Implementation Science: Application of Evidence-Based Practice Models to Improve Healthcare Quality

Implementation lead nurses to lead EBP quality improvement project using the PEACE framework

Implementing evidence-based practice (EBP) in clinical practice is an ongoing challenge for nurses. EQUIP-Evidence-based QUality Improvement Project- is a multiphase project aimed at equipping nurses with the essential skills to implement EBP and advanced nursing practice. EQUIP embraces the assumption that implementation science models and partnership models can facilitate the implementation process of EBP, leading to successful and sustainable change. The current study is one of the EQUIP feasibility investigations in which the perspective of 12 implementation lead nurses (IL nurses) who attended a 1-day PEACE-based workshop was explored. Thematic analysis identified 2 overarching themes, 6 themes, and 18 subthemes. The first overarching theme showed that the PEACE-based workshop has successfully achieved its intended training implications, and the second overarching theme gave insight into factors that may influence the role of IL nurses. IL nurses reported general satisfaction and willingness to use the PEACE model at work; however, some IL nurses found Step 3 difficult to apply. The study's findings provide evidence of the perceived usefulness of adopting the PEACE model as an augmented approach in the EQUIP and the interest and enthusiasm of IL nurses in receiving more training on the implementation process of EBP.

Student Engagement in Patient Safety and Healthcare Quality Improvement: A Brief Educational Approach

Achieving optimal patient safety (PS) remains a challenge in healthcare. Effective educational methods are critical for improving PS. Innovative teaching tools, like case-based learning, augmented reality, and active learning, can help students better understand and apply PS and healthcare quality improvement (HQI) principles. This study aimed to assess activities and tools implemented to improve PS and HQI education, as well as student engagement, in medical schools. We designed a two-week course for fourth-year medical students at the Autonomous University of Guadalajara, incorporating Fink's taxonomy of significant learning to create engaging activities. The course featured daily synchronous and asynchronous learning, with reinforcement activities using tools, like augmented reality and artificial intelligence. A total of 394 students participated, with their performance in activities and final exam outcomes analyzed using non-parametric tests. Students who passed the final exam scored higher in activities focused on application and reasoning (p = 0.02 and p = 0.018, respectively). Activity 7B, involving problem-solving and decision-making, was perceived as the most impactful. Activity 8A, a case-based learning exercise on incident reporting, received the highest score for perception of exam preparation. This study demonstrates innovative teaching methods and technology to enhance student understanding of PS and HQI, contributing to improved care quality and patient safety. Further research on the long-term impact is needed.

Implementation Strategies for Quality Improvement in Palliative Care: A Scoping Review

BACKGROUND

Quality improvement (QI) programs based on person-centred outcome measures (PCOMs) play an important role in promoting optimal palliative care. However, routine use of PCOMs has been slow and difficult to implement, including within QI programs.

OBJECTIVE

This study aimed to identify implementation strategies that support the implementation of PCOMs as routine practice in hospital-based palliative care, as well as the implementation theories, models and frameworks (TMFs) guiding the design of these implementation strategies.

METHODS

A scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) Scoping Review framework. Four databases (Medline, CINAHL, Scopus and PubMed) were systematically searched for literature published between 1 January 1990 and 8 March 2024.

RESULTS

One hundred and fifteen unique implementation strategies, identified from 11 included studies, were mapped onto the 73 Expert Recommendations for Implementing Change (ERIC) discrete implementation strategies, covering 52% of the ERIC strategies. The most commonly used categories were train and educate stakeholders, and support clinicians, followed by develop stakeholder interrelationships and use evaluation and iterative strategies. Three key themes emerged: what to do; how to do it; and who to do it with. Only four studies employed TMFs to guide the design of the implementation strategies in this review.

CONCLUSIONS

To promote the implementation of PCOM-based QI programs, strategies should be developed based on identified/potential barriers and facilitators by using rigorous TMFs. The components of the implementation strategies must be reported transparently and consistently to enable replication and measurement in future research and practice.

