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Beasley L, Grace S, Horstmanshof L. Responding and adapting to change: an allied health perspective. Leadersh Health Serv (Bradf Engl) 2020; 33:339-349. [PMID: 33635024 DOI: 10.1108/lhs-07-2019-0050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to review the literature on the response and adaption to change of allied health professionals. Understanding how individuals respond and adapt to change is essential to assist leaders to manage transformational change effectively. Contemporary health-care environments are characterised by frequent and rapid change, often with unrealistic and challenging time frames. Individuals operate independently, but also as members of teams, professions and organisations. Therefore, having a sound understanding of individual response to change is important for change leaders. In the Australian context, allied health professionals represent a quarter of the health-care workforce. There is a significant gap in understanding how allied health professionals respond and adapt to change. DESIGN/METHODOLOGY/APPROACH A scoping review was designed to report on the nature and extent of the literature on the response and adaption to change in the context of allied health professionals. Change leaders in the health-care environment face a number of complex challenges when attempting to facilitate change. While this scoping review did not identify any specific literature on the response and adaption to change of allied health professionals, it did however provide information on change models and factors to take into consideration when implementing a change process. FINDINGS The results of this scoping review identified findings in two main areas with regard to response and adaptation of allied health to change: a review of change management literature at the organisation level and change management for allied health. Most of the literature described organisational level change management without providing a structural framework for change. At the professional individual level, the literature focused on specific clinical interventions, rather than on the response and adaption to change for allied health. Minimal literature was identified in regard to the response and adaption to change of allied health professionals. In an environment characterised by continuous change and policy reform, a greater understanding of the response and adaption to change by allied health is a priority for research, policy and practice. RESEARCH LIMITATIONS/IMPLICATIONS This scoping review was undertaken to explore the response and adaption to change of allied health. It sought to identify the factors that may explain why certain disciplines within the allied health professional group responded to change differently. Scoping reviews do not set out to comprehensively source all relevant literature but rather to ascertain the nature and extent of the published literature in the field. Therefore, it is possible that a systematic review might uncover additional relevant papers. However, this scoping review provides a clear indication of the nature and extent of the literature in allied health. PRACTICAL IMPLICATIONS SOCIAL IMPLICATIONS This scoping review will assist change leaders to gain a better understanding of theoretical frameworks of individual, team and organisational change processes and the impacts these have individually and collectively on change processes. ORIGINALITY/VALUE To the best of the authors' knowledge, this scoping review is the first of its kind to identify the minimal literature available on the way allied health professionals respond and adapt to change.
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Affiliation(s)
- Lisa Beasley
- Northern NSW Local Health District, Lismore, Australia
| | - Sandra Grace
- Department of Health and Human Sciences, Southern Cross University, Bilinga, Australia
| | - Louise Horstmanshof
- Department of Health and Human Sciences, Southern Cross University, Bilinga, Australia
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Sutherland-Fraser S, McInnes E, Maher E, Middleton S. Peri-operative nurses' knowledge and reported practice of pressure injury risk assessment and prevention: A before-after intervention study. BMC Nurs 2012; 11:25. [PMID: 23176368 PMCID: PMC3573907 DOI: 10.1186/1472-6955-11-25] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 11/14/2012] [Indexed: 11/18/2022] Open
Abstract
UNLABELLED BACKGROUND Patients are at risk of developing pressure injuries in the peri-operative setting. Studies evaluating the impact of educational interventions on peri-operative nurses' knowledge and reported practice are scarce. The purpose of this study was to evaluate the effect of a multifaceted intervention on peri-operative nurses' (a) knowledge of pressure injury risks, risk assessment and prevention strategies for patients in the operating suite; and (b) reported practice relating to risk assessment practices and implementation of prevention strategies for patients in the operating suite. METHODS A before-after research design was used. A convenience sample of all registered and enrolled nurses employed in two hospitals' operating suites was recruited. A multifaceted intervention was delivered which comprised a short presentation, educational materials and reminder posters. A 48-item survey tool was completed pre-and post-intervention to measure self-reported knowledge and practice. RESULTS 70 eligible peri-operative nurses completed both surveys. Post-intervention, statistically significant improvements were seen in knowledge of correct descriptions of pressure injury stages (p=0.001); appropriate reassessment for patients with a new pressure injury (p=0.05); appropriate actions for patients with an existing stage 1 (p=0.02) and stage 2 pressure injury (p=0.04). Statistical improvements were also seen in reported practice relating to an increase in the use of a risk assessment tool in conjunction with clinical judgement (p=0.0008); verbal handover of patients' pressure injury risk status from the operating room nurse to the recovery room (p=0.023) and from the recovery room nurse to the postoperative ward nurse (p=0.045). The number of participants reporting use of non-recommended and recommended pressure-relieving strategies was unchanged. CONCLUSION A multi-faceted educational intervention can improve some aspects of perioperative nurses' knowledge and reported practice such as risk assessment practices but not others such as use of recommended pressure-relieving devices. Further research is required to ascertain effective interventions which improve all areas of practice and knowledge, particularly in the use of appropriate pressure-relieving devices in order to prevent pressure injuries in surgical patients.
