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Bu F, Cheng HT, Wang ZL, Hou YS, Zhuang Z, Li CY, Wang YQ, Zhang Y, Lyu J, Lyu QY. Effect of a fall within three months of admission on delirium in critically Ill elderly patients: a population-based cohort study. Aging Clin Exp Res 2024; 36:111. [PMID: 38743351 PMCID: PMC11093843 DOI: 10.1007/s40520-024-02740-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/18/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Delirium is common among elderly patients in the intensive care unit (ICU) and is associated with prolonged hospitalization, increased healthcare costs, and increased risk of death. Understanding the potential risk factors and early prevention of delirium is critical to facilitate timely intervention that may reverse or mitigate the harmful consequences of delirium. AIM To clarify the effects of pre-admission falls on ICU outcomes, primarily delirium, and secondarily pressure injuries and urinary tract infections. METHODS The study relied on data sourced from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Statistical tests (Wilcoxon rank-sum or chi-squared) compared cohort characteristics. Logistic regression was employed to investigate the association between a history of falls and delirium, as well as secondary outcomes, while Kaplan-Meier survival curves were used to assess short-term survival in delirium and non-delirium patients. RESULTS Study encompassed 22,547 participants. Delirium incidence was 40%, significantly higher in patients with a history of falls (54.4% vs. 34.5%, p < 0.001). Logistic regression, controlling for confounders, not only confirmed that a history of falls elevates the odds of delirium (OR: 2.11; 95% CI: 1.97-2.26; p < 0.001) but also showed it increases the incidence of urinary tract infections (OR:1.50; 95% CI:1.40-1.62; p < 0.001) and pressure injuries (OR:1.36; 95% CI:1.26-1.47; p < 0.001). Elderly delirium patients exhibited lower 30-, 180-, and 360-day survival rates than non-delirium counterparts (all p < 0.001). CONCLUSIONS The study reveals that history of falls significantly heighten the risk of delirium and other adverse outcomes in elderly ICU patients, leading to decreased short-term survival rates. This emphasizes the critical need for early interventions and could inform future strategies to manage and prevent these conditions in ICU settings.
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Affiliation(s)
- Fan Bu
- School of Nursing, Jinan University, Room 1015, Guangzhou, China
| | - Hong-Tao Cheng
- School of Nursing, Jinan University, Room 1015, Guangzhou, China
| | - Zi-Lin Wang
- School of Nursing, Jinan University, Room 1015, Guangzhou, China
| | - Yu-Shan Hou
- Department of Geriatric Psychology, Shandong Daizhuang Hospital, Jining, China
| | - Zhuang Zhuang
- School of Nursing, Jinan University, Room 1015, Guangzhou, China
| | - Can-Yang Li
- School of Nursing, Jinan University, Room 1015, Guangzhou, China
| | - Ya-Qi Wang
- School of Nursing, Jinan University, Room 1015, Guangzhou, China
| | - Yue Zhang
- School of Nursing, Jinan University, Room 1015, Guangzhou, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, China.
| | - Qi-Yuan Lyu
- School of Nursing, Jinan University, Room 1015, Guangzhou, China.
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Meteku BT, Quigley M, Turner T, Green SE. Barriers to and facilitators of living guidelines use in low-income and middle-income countries: a scoping review. BMJ Open 2024; 14:e074311. [PMID: 38233061 PMCID: PMC10806715 DOI: 10.1136/bmjopen-2023-074311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 11/22/2023] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION Living guidelines provide reliable, ongoing evidence surveillance and regularly updated recommendations for healthcare decision-making. As a relatively new concept, most of the initial application of living approaches has been undertaken in high-income countries. However, in this scoping review, we looked at what is currently known about how living guidelines were developed, used and applied in low-income and middle-income countries. METHODS Searches for published literature were conducted in Medline, Global Health, Cochrane Library and Embase. Grey literature was identified using Google Scholar and the WHO website. In addition, the reference lists of included studies were checked for missing studies. Studies were included if they described or reflected on the development, application or utility of living guideline approaches for low-income and middle-income countries. RESULTS After a full-text review, 21 studies were included in the review, reporting on the development and application of living recommendations in low-income and middle-income countries. Most studies reported living guideline activities conducted by the WHO (15, 71.4%), followed by China (4, 19%), Chile (1, 4.8%) and Lebanon (1, 4.8%). All studies based on WHO reports relate to living COVID-19 management guidelines. CONCLUSIONS Most of the studies in this review were WHO-reported studies focusing solely on COVID-19 disease treatment living guidelines. However, there was no clear explanation of how living guidelines were used nor information on the prospects for and obstacles to the implementation of living guidelines in low-income and middle-income countries.
