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Gayles JG, Chilenski SM, Barragán N, Rhoades Cooper B, Welsh JA, Galinsky M. Unpacking Technical Assistance (TA) Strategies Within a State-Level Prevention Support System: A Mixed-Method Study in Determining Types and Amount of TA. Eval Health Prof 2024; 47:204-218. [PMID: 38790112 PMCID: PMC11127505 DOI: 10.1177/01632787241248769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
The research-practice gap between evidence-based intervention efficacy and its uptake in real-world contexts remains a central challenge for prevention and implementation science. Providing technical assistance (TA) is considered a crucial support mechanism that can help narrow the gap. However, empirical measurement of TA strategies and their variation is often lacking. The current study unpacks the black box of TA, highlighting different TA strategies, amounts, and their relation to intervention characteristics. First, we qualitatively categorized interactions between TA providers and implementers. Second, we explored how characteristics of implementing organizations and the intervention related to variations in the amount of TA delivered. Using data spanning six years, we analyzed over 10,000 encounters between TA providers and implementers. Content analysis yielded four distinct strategies: Consultation (27.2%), Coordination Logistics (24.5%), Monitoring (16.5%), and Resource Delivery (28.2%). Organizations with prior experience required less monitoring and resource delivery. Additionally, characteristics of the intervention were significantly associated with the amount of consultation, monitoring, coordination logistics, and resource delivery provided. The specific features of the intervention showed significant variation in their relation to TA strategies. These findings provide initial insights into the implications of intervention characteristics in determining how much of which TA strategies are needed to support implementations in real-world settings.
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Affiliation(s)
- Jochebed G Gayles
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
| | - Sarah M Chilenski
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
| | - Nataly Barragán
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
| | | | - Janet Agnes Welsh
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
| | - Megan Galinsky
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
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2
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Maguire T, Ryan J, Levett-Jones T, Olasoji M, Garvey L. Modifying the clinical reasoning cycle to enhance forensic mental health nursing utility. Int J Ment Health Nurs 2024; 33:636-648. [PMID: 38012100 DOI: 10.1111/inm.13265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/11/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
Forensic mental health nursing is a specialty area of practice requiring specific knowledge and skills to work collaboratively with consumers. The Clinical Reasoning Cycle has been recognised as a potential framework to support nursing practice; however, it has been identified that adaptations are required to enhance utility in a forensic mental health services. The aim of this study was to explore and finalise a version of the cycle for forensic mental health nursing practice. Focus groups and interviews were used to explore adaptations with staff from a state-wide forensic service and forensic mental health nursing academics. Data were thematically analysed. Four main themes were interpreted: (1) allegiance to the Nursing Process, (2) moving the cycle from page to practice, (3) working as a team, or not, and (4) implementation will be a marathon and not a sprint. While nursing academics were more in favour of updating the Nursing Process to ensure contemporary practice is captured, staff from the service were supportive of the adapted cycle but emphasised the need to ensure collaboration with the consumer and their supporters. The adapted cycle was seen to articulate the contribution of forensic mental health nursing care, and support for a nursing-specific cycle was embraced by other disciplines, despite some hesitation from nurses. Prior to implementation there is a need to ensure the merits of the cycle are clearly articulated, along with a range of resources and specific contextual information to ensure the cycle can be successfully applied to enhance nursing practice and consumer care.
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Affiliation(s)
- Tessa Maguire
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Alphington, Victoria, Australia
- Forensicare (Victorian institute of Forensic Mental Health), Melbourne, Victoria, Australia
- Federation University, Melbourne, Victoria, Australia
| | - Jo Ryan
- Forensicare (Victorian institute of Forensic Mental Health), Melbourne, Victoria, Australia
| | | | | | - Loretta Garvey
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Alphington, Victoria, Australia
- Federation University, Melbourne, Victoria, Australia
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3
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Baraku A, Pavleković G. Quality Coordinators' Perspectives on Quality Improvement in Primary Healthcare in Kosovo: A Qualitative Study. J Healthc Qual 2024:01445442-990000000-00064. [PMID: 38697032 DOI: 10.1097/jhq.0000000000000431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
AIMS This qualitative descriptive study provides insights into the experiences of quality coordinators (QCs) in primary healthcare to inform policy and practice actions and empower QCs to enhance healthcare quality. METHODS We conducted focus group discussions with purposefully selected QCs to understand their motivations, job experiences, factors influencing healthcare quality, and suggestions for quality improvement. Content analysis and deductive coding were used to scrutinize the responses and answer the research questions. RESULTS The QCs thought highly about their job performance and were motivated by both extrinsic and intrinsic factors. Clinical audits, collegial reviews, and managerial support positively affected QCs' performance. In contrast, a lack of managerial support, limited working hours, and changes in organizing work caused the opposite. Empowerment and external support positively influenced healthcare quality, whereas lack of resources, managerial support, or training had a negative influence. Suggestions to improve quality include the role of QCs, external supervision, and centralization of the QCs' network. CONCLUSION Appointing QCs alone does not guarantee quality improvement. It is essential to ensure that QCs have the appropriate skills, tools, management support, and open communication channels. Further research is required to evaluate the effects of sex and age on QCs' performance.
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4
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Ozawa S, Ozawa-Morriello J, Perelman S, Thorpe E, Rock R, Pearse BL. Improving Patient Blood Management Programs: An Implementation Science Approach. Anesth Analg 2023; 136:397-407. [PMID: 36638516 DOI: 10.1213/ane.0000000000006273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Organized patient blood management (PBM) programs function in numerous hospitals and health systems around the world contributing to improved patient outcomes as well as increased patient engagement, decreased resource use, and reductions in health care costs. PBM "programming" ranges from the implementation of single strategies/initiatives to comprehensive programs led by dedicated clinicians and PBM committees, employing the use of multiple PBM strategies. Frontline health care professionals play an important role in leading, implementing, operationalizing, measuring, and sustaining successful PBM programs. In this article, we provide practical implementation guidance to support key clinical, administrative, leadership, and structural elements required for the safe and comprehensive delivery of care in PBM programs at the local level.
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Affiliation(s)
- Sherri Ozawa
- From Department of Clinical Optimization, Accumen Incorporated, Phoenix, Arizona.,Department of Bloodless Medicine and Surgery and Patient Blood Management, Englewood Health, Englewood, New Jersey.,Society for the Advancement of Patient Blood Management, Mt Royal, New Jersey
| | - Joshua Ozawa-Morriello
- Department of Bloodless Medicine and Surgery, Hackensack University Medical Center, Hackensack, New Jersey
| | - Seth Perelman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Langone Health, NYU School of Medicine, New York, New York
| | - Elora Thorpe
- From Department of Clinical Optimization, Accumen Incorporated, Phoenix, Arizona
| | - Rebecca Rock
- Department of Patient Blood Management, Alberta Health Services, Calgary, Alberta, Canada
| | - Bronwyn L Pearse
- Department of Surgery and Critical Care, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Department of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
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5
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Rushton S, Lewinski AA, Hwang S, Zullig LL, Ball Ricks KA, Ramos K, Gordon A, Ear B, Ballengee LA, Brahmajothi MV, Moore T, Blalock DV, Williams JW, Cantrell SE, Gierisch JM, Goldstein KM. Barriers and facilitators to the implementation and adoption of improvement coaching: A qualitative evidence synthesis. J Clin Nurs 2023; 32:3-30. [PMID: 35403322 DOI: 10.1111/jocn.16247] [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: 07/26/2021] [Revised: 10/15/2021] [Accepted: 01/12/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Healthcare organisations and teams perform improvement activities to facilitate high-quality healthcare. The use of an improvement coach who provides support and guidance to the healthcare team may facilitate improvement activities; however, no systematic review exists on the facilitators and barriers to implementing an improvement coach. AIMS We conducted a qualitative evidence synthesis to examine the facilitators and barriers to the implementation of improvement coaching. METHODS We searched MEDLINE® , Embase and CINAHL. The final search was in March 2021. The screening eligibility criteria included the following: interdisciplinary team receiving the coaching, improvement coaching, designs with a qualitative component and primary purpose of evaluating practice facilitation in OECD countries. An ecologically-informed consolidated framework for implementation research (CFIR) served as the framework for coding. Patterns of barriers and facilitators across domains were identified through matrix analysis. Risk of bias was assessed using Critical Appraisal Skills Program. PRISMA reporting guidelines served as a guide for reporting this review. RESULTS Nineteen studies with a qualitative component met the inclusion criteria. Four themes of barriers and facilitators crossed multiple CFIR domains: adaptability (e.g. making adjustments to the project; process, or approach); knowledge and skills (e.g. understanding of content and process for the project); engagement (e.g. willingness to be involved in the process) and resources (e.g. assets required to complete the improvement process). CONCLUSION Improvement coaching is a complex intervention that influences the context, healthcare team being coached and improvement activities. Improvement coaches should understand how to minimise barriers and promote facilitators that are unique to each improvement project across the domains. Limitations of the study are related to the nature of the intervention including potential publication bias given quality improvement focus; the variety of terms similar to improvement coaching or selection of framework.
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Affiliation(s)
- Sharron Rushton
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Allison A Lewinski
- School of Nursing, Duke University, Durham, North Carolina, USA.,Durham Veterans Affairs Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
| | - Soohyun Hwang
- Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Leah L Zullig
- Durham Veterans Affairs Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA.,Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Katharine A Ball Ricks
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Katherine Ramos
- Durham Veterans Affairs Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA.,Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, USA.,Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Adelaide Gordon
- Durham Veterans Affairs Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
| | - Belinda Ear
- Durham Veterans Affairs Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
| | - Lindsay A Ballengee
- Durham Veterans Affairs Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA.,Department of Orthopedic Surgery, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Mulugu V Brahmajothi
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Thomasena Moore
- Durham Veterans Affairs Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
| | - Dan V Blalock
- Durham Veterans Affairs Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA.,Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - John W Williams
- Durham Veterans Affairs Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA.,Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina, USA.,Division of General Internal Medicine, Department of Medicine, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Sarah E Cantrell
- School of Medicine, Duke University Medical Center Library & Archives, Duke University, Durham, North Carolina, USA
| | - Jennifer M Gierisch
- Durham Veterans Affairs Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA.,Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, USA.,Division of General Internal Medicine, Department of Medicine, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Karen M Goldstein
- Durham Veterans Affairs Health Care System, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA.,Division of General Internal Medicine, Department of Medicine, School of Medicine, Duke University, Durham, North Carolina, USA
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Eldh AC, Hälleberg-Nyman M, Joelsson-Alm E, Wallin L. Facilitating facilitators to facilitate-Some general comments on a strategy for knowledge implementation in health services. FRONTIERS IN HEALTH SERVICES 2023; 3:1112936. [PMID: 37138952 PMCID: PMC10149731 DOI: 10.3389/frhs.2023.1112936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/23/2023] [Indexed: 05/05/2023]
Abstract
Numerous endeavours to ensure that day-to-day healthcare is both evidence-based and person-centred have generated extensive, although partial, comprehension of what guarantees quality improvement. To address quality issues, researchers and clinicians have developed several strategies as well as implementation theories, models, and frameworks. However, more progress is needed regarding how to facilitate guideline and policy implementation that guarantees effective changes take place in a timely and safe manner. This paper considers experiences of engaging and supporting local facilitators in knowledge implementation. Drawing on several interventions, considering both training and support, this general commentary discusses whom to engage and the length, content, quantity, and type of support along with expected outcomes of facilitators' activities. In addition, this paper suggests that patient facilitators could help produce evidence-based and person-centred care. We conclude that research about the roles and functions of facilitators needs to include more structured follow-ups and also improvement projects. This can increase the speed of learning with respect to what works, for whom, in what context, why (or why not), and with what outcomes when it comes to facilitator support and tasks.
