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Barnden R, Snowdon DA, Lannin NA, Lynch E, Srikanth V, Andrew NE. Prospective application of theoretical implementation frameworks to improve health care in hospitals - a systematic review. BMC Health Serv Res 2023; 23:607. [PMID: 37296453 DOI: 10.1186/s12913-023-09609-y] [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: 11/11/2022] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Health Service implementation projects are often guided by theoretical implementation frameworks. Little is known about the effectiveness of these frameworks to facilitate change in processes of care and patient outcomes within the inpatient setting. The aim of this review was to assess the effectiveness of the application of theoretical implementation frameworks in inpatient healthcare settings to change processes of care and associated patient outcomes. METHOD We conducted a search in CINAHL, MEDLINE, EMBASE, PsycINFO, EMCARE and Cochrane Library databases from 1st January 1995 to 15th June 2021. Two reviewers independently applied inclusion and exclusion criteria to potentially eligible studies. Eligible studies: implemented evidence-based care into an in-patient setting using a theoretical implementation framework applied prospectively; used a prospective study design; presented process of care or patient outcomes; and were published in English. We extracted theoretical implementation frameworks and study design against the Workgroup for Intervention Development and Evaluation Research (WIDER) Checklist and implementation strategies mapped to the Cochrane Effective Practice and Organisation of Care (EPOC) taxonomy. We summarised all interventions using the Template for Intervention Description and Replication (TIDieR) checklist. We appraised study quality using the Item bank on risk of bias and precision of observational studies and the revised Cochrane risk of bias tool for cluster randomised trials. We extracted process of care and patient outcomes and described descriptively. We conducted meta-analysis for process of care and patient outcomes with reference to framework category. RESULTS Twenty-five studies met the inclusion criteria. Twenty-one used a pre-post (no comparison), two a pre-post with a comparison, and two a cluster randomised trial design. Eleven theoretical implementation frameworks were prospectively applied: six process models; five determinant frameworks; and one classic theory. Four studies used two theoretical implementation frameworks. No authors reported their justification for selecting a particular framework and implementation strategies were generally poorly described. No consensus was reached for a preferred framework or subset of frameworks based on meta-analysis results. CONCLUSIONS Rather than the ongoing development of new implementation frameworks, a more consistent approach to framework selection and strengthening of existing approaches is recommended to further develop the implementation evidence base. TRIAL REGISTRATION CRD42019119429.
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Affiliation(s)
- Rebecca Barnden
- Academic Unit, Peninsula Health, Frankston, VIC, Australia.
- Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston, VIC, Australia.
- National Centre for Healthy Ageing, Melbourne, VIC, Australia.
| | - David A Snowdon
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston, VIC, Australia
- National Centre for Healthy Ageing, Melbourne, VIC, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, Australia
- Alfred Health, Melbourne, VIC, Australia
| | - Elizabeth Lynch
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Velandai Srikanth
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston, VIC, Australia
- National Centre for Healthy Ageing, Melbourne, VIC, Australia
| | - Nadine E Andrew
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston, VIC, Australia
- National Centre for Healthy Ageing, Melbourne, VIC, Australia
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A Systematic Review of Systematic Reviews and Pooled Meta-Analysis on Psychosocial Interventions for Improving Cancer-Related Fatigue. Semin Oncol Nurs 2022:151354. [DOI: 10.1016/j.soncn.2022.151354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/06/2022] [Accepted: 10/12/2022] [Indexed: 11/15/2022]
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Singh BKS, Khor BH, Sahathevan S, Gafor AHA, Fiaccadori E, Chinna K, Ng SH, Karupaiah T. Barriers and Facilitators to Intradialytic Parenteral Nutrition Implementation Targeting Protein Energy Wasting in Malaysian Hemodialysis Patients. Healthcare (Basel) 2022; 10:healthcare10102090. [PMID: 36292538 PMCID: PMC9602673 DOI: 10.3390/healthcare10102090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 11/22/2022] Open
Abstract
