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Graverholt B, Espehaug B, Ciliska D, Potrebny T. The effectiveness of a knowledge translation intervention on the implementation of NEWS2 in nursing homes, a pragmatic cluster RCT. Implement Sci 2024; 19:64. [PMID: 39261938 PMCID: PMC11391697 DOI: 10.1186/s13012-024-01392-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 08/23/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Improving the uptake of relevant and reliable research is an important priority in long-term care to achieve sustainable and high-quality services for the increasingly older population. AIM The purpose was to assess the effectiveness of a tailored, adaptive and a multifaceted KT capacity program, relative to usual practice, on the implementation of National Early Warning Score 2 (NEWS2). METHODS This study was carried out as a pragmatic cluster-randomized controlled trial. The capacity program consisted of an educational part to address implementation capacity gaps and a facilitation-upon-implementation part to address a relevant knowledge gap in nursing homes. A collective decision was made to address the challenge of early detection of clinical deterioration among nursing home residents, by implementing the (NEWS2) as clinical innovation. Public nursing homes in a Norwegian municipality (n = 21) with a total of 1 466 beds were eligible for inclusion. The study-period spanned over a 22-month period, including a 12-month follow-up. Data was extracted from the Electronic Patient Journal system and analyzed using multilevel growth model analysis. RESULTS The intervention had a large effect on the use of NEWS2 among care staff in intervention nursing homes, compared to the control group (standardized mean difference, d = 2.42). During the final month of the implementation period, residents in the intervention group was assessed with NEWS2 1.44 times (95% CI: 1.23, 1.64) per month, which is almost four times more often than in the control group (mean = 0.38, 95% CI: 0.19, 0.57). During the follow-up period, the effect of the intervention was not only sustained in the intervention group but there was a substantial increase in the use of NEWS2 in both the intervention (mean = 1.75, 95% CI: 1.55, 1.96) and control groups (mean = 1.45, 95% CI: 1.27, 1.65). CONCLUSIONS This tailored implementation strategy had a large effect on the use of NEWS2 among care staff, demonstrating that integrated knowledge translation strategies can be a promising strategy to achieve evidence-based care in the nursing home sector. TRIAL REGISTRATION ISRCTN12437773 . Registered 19/3 2020, retrospectively.
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Affiliation(s)
- Birgitte Graverholt
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Bergen, Norway.
| | - Birgitte Espehaug
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Donna Ciliska
- Faculty of Health Sciences, McMaster University, Toronto, Canada
| | - Thomas Potrebny
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Wachtler C, Bergqvist M, Bastholm-Rahmner P, Gustafsson LL, Schmidt-Mende K. COVID-19 guidelines and media influenced ethical care in nursing homes. Nurs Ethics 2024:9697330241268923. [PMID: 39177002 DOI: 10.1177/09697330241268923] [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: 08/24/2024]
Abstract
BACKGROUND The early phase of the COVID-19 pandemic affected nursing homes and their residents heavily. Guidelines on how to mitigate the virus's spread and ensuring safe healthcare delivery were continually evolving. Concurrently, nursing homes faced intense media scrutiny. This challenging environment severely impacted registered nurses and physicians employed within these facilities. AIM To understand the ethical challenges experienced by registered nurses and physicians working in nursing homes during the COVID-19 pandemic. RESEARCH DESIGN Qualitative descriptive research using thematic analysis. PARTICIPANTS AND RESEARCH CONTEXT Individual online interviews with four registered nurses and eight physicians clinically active at nursing homes in Sweden. ETHICAL CONSIDERATIONS The study was approved by the Swedish Ethical Review Authority. All participants provided written consent. RESULTS Registered nurses and physicians working in nursing homes perceived ethical challenges stemming from early COVID-19 pandemic guidelines and media coverage. The main theme generated was 'Struggling to maintain professional and ethical standards under pressure' incorporating two subthemes: 'Guidelines developed without the profession put pressure on staff' and 'Media's biased reporting was perceived as unethical and undermined care'. Guidelines from the authorities were considered as developed without professional involvement. It made them difficult to adhere to without deviating from professional and ethical compasses. Media coverage adversely influenced relatives' perceptions, resulting in mistrust towards physicians' and registered nurses' in delivering optimal care for the residents. CONCLUSIONS Resilient care in nursing homes necessitates the collaborative development of guidelines involving registered nurses and physicians, particularly amidst crises. Moreover, it is vital to provide support to registered nurses navigating ethical dilemmas, especially during pandemics. Guidelines and principles for care during a crisis should be development with professional involvement, be transparent, and be available to the public, to promote neutral media coverage. Future research is crucial to enhance ethical standards and tackle challenges in this context.
