Predicting research use in nursing organizations: a multilevel analysis

Professional empowerment and evidence-based nursing: A mixed-method systematic review

AIMS AND OBJECTIVES

To review, synthesise and integrate primary research on the relationship between professional empowerment and evidence-based practice (EBP) in nursing.

BACKGROUND

Professional empowerment research exposes an association between empowerment and positive work behaviours and attitudes. Empowerment is associated with nurses' productivity, autonomy and resources. However, implementing evidence into practice is not easy due to barriers to EBP, namely organisational and cultural. Research demonstrating the relationship between professional empowerment and EBP will provide direction for future interventions aimed at the development of an effective healthcare sector.

DESIGN

A mixed-methods systematic review, according to the Joanna Briggs Institute approach, with results reported according to PRISMA. The associated checklist for systematic reviews was also used.

METHOD

The electronic databases searched for relevant studies included: Medline, Cumulative Nursing and Allied Health Literature (CINAHL), JBI Database of Systematic Reviews and Implementation Reports, and The Cochrane Library; thesis and dissertation databases; and Web pages of reference organisations and Scientific Events programs. Quality assessments, data extraction and analysis were completed on all included studies, according JBI. Thematic analysis was used to synthesise the data.

RESULTS

We identified 477 studies. After removing duplicates and reviewing title and abstract following the inclusion and exclusion criteria, 26 papers were evaluated for eligibility. The review included 9 articles. The literature was categorised into three themes: (a) organisational and leadership characteristics, (b) individual characteristics, and (c) outcomes/consequences.

CONCLUSION

This review highlights the importance of empowering environments in EBP. A relationship was evident between leadership, organisation, empowerment, individual characteristics and the use and implementation of evidence, resulting in tangible and measurable gains. However, more robust studies are needed. This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42018086414).

Effet d’un club de lecture sur le sentiment d’efficacité personnelle, les attentes et les intentions d’étudiantes en sciences infirmières à l’égard de l’utilisation des résultats probants

INTRODUCTION

Nursing associations require that nurses develop the skills to integrate evidence into practice to support the quality of care.

CONTEXT

Lack of self-confidence in the operational steps of evidence-based practice was identified as a barrier to integrating evidence into nursing practice.

OBJECTIVE

To assess the effect of a journal club (JC) on nursing students' self-efficacy (SE), expectations, and intentions to use evidence.

METHOD

Quasi-experimental, longitudinal approach with a non-randomized comparison group.

RESULTS

The development of SE toward the use of evidence-based practices favored students who participated in the JC (n=48) compared to students who received a conventional educational modality (CEM) (n=50). However, there was no significant group x time interaction effect on expectations or intentions.

DISCUSSION

The significant positive changes beyond the CEM may be explained by the fact that the JC incorporated modes of influence on SE.

CONCLUSION

The positive effect associated with the JC on SE is difficult to sustain without continued practice. It is important to maintain high outcome expectations within nursing training.

Military nurses' perspectives towards research utilization barriers

Objectives

Research utilization in nursing practice includes integrating research findings into clinical practice to guide nursing practice towards safe and effective clinical decision-making. However, nursing leaders are faced with barriers which hinder research utilization and hence create a gap between research and clinical practice. This study aimed to identify the barriers to research utilization as perceived by Jordanian Royal Medical Services nurses.

Methods

A descriptive cross-sectional design was employed. A convenience sample of 365 nurses working with the Jordanian Royal Medical Services was recruited from three hospitals. The BARRIERS scale and a self-designed questionnaire were used for data collection, and descriptive statistics, t-tests, one way ANOVA, and Pearson's correlation were used to analyze the data.

Results

The mean age of the participants was 30 years. The majority of the participating nurses were female (62.5%), and 91.8% held a bachelor's degree. Overall, the greatest barrier to research utilization was related to the setting factor (mean = 3.01), followed by the presentation of research factor (mean = 2.86). Further, lack of time to read research identified as a top-ranked barrier among the individual items (m = 3.3). In addition, there were significant differences in the participants' mean BARRIERS scale scores based on age and hospital (p value = .002 and <.0001, respectively).

Conclusion

The study findings highlighted the need for organizational support, recognition, and encouragement of research utilization. Continuous education for nurses that focuses on research skills, knowledge, and awareness is also crucial.

How Does the Facilitation Effort of Clinical Educators Interact With Aspects of Organizational Context to Affect Research Use in Long-term Care? Evidence From CHAID Analysis

PURPOSE

Organizational context influences the effect of facilitation efforts on research use in care settings. The interactions of these factors are complex. Therefore, the use of traditional statistical methods to examine their interrelationships is often impractical. Big Data analytics can automatically detect patterns within the data. We applied the chi-squared automatic interaction detection (CHAID) algorithm and classification tree technique to explore the dynamic and interdependent relationships between the implementation science concepts-context, facilitation, and research use.

DESIGN

Observational, cross-sectional study based on survey data collected from a representative sample of nursing homes in western Canada.

METHODS

We assessed three major constructs: (a) Conceptual research utilization (CRU) using the CRU scale; (b) facilitation of research use measured by the frequency of contacts between the frontline staff and a clinical educator, or person who brings new ideas to the care unit; and (c) organizational context at the unit level using the Alberta Context Tool (ACT). CHAID analysis was performed to detect the interactions between facilitation and context variables. Results were illustrated in a classification tree to provide a straightforward visualization.

FINDINGS

Data from 312 care units in three provinces were included in the final analysis. Results indicate significant multiway interactions between facilitation and various aspects of the organizational context, including leadership, culture, evaluation, structural resources, and organizational slack (staffing). Findings suggested the preconditions of the care settings where research use can be maximized.

CONCLUSIONS

CHAID analysis helped transform data into usable knowledge. Our findings provide insight into the dynamic relationships of facilitators' efforts and organizational context, and how these factors' interplay and their interdependence together may influence research use.

CLINICAL RELEVANCE

Knowledge of the combined effects of facilitators' efforts and various aspects of organizational context on research use can contribute to effective strategies to narrow the evidence-practice gap in care settings.

Determining Attitudes of Nurses Toward Evidence-Based Nursing in a University Hospital Sample

AIM

This study aimed to determine the attitudes of nurses working in a university hospital toward evidence-based nursing.

METHOD

This descriptive and cross-sectional research included 529 nurses working in a university hospital during November 1 to November 30, 2018. Data were collected using the information form and Attitude Toward Evidence-Based Nursing Questionnaire (AEBNQ). Descriptive statistical methods, the Shapiro–Wilk test, the Mann–Whitney U test, and the Kruskal–Wallis test were used for statistical analyses.

RESULTS

The average age of the nurses was 36.55±9.29 years, 91.1% were female, and the average work experience was 12.61±9.56 years. Moreover, 53.4% of the nurses were working in surgical departments, and 50.3% were working as clinical nurses. The total mean score of AEBNQ of the nurses was 58.23±9.34, and it was determined that their attitudes toward evidence-based nursing was positive. It was confirmed that for some subscales, the mean scores of AEBNQ of the female nurses and nurses working in internal disease departments were significantly high.