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Affiliation(s)
- Bekele Tesfaye Meteku
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Amhara, Ethiopia
| | - Matthew Quigley
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tari Turner
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Cochrane Australia, Melbourne, Victoria, Australia
| | - Sally E Green
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Cochrane Australia, Melbourne, Victoria, Australia
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Nadalin Penno L, Graham ID, Backman C, Davies B, Squires J. The SITS framework: sustaining innovations in tertiary settings. FRONTIERS IN HEALTH SERVICES 2023; 3:1102428. [PMID: 37363733 PMCID: PMC10287174 DOI: 10.3389/frhs.2023.1102428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/08/2023] [Indexed: 06/28/2023]
Abstract
Background To date, little attention has focused on what the determinants are and how evidence-based practices (EBPs) are sustained in tertiary settings (i.e., acute care hospitals). Current literature reveals several frameworks designed for implementation of EBPs (0-2 years), yet fewer exist for the sustainment of EBPs (>2 years) in clinical practice. Frameworks containing both phases generally list few determinants for the sustained use phase, but rather state ongoing monitoring or evaluation is necessary. Notably, a recent review identified six constructs and related strategies that facilitate sustainment, however, the pairing of determinants and how best to sustain EBPs in tertiary settings over time remains unclear. The aim of this paper is to present an evidence-informed framework, which incorporates constructs, determinants, and knowledge translation interventions (KTIs) to guide implementation practitioners and researchers in the ongoing use of EBPs over time. Methods We combined the results of a systematic review and theory analysis of known sustainability frameworks/models/theories (F/M/Ts) with those from a case study using mixed methods that examined the ongoing use of an organization-wide pain EBP in a tertiary care center (hospital) in Canada. Data sources included peer-reviewed sustainability frameworks (n = 8) related to acute care, semi-structured interviews with nurses at the department (n = 3) and unit (n = 16) level, chart audits (n = 200), and document review (n = 29). We then compared unique framework components to the evolving literature and present main observations. Results We present the Sustaining Innovations in Tertiary Settings (SITS) framework which consists of 7 unique constructs, 49 determinants, and 29 related KTIs that influence the sustainability of EBPs in tertiary settings. Three determinants and 8 KTIs had a continuous influence during implementation and sustained use phases. Attention to the level of application and changing conditions over time affecting determinants is required for sustainment. Use of a participatory approach to engage users in designing remedial plans and linking KTIs to target behaviors that incrementally address low adherence rates promotes sustainability. Conclusions The SITS framework provides a novel resource to support future practice and research aimed at sustaining EBPs in tertiary settings and improving patient outcomes. Findings confirm the concept of sustainability is a "dynamic ongoing phase".
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Affiliation(s)
- Letitia Nadalin Penno
- Faculty of Environment and Health Sciences, Canadore College, North Bay, ON, Canada
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Centre for Implementation Research, Ottawa Health Research Institute, Ottawa, ON, Canada
| | - Chantal Backman
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Barbara Davies
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Janet Squires
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Centre for Implementation Research, Ottawa Health Research Institute, Ottawa, ON, Canada
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Nadalin Penno L, Graham ID, Backman C, Fuentes-Plough J, Davies B, Squires J. Sustaining a nursing best practice guideline in an acute care setting over 10 years: A mixed methods case study. FRONTIERS IN HEALTH SERVICES 2022; 2:940936. [PMID: 36925887 PMCID: PMC10012662 DOI: 10.3389/frhs.2022.940936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022]
Abstract
Background To improve patient outcomes many healthcare organizations have undertaken a number of steps to enhance the quality of care, including the use of evidence-based practices (EBPs) such as clinical practice guidelines. However, there is little empirical understanding of the longer-term use of guideline-based practices and how to ensure their ongoing use. The aim of this study was to identify the determinants and knowledge translation interventions (KTIs) influencing ongoing use of selected recommendations of an institutional pain policy and protocol over time from an organizational perspective and 10 years post implementation on two units within an acute care setting. Methods We conducted a mixed methods case study guided by the Dynamic Sustainability Framework of an EBP 10 years post implementation. We examined protocol sustainability at the nursing department and unit levels of a multi-site tertiary center in Canada. Data sources included document review (n = 29), chart audits (n = 200), and semi-structured interviews with nurses at the department (n = 3) and unit (n = 16) level. Results We identified 32 sustainability determinants and 29 KTIs influencing ongoing use of an EBP in acute care. Three determinants and eight KTIs had a continuous influence in all three time periods: implementation phase (0-2 yrs), sustained phase (>2-10 yrs.), and at the 10-year mark. Implementation of KTIs evolved with the level of application (e.g., department vs. unit) to fit the EBP within the context highlighting the need to focus on determinants influencing ongoing use. Sustainability was associated with continual efforts of monitoring and providing timely feedback regarding adherence to recommendations. KTIs used to embed recommendations into routine practices/processes positively influenced high adherence rates. Use of a participatory approach for implementation and sustainment and linking KTIs designed to incrementally address low adherence rates facilitated sustainment. Conclusion This research provides insight into the relationship between implementation and sustainability determinants and related KTIs during implementation and sustained use phases. Unique determinants identified by department and unit nurses reflect their different perspectives toward the innovation based on their respective roles and responsibilities. KTIs fostered changed behaviors and facilitated EBP sustainment in acute care. Findings confirm the concept of sustainability is a dynamic "ongoing process."
