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Zeman D, Hagle M, Bratt MM, Eckert CL, Ndakuya-Fitzgerald F. Organizational and Practice Outcomes of a Post-Baccalaureate Registered Nurse Residency Program. J Nurses Prof Dev 2024; 40:201-207. [PMID: 38842444 DOI: 10.1097/nnd.0000000000001060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
A nurse residency for newly licensed registered nurses is best practice. A novel model for transitioning new nurses is a 1-year, postbaccalaureate residency that is rotation based with protected time for supervised clinical and didactic learning. After 10 years with this program, a summative evaluation found that retention rates for 1, 2, 3, and 5 years after program completion were 93%, 83%, 73%, and 82%, respectively, higher than similar programs in the literature.
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Waldrop J, Dunlap JJ. The Mountain Model for Evidence-Based Practice Quality Improvement Initiatives. Am J Nurs 2024; 124:32-37. [PMID: 38598260 DOI: 10.1097/01.naj.0001014540.57079.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
ABSTRACT This article introduces the Mountain Model, the first conceptual model for evidence-based practice quality improvement (EBPQI) initiatives. The Mountain Model merges modern evidence-based practice (EBP) and quality improvement (QI) paradigm principles into a unified conceptual framework with the goal of disseminating and sustaining EBPQI projects across health care and related settings. The model was developed within the nursing discipline, but is designed for transdisciplinary implementation through interprofessional teams.
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Affiliation(s)
- Julee Waldrop
- Julee Waldrop is a professor at the Duke University School of Nursing in Durham, NC, and editor-in-chief of the Journal for Nurse Practitioners . Jayne Jennings Dunlap is an associate professor at the Texas Woman's University College of Nursing in Houston. Contact author: Julee Waldrop, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise
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Keen A, Radecki B, Snyderman W, Rader T, Hemmelgarn A, Sierp A. INnovation, QUality Improvement, Research, and Evidence-Based Practice (INQUIRE): A Navigation Model for Change and Discovery. J Nurs Care Qual 2024; 39:18-23. [PMID: 37256671 DOI: 10.1097/ncq.0000000000000724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Despite scholarly articles and pathway models delineating quality improvement (QI), evidence-based practice (EBP), research, and innovation, guidance is lacking when determining the project method. A practical, step-by-step approach is needed to support project navigation. PURPOSE To describe development and evaluation of a decision-making pathway model. METHODS The INQUIRE Model was developed using an iterative approach and was evaluated with 23 national conference attendees. The evaluation included 4 Likert-type items ranging from 1 (strongly disagree) to 7 (strongly agree). RESULTS The model guides users through project planning steps based on an identified trigger (eg, problem, opportunity, and challenge) to ultimately select a project method that aligns with the project scope and availability of a solution. Model evaluation found identification of the project method improved by 14%, scanning for a solution by 8%, avoiding missed steps by 36%, and building a team by 10%. CONCLUSION Findings suggest INQUIRE can enhance project planning and method (eg, QI, EBP, research, and innovation) selection. Organizations should evaluate project planning current state to identify the potential benefit of model incorporation.
