The uptake of evidence‐based knowledge in practice is influenced by context. Observations are suggested as a valuable but under‐used approach in implementation research for gaining a holistic understanding of contexts.
The aim of this paper is to demonstrate how data from observations can provide insights about context and evidence use in implementation research.
Data were collected over 24 months in a randomised trial with an embedded realist evaluation in 24 nursing homes across four European countries; notes from 183 observations (representing 335 hours) were triangulated with interview transcripts and context survey data (from 357 staff interviews and 725 questionnaire responses, respectively).
Although there were similarities in several elements of context within survey, interview and observation data, the observations provided additional features of the implementation context. In particular, observations demonstrated if and how the resources (staffing and supplies) and leadership (formal and informal, teamwork, and professional autonomy) affected knowledge use and implementation. Further, the observations illuminated the influence of standards and the physical nursing environment on evidence‐based practice, and the dynamic interaction between different aspects of context.
Although qualitative observations are resource‐intensive, they add value when used with other data collection methods, further enlightening the understanding of the implementation context and how evidence use and sharing are influenced by context elements. Observations can enhance an understanding of the context, evidence use and knowledge‐sharing triad in implementation research.
New registered nurses (RNs) are at risk of developing symptoms of stress‐related ill health.
To evaluate the effect of a 3 × 3 hour group intervention aiming to prevent symptoms of stress‐related ill health among new RNs by increasing engagement in proactive behaviors. The intervention involves discussions and models of newcomer experiences and stress and the behavior change techniques reinforcing approach behaviors, systematic exposure, and action planning.
A randomized parallel group trial with an active control condition.
The study sample consisted of 239 new RNs participating in a transition‐to‐practice program for new RNs in a large county in Sweden.
Participants were randomized to either the experimental intervention or a control intervention. Data on experiences of stress, avoidance of proactive behaviors, engagement in leisure activities, role clarity, task mastery, and social acceptance were collected before and after the intervention. Effects were evaluated using multilevel model analysis and regression analysis. Missing data were imputed using multiple imputation.
The control group experienced a statistically significant increase in experiences of stress during the period of the study (t (194.13) = 1.98, p = .049), whereas the level in the experimental group remained stable. Greater adherence to the intervention predicted a greater effect on experiences of stress (β = −0.15, p = .039) and social acceptance (β = 0.16, p = .027).
Transition‐to‐practice programs may benefit from adding an intervention that specifically addresses new RNs’ experiences of stress to further support them as they adjust to their new professional role. However, replication studies with larger samples, more reliable measures, and longer periods of follow‐up are needed.
Burnout is a substantial phenomenon across healthcare settings, affecting more than half of healthcare professionals and leading to negative patient and health system outcomes. Infusion center professionals (ICPs) are at increased risk of burnout attributed to high patient volume and acuity levels. Strategies to address burnout have been developed and prioritized by the American Medical Association (AMA), the World Health Organization, and other organizations.
This quality improvement project aimed to address perceived burnout, job‐related stress, and job satisfaction among nurses, physician assistants, and medical assistants at a large pediatric hospital through integration of two infusion center (IC)‐based staff engagement interventions.
A pre‐ and post‐test study design was used. Existing team huddles in the IC were modified based on the AMA STEPS Forward program recommendations to incorporate appreciative inquiry and recognition into team and department events. Peer recognition was tailored toward institutional core values. The Mini‐Z Burnout survey was administered before and 3 months after implementation of both interventions.
Pre‐ to post‐intervention responses revealed a higher percentage of staff reporting no burnout (57.7% vs. 75%), low levels of job‐related stress (58.8% vs. 65.5%), and satisfaction with current job (70.6% vs. 82.8%). Most participants agreed or strongly agreed that structured huddles (69%) and recognition events (82.8%) were beneficial and recommended continuation (65.5% and 82.8%, respectively). Open‐ended responses regarding workplace stressors focused heavily on staffing and patient acuity.
Project outcomes support the integration of tailored interventions to reduce burnout among pediatric ICPs. Organizational commitment to addressing burnout can provide incentive to scale up institution‐wide staff engagement interventions. Further study is needed to assess the efficiency and effectiveness of such tailored interventions across diverse settings.