PATIENT AND PUBLIC CONTRIBUTION

This scoping review does not directly involve patients or the general public in its design or execution. However, it is part of an implementation study aimed at integrating the Palliative Care Outcome Collaboration (PCOC) model into routine clinical practice at a cancer hospital in China. Before the formal implementation, palliative care professionals from this hospital highlighted the need for a comprehensive analysis of existing evidence to support the effective adoption of the PCOC model in their specific clinical setting.

Implementation of Complex Suicide Prevention Interventions: Insights into Barriers, Facilitators and Lessons Learned

INTRODUCTION

Effective suicide prevention interventions are infrequently translated into practice and policy. One way to bridge this gap is to understand the influence of theoretical determinants on intervention delivery, adoption, and sustainment and lessons learned. This study aimed to examine barriers, facilitators and lessons learned from implementing complex suicide prevention interventions across the world.

METHODS AND MATERIALS

This study was a secondary analysis of a systematic review of complex suicide prevention interventions, following updated PRISMA guidelines. English published records and grey literature between 1990 and 2022 were searched on PubMed, CINAHL, PsycINFO, ProQuest, SCOPUS and CENTRAL. Related reports were organized into clusters. Data was extracted from clusters of reports on interventions and were mapped using the updated Consolidated Framework for Implementation Research.

RESULTS

The most frequently-reported barriers were reported within the intervention setting and were related to the perceived appropriateness of interventions within settings; shared norms, beliefs; and maintaining formal and informal networks and connections. The most frequently reported facilitators concerned individuals' motivation, capability/capacity, and felt need. Lessons learned focused on the importance of tailoring the intervention, responding to contextual needs and the importance of community engagement throughout the process.

CONCLUSION

This study emphasizes the importance of documenting and analyzing important influences on implementation. The complex interplay between the contextual determinants and implementation is discussed. These findings contribute to a better understanding of barriers and facilitators salient for implementation of complex suicide prevention interventions.

Near-infrared technology for improved PIVC placement: a clinical technology implementation model

AIMS

To share lessons learned from an evidence-based practice (EBP) initiative that implemented near-infrared (NIR) technology in a large US hospital system. A Clinical Technology Implementation Model (CTIM©) that can be adapted for use in other health institutions is presented.

BACKGROUND

EBP implementation, including the adoption of new cutting-edge technologies, is crucial to improving patient care. Yet there are significant delays in changes to clinical practice, often due to organisational challenges that stifle the implementation process. The evidence-practice gap is increasingly evident in peripheral intravenous access (PIV). Implementation science offers new insights into the challenges of updating clinical practice, which can support EBP implementation.

EVALUATION

Recent literature on implementation science, change theory, PIV access, NIR technology, and patient outcomes were reviewed. A model that can help nurse managers implement technology that aligns with EBP is presented, drawing on experience from the adoption of NIR vein visualisation to enhance PIV access in a large US hospital system.

KEY ISSUE

A pervasive hesitancy in healthcare to embrace technology, coupled with the challenges of implementing a change to practice, has led to limited application of EBP PIV access guidelines and a stagnant standard of care.

CONCLUSION

This article provides nurse managers with the tools necessary to successfully implement EBP, drawing on the experience from implementing NIR in a large US hospital. Nurse managers are uniquely positioned to lead the way in embracing technology to improve care and reduce the evidence-practice gap.

Implementing a Standardized Phase-of-Care Craniotomy Education Program

Leaders at a community hospital in the southeastern United States sought to add a craniotomy program to meet the needs of the local patient population. Perioperative and critical-care nurses required specific knowledge and skills to care for patients undergoing craniotomy procedures. The facility's education team applied adult learning theories and an innovation diffusion framework when developing an evidence-based craniotomy education program. A clinical nurse specialist conducted a gap analysis and readiness assessment to determine the nurses' knowledge, skills, and competence to care for patients; attitudes and behaviors toward implementation of the new program; and preferred learning methods. The three-tiered phase-of-care education program included didactic learning sessions, shadowing experiences, hands-on experience with equipment, and simulation sessions. The program focused on effective collaboration and care transitions. Nurses were satisfied with the program, and they continue to participate in ongoing quarterly simulation sessions with case study scenarios to enhance their skills.