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Affiliation(s)
- Letitia Nadalin Penno
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Ian D Graham
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Chantal Backman
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Jessica Fuentes-Plough
- Business School and Leadership School, Anahuac-Mayab University, Mérida, Yucatan, Mexico
| | - Barbara Davies
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Janet Squires
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Cleary-Holdforth J, O'Mathúna D, Fineout-Overholt E. Evidence-Based Practice Beliefs, Implementation, and Organizational Culture and Readiness for EBP Among Nurses, Midwives, Educators, and Students in the Republic of Ireland. Worldviews Evid Based Nurs 2021; 18:379-388. [PMID: 34750977 DOI: 10.1111/wvn.12543] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evidence-based practice (EBP) is an approach to health care that combines best available evidence, healthcare professionals' expertise, and patient preferences, yielding benefits for patients, healthcare professionals, and organizations. However, globally, EBP implementation remains inconsistent among nurses. Exploring this in an Irish context will establish a national baseline from which progress can be made on system-wide integration of EBP in nurse and midwife (i.e., clinician) practice, nursing/midwifery education, and the Irish healthcare system. AIM To establish clinician, educator, and student's EBP beliefs, knowledge, and implementation, and the organizational culture of the clinical and educational settings within the Republic of Ireland. METHODS Using a descriptive study design, a national survey with demographic questions, uniquely focused EBP scales, and an open-ended question were administered to clinicians, nursing/midwifery educators, and students. Ethical review was obtained. Descriptive and inferential statistics were used to analyze the quantitative data. RESULTS Clinicians, educators, and students reported positive beliefs about EBP (M = 59.98, SD 8.68; M = 87.72, SD = 10.91; M = 55.18, SD = 10.29, respectively). Beliefs regarding their ability to implement EBP were lower overall. EBP implementation was low across all groups (clinicians: M = 12.85, SD = 14; educators: M = 31.09, SD = 16.54; students: M = 16.59, SD = 12.11). Clinicians, educators, and students reported varying perceptions of organizational support and readiness for EBP (M = 74.07, SD = 19.65; M = 86.43, SD = 15.01; M = 93.21, SD = 16.21, respectively). Across all measures, higher scores indicated higher beliefs, implementation, and organizational culture and readiness for EBP. LINKING EVIDENCE TO ACTION Clinicians have a unique opportunity to facilitate system-wide integration of EBP. Furthermore, given the variable EBP knowledge, beliefs, and implementation, opportunities to enhance these attributes abound, particularly when supported by their organizations. This study established a contemporary baseline in Ireland from which to engage the identified strengths, challenges, and opportunities required to craft an organizational culture and environment that supports and advances an EBP approach to nursing and midwifery practice and education.
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Affiliation(s)
- Joanne Cleary-Holdforth
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin 9, Ireland
| | - Dónal O'Mathúna
- College of Nursing, Ohio State University, Columbus, Ohio, USA
| | - Ellen Fineout-Overholt
- Gallup Certified Strengths Coach, College of Nursing & Health Sciences, University of Texas at Tyler, Tyler, Texas, USA
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Dagne AH, Beshah MH. Implementation of evidence-based practice: The experience of nurses and midwives. PLoS One 2021; 16:e0256600. [PMID: 34449782 PMCID: PMC8396772 DOI: 10.1371/journal.pone.0256600] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 08/10/2021] [Indexed: 11/18/2022] Open
Abstract
Background Implementation of evidence-based practice in clinical practice is crucial. Nurses and midwives play a vital role in using updated evidence. However, limited support and barriers to implementing evidence-based practice hamper the use of up-to-date evidence in clinical decision-making practice. Therefore, this study aimed to explore the implementation of evidence-based practice of nurses and midwives working in public hospitals. Methods A qualitative descriptive study was conducted to explore the experience of implementing evidence-based practice among nurses and midwives working in public hospitals. A total of 86 participants, of which, 25 in-depth interviews, 5 FGDs having 47 participants and 14 participants were involved during observations, were considered in Amhara Region public hospitals from November 17, 2019 to April 25, 2020. The observational data, interview and FGD transcripts were imported into NVivo 12 plus to manage and analyze the data using the Computer-Assisted Data Analysis Software Program (CAQDAS). The data were analyzed through thematic content analysis. Results Nurses and midwives perceived that implementation of evidence-based practice is the use of research findings, guidelines, hospital protocols, books, and expert experience in clinical decision-making practice. However, there was limited support for the implementation of evidence-based practice by nurses and midwives. The lack of knowledge and skill to use evidence like research findings, time mismanagement, the lack of motivation, the lack of resources and training were the perceived barriers to the implementation of evidence-based practice. Stick to the traditional practice due to lack of incentive and unclear job description between diploma and BSc nurses and midwives were the perceived causes of the lack of motivation. Conclusions The experience of evidence-based practice of nurses and midwives indicated that there was limited support for the implementation of evidence-based practice. However, research findings were rarely used in clinical decision-making practice The Knowledge, attitude towards implementing evidence-based practice, lack of resources and training, time mismanagement and lack of motivation were the barriers to the implementation of evidence-based practice. Therefore, the promotion of adopting the implementation of evidence-based practice and training on the identified barriers are mandatory.