There is increased acknowledgment of the importance of knowledge translation (KT) in the role of graduate‐prepared healthcare practitioners, such as nurses, as change agents in the mobilization of evidence‐based knowledge. The offering of flexible educational programming online and hybrid course delivery in higher education is a response to insufficient didactic methods for providing graduate students with the competencies to facilitate KT.
To describe the development, implementation, and evaluation of a cohort‐based, online, innovative KT curriculum using a theoretical approach to KT called the Knowledge‐As‐Action Framework, which focuses on the knower, knowledge, and context as being inseparable. This process strategically engages with stakeholders to link practice concerns with existing realities, thus providing the best available knowledge to inform KT action in complex healthcare contexts.
The Model of Evidence‐Informed, Context‐Relevant, Unified Curriculum Development in Nursing Education guided the cohort‐based online KT course process. The development, implementation, and evaluation involved (a) an environmental scan, (b) a literature review, (c) faculty development, (d) curriculum design of two 10‐week courses, and (e) a summation of the concurrent participatory evaluation of the two courses, including faculty and student responses. The Knowledge‐As‐Action Framework is comprised of six interrelated dimensions as part of a “kite” metaphor, with the underlying premise that if any one of the dimensions results in an imbalance, the KT process may be grounded.
Evaluation revealed (a) intentionality of the core processes of curriculum work; (b) effectiveness of indicators for evaluating the KT courses; (c) leadership should be added as a learning domain for KT; (d) the Knowledge‐As‐Action Framework provided an integrated, philosophical, and evidence‐based approach to KT; (e) cohort model facilitated a community of inquiry; and (f) the formalized structured approach of the courses with ongoing supervision and mentoring allowed for timely completion.
Teaching and learning in an online cohort model created a community of inquiry and facilitated experiential learning. The active engagement of students with their practice‐based stakeholders promoted change in clinical settings and enhanced students’ professional development to lead change.
Reflective practice affects all levels of nursing, including students, as well as practicing nurses. Self‐reflective practice is a widespread concept in nursing; however, few empirical studies have demonstrated the possible effects of such a practice. The purpose of this integrative literature review was to identify evidence of the effects of self‐reflective practice on baccalaureate‐level nursing students, especially stress.
The literature search was conducted utilizing CINAHL and PubMed databases. The inclusion criteria were studies published between 2013 and 2018, articles that were peer‐reviewed, written in English, and focused on nursing education of baccalaureate programs only. A total of 15 articles were reviewed.
There is limited but growing evidence to suggest self‐reflective practices have positive effects on baccalaureate‐level nursing students. The self‐reflective practices decreased stress and anxiety and increased learning, competency, and self‐awareness of nursing practice. While written reflections were most commonly used in the studies, other forms of reflection, such as verbal and photography, were effective as well.
Nursing students can benefit from incorporating reflection into the didactic and clinical settings. Nursing faculty are encouraged to integrate reflection into the nursing curriculum. Nurses within the first year of practice could benefit from using reflective practice as well. Experienced nurses and nurse managers can encourage and mentor novice nurses on the use and benefits of reflective practice.
The study was conducted as a randomized controlled trial in order to determine the effects of acupressure on acute pain during venipuncture in children.
The population of the study consisted of children, aged between 9 and 12 years, who received venipuncture between September 2015 and June 2016 at a university hospital in Istanbul. The sample consisted of a total of 90 children, including 45 children in the acupressure group and 45 children in the control group, who met the sample inclusion criteria. The results of the study were obtained by using an information form, the State Anxiety Inventory for Children (STAIC), the visual analog scale (VAS), and the Faces Pain Scale‐Revised (FPS‐R). Acupressure was applied to the children in the acupressure group for 10 min before the venipuncture procedure. Pain, heart rate, and oxygen saturation levels of the children in the acupressure and control groups were evaluated both before and after the venipuncture procedure.
The children in the acupressure and control groups were found to be similar in terms of age, gender, parents’ educational levels and working status, number of venipuncture procedures, and mean anxiety scores. In the evaluation that was conducted before the venipuncture procedure, no statistically significant differences were observed between the heat rates, oxygen saturation levels, and expected pain scores from the venipuncture procedure in the children in the acupressure and control groups. On the other hand, it was observed that the children in the acupressure group (VAS: 19.51 ± 4.98; FPS‐R: 2.08 ± 0.41) experienced less pain than the children in the control group (VAS: 47.37 ± 9.89; FPS‐R: 4.84 ± 1.08), and there was a significant difference between the two groups (p < .000).
