, Adjorlolo S, Patiño-Lugo DF. Strategies to adapt and implement health system guidelines and recommendations: a scoping review. Health Res Policy Syst 2022; 20:64. [PMID: 35706039 PMCID: PMC9202131 DOI: 10.1186/s12961-022-00865-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/09/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Evidence-based health system guidelines are pivotal tools to help outline the important financial, policy and service components recommended to achieve a sustainable and resilient health system. However, not all guidelines are readily translatable into practice and/or policy without effective and tailored implementation and adaptation techniques. This scoping review mapped the evidence related to the adaptation and implementation of health system guidelines in low- and middle-income countries. METHODS We conducted a scoping review following the Joanna Briggs Institute methodology for scoping reviews. A search strategy was implemented in MEDLINE (Ovid), Embase, CINAHL, LILACS (VHL Regional Portal), and Web of Science databases in late August 2020. We also searched sources of grey literature and reference lists of potentially relevant reviews. All findings were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. RESULTS A total of 41 studies were included in the final set of papers. Common strategies were identified for adapting and implementing health system guidelines, related barriers and enablers, and indicators of success. The most common types of implementation strategies included education, clinical supervision, training and the formation of advisory groups. A paucity of reported information was also identified related to adaptation initiatives. Barriers to and enablers of implementation and adaptation were reported across studies, including the need for financial sustainability. Common approaches to evaluation were identified and included outcomes of interest at both the patient and health system level. CONCLUSIONS The findings from this review suggest several themes in the literature and identify a need for future research to strengthen the evidence base for improving the implementation and adaptation of health system guidelines in low- and middle-income countries. The findings can serve as a future resource for researchers seeking to evaluate implementation and adaptation of health system guidelines. Our findings also suggest that more effort may be required across research, policy and practice sectors to support the adaptation and implementation of health system guidelines to local contexts and health system arrangements in low- and middle-income countries.
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Affiliation(s)
- Sydney Breneol
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
- Strengthening Transitions in Care Lab, IWK Health Centre, 8th Floor Children's Site, 5850/5980 University Ave, Halifax, NS, B3K 6R8, Canada
| | - Janet A Curran
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada.
- Strengthening Transitions in Care Lab, IWK Health Centre, 8th Floor Children's Site, 5850/5980 University Ave, Halifax, NS, B3K 6R8, Canada.
| | - Robert Marten
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Kirti Minocha
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Catie Johnson
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
- Strengthening Transitions in Care Lab, IWK Health Centre, 8th Floor Children's Site, 5850/5980 University Ave, Halifax, NS, B3K 6R8, Canada
| | - Helen Wong
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
- Faculty of Health, Dalhousie University, Halifax, Canada
| | - Etienne V Langlois
- Partnership for Maternal, Newborn & Child Health (PMNCH), World Health Organization, Geneva, Switzerland
| | - Lori Wozney
- Nova Scotia Health Authority Policy and Planning, Dartmouth, Canada
| | - C Marcela Vélez
- Facultad de Medicina, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Christine Cassidy
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
- Strengthening Transitions in Care Lab, IWK Health Centre, 8th Floor Children's Site, 5850/5980 University Ave, Halifax, NS, B3K 6R8, Canada
| | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Melissa Rothfus
- W.K. Kellogg Health Science Library, Dalhousie University, Halifax, Canada
| | - Lydia Aziato
- School of Nursing and Midwifery, University of Ghana, Legon, Accra, Ghana
| | - Lisa Keeping-Burke
- Department of Nursing & Health Sciences, University of New Brunswick, St. John, Canada
| | - Samuel Adjorlolo
- Department of Mental Health Nursing, University of Ghana, Legon, Accra, Ghana
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Parmar J, Sacrey LA, Anderson S, Charles L, Dobbs B, McGhan G, Shapkin K, Tian P, Triscott J. Facilitators, barriers and considerations for the implementation of healthcare innovation: A qualitative rapid systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:856-868. [PMID: 34558143 DOI: 10.1111/hsc.13578] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 06/13/2023]
Abstract
Family caregiving scholars recommend that health providers receive competency-based education to partner with and support family caregivers to care and to maintain their own health. While it may be relatively easy to develop competency-based education for healthcare providers, ensuring widespread uptake and spread and scale of healthcare education is critical to ensuring consistent person-centered support for all family caregivers (FCGs) throughout the care trajectory. The development of novel healthcare innovations requires implementation strategies for uptake and spread, with implementation involving the use of strategies to integrate a novel innovation into healthcare. Research suggests that there are many factors involved in successful implementation and a synthesis of potential factors is warranted. The purpose of this review is to provide an in-depth examination of facilitators, barriers and considerations for implementation of a novel healthcare innovation that will be used to develop an implementation plan for spread and scale of our competency-based education for health providers to learn about person-centered care for FCGs. A systematic review of published and grey literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA [Moher et al., 2015]) guidelines. The systematic review involved searching four databases for original research articles that described barriers, facilitators and/or other considerations when implementing innovations. Twenty-eight articles were included in the qualitative thematic analyses and described three areas of implementation research: barriers, facilitators and recommendations. There were major and parallel themes that emerged under facilitators and barriers. There were a wide variety of strategies that were identified as recommendations. The findings were synthesised into five considerations for implementation: Research and information sharing, intentional implementation planning, organisational underpinnings, creating the clinical context and facilitative training. This review provides an integrative overview of identified facilitators, barriers and recommendations for implementation that may aid in developing implementation strategies that can be tailored to the local context or innovation being implemented.
