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KC A, Rönnbäck M, Humgain U, Basnet O, Bhattarai P, Axelin A. Implementation barriers and facilitators of Moyo foetal heart rate monitor during labour in public hospitals in Nepal. Glob Health Action 2024; 17:2328894. [PMID: 38577869 PMCID: PMC11000597 DOI: 10.1080/16549716.2024.2328894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/06/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Globally, every year, approximately 1 million foetal deaths take place during the intrapartum period, fetal heart monitoring (FHRM) and timely intervention can reduce these deaths. OBJECTIVE This study evaluates the implementation barriers and facilitators of a device, Moyo for FHRM. METHODS The study adopted a qualitative study design in four hospitals in Nepal where Moyo was implemented for HRM. The study participants were labour room nurses and convenience sampling was used to select them. A total of 20 interviews were done to reach the data saturation. The interview transcripts were translated to English, and qualitative content analysis using deductive approach was applied. RESULTS Using the deductive approach, the data were organised into three categories i) changes in practice of FHRM, ii) barriers to implementing Moyo and iii) facilitators of implementing Moyo. Moyo improved adherence to intermittent FHRM as the device could handle higher caseloads compared to the previous devices. The implementation of Moyo was hindered by difficulty to organise training ondevice during non-working hours, technical issue of the device, nurse mistrust towards the device and previous experience of poor implementation to similar innovations. Facilitators for implementation included effective training on how to use Moyo, improvement in intrapartum foetal monitoring and improvement in staff morale, ease of using the device, Plan Do Study Act (PDSA) meetings to improve use of Moyo and supportive leadership. CONCLUSION The change in FHRM practice suggests that the implementation of innovative solution such as Moyo was successful with adequate facilitation, supportive staff attitude and leadership.
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Affiliation(s)
- Ashish KC
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Mikaela Rönnbäck
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Urja Humgain
- Research Division, Golden Community, Lalitpur, Nepal
| | - Omkar Basnet
- Research Division, Golden Community, Lalitpur, Nepal
| | | | - Anna Axelin
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Department of Nursing Science, University of Turku, Turku, Finland
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Temple F, Carlsson Lalloo E, Berg M, Berg U, Munyali Désiré A, Nyakio O, Mulunda A, Bogren M. Evaluating the implementation of person-centred care and simulation-based learning in a midwifery education programme in the Democratic Republic of Congo: a study protocol. Glob Health Action 2024; 17:2370097. [PMID: 38916612 PMCID: PMC11207909 DOI: 10.1080/16549716.2024.2370097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 06/16/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Investing in midwives educated according to international standards is crucial for achieving Sustainable Development Goals in maternal and newborn health. Applying a person-centred care approach and using simulation-based learning to improve the learning experience for midwifery students may enhance the quality of childbirth care. This protocol describes a study evaluating the implementation of person-centred approach and simulation-based learning in childbirth as part of a midwifery education programme at the Evangelical University in Africa, DRC. METHODS The research will be exploratory and guided by an implementation research framework. Ethical approval has been obtained. Facilitators working at the programme's five clinical practice sites will be trained in: 1) Introducing person-centred childbirth care using a training programme called'Mutual Meetings'; and 2) integrating simulation-based learning, specifically by using the three courses: Essential Care of Labor, Bleeding after Birth, and Vacuum Extraction. Data will include interviews with midwifery students, facilitators and clinical preceptors, and maternal and neonatal outcomes from birth registers. DISCUSSION By integrating a validated and culturally adapted person-centred care training programme and simulation-based learning into a midwifery education programme and clinical practice sites, the findings from the study anticipate an improvement in the quality of childbirth care. Training facilitators in these methodologies aim to effectively mitigate maternal and neonatal adverse outcomes. The findings are expected to provide valuable recommendations for governments, policymakers, and healthcare providers in the DRC and beyond, contributing to significant improvements in midwifery education and aligning with global health priorities, including the Sustainable Development Goals. TRIAL REGISTRATION The study was registered retrospectively with the ISRCTN registry on the 23rd of February 2024. The registration number is: ISRCTN10049855.
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Affiliation(s)
- Frida Temple
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ewa Carlsson Lalloo
- Centre for Person‐Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Faculty of Medicine and Community Health, Evangelical University in Africa, Bukavu, Democratic Republic of Congo
| | - Urban Berg
- Faculty of Medicine and Community Health, Evangelical University in Africa, Bukavu, Democratic Republic of Congo
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alumeti Munyali Désiré
- Faculty of Medicine and Community Health, Evangelical University in Africa, Bukavu, Democratic Republic of Congo
| | - Olivier Nyakio
- Faculty of Medicine and Community Health, Evangelical University in Africa, Bukavu, Democratic Republic of Congo
| | - Aline Mulunda
- UNFPA DRC, United Nations of Population Fund, Kinshasa, Democratic Republic of Congo
| | - Malin Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person‐Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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Luckett T, Phillips J, Agar M, Richards L, Reynolds N, Garcia M, Davidson P, Shaw T, Currow D, Boyle F, Lam L, McCaffrey N, Lovell M. Factors influencing fidelity to guideline implementation strategies for improving pain care at cancer centres: a qualitative sub-study of the Stop Cancer PAIN Trial. BMC Health Serv Res 2024; 24:969. [PMID: 39174979 PMCID: PMC11342688 DOI: 10.1186/s12913-024-11243-1] [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: 04/10/2024] [Accepted: 06/25/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND The Stop Cancer PAIN Trial was a phase III pragmatic stepped wedge cluster randomised controlled trial which compared effectiveness of screening and guidelines with or without implementation strategies for improving pain in adults with cancer attending six Australian outpatient comprehensive cancer centres (n = 688). A system for pain screening was introduced before observation of a 'control' phase. Implementation strategies introduced in the 'intervention' phase included: (1) audit of adherence to guideline recommendations, with feedback to clinical teams; (2) health professional education via an email-administered 'spaced education' module; and (3) a patient education booklet and self-management resource. Selection of strategies was informed by the Capability, Opportunity and Motivation Behaviour (COM-B) Model (Michie et al., 2011) and evidence for each strategy's stand-alone effectiveness. A consultant physician at each centre supported the intervention as a 'clinical champion'. However, fidelity to the intervention was limited, and the Trial did not demonstrate effectiveness. This paper reports a sub-study of the Trial which aimed to identify factors inhibiting or enabling fidelity to inform future guideline implementation initiatives. METHODS The qualitative sub-study enabled in-depth exploration of factors from the perspectives of personnel at each centre. Clinical champions, clinicians and clinic receptionists were invited to participate in semi-structured interviews. Analysis used a framework method and a largely deductive approach based on the COM-B Model. RESULTS Twenty-four people participated, including 15 physicians, 8 nurses and 1 clinic receptionist. Coding against the COM-B Model identified 'capability' to be the most influential component, with 'opportunity' and 'motivation' playing largely subsidiary roles. Findings suggest that fidelity could have been improved by: considering the readiness for change of each clinical setting; better articulating the intervention's value proposition; defining clinician roles and responsibilities, addressing perceptions that pain care falls beyond oncology clinicians' scopes of practice; integrating the intervention within existing systems and processes; promoting patient-clinician partnerships; investing in clinical champions among senior nursing and junior medical personnel, supported by medical leaders; and planning for slow incremental change rather than rapid uptake. CONCLUSIONS Future guideline implementation interventions may require a 'meta-implementation' approach based on complex systems theory to successfully integrate multiple strategies. TRIAL REGISTRATION Registry: Australian New Zealand Clinical Trials Registry; number: ACTRN 12615000064505; data: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspxid=367236&isReview=true .
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Affiliation(s)
- Tim Luckett
- IMPACCT Centre-Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney (UTS), Building 10, 235 Jones St, Ultimo, Sydney, NSW, 2007, Australia.
| | - Jane Phillips
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Meera Agar
- IMPACCT Centre-Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney (UTS), Building 10, 235 Jones St, Ultimo, Sydney, NSW, 2007, Australia
- South West Sydney School of Clinical Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia
| | | | - Najwa Reynolds
- Palliative Care Department, Greenwich Hospital, HammondCare, Sydney, NSW, Australia
| | - Maja Garcia
- IMPACCT Centre-Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of Health, University of Technology Sydney (UTS), Building 10, 235 Jones St, Ultimo, Sydney, NSW, 2007, Australia
| | | | - Tim Shaw
- Charles Perkins Centre, School of Medical Sciences, The University of Sydney, Sydney, NSW, Australia
| | - David Currow
- University of Wollongong, Wollongong, NSW, Australia
| | - Frances Boyle
- Patricia Ritchie Centre for Cancer Care and Research, The University of Sydney, Sydney, NSW, Australia
- Northern Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Lawrence Lam
- Macau University of Science and Technology, Macau, China
| | - Nikki McCaffrey
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Melbourne, Australia
| | - Melanie Lovell
- Palliative Care Department, Greenwich Hospital, HammondCare, Sydney, NSW, Australia
- Northern Medical School, The University of Sydney, Sydney, NSW, Australia
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Iverson KM, Brady JE, Adjognon OL, Stolzmann K, Dichter ME, Bruce LE, Portnoy GA, Iqbal S, Gerber MR, Haskell SG, Miller CJ. Twelve-Month Sustainment of IPV Screening and Response Programs in Primary Care: Contextual Factors Impacting Implementation Success. Womens Health Issues 2024:S1049-3867(24)00062-8. [PMID: 39174417 DOI: 10.1016/j.whi.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 06/27/2024] [Accepted: 07/17/2024] [Indexed: 08/24/2024]
Abstract
PURPOSE The Veterans Health Administration (VHA) employed implementation facilitation (IF) as a strategy to boost uptake of intimate partner violence (IPV) screening programs in primary care. This study examined the sustainment of screening uptake 1 year after IF and identified factors impacting sustainment success. METHODS A mixed-methods evaluation using quantitative and qualitative data was conducted. IPV screening rates from the conclusion of the IF period (i.e., initial adoption) through the 1-year sustainment period served as the primary outcome. We categorized sites into four groups of screening adoption and sustainment success (high adoption and high sustainment, moderate adoption and moderate sustainment, low adoption and low sustainment, and no adoption and/or no sustainment). Qualitative analysis of key informant interviews was used to identify contextual factors affecting screening 12 months post-IF. A mixed sustainment analysis matrix integrated quantitative and qualitative findings and enabled the identification of cross-site patterns. MAIN FINDINGS Seven of the nine sites sustained IPV screening at the most basic level (saw static or increased screening rates). High adopting and high sustaining sites (n = 3) were marked by consistently supportive medical center leadership, ongoing training for clinicians, clear protocols for responding to positive screens, and robust referral options for women experiencing IPV. Nonsustaining sites (n = 2) were marked by a host of barriers including staffing shortages, competing priorities, and inconsistent messaging from leadership regarding the importance of IPV screening. CONCLUSIONS Knowing barriers and facilitators to successful IPV screening sustainment can inform health care systems to tailor IF and other implementation strategies to sustain IPV screening in primary care. Sustainment of IPV screening requires attention to a combination of facilitators (e.g., consistent leadership support and robust referral options) as well as addressing key barriers (e.g., staff turnover and competing priorities).
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Affiliation(s)
- Katherine M Iverson
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.
| | - Julianne E Brady
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts
| | - Omonyêlé L Adjognon
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Kelly Stolzmann
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts
| | - Melissa E Dichter
- Center for Health Equity Research and Promotion (CHERP), Crescenz VA Medical Center, Philadelphia, Pennsylvania; School of Social Work, Temple University, Philadelphia, Pennsylvania
| | - LeAnn E Bruce
- Intimate Partner Violence Assistance Program, Care Management and Social Work Services, Department of Veterans Affairs, Washington, District of Columbia; Department of Social Work, Western Kentucky University, Bowling Green, Kentucky
| | - Galina A Portnoy
- Pain Research Informatics Multi-morbidity Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Samina Iqbal
- VA Palo Alto Healthcare System, Palo Alto, California; Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Megan R Gerber
- Division of General Internal Medicine, Albany Medical College, Albany, New York; Albany Stratton VA Medical Center, Albany, New York
| | - Sally G Haskell
- Pain Research Informatics Multi-morbidity Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut; Office of Women's Health, Department of Veterans Affairs, Washington, District of Columbia; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Christopher J Miller
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Bender M, Williams MM. Describing a programme of implementation-effectiveness research on the organization and implementation of frontline nursing care delivery into diverse heath systems. J Adv Nurs 2024. [PMID: 39152611 DOI: 10.1111/jan.16395] [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: 05/25/2024] [Revised: 07/29/2024] [Accepted: 08/04/2024] [Indexed: 08/19/2024]
Abstract
AIMS The longitudinal programme of research described in this paper seeks to generate knowledge about factors influencing the implementation of a system-level intervention, the clinical nurse leader care model, involving nurses as leaders at the frontlines of care and the outcomes achievable with successful implementation. The research programme has the following aims, (a) to clarify clinical nurse leader practice, (b) develop and empirically validate a translational model of frontline care delivery that includes clinical nurse leader practice and (c) delineate the patterns of and critical outcomes of successful implementation of the clinical nurse leader care model. DESIGN This programme of research follows a knowledge-building trajectory involving multiple study designs in both qualitative (grounded theory, case study) and quantitative (descriptive, correlational and quasi-experimental) traditions. METHODS Multiple mixed methods within a system-based participatory framework were used to conduct this programme of implementation-effectiveness research. RESULTS Findings are demonstrating how the clinical nurse leader care model, as a complex system-level intervention, can be implemented in diverse healthcare contexts to make a difference to patient care quality and safety. Findings also contribute to implementation science, helping to better understand the dynamic interdependencies between implementation, the interventions implemented and the contexts in which they are implemented. CONCLUSION Findings translate into sets of evidence-informed implementation 'recipes' that health systems can match to their specific contexts and needs. This allows health systems to take on strategies that both maximize resource impact within their existing structures and support achieving intended outcomes. IMPLICATION This programme of research is producing actionable implementation and outcome evidence about ways to organize nursing knowledge and practice into care models that can be successfully adopted within real-world healthcare settings to achieve safer and higher quality patient care.
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Affiliation(s)
- Miriam Bender
- Sue & Bill Gross School of Nursing, University of California, Irvine 854 Medical Sciences Quad, Irvine, California, USA
| | - Marjory Micki Williams
- Research Investigator (WOC), Research Service, Central Texas Veterans Health Care System, Temple, Texas, USA
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Huang Q, Mitchell C, Theodoulou E, Lee ACK, Brown J. Implementation of fracture risk assessment in men with prostate cancer requiring long-term androgen deprivation therapy: a systematic scoping review using the i-PARIHS implementation framework. J Cancer Surviv 2024:10.1007/s11764-024-01659-3. [PMID: 39141309 DOI: 10.1007/s11764-024-01659-3] [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: 03/04/2024] [Accepted: 08/02/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE Androgen deprivation therapy (ADT) is a mainstay of treatment for prostate cancer (PCa) and is associated with increased risks of osteoporosis and fragility fractures. Despite international guidelines to mitigate fracture risk, osteoporosis is under-diagnosed and under-treated due to poor implementation. This scoping review aims to synthesise knowledge surrounding the implementation of guidelines to inform health service interventions to reduce fracture risk in men with PCa-taking ADT (PCa-ADT). METHOD Four databases and additional literature were searched for studies published between January 2000 and January 2023. Studies that provided evidence influencing guidelines implementation were included. The i-PARIHS (Promoting Action on Research Implementation in Health Services) implementation framework was used to inform the narrative synthesis. RESULTS Of the 1229 studies identified, 9 studies met the inclusion criteria. Overall, an improvement in fracture risk assessment was observed across heterogeneous study designs and outcome measures. Six studies were from Canada. Two studies involved family physicians or a community healthcare programme. Two studies incorporated patient or specialist surveys. One utilised an implementation framework. Implementation barriers included the lack of knowledge for both patients and clinicians, time constraints, unsupportive organisational structures, and challenges in transferring patient care from specialists to primary care. Effective strategies included education, novel care pathways using a multidisciplinary approach, incorporating a healthy bone prescription tool into routine care, point-of-care interventions, and bespoke clinics. CONCLUSION There is an unmet need to provide evidence-based bone healthcare in men with PCa receiving ADT. This study highlights barriers and strategies in the implementation of fracture risk assessment for PCa-ADT patients. IMPLICATIONS FOR CANCER SURVIVORS Primary care clinicians can play a significant role in the management of complications from long-term cancer treatment such as treatment-induced bone loss. Future studies should consult patients, families, specialists, and primary care clinicians in service re-design.
