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Mäkelä H, Axelin A, Niela-Vilén H. Journey toward Baby-Friendly Hospital Initiative designation: Healthcare professional's view on successful implementation process and maintenance of accreditation. Midwifery 2024; 135:104029. [PMID: 38824766 DOI: 10.1016/j.midw.2024.104029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 04/29/2024] [Accepted: 05/20/2024] [Indexed: 06/04/2024]
Abstract
PROBLEM The Baby-Friendly Hospital Initiative has yet to achieve widespread global implementation. BACKGROUND The implementation of the Baby-Friendly Hospital Initiative has been recognised as complex. The challenge has been to maintain accreditation. AIM To explore and gain a deeper understanding of the healthcare professionals' perceptions of the implementation process and the maintenance of the Baby-Friendly Hospital Initiative. METHODS A qualitative descriptive study with focus groups (n = 10) of the nurses, midwives and unit leaders (n = 43) perceptions of the implementation process were analysed using inductive thematic analysis. FINDINGS Analysis of the data revealed five main themes: groundwork for the baby-focused breastfeeding context, management support throughout the process, promoting baby-friendly practices, effective communication ensuring the right track, and supporting the maintenance of BFHI designation. The main themes describe the implementation as a journey of climbing a hill and after reaching the top trying to maintain their position. DISCUSSION The starting point for implementation was an optimal environment supporting baby-friendly breastfeeding practices. The support of the management of the organisation was an important way of moving the implementation forward. Commitment to the common goal strengthened the baby-friendly approach and with concrete and immediate feedback the right pathway on a journey was ensured. CONCLUSION Practical ways to support the implementation journey include regular update education on breastfeeding and continuous monitoring, as well as providing statistics to health professionals. Global guidelines on how to sustain change are needed. This will ensure that the work done is not wasted.
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Affiliation(s)
- Heli Mäkelä
- University of Turku, Department of Nursing Science, Turku, Finland; Satakunta University of Applied Sciences, Pori, Finland.
| | - Anna Axelin
- University of Turku, Department of Nursing Science, Turku, Finland
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Duan Y, Wang J, Lanham HJ, Berta W, Chamberlain SA, Hoben M, Choroschun K, Iaconi A, Song Y, Perez JS, Shrestha S, Beeber A, Anderson RA, Hayduk L, Cummings GG, Norton PG, Estabrooks CA. How context links to best practice use in long-term care homes: a mixed methods study. Implement Sci Commun 2024; 5:63. [PMID: 38849909 PMCID: PMC11157780 DOI: 10.1186/s43058-024-00600-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 05/28/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Context (work environment) plays a crucial role in implementing evidence-based best practices within health care settings. Context is multi-faceted and its complex relationship with best practice use by care aides in long-term care (LTC) homes are understudied. This study used an innovative approach to investigate how context elements interrelate and influence best practice use by LTC care aides. METHODS In this secondary analysis study, we combined coincidence analysis (a configurational comparative method) and qualitative analysis to examine data collected through the Translating Research in Elder Care (TREC) program. Coincidence analysis of clinical microsystem (care unit)-level data aggregated from a survey of 1,506 care aides across 36 Canadian LTC homes identified configurations (paths) of context elements linked consistently to care aides' best practices use, measured with a scale of conceptual research use (CRU). Qualitative analysis of ethnographic case study data from 3 LTC homes (co-occurring with the survey) further informed interpretation of the configurations. RESULTS Three paths led to very high CRU at the care unit level: very high leadership; frequent use of educational materials; or a combination of very high social capital (teamwork) and frequent communication between care aides and clinical educators or specialists. Conversely, 2 paths led to very low CRU, consisting of 3 context elements related to unfavorable conditions in relationships, resources, and formal learning opportunities. Our qualitative analysis provided insights into how specific context elements served as facilitators or barriers for best practices. This qualitative exploration was especially helpful in understanding 2 of the paths, illustrating the pivotal role of leadership and the function of teamwork in mitigating the negative impact of time constraints. CONCLUSIONS Our study deepens understanding of the complex interrelationships between context elements and their impact on the implementation of best practices in LTC homes. The findings underscore that there is no singular, universal bundle of context-related elements that enhance or hinder best practice use in LTC homes.
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Affiliation(s)
- Yinfei Duan
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada.
| | - Jing Wang
- Nursing Department, College of Health and Human Services, University of New Hampshire, Durham, NH, USA
| | - Holly J Lanham
- Joe R. & Teresa Lozano Long School of Medicine, University of Texas Health, San Antonio, TX, USA
| | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Matthias Hoben
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
- School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada
| | | | - Alba Iaconi
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Yuting Song
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Janelle Santos Perez
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shovana Shrestha
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Anna Beeber
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Ruth A Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leslie Hayduk
- Sociology Department, Faculty of Arts, University of Alberta, Edmonton, AB, Canada
| | - Greta G Cummings
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Peter G Norton
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
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3
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Wang J, Anderson R, Perez JS, Estabrooks CA, Berta W, Lanham HJ, Duan Y, Iaconi A, Beeber A. Understanding Adaptive Leadership in the Context of Nursing Homes. J Appl Gerontol 2024:7334648241243312. [PMID: 38566520 DOI: 10.1177/07334648241243312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Rapidly growing populations of older adults rely heavily on formal long-term care services such as those provided in nursing homes. Nursing home staff are confronted with complex challenges. We explored how staff (N = 88), particularly care aides, interpreted challenges and responded to them by taking adaptive leadership roles, and engaging in technical and adaptive work in nursing homes. We conducted analysis of the ethnographic case studies. In long-term care settings, staff face complex challenges in improving resident care due to contextual barriers. These include demanding work conditions and inadequate resources. Additionally, top-down communications, despite being well-intentioned, often lead to misinterpretation and a lack of staff motivation. Nonetheless, we found that certain staff managed to overcome these contextual barriers and effectively execute change initiatives by assuming adaptive leadership roles. Formal leaders have a vital role in empowering staff, including care aides, and facilitating their adaptive leadership behaviors.
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Affiliation(s)
- Jing Wang
- College of Health and Human Services, University of New Hampshire, Durham, NH, USA
| | - Ruth Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Janelle Santos Perez
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Holly J Lanham
- Joe R. & Teresa Lozano Long School of Medicine, University of Texas Health, San Antonio, TX, USA
| | - Yinfei Duan
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Alba Iaconi
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Anna Beeber
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
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Geagea D, Ogez D, Kimble R, Tyack Z. Redefining hypnosis: A narrative review of theories to move towards an integrative model. Complement Ther Clin Pract 2024; 54:101826. [PMID: 38199053 DOI: 10.1016/j.ctcp.2023.101826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/14/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024]
Abstract
Hypnosis is an ancient mind-body intervention that has regained interest with the surge of research in the last decade documenting its clinical validity. Yet, theoretical controversies and misconceptions prevail among theorists, clinicians, and the general public, impeding the understanding, acceptance, replication, and use of hypnosis. Providing adequate information, which dispels misconceptions and promotes more balanced views, is warranted to facilitate the implementation and adoption of hypnosis in clinical and research settings. This review re-examines the conceptualisation of hypnosis throughout history and the theoretical controversies surrounding it while highlighting their meeting points and clinical implications. Despite dichotomies, a broad agreement appears across theoretical approaches regarding hypnotic analgesia effects, key components, and vocabulary. Further, theories highlight key factors of hypnotic responding. For instance, social theories highlight social and contextual variables, whereas state theories highlight biopsychosocial mechanisms and individual factors. Based on theories, the terms hypnotherapy or clinical hypnosis are recommended to refer to the therapeutic use of hypnosis in psychotherapeutic and medical contexts, respectively. This review concludes with a model that integrates various theories and evidence and presents hypnosis as a complex multifaceted intervention encompassing multiple procedures, phenomena, and influencing factors. This review intends to deepen our understanding of hypnosis, and promote its more rapid adoption and adequate implementation in research and clinical contexts, in addition to steering research towards evidence-based hypnotic practice. The review can have important research and clinical implications by contributing to advancing knowledge regarding hypnotic procedures, phenomena, and influencing factors.
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Affiliation(s)
- Dali Geagea
- Child Health Research Centre, Centre for Children's Burns and Trauma Research, The University of Queensland, Brisbane, Australia.
| | - David Ogez
- Department of Anaesthesiology and Pain Medicine, University of Montreal, Montreal, Canada
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Queensland Children's Hospital, The University of Queensland, Brisbane, Australia
| | - Zephanie Tyack
- Child Health Research Centre, Centre for Children's Burns and Trauma Research, The University of Queensland, Brisbane, Australia; Australian Centre for Health Service Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
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Lizarondo L, McArthur A, Porche D, Corremans M, Perrenoud B, Rodrigues R, Lockwood C. Facilitation in evidence implementation - experiences, challenges, and determinants of perceived effectiveness: a qualitative systematic review. JBI Evid Implement 2023; 21:409-431. [PMID: 37975298 DOI: 10.1097/xeb.0000000000000399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Facilitation is a key element of evidence implementation. Although quantitative systematic reviews have been undertaken to examine its components and effectiveness, no attempt has been made to synthesize qualitative evidence examining the experiences of facilitators on how facilitation is operationalized, the challenges associated with it, and the factors that can influence its perceived effectiveness. METHODS A systematic review of qualitative studies was conducted using the JBI methodology. RESULTS A total of 36 qualitative studies was included in the systematic review, with the majority being assessed as high quality following critical appraisal. The findings were extracted and further synthesized, highlighting that facilitation involves providing technical and non-technical support to health professionals, as well as high-intensity collaborations and relationship building. Determinants of perceived effectiveness of facilitation include facilitators' access to resources and learning support; their skills, traits/attitudes, and approach to facilitation; and the context of the organization where the implementation occurs. Work demands, emotional stress, and lack of clarity in roles and career development can pose challenges for facilitators. CONCLUSION To maximize the outcomes of facilitation in evidence implementation, the team of facilitators should be carefully selected to ensure they have the right skills, traits/attitudes, and approach to facilitation. They should also be provided with dedicated time to conduct the facilitation and have access to resources, training, and mentoring support. Future research should aim to examine the perspectives of the "implementers" who received support from facilitators to gain a better understanding of which facilitation strategies have an impact on clinical practice behavior. REVIEW REGISTRATION NUMBER PROSPERO CRD42023402496.
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Affiliation(s)
- Lucylynn Lizarondo
- JBI, School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Alexa McArthur
- JBI, School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Demetrius Porche
- School of Nursing, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, USA
- The Louisiana Centre for Promotion of Optimal Health Outcomes: A JBI Centre of Excellence, New Orleans, LA, USA
| | | | - Beatrice Perrenoud
- Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
- ELS School of Health Sciences, HES-SO University of Applied Sciences and Arts, Western Switzerland, Lausanne, Switzerland
| | - Rogério Rodrigues
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Craig Lockwood
- JBI, School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Privitera D, Bassi E, Airoldi C, Capsoni N, Innocenti G, Santomauro I, Molin AD. Effectiveness of short peripheral intravenous catheter educational programmes to improve clinical outcomes protocol for a systematic review. MethodsX 2023; 11:102352. [PMID: 37705570 PMCID: PMC10495618 DOI: 10.1016/j.mex.2023.102352] [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: 08/08/2023] [Accepted: 08/26/2023] [Indexed: 09/15/2023] Open
Abstract
The placement of a short peripheral intravenous catheter (sPIVC) is the most common invasive clinical procedure for patients requiring fluid infusion and multiple blood draws. Phlebitis and infiltration represent the most common catheter-related complications. Occlusions, dislocations, and infections are less frequent. Insufficient knowledge and skills may increase the risk of these complications. This review aims to evaluate the effectiveness of training programmes to reduce sPIVC failure amongst hospitalised patients. We will search PubMed, Embase, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Vascular Specialized Register through the Cochrane Register of Studies, and Google Scholar. We defined the search query using the PICO framework (Participants: health professionals; Intervention: training programme; Comparison: No training programme; Outcomes: all-cause catheter failure). We will include experimental studies evaluating an educational programme to reduce early sPIVC failure amongst hospitalised patients. Two reviewers will independently screen studies for inclusion, extract data, and perform the risk of bias assessment using the Cochrane Effective Practice and Organisation of Care Risk of Bias tool for randomised controlled trials. This review will highlight important perspectives for future studies on the effectiveness of educational programmes focused on reducing the rate of sPIVC complications.
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Affiliation(s)
- Daniele Privitera
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Erika Bassi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Chiara Airoldi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Nicolò Capsoni
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Gloria Innocenti
- Centro Documentazione Biomedica, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Isabella Santomauro
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Alberto Dal Molin
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
- Health Professions’ Direction, Maggiore della Carità Hospital, Novara, Italy
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Geagea D, Ogez D, Kimble R, Tyack Z. Demystifying hypnosis: Unravelling facts, exploring the historical roots of myths, and discerning what is hypnosis. Complement Ther Clin Pract 2023; 52:101776. [PMID: 37402329 DOI: 10.1016/j.ctcp.2023.101776] [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: 04/27/2023] [Revised: 06/04/2023] [Accepted: 06/14/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND AND PURPOSE Hypnosis, a mind-body treatment dating back to early human history, has regained attention in the last decade, with research suggesting its effectiveness for varied physiological and psychological ailments such as distress, pain, and psychosomatic disorders. However, myths and misconceptions have prevailed among the general public and clinicians, hindering the adoption and acceptance of hypnosis. It is important to distinguish myths from facts and discern what is hypnosis and what is not to enhance the understanding, acceptance, and adoption of hypnotic interventions. METHODS This narrative review traces the history of myths surrounding hypnosis in contrast to the evolution of hypnosis as a treatment modality. In addition to comparing hypnosis to other interventions with similar procedures and features, the review unravels misconceptions that have impeded the adoption and acceptance of hypnosis in clinical and research settings and presents evidence to demystify this intervention. RESULTS This review examines the roots of myths while presenting historical facts and evidence that support hypnosis as a treatment modality and alleviate misconceptions depicting it as mystical. Further, the review distinguishes hypnotic and non-hypnotic interventions with overlapping procedures and phenomenological features to enhance our understanding of hypnotic techniques and phenomena. CONCLUSION This review enhances the understanding of hypnosis in historical, clinical, and research contexts by disproving related myths and misconceptions to promote the adoption of hypnosis in clinical and research contexts. Further, this review highlights knowledge gaps requiring further investigations to steer research toward an evidence-based practice of hypnosis and optimise multimodal therapies embedding hypnosis.