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Affiliation(s)
- Jasneet Parmar
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
- Edmonton Zone Home Living, Alberta Health Services, Edmonton, Alberta, Canada
| | - Lori Ann Sacrey
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Sharon Anderson
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Lesley Charles
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Bonnie Dobbs
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Gwen McGhan
- Faculty of Nursing, University of Calgary, Alberta, Canada
| | | | - Peter Tian
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jean Triscott
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
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Teggart K, Bryant-Lukosius D, Neil-Sztramko SE, Ganann R. Implementation strategies to address barriers to evidence-informed symptom management among outpatient oncology nurses: a scoping review protocol. BMJ Open 2022; 12:e057661. [PMID: 35487756 PMCID: PMC9058794 DOI: 10.1136/bmjopen-2021-057661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Despite the availability of clinical practice guidelines for cancer symptom management, cancer care providers do not consistently use them in practice. Oncology nurses in outpatient settings are well positioned to use established guidelines to inform symptom assessment and management; however, issues concerning inconsistent implementation persist. This scoping review aims to (1) identify reported barriers and facilitators influencing symptom management guideline adoption, implementation and sustainability among specialised and advanced oncology nurses in cancer-specific outpatient settings and (2) identify and describe the components of strategies that have been used to enhance the implementation of symptom management guidelines. METHODS AND ANALYSIS This scoping review will follow Joanna Briggs Institute methodology. Electronic databases CINAHL, Embase, Emcare and MEDLINE(R) and grey literature sources will be searched for studies published in English from January 2000 to March 2022. Primary studies and grey literature reports of any design that include specialised or advanced oncology nurses practicing in cancer-specific outpatient settings will be eligible. Sources describing factors influencing the adoption, implementation and sustainability of cancer symptom management guidelines and/or strategies to enhance guideline implementation will be included. Two reviewers will independently screen for eligibility and extract data. Data extraction of factors influencing implementation will be guided by the Consolidated Framework for Implementation Research (CFIR), and the seven dimensions of implementation strategies (ie, actors, actions, targets, temporality, dose, justifications and outcomes) will be used to extract implementation strategy components. Factors influencing implementation will be analysed descriptively, synthesised according to CFIR constructs and linked to the Expert Recommendations for Implementating Change strategies. Results will be presented through tabular/diagrammatic formats and narrative summary. ETHICS AND DISSEMINATION Ethics approval is not required for this scoping review. Planned knowledge translation activities include a national conference presentation, peer-reviewed publication, academic social media channels and dissemination within local oncology nursing and patient networks.
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Affiliation(s)
- Kylie Teggart
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Denise Bryant-Lukosius
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Sarah E Neil-Sztramko
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca Ganann
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
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Buckley C, Hartigan I, Coffey A, Cornally N, O'Connell S, O'Loughlin C, Timmons S, Lehane E. Evaluating the use of participatory action research to implement evidence-based guidance on dementia palliative care in long-term care settings: A creative hermeneutic analysis. Int J Older People Nurs 2022; 17:e12460. [PMID: 35362252 PMCID: PMC9539682 DOI: 10.1111/opn.12460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 01/21/2022] [Accepted: 03/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dementia affects a large proportion of society and places a significant burden on older people and healthcare systems internationally. Managing symptoms at the end of life for people with dementia is complex. Participatory action research can offer an approach that helps to encourage implementation of evidence-based practices in long-term care settings. METHODS Three evidence-based guidance documents (pain assessment and management, medication management, nutrition and hydration management) were introduced in three long-term care settings for older people. Data generated from work-based learning groups were analysed using a critical hermeneutic approach to explore the use of participatory action research to support the implementation of guidance documents in these settings. RESULTS Engagement and Facilitation emerged as key factors which both enabled and hindered the PAR processes at each study site. CONCLUSIONS This study adds to the body of knowledge that emphasises the value of participatory action research in enabling practice change. It further identifies key practice development approaches that are necessary to enable a PAR approach to occur in care settings for older people with dementia. The study highlights the need to ensure that dedicated attention is paid to strategies that facilitate key transformations in clinical practice.