The capacity to deliver intradialytic parenteral nutrition (IDPN) for patients on hemodialysis (HD) diagnosed with protein energy wasting (PEW) in low resource settings is unknown. This study aimed to examine the extent of IDPN practice in HD units in Malaysia, and its implementation to treat PEW. We surveyed pharmacists (n = 56), who are central to parenteral nutrition delivery in Malaysia including IDPN. Seventeen healthcare stakeholders engaging with the Promoting Action on Research Implementation in Health Services (PARIHS) framework used the Likert scale to rate survey outcomes on IDPN implementation to treat PEW, according to the Evidence, Context, and Facilitation elements. IDPN for HD patients was available in 28 of 56 hospitals providing parenteral nutrition services, with only 13 hospitals (23.2%) providing IDPN to outpatients. Outpatient treatment was concentrated to urban locations (12/13) and significantly associated (p < 0.001) with resident nephrologists. The Evidence domain was rated poorly (2.18 ± 0.15) pertaining to IDPN indication when the oral spontaneous intake was ≤20 kcal/kg/day. The Context domain indicated good adherence to international best practice relating to IDPN administration (4.59 ± 0.15) and infusion time (4.59 ± 0.12). Poor adherence was observed in the Facilitation domain on ’Access to pharmacist and dietitian at HD units’ (2.65 ± 0.21) and ’Access to continuous medical education on managing PEW patients on HD’ (2.53 ± 0.15). The IDPN outpatient service was concentrated to urban hospitals with greater manpower resources. The PARIHS evaluation on IDPN implementation to treat PEW revealed facilitators in good practice adherence for prescribing and administration of IDPN but highlighted major barriers relating to IDPN indication and nutrient calculation.
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Affiliation(s)
- Birinder Kaur Sadu Singh
- Department of Pharmacy, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Ban-Hock Khor
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Kota Kinabalu 88400, Malaysia
| | - Sharmela Sahathevan
- Division of Nutrition and Dietetics, Faculty of Health Sciences, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Abdul Halim Abdul Gafor
- Department of Medicine, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Enrico Fiaccadori
- Nephrology Unit, Department of Medicine and Surgery, Parma University Hospital, 43121 Parma, Italy
| | - Karuthan Chinna
- Faculty of Business and Management, USCI University, Kuala Lumpur 56000, Malaysia
| | - See-Hoe Ng
- School of BioSciences, Faculty of Health and Medical Sciences, Taylor’s University Lakeside, Selangor 47500, Malaysia
| | - Tilakavati Karupaiah
- School of BioSciences, Faculty of Health and Medical Sciences, Taylor’s University Lakeside, Selangor 47500, Malaysia
- Correspondence:
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Agbejule OA, Hart NH, Ekberg S, Koczwara B, Ladwa R, Simonsen C, Pinkham EP, Chan RJ. Bridging the research to practice gap: a systematic scoping review of implementation of interventions for cancer-related fatigue management. BMC Cancer 2021; 21:809. [PMID: 34261438 PMCID: PMC8278687 DOI: 10.1186/s12885-021-08394-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 05/23/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cancer-related fatigue (CRF) is one of the most common and distressing symptoms in people with cancer. Although efficacy of interventions for CRF have been extensively investigated, less has been done to ensure successful translation into routine clinical practice. The aim of this systematic scoping review was to synthesise knowledge surrounding the implementation of CRF interventions, summarise the processes and outcomes of implementation strategies used, and identify opportunities for further research. METHODS PubMed, Cochrane CENTRAL, EMBASE and CINAHL databases were searched (up to December 2020). The Cochrane Effective Practice and Organisation of Care (EPOC) Group taxonomy and the RE-AIM Framework were used to guide the evaluation of implementation strategies and outcomes, respectively. RESULTS Six studies were included. Three used an implementation framework (PARIHS, KTA, Cullens & Adams' Implementation Guide) to guide implementation. Overall, the implementation strategies used across all studies were reported to have directly resulted in immediate changes at the clinician level (e.g., increased clinician behaviours, self-efficacy, attitudes, knowledge of CRF management). No clear relationship was found between the use of implementation models and the number or type of implementation strategies used. For outcomes, Effectiveness and Implementation were the most highly reported RE-AIM measures followed by Reach then Maintenance. Adoption was the least reported. CONCLUSIONS Despite the high prevalence of CRF and evidence-based interventions for managing CRF, there is limited evidence informing the sustainable implementation of these interventions. This systematic scoping review emphasises the lack of quality CRF implementation studies presently available in the literature leading to a disconnect between effective CRF interventions, routine clinical care, and cancer survivors at present. This review highlights the need for robust study designs guided by established frameworks to methodically design and evaluate the implementation of CRF management interventions in the future.