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Affiliation(s)
- Asrat Hailu Dagne
- Department of Midwifery, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
- * E-mail: ,
| | - Mekonnen Haile Beshah
- Department of Midwifery, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
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Córcoles-Jiménez MP, Ruiz-García MV, Herreros-Sáez ML, Ayuso-Sánchez MJ, Flores-Bautista AB, Serna-Roldán MJ. Effectiveness of a best practice guideline to manage pain in surgical patients. Appl Nurs Res 2021; 60:151436. [PMID: 34247784 DOI: 10.1016/j.apnr.2021.151436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/14/2021] [Accepted: 04/22/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The prevention and control of acute postoperative pain is essential, not only to avoid unnecessary suffering, but to reduce postoperative morbidity, recovery time, hospital stay and associated costs. AIM To evaluate the effectiveness of implementing the Clinical Best Practice Guideline (BPG) "Assessment and Management of Pain" recommendations for pain control in surgical patients. METHODS Prospective, observational, longitudinal study. SUBJECTS Surgical patients over 14 admitted to the University Hospital Complex of Albacete, and discharged during the last working days of every month. VARIABLES 1) demographic data, hospital stay. 2) The process indicators of BPG implementation. 3) Patient outcomes: prevalence and intensity of pain in the first 24 postsurgical hours, maximum intensity of pain during hospitalization. TOOLS Scales of assessment of pain intensity (0-10). DATA COLLECTION Database of BPSO/CCEC® Program. ETHICAL ASPECTS Anonymous data. DATA ANALYSIS (SPSS® V12): Descriptive during four periods: baseline (T0: December 2012); initial (T1: June-December 2013); intermediate (T2: 2014-2015); consolidation (T3: 2016-2017). Measurements of central tendency and dispersion, absolute and relative frequencies, according to variables. Comparison of proportions (Chi-Square) and averages (Student t-test, ANOVA). STATISTICAL SIGNIFICANCE: p < 0.05. RESULTS Included 3934 patients, 52.3% (2058) men. Daily intervention of pain detection was performed in 73.5% (2890) of patients (28% T0; 67.4% T1; 66.7% T2; 89.9% T3; p < 0.0001), assessment of pain with a scale in 65.2% (2567) (0% T0; 48.8% T1; 59.4% T2; 85.6% T3; p < 0.0001); 35.3% (1389) had a care plan for assessment and management of pain (0% T0; 34.6% T1; 32.3% T2; 42.3% T3; p < 0.0001). The percentage of patients who had serious pain (>5) during the first 24 h was reduced from 12.4% (T1) to 5.3% (T3) (p < 0.0001). CONCLUSION Implementation of recommendations has led to a statistically significant improvement over the periods in the study. Pain intensity and the percentage of patients with severe pain have decreased in a significant way.