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Affiliation(s)
- Catherine Buckley
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland.,Northridge House Education and Research Centre, St Luke's Nursing Home, Cork, Ireland
| | - Irene Hartigan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Alice Coffey
- Health Implementation Science and Technology Cluster, Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Nicola Cornally
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Selena O'Connell
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland.,Health Implementation Science and Technology Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Elaine Lehane
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Knapp AA, Carroll AJ, Mohanty N, Fu E, Powell BJ, Hamilton A, Burton ND, Coldren E, Hossain T, Limaye DP, Mendoza D, Sethi M, Padilla R, Price HE, Villamar JA, Jordan N, Langman CB, Smith JD. A stakeholder-driven method for selecting implementation strategies: a case example of pediatric hypertension clinical practice guideline implementation. Implement Sci Commun 2022; 3:25. [PMID: 35256017 PMCID: PMC8900435 DOI: 10.1186/s43058-022-00276-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/19/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND This article provides a generalizable method, rooted in co-design and stakeholder engagement, to identify, specify, and prioritize implementation strategies. To illustrate this method, we present a case example focused on identifying strategies to promote pediatric hypertension (pHTN) Clinical Practice Guideline (CPG) implementation in community health center-based primary care practices that involved meaningful engagement of pediatric clinicians, clinic staff, and patients/caregivers. This example was chosen based on the difficulty clinicians and organizations experience in implementing the pHTN CPG, as evidenced by low rates of guideline-adherent pHTN diagnosis and treatment. METHODS We convened a Stakeholder Advisory Panel (SAP), comprising 6 pediatricians and 5 academic partners, for 8 meetings (~12 h total) to rigorously identify determinants of pHTN CPG adherence and to ultimately develop a testable multilevel, multicomponent implementation strategy. Our approach expanded upon the Expert Recommendations for Implementation Change (ERIC) protocol by incorporating a modified Delphi approach, user-centered design methods, and the Implementation Research Logic Model (IRLM). At the recommendation of our SAP, we gathered further input from youth with or at-risk for pHTN and their caregivers, as well as clinic staff who would be responsible for carrying out facets of the implementation strategy. RESULTS First, the SAP identified 17 determinants, and 18 discrete strategies were prioritized for inclusion. The strategies primarily targeted determinants in the domains of intervention characteristics, inner setting, and characteristics of the implementers. Based on SAP ratings of strategy effectiveness, feasibility, and priority, three tiers of strategies emerged, with 7 strategies comprising the top tier implementation strategy package. Next, input from caregivers and clinic staff confirmed the feasibility and acceptability of the implementation strategies and provided further detail in the definition and specification of those strategies. CONCLUSIONS This method-an adaptation of the ERIC protocol-provided a pragmatic structure to work with stakeholders to efficiently identify implementation strategies, particularly when supplemented with user-centered design activities and the intuitive organizing framework of the IRLM. This generalizable method can help researchers identify and prioritize strategies that align with the implementation context with an increased likelihood of adoption and sustained use.
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Affiliation(s)
- Ashley A. Knapp
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Allison J. Carroll
- Department of Psychiatry and Behavioral Sciences and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Nivedita Mohanty
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
- Alliance Chicago, Chicago, IL USA
| | - Emily Fu
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Byron J. Powell
- Center for Mental Health Services Research, Brown School & School of Medicine, Washington University in St. Louis, St. Louis, MO USA
| | - Alison Hamilton
- VA Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
| | | | | | | | | | | | | | | | - Heather E. Price
- Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Juan A. Villamar
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL USA
| | - Craig B. Langman
- Ann & Robert H. Lurie Children’s Hospital of Chicago and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Justin D. Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT USA
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Zhao J, Bai W, Zhang Q, Su Y, Wang J, Du X, Zhou Y, Kong C, Qing Y, Gong S, Meng M, Wei C, Li D, Wu J, Li X, Chen W, Hu J. Evidence-based practice implementation in healthcare in China: a living scoping review. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 20:100355. [PMID: 35036975 PMCID: PMC8743207 DOI: 10.1016/j.lanwpc.2021.100355] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Evidence-based practice (EBP) implementation plays a crucial role in bridging the knowledge-action gaps and reducing health inequities. Little is known about its development in China. This study aims to provide an overview of the EBP implementation research progress in healthcare in China and identify gaps for future studies. METHODS We conducted a scoping review following the Joanna Briggs Institute scoping review methodology and the Cochrane Collaboration's guidance on living reviews. We performed a literature search in four Chinese databases (i.e., China National Knowledge Infrastructure, Wan Fang Database, The VIP Database, and China Biology Medicine) and three English databases (i.e., Ovid MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, and EMBASE), Google scholar, and Baidu scholar from 1996 to 2021. We included EBP implementation studies conducted in healthcare settings in China and were published in Chinese and English literature. The search will be run on a regular basis to monitor the development of new literature and determine when to update the review. FINDINGS Of the 11,276 records identified, we finally included 309 papers. The publications were on a sharp rise since 2013 and were predominantly from the nursing field (292/309, 94.50%). The commonly researched areas were symptom management (75/309, 24.27%), tube care (46/309, 14.89%), perioperative care (43/309, 13.92%), and fundamental care (43/309, 13.92%). Joanna Briggs Institute model was the most frequently used model to guide the implementation process (92/159, 59.75%). A median number of 8 people often comprised an implementation team, with 113 studies (36.57%) taking a multidisciplinary approach. 204 studies reported utilizing audit criteria to assist evaluation of evidence implementation rate with diversified methods measuring the criteria. Lack of knowledge, skills, and resources, and incomplete procedures or pathways were top barriers impeding EBP implementation. Leadership support was considered the most common facilitator. Education and training were the most frequently described implementation strategies for healthcare professionals and patients. Optimizing workflows and developing evaluation tools were the primary strategies adopted by organizations. 291 studies measured patient outcomes and 174 studies measured healthcare professional outcomes. INTERPRETATION To our knowledge, this scoping review is the first one to systematically examine the EBP implementation research progress in healthcare in China. Based on this review, we identified contributions that Chinese EBP implementation research made to the global community, and provided eight recommendations for Chinese researchers in conducting implementation studies in the future. FUNDING None.
