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Strategic Priorities for Implementation of Father-Inclusive Practice in Mental Health Services for Children and Families: A Delphi Expert Consensus Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022:10.1007/s10488-022-01222-1. [DOI: 10.1007/s10488-022-01222-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 12/24/2022]
Abstract
AbstractThe aim of this study was to investigate expert consensus on barriers and facilitators to the organizational implementation of Father-Inclusive Practice (FIP) in child and family services to establish strategic priorities for implementation. An international panel of 56 experts in child and family service provision and father inclusion were surveyed using the Delphi technique. Three online questionnaires were used to gather opinions and measure experts’ levels of agreement in regard to factors that enable or hinder the organizational implementation of FIP. Survey design, analysis and interpretation was guided by the Consolidated Framework for Implementation Research (CFIR). Consensus was achieved for 46.4% (n = 13) statements. Eight barriers and five facilitators were identified as strategic priorities to organizational implementation of FIP. The key factors were related to the following CFIR themes: leadership engagement, access to information and knowledge, implementation climate, structural characteristics, networks and communication, client needs and resources, external policies and incentives, and reflecting and evaluating. The study findings suggest that issues related to central prioritization, top-down organizational processes and external policy context should represent priority areas for implementation. Our results prioritise methods for improving FIP by highlighting the key areas of organizational practice to be addressed by tailored implementation strategies.
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Sørensen K, Skirbekk H, Kvarstein G, Wøien H. Home administration of needle injections for children with rheumatic diseases: A qualitative study on nurses' perception of their educational role. J Pediatr Nurs 2022; 66:e137-e144. [PMID: 35491289 DOI: 10.1016/j.pedn.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/05/2022] [Accepted: 04/14/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE To explore nurses' perceptions of their educational role, pedagogical competence, and practice in teaching children with rheumatic diseases and their parents to manage subcutaneous injections at home. DESIGN AND METHODS In this qualitative study, we used thematic analysis to analyze data from three focus groups with 14 nurses responsible for patient education at one pediatric ward and two outpatient clinics. RESULTS We identified three main themes capturing nurses' perceptions of their educational role: myriad expectations, awareness of own competence, and facilitation and prioritization of patient education. Nurses perceived patient education as an expected but challenging duty of their work. They described a lack of pedagogical competence, insecurity in managing parents' and children's fears and worries, and limited organizational structures guiding their educational role. Nurses who worked in outpatient clinics felt freer to individualize education compared to ward nurses. CONCLUSIONS Nurses perceive their educational role as significant in enabling children and parents to manage subcutaneous injections at home; however, they require pedagogical competence integrated with daily practice to provide high-quality care. Short-term admissions require a different organization of patient education than before. PRACTICAL IMPLICATIONS Nurses need increased training in communication and management of children's pain and fear during needle injections. Competence development should include opportunities for reflection and guidance in clinical practice. Pediatric specialist nurses at outpatient clinics seem to have better competence to provide individual patient education for these families. The potential advantage of web-based solutions for nurses' patient education is a promising avenue for future research.
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Affiliation(s)
- Kari Sørensen
- Department of Nursing Science, Medical Faculty, University of Oslo, Norway; Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Department of Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway.
| | - Helge Skirbekk
- Department of Health Management and Health Economics, Medical Faculty, University of Oslo, Norway; Department of Undergraduate Studies, Lovisenberg Diaconal University College, Norway.
| | - Gunnvald Kvarstein
- Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway; Division of Emergencies and Critical Care, Oslo University Hospital, Norway.
| | - Hilde Wøien
- Department of Nursing Science, Medical Faculty, University of Oslo, Norway; Division of Emergencies and Critical Care, Oslo University Hospital, Norway.
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Manworren RCB. Nurses' management of children's acute postoperative pain: A theory of bureaucratic caring deductive study. J Pediatr Nurs 2022; 64:42-55. [PMID: 35149258 DOI: 10.1016/j.pedn.2022.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Few studies have examined the translation of nurses' knowledge of pain management into clinical practice or how nurses negotiated the bureaucracy of caring to treat patients' acute pain. PURPOSE This study describes factors that influence pediatric nurses' actions in caring for hospitalized children's acute post-surgical pain. METHOD Ray's Theory of Bureaucratic Caring provided the theoretical framework for this mixed methods study of ethnography and human factors engineering. Fourteen nurses were observed throughout their shifts (175.5 h) to elucidate humanistic and bureaucratic influences. FINDINGS Of 105 pain assessments, nurses intervened with pharmacologic (n = 45) and biobehavioral (n = 13) interventions for pediatric patients' post-surgical pain in less than 11 min; and 25 assessments revealed patients did not have pain. Pain was assessed and no intervention was provided to 4 patients who were asleep, 5 patients who refused, 2 patients who had no ordered analgesics and 10 patients who were assessed prior to peak effectiveness of their prior analgesic. Overall pain was well-controlled. Of the 28 themes identified, the interplay of 6 categorized to the social/cultural humanistic, 7 political, and 6 technologic/physiological bureaucratic dimensions most strongly influenced pain care. DISCUSSION To achieve optimal pain care outcomes, nurses' and parents' pain management knowledge was less influential for clinical practice translation than nurses' negotiation of other dimensions of bureaucratic caring.
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Affiliation(s)
- Renee C B Manworren
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Box 100, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Box 100, Chicago, IL 60611, USA.
