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Peterson-Katz K, Piccone C, Tuzi N, Kulkarni C, Reynolds JN. Barriers and facilitators to implementation of developmental screening and early intervention in Canadian organizations following completion of a training and coaching model: a thematic analysis. FRONTIERS IN HEALTH SERVICES 2023; 3:1160217. [PMID: 37425993 PMCID: PMC10326629 DOI: 10.3389/frhs.2023.1160217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/02/2023] [Indexed: 07/11/2023]
Abstract
Introduction Developmental delay affects approximately 1 in 4 children under 6 years old. Developmental delay can be detected using validated developmental screening tools, such as the Ages and Stages Questionnaires. Following developmental screening, early intervention can occur to address and support any developmental areas of concern. Frontline practitioners and supervisors must be trained and coached to organizationally implement developmental screening tools and early intervention practice. No prior work has qualitatively investigated the barriers and facilitators to implementing developmental screening and early intervention in Canadian organizations from the perspectives of practitioners and supervisors who have completed a specialized training and coaching model. Methods and Results Following semi-structured interviews with frontline practitioners and supervisors, thematic analysis identified four themes: cohesive networks support implementation efforts, implementation success is dependent on shared perspectives, established organizational policies increase implementation opportunities, and COVID-19 guidelines create organizational challenges. Each theme encompasses sub-themes that describe implementation facilitators: strong implementation context, multi-level multi-sectoral collaborative partnerships, adequate and collective awareness, knowledge, and confidence, consistent and critical conversations, clear protocols and procedures, and accessibility to information, tools, and best practice guidelines. Discussion The outlined barriers and facilitators fill a gap in implementation literature by informing a framework for organization-level implementation of developmental screening and early intervention following training and coaching.
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Affiliation(s)
| | - Caitlin Piccone
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | - Nicole Tuzi
- Infant and Early Mental Health Promotion, The Hospital for Sick Children, Toronto, ON, Canada
| | - Chaya Kulkarni
- Infant and Early Mental Health Promotion, The Hospital for Sick Children, Toronto, ON, Canada
| | - James N. Reynolds
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
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Bhawra J, Skinner K. Examination of tools associated with the evaluation of knowledge uptake and utilization: A scoping review. EVALUATION AND PROGRAM PLANNING 2020; 83:101875. [PMID: 33011561 DOI: 10.1016/j.evalprogplan.2020.101875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 09/01/2020] [Accepted: 09/11/2020] [Indexed: 06/11/2023]
Abstract
Knowledge transfer and exchange (KTE) has become an integral part of organizational practice. Evaluation of KTE, as well as knowledge products generated through this process, is important for understanding the effectiveness of KTE strategies. This scoping review aimed to identify tools and frameworks used to evaluate knowledge uptake and utilization (KUU). The search strategy included review of PubMed and Scopus databases, hand searching of relevant journals, and citation tracing. Over 6500 abstracts were screened; 292 full-text articles were shortlisted by two reviewers. Seventy-two articles described tools for evaluating KUU. A total of 23 tools could be generally applied to knowledge products/processes used in different sectors; 36 evaluation tools were designed for specific knowledge products (i.e., websites); 9 tools were discipline-specific (i.e., medical field), and four articles described evaluations of knowledge products/processes using alternative methods such as Google Analytics or qualitative methods. The majority of tools (n = 40, 56 %) focused on usability of a knowledge product or process. This scoping review identified various tools being used to assess the effectiveness and impact of KTE processes/products, however, the measures were as varied as the projects, and were often not designed to evaluate KTE in particular.
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Affiliation(s)
- Jasmin Bhawra
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Kelly Skinner
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
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Bergström A, Ehrenberg A, Eldh AC, Graham ID, Gustafsson K, Harvey G, Hunter S, Kitson A, Rycroft-Malone J, Wallin L. The use of the PARIHS framework in implementation research and practice-a citation analysis of the literature. Implement Sci 2020; 15:68. [PMID: 32854718 PMCID: PMC7450685 DOI: 10.1186/s13012-020-01003-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework. METHODS This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail. RESULTS The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated. CONCLUSIONS In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.
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Affiliation(s)
- Anna Bergström
- Department of Women’s and Children’s health, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Uppsala, Sweden
- Institute for Global Health, University College London, London, UK
| | - Anna Ehrenberg
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Ann Catrine Eldh
- Department of Medicine and Health, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kazuko Gustafsson
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- University Library, Uppsala University, Uppsala, Sweden
| | - Gillian Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Green Templeton College, University of Oxford, Oxford, UK
| | - Jo Rycroft-Malone
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancashire, UK
| | - Lars Wallin
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Galehdarifard A, Radfar M, Gholami M, Khademi M, Ebrahimzadeh F, Imani-Nasab MH. The effect of knowledge brokering on nurses' empathy with patients receiving cardiac care: a study protocol. BMC Health Serv Res 2020; 20:680. [PMID: 32703257 PMCID: PMC7376315 DOI: 10.1186/s12913-020-05377-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 05/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hospitalization could be an unpleasant experience for patients with cardiovascular disease leading to some negative emotional reactions. These emotions can be managed by nursing empathy. There are different methods for improving empathy, but some evidence indicates a dramatic drop in nurses' empathy. In this study, we aim to provide a protocol for investigating the effect of knowledge brokering on nurses' empathy with patients receiving cardiac care. METHODS This study protocol is developed based on SPIRIT checklist with an experimental design. The study population are nurses working in cardiac wards of three educational hospitals in western Iran, Khorramabad. The quota sampling method is used. The sample size is 100 individuals. The samples will be assigned to two intervention and comparison groups using stratified random allocation method. Permuted block randomization is used in each stratum. To prevent contamination between participants; firstly, the measurements of the comparison group is done. Knowledge brokering intervention is performed in 7 stages based on Dobbins' knowledge translation framework 2009. Monica's Empathy Construct Self-Rating Scale is used for measuring empathy. Statistical analyses are performed using SPSS (SPPS Inc. Chicago, Il, version 21). P value below 0.05 is considered as statistically significant. DISCUSSION To our knowledge, there is no similar study using an experimental design to examine the efficacy of a knowledge brokering method to improve humanistic knowledge. It helps nurses to improve their empathy in caring relationships.
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Affiliation(s)
- Atefeh Galehdarifard
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Moloud Radfar
- Faculty of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohammad Gholami
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mojgan Khademi
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Farzad Ebrahimzadeh
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mohammad-Hasan Imani-Nasab
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
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Choi M, DeGennaro R, Blevins C. Multimodal Education Program to Improve Nurses' Knowledge and Confidence on Delirium Recognition in a Surgical-Trauma Intermediate-Care Setting. J Dr Nurs Pract 2020; 13:31-41. [DOI: 10.1891/2380-9418.jdnp-d-19-00030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BackgroundHigh incidence of delirium in hospitalized patients has been reported in the United States and is significantly associated with increased morbidity and mortality. The lack of knowledge and confidence in performing delirium assessment (KCDA) has led to significant underrecognition of delirium by nurses regardless of evidence-based education intervention.ObjectiveThe purpose of this study was to determine the effectiveness of a multimodal educational program (MEP) to enhance nurses' KCDA.MethodsA MEP including an online didactic with a video-simulation and 1:1 bedside coaching with delirium screening (DS) was conducted in the surgical intermediate-care unit of an academic medical center. A quasi-experimental pre- and post-test design was used.ResultsOf 23 nurses, the majority were <41 years old (73.9%) and had at least a bachelor of science in nursing degree (78.3%) with <6 years of experience (60.9%). The overall KCDA scores and the performance of DS improved significantly after the MEP (p < .001). A positive correlation was noted between the changes of the KCDA scores (p = .009).ConclusionsThe MEP demonstrated improvement in nurses' KCDA. The MEP should focus on an individualized learning approach with a targeted patient population, using current delirium screening tools.Implications for NursingEducational programs are recommended in either an orientation or continuing education program on nursing units. This is also recommended for use in other academic centers that encompass similar clinical settings and could possibly be considered for use in other disease processes.
