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Evidence-informed decision-making in public health in Canada: a qualitative exploration. 加拿大公共卫生领域的循证决策:定性探索。
IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-23 DOI: 10.1097/XEB.0000000000000454
Isabella Romano, Emily C Clark, Janine Quiambao, Miranda Horn, Lynn Dare, Kristin Rogers, Maureen Dobbins

Introduction: Evidence-informed decision-making (EIDM) plays a vital role in public health practice. Canada has invested in support for evidence-informed approaches in public health. Despite growing expectations for EIDM, evidence integration has not been thoroughly evaluated.

Objective: This study explores EIDM within Canadian public health organizations before the COVID-19 pandemic. A secondary objective is to explore how EIDM in public health was affected by the COVID-19 pandemic.

Methods: Using a qualitative descriptive approach, data were collected and analyzed from interviews with public health professionals across Canada.

Results: From interviews with 20 participants in four Canadian provinces and one territory, all participants noted that EIDM was valued, but there was considerable variation in implementation. Participants reported differences in consistency of evidence use, resources available at their public health organizations to support EIDM, and staff knowledge and skills in EIDM. Leadership emerged as a strong influencer of EIDM; however, leadership investment in EIDM varied. Changes in evidence use during the COVID-19 pandemic revealed an urgency for decision-making amidst an influx of evidence and reallocated staff roles.

Conclusions: Despite gains in the recognized value of EIDM, gaps remain in the integration of evidence into decision-making and adequate resource investment to support EIDM. Time, resources, and skills to adapt processes and implement EIDM are needed for public health organizations in Canada to fully integrate EIDM into all aspects of public health decision-making.

Spanish abstract: http://links.lww.com/IJEBH/A249.

导言:循证决策(EIDM)在公共卫生实践中发挥着至关重要的作用。加拿大已投资支持公共卫生领域的循证方法。尽管人们对 EIDM 的期望越来越高,但尚未对证据整合进行全面评估:本研究探讨了 COVID-19 大流行之前加拿大公共卫生组织内部的 EIDM。次要目的是探讨 COVID-19 大流行对公共卫生领域的 EIDM 有何影响:方法:采用定性描述的方法,从对加拿大各地公共卫生专业人员的访谈中收集和分析数据:在对加拿大四个省和一个地区的 20 名参与者的访谈中,所有参与者都指出,EIDM 得到了重视,但在实施方面存在很大差异。参与者报告了在证据使用的一致性、公共卫生机构支持 EIDM 的可用资源以及员工在 EIDM 方面的知识和技能方面的差异。领导层对 EIDM 的影响很大;但是,领导层对 EIDM 的投入各不相同。在COVID-19大流行期间,证据使用方面的变化表明,在证据大量涌入和工作人员角色重新分配的情况下,决策变得十分紧迫:尽管 EIDM 的价值已得到认可,但在将证据纳入决策和投入足够资源支持 EIDM 方面仍存在差距。加拿大的公共卫生组织需要时间、资源和技能来调整流程和实施 EIDM,以便将 EIDM 全面融入公共卫生决策的各个方面。西班牙文摘要:http://links.lww.com/IJEBH/A249。
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引用次数: 0
Interruption reduction during oral medication rounds among nurses in hematology-oncology wards: a best practice implementation project. 减少血液肿瘤科病房护士口服药物查房时的中断:最佳实践实施项目。
IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-23 DOI: 10.1097/XEB.0000000000000457
Jia Wen Siah, Crystal Kai Tian Cheng, Chloe Leyi Choy, Poh Chi Tho, Siew Ping Lang

Objectives: The aim of the project was to reduce interruptions during oral medication rounds among nurses working in hematology-oncology wards by improving compliance with best practices by 20%.

Introduction: Medication errors can adversely affect patient safety. Hence, understanding the underlying contributors to medication errors is necessary. Nurses are the ones who administer medications to patients; however, in clinical areas, interruptions are prevalent and could contribute to medication errors. It is therefore recommended that interventions be implemented to minimize interruptions.

Methods: This project was conducted in two hematology-oncology wards from March 2022 to March 2023. Target participants were nurses who served medications in the morning. The project followed an evidence-based audit and feedback methodology using the seven-phase JBI Evidence Implementation Framework. JBI's Practical Application of Clinical Evidence System (PACES) was used to support the audit and feedback process. An interruption reduction bundle consisting of three best practices was implemented.