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Affiliation(s)
- Sally Sutherland-Fraser
- Clinical Nurse Consultant for Peri-operative Practice Development, St Vincents Hospital, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
| | - Elizabeth McInnes
- EM Deputy Director, EMaher Research Assistant, Nursing Research Institute, St Vincents & Mater Health Sydney and Australian Catholic University, St Vincent's Hospital, Level 5, deLacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
| | - Elizabeth Maher
- EM Deputy Director, EMaher Research Assistant, Nursing Research Institute, St Vincents & Mater Health Sydney and Australian Catholic University, St Vincent's Hospital, Level 5, deLacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
| | - Sandy Middleton
- EM Deputy Director, EMaher Research Assistant, Nursing Research Institute, St Vincents & Mater Health Sydney and Australian Catholic University, St Vincent's Hospital, Level 5, deLacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- Director, Nursing Research Institute, St Vincents & Mater Health Sydney and Australian Catholic University. Director, Executive Office, Level 5, deLacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
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Profetto-McGrath J, Negrin KA, Hugo K, Smith KB. Clinical Nurse Specialists' Approaches in Selecting and Using Evidence to Improve Practice. Worldviews Evid Based Nurs 2010; 7:36-50. [DOI: 10.1111/j.1741-6787.2009.00164.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Berta W, Teare GF, Gilbart E, Ginsburg LS, Lemieux-Charles L, Davis D, Rappolt S. Spanning the know-do gap: understanding knowledge application and capacity in long-term care homes. Soc Sci Med 2010; 70:1326-34. [PMID: 20170999 DOI: 10.1016/j.socscimed.2009.11.028] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2008] [Revised: 11/07/2009] [Accepted: 11/08/2009] [Indexed: 11/27/2022]
Abstract
Using a multiple case study design, this article explores the translation process that emerges within Ontario long-term care (LTC) homes with the adoption and implementation of evidence-based clinical practice guidelines (CPGs). Within-organization knowledge translation is referred to as knowledge application. We conducted 28 semi-structured interviews with a range of administrative and care staff within 7 homes differentiated by size, profit status, chain membership, and rural/urban location. We further undertook 7 focus groups at 5 locations, involving a total of 35 senior clinical staff representing 15 homes not involved in earlier structured interviews. The knowledge application process that emerges across our participant organizations is highly complex, iterative, and reliant upon a facility's knowledge application capacity, or absorptive capacity to effect change through learning. Knowledge application capacity underpins the emergence of the application process and the advancement of knowledge through it. We find that different elements of capacity are important to different stages of the knowledge application process. Capacity can pre-exist, or can be acquired. The majority of the capacity elements required for successful knowledge application in the LTC contexts we studied were organizational. It is essential for managers and practitioners therefore to conceptualize and orchestrate knowledge application initiatives at the organization level; organizational leaders (including clinical leaders) have a vital role to play in the success of knowledge application processes.
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Affiliation(s)
- Whitney Berta
- University of Toronto, Faculty of Medicine, Department of Health Policy, Management and Evaluation, 155 College Street, Suite 425, Toronto, Ontario, Canada M5T 3M6.