Acupressure administration is effective in reducing the pain that is experienced by children during a venipuncture procedure.
Published clinical practice guidelines on surgical site infection prevention are available; however, adherence to these guidelines remains suboptimal.
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.
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.
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.
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.
All nurses have responsibilities to enculturate evidence‐based practice (EBP) and translate and implement research findings into nursing care, practices, and procedures.
To report EBP‐related findings from the national Hospital‐Based Nursing Research Characteristics, Care Delivery Outcomes, and Economic Impact Survey questionnaire.
In this cross‐sectional survey research study of 181 nursing research leaders, 127 responded to these questions: “Has your hospital adopted or does it use a model of evidence‐based practice?” “If yes, what is the name of the model and how is it used?” “Does your hospital implement (translate) findings from nursing research into clinical practice?” “Describe how your hospital implements these findings and whose responsibility it is.” “What factors do you believe facilitate the implementation of findings from nursing research into clinical practice at your hospital?” Qualitative content analyses were used.
Over 90% of nursing research leaders specified that their hospital used an EBP model and implements findings into practice. The most frequently reported models were the Iowa Model of Evidence‐Based Practice, Johns Hopkins Nursing Evidence‐Based Practice Model, and Advancing Research and Clinical Practice Through Close Collaboration Model. EBP models were used most frequently for education and training, nurse residency programs, and EBP and research fellowships. Findings were implemented through policy and procedure committee processes, shared governance structures, and EBP processes. Those responsible for implementing findings were project leads, nursing professional practice councils, and clinical nurse specialists and advanced practice nurses. Implementation facilitators were nursing leadership, dissemination of findings, and engaged and educated nurses.
These new findings report >90% EBP model use and implementation. All nurses, especially our leaders, have responsibilities to evaluate EBP and how nursing research findings are implemented (translated) into practice. Ideally, engaged and educated nurses who enculturate, support, and sustain EBP will facilitate advancing nursing practice to improve patient and work environment–related outcomes.
The specific aim for this study was to describe differences in evidence‐based practice (EBP) and self‐efficacy in frontline RNs. This project utilized a national study with a convenience selection of acute care agencies to examine the relationship between organizational and unit culture, EBP, and self‐efficacy in frontline nurses.
This national study used descriptive correlational methodology to describe differences in EBP and self‐efficacy among RNs. The sample included 245 frontline RNs employed in acute care settings. To measure the study variables, the Nursing Evidence‐Based Practice Survey (Titler, Hill, Matthews, & Reed, 1999) and the Evidence‐Based Nursing Practice Self‐Efficacy Scale were used (Tucker, Olson, & Frusti, 2009). Each instrument was delivered via the Qualtrics online platform.
The correlation of bivariate interval level variables was analyzed using Pearson’s r . The correlation between EBP and self‐efficacy was strongly correlated: r (170) = .537, p = .01. Sections within the Nursing Evidence‐Based Practice Survey were calculated and found to be significant (unit culture r = .241, p = .01; organizational culture r = .570, p = .01; knowledge, skills, attitude r = .538, p = .01).
Several implications exist for education, staff development, and nursing management. Nursing school programs incorporate EBP into the curriculum so that nurses have a foundation for EBP. However, staff development professionals in clinical settings must continue to build on the nurses’ knowledge and skill, thus increasing self‐confidence for EBP. Nursing management can provide the resources for staffing models and policies to reinforce the value of EBP and positive patient outcomes. This combination provides frontline staff with EBP participation and increased self‐efficacy in its usage.
Clinicians’ knowledge and skills for evidence‐based practice (EBP) and organizational climate are important for science‐based care. There is scant literature regarding aligning organizational culture with EBP implementation and even less for unit and organizational culture. The Nursing EBP Survey examines individual, unit, and organizational factors to better understand registered nurses’ (RN) self‐reported EBP.
Establish and confirm factor loading, reliability, and discriminant validity for the untested Nursing EBP Survey.