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Carter B, Young R, Munro J. “Communicating Lily’s Pain”: A reflective narrative commentary about co‐creating a resource to provoke thinking and change about assessing and managing the pain of children with profound cognitive impairment. PAEDIATRIC AND NEONATAL PAIN 2022; 4:4-11. [PMID: 35546912 PMCID: PMC8975188 DOI: 10.1002/pne2.12074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 12/09/2021] [Accepted: 01/24/2022] [Indexed: 11/24/2022]
Abstract
This paper draws together about 20 years of research work and discovery and the development of a resource about pain assessment and management in children with profound cognitive impairment. The animation tells the story of an imagined child called Lily and the skills her mother uses and the challenges that her mother faces in assessing and managing Lily's pain. The animation is built on stories drawn from qualitative research findings, conversations while in clinical practice and with members of the general public, parent advisers and other sources. Most of the “evidence” came from stories shared by parents and healthcare professionals. This paper draws on some elements of socio‐narratology and is predicated on the basis that stories are important and they can act on and with us. By using an animation to tell Lily's story, the intention was to communicate research findings to a wider and more diverse audience than the typical readership of an academic journal. The intention was to act in and on people's consciousness about children's pain and to strengthen relationships and create bonds between clinicians, parents, and children in pain to make their dialog more social, connected, and meaningful. All three of us—the researcher, the writer, and the animator—have been marked and “re‐shaped” by our work related to creating Lily; we have learned more about children like Lily and their mothers, and we have learned more about ourselves and our humanity. This animation is still a story in progress, a story ‘in the wild’, a story (and a resource) we would like you to re‐tell and share. The story of Lily's pain aimed to change the lives of parents and children and professionals. Our hope is that you can be part of that change.
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Affiliation(s)
- Bernie Carter
- Faculty of Health, Social Care and Medicine Edge Hill University Ormskirk UK
| | - Rob Young
- Faculty Associate at NHS Research & Development North West Salford UK
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Reynolds SS, Woltz P, Keating E, Neff J, Elliott J, Hatch D, Yang Q, Granger BB. Results of the CHlorhexidine Gluconate Bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections Study (CHanGing BathS): a stepped wedge cluster randomized trial. Implement Sci 2021; 16:45. [PMID: 33902653 PMCID: PMC8074470 DOI: 10.1186/s13012-021-01112-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Central line-associated bloodstream infections (CLABSIs) result in approximately 28,000 deaths and approximately $2.3 billion in added costs to the U.S. healthcare system each year, and yet, many of these infections are preventable. At two large health systems in the southeast United States, CLABSIs continue to be an area of opportunity. Despite strong evidence for interventions to prevent CLABSI and reduce associated patient harm, such as use of chlorhexidine gluconate (CHG) bathing, the adoption of these interventions in practice is poor. The primary objective of this study was to assess the effect of a tailored, multifaceted implementation program on nursing staff's compliance with the CHG bathing process and electronic health record (EHR) documentation in critically ill patients. The secondary objectives were to examine the (1) moderating effect of unit characteristics and cultural context, (2) intervention effect on nursing staff's knowledge and perceptions of CHG bathing, and (3) intervention effect on CLABSI rates. METHODS A stepped wedged cluster-randomized design was used with units clustered into 4 sequences; each sequence consecutively began the intervention over the course of 4 months. The Grol and Wensing Model of Implementation helped guide selection of the implementation strategies, which included educational outreach visits and audit and feedback. Compliance with the appropriate CHG bathing process and daily CHG bathing documentation were assessed. Outcomes were assessed 12 months after the intervention to assess for sustainability. RESULTS Among the 14 clinical units participating, 8 were in a university hospital setting and 6 were in community hospital settings. CHG bathing process compliance and nursing staff's knowledge and perceptions of CHG bathing significantly improved after the intervention (p = .009, p = .002, and p = .01, respectively). CHG bathing documentation compliance and CLABSI rates did not significantly improve; however, there was a clinically significant 27.4% decrease in CLABSI rates. CONCLUSIONS Using educational outreach visits and audit and feedback implementation strategies can improve adoption of evidence-based CHG bathing practices. TRIAL REGISTRATION ClinicalTrials.gov, NCT03898115 , Registered 28 March 2019.
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Affiliation(s)
- Staci S Reynolds
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA.
- Duke University Hospital, 2310 Erwin Road, Durham, NC, 27710, USA.
| | - Patricia Woltz
- WakeMed Health & Hospitals, 3000 New Bern Avenue, Raleigh, NC, 27610, USA
| | - Edward Keating
- Duke University Hospital, 2310 Erwin Road, Durham, NC, 27710, USA
| | - Janice Neff
- WakeMed Health & Hospitals, 3000 New Bern Avenue, Raleigh, NC, 27610, USA
| | - Jennifer Elliott
- WakeMed Health & Hospitals, 3000 New Bern Avenue, Raleigh, NC, 27610, USA
| | - Daniel Hatch
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA
| | - Qing Yang
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA
| | - Bradi B Granger
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA
- Duke University Health System, 2310 Erwin Road, Durham, NC, 27710, USA
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Fry M, Elliott R, Curtis K, Mei J, Fitzpatrick L, Groth R, Murphy S, Jones K, Hofman C. Family members' perceptions of older person discharge from emergency departments. Int J Older People Nurs 2021; 16:e12365. [PMID: 33543594 DOI: 10.1111/opn.12365] [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: 06/23/2020] [Revised: 12/10/2020] [Accepted: 12/22/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND People aged over 64 years account for approximately 20% of adult emergency presentations, with up to 60% of people discharged home from emergency departments (EDs). Many older people discharged home are supported by family. OBJECTIVES The objective of this study was to explore the family members' perspectives of older people's discharge from ED to inform new alternative or innovative models of care. METHODS The design was a descriptive exploratory study. A convenience sample of family members was recruited from three EDs across Sydney, New South Wales. Telephone interviews were conducted over a six-month period and data were analysed using statistics or thematic analysis. RESULTS Interviews were conducted with 133 family members of whom the majority were female (n = 80, 60%) with a median age of 70 years (IQR 91-35). Over 87% of family members were satisfied with ED care and discharge processes that were provided to the older person. The majority (n = 129, 97%) of family members reported that they understood the treatment and perceived that the older person's condition was well managed (n = 119, 86%). The majority (n = 114, 86%) of family members reported being informed of the medical diagnosis and were confident (87%, n = 115) to continue care of the older person at home. Three themes emerged from qualitative data: (a) a sense of time-moving through ED; (b) giving voice to the impact of clinician communication; and (c) the delivery of comfort and basic care. DISCUSSION Family members reported that they were engaged in and satisfied with the older person's ED treatment and discharge. However, family members suggested that there was opportunity to improve communication consistency for ED discharge and managing the wait. CONCLUSION Clinicians need to engage with family members to optimise quality and safety. Clinicians need to understand that family members considered comfort and fundamentals of care to be an important dimension of the older person's ED management plan.