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Affiliation(s)
- Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Correspondence: Ann Catrine Eldh
| | - Maria Hälleberg-Nyman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
- Department of Orthopaedics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Anesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Lars Wallin
- Department of Health and Welfare, Dalarna University, Falun, Sweden
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Jervis-Rademeyer H, Ong K, Djuric A, Munce S, Musselman KE, Marquez-Chin C. Therapists' perspectives on using brain-computer interface-triggered functional electrical stimulation therapy for individuals living with upper extremity paralysis: a qualitative case series study. J Neuroeng Rehabil 2022; 19:127. [PMID: 36419166 PMCID: PMC9684970 DOI: 10.1186/s12984-022-01107-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Brain computer interface-triggered functional electrical stimulation therapy (BCI-FEST) has shown promise as a therapy to improve upper extremity function for individuals who have had a stroke or spinal cord injury. The next step is to determine whether BCI-FEST could be used clinically as part of broader therapy practice. To do this, we need to understand therapists' opinions on using the BCI-FEST and what limitations potentially exist. Therefore, we conducted a qualitative exploratory study to understand the perspectives of therapists on their experiences delivering BCI-FEST and the feasibility of large-scale clinical implementation. METHODS Semi-structured interviews were conducted with physical therapists (PTs) and occupational therapists (OTs) who have delivered BCI-FEST. Interview questions were developed using the COM-B (Capability, Opportunity, Motivation-Behaviour) model of behaviour change. COM-B components were used to inform deductive content analysis while other subthemes were detected using an inductive approach. RESULTS We interviewed PTs (n = 3) and OTs (n = 3), with 360 combined hours of experience delivering BCI-FEST. Components and subcomponents of the COM-B determined deductively included: (1) Capability (physical, psychological), (2) Opportunity (physical, social), and (3) Motivation (automatic, reflective). Under each deductive subcomponent, one to two inductive subthemes were identified (n = 8). Capability and Motivation were perceived as strengths, and therefore supported therapists' decisions to use BCI-FEST. Under Opportunity, for both subcomponents (physical, social), therapists recognized the need for more support to clinically implement BCI-FEST. CONCLUSIONS We identified facilitating and limiting factors to BCI-FEST delivery in a clinical setting according to clinicians. These factors implied that education, training, a support network or mentors, and restructuring the physical environment (e.g., scheduling) should be targeted as interventions. The results of this study may help to inform future development of new technologies and interventions.
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Affiliation(s)
- Hope Jervis-Rademeyer
- grid.17063.330000 0001 2157 2938Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada ,grid.231844.80000 0004 0474 0428The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Kenneth Ong
- grid.231844.80000 0004 0474 0428The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Alexander Djuric
- grid.231844.80000 0004 0474 0428The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Sarah Munce
- grid.17063.330000 0001 2157 2938Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada ,grid.231844.80000 0004 0474 0428The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Kristin E. Musselman
- grid.17063.330000 0001 2157 2938Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada ,grid.231844.80000 0004 0474 0428The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Cesar Marquez-Chin
- grid.231844.80000 0004 0474 0428The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada ,grid.17063.330000 0001 2157 2938Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
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Dairi MS. Physicians' Knowledge and Practices Regarding Asthma: A Cross-Sectional Study in Saudi Arabia. Int J Gen Med 2022; 15:6671-6680. [PMID: 36016985 PMCID: PMC9397430 DOI: 10.2147/ijgm.s369306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/29/2022] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to explore the characteristics of knowledge and practice of physicians towards asthma in Saudi Arabia. Methods An online cross-sectional study was conducted in Saudi Arabia between 28 August and 10 November 2021. Convenience sampling technique was applied in this study through social media websites. Previously developed 10-items questionnaire was used to assess the knowledge about asthma among the participating physicians. Descriptive statistics were used to describe the participants’ demographic characteristics. Binary logistic regression analysis was conducted to identify factors associated with being adherent to asthma practices guidelines. Results Overall, participants’ knowledge was moderate. The average percentage of physicians who reported practicing asthma management based on recommended guidelines 63.7%. Younger age (30–34 years) and having a work experience of (6–10 years) were significant predictors of being adherent to asthma practices guidelines (OR: 1.96 (95% CI: 1.21–3.17) (p=0.006) and OR: 1.67 (95% CI 1.05–2.67) (p=0.031), receptively). Conclusion This study showed that the percentage of physicians who reported practicing asthma management based on recommended guidelines in Saudi Arabia are moderate. Future studies to investigate factors associated with improvement in knowledge about asthma and adherence to guidelines are needed.
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Affiliation(s)
- Mohammad S Dairi
- Department of Internal Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
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9
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Ramuada L, Veldsman L, Livhuwani N, Blaauw R. Assessment of knowledge, attitude and practice of nurses regarding enteral nutrition at a military hospital. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2022. [DOI: 10.1080/16070658.2022.2076970] [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]
Affiliation(s)
- Londolani Ramuada
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Military Hospital, Thaba Tshwane, Pretoria, South Africa
| | - Lizl Veldsman
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | | | - Renée Blaauw
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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10
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Knowledge and attitudes of Implementation Support Practitioners-Findings from a systematic integrative review. PLoS One 2022; 17:e0267533. [PMID: 35544529 PMCID: PMC9094539 DOI: 10.1371/journal.pone.0267533] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 04/10/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND It requires thoughtful planning and work to successfully apply and sustain research-supported interventions like healthcare treatments, social support, or preventive programs in practice. Implementation support practitioners (ISPs) such as facilitators, technical assistance providers, knowledge brokers, coaches or consultants may be involved to actively support the implementation process. This article presents knowledge and attitudes ISPs bring to their work. METHODS Building on a previously developed program logic, a systematic integrative review was conducted. Literature was sourced by searching nine electronic data bases, organizational websites, and by launching a call for publications among selected experts and social media. Article screening was performed independently by two researchers, and data from included studies were extracted by members of the research team and quality-assured by the lead researcher. The quality of included RCTs was assessed based on a framework by Hodder and colleagues. Thematic Analysis was used to capture information on knowledge and attitudes of ISPs across the included studies. Euler diagrams and heatmaps were used to present the results. RESULTS Results are based on 79 included studies. ISPs reportedly displayed knowledge about the clinical practice they work with, implementation / improvement practice, the local context, supporting change processes, and facilitating evidence-based practice in general. In particular, knowledge about the intervention to be implemented and its target population, specific improvement / implementation methods and approaches, organizational structures and sensitivities, training, and characteristics of (good) research was described in the literature. Seven themes describing ISPs' attitudes were identified: 1) professional, 2) motivated / motivating / encouraging / empowering, 3) empathetic / respectful / sensitive, 4) collaborative / inclusive, 5) authentic, 6) creative / flexible / innovative / adaptive, and 7) frank / direct / honest. Pertaining to a professional attitude, being responsive and focused were the most prevalent indicators across included publications. CONCLUSION The wide range and complexity of knowledge and attitudes found in the literature calls for a comprehensive and systematic approach to collaboratively develop a professional role for ISPs across disciplines. Embedding the ISP role in different health and social welfare settings will enhance implementation capacities considerably.
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Bonham PA, Brunette G, Crestodina L, Droste LR, González A, Kelechi TJ, Ratliff CR, Varnado MF. 2021 Guideline for Management of Patients With Lower-Extremity Wounds Due to Diabetes Mellitus and/or Neuropathic Disease: An Executive Summary. J Wound Ostomy Continence Nurs 2022; 49:267-285. [PMID: 35523243 DOI: 10.1097/won.0000000000000860] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article provides an executive summary of the Wound, Ostomy, and Continence Nurses Society's (WOCN) "2021 Guideline for Management of Patients With Lower-Extremity wounds Due to Diabetes Mellitus and/or Neuropathic Disease." This executive summary presents an overview of the systematic process used to update and develop the guideline and recommendations from the guideline for screening and diagnosis, assessment, and management and education of patients with lower-extremity wounds due to diabetes mellitus and/or neuropathic disease. In addition, the executive summary provides suggestions for implementing recommendations from the guideline. The guideline is a resource for WOC nurse specialists and other nurses and health care professionals who work with adults who have/or are at risk for lower-extremity wounds due to diabetes mellitus/neuropathic disease. The complete guideline includes the evidence and references supporting the recommendations, and it is available in print and electronically from the Wound, Ostomy, and Continence Nurses Society, 1120 Rt 73, Suite 200, Mount Laurel, New Jersey, 08054; Web site: www.wocn.org.