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Affiliation(s)
- Alyson Keen
- Adult Academic Health Center, Indiana University Health, Indianapolis (Drs Keen and Sierp and Mss Rader and Hemmelgarn); Columbus Regional Heath, Columbus, Indiana (Ms Radecki); and Indiana University Health, South Central Region, Bloomington (Mr Snyderman)
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Kilroy G, Lorbiecki M, Ndakuya-Fitzgerald F, Hagle M. Supporting the Safe Use of the Dorsogluteal Intramuscular Injection Site: An Evidence-Based Quality Improvement Project. J Am Psychiatr Nurses Assoc 2023:10783903231178556. [PMID: 37366302 DOI: 10.1177/10783903231178556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Administering intramuscular (IM) injections is common in the adult mental health patient care setting, using the deltoid, vastus lateralis, ventrogluteal, or dorsogluteal site. Mental health nurses frequently use the dorsogluteal site to administer short and long-acting IM injections as specified in the drug package insert or because of patient agitation. However, the site is often not recommended due to the potential risk of nerve injury. AIMS Aims of this evidence-based quality improvement project were to (1) determine the best evidence for supporting the safe use of the dorsogluteal site for short and long-acting IM injections and (2) implement this evidence through nurse education. METHOD This project had two phases: Determining best evidence through an integrative literature review and implementing the recommendations to use the dorsogluteal site when directed by the drug package insert, clinical need, nursing judgment, or patient preference. Implementation followed the Plan-Do-Study-Act quality improvement process and involved written resources and simulation. RESULTS Evidence supported the use of the dorsogluteal site in four instances and the importance of education. Nurses were highly satisfied with the education and opportunity to practice their skills with feedback during return demonstration. After studying nurses' follow-up survey results, a refresher simulation and medical center guideline were completed. There were no reports of IM injection patient injuries after 2 years and approximately 768 dorsogluteal and ventrogluteal IM injections in the academic medical center. CONCLUSION Pursuing recent and possibly overlooked evidence provided guidance in supporting the safe use of the dorsogluteal site for IM injections.
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Affiliation(s)
- Grainne Kilroy
- Grainne Kilroy, BSN, RN, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA
| | - Meghan Lorbiecki
- Meghan Lorbiecki, MSN, RN, CNL, PMH-BC, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA
| | | | - Mary Hagle
- Mary Hagle, PhD, RN, NPD-BC, FAAN, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA
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Pereira RA, Bonacim CAG, da Costa LRM, Rigobello MCG, de Souza FB, Grande MM, Gimenes FRE. Impact of a quality improvement programme on the preparation and administration of medications via a nasoenteral feeding tube: 2014-2019 intervention study. BMJ Open Qual 2023; 12:e002183. [PMID: 37344005 DOI: 10.1136/bmjoq-2022-002183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/25/2023] [Indexed: 06/23/2023] Open
Abstract
AIMS Evaluate the impact of a quality improvement programme on the reduction of feeding tube obstruction frequencies, analyse the predictive variables of this safety incident, and estimate the economic costs related to the quality improvement programme during the period from 2014 to 2019. METHODS Plan-Do-Study-Act cycles were performed to test the changes in drug preparation and administration processes via a nasoenteral feeding tube and to evaluate the outcome, process and balance measures. Statistical control charts were elaborated, and the bottom-up direct costing methodology was used to estimate the costs of the improvement programme. The impact of the programme on the monitoring measures was evaluated using logistic regression analysis. INTERVENTIONS The following changes were tested in the hospital participating in the study: acquisition of the Easy Crush equipment for tablet crushing, use of appropriate packaging to crush hard tablets, standardise procedures for scheduling administration times and/or substitution of the pharmaceutical form, educational activities for the nursing team and elaboration and availability of infographics for the nursing team, patients and/or family/caregivers. RESULTS There was a significant improvement in the frequency of tube obstructions, from 41.1% in 2014 to 57.9% in 2015-2017 and 9.6% in 2018-2019 (p=0.0010). After the execution of the improvement programme, it was estimated that the cost of dose preparation was reduced from R$1067.50 in 2014 to R$719.80 in 2015-2017 and R$433.10 in 2015-2019. CONCLUSION By re-establishing the processes of drug preparation and administration via a nasoenteral feeding tube, through the acquisition of appropriate equipment for crushing hard tablets, together with educational activities for the nursing team, we could observe a reduction in tube obstructions and the cost of processes.