Results: At baseline, only 24% of medications administered occurred without interruption. One month after implementation, there was a 51% improvement in compliance. Six months after implementation, compliance increased to 58%. Nine months post-implementation, the compliance rate remained at 59%. Absolute interruption counts decreased from 47 (baseline), to 27 (1 month post-implementation), to 24 (6 months post-implementation), to 16 (9 months post-implementation). All types of interruptions decreased when comparing the baseline with the latest post-implementation result.

Conclusions: The project used evidence-based interventions in a bundle, effectively reducing interruptions during oral medication rounds, and sustaining positive results.

Spanish abstract: http://links.lww.com/IJEBH/A256.

项目目标该项目的目的是将血液肿瘤科病房护士在口服药物查房时的中断情况减少 20%,从而提高最佳实践的依从性:用药错误会对患者安全造成不利影响。因此,有必要了解造成用药错误的根本原因。护士是为患者用药的人,但在临床领域,中断用药的情况非常普遍,可能会导致用药错误。因此,建议实施干预措施,尽量减少中断:本项目于 2022 年 3 月至 2023 年 3 月在两个血液肿瘤科病房进行。目标参与者为上午提供药物的护士。该项目采用基于证据的审核和反馈方法,使用七阶段 JBI 证据实施框架。JBI 的临床证据实际应用系统 (PACES) 用于支持审核和反馈流程。实施了由三种最佳实践组成的减少中断捆绑计划:结果:基线时,只有 24% 的用药没有中断。实施一个月后,依从性提高了 51%。实施六个月后,依从性提高到 58%。实施九个月后,依从率保持在 59%。绝对中断次数从 47 次(基线)下降到 27 次(实施后 1 个月)、24 次(实施后 6 个月)和 16 次(实施后 9 个月)。将基线与实施后的最新结果相比,所有类型的中断次数都有所减少:该项目将循证干预措施捆绑使用,有效减少了口服药物查房期间的中断情况,并保持了积极成果。西班牙文摘要:http://links.lww.com/IJEBH/A256。
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引用次数: 0
Promoting sleep and rest in hospitalized children: a best practice implementation project. 促进住院儿童的睡眠和休息:最佳实践实施项目。
IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-23 DOI: 10.1097/XEB.0000000000000456
Carolina Lechosa-Muñiz, Laura Ruiz-Azcona, Elena Pérez Belmonte, Marina Gallego-Jiménez, María Jesús Cabero-Pérez

Objective: The objective of this project was to implement scientific evidence to promote sleep and rest in pediatric patients during hospitalization.

Introduction: Hospitals are not conducive to quality sleep, as external factors such as light, noise, and interruptions from health care staff can disturb patients. Being hospitalized has a detrimental impact on children's sleep because it reduces how much sleep they get and the quality of that sleep. It has been reported that up to 20% to 30% of hospitalized children experience sleep problems.

Methods: This project was conducted at the Marqués de Valdecilla University Hospital in Cantabria, northern Spain. The project used the JBI Evidence Implementation Framework, which is grounded in an audit, feedback, and re-audit process, together with a structured approach to identifying and managing barriers to change. The study subjects were 100 children aged 2 to 16 years, who were admitted to the hospital's pediatric unit from November to December 2021, and 27 multi-disciplinary health care staff.

Results: Implementing the evidence-based strategies improved our care practices, with the follow-up audit results showing a marked improvement in compliance. Thus, training health care staff on pediatric sleep increased from 4% to 80%; using a multi-faceted approach to sleep promotion increased from 21% to 87%; and promoting relaxation techniques to promote sleep increased from 0% to 80%.

Conclusions: The project met its objectives. Areas for improving children's sleep and rest during hospitalization were identified. To avoid resistance to change, it was necessary to involve the entire team and maintain training. We recommend follow-up audits once a year, to ensure the sustainability of the project.

Spanish abstract: http://links.lww.com/IJEBH/A252.