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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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Buckley C, Hartigan I, Coffey A, Cornally N, O'Connell S, O'Loughlin C, Timmons S, Lehane E. Evaluating the use of participatory action research to implement evidence-based guidance on dementia palliative care in long-term care settings: A creative hermeneutic analysis. Int J Older People Nurs 2022; 17:e12460. [PMID: 35362252 PMCID: PMC9539682 DOI: 10.1111/opn.12460] [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: 05/28/2021] [Revised: 01/21/2022] [Accepted: 03/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dementia affects a large proportion of society and places a significant burden on older people and healthcare systems internationally. Managing symptoms at the end of life for people with dementia is complex. Participatory action research can offer an approach that helps to encourage implementation of evidence-based practices in long-term care settings. METHODS Three evidence-based guidance documents (pain assessment and management, medication management, nutrition and hydration management) were introduced in three long-term care settings for older people. Data generated from work-based learning groups were analysed using a critical hermeneutic approach to explore the use of participatory action research to support the implementation of guidance documents in these settings. RESULTS Engagement and Facilitation emerged as key factors which both enabled and hindered the PAR processes at each study site. CONCLUSIONS This study adds to the body of knowledge that emphasises the value of participatory action research in enabling practice change. It further identifies key practice development approaches that are necessary to enable a PAR approach to occur in care settings for older people with dementia. The study highlights the need to ensure that dedicated attention is paid to strategies that facilitate key transformations in clinical practice.
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Affiliation(s)
- Catherine Buckley
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland.,Northridge House Education and Research Centre, St Luke's Nursing Home, Cork, Ireland
| | - Irene Hartigan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Alice Coffey
- Health Implementation Science and Technology Cluster, Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Nicola Cornally
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Selena O'Connell
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland.,Health Implementation Science and Technology Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Elaine Lehane
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Pereira VC, Silva SN, Carvalho VKS, Zanghelini F, Barreto JOM. Strategies for the implementation of clinical practice guidelines in public health: an overview of systematic reviews. Health Res Policy Syst 2022; 20:13. [PMID: 35073897 PMCID: PMC8785489 DOI: 10.1186/s12961-022-00815-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/10/2022] [Indexed: 01/08/2023] Open
Abstract
Abstract
Background
As a source of readily available evidence, rigorously synthesized and interpreted by expert clinicians and methodologists, clinical guidelines are part of an evidence-based practice toolkit, which, transformed into practice recommendations, have the potential to improve both the process of care and patient outcomes. In Brazil, the process of development and updating of the clinical guidelines for the Brazilian Unified Health System (Sistema Único de Saúde, SUS) is already well systematized by the Ministry of Health. However, the implementation process of those guidelines has not yet been discussed and well structured. Therefore, the first step of this project and the primary objective of this study was to summarize the evidence on the effectiveness of strategies used to promote clinical practice guideline implementation and dissemination.
Methods
This overview used systematic review methodology to locate and evaluate published systematic reviews regarding strategies for clinical practice guideline implementation and adhered to the PRISMA guidelines for systematic review (PRISMA).
