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Hanson A, Jackson S, Laures E. Implementing an Evidence-Based Functional Pain Assessment Scale in an Adult Inpatient Unit. Pain Manag Nurs 2024; 25:330-337. [PMID: 38616456 DOI: 10.1016/j.pmn.2024.03.004] [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: 05/26/2023] [Revised: 02/26/2024] [Accepted: 03/09/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND The focus on pain assessment using a single, one-dimension pain assessment scale can be problematic. Locally, challenges we faced with this were; a) pain was percieved as not being effectively managed, b) patients with chronic pain were not having their pain adequately controlled, and c) misconceptions and subsequent confusion between health care teams and patients related to what pain intensity scores mean to each individual. AIMS The purpose of this paper is to describe an evidence-based practice project aiming at improving pain assessment through the implementation of a Functional Pain Scale (FPS) on an adult inpatient cardiothoracic unit. DESIGN The Iowa Model-Revised and the Implementation Strategies for Evidence- Based Practice Guide served as the framework for this project. SETTING Over an 18-month period at a academic tertiary medical center in the midwest. PARTICIPANTS/SUBJECTS Staff and patients on an adult inpatient 48-bed medical and surgical cardiothoracic unit. METHODS Following a synthesis of the evidence, implementation of the FPS required various strategies, such as, individualized patient and staff education, audit and feedback, a pain policy revision, and creating documentation in the electronic medical record. Evaluation of the FPS consisted of patient and staff surveys pre- and postimplementation to assess knowledge, attitudes, and behaviors. RESULTS After the pilot period, over 75% of the patients preferred to use the FPS and almost all the patients found the scale easy to use. Nurses reported an increase in perception that pain documentation was complete, that the FPS allowed them to accurately document their patients' pain experience, and that their patients were well informed of their pain management plan. CONCLUSIONS This project supports successful implementation of the FPS within nursing workflow. The goal of using the FPS is to change pain management discussions from an intensity reduction to meeting goals of care, aligning expectations, and creating common language among patients and providers.
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Affiliation(s)
- Allison Hanson
- From the University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242; Iowa City VA Medical Center, Iowa City, Iowa.
| | - Seth Jackson
- From the University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242
| | - Elyse Laures
- From the University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242
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Tas V, Birisci E, Jones RA, Forbus JJ, Blaszak RT, Crawford B, Ilyas M, Magee JS, Sisterhen LL. Improving Pediatric Hypertension Screening in an Academic Primary Care Setting. Pediatr Qual Saf 2024; 9:e746. [PMID: 38993274 PMCID: PMC11236397 DOI: 10.1097/pq9.0000000000000746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 06/07/2024] [Indexed: 07/13/2024] Open
Abstract
Introduction Adherence to the American Academy of Pediatrics clinical practice guidelines for screening and managing high blood pressure (BP) is low. This team sought to improve recognition and documentation of relevant diagnoses in patients aged 13-20 years who presented to general pediatric clinics. Methods The primary outcome measure was the proportion of office visits for patients ages 13-20 with a BP ≥ 120/80 with a visit or problem list diagnosis of hypertension or elevated BP. Secondary measures included (1) the proportion of patients who had their BP measured in the right arm, (2) the proportion of patients who had a mid-arm circumference measurement recorded, and (3) the proportion of patients who had a second BP reading measured at the visit. Interventions addressed key drivers for evidence-based high BP screening: standard BP measurement, electronic health record clinical decision support, and clinical pathway adoption. Data were collected over a twenty-seven-month period and plotted using the Laney p' chart. Results Provider documentation of elevated BP or hypertension improved from a baseline mean of 24% in April 2020 through January 2022 to 41% in February 2021 through June 2022. All secondary outcome measures also demonstrated significant improvement. Conclusions This project demonstrates the feasibility of improving adherence to best practices of BP measurement in primary care clinics through education, acquisition of resources, and implementation of electronic health record flags for abnormal values.
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Affiliation(s)
- Vildan Tas
- From the Department of Pediatrics, University of Pittsburg Medical Center Children's Hospital of Pittsburgh, Little Rock, Penn
| | - Esma Birisci
- Department of Econometrics, Bursa Uludağ University, Bursa, Turkey
| | - Rachel Achor Jones
- Process Improvement and Population Health Departments, Arkansas Children's Hospital, Little Rock, Ark
| | - John J Forbus
- Process Improvement and Population Health Departments, Arkansas Children's Hospital, Little Rock, Ark
| | - Richard T Blaszak
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Brendan Crawford
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Mohammad Ilyas
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - James S Magee
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Laura L Sisterhen
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark
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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 PMCID: PMC12116293 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] [Download PDF] [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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Larson S, Laures E, Seo M, Cox M, Wagner M. Evidence-Based Pain Assessment in Nonverbal Palliative Care Patients. Pain Manag Nurs 2024; 25:152-159. [PMID: 38246815 DOI: 10.1016/j.pmn.2023.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 11/09/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Central to palliative care is the early assessment and treatment of pain, whether physical, psychosocial, or spiritual. Nonverbal palliative care patients are at risk for inadequate pain assessment leading to prolonged suffering. AIMS The purpose of this project was to implement and evaluate an evidence-based pain assessment tool for nonverbal palliative care patients. DESIGN The Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Healthcare and the Implementation Strategies for Evidence-Based Practice Guide provided the guiding frameworks. SETTINGS On a six-bed adult inpatient Palliative Care Unit (PCU). PARTICIPANTS/SUBJECTS Nonverbal palliative care patients. METHODS Evidence supported use of the Multidimensional Objective Pain Assessment Tool (MOPAT) for nonverbal patients receiving palliative care. During an eight-week pilot, nurses recorded pain assessments on a paper form and trended pain scores over a 24-hour period. Evaluation included knowledge, attitudes, and behaviors pre- and post-pilot and was subsequently used in a Precision Implementation Approach to promote adoption. RESULTS Nurses' attitudes toward palliative care pain assessment improved in all items on the evaluation tools. Pain was assessed using MOPAT for 74% of nonverbal palliative care patients and 88% of patients had linked pain interventions to MOPAT scores. CONCLUSIONS MOPAT is the only valid evidence-based pain assessment tool for nonverbal patients receiving palliative care. This project led to successful adoption of the MOPAT within the PCU.
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Affiliation(s)
- Sara Larson
- University of Iowa Hospitals and Clinics, Iowa City, Iowa; St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
| | - Elyse Laures
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Minjeong Seo
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Margo Cox
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Michele Wagner
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Walsh S, Ryan C, McCreary L, Ocho ON, Potisopha W, Jeremiah RD. 'Capacity building skills in the implementation of evidence-based practice for community health nurses: an exploratory descriptive cohort study'. Contemp Nurse 2024:1-12. [PMID: 38489482 DOI: 10.1080/10376178.2024.2322982] [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: 10/11/2023] [Accepted: 02/20/2024] [Indexed: 03/17/2024]
Abstract
Background: While nurses are strategically placed to support the achievement of universal health, their practice may not always be informed by evidence, especially in a context where research evidence is not commonly used to inform practice.Objective/Aim/Hypothesis: Improve management of clients with CNCDs in Caribbean community through evidence-based practice (EBP) capacity building workshops.Design/Methods: A descriptive, quantitative design was used for this study. Participants included Community Based Nurses who attended an initial and recall workshop on EBP in a Caribbean island. All participants were included as the sample. Data were collected as a Pre-Test and Post Test before the initial workshop and at the recall workshop. Analysis was done quantitatively. Since the sample was small, only descriptive statistics were used.Results: Data showed 64% of participants had no experience with EBP, 55% needed more essential resources to participate in EBP and 55% recognized a need to include EBP to change their clinical practice effectively.Conclusions: The nurses and district supervisors observed a high level of interest and commitment to initiating and completing EBP projects. However, the reality of significant workplace demands, and limitations in consistent logistical and supervisory support impacted long-term sustainability.
