A CALL FOR KNOWLEDGE TRANSLATION IN NURSING RESEARCH

Qualitative nursing research: evidence of scientific validation from a translational perspective

Abstract

This article aims to reflect on scientific validation strategies in qualitative research in the light of translational theory in nursing. It is a reflection based on translational theory applied to nursing in strategies for validating qualitative studies. From this angle, validation is recognized as an adaptable construct, capable of eliciting/favoring an understanding of the subjectivity of the target audience in its relationship with the object of interest/study/research. The potential for advancing the science-profession lies in the interdisciplinary confluence of validation mechanisms, qualitative studies, the translational perspective, and nursing research. This confluence has the capacity to extend beyond theoretical and epistemological aspects. However, it is crucial to emphasize its profound, expressive, and relevant impact on the construction of scientific evidence. This impact aims to enhance the rigor and reliability of qualitative research, thereby bolstering its credibility and applicability in clinical practice.

Care Transition From the Perspectives of Oncological Patients and the Multiprofessional Care Team: A Mixed Methods Study

BACKGROUND

Integration into the health system is essential for safe care and efficient use of resources.

OBJECTIVES

The aims of this study were to analyze the transition of care from the perspective of adult patients with neoplasia of the digestive tract and the multiprofessional care team, identify factors that influence the transition of care, and, collectively with professionals, create actions to improve the transition of care at the study site.

METHODS

The Care Transitions Measure-15 was administered in a mixed methods study, with a QUAN→QUAL sequential explanatory approach. The principles of deliberative dialogue were used as a knowledge translation strategy, and data integration was carried out.

RESULTS

The average score of the Care Transitions Measure-15 considered satisfactory was 74.3. The care plan factor had an unsatisfactory score of 66. Strategies to improve the care transition were listed by the focus group participants, such as supplementary care protocol for patients with neoplasms of the digestive tract, and providing a single discharge plan containing all information relevant to the treatment and continuity of patient care.

CONCLUSION

The low score for the care plan factor indicates weakness in the care transition.

IMPLICATIONS FOR PRACTICE

The integrated analysis results indicated that the care transition can be improved by an educational process during discharge planning, implementation of protocols for patients with neoplasia of the digestive tract, and identification of a reference caregiver to help patients navigate the healthcare system.

Fourth Generation Evaluation as a path for Knowledge Translation in mental health

OBJECTIVE

To discuss the use of the Fourth Generation Evaluation methodology as a powerful theoretical-methodological path for the implementation of Knowledge Translation in child and adolescent mental health.

METHOD

It comprises the description of the stages and fieldwork of a research that evaluated mental health practices aimed at adolescents in a Child and Adolescent Psychosocial Care Center, between August and December 2018, with the health care team.

RESULTS

Using strategies to involve workers in all stages, a dialectical construction of knowledge, the adaptation of the path to the field - with the implementation of interventions suggested by the participants - and the research path itself, in its condition of product/result, enable the interface with Knowledge Translation.

FINAL CONSIDERATIONS

The characteristics discussed allow to suggest using the Evaluation as an alternative to the implementation of Translation, especially in the field of mental health.

Study and promotion of safety culture using mixed methods research

Objective

With a positive safety culture, institutions offer the best quality and safe care to their patients. The objective of this study was to analyze patient safety culture from the perspective of the multidisciplinary team, to identify factors that influence patient safety culture, and to create/promote—jointly with the study participants—strategies for improving processes of change.

Methods

The study design represented a mixed methods research approach, with a sequential explanatory design. A multidisciplinary team of workers at a general hospital was eligible for the study. To collect quantitative data, we administered the Safety Attitudes Questionnaire (SAQ). The qualitative phase was accomplished via focus groups (FGs), with participants from the first phase of the study using the principles of deliberative dialogue (DD) as a knowledge-translation strategy. The STROBE guideline was used to develop the study.

Results

The overall SAQ score was positive (75.1 ± 10.4). Negative scores were found in the fields of Safety Climate, Working Conditions, and Stress Recognition. Focus group discussions identified the aspects that create a negative impact on safety culture, such as ineffective communication, punitive approach in the event of errors, the lack of commitment and adherence to the protocols, and the non-recognition of the stress and the mistakes. Actions for the promotion of safety culture were developed and implemented during the study.

