Jbi Evidence Implementation最新文献

Introduction: Rising mental health issues among university students in the United States may significantly affect their academic progress, contributing to a variety of negative outcomes, ranging from poor academic performance to forced attrition.

Objective: This study evaluated the implementation of an evidence-based practice (EBP) interdisciplinary approach to universal proactive mental health screening and triage at a university student health center (SHC).

Methods: Using the Knowledge to Action framework, a comprehensive program was developed to identify and triage university undergraduate students at risk of mental health conditions, to address a gap between current practice and emerging EBP. Potential barriers to implementation were identified and strategies were developed to improve the translation of knowledge to practice. A retroactive chart audit was used to evaluate the effectiveness of practice improvements.

Results: EBP interventions were implemented to proactively identify and triage mental health concerns in students, with positive results. Provider compliance with assessment and referral was 100%. Further studies are needed to assess long-term effectiveness.

Conclusion: Our results confirm the usefulness of a comprehensive, proactive mental health program for detecting and triaging undergraduate students at risk of anxiety and/or depression. This interdisciplinary approach has the potential to address mental health issues among college students in a timely fashion and to best steward limited campus resources.

Spanish abstract: http://links.lww.com/IJEBH/A327.

Introduction: Central venous catheters (CVCs) and other central venous access devices (CVADs) facilitate the administration of intravenous drugs, fluids, blood products, and parenteral nutrition in patients with chronic or critical illnesses. A lack of standardized practices had been identified in some countries, leading to the development and publication of guidelines.

Aim: This project aimed to improve CVAD care by promoting evidence-based practices in an intensive care unit and a hemodialysis unit in a hospital in Badajoz, Spain.

Methods: The study was based on the JBI approach to evidence implementation. A retrospective baseline audit was conducted before developing and implementing an evidence-based protocol for the assessment, patency, and management of occlusions in CVCs. The JBI Getting Research into Practice (GRiP) method was used to identify the factors underpinning gaps between evidence and everyday practice, as well as strategies to overcome them. A follow-up post-implementation audit was also conducted. The sample size was 34 patients.

Results: Improvements in compliance were found in four of the six audited criteria. The barriers identified during the implementation process were mostly addressed, contributing to the positive results.

Conclusions: This evidence implementation project resulted in the development of an evidence-based protocol on CVAD care in the selected units and can now be expanded to other settings. The project also improved the quality of nursing records and the maintenance of best practices.

Spanish abstract: http://links.lww.com/IJEBH/A325.

Abstract: Inadequate sustainability of health care innovations or evidence-based interventions has led to calls from policymakers, researchers, and funders for research on how sustainability can be optimized to avoid research waste. In this discussion paper, we argue that research on health care innovation sustainability needs to be advanced. We critically examine the literature on the concept of sustainability and propose that research should address the fundamental question: How can we advance knowledge on health care innovation sustainability? We provide examples of important work undertaken in the field of implementation science, including definitions and conceptualizations of sustainability. We also highlight theories, models, and frameworks that have been proposed to inform sustainability research and guide how to plan for sustainability. Our analysis of the literature reveals a growing interest in the sustainability of health care innovations but also confirms that implementation science has yet to put sustainability at the center of its research endeavors. To assist this shift, we identify priority research gaps and use the United Nations 2030 Agenda for Sustainable Development as a road map for an implementation science research agenda to drive health care innovation sustainability. We propose three new research directions that, overall, aim for "better health for all, leaving no one behind." These directions include: (1) advancing substantive research on sustainability while avoiding duplication; (2) identifying barriers, facilitators, and strategies to sustain engagement with multiple partners; and (3) advancing methods and tools to support monitoring, evaluation, and revision of strategies over time.

Spanish abstract: http://links.lww.com/IJEBH/A323.

Objectives: This evidence implementation project aimed to assess and improve compliance with evidence-based neuroimaging criteria for adult patients with suspected stroke.

Introduction: Stroke is the second leading cause of mortality and severe disability, requiring timely and accurate diagnosis. Clinical guidelines recommend brain imaging within 60 minutes of hospital arrival for suspected stroke patients. This project involved hospitals in North West Anglia NHS Foundation Trust, UK, serving 850,000 people with over 800 admissions annually.

Methods: The JBI Evidence Implementation Framework was used to guide this project. JBI software, the Practical Application of Clinical Evidence System (PACES), as well as JBI's Getting Research into Practice (GRiP) approach, were used to conduct the audit and implementation phases. The project followed three stages: (1) implementation planning, (2) baseline assessment and implementation, and (3) impact evaluation. Three audit criteria were used to represent best practices for diagnosing suspected stroke patients.