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Affiliation(s)
- Qizhi Huang
- Population Health, School of Medicine and Population Health, University of Sheffield, Sheffield, UK.
| | - Caroline Mitchell
- Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | - Elisavet Theodoulou
- Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Andrew C K Lee
- Population Health, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Janet Brown
- Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
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Pelto-Piri V, Kjellin L, Backman G, Carlsson K, Björkdahl A. Patient responsiveness as a safewards fidelity indicator: a qualitative interview study on an acute psychiatric in-patient ward. BMC Health Serv Res 2024; 24:922. [PMID: 39135020 PMCID: PMC11321007 DOI: 10.1186/s12913-024-11326-z] [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: 02/05/2024] [Accepted: 07/17/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND The Safewards model aims to reduce conflict and use of containment on psychiatric wards. To evaluate the implementation of Safewards and understand why it is effective in some settings but not in others, it is important to assess the level of implementation fidelity. To do this, the Safewards Fidelity Checklist (SFC) is often used, which focuses on objective visual observations of interventions but does not include patient responsiveness. The latter is a key indicator of implementation fidelity and includes engagement, relevance, acceptability and usefulness. The aim of the present study was to investigate the fidelity of Safewards implementation on an acute psychiatric ward from the perspective of patient responsiveness. METHOD The study was conducted on a ward for patients with mainly affective disorders. To assess the general level of fidelity the SFC was used together with a detailed ward walkthrough. Ten patients were interviewed with a focus on patient responsiveness to each of the seven interventions implemented on the ward. Data were analysed using qualitative descriptive analysis. RESULTS The findings indicate high implementation fidelity, which was reflected in the SFC assessment, walkthrough and patient responsiveness. Patients gave examples of improvements that had happened over time or of the ward being better than other wards. They felt respected, less alone, hopeful and safe. They also described supporting fellow patients and taking responsibility for the ward climate. However, some patients were unfamiliar with a ward where so much communication was expected. Several suggestions were made about improving Safewards. CONCLUSIONS This study confirms previous research that patient responsiveness is an important factor for achieving fidelity in a prevention programme. The patients' descriptions of the acceptability, relevance and usefulness of the specific interventions reflected to a high degree the objective visual observations made by means of the SFC and ward walkthrough. Patient engagement was demonstrated by several suggestions about how to adapt the interventions. There is potential to obtain valuable input from patients when adapting Safewards in practice. This study also presents many examples of practical work with these interventions and the effects it can have on patients' experiences of care.
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Affiliation(s)
- Veikko Pelto-Piri
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Lars Kjellin
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Gabriella Backman
- Psychiatric outpatient clinic, Region Värmland, Kristinehamn, Sweden
| | - Karoline Carlsson
- Psychiatric Outpatient Clinic, Västra Götalandsregionen, Alingsås, Sweden
| | - Anna Björkdahl
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Jarlenski M, Kennedy S, Johnson A, Hale C, D'Angelo Z, Nedhari A, Coffee G, Chappell-McPhail M, Green K, Méndez DD, Goetschius LG, Gareau S, Ashford K, Barnes AJ, Ahrens KA, Zivin K, Mosley E, Tang L. Study protocol: a mixed-methods study of the implementation of doula care to address racial health equity in six state Medicaid programs. Health Res Policy Syst 2024; 22:98. [PMID: 39118099 PMCID: PMC11308708 DOI: 10.1186/s12961-024-01185-9] [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: 05/01/2024] [Accepted: 07/22/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Racial inequities in severe maternal morbidity (SMM) and mortality constitute a public health crisis in the United States. Doula care, defined as care from birth workers who provide culturally appropriate, non-clinical support during pregnancy and postpartum, has been proposed as an intervention to help disrupt obstetric racism as a driver of adverse pregnancy outcomes in Black and other birthing persons of colour. Many state Medicaid programs are implementing doula programs to address the continued increase in SMM and mortality. Medicaid programs are poised to play a major role in addressing the needs of these populations with the goal of closing the racial gaps in SMM and mortality. This study will investigate the most effective ways that Medicaid programs can implement doula care to improve racial health equity. METHODS We describe the protocol for a mixed-methods study to understand how variation in implementation of doula programs in Medicaid may affect racial equity in pregnancy and postpartum health. Primary study outcomes include SMM, person-reported measures of respectful obstetric care, and receipt of evidence-based care for chronic conditions that are the primary causes of postpartum mortality (cardiovascular, mental health, and substance use conditions). Our research team includes doulas, university-based investigators, and Medicaid participants from six sites (Kentucky, Maryland, Michigan, Pennsylvania, South Carolina and Virginia) in the Medicaid Outcomes Distributed Research Network (MODRN). Study data will include policy analysis of doula program implementation, longitudinal data from a cohort of doulas, cross-sectional data from Medicaid beneficiaries, and Medicaid healthcare administrative data. Qualitative analysis will examine doula and beneficiary experiences with healthcare systems and Medicaid policies. Quantitative analyses (stratified by race groups) will use matching techniques to estimate the impact of using doula care on postpartum health outcomes, and will use time-series analyses to estimate the average treatment effect of doula programs on population postpartum health outcomes. DISCUSSION Findings will facilitate learning opportunities among Medicaid programs, doulas and Medicaid beneficiaries. Ultimately, we seek to understand the implementation and integration of doula care programs into Medicaid and how these processes may affect racial health equity. Study registration The study is registered with the Open Science Foundation ( https://doi.org/10.17605/OSF.IO/NXZUF ).
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Affiliation(s)
- Marian Jarlenski
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, 130 DeSoto St, A619, Pittsburgh, PA, 15261, United States of America.
- Center for Innovative Research On Gender Health Equity, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
| | - Susan Kennedy
- AcademyHealth, Washington, DC, United States of America
| | | | - Caroline Hale
- AcademyHealth, Washington, DC, United States of America
| | - Zoe D'Angelo
- AcademyHealth, Washington, DC, United States of America
| | - Aza Nedhari
- Mamatoto Village, Washington, DC, United States of America
| | - Gerria Coffee
- Genesis Birth Services, Williamsport, PA, United States of America
- PA Doula Commission, Landsdowne, PA, United States of America
| | | | - Kiddada Green
- Black Mothers' Breastfeeding Association, Detroit, MI, United States of America
| | - Dara D Méndez
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, United States of America
- Center for Health Equity, University of Pittsburgh School of Public Health, Pittsburgh, PA, United States of America
| | - Leigh G Goetschius
- The Hilltop Institute, University of Maryland, Baltimore County, Baltimore, MD, United States of America
| | - Sarah Gareau
- Institute for Families in Society, College of Social Work, University of South Carolina, Columbia, SC, United States of America
| | - Kristin Ashford
- College of Nursing, University of Kentucky, Lexington, United States of America
| | - Andrew J Barnes
- Health Policy, School of Population Health, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Katherine A Ahrens
- Public Health Program, Muskie School of Public Service, University of Southern Maine, Portland, ME, United States of America
| | - Kara Zivin
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - Elizabeth Mosley
- Center for Innovative Research On Gender Health Equity, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Lu Tang
- Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, PA, United States of America
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Zhang L, Luo Y, Long J, Yin Y, Fu Q, Wang L, Patil S. Enhancing Standardized Practices for Oral Mucositis Prevention in Pediatric Hematopoietic Stem Cell Transplantation: A Best Practice Implementation Project. Risk Manag Healthc Policy 2024; 17:1909-1920. [PMID: 39130104 PMCID: PMC11316476 DOI: 10.2147/rmhp.s471877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/31/2024] [Indexed: 08/13/2024] Open
Abstract
Background Oral mucositis (OM) poses a significant challenge in children undergoing hematopoietic stem cell transplantation (HSCT). There is a gap between clinical practice and the evidence, and nursing practices is not standardized. Objective This study aims to evaluate the effectiveness of applying the evidence for preventing HSCT chemotherapy-induced OM in children and to elevate the nurses' compliance to the evidence. Methods Following the clinical evidence practice application model of the Joanna Briggs Institute (JBI) evidence-Based Care Center. The process included reviewing literature, extracting evidence, identifying gaps, developing audit criteria, conducting a baseline audit, creating an action plan, implementing evidence-based interventions, and assessing outcomes. Results After the evidence implementation, 6 out of 12 audit criteria with poor compliance are significantly improved, with statistically significant differences (P<0.05). The incidence of OM decreases, with a statistically significant difference (66.6% vs 36.7%, P=0.02). The incidence of grade I, II, III, and IV OM also decreases (30% vs 23.3%, 23.3% vs 13.4%, 10% vs 0%, and 3.3% vs 0%). Ultimately, the standardized oral care practice routine and workflows to prevent OM were established. Conclusion Bridging the gap between evidence and clinical practice can standardize nurse behavior, decrease the incidence of OM, and lower the OM severity in children undergoing HSCT.
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Affiliation(s)
- Luyang Zhang
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Yuan Luo
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Jiewen Long
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Yan Yin
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Qin Fu
- Department of Nursing, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Lei Wang
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Sandip Patil
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
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Jolliffe L, Andrew NE, Srikanth V, Beare R, Noeske KE, Snowdon DA. Development of an implementation strategy for routine collection of generic patient reported outcome measures: a qualitative study in multidisciplinary community rehabilitation. Disabil Rehabil 2024; 46:3895-3904. [PMID: 37735798 DOI: 10.1080/09638288.2023.2258334] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE To explore staff perceptions of barriers and enablers towards implementing the EQ-5D-5L in community rehabilitation, and develop a theory-informed implementation approach for routine administration of generic patient-reported outcome measures (PROMs) using implementation science frameworks. MATERIALS AND METHODS A qualitative study was conducted at three sites. Multidisciplinary rehabilitation staff completed individual semi-structured interviews, which were transcribed and coded against the Theoretical Domains Framework (TDF). We identified and selected potentially effective behaviour change techniques using the Behavior Change Wheel. Hypothetical strategies were operationalised. RESULTS Twenty-one interviews were conducted, and four themes emerged: (1) The Impact of PROMs on patient centered-care; (2) Considerations for validity of PROMs; (3) Service-level impact of embedding PROMs; (4) Practical issues of embedding PROMs within the service. Barriers and enablers were mapped to seven of the TDF domains; relating most to clinicians' "belief about consequences", "reinforcement", and "environmental context and resources". Five hypothetical strategies were developed to overcome identified barriers and strengthen enablers. Key behaviour change techniques underpinning the strategies include: restructuring the physical environment, incentivisation, persuasion and education, enablement, and, social support. CONCLUSIONS Our implementation approach highlights the importance of automating processes, engaging site champions, routinely reporting, and using PROM data to inform service provision.
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Affiliation(s)
- Laura Jolliffe
- National Centre for Healthy Ageing (NCHA), Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
- Department of Occupational Therapy, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
- Peninsula Health, Melbourne, Australia
| | - Nadine E Andrew
- National Centre for Healthy Ageing (NCHA), Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
- Peninsula Health, Melbourne, Australia
| | - Velandai Srikanth
- National Centre for Healthy Ageing (NCHA), Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
- Peninsula Health, Melbourne, Australia
| | - Richard Beare
- National Centre for Healthy Ageing (NCHA), Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
- Peninsula Health, Melbourne, Australia
| | - Kate E Noeske
- National Centre for Healthy Ageing (NCHA), Melbourne, Australia
- Peninsula Health, Melbourne, Australia
| | - David A Snowdon
- National Centre for Healthy Ageing (NCHA), Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
- Peninsula Health, Melbourne, Australia
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Naik AD, Shanahan ML, Dindo L, Mecca MC, Arney J, Amspoker AB, Wydermyer S, Banks J, Street RL, Kiefer L, Zenoni M, Rosen T, Gonzalez RD, Catic A, Fried TR. An innovative approach to aligning healthcare with what matters most to patients: A hybrid type 1 trial protocol of patient priorities care for older adults with multiple chronic conditions. Contemp Clin Trials 2024; 143:107613. [PMID: 38914308 DOI: 10.1016/j.cct.2024.107613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 06/17/2024] [Accepted: 06/21/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Providing healthcare for older adults with multiple chronic conditions (MCC) is challenging. Polypharmacy and complex treatment plans can lead to high treatment burden and risk for adverse events. For clinicians, managing the complexities of patients with MCC leaves little room to identify what matters and align care options with patients' health priorities. New care approaches are needed to navigate these challenges. In this clinical trial, we evaluate implementation and effectiveness outcomes of an innovative, structured, patient-centered care approach (Patient Priorities Care; PPC) for reducing treatment burden and aligning health care decisions with the health priorities of older adults with MCC. METHODS This is a multisite, assessor-blind, two-arm, parallel hybrid type 1 randomized controlled trial. We are enrolling 396 older (65+) Veterans with MCC who receive primary care at the Veterans Affairs Medical Center. Veterans are randomly assigned to either PPC or usual care. In the PPC arm, Veterans have a brief telephone call with a study facilitator to identify their personal health priorities. Then, primary care providers use this information to align healthcare with Veteran priorities during their established clinic appointments. Data are collected at baseline and 4-month follow up to assess for changes in treatment burden and use of home and community services. Formative and summative evaluations are also collected to assess for implementation outcomes according to Proctor's implementation framework. CONCLUSIONS This work has the potential to significantly improve the standard of care by personalizing healthcare and helping patients achieve what is most important to them.
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Affiliation(s)
- Aanand D Naik
- Institute on Aging, University of Texas Health Science Center, Houston, TX, United States of America; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center, Houston, TX, United States of America.
| | - Mackenzie L Shanahan
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America
| | - Lilian Dindo
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, United States of America
| | - Marcia C Mecca
- Center for Innovation for Pain Research, Informatics, Multi-morbidities, and Education, VA Connecticut Healthcare System, West Haven, CT, United States of America; Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Jennifer Arney
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Sociology, University of Houston-Clear Lake, Houston, TX, United States of America
| | - Amber B Amspoker
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, United States of America
| | - Sheena Wydermyer
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, United States of America
| | - Jack Banks
- Institute on Aging, University of Texas Health Science Center, Houston, TX, United States of America; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center, Houston, TX, United States of America
| | - Richard L Street
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Communication and Journalism, Texas A&M University, College Station, TX, United States of America
| | - Lea Kiefer
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, United States of America
| | - Maria Zenoni
- Center for Innovation for Pain Research, Informatics, Multi-morbidities, and Education, VA Connecticut Healthcare System, West Haven, CT, United States of America; Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Tracey Rosen
- Institute on Aging, University of Texas Health Science Center, Houston, TX, United States of America; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, United States of America; Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center, Houston, TX, United States of America
| | - Raquel D Gonzalez
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, United States of America
| | - Angela Catic
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, United States of America
| | - Terri R Fried
- Center for Innovation for Pain Research, Informatics, Multi-morbidities, and Education, VA Connecticut Healthcare System, West Haven, CT, United States of America; Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America
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Bucher A, Chaudhry BM, Davis JW, Lawrence K, Panza E, Baqer M, Feinstein RT, Fields SA, Huberty J, Kaplan DM, Kusters IS, Materia FT, Park SY, Kepper M. How to design equitable digital health tools: A narrative review of design tactics, case studies, and opportunities. PLOS DIGITAL HEALTH 2024; 3:e0000591. [PMID: 39172776 PMCID: PMC11340894 DOI: 10.1371/journal.pdig.0000591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
With a renewed focus on health equity in the United States driven by national crises and legislation to improve digital healthcare innovation, there is a need for the designers of digital health tools to take deliberate steps to design for equity in their work. A concrete toolkit of methods to design for health equity is needed to support digital health practitioners in this aim. This narrative review summarizes several health equity frameworks to help digital health practitioners conceptualize the equity dimensions of importance for their work, and then provides design approaches that accommodate an equity focus. Specifically, the Double Diamond Model, the IDEAS framework and toolkit, and community collaboration techniques such as participatory design are explored as mechanisms for practitioners to solicit input from members of underserved groups and better design digital health tools that serve their needs. Each of these design methods requires a deliberate effort by practitioners to infuse health equity into the approach. A series of case studies that use different methods to build in equity considerations are offered to provide examples of how this can be accomplished and demonstrate the range of applications available depending on resources, budget, product maturity, and other factors. We conclude with a call for shared rigor around designing digital health tools that deliver equitable outcomes for members of underserved populations.