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Prihodova L, Guerin S, Tunney C, Kernohan WG. Key components of knowledge transfer and exchange in health services research: Findings from a systematic scoping review. J Adv Nurs 2019; 75:313-326. [PMID: 30168164 PMCID: PMC7379521 DOI: 10.1111/jan.13836] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 06/28/2018] [Accepted: 08/06/2018] [Indexed: 12/22/2022]
Abstract
AIMS To identify the key common components of knowledge transfer and exchange in existing models to facilitate practice developments in health services research. BACKGROUND There are over 60 models of knowledge transfer and exchange designed for various areas of health care. Many of them remain untested and lack guidelines for scaling-up of successful implementation of research findings and of proven models ensuring that patients have access to optimal health care, guided by current research. DESIGN A scoping review was conducted in line with PRISMA guidelines. Key components of knowledge transfer and exchange were identified using thematic analysis and frequency counts. DATA SOURCES Six electronic databases were searched for papers published before January 2015 containing four key terms/variants: knowledge, transfer, framework, health care. REVIEW METHODS Double screening, extraction and coding of the data using thematic analysis were employed to ensure rigour. As further validation stakeholders' consultation of the findings was performed to ensure accessibility. RESULTS Of the 4,288 abstracts, 294 full-text articles were screened, with 79 articles analysed. Six key components emerged: knowledge transfer and exchange message, Stakeholders and Process components often appeared together, while from two contextual components Inner Context and the wider Social, Cultural and Economic Context, with the wider context less frequently considered. Finally, there was little consideration of the Evaluation of knowledge transfer and exchange activities. In addition, specific operational elements of each component were identified. CONCLUSIONS The six components offer the basis for knowledge transfer and exchange activities, enabling researchers to more effectively share their work. Further research exploring the potential contribution of the interactions of the components is recommended.
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Affiliation(s)
- Lucia Prihodova
- UCD School of PsychologyUniversity College DublinDublinIreland
- Palliative Care Research NetworkAll Ireland Institute for Hospice and Palliative CareDublinIreland
| | - Suzanne Guerin
- UCD School of PsychologyUniversity College DublinDublinIreland
- Palliative Care Research NetworkAll Ireland Institute for Hospice and Palliative CareDublinIreland
- UCD Centre for Disability StudiesUniversity College DublinDublinIreland
| | - Conall Tunney
- UCD Centre for Disability StudiesUniversity College DublinDublinIreland
| | - W. George Kernohan
- Palliative Care Research NetworkAll Ireland Institute for Hospice and Palliative CareDublinIreland
- Institute of Nursing and Health ResearchUlster UniversityBelfastNorthern Ireland
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Parker PD, Heiney SP, Friedman DB, Felder TM, Estrada RD, Harris EH, Adams SA. How are health literacy principles incorporated into breast cancer chemotherapy education? A review of the literature. JOURNAL OF NURSING EDUCATION AND PRACTICE 2018; 8:77-84. [PMID: 31131068 PMCID: PMC6534157 DOI: 10.5430/jnep.v8n6p77] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Chemotherapy is commonly used in combination with other treatments for breast cancer. However, low adherence to chemotherapy is a growing concern, particularly among breast cancer patients. Side effects such as nausea and vomiting, fatigue, and arthralgia can contribute to reduced adherence. Other factors such as provider communication and limited insurance coverage can affect adherence. Studies have shown that as much as 28% of patients with breast cancer did not continue with their prescribed dose of chemotherapy. Research suggests that chemotherapy education materials can be critical to addressing problems with non-adherence, and may include written materials, verbal instruction, and multimedia programs. Despite this wide variety, the effectiveness and benefit of chemotherapy education hinges on the patients' health literacy. Breast cancer patients with low health literacy may be unclear about chemotherapy or face difficulty adhering to treatment if they do not understand the information provided to them. Thus, this scoping review summarizes the existing research on how health literacy principles are incorporated into breast cancer chemotherapy education materials. METHODS Using a combination of keywords (e.g. chemotherapy, education) and Medical subject headings (MeSH) terms (e.g., drug therapy, antineoplastic agents), we searched five databases (1977-2017): CINAHL, PubMed, PsycINFO, Cochrane Library, and Web of Science. RESULTS Eight of 4,624 articles met the inclusion criteria. Five articles incorporated health literacy principles (e.g., plain language, maintaining an active voice, using white space) into the development of written materials. Few articles used a theoretical framework to guide education material development (n = 3). Of the three articles that described pilot-testing of educational materials, two used post-tests only and one used a pre/post-test design. CONCLUSIONS Findings indicated that limited research exists regarding the use of health literacy principles in chemotherapy education materials. Much of the development of chemotherapy education is not grounded in theory and the application of health literacy principles is limited. Implementing health literacy principles may improve overall comprehension of education thereby increasing adherence.
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Affiliation(s)
- Pearman D. Parker
- College of Nursing, University of South Carolina, Columbia, South Carolina, United States
| | - Sue P. Heiney
- College of Nursing, University of South Carolina, Columbia, South Carolina, United States
| | - Daniela B. Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, Columbia, South Carolina, United States
- Statewide Cancer Prevention and Control Program
| | - Tisha M. Felder
- College of Nursing, University of South Carolina, Columbia, South Carolina, United States
- Statewide Cancer Prevention and Control Program
| | - Robin Dawson Estrada
- College of Nursing, University of South Carolina, Columbia, South Carolina, United States
| | - Eboni Herbert Harris
- College of Nursing, University of South Carolina, Columbia, South Carolina, United States
| | - Swann Arp Adams
- College of Nursing, University of South Carolina, Columbia, South Carolina, United States
- Statewide Cancer Prevention and Control Program
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, Columbia, South Carolina, United States
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Cranley LA, Cummings GG, Profetto-McGrath J, Toth F, Estabrooks CA. Facilitation roles and characteristics associated with research use by healthcare professionals: a scoping review. BMJ Open 2017; 7:e014384. [PMID: 28801388 PMCID: PMC5724142 DOI: 10.1136/bmjopen-2016-014384] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/30/2016] [Accepted: 02/21/2017] [Indexed: 12/29/2022] Open
Abstract
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.
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Affiliation(s)
- Lisa A Cranley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | | | | | - Ferenc Toth
- Faculty of Nursing, University of Alberta, Edmonton, Canada
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Aligning Documentation With Congenital Muscular Torticollis Clinical Practice Guidelines: Administrative Case Report. Phys Ther 2016; 96:111-20. [PMID: 26381809 DOI: 10.2522/ptj.20150012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 09/09/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE A hospital-based pediatric outpatient center, wanting to weave evidence into practice, initiated an update of knowledge, skills, and documentation patterns with its staff physical therapists and occupational therapists who treat people with congenital muscular torticollis (CMT). This case report describes 2 cycles of implementation: (1) the facilitators and barriers to implementation and (2) selected quality improvement outcomes aligned with published clinical practice guidelines (CPGs). CASE DESCRIPTION The Pediatric Therapy Services of St Joseph's Regional Medical Center in New Jersey has 4 full-time, 1 part-time, and 3 per diem staff. Chart audits in 2012 revealed variations in measurement, interventions, and documentation that led to quality improvement initiatives. An iterative process, loosely following the knowledge-to-action cycle, included a series of in-service training sessions to review the basic anatomy, pathokinesiology, and treatment strategies for CMT; reading assignments of the available CPGs; journal review; documentation revisions; and training on the recommended measurements to implement 2 published CPGs and measure outcomes. OUTCOMES A previous 1-page generic narrative became a 3-page CMT-specific form aligned with the American Physical Therapy Association Section on Pediatrics CMT CPG recommendations. Staff training on the Face, Legs, Activity, Cry, Consolability (FLACC) pain scale, classification of severity, type of CMT, prognostication, measures of cervical range of motion, and developmental progression improved documentation consistency from 0% to 81.9% to 100%. Clinicians responded positively to using the longer initial evaluation form. DISCUSSION Successful implementation of both clinical and documentation practices were facilitated by a multifaceted approach to knowledge translation that included a culture supportive of evidence-based practice, administrative support for training and documentation redesign, commitment by clinicians to embrace changes aimed at improved care, and clinical guidelines that provide implementable recommendations.