CONCLUSION

Attitudes of the nurses toward evidence-based nursing were found to be positive. It was concluded that the department in which the nurses worked and being female affected their attitudes toward evidence-based nursing.

The use of the PARIHS framework in implementation research and practice-a citation analysis of the literature

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.

Decreasing Barriers to Research Utilization Among Labor and Delivery Nurses

BACKGROUND

Intermittent fetal monitoring (IFM) is a recommended strategy for intrapartum fetal heart rate assessment in low-risk pregnancies; however, this "high touch, low tech" approach is underutilized.

OBJECTIVE

The aim of the study was to examine the relationships between labor and delivery nurses' intellectual capital and their perceptions of barriers to research utilization in the work setting.

METHODS

A cross-sectional correlational design using data derived from a larger study of labor and delivery nurses (N = 248) was used. Covell's theory of nursing intellectual capital was used as the conceptual and analytic framework to examine labor and delivery nurses' intellectual capital and their perceived barriers to research utilization.

RESULTS

Nurses who receive paid time off from their employer to attend conferences (p < .01) and nurses who do not report nurse-to-patient ratios as a problem in providing IFM (p < .01) perceive fewer barriers to research utilization.

DISCUSSION

Time, especially available time, has an effect on labor and delivery nurses' attitude toward IFM and their perceptions of barriers to research utilization.

Evidence-based practice integration in hospital wards-The complexities and challenges in achieving evidence-based practice in clinical nursing

AIM

Exploring the processes involved in two different strategies to integrate evidence-based practice into nursing practice.

DESIGN

Classical grounded theory methodology was used.

METHODS

Data were collected through 90 hr of observation and 4 focus groups among clinical nurses in two different hospital wards.

RESULTS

We identified a multidimensional evidence-based practice integration framework that illuminates the complexities involved in the integration process. The dimensions were approaches to evidence-based practice, positions of evidence-based practice and levels of evidence-based practice. The interactions between the dimensions gave five combinations; an explicit evidence-based practice performed as a parallel to daily work at the systems level, an implicit evidence-based practice integrated into daily work at the systems level, an explicit evidence-based practice integrated into daily work at the individual level, an explicit evidence-based practice integrated into daily work at the systems level and an implicit evidence-based practice integrated into daily work at the individual level.

Pace and determinants of implementation of the self-management of well-being group intervention: a multilevel observational study

Background

When implementing an empirically supported intervention (ESI) arrays of influencing factors operate on the professional and organizational level, but so far dependency between these levels has often been ignored. The aim of this study is to describe the pace and identify determinants of implementation of the Self-Management of Well-being (SMW) group intervention while taking the dependency between professionals and organizations into account.

Methods

Pace of implementation was measured as the time between training of professionals and first use of the SMW intervention in months. Determinants of first use were derived from the Fleuren framework and assessed using web-based questionnaires and telephone interviews. First, univariate analyses, Fisher’s exact tests and t-tests, were performed to identify determinants of first use of the SMW intervention on the individual professional and the organizational level independently. Second, multilevel analyses were performed to correct for the dependency between professionals and organizations. Simple multilevel logistic regression analyses were performed with determinants found significant in the univariate analyses as independent variables, first use as dependent variable, professionals entered in the first level, and organizations in the second level.

Results

Forty-eight professionals from 18 organizations were trained to execute the SMW intervention. Thirty-two professionals achieved first use, at a mean pace of 7.5 months ± 4.2. Determinants on the professional level were ‘ownership’, ‘relative advantage’, ‘support from colleagues’ and ‘compatibility’. Determinants on the organizational level were ‘organizational size’ and ‘innovation-task orientation fit’. Multilevel analysis showed that ‘compatibility’, a factor on the professional level, was the only significant determinant contributing to first use in the multilevel model.

Conclusions

This implementation study revealed a strong dependency between professionals and organizations. Results showed that a majority of professionals used the SMW intervention in about 8 months. When the dependency between professionals and organization was taken into account, the professionals’ perception of compatibility was the only remaining determinant of implementation on the professional level. Organizational size and managers’ perception of ‘innovation-task orientation fit’ were determinants of implementation on the organizational level. It is advisable to discuss the compatibility between new and current tasks among managers and professionals before adopting a new intervention.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-3891-x) contains supplementary material, which is available to authorized users.

Importance of clinical educators to research use and suggestions for better efficiency and effectiveness: results of a cross-sectional survey of care aides in Canadian long-term care facilities

OBJECTIVE

This study explored the effect of clinical educators as facilitators of research use and how it may be modified by organisational context in the settings.

DESIGN

Cross-sectional observational study.

SETTING

A representative sample of 91 residential long-term care (LTC) facilities across Western Canada.

PARTICIPANTS

We used surveys to collect data from the frontline care aides and information about the organisational context of the care units.

OUTCOME MEASURE AND EXPLANATORY VARIABLES

We assessed research use (the outcome) with the Conceptual Research Utilization (CRU) scale. Explanatory variables in the multiple regression analysis were facilitation, organisational context and the interaction terms. Facilitation was measured by the frequency of contacts between care aides and clinical educator or person who brings new ideas about resident care. Three core organisational context variables were measured using the Alberta Context Tool.

RESULTS

We included data of 3873 care aides from 294 care units in the LTC facilities. We found significant associations between CRU and facilitation, leadership, culture and evaluation. Interactions of facilitation x leadership and facilitation x culture were negative. The coefficient of the facilitation x evaluation term in the regression model was positive (0.019, 95% CI 0.012 to 0.026), suggesting synergistic effects between facilitation and a well-developed process to evaluate care quality using relevant data.

CONCLUSIONS

Findings indicate clinical educators are effective facilitators of research use among the care aides, but the effect is modified by organisational context. For greatest impact, managers can direct efforts of the clinical educators to care units where leadership and culture ratings are lowest, but a proficient feedback and evaluation process is in place. This understanding enables managers to deploy clinical educators (a scarce resource in LTC settings) most efficiently.

Organizational contextual features that influence the implementation of evidence-based practices across healthcare settings: a systematic integrative review

BACKGROUND

Organizational contextual features have been recognized as important determinants for implementing evidence-based practices across healthcare settings for over a decade. However, implementation scientists have not reached consensus on which features are most important for implementing evidence-based practices. The aims of this review were to identify the most commonly reported organizational contextual features that influence the implementation of evidence-based practices across healthcare settings, and to describe how these features affect implementation.

METHODS

An integrative review was undertaken following literature searches in CINAHL, MEDLINE, PsycINFO, EMBASE, Web of Science, and Cochrane databases from January 2005 to June 2017. English language, peer-reviewed empirical studies exploring organizational context in at least one implementation initiative within a healthcare setting were included. Quality appraisal of the included studies was performed using the Mixed Methods Appraisal Tool. Inductive content analysis informed data extraction and reduction.