Results
This overview identified 36 systematic reviews regarding 30 strategies targeting healthcare organizations, healthcare providers and patients to promote guideline implementation. The most reported interventions were educational materials, educational meetings, reminders, academic detailing and audit and feedback. Care pathways—single intervention, educational meeting—single intervention, organizational culture, and audit and feedback—both strategies implemented in combination with others—were strategies categorized as generally effective from the systematic reviews. In the meta-analyses, when used alone, organizational culture, educational intervention and reminders proved to be effective in promoting physicians' adherence to the guidelines. When used in conjunction with other strategies, organizational culture also proved to be effective. For patient-related outcomes, education intervention showed effective results for disease target results at a short and long term.
Conclusion
This overview provides a broad summary of the best evidence on guideline implementation. Even if the included literature highlights the various limitations related to the lack of standardization, the methodological quality of the studies, and especially the lack of conclusion about the superiority of one strategy over another, the summary of the results provided by this study provides information on strategies that have been most widely studied in the last few years and their effectiveness in the context in which they were applied. Therefore, this panorama can support strategy decision-making adequate for SUS and other health systems, seeking to positively impact on the appropriate use of guidelines, healthcare outcomes and the sustainability of the SUS.
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Steinskog TLD, Tranvåg O, Ciliska D, Nortvedt MW, Graverholt B. Integrated knowledge translation in nursing homes: exploring the experiences of practice development nurses. BMC Health Serv Res 2021; 21:1283. [PMID: 34844600 PMCID: PMC8628377 DOI: 10.1186/s12913-021-07282-7] [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: 05/31/2021] [Accepted: 11/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background Practice Development Nurses (PDNs) in Norwegian nursing homes (NHs) hold a specific responsibility for knowledge translation in this increasingly complex healthcare setting. They were involved as end users in an integrated knowledge translation (IKT) study, developing, testing and evaluating the IMPAKT (IMPlementation of Action to Knowledge Translation) intervention. PDNs participated in an educational programme tailored to their own defined needs. In a second intervention component, the PDNs applied their new skills with facilitation, in implementing the National Early Warning Score (NEWS2) in their respective NHs. The aim of this study was to explore 1) the PDNs’ experiences of participating in an IKT educational intervention, and 2) how they applied the learning in planning, tailoring and initial implementation of the NEWS2. Methods This is a qualitative exploratory study based on a phenomenological hermeneutical method. Study participants were PDNs working in the nine NHs in the intervention group of the IMPAKT trial. We conducted nine in-depth interviews and eight non-participatory observational sessions of the intervention delivery. Results The PDNs expressed that the educational programme met their needs and enhanced their understanding about leading knowledge translation (KT). They reported a move from operating in a “big black box of implementation” to a professional and structured mode of KT. The gamechanger was a shift from KT as the PDNs’ individual responsibility to KT as an organizational matter. The PDNs reported enhanced competencies in KT and in their ability to involve and collaborate with others in their facility. Organizational contextual factors challenged their KT efforts and implementation of the NEWS2. Conclusions This study demonstrates that an IKT approach has the potential to advance and improve staff competencies and NH readiness for KT. However, individual motivations and competencies were challenged within an organizational culture which was less receptive to this new leadership role and level of KT activity. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07282-7.
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Affiliation(s)
| | - Oscar Tranvåg
- Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway.,Norwegian Research Centre for Women's Health, Oslo University Hospital, Rikshospitalet, P.O. Box 4950 Nydalen, 0424, Oslo, Norway
| | - Donna Ciliska
- Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway.,McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | | | - Birgitte Graverholt
- Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
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Igland J, Potrebny T, Bendixen BE, Haugstvedt A, Espehaug B, Titlestad KB, Graverholt B. Translation and validation of the Alberta Context Tool for use in Norwegian nursing homes. PLoS One 2021; 16:e0258099. [PMID: 34624019 PMCID: PMC8500415 DOI: 10.1371/journal.pone.0258099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 09/18/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Organizational context is recognized as important for facilitating evidence-based practice and improving patient outcomes. Organizational context is a complex construct to measure and appropriate instruments that can quantify and measure context are needed. The aim of this study was to translate and cross-culturally adapt the Alberta Context Tool (ACT) to Norwegian, and to test the reliability and structural validity among registered nurses (RNs) and licenced practice nurses (LPNs) working in nursing homes. METHODS This study was a validation study utilizing a cross-sectional design. The sample consisted of n = 956 healthcare personnel from 28 nursing homes from a municipality in Norway. In the first stage, the ACT was translated before being administered in 28 nursing homes. In the second stage, internal consistency and structural validity were explored using Cronbach's alpha and confirmatory factor analysis. RESULTS A rigorous forward-and-back translation process was performed including a team of academics, experts, professional translators and the copyright holders, before an acceptable version of the ACT was piloted and finalized. The Norwegian version of the ACT showed good internal consistency with Chronbachs alpha above .75 for all concepts except for Formal interactions where the alpha was .69. Structural validity was acceptable for both RNs and LPNs with factors loadings more than .4 for most items. CONCLUSIONS The Norwegian version of the ACT is a valid measure of organizational context in Norwegian nursing homes among RNs and LPNs.
