Methods to Improve the Selection and Tailoring of Implementation Strategies

Nursing Research Capacity-Building Programmes in AcuteCare Hospitals: A Scoping Review

BACKGROUND

Research and evidence-based practice in nursing have a direct impact on the quality of care to patients. Its enactment in daily practice remains challenging, with nurses' insufficient research capacity and capability being one challenge, and the limited current state of knowledge another.

AIM

To map the knowledge landscape around capacity-building programmes aiming to increase evidence-based nursing practice and research activity in acutecare hospitals.

DESIGN

Scoping review using Joanna Briggs Institute methodology and PRISMA-ScR reporting guidelines.

METHOD

Articles from 2013 to 2023 were searched on PubMed, CINAHL, Medline/OVID, Cochrane Library, PsycINFO, Scopus and Web of Science. Two researchers screened their eligibility independently. To be eligible, studies needed to focus on nursing/midwifery in acute care settings, address research capacity-building practices and be either an empirical, review or theoretical publication. Data were extracted in a structured format and synthesised narratively.

RESULTS

Twenty-four articles were included, consisting of 12 empirical, 6 reviews and 6 non-data-based articles. Our analysis identified two dimensions of research capacity: (1) individual research capability and (2) organisational research capacity, each influenced by various determinants. Findings suggest that four key elements are required to build a research capacity programme: (1) context assessment, (2) multilevel leadership and management engagement, (3) programme tailored to context and (4) clear outcome indicators. We found nursing research capacity programmes lacked clear definitions and a consensus on a conceptual framework.

CONCLUSION

This review systematically synthesised the knowledge landscape on nursing research capacity building programmes in acute care hospitals, bringing clarity regarding concepts, dimensions, determinants and structural key elements.

IMPACT

The conceptual model developed through this review encourages comprehensive and comparable research capacity-building programmes, which can accelerate enhancement of research skills, literacy, activities and evidence-based practice among nurses, thereby improving quality of care and patient outcomes.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

A Multi-Method Study to Develop and Pilot Test an Interprofessional Transitional Care Model for Frail Older Adults - AdvantAGE

AIM(S)

To develop and pilot test the AdvantAGE transitional care model at a Swiss geriatric hospital.

DESIGN

Multi-method design.

METHODS

The study progressed in three stages from January 2021 to December 2023: (1) contextual analysis using the Consolidated Framework for Implementation Research, incorporating qualitative interviews, (2) development and pilot testing of transitional care interventions on three acute geriatric wards using a descriptive explorative study design and (3) development and validation of a logic model using an iterative approach involving project interest groups and researchers.

RESULTS

We identified central challenges and needs related to transitions from hospital to home, including insufficient information flow, patient and caregiver insecurities and lacking adherence to recommended treatment. The newly developed transitional care model comprised five core elements: continuous support for patients and caregivers, care coordination with primary care providers, comprehensive health management at home, medication- and self-management with patients and caregivers and advance care planning. Of 137 eligible patients, 62 participated in the 10-month pilot test of the preliminary transitional care intervention, with an average participation duration of 69 days. Findings from the pilot informed the refinement of the intervention elements and the development of a preliminary logic model.

CONCLUSION

Employing an implementation science approach facilitated the development and refinement of the AdvantAGE model, ensuring alignment with the needs of project interest groups and the specific implementation context.

IMPACT

This study demonstrates the development of a transitional care model tailored to the specific needs and circumstances of the local healthcare context. Findings provide valuable insights for healthcare practitioners, researchers and policymakers, offering implications for developing transitional care practices and policies.

PATIENT OR PUBLIC CONTRIBUTION

Limited patient and public involvement was incorporated, focusing on the interpretation of the findings of the first step of this study. Further contributions included providing feedback on the development of the elements of the AdvantAGE transitional care model, ensuring the research addressed priorities relevant to patients and primary health care providers in Basel-Stadt.

Consensus-Building Processes for Implementing Perioperative Care Pathways in Common Elective Surgeries: A Systematic Review

AIMS

To identify and understand the different approaches to local consensus discussions that have been used to implement perioperative pathways for common elective surgeries.

DESIGN

Systematic review.

DATA SOURCES

Five databases (MEDLINE, CINAHL, EMBASE, Web of Science and the Cochrane Library) were searched electronically for literature published between 1 January 2000 and 6 April 2023.