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Affiliation(s)
- Amy Bucher
- Behavioral Reinforcement Learning Lab (BReLL), Lirio, Inc., Knoxville, Tennessee, United States of America
| | - Beenish M. Chaudhry
- School of Computing and Informatics, University of Louisiana at Lafayette, Lafayette, Louisiana, United States of America
| | - Jean W. Davis
- College of Nursing, University of Central Florida, Orlando, Florida, United States of America
| | - Katharine Lawrence
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Emily Panza
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island, United States of America
| | - Manal Baqer
- Neamah Health Consulting, Boston, Massachusetts, United States of America
| | - Rebecca T. Feinstein
- AIHealth4All Center for Health Equity using Machine Learning and Artificial Intelligence, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Sherecce A. Fields
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas, United States of America
| | | | - Deanna M. Kaplan
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Department of Spiritual Health, Woodruff Health Science Center, Emory University, Atlanta, Georgia, United States of America
| | - Isabelle S. Kusters
- Department of Clinical, Health, and Applied Sciences, University of Houston-Clear Lake, Houston, Texas, United States of America
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, United States of America
| | - Frank T. Materia
- Otolaryngology and Population Health, University of Kansas Medical Center, Kansas City, Kansas, United States of America
| | - Susanna Y. Park
- Radiant Foundation, Salt Lake City, Utah, United States of America
| | - Maura Kepper
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
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13
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Du S, Hu Y, Zhou Y, Xing W, Zhu Z, Meng A, Zhi X, Dong G, Mao C. The implementation study of nurses' work related low back pain prevention and care guideline: A quasi-experimental study. Appl Nurs Res 2024; 78:151818. [PMID: 39053998 DOI: 10.1016/j.apnr.2024.151818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/15/2023] [Accepted: 06/25/2024] [Indexed: 07/27/2024]
Abstract
AIM To understand the implementation process and outcomes of nurses' work related low back pain (WLBP) prevention and care guideline. BACKGROUND WLBP is a common occupational injury for clinical nurses. We developed the first evidence-based guideline of nurses' WLBP prevention and care of its kind both at home and abroad, and it is necessary for us to explore its feasibility, appropriateness and effectiveness in practice. METHODS Based on the model of the integrated Promoting Action on Research Implementation in Health Services, we performed a four-phase implementation study in a tertiary hospital. The study was a non-randomized concurrent controlled trial design,and multilevel measures were examined including implementation outcomes and clinical outcomes. RESULTS For the implementation outcomes, the tailored recommendations of the guideline were found to be acceptable, appropriate, feasible, and well adopted both at the unit level and the hospital level. The clinical outcomes indicated that, compared with the control unit, nurses of the treatment unit performed better in awareness, knowledge, practice of WLBP prevention and care. CONCLUSIONS The implementation study supports the successful application of the guideline, which can serve as a valuable evidence-based document to improve back health of nursing personnel.
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Affiliation(s)
- Shizheng Du
- School of Nursing, Nanjing University of Chinese Medicine, #138 Xianlin Avenue, Nanjing 210023, China; School of Nursing, Fudan University, 305 Fenglin Road, Shanghai 200032, China
| | - Yan Hu
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai 200032, China.
| | - Yingfeng Zhou
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai 200032, China
| | - Weijie Xing
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai 200032, China
| | - Zheng Zhu
- School of Nursing, Fudan University, 305 Fenglin Road, Shanghai 200032, China
| | - Aifeng Meng
- Jiangsu Cancer Hospital, Jiangsu Cancer Research Institute, Cancer Hospital Affiliated to Nanjing Medical University, #42 Baiziting, Nanjing 210009, China
| | - Xiaoxu Zhi
- Jiangsu Cancer Hospital, Jiangsu Cancer Research Institute, Cancer Hospital Affiliated to Nanjing Medical University, #42 Baiziting, Nanjing 210009, China
| | - Gaoyue Dong
- Jiangsu Cancer Hospital, Jiangsu Cancer Research Institute, Cancer Hospital Affiliated to Nanjing Medical University, #42 Baiziting, Nanjing 210009, China
| | - Changmin Mao
- Jiangsu Cancer Hospital, Jiangsu Cancer Research Institute, Cancer Hospital Affiliated to Nanjing Medical University, #42 Baiziting, Nanjing 210009, China
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Khatri D, Falconer N, de Camargo Catapan S, Coulter S, Gray LC, Paterson DL, Freeman C. Exploring stakeholders' perspectives on antibiogram use, development, and implementation in residential aged care settings. Res Social Adm Pharm 2024; 20:747-754. [PMID: 38688774 DOI: 10.1016/j.sapharm.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/09/2024] [Accepted: 04/22/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Knowledge of local antibiotic resistance data provided by antibiograms (cumulative-antimicrobial-susceptibility-tests) can assist prescribers to make appropriate empirical antibiotic choices. OBJECTIVE This study explored the perceptions and knowledge of key stakeholders about the role of antibiograms in residential aged care facilities (RACF), and to understand barriers and enablers of antibiogram development and implementation in this setting. METHOD Semi-structured interviews were conducted with aged-care health professionals ('end-users') and antibiogram content experts. This study was conducted in Queensland, Australia in 2023. Using qualitative techniques, framework thematic analysis was used to identify themes, which were mapped to the 'Integrated Promoting Action on Research Implementation in Health Services' framework constructs. RESULTS Twenty interviews were conducted comprising of five 'content-experts' and fifteen 'end-users'. Five themes were identified which indicated lack of knowledge about how to use antibiograms, and its availability. Potential insufficient data was the primary issue identified by content experts with regards to feasibility of annual antibiograms. Pragmatic solutions were offered, such as pooling pathology data from facilities in the same geographical location, extending antibiogram data to two-or three-yearly, or utilising local hospital antibiograms. Presenting antibiogram data in a mode and format suiting preferences of individual users would encourage uptake and improve usability. Antimicrobial stewardship (AMS) champions and pharmacists were highlighted as drivers of educating and promoting antibiogram use. CONCLUSION Clinicians recognised the potential role of antibiograms in improving empirical antibiotic prescribing choices. Establishing their baseline knowledge provides an essential starting point for the education needs of this group. This study provides practical recommendations regarding the presentation of antibiograms to ensure appropriate use and uptake as an AMS tool in RACFs. Pragmatic solutions suggested to overcome challenges of antibiogram development for RACFs should be applied and evaluated to determine feasibility of RACF-specific antibiograms.
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Affiliation(s)
- Dipti Khatri
- UQ Centre for Health Service Research (CHSR), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia.
| | - Nazanin Falconer
- UQ Centre for Health Service Research (CHSR), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia; School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia; Princess Alexandra Hospital, Metro South Health, Woolloongabba, QLD, Australia
| | - Soraia de Camargo Catapan
- UQ Centre for Health Service Research (CHSR), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia; UQ Centre for Online Health (COH), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
| | - Sonali Coulter
- Pathology Queensland, Microbiology Queensland Public Health and Scientific Services, Herston, QLD, Australia
| | - Leonard C Gray
- UQ Centre for Health Service Research (CHSR), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
| | - David L Paterson
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Faculty of Medicine, The University of Queensland, Herston, QLD, Australia; Metro North Hospital and Health Service, Herston, QLD, Australia
| | - Christopher Freeman
- School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia; Faculty of Medicine, The University of Queensland, Herston, QLD, Australia; Metro North Hospital and Health Service, Herston, QLD, Australia
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15
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Vásquez P, Hall L, Merlo G. Societal Preferences in Health Technology Assessments for Rare Diseases and Orphan Drugs: A Systematic Literature Review of New Analytic Approaches. Value Health Reg Issues 2024; 44:101026. [PMID: 39059264 DOI: 10.1016/j.vhri.2024.101026] [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: 10/26/2023] [Revised: 05/24/2024] [Accepted: 06/18/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVES This systematic literature review aimed to explore experiences worldwide of societal preferences integration into health technology assessments (HTAs) for rare diseases (RDs) and orphan drugs (ODs) through the implementation of multicriteria decision analysis (MCDA), discrete choice experiments (DCEs), and person trade-off (PTO) methods, among others. METHODS A systematic search of the literature was conducted in April 2021 using PubMed, Cochrane, Embase, and Scopus databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach was used for the review phases. Finally, the Promoting Action on Research Implementation in Health Services framework was used to discuss the implementation of these instruments in the RD context. RESULTS A total of 33 articles met the inclusion criteria. The studies measured societal preferences for RD and OD as part of HTA using MCDA (n = 17), DCE (n = 8), and PTO (n = 4), among other methods (n = 4). These found that patients and clinicians do not prioritize funding based on rarity. The public is willing to allocate funds only if the OD demonstrates effectiveness and improves the quality of life, considering as relevant factors disease severity, unmet health needs, and quality of life. Conversely, HTA agency experts preferred their current approach, placing more weight on cost-effectiveness and evidence quality, even though they expressed concern about the fairness of the drug review process. CONCLUSIONS MCDA, PTO, and DCE are helpful and transparent methods for assessing societal preferences in HTA for RD and OD. However, their methodological limitations, such as arbitrary criteria selection, subjective scoring methods, framing effects, weighting adaptation, and value measurement models, could make implementation challenging.
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Affiliation(s)
- Paola Vásquez
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - Lisa Hall
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Gregory Merlo
- Healthcare Improvement Unit, Clinical Excellence Queensland, Queensland Health, Brisbane, QLD, Australia
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16
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Hurtig C, Årestedt L, Uhlin F, Eldh AC. Patient participation-18 months of patient and staff perspectives in kidney care: A mixed methods study addressing the effects of facilitating staff person-centredness. J Eval Clin Pract 2024. [PMID: 39023330 DOI: 10.1111/jep.14099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 06/30/2024] [Accepted: 07/08/2024] [Indexed: 07/20/2024]
Abstract
RATIONALE Patient participation should encapsulate the individual's resources and needs, though such standards remain rationed for people living with a long-term health concern like kidney failure. AIMS To illustrate what patient participation signified to patients and staff in kidney care, and whether an agreed or disagreed conceptualisation occurred over time, evaluating the influence of two study-specific interventions to facilitate more person-centred participation. METHOD By convergent mixed methods design across 9 units in Sweden, we repeated the following data collection at 3 time points over 18 months: semistructured interviews with patients and staff (n = 72), and structured reviews for accounts of participation in patient records (n = 240). Data were subjected to content analysis and descriptive statistics, respectively. The outcomes were appraised for changes over time besides the interventions to enhance attention to patients' participation: a clinical tool and guidance distributed to management, and additional local support, respectively. RESULTS Both patients and staff described patient participation as a comprehension of the disease and its management in everyday life. Yet, patients accentuated participation as one's experiences being recognised, and mutual knowledge exchange. Instead, staff emphasised the patients managing their treatment. The health records primarily represented what staff do to support their notion of patient participation. No influence of the interventions was noted, but what signified patient participation was maintained over time. CONCLUSION Both patients and staff stress the importance of patient participation, although they focus on different elements. Further person-centred conduct warrants a shared conceptualisation and strategies addressing and scaffolding patients' preferences and means.
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Affiliation(s)
- Caroline Hurtig
- Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
| | - Liselott Årestedt
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | - Fredrik Uhlin
- Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Nephrology, Region Östergötland, Linköping, Sweden
- Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia
| | - Ann Catrine Eldh
- Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Mignogna J, Russell PD, Borah E, Bryan CJ, Monteith LL, Bongiovanni K, Villareal E, Hoffmire CA, Peterson AL, Heise J, Mohatt N, Baack S, Weinberg K, Polk M, Mealer M, Kremer BR, Gallanos J, Blessing A, Scheihing J, Alverio T, Benzer J, DeBeer BB. Veteran suicide prevention learning collaborative: implementation strategy and processes. Front Psychiatry 2024; 15:1392218. [PMID: 39050918 PMCID: PMC11266129 DOI: 10.3389/fpsyt.2024.1392218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/13/2024] [Indexed: 07/27/2024] Open
Abstract
The majority of Veterans who died by suicide in 2021 had not recently used Veterans Health Administration (VA) services. A public health approach to Veteran suicide prevention has been prioritized as part of the VA National Strategy for Preventing Veteran Suicide. Aligned with this approach, VA's Patient Safety Center of Inquiry-Suicide Prevention Collaborative piloted a Veteran suicide prevention learning collaborative with both clinical and non-clinical community agencies that serve Veterans. The VA COmmunity LeArning CollaboraTive (CO-ACT) uses a quality improvement framework and facilitative process to support community organizational implementation of evidence-based and best practice suicide prevention strategies to achieve this goal. This paper details the structure of CO-ACT and processes by which it is implemented. This includes the CO-ACT toolkit, an organizational self-assessment, a summary of recommendations, creation of a blueprint for change, selection of suicide prevention program components, and an action plan to guide organizations in implementing suicide prevention practices. CO-ACT pilot outcomes are reported in a previous publication.