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Kim SA, Song Y, Sim HS, Ahn EK, Kim JH. Mediating role of critical thinking disposition in the relationship between perceived barriers to research use and evidence-based practice. Contemp Nurse 2015; 51:16-26. [DOI: 10.1080/10376178.2015.1095053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Davison CM, Ndumbe-Eyoh S, Clement C. Critical examination of knowledge to action models and implications for promoting health equity. Int J Equity Health 2015; 14:49. [PMID: 26022369 PMCID: PMC4460698 DOI: 10.1186/s12939-015-0178-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 05/22/2015] [Indexed: 11/09/2022] Open
Abstract
Introduction Knowledge and effective interventions exist to address many current global health inequities. However, there is limited awareness, uptake, and use of knowledge to inform action to improve the health of disadvantaged populations. The gap between knowledge and action to improve health equity is of concern to health researchers and practitioners. This study identifies and critically examines the usefulness of existing knowledge to action models or frameworks for promoting health equity. Methods We conducted a scoping review of existing literature to identify knowledge to action (KTA) models or frameworks and critiqued the models using a health equity support rubric. Results We identified forty-eight knowledge to action models or frameworks. Six models scored between eight and ten of a maximum 12 points on the health equity support rubric. These high scoring models or frameworks all mentioned equity-related concepts. Attention to multisectoral approaches was the factor most often lacking in the low scoring models. The concepts of knowledge brokering, integrative processes, such as those in some indigenous health research, and Ecohealth applied to KTA all emerged as promising areas. Conclusions Existing knowledge to action models or frameworks can help guide knowledge translation to support action on the social determinants of health and health equity. There is a need to further test existing models or frameworks. This process should be informed by participatory and integrative research. There is room to develop more robust equity supporting models. Electronic supplementary material The online version of this article (doi:10.1186/s12939-015-0178-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Colleen M Davison
- Department Public Health Sciences, Queen's University, 63 Fifth Field Company Lane, Kingston, ON, K7L 3N6, Canada.
| | - Sume Ndumbe-Eyoh
- National Collaborating Centre for Determinants of Health, St Francis Xavier University, P.O. Box 5000, Antigonish, NS, B2G 2WG, Canada.
| | - Connie Clement
- National Collaborating Centre for Determinants of Health, St Francis Xavier University, P.O. Box 5000, Antigonish, NS, B2G 2WG, Canada.
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Implementing an organization-wide quality improvement initiative: insights from project leads, managers, and frontline nurses. Nurs Adm Q 2015; 37:222-30. [PMID: 23744468 DOI: 10.1097/naq.0b013e318295ec9f] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
With the movement to advance quality care and improve health care outcomes, organizations have increasingly implemented quality improvement (QI) initiatives to meet these requirements. Key to implementation success is the multilevel involvement of frontline clinicians and leadership. To explore the perceptions and experiences of frontline nurses, project leads, and managers associated with an organization-wide initiative aimed at engaging nurses in quality improvement work. To address the aims of this study, a qualitative research approach was used. Two focus groups were conducted with a total of 13 nurse participants, and individual interviews were done with 10 managers and 6 project leads. Emergent themes from the interview data included the following: improving care in a networked approach; driving QI and having a sense of pride; and overcoming challenges. Specifically, our findings elucidate the value of communities of practice and ongoing mentorship for nurses as key strategies to acquire and apply QI knowledge to a QI project on their respective units. Key challenges emerged including workload and time constraints, as well as resistance to change from staff. Our study findings suggest that leaders need to provide learning opportunities and protected time for frontline nurses to participate in QI projects.
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Onyura B, Légaré F, Baker L, Reeves S, Rosenfield J, Kitto S, Hodges B, Silver I, Curran V, Armson H, Leslie K. Affordances of knowledge translation in medical education: a qualitative exploration of empirical knowledge use among medical educators. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:518-24. [PMID: 25470312 DOI: 10.1097/acm.0000000000000590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE Little is known about knowledge translation processes within medical education. Specifically, there is scant research on how and whether faculty incorporate empirical medical education knowledge into their educational practices. The authors use the conceptual framework of affordances to examine factors within the medical education practice environment that influence faculty utilization of empirical knowledge. METHOD In 2012, the authors, using a purposive sampling strategy, recruited medical education leaders in undergraduate medical education from a Canadian university. Recruits all had direct teaching and curricular development roles in either preclinical or clinical courses across the four years of the undergraduate curriculum. Data were collected through individual semistructured interviews on participants' use of empirical evidence, as well as the factors that influence integration of empirical knowledge into practice. Data were analyzed using thematic analysis. RESULTS Fifteen medical educators participated. The authors identified both constraining and facilitating affordances of empirical medical education knowledge use. Constraining affordances included poor quality and availability of evidence, inadequate knowledge delivery approaches, work and role overload, faculty and student change resistance, and resource limitations. Facilitating affordances included faculty development, peer recommendations, and local involvement in medical education knowledge creation. CONCLUSIONS Affordances of the medical education practice environment influence empirical knowledge use. Developing strategies for effective knowledge translation thus requires careful assessment of contextual factors that can enable, constrain, or inhibit evidence use. Empirical knowledge use is most likely to occur among medical educators who are afforded rich, facilitative opportunities for participation in creating, seeking, and implementing knowledge.
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Affiliation(s)
- Betty Onyura
- Dr. Onyura is research and evaluation consultant, Centre for Faculty Development, Li Ka Shing International Healthcare Education Centre, St. Michael's Hospital, Toronto, Ontario, Canada. Dr. Le´gare´ is Canada Research Chair in Implementation of Shared Decision Making in Primary Care and professor, Department of Family Medicine and Emergency Medicine, Laval University, Québec, Québec, Canada. Ms. Baker is research and education consultant, Centre for Faculty Development, Li Ka Shing International Healthcare Education Centre, St. Michael's Hospital, Toronto, Ontario, Canada. Dr. Reeves is professor of interprofessional research, Faculty of Health, Social Care and Education, Kingston University and St. Georges, University of London, London, United Kingdom. Dr. Rosenfield is professor, Faculty of Medicine, and vice dean of undergraduate medical education, University of Toronto, Toronto, Ontario, Canada. Dr. Kitto is a medical sociologist and assistant professor, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. Dr. Hodges is professor, Faculty of Medicine and Faculty of Education, University of Toronto, and vice president of education, University Health Network, Toronto, Ontario, Canada. Dr. Silver is professor, Faculty of Medicine, University of Toronto, and vice president of education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Dr. Curran is professor, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada. Dr. Armson is director of research, Foundation of Medical Practice Education, and professor, University of Calgary, Calgary, Alberta, Canada. Dr. Leslie is director, Centre for Faculty Development, Li Ka Shing International Healthcare Education Centre, St. Michael's Hospital, and associate professor, Department of Pediatrics, University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
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Perceptions of physicians about knowledge sharing barriers in Turkish health care system. J Med Syst 2015; 39:42. [PMID: 25732078 DOI: 10.1007/s10916-015-0230-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/11/2015] [Indexed: 10/23/2022]
Abstract
This study was based on knowledge sharing barriers about attitudes of physicians in Turkish health care system. The present study aims to determine whether the knowledge sharing barriers about attitudes of physicians vary depending on gender, position, departments at hospitals, and hospital ownership status. This study was planned and conducted on physicians at one public hospital, one university hospital, and one private hospital in Turkey. 209 physicians were reached for data collection. The study was conducted in June-September 2014. The questionnaire (developed by A. Riege, (J. Knowl. Manag. 9(3):18-35, 2005)), five point Likert-type scale including 39 items having the potential of the physicians' knowledge- sharing attitudes and behaviors, was used in the study for data collection. Descriptive statistics, reliability analysis, student t test and ANOVA were used for data analysis. According to results of this study, there was medium level of knowledge sharing barriers within hospitals. In general, physicians had perceptions about the lowest level individual barriers, intermediate level organizational barriers and the highest level technological barriers perceptions, respectively. This study revealed that some knowledge sharing barriers about attitudes of physicians were significantly difference according to hospital ownership status, gender, position and departments. Most evidence medical decisions and evidence based practice depend on experience and knowledge of existing options and knowledge sharing in health care organizations. Physicians are knowledge and information-intensive and principal professional group in health care context.