Evaluating the Impact of an Evidence-Based Practice Education Program in a Nurse Residency Program on Evidence-Based Practice Beliefs, Implementation, and Competency

This quality improvement project examined implementation of the John Hopkins Nursing evidence-based practice (EBP) model, a standardized EBP education curriculum, in a hospital-based nurse residency program. We found that EBP education increased nurse residents' EBP beliefs, implementation frequency, and competencies. Our findings suggest that adopting existing EBP curricula is a convenient and effective approach to EBP education. Staff development professionals should continue to support and advocate for the adoption of EBP education within their organizations.

Perspectives on implementing Individual Placement and Support (IPS) within primary health care settings for adults living in British Columbia, Canada

BACKGROUND

Individual placement and support (IPS) is an evidence-based practice (EBP) designed to help people with severe mental illness re-enter the labour market. Implementing an IPS program within a new context (e.g., primary health care setting) to support populations that are complex and multi-barriered presents a set of unique challenges and considerations. This paper provides community-based perspectives that identify implementation strengths and challenges and highlights potential strategies aimed at addressing emergent barriers.

METHODS

A case study was conducted across three community health centres in British Columbia (BC), Canada, where a novel IPS program was embedded within primary care services. Data collection consisted of open-ended surveys and focus groups with service providers directly involved in program implementation and their associated clinical and managerial support teams (n = 15). Using the updated Consolidated Framework for Implementation Research (CFIR) as a guide, we performed deductive thematic analysis to identify key areas impacting IPS implementation.

RESULTS

Integration with existing health care systems and primary health care teams and support from leadership across all levels were identified as both key facilitators and barriers to implementation. Facilitators and barriers were identified across all domains, with those within innovation and process most easily addressed. Four cross-cutting themes emerged for promoting more integrated and sustainable program implementation: investing in pre-implementation activities, supporting a dynamic and flexible program, building from community experiences, and developing a system for shared knowledge.

CONCLUSIONS

Implementing an IPS program embedded within primary health care settings is complex and requires extensive planning and consultation with community-based service providers and decision-makers to achieve full integration. Future practice and policy decisions aimed at supporting employment and well-being should be made in collaboration with communities.

Barriers and enablers to managing challenging behaviours after traumatic brain injury in the acute hospital setting: a qualitative study

BACKGROUND

Challenging behaviours after traumatic brain injury (TBI) in the acute setting are associated with risk of harm to the patient and staff, delays in commencing rehabilitation and increased length of hospital stay. Few guidelines exist to inform practice in acute settings, and specialist services providing multi-disciplinary expertise for TBI behaviour management are predominantly based in subacute inpatient services. This study aims to investigate acute and subacute staff perspectives of barriers and enablers to effectively managing challenging behaviours after TBI in acute hospital settings.

METHODS

Qualitative focus groups were conducted with 28 staff (17 from acute setting, 11 from subacute setting) across two sites who had experience working with patients with TBI. Data were analysed using inductive-deductive reflexive thematic analysis. Data were applied to the constructs of the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to generate themes representing barriers and enablers to managing challenging behaviours after TBI in the acute hospital setting.

RESULTS

Four barriers and three enablers were identified. Barriers include (1) Difficulties with clinical decision making; (2) Concerns for risks to staff and patients; (3) Hospital environment; (4) Intensive resources are required. Enablers were (1) Experienced staff with practical skills; (2) Incorporating person-centred care; and (3) Supportive teams.

CONCLUSION

These findings can inform pre-implementation planning for future improvements to TBI behaviour management in acute hospital settings. Difficulties with clinical decision making, concerns for risks of injury, the hospital environment and lack of resources are major challenges. Implementation strategies developed to address barriers will need to be trialled, with multi-disciplinary team approaches, and tailored to the acute setting.

The relative value of Pre-Implementation stages for successful implementation of evidence-informed programs

BACKGROUND

Most implementations fail before the corresponding services are ever delivered. Measuring implementation process fidelity may reveal when and why these attempts fail. This knowledge is necessary to support the achievement of positive implementation milestones, such as delivering services to clients (program start-up) and competency in treatment delivery. The present study evaluates the extent to which implementation process fidelity at different implementation stages predicts achievement of those milestones.