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Affiliation(s)
- Joseph Mignogna
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Patricia D. Russell
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Elisa Borah
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, United States
- Dell Medical School, University of Texas at Austin, Austin, TX, United States
| | - Craig J. Bryan
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, United States
- Veterans Affairs (VA) Center of Excellence for Suicide Prevention, Veterans Affairs (VA) Finger Lakes Health Care System, Canandaigua, NY, United States
| | - Lindsey L. Monteith
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kathryn Bongiovanni
- Veterans Affairs (VA) Veterans Integrated Service Network (VISN) 17 Clinical Resource Hub, Texas Valley Costal Bend Veterans Affairs (VA), Harlingen, TX, United States
| | - Edgar Villareal
- Office of Mental Health and Suicide Prevention, Veterans Affairs (VA) Central Office, Washington, DC, United States
| | - Claire A. Hoffmire
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Alan L. Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, United States
- Department of Psychology, University of Texas at San Antonio, San Antonio, TX, United States
| | - Jenna Heise
- Suicide Prevention Center of New York, Albany, NY, United States
- Zero Suicide Institute Faculty, Education Development Center, Waltham, MA, United States
| | - Nathaniel Mohatt
- Division of Prevention and Community Research, Yale School of Medicine, New Haven, CT, United States
- Booz Allen Hamilton, Arlington, VA, United States
| | - Sylvia Baack
- Michael E. DeBakey Veterans Affairs (VA) Medical Center, Houston, TX, United States
| | - Kimberly Weinberg
- Central Texas Veterans Affairs (VA) Health Care System, Temple, TX, United States
| | - Marcy Polk
- Veterans Affairs (VA) Portland Health Care System, Portland, OR, United States
| | - Meredith Mealer
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Benjamin R. Kremer
- Veterans Affairs (VA) Eastern Colorado Health Care System, Aurora, CO, United States
| | - James Gallanos
- Veterans Affairs (VA) Eastern Colorado Health Care System, Aurora, CO, United States
| | - Alexis Blessing
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, CO, United States
| | - Juliana Scheihing
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, CO, United States
| | - Tabitha Alverio
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Justin Benzer
- Veterans Integrated Service Network (VISN) 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, United States
- Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin, TX, United States
| | - Bryann B. DeBeer
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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18
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Drake C, Wang V, Stechuchak KM, Sperber N, Bruening R, Coffman CJ, Choate A, Van Houtven CH, Allen KD, Colon-Emeric C, Jackson GL, Tucker M, Meyer C, Kappler CB, Hastings SN. Enhancing team communication to improve implementation of a supervised walking program for hospitalized veterans: Evidence from a multi-site trial in the Veterans Health Administration. PM R 2024. [PMID: 38967454 DOI: 10.1002/pmrj.13190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION The timely translation of evidence-based programs into real-world clinical settings is a persistent challenge due to complexities related to organizational context and team function, particularly in inpatient settings. Strategies are needed to promote quality improvement efforts and implementation of new clinical programs. OBJECTIVE This study examines the role of CONNECT, a complexity science-based implementation intervention to promote team readiness, for enhancing implementation of the 'Assisted Early Mobility for Hospitalized Older Veterans' program (STRIDE), an inpatient, supervised walking program. DESIGN We conducted a stepped-wedge cluster randomized trial using a convergent mixed-methods design. Within each randomly assigned stepped-wedge sequence, Veterans Affairs Medical Centers (VAMCs) were randomized to receive standardized implementation support only or additional training via the CONNECT intervention. Data for the study were obtained from hospital administrative and electronic health records, surveys, and semi-structured interviews with clinicians before and after implementation of STRIDE. SETTING Eight U.S. VAMCs. PARTICIPANTS Three hundred fifty-three survey participants before STRIDE implementation and 294 surveys after STRIDE implementation. Ninety-two interview participants. INTERVENTION CONNECT, a complexity-science-based intervention to improve team function. MAIN OUTCOME MEASURES The implementation outcomes included STRIDE reach and fidelity. Secondary outcomes included validated measures of team function (i.e., team communication, coordination, role clarity). RESULTS At four VAMCs randomized to CONNECT, reach was higher (mean 12.4% vs. 3.8%), and fidelity was similar to four non-CONNECT VAMCs. VAMC STRIDE delivery teams receiving CONNECT reported improvements in team function domains, similar to non-CONNECT VAMCs. Qualitative findings highlight CONNECT's impact and the influence of team characteristics and contextual factors, including team cohesion, leadership support, and role clarity, on reach and fidelity. CONCLUSION CONNECT may promote greater reach of STRIDE, but improvement in team function among CONNECT VAMCs was similar to improvement among non-CONNECT VAMCs. Qualitative findings suggest that CONNECT may improve team function and implementation outcomes but may not be sufficient to overcome structural barriers related to implementation capacity.
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Affiliation(s)
- Connor Drake
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Virginia Wang
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Karen M Stechuchak
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Nina Sperber
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rebecca Bruening
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Cynthia J Coffman
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ashley Choate
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Courtney Harold Van Houtven
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kelli D Allen
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Medicine and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cathleen Colon-Emeric
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Geriatrics Research Education and Clinical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - George L Jackson
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Matthew Tucker
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Cassie Meyer
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Caitlin B Kappler
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Susan N Hastings
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Geriatrics Research Education and Clinical Center, Durham VA Health Care System, Durham, North Carolina, USA
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina, USA
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Thermaenius I, Udo C, Alvariza A, Lundberg T, Holm M, Lövgren M. The Family Talk Intervention Among Families Affected by Severe Illness: Hospital Social Workers' Experiences of Facilitators and Barriers to its Use in Clinical Practice. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2024:1-19. [PMID: 38968160 DOI: 10.1080/15524256.2024.2364589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
Hospital social workers (HSW) play an important role in health care, providing psychosocial support to families affected by severe illness, and having palliative care needs involving dependent children. However, there are few evidence-based family interventions for HSWs to apply when supporting these families. The Family Talk intervention (FTI), a psychosocial family-based intervention, was therefore evaluated in an effectiveness-implementation study. Within the study, HSWs were educated and trained in the use of FTI in clinical practice. This study examined HSWs' experiences of barriers and facilitating factors during their initial use of FTI in clinical practice. Altogether, 10 semi-structured focus groups were held with HSWs (n = 38) employed in cancer care and specialized palliative home care for adults, pediatric hospital care, and a children's hospice. Data were analyzed using content analysis. HSWs considered FTI to be a suitable psychosocial intervention for families affected by severe illness with dependent children. However, the way in which the care was organized acted either as a barrier or facilitator to the use of FTI, such as the HSWs' integration in the team and their possibility to organize their own work. The HSWs' work environment also impacted the use of FTI, where time and support from managers was seen as a significant facilitating factor, but which varied between the healthcare contexts. In conclusion, HSWs believed that FTI was a suitable family intervention for families involving dependent children where one family member had a severe illness. For successful initial implementation, strategies should be multi-functional, targeting the care organization and the work environment.
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Affiliation(s)
- Ingrid Thermaenius
- Department of Health Care Sciences, Marie Cederschiöld University, Stockholm, Sweden
| | - Camilla Udo
- Department of Health Care Sciences, Marie Cederschiöld University, Stockholm, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences, Marie Cederschiöld University, Stockholm, Sweden
- Research and Development unit/Palliative care, Stockholms Sjukhem, Stockholm, Sweden
| | - Tina Lundberg
- Department of Health Care Sciences, Marie Cederschiöld University, Stockholm, Sweden
- Medical Unit: Clinical Social Work, Karolinska University Hospital, Stockholm, Sweden
| | - Maja Holm
- Department of Health Care Sciences, Marie Cederschiöld University, Stockholm, Sweden
- Department of Nursing Sciences, Sophiahemmet University, Stockholm, Sweden
| | - Malin Lövgren
- Department of Health Care Sciences, Marie Cederschiöld University, Stockholm, Sweden
- Advanced Pediatric Home Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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20
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Chi XW, He R, Wu XH, Wu LJ, Yang YL, Huang Z. Development of best evidence-based practice protocols for central venous catheter placement and maintenance to reduce CLABSI. Medicine (Baltimore) 2024; 103:e38652. [PMID: 38968526 PMCID: PMC11224884 DOI: 10.1097/md.0000000000038652] [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: 11/09/2023] [Accepted: 05/31/2024] [Indexed: 07/07/2024] Open
Abstract
Although evidence-based interventions can reduce the incidence of central line-associated bloodstream infection (CLABSI), there is a large gap between evidence-based interventions and the actual practice of central venous catheter (CVC) care. Evidence-based interventions are needed to reduce the incidence of CLABSI in intensive care units (ICU) in China. Professional association, guidelines, and database websites were searched for data relevant to CLABSI in the adult ICUs from inception to February 2020. Checklists were developed for both CVC placement and maintenance. Based on the Integrated Promoting Action on Research Implementation in Health Services framework, a questionnaire collected the cognition and practice of ICU nursing and medical staff on the CLABSI evidence-based prevention guidelines. From January 2018 to December 2021, ICU CLABSI rates were collected monthly. Ten clinical guidelines were included after the screening and evaluation process and used to develop the best evidence-based protocols for CVC placement and maintenance. The CLABSI rates in 2018, 2019, and 2020 were 2.98‰ (9/3021), 1.83‰ (6/3276), and 1.69‰ (4/2364), respectively. Notably, the CLABSI rate in 2021 was 0.38‰ (1/2607). In other words, the ICU CLABSI rate decreased from 1.69‰ to 0.38‰ after implementation of the new protocols. Additionally, our data suggested that the use of ultrasound-guidance for catheter insertion, chlorhexidine body wash, and the use of a checklist for CVC placement and maintenance were important measures for reducing the CLABSI rate. The evidence-based processes developed for CVC placement and maintenance were effective at reducing the CLABSI rate in the ICU.
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Affiliation(s)
- Xiu-wen Chi
- School of Nursing, Guangdong Medical University, Dongguan, China
| | - Ru He
- Nursing Department, Longgang Central District Hospital, Shenzhen, China
| | - Xiao-heng Wu
- Department of Intensive Care Unit, Longgang Central District Hospital, Shenzhen, China
| | - Li-juan Wu
- School of Nursing, Guangdong Medical University, Dongguan, China
| | - Yuan-li Yang
- Department of Intensive Care Unit, Longgang Central District Hospital, Shenzhen, China
| | - Zhen Huang
- Office of Shenzhen Clinical College, Guangzhou University of Chinese Medicine, Longgang Central District Hospital, Shenzhen, China
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Hauffman A, Björk E, Edfeldt K, Fröjd C, Gunnarsson AK, Nyholm L, Avallin T, Jangland E. InCHARGE: Co-creating, implementing and evaluating interventions to utilize nurses' competence and achieve person-centred fundamental care-A research protocol describing an action research approach. PLoS One 2024; 19:e0304700. [PMID: 38954688 PMCID: PMC11218940 DOI: 10.1371/journal.pone.0304700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/15/2024] [Indexed: 07/04/2024] Open
Abstract
AIM AND OBJECTIVES This research protocol presents an action research project with the aim to demonstrate the value of person-centred fundamental care to nurses and nurse managers in surgical care units to encourage a far-reaching change in this direction. The objectives are to describe this process and to evaluate the effects on missed nursing care and person-centred fundamental care. METHODS In a novel collaboration between nursing science and medical humanities the action research design will be used to interact with nursing staff and leaders in three surgical care units and design interventions with the purpose to affect the direction of nursing. Initially, the care units will be presented with interactive workshops including evidence-based education on person-centered fundamental care, person-centredness, nurse role responsibility and leadership. This will be followed by cocreation of interventions to stimulate person-centered fundamental care. The Fundamentals of Care framework will be used as the overarching theoretical framework. Data on missed nursing care, person-centred climate and person-centered fundamental care will be collected repeatedly from patient- and nursing stakeholders through interviews and validated questionnaires. Additionally, data from written reflections following clinical observations and focus group interviews will be included. The duration of the study will be approximately five years from ethical approval. DISCUSSION It has been previously reported that the current working environments of registered nurses are forcing them to ration their caring responsibilities, leading to a lack of fulfillment of patients' fundamental care needs, with possible severe consequences for patients. The action research design helps researchers gain an understanding of the contextual factors important for forthcoming interventions, enabling reflective processes and cocreation of interventions with stakeholders. This may lead to feasible interventions and strengthen nursing leadership in the involved units.
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Affiliation(s)
- Anna Hauffman
- Department of Surgical Sciences, Section of Nursing research, Uppsala University, Uppsala, Sweden
| | - Elin Björk
- Department of Surgical Sciences, Section of Nursing research, Uppsala University, Uppsala, Sweden
| | - Katarina Edfeldt
- Department of Surgical Sciences, Section of Nursing research, Uppsala University, Uppsala, Sweden
| | - Camilla Fröjd
- Department of Surgical Sciences, Section of Nursing research, Uppsala University, Uppsala, Sweden
| | - Anna-Karin Gunnarsson
- Department of Surgical Sciences, Section of Nursing research, Uppsala University, Uppsala, Sweden
| | - Lena Nyholm
- Department of Surgical Sciences, Section of Nursing research, Uppsala University, Uppsala, Sweden
| | - Therese Avallin
- Department of Surgical Sciences, Section of Nursing research, Uppsala University, Uppsala, Sweden
- Department of Surgery, Uppsala university hospital, Uppsala, Sweden
| | - Eva Jangland
- Department of Surgical Sciences, Section of Nursing research, Uppsala University, Uppsala, Sweden
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22
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Babu D, Rowett D, Kalisch Ellett L, Marotti S, Wisdom A, Lim R, Harmon J. Exploration of 'micro' level factors that affect the involvement of clinical pharmacists in interprofessional ward rounds in hospitals: Through the lens of social cognitive theory. Res Social Adm Pharm 2024; 20:654-664. [PMID: 38627153 DOI: 10.1016/j.sapharm.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/05/2024] [Accepted: 04/07/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Macro and meso level factors that influence the participation by clinical pharmacists in ward rounds include pharmacy management culture, commitment to ward rounds and adequate time for ward rounds being included in workload models. The 'micro' level factors that affect the involvement of clinical pharmacists in ward rounds have not been widely explored. OBJECTIVE Explore 'micro' level factors to gain insight into clinical pharmacists' participation in interprofessional ward rounds in inpatient settings through the lens of social cognitive theory. METHOD A qualitative focused ethnographic study with five clinical pharmacists, four medical practitioners, one allied health professional and one nurse was conducted in three metropolitan hospitals in Southern Australia. Seven hours of semi-structured interview (n = 11) and 76-h of observations (n = 5) were conducted. A qualitative descriptive analysis was conducted (guided by Spradley) followed by reflexive thematic-analysis (according to Braun and Clarke's technique). RESULTS Three micro level factors influencing clinical pharmacist participation in ward rounds are: (1) Cognitive mindset of clinical pharmacists, (2) Behavioural conduct of clinical pharmacists, and (3) Social rules of the ward. Clinical pharmacists that did not participate in ward round reconciled their moral distress by transferring information without clinical judgement or interpretation of the patient scenario to medical practitioners. Clinical pharmacists that did participate in ward rounds demonstrated credibility by making relevant recommendations with a holistic lens. This enabled clinical pharmacists to be perceived as trustworthy by medical practitioners. Positive experiences of participating in ward rounds contributed to their cognitive upward spiral of thoughts and emotions, fostering continued participation. CONCLUSION Clinical pharmacists participate in ward rounds when they develop a positive mindset about ward round participation and perceive ward rounds as an enabler to the establishment of trusted professional relationships with medical practitioners. This trusted relationship creates an environment where the pharmacist develops confidence in making relevant recommendations.
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Affiliation(s)
- Dona Babu
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia; SA Pharmacy, SA Health, Adelaide, SA, 5000, Australia.
| | - Debra Rowett
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia; Drug and Therapeutics Information Service, Southern Adelaide Local Health Network, Adelaide, SA, 5000, Australia
| | - Lisa Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Sally Marotti
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia; SA Pharmacy, SA Health, Adelaide, SA, 5000, Australia
| | - Alice Wisdom
- SA Pharmacy, SA Health, Adelaide, SA, 5000, Australia
| | - Renly Lim
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Joanne Harmon
- Rosemary Bryant AO Research Centre, Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
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23
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Girard A, Doucet A, Lambert M, Ouadfel S, Caron G, Hudon C. What is known about the role of external facilitators during the implementation of complex interventions in healthcare settings? A scoping review. BMJ Open 2024; 14:e084883. [PMID: 38951001 PMCID: PMC11328637 DOI: 10.1136/bmjopen-2024-084883] [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] [Indexed: 07/03/2024] Open
Abstract
OBJECTIVE To synthesise current knowledge about the role of external facilitators as an individual role during the implementation of complex interventions in healthcare settings. DESIGN A scoping review was conducted. We reviewed original studies (between 2000 and 2023) about implementing an evidence-based complex intervention in a healthcare setting using external facilitators to support the implementation process. An information specialist used the following databases for the search strategy: MEDLINE, CINAHL, APA PsycINFO, Academic Search Complete, EMBASE (Scopus), Business Source Complete and SocINDEX. RESULTS 36 reports were included for analysis, including 34 different complex interventions. We performed a mixed thematic analysis to synthesise the data. We identified two primary external facilitator roles: lead facilitator and process expert facilitator. Process expert external facilitators have specific responsibilities according to their role and expertise in supporting three main processes: clinical, change management and knowledge/research management. CONCLUSIONS Future research should study processes supported by external facilitators and their relationship with facilitation strategies and implementation outcomes. Future systematic or realist reviews may also focus on outcomes and the effectiveness of external facilitation.