Results: The baseline audit revealed low compliance with the first criterion, with only 2.9% (1/35) of patients receiving a CT head scan within 1 hour of admission. In the follow-up audit, compliance improved to 45.2% (14/31). The other two criteria, diagnosis by a trained health care professional and baseline ECG assessment, had already achieved 100% compliance in the baseline audit.

Conclusions: Compliance with evidence-based neuroimaging criteria improved after implementing targeted educational strategies and training. The rate of CT scans conducted within 1 hour increased, although door-to-imaging times remain suboptimal compared with achievable benchmarks of ≤ 20 minutes. Ongoing education and training are crucial for sustaining high compliance and improving stroke patient outcomes.

Spanish abstract: http://links.lww.com/IJEBH/A324.

Introduction: Many older people belong to diverse and marginalized groups, with care needs and preferences outside of normative aged care services. Increasing the representation and contributions of these older people is central to an equity-sensitive implementation approach where adaptation to the context is critical.

Objective: This review assessed the extent and nature of the literature on implementing change in aged care contexts serving older people who belong to diverse and marginalized groups.

Methods: This scoping review searched for literature examining the implementation of change in any aged care context where older people from diverse and marginalized groups access care. The search was conducted in the PubMed, CINAHL, Scopus, and PsycINFO databases, and limited to papers published from 2013 onward. Of the 2,021 papers identified, 35 were included.

Results: The majority (70%) of studies were in a residential aged care context, and only 25% used an implementation framework. Less than half (40%) engaged with diverse and marginalized older people or their representatives to understand their needs and preferences. The majority engaged instead with staff or other stakeholders, and most engagement (64%) was limited to lower-level consultation such as seeking feedback rather than involving, collaborating, or empowering stakeholders to ensure their perspectives improved the implementation process.

Conclusions: There is little in the literature about ensuring changes in aged care identify and meet the needs and priorities of diverse and marginalized older people. This suggests a pressing need for implementation science to pay greater attention to equity and inclusion in the aged care context.

Spanish abstract: http://links.lww.com/IJEBH/A314.

Introduction: Champions are a well-recognized strategy for supporting the implementation of innovations in care settings, yet there is limited clear guidance to support their use in the particular context of aged care.

Aim: This study aimed to identify key lessons for optimizing the use of champions as an implementation strategy in aged care settings.

Methods: We conducted a secondary analysis of literature included in a recent scoping review on implementing innovations in aged care.

Results: The individuals who acted as champions came from a variety of roles and disciplines. The functions performed by champions largely involved influencing others, as well as other activities such as facilitating, educating, enabling, and reinforcing implementation. Key characteristics of champions included being enthusiastic and well-regarded by others, as well as having empathy and appropriate skills and knowledge. Champions were reportedly challenged by resourcing issues such as high workload, staff turnover, and competing priorities. The support of leaders and peers, a clearly identified role, adequate training, and appropriate selection were identified as key to optimizing champions' effectiveness.

Conclusions: For champions to be an effective implementation strategy, the champions need to be carefully selected, appropriately trained, and well supported. These findings can inform approaches to optimize the use of champions for implementing innovations in aged care.

Spanish abstract: http://links.lww.com/IJEBH/A318.

Objective: The objective of this scoping review was to identify the key factors that influence embedding organization-wide culture change programs (OWCCP) in health care.

Introduction: OWCCP have been used as a mechanism in health care to assist the workforce to embed safe quality care. There is little research on the embedding phase of sustaining OWCCP.

Inclusion criteria: This review included studies explicitly on embedding OWCCP in health care at an organizational or facility level.

Methods: Searches were conducted in Scopus, Web of Science, MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), ProQuest, OpenGrey, World Cat, and Bielefeld Academic Search Engine (BASE) for studies published between January 2013 and March 2024. Data from the full-text articles were extracted and reported according to the SQUIRE 2.0 guidelines. Factors that influence embedding were inductively coded, interpreted, and grouped into categories.

Results: Of the 7,922 studies screened, 17 were included in the final review. Ten key factors emerged as influencing the embedding of OWCCP in health care. These included education and training; integrating the change program into business; measurement, monitoring, and feedback of outcomes; supportive leadership; resources to support the change; alignment with organizational culture; shared and defined accountability; adaptable change programs; engaging key stakeholders; and alignment with the external environment.

Conclusions: Our findings can be used to guide and support sustaining OWCCP in health care. The review identified important gaps in the knowledge base of embedding OWCCP in health care, including a need for future studies to clearly define what embedding OWCCP entails, and investigate how the different populations, settings, systems, and processes influence the embedding of OWCCP.

