Implementation and efficacy of knowledge translation frameworks in family focused nursing care: A scoping review

AIM

To provide an overview of the characteristics, variety and outcomes of knowledge translation (KT) strategies used in nursing care involving adult patients and their family members.

BACKGROUND

The gap in providing family nursing practice could be due to a lack of explicit KT frameworks and understanding of ways to translate evidence-based knowledge into clinical practice.

DESIGN

A scoping review conducted according to the Joanna Briggs Institute.

METHODS

The review is reported according to PRISMA-ScR. Relevant studies were searched in MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL Complete, ProQuest Nursing & Allied Health Premium, PsycINFO, Social Work Abstracts, Social Services Abstracts and Scopus. Grey literature was searched in ProQuest Dissertations & Theses Global. Search results were imported into the web-based programme Covidence. Studies describing concepts of KT, strategies of implementation, involvement of families and nurses/family caregivers in adult health care and conducted within the last 15 years were included.

RESULTS

Eight studies met the inclusion criteria. Three studies used the KTA Framework to guide the implementation process. The remaining five studies used different frameworks/guidelines to translate a variety of family focused interventions into their clinical practice. Translation strategies were often targeted towards nurse education. Reported outcomes included nurses' attitudes towards and acceptance of involving families in health care. The outcomes were conceptualized and measured differently, showing inconclusive results on effectiveness on family focused care and family health.

CONCLUSION AND IMPLICATIONS FOR CLINICAL PRACTICE

The application of KT frameworks to implement evidence-based family nursing into clinical practice is limited. The process of KT mainly targets at nurses' adoption of family focused interventions with limited information about short-, intermediate- and long-term efficacy on family health. Clinical leaders should consider time and resources needed to implement family focused care KT strategies before putting it into practice.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution. Data were obtained from other's literature.

Politics in Search of Evidence-The Role of Public Health in the COVID Pandemic in Germany: Protocol for a Situational Analysis

The protocol presents a research project that explores the relationship between science and politics in the COVID-19 pandemic from the perspective of public health (PH) scientists in Germany with situational analysis (SA). In context of this global crisis, we ask how PH scientists negotiate their roles as scientists and political citizens; how PH scientists perceive the relationship between their own and other scientific disciplines; and which normative assumptions PH scientists make in the production and dissemination of research findings. To conduct SA, we combine qualitative interviews with PH experts and published documents from scientific societies in PH and related disciplines (e.g., position and opinion papers) to analyze the complexity of integrating evidence-based knowledge into politics. Data are analyzed using different SA mapping tools, focusing on social worlds/arena maps and positional maps. The approach will reveal both explicit positions in the PH community and implicit or hidden voices and will reflect normative assumptions as well as internal structures of PH in Germany. The findings will be discussed with the philosophy sub-project and in a stakeholder workshop with politicians and the public. Further insights will be gained for politics and PH responses to future global crises.

Shared decision-making in maternity care: Acknowledging and overcoming epistemic defeaters

Shared decision-making involves health professionals and patients/clients working together to achieve true person-centred health care. However, this goal is infrequently realized, and most barriers are unknown. Discussion between philosophers, clinicians, and researchers can assist in confronting the epistemic and moral basis of health care, with benefits to all. The aim of this paper is to describe what shared decision-making is, discuss its necessary conditions, and develop a definition that can be used in practice to support excellence in maternity care. Discussion between the authors, with backgrounds in philosophy, clinical maternity care, health care management, and maternity care research, assisted the team to confront established norms in maternity care and challenge the epistemic and moral basis of decision-making for caesarean section. The team concluded that shared decision-making must start in pregnancy and continue throughout labour and birth, with equality in discourse facilitated by the clinician. Clinicians have a duty of care for the adequacy of women's knowledge, which can only be fulfilled when relevant knowledge is offered freely and when personal beliefs and biases that may impinge on decision-making (defeaters) are disclosed. Informed consent is not shared decision-making. Key barriers include existing cultural norms of "the doctor knows best" and "patient acquiescence" that prevent defeaters being acknowledged and discussed and can lead to legal challenges, overuse of medical intervention and, in some areas, obstetric violence. Shared decision-making in maternity care can thus be defined as an enquiry by clinician and expectant woman aimed at deciding upon a course of care or none, which takes the form of a dialogue within which the clinician fulfils their duty of care to the client's knowledge by making available their complete knowledge (based on all types of evidence) and expertise, including an exposition of any relevant and recognized potential defeaters. Research to develop measurement tools is required.