RESULTS

The search generated 5152 citations. After removing duplicates and applying eligibility criteria, 36 journal articles were included. The majority (n = 20) of the study designs were qualitative, 11 were quantitative, and 5 used a mixed methods approach. Six main organizational contextual features (organizational culture; leadership; networks and communication; resources; evaluation, monitoring and feedback; and champions) were most commonly reported to influence implementation outcomes in the selected studies across a wide range of healthcare settings.

CONCLUSIONS

We identified six organizational contextual features that appear to be interrelated and work synergistically to influence the implementation of evidence-based practices within an organization. Organizational contextual features did not influence implementation efforts independently from other features. Rather, features were interrelated and often influenced each other in complex, dynamic ways to effect change. These features corresponded to the constructs in the Consolidated Framework for Implementation Research (CFIR), which supports the use of CFIR as a guiding framework for studies that explore the relationship between organizational context and implementation. Organizational culture was most commonly reported to affect implementation. Leadership exerted influence on the five other features, indicating it may be a moderator or mediator that enhances or impedes the implementation of evidence-based practices. Future research should focus on how organizational features interact to influence implementation effectiveness.

Promoting Action on Research Implementation in Health Services framework applied to TeamSTEPPS implementation in small rural hospitals

BACKGROUND

A particularly useful model for examining implementation of quality improvement interventions in health care settings is the PARIHS (Promoting Action on Research Implementation in Health Services) framework developed by Kitson and colleagues. The PARIHS framework proposes three elements (evidence, context, and facilitation) that are related to successful implementation.

PURPOSES

An evidence-based program focused on quality enhancement in health care, termed TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety), has been widely promoted by the Agency for Healthcare Research and Quality, but research is needed to better understand its implementation. We apply the PARIHS framework in studying TeamSTEPPS implementation to identify elements that are most closely related to successful implementation.

METHODOLOGY/APPROACH

Quarterly interviews were conducted over a 9-month period in 13 small rural hospitals that implemented TeamSTEPPS. Interview quotes that were related to each of the PARIHS elements were identified using directed content analysis. Transcripts were also scored quantitatively, and bivariate regression analysis was employed to explore relationships between PARIHS elements and successful implementation related to planning activities.

FINDINGS

The current findings provide support for the PARIHS framework and identified two of the three PARIHS elements (context and facilitation) as important contributors to successful implementation.

PRACTICE IMPLICATIONS

This study applies the PARIHS framework to TeamSTEPPS, a widely used quality initiative focused on improving health care quality and patient safety. By focusing on small rural hospitals that undertook this quality improvement activity of their own accord, our findings represent effectiveness research in an understudied segment of the health care delivery system. By identifying context and facilitation as the most important contributors to successful implementation, these analyses provide a focus for efficient and effective sustainment of TeamSTEPPS efforts.

Influence of leadership on implementing Dementia Care Mapping: A multiple case study

Dementia Care Mapping is an internationally applied method for enhancing person-centred care for people with dementia in nursing homes. Recent studies indicate that leadership is crucial for the successful implementation of Dementia Care Mapping; however, research on this topic is rare. This case study aimed to explore the influence of leadership on Dementia Care Mapping implementation in four nursing homes. Twenty-eight interviews with project coordinators, head nurses and staff nurses were analysed using qualitative content analysis. Nursing homes that failed to implement Dementia Care Mapping were characterised by a lack of leadership. The leaders of successful nursing homes promoted person-centred care and were actively involved in implementation. While overall leadership performance was positive in one of the successful nursing homes, conflicts related to leadership style occurred in the other successful nursing homes. Thus, it is important that leaders promote person-centred care in general and Dementia Care Mapping in particular. Furthermore, different types of leadership can promote successful implementation.

Trial registration of the primary study: Current Controlled Trials ISRCTN43916381.

Facilitation roles and characteristics associated with research use by healthcare professionals: a scoping review

BACKGROUND

Implementing research findings into practice is a complex process that is not well understood. Facilitation has been described as a key component of getting research findings into practice. The literature on facilitation as a practice innovation is growing. This review aimed to identify facilitator roles and to describe characteristics of facilitation that may be associated with successful research use by healthcare professionals.

METHODS

We searched 10 electronic databases up to December 2016 and used predefined criteria to select articles. We included conceptual papers and empirical studies that described facilitator roles, facilitation processes or interventions, and that focused on healthcare professionals and research use. We used content and thematic analysis to summarise data. Rogers' five main attributes of an innovation guided our synthesis of facilitation characteristics.

RESULTS

Of the 38 488 articles identified from our online and manual search, we included 195 predominantly research studies. We identified nine facilitator roles: opinion leaders, coaches, champions, research facilitators, clinical/practice facilitators, outreach facilitators, linking agents, knowledge brokers and external-internal facilitators. Fifteen facilitation characteristics were associated with research use, which we grouped into five categories using Rogers' innovation attributes: relative advantage, compatibility, complexity, trialability and observability.

CONCLUSIONS

We found a diverse and broad literature on the concept of facilitation that can expand our current thinking about facilitation as an innovation and its potential to support an integrated, collaborative approach to improving healthcare delivery.

Impact of Managers' Coaching Conversations on Staff Knowledge Use and Performance in Long-Term Care Settings

BACKGROUND

Extended lifespans and complex resident care needs have amplified resource demands on nursing homes. Nurse managers play an important role in staff job satisfaction, research use, and resident outcomes. Coaching skills, developed through leadership skill-building, have been shown to be of value in nursing.

AIMS

To test a theoretical model of nursing home staff perceptions of their work context, their managers' use of coaching conversations, and their use of instrumental, conceptual and persuasive research.

METHODS

Using a two-group crossover design, 33 managers employed in seven Canadian nursing homes were invited to attend a 2-day coaching development workshop. Survey data were collected from managers and staff at three time points; we analyzed staff data (n = 333), collected after managers had completed the workshop. We used structural equation modeling to test our theoretical model of contextual characteristics as causal variables, managers' characteristics, and coaching behaviors as mediating variables and staff use of research, job satisfaction, and burnout as outcome variables.

RESULTS

The theoretical model fit the data well (χ² = 58, df = 43, p = .06) indicating no significant differences between data and model-implied matrices. Resonant leadership (a relational approach to influencing change) had the strongest significant relationship with manager support, which in turn influenced frequency of coaching conversations. Coaching conversations had a positive, non-significant relationship with staff persuasive use of research, which in turn significantly increased instrumental research use. Importantly, coaching conversations were significantly, negatively related to job satisfaction.

LINKING EVIDENCE TO ACTION

Our findings add to growing research exploring the role of context and leadership in influencing job satisfaction and use of research by healthcare practitioners. One-on-one coaching conversations may be difficult for staff not used to participating in such conversations. Resonant leadership, as expected, has a significant impact on manager support and job satisfaction among nursing home staff.