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Examining the use of facilitation within guideline dissemination and implementation studies in nursing. INT J EVID-BASED HEA 2015; 12:105-27. [PMID: 24945960 DOI: 10.1097/xeb.0000000000000008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Facilitation is a mechanism for implementing practice guidelines in nursing. Facilitation aims to prepare clinicians and organisations for implementation and to provide support and help in problem-solving as implementation progresses. However, any evidence supporting its effectiveness is limited due to a lack of empirical testing. AIM : To examine the presence and role of facilitation in studies included in an existing systematic review of guideline dissemination and implementation in nursing. METHODS Using a descriptive, exploratory approach, we examined 28 studies for elements of facilitation that were included in a review of the effectiveness of interventions to increase the use of practice guidelines in nursing. We conducted a content analysis of a subset of studies that included facilitation activity to gather descriptions of study interventions, characteristics and skills required, use of theory, and effectiveness. Extracted data were analysed using a previously developed taxonomy containing 53 activities related to facilitation. RESULTS Ten of the 28 studies exhibited evidence of facilitation process and activity. Only two of the 10 studies explicitly referred to 'facilitators,' with just one indicating that facilitators were a part of the implementation intervention being tested. We identified facilitation processes in the eight remaining studies even though the authors did not report it as such. All studies used facilitation activities in combination with other interventions, the most common being educational meetings or distribution of educational materials. We found evidence related to facilitation for 37 of the 53 facilitation activities (70%) in the taxonomy in at least one study or across studies. An additional three novel facilitation-related activities were identified. Most studies exhibited evidence of external facilitation activity whereby researchers outside of the setting assisted nurses to implement guidelines. Theory informed the development or selection of implementation interventions in 60% (n = 6) of the studies. Drawing conclusions regarding effectiveness of interventions involving facilitation was difficult due to the small number of studies that were included. Furthermore, the included studies varied in the detail provided about the intervention or combination of interventions tested and how interventions were delivered. CONCLUSIONS Using an existing systematic review for the purpose of gaining insight into additional research questions was valuable. Although facilitation process and activities are used in interventions to enhance guideline uptake in nursing, these were not conceptualized or referred to by researchers as 'facilitation.' As such, facilitation may be a broader intervention that includes organizing and delivering other interventions. Further research is required to evaluate the relationship between facilitation and other guideline implementation interventions in nursing. The facilitation uncovered within included studies was located primarily in the context of research as it was the researchers who performed most of the facilitation activities. Future inquiries must explore non-researcher-initiated and delivered facilitation intervention activities by following local groups naturally within clinical contexts.
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Son YJ, Song Y, Park SY, Kim JI. A psychometric evaluation of the Korean version of the evidence-based practice questionnaire for nurses. Contemp Nurse 2015. [DOI: 10.1080/10376178.2014.11081948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
AIM To report a concept analysis of nursing-sensitive indicators within the applied context of the acute care setting. BACKGROUND The concept of 'nursing sensitive indicators' is valuable to elaborate nursing care performance. The conceptual foundation, theoretical role, meaning, use and interpretation of the concept tend to differ. The elusiveness of the concept and the ambiguity of its attributes may have hindered research efforts to advance its application in practice. DESIGN Concept analysis. DATA SOURCES Using 'clinical indicators' or 'quality of nursing care' as subject headings and incorporating keyword combinations of 'acute care' and 'nurs*', CINAHL and MEDLINE with full text in EBSCOhost databases were searched for English language journal articles published between 2000-2012. Only primary research articles were selected. METHODS A hybrid approach was undertaken, incorporating traditional strategies as per Walker and Avant and a conceptual matrix based on Holzemer's Outcomes Model for Health Care Research. RESULTS The analysis revealed two main attributes of nursing-sensitive indicators. Structural attributes related to health service operation included: hours of nursing care per patient day, nurse staffing. Outcome attributes related to patient care included: the prevalence of pressure ulcer, falls and falls with injury, nosocomial selective infection and patient/family satisfaction with nursing care. CONCLUSION This concept analysis may be used as a basis to advance understandings of the theoretical structures that underpin both research and practical application of quality dimensions of nursing care performance.
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Affiliation(s)
- Liza Heslop
- College of Health and Biomedicine, Victoria University, Melbourne, Victoria, Australia
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Doran D, Lefebre N, O'Brien-Pallas L, Estabrook CA, White P, Carryer J, Sun W, Qian G, Bai YQC, Li M. The relationship among evidence-based practice and client dyspnea, pain, falls, and pressure ulcer outcomes in the community setting. Worldviews Evid Based Nurs 2014; 11:274-83. [PMID: 25099877 PMCID: PMC4240472 DOI: 10.1111/wvn.12051] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2014] [Indexed: 12/18/2022]
Abstract
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.
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Affiliation(s)
- Diane Doran
- Professor Emerita, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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20
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Archibald MM, Fraser K. The potential for nurse practitioners in health care reform. J Prof Nurs 2014; 29:270-5. [PMID: 24075259 DOI: 10.1016/j.profnurs.2012.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Indexed: 10/26/2022]
Abstract
In Canada, health care reform is underway to address escalating costs, access and quality of care issues, and existing personnel shortages in various health disciplines. One response of the nursing profession to these stimuli has been the development of the advanced practice nurse, namely, the nurse practitioner (NP). NPs are in an excellent position to address current shortcomings through increasing points of access to the health care system, providing an emphasis on education and disease prevention, and delivering high-quality, cost-effective care in a multitude of practice settings. With an emphasis on the social determinants of health, NPs are in a prime position to provide care to underserved and vulnerable populations across Canada. Despite the potential for NPs to be instrumental in health care reform, there is a lack of support and regulation necessary for their optimal use. Barriers to mobilizing NPs in Canada exist and impede the integration of NPs into the Canadian health care system, which has both quality of care and social justice implications.
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Affiliation(s)
- Mandy M Archibald
- PhD student, University of Alberta; Registered Nurse and a doctoral trainee, Canadian Child Health Clinician Scientist Program, Stollery Children's Hospital, Edmonton, Alberta, Canada
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Jeffs L, Sidani S, Rose D, Espin S, Smith O, Martin K, Byer C, Fu K, Ferris E. Using theory and evidence to drive measurement of patient, nurse and organizational outcomes of professional nursing practice. Int J Nurs Pract 2013; 19:141-8. [PMID: 23577971 DOI: 10.1111/ijn.12048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
An evolving body of literature suggests that the implementation of evidence based clinical and professional guidelines and strategies can improve patient care. However, gaps exist in our understanding of the effect of implementation of guidelines on outcomes, particularly patient outcomes. To address this gap, a measurement framework was developed to assess the impact of an organization-wide implementation of two nursing-centric best-practice guidelines on patient, nurse and organizational level outcomes. From an implementation standpoint, we anticipate that our data will show improvements in the following: (i) patient satisfaction scores and safety outcomes; (ii) nurses ability to value and engage in evidence based practice; and (iii) organizational support for evidence-informed nursing care that results in quality patient outcomes. Our measurement framework and multifaceted methodological approach outlined in this paper might serve as a blueprint for other organizations in their efforts to evaluate the impacts associated with implementation of clinical and professional guidelines and best practices.
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Affiliation(s)
- Lianne Jeffs
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's, Canada.
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Yevchak AM, Fick DM, McDowell J, Monroe T, May K, Grove L, Kolanowski AM, Waller JL, Inouye SK. Barriers and facilitators to implementing delirium rounds in a clinical trial across three diverse hospital settings. Clin Nurs Res 2013; 23:201-15. [PMID: 24121464 DOI: 10.1177/1054773813505321] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Delirium occurs in more than half of hospitalized older adults with dementia, substantially worsening outcomes. The use of multiple strategies and a local opinion leader, unit champion, has cumulative and lasting effects compared with single-strategy interventions. The purpose of this article is to describe the early barriers and facilitators to rounding with unit champions in a cluster randomized clinical trial in Year 2 of a 5-year trial (5R01NR011042-02). This is a mixed-method study nested within an ongoing multisite cluster-randomized, controlled clinical trial. Descriptive and comparative statistics were collected on N = 192 nursing rounds. Qualitative data were thematically analyzed. On average, rounds lasted 25.54 min (SD = 13.18) and were conducted with the unit champion 64% of the time. This is one of the first studies to systematically address quantitative and qualitative barriers and facilitators to nurse-led delirium rounds, demonstrating the gradual adoption of an intervention in diverse clinical settings.