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Affiliation(s)
- Oluwaseyifunmi Andi Agbejule
- Cancer and Palliative Care Outcomes Centre, School of Nursing, N Block, Kelvin Grove Campus,, Queensland University of Technology (QUT), Kelvin Grove, Queensland, 4059, Australia.
| | - Nicolas H Hart
- Cancer and Palliative Care Outcomes Centre, School of Nursing, N Block, Kelvin Grove Campus,, Queensland University of Technology (QUT), Kelvin Grove, Queensland, 4059, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, 6027, Australia
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, 6959, Australia
| | - Stuart Ekberg
- Cancer and Palliative Care Outcomes Centre, School of Nursing, N Block, Kelvin Grove Campus,, Queensland University of Technology (QUT), Kelvin Grove, Queensland, 4059, Australia
| | - Bogda Koczwara
- Flinders University and Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5048, Australia
| | - Rahul Ladwa
- Princess Alexandra Hospital, Metro South Hospital and Health Services, Woolloongabba, Queensland, 4102, Australia
- School of Medicine, University of Queensland, St Lucia, Queensland, 4072, Australia
| | - Camilla Simonsen
- Cancer and Palliative Care Outcomes Centre, School of Nursing, N Block, Kelvin Grove Campus,, Queensland University of Technology (QUT), Kelvin Grove, Queensland, 4059, Australia
- Princess Alexandra Hospital, Metro South Hospital and Health Services, Woolloongabba, Queensland, 4102, Australia
| | - Elizabeth P Pinkham
- Cancer and Palliative Care Outcomes Centre, School of Nursing, N Block, Kelvin Grove Campus,, Queensland University of Technology (QUT), Kelvin Grove, Queensland, 4059, Australia
- Princess Alexandra Hospital, Metro South Hospital and Health Services, Woolloongabba, Queensland, 4102, Australia
- School of Health and Behavioural Science, University of Queensland, St Lucia, Queensland, 4072, Australia
| | - Raymond Javan Chan
- Cancer and Palliative Care Outcomes Centre, School of Nursing, N Block, Kelvin Grove Campus,, Queensland University of Technology (QUT), Kelvin Grove, Queensland, 4059, Australia
- Princess Alexandra Hospital, Metro South Hospital and Health Services, Woolloongabba, Queensland, 4102, Australia
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Knowledge, perceptions, and management of cancer-related fatigue: the patients' perspective. Support Care Cancer 2020; 29:2063-2071. [PMID: 32860177 PMCID: PMC7892505 DOI: 10.1007/s00520-020-05686-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/12/2020] [Indexed: 01/22/2023]
Abstract
Purpose This study aimed to assess cancer patients’ knowledge and perceptions regarding fatigue and to provide up-to-date information on the current fatigue management from the patients’ perspective. Methods The FiX study recruited 2508 cancer patients approximately 2 years after diagnosis via a cancer registry in Germany. Participants completed a questionnaire on their knowledge and perceptions of fatigue and the management received. Results More than half of respondents (58%), especially among the elderly patients, did not feel well informed about fatigue. Overall, 41% reported having never been asked about being exhausted by their treating physician. Even fewer patients stated that general practitioners or nurses have asked if they felt exhausted. Only 13% of patients who had experienced severe fatigue had received a fatigue assessment by means of a rating scale or questionnaire—although this is recommended by existing guidelines for fatigue screening. Health care professionals seemed less likely to address fatigue with elderly as well as female patients. The most commonly reported measure against fatigue was exercise or regular physical activity (68%). However, this was mostly done on patients’ own initiative. Psychological support was rarely used (13%) and only in approximately half of the cases upon the advice of a physician. Yoga, another promising intervention against fatigue, was performed by only 9% of patients. Conclusions Our study indicates deficits in terms of knowledge, education, screening, counseling, and treatment for fatigue and highlights starting points for targeted improvements in fatigue management based on patients’ needs. Electronic supplementary material The online version of this article (10.1007/s00520-020-05686-5) contains supplementary material, which is available to authorized users.