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Affiliation(s)
- Jannicke Igland
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Thomas Potrebny
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Bente E Bendixen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Anne Haugstvedt
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Birgitte Espehaug
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Kristine B Titlestad
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Birgitte Graverholt
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Faculty of Health Studies, VID Specialized University, Bergen, Norway
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Perruchoud E, Fernandes S, Verloo H, Pereira F. Beliefs and implementation of evidence-based practice among nurses in the nursing homes of a Swiss canton: An observational cross-sectional study. J Clin Nurs 2021; 30:3218-3229. [PMID: 33960546 PMCID: PMC8518770 DOI: 10.1111/jocn.15826] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/22/2021] [Accepted: 04/12/2021] [Indexed: 11/28/2022]
Abstract
Aims and objectives Examine beliefs about EBP and its level of implementation among nurses working in nursing homes in a bilingual canton of Switzerland and explore associations between these aspects and nurses’ sociodemographic and professional characteristics. Background Although evidence‐based practice (EBP) is recognised as an effective strategy for improving the quality and safety of care, little is known about its use in nursing homes. Nurses’ beliefs about EBP and their implementation of it in Switzerland’s nursing homes have never been explored. Design An observational cross‐sectional study. Methods Beliefs about and implementation of EBP were evaluated using validated French‐ and German‐language versions of the EBP Beliefs Scale and the EBP Implementation Scale, developed by Melnyk and Fineout‐Overholt (Melnyk, Fineout‐Overholt, & Mays, 2008, Worldviews on Evidence‐Based Nursing, 5, 208). The STROBE checklist for cross‐sectional studies was used in reporting this study. Results The participation rate was 40.6% (N = 194). Most participants stated that they had some knowledge of EBP and held favourable beliefs about it. Nevertheless, 37.1% of participants found the concept complicated and 36.1% found it time‐consuming. Participants were more likely to implement stages in the EBP process linked to direct clinical practice rather than those which required scientific knowledge and skills. Conclusion Most participants had favourable beliefs about EBP, but the level of implementation of EBP among nurses in their daily clinical practice was sub‐optimal. Relevance to clinical practice A greater emphasis should be put on fostering the use of EBP among nurses working in nursing homes. This could be achieved via training and the development of individual, institutional and contextual strategies promoting the integration of EBP in clinical settings.