METHODS

Two reviewers independently screened studies for inclusion and assessed quality. Data were extracted using a structured extraction tool. A narrative synthesis was undertaken to identify and categorise the core elements of local consensus discussions reported. Data were synthesised into process models for undertaking local consensus discussions.

RESULTS

The initial search returned 1159 articles after duplicates were removed. Following title and abstract screening, 135 articles underwent full-text review. A total of 63 articles met the inclusion criteria. Reporting of local consensus discussions varied substantially across the included studies. Four elements were consistently reported, which together define a structured process for undertaking local consensus discussions.

CONCLUSIONS

Local consensus discussions are a common implementation strategy used to reduce unwarranted clinical variation in surgical care. Several models for undertaking local consensus discussions and their implementation are presented.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Advancing our understanding of consensus building processes in perioperative pathway development could be significantly improved by refining reporting standards to include criteria for achieving consensus and assessing implementation fidelity, alongside advocating for a systematic approach to employing consensus discussions in hospitals.

IMPACT

These findings contribute to recognised gaps in the literature, including how decisions are commonly made in the design and implementation of perioperative pathways, furthering our understanding of the meaning of consensus processes that can be used by clinicians undertaking improvement initiatives.

REPORTING METHOD

This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. No patient or public contribution.

TRIAL REGISTRATION

CRD42023413817.

Provision of colonoscopy in rural settings: A qualitative assessment of provider context, barriers, facilitators, and capacity

PURPOSE

Colonoscopy can prevent morbidity and mortality from colorectal cancer (CRC) and is the most commonly used screening method in the United States. Barriers to colonoscopy at multiple levels can contribute to disparities. Yet, in rural settings, little is known about who delivers colonoscopy and facilitators and barriers to colonoscopy access through screening completion.

METHODS

We conducted a qualitative study with providers in rural Oregon who worked in endoscopy centers or primary care clinics. Semistructured interviews, conducted in July and August, 2021, focused on clinician experiences providing colonoscopy to rural Medicaid patients, including workflows, barriers, and access. We used thematic analysis, through immersion crystallization, to analyze interview transcripts and develop emergent themes.

FINDINGS

We interviewed 19 providers. We found two categories of colonoscopy providers: primary care providers (PCPs) doing colonoscopy on their own patients (n = 9; 47%) and general surgeons providing colonoscopy to patients referred to their services (n = 10; 53%). Providers described barriers to colonoscopy at the provider, community, and patient levels and suggested patient supports could help overcome them. Providers found current colonoscopy capacity sufficient, but noted PCPs trained to perform colonoscopy would be key to continued accessibility. Finally, providers shared concerns about the shrinking number of PCP endoscopists, especially with anticipated increased screening demand related to the CRC screening guideline shift.

CONCLUSIONS

These themes reflect opportunities to address multilevel barriers to improve access, colonoscopy capacity, and patient education approaches. Our results highlight that PCPs are an essential part of the workforce that provides colonoscopy in rural areas.

Strategies for implementing music-based interventions for people with dementia in long-term care facilities: A systematic review

OBJECTIVES

Research has found that music-based interventions can decrease behavioral and psychological symptoms of dementia or behaviors that challenge (BPSD/BtC). However, how to effectively implement these interventions is unclear. This study synthesizes available evidence regarding implementation strategies and outcomes of music-based interventions for people with dementia at residential long-term care facilities.

METHODS

Study registered with PROSPERO (registration number: CRD42020194354). We searched the following databases: PsychInfo, PubMed, MEDLINE, CINAHL, and The Cochrane Library. Inclusion criteria included articles targeting music-based interventions conducted for people with dementia, studies conducted in residential long-term care facilities, and articles that reported implementation strategies and outcomes of the intervention.

RESULTS

Of the included eight studies, half were studies of music therapy and the other half were on individualized music. 49 implementation strategies were reported. The most frequently reported category of strategies was planning (34.7%), followed by education (24.5%), quality management (24.5%), restructuring (12.2%), and finance (4.1%). No strategies under the category of attending to the policy context were reported. The most frequently reported implementation outcomes were appropriateness (27.3%), followed by adoption (22.7%), fidelity (22.7%), acceptability (9.1%), sustainability (9.1%), and cost (9.1%). No studies measured feasibility or penetration.

CONCLUSIONS

Although various effective implementation strategies were identified, we were unable to examine the effectiveness of individual implementation strategies due to the designs of the selected studies. Less attention has been paid to strategies that aim at structural changes of intervention delivery systems. Future studies should investigate facilitators and barriers of implementing music-based interventions especially focusing on structural aspects.