METHODS

Implementation process fidelity data-as measured by the Stages of Implementation Completion (SIC)-from 1287 implementing sites across 27 evidence-informed programs were examined in mixed effects regression models with sites nested within programs. Implementation process fidelity, as measured by the proportion of implementation activities completed during the three stages of the SIC Pre-Implementation phase and overall Pre-Implementation (Phase 1) and Implementation (Phase 2) proportion scores, was assessed as a predictor of sites achieving program start-up (i.e., delivering services) and competency in program delivery.

RESULTS

The predicted probability of start-up across all sites was low at 35% (95% CI [33%, 38%]). When considering the evidence-informed program being implemented, that probability was nearly twice as high (64%; 95% CI [42%, 82%]), and 57% of the total variance in program start-up was attributable to the program. Implementation process fidelity was positively and significantly associated with achievement of program start-up and competency. The magnitude of this relationship varied significantly across programs for Pre-Implementation Stage 1 (i.e., Engagement) only. Compared to other stages, completing more Pre-Implementation Stage 3 (Readiness Planning) activities resulted in the most rapid gains in probability of achieving program start-up. The predicted probability of achieving competency was very low unless sites had high scores in both Pre-Implementation and Implementation phases.

CONCLUSIONS

Strong implementation process fidelity-as measured by SIC Pre-Implementation and Implementation phase proportion scores-was associated with sites' achievement of program start-up and competency in program delivery, with early implementation process fidelity being especially potent. These findings highlight the importance of a rigorous Pre-Implementation process.

Development and Evaluation of the Fuld Institute Evidence-based Implementation and Sustainability Toolkit for Health Care Settings

Routine implementation and sustainability of evidence-based practices (EBPs) into health care is often the most difficult stage in the change process. Despite major advances in implementation science and quality improvement, a persistent 13- to 15-year research-to-practice gap remains. Nurse leaders may benefit from tools to support implementation that are based on scientific evidence and can be readily integrated into complex health care settings. This article describes development and evaluation of an evidence-based implementation and sustainability toolkit used by health care clinicians seeking to implement EBPs. For this project, implementation science and EBP experts created initial iterations of the toolkit based on Rogers' change theory, the Advancing Research through Close Collaboration (ARCC) model, and phases and strategies from implementation science. Face validity and end-user feedback were obtained after piloting the tool with health care clinicians participating in immersive EBP sessions. The toolkit was then modified, with subsequent content validity and usability evaluations conducted among implementation science experts and health care clinicians. This article presents the newly updated Fuld Institute Evidence-based Implementation and Sustainability Toolkit for health care settings. Nurse leaders seeking to implement EBPs may benefit from an evidence-based toolkit to provide a science-informed approach to implementation and sustainability of practice changes.

Decreased cardiac output: an integrative review

OBJECTIVE

to identify, in the scientific literature, the defining characteristics and contributing factors (related factors, associated conditions and populations at risk) for nursing diagnosis decreased cardiac output.

METHOD

an integrative literature review, conducted between September and October 2020, with an update in March 2022, in the MEDLINE via PubMed, LILACS, SciELO, CINAHL and EMBASE databases. Using acronym PEO, studies published in the last 10 years in Portuguese, English and Spanish were included. A descriptive analysis was carried out to present the elements mapped in the literature.

RESULTS

analysis of 31 articles identified different elements, highlighting 4 new related factors: hyperglycemic stress, prone position, left lateral position, sleep deprivation. Individuals with a history of cardiovascular disease and males were identified as possible populations at risk.

FINAL CONSIDERATIONS

the elements for decreased cardiac output, identified in the literature, add evidence that justifies the permanence of this diagnosis in the NANDA-I classification.

