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Blakeney EAR, Chu F, White AA, Randy Smith G, Woodward K, Lavallee DC, Salas RME, Beaird G, Willgerodt MA, Dang D, Dent JM, Tanner E“I, Summerside N, Zierler BK, O’Brien KD, Weiner BJ. A scoping review of new implementations of interprofessional bedside rounding models to improve teamwork, care, and outcomes in hospitals. J Interprof Care 2024; 38:411-426. [PMID: 34632913 PMCID: PMC8994791 DOI: 10.1080/13561820.2021.1980379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/13/2021] [Accepted: 08/29/2021] [Indexed: 01/22/2023]
Abstract
Poor communication within healthcare teams occurs commonly, contributing to inefficiency, medical errors, conflict, and other adverse outcomes. Interprofessional bedside rounds (IBR) are a promising model that brings two or more health professions together with patients and families as part of a consistent, team-based routine to share information and collaboratively arrive at a daily plan of care. The purpose of this systematic scoping review was to investigate the breadth and quality of IBR literature to identify and describe gaps and opportunities for future research. We followed an adapted Arksey and O'Malley Framework and PRISMA scoping review guidelines. PubMed, CINAHL, PsycINFO, and Embase were systematically searched for key IBR words and concepts through June 2020. Seventy-nine articles met inclusion criteria and underwent data abstraction. Study quality was assessed using the Mixed Methods Assessment Tool. Publications in this field have increased since 2014, and the majority of studies reported positive impacts of IBR implementation across an array of team, patient, and care quality/delivery outcomes. Despite the preponderance of positive findings, great heterogeneity, and a reliance on quantitative non-randomized study designs remain in the extant research. A growing number of interventions to improve safety, quality, and care experiences in hospital settings focus on redesigning daily inpatient rounds. Limited information on IBR characteristics and implementation strategies coupled with widespread variation in terminology, study quality, and design create challenges in assessing the effectiveness of models of rounds and optimal implementation strategies. This scoping review highlights the need for additional studies of rounding models, implementation strategies, and outcomes that facilitate comparative research.
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Affiliation(s)
- Erin Abu-Rish Blakeney
- Department of Biobehavioral Nursing and Health Informatics,
School of Nursing, University of Washington
| | | | - Andrew A. White
- Department of Medicine, University of Washington School of
Medicine
| | | | | | | | | | | | - Mayumi A. Willgerodt
- Department of Family and Child Nursing, School of Nursing,
University of Washington
| | | | | | | | | | - Brenda K. Zierler
- Department of Biobehavioral Nursing and Health
Informatics, School of Nursing, University of Washington
| | | | - Bryan J. Weiner
- Departments of Global Health and Health Services, School
of Public Health, University of Washington
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Influencing Factors of Nurses' Practice during the Bedside Handover: A Qualitative Evidence Synthesis Protocol. J Pers Med 2023; 13:jpm13020267. [PMID: 36836500 PMCID: PMC9965971 DOI: 10.3390/jpm13020267] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/20/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
Nursing Bedside Handover (NBH) is acknowledged as a nursing practice implemented at the patient's bedside to improve communication safety during the shift change, but it is vulnerable due to inconsistent application among nurses. This synthesis of qualitative evidence aims to review and synthesize the perceptions and experiences of nurses regarding the factors that, in their perspective, influence NBH practice. We will follow the thematic synthesis methodology of Thomas and Harden and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) Statement guidelines. A search will be conducted through the databases of MEDLINE, CINAHL, Web of Science, and Scopus, and we will follow the three-step search process to identify primary studies with qualitative or mixed-method research designs and projects of quality improvement. The screening and selection of the studies will be carried out by two independent reviewers. We will use the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) to report the screening, search, and selection of studies. To assess its methodological quality, two reviewers will independently use the CASM Tool. The extracted data will be reviewed, categorized, and summarized in tabular and narrative formats. The findings obtained will allow us to inform future research and change management led by nurse managers.
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Loberg RA, Smallheer BA, Thompson JA. A Quality Improvement Initiative to Evaluate the Effectiveness of the ABCDEF Bundle on Sepsis Outcomes. Crit Care Nurs Q 2022; 45:42-53. [PMID: 34818297 DOI: 10.1097/cnq.0000000000000387] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Sepsis affects 1.7 million Americans annually and often requires an intensive care unit (ICU) stay. Survivors of ICU can experience long-term negative effects. This quality improvement initiative was designed to increase compliance with ABCDEF bundle elements and improve clinical outcomes. A significant improvement was seen in the completion of spontaneous awakening and breathing trials (P = .002), delirium assessment (P = .041), and early mobility (P = .000), which was associated with a reduction in mortality and 30-day readmission rates. Findings were consistent with other research that demonstrated an improvement in care delivery and some clinical outcomes.
