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Sullivan JL, Pendergast J, Wray LO, Adjognon OL, Curyto KJ. Factors Related to Higher and Lower Performance and Adherence in STAR-VA Program Sustainment in Department of Veterans Affairs (VA) Community Living Centers (CLCs). J Am Med Dir Assoc 2024; 25:711-721. [PMID: 38128584 DOI: 10.1016/j.jamda.2023.11.011] [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: 07/06/2023] [Revised: 11/02/2023] [Accepted: 11/08/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES We identify factors associated with sustainment of an intervention (STAR-VA) to address distress behaviors in dementia (DBD), guided by the Organizational Memory Knowledge Reservoir (KR) framework, compared across 2 types of outcomes: (1) site performance improvement on a clinical outcome, the magnitude of change in levels of DBD, and (2) self-rated adherence to STAR-VA core components, a process outcome. DESIGN We used a cross-sectional sequential explanatory mixed methods design guided by the Organizational Memory Framework. SETTING AND PARTICIPANTS We selected 20 of 79 sites that completed STAR-VA training and consultation based on rankings on 2 outcomes-change in an indicator of DBD and reported adherence to STAR-VA core components. We recruited key informants most knowledgeable about STAR-VA resulting in a sample of 43% behavioral coordinators, 36% nurse champions, and 21% nurse leaders. METHODS We collected data with key informants at each Community Living Center (CLC) from December 2018 to June 2019. We analyzed data using within-case and cross-case matrixes created from the coded transcripts for each a priori KR domain. We then assessed if there were any similarities or differences for CLCs in comparable DBD performance and STAR-VA adherence categories. RESULTS We found 4 KRs that differentiated sustainment factors based on CLC implementation process and clinical outcomes-3 KRs related to DBD performance (people, relationships, and routines) and 2 related to STAR-VA adherence (relationships and culture). CONCLUSIONS AND IMPLICATIONS This evaluation found several knowledge retention mechanisms that differ in high and low performance/adherence sites. Our findings highlight knowledge retention/sustainment strategies based on site functioning to support sustainment strategies in the CLC. Understanding sustainment factors as they relate to clinical and process outcomes is innovative and can be used to support CLCs struggling with sustainment. More research is needed to inform tailored sustainment efforts based on site functioning in the nursing home setting.
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Affiliation(s)
- Jennifer L Sullivan
- Center of Innovation in Long Term Services and Supports (LTSS COIN), VA Providence Healthcare System, Capt. Jonathan H. Harwood Jr. Center for Research, Providence, RI, USA; Brown University, School of Public Health, Department of Health Service, Policy, and Practice, Providence, RI, USA.
| | - Jacquelyn Pendergast
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
| | - Laura O Wray
- VA Center for Integrated Healthcare, Office of Mental Health and Suicide Prevention, VA Central Office, Washington, DC, USA; Division of Geriatrics and Palliative Care, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Omonyêlé L Adjognon
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.
| | - Kimberly J Curyto
- Center for Integrated Healthcare, VA Western NY Healthcare System, Batavia, NY, USA
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Kaushal A, Dogra P. Factors affecting perception of Indian adolescent students toward interactive online mental health information during COVID-19. INFORMATION DISCOVERY AND DELIVERY 2021. [DOI: 10.1108/idd-09-2020-0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This study aims to identify the critical factors affecting the perception of adolescent students toward interactive online mental health information available on health-related websites.
Design/methodology/approach
The primary data was collected with the help of an online self–structured questionnaire. The questionnaire includes the identified variables extracted from previous literature related to the mental health information websites using the Likert scale. The respondents include the adolescent school students belonging to the northern region of India: semi-urban/rural locations of Uttar Pradesh (Agra and Mathura) and urban cities (Faridabad, Gaziabad, Delhi and NCR). The criteria for selecting respondents were that students must have visited any online health information-related websites at least once. Exploratory factor analysis was used to explore the factors with the help of SPSS.20.
Findings
The identified factors that include information delivery medium/mode, websites’ navigation structure, customized information or content, ability to form a virtual relationship and supplementary features of the websites may benefit the health communication system of any country and the health-care industry.
