Transformative learning and research utilization in nursing practice: a missing link?

Factors affecting research utilisation of nurses and midwives working in North Gondar and West Gojjam Zone public hospitals, Ethiopia: a cross-sectional study

BACKGROUND

Research utilisation in clinical decision-making is crucial to enhance quality healthcare, professional development and cost-effective health service. Nurses and midwives have a vital role in research utilisation. However, many factors influence research utilisation of nurses and midwives.

OBJECTIVES

To determine research utilisation and identify factors that affect research utilisation among nurses and midwives.

METHODS

An institutional-based, cross-sectional study was conducted from 23 May to 30 June 2019. A total of 631 nurses and midwives participated in the study. Categorical variables were coded with dummy variables and multiple linear regression model was carried out. The level of significance was set at p value less than or equal to 0.05 with 95% CI.

RESULTS

Participants' total mean score in the research utilisation scale was 2.27 (SD±0.77) and their mean age was 28.41 (SD±4.71) years. The study revealed that 70.4% (444) of participants had poor research utilisation. Self-efficacy in research utilisation skills (B=0.86, 95% CI 0.75 to 0.97), support for research utilisation (B=0.4, 95% CI 0.25 to 0.55), attitude (B=0.23, 95% CI 0.07 to 0.38), barriers to research utilisation (B=-0.63, 95% CI -0.72 to -0.54), nursing/midwifery work index (B=0.07, 95% CI 0.04 to 0.11) and hospital's level of healthcare (B=4.5, 95% CI 2.13 to 6.9) were statistically significantly associated factors of research utilisation.

CONCLUSIONS

This study revealed poor research utilisation among nurses and midwives. Barriers to research utilisation, supporting factors for research utilisation, attitude, self-efficacy in research utilisation skills, hospital's level of healthcare and nursing/midwifery work index were found to be statistically significant predictors of research utilisation. The most common barriers to research utilisation were insufficient time and inability to understand statistical terms used in research articles.

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

BACKGROUND

The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework.

METHODS

This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail.

RESULTS

The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated.

CONCLUSIONS

In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.

Influence of Student Feedback on the Quality of Teaching among Clinical Teachers in Bahrain

BACKGROUND

The effect of student feedback on teaching quality has been well-documented. However, only a few studies have examined the impact of feedback on clinical teachers delivering cross-border medical education in this geographical region. The aim of this study is to investigate (i) the quality of teaching among clinical teachers in a cross-border medical education setup, (ii) the impact of student feedback on teaching effectiveness, (iii) the differences in ratings among different groups of students, and (iv) factors that improve clinical teaching.

METHODS

Fifty-seven clinical teachers and 140 students participated in this study. Teachers received feedback on their performance and were allowed to reflect on them. Six months later, the teachers received feedback again. Additionally, semi-structured individual interviews were conducted with 5 selected clinical teachers working in 2 different hospitals to explore the factors that influenced clinical teaching.

RESULT

Overall, nearly half of the clinical teachers (n = 25) showed a trend of greater scores in the second assessment, while most of the remaining teachers (n = 24) continued to have more or less the same score or marginal fall in the second assessment. Even though few clinical teachers demonstrated significantly lesser scores, careful observation of data showed that the mean value of the second score either remained above (n = 5) or closer (n = 2) to the cut-off value of 3.74, except one teacher who recorded the least mean score of 3.17 in the second assessment. In qualitative analysis, teachers emphasised that the student feedback allowed them to develop more effective teaching approaches and strategies.

CONCLUSION

The pattern of results suggests that the effect of student feedback on teaching quality can have multiple outcomes, mostly positive or neutral, and very rarely negative. This study also advocates that feedback can be more beneficial if strengthened by other interventions like faculty training.

Implementation of Pre-/Post-Weights to Enhance Direct Breastfeeding in the NICU

Introduction

Mother's own milk (MOM) is recommended as the optimal nutrition for preterm infants. Direct breastfeeding (DBF) is correlated with a longer duration of receiving MOM during hospitalization. Infants' transition to DBF may be enhanced when accurate pre-/post-weights are incorporated into nursing practice. An evidence-based practice change was introduced to promote use and increase consistency in methodology of pre-/post-weights after DBF in the neonatal intensive care unit (NICU), with the ultimate goal of increasing DBF at hospital discharge.