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Affiliation(s)
- Susan Walsh
- PAHO/WHO Collaborating Centre for International Nursing Development in Primary Health Care, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Catherine Ryan
- PAHO/WHO Collaborating Centre for International Nursing Development in Primary Health Care, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Linda McCreary
- PAHO/WHO Collaborating Centre for International Nursing Development in Primary Health Care, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Oscar Noel Ocho
- PAHO/WHO Collaborating Centre in Nursing Policies and Leadership, School of Nursing, University of the West Indies St. Augustine, St. Augustine, Trinidad and Tobago
| | | | - Rohan D Jeremiah
- PAHO/WHO Collaborating Centre for International Nursing Development in Primary Health Care, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
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Wong J, Young E, Hung L, Mann J, Jackson L. Beyond Plan-Do-Study-Act cycle - staff perceptions on facilitators and barriers to the implementation of telepresence robots in long-term care. BMC Health Serv Res 2023; 23:772. [PMID: 37468953 DOI: 10.1186/s12913-023-09741-9] [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: 08/18/2022] [Accepted: 06/22/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Quality improvement (QI) programs with technology implementations have been introduced to long-term care (LTC) to improve residents' quality of life. Plan-Do-Study-Act (PDSA) cycle is commonly adopted in QI projects. There should be an appropriate investment of resources to enhance learning from iterative PDSA cycles. Recently, scholars explored possibilities of implementation science (IS) with QI methods to increase QI projects' generalisability and make them more widely applicable in other healthcare contexts. To date, scant examples demonstrate the complementary use of the two methods in QI projects involving technology implementation. This qualitative study explores staff and leadership teams' perspectives on facilitators and barriers of a QI project to implement telepresence robots in LTC guided by the Consolidated Framework for Implementation Research (CFIR). METHODS We employed purposive and snowballing methods to recruit 22 participants from two LTC in British Columbia, Canada: operational and unit leaders and interdisciplinary staff, including nursing staff, care aides, and allied health practitioners. CFIR was used to guide data collection and analysis. Semi-structured interviews and focus groups were conducted through in-person and virtual meetings. Thematic analysis was employed to generate insights into participants' perspectives. RESULTS Our analysis identified three themes: (a) The essential needs for family-resident connections, (b) Meaningful engagement builds partnership, and (c) Training and timely support gives confidence. Based on the findings and CFIR guidance, we demonstrate how to plan strategies in upcoming PDSA cycles and offer an easy-to-use tool 'START' to encourage the practical application of evidence-based strategies in technology implementation: Share benefits and failures; Tailor planning with staff partners; Acknowledge staff concerns; Recruit opinion leaders early; and Target residents' needs. CONCLUSIONS Our study offers pragmatic insights into the complementary application of CFIR with PDSA methods in QI projects on implementing technologies in LTC. Healthcare leaders should consider evidence-based strategies in implementing innovations beyond PDSA cycles.
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Affiliation(s)
- Joey Wong
- UBC IDEA Lab, School of Nursing, University of British Columbia, Vancouver, BC, Canada.
| | - Erika Young
- UBC IDEA Lab, School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Lillian Hung
- UBC IDEA Lab, School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Jim Mann
- UBC IDEA Lab, School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Lynn Jackson
- UBC IDEA Lab, School of Nursing, University of British Columbia, Vancouver, BC, Canada
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Cabilan CJ, McRae J, Ganzon K, Appo C, Rogers S, O'Sullivan M, Eley R, Snoswell C, Johnston A. Introducing a Digital Occupational Violence Risk Assessment Tool Into an Emergency Department: A Pilot Implementation Study. J Emerg Nurs 2023; 49:360-370. [PMID: 36872199 DOI: 10.1016/j.jen.2023.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION Occupational violence in emergency departments is prevalent and detrimental to staff and health services. There is an urgent call for solutions; accordingly, this study describes the implementation and early impacts of the digital Queensland Occupational Violence Patient Risk Assessment Tool (kwov-pro). METHODS Since December 7, 2021, emergency nurses have been using the Queensland Occupational Violence Patient Risk Assessment Tool to assess 3 occupational violence risk factors in patients: aggression history, behaviors, and clinical presentation. Violence risk then is categorized as low (0 risk factors), moderate (1 risk factor), or high (2-3 risk factors). An important feature of this digital innovation is the alert and flagging system for high-risk patients. Underpinned by the Implementation Strategies for Evidence-Based Practice Guide, from November 2021 to March 2022 we progressively mobilized a range of strategies, including e-learning, implementation drivers, and regular communications. Early impacts measured were the percentage of nurses who completed their e-learning, the proportion of patients assessed using the Queensland Occupational Violence Patient Risk Assessment Tool, and the number of reported violent incidents in the emergency department. RESULTS Overall, 149 of 195 (76%) of emergency nurses completed their e-learning. Further, adherence to Queensland Occupational Violence Patient Risk Assessment Tool was good, with 65% of patients assessed for risk of violence at least once. Since implementing the Queensland Occupational Violence Patient Risk Assessment Tool, there has been a progressive decrease in violent incidents reported in the emergency department. DISCUSSION Using a combination of strategies, the Queensland Occupational Violence Patient Risk Assessment Tool was successfully implemented in the emergency department with the indication that it could reduce the number of incidents of occupational violence. The work herein provides a foundation for future translation and robust evaluation of the Queensland Occupational Violence Patient Risk Assessment Tool in emergency departments.
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McNett M, Gorsuch PF, Gallagher-Ford L, Thomas B, Mazurek Melnyk B, Tucker S. Development and Evaluation of the Fuld Institute Evidence-based Implementation and Sustainability Toolkit for Health Care Settings. Nurs Adm Q 2023; 47:161-172. [PMID: 36649578 DOI: 10.1097/naq.0000000000000569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Routine implementation and sustainability of evidence-based practices (EBPs) into health care is often the most difficult stage in the change process. Despite major advances in implementation science and quality improvement, a persistent 13- to 15-year research-to-practice gap remains. Nurse leaders may benefit from tools to support implementation that are based on scientific evidence and can be readily integrated into complex health care settings. This article describes development and evaluation of an evidence-based implementation and sustainability toolkit used by health care clinicians seeking to implement EBPs. For this project, implementation science and EBP experts created initial iterations of the toolkit based on Rogers' change theory, the Advancing Research through Close Collaboration (ARCC) model, and phases and strategies from implementation science. Face validity and end-user feedback were obtained after piloting the tool with health care clinicians participating in immersive EBP sessions. The toolkit was then modified, with subsequent content validity and usability evaluations conducted among implementation science experts and health care clinicians. This article presents the newly updated Fuld Institute Evidence-based Implementation and Sustainability Toolkit for health care settings. Nurse leaders seeking to implement EBPs may benefit from an evidence-based toolkit to provide a science-informed approach to implementation and sustainability of practice changes.
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Affiliation(s)
- Molly McNett
- Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare (Drs McNett, Gorsuch, Gallagher-Ford, Mazurek Melnyk, and Tucker and Ms Thomas), College of Nursing (Drs McNett, Mazurek Melnyk, and Tucker), and College of Medicine (Dr Mazurek Melnyk), The Ohio State University, Columbus; and Summa Health System, Akron, Ohio (Dr Gorsuch)
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Cullen L, Laures E, Hanrahan K, Edmonds S. The Coat Hook Analogy and the Precision Implementation Approach® Solution. J Perianesth Nurs 2022; 37:732-736. [PMID: 36182248 DOI: 10.1016/j.jopan.2022.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Laura Cullen
- Nursing Research and Evidence-Based Practice, Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics, Iowa City, IA.