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Affiliation(s)
- Phyllis A Bonham
- Phyllis A. Bonham, PhD, MSN, RN, CWOCN, DPNAP, FAAN, Professor Emerita, College of Nursing, Medical University of South Carolina, Charleston, South Carolina
- Glenda Brunette, MSN, RN, CWON, Wound and Ostomy Care Nurse, Medical University of South Carolina, Charleston, South Carolina
- Lea Crestodina, MSN, APRN, CWOCN-AP, CDE, Wound Nurse Specialist, Joe DiMaggio Children's Hospital, Hollywood, Florida
- Linda R. Droste, MSN, RN, CWOCN, CBIS, WOC Nurse, Spinal Cord Injury and Disorder (SCI & D) Units, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
- Arturo González, DNP, APRN, ANP-BC, CWCN-AP, Clinical Assistant Professor, Graduate Nursing Department, Florida International University, Miami, Florida
- Teresa J. Kelechi, PhD, RN, CWCN, FAAN, Professor and Associate Dean for Research and PhD Studies, College of Nursing, The Medical University of South Carolina, Charleston, South Carolina
- Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, Associate Professor/Nurse Practitioner, University of Virginia Health System, Charlottesville, Virginia
- Myra F. Varnado, BS, RN, CWON, CFCN, Director of Clinical Services, Corstrata, Metairie, Louisiana
| | - Glenda Brunette
- Phyllis A. Bonham, PhD, MSN, RN, CWOCN, DPNAP, FAAN, Professor Emerita, College of Nursing, Medical University of South Carolina, Charleston, South Carolina
- Glenda Brunette, MSN, RN, CWON, Wound and Ostomy Care Nurse, Medical University of South Carolina, Charleston, South Carolina
- Lea Crestodina, MSN, APRN, CWOCN-AP, CDE, Wound Nurse Specialist, Joe DiMaggio Children's Hospital, Hollywood, Florida
- Linda R. Droste, MSN, RN, CWOCN, CBIS, WOC Nurse, Spinal Cord Injury and Disorder (SCI & D) Units, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
- Arturo González, DNP, APRN, ANP-BC, CWCN-AP, Clinical Assistant Professor, Graduate Nursing Department, Florida International University, Miami, Florida
- Teresa J. Kelechi, PhD, RN, CWCN, FAAN, Professor and Associate Dean for Research and PhD Studies, College of Nursing, The Medical University of South Carolina, Charleston, South Carolina
- Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, Associate Professor/Nurse Practitioner, University of Virginia Health System, Charlottesville, Virginia
- Myra F. Varnado, BS, RN, CWON, CFCN, Director of Clinical Services, Corstrata, Metairie, Louisiana
| | - Lea Crestodina
- Phyllis A. Bonham, PhD, MSN, RN, CWOCN, DPNAP, FAAN, Professor Emerita, College of Nursing, Medical University of South Carolina, Charleston, South Carolina
- Glenda Brunette, MSN, RN, CWON, Wound and Ostomy Care Nurse, Medical University of South Carolina, Charleston, South Carolina
- Lea Crestodina, MSN, APRN, CWOCN-AP, CDE, Wound Nurse Specialist, Joe DiMaggio Children's Hospital, Hollywood, Florida
- Linda R. Droste, MSN, RN, CWOCN, CBIS, WOC Nurse, Spinal Cord Injury and Disorder (SCI & D) Units, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
- Arturo González, DNP, APRN, ANP-BC, CWCN-AP, Clinical Assistant Professor, Graduate Nursing Department, Florida International University, Miami, Florida
- Teresa J. Kelechi, PhD, RN, CWCN, FAAN, Professor and Associate Dean for Research and PhD Studies, College of Nursing, The Medical University of South Carolina, Charleston, South Carolina
- Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, Associate Professor/Nurse Practitioner, University of Virginia Health System, Charlottesville, Virginia
- Myra F. Varnado, BS, RN, CWON, CFCN, Director of Clinical Services, Corstrata, Metairie, Louisiana
| | - Linda R Droste
- Phyllis A. Bonham, PhD, MSN, RN, CWOCN, DPNAP, FAAN, Professor Emerita, College of Nursing, Medical University of South Carolina, Charleston, South Carolina
- Glenda Brunette, MSN, RN, CWON, Wound and Ostomy Care Nurse, Medical University of South Carolina, Charleston, South Carolina
- Lea Crestodina, MSN, APRN, CWOCN-AP, CDE, Wound Nurse Specialist, Joe DiMaggio Children's Hospital, Hollywood, Florida
- Linda R. Droste, MSN, RN, CWOCN, CBIS, WOC Nurse, Spinal Cord Injury and Disorder (SCI & D) Units, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
- Arturo González, DNP, APRN, ANP-BC, CWCN-AP, Clinical Assistant Professor, Graduate Nursing Department, Florida International University, Miami, Florida
- Teresa J. Kelechi, PhD, RN, CWCN, FAAN, Professor and Associate Dean for Research and PhD Studies, College of Nursing, The Medical University of South Carolina, Charleston, South Carolina
- Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, Associate Professor/Nurse Practitioner, University of Virginia Health System, Charlottesville, Virginia
- Myra F. Varnado, BS, RN, CWON, CFCN, Director of Clinical Services, Corstrata, Metairie, Louisiana
| | - Arturo González
- Phyllis A. Bonham, PhD, MSN, RN, CWOCN, DPNAP, FAAN, Professor Emerita, College of Nursing, Medical University of South Carolina, Charleston, South Carolina
- Glenda Brunette, MSN, RN, CWON, Wound and Ostomy Care Nurse, Medical University of South Carolina, Charleston, South Carolina
- Lea Crestodina, MSN, APRN, CWOCN-AP, CDE, Wound Nurse Specialist, Joe DiMaggio Children's Hospital, Hollywood, Florida
- Linda R. Droste, MSN, RN, CWOCN, CBIS, WOC Nurse, Spinal Cord Injury and Disorder (SCI & D) Units, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
- Arturo González, DNP, APRN, ANP-BC, CWCN-AP, Clinical Assistant Professor, Graduate Nursing Department, Florida International University, Miami, Florida
- Teresa J. Kelechi, PhD, RN, CWCN, FAAN, Professor and Associate Dean for Research and PhD Studies, College of Nursing, The Medical University of South Carolina, Charleston, South Carolina
- Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, Associate Professor/Nurse Practitioner, University of Virginia Health System, Charlottesville, Virginia
- Myra F. Varnado, BS, RN, CWON, CFCN, Director of Clinical Services, Corstrata, Metairie, Louisiana
| | - Teresa J Kelechi
- Phyllis A. Bonham, PhD, MSN, RN, CWOCN, DPNAP, FAAN, Professor Emerita, College of Nursing, Medical University of South Carolina, Charleston, South Carolina
- Glenda Brunette, MSN, RN, CWON, Wound and Ostomy Care Nurse, Medical University of South Carolina, Charleston, South Carolina
- Lea Crestodina, MSN, APRN, CWOCN-AP, CDE, Wound Nurse Specialist, Joe DiMaggio Children's Hospital, Hollywood, Florida
- Linda R. Droste, MSN, RN, CWOCN, CBIS, WOC Nurse, Spinal Cord Injury and Disorder (SCI & D) Units, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
- Arturo González, DNP, APRN, ANP-BC, CWCN-AP, Clinical Assistant Professor, Graduate Nursing Department, Florida International University, Miami, Florida
- Teresa J. Kelechi, PhD, RN, CWCN, FAAN, Professor and Associate Dean for Research and PhD Studies, College of Nursing, The Medical University of South Carolina, Charleston, South Carolina
- Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, Associate Professor/Nurse Practitioner, University of Virginia Health System, Charlottesville, Virginia
- Myra F. Varnado, BS, RN, CWON, CFCN, Director of Clinical Services, Corstrata, Metairie, Louisiana
| | - Catherine R Ratliff
- Phyllis A. Bonham, PhD, MSN, RN, CWOCN, DPNAP, FAAN, Professor Emerita, College of Nursing, Medical University of South Carolina, Charleston, South Carolina
- Glenda Brunette, MSN, RN, CWON, Wound and Ostomy Care Nurse, Medical University of South Carolina, Charleston, South Carolina
- Lea Crestodina, MSN, APRN, CWOCN-AP, CDE, Wound Nurse Specialist, Joe DiMaggio Children's Hospital, Hollywood, Florida
- Linda R. Droste, MSN, RN, CWOCN, CBIS, WOC Nurse, Spinal Cord Injury and Disorder (SCI & D) Units, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
- Arturo González, DNP, APRN, ANP-BC, CWCN-AP, Clinical Assistant Professor, Graduate Nursing Department, Florida International University, Miami, Florida
- Teresa J. Kelechi, PhD, RN, CWCN, FAAN, Professor and Associate Dean for Research and PhD Studies, College of Nursing, The Medical University of South Carolina, Charleston, South Carolina
- Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, Associate Professor/Nurse Practitioner, University of Virginia Health System, Charlottesville, Virginia
- Myra F. Varnado, BS, RN, CWON, CFCN, Director of Clinical Services, Corstrata, Metairie, Louisiana
| | - Myra F Varnado
- Phyllis A. Bonham, PhD, MSN, RN, CWOCN, DPNAP, FAAN, Professor Emerita, College of Nursing, Medical University of South Carolina, Charleston, South Carolina
- Glenda Brunette, MSN, RN, CWON, Wound and Ostomy Care Nurse, Medical University of South Carolina, Charleston, South Carolina
- Lea Crestodina, MSN, APRN, CWOCN-AP, CDE, Wound Nurse Specialist, Joe DiMaggio Children's Hospital, Hollywood, Florida
- Linda R. Droste, MSN, RN, CWOCN, CBIS, WOC Nurse, Spinal Cord Injury and Disorder (SCI & D) Units, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
- Arturo González, DNP, APRN, ANP-BC, CWCN-AP, Clinical Assistant Professor, Graduate Nursing Department, Florida International University, Miami, Florida
- Teresa J. Kelechi, PhD, RN, CWCN, FAAN, Professor and Associate Dean for Research and PhD Studies, College of Nursing, The Medical University of South Carolina, Charleston, South Carolina
- Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, Associate Professor/Nurse Practitioner, University of Virginia Health System, Charlottesville, Virginia
- Myra F. Varnado, BS, RN, CWON, CFCN, Director of Clinical Services, Corstrata, Metairie, Louisiana
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Lynch B, McCance TV. Coproducing and Implementing Person-Centered Key Performance Indicators in Ambulatory Cancer Nursing. Cancer Nurs 2022; 46:E192-E203. [PMID: 35398853 DOI: 10.1097/ncc.0000000000001094] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Policy advocates person-centered healthcare for people living with cancer. Although nurses and patients alike recognize that a good care experience cannot be measured solely by clinical outcomes, the difficulty in finding indicators that measure the delivery of effective person-centered care remains a challenge. OBJECTIVE The aim of this study was to explore the impact of a coproduced implementation project using the person-centered nursing key performance indicators to support the development of person-centered practice across ambulatory chemotherapy units. METHODS The study adopted an evaluation approach derived from work of the Medical Research Council. A mobile app was used to collect and analyze 3 cycles of data using 4 measurement tools, with the aim of informing quality improvement activities. Six implementation teams were recruited from chemotherapy units across a region in the United Kingdom. Qualitative interviews were used to evaluate the experience of participants. RESULTS Data analysis revealed 4 themes: building relationships that nurture the care experience, inspiring nursing staff to flourish, shaping practice and service changes through the nature of the conversations, and becoming person-centered through coproduction. CONCLUSION This study provides evidence of the value of implementing these person-centered key performance indicators using a model of coproduction in cancer nursing. The data generated by the key performance indicators offer valuable feedback to nurses that can inform the development of person-centered practice and contribute to an enhanced patient experience. IMPLICATIONS FOR PRACTICE This study provides an innovative and transferable approach for implementing relevant and appropriate key performance indicators within cancer nursing, which can contribute to developing person-centered cultures.
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Ramazan F, Aarts S, Widdowfield M. Exploring the implementation of evidence-based optimisation strategies: A qualitative study of the experience of diagnostic radiographers. Radiography (Lond) 2022; 28:804-810. [PMID: 35221213 DOI: 10.1016/j.radi.2022.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Radiographers are responsible for ensuring safe and effective use of ionising radiation. Through evidence-based practice (EBP), valuable optimisation strategies can be implemented to fulfil these responsibilities. This study aimed to explore radiographers' attitudes, perceptions, and experience of using evidence-based optimisation strategies. METHODS A Grounded Theory approach using in-depth interviews. UK-based radiographers were recruited. Discussions focused on (1) the role of evidence-based optimisation strategies in daily practice, (2) assistance in implementing evidence-based optimisation strategies, and (3) the role of EBP and optimisation strategies in the future. Interviews were transcribed verbatim and analysed using open and axial coding. RESULTS Participants (n = 13) stated that EBP is not frequently used to implement optimisation strategies. Participants relied on the knowledge taught in education settings and their professional skills to optimise in daily practice, alongside departmental protocols. Barriers identified as affecting the implementation of optimisation strategies related to reluctance to change, a lack of support from superiors, and a lack of resources to engage with EBP. Some participants expected the use of optimisation strategies to become unnecessary due to technology advancements. CONCLUSION The results indicate that effective operationalisation of EBP is not part of daily practice among radiographers to implement valuable optimisation strategies in daily practice. IMPLICATIONS FOR PRACTICE The potential barriers to implementing evidence-based optimisation strategies highlighted in this study suggest that improving access to resources and empowerment of individual radiographers is required to enable radiographers to implement optimisation strategies.
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Affiliation(s)
- F Ramazan
- Alliance Medical, University Hospital of North Tees, Stockton-on-Tees, TS19 8PE, United Kingdom.
| | - S Aarts
- School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, Netherlands; Living Lab in Ageing and Long-Term Care, Department of Health Services Research, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, Netherlands.
| | - M Widdowfield
- Pasteur Building, Sciences Complex, University of Sunderland, Sunderland, SR2 7PT, United Kingdom.