Methods

The practice change was introduced through an educational program, a video demonstrating pre-/post-DBF weighing techniques, and a return-demonstration. A 10-item pre-/posttest was used to evaluate nurses' knowledge gained by an educational intervention that included seven knowledge questions, three attitude questions, and three demographic descriptors.

Results

Nurses' knowledge gained following the educational intervention was statistically significant (p < .001) using a paired t-test.

Conclusions

The use of pre-/post-DBF weights as an accurate assessment of MOM transfer can promote DBF during hospitalization through education of NICU nurses. Understanding nursing characteristics and attitudes can aid in promotion of DBF in the NICU by bedside nurses.

Implementation of an Evidence-Based Practice Nursing Handover Tool in Intensive Care Using the Knowledge-to-Action Framework

BACKGROUND

Miscommunication during handover has been linked to adverse patient events and is an international patient safety priority. Despite the development of handover resources, standardized handover tools for nursing team leaders (TLs) in intensive care are limited.

AIMS

The study aim was to implement and evaluate an evidence-based electronic minimum data set for nursing TL shift-to-shift handover in the intensive care unit using the knowledge-to-action (KTA) framework.

METHODS

This study was conducted in a 21-bed medical-surgical intensive care unit in Queensland, Australia. Senior registered nurses involved in TL handover were recruited. Three phases of the KTA framework (select, tailor, and implement interventions; monitor knowledge use; and evaluate outcomes) guided the implementation and evaluation process. A postimplementation practice audit and survey were carried out to determine nursing TL use and perceptions of the electronic minimum data set 3 months after implementation. Results are presented using descriptive statistics (median, IQR, frequency, and percentage).

RESULTS

Overall (86%, n = 49), TLs' use of the electronic minimum data set for handover and communication regarding patient plan increased. Key content items, however, were absent from handovers and additional documentation was required alongside the minimum data set to conduct handover. Of the TLs surveyed (n = 35), those receiving handover perceived the electronic minimum data set more positively than TLs giving handover (n = 35). Benefits to using the electronic minimum data set included the patient content (48%), suitability for short-stay patients (16%), decreased time updating (12%), and printing the tool (12%). Almost half of the participants, however, found the minimum data set contained irrelevant information, reported difficulties navigating and locating relevant information, and pertinent information was missing. Suggestions for improvement focused on modifications to the electronic handover interface.

LINKING EVIDENCE TO ACTION

Prior to developing and implementing electronic handover tools, adequate infrastructure is required to support knowledge translation and ensure clinician and organizational needs are met.

Fostering Transformation by Hearing Voices: Evaluating a 6-Second, Low-Fidelity Simulation

BACKGROUND

The stigma of psychosis, with the accompanying symptoms of auditory and visual hallucinations, can affect a nurse's ability to provide safe, effective care. Increasing knowledge of the patient's perspective during auditory hallucinations can increase the nurse's ability to be empathetic and engage in a therapeutic alliance.

OBJECTIVE

To evaluate the efficacy of a six-second auditory hallucination simulation to increase empathy in preclinical undergraduate nursing students.

DESIGN

This descriptive, content analysis, qualitative study evaluated narratives written by students in a pre-licensure baccalaureate nursing student population, assessing empathy, insight, knowledge, and therapeutic communication. Students experienced the 6-second auditory hallucination simulation as part of preclinical instruction, and then they wrote a self-reflection.

RESULTS

More than 200 self-reflections were collected, with a randomized final sample of 82 narratives evaluated.

CONCLUSION

Self-reflections indicated that the experience of the 6-second hearing voices simulation increased efficacy, insight, knowledge, and intention to use therapeutic communication.

The Hope Research Community of Practice

Background

Clinical nurses have multiple challenges in conducting high-quality nursing research to inform practice. Theoretically, the development of a community of practice on nursing research centered on the concept of hope is an approach that may address some of the challenges.

Purpose

This article describes the delivery and evaluation of a hope research community of practice (HRCoP) approach to facilitate research expertise in a group of advanced practice nurses in one hospital. It addressed the question: Does the establishment of a HRCoP for master’s prepared nurses increase their confidence and competence in leading nursing research?