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Bergström A, Ehrenberg A, Eldh AC, Graham ID, Gustafsson K, Harvey G, Hunter S, Kitson A, Rycroft-Malone J, Wallin L. The use of the PARIHS framework in implementation research and practice-a citation analysis of the literature. Implement Sci 2020; 15:68. [PMID: 32854718 PMCID: PMC7450685 DOI: 10.1186/s13012-020-01003-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework. METHODS This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail. RESULTS The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated. CONCLUSIONS In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.
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Affiliation(s)
- Anna Bergström
- Department of Women’s and Children’s health, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Uppsala, Sweden
- Institute for Global Health, University College London, London, UK
| | - Anna Ehrenberg
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Ann Catrine Eldh
- Department of Medicine and Health, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kazuko Gustafsson
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- University Library, Uppsala University, Uppsala, Sweden
| | - Gillian Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Green Templeton College, University of Oxford, Oxford, UK
| | - Jo Rycroft-Malone
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancashire, UK
| | - Lars Wallin
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Spoon D, Rietbergen T, Huis A, Heinen M, van Dijk M, van Bodegom-Vos L, Ista E. Implementation strategies used to implement nursing guidelines in daily practice: A systematic review. Int J Nurs Stud 2020; 111:103748. [PMID: 32961463 DOI: 10.1016/j.ijnurstu.2020.103748] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/29/2020] [Accepted: 08/10/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Research specifically addressing implementation strategies regarding nursing guidelines is limited. The objective of this review was to provide an overview of strategies used to implement nursing guidelines in all nursing fields, as well as the effects of these strategies on patient-related nursing outcomes and guideline adherence. Ideally, the findings would help guideline developers, healthcare professionals and organizations to implement nursing guidelines in practice. DESIGN Systematic review. PROSPERO registration number: CRD42018104615. DATA SOURCES We searched the Embase, Medline, PsycINFO, Web of Science, Cochrane, CINAHL and Google Scholar databases until August 2019 as well as the reference lists of relevant articles. REVIEW METHODS Studies were included that described quantitative data on the effect of implementation strategies and implementation outcomes of any type of a nursing guideline in any setting. No language or date of publication restriction was used. The Cochrane Effective Practice and Organisation of Care taxonomy was used to categorize the implementation strategies. Studies were classified as effective if a significant change in either patient-related nursing outcomes or guideline adherence was described. Strength of the evidence was evaluated using the 'Cochrane risk of bias tool' for controlled studies, and the 'Newcastle-Ottawa Quality Assessment form' for cohort studies. RESULTS A total of 54 articles regarding 53 different guideline implementation studies were included. Fifteen were (cluster) Randomized Controlled Trials or controlled before-after studies and 38 studies had a before-after design. The topics of the implemented guidelines were diverse, mostly concerning skin care (n = 9) and infection prevention (n = 7). Studies were predominantly performed in hospitals (n = 34) and nursing homes (n = 11). Thirty studies showed a positive significant effect in either patient-related nursing outcomes or guideline adherence (68%, n = 36). The median number of implementation strategies used was 6 (IQR 4-8) per study. Educational strategies were used in nearly all studies (98.1%, n = 52), followed by deployment of local opinion leaders (54.7%, n = 29) and audit and feedback (41.5%, n = 22). Twenty-three (43.4%) studies performed a barrier assessment, nineteen used tailored strategies. CONCLUSIONS A wide variety of implementation strategies are used to implement nursing guidelines. Not one single strategy, or combination of strategies, can be linked directly to successful implementation of nursing guidelines. Overall, thirty-six studies (68%) reported a positive significant effect of the implementation of guidelines on patient-related nursing outcomes or guideline adherence. Future studies should use a standardized reporting checklist to ensure a detailed description of the used implementation strategies to increase reproducibility and understanding of outcomes.