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Affiliation(s)
| | - Sofia Fernandes
- Les Maisons de la Providence Nursing Home, Le Châble, Switzerland
| | - Henk Verloo
- School of Health Sciences, HES-SO Valais/Wallis, Sion, Switzerland
| | - Filipa Pereira
- School of Health Sciences, HES-SO Valais/Wallis, Sion, Switzerland
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Törmä J, Pingel R, Cederholm T, Saletti A, Winblad U. Is it possible to influence ability, willingness and understanding among nursing home care staff to implement nutritional guidelines? A comparison of a facilitated and an educational strategy. Int J Older People Nurs 2021; 16:e12367. [PMID: 33624452 DOI: 10.1111/opn.12367] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 12/22/2020] [Accepted: 01/07/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Translating nutrition knowledge into care practice is challenging since multiple factors can affect the implementation process. This study examined the impact of two implementation strategies, that is external facilitation (EF) and educational outreach visits (EOVs), on the organisational context and individual factors when implementing nutritional guidelines in a nursing home (NH) setting. METHODS The EF strategy was a one-year, multifaceted (including support, guidance, a practice audit and feedback) intervention given to four NH units. The EOV strategy was a three-hour lecture about the nutritional guidelines given to four other NH units. Both strategies were directed at selected NH teams, consisting of a unit manager, a nurse and 5-10 care staff. A questionnaire was distributed, before and after the interventions, to evaluate the prerequisites for the staff to use the guidelines. Three conditions were used to examine the organisational context and the individual factors: the staff's ability and willingness to implement the nutritional guidelines and their understanding of them. Confirmatory factor analysis and structural equation models were used for the data analysis. RESULTS The results indicated that on average, there was a significant increase in the staff's ability to implement the nutritional guidelines in the EF group. The staff exposed to the EF strategy experienced better resources to implement the guidelines in terms of time, tools and support from leadership and a clearer assignment of responsibility regarding nutrition procedures. There was no change in staff's willingness and understanding of the guidelines in the EF group. On average, no significant changes were observed for the staff's ability, willingness or understanding in the EOV group. CONCLUSIONS A long-term, active and flexible implementation strategy (i.e. EF) affected the care staff's ability to implement the nutritional guidelines in an NH setting. No such impact was observed for the more passive, educational approach (i.e. EOV).
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Affiliation(s)
- Johanna Törmä
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Ronnie Pingel
- Department of Statistics, Uppsala University, Uppsala, Sweden
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Anja Saletti
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden
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Lorber M, Kmetec S, Mlinar Reljić N, Fekonja Z. Diabetes management of older adults in nursing homes: A retrospective study. J Nurs Manag 2021; 29:1293-1301. [PMID: 33482053 DOI: 10.1111/jonm.13268] [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: 09/22/2020] [Revised: 12/29/2020] [Accepted: 01/19/2021] [Indexed: 01/21/2023]
Abstract
AIM To examine the diabetes management of older adults in nursing homes. BACKGROUND Diabetes is an increasing problem in nursing homes, and diabetes care is defined as a neglected clinical area. METHODS A retrospective collected data review of 166 older adults with known diabetes from four nursing homes. RESULTS 65% older than 75 years had HbA1c levels lower than 7.5% (58 mmol/mol), 74% older than 85 years had HbA1c levels lower than 8% (64 mmol/mol). The HbA1c levels were 7.3% (56 mmol/mol) for those who had three and more chronic disorders and 6.8% (51 mmol/mol) for those who had less than three chronic disorders. Individuals treated with insulin had higher HbA1c levels (p < .001) and glycaemia (p = .002). Age was associated with a number of chronic disorders (p = .031), a number of regularly prescribed medications (p = .038) and a number of medications as needed (p = .009). CONCLUSIONS More than half to three quarters have diabetes well-managed. Nevertheless, there is still some potential for improving diabetes care, and these findings warrant further research for improving diabetes management of older adults in nursing homes. IMPLICATIONS FOR NURSING MANAGEMENT Interventions designed to promote a healthy lifestyle, documenting individuals' target level and regular monitoring of glycaemia and HbA1c levels may help to improve diabetes management, which may result in better well-being and quality of life for older adults with diabetes in nursing homes.