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Affiliation(s)
- Andrea M Yevchak
- Pennsylvania State University School of Nursing, University Park, USA
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Forchuk C, Martin ML, Jensen E, Ouseley S, Sealy P, Beal G, Reynolds W, Sharkey S. Integrating an evidence-based intervention into clinical practice: 'transitional relationship model'. J Psychiatr Ment Health Nurs 2013; 20:584-94. [PMID: 22827453 DOI: 10.1111/j.1365-2850.2012.01956.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The transitional relationship model (TRM) facilitates the discharge process by providing peer support and hospital staff involvement until a therapeutic relationship has been established with a community care provider. A quasi-experimental, action-oriented research design was employed in which psychiatric wards at six hospital sites implemented the model in three waves. Helpful strategies were identified by each wave of wards for consideration by subsequent wards. Using an ethnographic approach, qualitative data were examined to uncover experiences and perceptions of TRM implementation and to help identify key issues that were supporting or hampering implementation. Specific strategies that facilitate the implementation of TRM include: (1) the use of educational modules for on-ward hospital staff training and peer training; (2) presence of on-site champions; and (3) supportive documentation systems. Issues identified as barriers to implementation included: (1) feeling drowned, swamped and overwhelmed; (2) death by process; (3) team dynamics; and (4) changes in champions. Staged large-scale implementation of the TRM allowed for iterative improvements to the model leading to positive outcomes. This study highlights the need to address work environment issues, particularly interprofessional teams.
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Affiliation(s)
- C Forchuk
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, 1151 Richmond Street, London, Ontario, Canada.
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Eldh AC, Vogel G, Söderberg A, Blomqvist H, Wengström Y. Use of evidence in clinical guidelines and everyday practice for mechanical ventilation in Swedish intensive care units. Worldviews Evid Based Nurs 2013; 10:198-207. [PMID: 23796046 DOI: 10.1111/wvn.12008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIM One way to support evidence-based decisions in health care is by clinical guidelines, in particular, in highly specialized care such as intensive care units (ICUs). The aim of this study was to explore the development and dissemination of guidelines regarding mechanical ventilation (MV) in Swedish ICUs, and the use of evidence on MV in guidelines and everyday practice. METHODS Inviting all general ICUs in Sweden (N = 65), a national survey was performed on occurrence of MV guidelines, and a review of submitted ICU guidelines by four evidence items from the AGREE instrument. In addition, ICU head nurses and senior physicians were interviewed using semistructured and open-ended questions to explore development and dissemination of MV guidelines, staff adherence or nonadherence to guidelines, and everyday practice of MV management bedside. FINDINGS Fifty-five ICUs (85%) participated in the study; 51 ICUs submitted a total of 245 guidelines, including recommendations for medical or nursing MV actions. None of the documents included how evidence had been sought or assessed, while 22% included a list of references (n = 54). No guidelines included patients' experiences of MV. According to the managers, the guidelines were most often compiled by a multiprofessional team sharing the information through the ICU's website. The guidelines were mainly used as a basis for MV management bedside, but variation occurred as a result of personal preferences, lack of awareness, and adjustment to patients' needs. CONCLUSIONS Local MV guidelines seem to constitute a basis for healthcare practice in Swedish ICUs, even though the evidence proposed was limited with respect to how it was attained and lacked patient perspectives. In addition, the strategies used for dissemination were limited, suggesting that further initiatives are needed to support knowledge translation in advanced healthcare environments such as ICUs.
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Affiliation(s)
- Ann Catrine Eldh
- Research Fellow, Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden
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Shaffer ST, Zarnowsky CD, Green RC, Lim MLC, Holtzer BM, Ely EA. Strategies from bedside nurse perspectives in conducting evidence-based practice projects to improve care. Nurs Clin North Am 2013; 48:353-61. [PMID: 23659819 DOI: 10.1016/j.cnur.2013.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This article presents the bedside nurses' perspectives on their experience with conducting an evidence based practice project. This is especially important in the climate of hospitals working to achieve Magnet Recognition. The facilitators and barriers to project design and completion are discussed in detail. Strategies to overcome barriers are presented. Facilitators for bedside nurses include motivation and professional development. Most common barriers were lack of time and limited knowledge about the process. Interventions aimed at research utilization can be successful when mindful of commonly understood barriers to project completion with steps taken to resolve those barriers.
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Affiliation(s)
- Susan T Shaffer
- Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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Basson HA, Roets L. Workplace wellness for HIV/AIDS-affected nurses in South Africa. ACTA ACUST UNITED AC 2013; 22:38-44. [PMID: 23299210 DOI: 10.12968/bjon.2013.22.1.38] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The development of a framework for a workplace wellness programme for HIV/AIDS infected and/or affected nurses in South Africa, who comprise registered nurses and midwives, enrolled staff nurses and auxiliary nurses. RESEARCH OBJECTIVES To identify and describe components for a framework of a workplace wellness programme. BACKGROUND Registered nurses and midwives, enrolled staff nurses and auxiliary nurses (referred to as nurses) in the South African nursing workforce are confronted daily with HIV/AIDS in the workplace due to the high HIV/AIDS prevalence rate among sexually and economically active adult women between 15-49 years of age. The research explains how health and wellness could be promoted by instituting a workplace wellness programme. RESEARCH DESIGN Quantitative descriptive research. FINDINGS The nurses emphasised the threat of HIV/AIDS and considered a workplace wellness programme a priority. CONCLUSION A logic model underpinned the workplace wellness programme framework.
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Matthew-Maich N, Ploeg J, Jack S, Dobbins M. Leading on the frontlines with passion and persistence: a necessary condition for Breastfeeding Best Practice Guideline uptake. J Clin Nurs 2012. [PMID: 23186340 DOI: 10.1111/jocn.12027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES The research question explored was what are the processes and strategies used by frontline leaders to support the uptake of the Breastfeeding Best Practice Guideline by nurses in maternity care practice settings? BACKGROUND Best Practice Guidelines have been shown to enhance client care and outcomes. Leadership is known to have a key role in moving Best Practice Guidelines into nursing practice yet how this happens is poorly understood. This insight is needed to consistently and efficiently facilitate Best Practice Guideline uptake into clinical practice. DESIGN Constructivist grounded theory was used to explore the social processes and strategies involved in facilitating Best Practice Guideline uptake. METHODS Purposive, criterion-based, theoretical and negative case sampling were used recruiting 58 health professionals and 54 clients. Triangulation and constant comparison of data sources and types (interviews, documents and field notes) were used for analysis and rigour. RESULTS Passionate, persistent, respected frontline leaders using tailored, multifaceted strategies aimed at three groups of nurse adopters effectively support the uptake of the Breastfeeding Best Practice Guideline in nursing practice. Successful uptake strategies used by frontline leaders that are new or underdeveloped in the previous literature are presented. CONCLUSIONS The study findings illuminated multidimensional, tailored strategies that frontline leaders use to facilitate the uptake of Best Practice Guidelines. Attention to individual attitudes and beliefs, as well as organisational, interorganisational and interprofessional partnerships are vital to uptake. Organisations that aspire to foster Best Practice Guideline uptake must invest in frontline leaders to 'make it happen' and sustain Best Practice Guideline uptake in practice. RELEVANCE TO CLINICAL PRACTICE Understanding how frontline leaders facilitate Best Practice Guideline uptake is essential to selecting, educating and supporting them to foster desired practice changes. Strategies are explicated that frontline leaders can adopt and tailor to their own practice contexts.
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Affiliation(s)
- Nancy Matthew-Maich
- School of Nursing and Health Sciences Research & Innovation, Mohawk College, Hamilton, ON, Canada.