Method

Using interpretive descriptive qualitative research methodology, five participants were interviewed about their experiences within the HRCoP and facilitators engaged in participant observation.

Results

At 13 months, only four of the original seven participants remained in the HRCoP. While all participants discussed positive impacts of participation, they identified challenges of having protected time to complete their individual research projects, despite having administrative support to do so. Progress on individual research projects varied.

Conclusion

Nurse-led research remains a challenge for practicing nurses despite participating in an evidence-based HRCoP. Lessons learned from this project can be useful to other academic clinical partnerships.

Translating research findings to clinical nursing practice

AIMS AND OBJECTIVES

To describe the importance of, and methods for, successfully conducting and translating research into clinical practice.

BACKGROUND

There is universal acknowledgement that the clinical care provided to individuals should be informed on the best available evidence. Knowledge and evidence derived from robust scholarly methods should drive our clinical practice, decisions and change to improve the way we deliver care. Translating research evidence to clinical practice is essential to safe, transparent, effective and efficient healthcare provision and meeting the expectations of patients, families and society. Despite its importance, translating research into clinical practice is challenging. There are more nurses in the frontline of health care than any other healthcare profession. As such, nurse-led research is increasingly recognised as a critical pathway to practical and effective ways of improving patient outcomes. However, there are well-established barriers to the conduct and translation of research evidence into practice.

DESIGN

This clinical practice discussion paper interprets the knowledge translation literature for clinicians interested in translating research into practice.

METHODS

This paper is informed by the scientific literature around knowledge translation, implementation science and clinician behaviour change, and presented from the nurse clinician perspective. We provide practical, evidence-informed suggestions to overcome the barriers and facilitate enablers of knowledge translation. Examples of nurse-led research incorporating the principles of knowledge translation in their study design that have resulted in improvements in patient outcomes are presented in conjunction with supporting evidence.

CONCLUSIONS

Translation should be considered in research design, including the end users and an evaluation of the research implementation. The success of research implementation in health care is dependent on clinician/consumer behaviour change and it is critical that implementation strategy includes this.

RELEVANCE TO PRACTICE

Translating best research evidence can make for a more transparent and sustainable healthcare service, to which nurses are central.

A structured framework improves clinical patient assessment and nontechnical skills of early career emergency nurses: a pre-post study using full immersion simulation

AIMS AND OBJECTIVES

The aim of this study was to evaluate the effect of the new evidence-informed nursing assessment framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, reassessment and communication) on the quality of patient assessment and fundamental nontechnical skills including communication, decision making, task management and situational awareness.

BACKGROUND

Assessment is a core component of nursing practice and underpins clinical decisions and the safe delivery of patient care. Yet there is no universal or validated system used to teach emergency nurses how to comprehensively assess and care for patients.

DESIGN

A pre-post design was used.

METHODS

The performance of thirty eight emergency nurses from five Australian hospitals was evaluated before and after undertaking education in the application of the HIRAID assessment framework. Video recordings of participant performance in immersive simulations of common presentations to the emergency department were evaluated, as well as participant documentation during the simulations. Paired parametric and nonparametric tests were used to compare changes from pre to postintervention.

RESULTS

From pre to postintervention, participant performance increases were observed in the percentage of patient history elements collected, critical indicators of urgency collected and reported to medical officers, and patient reassessments performed. Participants also demonstrated improvement in each of the four nontechnical skills categories: communication, decision making, task management and situational awareness.

CONCLUSION

The HIRAID assessment framework improves clinical patient assessments performed by emergency nurses and has the potential to enhance patient care.

RELEVANCE TO CLINICAL PRACTICE

HIRAID should be considered for integration into clinical practice to provide nurses with a systematic approach to patient assessment and potentially improve the delivery of safe patient care.

Knowledge 'Translation' as social learning: negotiating the uptake of research-based knowledge in practice

BACKGROUND

Knowledge translation and evidence-based practice have relied on research derived from clinical trials, which are considered to be methodologically rigorous. The result is practice recommendations based on a narrow view of evidence. We discuss how, within a practice environment, in fact individuals adopt and apply new evidence derived from multiple sources through ongoing, iterative learning cycles.