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Affiliation(s)
- Mateja Lorber
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | - Sergej Kmetec
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | | | - Zvonka Fekonja
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
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Madrigal C, Kolanowski A, Berish D, VanHaitsma K. Feasible and Appropriate Strategies for Implementing Evidence-Based Practices in Nursing Homes. J Am Med Dir Assoc 2021; 22:717-720. [PMID: 33421370 DOI: 10.1016/j.jamda.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/18/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Caroline Madrigal
- Center of Innovation in Long-Term Services and Supports, Providence, RI, USA
| | - Ann Kolanowski
- College of Nursing, Penn State University, University Park, PA, USA
| | - Diane Berish
- College of Nursing, Penn State University, University Park, PA, USA
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12
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Spoon D, Rietbergen T, Huis A, Heinen M, van Dijk M, van Bodegom-Vos L, Ista E. Implementation strategies used to implement nursing guidelines in daily practice: A systematic review. Int J Nurs Stud 2020; 111:103748. [PMID: 32961463 DOI: 10.1016/j.ijnurstu.2020.103748] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/29/2020] [Accepted: 08/10/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Research specifically addressing implementation strategies regarding nursing guidelines is limited. The objective of this review was to provide an overview of strategies used to implement nursing guidelines in all nursing fields, as well as the effects of these strategies on patient-related nursing outcomes and guideline adherence. Ideally, the findings would help guideline developers, healthcare professionals and organizations to implement nursing guidelines in practice. DESIGN Systematic review. PROSPERO registration number: CRD42018104615. DATA SOURCES We searched the Embase, Medline, PsycINFO, Web of Science, Cochrane, CINAHL and Google Scholar databases until August 2019 as well as the reference lists of relevant articles. REVIEW METHODS Studies were included that described quantitative data on the effect of implementation strategies and implementation outcomes of any type of a nursing guideline in any setting. No language or date of publication restriction was used. The Cochrane Effective Practice and Organisation of Care taxonomy was used to categorize the implementation strategies. Studies were classified as effective if a significant change in either patient-related nursing outcomes or guideline adherence was described. Strength of the evidence was evaluated using the 'Cochrane risk of bias tool' for controlled studies, and the 'Newcastle-Ottawa Quality Assessment form' for cohort studies. RESULTS A total of 54 articles regarding 53 different guideline implementation studies were included. Fifteen were (cluster) Randomized Controlled Trials or controlled before-after studies and 38 studies had a before-after design. The topics of the implemented guidelines were diverse, mostly concerning skin care (n = 9) and infection prevention (n = 7). Studies were predominantly performed in hospitals (n = 34) and nursing homes (n = 11). Thirty studies showed a positive significant effect in either patient-related nursing outcomes or guideline adherence (68%, n = 36). The median number of implementation strategies used was 6 (IQR 4-8) per study. Educational strategies were used in nearly all studies (98.1%, n = 52), followed by deployment of local opinion leaders (54.7%, n = 29) and audit and feedback (41.5%, n = 22). Twenty-three (43.4%) studies performed a barrier assessment, nineteen used tailored strategies. CONCLUSIONS A wide variety of implementation strategies are used to implement nursing guidelines. Not one single strategy, or combination of strategies, can be linked directly to successful implementation of nursing guidelines. Overall, thirty-six studies (68%) reported a positive significant effect of the implementation of guidelines on patient-related nursing outcomes or guideline adherence. Future studies should use a standardized reporting checklist to ensure a detailed description of the used implementation strategies to increase reproducibility and understanding of outcomes.
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Affiliation(s)
- Denise Spoon
- Department of Internal Medicine, Section Nursing Science, Erasmus MC University Medical Centre, Room Rg-532, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands.