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Dagne AH, Tebeje H/MD. Research utilisation in clinical practice: the experience of nurses and midwives working in public hospitals. Reprod Health 2021; 18:62. [PMID: 33722262 PMCID: PMC7962333 DOI: 10.1186/s12978-021-01095-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/31/2021] [Indexed: 11/21/2022] Open
Abstract
Background Nurses and midwives play a vital role to utilise research in clinical decision-making practice. However, limited support for research utilisation and barriers of research utilisation hamper to utilise up-to-date research findings in clinical practice. Therefore, this study aimed to explore nurses’ and midwives’ experience of research utilisation in public hospitals. Methods A qualitative descriptive approach was conducted to explore nurses’ and midwives’ experience of research utilisation in clinical practice within South Gondar Zone public hospitals from January 3 to June 28, 2020. A total of 20 interviewees, 40 participants of FGDs, and 8 observations were considered in the study. Data from the interview, FGD, and observation were imported into NVivo 12 plus to manage and analyze the data using the Computer-Assisted Data Analysis Software Program (CAQDAS). The data were analyzed through thematic content analysis. Results Nurses’ and midwives’ experience of using research findings in clinical decision-making emerged as “the non-intentional research utilisation” the main theme. Data analysis produced as “the belief towards research utilisation”, “the limited support for nurses and midwives”, and, “the perceived barriers of research utilisation” as the three themes. Participants believed that the non-use of the primary research was recommended due to fear of accountability for client harm. The limited support for nurses’ and midwives’ experience of research utilisation decrease nurses’ and midwives’ confidence to utilise research in clinical practice. Knowledge, attitude, time mismanagement, and the lack of motivation were perceived barriers to research utilisation. The lack of training and access to systematic review and meta-analysis research findings limited the research utilisation in clinical practice. Conclusions The experience of research utilisation indicated that there was limited support for nurses and midwives to utilise research. Nurses and midwives did not utilise research in their clinical practice intentionally. This study identified that knowledge, negative attitude towards research utilisation, lack of training; time mismanagement, and lack of motivation were the perceived barriers to research utilisation. Therefore, the promotion of adopting the research utilisation and training on the identified barriers are mandatory. Plain English summary Nurses and midwives play a vital role to utilise research in clinical decision-making practice. However, the limited support for research utilisation and barriers of research utilisation hamper the utilisation of up-to-date research in clinical practice. Therefore, this study aimed to explore nurses’ and midwives’ experience of using the knowledge obtained from research findings in clinical and healthcare decision-making practice within public hospitals. The experience of research utilisation among nurses and midwives working in public hospitals was studied. There was limited support for nurses’ and midwives’ experience of research utilisation. Nurses and midwives did not utilise research in their clinical practice intentionally. The knowledge, negative attitude towards research utilisation, lack of training, time mismanagement, and lack of motivation were the perceived barriers to research utilisation. Therefore, the promotion of adopting the research utilisation and training on the identified barriers are mandatory. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01095-x.
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Affiliation(s)
- Asrat Hailu Dagne
- Department of Midwifery, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia.
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Dagne AH, Beshah MH, Kassa BG, Dagnaw EH. Implementation of evidence-based practice and associated factors among nurses and midwives working in Amhara Region government hospitals: a cross-sectional study. Reprod Health 2021; 18:36. [PMID: 33579309 PMCID: PMC7881559 DOI: 10.1186/s12978-021-01096-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/31/2021] [Indexed: 11/10/2022] Open
Abstract
Background Implementation of evidence-based practice is crucial to enhance quality health care, professional development, and cost-effective health service. However, many factors influence the implementation of evidence-based practice. Therefore, this study aimed to assess the implementation of evidence-based practice and associated factors among nurses and midwives. Methods Institutional-based cross-sectional study design was conducted to assess the implementation of evidence-based practice and associated factors from February 15 to March 15, 2019, among 790 nurses and midwives. Data were entered into EpiData version 3.1 then exported to SPSS version 20 for statistical analysis. Categorical variables were presented as frequency tables. Continuous variables were presented as descriptive measures, expressed as mean and standard deviation. Cronbach’s alpha was used to measure reliability, mean, standard deviation, and inter-items correlation of the factors. Independent variables with a probability value (P-value) of less than 0.2 in the Chi-square analysis were entered in the multivariable logistic regression model. Statistically significant associated factors were identified at probability value (P-value) less than 0.05 and adjusted odds ratio with a 95% confidence interval. Results The mean age of participants was 28.35 (SD ± 4.5) years. This study revealed that 34.7% (95% CI 31.5–38%) of participants implemented evidence-based practice moderately or desirably. Age of participants (AOR = 5.98, CI 1.34–26.7), barriers of implementation of evidence-based practice (AOR = 4.8, CI 2.2–10.6), the attitude of participants (AOR = 5.02, CI 1.2–21.5), nursing/midwifery work index (AOR = 3.9, CI 1.4–10.87), self-efficacy of implementation of evidence-based practice skills (AOR = 12.5, CI 5.7–27.5) and knowledge of participants (AOR = 3.06, CI 1.6–5.77) were statistically significant associated factors of implementation of evidence-based practice Concussion Implementation of evidence-based practice of nurses and midwives was poor. Age of participants, barriers of implementation of evidence-based practice, the attitude of participants, self-efficacy of implementation of evidence-based practice skills, nursing/midwifery work index, and knowledge of participants were found to be predictors of implementation of evidence-based practice. Insufficient time and difficulty in judging the quality of research papers and reports were the most common barriers to the implementation of evidence-based practice.