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Christie J, Hamill C, Power J. How can we maximize nursing students’ learning about research evidence and utilization in undergraduate, preregistration programmes? A discussion paper. J Adv Nurs 2012; 68:2789-801. [DOI: 10.1111/j.1365-2648.2012.05994.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Seers K, Cox K, Crichton NJ, Edwards RT, Eldh AC, Estabrooks CA, Harvey G, Hawkes C, Kitson A, Linck P, McCarthy G, McCormack B, Mockford C, Rycroft-Malone J, Titchen A, Wallin L. FIRE (Facilitating Implementation of Research Evidence): a study protocol. Implement Sci 2012; 7:25. [PMID: 22453077 PMCID: PMC3356232 DOI: 10.1186/1748-5908-7-25] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 03/27/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research evidence underpins best practice, but is not always used in healthcare. The Promoting Action on Research Implementation in Health Services (PARIHS) framework suggests that the nature of evidence, the context in which it is used, and whether those trying to use evidence are helped (or facilitated) affect the use of evidence. Urinary incontinence has a major effect on quality of life of older people, has a high prevalence, and is a key priority within European health and social care policy. Improving continence care has the potential to improve the quality of life for older people and reduce the costs associated with providing incontinence aids. OBJECTIVES This study aims to advance understanding about the contribution facilitation can make to implementing research findings into practice via: extending current knowledge of facilitation as a process for translating research evidence into practice; evaluating the feasibility, effectiveness, and cost-effectiveness of two different models of facilitation in promoting the uptake of research evidence on continence management; assessing the impact of contextual factors on the processes and outcomes of implementation; and implementing a pro-active knowledge transfer and dissemination strategy to diffuse study findings to a wide policy and practice community. SETTING AND SAMPLE Four European countries, each with six long-term nursing care sites (total 24 sites) for people aged 60 years and over with documented urinary incontinence METHODS AND DESIGN Pragmatic randomised controlled trial with three arms (standard dissemination and two different programmes of facilitation), with embedded process and economic evaluation. The primary outcome is compliance with the continence recommendations. Secondary outcomes include proportion of residents with incontinence, incidence of incontinence-related dermatitis, urinary tract infections, and quality of life. Outcomes are assessed at baseline, then at 6, 12, 18, and 24 months after the start of the facilitation interventions. Detailed contextual and process data are collected throughout, using interviews with staff, residents and next of kin, observations, assessment of context using the Alberta Context Tool, and documentary evidence. A realistic evaluation framework is used to develop explanatory theory about what works for whom in what circumstances. TRIAL REGISTRATION Current Controlled Trials ISRCTN11598502.
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Affiliation(s)
- Kate Seers
- Royal College of Nursing Research Institute, School of Health and Social Studies, University of Warwick, Coventry, UK.
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Chaboyer W, Lin F, Foster M, Retallick L, Panuwatwanich K, Richards B. Redesigning the ICU nursing discharge process: a quality improvement study. Worldviews Evid Based Nurs 2011; 9:40-8. [PMID: 22151856 DOI: 10.1111/j.1741-6787.2011.00234.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the impact of a redesigned intensive care unit (ICU) nursing discharge process on ICU discharge delay, hospital mortality, and ICU readmission within 72 hours. METHODS A quality improvement study using a time series design and statistical process control analysis was conducted in one Australian general ICU. The primary outcome measure was hours of discharge delay per patient discharged alive per month, measured for 15 months prior to, and for 12 months after the redesigned process was implemented. The redesign process included appointing a change agent to facilitate process improvement, developing a patient handover sheet, requesting ward staff to nominate an estimated transfer time, and designing a daily ICU discharge alert sheet that included an expected date of discharge. RESULTS A total of 1,787 ICU discharges were included in this study, 1,001 in the 15 months before and 786 in the 12 months after the implementation of the new discharge processes. There was no difference in in-hospital mortality after discharge from ICU or ICU readmission within 72 hours during the study period. However, process improvement was demonstrated by a reduction in the average patient discharge delay time of 3.2 hours (from 4.6 hour baseline to 1.0 hours post-intervention). CONCLUSIONS Involving both ward and ICU staff in the redesign process may have contributed to a shared situational awareness of the problems, which led to more timely and effective ICU discharge processes. The use of a change agent, whose ongoing role involved follow-up of patients discharged from ICU, may have helped to embed the new process into practice.
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Affiliation(s)
- Wendy Chaboyer
- NHMRC Centre of Research Excellence in Nursing Interventions for Hospitalised Patients, Research Centre for Clinical and Community Practice Innovation, Griffith Health Institute, Griffith University, Gold Coast campus, Queensland, Australia.
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McKillop A, Crisp J, Walsh K. Barriers and enablers to implementation of a New Zealand-wide guideline for assessment and management of cardiovascular risk in primary health care: a template analysis. Worldviews Evid Based Nurs 2011; 9:159-71. [PMID: 22151788 DOI: 10.1111/j.1741-6787.2011.00233.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to identify the enablers and barriers to guideline implementation in a primary healthcare setting by employing the Promoting Action on Research Implementation in Health Services (PARIHS) framework as a template for data analysis and interpretation. BACKGROUND The use of clinical practice guidelines is pivotal to improving health outcomes. However, the implementation of guidelines into practice is complex, unpredictable, and, in spite of much investigation, remains resistant to explanation of what works and why. Optimising the enablers and minimising the barriers to implementation of a guideline for reducing cardiovascular disease risk has the potential to significantly reduce the burden of disease. The PARIHS framework has been successfully applied in a number of clinical contexts and has been found useful in illuminating the barriers and enablers to evidence implementation. APPROACH This qualitative study involved focus groups with 20 primary healthcare nurses, 4 general practitioners, 5 managers, and individual interviews with 3 funder/planners who discussed their contribution to the use of a guideline for the assessment and management of cardiovascular risk. Template analysis based on the PARIHS framework was applied to semi-structured narrative data to provide an in-depth analysis of the barriers and enablers to implementation of the guideline. CONCLUSIONS The lack of facilitation of the guideline into practice was a major barrier to implementation. Implementation plans that address the concerns and complexities of everyday practice are an essential aspect of guideline development. The PARIHS framework was found to be comprehensive and accommodating of the complexity of everyday practice associated with guideline implementation in primary health care. The pertinence of the framework confirms its usefulness as a tool to guide implementation.
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Affiliation(s)
- Ann McKillop
- School of Nursing, The University of Auckland, Auckland, New Zealand.
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Harvey G, Fitzgerald L, Fielden S, McBride A, Waterman H, Bamford D, Kislov R, Boaden R. The NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester: combining empirical, theoretical and experiential evidence to design and evaluate a large-scale implementation strategy. Implement Sci 2011; 6:96. [PMID: 21861886 PMCID: PMC3170237 DOI: 10.1186/1748-5908-6-96] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 08/23/2011] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In response to policy recommendations, nine National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) were established in England in 2008, aiming to create closer working between the health service and higher education and narrow the gap between research and its implementation in practice. The Greater Manchester (GM) CLAHRC is a partnership between the University of Manchester and twenty National Health Service (NHS) trusts, with a five-year mission to improve healthcare and reduce health inequalities for people with cardiovascular conditions. This paper outlines the GM CLAHRC approach to designing and evaluating a large-scale, evidence- and theory-informed, context-sensitive implementation programme. DISCUSSION The paper makes a case for embedding evaluation within the design of the implementation strategy. Empirical, theoretical, and experiential evidence relating to implementation science and methods has been synthesised to formulate eight core principles of the GM CLAHRC implementation strategy, recognising the multi-faceted nature of evidence, the complexity of the implementation process, and the corresponding need to apply approaches that are situationally relevant, responsive, flexible, and collaborative. In turn, these core principles inform the selection of four interrelated building blocks upon which the GM CLAHRC approach to implementation is founded. These determine the organizational processes, structures, and roles utilised by specific GM CLAHRC implementation projects, as well as the approach to researching implementation, and comprise: the Promoting Action on Research Implementation in Health Services (PARIHS) framework; a modified version of the Model for Improvement; multiprofessional teams with designated roles to lead, facilitate, and support the implementation process; and embedded evaluation and learning. SUMMARY Designing and evaluating a large-scale implementation strategy that can cope with and respond to the local complexities of implementing research evidence into practice is itself complex and challenging. We present an argument for adopting an integrative, co-production approach to planning and evaluating the implementation of research into practice, drawing on an eclectic range of evidence sources.