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14
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Gallione C, Barisone M, Molon A, Pavani M, Torgano C, Bassi E, Dal Molin A. Extrinsic and intrinsic factors acting as barriers or facilitators in nurses' implementation of clinical practice guidelines: a mixed-method systematic review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022252. [PMID: 35775756 PMCID: PMC9335442 DOI: 10.23750/abm.v93i3.12942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/06/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Greater evaluations are needed to identify barriers or facilitators in nurses' guidelines adherence. The current review aims to explore extrinsic and intrinsic factors impacting nurses' compliance. METHODS Mixed-method systematic review with a convergent approach, following the PRISMA checklist and the JBI Mixed Methods Review Methodological Guidance was conducted. MEDLINE, Embase, CINAHL were systematically searched, to find studies published between 2010 and 2021, including qualitative, quantitative or mixed-methods articles. RESULTS Sixty studies were included, and the major findings were analysed by aggregating them in two main themes: intrinsic and extrinsic factors. The intrinsic factors were: a) knowledge and skills; b) attitudes of health personnel; c) sense of belonging towards guidelines. The extrinsic factors were: a) organizational and environmental factors; b) workload; c) guidelines structure; d) patients and caregivers' attitude. CONCLUSIONS The included studies report lack of resources, among environmental factors, as the main barrier perceived. Nurses, who are at the forefront in addressing the direct application of knowledge and skills to ensure patient safety, have a higher perception of this kind of barriers than other healthcare personnel. Potential facilitators emerged in the review are positive feedback and reinforcements at the workplace, either from the members of the team or from the leaders. Moreover, the level of active participation of the patient and caregiver could have a positive impact on nurses' guidelines adherence. Guidelines implementation remains a complex process, resulting in a strong recommendation to support health policymakers and nursing leaders in implementing continuing education programs.
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Affiliation(s)
- Chiara Gallione
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy, Maggiore della Carità University Hospital, Novara, Italy
| | - Michela Barisone
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | | | - Moreno Pavani
- Maggiore della Carità University Hospital, Novara, Italy
| | | | - Erika Bassi
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy, Maggiore della Carità University Hospital, Novara, Italy
| | - Alberto Dal Molin
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy, Maggiore della Carità University Hospital, Novara, Italy
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Exploring Internal Facilitators' Experience With NeoECHO to Foster NEC Prevention and Timely Recognition Through the iPARIHS Lens. Adv Neonatal Care 2021; 21:462-472. [PMID: 34711740 DOI: 10.1097/anc.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Necrotizing enterocolitis (NEC) remains a major complication in the neonatal population. Standard practices regarding the care of premature infants and attitudes toward NEC prevention strategies vary across neonatal intensive care units (NICUs). Evidence-based best practice dissemination was presented through the NEC-Zero bundle. To close gaps between evidence and practice, a telehealth-delivered intervention (ie, NeoECHO) was provided to NICUs. PURPOSE The purpose of this study was to enable adoption of best practice for NEC prevention using NeoECHO through describing the local volunteer unit leaders', or internal facilitators' (IFs'), experiences in participating in NeoECHO and identifying the extent to which the facilitation activities within the NeoECHO experience were consistent with constructs from the integrated Promoting Action on Research Implementation in Health Services (iPARHIS) framework. METHODS The design of this study was qualitative descriptive. Six IFs were recruited in the Southwest. After 6 NeoECHO sessions, individual interviews were conducted and transcribed verbatim. Content analysis was applied. Codes were informed by the iPARIHS framework. RESULTS Major themes were (1) Innovation: Quality Improvement Projects, Bundles of Care, and Huddle; (2) Recipient: Reluctant Stakeholders and Technical Modalities; (3) Context: Buy-In, Timing, Resources, Leadership, and Blame; (4) Facilitation: Betterment, Buddy System, Passionate Care, and Empowerment; and (5) Adoption: Continuous Quality Improvement, Evidence-Based Practice, and Honest Discussions. IMPLICATIONS FOR PRACTICE AND RESEARCH NeoECHO fostered a learning community to share current practices, policies, and strategies for NEC prevention, but the IFs were essential to foster local participation. The long-term impacts of NeoECHO are the focus of current research.Video Abstract available athttps://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.
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Li Y, Lu Q, Wang B, Tang W, Fan L, Li D. Preoperative Fasting Times for Patients Undergoing Elective Surgery at a Pediatric Hospital in Shanghai: The Big Evidence-Practice Gap. J Perianesth Nurs 2021; 36:559-563. [PMID: 34404604 DOI: 10.1016/j.jopan.2021.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/13/2020] [Accepted: 01/08/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Preoperative fasting is a necessary experience for pediatric patients undergoing elective surgery. The American Society of Anesthesiologist guideline shows that preoperative fasting times were reduced and safe (no solid food up to 8 hours, no fluid or formula up to 6 hours, no breast milk up to 4 hours, and no clear fluids up to 2 hours before surgery). However, preoperative fasting is usually more prolonged than the suggested time. This study aimed to investigate the duration of preoperative fasting for elective surgery at a pediatric hospital in Shanghai, China, and compare it with the evidence from guidelines. DESIGN The study used a descriptive cross-sectional design. METHODS A total of 211 children under anesthesia in a Shanghai's pediatric hospital were included in the study. The preoperative fasting status was assessed using a self-administered record card of preoperative fasting developed by Chinese researchers. FINDINGS The results indicated that the length of time fasted preoperatively was longer for all participants than that recommended by the American Society of Anesthesiologists. With the long length of fasting time, it is evident that the majority of children experienced hunger (17.5%), thirst (19.4%), and anxiety (16.1%) as indicated with 8 points of the Likert 10-point scale. The degrees of these experiences were relevant to the length of preoperative fasting time. CONCLUSIONS A big gap was revealed between the recommendation and actual practice, and children underwent an uncomfortable experience before the surgery. These results suggest that evidence-based clinical improvement is required, and the recommended preoperative fasting instruction transform into clinical practice should be promoted.
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Affiliation(s)
- Youwei Li
- Cardiothoracic surgery Department, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Qunfeng Lu
- Nursing Department, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China.
| | - Beini Wang
- Cardiothoracic surgery Department, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China.
| | - Wenjuan Tang
- General Surgery Department, Shanghai Children's Hospital Jiaotong University, Shanghai, China
| | - Lingyan Fan
- Orthopedics Department, Shanghai Children's Hospital Jiaotong University, Shanghai, China
| | - Dan Li
- Gastroenterology Department, Shanghai Children's Hospital Jiaotong University, Shanghai, China
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Ritchie MJ, Parker LE, Kirchner JE. From novice to expert: methods for transferring implementation facilitation skills to improve healthcare delivery. Implement Sci Commun 2021; 2:39. [PMID: 33832549 PMCID: PMC8033694 DOI: 10.1186/s43058-021-00138-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 03/22/2021] [Indexed: 12/24/2022] Open
Abstract
Background There is substantial evidence that facilitation can address the challenges of implementing evidence-based innovations. However, facilitators need a wide variety of complex skills; lack of these can have a negative effect on implementation outcomes. Literature suggests that novice and less experienced facilitators need ongoing support from experts to develop these skills. Yet, no studies have investigated the transfer process. During a test of a facilitation strategy applied at 8 VA primary care clinics, we explored the techniques and processes an expert external facilitator utilized to transfer her skills to two initially novice internal facilitators who became experts. Methods In this qualitative descriptive study, we conducted monthly debriefings with three facilitators over a 30-month period and documented these in detailed notes. Debriefings with the expert facilitator focused on how she trained and mentored facilitation trainees. We also conducted, recorded, and transcribed two semi-structured qualitative interviews with each facilitator and queried them about training content and process. We used a mix of inductive and deductive approaches to analyze data; our analysis was informed by a review of mentoring, coaching, and cognitive apprenticeship literature. We also used a case comparison approach to explore how the expert tailored her efforts. Results The expert utilized 21 techniques to transfer implementation facilitation skills. Techniques included both active (providing information, modeling, and coaching) and participatory ones. She also used techniques to support learning, i.e., cognitive supports (making thinking visible, using heuristics, sharing experiences), psychosocial supports, strategies to promote self-learning, and structural supports. Additionally, she transferred responsibility for facilitation through a dynamic process of interaction with trainees and site stakeholders. Finally, the expert varied the level of focus on particular skills to tailor her efforts to trainee and local context. Conclusions This study viewed the journey from novice to expert facilitator through the lens of the expert who transferred facilitation skills to support implementation of an evidence-based program. It identified techniques and processes that may foster transfer of these skills and build organizational capacity for future implementation efforts. As the first study to document the implementation facilitation skills transfer process, findings have research and practical implications. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00138-5.
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Affiliation(s)
- Mona J Ritchie
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Department of Veterans Affairs, 2200 Ft Roots Dr, Building 58, North Little Rock, AR, 72114, USA. .,Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W Markham St, #755, Little Rock, AR, 72205, USA.
| | - Louise E Parker
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Department of Veterans Affairs, 2200 Ft Roots Dr, Building 58, North Little Rock, AR, 72114, USA.,Department of Management, College of Management, University of Massachusetts, 100 Morrissey Blvd, Boston, MA, 02125, USA
| | - JoAnn E Kirchner
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Department of Veterans Affairs, 2200 Ft Roots Dr, Building 58, North Little Rock, AR, 72114, USA.,Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W Markham St, #755, Little Rock, AR, 72205, USA
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Orton ML, Nelson Follin N, Dannapfel P, Wengström Y. Roles and functions in clinical care for registered nurses with a PhD-A systematic literature review. Scand J Caring Sci 2021; 36:16-26. [PMID: 33713487 DOI: 10.1111/scs.12979] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 02/02/2021] [Accepted: 02/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nurses are responsible for nursing care and their expertise is crucial for quality of care. One factor important to successful delivery of evidence-based care is availability of staff with the expertise to support their colleagues in this endeavour. RN/PhDs versed in scientific research with a thorough knowledge of their disciplines have the potential to help narrow the gap between theory and practice. The roles and functions of RN/PhDs involved in clinical care have not yet been well defined. AIM To explore publications concerning clinical contributions from registered nurses who hold a PhD (RN/PhDs) regarding impact on quality and improvement of care. METHOD A systematic literature review was conducted and qualitative content analysis was applied to the data obtained from the included studies. FINDINGS The leadership role is considered essential for RN/PhDs, where the focus is on the pursuit of evidence-based practice and the improvement of nursing practices. The opportunity to combine the clinical and academic aspects of nursing is considered crucial in order for RN/PhDs to influence and improve care, yet few such positions are currently available. RN/PhDs cited limited career opportunities as one important reason for not combining clinical and academic work. CONCLUSIONS In order for nursing practice to reach full potential, clinical positions with clearly defined job descriptions for RN/PhDs are needed. To fully leverage their expertise, it is important to allocate sufficient time to conduct relevant research, as well as to support colleagues and students in the improvement of clinical practice.
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Affiliation(s)
- Marie-Louise Orton
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden
| | - Nina Nelson Follin
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden.,Division of Children's and Women's Health, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,National Specialized Medical Care, Stockholm, Sweden
| | - Petra Dannapfel
- Karolinska University Hospital, Stockholm, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Yvonne Wengström
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.,Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
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Yong SY, Siop S, Kho WM. A cross-sectional study of early mobility practice in intensive care units in Sarawak Hospitals, Malaysia. Nurs Open 2021; 8:200-209. [PMID: 33318828 PMCID: PMC7729545 DOI: 10.1002/nop2.619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/02/2020] [Accepted: 08/06/2020] [Indexed: 11/30/2022] Open
Abstract
Aims To determine the prevalence, characteristics of EM activities, the relationship between level of activity and mode of ventilation and adherence rate of EM protocol. Background Mobilizing ICU patients remains a challenge, despite its safety, feasibility and positive short-term outcomes. Design A cross-sectional point prevalence study. Methods All patients who were eligible and admitted to the adult ICUs during March 2018 were recruited. Data were analysed by using the Statistical Package for Social Sciences version 24 for Windows. Results The prevalence of EM practice was 65.6%. The most frequently reported avoidable and unavoidable factors inhibit mobility were deep sedation and vasopressor infusion, respectively. Level II of activity was the most common level of activity performed in ICU patients. The invasive ventilated patient had 12.53 the odds to stay in bed as compared to non-invasive ventilated patient. An average adherence rate of EM protocol was 52.5%.