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Affiliation(s)
- Asrat Hailu Dagne
- Department of Midwifery, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia.
| | - Mekonnen Haile Beshah
- Department of Midwifery, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
| | - Bekalu Getnet Kassa
- Department of Midwifery, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
| | - Eyaya Habtie Dagnaw
- Department of Midwifery, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
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Measurement and Validation of Primary Care Nursing Indicators Based on a Wound Care Tracer Condition. J Nurs Care Qual 2020; 35:63-69. [PMID: 30973427 DOI: 10.1097/ncq.0000000000000403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Access to both valid and reliable nursing-sensitive indicators is currently limited in primary care. PURPOSE The objectives were to (1) measure primary care nursing indicators using a wound care tracer condition and (2) study the associations between process and outcome indicators. METHODS We conducted a longitudinal study in an ambulatory care clinic in Quebec, Canada. The sample included 482 episodes of care. We studied 5 indicators related to processes and 3 to outcomes. RESULTS Performance levels were moderately high for indicators of initial assessment and duration and low for those of continuity and education. Associations between nursing follow-up and continuity indicators and 3 outcome indicators were highly significant. CONCLUSION Continuity and nursing follow-up are associated with improved outcomes. Increasing these indicators' performance level can improve both nursing processes and patient outcomes.
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Kim J, Lee JY, Lee E. Risk factors for newly acquired pressure ulcer and the impact of nurse staffing on pressure ulcer incidence. J Nurs Manag 2019; 30:O1-O9. [PMID: 31811735 PMCID: PMC9545092 DOI: 10.1111/jonm.12928] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 11/29/2019] [Accepted: 12/04/2019] [Indexed: 12/14/2022]
Abstract
Aim To analyse patient factors and nurse staffing‐related issues involving hospital‐acquired pressure ulcers in patients at two types of hospital. Background Hospital‐acquired pressure ulcers are important for the safety of hospitalized patients. Hospital‐acquired pressure ulcers not only cause health problems, but also pose an economic burden to patients. In addition to patient factors such as mobility and skin integrity, hospital factors such as nurse staffing can also affect the management of such patients. Methods This study is a retrospective review of patient data and analysis of factors related to hospital‐acquired pressure ulcers using stratified Cox proportional hazards regression. Results A total of 53,923 patients were included. The incidence of hospital‐acquired pressure ulcers was 0.98 per 1,000 days. Hospital‐acquired pressure ulcers were affected by gender, age, previous falls, low oxygen levels, positioning and toilet use. When the levels of nurse staffing were determined as one of the hospital factors, the daily hours of patient care was increased thereby contributing to the reduced incidents of hospital‐acquired pressure ulcers. Conclusion Strategies for preventing hospital‐acquired pressure ulcers should be based on the analysis of risk factors. Implications for Nursing Management Most individual risk factors for hospital‐acquired pressure ulcers identified cannot be modified easily in a short time. Nurse staffing should be set at adequate levels to prevent hospital‐acquired pressure ulcers.
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Affiliation(s)
- Jinhyun Kim
- College of Nursing, Seoul National University, Seoul, Korea
| | - Jai-Yon Lee
- College of Nursing, Seoul National University, Seoul, Korea
| | - Eunhee Lee
- School of Nursing/Research Institute of Nursing Science, Hallym University, Chuncheon, Korea
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Maessen K, van Vught A, Gerritsen DL, Lovink MH, Vermeulen H, Persoon A. Development and Validation of the Dutch EBPAS-ve and EBPQ-ve for Nursing Assistants and Nurses with a Vocational Education. Worldviews Evid Based Nurs 2019; 16:371-380. [PMID: 31489765 DOI: 10.1111/wvn.12389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND In recent years, there has been an increasing focus on the role of evidence-based practice (EBP) to increase the quality and safety of care. However, EBP implementation research has predominantly taken place in hospitals and hardly in nursing homes or home care. In these care settings, patients are attended by nursing assistants and registered vocationally trained nurses. A good EBP starting point is to assess their current attitude toward and use of EBP. However, current questionnaires are not valid for assistants and nurses with vocational education. AIMS To adapt the Evidence-Based Practice Attitude Scale (EBPAS) and the Evidence-Based Practice Questionnaire (EBPQ) to a Dutch questionnaire for nursing assistants and registered vocationally trained nurses European Qualification Framework level 3-4 employed in home care or nursing homes. METHODS Translation, adaptation through cross-cultural validation, pretesting, exploratory factor analysis, and evaluation of psychometric properties among a group of nursing assistants and registered vocationally trained nurses. RESULTS Cross-cultural validation led to modified items of EBPQ and EBPAS. The sample comprised 273 nurses. Analysis of both instruments showed a robust factor structure. EBPAS-ve: internal consistency: α = 0.76; intra-rater reliability: ICC = 0.52. EBPQ-ve: α = 0.75; ICC = 0.60. Convergent validity (correlation EBPAS-ve and EBPQ-ve's subscale Attitude): r = .300 (p < .01). Construct validity: significantly higher scores (p < .01) in the group with higher education. LINKING EVIDENCE TO ACTION Psychometric qualities of both instruments were satisfactory, although we recommend refinement of EBPAS-ve's subscale Divergence and extra instructions for the EBPQ's subscale Attitude. To our knowledge, this is the first adaptation of an EBP measurement instrument for nursing assistants and registered vocationally trained nurses. The questionnaires appeared to be feasible and showed multiple valid and reliable properties, including a satisfactory intra-rater reliability. Both questionnaires may facilitate the implementation of EBP as they contribute to a richer understanding of the attitude toward and use of EBP in nursing homes and home care.