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Affiliation(s)
- Ariane Girard
- School of Nursing, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Amélie Doucet
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Mireille Lambert
- Department of Family Medicine and Emergency, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Sarah Ouadfel
- Department of Family Medicine and Emergency, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Genève Caron
- Departement of Psychology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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24
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Baker A, Cornwell P, Gustafsson L, Lannin NA. Implementing a tailored, co-designed goal-setting implementation package in rehabilitation services: a process evaluation. Disabil Rehabil 2024; 46:3116-3127. [PMID: 37551867 DOI: 10.1080/09638288.2023.2243589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 07/29/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE This study aims to evaluate the process of implementing an evidence-based goal-setting package into five rehabilitation services across the continuum of rehabilitation. MATERIALS AND METHODS This study used a mixed methods approach guided by Medical Research Council (MRC) recommendations for conducting process evaluations, the RE-AIM framework, and the Theoretical Domains Framework (TDF). This study will evaluate the reach, adoption, implementation, and maintenance of the goal-setting package over six months. RESULTS Environmental context and resources, the clinician's social and professional role and identity, social influences and clinician beliefs about goal-setting consequences and individuals' capabilities were all identified as barriers or enablers throughout the implementation process. Community rehabilitation services faced challenges implementing paper-based resources, whilst inpatient rehabilitation sites faced challenges engaging nursing staff in the interdisciplinary approach to goal-setting. Social influences were an enabler in two sites that used the case conference format to facilitate setting common goals. Clinicians in all sites continued to express difficulties implementing shared decision-making with people who had cognitive impairments or were no longer progressing in their rehabilitation. CONCLUSIONS A team-based approach to implementing the goal-setting interventions centred around the case conference format appeared to be the most successful mode for implementing interdisciplinary person-centred goal-setting.
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Affiliation(s)
- Amanda Baker
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
- Statewide Rehabilitation Clinical Network, Clinical Excellence Division, Queensland Health, Brisbane, Australia
- Allied Health, Physiotherapy Department, Sunshine Coast Hospital and Health Service, Queensland Health, Nambour, Australia
| | - Petrea Cornwell
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Louise Gustafsson
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
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25
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Tiet QQ, Davis L, Rosen C, Norman SB, Leyva YE, Duong H. Factors Associated With Increased Substance Use Disorder Care in VA PTSD Specialty Outpatient Treatment. J Dual Diagn 2024; 20:223-235. [PMID: 38710212 DOI: 10.1080/15504263.2024.2348105] [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] [Indexed: 05/08/2024]
Abstract
OBJECTIVE Substance use disorders (SUDs) commonly co-occur with posttraumatic stress disorder (PTSD). Understanding PTSD clinics that serve higher percentages of patients with PTSD/SUD is crucial for improving SUD care in clinics with lower percentages of such patients. This study examined the differences between Veterans Affairs (VA) PTSD treatment sites with higher percentages ("High%") and lower percentages ("Low%") of patients with PTSD/SUD as well as exploring the roles of the PTSD/SUD specialists. METHODS The study collected quantitative and qualitative data from 18 clinic directors and 21 specialists from 33 VA PTSD specialty outpatient clinics from 2014 to 2016. The clinics were chosen from the top and bottom quartiles based on two criteria: (1) the percentage of patients with PTSD/SUD and (2) the percentage of patients with PTSD/SUD who completed at least three SUD visits within the first month of their SUD treatment. The interviews sought to identify distinguishing characteristics between the High% and Low% clinics in terms of treatment access and practices for patients with PTSD/SUD. RESULTS More of the High% clinics reported providing evidence-based, patient-centered, and integrated/concurrent PTSD/SUD treatment and had staff members with more up-to-date knowledge and skills than the Low% clinics. We also found the roles of the PTSD/SUD specialists were demanding and confusing, leading to high turnover rates. CONCLUSIONS The two groups of PTSD clinics differed in three key factors: Resources, knowledge and skills of staff members, and local policies. Future research should focus on addressing resource limitations, knowledge gaps, and local policy disparities in Low% clinics. By emulating the practices of High% clinics, VA PTSD clinics can improve SUD care for patients with PTSD/SUD.
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Affiliation(s)
- Quyen Q Tiet
- California School of Professional Psychology, Alliant International University, San Francisco Bay Area, CA, USA
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Laila Davis
- Kaiser Permanente Rancho Cordova Medical Center, Rancho Cordova, CA, USA
| | - Craig Rosen
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Sonya B Norman
- National Center for PTSD, White River Junction, VT, USA
- University of California San Diego School of Medicine, San Diego, CA, USA
| | - Yani E Leyva
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Heather Duong
- Kaiser Permanente San Leandro Medical Center, San Leandro, CA, USA
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Ramadurai D, Shea JA. Leveraging the health equity implementation framework to foster an equity focus in medical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:1047-1058. [PMID: 37668934 PMCID: PMC10912357 DOI: 10.1007/s10459-023-10277-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/13/2023] [Indexed: 09/06/2023]
Abstract
Teaching equitable clinical practice is of critical importance, yet how best to do so remains unknown. Educators utilize implementation science frameworks to disseminate clinical evidence-based practices (EBP). The Health Equity Implementation Framework (HEIF) is one of these frameworks, and it delineates how health equity may be concomitantly assessed and addressed in planning the implementation of an EBP. The HEIF therefore lays a strong foundation to understand and explain barriers and facilitators to implementation through an equity lens, making it well-suited for use by medical educators. Three equity-focused frames of reference within the model include (1) the clinical encounter, (2) societal context, and (3) culturally relevant factors, herein referred to as domains. The HEIF provides a structure for prospective and retrospective assessment of how EBP are taught and ultimately incorporated into clinical practice by trainees, with specific attention to delivering equitable care. We present three examples of common topics in internal medicine, contextualized by the three equity domains of the HEIF. We additionally acknowledge the limitations of this framework as a research tool with complex features that may not be suitable for brief teaching in the clinical environment. We propose a 360-degree learner assessment to ensure implementation of this framework is successful. By encouraging trainees to explore the narrative experiences of their patients and examine their own implicit biases, the HEIF provides a structure to address gaps in knowledge about delivering equitable care.
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Affiliation(s)
- Deepa Ramadurai
- Division of Pulmonary, Allergy and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Judy A Shea
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Forbat L, Macgregor A, Spilsbury K, McCormack B, Rutherford A, Hanratty B, Hockley J, Davison L, Ogden M, Soulsby I, McKenzie M. Using Palliative Care Needs Rounds in the UK for care home staff and residents: an implementation science study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-134. [PMID: 39046763 DOI: 10.3310/krwq5829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
Background Care home residents often lack access to end-of-life care from specialist palliative care providers. Palliative Care Needs Rounds, developed and tested in Australia, is a novel approach to addressing this. Objective To co-design and implement a scalable UK model of Needs Rounds. Design A pragmatic implementation study using the integrated Promoting Action on Research Implementation in Health Services framework. Setting Implementation was conducted in six case study sites (England, n = 4, and Scotland, n = 2) encompassing specialist palliative care service working with three to six care homes each. Participants Phase 1: interviews (n = 28 care home staff, specialist palliative care staff, relatives, primary care, acute care and allied health practitioners) and four workshops (n = 43 care home staff, clinicians and managers from specialist palliative care teams and patient and public involvement and engagement representatives). Phase 2: interviews (n = 58 care home and specialist palliative care staff); family questionnaire (n = 13 relatives); staff questionnaire (n = 171 care home staff); quality of death/dying questionnaire (n = 81); patient and public involvement and engagement evaluation interviews (n = 11); fidelity assessment (n = 14 Needs Rounds recordings). Interventions (1) Monthly hour-long discussions of residents' physical, psychosocial and spiritual needs, alongside case-based learning, (2) clinical work and (3) relative/multidisciplinary team meetings. Main outcome measures A programme theory describing what works for whom under what circumstances with UK Needs Rounds. Secondary outcomes focus on health service use and cost effectiveness, quality of death and dying, care home staff confidence and capability, and the use of patient and public involvement and engagement. Data sources Semistructured interviews and workshops with key stakeholders from the six sites; capability of adopting a palliative approach, quality of death and dying index, and Canadian Health Care Evaluation Project Lite questionnaires; recordings of Needs Rounds; care home data on resident demographics/health service use; assessments and interventions triggered by Needs Rounds; semistructured interviews with academic and patient and public involvement and engagement members. Results The programme theory: while care home staff experience workforce challenges such as high turnover, variable skills and confidence, Needs Rounds can provide care home and specialist palliative care staff the opportunity to collaborate during a protected time, to plan for residents' last months of life. Needs Rounds build care home staff confidence and can strengthen relationships and trust, while harnessing services' complementary expertise. Needs Rounds strengthen understandings of dying, symptom management, advance/anticipatory care planning and communication. This can improve resident care, enabling residents to be cared for and die in their preferred place, and may benefit relatives by increasing their confidence in care quality. Limitations COVID-19 restricted intervention and data collection. Due to an insufficient sample size, it was not possible to conduct a cost-benefit analysis of Needs Rounds or calculate the treatment effect or family perceptions of care. Conclusions Our work suggests that Needs Rounds can improve the quality of life and death for care home residents, by enhancing staff skills and confidence, including symptom management, communications with general practitioners and relatives, and strengthen relationships between care home and specialist palliative care staff. Future work Conduct analysis of costs-benefits and treatment effects. Engagement with commissioners and policy-makers could examine integration of Needs Rounds into care homes and primary care across the UK to ensure equitable access to specialist care. Study registration This study is registered as ISRCTN15863801. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128799) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 19. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Liz Forbat
- Faculty of Social Science, University of Stirling, Stirling, UK
| | - Aisha Macgregor
- Faculty of Social Science, University of Stirling, Stirling, UK
| | | | - Brendan McCormack
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
- Queen Margaret University Edinburgh, Scotland, UK
- Østfold University College, Norway
| | | | - Barbara Hanratty
- Faculty of Medical Sciences, University of Newcastle, England, UK
| | - Jo Hockley
- College of Medicine and Veterinary Science, University of Edinburgh, UK
| | - Lisa Davison
- Faculty of Social Science, University of Stirling, Stirling, UK
| | - Margaret Ogden
- Patient and Public Involvement and Engagement, Faculty of Social Science, University of Stirling, UK
| | - Irene Soulsby
- Patient and Public Involvement and Engagement, Faculty of Social Science, University of Stirling, UK
| | - Maisie McKenzie
- Patient and Public Involvement and Engagement, Faculty of Social Science, University of Stirling, UK
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Zaforteza-Lallemand C, Blanco-Mavillard I, Pol-Castañeda S, Villafáfila-Gomila CJ, Ferrer-Cruz F, Rodríguez-Calero MÁ. Strategies for knowledge mobilization by advanced practice nurses in three hospitals in Spain: a qualitative study. BMC Nurs 2024; 23:440. [PMID: 38926719 PMCID: PMC11202328 DOI: 10.1186/s12912-024-02095-5] [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: 11/28/2023] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Evidence-based practice, in conjunction with optimum care quality, improves patients' clinical outcomes. However, its implementation in daily clinical practice continues to present difficulties. The aim of this study was to identify the strategies applied by Advanced Practice Nurses (APNs) to foster adherence to clinical practice guideline recommendations. METHODS An exploratory qualitative study was conducted with six focus groups at three public hospitals belonging to the Balearic Islands Health Care Service (Spain). The study participants were 32 ward nurses and 5 advanced practice nurses working routinely with inpatients at these hospitals. The study was conducted from November 2020 to January 2021, using thematic analysis, based on the COREQ checklist. RESULTS Four major themes related to the facilitation process were identified either by RNs and APNs: the context of the project, APN contribution to nursing team management, healthcare provision on the ward, and the acquisition and application of knowledge. CONCLUSIONS The APNs adapted their actions to the characteristics and needs of the local context, employing strategies aimed at improving teamwork, healthcare, and knowledge management. Each of these contributions enhanced the sustainability of the changes made.
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Affiliation(s)
- Concha Zaforteza-Lallemand
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma, Balearic Islands, 07122, Spain
- Balearic Islands Health Services, Palma, Balearic Islands, 07003, Spain
- CurES Research Group, Health Research Institute of the Balearic Islands (IdISBa), Palma, Balearic Islands, 07120, Spain
| | - Ian Blanco-Mavillard
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma, Balearic Islands, 07122, Spain.
- Healthcare Implementation and Research Unit, Hospital Regional Universitario de Málaga, Avd. de Carlos Haya, 84. Málaga 29010, Málaga, 29010, Spain.
- CurES Research Group, Health Research Institute of the Balearic Islands (IdISBa), Palma, Balearic Islands, 07120, Spain.
| | - Sandra Pol-Castañeda
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma, Balearic Islands, 07122, Spain
- Hospital Son Llàtzer, Palma, Balearic Islands, 07198, Spain
- CurES Research Group, Health Research Institute of the Balearic Islands (IdISBa), Palma, Balearic Islands, 07120, Spain
| | - Carlos Javier Villafáfila-Gomila
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma, Balearic Islands, 07122, Spain
- Balearic Islands Health Services, Palma, Balearic Islands, 07003, Spain
- CurES Research Group, Health Research Institute of the Balearic Islands (IdISBa), Palma, Balearic Islands, 07120, Spain
| | | | - Miguel Ángel Rodríguez-Calero
- CurES Research Group, Health Research Institute of the Balearic Islands (IdISBa), Palma, Balearic Islands, 07120, Spain
- Quality Department, Torrecárdenas University Hospital, Almería, 04003, Spain
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Wang W, Zhang Y, Ling F, Hu S, Gu Y. Goal-oriented temperature management in severely traumatized children in the emergency department: an evidence-based practice project. JBI Evid Implement 2024:02205615-990000000-00107. [PMID: 38912642 DOI: 10.1097/xeb.0000000000000439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
INTRODUCTION AND OBJECTIVES Hypothermia commonly occurs in trauma patients. Evidence-based practices for hypothermia prevention are not strictly followed by all medical staff in the emergency department. This study aimed to assess compliance with evidence-based practices regarding goal-oriented temperature management for severely traumatized children in a Chinese hospital. METHODS This project used the JBI Evidence Implementation Framework to translate evidence into practice. The Integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework was used to identify barriers to compliance with best practices. A goal-oriented temperature management strategy for trauma patients was developed based on the identified barriers, along with a simulation training module, and the supply of warming materials. Field observation, review of medical records, and interviews with medical staff and patients were used to assess baseline and follow-up audit compliance with best practices. RESULTS Twelve criteria were audited in the baseline and follow-up audits, with 11 and 37 trauma patients, respectively. In the follow-up audit, compliance with all criteria increased, with a reduction in shivering and cold discomfort scores. Except for two patients who died, hypothermia did not occur in any of the patients. CONCLUSIONS The JBI Evidence Implementation Framework was used to successfully improve compliance with best practices. Future audits should be conducted to sustain the evidence-based behavior of all medical staff. SPANISH ABSTRACT http://links.lww.com/IJEBH/A234.
