Jbi Evidence Implementation最新文献

Introduction: Theories, models, and frameworks are essential resources for planning effective implementation. However, it is unclear whether the reporting of principles in the published implementation literature reflects their role as a core foundation for practice change.

Aim: Our aim was to evaluate manuscripts informed by the JBI Model of Evidence-based Healthcare to identify and describe the reporting frequency of the four core principles of Culture, Communication, Capacity, and Collaboration (4Cs) which underpin the model.

Methods: This was a retrospective descriptive study which used eight purposively selected published JBI implementation reports. We piloted and extracted data in the form of verbatim text, which was mapped to the CFIR-2 sub-domains and the JBI Model's 4C principles. Data were then condensed into related concepts for frequency counts.

Results: There were 337 instances of the JBI 4C principles, with a mean of 42 reported per publication. Instances ranged from 17 to 147, with the highest frequencies occurring for Capacity (n = 147) and Culture (n = 142), and the lowest for Communication (n = 31) and Collaboration (n = 17).

Conclusions: The data suggest that the JBI 4Cs have intrinsic value and utility for authors, yet are used variably. Principles presented without operational definitions or descriptions are difficult for implementers to engage with. Therefore, further conceptual and operational studies are needed to increase the clarity and specificity of use case for the JBI 4Cs.

Spanish abstract: http://links.lww.com/IJEBH/A478.

Introduction: Patients with liver cancer experience varying degrees of post-operative pain (POP) after hepatic resection, which adversely affects their quality of life, clinical outcomes, and satisfaction. POP assessment, the first step in POP management, is often inadequate.

Objective: This project aimed to implement best practices for POP assessment in the General Surgery department of a hospital in China.

Methods: Using the JBI Evidence Implementation Framework, we conducted a non-concurrent control study. A baseline audit evaluated adherence to evidence-based practices. Then, a barriers analysis was conducted, and a follow-up audit was performed after the implementation of strategies. Patient outcomes as well as nurses' knowledge and attitudes were also evaluated at baseline and follow-up.

Results: Baseline compliance with best practices was low. However, after implementation, significant improvements were observed: a multidisciplinary team was established; nurse training coverage increased from 40% to 100% ( p  < 0.001); regular rest POP assessment rose from 0% to 66.67% ( p  < 0.001); twice daily POP assessment during activity increased from 0% to 80% ( p  < 0.001); provision of pre-operative pain diary instruction and patient use of pain diary increased from 0% to 70% and 60%, respectively (both p  < 0.001). Patient satisfaction with POP management and education significantly increased ( p  < 0.001), as did patients' pain-related knowledge, attitudes, and behaviors (all p  < 0.001). Nurses' knowledge and attitudes toward POP assessment also improved significantly ( p  < 0.001).

Conclusion: The implementation of multifaceted, evidence-based strategies substantially improved POP assessment practices in patients after hepatectomy, demonstrating the effectiveness of a systematic approach for quality improvement in POP management.

Spanish abstract: http://links.lww.com/IJEBH/A492.

Introduction: Older adults are at higher risk of dehydration due to age-related physiological and cognitive factors. They are commonly affected by hypertonic dehydration, usually caused by inadequate fluid intake.

Objectives: This project aimed to promote evidence-based practices (EBPs) for dehydration prevention in older adults in a nursing home in rural Mississippi, USA.

Methods: Guided by the JBI Evidence Implementation Framework, the project used clinical audits to assess barriers and enablers of EBP compliance. Nine EBPs derived from a JBI Evidence Summary served as audit criteria. The baseline audit included a policy review, leadership interviews, and staff survey. Identified barriers informed strategies which were then implemented. A follow-up audit using the same nine criteria was then conducted. The results were compared to baseline data to assess changes in compliance with EBPs.

Results: The baseline audit showed average compliance of 27%. Two barriers to EBPs were identified: (1) lack of staff awareness, knowledge, and training regarding hydration EBPs, and (2) inadequate resources or materials related to hydration care. A hydration protocol was created and implemented. Staff were trained and observed using the protocol. An educational pamphlet was developed for residents and visitors. Post-intervention audits showed 62% compliance, a 35% increase from baseline.

Conclusions: Post-audit results showed significant improvement, especially regarding residents' recommended fluid intake. Embedding the hydration protocol into standard procedures and maintaining leadership support will enhance the project's sustainability.

Spanish abstract: http://links.lww.com/IJEBH/A452.

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 multifaceted 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 multifaceted 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 multifaceted interventions.

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

Abstract: This article explores the development and utility of the PIECE (Practice/Problem of interest, Intervention/Implementation, Evaluation, Context, and Engagement) planning and question framework as a structured approach for planning and conducting evidence implementation projects. Traditionally, the PICO model has been used as a guiding framework for formulating clinical questions and structuring systematic reviews; however, the elements of PICO do not suit the unique requirements of evidence implementation projects in real-world settings. Each element of PIECE addresses a critical component of implementation: selecting a problem grounded in evidence, choosing effective interventions, defining evaluation metrics, assessing contextual factors, and engaging relevant stakeholders. Through examples of successful JBI implementation projects, we illustrate how PIECE can be used to conceptualize and execute implementation efforts. The proposed framework provides a structured yet flexible roadmap, allowing health care teams to initiate and sustain meaningful improvements. PIECE supports the planning phase of implementation projects, fostering better alignment with organizational goals and greater stakeholder engagement. As implementation science continues to evolve, PIECE offers a grounded approach for clinicians seeking to embed evidence into daily practice.

Introduction: The efficient and effective management of gastrostomy patients should be based on best practices.

Objective: This project aimed to improve gastrostomy management in a semi-intensive care unit of a private hospital in São Paulo, Brazil.