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Affiliation(s)
- Siew Yieng Yong
- Advanced Diploma in Intensive Care NursingMinistry of Health Malaysia Training InstitutionKuchingMalaysia
| | - Sidiah Siop
- Nursing DepartmentFaculty of Medicine and Health SciencesUniversiti Malaysia Sarawak (UNIMAS)KuchingMalaysia
| | - Wee Meng Kho
- Internal Medicine and DermatologyTimberland Medical CentreKuchingMalaysia
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Facilitation of evidence implementation within a clinical fellowship program: a mixed methods study. JBI Evid Implement 2020; 19:130-141. [PMID: 32897914 DOI: 10.1097/xeb.0000000000000252] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM Facilitation is a multifaceted process for supporting and enabling individual or group of health practitioners to implement positive changes in clinical practice. Facilitation has never been explored within the context of an educational program that integrates a practical, evidence-based implementation component, such as a clinical fellowship program (CFP). The aim of this research was to identify features of facilitation as it occurs in the JBI (formerly known as Joanna Briggs Institute) CFP that promotes the use of evidence into clinical practice. METHODS We used a mixed methods study design to address the objective of this study. An electronic survey was administered to clinicians of different clinical backgrounds who completed the CFP (i.e. clinical fellows). Purposively selected clinical fellows and assigned internal or external facilitators were interviewed. RESULTS Forty-three clinical fellows completed the survey and 16 individual interviews and two focus groups were conducted. Findings from the survey and interviews demonstrated that facilitation within the context of a CFP is a collaborative effort between assigned facilitators and clinical fellows. Our study showed that both assigned facilitators and clinical fellows perform facilitation activities, with assigned internal and external facilitators providing support and assistance to clinical fellows, who in turn, support the evidence implementation project within their local organization. The study also suggests that external facilitation should be tailored to the individual clinical fellow's characteristics and their previous experiences. CONCLUSION Facilitation in an evidence-based CFP involves a partnership between clinical fellows and assigned facilitators, indicating a collaborative effort that involves a set of internal and external facilitation activities. Our study findings can guide the delivery of CFPs, particularly in identifying suitable people for the facilitator's role, which can have important implications for evidence implementation. Future research should focus on evaluating the effectiveness of these programs in improving practice and health outcomes.
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21
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Bergström A, Ehrenberg A, Eldh AC, Graham ID, Gustafsson K, Harvey G, Hunter S, Kitson A, Rycroft-Malone J, Wallin L. The use of the PARIHS framework in implementation research and practice-a citation analysis of the literature. Implement Sci 2020; 15:68. [PMID: 32854718 PMCID: PMC7450685 DOI: 10.1186/s13012-020-01003-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework. METHODS This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail. RESULTS The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated. CONCLUSIONS In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.
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Affiliation(s)
- Anna Bergström
- Department of Women’s and Children’s health, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Uppsala, Sweden
- Institute for Global Health, University College London, London, UK
| | - Anna Ehrenberg
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Ann Catrine Eldh
- Department of Medicine and Health, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kazuko Gustafsson
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- University Library, Uppsala University, Uppsala, Sweden
| | - Gillian Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Green Templeton College, University of Oxford, Oxford, UK
| | - Jo Rycroft-Malone
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancashire, UK
| | - Lars Wallin
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Point-of-care used in the treatment of older patients with cancer. The perception and experience of nurses. Appl Nurs Res 2020; 53:151268. [PMID: 32451011 DOI: 10.1016/j.apnr.2020.151268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 04/03/2020] [Accepted: 04/16/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Nursing tasks are changing as the proportion of people over the age of 65 years is increasing and is expected to double over the next four decades. New innovative solutions such as Point of Care Treatment (POCT) are being tested in oncological settings in order to optimise treatment, and this changes the nurse management in oncology. There is a need to explore oncology nurses' perception and experience when implementing the innovations in order to understand the implications for nursing and the treatment of older patients with cancer. METHODS Qualitative research with face to face interviews with nurses working in oncology. Sample size (Mean = 8). Data were recorded verbatim, transcribed, and thematic analysis used. RESULTS Three themes were identified: a, A great advantage in nursing, b, Change of practice in nursing care, c, Challenges in shifting roles. A majority of the participants had the perception that POCT treatment was an advantage not only for the nursing profession but for the older patients in cancer treatment as well. Monitoring the older patients with cancer at home would prevent them from accessing the hospital and get exposed to viral infections as well as saving them the journey to the hospital. Involvement from relatives, clear communication and management of the device and data transferred is essential. CONCLUSIONS The use of POCT in oncology will shift the nurses' tasks on the ward as well as improve treatment for older patients with cancer.
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Clavijo-Chamorro MZ, Sanz-Martos S, Gómez-Luque A, Romero-Zarallo G, López-Medina IM. Context as a Facilitator of the Implementation of Evidence-based Nursing: A Meta-synthesis. West J Nurs Res 2020; 43:60-72. [PMID: 32321372 DOI: 10.1177/0193945920914397] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nurses have numerous difficulties in implementing science due to obstacles related to the work context. The aim is to explore the work-context-related facilitators of the application of evidence in clinical practice by nursing professionals. Qualitative meta-synthesis of primary studies on nurses' experiences of work-context-related facilitators, as defined by the Promoting Action on Research Implementation in Health Services model. Using the Qualitative Appraisal and Review Instrument of the Joanna Briggs Institute. Of the total 57 primary research articles included, an explanatory model of the facilitating factors related to the work context was generated on the basis of four general categories: institutional support (leadership), multidisciplinary support (teamwork and communication), culture of improving quality of care (nursing professionals' attitudes towards change) and use of research (valuing research). Action can be taken on the facilitating factors of the evidence-based practice application in nursing clinical environments, providing resources and motivation from the organization.
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Affiliation(s)
- María Zoraida Clavijo-Chamorro
- Department of Nursing, Faculty of Nursing and Occupational Therapy, University of Extremadura, Cáceres, Extremadura, Spain
| | - Sebastián Sanz-Martos
- Department of Nursing, Faculty of Health Sciences, University of Jaén, Andalusia, Spain
| | - Adela Gómez-Luque
- Department of Nursing, Faculty of Nursing, University of Extremadura, Plasencia, Extremadura, Spain
| | - Gema Romero-Zarallo
- Department of Nursing, Faculty of Nursing and Occupational Therapy, University of Extremadura, Cáceres, Extremadura, Spain
| | - Isabel M López-Medina
- Department of Nursing, Faculty of Health Sciences, University of Jaén, Andalusia, Spain
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Lin F, Marshall AP, Gillespie B, Li Y, O'Callaghan F, Morrissey S, Whitelock K, Morley N, Chaboyer W. Evaluating the Implementation of a Multi-Component Intervention to Prevent Surgical Site Infection and Promote Evidence-Based Practice. Worldviews Evid Based Nurs 2020; 17:193-201. [PMID: 32282120 DOI: 10.1111/wvn.12436] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Published clinical practice guidelines on surgical site infection prevention are available; however, adherence to these guidelines remains suboptimal. AIMS The aim of this study was to evaluate the effectiveness and perceived benefits of intervention and implementation strategies co-created by researchers and clinicians to prevent surgical site infections. METHODS This mixed-method evaluation study involved an audit of nurses' wound care practices, followed by focus group and individual interviews to understand the perceived benefits of the intervention and implementation strategies. Descriptive statistical analyses were used to compare post-intervention audit data with baseline results. Deductive and inductive content analyses were undertaken on the qualitative data. RESULTS The audit showed improvements in using aseptic technique and wound care documentation practices following intervention implementation. Nurses perceived the change champion as effective in role-modelling good practice. Education strategies including a poster and using a scenario-based quiz were viewed as easy to understand and helpful for nurses to apply aseptic technique in practice. The instructions and education conducted to improve documentation were considered important in the success of the Wound Care Template implementation. LINKING EVIDENCE TO ACTION The integrated knowledge translation approach used in this study ensured the intervention and the implementation strategies employed were appropriate and meaningful for clinicians. Such strategies may be used in other intervention studies. The change champion played an important role in driving change and acted as a vital partner during the co-creation and the implementation processes. Ongoing education, audit and feedback became integrated in the ward nurses' routine practice, which has the potential to continuously improve and sustain evidence-based practice.
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Affiliation(s)
- Frances Lin
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Gold Coast Health and Griffith University, Gold Coast, Queensland, Australia
| | - Andrea P Marshall
- Menzies Health Institute Queensland, Gold Coast Health and Griffith University, Gold Coast, Queensland, Australia
| | - Brigid Gillespie
- Menzies Health Institute Queensland, Gold Coast Health and Griffith University, Gold Coast, Queensland, Australia
| | - Yu Li
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Frances O'Callaghan
- School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia
| | - Shirley Morrissey
- School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia
| | - Karen Whitelock
- Surgical Specialties Unit, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Nicola Morley
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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2019 Guideline for Management of Wounds in Patients With Lower-Extremity Venous Disease (LEVD): An Executive Summary. J Wound Ostomy Continence Nurs 2020; 47:97-110. [PMID: 32150136 DOI: 10.1097/won.0000000000000622] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article provides an executive summary of the 2019 Guideline for Management of Wounds in Patients with Lower-Extremity Venous Disease (LEVD) published by the Wound, Ostomy and Continence Nurses Society (WOCN). The executive summary presents an overview of the systematic process used to update and develop the guideline. It also lists the specific recommendations from the guideline for assessment, prevention, and management of LEVD and venous leg ulcers (VLUs). In addition, the guideline includes a new section regarding implementation of clinical practice guidelines. The LEVD guideline is a resource for WOC nurse specialists and other nurses, physicians, therapists, and health care professionals who work with adults who have or who are at risk for VLU.
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Connolly SL, Sullivan JL, Ritchie MJ, Kim B, Miller CJ, Bauer MS. External facilitators' perceptions of internal facilitation skills during implementation of collaborative care for mental health teams: a qualitative analysis informed by the i-PARIHS framework. BMC Health Serv Res 2020; 20:165. [PMID: 32131824 PMCID: PMC7057643 DOI: 10.1186/s12913-020-5011-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 02/20/2020] [Indexed: 11/16/2022] Open
Abstract
Background Facilitation is a key strategy that may contribute to successful implementation of healthcare innovations. In blended facilitation, external facilitators (EFs) guide and support internal facilitators (IFs) in directing implementation processes. Developers of the i-PARIHS framework propose that successful facilitation requires project management, team/process, and influencing/negotiating skills. It is unclear what IF skills are most important in real-world settings, which could inform recruitment and training efforts. As prior qualitative studies of IF skills have only interviewed IFs, the perspectives of their EF partners are needed. Furthermore, little is known regarding the distribution of implementation tasks between IFs and EFs, which could impact sustainability once external support is removed. In the context of an implementation trial, we therefore: 1) evaluated IFs’ use of i-PARIHS facilitation skills, from EFs’ perspectives; 2) identified attributes of IFs not encompassed within the i-PARIHS skills; and 3) investigated the relative contributions of IFs and EFs during facilitation. Methods Analyses were conducted within a hybrid type II trial utilizing blended facilitation to implement the collaborative chronic care model within mental health teams of nine VA medical centers. Each site committed one team and an IF to weekly process design meetings and additional implementation activities over 12 months. Three EFs worked with three sites each. Following study completion, the EFs completed semi-structured qualitative interviews reflecting on the facilitation process, informed by the i-PARIHS facilitation skill areas. Interviews were analyzed via directed content analysis. Results EFs emphasized the importance of IFs having strong project management, team/process, and influencing/negotiating skills. Prior experience in these areas and a mental health background were also benefits. Personal characteristics (e.g., flexible, assertive) were described as critical, particularly when faced with conflict. EFs discussed the importance of clear delineation of EF/IF roles, and the need to shift facilitation responsibilities to IFs. Conclusions Key IF skills, according to EFs, are aligned with i-PARIHS recommendations, but IFs’ personal characteristics were also emphasized as important factors. Findings highlight traits to consider when selecting IFs and potential training areas (e.g., conflict management). EFs and IFs must determine an appropriate distribution of facilitation tasks to ensure long-term sustainability of practices. Trial registration Clinicaltrials.gov, September 7, 2015, #NCT02543840.