Protocol of a scoping review on knowledge translation competencies

BACKGROUND

Knowledge translation (KT) activities can reduce the gap between "what is known" and "what is done". Several factors hinder or facilitate KT activities including individual characteristics and organizational attributes; we will focus on individual healthcare professional modifiable characteristics. The purpose of this scoping review is to summarize knowledge on KT competencies for knowledge users, knowledge brokers, and knowledge producers/researchers to support evidence-based practice (EBP) and inform policy and research in health. Our objectives are to explore the relevant theoretical and empirical literature; map the publications for key themes and research gaps of KT competencies, and interventions for enhancing KT competencies; summarize and disseminate findings; produce an action plan and research agenda; and develop self-assessment tools (the KT Pathways) for professional development for our three target audiences.

METHODS

The scoping review method will guide our study by following six stages: formulating the research question; identifying relevant studies; selecting the literature; charting the data; collating, summarizing, and reporting the results; and developing a KT plan and consulting stakeholders involved in the fields of KT, EBP, evidence-informed policy-making, and/or research. We will include empirical and theoretical/conceptual peer-reviewed and grey literature in health that examine knowledge user, knowledge broker and knowledge producer KT competencies. Publications written in the English language and published after 2003 only will be considered. Our multidisciplinary research team will collaborate using technology (i.e., WebEx for discussions and a Web 2.0 website for storing documents). Our KT plan consists of an Advisory Group and dissemination plan of the findings.

DISCUSSION

We expect the identified KT competencies to contribute to the KT science by providing positive outcomes in practice, policy, education, and future research. Incorporation of the core KT competencies may enhance safety, effectiveness of clinical care, and quality of health outcomes; contribute to and facilitate collaboration among practitioners, knowledge users, knowledge brokers, researchers, employers, and educators; improve education of healthcare professionals and inform policy-making process; benefit practitioners by guiding their KT professional development to become effective at moving evidence into practice and policy; guide suitable interventions and strategies to enhance KT activities in the health sector; and direct future research.

Barriers to the implementation of research perceived by nurses from Osakidetza

OBJECTIVE

To understand the barriers to implementing nursing research findings into practice, as perceived by the nurses working in Osakidetza and to analyze if the workplace factor and time worked affect the perception of these barriers.

METHODS

Cross-sectional study. BARRIERS Scale questionnaire was given to a representative sample of 1,572 Basque Health Service nurses, stratified and randomized, according to scope of work and job responsibility (response rate: 43.76%).

RESULTS

According to the research results, the first important barrier was "insufficient time on the job to implement new ideas". Nurses have perceived the organizational factor as the most important barrier in their practice. Nurses in "Special hospital departments" perceived more barriers in the "quality of research" factor than those working in "Primary Care". Years of service showed a slight influence.

CONCLUSIONS

The nurses stated that external factors related to the organization principally interfered in implementing results into clinical practice. They placed lack of critical reading training second. Working environment and seniority mark differences in the perception of barriers. This study may help to develop strategies for planning training programs to facilitate the use of research in clinical practice, in order to provide quality care.

Improving Nursing Home Care through Feedback On PerfoRMance Data (INFORM): Protocol for a cluster-randomized trial

BACKGROUND

Audit and feedback is effective in improving the quality of care. However, methods and results of international studies are heterogeneous, and studies have been criticized for a lack of systematic use of theory. In TREC (Translating Research in Elder Care), a longitudinal health services research program, we collect comprehensive data from care providers and residents in Canadian nursing homes to improve quality of care and life of residents, and quality of worklife of caregivers. The study aims are to a) systematically feed back TREC research data to nursing home care units, and b) compare the effectiveness of three different theory-based feedback strategies in improving performance within care units.

METHODS

INFORM (Improving Nursing Home Care through Feedback On PerfoRMance Data) is a 3.5-year pragmatic, three-arm, parallel, cluster-randomized trial. We will randomize 67 Western Canadian nursing homes with 203 care units to the three study arms, a standard feedback strategy and two assisted and goal-directed feedback strategies. Interventions will target care unit managerial teams. They are based on theory and evidence related to audit and feedback, goal setting, complex adaptive systems, and empirical work on feeding back research results. The primary outcome is the increased number of formal interactions (e.g., resident rounds or family conferences) involving care aides - non-registered caregivers providing up to 80% of direct care. Secondary outcomes are a) other modifiable features of care unit context (improved feedback, social capital, slack time) b) care aides' quality of worklife (improved psychological empowerment, job satisfaction), c) more use of best practices, and d) resident outcomes based on the Resident Assessment Instrument - Minimum Data Set 2.0. Outcomes will be assessed at baseline, immediately after the 12-month intervention period, and 18 months post intervention.

DISCUSSION

INFORM is the first study to systematically assess the effectiveness of different strategies to feed back research data to nursing home care units in order to improve their performance. Results of this study will enable development of a practical, sustainable, effective, and cost-effective feedback strategy for routine use by managers, policy makers and researchers. The results may also be generalizable to care settings other than nursing homes.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02695836 . Date of registration: 24 February 2016.

The influence of organizational context on best practice use by care aides in residential long-term care settings

OBJECTIVE

This study assessed individual and organizational context (work environment) factors that influence use of best practices by care aides (nursing assistants) in nursing homes. Little scientific attention has been focused on understanding best practice use in nursing homes and almost none on care aides.

SETTING AND PARTICIPANTS

A total of 1262 care aides in 25 nursing homes in the 3 Canadian prairie provinces. Care aides are unregulated workers who provide 80% of direct care to residents in Canadian nursing homes.

METHOD

We used hierarchical linear modeling to (1) assess the amount of variance in use of best practices, as reported by care aides, that could be attributed to individual or organizational factors, and (2) identify predictors of best practices use by care aides.

RESULTS

At the individual level, statistically significant predictors of instrumental use of best practices included sex, age, shift worked, job efficacy, and belief suspension. At the unit level, significant predictors were social capital, organizational slack (staffing and time), number of informal interactions, and unit type. At the facility level, ownership model and province were significant. Significant predictors of conceptual use of best practices at the individual level included English as a first language, job efficacy, belief suspension, intent to use research, adequate knowledge, and number of information sources used. At the unit level, significant predictors were evaluation (feedback mechanisms), structural resources, and organizational slack (time). At the facility level, province was significant. The R(2) was 18.3% for instrumental use of best practices and 43.4% for conceptual use. Unit level factors added a substantial amount of explained variance whereas facility level factors added relatively little explained variance.

CONCLUSIONS

Our study suggests that context plays an important role in care aides' use of best practices in nursing homes. Individual characteristics played a more prominent role than contextual factors in predicting conceptual use of best practices.