| | - Elyse Laures
- Nursing Research and Evidence-Based Practice, Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Kirsten Hanrahan
- Nursing Research and Evidence-Based Practice, Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Stephanie Edmonds
- Nursing Research and Evidence-Based Practice, Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics, Iowa City, IA
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CE: An Evidence-Based Yoga Practice for Hospitalized Adults on Medical-Psychiatric Units. Am J Nurs 2022; 122:28-36. [PMID: 35736601 DOI: 10.1097/01.naj.0000840304.76501.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Yoga-based treatments, which are recognized by the National Institutes of Health's National Center for Complementary and Integrative Health as a form of complementary and alternative medicine, have proven to be beneficial for people with various psychiatric disorders, including depression, anxiety, posttraumatic stress disorder, and attention deficit-hyperactivity disorder, as well as schizophrenia and other psychotic disorders. PURPOSE The purpose of this evidence-based practice (EBP) project was to offer structured yoga sessions as a means of providing stress relief, promoting relaxation, reducing anxiety, and improving quality of care among male and female adult patients (ages 18 years and older) hospitalized in a locked medical-psychiatric unit within an academic medical center for treatment of both acute medical and acute psychiatric conditions. PRACTICE CHANGE AND IMPLEMENTATION The Iowa Model and Implementation Strategies for EBP provided the guiding framework for this pilot project. Patients were offered once weekly, 30-to-60-minute yoga sessions for 12 weeks and were screened for their ability to participate by the nurse-yoga instructor and the interprofessional team. Using a Precision Implementation Approach, a data-driven selection of strategies from the implementation framework promoted the adoption and sustainability of the practice change, which were further advanced through interprofessional reinforcement of yoga practice and internal reporting. RESULTS Patient feedback was sought before and after yoga sessions. Thirty-nine patients responded to the pre-yoga questionnaire and 38 patients responded to the post-yoga questionnaire. Patients reported improved mood after yoga, with 23% (nine of 39) reporting feelings of calm and relaxation pre-yoga compared with 76% (29 of 38) post-yoga, and 41% (16 of 39) reporting feelings of anxiety pre-yoga compared with just 5% (two of 38) post-yoga. CONCLUSION Yoga sessions provided by a nurse certified in yoga instruction improved patients' mood and sense of well-being. Instructional materials and videos were created to promote sustained use. The EBP of providing yoga sessions grew from a pilot program to a sustained change with more widespread use. In addition to patients hospitalized on medical-psychiatric units, the health system expanded the sessions to include inpatients on behavioral health units.
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Evidence Into Practice: Journal Clubs as an Implementation Strategy. J Perianesth Nurs 2022; 37:411-415. [PMID: 35667816 DOI: 10.1016/j.jopan.2021.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 11/28/2021] [Indexed: 11/21/2022]
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Scientific and Clinical Abstracts From WOCNext® 2022: Fort Worth, Texas ♦ June 5-8, 2022. J Wound Ostomy Continence Nurs 2022; 49:S1-S99. [PMID: 35639023 DOI: 10.1097/won.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kumah EA, McSherry R, Bettany-Saltikov J, van Schaik P. Evidence-informed practice: simplifying and applying the concept for nursing students and academics. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:322-330. [PMID: 35333562 DOI: 10.12968/bjon.2022.31.6.322] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Nurses' ability to apply evidence effectively in practice is a critical factor in delivering high-quality patient care. Evidence-based practice (EBP) is recognised as the gold standard for the delivery of safe and effective person-centred care. However, decades following its inception, nurses continue to encounter difficulties in implementing EBP and, although models for its implementation offer stepwise approaches, factors, such as the context of care and its mechanistic nature, act as barriers to effective and consistent implementation. It is, therefore, imperative to find a solution to the way evidence is applied in practice. Evidence-informed practice (EIP) has been mooted as an alternative to EBP, prompting debate as to which approach better enables the transfer of evidence into practice. Although there are several EBP models and educational interventions, research on the concept of EIP is limited. This article seeks to clarify the concept of EIP and provide an integrated systems-based model of EIP for the application of evidence in clinical nursing practice, by presenting the systems and processes of the EIP model. Two scenarios are used to demonstrate the factors and elements of the EIP model and define how it facilitates the application of evidence to practice. The EIP model provides a framework to deliver clinically effective care, and the ability to justify the processes used and the service provided by referring to reliable evidence.
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Affiliation(s)
| | - Robert McSherry
- Professor of Nursing and Practice Development, Faculty of Health and Social Care, University of Chester, Chester
| | | | - Paul van Schaik
- Professor of Research, School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough
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Cullen L, Hanrahan K, Edmonds SW, Reisinger HS, Wagner M. Iowa Implementation for Sustainability Framework. Implement Sci 2022; 17:1. [PMID: 34983585 PMCID: PMC8725573 DOI: 10.1186/s13012-021-01157-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background An application-oriented implementation framework designed for clinicians and based on the Diffusion of Innovations theory included 81 implementation strategies with suggested timing for use within four implementation phases. The purpose of this research was to evaluate and strengthen the framework for clinician use and propose its usefulness in implementation research. Methods A multi-step, iterative approach guided framework revisions. Individuals requesting the use of the framework over the previous 7 years were sent an electronic questionnaire. Evaluation captured framework usability, generalizability, accuracy, and implementation phases for each strategy. Next, nurse leaders who use the framework pile sorted strategies for cultural domain analysis. Last, a panel of five EBP/implementation experts used these data and built consensus to strengthen the framework. Results Participants (n = 127/1578; 8% response) were predominately nurses (94%), highly educated (94% Master’s or higher), and from across healthcare (52% hospital/system, 31% academia, and 7% community) in the USA (84%). Most (96%) reported at least some experience using the framework and 88% would use the framework again. A 4-point scale (1 = not/disagree to 4 = very/agree) was used. The framework was deemed useful (92%, rating 3–4), easy to use (72%), intuitive (67%), generalizable (100%), flexible and adaptive (100%), with accurate phases (96%), and accurate targets (100%). Participants (n = 51) identified implementation strategy timing within four phases (Cochran’s Q); 54 of 81 strategies (66.7%, p < 0.05) were significantly linked to a specific phase; of these, 30 (55.6%) matched the original framework. Next, nurse leaders (n = 23) completed a pile sorting activity. Anthropac software was used to analyze the data and visualize it as a domain map and hierarchical clusters with 10 domains. Lastly, experts used these data and implementation science to refine and specify each of the 75 strategies, identifying phase, domain, actors, and function. Strategy usability, timing, and groupings were used to refine the framework. Conclusion The Iowa Implementation for Sustainability Framework offers a typology to guide implementation for evidence-based healthcare. This study specifies 75 implementation strategies within four phases and 10 domains and begins to validate the framework. Standard use of strategy names is foundational to compare and understand when implementation strategies are effective, in what dose, for which topics, by whom, and in what context. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-021-01157-5.
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Affiliation(s)
- Laura Cullen
- Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics, 200 Hawkins Dr., Iowa City, IA, 52242, USA.
| | - Kirsten Hanrahan
- Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics, 200 Hawkins Dr., Iowa City, IA, 52242, USA
| | - Stephanie W Edmonds
- Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics, 200 Hawkins Dr., Iowa City, IA, 52242, USA
| | - Heather Schacht Reisinger
- Department of Internal Medicine, University of Iowa, 200 Hawkins Dr., Iowa City, IA, 52242, USA.,Institute for Clinical and Translational Science, University of Iowa, 200 Hawkins Dr., Iowa City, IA, 52242, USA
| | - Michele Wagner
- Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics, 200 Hawkins Dr., Iowa City, IA, 52242, USA
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15
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Grutz K, Poch N. Meditation for Preoperative Anxiety and Postoperative Pain in Bariatric Surgery. J Perianesth Nurs 2021; 36:586-590. [PMID: 34688457 DOI: 10.1016/j.jopan.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/11/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Krista Grutz
- Family Nurse Practitioner, Family Medicine, Unity Point Clinic Family Medicine and Walk-in Care-Peosta, Peosta, IA
| | - Nicholas Poch
- Interim Director of Centralized Functions, Department of Nursing, University of Iowa Hospitals and Clinics, Iowa City, IA
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16
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Rheeder A, Lubbe W, van der Walt CSJ, Pretorius R. Compliance With Best Practice Guidelines for Neurodevelopmental Supportive Care in South Africa: A Situational Analysis. J Perinat Neonatal Nurs 2021; 35:E83-E96. [PMID: 29194079 DOI: 10.1097/jpn.0000000000000275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neurodevelopmental supportive care provides preterm infants with evidence-based care to ensure the best possible neurological outcomes. The study aimed to determine the compliance of current nursing care practices with best practice guidelines by means of a situational analysis. The situational analysis was done in 2 cycles in the neonatal intensive care units (n = 25) of a private healthcare provider in South Africa. Structured observations were done in cycle 1 using the Implementation of Neurodevelopmental Supportive Care checklist. Cycle 2 comprised focus group discussions to verify findings from cycle 1. Seventeen conclusion statements were formulated, which were thematically combined to be presented as 9 categories: neonatal intensive care unit design, individualized care, family-centered care, infant positioning, handling techniques, environmental manipulation, pain management, knowledge of infant behavior, and feeding. The conclusion statements identified improvement opportunities in current practice and offer suggestions, which can be used to guide an implementation strategy for best practice guidelines of neurodevelopmental supportive care in the neonatal intensive care units of the private healthcare group in future. Addressing improvement opportunities in all the categories will ensure that all aspects of the guideline requirements are met, resulting in a comprehensive strategy improving practice and patient outcomes.