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Affiliation(s)
- Dali Geagea
- Child Health Research Centre, Centre for Children's Burns and Trauma Research, The University of Queensland, Brisbane, Australia.
| | - David Ogez
- Department of Anaesthesiology and Pain Medicine, University of Montreal, Montreal, Canada
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Queensland Children's Hospital, The University of Queensland, Brisbane, Australia
| | - Zephanie Tyack
- Child Health Research Centre, Centre for Children's Burns and Trauma Research, The University of Queensland, Brisbane, Australia; Australian Centre for Health Service Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
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8
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Vogel C, Dijkstra C, Huitink M, Dhuria P, Poelman MP, Mackenbach JD, Crozier S, Seidell J, Baird J, Ball K. Real-life experiments in supermarkets to encourage healthy dietary-related behaviours: opportunities, challenges and lessons learned. Int J Behav Nutr Phys Act 2023; 20:73. [PMID: 37340326 DOI: 10.1186/s12966-023-01448-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 04/04/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Supermarkets are the primary source of food for many people yet their full potential as a setting to encourage healthy dietary-related behaviours remains underutilised. Sharing the experiences from research groups who have worked with supermarket chains to evaluate strategies that promote healthy eating could improve the efficiency of building such relationships and enhance the design quality of future research studies. METHODS A collective case study approach was used to synthesise experiences of engaging and sustaining research collaborations with national supermarket chains to test the effectiveness of health-focused in-store interventions. The collective narrative covers studies conducted in three high-income countries: Australia, the Netherlands and the United Kingdom. RESULTS We have distilled our experiences and lessons learned into six recommendations for conducting high quality public health research with commercial supermarket chains. These include: (i) using personal contacts, knowledge of supermarket activities and engaging executive management to establish a partnership and allowing time to build trust; (ii) using scientifically robust study designs with appropriate sample size calculations; (iii) formalising data exchange arrangements and allocating adequate resource for data extraction and re-categorisation; (iv) assessing effects at individual/households level where possible; (v) designing a mixed-methods process evaluation to measure intervention fidelity, dose and unintended consequences; and (vi) ensuring scientific independence through formal contract agreements. CONCLUSIONS Our collective experiences of working in non-financial partnerships with national supermarket chains could be useful for other research groups looking to develop and implement supermarket studies in an efficient manner. Further evidence from real-life supermarket interventions is necessary to identify sustainable strategies that can improve population diet and maintain necessary commercial outcomes.
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Affiliation(s)
- Christina Vogel
- Centre for Food Policy, City, University of London, Northampton Square, London, EC1V 0HB, UK.
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD, UK.
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.
| | - Coosje Dijkstra
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands.
| | - Marlijn Huitink
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands
| | - Preeti Dhuria
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD, UK
| | - Maartje P Poelman
- Chair group Consumption and Healthy Lifestyles, Wageningen University & Research, P.O. Box 8130, Wageningen, 6700 EW, The Netherlands
| | - Joreintje D Mackenbach
- Department of Epidemiology and Data Science, Amsterdam UMC, location VUmc, Amsterdam Public Health research institute, De Boelelaan 1089a, 1081HV, Amsterdam, the Netherlands
| | - Sarah Crozier
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD, UK
| | - Jacob Seidell
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Kylie Ball
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
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Lau EY, Small SS, Butcher K, Cragg A, Loh GW, Shalansky S, Hohl CM. An external facilitation intervention to increase uptake of an adverse drug event reporting intervention. FRONTIERS IN HEALTH SERVICES 2023; 3:1106586. [PMID: 37332530 PMCID: PMC10272762 DOI: 10.3389/frhs.2023.1106586] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/09/2023] [Indexed: 06/20/2023]
Abstract
Background Adverse drug events (ADEs) are a leading cause of emergency department visits and hospital admissions in Canada. ActionADE prevents repeat ADEs by enabling clinicians to document and communicate standardized ADE information across care settings. We used an external facilitation intervention to promote the uptake of ActionADE in four hospitals in British Columbia, Canada. This study examined whether, how and in what context external facilitation influenced the uptake of ActionADE. Methods In this convergent-parallel mixed-methods study, an external facilitator used a four-step iterative process to support site champions using context-specific implementation strategies to increase the ADE reporting rate at their sites. We extracted archival data to assess implementation determinants before and after the implementation of the external facilitation and implementation strategies. We also retrieved data on the mean monthly counts of reported ADEs for each user from the ActionADE server. Zero-inflated Poisson models were used to examine changes in mean monthly counts of reported ADEs per user between pre-intervention (June 2021 to October 2021) and intervention (November 2021 to March 2022) periods. Results The external facilitator and site champions co-created three functions: (1) educate pharmacists about what and how to report in ActionADE, (2) educate pharmacists about the impact of ActionADE on patient outcomes, and (3) provide social support for pharmacists to integrate ADE reporting into clinical workflows. Site champions used eight forms to address the three functions. Peer support and reporting competition were the two common strategies used by all sites. Sites' responses to external facilitation varied. The rate of mean monthly counts of reported ADEs per user significantly increased during the intervention period compared to the pre-intervention period at LGH (RR: 3.74, 95% CI 2.78 to 5.01) and RH (RR: 1.43, 95% CI 1.23 to 1.94), but did not change at SPH (RR: 0.68, 95% CI: 0.43 to 1.09) and VGH (RR: 1.17, 95% CI 0.92 to 1.49). Leave of absence of the clinical pharmacist champion and failure to address all identified functions were implementation determinants that influenced the effectiveness of external facilitation. Conclusion External facilitation effectively supported researchers and stakeholders to co-create context-specific implementation strategies. It increased ADE reporting at sites where clinical pharmacist champions were available, and where all functions were addressed.
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Affiliation(s)
- Erica Y. Lau
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health Research Centre, Centre for Clinical Epidemiology andEvaluation, Vancouver, BC, Canada
| | - Serena S. Small
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health Research Centre, Centre for Clinical Epidemiology andEvaluation, Vancouver, BC, Canada
| | - Kate Butcher
- Vancouver Coastal Health Research Centre, Centre for Clinical Epidemiology andEvaluation, Vancouver, BC, Canada
- Pharmaceutical Science, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Amber Cragg
- Vancouver Coastal Health Research Centre, Centre for Clinical Epidemiology andEvaluation, Vancouver, BC, Canada
| | - Gabriel W. Loh
- Richmond Hospital Pharmacy Department, Lower Mainland Pharmacy Services, Richmond, BC, Canada
| | - Steve Shalansky
- Pharmacy Department, St. Paul’s Hospital, Providence Health Care, Vancouver, BC, Canada
| | - Corinne M. Hohl
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health Research Centre, Centre for Clinical Epidemiology andEvaluation, Vancouver, BC, Canada
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Geagea D, Tyack Z, Kimble R, Polito V, Ayoub B, Terhune DB, Griffin B. Clinical Hypnosis for Procedural Pain and Distress in Children: A Scoping Review. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:661-702. [PMID: 36448690 PMCID: PMC10233484 DOI: 10.1093/pm/pnac186] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 07/25/2023]
Abstract
OBJECTIVE Pain and distress are common in children undergoing medical procedures, exposing them to acute and chronic biopsychosocial impairments if inadequately treated. Clinical hypnosis has emerged as a potentially beneficial treatment for children's procedural pain and distress due to evidence of effectiveness and potential superiority to other psychological interventions. However, systematic reviews of clinical hypnosis for children's procedural pain and distress have been predominantly conducted in children undergoing oncology and needle procedures and are lacking in broader pediatric contexts. This scoping review maps the evidence of clinical hypnosis for children's procedural pain and distress across broad pediatric contexts while highlighting knowledge gaps and areas requiring further investigation. METHODS Published databases (PubMed, Cochrane Library, PsycINFO, Embase, CINAHL, Scopus, and Web of Science) and grey literature were searched in addition to hand-searching reference lists and key journals (up to May 2022). Two independent reviewers screened the titles and abstracts of search results followed by a full-text review against eligibility criteria. Articles were included if they involved a clinical hypnosis intervention comprising an induction followed by therapeutic suggestions for pain and distress in children undergoing medical procedures. This review followed the Arksey and O'Malley (2005) methodology and incorporated additional scoping review recommendations by the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS A total of 38 eligible studies involving 2,205 children were included after 4,775 articles were screened. Research on clinical hypnosis for children's procedural pain and distress was marked by a lack of fidelity measures and qualitative data as well as by inadequate intervention reporting and high attrition rates. Evidence regarding the safety of clinical hypnosis, pain unpleasantness outcomes, factors influencing outcomes, as well as barriers and facilitators to implementing hypnosis and study procedures was also lacking. Clinical hypnosis has potential benefits for children's procedural pain and distress based on evidence of superiority to control conditions and nonpharmacological interventions (e.g., distraction, acupressure) with moderate to large effect sizes as reported in 76% of studies. However, heterogeneous interventions, contexts, study designs, and populations were identified, and the certainty of the evidence was not evaluated. CONCLUSIONS The review suggests potential benefits of clinical hypnosis for children's procedural pain and distress and thus provides a precursor for further systematic reviews and trials investigating the effectiveness of clinical hypnosis. The review also indicates the need to further explore the feasibility, acceptability, implementation, and safety of clinical hypnosis in children undergoing painful procedures. Based on the review, researchers implementing clinical hypnosis should adequately report interventions or use treatment manuals, follow recommended research guidelines, and assess the fidelity of intervention delivery to promote replicating and comparing interventions. The review also highlights common methodological shortcomings of published trials to avoid, such as the lack of implementation frameworks, small sample sizes, inadequate reporting of standard care or control conditions, and limited evidence on pain unpleasantness outcomes.
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Affiliation(s)
- Dali Geagea
- Child Health Research Centre, Centre for Children's Burns and Trauma Research, The University of Queensland, Brisbane, Australia
| | - Zephanie Tyack
- Child Health Research Centre, Centre for Children's Burns and Trauma Research, The University of Queensland, Brisbane, Australia
- Australian Centre for Health Service Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Queensland Children's Hospital, The University of Queensland, Brisbane, Australia
| | - Vince Polito
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Bassel Ayoub
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Devin B Terhune
- Department of Psychology, Goldsmiths University of London, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Bronwyn Griffin
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
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Sue KL, Chawarski M, Curry L, McNeil R, Coupet E, Schwartz RP, Wilder C, Tsui JI, Hawk KF, D’Onofrio G, O’Connor PG, Fiellin DA, Edelman EJ. Perspectives of Clinicians and Staff at Community-Based Opioid Use Disorder Treatment Settings on Linkages With Emergency Department-Initiated Buprenorphine Programs. JAMA Netw Open 2023; 6:e2312718. [PMID: 37163263 PMCID: PMC10173026 DOI: 10.1001/jamanetworkopen.2023.12718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/24/2023] [Indexed: 05/11/2023] Open
Abstract
Importance An increasing number of emergency departments (EDs) are initiating buprenorphine for opioid use disorder (OUD) and linking patients to ongoing community-based treatment, yet community-based clinician and staff perspectives regarding this practice have not been characterized. Objective To explore perspectives and experiences regarding ED-initiated buprenorphine among community-based clinicians and staff in geographically distinct regions. Design, Setting, and Participants This qualitative study reports findings from Project ED Health, a hybrid type 3 effectiveness-implementation study designed to evaluate the impact of implementation facilitation on ED-initiated buprenorphine with referral to ongoing medication treatment. Clinicians and staff from community-based treatment programs were identified by urban academic EDs as potential referral sites for ongoing OUD treatment in 4 cities across the US in a formative evaluation as having the capability to continue medication treatment. Focus groups were held from April 1, 2018, to January 11, 2019, to examine community OUD treatment clinician and staff perspectives on accepting patients who have received ED-initiated buprenorphine. Data were analyzed from August 2020 to August 2022. Main Outcomes and Measures Data collection and analysis were grounded in the Promoting Action on Research Implementation in Health Services (PARIHS) implementation science framework, focusing on domains including evidence, context, and facilitation. Results A total of 103 individuals (mean [SD] age, 45.3 [12.0] years; 76 female and 64 White) participated in 14 focus groups (groups ranged from 3-22 participants). Participants shared negative attitudes toward buprenorphine and variable attitudes toward ED-initiated buprenorphine. Prominent barriers included the community site treatment capacity and structure as well as payment and regulatory barriers. Perceived factors that could facilitate this model included additional substance use disorder training for ED staff, referrals and communication, greater inclusion of peer navigators, and addressing sociostructural marginalization that patients faced. Conclusions and Relevance In this study of community-based clinicians and staff positioned to deliver OUD treatment, participants reported many barriers to successful linkages for patients who received ED-initiated buprenorphine. Strategies to improve these linkages included educating communities and programs, modeling low-barrier philosophies, and using additional staff trained in addiction as resources to improve transitions from EDs to community partners.