Oncology nurses' experience of collaboration: A case study

PURPOSE

Changes in the health system have created new models of healthcare delivery such as nurse-led teams. This has resulted in the increased opportunity for enhanced collaboration among nurses. Oncology nurses have a long history of working together, yet little is known about their perceptions about collaboration in the practice setting. This paper aimed to explore and describe the experiences of collaboration among oncology nurses, and to understand the factors that influenced collaboration.

METHOD

Qualitative, case study design was used to study fourteen oncology nurses from one cancer center in Canada. Participants were registered nurses or nurse practitioners, employed full-time or permanent part-time in an oncology nurse role, and working on an in-patient or out-patient unit. Data were collected in 2013 using individual telephone interviews and document reviews.

RESULTS

Thematic analysis revealed two themes: Art of dancing together, and the stumbling point. The first theme related to the facilitators of collaboration including having: regular face-to-face interaction, an existing and/or previous relationship, oncology nursing experience, and good interpersonal skills. The second theme related to the barriers to collaboration such as: role ambiguity, organizational leadership, and multi-generational differences.

CONCLUSIONS

Collaboration is a complex process that does not occur spontaneously. To improve collaboration nursing leadership needs to support and promote opportunities for nurses to build the relationships required to effectively collaborate. It is equally important that individual nurses be willing to collaborate and possess the interpersonal skills required to build and maintain the collaborative relationship despite differences in age, generation, and clinical experience.

The relationship among evidence-based practice and client dyspnea, pain, falls, and pressure ulcer outcomes in the community setting

Background

There are gaps in knowledge about the extent to which home care nurses’ practice is based on best evidence and whether evidence-based practice impacts patient outcomes.

Aim

The purpose of this study was to investigate the relationship between evidence-based practice and client pain, dyspnea, falls, and pressure ulcer outcomes in the home care setting. Evidence-based practice was defined as nursing interventions based on best practice guidelines.

Methods

The Nursing Role Effectiveness model was used to guide the selection of variables for investigation. Data were collected from administrative records on percent of visits made by Registered Nurses (RN), total number of nursing visits, and consistency of visits by principal nurse. Charts audits were used to collect data on nursing interventions and client outcomes. The sample consisted of 338 nurses from 13 home care offices and 939 de-identified client charts. Hierarchical generalized linear regression approaches were constructed to explore which variables explain variation in client outcomes.

Results

The study found documentation of nursing interventions based on best practice guidelines was positively associated with improvement in dyspnea, pain, falls, and pressure ulcer outcomes. Percent of visits made by an RN and consistency of visits by a principal nurse were not found to be associated with improved client outcomes, but the total number of nursing visits was.

Linking Evidence to Action

Implementation of best practice is associated with improved client outcomes in the home care setting. Future research needs to explore ways to more effectively foster the documentation of evidence-based practice interventions.

A multisample model validation of the evidence-based practice questionnaire

Evidence-based practice may be implemented more successfully if the barriers to its implementation have been previously identified. Many of the available instruments to measure these barriers have been validated in single samples or without confirmatory analyses. The objective of the study was to contrast the goodness of fit of two measurement models (24 items and 19 items) for the Spanish version of the Evidence-Based Practice Questionnaire (EBPQ) in a sample of 1,673 full-time registered nurses in 10 hospitals and 57 primary health care centers in the Spanish Public Health Service. The 19-item model performed better in all four subsamples. A hypothesis of strict invariance, with equal factor loadings, intercepts, and error variance in all contexts in which it was evaluated, was supported. Goodness-of-fit indices provided strong evidence of good fit according to standard cut-off criteria in a multisample confirmatory factor analysis.

An educational innovation to foster evidence-informed practice

This article describes an innovation in baccalaureate nursing education that is intended to assist in the preparation of nursing students for careers in which evidence-informed practice is an imperative. The innovation involves the combination of central aspects of the internationally recognized Registered Nurses' Association of Ontario Best Practice Guidelines Program with existing curricular goals and themes in a baccalaureate nursing program at a small university in southern Ontario in Canada.

Sources of knowledge used by intensive care nurses in Norway: an exploratory study

This study explored the sources of knowledge that intensive care nurses used in their daily nursing practice. It used a qualitative design based on four focus group interviews with 20 intensive care nurses, from four intensive care units in Norway. Data were analysed using systematic text condensation. The following condensed meaning units were identified: research, theoretical knowledge, experiential knowledge, work place culture, clinical expertise and patient participation. This study illustrates the complexity and variety of the knowledge bases of intensive care nurses. Despite some variation in nurses' familiarity with research literature, nursing interventions found by research to be useful were given priority, and research affected daily practice through changes in guidelines and procedures.

The influence of organizational context on the use of research by nurses in Canadian pediatric hospitals

Background

Organizational context is recognized as an important influence on the successful implementation of research by healthcare professionals. However, there is relatively little empirical evidence to support this widely held view.

Methods

The objective of this study was to identify dimensions of organizational context and individual (nurse) characteristics that influence pediatric nurses’ self-reported use of research. Data on research use, individual, and contextual variables were collected from registered nurses (N = 735) working on 32 medical, surgical and critical care units in eight Canadian pediatric hospitals using an online survey. We used Generalized Estimating Equation modeling to account for the correlated structure of the data and to identify which contextual dimensions and individual characteristics predict two kinds of self-reported research use: instrumental (direct) and conceptual (indirect).

Results

Significant predictors of instrumental research use included: at the individual level; belief suspension-implement, research use in the past, and at the hospital unit (context) level; culture, and the proportion on nurses possessing a baccalaureate degree or higher. Significant predictors of conceptual research use included: at the individual nurse level; belief suspension-implement, problem solving ability, use of research in the past, and at the hospital unit (context) level; leadership, culture, evaluation, formal interactions, informal interactions, organizational slack-space, and unit specialty.

Conclusions

Hospitals, by focusing attention on modifiable elements of unit context may positively influence nurses’ reported use of research. This influence of context may extend to the adoption of best practices in general and other innovative or quality interventions.

Organizational fidelity to a medication management evidence-based practice in the treatment of schizophrenia

Organizational support is essential for successful implementation of evidence-based practice (EBP) in clinical settings. This 3-year study used a mixed qualitative and quantitative design to implement a medication management EBP in the treatment of schizophrenia in six community mental health clinics in a south-central state of the United States. Findings from organizational fidelity assessments indicate that support for EBP implementation was moderate. Organizational support was highest for prescriber access to relevant patient information at each medication visit, scheduling flexibility for patients' urgent problems, and availability of medication guidelines. Organizational support was lowest for medication availability and identification of treatment refractory patients. Findings suggest that leadership is essential to support successful implementation. Nurse educators can incorporate implementation research and leadership training into graduate nursing programs to facilitate successful EBP implementation in practice settings.