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Affiliation(s)
- Margaret Fry
- Northern Sydney Local Health District, Faculty of Health, Royal North Shore Hospital, University of Technology Sydney, St Leonards, NSW, Australia.,Sydney Nursing School, University of Sydney, Camperdown, NSW, Australia.,Faculty of Health, University of Technology Sydney, St Leonards, NSW, Australia
| | - Rosalind Elliott
- Research & Practice Development Unit, Royal North Shore Hospital, Nursing and Midwifery Directorate, St Leonards, NSW, Australia
| | - Kate Curtis
- Sydney Nursing School, University of Sydney, Camperdown, NSW, Australia.,Emergency Services, ISLHD, Woollongong, NSW, Australia
| | - Joy Mei
- Aged Service in Emergency Team (ASET), Northern Sydney Local Health District, Hornsby Hospital, Hornsby, NSW, Australia
| | - Lesley Fitzpatrick
- Faculty of Health, University of Technology Sydney, St Leonards, NSW, Australia.,Emergency Department, Northern Sydney Local Health District, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Rachel Groth
- Aged Service in Emergency Team (ASET), Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Sandra Murphy
- Research & Practice Development Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Keryn Jones
- Emergency Department, South East Local Health District, St George Hospital, Kogarah, NSW, Australia
| | - Catherine Hofman
- Aged Service in Emergency Team (ASET), Emergency Department, South East Sydney Local Health District, St George Hospital, Kogarah, NSW, Australia
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Questionnaires to Measure Process and Structure of Quality Indicators for Pediatric Nursing. Pediatr Qual Saf 2020; 6:e381. [PMID: 33409433 PMCID: PMC7781297 DOI: 10.1097/pq9.0000000000000381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 09/11/2020] [Indexed: 12/26/2022] Open
Abstract
The quality of nursing care has a significant impact on the outcomes of care. The specific needs of children requiring hospital care make it essential to monitor and compare data not only on the medically oriented outcome measure but also on nursing care, structure, and process, requiring perspectives from registered nurses (RNs) and nurse managers (NMs). Thus, this project aimed to evaluate the structure and process of nursing quality indicators in pediatric hospital care with questionnaires distributed to RN and NM.
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Measuring nurses' perceptions of their work environment and linking with behaviour change theories and implementation strategies to support evidence based practice change. Appl Nurs Res 2020; 56:151374. [PMID: 33280792 DOI: 10.1016/j.apnr.2020.151374] [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: 06/02/2020] [Revised: 07/28/2020] [Accepted: 10/09/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE Survey tools, such as the Alberta Context Tool, reliably measure context but researchers have no process to map context to clinician behaviour and develop strategies to support practice change. Therefore, we aimed to map the Alberta Context Tool to the Theoretical Domains Framework and the Behaviour Change Wheel. METHOD The multi-centre study used the Alberta Context Tool to collect data from a convenience sample of nurses working in two emergency departments. These findings were categorised as barriers and enablers, and then mapped to the Theoretical Domains Framework to examine for behavioural domains. Using the Behaviour Change Wheel functions, strategies were developed to target clinician behaviour change. RESULTS Survey response rate was 42% (n = 68). Nurses perceived a positive work environment in the dimensions of Social Capital (median 4.00, IQR 0.33), Culture (median 3.83, IQR 1.16) and Leadership (median 3.60, IQR 1.1). Low scoring dimensions included Formal Interactions (median 2.75, IQR 1.00); Time (median 2.60, IQR 1.00) Staffing (median 3.0, IQR 2.00) and Space (median 3.0, IQR 2.00). Enablers (n = 77) and barriers (n = 25) were identified in both sites. The Theoretical Domains Framework was mapped to Alberta Context Tool barriers and enablers. The behaviour change strengths included: social and professional role; beliefs about capability; goals; and emotions. Using the Behaviour Change Wheel functions, 67 strategies were developed to address barriers and enablers. CONCLUSIONS The Alberta Context Tool successfully measured two emergency environments identifying barriers and enablers. This approach enabled environment dimensions to be targeted with practical solutions to support evidence-based practice implementation.
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Schadewaldt V, McElduff B, D'Este C, McInnes E, Dale S, Fasugba O, Cadilhac DA, Considine J, Grimshaw JM, Cheung NW, Levi C, Gerraty R, Fitzgerald M, Middleton S. Measuring organizational context in Australian emergency departments and its impact on stroke care and patient outcomes. Nurs Outlook 2020; 69:103-115. [PMID: 32981669 DOI: 10.1016/j.outlook.2020.08.009] [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: 04/21/2020] [Revised: 07/22/2020] [Accepted: 08/15/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Emergency departments (ED) are challenging environments but critical for early management of patients with stroke. PURPOSE To identify how context affects the provision of stroke care in 26 Australian EDs. METHOD Nurses perceptions of ED context was assessed with the Alberta Context Tool. Medical records were audited for quality of stroke care and patient outcomes. FINDINGS Collectively, emergency nurses (n = 558) rated context positively with several nurse and hospital characteristics impacting these ratings. Despite these positive ratings, regression analysis showed no significant differences in the quality of stroke care (n = 1591 patients) and death or dependency (n = 1165 patients) for patients in EDs with high or low rated context. DISCUSSION Future assessments of ED context may need to examine contextual factors beyond the scope of the Alberta Context Tool which may play an important role for the understanding of stroke care and patient outcomes in EDs.