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Källman U, Suserud BO. Knowledge, attitudes and practice among nursing staff concerning pressure ulcer prevention and treatment--a survey in a Swedish healthcare setting. Scand J Caring Sci 2009; 23:334-41. [PMID: 19645807 DOI: 10.1111/j.1471-6712.2008.00627.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study was to investigate (i) attitudes among Registered Nurses (RNs) and Nursing Assistants (NAs) regarding pressure ulcer prevention, (ii) knowledge among RNs and NAs of pressure ulcer prevention and treatment, (iii) practice of risk assessment and documentation regarding pressure ulcers among RNs and NAs and (iv) to identify perceived possibilities and barriers in pressure ulcer prevention and treatment. In this cross-sectional study, a total of 230 questionnaires were distributed to an equal number of RNs and NAs in both municipality as well as hospital care settings. The response rate was 67% (n = 154). In general, all respondents displayed good knowledge on prevention and treatment of pressure ulcers and demonstrated a positive attitude towards this area of care. However, answers provided to some questions indicate that recent research findings and guidelines have not succeeded in reaching out to these occupational groups. Furthermore, only 37% (n = 55) of the participants said that they have an agreed strategy for the prevention of pressure ulcers in their unit. These shortcomings may affect the quality of care provided to the patient and lead to pressure ulcers developing as a consequence. Today, evidence-based methods for risk assessment are available but are not adopted and used in practice. The study highlights the need to further reduce the gap between research and practice.
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Affiliation(s)
- Ulrika Källman
- Dermatology Department, South Alvsborg Hospital, Borås, Sweden.
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Munten G, van den Bogaard J, Cox K, Garretsen H, Bongers I. Implementation of evidence-based practice in nursing using action research: a review. Worldviews Evid Based Nurs 2009; 7:135-57. [PMID: 19778316 DOI: 10.1111/j.1741-6787.2009.00168.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND As is often reported in the literature exploring the research-practice gap, applying the principles of evidence-based practice is easier said than done. Action research is a methodology with an explicit intent of linking the worlds of research and practice. This review attempts to answer the question: What is known about implementing evidence-based practice in nursing through action research? APPROACH A total of 21 action research studies have been used to answer this question. To prevent possible confusion over terminology, we used a conceptual framework that distinguishes various influencing factors in terms of four target groups (ranging from the individual end user to society as a whole) at whom the strategy is aimed and various strategies (ranging from individual feedback to contracting care providers) related to the same four target groups. FINDINGS Studies often failed to name the implementation strategies applied, necessitating deduction from the text by the reader. In most of the studies the implementation strategy was directed at a combination of target groups. Many of the projects reviewed reported positive contextual outcomes, "knowledge improvement" among nurses, and to a lesser degree, improved "performance." Patient outcomes were the least reported outcome measure. CONCLUSION With an element of caution, this review concludes that the implementation of evidence-based practice using action research is a promising approach. Caution is needed because of the lack of detailed descriptions of implementation strategies, and their intensity and frequency prevents us from drawing firm conclusions. These are important considerations for any action researcher intending to implement EBP using this approach.
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Affiliation(s)
- Guus Munten
- Fontys University of Applied Science, Eindhoven, the Netherlands.
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Jones KR, Fink R, Vojir C, Pepper G, Hutt E, Clark L, Scott J, Martinez R, Vincent D, Mellis BK. Translation research in long-term care: improving pain management in nursing homes. Worldviews Evid Based Nurs 2008; 1 Suppl 1:S13-20. [PMID: 17129330 DOI: 10.1111/j.1524-475x.2004.04045.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pain prevalence in nursing homes remains high, with multiple resident, staff, and physician barriers presenting serious challenges to its improvement. AIMS The study aims were to (1) develop and test a multifaceted, culturally competent intervention to improve nursing home pain practices; (2) improve staff, resident, and physician knowledge and attitudes about pain and its management; (3) improve actual pain practices in nursing homes; and (4) improve nursing home policies and procedures related to pain. METHODS A multifaceted, culturally competent intervention was developed and tested in six Colorado nursing homes, with another six nursing homes serving as control sites. Both educational and behavioral change strategies were employed. FINDINGS The intervention was successful in improving the percentage of residents reporting constant pain in the treatment homes. Contextual factors (implementation of Medicare's Nursing Home Compare report card) appeared to exert a positive influence on pain documentation. There was no reduction in the percentage of residents reporting pain or reporting moderate/severe pain. DISCUSSION Multiple challenges to quality improvement exist in nursing homes. Turnover of nursing staff reduced actual exposure to the intervention, and turnover of directors of nursing influenced constancy of message and overall facility stability. Residents often failed to report their pain, and physicians were reluctant to alter their prescribing practices. IMPLICATIONS Any intervention to improve pain management in nursing homes must target explicitly the residents, nursing home staff, and primary care physicians. Implementation strategies need to accommodate the high turnover rates among staff, as well as the changes among the nursing home leadership. CONCLUSIONS Pain is a complex problem in the nursing home setting. Multiple factors must be considered in both the design and implementation of interventions to improve pain practices and reduce pain prevalence in nursing homes.