The Doctor of Nursing Practice help desk: An innovative approach to developing evidence-based practice competency and providing DNP project support

BACKGROUND

The 2021 American Association for Colleges of Nursing (AACN) Essentials for Professional Nursing Education identifies evidence-based practice (EBP) as a core concept meant to be integrated across curricula. Integrating EBP in Doctor of Nursing Practice (DNP) programs is challenging because of barriers including persistent confusion between research, EBP, and quality improvement; low faculty confidence and competence in their EBP skills and mentoring; increased faculty workload with growing program enrollments; and limited opportunities for students and faculty to practice EBP skills.

AIMS

The aim of this initiative was to implement and evaluate an innovative education strategy to build DNP students' and faculty's EBP competency and confidence while mitigating barriers faced by DNP programs.

METHODS

A DNP Help Desk was created and implemented at a large, Midwestern college of nursing with participation and support from EBP experts. Student and faculty participation were tracked, and perceptions of the help desk were evaluated. Opportunities to evolve the help desk were identified and implemented.

RESULTS

Outcomes included a self-reported increase in student and faculty confidence and EBP competency, increased integration, and utilization of EBP in project work, elevated DNP project quality, and decreased demands on DNP project advisors.

LINKING EVIDENCE TO ACTION

Engaging in innovative strategies aimed at increasing EBP competency and confidence may lead to increased EBP engagement and positive outcomes for students, faculty, and DNP programs.

De-adopting low-value care: The missing step in evidence-based practice?

BACKGROUND

Low-value care provides little or no benefit to pediatric patients, has the potential to cause harm, waste healthcare resources, and increase healthcare costs. Nursing has a responsibility to identify and de-adopt low-value practices to help promote quality care.

PURPOSE

1) Describe the process of identifying and de-adopting low-value clinical practices guided by a conceptual model using a case study approach. 2) Identify facilitators and barriers to de-adoption practices, including levels of stakeholder engagement, organizational structures, and the quality of available scientific and non-scientific evidence.

METHODOLOGY

An evidence-based practice (EBP) project investigating the efficacy of antihistamines in decreasing infusion reactions to infliximab identified a low-value practice within a pediatric infusion center. The Synthesis Model for the Process of De-adoption was then applied to guide the de-adoption of this low-value practice. Case study analysis highlighted facilitators and barriers to de-adoption efforts.

CONCLUSIONS

The process for de-adopting care is an essential component of EBP and, as such, should be explicated through robust, standardized EBP processes and education.

PRACTICE IMPLICATIONS

Nurses are best positioned to identify, assess and prioritize low-value practices and facilitate the de-adoption of low-value practice that impact pediatric patients and families. Models to support de-adoption and a focus on site-specific practices including a prepared nursing workforce, continuous evaluation of care processes and the use of resources to assess for contextual determinants facilitates success and sustainability of this essential EBP approach.

Débito cardíaco diminuído: revisão integrativa

RESUMO Objetivo: identificar, na literatura científica, as características definidoras e fatores contribuintes (fatores relacionados, condições associadas e populações em risco) para o diagnóstico de enfermagem débito cardíaco diminuído. Método: revisão integrativa da literatura, conduzida entre setembro e outubro de 2020, com atualização em março de 2022, nas bases de dados MEDLINE via PubMed, LILACS, SciELO, CINAHL e EMBASE. Com uso do acrônimo PEO, foram incluídos estudos publicados nos últimos 10 anos em português, inglês e espanhol. Realizouse análise descritiva para apresentar os elementos mapeados na literatura. Resultados: análise de 31 artigos identificou diferentes elementos, com destaque para 4 novos fatores relacionados: estresse hiperglicêmico, posição prona, posição lateral esquerda, privação do sono. Indivíduos com história de doença cardiovascular e do sexo masculino foram apontados como possíveis populações em risco. Considerações finais: os elementos para débito cardíaco diminuído, identificados na literatura, agregam evidências que justificam a permanência desse diagnóstico na classificação da NANDA-I.

Implementing a behavior management approach in the hospital setting for individuals with challenging behaviors during acute traumatic brain injury

PRIMARY OBJECTIVE

This study aimed to determine if implementing a clinically pragmatic behavior management approach for challenging behaviors during acute TBI reduces use of restraints, security incidences, acute length of stay admission and cost, thereby improving progress to rehabilitation.