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Affiliation(s)
- Gill Harvey
- Manchester Business School, University of Manchester, Booth Street West, Manchester, M15 6PB, UK
| | - Louise Fitzgerald
- Manchester Business School, University of Manchester, Booth Street West, Manchester, M15 6PB, UK
| | - Sandra Fielden
- Manchester Business School, University of Manchester, Booth Street West, Manchester, M15 6PB, UK
| | - Anne McBride
- Manchester Business School, University of Manchester, Booth Street West, Manchester, M15 6PB, UK
| | - Heather Waterman
- School of Nursing, Midwifery and Social Work, University of Manchester
| | - David Bamford
- Manchester Business School, University of Manchester, Booth Street West, Manchester, M15 6PB, UK
| | - Roman Kislov
- Manchester Business School, University of Manchester, Booth Street West, Manchester, M15 6PB, UK
| | - Ruth Boaden
- Manchester Business School, University of Manchester, Booth Street West, Manchester, M15 6PB, UK
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Bellman L, Webster J, Jeanes A. Knowledge transfer and the integration of research, policy and practice for patient benefit. J Res Nurs 2011. [DOI: 10.1177/1744987110385271] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Multiple routes are proposed within the nursing and healthcare literature for implementing traditional and reflexive research evidence into practice. Knowledge transfer is a relatively new field of inquiry, which, as both a process and a strategy, can lead to the utilisation of research findings and improved outcomes for patients. Nurse leaders and the public have recognised the need to ensure that evidence-based practice is introduced expeditiously. Nurses working at an advanced level of practice, such as consultant nurses, use all forms of knowledge in sophisticated ways to lead the integration of research findings into diverse practice settings. Within healthcare organisations evidence-based practice is far more likely to occur when it is linked to implementing healthcare policy in practice. The current international, collaborative knowledge transfer research agenda includes the need to learn if knowledge transfer programmes, structures, frameworks and theories are working, and if not, why not. The knowledge transfer process is illustrated by consultant nurses using the knowledge-to-action framework to underpin two recent UK policy examples: safeguarding vulnerable adults and the prevention of Clostridium difficile. For the future, clinical academic partnerships are required to foster a culture of evidence-based practice through practical engagement, and the sharing of nursing knowledge and expertise in a systematic way, both to improve patient care and address the current research—practice gap.
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Affiliation(s)
- Loretta Bellman
- Independent Consultant Nursing & Healthcare (formerly Senior Nurse Research & Development, University College London Hospitals NHS Foundation Trust, UK) Trustee, Foundation of Nursing Studies (FoNS), UK,
| | - Jonathan Webster
- Assistant Director, Quality and Clinical Performance (formerly Consultant Nurse, Older People, University College London Hospitals NHS Foundation Trust, UK) Director of Infection Prevention and Control, Bexley Care NHS Trust, UK Honorary Senior Research Fellow, Christ Church Canterbury University, UK
| | - Annette Jeanes
- Consultant Nurse (Infection Control) Director of Infection Prevention and Control, University College London Hospitals NHS Foundation Trust, UK
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Mitchell SA, Fisher CA, Hastings CE, Silverman LB, Wallen GR. A thematic analysis of theoretical models for translational science in nursing: mapping the field. Nurs Outlook 2011; 58:287-300. [PMID: 21074646 DOI: 10.1016/j.outlook.2010.07.001] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Indexed: 01/28/2023]
Abstract
The quantity and diversity of conceptual models in translational science may complicate rather than advance the use of theory. This paper offers a comparative thematic analysis of the models available to inform knowledge development, transfer, and utilization. Literature searches identified 47 models for knowledge translation. Four thematic areas emerged: (1) evidence-based practice and knowledge transformation processes, (2) strategic change to promote adoption of new knowledge, (3) knowledge exchange and synthesis for application and inquiry, and (4) designing and interpreting dissemination research. This analysis distinguishes the contributions made by leaders and researchers at each phase in the process of discovery, development, and service delivery. It also informs the selection of models to guide activities in knowledge translation. A flexible theoretical stance is essential to simultaneously develop new knowledge and accelerate the translation of that knowledge into practice behaviors and programs of care that support optimal patient outcomes.
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Helfrich CD, Damschroder LJ, Hagedorn HJ, Daggett GS, Sahay A, Ritchie M, Damush T, Guihan M, Ullrich PM, Stetler CB. A critical synthesis of literature on the promoting action on research implementation in health services (PARIHS) framework. Implement Sci 2010; 5:82. [PMID: 20973988 PMCID: PMC2988065 DOI: 10.1186/1748-5908-5-82] [Citation(s) in RCA: 185] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 10/25/2010] [Indexed: 12/01/2022] Open
Abstract
Background The Promoting Action on Research Implementation in Health Services framework, or PARIHS, is a conceptual framework that posits key, interacting elements that influence successful implementation of evidence-based practices. It has been widely cited and used as the basis for empirical work; however, there has not yet been a literature review to examine how the framework has been used in implementation projects and research. The purpose of the present article was to critically review and synthesize the literature on PARIHS to understand how it has been used and operationalized, and to highlight its strengths and limitations. Methods We conducted a qualitative, critical synthesis of peer-reviewed PARIHS literature published through March 2009. We synthesized findings through a three-step process using semi-structured data abstraction tools and group consensus. Results Twenty-four articles met our inclusion criteria: six core concept articles from original PARIHS authors, and eighteen empirical articles ranging from case reports to quantitative studies. Empirical articles generally used PARIHS as an organizing framework for analyses. No studies used PARIHS prospectively to design implementation strategies, and there was generally a lack of detail about how variables were measured or mapped, or how conclusions were derived. Several studies used findings to comment on the framework in ways that could help refine or validate it. The primary issue identified with the framework was a need for greater conceptual clarity regarding the definition of sub-elements and the nature of dynamic relationships. Strengths identified included its flexibility, intuitive appeal, explicit acknowledgement of the outcome of 'successful implementation,' and a more expansive view of what can and should constitute 'evidence.' Conclusions While we found studies reporting empirical support for PARIHS, the single greatest need for this and other implementation models is rigorous, prospective use of the framework to guide implementation projects. There is also need to better explain derived findings and how interventions or measures are mapped to specific PARIHS elements; greater conceptual discrimination among sub-elements may be necessary first. In general, it may be time for the implementation science community to develop consensus guidelines for reporting the use and usefulness of theoretical frameworks within implementation studies.
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Affiliation(s)
- Christian D Helfrich
- Northwest HSR&D Center of Excellence, VA Puget Sound Healthcare System, Seattle, Washington, USA.
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Doran D, Paterson J, Clark C, Srivastava R, Goering PN, Kushniruk AW, Bajnok I, Nagle L, Almost J, Carryer J. A pilot study of an electronic interprofessional evidence-based care planning tool for clients with mental health problems and addictions. Worldviews Evid Based Nurs 2010; 7:174-84. [PMID: 20367805 DOI: 10.1111/j.1741-6787.2010.00191.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The health system must develop effective solutions to the growing challenges it faces with respect to individuals who suffer with mental health disorders and addictions. The purpose of this study was to evaluate the usability and potential impact on outcomes of a knowledge translation system aimed at improving client-centered, evidence-based care for hospitalized individuals with schizophrenia. METHODOLOGY A pre-posttest design was used. The e-Volution-TREAT system was implemented on two inpatient units at a large mental health facility. Thirty-seven nurses, allied health workers, and physicians participated from two units. Data collection involved questionnaires, semistructured interviews, and observations. Thirty-eight consenting clients' outcome data were collected from organizational records. RESULTS Overall, staff participants were very satisfied with the functions of the e-Volution-TREAT system. Barriers to using the system were identified by participants related to the work environment, to understaffing, equipment problems, discomfort with technology, and a focus on short-term rather than long-term goals. There was moderate uptake of guidelines related to social issues, and low uptake of guidelines related to family support and addictions. There were significant improvements in four client outcomes over time, specifically aggressive behavior, depression, withdrawal, and psychosis. CONCLUSIONS In conclusion, users were overall satisfied with the e-Volution-TREAT system, although expressed challenges related to workload that interfered with time to utilize the system. It would be premature to conclude the change in client outcomes was related to the e-Volution-TREAT system without a randomized controlled trial with outcomes compared to a control group. Future research needs to incorporate strategies for modifying the context and engage clinicians who are in a position of influence to model change.