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Affiliation(s)
- Aletta Rheeder
- INSINQ-Research to Advance Quality in Nursing and Midwifery, North-West University, Potchefstroom, South Africa (Ms Rheeder and Drs Lubbe and van der Walt); and Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa (Dr Pretorius)
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17
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Liaw YQ, Goh ML. Reducing contamination of midstream urine samples through standardized collection processes: a best practice implementation project. JBI Evid Synth 2021; 18:256-271. [PMID: 31972684 DOI: 10.11124/jbisrir-d-19-00149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this project is to decrease the rates of midstream urine sample contamination through standardization of evidence-based techniques among nurses. INTRODUCTION Urinary tract infection is a prevalent health problem worldwide. The diagnosis and treatment of urinary tract infection depend on a thorough physical examination and the results of an uncontaminated midstream specimen of urine. However, improper techniques used in the collection often cause sample contamination, leading to delayed diagnosis and the use of inappropriate antibiotics for treatment. As nurses are at the forefront of care delivery, they are involved in reducing the rates of midstream urine sample contamination. Thus, the use of an evidence-based approach to standardize collection of midstream urine culture is crucial for the provision of higher-quality patient care. METHODS Education sessions were delivered to the nurses and an evidence-informed standardized patient education leaflet was crafted by the project team for implementation. With a sample size of 30 nurses and patients, the project took place in a 21-bed adult surgical ward in a hospital in Singapore. The JBI Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) programs were used to implement the evidence-based project. The project was implemented in three phases from October 2018 to January 2019. A standardized audit tool devised from JBI PACES was used for the audits in this project. The rates of midstream urine specimen contamination and the knowledge of nurses were also monitored. RESULTS The baseline audit revealed that the nursing staff required educational sessions to improve their knowledge of midstream urine sample collection. Aside from criteria 1,3 and 4, the remaining criteria achieved compliance of more than 80%. The criteria below 80% compliance became the main focus of the project interventions. At follow-up cycle 1, all criteria achieved at least 80% compliance except criteria 4 and 5, which achieved 73% and 69% compliance, respectively. At the three-month post implementation audit, all criteria achieved a compliance rate of at least 80%. Fisher's exact test was carried out, and statistical significance of the results was achieved (p < 0.001) when compared to baseline audit. The rates of midstream urine specimen contamination also significantly decreased from 40% at the baseline audit to 20% at the third-month post implementation audit. Nurses' knowledge markedly improved as measured by the three-question quiz. CONCLUSION This evidence-based implementation project highlights the effectiveness of the JBI PACES and GRiP processes for initiating best practice within a nursing environment. The use of JBI best-practice recommendations to standardize methods for midstream urine specimen collection effectively reduced the rates of midstream urine contamination.
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Affiliation(s)
- Yi Qi Liaw
- University of Surgical Cluster, National University Hospital, Singapore
| | - Mien Li Goh
- Evidence Based Nursing Unit, National University Hospital, Singapore.,Singapore National University Hospital (NUH) Centre for Evidence-Based Nursing: A Joanna Briggs Institute Centre of Excellence
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18
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Tucker S, McNett M, Mazurek Melnyk B, Hanrahan K, Hunter SC, Kim B, Cullen L, Kitson A. Implementation Science: Application of Evidence-Based Practice Models to Improve Healthcare Quality. Worldviews Evid Based Nurs 2021; 18:76-84. [PMID: 33779042 DOI: 10.1111/wvn.12495] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Translating research into practice is complex for clinicians, yet essential for high quality patient care. The field of implementation science evolved to address this gap by developing theoretical approaches to guide adoption and sustained implementation of practice changes. Clinicians commonly lack knowledge, time, and resources of how evidence-based practice (EBP) models can guide implementation, contributing to the knowledge-to-practice gap. AIM This paper aimed to equip clinicians and other healthcare professionals with implementation science knowledge, confidence, and models to facilitate EBP change in their local setting and ultimately improve healthcare quality, safety, and population health outcomes. METHODS The field of implementation science is introduced, followed by application of three select models. Models are applied to a clinical scenario to emphasize contextual factors, process, implementation strategies, and outcome evaluation. Key attributes, strengths, opportunities, and utilities of each model are presented, along with general resources for selecting and using published criteria to best fit clinical needs. Partnerships between implementation scientists and clinicians are highlighted to facilitate the uptake of evidence into practice. LINKING EVIDENCE TO ACTION Knowledge of implementation science can help clinicians adopt high-quality evidence into their practices. Application-oriented approaches can guide clinicians through the EBP processes. Clinicians can partner with researchers in advancing implementation science to continue to accelerate the adoption of evidence and reduce the knowledge-to-action gap.
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Affiliation(s)
- Sharon Tucker
- Implementation Science Core, Helene Fuld Health Trust National Institute for EBP, College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Molly McNett
- Implementation Science, Helene Fuld Health Trust National Institute for EBP, College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Bernadette Mazurek Melnyk
- Implementation Science Core, Helene Fuld Health Trust National Institute for EBP, College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Kirsten Hanrahan
- Department of Nursing Services and Patient Care, University of Iowa Health Care, Iowa City, IA, USA
| | - Sarah C Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - Bo Kim
- HSR&D Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Laura Cullen
- Department of Nursing Services and Patient Care, University of Iowa Health Care, Iowa City, IA, USA
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
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19
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Arsenault Knudsen ÉN, King BJ, Steege LM. The realities of practice change: Nurses' perceptions. J Clin Nurs 2021; 30:1417-1428. [PMID: 33559236 DOI: 10.1111/jocn.15693] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/23/2021] [Accepted: 01/27/2021] [Indexed: 01/03/2023]
Abstract
AIMS AND OBJECTIVES To explore registered nurses' perceptions of practice change and describe factors that influence the adoption of practice changes. BACKGROUND Nurses play a critical role in optimising patient outcomes. Healthcare organisations and nurses must do their part to achieve the Quadruple Aim, which requires nurses to change their practice. Nurses are ideally positioned to improve patient outcomes by changing their practice to align it with research evidence and organisational initiatives; however, this experience of practice change by nurses is grossly under-studied. DESIGN A qualitative design, inductive content analysis, was used to understand nurses' perceptions of practice change. METHODS Eleven registered nurses, who worked in one hospital system, participated in one-on-one semi-structured interviews. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) were followed. FINDINGS The 11 participants described 63 distinct experiences with practice changes. Their experiences with and perceptions of practice change are categorised as (1) There is A History; (2) It's A Lot of Work; (3) It Happens to Nurses; and (4) Doing Right for the Patient. CONCLUSION Nurses experience practice change as a central part of the work they do; it occurs frequently and multiple practice changes may co-occur. Nurses identify strategies, such as thoughtful planning, engaging nurses, and communicating the rationale for and the outcomes of the practice change, to facilitate changing practice. RELEVANCE TO CLINICAL PRACTICE Involving nurses in practice changes could alleviate some inhibiting factors for adopting new practices. Local hospital and national policies should explore creative and practical ways to balance the competing needs of nurses providing direct care at the bedside and dedicated time to be engaged in practice change initiatives. With the ongoing focus on improving patient care and optimising patient safety, nurses should be viewed as highly valued members of the team when designing and implementing practice changes.