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Affiliation(s)
- Wenchao Wang
- Emergency Department, Children's Hospital of Fudan University, Shanghai, China
| | - Yanhong Zhang
- Emergency Department, Children's Hospital of Fudan University, Shanghai, China
| | - Fang Ling
- Emergency Department, Children's Hospital of Fudan University, Shanghai, China
| | - Shenjie Hu
- Emergency Department, Children's Hospital of Fudan University, Shanghai, China
| | - Ying Gu
- Nursing Department, Children's Hospital of Fudan University, Shanghai, China
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30
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Weaver SJ, Breslau ES, Russell LE, Zhang A, Sharma R, Bass EB, Marsteller JA, Snyder C. Health-care organization characteristics in cancer care delivery: an integrated conceptual framework with content validation. J Natl Cancer Inst 2024; 116:800-811. [PMID: 38419574 DOI: 10.1093/jnci/djae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/01/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
Context can influence cancer-related outcomes. For example, health-care organization characteristics, including ownership, leadership, and culture, can affect care access, communication, and patient outcomes. Health-care organization characteristics and other contextual factors can also influence whether and how clinical discoveries reduce cancer incidence, morbidity, and mortality. Importantly, policy, market, and technology changes are transforming health-care organization design, culture, and operations across the cancer continuum. Consequently, research is essential to examine when, for whom, and how organizational characteristics influence person-level, organization-level, and population-level cancer outcomes. Understanding organizational characteristics-the structures, processes, and other features of entities involved in health care delivery-and their dynamics is an important yet understudied area of care delivery research across the cancer continuum. Research incorporating organizational characteristics is critical to address health inequities, test care delivery models, adapt interventions, and strengthen implementation. The field lacks conceptual grounding, however, to help researchers identify germane organizational characteristics. We propose a framework identifying organizational characteristics relevant for cancer care delivery research based on conceptual work in health services, organizational behavior, and management science and refined using a systematic review and key informant input. The proposed framework is a tool for organizing existing research and enhancing future cancer care delivery research. Following a 2012 Journal of the National Cancer Institute monograph, this work complements National Cancer Institute efforts to stimulate research addressing the relationship between cancer outcomes and contextual factors at the patient, provider, team, delivery organization, community, and health policy levels.
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Affiliation(s)
- Sallie J Weaver
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Erica S Breslau
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Lauren E Russell
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Allen Zhang
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ritu Sharma
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric B Bass
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jill A Marsteller
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claire Snyder
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
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31
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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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Sheringham J, Steed L, McClatchey K, Delaney B, Barat A, Hammersley V, Marsh V, Fulop NJ, Taylor SJC, Pinnock H. Understanding the processes underpinning IMPlementing IMProved Asthma self-management as RouTine (IMP 2ART) in primary care: study protocol for a process evaluation within a cluster randomised controlled implementation trial. Trials 2024; 25:359. [PMID: 38835102 PMCID: PMC11151520 DOI: 10.1186/s13063-024-08179-6] [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: 02/11/2024] [Accepted: 05/16/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Providing supported self-management for people with asthma can reduce the burden on patients, health services and wider society. Implementation, however, remains poor in routine clinical practice. IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) is a UK-wide cluster randomised implementation trial that aims to test the impact of a whole-systems implementation strategy, embedding supported asthma self-management in primary care compared with usual care. To maximise opportunities for sustainable implementation beyond the trial, it is necessary to understand how and why the IMP2ART trial achieved its clinical and implementation outcomes. METHODS A mixed-methods process evaluation nested within the IMP2ART trial will be undertaken to understand how supported self-management was implemented (or not) by primary care practices, to aid interpretation of trial findings and to inform scaling up and sustainability. Data and analysis strategies have been informed by mid-range and programme-level theory. Quantitative data will be collected across all practices to describe practice context, IMP2ART delivery (including fidelity and adaption) and practice response. Case studies undertaken in three to six sites, supplemented by additional interviews with practice staff and stakeholders, will be undertaken to gain an in-depth understanding of the interaction of practice context, delivery, and response. Synthesis, informed by theory, will combine analyses of both qualitative and quantitative data. Finally, implications for the scale up of asthma self-management implementation strategies to other practices in the UK will be explored through workshops with stakeholders. DISCUSSION This mixed-methods, theoretically informed, process evaluation seeks to provide insights into the delivery and response to a whole-systems approach to the implementation of supported self-management in asthma care in primary care. It is underway at a time of significant change in primary care in the UK. The methods have, therefore, been developed to be adaptable to this changing context and to capture the impact of these changes on the delivery and response to research and implementation processes.
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Affiliation(s)
- J Sheringham
- Institute of Epidemiology and Health Care, UCL, London, WC1E 6BT, UK.
| | - L Steed
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | - B Delaney
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - A Barat
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - V Hammersley
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - V Marsh
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - N J Fulop
- Institute of Epidemiology and Health Care, UCL, London, WC1E 6BT, UK
| | - S J C Taylor
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - H Pinnock
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
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Trotta F, Petrosino F, Pucciarelli G, Alvaro R, Vellone E, Bartoli D. Reliability and validity of the training satisfaction questionnaire for family members (TSQ-FM) entering the ICU during an isolation disease outbreak. Heart Lung 2024; 66:37-45. [PMID: 38574598 DOI: 10.1016/j.hrtlng.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND The presence of family members in an isolated ICU during an isolation disease outbreak is restricted by hospital policies because of the infectious risk. This can be overcome by conferring to family members the skill and the ability to safely don and doff the personal protective equipment (PPE) through a nurse-led training intervention and assess their satisfaction, to respond to the need to define a safe, effective and quality care pathway focused on Family-Centered Care (FCC) principles. OBJECTIVE the study aimed to build a valid and reliable instrument for clinical practice to assess family members' satisfaction to allow ICU nurses to restore family integrity in any case of infectious disease outbreak that requires isolation. METHODS A cross-sectional study was conducted to test the psychometric properties. The questionnaire was constructed based on a literature review on the needs of family members in the ICU. 76 family members were admitted to a COVID-ICU. Cronbach's coefficient, Geomin rotated loading, and EFA were applied to assess the reliability and validity of the instrument. RESULTS The Kaiser-Mayer-Olkin (KMO) measure was 0.662, the Bartlett sphericity test showed a significant p-value (χ²=448.33; df=45; p < 0.01), Cronbach's alpha coefficient was.896. A further CFA analysis confirmed that all fit indices were acceptable. The results showed satisfactory validity and reliability, which could be generalized and extended to any outbreak of isolation disease. CONCLUSIONS This study provides a valid and reliable instrument for clinical practice to maintain family integrity in the dyadic relationship between the patient and the family member, even during an emergency infectious disease outbreak that requires isolation.
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Affiliation(s)
- Francesca Trotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Francesco Petrosino
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Davide Bartoli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Pestka DL, Boes S, Ramezani S, Peters M, Usher MG, Koopmeiners JS, Beebe TJ, Melton GB, Streib CD. Implementing Telestroke in the Inpatient Setting: Identifying Factors for Success. Stroke 2024; 55:1517-1524. [PMID: 38639090 DOI: 10.1161/strokeaha.123.046024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/13/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Inpatient telestroke programs have emerged as a solution to provide timely stroke care in underserved areas, but their successful implementation and factors influencing their effectiveness remain underexplored. This study aimed to qualitatively evaluate the perspectives of inpatient clinicians located at spoke hospitals participating in a newly established inpatient telestroke program to identify implementation barriers and facilitators. METHODS This was a formative evaluation relying on semistructured qualitative interviews with 16 inpatient providers (physicians and nurse practitioners) at 5 spoke sites of a hub-and-spoke inpatient telestroke program. The Integrated-Promoting Action on Research Implementation in Health Services framework guided data analysis, focusing on the innovation, recipients, context, and facilitation aspects of implementation. Interviews were transcribed and coded using thematic analysis. RESULTS Fifteen themes were identified in the data and mapped to the Integrated-Promoting Action on Research Implementation in Health Services framework. Themes related to the innovation (the telestroke program) included easy access to stroke specialists, the benefits of limiting patient transfers, concerns about duplicating tests, and challenges of timing inpatient telestroke visits and notes to align with discharge workflow. Themes pertaining to recipients (care team members and patients) were communication gaps between teams, concern about the supervision of inpatient telestroke advanced practice providers and challenges with nurse empowerment. With regard to the context (hospital and system factors), providers highlighted familiarity with telehealth technologies as a facilitator to implementing inpatient telestroke, yet highlighted resource limitations in smaller facilities. Facilitation (program implementation) was recognized as crucial for education, standardization, and buy-in. CONCLUSIONS Understanding barriers and facilitators to implementation is crucial to determining where programmatic changes may need to be made to ensure the success and sustainment of inpatient telestroke services.
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Affiliation(s)
- Deborah L Pestka
- Center for Learning Health System Sciences, University of Minnesota Medical School, Minneapolis (D.L.P., M.P., M.G.U., J.S.K., T.J.B., G.B.M.)
| | - Samuel Boes
- Department of Neurology (S.B., S.R., C.D.S.), University of Minnesota, Minneapolis
| | - Solmaz Ramezani
- Department of Neurology (S.B., S.R., C.D.S.), University of Minnesota, Minneapolis
| | - Maya Peters
- Center for Learning Health System Sciences, University of Minnesota Medical School, Minneapolis (D.L.P., M.P., M.G.U., J.S.K., T.J.B., G.B.M.)
| | - Michael G Usher
- Center for Learning Health System Sciences, University of Minnesota Medical School, Minneapolis (D.L.P., M.P., M.G.U., J.S.K., T.J.B., G.B.M.)
| | - Joseph S Koopmeiners
- Center for Learning Health System Sciences, University of Minnesota Medical School, Minneapolis (D.L.P., M.P., M.G.U., J.S.K., T.J.B., G.B.M.)
- Division of Biostatistics and Health Data Science, School of Public Health (J.S.K.), University of Minnesota, Minneapolis
| | - Timothy J Beebe
- Center for Learning Health System Sciences, University of Minnesota Medical School, Minneapolis (D.L.P., M.P., M.G.U., J.S.K., T.J.B., G.B.M.)
- Division of Health Policy Management, School of Public Health (T.J.B.), University of Minnesota, Minneapolis
| | - Genevieve B Melton
- Center for Learning Health System Sciences, University of Minnesota Medical School, Minneapolis (D.L.P., M.P., M.G.U., J.S.K., T.J.B., G.B.M.)
- Department of Surgery (G.B.M.), University of Minnesota, Minneapolis
- Institute for Health Informatics (G.B.M.), University of Minnesota, Minneapolis
| | - Christopher D Streib
- Department of Neurology (S.B., S.R., C.D.S.), University of Minnesota, Minneapolis
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Iaconi A, Hoben M, Berta, PhD W, Duan Y, Norton PG, Song Y, Chamberlain SA, Beeber A, Anderson RA, Lanham HJ, Perez J, Wang J, Choroschun K, Shrestha S, Cummings G, Estabrooks CA. The Association of Nursing Homes' Organizational Context With Care Aide Empowerment: A Cross-Sectional Study. THE GERONTOLOGIST 2024; 64:gnae033. [PMID: 38695153 PMCID: PMC11129593 DOI: 10.1093/geront/gnae033] [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: 01/19/2023] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Organizational context is thought to influence whether care aides feel empowered, but we lack empirical evidence in the nursing home sector. Our objective was to examine the association of features of nursing homes' unit organizational context with care aides' psychological empowerment. RESEARCH DESIGN AND METHODS This cross-sectional study analyzed survey data from 3765 care aides in 91 Western Canadian nursing homes. Random-intercept mixed-effects regressions were used to examine the associations between nursing home unit organizational context and care aides' psychological empowerment, controlling for care aide, care unit, and nursing home covariates. RESULTS Organizational (IVs) culture, social capital, and care aides' perceptions of sufficient time to do their work were positively associated with all four components of psychological empowerment (DVs): competence (0.17 [0.13, 0.21] for culture, 0.18 [0.14, 0.21] for social capital, 0.03 [0.01, 0.05] for time), meaning (0.21 [0.18, 0.25] for culture, 0.19 [0.16, 0.23] for social capital, 0.03 [0.01, 0.05 for time), self-determination (0.38 [0.33, 0.44] for culture, 0.17 [0.12, 0.21] for social capital, 0.08 [0.05, 0.11] for time), and impact (0.26 [0.21, 0.31] for culture, 0.23 [0.19, 0.28] for social capital, 0.04 [0.01, 0.07] for time). DISCUSSION AND IMPLICATIONS In this study, modifiable elements of organizational context (i.e., culture, social capital, and time) were positively associated with care aides' psychological empowerment. Future interventions might usefully target these modifiable elements of unit level context in the interest of assessing their effects on staff work attitudes and outcomes, including the quality of resident care.
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Affiliation(s)
- Alba Iaconi
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Matthias Hoben
- Faculty of Health, School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Whitney Berta, PhD
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Yinfei Duan
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Peter G Norton
- Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yuting Song
- Faculty of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Stephanie A Chamberlain
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Anna Beeber
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ruth A Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Holly J Lanham
- Joe R. & Teresa Lozano Long School of Medicine, The University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Janelle Perez
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jing Wang
- Nursing Department, College of Health and Human Services, University of New Hampshire, Durham, New Hampshire, USA
| | | | - Shovana Shrestha
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Greta Cummings
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
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Simpson A, Ali RA, Chadwick M, Foye U, Brennan G. Implementing Safewards on Children and Young People's Wards: A Process and Outcomes Evaluation. Issues Ment Health Nurs 2024; 45:563-579. [PMID: 38829922 DOI: 10.1080/01612840.2024.2347507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Safewards reduces conflict and containment on adult inpatient wards but there is limited research exploring the model in Children and Young People (CYP) mental health services. We investigated whether Safewards can be successfully implemented on twenty CYP wards across England. A process and outcomes evaluation was employed, utilizing the Integrated Promoting Action on Research Implementation in Health Sciences (i-PARiHS) framework. Existing knowledge and use of Safewards was recorded via a self-report benchmarking exercise, verified during visits. Implementation of the 10 Safewards components on each ward was recorded using the Safewards Organizational Fidelity measure. Data from 11 surveys and 17 interviews with ward staff and four interviews with project workers were subject to thematic analysis and mapped against the four i-PARiHS constructs. Twelve of the 20 wards implemented at least half of the Safewards interventions in 12 months, with two wards delivering all 10 interventions. Facilitators and barriers are described. Results demonstrated Safewards is acceptable to a range of CYP services. Whilst implementation was hindered by difficulties outlined, wards with capacity were able and willing to implement the interventions. Results support the commissioning of a study to evaluate the implementation and outcomes of Safewards in CYP units.
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Affiliation(s)
- Alan Simpson
- Care in Long Term Conditions Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rubbia A Ali
- Care in Long Term Conditions Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Madeleine Chadwick
- Care in Long Term Conditions Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Una Foye
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Geoff Brennan
- Care in Long Term Conditions Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Mental Health Programmes, Royal College of Nursing, London, UK
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Lichtfuss K, Franco-Arellano B, Jefferson K, Brady J, Arcand J. The implementation of non-weight focused approaches in clinical practice: A Canadian cross-sectional study among registered dietitians. J Hum Nutr Diet 2024; 37:610-621. [PMID: 38273641 DOI: 10.1111/jhn.13284] [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: 08/21/2023] [Accepted: 01/03/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND An increasing number of dietitians use non-diet approaches, referred to as non-weight focused practice approaches (NWFAs), in clinical practice when working with higher weight adult clients. However, the factors that impact dietitians' ability to successfully implement these approaches in practice are unknown. METHODS Aiming to examine how implementing NWFAs in clinical practice differs based on the extent to which a dietitian uses NWFAs with their clients, we conducted a cross-sectional online survey among Canadian registered dietitians who work with higher weight adults (May to July 2021), developed and validated following the Consolidated Framework for Implementation Research. Descriptive statistics were conducted to identify barriers and facilitators with respect to implementing NWFAs. The Kruskal-Wallis was used to test for differences in barriers and facilitators with respect to implementing NWFAs among five different practice approaches. The results showed that, among participants (n = 383; 82% white; 95% women) the most important barriers for implementation of NWFAs were clients' focus on weight as an outcome, when losing weight is a condition to access enhanced services, requiring changes to their practice philosophy, difficulty funding professional development and not having sufficient skills or knowledge to implement NWFAs in practice. Top-rated facilitators included the use of clinical guidelines, scientific publications and educational materials, which were rated with higher agreement across all implementation stages (p < 0.001). CONCLUSIONS The present study highlights important factors that may impact the effective implementation of NWFAs in dietetic practice for higher weight adult clients, which is essential to minimise barriers in practice.