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Affiliation(s)
- Junqiang Zhao
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Wenhui Bai
- Department of nursing, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital, Zhengzhou, China
| | - Qian Zhang
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Yujie Su
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Jinfang Wang
- School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiaoning Du
- Department of nursing, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yajing Zhou
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Chang Kong
- School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yanbing Qing
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Shaohua Gong
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Meiqi Meng
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Changyun Wei
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Dina Li
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Jian Wu
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Xuejing Li
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Wenjun Chen
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Jiale Hu
- Department of Nurse Anesthesia, Virginia Commonwealth University, Richmond, USA
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Akiba CF, Powell BJ, Pence BW, Nguyen MXB, Golin C, Go V. The case for prioritizing implementation strategy fidelity measurement: benefits and challenges. Transl Behav Med 2022; 12:335-342. [PMID: 34791480 PMCID: PMC8849000 DOI: 10.1093/tbm/ibab138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Implementation strategies are systematic approaches to improve the uptake and sustainability of evidence-based interventions. They frequently focus on changing provider behavior through the provision of interventions such as training, coaching, and audit-and-feedback. Implementation strategies often impact intermediate behavioral outcomes like provider guideline adherence, in turn improving patient outcomes. Fidelity of implementation strategy delivery is defined as the extent to which an implementation strategy is carried out as it was designed. Implementation strategy fidelity measurement is under-developed and under-reported, with the quality of reporting decreasing over time. Benefits of fidelity measurement include the exploration of the extent to which observed effects are moderated by fidelity, and critical information about Type-III research errors, or the likelihood that null findings result from implementation strategy fidelity failure. Reviews of implementation strategy efficacy often report wide variation across studies, commonly calling for increased implementation strategy fidelity measurement to help explain variations. Despite the methodological benefits of rigorous fidelity measurement, implementation researchers face multi-level challenges and complexities. Challenges include the measurement of a complex variable, multiple data collection modalities with varying precision and costs, and the need for fidelity measurement to change in-step with adaptations. In this position paper, we weigh these costs and benefits and ultimately contend that implementation strategy fidelity measurement and reporting should be improved in trials of implementation strategies. We offer pragmatic solutions for researchers to make immediate improvements like the use of mixed methods or innovative data collection and analysis techniques, the inclusion of implementation strategy fidelity assessment in reporting guidelines, and the staged development of fidelity tools across the evolution of an implementation strategy. We also call for additional research into the barriers and facilitators of implementation strategy fidelity measurement to further clarify the best path forward.
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Affiliation(s)
- Christopher F Akiba
- Department of Health Behavior, Gillings School of Global Public Health, UNC-Chapel Hill, NC, USA
| | - Byron J Powell
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, UNC-Chapel Hill, Chapel Hill, NC, USA
| | - Minh X B Nguyen
- Department of Health Behavior, Gillings School of Global Public Health, UNC-Chapel Hill, NC, USA
| | - Carol Golin
- Department of Health Behavior, Gillings School of Global Public Health, UNC-Chapel Hill, NC, USA
- Division of General Medicine and Clinical Epidemiology, School of Medicine, UNC-Chapel Hill, NC, USA
| | - Vivian Go
- Department of Health Behavior, Gillings School of Global Public Health, UNC-Chapel Hill, NC, USA
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Amano T, Hooley C, Strong J, Inoue M. Strategies for implementing music-based interventions for people with dementia in long-term care facilities: A systematic review. Int J Geriatr Psychiatry 2022; 37. [PMID: 34647348 DOI: 10.1002/gps.5641] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/11/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Research has found that music-based interventions can decrease behavioral and psychological symptoms of dementia or behaviors that challenge (BPSD/BtC). However, how to effectively implement these interventions is unclear. This study synthesizes available evidence regarding implementation strategies and outcomes of music-based interventions for people with dementia at residential long-term care facilities. METHODS Study registered with PROSPERO (registration number: CRD42020194354). We searched the following databases: PsychInfo, PubMed, MEDLINE, CINAHL, and The Cochrane Library. Inclusion criteria included articles targeting music-based interventions conducted for people with dementia, studies conducted in residential long-term care facilities, and articles that reported implementation strategies and outcomes of the intervention. RESULTS Of the included eight studies, half were studies of music therapy and the other half were on individualized music. 49 implementation strategies were reported. The most frequently reported category of strategies was planning (34.7%), followed by education (24.5%), quality management (24.5%), restructuring (12.2%), and finance (4.1%). No strategies under the category of attending to the policy context were reported. The most frequently reported implementation outcomes were appropriateness (27.3%), followed by adoption (22.7%), fidelity (22.7%), acceptability (9.1%), sustainability (9.1%), and cost (9.1%). No studies measured feasibility or penetration. CONCLUSIONS Although various effective implementation strategies were identified, we were unable to examine the effectiveness of individual implementation strategies due to the designs of the selected studies. Less attention has been paid to strategies that aim at structural changes of intervention delivery systems. Future studies should investigate facilitators and barriers of implementing music-based interventions especially focusing on structural aspects.