Research limitations/implications
There are some limitations such as a limited number of respondents and even on that sample was taken for teenagers; thereby creating fewer generalizations related to the present context. Further, only exploratory factor analysis is applied in the study to identify the factors but future researchers may proceed to develop the conceptual model of perception toward online information with the help of confirmatory factor analysis and structural equation modeling techniques.
Practical implications
The results of this study are useful for government officials especially those related to the ministry of health care and public health organizations of various countries, who usually invest in co-designing authentic, reliable and high interactive online information-sharing websites.
Social implications
The results of the study will facilitate the various social child welfare associations and non-governmental organizations that are usually involved in the holistic development of adolescents. The identified factors can be seriously taken into considerations by these associations while they are formulating any on line websites for sharing health-related information to adolescents.
Originality/value
The study is unique as it provides insight into the opinion of the adolescent students, primarily upon encountering the online mental health information concerning the Indian perspective. Future researchers, health-care policymakers and health-care professionals may use the study to capture a complete picture of a relevant phenomenon in their work.
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Bergström A, Ehrenberg A, Eldh AC, Graham ID, Gustafsson K, Harvey G, Hunter S, Kitson A, Rycroft-Malone J, Wallin L. The use of the PARIHS framework in implementation research and practice-a citation analysis of the literature. Implement Sci 2020; 15:68. [PMID: 32854718 PMCID: PMC7450685 DOI: 10.1186/s13012-020-01003-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework. METHODS This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail. RESULTS The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated. CONCLUSIONS In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.
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Affiliation(s)
- Anna Bergström
- Department of Women’s and Children’s health, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Uppsala, Sweden
- Institute for Global Health, University College London, London, UK
| | - Anna Ehrenberg
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Ann Catrine Eldh
- Department of Medicine and Health, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kazuko Gustafsson
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- University Library, Uppsala University, Uppsala, Sweden
| | - Gillian Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Green Templeton College, University of Oxford, Oxford, UK
| | - Jo Rycroft-Malone
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancashire, UK
| | - Lars Wallin
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Applying Evidence-Based Knowledge to Clinical Practice: A View From Here. J Wound Ostomy Continence Nurs 2020; 47:195-196. [PMID: 32150146 DOI: 10.1097/won.0000000000000630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Duff J. The Role of the Facilitator. J Perianesth Nurs 2020; 35:87-88. [DOI: 10.1016/j.jopan.2019.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/24/2019] [Indexed: 10/25/2022]
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Zaboli R, Tofighi S, Aghighi A, Shokouh SJH, Naraghi N, Goodarzi H. Barriers Against Implementing Blunt Abdominal Trauma Guidelines in a Hospital: A Qualitative Study. Electron Physician 2016; 8:2793-2801. [PMID: 27757191 PMCID: PMC5053462 DOI: 10.19082/2793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/18/2016] [Indexed: 11/20/2022] Open
Abstract
Introduction Clinical practice guidelines are structured recommendations that help physicians and patients to make proper decisions when dealing with a specific clinical condition. Because blunt abdominal trauma causes a various range of mild, single-system, and multisystem injuries, early detection will help to reduce mortality and resulting disability. Emergency treatment should be initiated based on CPGs. This study aimed to determine the variables affecting implementing blunt abdominal trauma CPGs in an Iranian hospital. Methods This study was conducted as a qualitative and phenomenology study in the Family Hospital in Tehran (Iran) in 2015. The research population included eight experts and key people in the area of blunt abdominal trauma clinical practice guidelines. Sampling was based on purposive and nonrandom methods. A semistructured interview was done for the data collection. A framework method was applied for the data analysis by using Atlas.ti software. Results After framework analyzing and various reviewing and deleting and combining the codes from 251 codes obtained, 15 families and five super families were extracted, including technical knowledge barriers, economical barriers, barriers related to deployment and monitoring, political will barriers, and managing barriers. Conclusion Structural reform is needed for eliminating the defects available in the healthcare system. As with most of the codes, subconcepts and concepts are classified into the field of human resources; it seems that the education and knowledge will be more important than other resources such as capital and equipment.
