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Many adverse events are identified as nursing-sensitive indicators (NSIs) and have evidence-based care bundles known to reduce risk of occurrence. Kamishibai cards are a tool from the manufacturing industry used for practice auditing and improvements. Use of Kamishibai cards is believed to be common in the healthcare setting, but true evidence-based guidelines do not yet exist to guide their implementation.
The aim of this integrative review was to identify best practices around the implementation of Kamishibai cards in the healthcare setting for improvement in NSI-associated outcomes.
Eleven nurses at three facilities worked through the evidence using the Johns Hopkins Evidence-Based Practice Model.
Ten articles were included for this review. Broad themes included direct observation with non-punitive and timely feedback, clearly visualized results, use of evidence-based care bundles, pre-implementation education, and both leadership and frontline-staff involvement. All facilities showed improvement in NSI-associated outcomes after the implementation of K-cards.
In health care, K-cards can be implemented and designed with additional focus on the bundles of care they are intended to audit and staff support, but further evidence would better define guidelines around implementation.
To present the development, implementation and evaluation of a theoretically grounded novel virtual dissemination evaluation (VDE) framework.
Care of intensive care unit patients requires access to the most up-to-date knowledge and best practices. To address this challenge, we present the development, implementation and evaluation of a theoretically grounded novel VDE framework. This framework is applied to a dissemination strategy, NeoECHO, in neonatal intensive care units. Evidence-based virtual education is implemented to prevent, detect and treat necrotizing enterocolitis in neonates.
Research Methodology: Discussion Paper—Methodology.
The virtual dissemination evaluation framework is a sequential combination of Integration of Integrated-Promoting Action on Research Implementation in Health Services and Moore's Expanded Outcomes frameworks. The framework's conceptual determinants, virtual facilitators and implementation evaluations were operationalized in the NeoECHO dissemination strategy and evaluated for feasibility. The virtual dissemination evaluation framework was conceptually mapped, and operational activities were examined including theoretical constructs drawing on insights of nursing theorists, especially Fawcett's criteria (2005) for frameworks with practical application (significance, internal consistency, parsimony, testability and design fit). The NeoECHO strategy was evaluated for virtual dissemination evaluation adherence, operationalization and feasibility of implementation evaluation.
The virtual dissemination evaluation framework meets the criteria for a practical application and demonstrates feasibility for adherence and operationalization consistency. The implementation evaluation was usable in the virtual dissemination of best practices for neonatal care for necrotizing enterocolitis and healthcare providers were actively engaged in using NeoECHO as an implementation strategy.
This examination of the foundational aspects of the framework underscores the rigour required for generalization of practical application. Effective virtual dissemination of evidence-based practices to hospital units requires structured delivery and evaluation, enabling engaged healthcare providers to actualize education rapidly. The virtual dissemination evaluation frameworks' potential for narrowing the evidence-based practice gap in neonatal care showcases its wider significance and applicability.
Care of neonates in NICUs requires a multidisciplinary approach and necessitates access to the most up-to-date knowledge and best practices. More than traditional dissemination methods are required to bridge the implementation gap.
The effective use of the VDE framework can enhance the design, implementation and evaluation of knowledge dissemination, ultimately elevating neonatal care quality.
This paper introduces the VDE framework, a sequential combination of the iPARIHS and Moore's EO frameworks—as a methodological tool for designing, implementing and evaluating a neonatal strategy (NeoECHO) for virtual dissemination of education in NICUs.
No patient or public contribution.
To describe the lived experiences of nurses caring for patients and families in the context of COVID-19 in Brazil and United States.
A phenomenological philosophical approach following the van Manen analysis method.
Participants were recruited in Brazil and the United States, including nurses working in health care settings caring for COVID-19 patients. Recruitment used purposive and snowball sampling. Participants completed a demographic survey and semi-structured interviews that were audio-recorded and transcribed for analysis. A cross-cultural examination occurred among researchers from each country.
The result was described (n = 35) by the themes, representing the essences of each lifeworld (relationship, time, space and body). The nurses' lived experience was one of reframing care while enduring repeated trauma of witnessing disrupted patient-family-nurse relationships. Themes were as follows: (a) Living a silent and lonely experience; (b) Providing connectedness for disrupted patient and family relationships; (c) Feeling the burden of the demands; (d) Being a helping connector; (e) Reshaping spaces amidst evolving interventions and policies; (f) Creating safe spaces, surrounded by turmoil, threat, and distress within an unsafe environment; (g) Reorganizing care and reframing time; (h) Reconciling losses, regrets, victories and lessons.
The nurses' lived experience of caring for patients and families during the COVID-19 pandemic prompted the need to respond to repeated traumas and distress posed by interrupted patient-family and nurse-own family relationships, vulnerable bodies, threatened space and dynamic and volatile time.
Cultural nuances were discovered depending on the practice setting, political discourse and the autonomy of the nurse. Innovative models of care that create structures and processes to support nurses in caring for patients in threatening environments and the commitment to connecting family members have potential to contribute to the ongoing health of the nursing profession.
To create a programme theory of family engagement in paediatric acute care to explicate the relationships between contexts and mechanisms of family engagement that align with family, direct care providers and healthcare organization outcomes.
Realist review and synthesis.
PubMed, CINAHL, PsycINFO and Web of Science searches for the 2.5-year period (July 2019–December 2021) following our 2021 scoping review.
Following methods described by Pawson and Rycroft-Malone, we defined the scope of the review, searched for and appraised the evidence, extracted and synthesized study findings and developed a supporting narrative of our results.
Of 316 initial citations, 101 were included in our synthesis of the final programme theory. Contexts included family and direct care provider individualism, and the organizational care philosophy and environment. Mechanisms were family presence, family enactment of a role in the child's care, direct care providers facilitating a family role in the child's care, unit/organizational promotion of a family role, relationship building and mutually beneficial partnerships. Outcomes were largely family-focussed, with a paucity of organizational outcomes studied. We identified four context–mechanism–outcome configurations.
This realist review uncovered underlying contexts and mechanisms between patients, direct care providers and organizations in the family engagement process and key components of a mutually beneficial partnership. Given that successful family engagement requires direct care provider and organizational support, future research should expand beyond family outcomes to include direct care providers, particularly nurses and healthcare organization outcomes.
The final programme theory of family engagement in paediatric acute care provides a roadmap for clinicians to develop complex interventions to engage families and evaluate their impact. The components of our final programme theory reflect family engagement concepts that have been evolving for decades.
The team conducting this review included members from the practice setting (JT & KG). In the future, as we and others use this model in practice, we will seek input for refinement from clinicians, patients and caregivers.
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