| | - Tessa Rietbergen
- Department of Biomedical Data Sciences, section Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Anita Huis
- Radboud university medical centre, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
| | - Maud Heinen
- Radboud university medical centre, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
| | - Monique van Dijk
- Department of Internal Medicine, Section Nursing Science, Erasmus MC University Medical Centre, Room Rg-532, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands; Department of Paediatric Surgery and Intensive Care, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, section Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Erwin Ista
- Department of Internal Medicine, Section Nursing Science, Erasmus MC University Medical Centre, Room Rg-532, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands; Department of Paediatric Surgery and Intensive Care, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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13
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Belita E, Squires JE, Yost J, Ganann R, Burnett T, Dobbins M. Measures of evidence-informed decision-making competence attributes: a psychometric systematic review. BMC Nurs 2020; 19:44. [PMID: 32514242 PMCID: PMC7254762 DOI: 10.1186/s12912-020-00436-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 05/19/2020] [Indexed: 11/10/2022] Open
Abstract
Background The current state of evidence regarding measures that assess evidence-informed decision-making (EIDM) competence attributes (i.e., knowledge, skills, attitudes/beliefs, behaviours) among nurses is unknown. This systematic review provides a narrative synthesis of the psychometric properties and general characteristics of EIDM competence attribute measures in nursing. Methods The search strategy included online databases, hand searches, grey literature, and content experts. To align with the Cochrane Handbook of Systematic Reviews, psychometric outcome data (i.e., acceptability, reliability, validity) were extracted in duplicate, while all remaining data (i.e., study and measure characteristics) were extracted by one team member and checked by a second member for accuracy. Acceptability data was defined as measure completion time and overall rate of missing data. The Standards for Educational and Psychological Testing was used as the guiding framework to define reliability, and validity evidence, identified as a unified concept comprised of four validity sources: content, response process, internal structure and relationships to other variables. A narrative synthesis of measure and study characteristics, and psychometric outcomes is presented across measures and settings. Results A total of 5883 citations were screened with 103 studies and 35 unique measures included in the review. Measures were used or tested in acute care (n = 31 measures), public health (n = 4 measures), home health (n = 4 measures), and long-term care (n = 1 measure). Half of the measures assessed a single competence attribute (n = 19; 54.3%). Three measures (9%) assessed four competence attributes of knowledge, skills, attitudes/beliefs and behaviours. Regarding acceptability, overall missing data ranged from 1.6–25.6% across 11 measures and completion times ranged from 5 to 25 min (n = 4 measures). Internal consistency reliability was commonly reported (21 measures), with Cronbach’s alphas ranging from 0.45–0.98. Two measures reported four sources of validity evidence, and over half (n = 19; 54%) reported one source of validity evidence. Conclusions This review highlights a gap in the testing and use of competence attribute measures related to evidence-informed decision making in community-based and long-term care settings. Further development of measures is needed conceptually and psychometrically, as most measures assess only a single competence attribute, and lack assessment and evidence of reliability and sources of established validity evidence. Registration PROSPERO #CRD42018088754.
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Affiliation(s)
- Emily Belita
- McMaster University, School of Nursing, McMaster Innovation Park (MIP), 175 Longwood Road South, Suite 210a, Hamilton, ON L8P 0A1 Canada
| | - Janet E Squires
- University of Ottawa/Université d'Ottawa, School of Nursing/École des sciences infirmières, Room RGN 3038, Guindon Hall, 451 Smyth Road, Ottawa, ON Canada
| | - Jennifer Yost
- Villanova University, M. Louise Fitzpatrick College of Nursing, Driscoll Hall, Room 330, 800 Lancaster Avenue, Villanova, PA 19085 USA
| | - Rebecca Ganann
- McMaster University, School of Nursing, 1280 Main St. W., HSC 3N25F, Hamilton, ON Canada
| | - Trish Burnett
- McMaster University, School of Nursing, McMaster Innovation Park (MIP), 175 Longwood Road South, Suite 210a, Hamilton, ON L8P 0A1 Canada
| | - Maureen Dobbins
- McMaster University, School of Nursing, McMaster Innovation Park (MIP), 175 Longwood Road South, Suite 210a, Hamilton, ON L8P 0A1 Canada
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14
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Quality Clinical Care in Nursing Facilities. J Am Med Dir Assoc 2019; 19:833-839. [PMID: 30268289 DOI: 10.1016/j.jamda.2018.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 01/29/2023]