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Affiliation(s)
- Kimberly L. Sue
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Marek Chawarski
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Leslie Curry
- Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Ryan McNeil
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Edouard Coupet
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Christine Wilder
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Judith I. Tsui
- Department of Medicine, University of Washington School of Medicine, Seattle
| | - Kathryn F. Hawk
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Gail D’Onofrio
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Patrick G. O’Connor
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
| | - David A. Fiellin
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut
| | - E. Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut
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Abdullahi L, Hara H, Kahurani E, Kamthunzi V, Nthakomwa L, Oronje R, Madise N. EIDM training as a key intervention among researchers to enhance research uptake and policy engagement: an evaluation study. Wellcome Open Res 2023. [DOI: 10.12688/wellcomeopenres.18018.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In the past decade, the field of Evidence Informed Decision Making (EIDM) has been evolving faster than before. This shows a need for capacity enhancement amongst evidence producers and evidence users in EIDM training. Through the Enhance DELTAS programme, led by the African Institute for Development Policy (AFIDEP), we provided research uptake and policy engagement training, mentorship and webinars to awardees of the Developing Excellence in Leadership, Training and Science (DELTAS) Africa initiative, led by the African Academy of Sciences (AAS). Two workshops were offered to individual early career DELTAS researchers in policy engagement and evidence uptake, referred to as ENHD101, and among research leaders to enhance institutional capacity on policy engagement and evidence uptake, (ENHD102). Overall, over the eight months’ period of training, mentorship and webinars, the programme attracted 31 early career researchers and 20 research leaders. Following the programme, the early career researchers understood the importance of EIDM for better health policies and programmes. In addition, the team appreciated the complexities of the policymaking processes as they developed the policy engagement strategy for their research. The utilisation of the EIDM knowledge was reflected during the mentorship with policy briefs as end product. For research leaders, they appreciated their role in strengthening capacity for EIDM in decision-making spaces. Although during the programme none of the research leaders participated in strengthening capacity for EIDM, the team anticipated improving in the area in the long run. In addition, the research leaders developed and implemented institutional strategies for policy engagement and research uptake through use of social media to influence policymakers. In conclusion, the project supported capacity building of African researchers in EIDM. It was evident that enhancing knowledge and skills on EIDM through an integrated approach to include training, mentorship, and webinars demonstrated enhanced capacity for policy engagement and evidence uptake.
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Eklund M, Argentzell E. Implementing an occupational therapy specific mental health intervention in a multi-professional context - the case of Balancing Everyday Life (BEL). Scand J Occup Ther 2023; 30:182-194. [PMID: 34739360 DOI: 10.1080/11038128.2021.1998608] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The occupation-based intervention Balancing Everyday Life (BEL) was found effective under controlled conditions but should also be studied in a natural clinical practice context. AIM The aim was to study the implementation process of BEL when provided in a multi-professional mental health team. The focus was particularly on how BEL was received and functioned. METHODS This qualitative study was based on manifest content analysis and used semi-structured telephone interviews with 13 occupational therapists and three managers. RESULTS Three themes were identified: '1 - Conditions and opportunities in the setting', '2 - Putting the BEL intervention into practice' and '3 - Experiences of practicing BEL'. BEL was a welcomed alternative, as stated by managers and occupational therapists. The team helped to recruit BEL participants, but the occupational therapists had to give rigorous information to team members and prospective participants for this to work. The social, physical and political contexts were essential for the implementation. CONCLUSIONS Successful implementation of an occupational therapy-specific intervention such as BEL requires a reasonable match between existing team policies and the underpinnings of the intervention. It is crucial to repeat information to all stakeholders and make the intervention a matter of urgency for the whole team.
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Affiliation(s)
- Mona Eklund
- Department of Health Sciences, Mental Health, Activity and Participation (MAP), Lund University, Lund, Sweden
| | - Elisabeth Argentzell
- Department of Health Sciences, Mental Health, Activity and Participation (MAP), Lund University, Lund, Sweden
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Wilderink L, Visscher A, Bakker I, Schuit AJ, Seidell JC, Renders CM. Mechanisms and contextual factors related to key elements of a successful integrated community-based approach aimed at reducing socioeconomic health inequalities in the Netherlands: A realist evaluation perspective. PLoS One 2023; 18:e0284903. [PMID: 37195985 DOI: 10.1371/journal.pone.0284903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/11/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Reducing health inequalities is a challenge for policymakers and civil society. A multisectoral and multilevel approach is most promising to reduce those inequalities. Previous research showed what key elements of Zwolle Healthy City, an integrated community-based approach aimed at reducing socioeconomic health inequalities, are. To fully understand approaches that are complex and context dependent, questions as 'how does the intervention work' and 'in what context does it work' are just as important as 'what works'. The current study aimed to identify mechanisms and contextual factors associated with the key elements of Zwolle Healthy City, using a realist evaluation perspective. METHODS Transcripts of semi-structured interviews with a wide range of local professionals were used (n = 29). Following realist evaluation logic in the analysis of this primary data, context-mechanism-outcome configurations were identified and thereafter discussed with experts (n = 5). RESULTS How mechanisms (M) in certain contexts (C) were of influence on the key elements (O) of the Zwolle Healthy City approach are described. For example, how, in the context of the responsible aldermen embracing the approach (C), regular meetings with the aldermen (M) increased support for the approach among involved professionals (O). Or, how, in the context of available financial resources (C), assigning a program manager (M) contributed positively to coordination and communication (O). All 36 context-mechanism-outcome configurations can be found in the repository. CONCLUSION This study showed what mechanisms and contextual factors are associated with the key elements of Zwolle Healthy City. By applying realist evaluation logic in the analysis of primary qualitative data we were able to disentangle the complexity of processes of this whole system approach and show this complexity in a structured manner. Also, by describing the context in which the Zwolle Healthy City approach is implemented, we contribute to the transferability of this approach across different contexts.
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Affiliation(s)
- Lisa Wilderink
- Department of Health Sciences, Faculty of Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Healthy Society, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Annemijn Visscher
- Research Department of the Municipal Public Health Service Organization Flevoland, Lelystad, The Netherlands
| | - Ingrid Bakker
- Department of Healthy Society, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Albertine J Schuit
- School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Jacob C Seidell
- Department of Health Sciences, Faculty of Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Carry M Renders
- Department of Health Sciences, Faculty of Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Duan Y, Iaconi A, Wang J, Perez JS, Song Y, Chamberlain SA, Shrestha S, Choroschun K, Hoben M, Beeber A, Anderson RA, Cummings GG, Lanham HJ, Norton PG, Estabrooks CA, Berta W. Conceptual and relational advances of the PARIHS and i-PARIHS frameworks over the last decade: a critical interpretive synthesis. Implement Sci 2022; 17:78. [PMID: 36476376 PMCID: PMC9730581 DOI: 10.1186/s13012-022-01254-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The number of research publications reporting the use of the Promoting Action on Research Implementation in Health Services (PARIHS) framework and the integrated PARIHS (i-PARIHS) framework has grown steadily. We asked how the last decade of implementation research, predicated on the (i-)PARIHS framework (referring to the PARIHS or i-PARIHS framework), has contributed to our understanding of the conceptualizations of, relationships between, and dynamics among the core framework elements/sub-elements. Building on the Helfrich et al. (2010) review of research on the PARIHS framework, we undertook a critical interpretive synthesis to: (1) identify conceptual and relational advances in the (i-)PARIHS framework and (2) identify conceptual and relational aspects of the (i-)PARIHS framework that warrant further work. METHODS We performed a systematic search in PubMed/PubMed Central, Ovid MEDLINE, CINAHL, JSTOR, SCOPUS, Web of Science, and PsycInfo. Articles were eligible for synthesis if they (a) were peer-reviewed articles, written in English, and published between January 2009 and December 2021, (b) applied the (i-)PARIHS framework explicitly to guide implementation research, and (c) made conceptual (expanding the conceptualization of core elements) and/or relational contributions (elaborating relationships among elements/sub-elements, or theorizing the relationships using empirical data). We used a critical interpretive synthesis approach to synthesize conceptual-relational advances of the (i-)PARIHS framework. RESULTS Thirty-seven articles were eligible for synthesis. Twenty-four offered conceptual contributions, and 18 offered relational contributions (5 articles contributed in both ways). We found conceptual expansion of all core (i-)PARIHS elements, with most emphasis on context (particularly outer context and leadership), facilitation, and implementation success. Articles also gave insights into the complex relationships and relational dynamism among these elements, characterized as contingent, interactive, multilevel, and temporal effects. CONCLUSIONS We observed developmental advances of the (i-)PARIHS framework and proposed several directions to further advance the framework. Conceptualization of (i-)PARIHS elements (particularly evidence/innovation and recipients) need to be further developed by specifying conceptual and operational definitions of underlying sub-elements. Relationships among (i-)PARIHS elements/sub-elements need to be further elaborated through empirical studies that consider situational contingencies and causal complexities. This will require examining necessity and sufficiency of (i-)PARIHS elements/sub-elements in relation to implementation outcomes, interactions among elements, and mechanism-based explanations.
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Affiliation(s)
- Yinfei Duan
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Alba Iaconi
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Jing Wang
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Janelle Santos Perez
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yuting Song
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | | | - Shovana Shrestha
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Matthias Hoben
- School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Anna Beeber
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Ruth A Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Greta G Cummings
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Holly J Lanham
- Joe R. & Teresa Lozano Long School of Medicine, University of Texas Health, San Antonio, TX, USA
| | - Peter G Norton
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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Improving the Physical Health of Psychiatric Hospital Residents: An Evaluation of an Obesity Education Program for Mental Health Professionals. Healthcare (Basel) 2022; 10:healthcare10101851. [PMID: 36292296 PMCID: PMC9601487 DOI: 10.3390/healthcare10101851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/06/2022] [Accepted: 09/19/2022] [Indexed: 11/19/2022] Open
Abstract
Background: People living with mental health disorders are at increased risk for developing obesity due to poor diet, physical inactivity, and antipsychotic medications. In the United States, the obesity rate is 36% in the general population and more than 50% for people living with mental health disorders. Although mental health clinicians concentrate on managing psychiatric disorders, they seldom recognize the gradual increase in body mass index of their patients. The result is a disconnection between the clinical management of psychiatric disorders and the medical management of obesity. Purpose: This study assessed the effectiveness of an evidence-based education program for improving the obesity management practices of mental health clinicians caring for residents at a state psychiatric hospital. Methods: This was a quasi-experimental study design with a pretest and posttest evaluation. Convenience sampling was used to recruit mental health professionals, or clinicians, at a large psychiatric hospital in the Southern region of the United States. Data was collected with the Advising and Treating Overweight and Obese Patient questionnaire (17 items). Data analysis included descriptive and inferential statistics. The findings were reported in accordance with the TREND and GREET guidelines. Results: The education program was completed by 50 MHCs. The pretest indicated that 76% of MHCs were not involved in helping obese residents manage their weight, but the posttest indicated 90% were involved. There was a significant increase in MHC knowledge about obesity management and reported actions 90-days after the program. MHCs were unable to arrange follow-up visits for residents, a task not directly within their control. Conclusions: Mental health clinicians reported increased knowledge and improved clinical practice after an education program. Because the outcomes were reported at 90-days after the program, further research needs to evaluate the longitudinal impact of this type of program, where the reported behaviors are correlated to process and clinical outcome measures for obesity.
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Ritchie MJ, Drummond KL, Smith BN, Sullivan JL, Landes SJ. Development of a qualitative data analysis codebook informed by the i-PARIHS framework. Implement Sci Commun 2022; 3:98. [PMID: 36104801 PMCID: PMC9476709 DOI: 10.1186/s43058-022-00344-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background The Integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and its predecessor, PARIHS, have been widely utilized in implementation studies. Although i-PARIHS developers have focused on creating tools to guide facilitators in its application in practice, tools are also needed for evaluation and research. Codebooks with clear and meaningful code labels and definitions are an important component of qualitative data analysis and have been developed for other widely used frameworks. There is no such codebook for i-PARIHS. Additionally, sub-constructs for the Innovation, Recipients, and Context constructs lack definitions, and there is no sub-classification of facilitation activities for the Facilitation construct. The lack of a standardized codebook hinders our ability to synthesize research findings across studies, explore and test the range of activities that are utilized in facilitation efforts, and potentially validate and further refine i-PARIHS. This paper describes a rigorous process of developing a detailed qualitative codebook informed by the i-PARIHS framework. Methods A workgroup of qualitative researchers conducted a rigorous four-phase process to develop a codebook informed by i-PARIHS. In phase 1, workgroup members reviewed and discussed literature, consulted an organizational scientist, and drafted and refined subcodes and definitions for i-PARIHS constructs. In phase 2, they obtained feedback from an expert panel and further refined subcodes and definitions. In phase 3, they obtained feedback from i-PARIHS developers/experts and incorporated it into the codebook. Finally, two studies piloted the application of the codebook which informed the final version. Results The resulting i-PARIHS-informed codebook includes definitions for the four main constructs of the framework: Innovation, Recipients, Context, and Facilitation; subcodes and definitions for characteristics of each of these constructs; and instructions for the suggested application of individual codes and use of the codebook generally. Conclusions The standardized codes and definitions in the codebook can facilitate data exploration, pattern identification, and insight development informed by the i-PARIHS framework. Qualitative analysts can also use them to explore interactions between i-PARIHS constructs, maximize the potential for comparing findings across studies, and support the refinement of the i-PARIHS framework using empirical findings from multiple studies. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00344-9.