项目目标本项目旨在通过科学证据促进儿科患者在住院期间的睡眠和休息:医院不利于提高睡眠质量,因为光线、噪音和医护人员的打扰等外部因素都会干扰患者。住院对儿童的睡眠有不利影响,因为这会减少他们的睡眠时间和睡眠质量。据报道,多达 20% 至 30% 的住院儿童有睡眠问题:该项目在西班牙北部坎塔布里亚的马尔凯斯-德-瓦尔德西利亚大学医院进行。该项目采用了JBI证据实施框架,该框架以审计、反馈和再审计流程为基础,并采用结构化方法来识别和管理变革的障碍。研究对象为 2021 年 11 月至 12 月期间在医院儿科住院的 100 名 2 至 16 岁儿童,以及 27 名跨学科医护人员:结果:实施循证策略后,我们的护理实践得到了改善,后续审计结果显示,依从性明显提高。因此,对医护人员进行儿科睡眠培训的比例从 4% 提高到 80%;采用多方位方法促进睡眠的比例从 21% 提高到 87%;推广放松技巧促进睡眠的比例从 0% 提高到 80%:结论:该项目达到了预期目标。结论:该项目达到了预期目标,确定了改善儿童住院期间睡眠和休息的领域。为避免变革阻力,有必要让整个团队参与进来并保持培训。我们建议每年进行一次跟踪审计,以确保项目的可持续性。西班牙文摘要:http://links.lww.com/IJEBH/A252。
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引用次数: 0
Patency, assessment, and management of central catheter occlusion in adult patients in the intensive care unit: a best practice implementation project. 重症监护室成人患者中央导管闭塞的通畅、评估和管理:最佳实践实施项目。
IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1097/XEB.0000000000000426
Paula Marqués Irigoyen, Marina Gallego Jimenez, Eva María López Arellano, Montserrat Sicilia Pérez, Rebeca Villanueva Cabredo

Introduction: Cannulation with a central venous catheter (CVC) is a common procedure used in critical care. One of the main complications is occlusion, which can lead to delayed treatment, prolonged hospital stay, and increased health care costs.

Objective: The aim of this project was to promote evidence-based practice for nurses caring for patients with a CVC in a Spanish intensive care unit. The project also aimed to reduce CVC occlusion and ensure CVC patency.

Methods: This project was guided by the JBI Model of Evidence-based Healthcare and the JBI Evidence Implementation Framework. Seven phases were followed using evidence-based auditing and feedback. The JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) tools were used to support data collection, data analysis, and implementation planning.

Results: After project implementation, the following results were obtained. Criterion 1 (assessing the CVC, flushing, and aspirating) reached 100% compliance in both audits. Criterion 2 (occlusion documentation) showed a modest improvement, rising from 13.33% to 36.67%. Improvement for Criterion 3 (the need for a policy and protocol) was excellent, rising from 0% at baseline to 100% following implementation. Criterion 4 (rapid instillation of an appropriate thrombolytic agent if a CVC is occluded) remained at 0% compliance in both audits. Criterion 5 (continuing education for health care professionals) improved from 10% to 60%. Criterion 6 (flushing and locking before procedures) improved from 90% to 100%.

Conclusion: The project objectives were largely met and resulted in a protocol, which has been shared with other departments within the hospital. The implementation of best clinical practice will be continued, including the use of thrombolytic agents.

Spanish abstract: http://links.lww.com/IJEBH/A200.

导言:使用中心静脉导管(CVC)插管是重症监护中的一种常见程序。主要并发症之一是闭塞,可导致治疗延误、住院时间延长和医疗费用增加:该项目的目的是向在西班牙重症监护病房护理使用 CVC 患者的护士推广循证实践。该项目还旨在减少 CVC 闭塞,确保 CVC 的通畅:该项目以 JBI 循证医疗模式和 JBI 循证实施框架为指导。采用循证审核和反馈方法,共分为七个阶段。JBI临床证据实际应用系统(PACES)和将研究融入实践(GRiP)工具用于支持数据收集、数据分析和实施规划:项目实施后,取得了以下成果。标准 1(评估 CVC、冲洗和抽吸)在两次审核中均达到 100%。标准 2(闭塞记录)略有改善,从 13.33% 提高到 36.67%。标准 3(对政策和规程的需求)的改进非常显著,从基线的 0% 提高到实施后的 100% 。标准 4(在 CVC 闭塞时迅速注入适当的溶栓药物)在两次审核中的达标率均为 0%。标准 5(医护人员继续教育)从 10% 提高到 60%。标准 6(手术前冲洗和锁定)从 90% 提高到 100%:项目目标已基本实现,并制定了一份协议,与医院其他部门共享。西班牙文摘要:http://links.lww.com/IJEBH/A200。
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引用次数: 0
Pelvic floor muscle training for urinary incontinence in older adults: a best practice implementation project. 针对老年人尿失禁的盆底肌肉训练:最佳实践实施项目。
IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1097/XEB.0000000000000432
Terese Kochuvilayil Sic, Sunu Alice Cherian, Saritha Susan Vargese, Alexa McArthur, Lucylynn Lizarondo

Objectives: This project aimed to implement best practices for pelvic floor muscle training to manage urinary incontinence among older women in long-term care in Kerala, India.