Abstract
Despite improvements in selected nursing facility (NF) quality measures such as reduction in antipsychotic use; local, state, and national initiatives; and regulatory incentives, the quality of clinical care delivered in this setting remains inconsistent. Herein, recommendations for overcoming barriers to achieving consistent, high-quality clinical outcomes in long-term (LTC) and post-acute care are provided to address inadequate workforce, suboptimal culture and interprofessional teamwork, insufficiently evidence-based processes of care, and poor adoption and fidelity of technology and integrated clinical decision support. With high staff attrition rates in NFs, mechanisms to measure and close knowledge gaps as well as opportunities for practice simulations should be available to educate and ensure adoption of clinical quality standards on clinician hiring and on an ongoing basis. Multipronged, integrated approaches are needed to further the quest for sustainment of high clinical quality in NF care. In addition to setting a tone for attainment of clinical quality, leadership should champion adoption of practice standards, quality initiatives, and evidence-based guidelines. Maintaining an optimal ratio of hours per resident per day of nurses and nurse aides can improve quality outcomes and staff satisfaction. Clinicians must consistently and effectively apply care processes that include recognition, problem definition, diagnosis, goal identification, intervention, and monitoring resident progress. In order to do so they must have rapid, easy access to necessary tools, including evidence-based standards, algorithms, care plans, during the care delivery process. Embedding such tools into workflow of electronic health records has the potential to improve quality outcomes. On a national and international level, quality standards should be developed by interprofessional LTC experts committed to applying the highest levels of clinical evidence to improve the care of older persons. The standards should be realistic and practical, and basic principles of implementation science must be used to achieve the desired outcomes.
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Andersen Fortes A, André-Brylle J, Westmark S, Melgaard D. Primary Healthcare Professionals Experience of Transfer and Meaning According to Screening for Dysphagia. Geriatrics (Basel) 2019; 4:E54. [PMID: 31569786 PMCID: PMC6960732 DOI: 10.3390/geriatrics4040054] [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: 07/23/2019] [Revised: 09/23/2019] [Accepted: 09/26/2019] [Indexed: 11/16/2022] Open
Abstract
Transfer is a well-known theory about learning in practice contexts. This concept, combined with the need to implement screening for dysphagia in the nursing homes, has led to this project describing the experienced transfer effect and meaning among healthcare professionals after participation in a practice-orientated workshop focusing on implementing the Minimal Eating Observation Form-II (MEOF-II). Fifty-eight healthcare professionals participated in a 2.5-hour facilitated practice-orientated workshop in the period from March to September, 2018. Before and after the workshop, they filled out a questionnaire that focused on the healthcare professional's experience of skills related to dysphagia. The study documented that, after the workshop, more healthcare professionals felt competent to perform the MEOF-II to identify signs of dysphagia and know their role in screening for dysphagia. Nine months after the workshop, 80% of the residents in the nursing home had been screened for dysphagia by using the MEOF-II. This study documented that practice-orientated workshops and systematic follow-up encouraged the healthcare professionals to use the MEOF-II to contribute to the early detection of dysphagia in the nursing home. Workshops based on the transfer theory may also be relevant for implementation and application of other new skills in similar settings.
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Affiliation(s)
| | | | - Signe Westmark
- Centre for Clinical Research, North Denmark Regional Hospital, 9800 Hjoerring, Denmark.
| | - Dorte Melgaard
- Centre for Clinical Research, North Denmark Regional Hospital, 9800 Hjoerring, Denmark.
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Haugstvedt A, Graue M, Aarflot M, Heimro LS, Johansson H, Hjaltadottir I, Sigurdardottir AK. Challenges in maintaining satisfactory documentation routines and evidence-based diabetes management in nursing homes. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/20573316.2016.1262588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Anne Haugstvedt
- Department of Nursing, Bergen University College, Bergen, Norway
- Centre for Evidence Based Practice, Bergen University College, Bergen, Norway
| | - Marit Graue
- Department of Nursing, Bergen University College, Bergen, Norway
- Centre for Evidence Based Practice, Bergen University College, Bergen, Norway
| | - Morten Aarflot
- Department of Community Medicine, The Arctic University of Norway
| | | | | | - Ingibjörg Hjaltadottir
- Faculty of Nursing, University of Iceland, Reykjavik, Iceland
- National University Hospital Iceland, Reykjavik, Iceland
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