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Affiliation(s)
- Takashi Amano
- Rutgers University - Newark, Newark, New Jersey, USA
| | | | - Joe Strong
- University of North Carolina - Greensboro, Greensboro, North Carolina, USA
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Shin HD, Cassidy C, Weeks LE, Campbell LA, Drake EK, Wong H, Donnelly L, Dorey R, Kang H, Curran JA. Interventions to change clinicians' behavior related to suicide-prevention care in the emergency department: a scoping review. JBI Evid Synth 2021; 20:788-846. [PMID: 34907133 DOI: 10.11124/jbies-21-00149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this scoping review was to explore, characterize, and map the literature on interventions and intervention components implemented to change emergency department clinicians' behavior related to suicide prevention using the Behaviour Change Wheel as a guiding theoretical framework. INTRODUCTION An emergency department is a critical place for suicide prevention, yet patients are often discharged without proper suicide risk assessments and/or referrals. In response, we must support emergency department clinicians' behavior change to follow evidence-based suicide prevention strategies. However, reviews to date have yet to systematically and theoretically examine interventions' functional characteristics and how they can influence emergency department clinicians' behaviors related to suicide-prevention care. INCLUSION CRITERIA This review considered interventions that targeted emergency department clinicians' behavior change related to suicide prevention. Behavior change referred to observable practice changes as well as proxy measures of behavior change, including changes in knowledge and attitude. METHODS This review followed JBI methodology for scoping reviews. Searches included PubMed, PsycINFO, CINAHL, Embase, and gray literature, including targeted Google searches for relevant organizations/websites, ProQuest Dissertations and Theses Global, and Scopus conference papers (using a specific filter). This review did not apply any date limits, but our search was limited to the English language. Data extraction was undertaken using a charting table developed specifically for the review objective. Narrative descriptions of interventions were coded using the Behavior Change Wheel's intervention functions. Reported outcome measures were categorized. Findings are tabulated and synthesized narratively. RESULTS Forty-one studies were included from the database searches, representing a mixture of experimental (n = 2), quasi-experimental (n = 24), non-experimental (n = 12), qualitative (n = 1), and mixed methods (n = 2) approaches. An additional 29 citations were included from gray literature searches. One was a pilot mixed methods study, and the rest were interventions. In summary, this review included a total of 70 citations, describing 66 different interventions. Identified interventions comprised a wide range of Behaviour Change Wheel intervention functions to change clinicians' behavior: education (n = 48), training (n = 40), enablement (n = 36), persuasion (n = 21), environmental restructuring (n = 18), modeling (n = 7), and incentivisation (n = 2). Based on the Behaviour Change Wheel analysis, many interventions targeted more than one determinant of behavior change, often employing education and training to improve clinicians' knowledge and skills simultaneously. Among the 42 studies that reported outcome measures, effectiveness was measured at clinician (n = 38), patient (n = 4), and/or organization levels (n = 6). Few studies reported implementation outcomes, such as measures of reach (n = 4), adoption (n = 5), or fidelity (n = 1). There were no evaluation data reported on the interventions identified through Google searches. CONCLUSIONS Interventions included in this review were diverse and leveraged a range of mechanisms to change emergency department clinicians' behavior. However, most interventions relied solely on education and/or training to improve clinicians' knowledge and/or skills. Future research should consider diverse intervention functions to target both individual- and/or organization-level barriers for a given context. Secondly, the ultimate goal for changing emergency department clinicians' behavior is to improve patient health outcomes related to suicide-related thoughts and behaviors, but current research has most commonly evaluated clinicians' behavior in isolation of patient outcomes. Future studies should consider reporting patient-level outcomes alongside clinician-level outcomes.