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Affiliation(s)
| | - Barbara J King
- School of Nursing, University of Wisconsin - Madison, Madison, WI, USA
| | - Linsey M Steege
- School of Nursing, University of Wisconsin - Madison, Madison, WI, USA
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20
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Chiwaula CH, Kanjakaya P, Chipeta D, Chikatipwa A, Kalimbuka T, Zyambo L, Nkata S, Jere DL. Introducing evidence based practice in nursing care delivery, utilizing the Iowa model in intensive care unit at Kamuzu Central Hospital, Malawi. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2020.100272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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21
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Laures EL, Bruene D, Fayram LR, Houston A, Kephart K, Merrifield E, Vitale S. Pediatric Pain Assessment in the Intensive Care Unit: An Evidence-Based Algorithm. Pain Manag Nurs 2020; 22:260-267. [PMID: 33288443 DOI: 10.1016/j.pmn.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/29/2020] [Accepted: 10/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Conducting an adequate pain assessment in the Pediatric Intensive Care Unit (PICU) is multifactorial and complex due to the diversity of the population. It is critical that validated pain assessment methods are used appropriately and consistently to aid in evaluation of pain and pain management interventions. PURPOSE The aim of this evidence-based practice project was to improve pain assessment practices in the PICU through a decision-support algorithm. DESIGN & METHODS The Iowa Model-Revised was used to guide the development and implementation of an evidence-based decision algorithm. Pre- and postdata were collected via surveys (nursing knowledge and confidence) and documentation audits (nursing pain assessments). Various implementation strategies were used to facilitate the integration and sustainability of the algorithm in practice. RESULTS The majority of survey items showed an increase in nursing knowledge and confidence. Audits of pain assessment documentation displayed an increase in appropriate pain assessment documentation related to a child's communicative ability. However, there is a need for reinfusion related to the documentation of sedation assessments. CONCLUSIONS The use of an algorithm supported the ability of PICU nurses to critically consider and choose the pain assessment method most appropriate for the patient's condition. The algorithm promotes nursing clinical judgement, prioritizes pain management, and includes patients receiving sedation. The algorithm supports a comprehensive pain assessment in a difficult pediatric patient population. Future research is needed to strengthen and standardize the usage of terms "assume pain present" and "assume pain managed," and to also improve the overall feasibility and effectiveness of the algorithm.
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Affiliation(s)
- Elyse L Laures
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa; University of Iowa Hospitals and Clinics, Iowa City, Iowa.
| | - Debra Bruene
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - Lindsay R Fayram
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - Amanda Houston
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - Karreen Kephart
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | | | - Sabrina Vitale
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
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22
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Worum H, Lillekroken D, Ahlsen B, Roaldsen KS, Bergland A. Otago exercise programme-from evidence to practice: a qualitative study of physiotherapists' perceptions of the importance of organisational factors of leadership, context and culture for knowledge translation in Norway. BMC Health Serv Res 2020; 20:985. [PMID: 33109177 PMCID: PMC7590709 DOI: 10.1186/s12913-020-05853-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/22/2020] [Indexed: 12/22/2022] Open
Abstract
Background Falls and fall-related injuries are a major public health problem and an international priority for health services. Despite research showing that evidence-based fall prevention is effective, its translation into practice has been delayed and limited. Although organisational factors such as leadership, culture and context are key factors for implementing evidence-based practice, there is still limited information on whether these factors represent barriers in the Norwegian and international healthcare context. Thus, this study aimed to explore the views of physiotherapists in clinical practice and their leaders’ views on the importance of organisational factors, such as leadership, culture and contextual and human resources, regarding successful knowledge translation of the Otago evidence-based fall programme in a Norwegian community. Methods Four in-depth interviews with physiotherapists and a focus group interview with nine physiotherapists and leaders representing local hospitals and municipalities were conducted to collect data. The data were analysed using a thematic analysis. Results The analysis yielded an overarching theme: an empowering leader as an anchor is needed for successful knowledge translation of physiotherapists’ and leaders’ views about the role of organisational structure, leadership, culture, financial resources and competence in research-based knowledge, as well as how to enhance the clinical staff’s expertise. Four main themes further elaborated on the overarching theme: (1) multifactor leadership—the importance of reinforcement, knowledge, goals and attention; (2) potential for change in professional roles as shaped by culture, context and type of practice; (3) knowledge translation—the tension between real-life capabilities, optimism and learning; and (4) different types of support—environmental resources and social influences. Conclusions This study highlighted the importance of organisational factors in knowledge translation in fall prevention. The findings emphasise the importance of leaders’ role and style in providing a supportive culture and contextual factors during the knowledge translation process. This study provides an understanding of the knowledge translation and sustainability of evidence-based practice and the Otago exercise programme for fall prevention programmes for community-dwelling older adults in Norway. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12913-020-05853-8.
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Affiliation(s)
- Hilde Worum
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Postbox 4, St. Olavs Plass, 0130, Oslo, Norway.
| | - Daniela Lillekroken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Birgitte Ahlsen
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Postbox 4, St. Olavs Plass, 0130, Oslo, Norway
| | - Kirsti Skavberg Roaldsen
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Postbox 4, St. Olavs Plass, 0130, Oslo, Norway.,Department of Neurobiology, Health Sciences and Society, Karolinska Institute, Stockholm, Sweden.,Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Postbox 4, St. Olavs Plass, 0130, Oslo, Norway
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23
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Duff J, Cullen L, Hanrahan K, Steelman V. Determinants of an evidence-based practice environment: an interpretive description. Implement Sci Commun 2020; 1:85. [PMID: 33043300 PMCID: PMC7542098 DOI: 10.1186/s43058-020-00070-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 09/07/2020] [Indexed: 12/21/2022] Open
Abstract
Background Despite the available research to inform nursing practice, many patients still fail to receive evidence-based care. Several evidence-based practice (EBP) models have been developed to guide nurses through the steps in the process, yet these models have not been uniformly adopted or consistently used. The original purpose of this research was to gather perspectives and experiences of nurses using the Iowa Model of EBP to help inform its introduction into other practice settings. As a more in-depth understanding was gained, the emphasis of the study shifted towards understanding the determinants of the EBP environment. Method The study was conducted in an 800-bed comprehensive academic medical centre in the USA with a 25-year history of using the Iowa Model of EBP. Semi-structured in-depth interviews were conducted with twelve nurses from various roles to ascertain their perspectives and experiences using the model. The interview transcripts were reviewed alongside relevant published literature and internal documents in a process of synthesising, theorising, and conceptualising. Data were collected during the first half of 2019. Results Four determinants of the local EBP environment were identified from the perspectives and experiences of participants: (1) the importance of a shared model to guide staff through the EBP process; (2) support for EBP in the form of education, hands-on training, and knowledge infrastructure; (3) active team facilitation by direct care nurses, nurse managers, nurse specialists, and nurse scientists; and (4) a culture and leadership that encourages EBP. Conclusion Introducing an EBP model is an essential first step for an organisation to improve consistent and reliable evidence-based care; to be most effective, this should be done in conjunction with efforts to optimise the EBP environment.