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Affiliation(s)
| | | | | | | | | | - Marcia Mazzeo Grande
- Faculty of Economics Business and Accountancy of Ribeirão Preto, University of São Paulo, Ribeirao Preto, Brazil
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Dusin J, Melanson A, Mische-Lawson L. Evidence-based practice models and frameworks in the healthcare setting: a scoping review. BMJ Open 2023; 13:e071188. [PMID: 37217268 DOI: 10.1136/bmjopen-2022-071188] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
OBJECTIVES The aim of this scoping review was to identify and review current evidence-based practice (EBP) models and frameworks. Specifically, how EBP models and frameworks used in healthcare settings align with the original model of (1) asking the question, (2) acquiring the best evidence, (3) appraising the evidence, (4) applying the findings to clinical practice and (5) evaluating the outcomes of change, along with patient values and preferences and clinical skills. DESIGN A Scoping review. INCLUDED SOURCES AND ARTICLES Published articles were identified through searches within electronic databases (MEDLINE, EMBASE, Scopus) from January 1990 to April 2022. The English language EBP models and frameworks included in the review all included the five main steps of EBP. Excluded were models and frameworks focused on one domain or strategy (eg, frameworks focused on applying findings). RESULTS Of the 20 097 articles found by our search, 19 models and frameworks met our inclusion criteria. The results showed a diverse collection of models and frameworks. Many models and frameworks were well developed and widely used, with supporting validation and updates. Some models and frameworks provided many tools and contextual instruction, while others provided only general process instruction. The models and frameworks reviewed demonstrated that the user must possess EBP expertise and knowledge for the step of assessing evidence. The models and frameworks varied greatly in the level of instruction to assess the evidence. Only seven models and frameworks integrated patient values and preferences into their processes. CONCLUSION Many EBP models and frameworks currently exist that provide diverse instructions on the best way to use EBP. However, the inclusion of patient values and preferences needs to be better integrated into EBP models and frameworks. Also, the issues of EBP expertise and knowledge to assess evidence must be considered when choosing a model or framework.
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Affiliation(s)
- Jarrod Dusin
- Department of Evidence Based Practice, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
- Therapeutic Science, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andrea Melanson
- Department of Evidence Based Practice, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Lisa Mische-Lawson
- Therapeutic Science, The University of Kansas Medical Center, Kansas City, Kansas, USA
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Holt JM, Talsma A, Woehrle LM, Klingbeil C, Avdeev I. Fostering Innovation and Design Thinking in Graduate Programs. Nurse Educ 2022; 47:356-357. [PMID: 35503107 DOI: 10.1097/nne.0000000000001206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Jeana M Holt
- Assistant Professor (Dr Holt), Associate Professor (Drs Talsma and Woehrle), and Clinical Associate Professor (Dr Klingbeil), College of Nursing, and Associate Professor (Dr Avdeev), College of Engineering and Applied Science, University of Wisconsin-Milwaukee
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Lavin P, Vetter MJ. Using Lean Six Sigma to Increase the Effectiveness of an Evidence-Based Quality Improvement Program. J Nurs Care Qual 2022; 37:81-86. [PMID: 33990092 DOI: 10.1097/ncq.0000000000000567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Evidence-based quality improvement (EBQI) is an established methodology for identifying nursing practice changes that improve health care quality and safety. However, EBQI itself does not provide a framework for navigating the barriers to practice change. LOCAL PROBLEM An EBQI program in an orthopedic specialty hospital fostered many successful quality improvement projects. However, program participants frequently encountered barriers to project implementation. METHODS Lean Six Sigma (LSS) principles, tools, and strategies were incorporated into the EBQI program to help participants overcome organizational barriers to successful implementation. INTERVENTIONS LSS interventions included stakeholder alignment, process analysis, change management, project management, structured check-ins, mentoring, and organizational recognition. RESULTS The addition of LSS principles gave EBQI project leaders new tools for gaining executive support, securing resources, and overcoming organizational inertia to facilitate effective practice change. CONCLUSIONS Lean Six Sigma can increase the effectiveness of an EBQI program.