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Affiliation(s)
- Verena Schadewaldt
- Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Darlinghurst, New South Wales, Australia.
| | - Benjamin McElduff
- Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Darlinghurst, New South Wales, Australia
| | - Catherine D'Este
- National Centre for Epidemiology and Population Health (NCEPH), Australian National University, Canberra, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Darlinghurst, New South Wales, Australia
| | - Simeon Dale
- Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Darlinghurst, New South Wales, Australia
| | - Oyebola Fasugba
- Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Darlinghurst, New South Wales, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Julie Considine
- Deakin University - Eastern Health; School of Nursing and Midwifery and Centre for Quality and Patient Safety Research - Eastern Health Partnership, Deakin University, Geelong, Victoria, Australia
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa Hospital - General Campus, Centre for Practice-Changing Research (CPCR), Ottawa, Ontario, Canada
| | - N Wah Cheung
- Centre for Diabetes and Endocrinology Research, Westmead Hospital and University of Sydney, Westmead, Sydney, New South Wales, Australia
| | - Chris Levi
- The Sydney Partnership for Health Education Research & Enterprise (SPHERE), University of New South Wales, Liverpool, New South Wales, Australia
| | - Richard Gerraty
- Department of Medicine, Monash University, Melbourne, Australia
| | - Mark Fitzgerald
- Alfred Hospital, Melbourne, Victoria, Australia; Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Faculty of Science, Engineering and Technology, Swinburne University of Technology, Melbourne, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Darlinghurst, New South Wales, Australia
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Hutchinson AM, Brotto V, Chapman A, Sales AE, Mohebbi M, Bucknall TK. Use of an audit with feedback implementation strategy to promote medication error reporting by nurses. J Clin Nurs 2020; 29:4180-4193. [PMID: 32757427 DOI: 10.1111/jocn.15447] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 06/18/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To outline the development and effect of an audit with feedback implementation strategy that intended to increase the rate of voluntary medication error reporting by nurses. BACKGROUND Medication errors are a serious global health issue. Audit with feedback is a widely used implementation strategy that has potential to modify nurses' reporting behaviour and improve medication error reporting rates. DESIGN Quasi-experimental implementation study (fulfilling the TIDieR checklist) with two pairs of matched wards at a private hospital in Australia was conducted from March 2015-September 2016. One ward from each pair was randomised to either the intervention or control group. METHOD Nurses within intervention wards received audit with feedback on a quarterly basis over a 12-month implementation period. Control wards underwent quarterly audits only (without feedback). Feedback consisted of a one-page infographic poster, with content based on medication error data obtained from audits and the hospitals' risk management system (RiskMan). The primary outcome-rate of medication errors reported per month-was determined in both groups at pre-implementation, implementation and postimplementation phases. Differences between groups were compared using generalised linear mixed models with Poisson distribution and log link. RESULTS A nonsignificant intervention effect was found for rate of medication errors reported per month. Interestingly, when combining data from both groups, a significant increasing time trend was observed for medication errors reported per month across pre-implementation and implementation phases (80% increase). CONCLUSIONS The audit with feedback strategy developed in the present study did not effectively influence the voluntary reporting of medication errors by nurses. RELEVANCE TO CLINICAL PRACTICE Despite the lack of intervention effects, the use of a published checklist to optimise the reporting quality of this study will contribute to the field by furthering the understanding of how to enhance audit with feedback implementation strategies for nurses.
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Affiliation(s)
- Alison M Hutchinson
- School of Nursing & Midwifery, Centre for Quality & Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Monash Health, Clayton, VIC, Australia
| | - Vanessa Brotto
- School of Nursing & Midwifery, Centre for Quality & Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Anna Chapman
- School of Nursing & Midwifery, Centre for Quality & Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Monash Health, Clayton, VIC, Australia
| | - Anne E Sales
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA.,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Mohammadreza Mohebbi
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Tracey K Bucknall
- School of Nursing & Midwifery, Centre for Quality & Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Alfred Health, Melbourne, VIC, Australia
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Rogers L, De Brún A, McAuliffe E. Defining and assessing context in healthcare implementation studies: a systematic review. BMC Health Serv Res 2020; 20:591. [PMID: 32600396 PMCID: PMC7322847 DOI: 10.1186/s12913-020-05212-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 04/13/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The implementation of evidence-based healthcare interventions is challenging, with a 17-year gap identified between the generation of evidence and its implementation in routine practice. Although contextual factors such as culture and leadership are strong influences for successful implementation, context remains poorly understood, with a lack of consensus regarding how it should be defined and captured within research. This study addresses this issue by providing insight into how context is defined and assessed within healthcare implementation science literature and develops a definition to enable effective measurement of context. METHODS Medline, PsychInfo, CINAHL and EMBASE were searched. Articles were included if studies were empirical and evaluated context during the implementation of a healthcare initiative. These English language articles were published in the previous 10 years and included a definition and assessment of context. Results were synthesised using a narrative approach. RESULTS Three thousand and twenty-one search records were obtained of which 64 met the eligibility criteria and were included in the review. Studies used a variety of definitions in terms of the level of detail and explanation provided. Some listed contextual factors (n = 19) while others documented sub-elements of a framework that included context (n = 19). The remaining studies provide a rich definition of general context (n = 11) or aspects of context (n = 15). The Alberta Context Tool was the most frequently used quantitative measure (n = 4), while qualitative papers used a range of frameworks to evaluate context. Mixed methods studies used diverse approaches; some used frameworks to inform the methods chosen while others used quantitative measures to inform qualitative data collection. Most studies (n = 50) applied the chosen measure to all aspects of study design with a majority analysing context at an individual level (n = 29). CONCLUSIONS This review highlighted inconsistencies in defining and measuring context which emphasised the need to develop an operational definition. By providing this consensus, improvements in implementation processes may result, as a common understanding will help researchers to appropriately account for context in research.