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Affiliation(s)
- Kim Maessen
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Anneke van Vught
- Institute of Nursing, HAN University of Applied Science, Nijmegen, The Netherlands
| | - Debby L Gerritsen
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Marleen H Lovink
- Department of Primary Care and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Hester Vermeulen
- Department of IQ Healthcare, Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anke Persoon
- Department of Primary Care and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Lukewich JA, Tranmer JE, Kirkland MC, Walsh AJ. Exploring the utility of the Nursing Role Effectiveness Model in evaluating nursing contributions in primary health care: A scoping review. Nurs Open 2019; 6:685-697. [PMID: 31367390 PMCID: PMC6650680 DOI: 10.1002/nop2.281] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/21/2019] [Accepted: 03/12/2019] [Indexed: 02/02/2023] Open
Abstract
AIMS To inform a discussion for the applicability of using the Nursing Role Effectiveness Model (NREM) in the primary health care setting through a synthesis of the literature that has used the model in all health care sectors. DESIGN Scoping Review. METHODS Articles were considered for inclusion if they discussed any aspect of the NREM in health care research that presented information related to any nursing regulatory designation, such as nurse practitioner (NP), registered nurse (RN), licensed/registered practical nurse (LPN/RPN) and considered both quantitative and qualitative study designs, including expert opinions and reports. RESULTS A total of 22 articles that cited and/or used the NREM were identified in this review. Only two studies were focused in the primary health care setting. There is precedence for the use of the NREM to guide research in primary health care. The NREM should be modified to incorporate the unique characteristics of the primary health care setting.
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Affiliation(s)
- Julia A. Lukewich
- Faculty of NursingMemorial University of NewfoundlandSt. John'sNewfoundland and LabradorCanada
| | - Joan E. Tranmer
- School of Nursing and Department of Public Health Sciences, Faculty of Health SciencesQueen's UniversityKingstonOntarioCanada
| | - Megan C. Kirkland
- Faculty of MedicineMemorial University of NewfoundlandSt. John'sNewfoundland and LabradorCanada
| | - Anna J. Walsh
- Department of PsychologyMemorial University of NewfoundlandSt. John'sNewfoundland and LabradorCanada
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Dufour É, Duhoux A, Contandriopoulos D. Reliability of a Canadian database for primary care nursing services' clinical and administrative data. Int J Med Inform 2018; 117:1-5. [PMID: 30032957 DOI: 10.1016/j.ijmedinf.2018.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 05/04/2018] [Accepted: 05/20/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The use of electronic clinical and administrative data can be an advantageous source of information for assessing nursing performance in primary care. In Québec (Canada), the I-CLSC electronic database could be used to measure performance indicators. However, little is known about the reliability of the data contained in this database. The objective of this study was to assess the reliability of the clinical and administrative data contained in the I-CLSC electronic database based on the data entered in medical records. METHODS We used a longitudinal design for this study. A sample of 100 patients who had experienced 107 episodes of wound care were randomly selected from all patients who had two or more consultations during the year 2015. The paper records were used as reference. We collected data regarding eight nursing sensitive indicators from both sources. We assessed the concordance between the electronic data and the paper records by measuring inter-rater agreement. RESULTS Six of the eight indicators showed a percentage agreement ≥ 85%, and kappa scores between 0.7 and 1.00 (p < 0.001), indicating high to perfect levels of agreement between the two data sources. Two indicators presented fair kappa scores. CONCLUSION This database provides reliable data relating to the organization of care but shows lower reliability for specific acts performed by nurses in primary care. This existing database can be used to assess, manage and improve certain dimensions of nursing performance in primary care.
