Engaging national and regional partners to accelerate broad-scale implementation of nurse-developed interventions

Scaling Up Public Health Interventions: Engaging Partners Across Multiple Levels

Advancing the science of intervention scale-up is essential to increasing the impact of effective interventions at the regional and national levels. In contrast with work in high-income countries (HICs), where scale-up research has been limited, researchers in low- and middle-income countries (LMICs) have conducted numerous studies on the regional and national scale-up of interventions. In this article, we review the state of the science on intervention scale-up in both HICs and LMICs. We provide an introduction to the elements of scale-up followed by a description of the scale-up process, with an illustrative case study from our own research. We then present findings from a scoping review comparing scale-up studies in LMIC and HIC settings. We conclude with lessons learned and recommendations for improving scale-up research. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

A Refined Model of Stress-Diathesis Relationships in Mothers With Significant Depressive Symptom Severity

BACKGROUND: Mothers' depressive symptoms affect their children's growth as well as physical and mental well-being. Moreover, mothers of young children with developmental delay or disability (DD) tend to have higher depressive symptoms. AIMS: The purpose of this study was to examine associations between maternal depressive symptoms and number of children with DD among mothers with significant levels of depressive symptoms, while accounting for maternal diathesis factors and family stress factors. METHODS: This study was a secondary analysis of pooled baseline data collected from 2004 to 2012 in the northeastern and southeastern United States from three intervention studies to reduce depressive symptoms of mothers with young children (n = 364). Multiple regression analyses were conducted to examine associations between maternal depressive symptoms and number of children with DD, followed by the post hoc pairwise comparison. RESULTS: In the model including family stress factors, we found a significant test for linear trend in the mean for maternal depressive symptoms across the number of children with DD (F[1] = 4.3, p = .0388). CONCLUSIONS: Mothers who have multiple children with DD tend to experience higher depressive symptoms; thus, interventions are needed to help prevent these mothers from experiencing higher depressive symptoms or to reduce their current depressive symptoms. Both theory-based and strength-based interventions can target conflict management at the family level, reducing maternal depressive symptoms while improving mothers' self-efficacy, which would help mothers care for their own health, manage family conflict, and seek appropriate support to manage the children's medical and developmental needs.

Advancing Evidence-Based Practice Through Implementation Science: Critical Contributions of Doctor of Nursing Practice- and Doctor of Philosophy-Prepared Nurses

PURPOSE

Describe the evolution of implementation science and the roles and potential collaborations of doctorally prepared nurses to advance implementation science in practice settings.

METHODS

Review of academic preparation and areas of expertise for doctorally prepared nurses as it relates to implementation science and evidence-based practice (EBP).

FINDINGS

There have been substantial gains in the number of academic programs in healthcare that include content on EBP, resulting in healthcare teams that are motivated to align practices with best evidence. Unfortunately, many EBP initiatives stall during early stages of implementation, resulting in fragmented practices and persistent gaps between evidence and practice. Implementation science aims to bridge this gap and provides a structured, science-based approach to implementation. Few healthcare teams are familiar with implementation science, and many do not incorporate knowledge from the field when implementing EBPs. Doctorally prepared nurses are in a unique position to serve as leaders in EBP implementation due to the breadth and depth of academic preparation and their pivotal roles across practice settings.

CONCLUSIONS

Collaboratively aligning existing strengths of PhD and DNP prepared nurses with knowledge of implementation science can advance implementation of EBP across practice settings to effectively incorporate and sustain meaningful change to improve outcomes.

LINKING EVIDENCE TO ACTION SECTION

Doctorally prepared nurses are in a unique position to advance and apply the science of implementation in practice settings. Nurse scientists can generate evidence on effective strategies and outcomes among healthcare teams to successfully integrate evidence based practices into routine care. Nurse leaders and educators can apply these findings and use an implementation science approach when leading clinical teams in evidence-based practice changes.

Implementation Science Training and Resources for Nurses and Nurse Scientists

PURPOSE

The purpose of this article is to describe the differences between quality improvement and implementation science, the urgency for nurses and nurse scientists to engage in implementation science, and international educational opportunities and resources for implementation science.

ORGANIZING CONSTRUCT

There is a push for providing safe, effective, patient-centered, timely, efficient, and equitable health care. Implementation science plays a key role in adoption and integration of evidence-based practices to improve quality of care.

METHODS

We reviewed implementation science programs, organizations, and literature to analyze the roles of nurses and nurse scientists in translating evidence into routine practice.

FINDINGS

Implementation-trained nurses and nurse scientists are needed as part of multidisciplinary teams to advance implementation science because of their unique understanding of contextual barriers within nursing practice. Likewise, nurses are uniquely qualified for recognizing what implementation strategies are needed to improve nursing care across practice settings.

CONCLUSIONS

Many international clinical and training resources exist and are supplied to aid interested readers in learning more about implementation science.

CLINICAL RELEVANCE

Half of research evidence never reaches the clinical setting, and the other half takes 20 years to translate into clinical practice. Implementation science-trained nurses are in a position to be excellent improvers for meaningful change in practice.