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Affiliation(s)
- L. Rogers
- University College Dublin Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), Belfield, Dublin 4, Ireland
- University College Dublin School of Nursing, Midwifery and Health Systems, Belfield, Dublin 4, Ireland
| | - A. De Brún
- University College Dublin Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), Belfield, Dublin 4, Ireland
- University College Dublin School of Nursing, Midwifery and Health Systems, Belfield, Dublin 4, Ireland
| | - E. McAuliffe
- University College Dublin Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), Belfield, Dublin 4, Ireland
- University College Dublin School of Nursing, Midwifery and Health Systems, Belfield, Dublin 4, Ireland
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Xiong W, Li L, Bao D, Wang Y, Liang Y, Lu P, Zhang D, Liu G, Qiao L, Zheng N, Jin X. Postoperative analgesia of scalp nerve block with ropivacaine in pediatric craniotomy patients: a protocol for a prospective, randomized, placebo-controlled, double-blinded trial. Trials 2020; 21:580. [PMID: 32586348 PMCID: PMC7318534 DOI: 10.1186/s13063-020-04524-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 06/16/2020] [Indexed: 02/12/2023] Open
Abstract
Background Moderate-to-severe postoperative pain following craniotomy has a high incidence in pediatric patients. Such pain may cause agitation, intracranial hypertension, epileptic seizures, and postoperative hematoma, which affect morbidity and mortality. Although scalp nerve block (SNB) achieves satisfactory pain relief except for suboccipital mid-craniotomy in adults and ropivacaine is widely used as a long-acting peripheral nerve block agent in children, there are few studies of SNB with ropivacaine in pediatric patients undergoing craniotomy. In addition, the neurosurgery operation time is relatively long, but the duration of action of SNB is limited. It is generally believed that postoperative SNB is better than preoperative SNB for postoperative analgesia. However, considering the concept of preemptive analgesia, we believe that preoperative SNB may achieve a longer postoperative analgesia effect than we expected. Methods This trial is a single-institution, prospective, randomized, controlled, double-blind study. A total of 180 children aged between 1 and 12 years who are undergoing elective craniotomy will be randomly allocated in a 1:1:1 ratio to three groups: group B (preoperative ropivacaine block group), group A (postoperative ropivacaine block group), and group N (nonblocking control group). This randomization will be stratified by age in two strata (1–6 years and 7–12 years). The primary outcome is the total consumption of sufentanil within 24 h after surgery. The secondary outcomes include assessment of pain scores, total consumption of sufentanil and emergency-remedy medicine consumption at observation points, the occurrence of postoperative complications, and the length of hospitalization after surgery. Discussion This study is designed to explore the effect and feasibility of SNB with ropivacaine for postoperative analgesia in pediatric patients undergoing craniotomy. Further aims are to compare the effects of preoperative and postoperative SNB on postoperative analgesia in order to identify whether there is a preemptive analgesic effect and determine the better time to implement SNB in pediatric patients during craniotomy. Trial registration Chinese Clinical Trial Registry ChiCTR1800017386. Registered on 27 July 2018.
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Affiliation(s)
- Wei Xiong
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Lu Li
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Di Bao
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yaxin Wang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yi Liang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Pengwei Lu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Di Zhang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Gaifen Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Lanxin Qiao
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Na Zheng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xu Jin
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
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Coles E, Anderson J, Maxwell M, Harris FM, Gray NM, Milner G, MacGillivray S. The influence of contextual factors on healthcare quality improvement initiatives: a realist review. Syst Rev 2020; 9:94. [PMID: 32336290 PMCID: PMC7184709 DOI: 10.1186/s13643-020-01344-3] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/30/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Recognising the influence of context and the context-sensitive nature of quality improvement (QI) interventions is crucial to implementing effective improvements and successfully replicating them in new settings, yet context is still poorly understood. To address this challenge, it is necessary to capture generalisable knowledge, first to understand which aspects of context are most important to QI and why, and secondly, to explore how these factors can be managed to support healthcare improvement, in terms of implementing successful improvement initiatives, achieving sustainability and scaling interventions. The research question was how and why does context influence quality improvement initiatives in healthcare? METHODS A realist review explored the contextual conditions that influence healthcare improvement. Realist methodology integrates theoretical understanding and stakeholder input with empirical research findings. The review aimed to identify and understand the role of context during the improvement cycle, i.e. planning, implementation, sustainability and transferability; and distil new knowledge to inform the design and development of context-sensitive QI initiatives. We developed a preliminary theory of the influence of context to arrive at a conceptual and theoretical framework. RESULTS Thirty-five studies were included in the review, demonstrating the interaction of key contextual factors across healthcare system levels during the improvement cycle. An evidence-based explanatory theoretical model is proposed to illustrate the interaction between contextual factors, system levels (macro, meso, micro) and the stages of the improvement journey. Findings indicate that the consideration of these contextual factors would enhance the design and delivery of improvement initiatives, across a range of improvement settings. CONCLUSIONS This is the first realist review of context in QI and contributes to a deeper understanding of how context influences quality improvement initiatives. The distillation of key contextual factors offers the potential to inform the design and development of context-sensitive interventions to enhance improvement initiatives and address the challenge of spread and sustainability. Future research should explore the application of our conceptual model to enhance improvement-planning processes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017062135.