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Affiliation(s)
- Rouhollah Zaboli
- Ph.D. of Health Services Administration, Assistant Professor, Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Shahram Tofighi
- Ph.D. of Health Services Administration, Assistant Professor, Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ali Aghighi
- Ph.D. of Health Services Administration, Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Nader Naraghi
- Assistant professor, AJA University of Medical Science, Tehran, Iran
| | - Hassan Goodarzi
- MD, Emergency Medicine Department, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Eriksson L, Huy TQ, Duc DM, Ekholm Selling K, Hoa DP, Thuy NT, Nga NT, Persson LÅ, Wallin L. Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in the Quang Ninh province, Vietnam. Trials 2016; 17:23. [PMID: 26762125 PMCID: PMC4711002 DOI: 10.1186/s13063-015-1141-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 12/21/2015] [Indexed: 11/10/2022] Open
Abstract
Background Annually, 2.8 million neonatal deaths occur worldwide, despite the fact that three-quarters of them could be prevented if available evidence-based interventions were used. Facilitation of community groups has been recognized as a promising method to translate knowledge into practice. In northern Vietnam, the Neonatal Health – Knowledge Into Practice trial evaluated facilitation of community groups (2008–2011) and succeeded in reducing the neonatal mortality rate (adjusted odds ratio, 0.51; 95 % confidence interval 0.30–0.89). The aim of this paper is to report on the process (implementation and mechanism of impact) of this intervention. Methods Process data were excerpted from diary information from meetings with facilitators and intervention groups, and from supervisor records of monthly meetings with facilitators. Data were analyzed using descriptive statistics. An evaluation including attributes and skills of facilitators (e.g., group management, communication, and commitment) was performed at the end of the intervention using a six-item instrument. Odds ratios were analyzed, adjusted for cluster randomization using general linear mixed models. Results To ensure eight active facilitators over 3 years, 11 Women’s Union representatives were recruited and trained. Of the 44 intervention groups, composed of health staff and commune stakeholders, 43 completed their activities until the end of the study. In total, 95 % (n = 1508) of the intended monthly meetings with an intervention group and a facilitator were conducted. The overall attendance of intervention group members was 86 %. The groups identified 32 unique problems and implemented 39 unique actions. The identified problems targeted health issues concerning both women and neonates. Actions implemented were mainly communication activities. Communes supported by a group with a facilitator who was rated high on attributes and skills (n = 27) had lower odds of neonatal mortality (odds ratio, 0.37; 95 % confidence interval, 0.19–0.73) than control communes (n = 46). Conclusions This evaluation identified several factors that might have influenced the outcomes of the trial: continuity of intervention groups’ work, adequate attributes and skills of facilitators, and targeting problems along a continuum of care. Such factors are important to consider in scaling-up efforts. Trial registration ISRCTNISRCTN44599712. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-1141-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Leif Eriksson
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Tran Q Huy
- Nursing office, Department of Medical Services Administration, Ministry of Health, Hanoi, Vietnam.
| | - Duong M Duc
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. .,Hanoi School of Public Health, Hanoi, Vietnam.
| | - Katarina Ekholm Selling
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Dinh P Hoa
- Hanoi School of Public Health, Hanoi, Vietnam.
| | - Nguyen T Thuy
- Vietnam Sweden Uong Bi General Hospital, Quang Ninh, Vietnam.
| | - Nguyen T Nga
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. .,Vietnam Sweden Uong Bi General Hospital, Quang Ninh, Vietnam.