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Affiliation(s)
- Hwayeon Danielle Shin
- School of Nursing, Dalhousie University, Halifax, NS, Canada Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada Faculty of Health, Dalhousie University, Halifax, NS, Canada Nova Scotia Health Authority, Halifax, NS, Canada
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Cassidy CE, Harrison MB, Godfrey C, Nincic V, Khan PA, Oakley P, Ross-White A, Grantmyre H, Graham ID. Use and effects of implementation strategies for practice guidelines in nursing: a systematic review. Implement Sci 2021; 16:102. [PMID: 34863220 PMCID: PMC8642950 DOI: 10.1186/s13012-021-01165-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Practice guidelines can reduce variations in nursing practice and improve patient care. However, implementation of guidelines is complex and inconsistent in practice. It is unclear which strategies are effective at implementing guidelines in nursing. This review aimed to describe the use and effects of implementation strategies to facilitate the uptake of guidelines focused on nursing care. METHODS We conducted a systematic review of five electronic databases in addition to the Cochrane Effective Practice and Organization of Care (EPOC) Group specialized registry. Studies were included if implementation of a practice guideline in nursing and process or outcome of care provided by nurses were reported. Two reviewers independently screened studies, assessed study quality, extracted data, and coded data using the EPOC taxonomy of implementation strategies. For those strategies not included in the EPOC taxonomy, we inductively categorized these strategies and generated additional categories. We conducted a narrative synthesis to analyze results. RESULTS The search identified 46 papers reporting on 41 studies. Thirty-six studies used a combination of educational materials and educational meetings. Review findings show that multicomponent implementation strategies that include educational meetings, in combination with other educational strategies, report positive effects on professional practice outcomes, professional knowledge outcomes, patient health status outcomes, and resource use/expenditures. Twenty-three of the 41 studies employed implementation strategies not listed within the EPOC taxonomy, including adaptation of practice guidelines to local context (n = 9), external facilitation (n = 14), and changes to organizational policy (n = 3). These implementation strategies also corresponded with positive trends in patient, provider, and health system outcomes. CONCLUSIONS Nursing guideline implementation may benefit from using the identified implementation strategies described in this review, including participatory approaches such as facilitation, adaptation of guidelines, and organizational policy changes. Further research is needed to understand how different implementation strategy components work in a nursing context and to what effect. As the field is still emerging, future reviews should also explore guideline implementation strategies in nursing in quasi or non-experimental research designs and qualitative research studies.
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Affiliation(s)
- Christine E. Cassidy
- School of Nursing, Dalhousie University, 5860 University Ave., Halifax, NS B3H 4R2 Canada
| | - Margaret B. Harrison
- School of Nursing, Queen’s University, 92 Barrie Street, Kingston, ON K7L 3J9 Canada
| | - Christina Godfrey
- School of Nursing, Queen’s University, 92 Barrie Street, Kingston, ON K7L 3J9 Canada
| | - Vera Nincic
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 209 Victoria Street, Toronto, ON M5B 1W8 Canada
| | - Paul A. Khan
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 209 Victoria Street, Toronto, ON M5B 1W8 Canada
| | - Patricia Oakley
- National Research Council Canada, Institute for Information Technology, 46 Dineen Drive, Fredericton, NB E3B 9W4 Canada
| | - Amanda Ross-White
- Queen’s University Library, Queen’s University, 18 Stuart Street, Kingston, ON K7L 3N6 Canada
| | - Hilary Grantmyre
- School of Nursing, Dalhousie University, 5860 University Ave., Halifax, NS B3H 4R2 Canada
| | - Ian D. Graham
- School of Epidemiology and Public HealthSchool of Nursing, University of Ottawa, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
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Moore JL, Bø E, Erichsen A, Rosseland I, Halvorsen J, Bratlie H, Hornby TG, Nordvik JE. Development and Results of an Implementation Plan for High-Intensity Gait Training. J Neurol Phys Ther 2021; 45:282-291. [PMID: 34369450 PMCID: PMC8423140 DOI: 10.1097/npt.0000000000000364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND AND PURPOSE High-intensity gait training is recommended in stroke rehabilitation to improve gait speed, walking distance, and balance. However, identifying effective and efficient implementation methods is a challenge for rehabilitation providers. This article describes the development of an implementation plan, presents findings of each implementation phase, and identifies the project's impact on clinicians and the health system. METHODS Two inpatient rehabilitation facilities, including 9 physical therapists, collaborated with a knowledge translation center to implement this program. We developed an implementation plan using the Knowledge-to-Action Framework and utilized the Consolidated Framework for Implementation Research to identify barriers and select implementation strategies. Using mix-methods research, including surveys and informal discussions, we evaluated current practice, barriers, outcomes, and the sustainability of high-intensity gait training in practice. RESULTS A multicomponent implementation plan that targeted barriers was developed. Before implementation, clinicians reported providing several balance, strength training, and gait interventions to improve walking. Barriers to using high-intensity gait training included knowledge, beliefs, adaptability of high-intensity gait training, resources, culture, and others. Twenty-six implementation strategies were selected to target the barriers. Surveys and informal discussions identified significant changes in perceived practice, adoption of high-intensity gait training, and positive impacts on the health system. The 2-year follow-up survey indicated that the new practice was sustained. DISCUSSION AND CONCLUSIONS Using a multicomponent implementation plan that targeted barriers, we successfully implemented high-intensity gait training in clinical practice. Contributors to successful implementation may include the implementation methods, usual care interventions, and clinicians' readiness for this change.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A352.).