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Affiliation(s)
- Kori Lichtfuss
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | | | | | - Jennifer Brady
- School of Nutrition and Dietetics, Acadia University, Wolfville, NS, Canada
| | - JoAnne Arcand
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
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Lehane E, Buckley C, Mulcahy H, McCarthy E, Cogan L, O'Connell R, Murphy M, Leahy-Warren P. Evaluating the process of practice enhancement for exclusive breastfeeding (PEEB): a participatory action research approach for clinical innovation. Int Breastfeed J 2024; 19:39. [PMID: 38822371 PMCID: PMC11140990 DOI: 10.1186/s13006-024-00648-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/25/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Despite the known benefits of exclusive breastfeeding, global rates remain below recommended targets, with Ireland having one of the lowest rates in the world. This study explores the efficacy of Participatory Action Research (PAR) and Work-Based Learning Groups (WBLGs) to enhance breastfeeding practices within Irish healthcare settings from the perspective of WBLG participants and facilitators. METHODS Employing a PAR approach, interdisciplinary healthcare professionals across maternity, primary, and community care settings (n = 94) participated in monthly WBLGs facilitated by three research and practice experts. These sessions, conducted over nine months (November 2021 - July 2022), focused on critical reflective and experiential learning to identify and understand existing breastfeeding culture and practices. Data were collected through participant feedback, facilitator notes, and reflective exercises, with analysis centered on participant engagement and the effectiveness of WBLGs. This approach facilitated a comprehensive understanding of breastfeeding support challenges and opportunities, leading to the development of actionable themes and strategies for practice improvement. RESULTS Data analysis from WBLG participants led to the identification of five key themes: Empowerment, Ethos, Journey, Vision, and Personal Experience. These themes shaped the participants' meta-narrative, emphasising a journey of knowledge-building and empowerment for breastfeeding women and supporting staff, underlining the importance of teamwork and multidisciplinary approaches. The project team's evaluation highlighted four additional themes: Building Momentum, Balancing, Space Matters, and Being Present. These themes reflect the dynamics of the PAR process, highlighting the significance of creating a conducive environment for discussion, ensuring diverse engagement, and maintaining energy and focus to foster meaningful practice changes in breastfeeding support. CONCLUSION This study highlights the potential of WBLGs and PAR to enhance the understanding and approach of healthcare professionals towards breastfeeding support. By fostering reflective and collaborative learning environments, the study has contributed to a deeper understanding of the challenges in breastfeeding support and identified key areas for improvement. The methodologies and themes identified hold promise to inform future practice and policy development in maternal and child health.
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Affiliation(s)
- Elaine Lehane
- School of Nursing and Midwifery, University College Cork, Cork, Ireland.
| | - Catherine Buckley
- Northridge House Education and Research Centre, St Luke's Home, Cork, Ireland
| | - Helen Mulcahy
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Liz Cogan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Rhona O'Connell
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Margaret Murphy
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Crook R, Lennox C, Awenat Y, Edge D, Knowles S, Honeywell D, Gooding P, Haddock G, Brooks H, Pratt D. Development of the Prevention of Suicide Behaviour in Prisons: Enhancing Access to Therapy (PROSPECT) logic model and implementation strategies. BJPsych Bull 2024:1-9. [PMID: 38708568 DOI: 10.1192/bjb.2024.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
AIMS AND METHOD This study aimed to develop and articulate a logic model and programme theories for implementing a new cognitive-behavioural suicide prevention intervention for men in prison who are perceived to be at risk of death by suicide. Semi-structured one-to-one interviews with key stakeholders and a combination of qualitative analysis techniques were used to develop programme theories. RESULTS Interviews with 28 stakeholders resulted in five programme theories, focusing on: trust, willingness and engagement; readiness and ability; assessment and formulation; practitioner delivering the 'change work' stage of the intervention face-to-face in a prison environment; and practitioner training, integrating the intervention and onward care. Each theory provides details of what contextual factors need to be considered at each stage, and what activities can facilitate achieving the intended outcomes of the intervention, both intermediate and long term. CLINICAL IMPLICATIONS The PROSPECT implementation strategy developed from the five theories can be adapted to different situations and environments.
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Affiliation(s)
- Rebecca Crook
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester NHS Foundation Trust, Manchester, UK
| | - Charlotte Lennox
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Yvonne Awenat
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester NHS Foundation Trust, Manchester, UK
| | - Dawn Edge
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | | | | | - Patricia Gooding
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester NHS Foundation Trust, Manchester, UK
| | - Gillian Haddock
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester NHS Foundation Trust, Manchester, UK
| | | | - Daniel Pratt
- University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester NHS Foundation Trust, Manchester, UK
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Wang W, Fu Q, Shen W, Xu Y, Wang L, Chun X, Shi Y, Lin J, Zhao Y, Gu Y. Using the i-PARIHS theoretical framework to develop evidence implementation strategies for central venous catheter maintenance: a multi-site quality improvement project. JBI Evid Implement 2024; 22:195-204. [PMID: 38557993 PMCID: PMC11107888 DOI: 10.1097/xeb.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Evidence-based nursing practice can reduce complications associated with central venous catheters (CVCs). In this project, the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework was considered an ideal theoretical instrument to identify facilitators and barriers to implementing evidence-based practice. METHODS The project was conducted in pediatric intensive care units in six Chinese tertiary children's hospitals. Twenty-two audit criteria were obtained from best practice recommendations, and a baseline audit was conducted to assess current practice against best practice. Next, the i-PARIHS framework was used to identify facilitators and barriers to best practice and develop improvement strategies. A follow-up audit was then conducted to measure changes in compliance with best practices. RESULTS Facilitators and barriers were identified at the innovation, recipient, and context levels. A comprehensive CVC maintenance strategy was then developed to apply the best evidence to nurses' clinical work. Of the 22 audit criteria, 17 showed significant improvement compared with the baseline audit. CONCLUSIONS The i-PARIHS framework is an effective tool for developing targeted, evidence-based improvement strategies and applying these to the clinical setting. The quality of the nurses' clinical practice improved during CVC maintenance. However, there is no certainty that these positive results can be maintained, and long-term data are needed to verify this. SPANISH ABSTRACT http://links.lww.com/IJEBH/A185.
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Affiliation(s)
- Wenchao Wang
- Emergency Department, Children's Hospital of Fudan University, Shanghai, China
| | - Qin Fu
- Nursing Department, ShenZhen Children's Hospital, Guangdong, China
| | - Weijie Shen
- Pediatric Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Yulu Xu
- Cardiac Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Linjuan Wang
- Pediatric Intensive Care Unit, Shenzhen Children's Hospital, Guangdong, China
| | - Xiao Chun
- Pediatric Intensive Care Unit, Guangzhou Woman and Children's Medical Center, Guangdong, China
| | - Yuyun Shi
- Pediatric Intensive Care Unit, Children's Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Jianping Lin
- Pediatric Intensive Care Unit, Xiamen Children's Hospital, Fujian, China
| | - Yaxun Zhao
- Pediatric Intensive Care Unit, Anhui Children's Hospital, Anhui, China
| | - Ying Gu
- Nursing Department, Children's Hospital of Fudan University, Shanghai, China
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Levy C, Kononowech J, Ersek M, Phibbs CS, Scott W, Sales A. Evaluating feedback reports to support documentation of veterans' care preferences in home based primary care. BMC Geriatr 2024; 24:389. [PMID: 38693502 PMCID: PMC11064362 DOI: 10.1186/s12877-024-04999-y] [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: 01/09/2024] [Accepted: 04/19/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND To evaluate the effectiveness of delivering feedback reports to increase completion of LST notes among VA Home Based Primary Care (HBPC) teams. The Life Sustaining Treatment Decisions Initiative (LSTDI) was implemented throughout the Veterans Health Administration (VHA) in the United States in 2017 to ensure that seriously ill Veterans have care goals and LST decisions elicited and documented. METHODS We distributed monthly feedback reports summarizing LST template completion rates to 13 HBPC intervention sites between October 2018 and February 2020 as the sole implementation strategy. We used principal component analyses to match intervention to 26 comparison sites and used interrupted time series/segmented regression analyses to evaluate the differences in LST template completion rates between intervention and comparison sites. Data were extracted from national databases for VA HBPC in addition to interviews and surveys in a mixed methods process evaluation. RESULTS LST template completion rose from 6.3 to 41.9% across both intervention and comparison HBPC teams between March 1, 2018, and February 26, 2020. There were no statistically significant differences for intervention sites that received feedback reports. CONCLUSIONS Feedback reports did not increase documentation of LST preferences for Veterans at intervention compared with comparison sites. Observed increases in completion rates across intervention and comparison sites can likely be attributed to implementation strategies used nationally as part of the national roll-out of the LSTDI. Our results suggest that feedback reports alone were not an effective implementation strategy to augment national implementation strategies in HBPC teams.
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Affiliation(s)
- Cari Levy
- Denver-Seattle VA Center of Innovation for Value Driven & Veteran-Centric Care, Rocky Mountain Regional VA Medical Center at VA Eastern Colorado Health Care System, Aurora, CO, USA
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jennifer Kononowech
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
| | - Mary Ersek
- Center for Health Equity and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Schools of Nursing and Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ciaran S Phibbs
- Geriatrics and Extended Care Data and Analysis Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Departments of Pediatrics and Health Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Winifred Scott
- Geriatrics and Extended Care Data and Analysis Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Anne Sales
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Sinclair School of Nursing, Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA
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Levine R, Zingelman S, McSween MP, Shrubsole K, Hill AJ, Copland DA. Allied Health Clinicians' Uptake of Evidence in Stroke Rehabilitation: A Systematic Review of Determinants Targeted in Implementation Studies. Arch Phys Med Rehabil 2024; 105:988-999. [PMID: 37666287 DOI: 10.1016/j.apmr.2023.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE This study aimed to determine whether targeting specific implementation determinants is associated with allied health clinicians' uptake of evidence when implemented within stroke rehabilitation settings. DATA SOURCES 7 key databases were searched to identify articles published between 1990 and 2022 for inclusion. Reference lists of relevant articles were hand searched. STUDY SELECTION Studies were independently screened by 2 authors and included if the implementation intervention targeted allied health clinical practice in any stroke rehabilitation context and reported at least 1 quantitative measure of evidence uptake. Thirty studies met inclusion criteria. DATA EXTRACTION Data were independently extracted by the first and second author. Implementation outcomes for each study were categorized as either mostly successful, partially successful, or not successful based on the degree of evidence uptake achieved. Determinants targeted were categorized using the Consolidated Framework for Implementation Research (CFIR). DATA SYNTHESIS Patterns between the degree of evidence uptake and determinants targeted across studies were analyzed by the first and second authors in 1 of 3 groups: A (pre-post statistical analysis), B (pre-post descriptive analysis), or C (post-only descriptive analysis). Patterns between evidence uptake and determinants targeted were first identified within groups A and B, with group C consulted to support findings. All studies categorized as "mostly successful" targeted facilitation in combination with establishing face-to-face networks and communication strategies. Conversely, no studies rated "not successful" targeted either of these determinants. Studies rated "partially successful" targeted either 1, but seldom both, of these determinants. CONCLUSIONS This review has provided descriptive evidence of determinants which may be important to target for allied health clinicians' uptake of evidence within stroke rehabilitation settings.
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Affiliation(s)
- Rachel Levine
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia; STARS Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia.
| | - Sally Zingelman
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia; STARS Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - Marie-Pier McSween
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia; STARS Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - Kirstine Shrubsole
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia; STARS Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia; Faculty of Health, Southern Cross University, Bilinga, Queensland Australia
| | - Annie Jane Hill
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia; STARS Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - David A Copland
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia; STARS Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
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Fletcher L, Burrowes S, Sabin LL, McCann N, Khan GK, Ruiz-Mercado G, Johnson S, Kimmel SD, Pierre C, Drainoni ML. Long-Acting Injectable ART in Practice: A Mixed Methods Implementation Study Assessing the Feasibility of Using LAI ART in High Risk Populations and At Alternative Low Barrier Care Sites. AIDS Patient Care STDS 2024; 38:221-229. [PMID: 38656905 DOI: 10.1089/apc.2024.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Long-acting injectable (LAI) antiretroviral therapy (ART) has the potential to change the lives of people living with HIV (PLWH). To ensure equitable access to new treatment modalities, we examined the feasibility and acceptability of administering Cabotegravir Rilpivirine Long Acting (CAB/RPV LA) to individuals who experience challenging social determinants of health (SDoH) and struggle with adherence to traditional oral ART. Quantitative and qualitative data were used to assess feasibility of utilizing ART at alternative clinic. Data were collected on individuals eligible to receive CAB/RPV LA at an alternative street-based clinic and on individuals receiving CAB/RPV LA at a traditional HIV clinic. After 6 months, participants were interviewed about their experience. Providers involved in the implementation were also interviewed about their experiences. Only one participant (out of 5) who received CAB/RPV LA at the alternative clinic received consistent treatment, whereas 17 out of 18 participants receiving CAB/RPV LA at the traditional clinic site were adherent. Participants and providers believed that LAI had potential for making treatment adherence easier, but identified several barriers, including discrepancies between patients' desires and their lifestyles, impact of LAI on interactions with the medical system, risk of resistance accompanying sub-optimal adherence, and need for a very high level of resources. While LAI has major potential benefits for high-risk patients, these benefits must be balanced with the complexities of implementation. Despite challenges that impacted study outcomes, improving treatment outcomes for PLWH requires addressing SDoH and substance use.
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Affiliation(s)
- Laura Fletcher
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Shana Burrowes
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
- Aram V. Chobanian & Edward Avedisian School of Medicine, Department of Medicine, Boston University, Boston, Massachusetts, USA
| | - Lora L Sabin
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Nicole McCann
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Ghulam Karim Khan
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Glorimar Ruiz-Mercado
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Samantha Johnson
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Simeon D Kimmel
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
- Aram V. Chobanian & Edward Avedisian School of Medicine, Department of Medicine, Boston University, Boston, Massachusetts, USA
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Cassandra Pierre
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
- Aram V. Chobanian & Edward Avedisian School of Medicine, Department of Medicine, Boston University, Boston, Massachusetts, USA
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
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Granberg A, Lundqvist LO, Duberg A, Matérne M. The influence of contextual factors on an intervention for people with disabilities from support persons' and health personnel's perspectives: a focus group study. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1294990. [PMID: 38751820 PMCID: PMC11094220 DOI: 10.3389/fresc.2024.1294990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Abstract
Introduction Contextual factors influence interventions in healthcare and pose a particular challenge in interventions designed for people with profound intellectual and multiple disabilities (PIMD). Exploring support persons' and health personnel's experience of an intervention may improve our understanding of the influence of contextual factors. Such exploration is important for revealing areas and focus points for future implementations. Therefore, the aim of this study is to explore support persons' and health personnel's experience of contextual factors during involvement in an intervention for people with PIMD. Methods This focus group study includes eight groups, comprising a total of 34 support persons and health personnel, at habilitation centres at four regions in central Sweden. Data were analysed inductively using a content analysis approach. Results Three themes emerged from the analysis of the informants' perspectives on the contextual factors: (1) structure and support enhances intervention feasibility; (2) an intervention's benefit for people with PIMD increases its acceptability; and (3) being engaged and involved increases support persons' and health personnel's motivation. Our findings show that the implementation of an intervention for people with PIMD should focus on the recipients of the intervention in its context, forming a clear communication plan. A training programme should be provided for the recipients and providers of the intervention. Discussion Finally, the implementation process can be facilitated by creating space for staff to contribute and by encouraging participation and ownership for everyone involved. Using a co-design strategy can enable a shared responsibility to solve the identified challenges, while contributing to the development and design of future interventions for people with disabilities.