Spanish abstract: http://links.lww.com/IJEBH/A319.

Introduction: Prolonged sleep deprivation and poor sleep quality are common complaints among pregnant and postpartum women, and they have adverse effects on the physiological and psychological well-being of mothers antenatally and postnatally.

Objectives: The aim of this project was to improve antenatal and postnatal mothers' night-time sleep quality during hospitalization in an obstetric ward through multi-faceted interventions.

Methods: This project followed the JBI Model of Evidence-based Healthcare and applied the seven phases of the JBI Evidence Implementation Framework to conduct context analysis, strategy implementation, and review of practice using evidence-based audit criteria. JBI's Practical Application of Clinical Evidence System and the Getting Research into Practice situational analysis tool were used to support data collection and identify barriers and strategies. Mothers' sleep quality was measured using an adapted St. Mary's Hospital Sleep Questionnaire.

Results: Baseline audit results (0%) revealed that midwives and nurses were not implementing the multi-faceted interventions to promote sleep in mothers. The results in follow-up audit 1 and follow-up audit 2 achieved compliance of 63.3% (p < 0.000), respectively. Overall, the mothers were fairly satisfied with their sleep quality, were able to sleep longer, and felt more alert when waking up in the morning.

Conclusions: There was an increase in compliance with best practices to improve mothers' sleep quality in the obstetric wards, although these results could be further improved. Mothers' perspectives of sleep promotion strategies should be explored in future projects to tailor the strategies to their needs. Sustainability plans include conducting follow-up audits and engaging ward nurses to continue implementing the multi-faceted interventions.

Spanish abstract: http://links.lww.com/IJEBH/A307.

Introduction: People with stroke are at risk of poor oral hygiene caused by neurological deficits, which can be motor, sensory, or cognitive. Good oral hygiene has been shown to reduce adverse events and improve the patient's quality of life. Although nurses recognize the benefits of oral hygiene, evidence shows that this area of care is frequently overlooked.

Aim: This evidence implementation project aimed to improve oral hygiene in stroke patients through the application of best practices.

Methods: This project was conducted in a stroke unit in a hospital in northern Portugal. The project followed the JBI Evidence Implementation Framework, which is grounded in an audit, feedback, and re-audit process. Four audit criteria were used in the baseline and follow-up audits. Observation of nursing care and analysis of nursing records were used to assess current practice against best practice recommendations. Nurses were engaged in the project through brainstorming to identify barriers, co-create strategies to address the barriers, and ensure project sustainability.

Results: The baseline audit revealed low compliance with the four audit criteria. The follow-up audit showed increased compliance, with Criterion 1 improving from 0% to 100%, with all nurses receiving training on oral hygiene assessment and management. Compliance increased by 40% for Criterion 2 and 36.7% for Criteria 3 and 4, respectively.

Conclusions: The project successfully promoted compliance with best practice recommendations and increased evidence-based practice for oral hygiene in patients with stroke in a stroke unit.

Spanish abstract: http://links.lww.com/IJEBH/A302.

Introduction and objectives: Health care providers need a high level of communication skills in dealing with pediatric patients and their carers. The objective of this project was to evaluate current practice and implement best practices promoting health care provider communication with pediatric patients and carers in a children's hospital in Tabriz, Iran.

Methods: This project used the JBI Model of Evidence-Based Healthcare, which guided the conceptualization of evidence implementation, context analysis, project implementation, and evaluation of outcomes using evidence-based quality indicators. An audit and feedback strategy was adopted to measure baseline compliance with best practices, develop strategies to address areas of non-compliance, and conduct a final audit to measure any changes in compliance. Four criteria were developed for the baseline and follow-up audits. Criteria 1 and 2 were evaluated using a sample of 30 health care providers, while Criteria 3 and 4 were evaluated using a sample of 80 pediatric patients and carers.

Results: All four criteria improved at the end of the project. Criterion 1 (health care staff receive communication skills training) had the highest mean score at baseline and follow-up (63% and 83%, respectively). Criterion 2 (implementation of local strategies by health care organizations) increased from 45% to 55%. However, this rate of improvement was the lowest of all the criteria. Criterion 3 (pediatric patients receive relevant education) improved from low to moderate, rising from 18% to 49%. A more significant improvement was noted for Criterion 4 (parents receive relevant education), which rose from 19% to 56%.

Conclusions: The strategies implemented in this project successfully improved health care provider communication with pediatric patients and their carers. To ensure project sustainability, repeat audits will be conducted after 3, 6, and 12 months.

Spanish abstract: http://links.lww.com/IJEBH/A199.