DISCUSSION

The discussion is presented in four sections. After elaborating on the multiple forms of evidence used in practice, in section 2 we argue that the practitioner derives contextualized knowledge through reflective practice. Then, in section 3, the focus shifts from the individual to the team with consideration of social learning and theories of practice. In section 4 we discuss the implications of integrative and negotiated knowledge exchange and generation within the practice environment. Namely, how can we promote the use of research within a team-based, contextualized knowledge environment? We suggest support for: 1) collaborative learning environments for active learning and reflection, 2) engaged scholarship approaches so that practice can inform research in a collaborative manner and 3) leveraging authoritative opinion leaders for their clinical expertise during the shared negotiation of knowledge and research. Our approach also points to implications for studying evidence-informed practice: the identification of practice change (as an outcome) ought to be supplemented with understandings of how and when social negotiation processes occur to achieve integrated knowledge. This article discusses practice knowledge as dependent on the practice context and on social learning processes, and suggests how research knowledge uptake might be supported from this vantage point.

Effectiveness of multifaceted and tailored strategies to implement a fall-prevention guideline into acute care nursing practice: a before-and-after, mixed-method study using a participatory action research approach

Background

Research- and/or evidence-based knowledge are not routinely adopted in healthcare and nursing practice. It is also unclear which implementation strategies are effective in nursing practice and what expenditures of time and money are required for the successful implementation of clinical practice guidelines (CPGs). The aim in this study was to assess the effectiveness and required time investment of multifaceted and tailored strategies for implementing an evidence-based fall-prevention guideline (Falls CPG) into nursing practice in an acute care hospital setting.

Methods

A before-and-after, mixed-method design was used within a participatory action research approach (PAR). The study was carried out in two departments of an Austrian university teaching hospital and included all graduate and assistant nurses. Data were collected through a questionnaire, group discussions and semi-structured interviews. Qualitative data were content-analysed using a template based on the Consolidated Framework for Implementation Research (CFIR), which also served as a theoretical framework for the study. Quantitative data were descriptively analysed using appropriate tests for independent groups.

Results

By applying multifaceted and tailored implementation strategies, the graduate and assistant nurses’ knowledge on fall prevention, how to access the Falls CPG and the guideline itself increased significantly between baseline and final assessment (p ≤ .001). Qualitative data also revealed an increase in participant awareness of fall prevention. A baseline positive attitude towards guidelines improved significantly towards the end of the project (p = .001). Required fall prevention equipment like baby monitors or one-way glide sheets were available for use and any required environmental adaptations, e.g. a handrail in the corridor, were made. Hospital nursing personnel (approximately 150) invested a total of 1192 hours of working time over the course of the project.

Conclusions

Multifaceted strategies tailored to the specific setting within a PAR approach and guided by the CFIR enabled the effective implementation of a CPG into acute care nursing practice. Nursing managers now have sound knowledge of the time resources required for CPG implementation.

Electronic supplementary material

The online version of this article (doi:10.1186/s12912-015-0064-z) contains supplementary material, which is available to authorized users.

The feasibility of ethnodrama as intervention to highlight late-life potential for nursing students and older adults

One barrier to the expansion of geriatric health care providers is the limited desire of nursing students to work with older adults. The purpose of this study is to evaluate the feasibility of using ethnodrama as an intervention to highlight late-life potential. Twelve baccalaureate nursing students were paired with 12 residents of an assisted living facility to complete transformative learning activities focused on the topic of late-life potential culminating in a performance of an ethnodrama developed from these data. Transcripts of initial student meetings, self-reflections, the performance, postperformance discussion, and open-ended survey questions were analyzed using in vivo and pattern coding. Older adult participants recognized and emphasized positive late-life potential, whereas students explored potential throughout the life span and reflected on its meaning in their own lives. Increasing discussion about late-life potential may alter the stigma associated with aging.

Clinical nurses' attitudes towards research, management and organisational resources in a university hospital: part 1

AIM

The aim of this study was to determine clinical nurses' interest in and motivation for research. An additional aim was to identify management and organisational resources in order to improve nurses' research capacity in practice.

BACKGROUND

Clinical nurses find conducting research challenging, which accords with observations of the continuing research-practice gap.

METHODS

This descriptive cross-sectional survey sampled 364 clinical nurses from a university hospital on the west coast of Norway.