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Affiliation(s)
- Emma Coles
- Nursing Midwifery & Allied Health Professions Research Unit (NMAHP-RU), University of Stirling, Scion House, University of Stirling Innovation Park, Stirling, FK9 4NF UK
| | - Julie Anderson
- Scottish Improvement Science Collaborating Centre (SISCC), School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ UK
| | - Margaret Maxwell
- Nursing Midwifery & Allied Health Professions Research Unit (NMAHP-RU), University of Stirling, Scion House, University of Stirling Innovation Park, Stirling, FK9 4NF UK
| | - Fiona M. Harris
- Nursing Midwifery & Allied Health Professions Research Unit (NMAHP-RU), University of Stirling, Scion House, University of Stirling Innovation Park, Stirling, FK9 4NF UK
| | - Nicola M. Gray
- Scottish Improvement Science Collaborating Centre (SISCC), School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ UK
| | - Gill Milner
- Scottish Improvement Science Collaborating Centre (SISCC), School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ UK
| | - Stephen MacGillivray
- School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ UK
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14
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A systematic review of empirical studies examining mechanisms of implementation in health. Implement Sci 2020. [PMID: 32299461 DOI: 10.1186/s13012‐020‐00983‐3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding the mechanisms of implementation strategies (i.e., the processes by which strategies produce desired effects) is important for research to understand why a strategy did or did not achieve its intended effect, and it is important for practice to ensure strategies are designed and selected to directly target determinants or barriers. This study is a systematic review to characterize how mechanisms are conceptualized and measured, how they are studied and evaluated, and how much evidence exists for specific mechanisms. METHODS We systematically searched PubMed and CINAHL Plus for implementation studies published between January 1990 and August 2018 that included the terms "mechanism," "mediator," or "moderator." Two authors independently reviewed title and abstracts and then full texts for fit with our inclusion criteria of empirical studies of implementation in health care contexts. Authors extracted data regarding general study information, methods, results, and study design and mechanisms-specific information. Authors used the Mixed Methods Appraisal Tool to assess study quality. RESULTS Search strategies produced 2277 articles, of which 183 were included for full text review. From these we included for data extraction 39 articles plus an additional seven articles were hand-entered from only other review of implementation mechanisms (total = 46 included articles). Most included studies employed quantitative methods (73.9%), while 10.9% were qualitative and 15.2% were mixed methods. Nine unique versions of models testing mechanisms emerged. Fifty-three percent of the studies met half or fewer of the quality indicators. The majority of studies (84.8%) only met three or fewer of the seven criteria stipulated for establishing mechanisms. CONCLUSIONS Researchers have undertaken a multitude of approaches to pursue mechanistic implementation research, but our review revealed substantive conceptual, methodological, and measurement issues that must be addressed in order to advance this critical research agenda. To move the field forward, there is need for greater precision to achieve conceptual clarity, attempts to generate testable hypotheses about how and why variables are related, and use of concrete behavioral indicators of proximal outcomes in the case of quantitative research and more directed inquiry in the case of qualitative research.
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15
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Lewis CC, Boyd MR, Walsh-Bailey C, Lyon AR, Beidas R, Mittman B, Aarons GA, Weiner BJ, Chambers DA. A systematic review of empirical studies examining mechanisms of implementation in health. Implement Sci 2020; 15:21. [PMID: 32299461 PMCID: PMC7164241 DOI: 10.1186/s13012-020-00983-3] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/12/2020] [Indexed: 11/15/2022] Open
Abstract
Background Understanding the mechanisms of implementation strategies (i.e., the processes by which strategies produce desired effects) is important for research to understand why a strategy did or did not achieve its intended effect, and it is important for practice to ensure strategies are designed and selected to directly target determinants or barriers. This study is a systematic review to characterize how mechanisms are conceptualized and measured, how they are studied and evaluated, and how much evidence exists for specific mechanisms. Methods We systematically searched PubMed and CINAHL Plus for implementation studies published between January 1990 and August 2018 that included the terms “mechanism,” “mediator,” or “moderator.” Two authors independently reviewed title and abstracts and then full texts for fit with our inclusion criteria of empirical studies of implementation in health care contexts. Authors extracted data regarding general study information, methods, results, and study design and mechanisms-specific information. Authors used the Mixed Methods Appraisal Tool to assess study quality. Results Search strategies produced 2277 articles, of which 183 were included for full text review. From these we included for data extraction 39 articles plus an additional seven articles were hand-entered from only other review of implementation mechanisms (total = 46 included articles). Most included studies employed quantitative methods (73.9%), while 10.9% were qualitative and 15.2% were mixed methods. Nine unique versions of models testing mechanisms emerged. Fifty-three percent of the studies met half or fewer of the quality indicators. The majority of studies (84.8%) only met three or fewer of the seven criteria stipulated for establishing mechanisms. Conclusions Researchers have undertaken a multitude of approaches to pursue mechanistic implementation research, but our review revealed substantive conceptual, methodological, and measurement issues that must be addressed in order to advance this critical research agenda. To move the field forward, there is need for greater precision to achieve conceptual clarity, attempts to generate testable hypotheses about how and why variables are related, and use of concrete behavioral indicators of proximal outcomes in the case of quantitative research and more directed inquiry in the case of qualitative research.