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Affiliation(s)
- Samantha L Connolly
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave., Building 9, Room 208C, Boston, MA, 02130, USA. .,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Jennifer L Sullivan
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave., Building 9, Room 208C, Boston, MA, 02130, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Mona J Ritchie
- VA Quality Enhancement Research Initiative (QUERI) Program for Team-Based Behavioral Health, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Bo Kim
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave., Building 9, Room 208C, Boston, MA, 02130, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Christopher J Miller
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave., Building 9, Room 208C, Boston, MA, 02130, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Mark S Bauer
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave., Building 9, Room 208C, Boston, MA, 02130, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Ritchie MJ, Parker LE, Kirchner JE. From novice to expert: a qualitative study of implementation facilitation skills. Implement Sci Commun 2020; 1:25. [PMID: 32885184 PMCID: PMC7427882 DOI: 10.1186/s43058-020-00006-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/09/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND It is widely reported that facilitation can aid implementation of evidence-based practices. Although scholars agree that facilitators need a diverse range of skills, only a few retrospective studies have identified some of these. During the test of a facilitation strategy within the context of a VA initiative to implement evidence-based care delivery models, we documented the skills an expert external facilitator transferred to two initially novice internal regional facilitators. Ours is the first study to explore facilitation skills as they are being applied and transferred. METHODS Facilitators applied the strategy at eight primary care clinics that lacked implementation capacity in two VA networks. We conducted monthly debriefing interviews over a 30-month period and documented these in detailed notes. External facilitator interviews focused specifically on training and mentoring internal facilitators and the skills that she transferred. We also conducted, recorded, and transcribed two qualitative interviews with each facilitator and queried them about training content and process. We conducted a content analysis of the data, using deductive and inductive methods, to identify skills the external facilitator helped internal facilitators learn. We also explored the complexity of facilitation skills and grouped them into overarching skillsets. RESULTS The external facilitator helped internal facilitators learn 22 complex skills; with few exceptions, these skills were not unique but overlapped with one another. We clustered 21 of these into 5 groups of overarching skillsets: (1) building relationships and creating a supportive environment, (2) changing the system of care and the structure and processes that support it, (3) transferring knowledge and skills and creating infrastructure support for ongoing learning, (4) planning and leading change efforts, and (5) assessing people, processes, and outcomes and creating infrastructure for program monitoring. CONCLUSIONS This study documented a broad range of implementation facilitation skills that are complex and overlapping. Findings suggest that studies and initiatives planning or applying facilitation as an implementation strategy should ensure that facilitators have or have the opportunity to learn the skills they need. Because facilitation skills are complex, the use of didactic methods alone may not be sufficient for transferring skills; future work should explore other methods and techniques.
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Affiliation(s)
- Mona J. Ritchie
- VA Quality Enhancement Research Initiative (QUERI) Program for Team-Based Behavioral Health, Department of Veterans Affairs, 2200 Ft Roots Dr, Building 58, North Little Rock, AR 72114 USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W Markham St, #755, Little Rock, AR 72205 USA
| | - Louise E. Parker
- VA Quality Enhancement Research Initiative (QUERI) Program for Team-Based Behavioral Health, Department of Veterans Affairs, 2200 Ft Roots Dr, Building 58, North Little Rock, AR 72114 USA
- Department of Management and Marketing, College of Management, University of Massachusetts, 100 Morrissey Blvd, Boston, MA 02125 USA
| | - JoAnn E. Kirchner
- VA Quality Enhancement Research Initiative (QUERI) Program for Team-Based Behavioral Health, Department of Veterans Affairs, 2200 Ft Roots Dr, Building 58, North Little Rock, AR 72114 USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W Markham St, #755, Little Rock, AR 72205 USA
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Gallagher‐Ford L, Koshy Thomas B, Connor L, Sinnott LT, Melnyk BM. The Effects of an Intensive Evidence‐Based Practice Educational and Skills Building Program on EBP Competency and Attributes. Worldviews Evid Based Nurs 2020; 17:71-81. [DOI: 10.1111/wvn.12397] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Lynn Gallagher‐Ford
- Helene Fuld Health Trust National Institute for EBP in Nursing & Healthcare Columbus OH USA
- Helene Fuld Health Trust National Institute for EBP in Nursing & Healthcare, College of Nursing The Ohio State University Columbus OH USA
| | - Bindu Koshy Thomas
- Helene Fuld Health Trust National Institute for EBP in Nursing & Healthcare, College of Nursing The Ohio State University Columbus OH USA
| | - Linda Connor
- Helene Fuld Health Trust National Institute for EBP in Nursing & Healthcare, College of Nursing The Ohio State University Columbus OH USA
- College of Nursing The Ohio State University Columbus OH USA
| | | | - Bernadette Mazurek Melnyk
- Helene Fuld Health Trust National Institute for EBP in Nursing & Healthcare Columbus OH USA
- College of Nursing The Ohio State University Columbus OH USA
- College of Medicine The Ohio State UniversityColumbus OH USA
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Baloh J, Zhu X, Ward MM. What Influences Sustainment and Nonsustainment of Facilitation Activities in Implementation? Analysis of Organizational Factors in Hospitals Implementing TeamSTEPPS. Med Care Res Rev 2019; 78:146-156. [PMID: 31092101 DOI: 10.1177/1077558719848267] [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] [Indexed: 11/15/2022]
Abstract
Implementation processes are often long and complex, requiring sustained facilitation efforts. Drawing on organizational and implementation literature, we examined the influence of senior management support (SMS), middle management support (MMS), facilitator team time availability (TIME) and team continuity (CONTINUITY) on sustainment of internal facilitation activities. For 2 years, we followed 10 small rural hospitals implementing TeamSTEPPS, a patient safety program, and conducted quarterly interviews with key informants. We coded, calibrated, and analyzed the data using the fuzzy-set qualitative comparative analysis. We found that five hospitals sustained facilitation activities and the combination of SMS, MMS, and CONTINUITY (i.e., presence of all three factors) was a sufficient condition for sustainment. Five other hospitals did not sustain facilitation activities and they either lacked MMS or lacked both TIME and CONTINUITY. In follow-up analyses, we found that team leadership continuity also influenced sustainment patterns. We discussed the implications for research and practice.
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Affiliation(s)
- Jure Baloh
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Xi Zhu
- University of Iowa, Iowa City, Iowa, USA
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Orton M, Andersson Å, Wallin L, Forsman H, Eldh AC. Nursing management matters for registered nurses with a PhD working in clinical practice. J Nurs Manag 2019; 27:955-962. [DOI: 10.1111/jonm.12750] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/10/2019] [Accepted: 01/13/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Marie‐Louise Orton
- Department of Neurobiology, Care Sciences and Society Karolinska Institutet Stockholm Sweden
- Department of Quality and Patient Safety Karolinska University Hospital Stockholm Sweden
| | | | - Lars Wallin
- School of Education, Health and Social Studies Dalarna University Falun Sweden
- Division of Nursing, Department of Neurobiology, Care Sciences and Society Karolinska Institutet Stockholm Sweden
- Department of Health and Care Sciences, The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Henrietta Forsman
- School of Education, Health and Social Studies Dalarna University Falun Sweden
| | - Ann Catrine Eldh
- Faculty of Medicine and Health Sciences Linköping University Linköping Sweden
- Department of Public Health and Caring Sciences Uppsala University Uppsala Sweden
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Elledge C, Avworo A, Cochetti J, Carvalho C, Grota P. Characteristics of facilitators in knowledge translation: An integrative review. Collegian 2019. [DOI: 10.1016/j.colegn.2018.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Kingsnorth S, Orava T, Parker K, Milo-Manson G. From knowledge translation theory to practice: developing an evidence to care hub in a pediatric rehabilitation setting. Disabil Rehabil 2019; 42:869-879. [PMID: 30621521 DOI: 10.1080/09638288.2018.1514075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose: Ensuring evidence-informed care happens systematically and consistently is not easy in complex health facilities. This paper describes the evolution of knowledge translation infrastructure (Evidence to Care) within a pediatric rehabilitation hospital to address barriers to evidence-informed decision-making and accelerate research uptake to influence clinical care.Methods: Development of Evidence to Care involved a series of steps integrating knowledge translation principles, best evidence and stakeholder needs. Key aspects included: recognizing health system drivers and organizational enablers; establishing organizational structures and processes; building and operationalizing a strategic vision through activities and demonstration projects; and evaluating impact.Results: By way of a fully realized working model, two large-scale demonstration projects aligned with the Knowledge-to-Action Cycle have been completed. Audit findings demonstrate tangible examples of improving healthcare quality through investment in knowledge translation resources, processes and tailored evidence products. Critical enablers of this infrastructure include strong leadership commitment and ongoing direction, a dedicated expert team, alignment with strategic priorities and situated within organizational structures to link research, clinical care and education.Conclusions: With a replicable model, Evidence to Care addresses established health system barriers related to time, resources, skill and knowledge through dedicated knowledge translation specialists and knowledge brokers to facilitate knowledge translation practice.Implications for rehabilitationDeveloping dedicated knowledge translation infrastructure is both novel and relatively new in healthcare.Sharing step by step processes helps other organizations learn from field-tested experiences of what works and what doesn't in a particular setting.Involving stakeholders at all levels of an organization is key to valuing knowledge translation and fostering an evidence-friendly culture.Co-creating tailored knowledge products and planning for dissemination and uptake fosters inter-disciplinary collaboration and joint problem-solving among clients, families and providers.