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Profetto-McGrath J, Smith KB, Hugo K, Taylor M, El-Hajj H. Clinical Nurse Specialists' Use of Evidence in Practice: A Pilot Study. Worldviews Evid Based Nurs 2007; 4:86-96. [PMID: 17553109 DOI: 10.1111/j.1741-6787.2007.00086.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The interest in finding ways to bridge the gap between nursing research and implementation of findings into practice has been increasing. Clinical nurse specialists (CNSs) may be a bridge between frontline nurses and current developments in practice. While several researchers have studied the use of evidence by nurses in general, no known studies have been focused specifically on the use of evidence by CNSs. PURPOSE The purpose of this pilot study was to develop an understanding of the sources, nature, and application of evidence used by CNSs in practice and to investigate the feasibility of conducting a qualitative study focused on the CNS role in relation to evidence use in practice. METHODS This pilot study is a descriptive exploratory design in the qualitative paradigm. Seven CNSs from a large Western Canadian health region were interviewed. Interview transcripts were reviewed for recurrent themes about sources of evidence, evidence use, and barriers and facilitators to evidence use. FINDINGS CNSs access and use evidence from a variety of sources. All CNSs indicated that research literature was a primary source of evidence and research was used in decision-making. Peers and experience were also important sources of evidence. CNSs used the Internet extensively to consult research databases, online sources of evidence, and to contact peers about current practice. CNSs also gathered evidence from frontline nurses, healthcare team members, and families before decision-making. The choice of evidence often depended upon the type of question they were attempting to answer. Barriers cited by CNSs support previous research and included lack of time, resources, and receptivity at clinical and organizational levels. Facilitators included peers, organizational support, and advanced education. DISCUSSION CNSs in Canada have advanced education and clinical expertise and many are employed in roles that permeate organizational management and clinical nursing care. It is suggested that qualitative research in naturalized settings that investigates the role of CNSs in relation to the dissemination of evidence in nursing practice needs attention.
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Affiliation(s)
- Joanne Profetto-McGrath
- Faculty of Nursing, Knowledge Utilization Studies Program (KUSP), and Centre for Knowledge Transfer, University of Alberta, Edmonton, Alberta, Canada.
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Hulsenboom MA, Bours GJJW, Halfens RJG. Knowledge of pressure ulcer prevention: a cross-sectional and comparative study among nurses. BMC Nurs 2007; 6:2. [PMID: 17349049 PMCID: PMC1821326 DOI: 10.1186/1472-6955-6-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 03/09/2007] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Pressure ulcers are a common, painful and costly condition. Results of a 1991 study into the knowledge among Dutch hospital nurses on the usefulness of measures to prevent pressure ulcers showed moderate knowledge. Results were confirmed by subsequent studies. In recent years, Dutch guidelines have been updated and the attention given to pressure ulcer care has been increased. This was expected to improve pressure ulcer care and to increase nurses' knowledge. The aims of the current study were to investigate (1) how much nurses employed in Dutch hospitals know about the usefulness of 28 preventive measures considered in the most recent national pressure ulcer guideline; (2) whether differences in knowledge exist between nurses working in hospitals that audit pressure ulcers and those employed in hospitals that do not; and (3) to study whether knowledge among Dutch hospital nurses regarding the usefulness of preventive measures had changed between 1991 and 2003. METHODS A cross-sectional study design among nurses employed in Dutch hospitals in 2003 was used to investigate their knowledge and differences in knowledge between nurses employed in different types of institution. A comparative design was used to assess whether knowledge differed between this population and that of Dutch hospital nurses in 1991. The nurses' knowledge was assessed by a written questionnaire. Data of 522 respondents meeting the inclusion criteria were analyzed and compared with the results of the 351 nurses included in the 1991 study. RESULTS Knowledge in 2003 was slightly better than that in 1991. The nurses were moderately aware of the usefulness of preventive measures. Nurses employed in organizations that monitored pressure ulcers did not display greater knowledge than those employed in organizations that did not do so. CONCLUSION Knowledge among Dutch hospital nurses about the usefulness of measures to prevent pressure ulcers seems to be moderate. Being employed in an institution that monitors pressure ulcer care hardly affects the knowledge level. Knowledge about prevention has improved little since 1991.