A formative evaluation of nurses' use of electronic devices in a home care setting

The purpose of this study was to evaluate the implementation of a clinical information system (CIS) in a community setting. The researchers used a mixed-method design involving interviews, focus groups, and surveys. An independent cross-sectional sample of nurses was surveyed. At time 1 a total of 118 nurses responded and at time 2 a total of 81. Respondents were moderately satisfied with features of the CIS. User satisfaction was positively associated with access to structural and electronic resources and social capital and negatively associated with nurses' age at time 1. Social capital was positively associated with user satisfaction at time 2. Younger age was associated with overall research use at both time 1 and time 2. Research use was negatively associated with evaluation and feedback but positively associated with formal interactions. This evaluation identified the importance of educational support, user-centred design, and responsiveness to successful implementation of CISs in a community setting.

An exploration of context and the use of evidence-based nonpharmacological practices in emergency departments

BACKGROUND

The uptake of evidence in practice remains a challenge for healthcare professionals including nurses and providers. Increased use of evidence-based practices (EBPs) in healthcare settings may improve patient conditions such as pain and decrease the cost of health care. The relationship between context in the practice environment and uptake of EBP remains an understudied area.

AIMS

This study explored the relationships of context including the elements of individual, unit, and hospital and the use of evidence-based nonpharmacological pediatric pain management practices (EBNPPs) using an existing data set of RNs and providers, defined as doctors of medicine and osteopathy, nurse practitioners, and physician assistants caring for children in the emergency department.

METHODS

A secondary data analysis was conducted using correlation and regression.

RESULTS

Initial analysis identified several significant positive correlations with individual, unit, and hospital context elements and EBNPP. A significant correlation was not found between evaluation and EBNPP and magnet status and EBNPP for RNs or providers. RN regression analyses found that knowledge and continuing education were significant predictors of EBNPP. Overall context was a significant predictor of EBNPP for both the RN and provider models. A pooled regression analysis with RNs and providers found that RNs had a significant increased use of EBNPP when compared to providers.

CONCLUSIONS

Regression analyses found that overall context significantly predicted the use of EBPPM for RNs and providers although no one element-individual, unit, or hospital-was identified as more important. The effect of context on EBNPP did not differ by profession in this sample. Future research should focus on the overall influence of context on EBP and consider other factors that may play a role in the uptake of EBP.

Marking out the clinical expert/clinical leader/clinical scholar: perspectives from nurses in the clinical arena

BACKGROUND

Clinical scholarship has been conceptualised and theorised in the nursing literature for over 30 years but no research has captured nurses' clinicians' views on how it differs or is the same as clinical expertise and clinical leadership. The aim of this study was to determine clinical nurses' understanding of the differences and similarities between the clinical expert, clinical leader and clinical scholar.

METHODS

A descriptive interpretative qualitative approach using semi-structured interviews with 18 practising nurses from Australia, Canada and England. The audio-taped interviews were transcribed and the text coded for emerging themes. The themes were sorted into categories of clinical expert, clinical leader and clinical scholarship as described by the participants. These themes were then compared and contrasted and the essential elements that characterise the nursing roles of the clinical expert, clinical leader and clinical scholar were identified.

RESULTS

Clinical experts were seen as linking knowledge to practice with some displaying clinical leadership and scholarship. Clinical leadership is seen as a positional construct with a management emphasis. For the clinical scholar they linked theory and practice and encouraged research and dissemination of knowledge.

CONCLUSION

There are distinct markers for the roles of clinical expert, clinical leader and clinical scholar. Nurses working in one or more of these roles need to work together to improve patient care. An 'ideal nurse' may be a blending of all three constructs. As nursing is a practice discipline its scholarship should be predominantly based on clinical scholarship. Nurses need to be encouraged to go beyond their roles as clinical leaders and experts to use their position to challenge and change through the propagation of knowledge to their community.

What, why, and how care protocols are implemented in Ontario nursing homes

The aim of this study was to better understand care protocol implementation, including the influence of organizational-contextual factors on implementation approaches, in long-term care homes operating in Ontario. We surveyed directors of care employed in all 547 Ontario LTC homes, and combined survey data with secondary organizational data on rural/urban location, nursing home size, chain membership, type of ownership, and accreditation status. Motivations for the use/selection of care protocols in nursing homes primarily derived from beliefs in continuous improvement and in evidence-based care. Protocol selection was largely participative, involving management and staff. External information sources were important for protocol implementation, and in-service education was the chief means of training and educating staff. Significant differences in approaches to implementation were evident in association with differences in ownership. Three key success factors for implementation were identified: contextualizing the practice change, adequately resourcing for implementation, and demonstrating connections between practice change and outcomes.

The role of organizational context and individual nurse characteristics in explaining variation in use of information technologies in evidence based practice

Background

There is growing awareness of the role of information technology in evidence-based practice. The purpose of this study was to investigate the role of organizational context and nurse characteristics in explaining variation in nurses’ use of personal digital assistants (PDAs) and mobile Tablet PCs for accessing evidence-based information. The Promoting Action on Research Implementation in Health Services (PARIHS) model provided the framework for studying the impact of providing nurses with PDA-supported, evidence-based practice resources, and for studying the organizational, technological, and human resource variables that impact nurses’ use patterns.

Methods

A survey design was used, involving baseline and follow-up questionnaires. The setting included 24 organizations representing three sectors: hospitals, long-term care (LTC) facilities, and community organizations (home care and public health). The sample consisted of 710 participants (response rate 58%) at Time 1, and 469 for whom both Time 1 and Time 2 follow-up data were obtained (response rate 66%). A hierarchical regression model (HLM) was used to evaluate the effect of predictors from all levels simultaneously.

Results

The Chi square result indicated PDA users reported using their device more frequently than Tablet PC users (p = 0.001). Frequency of device use was explained by ‘breadth of device functions’ and PDA versus Tablet PC. Frequency of Best Practice Guideline use was explained by ‘willingness to implement research,’ ‘structural and electronic resources,’ ‘organizational slack time,’ ‘breadth of device functions’ (positive effects), and ‘slack staff’ (negative effect). Frequency of Nursing Plus database use was explained by ‘culture,’ ‘structural and electronic resources,’ and ‘breadth of device functions’ (positive effects), and ‘slack staff’ (negative). ‘Organizational culture’ (positive), ‘breadth of device functions’ (positive), and ‘slack staff ‘(negative) were associated with frequency of Lexi/PEPID drug dictionary use.

Conclusion

Access to PDAs and Tablet PCs supported nurses’ self-reported use of information resources. Several of the organizational context variables and one individual nurse variable explained variation in the frequency of information resource use.