RESULTS

The response rate was 61%. An increasingly positive attitude towards research emerged (40%), despite the fact that few were engaged in research-based activities. Clinical nurses emphasised that lack of designated time (60%), interest (31%) and knowledge (31%) constituted important research barriers, as did lack of research supervision and support (25%). Research supervision was one of the most significant needs to enhance clinical nurses' research skills, management and organisation of research activities (30%).

CONCLUSION

Conscious efforts strategically built on clinical and academic collaborative networks are required to promote and sustain clinical nurses' research capacity.

IMPLICATION FOR NURSING MANAGEMENT

The findings of this survey should be useful in the building of clinical nurses' research capacity.

Leading on the frontlines with passion and persistence: a necessary condition for Breastfeeding Best Practice Guideline uptake

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.

The PBRN initiative: transforming new technologies to improve patient care

The NIDCR-supported Practice-based Research Network initiative presents dentistry with an unprecedented opportunity by providing a pathway for modifying and advancing the profession. It encourages practitioner participation in the transfer of science into practice for the improvement of patient care. PBRNs vary in infrastructure and design, and sustaining themselves in the long term may involve clinical trial validation by regulatory agencies. This paper discusses the PBRN concept in general and uses the New York University College of Dentistry's Practitioners Engaged in Applied Research and Learning (PEARL) Network as a model to improve patient outcomes. The PEARL Network is structured to ensure generalizability of results, data integrity, and to provide an infrastructure in which scientists can address clinical practitioner research interests. PEARL evaluates new technologies, conducts comparative effectiveness research, participates in multidisciplinary clinical studies, helps evaluate alternative models of healthcare, educates and trains future clinical faculty for academic positions, expands continuing education to include "benchmarking" as a form of continuous feedback to practitioners, adds value to dental schools' educational programs, and collaborates with the oral health care and pharmaceutical industries and medical PBRNs to advance the dental profession and further the integration of dental research and practice into contemporary healthcare (NCT00867997, NCT01268605).

Information retrieval - Swedish specialist student nurses` strategies for finding clinical evidence

The care that intra-operative nurses perform has to be based on scientific knowledge. It is therefore vitally important that they have access to different databases and the Internet, as well as knowledge of the search procedure to find evidence for best practice. This means that specialist nurses should be proficient in the search procedure, interpretation of data, and implementation of available knowledge.The aim of this study was therefore to highlight the search strategies of specialist student nurses for finding scientific knowledge with regard to specific clinical issues. An additional aim was to assess their ability to critically evaluate scientific articles.

METHODS

The participants, n 16, all students enrolled in a university programme for specialist nursing in anaesthesia care, were required to find support for six questions, by using scientific knowledge databases. The tasks that required support are related to their future profession and were divided into three main areas: pre-, intra-, and post-operative care. Two distinct questions for each main area had to be answered. The data was analysed quantitatively using manifest content analysis as a basis.

RESULT

This study reveals that the student nurses mostly used the CINAHL and PubMed databases to search for answers related to the areas in focus. The keywords the participants used differed between the individuals and were applied more frequently than MESH terms. In addition, the critical evaluation of articles of scientific value that were found was not optimal. The study demonstrated that most of the participants were unable to complete all the required tasks. With regard to the initial questions, all 16 participants provided answers, while only eight student nurses completed the final questions.

CONCLUSIONS

The specialist student nurses in this study used the databases Chinal and PubMed to find scientific knowledge with the help of MESH-terms and keywords. Further research is needed to understand how education of the specialist student nurses should be carried out, in order to optimise their search strategies and critical evaluation of scientific articles.

High-fidelity simulation and legal/ethical concepts

Students in an undergraduate legal and ethical issues course continually told the authors that they did not have time to study for the course because they were busy studying for their clinical courses. Faculty became concerned that students were failing to realize the value of legal and ethical concepts as applicable to clinical practice. This led the authors to implement a transformational learning experience in which students applied legal and ethical course content in a high-fidelity human simulation (HFHS) scenario. A preliminary evaluation compared the new HFHS experience with in-person and online student groups using the same case. Based on both student and faculty perceptions, the HFHS was identified as the best of the three approaches for providing a transformational learning experience regarding legal and ethical content.