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Affiliation(s)
- Rachel A Loberg
- Advocate Aurora Health, Libertyville, Illinois (Dr Loberg); Duke University School of Nursing, Durham, North Carolina (Drs Smallheer and Thompson); and Duke Raleigh Hospital, Raleigh, North Carolina (Dr Smallheer)
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Utilization of Kotter's Stages and Statistical Process Control to Implement and Sustain Delirium Screening in PICU. Pediatr Qual Saf 2021; 6:e536. [PMID: 34901682 PMCID: PMC8654424 DOI: 10.1097/pq9.0000000000000536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022] Open
Abstract
Supplemental Digital Content is available in the text. Delirium is a preventable cause of ICU morbidity and mortality. Prior unstructured efforts to implement delirium screening in our hospital were unsuccessful. This project aimed to improve the delirium screening compliance from baseline 0% to more than 80% within 12 months (07/2019–06/2020).
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Shea CM. A conceptual model to guide research on the activities and effects of innovation champions. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2. [PMID: 34541541 PMCID: PMC8445003 DOI: 10.1177/2633489521990443] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The importance of having a champion to promote implementation efforts has been discussed in the literature for more than five decades. However, the empirical literature on champions remains underdeveloped. As a result, health organizations commonly use champions in their implementation efforts without the benefit of evidence to guide decisions about how to identify, prepare, and evaluate their champions. The goal of this article is to present a model of champion impact that draws upon previous literature and is intended to inform future research on champions and serve as a guide for practitioners serving in a champion role. Methods The proposed model is informed by existing literature, both conceptual and empirical. Prior studies and reviews of the literature have faced challenges in terms of operationalizing and reporting on champion characteristics, activities, and impacts. The proposed model addresses this challenge by delineating these constructs, which allows for consolidation of factors previously discussed about champions as well as new hypothesized relationships between constructs. Results The model proposes that a combination of champion commitment and champion experience and self-efficacy influence champion performance, which influences peer engagement with the champion, which ultimately influences the champion's impact. Two additional constructs have indirect effects on champion impact. Champion beliefs about the innovation and organizational support for the champion affect champion commitment. Conclusion The proposed model is intended to support prospective studies of champions by hypothesizing relationships between constructs identified in the champion literature, specifically relationships between modifiable factors that influence a champion's potential impact. Over time, the model should be modified, as appropriate, based on new findings from champion-related research.
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Affiliation(s)
- Christopher M Shea
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Harrison R, Fischer S, Walpola RL, Chauhan A, Babalola T, Mears S, Le-Dao H. Where Do Models for Change Management, Improvement and Implementation Meet? A Systematic Review of the Applications of Change Management Models in Healthcare. J Healthc Leadersh 2021; 13:85-108. [PMID: 33737854 PMCID: PMC7966357 DOI: 10.2147/jhl.s289176] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/10/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The increasing prioritisation of healthcare quality across the six domains of efficiency, safety, patient-centredness, effectiveness, timeliness and accessibility has given rise to accelerated change both in the uptake of initiatives and the realisation of their outcomes to meet external targets. Whilst a multitude of change management methodologies exist, their application in complex healthcare contexts remains unclear. Our review sought to establish the methodologies applied, and the nature and effectiveness of their application in the context of healthcare. METHODS A systematic review and narrative synthesis was undertaken. Two reviewers independently screened the titles and abstracts followed by the full-text articles that were potentially relevant against the inclusion criteria. An appraisal of methodological and reporting quality of the included studies was also conducted by two further reviewers. RESULTS Thirty-eight studies were included that reported the use of 12 change management methodologies in healthcare contexts across 10 countries. The most commonly applied methodologies were Kotter's Model (19 studies) and Lewin's Model (11 studies). Change management methodologies were applied in projects at local ward or unit level (14), institutional level (12) and system or multi-system (6) levels. The remainder of the studies provided commentary on the success of change efforts that had not utilised a change methodology with reference to change management approaches. CONCLUSION Change management methodologies were often used as guiding principle to underpin a change in complex healthcare contexts. The lack of prescription application of the change management methodologies was identified. Change management methodologies were valued for providing guiding principles for change that are well suited to enable methodologies to be applied in the context of complex and unique healthcare contexts, and to be used in synergy with implementation and improvement methodologies.