Introduction: Urinary incontinence is a prevalent and distressing condition that affects a significant proportion of older adults and is characterized by involuntary loss of urine, leading to social embarrassment, decreased quality of life, and increased health care costs. It is more prevalent in women and is associated with dementia, limited mobility, and other comorbidities in long-term care. Pelvic floor muscle training is a first-line treatment option for urinary incontinence in older adults, given its potential to improve quality of life and reduce health care costs.

Methods: This project was based on the JBI Evidence Implementation Framework. A baseline audit was conducted to evaluate current practice against best practices. After identifying barriers and implementing strategies, follow-up audits were conducted after 3 and 6 months.

Results: The baseline audit showed 0% compliance with all best practices. Barriers such as lack of knowledge and practice of pelvic floor exercises for urinary incontinence among participants and nurses; unknown cognitive status; and health emergencies were identified. Strategies including video-assisted training of pelvic floor muscle exercises, training calendars, and flip charts with instructions. The follow-up audits showed significant improvements in compliance.

Conclusions: This project reduced urinary incontinence in the participants. Although two of the audit criteria did not reach 100% compliance by the end of 6 months, the stakeholders of the long-term care facility understood the importance of pelvic floor muscle training, which will be beneficial for future residents with urinary incontinence.

Spanish abstract: http://links.lww.com/IJEBH/A211.

项目目标本项目旨在对印度喀拉拉邦长期护理机构中的老年妇女实施骨盆底肌肉训练的最佳实践,以控制尿失禁:尿失禁是一种普遍且令人苦恼的疾病,影响着很大一部分老年人,其特点是非自主性遗尿,导致社交尴尬、生活质量下降和医疗费用增加。这种疾病在女性中更为普遍,并且与痴呆症、行动不便以及长期护理中的其他合并症有关。盆底肌肉训练是治疗老年人尿失禁的一线选择,因为它具有改善生活质量和降低医疗费用的潜力:该项目基于 JBI 证据实施框架。方法:该项目以 JBI 证据实施框架为基础,进行了基线审计,以对照最佳实践评估当前的做法。在确定障碍和实施策略后,分别在 3 个月和 6 个月后进行了后续审核:基线审计显示,所有最佳实践的合规率为 0%。发现的障碍包括参与者和护士对治疗尿失禁的盆底运动缺乏了解和实践;认知状况不明;以及健康紧急情况。采取的策略包括骨盆底肌肉锻炼的视频辅助训练、训练日历和附有说明的挂图。后续审计显示,遵从性有了明显改善:结论:该项目减少了参与者的尿失禁情况。虽然有两项审核标准在 6 个月结束时未达到 100%的达标率,但长期护理机构的利益相关者了解了盆底肌肉训练的重要性,这将对未来患有尿失禁的居民有益。西班牙文摘要:http://links.lww.com/IJEBH/A211。
{"title":"Pelvic floor muscle training for urinary incontinence in older adults: a best practice implementation project.","authors":"Terese Kochuvilayil Sic, Sunu Alice Cherian, Saritha Susan Vargese, Alexa McArthur, Lucylynn Lizarondo","doi":"10.1097/XEB.0000000000000432","DOIUrl":"10.1097/XEB.0000000000000432","url":null,"abstract":"<p><strong>Objectives: </strong>This project aimed to implement best practices for pelvic floor muscle training to manage urinary incontinence among older women in long-term care in Kerala, India.</p><p><strong>Introduction: </strong>Urinary incontinence is a prevalent and distressing condition that affects a significant proportion of older adults and is characterized by involuntary loss of urine, leading to social embarrassment, decreased quality of life, and increased health care costs. It is more prevalent in women and is associated with dementia, limited mobility, and other comorbidities in long-term care. Pelvic floor muscle training is a first-line treatment option for urinary incontinence in older adults, given its potential to improve quality of life and reduce health care costs.</p><p><strong>Methods: </strong>This project was based on the JBI Evidence Implementation Framework. A baseline audit was conducted to evaluate current practice against best practices. After identifying barriers and implementing strategies, follow-up audits were conducted after 3 and 6 months.</p><p><strong>Results: </strong>The baseline audit showed 0% compliance with all best practices. Barriers such as lack of knowledge and practice of pelvic floor exercises for urinary incontinence among participants and nurses; unknown cognitive status; and health emergencies were identified. Strategies including video-assisted training of pelvic floor muscle exercises, training calendars, and flip charts with instructions. The follow-up audits showed significant improvements in compliance.</p><p><strong>Conclusions: </strong>This project reduced urinary incontinence in the participants. Although two of the audit criteria did not reach 100% compliance by the end of 6 months, the stakeholders of the long-term care facility understood the importance of pelvic floor muscle training, which will be beneficial for future residents with urinary incontinence.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A211.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":"242-249"},"PeriodicalIF":2.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Factors influencing nurses' use of sedation interruptions in a critical care unit: a descriptive qualitative study. 影响重症监护病房护士使用镇静中断的因素:一项描述性定性研究。
IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1097/XEB.0000000000000415
Nicole D Graham, Ian D Graham, Brandi Vanderspank-Wright, Letitia Nadalin Penno, Dean A Fergusson, Janet E Squires

Introduction and aims: This study examined critical care nurses', physicians', and allied health professionals' perceptions of factors that support, inhibit, or limit the use of sedation interruption (SI) to improve the use of this integral component of care for mechanically ventilated patients.