Dentists' levels of evidence-based clinical knowledge and attitudes about using pit-and-fissure sealants

BACKGROUND

Although the prevalence of pit-and-fissure sealants in children in the United States is low, the problem is magnified in low-income children. A small proportion of Florida's low-income children receive any preventive dental services, including sealants. The authors conducted a cross-sectional study to assess whether Florida's dentists provide sealants as a preventive measure in their practices, their attitudes and their levels of evidence-based clinical knowledge about appropriate sealant use according to the American Dental Association (ADA) recommendations. The authors also assessed whether the number of years since graduation and reliance on peers or colleagues for regular clinical information were associated with dentists' knowledge.

METHODS

The authors administered a 25-item pretested questionnaire to a convenience sample of general and pediatric dentists (n = 163) at the 2013 Florida National Dental Convention in Kissimmee, Fla. The authors conducted multivariate linear regression modeling to predict dentists' levels of evidence-based clinical knowledge.

RESULTS

Years since graduation (P = .2) and reliance on peers or colleagues for regular clinical information (P = .6) did not predict higher knowledge. Male dentists (P = .003) and those who accepted children enrolled in Medicaid as new patients (P = .01) had significantly more knowledge compared with their counterparts.

CONCLUSIONS

Most participating dentists used sealants in their practices and had high levels of positive attitudes about using sealants. Overall knowledge regarding the appropriate use of sealants, however, was low.

PRACTICAL IMPLICATIONS

For practicing dental professionals, the authors recommend disseminating evidence-based recommendations for the use of dental sealants via continuing education courses and other possible modalities. They also recommend that dental schools update their existing courses or modules about sealants by integrating the ADA's recommendations.

The dark side of cognitive illusions: when an illusory belief interferes with the acquisition of evidence-based knowledge

Cognitive illusions are often associated with mental health and well‐being. However, they are not without risk. This research shows they can interfere with the acquisition of evidence‐based knowledge. During the first phase of the experiment, one group of participants was induced to develop a strong illusion that a placebo medicine was effective to treat a fictitious disease, whereas another group was induced to develop a weak illusion. Then, in Phase 2, both groups observed fictitious patients who always took the bogus treatment simultaneously with a second treatment which was effective. Our results showed that the group who developed the strong illusion about the effectiveness of the bogus treatment during Phase 1 had more difficulties in learning during Phase 2 that the added treatment was effective.

The place of standardisation in home care practice: an ethnographic study

AIMS AND OBJECTIVES

To explore the benefits and shortcomings of using standardised work methods in home care nursing.

BACKGROUND

Health care is increasingly shaped by the use of standardised work methods. This trend is reflected in the use of management tools aimed at monitoring service quality and efficiency, as well as in the evidence-based movement that has led to a shift in focus from the practitioner to the knowledge found in guidelines and clinical protocols. This study addressed the impact of this development on home care services.

DESIGN

This is an ethnographic study involving fieldwork in home care nursing in Iceland.

METHODS

The study took place in one neighbourhood in an urban area in Iceland in 2010. Members of five of six home care nursing teams agreed to participate. Team leaders were observed during visits to older person's homes and at team and interdisciplinary meetings. Semi-structured interviews were conducted with the team leaders and 15 older persons.

RESULTS

The results were presented as three themes: For it all to hang together, which referred to attempts on behalf of the team leaders to coordinate complex services and assistance for the benefit of each patient; Working with more advanced cases, which reflected the uptake of standardised methods to address health matters locally; and Being heard, which reflects the politics of using standardised methods.

CONCLUSIONS

Standardised work methods can be helpful and are welcomed by home care nurses as long as they can also use their own discretion and draw on other forms of knowledge when needed.

RELEVANCE TO CLINICAL PRACTICE

This study brought out the importance of flexibility in home care practice. Standardised work methods are welcomed and seen as helpful as long as they can be used based on the discretion of the practitioner.