| | - Lars-Åke Persson
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Lars Wallin
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden. .,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
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Eriksson L, Duc DM, Eldh AC, Vu PNT, Tran QH, Målqvist M, Wallin L. Lessons learned from stakeholders in a facilitation intervention targeting neonatal health in Quang Ninh province, Vietnam. BMC Pregnancy Childbirth 2013; 13:234. [PMID: 24330472 PMCID: PMC3866580 DOI: 10.1186/1471-2393-13-234] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 12/11/2013] [Indexed: 12/02/2022] Open
Abstract
Background In northern Vietnam the Neonatal health - Knowledge Into Practice (NeoKIP, Current Controlled Trials ISRCTN44599712) trial has evaluated facilitation as a knowledge translation intervention to improve neonatal survival. The results demonstrated that intervention sites, each having an assigned group including local stakeholders supported by a facilitator, lowered the neonatal mortality rate by 50% during the last intervention year compared with control sites. This process evaluation was conducted to identify and describe mechanisms of the NeoKIP intervention based on experiences of facilitators and intervention group members. Methods Four focus group discussions (FGDs) were conducted with all facilitators at different occasions and 12 FGDs with 6 intervention groups at 2 occasions. Fifteen FGDs were audio recorded, transcribed verbatim, translated into English, and analysed using thematic analysis. Results Four themes and 17 sub-themes emerged from the 3 FGDs with facilitators, and 5 themes and 18 sub-themes were identified from the 12 FGDs with the intervention groups mirroring the process of, and the barriers to, the intervention. Facilitators and intervention group members concurred that having groups representing various organisations was beneficial. Facilitators were considered important in assembling the groups. The facilitators functioned best if coming from the same geographical area as the groups and if they were able to come to terms with the chair of the groups. However, the facilitators’ lack of health knowledge was regarded as a deficit for assisting the groups’ assignments. FGD participants experienced the NeoKIP intervention to have impact on the knowledge and behaviour of both intervention group members and the general public, however, they found that the intervention was a slow and time-consuming process. Perceived facilitation barriers were lack of money, inadequate support, and the function of the intervention groups. Conclusions This qualitative process evaluation contributes to explain the improved neonatal survival and why this occurred after a latent period in the NeoKIP project. The used knowledge translation intervention, where facilitators supported multi-stakeholder coalitions with the mandate to impact upon attitudes and behaviour in the communes, has low costs and potential for being scaled-up within existing healthcare systems.
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Affiliation(s)
- Leif Eriksson
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, SE-751 85, Uppsala, Sweden.
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Irwin MM, Bergman RM, Richards R. The Experience of Implementing Evidence-Based Practice Change: A Qualitative Analysis. Clin J Oncol Nurs 2013; 17:544-9. [DOI: 10.1188/13.cjon.544-549] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Boblin SL, Ireland S, Kirkpatrick H, Robertson K. Using Stake's qualitative case study approach to explore implementation of evidence-based practice. QUALITATIVE HEALTH RESEARCH 2013; 23:1267-1275. [PMID: 23925405 DOI: 10.1177/1049732313502128] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Although the use of qualitative case study research has increased during the past decade, researchers have primarily reported on their findings, with less attention given to methods. When methods were described, they followed the principles of Yin; researchers paid less attention to the equally important work of Stake. When Stake's methods were acknowledged, researchers frequently used them along with Yin's. Concurrent application of their methods did not take into account differences in the philosophies of these two case study researchers. Yin's research is postpositivist whereas Stake's is constructivist. Thus, the philosophical assumptions they used to guide their work were different. In this article we describe how we used Stake's approach to explore the implementation of a falls-prevention best-practice guideline. We focus on our decisions and their congruence with Stake's recommendations, embed our decisions within the context of researching this phenomenon, describe rationale for our decisions, and present lessons learned.
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Porter RM, Thrasher J, Krebs NF. Implementing a pediatric obesity care guideline in a freestanding children's hospital to improve child safety and hospital preparedness. J Pediatr Nurs 2012; 27:707-14. [PMID: 22178030 PMCID: PMC3607510 DOI: 10.1016/j.pedn.2011.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 08/29/2011] [Accepted: 11/15/2011] [Indexed: 11/30/2022]
Abstract
Medical and surgical care of children with severe obesity is complicated and requires recognition of the problem, appropriate equipment, and safe management. There is little literature describing patient, provider, and institutional needs for the severely obese pediatric patient. Nonetheless, the limited data suggest 3 broad categories of needs unique to this population: (a) airway management, (b) drug dosing and pharmacology, and (c) equipment and infrastructure. We describe an opportunity at the Children's Hospital Colorado to better prepare and optimize care for this patient population by creation of a Pediatric Obesity Care Guideline that focused on key areas of quality and safety.
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Affiliation(s)
- Renee M Porter
- Section of Nutrition, Department of Pediatrics, University of Colorado Denver, School of Medicine, Aurora, CO, USA.