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Affiliation(s)
- Jennifer L. Moore
- First Oslo team members are as follows: Tonje Barkenæs, Miriam Byhring, Magnus Hågå, Chris Henderson, Mari Klokkerud, Julia Mbalilaki, Stein-Arne Rimehaug, Thomas Tomren, and Karen Vergoossen
| | - Elisabeth Bø
- First Oslo team members are as follows: Tonje Barkenæs, Miriam Byhring, Magnus Hågå, Chris Henderson, Mari Klokkerud, Julia Mbalilaki, Stein-Arne Rimehaug, Thomas Tomren, and Karen Vergoossen
| | - Anne Erichsen
- First Oslo team members are as follows: Tonje Barkenæs, Miriam Byhring, Magnus Hågå, Chris Henderson, Mari Klokkerud, Julia Mbalilaki, Stein-Arne Rimehaug, Thomas Tomren, and Karen Vergoossen
| | - Ingvild Rosseland
- First Oslo team members are as follows: Tonje Barkenæs, Miriam Byhring, Magnus Hågå, Chris Henderson, Mari Klokkerud, Julia Mbalilaki, Stein-Arne Rimehaug, Thomas Tomren, and Karen Vergoossen
| | - Joakim Halvorsen
- First Oslo team members are as follows: Tonje Barkenæs, Miriam Byhring, Magnus Hågå, Chris Henderson, Mari Klokkerud, Julia Mbalilaki, Stein-Arne Rimehaug, Thomas Tomren, and Karen Vergoossen
| | - Hanne Bratlie
- First Oslo team members are as follows: Tonje Barkenæs, Miriam Byhring, Magnus Hågå, Chris Henderson, Mari Klokkerud, Julia Mbalilaki, Stein-Arne Rimehaug, Thomas Tomren, and Karen Vergoossen
| | - T. George Hornby
- First Oslo team members are as follows: Tonje Barkenæs, Miriam Byhring, Magnus Hågå, Chris Henderson, Mari Klokkerud, Julia Mbalilaki, Stein-Arne Rimehaug, Thomas Tomren, and Karen Vergoossen
| | - Jan Egil Nordvik
- First Oslo team members are as follows: Tonje Barkenæs, Miriam Byhring, Magnus Hågå, Chris Henderson, Mari Klokkerud, Julia Mbalilaki, Stein-Arne Rimehaug, Thomas Tomren, and Karen Vergoossen
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Wang J, Zhang Y, Chen Y, Li M, Yang H, Chen J, Tang Q, Jin J. Effectiveness of Rehabilitation Nursing versus Usual Therapist-Led Treatment in Patients with Acute Ischemic Stroke: A Randomized Non-Inferiority Trial. Clin Interv Aging 2021; 16:1173-1184. [PMID: 34188460 PMCID: PMC8233001 DOI: 10.2147/cia.s306255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/13/2021] [Indexed: 01/17/2023] Open
Abstract
Purpose To determine the effectiveness of rehabilitation nursing program interventions in patients with acute ischemic stroke. Patients and Methods An assessment-blinded randomized controlled trial was conducted at a tertiary referral hospital in China. Eligible patients were stratified according to their weighted corticospinal tract lesion load and then randomly assigned to an experimental group (n = 121) or a control group (n = 103). The experimental group received rehabilitation nursing from well-trained, qualified nurses (30 minutes per session, two sessions per day for seven consecutive days). The control group received therapist-led rehabilitation with the same timing and frequency. Comparative analysis of the primary outcomes was performed to determine non-inferiority with a predetermined non-inferiority margin. The primary outcomes were the Motor Assessment Scale, Fugl-Meyer Assessment, and the Action Research Arm Test assessed at baseline and after seven days of treatment. The secondary outcomes were the modified Barthel Index, the National Institutes of Health Stroke Scale, and the modified Rankin Scale, evaluated before and after the intervention and at 4 and 12 weeks of follow-up. Results Two hundred participants completed the trial. In both groups, all outcomes improved significantly after seven days and at follow-ups. The rehabilitation nursing program was non-inferior to therapist-led treatment with lower 95% confidence limits beyond the margins for primary outcomes (P < 0.001). Conclusion Both treatments had comparable effects; however, no definite conclusion could be drawn. Adequately powered studies are required.
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Affiliation(s)
- Jianmiao Wang
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
| | - Yuping Zhang
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
| | - Yuanyuan Chen
- Neurology Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
| | - Mei Li
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
| | - Hongyan Yang
- Neurology Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
| | - Jinhua Chen
- Neurology Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
| | - Qiaomin Tang
- Neurology Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
| | - Jingfen Jin
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China.,Changxing Branch Hospital, The Second Affiliated Hospital of Zhejiang University School of Medicine, Huzhou, Zhejiang Province, People's Republic of China
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Moss SJ, Wollny K, Poulin TG, Cook DJ, Stelfox HT, Ordons ARD, Fiest KM. Bereavement interventions to support informal caregivers in the intensive care unit: a systematic review. BMC Palliat Care 2021; 20:66. [PMID: 33980242 PMCID: PMC8117265 DOI: 10.1186/s12904-021-00763-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/28/2021] [Indexed: 12/29/2022] Open
Abstract
Background Informal caregivers of critically ill patients in intensive care unit (ICUs) experience negative psychological sequelae that worsen after death. We synthesized outcomes reported from ICU bereavement interventions intended to improve informal caregivers’ ability to cope with grief. Data sources MEDLINE, EMBASE, CINAHL and PsycINFO from inception to October 2020. Study selection Randomized controlled trials (RCTs) of bereavement interventions to support informal caregivers of adult patients who died in ICU. Data extraction Two reviewers independently extracted data in duplicate. Narrative synthesis was conducted. Data synthesis Bereavement interventions were categorized according to the UK National Institute for Health and Clinical Excellence three-tiered model of bereavement support according to the level of need: (1) Universal information provided to all those bereaved; (2) Selected or targeted non-specialist support provided to those who are at-risk of developing complex needs; and/or (3) Professional specialist interventions provided to those with a high level of complex needs. Outcome measures were synthesized according to core outcomes established for evaluating bereavement support for adults who have lost other adults to illness. Results Three studies of ICU bereavement interventions from 31 ICUs across 26 hospitals were included. One trial examining the effect of family presence at brain death assessment integrated all three categories of support but did not report significant improvement in emotional or psychological distress. Two other trials assessed a condolence letter intervention, which did not decrease grief symptoms and may have increased symptoms of depression and post-traumatic stress disorder, and a storytelling intervention that found no significant improvements in anxiety, depression, post-traumatic stress, or complicated grief. Four of nine core bereavement outcomes were not assessed anytime in follow-up. Conclusions Currently available trial evidence is sparse and does not support the use of bereavement interventions for informal caregivers of critically ill patients who die in the ICU. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00763-w.