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Affiliation(s)
- Shauna Kingsnorth
- Teaching & Learning Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Taryn Orava
- Teaching & Learning Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Kathryn Parker
- Teaching & Learning Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Golda Milo-Manson
- Teaching & Learning Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada
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Palese A, Gonella S, Grassetti L, Destrebecq A, Mansutti I, Terzoni S, Zannini L, Altini P, Bevilacqua A, Brugnolli A, Dal Ponte A, De Biasio L, Fascì A, Grosso S, Mantovan F, Marognolli O, Nicotera R, Randon G, Tollini M, Canzan F, Saiani L, Dimonte V. Multilevel National Analysis of Nursing Students' Perceived Opportunity to Access Evidence-Based Tools During Their Clinical Learning Experience. Worldviews Evid Based Nurs 2018; 15:480-490. [PMID: 30328676 DOI: 10.1111/wvn.12328] [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] [Accepted: 08/03/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Easy-to-access tools have been demonstrated to improve evidence-based practice (EBP) competences among nursing students. However, students' perception of access to EBP tools (e.g., clinical practice guidelines [CPGs], protocols) is unknown. AIMS To explore: (1) nursing students' opportunity to access EBP tools during their education, and (2) associated factors. METHODS A national cross-sectional study including all Italian nursing programs. Nursing students were deemed eligible according to the following inclusion criteria: Those who (1) were attending or just ended their practical rotation lasting at least 2 weeks at the time of the survey, and (2) expressed through written informed consent their willingness to take part in the study. Participants were asked about their perceived opportunity to access EBP tools during their most recent clinical learning experience (from 0 - not at all to 3 - always). A set of explanatory variables was collected at the individual, nursing program, and regional levels by using a questionnaire. RESULTS Nine thousand six hundred and seven (91.6%) out of 10,480 nursing students took part in the study. Overall, 4,376 (45.6%) students perceived not at all or only a small opportunity to access EBP tools during their most recent clinical rotation. In the multilevel analysis, factors promoting access were mainly set at the clinical learning environment level (high safety and nursing care quality, high self-directed learning opportunities, high quality of the learning environment, and being supervised by a clinical nurse). In contrast, male gender and lower academic class were associated with a lower perception of accessibility to EBP tools. A consistent variability in the perceived opportunity to access EBP tools emerged across regions. LINKING EVIDENCE TO ACTION Evidence-based decision-making is increasingly expected from nurses. Therefore, nursing faculties should safeguard and continuously improve students' competence regarding EBP, by implementing strategies mainly at the nursing program and regional levels.
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Affiliation(s)
- Alvisa Palese
- Department of Medical Sciences, University of Udine, Udine, Italy
| | | | - Luca Grassetti
- Department of Medical Sciences, University of Udine, Udine, Italy
| | | | - Irene Mansutti
- Department of Medical Sciences, University of Udine, Udine, Italy
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Saunders H, Vehviläinen‐Julkunen K. Key considerations for selecting instruments when evaluating healthcare professionals’ evidence‐based practice competencies: A discussion paper. J Adv Nurs 2018; 74:2301-2311. [DOI: 10.1111/jan.13802] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/02/2018] [Accepted: 06/27/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Hannele Saunders
- Faculty of Health Sciences Department of Nursing Science University of Eastern Finland Kuopio Finland
- South‐Eastern Finland University of Applied Sciences (Xamk) Kuopio Finland
| | - Katri Vehviläinen‐Julkunen
- Faculty of Health Sciences Department of Nursing Science University of Eastern Finland and Kuopio University Hospital Kuopio Finland
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Lockwood R, Kable A, Hunter S. Evaluation of a nurse-led intervention to improve adherence to recommended guidelines for prevention of venous thromboembolism for hip and knee arthroplasty patients: A quasi-experimental study. J Clin Nurs 2018; 27:e1048-e1060. [PMID: 29076258 DOI: 10.1111/jocn.14141] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To measure adherence to a nurse-led evidence-based venous thromboembolism prevention programme (intervention) compared to usual care in hip and knee arthroplasty patients and associated clinical outcomes. BACKGROUND Venous thromboembolism morbidity and mortality of hospitalised patients is a major concern for health professionals. Venous thromboembolism prevention guidelines have been developed; however, adherence to guidelines is variable. PARTICIPANTS There were 410 potential participants who were adult patients that were booked for elective hip or knee arthroplasty at the two study sites during a 2-year period (2011-2013). Of these, 27 did not meet the inclusion criteria, and the remainder were eligible for inclusion in the study (intervention site n = 196 and control site n = 187, total population n = 383). METHODS This study adopted a quasi-experimental design, using an intervention and control study site, conducted in two private hospitals in a regional area in Australia. RESULTS The intervention group had a mean compliance score of 11.09, higher than the control group score of 7.19. This is equivalent to a compliance rate of 85% and 55%, respectively, and indicates that adherence at the study site was significantly higher. Patient adherence and outcomes in the postdischarge period were not significantly different between the study sites. CONCLUSION This study demonstrated a nurse-led intervention achieved high adherence with translating evidence-based guidelines into routine patient care for hip and knee arthroplasty patients. Nurses can be critical to implementing clinical practice guidelines and adopting preventive programmes in acute care to improve patient outcomes and reduce postoperative venous thromboembolism in arthroplasty patients. RELEVANCE TO CLINICAL PRACTICE This research demonstrates the capacity of nurses to lead the translation of evidence-based practice guidelines for prevention of venous thromboembolism into routine patient care.
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Affiliation(s)
- Rosemarie Lockwood
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
| | - Ashley Kable
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
| | - Sharyn Hunter
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
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Lin FF, Chaboyer W, Foster M, Hervey L, Marshall AP. Facilitating the relocation of an intensive care unit from shared room to single room setting: Staff perceptions on the effectiveness of a multicomponent intervention. Aust Crit Care 2018; 32:279-284. [PMID: 30087061 DOI: 10.1016/j.aucc.2018.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/20/2018] [Accepted: 06/26/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Current strategies for new and redesigned intensive care units (ICUs) involve incorporation of single occupancy rooms. These changes have largely been made for infection control and patient privacy reasons. However, there is limited literature available on how to manage the transition of an ICU from shared room to a single room environment. AIMS The aim of this study was to evaluate staff members' perceived effectiveness of a multicomponent intervention to facilitate transition from a shared to a single room setting. METHODS This qualitative study was conducted in a 20-bed ICU of an Australian tertiary teaching hospital. In total, 24 staff members were interviewed in five groups and five individual interviews 6 months after the ICU relocation. FINDINGS Three themes emerged from data analysis: (1) facilitating staff members' transition and engagement during relocation planning; (2) simulating new work processes for the single room setting; and (3) supporting nurses working in the single rooms. The components of the intervention, including the change agent, the relocation working party, Assistance, Coordination, Contingency, Education, Supervision, and Support nurse rounding model, and the safe single room model, were perceived as important strategies to support the relocation transition. The regular newsletter and the information dissemination strategy informed by the social networking survey were viewed to improve communication. Staffing levels and education models that are suitable for the single room setting were identified as areas for improvement. DISCUSSION AND CONCLUSION A systematic change management approach, clear communication, staff engagement, and continuously monitoring new work processes are important strategies to ensure the success of the relocation. Delivery of education in the clinical area needs to be further explored to ascertain the impact of a single room environment on its delivery. Intervention co-creation involving research team members and the clinical staff was important in building change management capacity, which may contribute to intervention sustainability and continued clinical practice improvement.
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Affiliation(s)
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Griffith University, Australia; National Centre of Research Excellence in Nursing Interventions for Hospitalised Patients (NCREN), Menzies Health Institute Queensland, Griffith University, Australia
| | - Michelle Foster
- Intensive Care Unit, Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia
| | - Lucy Hervey
- Intensive Care Unit, Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia
| | - Andrea P Marshall
- School of Nursing and Midwifery, Griffith University, Australia; National Centre of Research Excellence in Nursing Interventions for Hospitalised Patients (NCREN), Menzies Health Institute Queensland, Griffith University, Australia; Intensive Care Unit, Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia
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Smith SN, Almirall D, Prenovost K, Goodrich DE, Abraham KM, Liebrecht C, Kilbourne AM. Organizational culture and climate as moderators of enhanced outreach for persons with serious mental illness: results from a cluster-randomized trial of adaptive implementation strategies. Implement Sci 2018; 13:93. [PMID: 29986765 PMCID: PMC6038326 DOI: 10.1186/s13012-018-0787-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 06/26/2018] [Indexed: 01/05/2023] Open
Abstract
Background Organizational culture and climate are considered key factors in implementation efforts but have not been examined as moderators of implementation strategy comparative effectiveness. We investigated organizational culture and climate as moderators of comparative effectiveness of two sequences of implementation strategies (Immediate vs. Delayed Enhanced Replicating Effective Programs [REP]) combining Standard REP and REP enhanced with facilitation on implementation of an outreach program for Veterans with serious mental illness lost to care at Veterans Health Administration (VA) facilities nationwide. Methods This study is a secondary analysis of the cluster-randomized Re-Engage implementation trial that assigned 3075 patients at 89 VA facilities to either the Immediate or Delayed Enhanced REP sequences. We hypothesized that sites with stronger entrepreneurial culture, task, or relational climate would benefit more from Enhanced REP than Standard REP. Veteran- and site-level data from the Re-Engage trial were combined with site-aggregated measures of entrepreneurial culture and task and relational climate from the 2012 VA All Employee Survey. Longitudinal mixed-effects logistic models examined whether the comparative effectiveness of the Immediate vs. Delayed Enhanced REP sequences were moderated by culture or climate measures at 6 and 12 months post-randomization. Three Veteran-level outcomes related to the engagement with the VA system were assessed: updated documentation, attempted contact by coordinator, and completed contact. Results For updated documentation and attempted contact, Veterans at sites with higher entrepreneurial culture and task climate scores benefitted more from Enhanced REP compared to Standard REP than Veterans at sites with lower scores. Few culture or climate moderation effects were detected for the comparative effectiveness of the full sequences of implementation strategies. Conclusions Implementation strategy effectiveness is highly intertwined with contextual factors, and implementation practitioners may use knowledge of contextual moderation to tailor strategy deployment. We found that facilitation strategies provided with Enhanced REP were more effective at improving uptake of a mental health outreach program at sites with stronger entrepreneurial culture and task climate; Veterans at sites with lower levels of these measures saw more similar improvement under Standard and Enhanced REP. Within resource-constrained systems, practitioners may choose to target more intensive implementation strategies to sites that will most benefit from them. Trial registration ISRCTN: ISRCTN21059161. Date registered: April 11, 2013. Electronic supplementary material The online version of this article (10.1186/s13012-018-0787-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shawna N Smith
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA. .,Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Daniel Almirall
- Institute for Social Research and Department of Statistics, University of Michigan, Ann Arbor, MI, USA
| | - Katherine Prenovost
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - David E Goodrich
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Kristen M Abraham
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Psychology, University of Detroit Mercy, Detroit, MI, USA
| | - Celeste Liebrecht
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Amy M Kilbourne
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Health Services Research and Development, Veterans Health Administration, US Department of Veterans, Washington DC, USA
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Travers C, Henderson A, Graham F, Beattie E. CogChamps: impact of a project to educate nurses about delirium and improve the quality of care for hospitalized patients with cognitive impairment. BMC Health Serv Res 2018; 18:534. [PMID: 29986686 PMCID: PMC6038243 DOI: 10.1186/s12913-018-3286-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Achieving sustainable practice changes to ensure best-practice nursing care in acute hospital environments can be challenging and is not well understood. A multi-faceted practice change intervention was implemented in a large Australian hospital to enhance the capacity of the nursing workforce to provide quality care for older patients with cognitive impairment (CI). METHODS Thirty-four experienced Registered Nurses (RNs) became Cognition Champions (CogChamps), and led practice-change initiatives to improve nursing care for older patients (≥65 years) on six wards in one hospital. The CogChamps received comprehensive education about dementia and the identification, prevention, and management of delirium. Over five months, they were supported to develop and implement ward-specific Action Plans designed to change care practices. Nurse-patient interactions were observed and patient charts were audited prior to the implementation of the plans and regularly throughout, using a purpose built Audit/ Observational tool. Data were also collected at a comparable hospital where there were no CogChamps. Data were analyzed for evidence of practice change. RESULTS Observational and audit data were collected for 181 patients (average age = 82.5 years) across the two hospitals. All patients had CI and both cohorts had similar behavioral characteristics requiring a high level of care assistance [e.g. 38% displayed evidence of confusion/disorientation and a majority experienced meal-time difficulty (62-70%)]. While nursing practices were generally the same at both hospitals, some differences were evident (e.g. analgesia use was higher at the control hospital). Following implementation of Action Plans, significant increases in nurses' assessments of patients' cognitive functioning (35 to 69%), and administration of analgesia (27 to 48%) were observed at the intervention hospital, although only the improvement in cognitive assessments was maintained at three months follow-up. No other changes in nursing processes were evident. CONCLUSION The CogChamps project demonstrates how RN champions were empowered to educate their colleagues about dementia and delirium resulting in a sustained increase in cognitive assessments by ward nurses. Practice improvements were mostly associated with clearly defined Action Plan tasks and goals and where responsibility for task completion was clearly assigned. These elements appear to be important when implementing practice changes. TRIAL REGISTRATION Australian Clinical Trials Registration Number: ACTRN 12617000563369 . Retrospectively registered.