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Nurse-directed interventions to reduce catheter-associated urinary tract infections. Am J Infect Control 2012; 40:548-53. [PMID: 22047997 DOI: 10.1016/j.ajic.2011.07.018] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 07/26/2011] [Accepted: 07/26/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are common, morbid, and costly. Nearly 25% of hospitalized patients are catheterized yearly, and 10% develop urinary tract infections. Evidence-based guidelines exist for indwelling urinary catheter management but are not consistently followed. METHODS A pre/post intervention design was used in this quality improvement project to test the impact of nurse-driven interventions based on current evidence to reduce CAUTIs in hospitalized patients on 2 medical/surgical units. Interventions consisted of hospital-wide strategies including policy and product improvements and unit-specific strategies that focused on a review of current evidence to guide practice. RESULTS The number of catheter days decreased from 3.01 to 2.2 (P = .018) on the surgery unit and from 3.53 to 2.7 (P = .076) on the medical unit. CAUTI rates were too low to achieve significant reduction. Product cost savings were estimated at $52,000/year. CONCLUSION Guidelines derived from research and other sources of evidence can successfully improve patient outcomes. Nurse-driven interventions, combined with system-wide product changes, and patient and family involvement may be effective strategies that reduce CAUTI.
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Ireland S, Kirkpatrick H, Boblin S, Robertson K. The Real World Journey of Implementing Fall Prevention Best Practices in Three Acute Care Hospitals: A Case Study. Worldviews Evid Based Nurs 2012; 10:95-103. [DOI: 10.1111/j.1741-6787.2012.00258.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Sandra Ireland
- Assistant Clinical Professor, McMaster University School of Nursing; Hamilton; ON; Canada
| | - Helen Kirkpatrick
- Assistant Clinical Professor, McMaster University School of Nursing and BPSO Coordinator; St. Joseph's Healthcare Hamilton; Hamilton; ON; Canada
| | - Sheryl Boblin
- Associate Professor, McMaster University School of Nursing; Hamilton; ON; Canada
| | - Kim Robertson
- Management Specialist, St. Joseph's Health Care Hamilton; Hamilton; ON; Canada
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The Clinical Nurse Leader: Addressing Health-Care Challenges Through Partnerships and Innovation. JOURNAL OF NURSING REGULATION 2011. [DOI: 10.1016/s2155-8256(15)30286-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Helfrich CD, Damschroder LJ, Hagedorn HJ, Daggett GS, Sahay A, Ritchie M, Damush T, Guihan M, Ullrich PM, Stetler CB. A critical synthesis of literature on the promoting action on research implementation in health services (PARIHS) framework. Implement Sci 2010; 5:82. [PMID: 20973988 PMCID: PMC2988065 DOI: 10.1186/1748-5908-5-82] [Citation(s) in RCA: 184] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 10/25/2010] [Indexed: 12/01/2022] Open
Abstract
Background The Promoting Action on Research Implementation in Health Services framework, or PARIHS, is a conceptual framework that posits key, interacting elements that influence successful implementation of evidence-based practices. It has been widely cited and used as the basis for empirical work; however, there has not yet been a literature review to examine how the framework has been used in implementation projects and research. The purpose of the present article was to critically review and synthesize the literature on PARIHS to understand how it has been used and operationalized, and to highlight its strengths and limitations. Methods We conducted a qualitative, critical synthesis of peer-reviewed PARIHS literature published through March 2009. We synthesized findings through a three-step process using semi-structured data abstraction tools and group consensus. Results Twenty-four articles met our inclusion criteria: six core concept articles from original PARIHS authors, and eighteen empirical articles ranging from case reports to quantitative studies. Empirical articles generally used PARIHS as an organizing framework for analyses. No studies used PARIHS prospectively to design implementation strategies, and there was generally a lack of detail about how variables were measured or mapped, or how conclusions were derived. Several studies used findings to comment on the framework in ways that could help refine or validate it. The primary issue identified with the framework was a need for greater conceptual clarity regarding the definition of sub-elements and the nature of dynamic relationships. Strengths identified included its flexibility, intuitive appeal, explicit acknowledgement of the outcome of 'successful implementation,' and a more expansive view of what can and should constitute 'evidence.' Conclusions While we found studies reporting empirical support for PARIHS, the single greatest need for this and other implementation models is rigorous, prospective use of the framework to guide implementation projects. There is also need to better explain derived findings and how interventions or measures are mapped to specific PARIHS elements; greater conceptual discrimination among sub-elements may be necessary first. In general, it may be time for the implementation science community to develop consensus guidelines for reporting the use and usefulness of theoretical frameworks within implementation studies.