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Affiliation(s)
- Mirjam A Hulsenboom
- Maastricht University, Department of Health Care Studies, Section of Nursing Science, The Netherlands
| | - Gerrie JJW Bours
- Maastricht University, Department of Health Care Studies, Section of Nursing Science, The Netherlands
- Zuyd University, Center of expertise on Autonomy and Participation, The Netherlands
| | - Ruud JG Halfens
- Maastricht University, Department of Health Care Studies, Section of Nursing Science, The Netherlands
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Affiliation(s)
- Pamela E Windle
- Day Surgery Center, PACU, and Surgical Observation Unit, St. Luke's Episcopal Hospital, 6720 Bertner, Houston, TX, USA.
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Abstract
The use of evidence-based practice for improving patient care outcomes is discussed extensively in the literature. This article describes how a model for change to evidence-based practice developed by Rosswurm and Larrabee was used for the effective implementation of the American Stroke Association's Acute Stroke Program in an acute care hospital. The results demonstrated that patient care and outcomes were improved through the implementation of this exemplar of evidence-based practice.
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Gerrish K. Evidence-based practice: unravelling the rhetoric and making it real. ACTA ACUST UNITED AC 2006. [DOI: 10.1002/pdh.95] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
A study conducted in Sunderland investigated how staff in a private sector care home manage pressure ulcer prevention and what staff perceive to be the reasons why residents in their care develop pressure ulcers. It also identified how using a collaborative action research study design (utilizing an action research cycle with collaborative focus groups) can bring about an improvement in practice, by allowing the staff to reflect on and analyse the way they work and develop and implement strategies to provide solutions to the problems they identify.
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Abstract
BACKGROUND The 'information explosion' presents a significant challenge to the nursing profession. One way to assist access to information is to provide electronic information resources at the point of care. A large-scale survey of nurses working in the public health system in New South Wales, Australia, was undertaken as part of a 2-year evaluation of the Clinical Information Access Program (CIAP). This is a website which provides 24 hour, online access to a range of evidence sources at the point of care. AIM This paper reports a study to investigate factors influencing nurses' use of online evidence available at the point of care and to examine differences between nurses in different roles. METHOD Nurses from 65 randomly selected hospitals were surveyed. A convenience sample representing 25% of nursing staff at these hospitals was sought. Eighty-four per cent of the survey quota was met and 3128 questionnaires were completed and returned. RESULTS The results showed that 58% of nurses had heard of the CIAP and, of those, 70% had used the website's resources. Senior nurses had greater awareness and use than others. The most frequent reasons for use were to fill a knowledge gap and for personal education. Lack of training was the most frequently cited reason for not using the website. Use of online evidence, particularly amongst senior staff, was higher than reported in previous studies. CONCLUSION Use of online evidence was associated with nursing role, and with managerial and organizational support. Diffusion of innovation theory can help to explain some of the patterns observed. The use and impact of online evidence should be interpreted in the context of nursing practice and culture.
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Affiliation(s)
- A Sophie Gosling
- Department of Psychology, Royal Holloway University of London, Egham, Surrey, UK.
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Abstract
AIM To examine factors influencing the achievement of evidence-based practice. BACKGROUND This paper reports on the approach taken by a large teaching hospital in England to promote evidence-based practice. A summary of initiatives spanning a 5 year period is presented in order to set the scene for a recent survey of nurses to review progress made. Consideration is given to how the findings from the survey have been used to inform policy and practice. METHODS A survey by self-completed questionnaire was undertaken with a sample of clinical nurses (n = 330). The questionnaire examined the extent to which nurses utilised different sources of knowledge to inform their practice; perceived barriers to accessing evidence-based information and effecting change in practice; and a self-assessment of core skills necessary to underpin evidence-based practice. FINDINGS Nurses relied most heavily on experiential knowledge gained through their interactions with nursing colleagues, medical staff and patients to inform their practice. Organisational information in the form of policies and audit reports was drawn upon more frequently than research reports. Lack of time, resources and perceived authority to change practice influenced the extent to which nurses utilised formal sources of evidence. Whereas nurses were relatively well skilled at accessing and reviewing research evidence, they were less confident about their ability to change practice. CONCLUSION Health care organisations need to consider multiple strategies to facilitate and promote evidence-based practice. Managerial support, facilitation, and a culture that is receptive to change are essential.
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Affiliation(s)
- Kate Gerrish
- School of Nursing and Midwifery, The University of Sheffield, Sheffield Formerly Research Fellow in Nursing, Sheffield Hallam University, Sheffield, UK.