Older Persons' Transitions in Care (OPTIC): a study protocol

BACKGROUND

Changes in health status, triggered by events such as infections, falls, and geriatric syndromes, are common among nursing home (NH) residents and necessitate transitions between NHs and Emergency Departments (EDs). During transitions, residents frequently experience care that is delayed, unnecessary, not evidence-based, potentially unsafe, and fragmented. Furthermore, a high proportion of residents and their family caregivers report substantial unmet needs during transitions. This study is part of a program of research whose overall aim is to improve quality of care for frail older adults who reside in NHs. The purpose of this study is to identify successful transitions from multiple perspectives and to identify organizational and individual factors related to transition success, in order to inform improvements in care for frail elderly NH residents during transitions to and from acute care. Specific objectives are to: 1. define successful and unsuccessful elements of transitions from multiple perspectives; 2. develop and test a practical tool to assess transition success; 3. assess transition processes in a discrete set of transfers in two study sites over a one year period; 4. assess the influence of organizational factors in key practice locations, e.g., NHs, emergency medical services (EMS), and EDs, on transition success; and 5. identify opportunities for evidence-informed management and quality improvement decisions related to the management of NH - ED transitions.

METHODS/DESIGN

This is a mixed-methods observational study incorporating an integrated knowledge translation (IKT) approach. It uses data from multiple levels (facility, care unit, individual) and sources (healthcare providers, residents, health records, and administrative databases).

DISCUSSION

Key to study success is operationalizing the IKT approach by using a partnership model in which the OPTIC governance structure provides for team decision-makers and researchers to participate equally in developing study goals, design, data collection, analysis and implications of findings. As preliminary and ongoing study findings are developed, their implications for practice and policy in study settings will be discussed by the research team and shared with study site administrators and staff. The study is designed to investigate the complexities of transitions and to enhance the potential for successful and sustained improvement of these transitions.

Does journal club membership improve research evidence uptake in different allied health disciplines: a pre-post study

BACKGROUND

Although allied health is considered to be one 'unit' of healthcare providers, it comprises a range of disciplines which have different training and ways of thinking, and different tasks and methods of patient care. Very few empirical studies on evidence-based practice (EBP) have directly compared allied health professionals. The objective of this study was to examine the impact of a structured model of journal club (JC), known as iCAHE (International Centre for Allied Health Evidence) JC, on the EBP knowledge, skills and behaviour of the different allied health disciplines.

METHODS

A pilot, pre-post study design using maximum variation sampling was undertaken. Recruitment was conducted in groups and practitioners such as physiotherapists, occupational therapists, speech pathologists, social workers, psychologists, nutritionists/dieticians and podiatrists were invited to participate. All participating groups received the iCAHE JC for six months. Quantitative data using the Adapted Fresno Test (McCluskey & Bishop) and Evidence-based Practice Questionnaire (Upton & Upton) were collected prior to the implementation of the JC, with follow-up measurements six months later. Mean percentage change and confidence intervals were calculated to compare baseline and post JC scores for all outcome measures.

RESULTS

The results of this study demonstrate variability in EBP outcomes across disciplines after receiving the iCAHE JC. Only physiotherapists showed statistically significant improvements in all outcomes; speech pathologists and occupational therapists demonstrated a statistically significant increase in knowledge but not for attitude and evidence uptake; social workers and dieticians/nutritionists showed statistically significant positive changes in their knowledge, and evidence uptake but not for attitude.

CONCLUSIONS

There is evidence to suggest that a JC such as the iCAHE model is an effective method for improving the EBP knowledge and skills of allied health practitioners. It may be used as a single intervention to facilitate evidence uptake in some allied health disciplines but may need to be integrated with other strategies to influence practice behaviour in other practitioners. An in-depth analysis of other factors (e.g. individual, contextual, organisational), or the relative contribution of these variables is required to better understand the determinants of evidence uptake in allied health.

Utilisation of strategic communication to create willingness to change work practices among primary care staff: a long-term follow-up study

AIM

To evaluate the long-term utilisation of strategic communication as a factor of importance when changing work practices among primary care staff.

BACKGROUND

In many health care organisations, there is a gap between theory and practice. This gap hinders the provision of optimal evidence-based practice and, in the long term, is unfavourable for patient care. One way of overcoming this barrier is systematically structured communication between the scientific theoretical platform and clinical practice.

METHODS

This longitudinal evaluative study was conducted among a primary care staff cohort. Strategic communication was considered to be the intervention platform and included a network of ambassadors who acted as a component of the implementation. Measurements occurred 7 and 12 years after formation of the cohort. A questionnaire was used to obtain information from participants. In total, 846 employees (70%) agreed to take part in the study. After 12 years, the 352 individuals (60%) who had remained in the organisation were identified and followed up. Descriptive statistics and multivariate analysis were used to analyse the data.

FINDINGS

Continuous information contributed to significant improvements over time with respect to new ideas and the intention to change work practices. There was a statistically significant synergistic effect on the new way of thinking, that is, willingness to change work practices. During the final two years, the network of ambassadors had created a distinctive image for itself in the sense that primary care staff members were aware of it and its activities. This awareness was associated with a positive change with regard to new ways of thinking. More years of practice was inversely associated with willingness to change work practices. Strategic communication may lead to a scientific platform that promotes high-quality patient care by means of new methods and research findings.

Perception of evidence-based practice and the professional environment of primary health care nurses in the Spanish context: a cross-sectional study

Background

The study of the factors that encourage evidence-based clinical practice, such as structure, environment and professional skills, has contributed to an improvement in quality of care. Nevertheless, most of this research has been carried out in a hospital context, neglecting the area of primary health care. The main aim of this work was to assess the factors that influence an evidence-based clinical practice among nursing professionals in Primary Health Care.

Methods

A multicentre cross-sectional study was designed, taking the 619 Primary Care staff nurses at the Balearic Islands’ Primary Health Care Service, as the study population. The methodology applied consisted on a self-administered survey using the instruments Evidence-Based Practice Questionnaire (EBPQ) and Nursing Work Index (NWI).

Results

Three hundred and seventy seven surveys were received (60.9% response rate). Self-assessment of skills and knowledge, obtained 66.6% of the maximum score. The Knowledge/Skills factor obtained the best scores among the staff with shorter professional experience. There was a significant difference in the Attitude factor (p = 0.008) in favour of nurses with management functions, as opposed to clinical nurses.

Multivariate analysis showed a significant positive relationship between NWI and level of evidence-based practice (p < 0,0001).

Conclusions

Institutions ought to undertake serious reflection on the lack of skills of senior nurses about Evidence-Based Clinical Practice, even when they have more professional experience. Leadership emerge as a key role in the transferral of knowledge into clinical practice.

Contribution mapping: a method for mapping the contribution of research to enhance its impact

Background

At a time of growing emphasis on both the use of research and accountability, it is important for research funders, researchers and other stakeholders to monitor and evaluate the extent to which research contributes to better action for health, and find ways to enhance the likelihood that beneficial contributions are realized. Past attempts to assess research 'impact' struggle with operationalizing 'impact', identifying the users of research and attributing impact to research projects as source. In this article we describe Contribution Mapping, a novel approach to research monitoring and evaluation that aims to assess contributions instead of impacts. The approach focuses on processes and actors and systematically assesses anticipatory efforts that aim to enhance contributions, so-called alignment efforts. The approach is designed to be useful for both accountability purposes and for assisting in better employing research to contribute to better action for health.