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Erichsen Andersson A, Gillespie BM, Karlsson M, Malchau H, Nellgård B, Wikström E, Rogmark C, Tillander J. Reduction of early surgical site and other care related infections in 3553 hip fracture patients: lessons learned from the 5-year Safe Hands project. Antimicrob Resist Infect Control 2022; 11:113. [PMID: 36064457 PMCID: PMC9444111 DOI: 10.1186/s13756-022-01153-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background Surgical site infection (SSI) after acute hip fracture surgery is a devastating complication associated with increased suffering and mortality. The aim of the study was to investigate early SSI, sepsis, pneumonia and urinary tract infections over five years, before and after the implementation of the Safe Hands project. Methods This was a single-centre observational study with a 5-year longitudinal design, investigating the effects of an infection-prevention intervention targeting the clinical care pathway of individuals with acute hip fracture. Statistical analyses were based on routinely collected patient outcome data comprising 3553 patients. The study conforms to the criteria of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Results The incidence of early SSIs decreased from 2.5% in years 1–2 to 1.1% in years 4–5. Similar results were observed for sepsis (2.7% to 1.3%) and urinary tract infections (14.2% to 4.2%). The multivariable regression results suggest that, for every observed year, the odds of early SSIs decreased. Male gender, procedure time, sepsis and preoperative skin damage increased the odds significantly.
Conclusions Our preventive bundle, based on partnership between researchers, managers and clinicians and a strong commitment to change from the involved professions, appear to be effective in reducing the frequency of potentially devastating SSIs and other hospital acquired infections after hip fracture surgery. The use of external and internal facilitators was crucial to enable individual and organisational learning and overcoming barriers to improvements.
Trial registration: Clinical Trials.gov ID: NCT02983136 Registered 6 December 2016—Retrospectively registered.
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Gately ME, Quach ED, Shirk SD, Trudeau SA. Understanding Variation in Adoption of Video Telehealth and Implications for Health Care Systems. MEDICAL RESEARCH ARCHIVES 2022; 10:10.18103/mra.v10i5.2751. [PMID: 36405543 PMCID: PMC9670247 DOI: 10.18103/mra.v10i5.2751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Telehealth has rapidly expanded since COVID-19. Veterans Health Administration (VHA), the largest integrated health care system in the United States, was well-positioned to incorporate telehealth across specialties due to existing policies and infrastructure. OBJECTIVES The objective of this study is to investigate predictors of occupational therapy (OT) practitioners' adoption of video telehealth. METHODS This study presents data from a convenience sample of VHA occupational therapy (OT) practitioners administered pre-pandemic, in fall 2019. Survey development was guided by the Promoting Action on Research Implementation in Health Services framework, and gathered clinician attitudes, experiences, and perspectives about video telehealth to deliver OT services. Items included telehealth usage, perceived effectiveness of specific OT interventions, and perceptions about evidence. Our outcome variable denoted practitioners' level of adoption of video telehealth: telehealth users (adopters), non-users who want to use telehealth (potential adopters and reference group), and non-users who do not want to use telehealth (non-adopters). In multiple multinomial logistic regressions, we tested whether level of adoption was associated with years of VHA work experience and perceived strength of evidence. RESULTS Of approximately 1455 eligible practitioners, 305 VHA occupational therapy practitioners participated in the survey (21% response rate). One hundred and twenty-five (41%) reported using video telehealth, whereas 180 (59%) reported not using video telehealth. Among non-users, 107 (59%) indicated willingness to adopt telehealth whereas 73 (41%) were not willing. More VHA work experience predicted higher odds of being an adopter than a potential adopter; perceptions of stronger evidence regarding video telehealth predicted higher odds of being a potential adopter than a non-adopter. CONCLUSION Clinician beliefs and years of experience exerted an influence on clinicians' use or willingness to use video telehealth. Efforts to enhance adoption of video telehealth should address clinicians' beliefs regarding the innovative nature of and organizational resources necessary to foster utilization.
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Affiliation(s)
- Megan E Gately
- Geriatric Research Education and Clinical Center, VA Bedford Healthcare System Bedford, MA
| | - Emma D Quach
- Geriatric Research Education and Clinical Center, VA Bedford Healthcare System Bedford, MA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
- Department of Gerontology, University of Massachusetts Boston
| | - Steven D Shirk
- VA Bedford Healthcare System, Bedford, MA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Scott A Trudeau
- Geriatric Research Education and Clinical Center, VA Bedford Healthcare System Bedford, MA
- American Occupational Therapy Association, Bethesda, MD
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Yamokoski C, Barron S, Fowler J, Fast E, Flores H. Barriers and Facilitators to the Implementation of Intensive Treatments for PTSD: Early Lessons Learned From the Field. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Mosch LK, Poncette AS, Spies C, Weber-Carstens S, Schieler M, Krampe H, Balzer F. Creation of an Evidence-Based Implementation Framework for Digital Health Technology in the Intensive Care Unit: Qualitative Study. JMIR Form Res 2022; 6:e22866. [PMID: 35394445 PMCID: PMC9034425 DOI: 10.2196/22866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 02/01/2021] [Accepted: 11/27/2021] [Indexed: 12/01/2022] Open
Abstract
Background Digital health technologies such as continuous remote monitoring and artificial intelligence–driven clinical decision support systems could improve clinical outcomes in intensive care medicine. However, comprehensive evidence and guidelines for the successful implementation of digital health technologies into specific clinical settings such as the intensive care unit (ICU) are scarce. We evaluated the implementation of a remote patient monitoring platform and derived a framework proposal for the implementation of digital health technology in an ICU. Objective This study aims to investigate barriers and facilitators to the implementation of a remote patient monitoring technology and to develop a proposal for an implementation framework for digital health technology in the ICU. Methods This study was conducted from May 2018 to March 2020 during the implementation of a tablet computer–based remote patient monitoring system. The system was installed in the ICU of a large German university hospital as a supplementary monitoring device. Following a hybrid qualitative approach with inductive and deductive elements, we used the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change to analyze the transcripts of 7 semistructured interviews with clinical ICU stakeholders and descriptive questionnaire data. The results of the qualitative analysis, together with the findings from informal meetings, field observations, and previous explorations, provided the basis for the derivation of the proposed framework. Results This study revealed an insufficient implementation process due to lack of staff engagement and few perceived benefits from the novel solution. Further implementation barriers were the high staff presence and monitoring coverage in the ICU. The implementation framework includes strategies to be applied before and during implementation, targeting the implementation setting by involving all ICU stakeholders, assessing the intervention’s adaptability, facilitating the implementation process, and maintaining a vital feedback culture. Setting up a unit responsible for implementation, considering the guidance of an implementation advisor, and building on existing institutional capacities could improve the institutional context of implementation projects in the ICU. Conclusions Implementation of digital health in the ICU should involve a thorough preimplementation assessment of the ICU’s need for innovation and its readiness to change, as well as an ongoing evaluation of the implementation conditions. Involvement of all stakeholders, transparent communication, and continuous feedback in an equal atmosphere are essential, but leadership roles must be clearly defined and competently filled. Our proposed framework may guide health care providers with concrete, evidence-based, and step-by-step recommendations for implementation practice, facilitating the introduction of digital health in intensive care. Trial Registration ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173
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Affiliation(s)
- Lina Katharina Mosch
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Akira-Sebastian Poncette
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Monique Schieler
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Henning Krampe
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Balzer
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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22
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Mathisen TS, Eilertsen G, Ormstad H, Falkenberg HK. 'If we don't assess the patient's vision, we risk starting at the wrong end': a qualitative evaluation of a stroke service knowledge translation project. BMC Health Serv Res 2022; 22:351. [PMID: 35296327 PMCID: PMC8925164 DOI: 10.1186/s12913-022-07732-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/22/2022] [Indexed: 12/29/2022] Open
Abstract
Background Visual impairments (VIs) affect 60% of stroke survivors and have negative consequences for rehabilitation and quality of life poststroke. Symptoms of VIs post stroke are difficult to identify for stroke survivors and health care professionals without using a structured vision assessment. In this study, we qualitatively evaluate the implementation outcomes after implementing a structured visual assessment with the Competence, Rehabilitation of Sight after Stroke Vision (KROSS) assessment tool in stroke care services. Methods This is a qualitative study comprising four focus group interviews. The health care personnel (HCP) involved in the implementation or with experience using the KROSS assessment tool in practice were invited to participate. We used Proctor et al.’s definitions of implementation outcomes as a framework, which informed the interview guide and analysis. We used a deductive - inductive content analysis, as described by Elo and Kyngäs. Results The participants found the structured vision assessment with the KROSS tool as being acceptable; they expressed a motivation and intention to use the new routine in practice. They believed it was important to assess their patient’s visual function because it influenced other rehabilitation activities and activities of daily living. Most of the participants reported having adopted the vision assessment in their practice, except for those participants from the home care services who experienced that they have few stroke survivors to follow up on. The assessment was believed to be more appropriate to perform within the rehabilitation services where there is more of a focus on functional assessments. Although vision assessment was new to all the participants, they felt that they improved their vision assessment skills by regularly using the assessment tool. Together with sufficient instructions and supervision, they believed that vison assessment was feasible for their practise. Including the vison assessment in the existing routines and systems was important to promote sustainable implementation. Conclusion Implementing a structured vision assessment with the KROSS tool in health care services was experienced as acceptable and feasible. The new routine led to increased attention towards poststroke VIs and increased collaboration with vision experts. Tailoring the routine to each practice and how they organise their work can support the integration of a vision assessment in their routines. To promote better vision care poststroke vision assessment and follow up should be included in the stroke care pathways. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07732-w.
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Affiliation(s)
- Torgeir S Mathisen
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Hasbergs vei 36, 3616, Kongsberg, Norway. .,USN Research Group of Older Peoples' Health, University of South-Eastern Norway, Drammen, Norway.
| | - Grethe Eilertsen
- USN Research Group of Older Peoples' Health, University of South-Eastern Norway, Drammen, Norway.,Department of Nursing and Health Science, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Heidi Ormstad
- Department of Nursing and Health Science, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Helle K Falkenberg
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Hasbergs vei 36, 3616, Kongsberg, Norway.,USN Research Group of Older Peoples' Health, University of South-Eastern Norway, Drammen, Norway
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23
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Doupe M, Brunkert T, Wagg A, Ginsburg L, Norton P, Berta W, Knopp-Sihota J, Estabrooks C. SCOPE: safer care for older persons (in residential) environments-a pilot study to enhance care aide-led quality improvement in nursing homes. Pilot Feasibility Stud 2022; 8:26. [PMID: 35115053 PMCID: PMC8812152 DOI: 10.1186/s40814-022-00975-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 01/11/2022] [Indexed: 12/26/2022] Open
Abstract
Background Nursing home residents require daily support. While care aides provide most of this support they are rarely empowered to lead quality improvement (QI) initiatives. Researchers have shown that care aide-led teams can successfully participate in a QI intervention called Safer Care for Older Persons in Residential Care Environments (SCOPE). In preparation for a large-scale study, we conducted a 1-year pilot to evaluate how well coaching strategies helped teams to enact this intervention. Secondarily, we measured if improvements in team cohesion and communication, and resident quality of care, occurred. Methods This study was conducted using a prospective single-arm study design, on 7 nursing homes in Winnipeg Manitoba belonging to the Translating Research in Elder Care research program. One QI team was selected per site, led by care aides who partnered with other front-line staff. Each team received facilitated coaching to enact SCOPE during three learning sessions, and additional support from quality advisors between these sessions. Researchers developed a rubric to evaluate how well teams enacted their interventions (i.e., created actionable aim statements, implemented interventions using plan-do-study-act cycles, and used measurement to guide decision-making). Team cohesion and communication were measured using surveys, and changes in unit-level quality indicators were measured using Resident Assessment Instrument-Minimum Data Set data. Results Most teams successfully enacted their interventions. Five of 7 teams created adequate-to-excellent aim statements. While 6 of 7 teams successfully implemented plan-do-study-act cycles, only 2 reported spreading their change ideas to other residents and staff on their unit. Three of 7 teams explicitly stated how measurement was used to guide intervention decisions. Teams scored high in cohesion and communication at baseline, and hence improved minimally. Indicators of resident quality care improved in 4 nursing home units; teams at 3 of these sites were scored as ‘excellent’ in two or more enactment areas, versus 1 of the 3 remaining teams. Conclusions Our coaching strategies helped most care aide-led teams to enact SCOPE. Coaching modifications are needed to help teams more effectively use measurement. Refinements to our evaluation rubric are also recommended. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-00975-8.
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Affiliation(s)
- Malcolm Doupe
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Thekla Brunkert
- University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland.,Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Adrian Wagg
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Liane Ginsburg
- School of Health Policy & Management, York University, Toronto, Canada
| | - Peter Norton
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Whitney Berta
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
| | | | - Carole Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Lockwood I, Walker RM, Latimer S, Chaboyer W, Cooke M, Gillespie BM. Process evaluations undertaken alongside randomised controlled trials in the hospital setting: A scoping review. Contemp Clin Trials Commun 2022; 26:100894. [PMID: 36684693 PMCID: PMC9846456 DOI: 10.1016/j.conctc.2022.100894] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 11/09/2021] [Accepted: 01/17/2022] [Indexed: 01/25/2023] Open
Abstract
Background There is increasing recognition of the importance of undertaking process evaluations alongside implementation of health interventions by examining mechanisms of impact and contextual factors. However, a comprehensive synthesis of process evaluations undertaken alongside clinical trials in hospital settings is lacking. We undertook a scoping review to address this gap. Methods This review was guided by the methodological framework for scoping studies. Studies were identified using four databases; Ovid Medline, EBSCO CINAHL, EMBASE and Scopus. Two authors independently screened all titles and available abstracts, with a third author available to adjudicate. Studies were eligible for inclusion if they described a process evaluation undertaken alongside a randomised controlled trial in the hospital setting. Data were abstracted by one author and checked by two others and analysed both descriptively and using inductive content analysis. Results Data were extracted from 30 articles reporting on 15 trials, most of which were cluster randomised trials (c-RTs) (n = 12). The most common data collection methods used in process evaluations were interviews, questionnaires or surveys, and records or logs. Data analysis revealed three themes relative to how authors: use process data to interpret, understand and explain trial outcomes; evaluate responses to the intervention; and consider the implementation context. Conclusions Findings from this review demonstrate the complex nature of intervention implementation in the hospital setting. Overall, there is need for standardised reporting of process evaluations and more explicit descriptions of how authors use frameworks to guide their evaluation.