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Abstract
AIM This article aims to identify the contributions of qualitative research to evidence-based practice in nursing. BACKGROUND Qualitative research dates back to the 1920s and 1930s, when anthropologists and sociologists used qualitative research methods to study human phenomena in naturalistic settings and from a holistic viewpoint. Afterwards, other subject matters, including nursing, adopted qualitative methods to answer their research questions. The restructuring of health care over the past decade has brought about increased accountability in nursing research. One method for increasing this accountability is evidence-based practice. METHOD The method used was a search in the Cumulative Index to Nursing and Allied Health Literature database from 1999-present. The search resulted in 61 citations for evidence-based practice in nursing research; however, only 5 citations focused on evidence-based practice and qualitative research. FINDINGS The authors' findings revealed six contributions of qualitative research to evidence-based practice: generation of hypotheses; development and validation of instruments; provision of context for evaluation; development of nursing interventions; development of new research questions; and application of Qualitative Outcome Analysis. CONCLUSION Qualitative research makes important contributions to the quality of evidence-based practice.
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Affiliation(s)
- Rita L Ailinger
- College of Nursing and Health Science, George Mason University.
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Gosling AS, Westbrook JI, Coiera EW. Variation in the use of online clinical evidence: a qualitative analysis. Int J Med Inform 2003; 69:1-16. [PMID: 12485700 DOI: 10.1016/s1386-5056(02)00046-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate factors influencing variations in clinicians' use of an online evidence retrieval system. SETTING Public hospitals in New South Wales, Australia. METHOD Web log analysis demonstrated considerable variation in rates of evidence use by clinicians at different hospitals. Focus groups and interviews were held with 61 staff from three hospitals, two with high rates of use and one with a low rate of use, to explore variation in evidence use. RESULTS Differences between hospitals' and professional groups' (doctors, nurses and allied health) use of online evidence could be explained by organizational, professional and cultural factors. These included the presence of champions, organizational cultures which supported evidence-based practice (EBP), and database searching skills of individual clinicians. Staff shortages, ease of access and time taken to use the online evidence system were cited as barriers to use at the low use site, but no objective differences in these measures were found between the high and low use sites. CONCLUSION Social and cultural factors were found to be better discriminators of high and low evidence use than technical factors.
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Affiliation(s)
- A Sophie Gosling
- Center for Health Informatics, Level 2, Samuels Building, University of New South Wales, Sydney 2052, Australia.
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Stephens F, Bick D. A national pilot to implement pressure ulcer guidelines: results of the baseline audit. Br J Community Nurs 2002:34-8. [PMID: 12514499 DOI: 10.12968/bjcn.2002.7.sup3.10898] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
The Royal College of Nursing (RCN) national pilot audit project aims to facilitate the dissemination and implementation of the RCN clinical guideline on pressure ulcer risk assessment and prevention using an evidence-based, tailored strategy. Recent government White Papers reinforced the move towards evidence-based healthcare that includes performance measures, clinical effectiveness and ongoing professional development. Structured dissemination and implementation of the RCN guideline can aid this process by improving patient care, as well as in a culture where more patients are seeking recompense for "poor" care assist in reducing litigation and complaints. This article focuses on the findings of the baseline audit. Providing a summary of the project to date, looking at site recruitment, the provisional results and recommendations of the baseline audit and local initiatives for supporting the ongoing implementation and the implementation resources developed to assist the sites in the process. The project is due for completion at the end of 2002 following which the final results will be published.
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Affiliation(s)
- Fiona Stephens
- RCN National Audit Project, Royal College of Nursing Institute, Oxford, UK
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Dlugacz YD, Stier L, Greenwood A. Changing the system: a quality management approach to pressure injuries. J Healthc Qual 2001; 23:15-9; quiz 19-20. [PMID: 11565165 DOI: 10.1111/j.1945-1474.2001.tb00369.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The quality management (QM) department at a large integrated healthcare system developed a methodology for preventing, predicting, and treating pressure injuries across the continuum, from acute care to long-term care to home care. The initiative, the first recipient of the Ernest A. Codman Award of the Joint Commission on Accreditation of Healthcare Organizations in the network category, resulted in decreased incidence and severity of pressure injuries, reduced length of stay, and significant cost savings to the system. The process the department used illustrates how an innovative QM program can facilitate change and institute a uniform standard of care.
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Affiliation(s)
- Y D Dlugacz
- North Shore Long Island Jewish Health System in Great Neck, NY, USA.
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