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Affiliation(s)
- Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA. .,Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th Street, Bloomington, IN, 47405, USA. .,Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 1959 NE Pacific Avenue, Seattle, WA, 98195, USA.
| | - Meredith R Boyd
- Department of Psychology, University of California Los Angeles, 1177 Franz Hall, 502 Portola Plaza, Los Angeles, CA, 90095, USA
| | - Callie Walsh-Bailey
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.,Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 1959 NE Pacific Avenue, Seattle, WA, 98195, USA
| | - Rinad Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA
| | - Brian Mittman
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Avenue, Pasadena, CA, 91101, USA
| | - Gregory A Aarons
- Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Bryan J Weiner
- Department of Health Services, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - David A Chambers
- Division of Cancer Control and Population Science, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA
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16
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Schadewaldt V, McElduff B, D’Este C, McInnes E, Dale S, Gunaratne A, Squires J, Cadilhac DA, Middleton S. Validating the Alberta Context Tool in a multi-site Australian Emergency Department nurse population. PLoS One 2019; 14:e0215153. [PMID: 30964916 PMCID: PMC6456203 DOI: 10.1371/journal.pone.0215153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 03/27/2019] [Indexed: 11/26/2022] Open
Abstract
The organisational context of healthcare settings has an essential role in how research evidence is used in clinical practice. The Alberta Context Tool (ACT) measures 10 concepts of organisational context with higher scores indicating a more positive work environment and potentially better use of research evidence in patient care. We assessed the psychometric properties of the ACT in Emergency Departments (EDs). This validation study was conducted as part of a multi-centre trial of triage, treatment and transfer (T3 Trial) of patients with stroke admitted to EDs. Stratified sampling with proportional allocation was used to recruit ED nurses from 26 participating hospitals at baseline. Nurses completed a survey containing the ACT. Structural validity was investigated by exploratory and confirmatory factor analysis. Reliability was assessed using Cronbach’s alpha and intraclass correlation coefficients. Item-rest correlations and the average inter-item correlations were also assessed. 558 ED nurses completed the survey, comprised of 433 surveys without missing data. Our exploratory factor analysis produced a 14-factor structure, explaining 62% of variance of organisational context. For eight of ten concepts, item loadings matched the factor structure of the original ACT. Confirmatory factor analysis of the 10 ACT concepts showed moderate model fit (p = 0.001, root mean square error of approximation: 0.049, standardised root mean squared residual: 0.048). Cronbach’s alphas showed very good internal consistency for nine of ten ACT concepts (α>0.7; 0.45–0.90). Item-rest correlations indicated that most ACT items (50 of 56 items) within any concept related well to the total score of the concept. Average inter-item correlations indicated potential redundant items for three concepts (feedback processes, leadership, staffing) that were above the threshold of 0.5. While identifying a few shortcomings for some ACT concepts in an ED context, the majority of findings confirm reliability and validity of the original ACT in an Australian population of ED nurses.
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Affiliation(s)
- Verena Schadewaldt
- Nursing Research Institute, Australian Catholic University and St Vincent’s Health Australia Sydney, Darlinghurst, New South Wales, Australia
| | - Benjamin McElduff
- Nursing Research Institute, Australian Catholic University and St Vincent’s Health Australia Sydney, Darlinghurst, New South Wales, Australia
| | - Catherine D’Este
- National Centre for Epidemiology and Population Health (NCEPH), Australian National University, Canberra, Australian Capital Territory, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Elizabeth McInnes
- Nursing Research Institute, Australian Catholic University and St Vincent’s Health Australia Sydney, Darlinghurst, New South Wales, Australia
| | - Simeon Dale
- Nursing Research Institute, Australian Catholic University and St Vincent’s Health Australia Sydney, Darlinghurst, New South Wales, Australia
| | - Anoja Gunaratne
- Nursing Research Institute, Australian Catholic University and St Vincent’s Health Australia Sydney, Darlinghurst, New South Wales, Australia
| | - Janet Squires
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dominique A. Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Sandy Middleton
- Nursing Research Institute, Australian Catholic University and St Vincent’s Health Australia Sydney, Darlinghurst, New South Wales, Australia
- * E-mail:
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17
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Gifford WA, Squires JE, Angus DE, Ashley LA, Brosseau L, Craik JM, Domecq MC, Egan M, Holyoke P, Juergensen L, Wallin L, Wazni L, Graham ID. Managerial leadership for research use in nursing and allied health care professions: a systematic review. Implement Sci 2018; 13:127. [PMID: 30261927 PMCID: PMC6161344 DOI: 10.1186/s13012-018-0817-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 09/10/2018] [Indexed: 01/08/2023] Open
Abstract
Background Leadership by point-of-care and senior managers is increasingly recognized as critical to the acceptance and use of research evidence in practice. The purpose of this systematic review was to identify the leadership behaviours of managers that are associated with research use by clinical staff in nursing and allied health professionals. Methods A mixed methods systematic review was performed. Eight electronic bibliographic databases were searched. Studies examining the association between leadership behaviours and nurses and allied health professionals’ use of research were eligible for inclusion. Studies were excluded if leadership could not be clearly attributed to someone in a management position. Two reviewers independently screened abstracts, reviewed full-text articles, extracted data and performed quality assessments. Narrative synthesis was conducted. Results The search yielded 7019 unique titles and abstracts after duplicates were removed. Three hundred five full-text articles were reviewed, and 31 studies reported in 34 articles were included. Methods used were qualitative (n = 19), cross-sectional survey (n = 9), and mixed methods (n = 3). All studies included nurses, and six also included allied health professionals. Twelve leadership behaviours were extracted from the data for point-of-care managers and ten for senior managers. Findings indicated that managers performed a diverse range of leadership behaviours that encompassed change-oriented, relation-oriented and task-oriented behaviours. The most commonly described behavior was support for the change, which involved demonstrating conceptual and operational commitment to research-based practices. Conclusions This systematic review adds to the growing body of evidence that indicates that manager-staff dyads are influential in translating research evidence into action. Findings also reveal that leadership for research use involves change and task-oriented behaviours that influence the environmental milieu and the organisational infrastructure that supports clinical care. While findings explain how managers enact leadership for research use, we now require robust methodological studies to determine which behaviours are effective in enabling research use with nurses and allied health professionals for high-quality evidence-based care. Trial registration PROSPERO CRD42014007660 Electronic supplementary material The online version of this article (10.1186/s13012-018-0817-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wendy A Gifford
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.