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Affiliation(s)
- Stephana J Moss
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Krista Wollny
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary, AB, Canada.,Faculty of Nursing, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Therese G Poulin
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Deborah J Cook
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Henry T Stelfox
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary, AB, Canada
| | - Amanda Roze des Ordons
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary, AB, Canada.,Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine, Calgary, AB, Canada
| | - Kirsten M Fiest
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada. .,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada. .,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada. .,Alberta Health Services, Calgary, AB, Canada. .,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Törmä J, Pingel R, Cederholm T, Saletti A, Winblad U. Is it possible to influence ability, willingness and understanding among nursing home care staff to implement nutritional guidelines? A comparison of a facilitated and an educational strategy. Int J Older People Nurs 2021; 16:e12367. [PMID: 33624452 DOI: 10.1111/opn.12367] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 12/22/2020] [Accepted: 01/07/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Translating nutrition knowledge into care practice is challenging since multiple factors can affect the implementation process. This study examined the impact of two implementation strategies, that is external facilitation (EF) and educational outreach visits (EOVs), on the organisational context and individual factors when implementing nutritional guidelines in a nursing home (NH) setting. METHODS The EF strategy was a one-year, multifaceted (including support, guidance, a practice audit and feedback) intervention given to four NH units. The EOV strategy was a three-hour lecture about the nutritional guidelines given to four other NH units. Both strategies were directed at selected NH teams, consisting of a unit manager, a nurse and 5-10 care staff. A questionnaire was distributed, before and after the interventions, to evaluate the prerequisites for the staff to use the guidelines. Three conditions were used to examine the organisational context and the individual factors: the staff's ability and willingness to implement the nutritional guidelines and their understanding of them. Confirmatory factor analysis and structural equation models were used for the data analysis. RESULTS The results indicated that on average, there was a significant increase in the staff's ability to implement the nutritional guidelines in the EF group. The staff exposed to the EF strategy experienced better resources to implement the guidelines in terms of time, tools and support from leadership and a clearer assignment of responsibility regarding nutrition procedures. There was no change in staff's willingness and understanding of the guidelines in the EF group. On average, no significant changes were observed for the staff's ability, willingness or understanding in the EOV group. CONCLUSIONS A long-term, active and flexible implementation strategy (i.e. EF) affected the care staff's ability to implement the nutritional guidelines in an NH setting. No such impact was observed for the more passive, educational approach (i.e. EOV).
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Affiliation(s)
- Johanna Törmä
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Ronnie Pingel
- Department of Statistics, Uppsala University, Uppsala, Sweden
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Anja Saletti
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden
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Barriers to and Facilitators of Adherence to Clinical Practice Guidelines in the Middle East and North Africa Region: A Systematic Review. Healthcare (Basel) 2020; 8:healthcare8040564. [PMID: 33333843 PMCID: PMC7765264 DOI: 10.3390/healthcare8040564] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/19/2020] [Accepted: 12/08/2020] [Indexed: 12/17/2022] Open
Abstract
The current review aims to investigate the barriers to and facilitators of the adherence to clinical practice guidelines (CPGs) in the Middle East and North Africa (MENA) region. English language studies published between January 2010 and May 2019 were searched on PubMed, Embase, and EBSCO. The barriers were categorized as clinician-related factors, such as lack of awareness of familiarity with the CPGs, and external factors, such as patients, guidelines, and environmental factors. The search identified 295 titles, out of which 15 were included. Environmental factors, specifically lack of time, resources, incentives, availability, and costs of treatment or diagnostic tests, training, and dissemination plans were the most commonly identified barriers. The familiarity with or awareness of healthcare professionals about the guideline, guideline characteristics, lack of agreement with the guidelines and preference in clinical judgment, physician self-efficacy, and motivation were reported to a lesser extent. Few studies reported on the compliance of facilitators with the guidelines including disseminating and advertising guideline materials, education and training on the guidelines, regulatory and financial incentives, and support from institutions. The review highlights that the studies on barriers to and facilitators of compliance with CPGs in the MENA region are limited in number and quality.
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