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Affiliation(s)
- Jed Duff
- Queensland University of Technology, Nursing & Midwifery Research Centre, Royal Brisbane & Women's Hospital, Butterfield St, Herston, QLD 4029 Australia.,University of Newcastle, School of Nursing and Midwifery, University Drive, Callaghan, NSW 2308 Australia
| | - Laura Cullen
- University of Iowa Hospitals and Clinics, Nursing Research and Evidence-Based Practice, 200 Hawkins Dr, Iowa City, IA 52242 USA
| | - Kirsten Hanrahan
- University of Iowa Hospitals and Clinics, Nursing Research and Evidence-Based Practice, 200 Hawkins Dr, Iowa City, IA 52242 USA
| | - Victoria Steelman
- College of Nursing, University of Iowa, 50 Newton Rd, Iowa City, IA 52242 USA
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24
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Galiano A, Simonetti M, Quiroga N, Larrain A. Development, implementation and evaluation of an evidence-based practice model in a new hospital in Chile. J Nurs Manag 2020; 28:1748-1757. [PMID: 32799398 DOI: 10.1111/jonm.13134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/03/2020] [Accepted: 08/07/2020] [Indexed: 11/29/2022]
Abstract
AIMS To describe an implementation programme for an evidence-based practice (EBP) model in a new Chilean hospital and to analyse the programme evaluation results. BACKGROUND Evidence-based practice is key to professional nursing for improving health care safety and quality. METHODS First, a literature review was performed to develop an institutional EBP model. Second, internal and external analyses contributed to assessing facilitators for and barriers to implementation. Third, a multi-stage implementation plan was conducted. Fourth, process and outcome indicators were evaluated. RESULTS The model considered the basic elements of EBP and outlined different decision-making levels in clinical practice. Several facilitators for implementation were identified. Each implementation stage included activities addressing EBP knowledge, attitude and skills. Outcome indicators showed significant improvement regarding knowledge (p = .038). Providers with formal EBP training, compared with providers without training, showed a significant difference of 8.6% (0.6 points) in the average CPBE-19 score in knowledge, attitude and application in the last evaluation (p < .01). CONCLUSION Having an EBP programme with ongoing implementation strategies improves knowledge over time, and formal training enhances positive results. IMPLICATIONS FOR NURSING MANAGEMENT Nurse managers can build an institutional research culture to improve the quality of care using an EBP programme that fits organisational needs.
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Affiliation(s)
| | - Marta Simonetti
- Universidad de los Andes Chile Facultad de Enfermería y Obstetricia Escuela de Enfermería
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25
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EBP 2.0: Implementing and Sustaining Change: Implementing Improved Central Line Flushing Practices. Am J Nurs 2020; 120:66-70. [PMID: 32732486 DOI: 10.1097/01.naj.0000694600.82867.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This is the eighth article in a series about evidence-based practice (EBP) that builds on AJN's award-winning previous series-Evidence-Based Practice, Step by Step-published between 2009 and 2011 (to access the series, go to http://links.lww.com/AJN/A133). This follow-up series features exemplars illustrating the various strategies that can be used to implement EBP changes-one of the most challenging steps in the EBP process.
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26
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Laures E, Fowler C. The Power of the Pilot. J Perianesth Nurs 2020; 35:543-547. [PMID: 32712066 DOI: 10.1016/j.jopan.2020.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 02/22/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Elyse Laures
- Office of Nursing Research & Evidence-Based Practice, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, Iowa City, IA.
| | - Cassandra Fowler
- Office of Nursing Research & Evidence-Based Practice, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, Iowa City, IA
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27
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Farrington M, Ward E, Dawson C. Reducing Reliance on Agency Staff = $7.7 Million in Savings and Improved Nurse Engagement. J Perianesth Nurs 2020; 35:333-336. [PMID: 32498799 DOI: 10.1016/j.jopan.2020.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/16/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Michele Farrington
- Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Emily Ward
- Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Cindy Dawson
- Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics, Iowa City, IA
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28
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Tucker S, Zadvinskis IM, Connor L. Development and Psychometric Testing of the Implementation Self-efficacy for EBP (ISE4EBP) Scale. West J Nurs Res 2020; 43:45-52. [DOI: 10.1177/0193945920925032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is inadequate research about nurses’ confidence in implementation strategies that foster the application and sustainability of evidence-based practice (EBP). Guided by Bandura’s self-efficacy theory, we propose that self-efficacy (confidence) in EBP implementation strategies can accelerate the uptake of evidence into practice to improve health care quality. The purpose of this study was to develop and test the psychometric properties of the Implementation Self-efficacy for EBP (ISE4EBP) scale as a measure for evaluating self-efficacy in using EBP implementation strategies. In a sample of 65 registered nurses, the 29-item ISE4EBP scale demonstrated adequate content validity (via content validity index), internal consistency reliability (Cronbach's alpha = 0.987), and construct validity indicated by associations with organizational readiness for EBP. Clinicians may use the ISE4EBP scale to identify areas for building implementation confidence to accelerate the uptake of evidence to improve quality care.
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Affiliation(s)
- Sharon Tucker
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | | | - Linda Connor
- College of Nursing, The Ohio State University, Columbus, OH, USA
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29
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Oh EG, Yoo JY. Experiences of evidence-based practice mentors: a phenomenological study. Contemp Nurse 2020; 56:331-343. [PMID: 32270744 DOI: 10.1080/10376178.2020.1736593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: The importance of the role of clinical nursing leaders as Evidence-based Practice (EBP) mentors has increased; however, information regarding their experiences is limited. Aims: This study aimed to explore EBP mentors' lived experiences. Design: This qualitative study used a phenomenological framework suggested by Colaizzi. Methods: The participants were seven EBP mentors working as unit managers in Korea. Data were collected via in-depth, semi-structured interviews. Findings: The experiences of EBP mentors were identified to three categories: 'challenges in taking on the new role of EBP mentor', 'forming intimate EBP mentor-staff nurse relations' and 'becoming independent as a facilitator'. The EBP mentors experienced role ambiguity, stress, and burden during the initial phase of EBP mentorship; however, they adjusted and reported positive experiences during the adjustment process. Conclusion: Before implementation an EBP initiative, systematic and educational programs that target the EBP mentors should be offered. A systematic approach to creating an institutional culture of EBP are also needed.
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Affiliation(s)
- Eui Geum Oh
- College of Nursing, Yonsei University, Seoul, South Korea.,Yonsei Evidence Based Nursing Centre of Korea, A Joanna Briggs Institute Centre of Excellence, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Jae Yong Yoo
- Department of Nursing, College of Medicine, Chosun University, 309 Pilmundae-ro, Dong-gu, Gwangju 61452, South Korea
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30
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Speroni KG, McLaughlin MK, Friesen MA. Use of Evidence‐based Practice Models and Research Findings in Magnet‐Designated Hospitals Across the United States: National Survey Results. Worldviews Evid Based Nurs 2020; 17:98-107. [DOI: 10.1111/wvn.12428] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2019] [Indexed: 11/30/2022]
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32
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Cerderbom S, Bjerk M, Bergland A. The tensions between micro-, meso- and macro-levels: physiotherapists' views of their role towards fall prevention in the community - a qualitative study. BMC Health Serv Res 2020; 20:97. [PMID: 32028938 PMCID: PMC7006061 DOI: 10.1186/s12913-020-4940-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 01/28/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Falls are a global public health concern. Physiotherapists are a key resource in this context, but there is sparse knowledge about how they perceive their role in the primary care setting. Therefore, the purpose of the present study is to explore physical therapists' (PTs) view of how they experience and perceive their role working with fall prevention in a community care setting. METHODS Semi-structured interviews were conducted with 17 physiotherapists. Data were analysed using a qualitative thematic analysis. RESULTS The analysis resulted in a core theme and three subthemes. The core theme was 'capability to cope with the tensions between the micro-, meso- and macro-levels in fall, prevention', which indicated the importance of an evolving multifaceted, evidence based and innovative physiotherapy role. A key factor for this role is to take an integrative biopsychosocial approach based on how biological and psychosocial factors are uniquely related in fall prevention. The three themes were as follows: 1) always moving and changing: the competent explorative knowledge-hungry clinician's multifaceted role; 2) multiprofessional - but in the end alone; 3) reaching out - from the bottom to the top. Success in the role of physiotherapists in fall prevention depends on the empowering leadership and working culture, as well as on the time and multifaceted professional competence of the clinicians. CONCLUSION Our findings indicate that the PTs' role reflects their abilities to change and improve their professional work in accordance with evidence based knowledge. To ensure good quality the PTs focused on the special needs of the patients, evidence-based fall prevention, interdisciplinary team work, good clinical competences, good skills in communication, and interpersonal relations. Attention should be placed on the importance of biopsychosocial perspective framing in the actual clinical and political context. The PTs saw the need for working at the micro-, meso- and macro-levels to succeed in the work of fall prevention.