Methods

Contribution Mapping is inspired by a perspective from social studies of science on how research and knowledge utilization processes evolve. For each research project that is assessed, a three-phase process map is developed that includes the main actors, activities and alignment efforts during research formulation, production and knowledge extension (e.g. dissemination and utilization). The approach focuses on the actors involved in, or interacting with, a research project (the linked actors) and the most likely influential users, who are referred to as potential key users. In the first stage, the investigators of the assessed project are interviewed to develop a preliminary version of the process map and first estimation of research-related contributions. In the second stage, potential key-users and other informants are interviewed to trace, explore and triangulate possible contributions. In the third stage, the presence and role of alignment efforts is analyzed and the preliminary results are shared with relevant stakeholders for feedback and validation. After inconsistencies are clarified or described, the results are shared with stakeholders for learning, improvement and accountability purposes.

Conclusion

Contribution Mapping provides an interesting alternative to existing methods that aim to assess research impact. The method is expected to be useful for research monitoring, single case studies, comparing multiple cases and indicating how research can better be employed to contribute to better action for health.

Burnout during nursing education predicts lower occupational preparedness and future clinical performance: a longitudinal study

BACKGROUND

Early-career burnout among nurses can influence health and professional development, as well as quality of care. However, the prospective occupational consequences of study burnout have not previously been investigated in a national sample using a longitudinal design.

OBJECTIVES

To prospectively monitor study burnout for a national sample of nursing students during their years in higher education and at follow-up 1 year post graduation. Further, to relate the possible development of study burnout to prospective health and life outcomes, as well as student and occupational outcomes.

DESIGN

A longitudinal cohort of Swedish nursing students (within the population-based LANE (Longitudinal Analysis of Nursing Education/Entry) study) from all sites of education in Sweden was surveyed annually. Data were collected at four points in time over 4 years: three times during higher education and 1 year post graduation.

PARTICIPANTS

: A longitudinal sample of 1702 respondents was prospectively followed from late autumn 2002 to spring 2006.

METHODS

Mean level changes of study burnout (as measured by the Oldenburg Burnout Inventory, i.e. the Exhaustion and Disengagement subscales) across time, as well as prospective effects of baseline study burnout and changes in study burnout levels, were estimated using Latent Growth Curve Modeling.

RESULTS

An increase in study burnout (from 30% to 41%) across 3 years in higher education was found, and levels of both Exhaustion and Disengagement increased significantly across the years in education (p<0.001). Baseline levels, as well as development of study burnout, predicted lower levels of in-class learner engagement and occupational preparedness in the final year. At follow-up 1 year post graduation, earlier development of study burnout was related to lower mastery of occupational tasks, less research utilization in everyday clinical practice and higher turnover intentions.

CONCLUSIONS

The results suggest that study burnout may have interfered with learning and psychological well-being. Aspects related to work skills and intention to leave the profession were also affected. Thus, burnout development during higher education may be an important concern, and effective preventive measures to counteract burnout development may be necessary already at the outset of nursing education.

Differences in Perceptions of Patient Safety Culture between Charge and Noncharge Nurses: Implications for Effectiveness Outcomes Research

The implementation of evidence-based practice guidelines can be influenced by nurses' perceptions of the organizational safety culture. Shift-by-shift management of each nursing unit is designated to a subset of staff nurses (charge nurses), whom are often recruited as champions for change. The findings indicate that compared to charge nurses, noncharge nurses were more positive about overall perceptions of safety (P = .05) and teamwork (P < .05). Among charge nurses, significant differences were observed based on the number of years' experience in charge: perception of teamwork within units [F(3, 365) = 3.52, P < .01]; overall perceptions of safety, [F(3, 365) = 4.20, P < .05]; safety grade for work area [F(3, 360) = 2.61, P < .05]; number of events reported within the last month [F(3, 362) = 3.49, P < .05]. These findings provide important insights to organizational contextual factors that may impact effectiveness outcomes research in the future.

A modest start, but a steady rise in research use: a longitudinal study of nurses during the first five years in professional life

Background

Newly graduated nurses are faced with a challenging work environment that may impede their ability to provide evidence-based practice. However, little is known about the trajectory of registered nurses' use of research during the first years of professional life. Thus, the aim of the current study was to prospectively examine the extent of nurses' use of research during the first five years after undergraduate education and specifically assess changes over time.

Method

Survey data from a prospective cohort of 1,501 Swedish newly graduated nurses within the national LANE study (Longitudinal Analyses of Nursing Education and Entry in Worklife) were used to investigate perceived use of research over the first five years as a nurse. The dependent variables consisted of three single items assessing instrumental, conceptual, and persuasive research use, where the nurses rated their use on a five-point scale, from 'never' (1) to 'on almost every shift' (5). These data were collected annually and analyzed both descriptively and by longitudinal growth curve analysis.

Results

Instrumental use of research was most frequently reported, closely followed by conceptual use, with persuasive use occurring to a considerably lower extent. The development over time showed a substantial general upward trend, which was most apparent for conceptual use, increasing from a mean of 2.6 at year one to 3.6 at year five (unstandardized slope +0.25). However, the descriptive findings indicated that the increase started only after the second year. Instrumental use had a year one mean of 2.8 and a year five mean of 3.5 (unstandardized slope +0.19), and persuasive use showed a year one mean of 1.7 and a year five mean of 2.0 (unstandardized slope +0.09).

Conclusion

There was a clear trend of increasing research use by nurses during their first five years of practice. The level of the initial ratings also indicated the level of research use in subsequent years. However, it took more than two years of professional development before this increase 'kicked in.' These findings support previous research claiming that newly graduated nurses go through a 'transition shock,' reducing their ability to use research findings in clinical work.

[Usefulness of multilevel analysis of satisfaction questionnaires on clinical units and medical specialties]

OBJECTIVES

Evaluate the usefulness of multilevel analysis applied to satisfaction surveys to assess the ambulatory care offered by the Clinical Units and Medical Specialties.

METHODS

Telephone surveys were conducted on 6,922 patients seen in outpatient visits in the Navarra Health System in order to assess 94 Clinical Units and 37 Medical Specialties. A hierarchical analysis was then performed at 3 levels (patients, Clinical Units and Medical Specialties).

RESULTS

The patient explained between 91.7% and 99.3% of the variability in the satisfaction survey scores. The patient perception of service quality also depends of the clinical unit, in 18 out of 20 items analysed, the variance related to the Clinical Unit was statistically significant, and ranged from 0.9% and 8.3%. The Medical Specialty explained 4.2% of the variability in only one item. Patients aged under 65 years, patients seen in first visit, and those who were seen at tertiary hospitals gave the lowest scores.

CONCLUSIONS

Multilevel analysis is a useful tool to analyse and compare satisfaction survey results, as it can correctly distinguish the different Clinical Units of a health service, and this is a key element in the management of these Units. Moreover, it gives the percentage of variability due to each level and which variables predict the quality of service obtained.