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Affiliation(s)
- Diane Doran
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto ON, Canada.
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Dogherty EJ, Harrison MB, Graham ID. Facilitation as a role and process in achieving evidence-based practice in nursing: a focused review of concept and meaning. Worldviews Evid Based Nurs 2010; 7:76-89. [PMID: 20180826 DOI: 10.1111/j.1741-6787.2010.00186.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Facilitation is proposed as an important strategy to assist practitioners to implement evidence into practice. However, from a front-line nursing perspective, what is actually involved in facilitation, particularly in regards to research utilization, is poorly understood. AIM To examine the current state of knowledge surrounding the concept of facilitation as a role and process in the implementation of research findings within the nursing context. Building on a previous concept analysis, we examined how facilitation has evolved over the last decade, particularly focusing on the practical elements (e.g., what it entails to operationalize and implement facilitation in nursing). METHODS A systematic search of electronic databases identified theory and research-based nursing papers explicitly focused on facilitation in research utilization. Through a content analysis, we examined how the concept is being used, described, and applied within nursing. RESULTS Facilitation continues to be described as supporting and enabling practitioners to improve practice through evidence implementation. Certain aspects of the role and the strategies being employed to promote change are more evident. It was possible to formulate these into a taxonomy. Key findings include: * facilitation is now being viewed as an individual role as well as a process involving individuals and groups; * project management/leadership are important components; * no matter which approach is selected, tailoring facilitation to the local context is critical; * there is a growing emphasis on evaluation, particularly linking outcomes to nursing actions. CONCLUSIONS Further understanding of what facilitators are actually doing to enable changes in nursing practice based on research findings will provide the groundwork for the design and evaluation of practical strategies for evidence-based practice in nursing. Research is needed to clarify how facilitation may be used to implement change in nursing practice along with evaluation of the effectiveness of various approaches.
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Doran DM, Hirdes J, Blais R, Ross Baker G, Pickard J, Jantzi M. The nature of safety problems among Canadian homecare clients: evidence from the RAI-HC reporting system. J Nurs Manag 2009; 17:165-74. [PMID: 19416419 DOI: 10.1111/j.1365-2834.2009.00974.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM(S) The purpose of this study was to identify the nature of patient safety problems among Canadian homecare (HC) clients, using data collected through the RAI-HC((c)) assessment instrument. BACKGROUND Problems of patient safety have been well documented in hospitals. However, we have very limited data about patient safety problems among HC clients. METHOD(S) The study methodology involved a secondary analysis of data collected through the Canadian home care reporting system. The study sample consisted of all HC clients who qualified to receive a RAI-HC assessment from Ontario, Nova Scotia and Winnipeg Regional Health Authority for the 2003-2007 reporting period. There were a total of 238 958 cases available for analysis; 205 953 from Ontario, 26 751 from Nova Scotia and 6254 from Winnipeg Regional Health Authority. RESULTS New fall (11%), unintended weight loss (9%), new emergency room (ER) visits (7%) and new hospital visits (8%) were the most prevalent potential adverse events identified in our study. A small proportion of the HC clients experienced a new urinary tract infection (2%). CONCLUSION(S) Understanding clients' risk profiles is foundational to effective patient care management. IMPLICATIONS FOR NURSING MANAGEMENT We need to begin to develop evidence about best practices for ameliorating safety risk.
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Affiliation(s)
- Diane M Doran
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, Ontario, Canada.
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Clinical Applications of Outcome Tools in Ambulatory Children with Cerebral Palsy. Phys Med Rehabil Clin N Am 2009; 20:549-65. [DOI: 10.1016/j.pmr.2009.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Wallin L. Knowledge translation and implementation research in nursing. Int J Nurs Stud 2009; 46:576-87. [DOI: 10.1016/j.ijnurstu.2008.05.006] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2008] [Revised: 05/20/2008] [Accepted: 05/20/2008] [Indexed: 10/21/2022]
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Tolson D, Booth J, Lowndes A. Achieving evidence-based nursing practice: impact of the Caledonian Development Model. J Nurs Manag 2009; 16:682-91. [PMID: 18808462 DOI: 10.1111/j.1365-2834.2008.00889.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To determine the impact of the Caledonian Development Model, designed to promote evidence-based practice. BACKGROUND The model features practice-development activities, benchmarking, knowledge pooling and translation through membership of a community of practice and a virtual college. METHODS Twenty-four nurses, from 18 practice sites formed three communities of practice, each selecting evidence-based guidance to implement. A modified group supervision framework empowered nurses to champion local implementation. Outcomes were determined at 6 months. RESULTS Eighty per cent of the patient-related criteria and 35% of the facilities criteria were achieved. The Revised Nursing Work Index indicated these nurses experienced greater autonomy (P = 0.019) and increased organizational support (P = 0.037). Focus groups revealed a deepening organizational support for the initiative over time, illuminated work-based learning challenges and overall enthusiasm for the approach. CONCLUSION Implementation of the model effectively promoted evidence-based practice, most notably at the level of the individual patient. IMPLICATIONS FOR NURSING MANAGEMENT Time and budgetary constraints necessitate smart, value for money approaches to developing evidence-based practice and improved care standards. This work demonstrates an effective model that strikes a balance between individual and group learning, virtual and real-time activities, coupled with resource pooling across organizations and sectors.
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Affiliation(s)
- Debbie Tolson
- School of Nursing, Midwifery & Community Health, Glasgow Caledonian University, Glasgow, UK.
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Davies B, Edwards N, Ploeg J, Virani T. Insights about the process and impact of implementing nursing guidelines on delivery of care in hospitals and community settings. BMC Health Serv Res 2008; 8:29. [PMID: 18241349 PMCID: PMC2279128 DOI: 10.1186/1472-6963-8-29] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Accepted: 02/02/2008] [Indexed: 11/16/2022] Open
Abstract
Background Little is known about the impact of implementing nursing-oriented best practice guidelines on the delivery of patient care in either hospital or community settings. Methods A naturalistic study with a prospective, before and after design documented the implementation of six newly developed nursing best practice guidelines (asthma, breastfeeding, delirium-dementia-depression (DDD), foot complications in diabetes, smoking cessation and venous leg ulcers). Eleven health care organisations were selected for a one-year project. At each site, clinical resource nurses (CRNs) worked with managers and a multidisciplinary steering committee to conduct an environmental scan and develop an action plan of activities (i.e. education sessions, policy review). Process and patient outcomes were assessed by chart audit (n = 681 pre-implementation, 592 post-implementation). Outcomes were also assessed for four of six topics by in-hospital/home interviews (n = 261 pre-implementation, 232 post-implementation) and follow-up telephone interviews (n = 152 pre, 121 post). Interviews were conducted with 83/95 (87%) CRN's, nurses and administrators to describe recommendations selected, strategies used and participants' perceived facilitators and barriers to guideline implementation. Results While statistically significant improvements in 5% to 83% of indicators were observed in each organization, more than 80% of indicators for breastfeeding, DDD and smoking cessation did not change. Statistically significant improvements were found in > 50% of indicators for asthma (52%), diabetes foot care (83%) and venous leg ulcers (60%). Organizations with > 50% improvements reported two unique implementation strategies which included hands-on skill practice sessions for nurses and the development of new patient education materials. Key facilitators for all organizations included education sessions as well as support from champions and managers while key barriers were lack of time, workload pressure and staff resistance. Conclusion Implementation of nursing best practice guidelines can result in improved practice and patient outcomes across diverse settings yet many indicators remained unchanged. Mobilization of the nursing workforce to actively implement guidelines and to monitor the delivery of their care is important so that patients may learn about and receive recommended healthcare.
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Affiliation(s)
- Barbara Davies
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
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