Conclusions

The use of the principles of DD as a strategy for knowledge translation (KT) made it possible to identify and plan for joint actions to generate improvements in safety culture.

Safety culture in healthcare: mixed method study

PURPOSE

Healthcare providers' perceptions of management's effectiveness in achieving safety culture improvements are low, and there is little information in the literature on the subject. Objective: The overall aim of this study was to examine the patient safety culture within an interprofessional team - physicians, nurses, nurse technicians, speech therapist, psychologist, social worker, administrative support - practicing in an advanced neurology and neurosurgery center in Southern Brazil.

DESIGN/METHODOLOGY/APPROACH

The authors applied the safety attitudes questionnaire (SAQ) in a mixed methods study, with a quan→QUAL sequential explanatory approach.

FINDINGS

In the quantitative phase, the authors found a negative safety climate through the SAQ. In the qualitative phase, the approach enabled participants to identify specific safety problems. For that, participants proposed improvements that were directly and quickly implemented in the workplace during the study. The joint analysis of the quantitative and qualitative data inferred that the information and reflections of the focus group participants supported and validated the SAQ statistical analysis results. This integrated approach illustrated the importance of various safety culture aspects as a multifaceted phenomenon related to healthcare quality.

ORIGINALITY/VALUE

This study provides explanations for why management is associated negatively with safety climate in healthcare institutions. In addition, the study provides a novel contribution adding value to mixed methods research methodology.

Good Practices in Transitional Care: continuity of care for patients undergoing liver transplantation

OBJECTIVES

to develop a guide of care recommendations for good practices in care transition for adult patients undergoing liver transplantation.

METHODS

a methodological study, based on the Appraisal of Guidelines for Research & Evaluation in the updated version, II. Care recommendations were sustained by conducting an integrative literature review and qualitative research.

RESULTS

from evidence, three topics emerged: Care Transition Planning; Health Education for Self-Care; Care Management. Each of the central topics has respective subtopics, totaling six, giving rise to 30 care recommendations. Concerning evaluators' scores, in all domains the scores were higher than 90%.

FINAL CONSIDERATIONS

the proposed guide assists professionals in conducting care transition in liver transplantation, ensuring greater safety for patients in continuity of home care.

Quality improvement strategy to enhance compliance with the World Health Organization Surgical Safety Checklist in a large hospital: Quality improvement study

Background

The World Health Organization Surgical Safety Checklist is an effective tool to reduce morbidity, mortality, perioperative complications, and hospital length of stay. However, its implementation that involves complex social interaction is still challenging.

Objectives

The aim was to increase use of the Surgical Safety Checklist to 100% of performed surgeries compared to current practice at Hospital Moinhos de Vento, in Porto Alegre, Brazil.

Methods

A quality improvement strategy was implemented based on the Plan, Do, Study, Act cycle. During the intervention, Surgical Safety Checklist structure and content were adjusted to the local context and surgeons were engaged in discussions of the medical and scientific basis of the Surgical Safety Checklist. Also, the surgery center nursing team was trained as well as empowered to use the Surgical Safety Checklist.

Results

As compared to baseline data, there was an increase in the use of the tool and data was monitored to evaluate sustainability of the strategy over 26 months. Mean compliance with the Surgical Safety Checklist after the intervention reached 89%. Compliance with the most critical phase – time out – began at 26%. After the intervention, an increase in time out compliance was noted, varying from 60% to 90%.

Conclusion

The proposed quality improvement strategy, implemented at no additional cost to the institution, was effective to increase Surgical Safety Checklist compliance and produced sustainable results.

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It is the first article of this kind in Brazil. This paper describes the implementation of a quality improvement strategy based on the Plan, Do, Study, Act (PDSA) cycle. The aim was to increase use of the Surgical Safety Checklist to 100% of performed surgeries compared to current practice at Hospital Moinhos de Vento, in Porto Alegre, Brazil.

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Our data show that adjustment of World Health Organization Surgical Safety Checklist (WHO SSC) structure and content to the local context, as well as engagement of decision-makers and risk management staff to promote WHO SSC compliance contributed to the success of the proposed intervention.

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Strong points of our quality improvement strategy include the use of an explicit method, namely the Institute for Healthcare Improvement's Plan-Do-Study-Act model, which facilitated the understanding of the intervention/improvement process and allowed us to explore the method's full potential.