| | - Janet E Squires
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Douglas E Angus
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - Lisa A Ashley
- Canadian Nurses Association, Ottawa, Ontario, Canada
| | - Lucie Brosseau
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Janet M Craik
- Canadian Association of Occupational Therapists, Ottawa, Ontario, Canada
| | | | - Mary Egan
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada.,Elisabeth Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Paul Holyoke
- SE Research Centre, SE Health, Markham, Ontario, Canada
| | - Linda Juergensen
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.,Faculty of Health, School of Nursing, York University, Toronto, Ontario, Canada
| | - Lars Wallin
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Sahlgrenska Academy, Department of Health Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing Karolinska Institutet, Stockholm, Sweden
| | - Liquaa Wazni
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Ian D Graham
- Sahlgrenska Academy, Department of Health Care Sciences, University of Gothenburg, Gothenburg, Sweden.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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18
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Xiang LL, Hua ZY. [Application of the Evidence-based Practice for Improving Quality method in neonatal intensive care units]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:686-690. [PMID: 30111481 PMCID: PMC7389753 DOI: 10.7499/j.issn.1008-8830.2018.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/24/2018] [Indexed: 06/08/2023]
Abstract
The Evidence-based Practice for Improving Quality (EPIQ) method was proposed by Canadian Neonatal Network for high quality health care. The method is characterized by evidence-based, targeted, collaborative and continuous concept. At present it is applied in neonatal intensive care units (NICUs). This review article focuses on the application of the method in NICUs.
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Affiliation(s)
- Ling-Ling Xiang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
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19
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Li SA, Jeffs L, Barwick M, Stevens B. Organizational contextual features that influence the implementation of evidence-based practices across healthcare settings: a systematic integrative review. Syst Rev 2018; 7:72. [PMID: 29729669 PMCID: PMC5936626 DOI: 10.1186/s13643-018-0734-5] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/18/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Organizational contextual features have been recognized as important determinants for implementing evidence-based practices across healthcare settings for over a decade. However, implementation scientists have not reached consensus on which features are most important for implementing evidence-based practices. The aims of this review were to identify the most commonly reported organizational contextual features that influence the implementation of evidence-based practices across healthcare settings, and to describe how these features affect implementation. METHODS An integrative review was undertaken following literature searches in CINAHL, MEDLINE, PsycINFO, EMBASE, Web of Science, and Cochrane databases from January 2005 to June 2017. English language, peer-reviewed empirical studies exploring organizational context in at least one implementation initiative within a healthcare setting were included. Quality appraisal of the included studies was performed using the Mixed Methods Appraisal Tool. Inductive content analysis informed data extraction and reduction. RESULTS The search generated 5152 citations. After removing duplicates and applying eligibility criteria, 36 journal articles were included. The majority (n = 20) of the study designs were qualitative, 11 were quantitative, and 5 used a mixed methods approach. Six main organizational contextual features (organizational culture; leadership; networks and communication; resources; evaluation, monitoring and feedback; and champions) were most commonly reported to influence implementation outcomes in the selected studies across a wide range of healthcare settings. CONCLUSIONS We identified six organizational contextual features that appear to be interrelated and work synergistically to influence the implementation of evidence-based practices within an organization. Organizational contextual features did not influence implementation efforts independently from other features. Rather, features were interrelated and often influenced each other in complex, dynamic ways to effect change. These features corresponded to the constructs in the Consolidated Framework for Implementation Research (CFIR), which supports the use of CFIR as a guiding framework for studies that explore the relationship between organizational context and implementation. Organizational culture was most commonly reported to affect implementation. Leadership exerted influence on the five other features, indicating it may be a moderator or mediator that enhances or impedes the implementation of evidence-based practices. Future research should focus on how organizational features interact to influence implementation effectiveness.
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Affiliation(s)
- Shelly-Anne Li
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada. .,Child Health Evaluative Sciences, Research Institute, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Lianne Jeffs
- St Michael's Hospital Volunteer Association Chair in Nursing Research, Li Ka Shing Knowledge Institute, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing and Institute of Health, Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Melanie Barwick
- Child Health Evaluative Sciences, Research Institute, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,The Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Bonnie Stevens
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Child Health Evaluative Sciences, Research Institute, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada.,Faculties of Medicine and Dentistry, University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, Canada
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20
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Developing a Sense of Knowing and Acquiring the Skills to Manage Pain in Children with Profound Cognitive Impairments: Mothers' Perspectives. Pain Res Manag 2017; 2017:2514920. [PMID: 28458591 PMCID: PMC5385219 DOI: 10.1155/2017/2514920] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 02/11/2017] [Accepted: 03/09/2017] [Indexed: 11/18/2022]
Abstract
Children with profound cognitive impairment (PCI) are a heterogenous group who often experience frequent and persistent pain. Those people closest to the child are key to assessing their pain. This mixed method study aimed to explore how parents acquire knowledge and skills in assessing and managing their child's pain. Eight mothers completed a weekly pain diary and were interviewed at weeks 1 and 8. Qualitative data were analysed using thematic analysis and the quantitative data using descriptive statistics. Mothers talked of learning through a system of trial and error (“learning to get on with it”); this was accomplished through “learning to know without a rule book or guide”; “learning to be a convincing advocate”; and “learning to endure and to get things right.” Experiential and reflective learning was evident in the way the mothers developed a “sense of knowing” their child's pain. They drew on embodied knowledge of how their child usually expressed and responded to pain to help make pain-related decisions. Health professionals need to support mothers/parents to develop their knowledge and skills and to gain confidence in pain assessment and they should recognise and act on the mothers' concerns.
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