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Affiliation(s)
- Anette Granberg
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Lars-Olov Lundqvist
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Anna Duberg
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Marie Matérne
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
- School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Sweden
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Kim B, Guyer M, Keshavan M. Using implementation science to operate as a learning health system to improve outcomes in early psychosis. Early Interv Psychiatry 2024; 18:374-380. [PMID: 38527863 DOI: 10.1111/eip.13496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 09/23/2023] [Accepted: 01/24/2024] [Indexed: 03/27/2024]
Abstract
AIM Early interventions are well understood to improve psychosis outcomes, but their successful implementation remains limited. This article introduces a three-step roadmap for advancing the implementation of evidence-based practices to operate as a learning health system, which can be applied to early interventions for psychosis and is intended for an audience that is relatively new to systematic approaches to implementation. METHODS The roadmap is grounded in implementation science, which specializes in methods to promote routine use of evidence-based innovations. The roadmap draws on learning health system principles that call for commitment of leadership, application of evidence, examination of care experiences, and study of health outcomes. Examples are discussed for each roadmap step, emphasizing both data- and stakeholder-related considerations applicable throughout the roadmap. CONCLUSIONS Early psychosis care is a promising topic through which to discuss the critical need to move evidence into practice. Despite remarkable advances in early psychosis interventions, population-level impact of those interventions is yet to be realized. By providing an introduction to how implementation science principles can be operationalized in a learning health system and sharing examples from early psychosis care, this article prompts inclusion of a wider audience in essential discourse on the role that implementation science can play for moving evidence into practice for other realms of psychiatric care as well. To this end, the proposed roadmap can serve as a conceptual guiding template and framework through which various psychiatric services can methodically pursue timely implementation of evidence-based interventions for higher quality care and improved outcomes.
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Affiliation(s)
- Bo Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Margaret Guyer
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts Department of Mental Health, Boston, Massachusetts, USA
| | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Lövestam E, Orrevall Y, Boström AM. Individual and contextual factors in the Swedish Nutrition Care Process Terminology implementation. HEALTH INF MANAG J 2024; 53:94-103. [PMID: 36254749 PMCID: PMC11067422 DOI: 10.1177/18333583221133465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Standardised terminologies and classification systems play an increasingly important role in the continuous work towards high quality patient care. Currently, a standardised terminology for nutrition care, the Nutrition Care Process (NCP) Terminology (NCPT), is being implemented across the world, with terms for four steps: Nutrition Assessment (NA), Nutrition Diagnosis (ND), Nutrition Intervention (NI) and Nutrition Monitoring and Evaluation (NME). OBJECTIVE To explore associations between individual and contextual factors and implementation of a standardised NCPT among Swedish dietitians. METHOD A survey was completed by 226 dietitians, focussing on: (a) NCPT implementation level; (b) individual factors; and (c) contextual factors. Associations between these factors were explored through a two-block logistic regression analysis. RESULTS Contextual factors such as intention from management to implement the NCPT (OR (odds ratio) ND 15.0, 95% Confidence Interval (CI) 3.9-57.4, NME 3.7, 95% CI 1.1-13.0) and electronic health record (EHR) headings from the NCPT (OR NI 3.6, 95% CI 1.4-10.7, NME 3.8, 95% CI 1.1-11.5) were associated with higher implementation. A positive attitude towards the NCPT (model 1 OR ND 3.8, 95% CI 1.5-9.8, model 2 OR ND 5.0, 95% CI 1.4-17.8) was also associated with higher implementation, while other individual factors showed less association. CONCLUSION Contextual factors such as intention from management, EHR structure, and pre-defined terms and headings are key to implementation of a standardised terminology for nutrition and dietetic care. IMPLICATIONS FOR PRACTICE Clinical leadership and technological solutions should be considered key areas in future NCPT implementation strategies.
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Affiliation(s)
- Elin Lövestam
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Sweden
| | - Ylva Orrevall
- Department of Biosciences and Nutrition, Karolinska Institutet, Sweden
- Clinical Nutrition, Women’s Health and Allied Health Professionals, Karolinska University Hospital, Sweden
| | - Anne-Marie Boström
- Inflammation and Aging, Nursing Unit Aging, Karolinska University Hospital, Sweden
- Research and Development Unit, Stockholms Sjukhem, Sweden
- Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Sweden
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Nitto AM, Crespo-Bellido M, Yenerall J, Anderson Steeves ET, Kersten SK, Vest D, Hill JL. Mixed methods evaluation of the COVID-19 changes to the WIC cash-value benefit for fruits and vegetables. Front Public Health 2024; 12:1371697. [PMID: 38741911 PMCID: PMC11089207 DOI: 10.3389/fpubh.2024.1371697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction Recent cash-value benefit (CVB) increases are a positive development to help increase WIC participant fruits and vegetables (FV) access. Little is known about the impacts of the CVB changes on FV redemptions or about implementation successes and challenges among WIC State and local agencies. This mixed method study aimed to evaluate (a) the CVB changes' impact on FV access among WIC child participants measured by CVB redemption rates, (b) facilitators and barriers to CVB changes' implementation, and (c) differences in FV redemption and facilitators and barriers by race/ethnicity. Methods We requested redemption data from all 89 State agencies for April 2020 to September 2022 and utilized descriptive statistics, interrupted time series analysis (ITS), and generalized linear regression analysis. Additionally, we recruited State agencies, local agencies, and caregivers across the U.S. for interviews and used rapid qualitative analysis to find emerging themes anchored in policy evaluation and implementation science frameworks. Results We received redemption data from 27 State agencies and interviewed 23 State agencies, 61 local agencies, and 76 caregivers of child WIC participants. CVB monthly redemptions increased at $35/child/month compared to $9/child/month; however, adjusted ITS analyses found a decrease in redemption rates at $35/child/month. The decrease was not significant when the transition/first implementation month was excluded with rates progressively increasing over time. Differences were found among racial/ethnic groups, with lower redemption rates observed for non-Hispanic Black caregivers. Overall, WIC caregivers reported high satisfaction and utilization at the $35/child/month. The frequent and quick turnaround CVB changes strained WIC agency resources with agencies serving higher caseloads of diverse racial and ethnic populations experiencing greater issues with implementing the CVB changes. Conclusion Despite implementation challenges, the increased CVB shows promise to improve WIC participant FV access and satisfaction with WIC. WIC agencies need adequate lead time to update the CVB amounts, and resources and support to help ensure equitable distribution and utilization of the FV benefits.
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Affiliation(s)
| | | | - Jackie Yenerall
- Department of Agricultural and Resource Economics, University of Tennessee, Knoxville, TN, United States
| | | | | | - Daniele Vest
- Gretchen Swanson Center for Nutrition, Omaha, NE, United States
| | - Jennie L. Hill
- Gretchen Swanson Center for Nutrition, Omaha, NE, United States
- Population Health Sciences, University of Utah, Salt Lake City, UT, United States
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Lyng HB, Ree E, Strømme T, Johannessen T, Aase I, Ullebust B, Thomsen LH, Holen-Rabbersvik E, Schibevaag L, Bates DW, Wiig S. Barriers and enablers for externally and internally driven implementation processes in healthcare: a qualitative cross-case study. BMC Health Serv Res 2024; 24:528. [PMID: 38664668 PMCID: PMC11046894 DOI: 10.1186/s12913-024-10985-2] [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: 03/14/2023] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Quality in healthcare is a subject in need of continuous attention. Quality improvement (QI) programmes with the purpose of increasing service quality are therefore of priority for healthcare leaders and governments. This study explores the implementation process of two different QI programmes, one externally driven implementation and one internally driven, in Norwegian nursing homes and home care services. The aim for the study was to identify enablers and barriers for externally and internally driven implementation processes in nursing homes and homecare services, and furthermore to explore if identified enablers and barriers are different or similar across the different implementation processes. METHODS This study is based on an exploratory qualitative methodology. The empirical data was collected through the 'Improving Quality and Safety in Primary Care - Implementing a Leadership Intervention in Nursing Homes and Homecare' (SAFE-LEAD) project. The SAFE-LEAD project is a multiple case study of two different QI programmes in primary care in Norway. A large externally driven implementation process was supplemented with a tracer project involving an internally driven implementation process to identify differences and similarities. The empirical data was inductively analysed in accordance with grounded theory. RESULTS Enablers for both external and internal implementation processes were found to be technology and tools, dedication, and ownership. Other more implementation process specific enablers entailed continuous learning, simulation training, knowledge sharing, perceived relevance, dedication, ownership, technology and tools, a systematic approach and coordination. Only workload was identified as coincident barriers across both externally and internally implementation processes. Implementation process specific barriers included turnover, coping with given responsibilities, staff variety, challenges in coordination, technology and tools, standardizations not aligned with work, extensive documentation, lack of knowledge sharing. CONCLUSION This study provides understanding that some enablers and barriers are present in both externally and internally driven implementation processes, while other are more implementation process specific. Dedication, engagement, technology and tools are coinciding enablers which can be drawn upon in different implementation processes, while workload acted as the main barrier in both externally and internally driven implementation processes. This means that some enablers and barriers can be expected in implementation of QI programmes in nursing homes and home care services, while others require contextual understanding of their setting and work.
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Affiliation(s)
- Hilda Bø Lyng
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, N-4036, Norway.
| | - Eline Ree
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, N-4036, Norway
| | - Torunn Strømme
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, N-4036, Norway
| | - Terese Johannessen
- Department of Health and Nursing Sciences, Faculty of Health and Sports Science, University of Agder, Kristiansand, N-4604, Norway
| | - Ingunn Aase
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, N-4036, Norway
| | | | - Line Hurup Thomsen
- Helse Campus Stavanger, University of Stavanger, Stavanger, N-4036, Norway
| | - Elisabeth Holen-Rabbersvik
- Department of Health and Nursing Sciences, Faculty of Health and Sports Science, University of Agder, Kristiansand, N-4604, Norway
- Kristiansand municipality, Kristiansand, N-4604, Norway
| | - Lene Schibevaag
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, N-4036, Norway
| | - David W Bates
- Division of General Internal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Siri Wiig
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, N-4036, Norway
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Fjordkvist E, Eldh AC, Winberg M, Joelsson-Alm E, Hälleberg Nyman M. First-line managers' experience of guideline implementation during the COVID-19 pandemic. J Adv Nurs 2024. [PMID: 38644671 DOI: 10.1111/jan.16204] [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: 11/30/2023] [Revised: 03/23/2024] [Accepted: 04/06/2024] [Indexed: 04/23/2024]
Abstract
AIM(S) To explore first-line managers' experience of guideline implementation in orthopaedic care during the COVID-19 pandemic. DESIGN A descriptive, qualitative study. METHODS Semi-structured interviews with 30 first-line nursing and rehabilitation managers in orthopaedic healthcare at university, regional and local hospitals. The interviews were analysed by thematic analysis. RESULTS First-line managers described the implementation of guidelines related to the pandemic as different from everyday knowledge translation, with a swifter uptake and time freed from routine meetings in order to support staff in adoption and adherence. The urgent need to address the crisis facilitated guideline implementation, even though there were specific pandemic-related barriers such as staffing and communication issues. An overarching theme, Hanging on to guidelines for dear life, is substantiated by three themes: Adapting to facilitate change, Anchoring safety through guidelines and Embracing COVID guidelines. CONCLUSION A health crisis such as the COVID-19 pandemic can generate enabling elements for guideline implementation in healthcare, despite prevailing or new hindering components. The experience of guideline implementation during the COVID-19 pandemic can improve understanding of context aspects that can benefit organizations in everyday translation of evidence into practice. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Recognizing what enabled guideline implementation in a health crisis can help first-line managers to identify local enabling context elements and processes. This can facilitate future guideline implementation. IMPACT During the COVID-19 pandemic, the healthcare context and staff's motivation for guideline recognition and adoption changed. Resources and ways to bridge barriers in guideline implementation emerged, although specific challenges arose. Nursing managers can draw on experiences from the COVID-19 pandemic to support implementation of new evidence-based practices in the future. REPORTING METHOD This study adheres to the EQUATOR guidelines by using Standards for Reporting Qualitative Research (SRQR). No Patient or Public Contribution.
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Affiliation(s)
- Erika Fjordkvist
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
- Department of Orthopaedics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ann Catrine Eldh
- Faculty of Medicine and Health Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Madeleine Winberg
- Faculty of Medicine and Health Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Maria Hälleberg Nyman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
- University Health Care Research Center and Department of Orthopaedics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Smith JL, Ritchie MJ, Kim B, Miller CJ, Chinman MJ, Kelly PA, Landes SJ, Kirchner JE. Getting to Fidelity: Consensus Development Process to Identify Core Activities of Implementation Facilitation. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2024; 2024:10.1007/s43477-024-00119-5. [PMID: 38765294 PMCID: PMC11100021 DOI: 10.1007/s43477-024-00119-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/16/2024] [Indexed: 05/22/2024]
Abstract
Transferring successful implementation strategies from research to practice requires approaches for assessing fidelity to the strategy's core components. Implementation facilitation (IF) is a strategy involving an interactive process of problem-solving, enabling, and supporting individuals in efforts to implement clinical innovations that occurs in the context of a recognized need for improvement and supportive interpersonal relationships. Because IF is a dynamic strategy involving numerous activities, our objective was to conduct a rigorous consensus development process to identify core activities for monitoring fidelity to IF when applied in clinical settings. We first conducted a scoping literature review to identify the range of activities used when IF has been applied in clinical settings, searching multiple citation databases for English-language articles including "facilitation" or other commonly-used terms for the strategy published from 1996-2015. Through multi-stage screening, 135 articles (from 94 studies) were identified for data extraction on IF activities, frequency with which IF activities were identified as 'core' by study authors, and study outcomes. From the literature review, we identified 32 distinct IF activities and developed definitions/examples for each. Next, we conducted a 3-stage, modified-Delphi expert panel consensus development process to identify core IF activities across three implementation phases (i.e., Pre-Implementation, Implementation, Sustainment). The expert panel identified 8 core activities for the Pre-Implementation Phase, 8 core activities for the Implementation Phase, and 4 core activities for the Sustainment Phase. This work provides an important foundation for developing measures/tools to assess use of core IF activities to ensure the strategy is delivered with fidelity.
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Affiliation(s)
- Jeffrey L. Smith
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI) & HSR&D Center for Mental Healthcare & Outcomes Research (CeMHOR), Central Arkansas Veterans Healthcare System, 900 S. Shackelford Road, Fifth Floor, Little Rock, AR 72211, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham Street, #755, Little Rock, AR 72205, USA
| | - Mona J. Ritchie
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI) & HSR&D Center for Mental Healthcare & Outcomes Research (CeMHOR), Central Arkansas Veterans Healthcare System, 900 S. Shackelford Road, Fifth Floor, Little Rock, AR 72211, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham Street, #755, Little Rock, AR 72205, USA
| | - Bo Kim
- VA Behavioral Health QUERI & HSR&D Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Christopher J. Miller
- VA Behavioral Health QUERI & HSR&D Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Matthew J. Chinman
- VA Pittsburgh Healthcare System, Research Office Building (151R), University Drive C, Pittsburgh, PA 15240, USA
| | - P. Adam Kelly
- Southeast Louisiana Veterans Healthcare System, 2400 Canal Street (11F), New Orleans, LA 70119, USA
| | - Sara J. Landes
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI) & HSR&D Center for Mental Healthcare & Outcomes Research (CeMHOR), Central Arkansas Veterans Healthcare System, 900 S. Shackelford Road, Fifth Floor, Little Rock, AR 72211, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham Street, #755, Little Rock, AR 72205, USA
| | - JoAnn E. Kirchner
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI) & HSR&D Center for Mental Healthcare & Outcomes Research (CeMHOR), Central Arkansas Veterans Healthcare System, 900 S. Shackelford Road, Fifth Floor, Little Rock, AR 72211, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham Street, #755, Little Rock, AR 72205, USA
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