RESEARCH DESIGN

This pilot study involved a behavior management group (n = 27), compared with a historical control group (n = 74).

METHOD AND PROCEDURES

The behavior management group received care following the implementation of a behavior management approach for challenging behaviors during acute TBI at two hospitals in South Australia.

MAIN OUTCOMES AND RESULTS

Fidelity results demonstrated high level of adherence to the implemented behavior management approach. The behavior management group had significant lower use of mechanical restraints (p = 0.03), and significantly lower acute admission costs (p = 0.034). Trends in lower pharmacological restraint usage, lower acute hospital length of stay and time from admission to rehabilitation acceptance were recorded.

CONCLUSIONS

These pilot results contribute to improving quality of health care but methodological limitations make outcomes difficult to interpret as a direct result of the intervention. Future studies are required to investigate evidence-based behavior management interventions for acute TBI patients using more rigorous knowledge translation implementation designs.

Psychometric properties of the evidence-based practice mentorship scale

BACKGROUND

Evidence-based practice (EBP) improves the quality of care, decreases healthcare costs, and improves job satisfaction. However, nurses and other clinicians, as well as their institutions, struggle to consistently implement EBP. The Advancing Research and Clinical practice through close Collaboration (ARCC©) Model established that a cadre of EBP mentors is key to improving EBP knowledge, beliefs, competency, and implementation in clinicians. Yet, there has not been a valid and reliable measure of EBP mentorship.

AIMS

The aim of this study was to determine the psychometric properties of the new 8-item EBP Mentorship Scale. This scale measures the degree to which clinicians perceive that EBP mentorship is available to them.

METHODS

The EBP Mentorship Scale data were obtained from a previous national cross-sectional descriptive study with 2344 nurses from 19 hospitals and healthcare systems. Descriptive statistics summarized the sample and distributions of the scale items. Cronbach's alpha, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) were conducted.

RESULTS

Cronbach's alpha of the scale was 0.99. A one-factor model was supported by EFA and retained for CFA. Model fit indices for CFA indicated a good fit.

LINKING EVIDENCE TO ACTION

The new EBP Mentorship Scale is valid and reliable and can be used to assess the level of EBP mentorship support available in hospitals and healthcare systems. EBP mentors are key in sustaining an EBP organizational culture and enhancing clinician EBP knowledge, beliefs, competency, and implementation.

Adaptation of communication assessment tool for community pharmacists in medication adherence and minor diseases management

Aim: To develop two versions of the Communication Assessment Tool (CAT) skilled for the setting of community pharmacy and to pilot test it on a selected sample.

Materials: Development of two versions of CAT-tool for community pharmacists. Validity and reliability assessments were required to determine the psychometric properties of developed tool versions. To investigate the construct validity of each adapted tool item, confirmatory factor analysis was performed. Reliability was assessed with the Cronbach’s Alpha evaluation, internal validity by submitting tool versions to patients of eleven pharmacies from North, Center, and South of Italy for pilot testing.

Results: Two CAT versions were developed and tested: CAT-Pharm-community Adherence to therapy and Minor Disease Management versions. First to evaluate pharmacist-patient communication following the dispensing of a prescription drug, second a consultation for minor disease management.

Conclusion: Communication tools are useful to implement optimal management of chronic diseases to minimize non-adherence and patients’ negative health outcomes.

Translation of an evidence-based virtual reality simulation-based interprofessional education into health education curriculums: An implementation science method

BACKGROUND

The development of interprofessional competencies through an evidence-based program is paramount to nurture a collaborative practice-ready workforce for patient-centered care and safety.

AIMS

To describe an implementation science approach for translation of an evidence-based virtual reality simulation-based interprofessional education (VR-Sim-IPE) program into medical and nursing curriculums, and to evaluate the implementation outcomes.