Methods: This study followed the JBI Evidence Implementation Framework. The JBI approach to evidence implementation is grounded in an audit, feedback, and re-audit strategy. A baseline audit was conducted to measure current practices against recommended best practices. Feedback from the audit was used to identify barriers and design implement strategies to improve practice. A follow-up audit was then conducted to measure changes in compliance with best practices.

Results: The baseline audit involved an evaluation of 33 nurses and 90 nursing technicians, as well as 10 gastrostomy patients. The follow-up audit evaluated 37 nurses and 80 nursing technicians, as well as 10 gastrostomy patients. The follow-up audit revealed that compliance increased to 90% for three of the eight criteria. For the remainder, it varied between 20% and 50%.

Conclusion: The baseline audit and feedback strategy led to improved compliance in five of the eight criteria. Future audits will be necessary to maintain these results.

Spanish abstract: http://links.lww.com/IJEBH/A259.

Introduction: Operating room pressure injuries (ORPIs) serve as a critical measure of health care quality.

Objective: The aim of this project was to reduce incidence of ORPIs in an operating room of a medical center in eastern Taiwan by promoting evidence-based strategies.

Methods: This project was conceptually informed by the JBI Model of Evidence-based Healthcare, in particular, the conceptualization of evidence implementation as inclusive of context analysis, implementation, and evaluation of outcomes using evidence-based quality indicators. Within the seven-phase implementation process, we used audit and feedback in a pre- and post-test design to measure baseline compliance, develop an implementation strategy responsive to gaps in compliance, and undertake a final evaluation to measure changes in compliance to evaluate the impact of our project. The JBI software, PACES, and JBI's situational analysis method, GRiP, were used to support data collection and implementation planning. There were five evidence-based criteria; our sample size was 30 patients for each criterion. The team carried out the project from March to July 2024.

Results: After implementing the strategies, the average knowledge test score for the prevention of ORPIs among nurses rose from 40 to 100. Compliance of patients with prevention management of ORPIs using evidence-based guidelines reached 100%, while the incidence of ORPIs decreased from 1.31% to 0.34%.

Conclusions: ORPIs are a crucial medical care quality indicator in hospital. In our project, through multidisciplinary collaboration, innovative experiential learning methods, and a virtual nurse application, it was possible to enhance the knowledge and compliance of nurses in terms of reducing ORPIs.

Spanish abstract: http://links.lww.com/IJEBH/A364.

Introduction: Implantable venous ports (IVPs) are widely used in patients with cancer for administering intravenous medications and fluids. Inadequate IVP care increases the risk of occlusion or infection, necessitating IVP removal.

Aim: This project aimed to improve nurses' IVP management in oncology patients by implementing evidence-based recommendations.

Methods: The project was conducted in a medical center in Taiwan. Using the JBI Evidence Implementation Framework, four audit criteria were developed to conduct baseline and follow-up audits. Nurses' IVP care skills and compliance were evaluated through an objective structured clinical examination (OSCE) and bedside observations. JBI's Getting Research into Practice (GRiP) tool was used to identify barriers and design strategies for project planning and implementation. To address these barriers, nurses were given IVP training (through videos), which enabled them to provide appropriate IVP care at the bedside.

Results: Although 62.5% of the nurses had received training on IVP care before project implementation, only 18.8% passed the OSCE. The nurses neither administered topical local anesthetics nor implemented measures to minimize patient discomfort before or during IVP needle insertion. Moreover, nurses did not use normal saline to flush and lock IVPs when not in use, as recommended by best practices. After project implementation, compliance with all four audit criteria increased to 100%. No episodes of occlusion were reported. Furthermore, the IVP infection rate markedly decreased from 8.45‰ to 2‰.

Conclusion: Proper IVP management skills are important for oncology nurses in providing good quality of care and preventing IVP infection. Nurse practitioners can play a key role in developing evidence-based care protocols and addressing barriers to IVP care in clinical settings. The evidence-based video training and bedside observations successfully improved oncology nurses' competence and compliance with best practices for IVP management.

Spanish abstract: http://links.lww.com/IJEBH/A408.

Introduction: Although health care agencies are encouraged to use quality improvement (QI) initiatives to improve quality of care, the ethical integrity of such initiatives has received little attention.

Objective: This project aimed to develop and evaluate key criteria to operationalize the Assessment of the Ethical Integrity of QI Studies (AEGIS).

Methods: The study used a four-phase sequential mixed methods design, comprising (i) a systematic mapping study to identify [Phase I] and map [Phase II] preliminary criteria against international ethical guidelines; (ii) an e-Delphi study to reach consensus on the transformed AEGIS criteria [Phase III]; and (iii) a psychometric evaluation to assess the utility and reliability of the AEGIS criteria [Phase IV].

Results: Phase I identified 23 preliminary AEGIS criteria, which were mapped against 18 ethical guidelines/statements [Phase II]. No statements were mapped to the five levels of ethical review; 0%-61.5% were mapped to four criteria for ethical review exemption; 15.4%-30.8% were mapped to seven triggers for ethical review; and 69.2%-100% were mapped to seven ethical principles. Preliminary criteria were transformed into 18 criteria, with a Delphi panel reaching > 70% consensus on all criteria [Phase III]. A panel of international experts tested the AEGIS tool against five randomly selected publications of QI activities [Phase IV], demonstrating that the tool had good internal consistency (α = 0.734), moderate interrater reliability (κ = 0.481), and good utility.

Conclusions: The 18-item AEGIS tool demonstrated excellent face and content validity, good internal consistency and utility, moderate interrater reliability, and broad application and international relevance. Thus, the AEGIS tool represents an important step toward improving the ethical conduct and integrity of QI projects.

Spanish abstract: http://links.lww.com/IJEBH/A451.