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Affiliation(s)
- Sara Cerderbom
- Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, 0130, Oslo, Norway
| | - Maria Bjerk
- Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, 0130, Oslo, Norway
| | - Astrid Bergland
- Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, 0130, Oslo, Norway.
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Beeler C, Kerley D, Davis C, Hazen D, Snyderman W, Lyons K, Sadowski J, Sweeney J, Dbeibo L, Kelley K, Webb DH. Strategies for the successful implementation of disinfecting port protectors to reduce CLABSI in a large tertiary care teaching hospital. Am J Infect Control 2019; 47:1505-1507. [PMID: 31324493 DOI: 10.1016/j.ajic.2019.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 12/28/2022]
Abstract
Disinfecting port protectors are a supplement to the central line-associated bloodstream infection prevention bundle as an optional recommendation from the Centers for Disease Control and Prevention. Despite evidence of effectiveness, few centers have successfully reported systematic, sustained implementation of these devices. In this article, we discuss a successful implementation in a large tertiary care teaching hospital, using an evidence-based, multidisciplinary approach. Infection prevention; Bacteremia; Ethanol caps; Bundle measures; Quality improvement; Hub infection.
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Hanrahan K, Fowler C, McCarthy AM. Iowa Model Revised: Research and Evidence-based Practice Application. J Pediatr Nurs 2019; 48:121-122. [PMID: 31060885 DOI: 10.1016/j.pedn.2019.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 04/22/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Kirsten Hanrahan
- University of Iowa Hospitals and Clinics, IA, United States of America.
| | - Cassandra Fowler
- University of Iowa Stead Family Children's Hospital, IA, United States of America
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Melo RCCPD, Costa PJ, Henriques LVL, Tanaka LH, Queirós PJP, Araújo JP. Humanitude in the humanization of elderly care: experience reports in a health service. Rev Bras Enferm 2019; 72:825-829. [PMID: 31269152 DOI: 10.1590/0034-7167-2017-0363] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 01/02/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe the experience in the implementation of the Humanitude Care Methodology (MCH) in the humanization of care for the elderly. METHODOLOGY This is an experience report about the implementation of the MCH, in a Health Service in Portugal, with capacity for 30 elderly people, most of them having cognitive alterations. RESULTS The implementation of the MCH has shown positive results in the humanization of care for the elderly, namely in the reduction of agitation behaviors and better acceptance of care. There was a change in organizational culture, more focused on the person and on the humanization of care. CONCLUSION The results reflect the need to introduce innovative care methodologies in the training of health professionals, with a focus on interaction, for a professionalized relational care that dignifies the person cared for and the care giver.
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Scientific and Clinical Abstracts From WOCNext 2019. J Wound Ostomy Continence Nurs 2019. [DOI: 10.1097/won.0000000000000530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tucker S, Sheikholeslami D, Farrington M, Picone D, Johnson J, Matthews G, Evans R, Gould R, Bohlken D, Comried L, Petrulevich K, Perkhounkova E, Cullen L. Patient, Nurse, and Organizational Factors That Influence Evidence‐Based Fall Prevention for Hospitalized Oncology Patients: An Exploratory Study. Worldviews Evid Based Nurs 2019; 16:111-120. [DOI: 10.1111/wvn.12353] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Sharon Tucker
- Translational Research CoreHelene Fuld Health Trust National Institute for EBP in Nursing & HealthcareCollege of NursingThe Ohio State University Columbus OH USA
| | - Deborah Sheikholeslami
- Medical Surgical Nursing DivisionDepartment of Nursing Services and Patient CareUniversity of Iowa Hospitals and Clinics Iowa City IA USA
| | - Michele Farrington
- Office of Nursing Research andEvidence‐Based PracticeDepartment of Nursing Services and Patient CareUniversity of Iowa Hospitals and Clinics Iowa City IA USA
| | - Debra Picone
- Office of Clinical Quality, Safety and Performance ImprovementUniversity of Iowa Hospitals and Clinics Iowa City IA USA
| | - Janis Johnson
- Medical Surgical Nursing DivisionDepartment of Nursing Services and Patient CareUniversity of Iowa Hospitals and Clinics Iowa City IA USA
| | - Grace Matthews
- Medical Surgical Nursing DivisionDepartment of Nursing Services and Patient CareUniversity of Iowa Hospitals and Clinics Iowa City IA USA
| | - Rhonda Evans
- Medical Surgical Nursing DivisionDepartment of Nursing Services and Patient CareUniversity of Iowa Hospitals and Clinics Iowa City IA USA
| | - Renee Gould
- Office of Nursing ResearchEvidence‐Based Practice and QualityDepartment of Nursing Services and Patient CareUniversity of Iowa Hospitals and Clinics Iowa City IA USA
| | - Deborah Bohlken
- Department of Nursing Services and Patient CareUniversity of Iowa Hospitals and Clinics Iowa City IA USA
| | - Lynn Comried
- Department of Nursing Services and Patient CareUniversity of Iowa Hospitals and Clinics Iowa City IA USA
| | - Kelly Petrulevich
- Department of Nursing Services and Patient CareUniversity of Iowa Hospitals and Clinics Iowa City IA USA
| | | | - Laura Cullen
- Office of Nursing Research andEvidence‐Based PracticeDepartment of Nursing Services and Patient CareUniversity of Iowa Hospitals and Clinics Iowa City IA USA
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CE: Original Research: Exploring Clinicians' Perceptions About Sustaining an Evidence-Based Fall Prevention Program. Am J Nurs 2019; 118:24-33. [PMID: 29664739 DOI: 10.1097/01.naj.0000532806.35972.29] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
: Purpose: This study aimed to address the knowledge gap between implementing and sustaining evidence-based fall prevention practices for hospitalized patients by exploring perspectives of the interprofessional health care team. DESIGN A qualitative design was used to capture insights from clinicians across disciplines in a large midwestern academic medical center. METHODS Four homogenous semistructured focus groups and three individual interviews involving a total of 20 clinicians were conducted between October 2013 and March 2014. Audio-recorded data were transcribed and analyzed using inductive qualitative analysis. FINDINGS Two primary themes emerged from participants regarding the sustainability of an evidence-based fall prevention program: communication patterns within the interprofessional health care team and influences of hospital organizational practices and elements. Several subthemes also emerged. Participants gave nursing staff primary responsibility for fall risk assessment and prevention. CONCLUSIONS Individual professional perceptions and practices, as well as organizational characteristics, affect the sustainability of evidence-based fall prevention practices. While all team members recognized patient falls as a significant quality and safety issue, most believed that direct care nurses hold primary responsibility for leading fall prevention efforts. The data support the importance of effective interprofessional team communication and organizational practices in sustaining an evidence-based fall prevention program across inpatient units. Furthermore, the data call into question the wisdom in labeling quality indicators as "nursing sensitive"; the evidence indicates that a team approach is best.
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Downey J, Kruse D, Plonczynski DJ. Nurses Reduce Epidural-Related Urinary Retention and Postpartum Hemorrhages. J Perianesth Nurs 2019; 34:206-210. [PMID: 30686375 DOI: 10.1016/j.jopan.2018.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 09/03/2018] [Indexed: 10/27/2022]
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Bourgault AM, Upvall MJ. De-implementation of tradition-based practices in critical care: A qualitative study. Int J Nurs Pract 2019; 25:e12723. [PMID: 30656794 DOI: 10.1111/ijn.12723] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 10/25/2018] [Accepted: 12/15/2018] [Indexed: 12/13/2022]
Abstract
AIM To explore the process of tradition-based practice (TBP) de-implementation by critical care nurses. BACKGROUND Ritualistic and routine practices have been described as sacred cows or TBPs. Many clinical practices have insufficient or no evidence and may lead to poor patient outcomes. De-implementation (termination) of potentially harmful, ineffective, or non cost-effective TBP is necessary to facilitate evidence-based practice (EBP) in the clinical setting. DESIGN Descriptive qualitative inquiry guided this study. METHODS Twenty-two critical care nurses from an acute care hospital in central Florida participated. Individual and focus group interviews were performed March to July 2016 and analysed using thematic analysis. RESULTS Three themes were identified: (a) uncertainty, (b) desire to know, and (c) preparing for practice change. Nurses were uncertain about the scientific underpinnings of everyday clinical practices and had difficulty differentiating TBP from EBP. De-implementation processes and strategies appeared to replicate implementation processes. CONCLUSION More research is needed to evaluate de-implementation processes and strategies used for de-implementation. An emphasis should be placed on ensuring that nurses are knowledgeable about fundamental EBP skills to encourage assessment of clinical practices for supporting research evidence. Awareness and understanding of TBPs will facilitate a more comprehensive approach towards achieving the gold standard of EBP.