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Affiliation(s)
- Ishtar Lockwood
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Australia,School of Nursing and Midwifery, Griffith University, Brisbane and Gold Coast, Australia
| | - Rachel M. Walker
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Australia,School of Nursing and Midwifery, Griffith University, Brisbane and Gold Coast, Australia,Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Sharon Latimer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Australia,School of Nursing and Midwifery, Griffith University, Brisbane and Gold Coast, Australia,Gold Coast University Hospital, Southport, Queensland, Australia,Corresponding author. Building L05, Room 3.44, Griffith University, Logan, Queensland, 4131, Australia.
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Australia,School of Nursing and Midwifery, Griffith University, Brisbane and Gold Coast, Australia
| | - Marie Cooke
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Australia,School of Nursing and Midwifery, Griffith University, Brisbane and Gold Coast, Australia
| | - Brigid M. Gillespie
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Australia,School of Nursing and Midwifery, Griffith University, Brisbane and Gold Coast, Australia,Gold Coast University Hospital, Southport, Queensland, Australia
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25
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Hawk K, McCormack R, Edelman EJ, Coupet E, Toledo N, Gauthier P, Rotrosen J, Chawarski M, Martel S, Owens P, Pantalon MV, O’Connor P, Whiteside LK, Cowan E, Richardson LD, Lyons MS, Rothman R, Marsch L, Fiellin DA, D’Onofrio G. Perspectives About Emergency Department Care Encounters Among Adults With Opioid Use Disorder. JAMA Netw Open 2022; 5:e2144955. [PMID: 35076700 PMCID: PMC8790663 DOI: 10.1001/jamanetworkopen.2021.44955] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Emergency departments (EDs) are increasingly initiating treatment for patients with untreated opioid use disorder (OUD) and linking them to ongoing addiction care. To our knowledge, patient perspectives related to their ED visit have not been characterized and may influence their access to and interest in OUD treatment. OBJECTIVE To assess the experiences and perspectives regarding ED-initiated health care and OUD treatment among US patients with untreated OUD seen in the ED. DESIGN, SETTING, AND PARTICIPANTS This qualitative study, conducted as part of 2 studies (Project ED Health and ED-CONNECT), included individuals with untreated OUD who were recruited during an ED visit in EDs at 4 urban academic centers, 1 public safety net hospital, and 1 rural critical access hospital in 5 disparate US regions. Focus groups were conducted between June 2018 and January 2019. MAIN OUTCOMES AND MEASURES Data collection and thematic analysis were grounded in the Promoting Action on Research Implementation in Health Services (PARIHS) implementation science framework with evidence (perspectives on ED care), context (ED), and facilitation (what is needed to promote change) elements. RESULTS A total of 31 individuals (mean [SD] age, 43.4 [11.0] years) participated in 6 focus groups. Twenty participants (64.5%) identified as male and most 13 (41.9%) as White; 17 (54.8%) reported being unemployed. Themes related to evidence included patients' experience of stigma and perceived minimization of their pain and medical problems by ED staff. Themes about context included the ED not being seen as a source of OUD treatment initiation and patient readiness to initiate treatment being multifaceted, time sensitive, and related to internal and external patient factors. Themes related to facilitation of improved care of patients with OUD seen in the ED included a need for on-demand treatment and ED staff training. CONCLUSIONS AND RELEVANCE In this qualitative study, patients with OUD reported feeling stigmatized and minimized when accessing care in the ED and identified several opportunities to improve care. The findings suggest that strategies to address stigma, acknowledge and treat pain, and provide ED staff training should be implemented to improve ED care for patients with OUD and enhance access to life-saving treatment.
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Affiliation(s)
- Kathryn Hawk
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale School of Public Health, New Haven, Connecticut
- Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Ryan McCormack
- Department of Emergency Medicine, NYU Grossman School of Medicine, New York
| | - E. Jennifer Edelman
- Yale School of Public Health, New Haven, Connecticut
- Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Edouard Coupet
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Nicolle Toledo
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Phoebe Gauthier
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - John Rotrosen
- Department of Psychiatry, NYU Grossman School of Medicine, New York
| | - Marek Chawarski
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Shara Martel
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Patricia Owens
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Michael V. Pantalon
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Patrick O’Connor
- Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Lauren K. Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle
| | - Ethan Cowan
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lynne D. Richardson
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael S. Lyons
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Center for Addiction Research, University of Cincinnati, Cincinnati, Ohio
| | - Richard Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa Marsch
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - David A. Fiellin
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale School of Public Health, New Haven, Connecticut
- Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Gail D’Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale School of Public Health, New Haven, Connecticut
- Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut
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26
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He S, Lim CYS, Dhillon HM, Shaw J. Australian oncology health professionals' knowledge, perceptions, and clinical practice related to cancer-related cognitive impairment and utility of a factsheet. Support Care Cancer 2022; 30:4729-4738. [PMID: 35122530 PMCID: PMC9046357 DOI: 10.1007/s00520-022-06868-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/24/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Cancer-related cognitive impairment (CRCI) can have debilitating effects on cancer survivors' quality of life. Despite this, patients often report a lack of information provided by health professionals (HPs) to assist with understanding and managing cognitive changes. This study aimed to explore Australian oncology HPs' understanding of and clinical practice related to CRCI including the use of a Cancer Council Australia CRCI factsheet. METHODS Australian oncology HPs (medical oncologists, cancer nurses, and clinical psychologists) completed a questionnaire that assessed CRCI knowledge, prior to receiving the factsheet. Semi-structured interviews were conducted to explore their perceptions of CRCI and the factsheet. Interviews were recorded, transcribed, and analyzed using framework analysis to identify key themes. RESULTS Questionnaires were completed by twenty-nine HPs. Most HPs had moderate to high knowledge of CRCI, yet low knowledge of the relationship between CRCI and cancer. Twenty-six (response rate 90%) HPs; medical oncologists (n = 7), cancer nurses (n = 12), and clinical psychologists (n = 7), consented to be interviewed. Three main themes were identified: (1) Is CRCI impact real or over-rated?; (2) If it is important, they will tell me: identifying and responding to CRCI in clinical practice; and (3) Using a factsheet in clinical practice. CONCLUSION This study's multi-disciplinary exploration of Australian oncology HPs' perceptions of CRCI highlighted that health professional perceptions drive CRCI discussions with patients. Further education to support clinicians to discuss CRCI is required. Consideration of the barriers and facilitators within healthcare settings is important for successful integration of the factsheet into routine care.
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Affiliation(s)
- Sharon He
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW Australia ,Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW Australia
| | - Chloe Yi Shing Lim
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW Australia ,Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW Australia
| | - Haryana M. Dhillon
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW Australia ,Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW Australia ,Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW Australia
| | - Joanne Shaw
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW Australia ,Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW Australia
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27
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Metz A, Kainz K, Boaz A. Intervening for sustainable change: Tailoring strategies to align with values and principles of communities. FRONTIERS IN HEALTH SERVICES 2022; 2:959386. [PMID: 36925846 PMCID: PMC10012724 DOI: 10.3389/frhs.2022.959386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/05/2022] [Indexed: 01/19/2023]
Abstract
This paper presents a rationale for tailoring implementation strategies within a values-driven implementation approach. Values-driven implementation seeks to organize implementers around clarifying statements of their shared values in ways that harmonize implementation dynamics related to individual and group mental models, relationships among implementers, and the implementation climate. The proposed approach to tailoring strategies is informed by systems theory and emphasizes the need to focus on both tangible events and behaviors, as well deeper patterns, structures, relationships, and mental models, in order to increase the likelihood of sustaining implementation efforts and improving outcomes for people and communities. We offer for consideration three specific sets of context determinants that are under-represented in the implementation literature and that emerge as especially relevant within a systems approach to identifying and successfully tailoring implementation strategies in the implementation setting including relationships, mental models, and implementation climate.
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Affiliation(s)
- Allison Metz
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kirsten Kainz
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Annette Boaz
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, England
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28
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Metz A, Jensen T, Farley A, Boaz A. Is implementation research out of step with implementation practice? Pathways to effective implementation support over the last decade. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221105585. [PMID: 37091077 PMCID: PMC9978647 DOI: 10.1177/26334895221105585] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: There is growing interest in the lived experience of professionals who provide implementation support (i.e., implementation support practitioners). However, there remains limited knowledge about their experiences and how those experiences can contribute to the knowledge base on what constitutes successful and sustainable implementation support models. This study aimed to examine pathways of implementation support practice, as described by experienced professionals actively supporting systems' uptake and sustainment of evidence to benefit children and families. Methods: Seventeen individuals with extensive experience providing implementation support in various settings participated in semi-structured interviews. Data were analyzed using qualitative content analysis and episode profile analysis approaches. Iterative diagramming was used to visualize the various pathways of implementation support practitioners' role reflection and transformation evidenced by the interview data. Results: Findings highlighted rich pathways of implementation support practitioners' role reflection and transformation. Participants described their roots in providing implementation support as it relates to implementing and expanding the use of evidence-based programs and practices in child and family services. Almost all participants reflected on the early stages of their careers providing implementation support and described a trajectory starting with the use of "push models," which evolved into "pull models" and eventually "co-creation or exchange models" of implementation support involving both technical and relational skills. Conclusions: Developing an implementation support workforce will require a deeper understanding of this lived experience to prevent repeated use of strategies observed to be unsuccessful by those most proximal to the work. The pathways for implementation practice in this study highlight impressive leaps forward in the field of implementation over the last 15 years and speaks to the importance of the professionals leading change efforts in this growth. Plain Language Summary Over the past few years, professionals in the field of implementation science have identified a growing gap between implementation research and implementation practice. While this issue has been highlighted informally, the field is lacking a shared understanding and clear way forward to reconcile this gap. In this paper, the authors describe how professionals providing implementation support have shifted their implementation practice over time through systematic observations of what works (and what does not work) for supporting and sustaining evidence use in service systems to improve population outcomes. The authors share the impressive leaps forward made in the field of implementation practice - from didactic training to responsive and tailored implementation strategies to co-created and relationship-based implementation solutions. The paper concludes with a call to action to the field for the creation of a virtuous learning cycle between professionals conducting implementation research and professionals providing implementation support to change practice as a way to produce a more robust and relevant science of implementation.
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Affiliation(s)
- Allison Metz
- School of Social Work, University of North Carolina at Chapel
Hill, Chapel Hill, NC, USA
| | - Todd Jensen
- School of Social Work, University of North Carolina at Chapel
Hill, Chapel Hill, NC, USA
| | - Amanda Farley
- School of Social Work, University of North Carolina at Chapel
Hill, Chapel Hill, NC, USA
| | - Annette Boaz
- Department of Health Services Research and Policy, London School of Hygiene and Tropical
Medicine, London, UK
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Ungar M, Jefferies P. Becoming More Rugged and Better Resourced: The R2 Resilience Program's© Psychosocial Approach to Thriving. Front Psychol 2021; 12:745283. [PMID: 34955964 PMCID: PMC8702437 DOI: 10.3389/fpsyg.2021.745283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
The past decade has seen growing interest in interventions that build resilience as a complementary practice to trauma-informed care. From school-based programs focused on self-regulation and academic success to programs that support the well-being of disadvantaged populations or healthcare workers at risk of burnout, the concept of resilience is being used most commonly for programming that builds the capacity of individuals to adapt under conditions of adversity. Critiques have raised concerns that resilience-promoting programs demonstrate bias toward changing individual-level factors such as cognitions (e.g., mindfulness and grit), behavior (e.g., expressing gratitude and changing personal routines), or attachments (e.g., feeling secure in relationships) which help people adapt to socially toxic situations without changing access to the resources they require to overcome exposure to adverse psychosocial factors. This trend belies advances to the theory of resilience which support a more contextualized, multisystemic understanding of how external protective factors (resources) enhance individual qualities (ruggedness) and vice versa. Building on a multisystemic description of resilience, the R2 Resilience Program© was developed and piloted with six different populations ranging from clients of urban social services to workers in a long-term care facility, managers in the health care sector, staff of a Fortune 500 corporation, students in a primary to grade 12 school, and adult volunteers affiliated with an international NGO. Focused on building both individual ruggedness and enhancing people's resources (the two Rs), the program provides contextualized content for each population by selecting from 52 resilience promoting factors with a strong evidence base to create training curricula that enhance the personal qualities and social, physical, and institutional resources most likely to support resilience. This paper reviews the justification for a multisystemic approach to designing resilience interventions and then explains the process of implementation of the R2 program. Preliminary findings are reported, which suggest the program is experienced as effective, with evaluations ongoing.