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Affiliation(s)
| | - Amanda Henderson
- Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Frederick Graham
- Queensland University of Technology, Kelvin Grove, QLD, Australia
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Travers C, Henderson A, Graham F, Beattie E. Turning education into action: Impact of a collective social education approach to improve nurses' ability to recognize and accurately assess delirium in hospitalized older patients. NURSE EDUCATION TODAY 2018; 62:91-97. [PMID: 29306752 DOI: 10.1016/j.nedt.2017.12.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 11/20/2017] [Accepted: 12/20/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Although cognitive impairment including dementia and delirium is common in older hospital patients, it is not well recognized or managed by hospital staff, potentially resulting in adverse events. This paper describes, and reports on the impact of a collective social education approach to improving both nurses' knowledge of, and screening for delirium. METHODS Thirty-four experienced nurses from six hospital wards, became Cognition Champions (CogChamps) to lead their wards in a collective social education process about cognitive impairment and the assessment of delirium. At the outset, the CogChamps were provided with comprehensive education about dementia and delirium from a multidisciplinary team of clinicians. Their knowledge was assessed to ascertain they had the requisite understanding to engage in education as a collective social process, namely, with each other and their local teams. Following this, they developed ward specific Action Plans in collaboration with their teams aimed at educating and evaluating ward nurses' ability to accurately assess and care for patients for delirium. The plans were implemented over five months. The broader nursing teams' knowledge was assessed, together with their ability to accurately assess patients for delirium. RESULTS Each ward implemented their Action Plan to varying degrees and key achievements included the education of a majority of ward nurses about delirium and the certification of the majority as competent to assess patients for delirium using the Confusion Assessment Method. Two wards collected pre-and post-audit data that demonstrated a substantial improvement in delirium screening rates. CONCLUSION The education process led by CogChamps and supported by educators and clinical experts provides an example of successfully educating nurses about delirium and improving screening rates of patients for delirium. TRIAL REGISTRATION ACTRN 12617000563369.
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Affiliation(s)
- Catherine Travers
- Dementia Collaborative Research Centre, School of Nursing, Queensland University of Technology, Victoria Park Road, Kelvin Grove Q 4059, Australia.
| | - Amanda Henderson
- Nursing Practice Development Unit, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Qld 4102, Australia.
| | - Fred Graham
- Dementia and Delirium, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Qld 4102, Australia.
| | - Elizabeth Beattie
- Dementia Centre for Collaborative (DCRC School of Nursing), Queensland University of Technology (QUT), Level 6, N Block, Victoria Park Rd., Kelvin Grove, Qld 4059, Australia.
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Ranade-Kharkar P, Weir C, Norlin C, Collins SA, Scarton LA, Baker GB, Borbolla D, Taliercio V, Del Fiol G. Information needs of physicians, care coordinators, and families to support care coordination of children and youth with special health care needs (CYSHCN). J Am Med Inform Assoc 2018; 24:933-941. [PMID: 28371887 DOI: 10.1093/jamia/ocx023] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/24/2017] [Indexed: 12/22/2022] Open
Abstract
Objectives Identify and describe information needs and associated goals of physicians, care coordinators, and families related to coordinating care for medically complex children and youth with special health care needs (CYSHCN). Materials and Methods We conducted 19 in-depth interviews with physicians, care coordinators, and parents of CYSHCN following the Critical Decision Method technique. We analyzed the interviews for information needs posed as questions using a systematic content analysis approach and categorized the questions into information need goal types and subtypes. Results The Critical Decision Method interviews resulted in an average of 80 information needs per interview. We categorized them into 6 information need goal types: (1) situation understanding, (2) care networking, (3) planning, (4) tracking/monitoring, (5) navigating the health care system, and (6) learning, and 32 subtypes. Discussion and Conclusion Caring for CYSHCN generates a large amount of information needs that require significant effort from physicians, care coordinators, parents, and various other individuals. CYSHCN are often chronically ill and face developmental challenges that translate into intense demands on time, effort, and resources. Care coordination for CYCHSN involves multiple information systems, specialized resources, and complex decision-making. Solutions currently offered by health information technology fall short in providing support to meet the information needs to perform the complex care coordination tasks. Our findings present significant opportunities to improve coordination of care through multifaceted and fully integrated informatics solutions.
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Affiliation(s)
- Pallavi Ranade-Kharkar
- Intermountain Healthcare, Murray, UT, USA.,Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA.,VA Medical Center, Salt Lake City, UT, USA
| | - Chuck Norlin
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA.,Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Sarah A Collins
- Partners HealthCare, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lou Ann Scarton
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | | | - Damian Borbolla
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Vanina Taliercio
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
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Duncombe DC. A multi-institutional study of the perceived barriers and facilitators to implementing evidence-based practice. J Clin Nurs 2018; 27:1216-1226. [DOI: 10.1111/jocn.14168] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2017] [Indexed: 11/27/2022]
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Heyns T, Botma Y, Van Rensburg G. A creative analysis of the role of practice development facilitators in a critical care environment. Health SA 2017. [DOI: 10.1016/j.hsag.2016.03.002] [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] Open
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Lizarondo L, McArthur A. Strategies for Effective Facilitation as a Component of an Evidence-Based Clinical Fellowship Program. J Contin Educ Nurs 2017; 48:458-463. [DOI: 10.3928/00220124-20170918-07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/26/2017] [Indexed: 11/20/2022]
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Cranley LA, Cummings GG, Profetto-McGrath J, Toth F, Estabrooks CA. Facilitation roles and characteristics associated with research use by healthcare professionals: a scoping review. BMJ Open 2017; 7:e014384. [PMID: 28801388 PMCID: PMC5724142 DOI: 10.1136/bmjopen-2016-014384] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/30/2016] [Accepted: 02/21/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Implementing research findings into practice is a complex process that is not well understood. Facilitation has been described as a key component of getting research findings into practice. The literature on facilitation as a practice innovation is growing. This review aimed to identify facilitator roles and to describe characteristics of facilitation that may be associated with successful research use by healthcare professionals. METHODS We searched 10 electronic databases up to December 2016 and used predefined criteria to select articles. We included conceptual papers and empirical studies that described facilitator roles, facilitation processes or interventions, and that focused on healthcare professionals and research use. We used content and thematic analysis to summarise data. Rogers' five main attributes of an innovation guided our synthesis of facilitation characteristics. RESULTS Of the 38 488 articles identified from our online and manual search, we included 195 predominantly research studies. We identified nine facilitator roles: opinion leaders, coaches, champions, research facilitators, clinical/practice facilitators, outreach facilitators, linking agents, knowledge brokers and external-internal facilitators. Fifteen facilitation characteristics were associated with research use, which we grouped into five categories using Rogers' innovation attributes: relative advantage, compatibility, complexity, trialability and observability. CONCLUSIONS We found a diverse and broad literature on the concept of facilitation that can expand our current thinking about facilitation as an innovation and its potential to support an integrated, collaborative approach to improving healthcare delivery.
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Affiliation(s)
- Lisa A Cranley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | | | | | - Ferenc Toth
- Faculty of Nursing, University of Alberta, Edmonton, Canada
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Transferring Scientific Knowledge Into Action at the Point of Care: Do We Have All the Facts? CLIN NURSE SPEC 2017; 30:315-317. [PMID: 27753667 DOI: 10.1097/nur.0000000000000249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Larochelle N, Beaudet L. Développement du rôle des infirmières-chefs pour accroître les pratiques basées sur des résultats probants chez les infirmières soignantes en centre hospitalier : une revue intégrative des écrits. Rech Soins Infirm 2017:6-28. [DOI: 10.3917/rsi.128.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Skela-Savič B, Hvalič-Touzery S, Pesjak K. Professional values and competencies as explanatory factors for the use of evidence-based practice in nursing. J Adv Nurs 2017; 73:1910-1923. [DOI: 10.1111/jan.13280] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Brigita Skela-Savič
- Fakulteta za zdravstvo Angele Boškin/Angela Boškin; Faculty of Health Care; Slovenia
| | - Simona Hvalič-Touzery
- Fakulteta za zdravstvo Angele Boškin/Angela Boškin; Faculty of Health Care; Slovenia
| | - Katja Pesjak
- Fakulteta za zdravstvo Angele Boškin/Angela Boškin; Faculty of Health Care; Slovenia
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Harvey G, Lynch E. Enabling Continuous Quality Improvement in Practice: The Role and Contribution of Facilitation. Front Public Health 2017; 5:27. [PMID: 28275594 PMCID: PMC5319965 DOI: 10.3389/fpubh.2017.00027] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/09/2017] [Indexed: 11/13/2022] Open
Abstract
Facilitating the implementation of continuous quality improvement (CQI) is a complex undertaking. Numerous contextual factors at a local, organizational, and health system level can influence the trajectory and ultimate success of an improvement program. Some of these contextual factors are amenable to modification, others less so. As part of planning and implementing healthcare improvement, it is important to assess and build an understanding of contextual factors that might present barriers to or enablers of implementation. On the basis of this initial diagnosis, it should then be possible to design and implement the improvement intervention in a way that is responsive to contextual barriers and enablers, often described as “tailoring” the implementation approach. Having individuals in the active role of facilitators is proposed as an effective way of delivering a context-sensitive, tailored approach to implementing CQI. This paper presents an overview of the facilitator role in implementing CQI. Drawing on empirical evidence from the use of facilitator roles in healthcare, the type of skills and knowledge required will be considered, along with the type of facilitation strategies that can be employed in the implementation process. Evidence from both case studies and systematic reviews of facilitation will be reviewed and key lessons for developing and studying the role in the future identified.
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Affiliation(s)
- Gillian Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, SA, Australia; Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Elizabeth Lynch
- Adelaide Nursing School, University of Adelaide, Adelaide, SA, Australia; Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
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Connor L, Paul F, McCabe M, Ziniel S. Measuring Nurses’ Value, Implementation, and Knowledge of Evidence-Based Practice: Further Psychometric Testing of the Quick-EBP-VIK Survey. Worldviews Evid Based Nurs 2017; 14:10-21. [DOI: 10.1111/wvn.12190] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2016] [Indexed: 01/04/2023]
Affiliation(s)
- Linda Connor
- Staff Nurse III, Perioperative Program Surgical Services; Boston Children's Hospital; Boston MA USA
| | - Fiona Paul
- Nurse Practitioner, GI Program Medical, Patient Services; Boston Children's Hospital; Boston MA USA
| | - Margaret McCabe
- Nurse Scientist, Medicine Patient Services; Boston Children's Hospital, Boston; MA USA
| | - Sonja Ziniel
- Assistant Research Professor, Department of Pediatrics; University School of Medicine; Aurora CO USA
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