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Affiliation(s)
- Denise Spoon
- Department of Internal Medicine, Section Nursing Science, Erasmus MC University Medical Centre, Room Rg-532, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands.
| | - Tessa Rietbergen
- Department of Biomedical Data Sciences, section Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Anita Huis
- Radboud university medical centre, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
| | - Maud Heinen
- Radboud university medical centre, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
| | - Monique van Dijk
- Department of Internal Medicine, Section Nursing Science, Erasmus MC University Medical Centre, Room Rg-532, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands; Department of Paediatric Surgery and Intensive Care, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, section Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Erwin Ista
- Department of Internal Medicine, Section Nursing Science, Erasmus MC University Medical Centre, Room Rg-532, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands; Department of Paediatric Surgery and Intensive Care, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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Integrating the "best" evidence into nursing of venous thromboembolism in ICU patients using the i-PARIHS framework. PLoS One 2020; 15:e0237342. [PMID: 32760163 PMCID: PMC7410309 DOI: 10.1371/journal.pone.0237342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/23/2020] [Indexed: 11/19/2022] Open
Abstract
Objectives To explore how to integrate the “best” practice into nursing of venous thromboembolism (VTE) based on the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Methods A mixed-methods design was used. A steering group for clinical evidence implementation (EI) was established to conduct pre-implementation baseline surveys, a thorough analysis of the evidence, and an analysis of the survey results. The hindering and enabling factors associated with the clinical implementation of the evidence were analysed based on the three core elements of i-PARIHS, to formulate the clinical implementation plan for VTE nursing evidence. On-site expert reviews and focus group interviews were used to evaluate the feasibility of the draft plan, make adjustments, and finalize the evidence-based practice plan, which was then put into practice and evaluated. Results A new nursing process, a health education manual and a nursing quality checklist on VTE has been established and proved to be appropriate through the implementation. Compliance with evidence related to VTE nursing increased significantly in the two units, with better compliance in unit B than unit A. The knowledge, attitude and behaviour scores for VTE nursing increased substantially in both nurses and patients. Conclusion The EI programme of incorporating the “best” evidence on VTE nursing into clinical practice using the i-PARIHS framework demonstrated feasibility, appropriateness and effectiveness and could serve as a reference.
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An implementation science primer for psycho-oncology: translating robust evidence into practice. ACTA ACUST UNITED AC 2019. [DOI: 10.1097/or9.0000000000000014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wang N, Yang Z, Miao J, Mi X, Liu S, Stern C, Porritt K, Zhang L. Clinical management of cancer-related fatigue in hospitalized adult patients: a best practice implementation project. ACTA ACUST UNITED AC 2019; 16:2038-2049. [PMID: 30335042 DOI: 10.11124/jbisrir-2017-003769] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES This project aimed to identify and promote evidence-based practice in the management of cancer related fatigue (CRF) in the oncology unit of Nanfang Hospital, affiliated with the Southern Medical University in People's Republic of China. INTRODUCTION Cancer-related fatigue is one of the most common symptoms in patients with cancer and significantly affects their functioning and quality of life. However, it is often inadequately addressed and evidence-based practices are not always followed. METHODS The Joanna Briggs Institute (JBI) has a validated audit and feedback tool to assist with best practice implementation audits. The JBI Practical Application of Clinical Evidence System (PACES) was used in this project. A three-phase project was undertaken: i) a pre-implementation audit of current practice against evidence-based audit criteria, ii) identification of barriers and implementation of strategies to improve practice using the JBI Getting Research into Practice (GRiP) tool and iii) a post-implementation audit. RESULTS The baseline audit results identified non-compliance to best practice in all areas of CRF. Strategies to improve practice involved relevant education for nurses, establishment of a CRF management routine and related documentation systems and displaying and distributing educational materials for the patients. Improved compliance was shown across all audit criteria in post-evaluation. CONCLUSIONS The implementation of institution specific evidence-based resources demonstrated immediate improvement in CRF management and practice. Continuous effort is required to maintain changes and further improve practice. Future projects should focus on measuring the impact of changed practice on patient outcomes.