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Affiliation(s)
- Reema Harrison
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Sarah Fischer
- Clinical Excellence Commission, New South Wales Health, Sydney, NSW, Australia
- School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Ramesh L Walpola
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Ashfaq Chauhan
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Temitope Babalola
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Stephen Mears
- Hunter New England Medical Library, New Lambton, NSW, Australia
| | - Huong Le-Dao
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
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Nygaard AM, Haugdahl HS, Brinchmann BS, Lind R. Information concerning ICU patients' families in the handover-The clinicians' «game of whispers»: A qualitative study. J Clin Nurs 2020; 29:3822-3834. [PMID: 32671917 DOI: 10.1111/jocn.15414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/29/2020] [Accepted: 07/03/2020] [Indexed: 02/06/2023]
Abstract
AIMS AND OBJECTIVES To explore how information concerning ICU patients´ families is included in the ICU clinicians' daily handover. BACKGROUND Handover refers to the transfer of information and care responsibility between clinicians. An effective and precise handover are of great importance to ensure quality of care. Although improvements in handovers have received increasing attention in recent decades, little is known about how information about ICU patients' family members is included in handovers. DESIGN A qualitative study using Charmaz' constructivist grounded theory approach. METHODS Data were gathered through participant observation, focus groups, dyadic and individual interviews of physicians and nurses from four ICUs in different Norwegian hospitals. The data consist of 270 observation hours, seven focus groups, three dyadic interviews and two individual interviews. Field notes and transcribed interview data were analysed using constructivist grounded theory approach. COREQ checklist was applied as reporting guideline for this study. FINDINGS "A game of whispers" emerged as the core category, representing missing information about the patient's family during the handover. Together with three subcategories: "documentation dilemmas," "being updated" and "talking together," the core category explains how transfer of family-related information between clinicians is continually processed and resolved. CONCLUSIONS This study indicates challenges related to appropriate and high-quality handover concerning ICU patients´ families. Oral handovers are essential in terms of clinicians' need to elaborate on written information and update each other. However, oral transmission involves a high risk of information loss during the handover. Written documentation about the family seems to be inadequate and poorly structured. RELEVANCE TO CLINICAL PRACTICE The study findings suggest a need for increased awareness in practice and research of the importance of transferring appropriate and reliable information about patients' families between ICU clinicians. User-friendly handover tools and patient records that include information on patients' family members should be developed.
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Affiliation(s)
- Anne Mette Nygaard
- Department of Health and Care Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Hege Selnes Haugdahl
- Department of Public Health and Nursing, Levanger Hospital, Nord-Trøndelag Hospital Trust and NTNU Norwegian University of Science and Technology, Levanger, Norway
| | | | - Ranveig Lind
- Department of Health and Care Sciences, UiT The Arctic University of Norway and Research Nurse at Intensive Care Unit, University Hospital of North Norway, Tromsø, Norway
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Banerjee Y, Tuffnell C, Alkhadragy R. Mento's change model in teaching competency-based medical education. BMC MEDICAL EDUCATION 2019; 19:472. [PMID: 31882006 PMCID: PMC6935174 DOI: 10.1186/s12909-019-1896-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/02/2019] [Indexed: 05/08/2023]
Abstract
BACKGROUND Resistance to change is customary and is expected in any organization. However, most of the downsides of change can be avoided if the organization/individual prepares for the change by acknowledging guided strategies. In healthcare, change is the state of nature, which has also translated to medical education (ME). ME in the current era has undergone a shift from a traditional content-based curriculum to a competency-based curriculum. Recently, however, the broader social-accountability movement has accelerated this rate of transformation. One of the key challenges to educators harbingering this transformation to competency-based medical education (CBME) is to redesign the processes of teaching. AIM Here we define a framework designed using Mento's model of change that will totally agree with introducing positive change in teaching in an institution undergoing transformation from a traditional content-based curriculum to a competency-based curriculum. METHODOLOGY Using Schein's "unfreezing" as a guide term we critically reflected on the popular change-management models, to home in on Kotter's model of change to transform organizations. However, Kotter's change-model draws from Situational and Contingency Leadership Theories, which may not agree with academic organizations involved in ME. As such organizations adhere to Transactional and Transformational Leadership archetypes, where Leadership is constructively executed by "The Leader Team", we decided to adopt Mento's change-model for our study. Mento's model not only draws from the precepts of Kotter's model, but also incorporates axioms of Jick's and GE's change-models. RESULTS Using Mento's model a framework was blueprinted to implement active learning (AL) strategies in CBME. Here we have elaborated on the framework using the exemplar of flipped teaching. The development of this framework required the design and execution of a faculty development program, and a step by step guidance plan to chaperon, instruct and implement change in teaching to harbinger CBME. Further, we have also reflected on the change process using Gravin's framework. CONCLUSION To our knowledge this is the first report of the use of Mento's model of change in medical education. Also, the blueprinted framework is supported by acknowledged leadership theories and can be translated to implement any curricular change in CBME.
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Affiliation(s)
- Yajnavalka Banerjee
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health Care City, Dubai, United Arab Emirates.
- Centre for Outcomes and Research in Education, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.
- Centre for Medical Education, University of Dundee, Dundee, UK.
| | - Christopher Tuffnell
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health Care City, Dubai, United Arab Emirates
- Centre for Outcomes and Research in Education, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Rania Alkhadragy
- Centre for Medical Education, University of Dundee, Dundee, UK
- Department of Medical Education, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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