METHODS

Implementation strategies from the "Expert Recommendations for Implementing Change" were used to support implementation of the VR-Sim-IPE program. This included recruiting and training 28 practicing clinicians as facilitators to deliver the program to 599 medical and nursing students. Proctor's conceptual framework for implementation outcomes was applied with multiple data collection methods to evaluate the VR-Sim-IPE program. An online survey was administered to measure the levels of acceptability, appropriateness, feasibility, and adoption. Forty-four sessions of structured observations were carried out to examine the facilitators' implementation fidelity. Individual interviews were conducted with 15 facilitators to identify the facilitators and barriers to the program implementation. An implementation cost analysis was also conducted.

RESULTS

Both facilitators and students had positive perceptions of the acceptability, adoption, appropriateness, and feasibility of the VR-Sim-IPE program. Facilitators were observed to implement the program with high fidelity, including program adherence, dosage, quality of delivery, and student responsiveness. While opportunities to contribute and learn, as well as receiving training and support, were identified as facilitators to implementation, the lack of familiarity with the virtual environment, varying levels of student participation, and facilitating interprofessional groups were reported barriers. The implementation costs amounted to USD45,648.50.

CONCLUSION

The evaluation of implementation outcomes identifies strategies for future implementation that could potentially enhance program acceptance, reduce implementation cost, improve penetration, and achieve program sustainability. These include increasing facilitation group size, preparing students to be active participants, and incorporating interprofessional facilitation skills in facilitators' training.

Noise reduction in the ICU: a best practice implementation project

INTRODUCTION

Sleep deprivation is a relevant problem among patients hospitalized in ICUs. Further, noise is the most critical disruptive factor according to patients.

OBJECTIVE

To implement scientific evidence-based best practices for noise control in an adult ICU.

METHODS

This was an evidence-based implementation project of best practices in noise control, conducted in a high-complexity hospital's adult ICU. The intervention consisted of three steps: baseline audit and identification of barriers, implementation of best practices, and a follow-up audit.

RESULTS

No compliance with best practices was detected in the baseline audit. After the implementation phase, the unit reached compliance levels of 78-88% for most of these criteria only one criterion related to noise level did not match the expected compliance.

CONCLUSION

Adherence to best practices regarding noise control was satisfactory, achieving more than 70% compliance in the six audit criteria. Only the noise level did not reach the threshold recommended by the WHO - a difficulty reported in other studies.

RELEVANCE TO CLINICAL PRACTICE

Best practices related to noise control are essential for managing sleep deprivation in ICUs and include changes in the behaviour of involved professionals.

Evidence-Based Practice Culture and Mentorship Predict EBP Implementation, Nurse Job Satisfaction, and Intent to Stay: Support for the ARCC© Model

BACKGROUND

The Advancing Research and Clinical practice through close Collaboration (ARCC^© ) Model is a system-wide framework for implementing and sustaining evidence-based practice (EBP) in hospitals and healthcare systems. The model involves assessing organizational culture and readiness for EBP in addition to the development of a critical mass of EBP mentors who work with point-of-care clinicians to facilitate the implementation of evidence-based care. Determining how the various components of the ARCC^© Model relate to one another is important for understanding how EBP culture and mentorship impact EBP implementation, nurses' job satisfaction, and intent to stay.

AIMS

The current study aimed to test a model that could explain the relationships and direct pathways among eight key variables in the ARCC^© Model: (1) EBP culture, (2) mentorship, (3) knowledge, (4) beliefs, (5) competency, (6) implementation, (7) nurses' job satisfaction, and (8) intent to stay.

METHODS

Structural equation modeling was used to test relationships among the variables in the ARCC^© Model with data obtained from an earlier cross-sectional descriptive study with 2,344 nurses from 19 hospitals and healthcare systems across the United States.

RESULTS

The final structural equation model found that EBP culture and mentorship were key variables that positively impacted EBP knowledge, beliefs, competency, implementation, job satisfaction, and intent to stay among nurses.

LINKING EVIDENCE TO ACTION

As described in the ARCC^© Model, establishing a strong sustainable EBP culture along with a critical mass of EBP mentors is crucial for the development of EBP competency and consistent implementation of evidence-based care by nurses. A strong EBP culture along with EBP mentorship also can result in higher job satisfaction and intent to stay. Implementation of the ARCC^© Model is a key strategy in assisting systems to reach health care's Quadruple Aim.