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Affiliation(s)
- Patricia Lavin
- NYU Langone Orthopedic Hospital, NYU Langone Health System, New York (Ms Lavin); and New York University Rory Meyers College of Nursing, New York (Dr Vetter)
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van Schothorst-van Roekel J, Weggelaar-Jansen AMJWM, Hilders CCGJM, Wallenburg I, de Bont A. Role of Dutch internal policy advisors in a hospital quality improvement programme and their influence on nurses' role development: a qualitative study. BMJ Open 2021; 11:e051998. [PMID: 34489293 PMCID: PMC8422484 DOI: 10.1136/bmjopen-2021-051998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Nurses are vital in providing and improving quality of care. To enhance the quality improvement (QI) competencies of nurses, hospitals in the Netherlands run developmental programmes generally led by internal policy advisors (IPAs). In this study, we identify the roles IPAs play during these programmes to enhance the development of nurses' QI competencies and studied how these roles influenced nurses and management. DESIGN An exploratory ethnographical study comprising observations, informal conversations, semistructured interviews, focus groups and a strategy evaluation meeting. SETTING A teaching hospital in an urban region in the Netherlands. PARTICIPANTS IPAs (n=7) in collaboration with four teams of nurses (n=131), team managers (n=4), senior managers (n=4) and the hospital director (n=1). RESULTS We identified five distinct advisory roles that IPAs perform in the hospital programme: gatekeeper, connector, converter, reflector and implementer. In describing these roles, we provide insights into how IPAs help nurses to develop QI competencies. The IPA's professional background was a driving force for nurses' QI role development. However, QI development was threatened if IPAs lost sight of different stakeholders' interests and consequently lost their credibility. QI role development among nurses was also threatened if the IPA took on all responsibility instead of delegating it timely to managers and nurses. CONCLUSIONS We have shown how IPAs' professional background and advisory knowledge connect organisational, managerial and professional aims and interests to enhance professionalisation of nurses.
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Affiliation(s)
| | | | - Carina C G J M Hilders
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - Iris Wallenburg
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - Antoinette de Bont
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
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Abstract
BACKGROUND Two evidence-based practice projects and an innovative model provided best evidence and a framework for the implementation and sustainment of a bedside shift report (BSR) quality improvement project. PROBLEM Without a standardized BSR process, there was a lack of Veteran involvement in care planning decisions and nurse dissatisfaction related to missed communication of pertinent patient information. APPROACH Facilitators and barriers were identified and addressed during planning. Key elements of BSR were incorporated. After approval by shared governance, unit-based champions and leaders supported the change. Implementation began every 2 weeks on a different unit. OUTCOMES Implementation was completed in 4 months for 11 units. After 15 months, there was consistent BSR on 82% of the units and improved patient satisfaction with nurses taking time to listen. CONCLUSIONS Best evidence, unit-based champions, leadership support, project coordinators, and persistence are critical to implementing and sustaining practice change.
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Rodó Cobo M, Medina Moya JL, Garrido Aguilar E, Solà Pola M. A qualitative model for evaluating and improving nursing governance in medium- and long-term intermediate care. J Nurs Manag 2020; 28:1391-1399. [PMID: 32657486 DOI: 10.1111/jonm.13096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/22/2020] [Accepted: 07/02/2020] [Indexed: 11/27/2022]
Abstract
AIM To evaluate nursing governance in intermediate care in Catalonia Spain and propose improvements. BACKGROUND Drawing on two existing models, the Magnet model and the corporate governance model, we propose that good nursing governance requires nursing leaders to apply the following dimensions: transformational leadership, transformational culture, commitment and sustainability, authority, scientific evidence, transparency and communication, and teamwork. METHOD A qualitative, exploratory study conducted in two phases. First, we asked nursing leaders in intermediate care to describe their opinions and experiences in each of the dimensions. Next, we observed governance practices at two intermediate care centres and conducted interviews with their nursing leaders. Content analysis was used. RESULTS Our participants' behaviour corresponded closely to the model in the dimensions of transformational culture and commitment and sustainability but failed to meet the model in the dimensions of scientific evidence and transparency and communication. CONCLUSIONS Participants had a leadership style focused on transforming their surroundings. According to the model, the leaders in our sample should draw more on scientific evidence and improve their internal communication about outcomes. IMPLICATIONS FOR NURSING MANAGEMENT Establishing committees of nurses to address areas in which governance does not adhere to the model would create sustainable benefits for patients and nurses in intermediate care.
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Affiliation(s)
- Montserrat Rodó Cobo
- University School of Nursing and Occupational Therapy of Terrassa, Autonomous University of Barcelona, Barcelona, Spain
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