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Affiliation(s)
- Annette M Bourgault
- Department of Nursing Systems, College of Nursing, Academic Health Sciences Center, University of Central Florida, USA.,Center for Nursing Research, Orlando Health, Orlando, Florida, USA
| | - Michele J Upvall
- Department of Nursing Systems, College of Nursing, Academic Health Sciences Center, University of Central Florida, USA
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Acker M, Deem N. The Development of a Pediatric Medication Administration Guideline for Preprocedure Nurse Callers. J Perianesth Nurs 2018; 34:559-566. [PMID: 30392711 DOI: 10.1016/j.jopan.2018.06.102] [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: 03/04/2018] [Revised: 06/09/2018] [Accepted: 06/11/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE This article describes the authors' development of a pediatric medication administration guideline for use by preprocedure nurse callers. Preprocedure refers to procedures done with general anesthesia such as surgery, endoscopy, or magnetic resonance imaging. DESIGN This article describes a process improvement project. METHODS The literature was searched using Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Google Scholar, and Google. No existing peer-reviewed pediatric preprocedure medication administration guidelines were found. A guideline with instructions for commonly prescribed pediatric medications was developed. FINDINGS Use of the guideline improves patient safety by providing clear medication administration instructions, while increasing the efficiency and autonomy of our nurse callers. Surveys of the nurse callers demonstrated that the guideline was clear, caregivers were receptive to receiving instructions from nurse callers, and use of the guideline decreased the number of calls made to other providers. CONCLUSIONS The use of a medication administration guideline improves patient safety, nurse efficiency, and nurse autonomy.
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The Teach Back Project: A System-wide Evidence Based Practice Implementation. J Pediatr Nurs 2018; 42:81-85. [PMID: 30219303 DOI: 10.1016/j.pedn.2018.06.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 06/02/2018] [Accepted: 06/02/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE Teach-back is an evidence-based strategy identified as a cornerstone intervention for improving communication during healthcare encounters. Evidence supports the use of teach back with patients and families to improve understanding of discharge instructions and supporting self-management. There is significant evidence that staff do not routinely use teach-back while communicating with patients and families. DESIGN AND METHODS This evidence-based practice project examined the impact of a brief educational intervention for a multidisciplinary staff on knowledge of health literacy and the use of teach-back during patient-education. Clinical staff working at a 290 bed Magnet® designated Midwest pediatric healthcare organization attended a 45-60 min, standardized, instructor led interactive teaching session about the impact of low health literacy, the use of open ended questions and how to use teach-back with patients and families. Pre and post education surveys, and a one-year sustainability survey were administered. RESULTS Over 300 multidisciplinary team members (including acute care, emergency room, and surgical nurses, dieticians, respiratory care practitioners and occupational and physical therapists) participated in the education and surveys. Both nurses and non-nurses demonstrated increased knowledge of the teach-back process and reported high rates of clarifying information and correcting misunderstandings when using teach back with patients and families. Qualitative data revealed clarifications are often about medications and skill-based treatments. CONCLUSIONS AND PRACTICE IMPLICATIONS Teach-back is a valuable strategy that can improve the safety and quality of health care and supports the National Action Plan to Improve Health Literacy.
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Cullen L. Translating EBP Into the Reality of Daily Practice: Leadership Solutions for Creating a Path Forward. J Perianesth Nurs 2018; 33:752-756. [PMID: 30107980 DOI: 10.1016/j.jopan.2018.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 05/20/2018] [Indexed: 10/28/2022]
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Kim YH, Lim J, Kim JH, Kim J, Lim JH, Shin HJ, Shin YA, Kim YJ, Lee KR. Conduction, Evaluation, and Future Considerations for an Obesity Educator Training Program in Korea. J Obes Metab Syndr 2017; 26:251-256. [PMID: 31089527 PMCID: PMC6489476 DOI: 10.7570/jomes.2017.26.4.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/10/2017] [Accepted: 09/26/2017] [Indexed: 11/02/2022] Open
Abstract
To reduce the prevalence of obesity and provide information on evidence-based obesity treatments, the Education Committee of the Korean Society for the Study of Obesity (KSSO) has developed and launched the first Obesity Educator Training Program (OETP). After the course, we analyzed the results of a survey from 110 participants, comprising medical doctors (n=58), nutrition specialists (n=19), exercise specialists (n=14), and students (n=6). Approximately half of the participants were recruited through the Internet (48%), followed by academic leaflets, such as conference posters (21%); the reasons for participation were to learn about evidence-based treatments for obesity (47%), to receive up-to-date knowledge on obesity treatments (39%), to obtain basic information on obesity (10%), and others (4%). More than half of the participants found the date, lecture time, process, and theme of the OETP favorable. The participants indicated that there should be an in-depth course, sharing of the presented files with attendees, a longer lecture time, and a broader OETP that includes other specialties such as nursing. To improve the OETP, the educational committee of the KSSO must develop an in-depth OETP that will reflect these participant's feedback.
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Affiliation(s)
- Yang-Hyun Kim
- Department of Family Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jisun Lim
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong-Hwa Kim
- Department of Endocrinology, Bucheon Sejong Hospital, Bucheon, Korea
| | - JungHwan Kim
- Department of Family Medicine, Eulji Hospital, Eulji University, Seoul, Korea
| | - Jeong-Hyun Lim
- Department of Food Service and Nutrition Care, Seoul National University Hospital, Seoul, Korea
| | - Hye-Jung Shin
- Department of Pediatrics, National Medical Center, Seoul, Korea
| | - Yun-A Shin
- Department Prescription and Rehabilitation of Exercise, Dankook University, Cheonan, Korea
| | - Yong Jin Kim
- Department of Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Kyu Rae Lee
- Department of Family Medicine, Dongincheon Gil Hospital, Gachon University of Medicine and Science, Incheon, Korea
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Abstract
: An evidence-based practice change at a radiation oncology center in a large academic medical center was designed to reduce the severity of oral mucositis in adults receiving radiation treatment for head and neck cancer. In the intervention described, patients were given newly created oral care kits and educational materials to improve their oral hygiene. Evaluations were conducted at three points during the project (before radiation treatment, during week 4 to 5 of treatment, and one month after treatment). At week 4 to 5-when the severity of oral mucositis is expected to peak-patients reported improved oral hygiene practices and reduced oral mucositis severity. The authors conclude that the use of these oral care kits and educational materials lessened the effects of oral mucositis during and after radiation treatment.
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Loudon J. Standardized Implementation of Clinical Practices. J Med Imaging Radiat Sci 2017; 48:326-327. [DOI: 10.1016/j.jmir.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 09/08/2017] [Indexed: 10/18/2022]
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Abbott L, Hooke MC. Energy Through Motion©: An Activity Intervention for Cancer-Related Fatigue in an Ambulatory Infusion Center. Clin J Oncol Nurs 2017; 21:618-626. [DOI: 10.1188/17.cjon.618-626] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Evidence-Based Nurse-Driven Algorithm for Intrapartum Bladder Care. J Perianesth Nurs 2017; 32:483-489. [PMID: 28938985 DOI: 10.1016/j.jopan.2017.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 03/25/2017] [Indexed: 11/20/2022]
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