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Affiliation(s)
- Michael Ungar
- Faculty of Health, Resilience Research Centre, Dalhousie University, Halifax, NS, Canada
| | - Philip Jefferies
- Faculty of Health, Resilience Research Centre, Dalhousie University, Halifax, NS, Canada
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Radbron E, Middleton R, Wilson V, McCance T. How nurses and midwives engage with patient experience data to inform person-centred quality and safety improvements. J Clin Nurs 2021; 31:3464-3476. [PMID: 34897879 DOI: 10.1111/jocn.16173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 11/25/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore how nurses and midwives engage with patient experience data collected via a mobile health app to inform person-centred practice improvements. BACKGROUND A large amount of data is collected in healthcare, yet there is limited evidence outlining how nursing and midwifery staff utilise patient experience data to inform person-centred quality and safety improvements. METHODS This study utilised action research, underpinned by Practice Development methodology and has been reported using the SQUIRE 2.0 checklist. Six clinical units (medical short stay, acute medical, surgical, oncology/haematology, day surgery and maternity) in a large health district in Australia engaged in three cycles of data collection using a mobile health app. The app captured patient experience data relating to the person-centred KPIs developed and tested by McCance et al. (2012). Staff used the data to develop and evaluate person-centred practice. RESULTS A number of improvements in scores and practice occurred through engaging with the data in a cyclical way. All six clinical units saw an improvement in four or more of the KPIs in the patient survey results from cycle one to cycle three, with two clinical units improving in all eight. On average across the six units, there was also an increase in time nurses/midwives were visible to their patients, an increase in clinical documentation reflecting the patients' needs and what was important to them, an increase in positive comments and a decrease in negative comments in patient stories. CONCLUSION This study shows that collecting and utilising data from the person-centred KPIs in a collaborative and cyclical way lead to enhanced patient experience and the development and implementation of person-centred quality and safety improvements. RELEVANCE TO CLINICAL PRACTICE Capturing and utilising data that are meaningful to nursing/midwifery teams in a cyclical, action-orientated approach result in person-centred practice improvements that enhance the experience of those that are receiving and delivering patient care.
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Affiliation(s)
- Emma Radbron
- PhD Candidate, School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia.,Nurse Manager-iMPAKT Study, Nursing and Midwifery Research Unit Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Rebekkah Middleton
- Senior Lecturer, Faculty of Science, Medicine and Health, School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Valerie Wilson
- Professor of Nursing, Nursing and Midwifery Research Unit, Illawarra Shoalhaven Local Health District and University of Wollongong, Wollongong, New South Wales, Australia
| | - Tanya McCance
- The Mona Grey Professor of Nursing, Nursing Research & Development, University of Ulster, Jordanstown, Northern Ireland
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Geagea D, Tyack Z, Kimble R, Eriksson L, Polito V, Griffin B. Hypnotherapy for Procedural Pain and Distress in Children: A Scoping Review Protocol. PAIN MEDICINE (MALDEN, MASS.) 2021; 22:2818-2826. [PMID: 33528510 PMCID: PMC8665999 DOI: 10.1093/pm/pnab038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Inadequately treated pain and distress elicited by medical procedures can put children at higher risk of acute and chronic biopsychosocial sequelae. Children can benefit from hypnotherapy, a psychologically tailored intervention, as an adjunct to pharmacological agents to address the multiple components of pain and distress. Despite providing evidence on the effectiveness and potential superiority of hypnotherapy to other psychological interventions, research on hypnotherapy for pediatric procedural pain and distress has been predominantly limited to oncology and needle procedures. Plus, there is a lack of reporting of intervention manuals, factors influencing hypnotic responding, pain unpleasantness outcomes, theoretical frameworks, adverse events, as well as barriers and facilitators to the feasibility of delivering the intervention and study procedures. The proposed review aims to map the range and nature of the evidence on hypnotherapy for procedural pain and distress in children to identify gaps in literature and areas requiring further investigation. METHODS This review will follow the Arksey and O'Malley (2005) methodology and incorporate additional scoping review recommendations by the Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses. Relevant studies will be identified through searching published literature databases (PubMed, Cochrane Library, PsycINFO, Embase, CINAHL, Scopus and Web of Science) and grey literature in addition to hand-searching of reference lists and key journals. Two authors will independently screen titles and abstracts of search results followed by full-texts review against eligibility criteria. CONCLUSION Findings are anticipated to guide future research and inform the development of tailored hypnotic interventions in children.
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Affiliation(s)
- Daly Geagea
- Centre for Children’s Burns and Trauma Research, The University of Queensland, Brisbane, Australia
| | - Zephanie Tyack
- Centre for Children’s Burns and Trauma Research, The University of Queensland, Brisbane, Australia
| | - Roy Kimble
- Centre for Children’s Burns and Trauma Research, The University of Queensland, Brisbane, Australia
| | - Lars Eriksson
- Herston Health Sciences Library, The University of Queensland, Brisbane, Australia
| | - Vince Polito
- Department of Cognitive Science, Macquarie University, Sydney, Australia
| | - Bronwyn Griffin
- Centre for Children’s Burns and Trauma Research, The University of Queensland, Brisbane, Australia
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Kelly RJ, Hearld LR. Burnout and Leadership Style in Behavioral Health Care: a Literature Review. J Behav Health Serv Res 2021; 47:581-600. [PMID: 32189184 PMCID: PMC7223098 DOI: 10.1007/s11414-019-09679-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Burnout among behavioral health care providers and employees is associated with poor patient and provider outcomes. Leadership style has generally been identified as a means of reducing burnout, yet it is unclear whether some leadership styles are more effective than others at mitigating burnout. Additionally, behavioral health care is provided in a variety of contexts and a leadership style employed in one context may not be effective in another. The purpose of this paper was to review the literature on leadership style and burnout in behavioral health care contexts to identify the different leadership styles and contexts in which the relationship between the two constructs was studied. Studies were categorized based on the leadership style, study design, research methods, and study context. Findings of this review provide insights into potential approaches to prevent employee burnout and its attending costs, as well as ways to improve future research in this critical area.
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Affiliation(s)
- Reena Joseph Kelly
- Department of Health Services Administration, University of Alabama at Birmingham, 1716 9th Ave. S., SHPB 547, Birmingham, AL, 35233, USA.
| | - Larry R Hearld
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, 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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Blanco-Mavillard I, de Pedro-Gómez JE, Rodríguez-Calero MÁ, Bennasar-Veny M, Parra-García G, Fernández-Fernández I, Bujalance-Hoyos J, Moya-Suárez AB, Cobo-Sánchez JL, Ferrer-Cruz F, Castro-Sánchez E. Multimodal intervention for preventing peripheral intravenous catheter failure in adults (PREBACP): a multicentre, cluster-randomised, controlled trial. LANCET HAEMATOLOGY 2021; 8:e637-e647. [PMID: 34450101 DOI: 10.1016/s2352-3026(21)00206-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND 2 billion peripheral intravenous catheters (PIVC) are inserted into inpatients worldwide each year. Almost one in two PIVCs fail before completion of intravenous therapy. We aimed to determine the efficacy and costs of a multimodal intervention to reduce PIVC failure among hospitalised patients. METHODS PREBACP was a cluster-randomised, controlled trial done at seven public hospitals in Spain. Clusters (hospital wards) had at least 70% permanent staff and data were collected from patients aged 18 years and older with one or more PIVCs at the start of intravenous therapy. Clusters were randomly assigned (1:1) to the multimodal intervention or control group using a centralised, web-based randomisation software, and stratified by type of setting. We concealed randomisation to allocation, without masking patients or professionals to the intervention. An intervention using a multimodal model and dissemination of protocols, education for health-care professionals and patients, and feedback on performance was implemented for 12 months in the intervention group. The control group received usual care. The primary outcome was all-cause PIVC failure at 12 months (phlebitis, extravasation, obstruction, or infections). Subsequently, through an amendment to the protocol approved on July 25, 2021, we included dislodgement as part of PIVC failure. Analysis was by modified intention to treat, which included all randomly assigned hospital wards for whom data on the primary endpoint were available. This trial is registered with the ISRCTN Registry, ISRCTN10438530. FINDINGS Between Jan 1, 2019, and March 1, 2020, we randomly assigned 22 eligible clusters to receive the multimodal intervention (n=11 clusters; 2196 patients, 2235 PIVCs, and 131 nurses) or usual practice in the control group (n=11 clusters; 2282 patients, 2330 PIVCs, and 138 nurses). At 12 months, the proportion of PIVC failures was lower in the intervention group than in the control group (37·10% [SD 1·32], HR 0·81 [95% CI 0·72 to 0·92] vs 46·49% [2·59], HR 1·23 [1·04 to 1·39]; mean difference -9·39% [95% CI -11·22 to -7·57]; p<0·0001). Per-protocol-prespecified analysis of the primary outcome excluding dislodgement also showed the intervention significantly reduced PIVC failure compared with the control group at 12 months (33·47% [SD 2·98], HR 0·85 [95% CI 0·75 to 0·96] vs 41·06% [4·62], HR 1·18 [1·04 to 1·33]; mean difference -7·59% [95% CI -11·05 to -4·13]; p<0·0001). INTERPRETATION A multimodal intervention reduced PIVC failure, thereby reducing potentially serious complications for hospitalised patients. The findings of PREBACP enabled a deeper understanding of decision making, knowledge mobilisation, and sense making in routine clinical practice. FUNDING The College of Nurses of the Balearic Islands. TRANSLATION For the Spanish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Ian Blanco-Mavillard
- Quality, Teaching and Research Unit, Hospital de Manacor, Manacor, Spain; Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma, Spain; Care, Chronicity and Evidence in Health Research Group, Health Research Institute of the Balearic Islands, Palma, Spain.
| | - Joan Ernest de Pedro-Gómez
- Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma, Spain; Care, Chronicity and Evidence in Health Research Group, Health Research Institute of the Balearic Islands, Palma, Spain
| | - Miguel Ángel Rodríguez-Calero
- Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma, Spain; Care, Chronicity and Evidence in Health Research Group, Health Research Institute of the Balearic Islands, Palma, Spain; Health Care Office, Balearic Islands Health Service, Palma, Spain
| | - Miquel Bennasar-Veny
- Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | | | | | - Ana Belén Moya-Suárez
- Department of Nursing, Agencia Sanitaria Costa del Sol, Marbella, Málaga, Spain; Biomedical Research Institute of Málaga, Málaga, Spain
| | | | | | - Enrique Castro-Sánchez
- City, University of London, London, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
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McIntyre SA, Francis JJ, Gould NJ, Lorencatto F. The use of theory in process evaluations conducted alongside randomized trials of implementation interventions: A systematic review. Transl Behav Med 2021; 10:168-178. [PMID: 30476259 DOI: 10.1093/tbm/iby110] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Interventions to implement changes into health care practice (i.e., implementation interventions) are critical to improving care but their effects are poorly understood. Two strategies to better understand intervention effects are conducting process evaluations and using theoretical approaches (i.e., theories, models, frameworks). The extent to which theoretical approaches have been used in process evaluations conducted alongside trials of implementation interventions is unclear. In this study context, we reviewed (a) the proportion of process evaluations citing theoretical approaches, (b) which theoretical approaches were cited, and (c) whether and how theories were used. Systematic review (PROSPERO: CRD42016042789). MEDLINE, PsycINFO, Embase, CINAHL, and Cochrane CENTRAL were searched up to July 31, 2017. For all studies, data extraction included names and types of theoretical approaches cited. For studies citing a theory, data extraction included study characteristics and extent of theory use (i.e., "informed by," "applied," "tested," "built/created" theory). We identified 123 process evaluations. Key findings: (a) 77 (63%) process evaluations cited a theoretical approach; (b) the most cited theory was normalization process theory; (c) 32 (26%) process evaluations used theory: 7 (22%) were informed by, 18 (56%) applied, 7 (22%) tested, and none built/created theory. Although nearly two thirds of process evaluations cited a theoretical approach, only a quarter were informed by, applied, or tested a theory-despite the potential complementarity of these strategies. When theory was used, it was primarily applied. Using theory more substantively in process evaluations may accelerate our understanding of how implementation interventions operate.
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Affiliation(s)
- Stephen A McIntyre
- Centre for Health Services Research, School of Health Sciences, City, University of London, London, UK
| | - Jill J Francis
- Centre for Health Services Research, School of Health Sciences, City, University of London, London, UK
| | - Natalie J Gould
- Centre for Health Services Research, School of Health Sciences, City, University of London, London, UK
| | - Fabiana Lorencatto
- Centre for Health Services Research, School of Health Sciences, City, University of London, London, UK.,UCL Centre for Behaviour Change, University College London, London, UK
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Steel A, Leach M, Brosnan C, Ward V, Lloyd I. Naturopaths' mobilisation of knowledge and information in clinical practice: an international cross-sectional survey. BMC Complement Med Ther 2021; 21:205. [PMID: 34362370 PMCID: PMC8343215 DOI: 10.1186/s12906-021-03383-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/21/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The contemporary evidence-based practice model acknowledges the importance of patient preferences and clinician experience when applying evidence within a clinical setting. Knowledge mobilisation (KM) acknowledges the complexities of knowledge translation by recognising and respecting diversity in types of knowledge and how such diversity can influence health care and health care choices. While there has been considerable discussion on KM in health care, it has received little attention in the field of naturopathy. Despite naturopathy's widespread international use, it is unclear how naturopathic practitioners (NPs) use and share knowledge and information in clinical practice. This study examines the mobilisation of knowledge amongst NPs internationally. METHODS Online, international, cross-sectional survey of a self-selected sample of NPs from any country, that were either currently in clinical practice or had been in practice within the previous 12 months. The survey was administered in five languages (English, French, Portuguese, Spanish, German). Descriptive statistics were prepared for all survey items. RESULTS The survey was completed by 478 NPs who reported using an average of seven (median = 7, SD = 2.6) information sources to inform patient care. NPs also drew on knowledge gained through patients sharing their perspectives of living with their health condition (Always/Most of the time: 89.3%). They mostly sought knowledge about how a treatment might benefit a patient, as well as knowledge about treatment safety and a better understanding of a patient's health condition. NPs frequently reported sharing knowledge developed through consideration of the patient's unique needs (83.3%), and primarily shared knowledge by producing information for the public (72.6%) and for patients (72.2%). CONCLUSIONS Based on these findings, it may be argued that NPs practice knowledge mobilisation; employing multiple forms and sources of knowledge, and mobilising knowledge to - as well as from - others. Due to their active engagement in patient and community education, NPs also may be considered knowledge brokers. In the context of the growing understanding of the complexities of knowledge translation and mobilisation in contemporary health care - and particularly within the context of implementation science - this study provides novel insights into an under-researched element of health services accessed by the community.