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Affiliation(s)
- Ning Wang
- PR China Southern Centre for Evidence Based Nursing and Midwifery Practice: a Joanna Briggs Institute Affiliated Group.,School of Nursing, Southern Medical University, Guangzhou City, PR China
| | - Zhihui Yang
- PR China Southern Centre for Evidence Based Nursing and Midwifery Practice: a Joanna Briggs Institute Affiliated Group.,School of Nursing, Southern Medical University, Guangzhou City, PR China
| | - Jingxia Miao
- Oncology Unit, Nanfang Hospital, Southern Medical University, Guangzhou City, PR China
| | - Xue Mi
- School of Nursing, Southern Medical University, Guangzhou City, PR China
| | - Suting Liu
- School of Nursing, Southern Medical University, Guangzhou City, PR China
| | - Cindy Stern
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Kylie Porritt
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Lili Zhang
- PR China Southern Centre for Evidence Based Nursing and Midwifery Practice: a Joanna Briggs Institute Affiliated Group.,School of Nursing, Southern Medical University, Guangzhou City, PR China
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Avci S, Sari HY. Effect of An Evidence-Based Nursing Intervention on the Diagnosis of Oral Mucositis in the Pediatric Stem Cell Transplant Unit. Asia Pac J Oncol Nurs 2019; 6:292-299. [PMID: 31259226 PMCID: PMC6518993 DOI: 10.4103/apjon.apjon_5_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective: This quasi-experimental, single-group study with a pre- and post-repeated measures design was carried out at the Pediatric Stem Cell Transplant Unit of a University Hospital. The study was aimed at investigating the effect of an evidence-based nursing intervention program, held for nurses providing care for pediatric stem cell transplant patients, on their skills in diagnosing oral mucositis (OM). Methods: Before training, data were collected from all the nurses using a sociodemographic characteristics questionnaire. Six patients who were admitted to the clinic and started chemotherapy (CT) were followed up for a maximum of 1 month during their hospitalization to find whether the diagnosis of OM was performed. During the intervention stage, the researcher provided nurses with training on the importance of the use of evidence-based research results in the clinic, including evidence regarding OM. After the training, the records of six patients who were admitted to the clinic and started CT were tracked for up to 1 month during their hospitalization to find whether the diagnosis of OM was performed. Results: At the end of the study, the rate of OM diagnosis was performed by nurses, which was 2.8% before the program and increased to 8.7% after the program. The difference between the percentages of performing OM diagnosis by the nurses before and after the program was 5.9%, which was considered statistically significant (χ2 = 11.004, P < 0.01). The postprogram rate of diagnosis of OM was 3.12 times higher (212% increase) than the preprogram rate (P < 0.01). Conclusions: One of the most important recommendations of the present study is to provide regular and continuous training sessions for nurses to improve and update their knowledge on oral care. It is also concluded that the establishment of oral diagnosis as a follow-up parameter, similar to vital signs in the clinic, will enable nurses to improve their skills in performing daily diagnosis and keeping proper records of the patients’ outcomes.
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Affiliation(s)
- Seyda Avci
- Department of Pediatric Stem Cell Transplantation, Ege University Medical Hospital, İzmir, Turkey
| | - Hatice Yildirim Sari
- Department of Nursing, Faculty of Health Science, İzmir Katip Çelebi University, İzmir, Turkey
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