The study employed a descriptive cross‐sectional survey design and was targeted for RNs. The setting included 14 hospitals and 680 medical offices in Southern California. The 1999 instrument consisted of 22 items; 7 items were added in 2005 for 29 items. The questionnaire used a 5 point, Likert‐type scale. The survey website opened in November 2016 and closed after 23 weeks. Psychometric testing and factor determination used parallel analysis, exploratory factor analysis, confirmatory factor analysis (CFA), and ANOVA post hoc comparisons.
One thousand one hundred and eighty‐one RNs completed the survey. All factor loadings in the CFA model were positive and significant (p < .001). All standardized loadings ranged from .70 to .94. The covariance estimate between Factor 1 and Factor 2 was marginally significant (p = .07). All other covariances and error variances were significant (p < .001). Final factor names were Practice Climate (Factor 1), Data Collection (Factor 2), Evidence Appraisal (Factor 3), Implementation (Factor 4), and Access to Evidence (Factor 5). Four of 5 factors showed significant differences between education levels (p < .05 level). All factors showed significant differences (p < .05) between inpatient and ambulatory staff, with higher scores for inpatient settings.
Nurses’ knowledge, attitudes, and skills for EBP vary. The 2019 Nursing EBP survey offers RNs direction to plan and support improvement in evidence‐based outcomes and tailors future EBP initiatives.
Anecdotal reports from across the country highlight the fact that nurses are facing major challenges in moving new evidence‐based practice (EBP) initiatives into the electronic health record (EHR).
The purpose of this study was to: (a) learn current processes for embedding EBP into EHRs, (b) uncover facilitators and barriers associated with rapid movement of new evidence‐based nursing practices into the EHR and (c) identify strategies and processes that have been successfully implemented in healthcare organizations across the nation.
A qualitative study design was utilized. Purposive sampling was used to recruit nurses from across the country (N = 29). Nine focus group sessions were conducted. Semistructured interview questions were developed. Focus groups were conducted by video and audio conferencing. Using an inductive approach, each transcript was read and initial codes were generated resulting in major themes and subthemes.
Five major themes were identified: (a) barriers to advancing EBP secondary to the EHR, (b) organizational structure and governing processes of the EHR, (c) current processes for prioritization of EHR changes, (d) impact on ability of clinicians to implement EBP and (e) wait times and delays.
Delays in moving new EBP practice changes into the EHR are significant. These delays are sources of frustration and job dissatisfaction. Our results underscore the importance of a priori planning for anticipated changes and building expected delays into the timeline for EBP projects. Moreover, nurse executives must advocate for greater representation of nursing within informatics technology governance structures and additional resources to hire nurse informaticians.
Early rehabilitation has been shown to enhance functional outcomes. Whether the addition of virtual reality (VR) training could further improve muscle strength, mood state, and functional status for patients with acute stroke is unknown.
To investigate the effectiveness of VR training on muscle strength, mood state (depression, anxiety), and functional status in patients following acute stroke.
A randomized controlled trial was conducted. Patients with acute ischemic stroke (N = 152) were selected and randomly assigned with a 1:3 randomization ratio to either experimental group (EG) or comparison group (CG). Both groups received early rehabilitation. The EG received an extra 5 days of VR training (15 min of time, two times a day), started 24 hr to 3 days poststroke. Muscle strength, mood state, and functional status were collected at admission and at the day of discharge. Generalized estimating equations were applied to examine the intervention effects.
A total of 143 participants (94%) completed the study, and 145 were included in the intention‐to‐treat analysis. Participants in the EG reported increased muscle strength of upper and lower limbs in both affected and unaffected sides, decreased depression and anxiety, and increased functional status at discharge. When the group–time interaction was examined, the EG had greater increased upper limb muscle strength of the unaffected side (ß = 0.34, p < .001) and decreased depression and anxiety scores (ß = −2.31, p = .011; ß = −1.63, p = .047) at discharge compared with the CG. However, there was no difference in the functional status change scores from baseline between EG and CG.
A poststroke program that includes both early rehabilitation and VR training has greater benefit in relation to mood state and muscle strength at discharge than early rehabilitation alone. Therefore, an early physical rehabilitation program that includes VR training for acute stroke inpatients should be considered for implementation in clinical settings.