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Affiliation(s)
- Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.
| | - Matthew Leach
- National Centre of Naturopathic Medicine, Southern Cross University, Lismore, NSW, Australia
| | - Caragh Brosnan
- School of Humanities and Social Science, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, Australia
| | - Vicky Ward
- Reader in Management, School of Management, University of St Andrews, St Andrews, UK
| | - Iva Lloyd
- World Naturopathic Federation, Toronto, ON, Canada
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Berthelsen C, Koreska M. Creating a practice-related culture for research: A qualitative study of engaging clinical nurses in utilization of developmental and research-based knowledge in hospital settings. Int J Nurs Pract 2021; 27:e12990. [PMID: 34227184 DOI: 10.1111/ijn.12990] [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: 09/25/2020] [Revised: 04/29/2021] [Accepted: 06/18/2021] [Indexed: 11/27/2022]
Abstract
AIM To describe academic nurses' experiences engaging clinical nurses in utilizing and implementing developmental and research-based knowledge in hospital settings. METHODS This study used a descriptive qualitative design. Fourteen academic nurses at Masters or PhD level from three different regions of Denmark participated in the study, relating their successful experiences engaging clinical nurses in utilizing and implementing developmental and research-based knowledge. Data were collected in February 2020 through qualitative semi-structured interviews and analysed using a qualitative manifest content analysis. RESULTS The main theme revealed was that academic nurses were 'Working towards creating a practice-related culture for research' to engage clinical nurses. This was supported by three subthemes: 'Focusing on evidence-based practice knowledge', 'Facilitating knowledge through a pedagogical approach' and 'Aiming for future changes'. CONCLUSIONS The academic nurses experienced their engagement of clinical nurses and the subsequent change of practice in patient care and nurses' workflows in the department settings, as successful due to the academic nurses' pedagogical actions to educate clinical nurses and due to the academic nurses' practice-related approach to research and implementation.
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Affiliation(s)
- Connie Berthelsen
- Section of Nursing, Institute of Health Science, Aarhus University, Copenhagen, Denmark
| | - Mai Koreska
- Department of Neurology, Rigshospitalet, Denmark
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Marchal B, Abejirinde IOO, Sulaberidze L, Chikovani I, Uchaneishvili M, Shengelia N, Diaconu K, Vassall A, Zoidze A, Giralt AN, Witter S. How do participatory methods shape policy? Applying a realist approach to the formulation of a new tuberculosis policy in Georgia. BMJ Open 2021; 11:e047948. [PMID: 34187826 PMCID: PMC8245474 DOI: 10.1136/bmjopen-2020-047948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/10/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This paper presents the iterative process of participatory multistakeholder engagement that informed the development of a new national tuberculosis (TB) policy in Georgia, and the lessons learnt. METHODS Guided by realist evaluation methods, a multistakeholder dialogue was organised to elicit stakeholders' assumptions on challenges and possible solutions for better TB control. Two participatory workshops were conducted with key actors, interspersed by reflection meetings within the research team and discussions with policymakers. Using concept mapping and causal mapping techniques, and drawing causal loop diagrams, we visualised how actors understood TB service provision challenges and the potential means by which a results-based financing (RBF) policy could address these. SETTING The study was conducted in Tbilisi, Georgia. PARTICIPANTS A total of 64 key actors from the Ministry of Labour, Health and Social Affairs, staff of the Global Fund to Fight AIDS, TB and Malaria Georgia Project, the National Centre for Disease Control and Public Health, the National TB programme, TB service providers and members of the research team were involved in the workshops. RESULTS Findings showed that beyond provider incentives, additional policy components were necessary. These included broadening the incentive package to include institutional and organisational incentives, retraining service providers, clear redistribution of roles to support an integrated care model, and refinement of monitoring tools. Health system elements, such as effective referral systems and health information systems were highlighted as necessary for service improvement. CONCLUSIONS Developing policies that address complex issues requires methods that facilitate linkages between multiple stakeholders and between theory and practice. Such participatory approaches can be informed by realist evaluation principles and visually facilitated by causal loop diagrams. This approach allowed us leverage stakeholders' knowledge and expertise on TB service delivery and RBF to codesign a new policy.
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Affiliation(s)
- Bruno Marchal
- Health Systems and Health Policy Research Group, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Ibukun-Oluwa Omolade Abejirinde
- Health Systems and Health Policy Research Group, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Lela Sulaberidze
- Research Unit, Curatio International Foundation, Tbilisi, Georgia
| | - Ivdity Chikovani
- Research Unit, Curatio International Foundation, Tbilisi, Georgia
| | | | - Natia Shengelia
- Research Unit, Curatio International Foundation, Tbilisi, Georgia
| | - Karin Diaconu
- Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UK
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Akaki Zoidze
- Research Unit, Curatio International Foundation, Tbilisi, Georgia
| | - Ariadna Nebot Giralt
- Health Systems and Health Policy Research Group, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Sophie Witter
- Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UK
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Mathisen TS, Eilertsen G, Ormstad H, Falkenberg HK. Barriers and facilitators to the implementation of a structured visual assessment after stroke in municipal health care services. BMC Health Serv Res 2021; 21:497. [PMID: 34030691 PMCID: PMC8147019 DOI: 10.1186/s12913-021-06467-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/29/2021] [Indexed: 01/10/2023] Open
Abstract
Background Stroke is a leading cause of disability worldwide. Visual impairments (VIs) affect 60% of stroke survivors, and have negative consequences for rehabilitation and post-stroke life. VIs after stroke are often overlooked and undertreated due to lack of structured routines for visual care after stroke. This study aims to identify and assess barriers and facilitators to the implementation of structured visual assessment after stroke in municipal health care services. The study is part of a larger knowledge translation project. Methods Eleven leaders and municipal interdisciplinary health care professionals participated in qualitative interviews. During two workshops, results from the interviews were discussed with 26 participants from municipal health care services and user representatives. Data from interviews and workshops were collected before the intervention was implemented and analyzed using content analysis. Results The analysis identified individual and contextual barriers and facilitators. The individual barriers were related to the participants' experiences of having low competence of visual functions and vision assessment skills. They considered themselves as generalists, not stroke experts, and some were reluctant of change because of previous experiences of unsuccessful implementation projects. Individual facilitators were strong beliefs that including vision in stroke care would improve health care services. If experienced as useful and evidence based, the new vision routine would implement easier. Contextual barriers were experiences of unclear responsibility for vision care, lack of structured interdisciplinary collaboration and lack of formal stroke routines. Time constraints and practical difficulties with including the vision tool in current medical records were also expressed barriers. Contextual facilitators were leader support and acknowledgement, in addition to having a flexible work schedule. Conclusions This study shows that improving competence about VIs after stroke and skills in assessing visual functions are particularly important to consider when planning implementation of new vision routines in municipal health care services. Increased knowledge about the consequences of living with VIs after stroke, and the motivation to provide best possible care, were individual facilitators for changing clinical practice. Involving knowledge users, solutions for integrating new knowledge in existing routines, along with easily accessible supervision in own practise, are essential facilitators for promoting a successful implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06467-4.
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Affiliation(s)
- Torgeir S Mathisen
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Hasbergs vei 36, 3616, Kongsberg, Norway. .,USN Research Group of Older Peoples' Health, University of South-Eastern Norway, Drammen, Norway.
| | - Grethe Eilertsen
- USN Research Group of Older Peoples' Health, University of South-Eastern Norway, Drammen, Norway.,Department of Nursing and Health Science, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | | | - Helle K Falkenberg
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Hasbergs vei 36, 3616, Kongsberg, Norway.,USN Research Group of Older Peoples' Health, University of South-Eastern Norway, Drammen, Norway
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Dash D, Schumacher C, Jones A, Costa AP. Lessons learned implementing and managing the DIVERT-CARE trial: practice recommendations for a community-based chronic disease self-management model. BMC Geriatr 2021; 21:303. [PMID: 33975541 PMCID: PMC8111935 DOI: 10.1186/s12877-021-02248-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/28/2021] [Indexed: 11/15/2022] Open
Abstract
Background Chronic disease management models of care provide an opportunity to assist home care clients to manage their disease burden. However, pragmatic trial management practices and lessons learned from such models are poorly illustrated in the literature. Methods We describe the processes of implementing a community-based cardiorespiratory self-management model, known as DIVERT-CARE, across the home care programs of three health regions in Canada. The DIVERT-CARE model is a multi-component complex intervention that identifies home care clients at the highest risk of deterioration and provides them with resources and capacity to manage their conditions. We conducted a retrospective analysis of baseline participant characteristics, needs assessments, reviewed findings from site visits and a national workshop with study partners, and examined other study documentation. Results Three home care regions in Canada participated in the study. A robust and data-driven review of each site was necessary to understand the local context, home care caseloads, structure of local systems, and intensity of resources, which influenced study processes. The creation of an intervention framework highlighted the need to adapt the intervention in a way that was sensitive to the local context while maintaining intervention outcomes. Conclusion Our detailed review showcases the relevant activities and on-the-ground steps needed to manage and conduct a multi-site pragmatic trial in home care. This example can help other researchers in implementing multi-disciplinary and multi-component care models for practice-based research. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02248-0.
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Affiliation(s)
- Darly Dash
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. W, Hamilton, ON, L8S 4L8, Canada.
| | - Connie Schumacher
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. W, Hamilton, ON, L8S 4L8, Canada.,Hamilton Niagara Haldimand Brant Local Health Integration Network, Hamilton, Canada.,Department of Nursing, Brock University, St. Catharines, Canada
| | - Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. W, Hamilton, ON, L8S 4L8, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. W, Hamilton, ON, L8S 4L8, Canada.,Schlegel Chair in Clinical Epidemiology & Aging, Schlegel-UW Research Institute for Aging, Waterloo, Canada
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Huang W, Chang CH, Stuart EA, Daumit GL, Wang NY, McGinty EE, Dickerson FB, Igusa T. Agent-Based Modeling for Implementation Research: An Application to Tobacco Smoking Cessation for Persons with Serious Mental Illness. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2. [PMID: 34308355 DOI: 10.1177/26334895211010664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Implementation researchers have sought ways to use simulations to support the core components of implementation, which typically include assessing the need for change, designing implementation strategies, executing the strategies, and evaluating outcomes. The goal of this paper is to explain how agent-based modeling could fulfill this role. Methods We describe agent-based modeling with respect to other simulation methods that have been used in implementation science, using non-technical language that is broadly accessible. We then provide a stepwise procedure for developing agent-based models of implementation processes. We use, as a case study to illustrate the procedure, the implementation of evidence-based smoking cessation practices for persons with serious mental illness (SMI) in community mental health clinics. Results For our case study, we present descriptions of the motivating research questions, specific models used to answer these questions, and a summary of the insights that can be obtained from the models. In the first example, we use a simple form of agent-based modeling to simulate the observed smoking behaviors of persons with SMI in a recently completed trial (IDEAL, Comprehensive Cardiovascular Risk Reduction Trial in Persons with SMI). In the second example, we illustrate how a more complex agent-based approach that includes interactions between patients, providers and site administrators can be used to provide guidance for an implementation intervention that includes training and organizational strategies. This example is based in part on an ongoing project focused on scaling up evidence-based tobacco smoking cessation practices in community mental health clinics in Maryland. Conclusion In this paper we explain how agent-based models can be used to address implementation science research questions and provide a procedure for setting up simulation models. Through our examples, we show how what-if scenarios can be examined in the implementation process, which are particularly useful in implementation frameworks with adaptive components.
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Affiliation(s)
- Wanyu Huang
- Department of Civil and Systems Engineering, Johns Hopkins University
| | - Chia-Hsiu Chang
- Department of Civil and Systems Engineering, Johns Hopkins University
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | - Gail L Daumit
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health.,Division of General Internal Medicine, Johns Hopkins University School of Medicine.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University
| | - Nae-Yuh Wang
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health.,Division of General Internal Medicine, Johns Hopkins University School of Medicine.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University
| | - Emma E McGinty
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | | | - Takeru Igusa
- Department of Civil and Systems Engineering, Johns Hopkins University.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health.,Department of Applied Mathematics and Statistics, Johns Hopkins University
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Losfeld X, Istas L, Schoonvaere Q, Vergnion M, Bergs J. Impact of a blended curriculum on nursing handover quality: a quality improvement project. BMJ Open Qual 2021; 10:bmjoq-2020-001024. [PMID: 33781991 PMCID: PMC8009218 DOI: 10.1136/bmjoq-2020-001024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 02/24/2021] [Accepted: 03/17/2021] [Indexed: 11/15/2022] Open
Abstract
Context and objective The negative consequences of inadequate nursing handovers on patient safety are widely acknowledged, both within the literature as in practice. Evidence regarding strategies to improve nursing handover is, however, lacking. This study investigates the effect of a tailored, blended curriculum on nurses’ perception of handover quality. Methods We used a pre-test/post-test design within four units of a Belgian general hospital. Our educational intervention consisted of an e-learning module on professional communication and a face-to-face session on the use of a structured method for handovers. All nurses completed this blended curriculum (n=87). We used the Handover Evaluation Scale (HES) to evaluate nurses’ perception of handover quality before and after the intervention. The HES was answered by 87.4% of the nurses (n=76 of 87) before and 50.6% (n=44 of 87) after the intervention. Confirmatory factor analysis was used to assess the validity of the HES. Results The original factor structure did not fit with our data. We identified a new HES structure with acceptable or good fit indices. The overall internal consistency of our HES structure was considered adequate. Perception of nurses on Relevance of information showed a significant improvement (M=53.19±4.33 vs M=61.03±6.01; p=0.04). Nurses also felt that the timely provision of patient information improved significantly (M=4.50±0.34 vs M=5.16±0.40; p=0.01). Conclusion The applied intervention resulted in an improved awareness on the importance of Relevance of information during handovers. After our intervention, the nurses’ perception of the HES item ‘Patient information is provided in a timely manner’ also improved significantly. We are aware that the educational intervention is only the first step to achieve the long-term implementation of a culture of professional communication based on mutual support.