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Affiliation(s)
- Émilie Dufour
- Faculty of Nursing, Université de Montréal, Marguerite-d'Youville Campus, Montréal, QC, H3C 3J7, Canada.
| | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Marguerite-d'Youville Campus, Montréal, QC, H3C 3J7, Canada; CR-CSIS (Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé), Université de Sherbrooke, Longueuil Campus, Longueuil, QC, J4K 0A8, Canada
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Pressure ulcer incidence and Braden subscales: Retrospective cohort analysis in general wards of a Portuguese hospital. J Tissue Viability 2018; 27:95-100. [DOI: 10.1016/j.jtv.2018.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 01/12/2018] [Accepted: 01/15/2018] [Indexed: 11/19/2022]
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Lee E. Longitudinal Outcomes of Home Care in Korea to Manage Pressure Ulcers. Res Nurs Health 2017; 40:255-262. [PMID: 28470975 DOI: 10.1002/nur.21793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2017] [Indexed: 01/03/2023]
Abstract
Home care provides preventive, support, and treatment services to economically vulnerable community populations. In this study, we examined the outcomes of a home care program for pressure ulcers (PrUs) in an economically vulnerable group. The 184 participants were admitted with PrUs and received services from a home care agency in South Korea during a study window of 5 years. The changes in PrU staging over time were analyzed in relation to the agency's home care data and the participants' health data. At enrollment, approximately 60% had a single ulcer; 40% had two or more. Most patients' ulcers were at stages 3 or 4, and most patients were bedridden. The maximum odds of reduced ulcer size from one measurement point to the next was estimated at 14.3% for ulcers in stages 1 and 2, 33.4% of those in stage 3, and 25.5% of those in stage 4; more than 10% of ulcers healed completely within a year. PrUs were a serious problem in this community-dwelling economically vulnerable group, and home care played a critical role in providing health care to this population. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Eunhee Lee
- Division of Nursing/Research Institute of Nursing Science, Hallym University, 1 Hallymdaehak-gil, Chuncheon, Gangwon-do, 24252 Republic of Korea
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demirci şahin A. EVDE BAKIM HASTALARINDA BASI YARALARINA YAKLAŞIM: EN UYGUN YAKLAŞIM KORUYUCU HEKİMLİK. KONURALP TIP DERGISI 2017. [DOI: 10.18521/ktd.286610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Evidence-based practice (EBP) is an approach used in numerous professions that focuses attention on evidence quality in decision making and action. We review research on EBP implementation, identifying critical underlying psychological factors facilitating and impeding its use. In describing EBP and the forms of evidence it employs, we highlight the challenges individuals face in appraising evidence quality, particularly that of their personal experience. We next describe critical EBP competencies and the challenges underlying their acquisition: foundational competencies of critical thinking and domain knowledge, and functional competencies such as question formulation, evidence search and appraisal, and outcome evaluation. We then review research on EBP implementation across diverse fields from medicine to management and organize findings around three key contributors to EBP: practitioner ability, motivation, and opportunity to practice (AMO). Throughout, important links between psychology and EBP are highlighted, along with the contributions psychological research can make to further EBP development and implementation.
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Affiliation(s)
- Denise M Rousseau
- Heinz College of Public Policy, Information, and Management and Tepper School of Business, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213;
| | - Brian C Gunia
- Carey Business School, Johns Hopkins University, Baltimore, Maryland 21202-1099;
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Developing a Web-Based Nursing Practice and Research Information Management System: A Pilot Study. Comput Inform Nurs 2015; 33:410-6. [PMID: 26176636 DOI: 10.1097/cin.0000000000000176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Many hospital information systems have been developed and implemented to collect clinical data from the bedside and have used the information to improve patient care. Because of a growing awareness that the use of clinical information improves quality of care and patient outcomes, measuring tools (electronic and paper based) have been developed, but most of them require multiple steps of data collection and analysis. This necessitated the development of a Web-based Nursing Practice and Research Information Management System that processes clinical nursing data to measure nurses' delivery of care and its impact on patient outcomes and provides useful information to clinicians, administrators, researchers, and policy makers at the point of care. This pilot study developed a computer algorithm based on a falls prevention protocol and programmed the prototype Web-based Nursing Practice and Research Information Management System. It successfully measured performance of nursing care delivered and its impact on patient outcomes successfully using clinical nursing data from the study site. Although Nursing Practice and Research Information Management System was tested with small data sets, results of study revealed that it has the potential to measure nurses' delivery of care and its impact on patient outcomes, while pinpointing components of nursing process in need of improvement.
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