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Affiliation(s)
- Christian D Helfrich
- Northwest HSR&D Center of Excellence, VA Puget Sound Healthcare System, Seattle, Washington, USA.
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Dogherty EJ, Harrison MB, Graham ID. Facilitation as a role and process in achieving evidence-based practice in nursing: a focused review of concept and meaning. Worldviews Evid Based Nurs 2010; 7:76-89. [PMID: 20180826 DOI: 10.1111/j.1741-6787.2010.00186.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Facilitation is proposed as an important strategy to assist practitioners to implement evidence into practice. However, from a front-line nursing perspective, what is actually involved in facilitation, particularly in regards to research utilization, is poorly understood. AIM To examine the current state of knowledge surrounding the concept of facilitation as a role and process in the implementation of research findings within the nursing context. Building on a previous concept analysis, we examined how facilitation has evolved over the last decade, particularly focusing on the practical elements (e.g., what it entails to operationalize and implement facilitation in nursing). METHODS A systematic search of electronic databases identified theory and research-based nursing papers explicitly focused on facilitation in research utilization. Through a content analysis, we examined how the concept is being used, described, and applied within nursing. RESULTS Facilitation continues to be described as supporting and enabling practitioners to improve practice through evidence implementation. Certain aspects of the role and the strategies being employed to promote change are more evident. It was possible to formulate these into a taxonomy. Key findings include: * facilitation is now being viewed as an individual role as well as a process involving individuals and groups; * project management/leadership are important components; * no matter which approach is selected, tailoring facilitation to the local context is critical; * there is a growing emphasis on evaluation, particularly linking outcomes to nursing actions. CONCLUSIONS Further understanding of what facilitators are actually doing to enable changes in nursing practice based on research findings will provide the groundwork for the design and evaluation of practical strategies for evidence-based practice in nursing. Research is needed to clarify how facilitation may be used to implement change in nursing practice along with evaluation of the effectiveness of various approaches.
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Stetler CB, Caramanica L. Evaluation of an evidence-based practice initiative: outcomes, strengths and limitations of a retrospective, conceptually-based approach. Worldviews Evid Based Nurs 2008; 4:187-99. [PMID: 18076462 DOI: 10.1111/j.1741-6787.2007.00097.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Making evidence-based practice (EBP) a sustained reality is a difficult endeavor. This relates, among other factors, to lack of sufficient research upon which to base implementation efforts. Alternative sources of evidence therefore need to be considered, particularly where organizational level EBP is the goal. In this article a brief evaluation of a service-based initiative with the aim of obtaining insights regarding multiple types and levels of EBP-related outcomes is described. METHODS A structured, retrospective improvement evaluation was conducted. Semi-structured interviews and available documents were chosen to obtain information regarding outcomes, perceived spread of reported individual changes, and factors related to the degree of progress. Underlying the method is an evaluation model that shows a progressive set of EBP outcomes at both individual and group levels. FINDINGS Evaluative results, although limited by several factors, provided credible and sufficient internal evidence for this organization's leadership team to build upon past efforts and refine their approach to integrating research utilization (RU) throughout the department of nursing. For example, the evaluation indicated a set of RU outcomes at the individual nurse level not previously considered and also indicated limitations and challenges to full achievement of initial project-related goals. DISCUSSION AND IMPLICATIONS The evaluation provided suggestive internal evidence regarding potential benefits of one component of a long-term, valued EBP initiative. However, the evaluation also raised questions regarding structural aspects of this initiative; identified barriers to progress; provided information for dialogue and planning; and highlighted future needs for a proactive, systematic evaluation and a documented trail of data related to all EBP program goals. For those in settings with similar characteristics and aims that have not built in such a prospective evaluation for EBP initiatives, this evaluative project can be assessed for its applicability.
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Affiliation(s)
- Cheryl B Stetler
- Evidence-based Practice/Evaluation Consultant, Amherst, MA, USA.
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