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Affiliation(s)
| | - Laure Istas
- Platform for Continuous Improvement of Quality of Care and Patient Safety (PAQS ASBL), Brussels, Belgium
| | - Quentin Schoonvaere
- Platform for Continuous Improvement of Quality of Care and Patient Safety (PAQS ASBL), Brussels, Belgium
| | | | - Jochen Bergs
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Belgium
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Malone S, McKay VR, Krucylak C, Powell BJ, Liu J, Terrill C, Saito JM, Rangel SJ, Newland JG. A cluster randomized stepped-wedge trial to de-implement unnecessary post-operative antibiotics in children: the optimizing perioperative antibiotic in children (OPerAtiC) trial. Implement Sci 2021; 16:29. [PMID: 33741048 PMCID: PMC7980649 DOI: 10.1186/s13012-021-01096-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antibiotic-resistant infections have become a public health crisis that is driven by the inappropriate use of antibiotics. In the USA, antibiotic stewardship programs (ASP) have been established and are required by regulatory agencies to help combat the problem of antibiotic resistance. Post-operative antibiotic use in surgical cases deemed low-risk for infection is an area with significant overuse of antibiotics in children. Consensus among leading public health organizations has led to guidelines eliminating post-operative antibiotics in low-risk surgeries. However, the best strategies to de-implement these inappropriate antibiotics in this setting are unknown. METHODS/DESIGN A 3-year stepped wedge cluster randomized trial will be conducted at nine US Children's Hospitals to assess the impact of two de-implementation strategies, order set change and facilitation training, on inappropriate post-operative antibiotic prescribing in low risk (i.e., clean and clean-contaminated) surgical cases. The facilitation training will amplify order set changes and will involve a 2-day workshop with antibiotic stewardship teams. This training will be led by an implementation scientist expert (VRM) and a pediatric infectious diseases physician with antibiotic stewardship expertise (JGN). The primary clinical outcome will be the percentage of surgical cases receiving unnecessary post-operative antibiotics. Secondary clinical outcomes will include the rate of surgical site infections and the rate of Clostridioides difficile infections, a common negative consequence of antibiotic use. Monthly semi-structured interviews at each hospital will assess the implementation process of the two strategies. The primary implementation outcome is penetration, which will be defined as the number of order sets changed or developed by each hospital during the study. Additional implementation outcomes will include the ASP team members' assessment of the acceptability, appropriateness, and feasibility of each strategy while they are being implemented. DISCUSSION This study will provide important information on the impact of two potential strategies to de-implement unnecessary post-operative antibiotic use in children while assessing important clinical outcomes. As more unnecessary medical practices are identified, de-implementation strategies, including facilitation, need to be rigorously evaluated. Along with this study, other rigorously designed studies evaluating additional strategies are needed to further advance the burgeoning field of de-implementation. TRIAL REGISTRATION NCT04366440. Registered April 28, 2020, https://clinicaltrials.gov/ct2/show/NCT04366440 .
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Affiliation(s)
- Sara Malone
- Brown School, Washington University in St. Louis, St. Louis, MO, USA.,Division of Pediatric Infectious Diseases, Department of Pediatrics, Washington University in St. Louis School of Medicine, Campus Box 8116, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Virginia R McKay
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Christina Krucylak
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Washington University in St. Louis School of Medicine, Campus Box 8116, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Byron J Powell
- Brown School, Washington University in St. Louis, St. Louis, MO, USA.,Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Jingxia Liu
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Cindy Terrill
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Washington University in St. Louis School of Medicine, Campus Box 8116, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Jacqueline M Saito
- Division of Pediatric Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Shawn J Rangel
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MO, USA
| | - Jason G Newland
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Washington University in St. Louis School of Medicine, Campus Box 8116, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.
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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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An innovative DNP post-doctorate program to improve quality improvement and implementation science skills. J Prof Nurs 2021; 37:48-52. [PMID: 33674108 DOI: 10.1016/j.profnurs.2020.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Doctor of Nursing Practice programs prepare nurse leaders for unique roles to address healthcare needs across the quality spectrum. However, additional mentoring and training in implementation science and analytical skills is needed to effectively lead system-wide quality initiatives. PURPOSE The purpose of this article is to describe the planning, implementation, and evaluation of an innovative post-doctoral DNP Quality Implementation Scholars Program developed through an academic-practice partnership to address this need. PROJECT METHOD Throughout the one year post-doctoral program, we evaluated student experiences qualitatively using focus groups and quantitatively using standardized course and instructor surveys to assess overall programmatic goals. Program outcomes were evaluated from the perspective of the academic-practice partnership planning committee through a Qualtrics© survey. FINDINGS Strengths of the program included the in-depth mentoring by faculty and relationships built across the larger health system. Both scholars and the planning team noted that the system-wide project implemented by the scholars was relevant, timely, and quality-focused. CONCLUSIONS This innovative DNP post-doctoral program leveraged the skill-sets of DNP-prepared nurse leaders to lead system-wide quality improvement initiatives tailored specifically to healthcare organizations.
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Loo S, Brochier A, Wexler MG, Long K, Kavanagh PL, Garg A, Drainoni ML. Addressing unmet basic needs for children with sickle cell disease in the United States: clinic and staff perspectives. BMC Health Serv Res 2021; 21:55. [PMID: 33435984 PMCID: PMC7802171 DOI: 10.1186/s12913-020-06055-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/30/2020] [Indexed: 11/16/2022] Open
Abstract
Background The purpose of this study was to assess pediatric hematology clinic staff’s perspectives regarding barriers and facilitators in addressing unmet basic needs for children with sickle cell disease (SCD). Methodology Six focus groups were held at four urban pediatric hematology clinics in the Northeastern region of the United States from November to December 2019. Discussion questions were developed to align with the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) implementation science framework, focusing on the domains of context and recipient and how clinics address adverse social determinants of health (SDoH) in their patient populations. A summative content analytical approach was taken to identify major themes in the data. Results We discerned the following themes: (1) families of children with SCD experience numerous unmet basic needs; (2) clinic staff believed they had a role to play in addressing these unmet basic needs; (3) staff felt their ability to address families’ unmet basic needs depended upon caregivers’ capacity to act on staff’s recommendations; and (4) clinic staff’s ability to address these needs was limited by organizational and systemic factors beyond their control. Conclusions These findings have important implications for how best to address adverse SDoH for this vulnerable pediatric population so that urban-based pediatric hematology clinics can more equitably support families. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-06055-y.
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Affiliation(s)
- Stephanie Loo
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA.
| | | | | | - Kristin Long
- Department of Psychological and Brain Sciences, Boston University, Boston, USA
| | - Patricia L Kavanagh
- Department of Pediatrics, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Arvin Garg
- Department of Pediatrics, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA.,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, USA.,Evans Center for Implementation and Improvement Sciences, Boston University, Boston, USA.,Center for Healthcare Organization and Implementation Research, ENRM Veteran's Administration Hospital, Boston, USA
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Thestrup Hansen S, Kjerholt M, Friis Christensen S, Brodersen J, Hølge-Hazelton B. User experiences on implementation of patient reported outcome measures (PROMs)in a Haematological outpatient clinic. J Patient Rep Outcomes 2020; 4:87. [PMID: 33113030 PMCID: PMC7593370 DOI: 10.1186/s41687-020-00256-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/11/2020] [Indexed: 12/26/2022] Open
Abstract
Background PROMs can help healthcare professionals gain an improved understanding of patients’ physical burdens, functional levels, and (health-related) quality of life throughout disease and medical treatment. The aim of this study was to investigate the barriers and potential opportunities PROMs may present in a haematological outpatient clinic from three different perspectives: patients, nurses and haematologists. Methods The present study synthesizes three previously published studies that separately explored the experiences of patients, nurses and haematologists when implementing PROMs. The studies were all guided by the qualitative methodology Interpretive Description, including a focused ethnographic approach, to develop implications for future practice. Results The overall themes that emerged from the analysis were “Structural similarities influence the adoption of PROMs” and “Different perspectives on the potential of PROMs.” Conclusion Across the different user groups in the haematological outpatient clinic, the use of PROMs was thwarted due to an unquestioned commitment to biomedical knowledge and the system’s rationality and norms: PROM data was not used in patient consultations. Nurses and haematologists expressed different preferences related to potential future PROMs and different objectives for PROMs in clinical practice. From the different perspectives of the patients, nurses and haematologists, PROMs were not compatible with clinical practice. Further research is recommended to develop PROMs validated for use in haematological outpatient clinics. Moreover, implementation strategies adjusted to the structural barriers of the system are crucial. Supplementary information Supplementary information accompanies this paper at 10.1186/s41687-020-00256-z.
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Affiliation(s)
- Stine Thestrup Hansen
- Department of Haematology, Zealand University Hospital, Vestermarksvej 9, 1.sal, 4000, Roskilde, Denmark. .,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark. .,Department of Plastic Surgery and Breast Surgery, Zealand University Hospital, Roskilde, Denmark.
| | - Mette Kjerholt
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Sarah Friis Christensen
- Department of Haematology, Zealand University Hospital, Vestermarksvej 9, 1.sal, 4000, Roskilde, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - John Brodersen
- Section of General Practice and Research Unit for General practice, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Primary Health Care Research Unit, Zealand Region, Denmark
| | - Bibi Hølge-Hazelton
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,The Research Support Unit, Zealand University Hospital, Roskilde, Denmark
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Sustainability of innovations in healthcare: A systematic review and conceptual framework for professional pharmacy services. Res Social Adm Pharm 2020; 16:1331-1343. [DOI: 10.1016/j.sapharm.2020.01.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 12/13/2019] [Accepted: 01/26/2020] [Indexed: 01/11/2023]
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Mogaka JJO, James SE, Chimbari MJ. Leveraging implementation science to improve implementation outcomes in precision medicine. Am J Transl Res 2020; 12:4853-4872. [PMID: 33042394 PMCID: PMC7540127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 02/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND PURPOSE Introduction of omics technologies in clinical practice means increased use of validated biomarkers, through precision medicine (PM). Although implementation science (IS) affords an array of theoretical approaches that can potentially explain PM intervention uptake, their relevance and applicability in PM implementation has not been empirically tested. This article identifies and examines existing implementation frameworks for their applicability in PM, demonstrating how different IS theories can be used to generate testable implementation hypotheses in PM. METHODS A three-step methodology was employed to search and select implementation models: a scoping search in Google Scholar produced 15 commonly used models in healthcare; a systematic search in PUBMED and Web of Science using the names of each model as keywords in search strings produced 290 publications for screening and abstraction; finally, a citation frequency search in the 3 databases produced most cited models that were included in the narrative synthesis. RESULTS Main concepts and constructs associated with each of the 15 models were identified. Four most cited frameworks in healthcare were: REAIM, CFIR, PRISM and PARiHS. Corresponding constructs were mapped and examined for potential congruence to PM. A generalized PM implementation conceptual framework was developed showing how omics biomarker uptake relates to their evidence base, patient and provider engagement and Big data capabilities of involved organizations. CONCLUSION We demonstrated how implementation complexities in PM can be addressed by explicit use of implementation theories. The work here may provide a reference for further research of empirically testing and refining the identified implementation constructs.
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Affiliation(s)
- John J O Mogaka
- Department of Public Health Medicine, University of KwaZulu-NatalDurban, South Africa
| | - San E James
- KZN Research and Innovation Sequencing Platform (KRISP), University of KwaZulu NatalDurban, South Africa
| | - Moses J Chimbari
- Department of Public Health Medicine, University of KwaZulu-NatalDurban, South Africa
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Bergström A, Ehrenberg A, Eldh AC, Graham ID, Gustafsson K, Harvey G, Hunter S, Kitson A, Rycroft-Malone J, Wallin L. The use of the PARIHS framework in implementation research and practice-a citation analysis of the literature. Implement Sci 2020; 15:68. [PMID: 32854718 PMCID: PMC7450685 DOI: 10.1186/s13012-020-01003-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework. METHODS This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail. RESULTS The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated. CONCLUSIONS In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.
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Affiliation(s)
- Anna Bergström
- Department of Women’s and Children’s health, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Uppsala, Sweden
- Institute for Global Health, University College London, London, UK
| | - Anna Ehrenberg
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Ann Catrine Eldh
- Department of Medicine and Health, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kazuko Gustafsson
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- University Library, Uppsala University, Uppsala, Sweden
| | - Gillian Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Green Templeton College, University of Oxford, Oxford, UK
| | - Jo Rycroft-Malone
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancashire, UK
| | - Lars Wallin
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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