Method: We conducted a theory-based, descriptive qualitative study using semi-structured interviews with critical care registered nurses, respiratory therapists, a pharmacist, and a physician in a hospital in Ontario, Canada. The interview guide and analysis were informed by the Theoretical Domains Framework and transcripts were analyzed using content analysis.

Results: We identified 9 facilitators and 20 barriers to SI use by nurses. Facilitators included the innovation (importance of protocols) and potential adopters (comfort with the skill). The barriers were the potential adopters' (nurses) knowledge gaps regarding the performance and goal of SI and the practice environment (lack of time, availability of extra staff, and lack of multidisciplinary rounds).

Conclusion: This study identified facilitators and barriers to SI for mechanically ventilated patients. Implementation efforts must address barriers associated with nurses, the environment, and contextual factors. A team-based approach is essential, as the absence of interprofessional rounds is a significant barrier to the appropriate use or non-use of SI. Future research can focus on the indications, contraindications, and goals of SI, emphasizing a shared appreciation for these factors across disciplines. Nursing capacity to manage a patient waking up from sedation is necessary for point-of-care adherence; future research should focus on the best ways to do so. Implementation study designs should use theory and evidence-based determinants of SI to bridge the evidence-to-practice gap.

Spanish abstract: http://links.lww.com/IJEBH/A178.

引言和目的:本研究调查了重症监护护士、医生和专职医疗人员对支持、抑制或限制使用镇静中断(SI)的因素的看法,以改进机械通气患者护理中这一不可或缺的组成部分的使用:我们对加拿大安大略省一家医院的重症监护注册护士、呼吸治疗师、药剂师和医生进行了半结构化访谈,开展了一项基于理论的描述性定性研究。访谈指南和分析参考了理论领域框架,并采用内容分析法对访谈记录进行了分析:结果:我们确定了护士使用 SI 的 9 个促进因素和 20 个障碍。促进因素包括创新(协议的重要性)和潜在采用者(对技能的舒适度)。障碍包括潜在采用者(护士)对 SI 的性能和目标的认识不足以及实践环境(缺乏时间、额外人员的可用性以及缺乏多学科查房):本研究确定了对机械通气患者实施 SI 的促进因素和障碍。实施工作必须解决与护士、环境和背景因素相关的障碍。以团队为基础的方法至关重要,因为缺乏跨专业查房是适当使用或不使用 SI 的重大障碍。未来的研究可以重点关注 SI 的适应症、禁忌症和目标,强调各学科对这些因素的共同认识。管理从镇静中醒来的患者的护理能力是坚持护理点的必要条件;未来的研究应重点关注这样做的最佳方法。实施研究设计应使用理论和基于证据的SI决定因素,以弥合证据与实践之间的差距。西班牙文摘要:http://links.lww.com/IJEBH/A178。
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引用次数: 0
Reducing insulin omission errors among patients with diabetes mellitus in general surgical wards: a best practice implementation project. 减少普通外科病房糖尿病患者的胰岛素遗漏错误:最佳实践实施项目。
IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1097/XEB.0000000000000437
Sharlyn Jia Yi Ng, Mien Li Goh

Introduction and objectives: Omission of insulin, a high-alert medication with one of the highest locally reported errors, could lead to severe hyperglycemia, which could result in coma or death if not treated timeously. This study aimed to identify, evaluate, and implement strategies to reduce the occurrence of insulin omission errors in diabetic adult patients requiring insulin.

Methods: This project followed the JBI Evidence Implementation Framework and conducted context analysis, strategy implementation, and evaluation of outcomes according to evidence-based quality indicators. The JBI PACES and JBI GRiP situational analysis tools were used to support data collection and implementation planning. There was one evidence-based criterion and five sub-criteria, with a sample size of 22 patients.

Results: There was increased compliance with best practices to reduce interruptions and distractions from baseline audit (50%) to follow-up audits 1 (45.4%) and 2 (31.8%), and no insulin omission incidences during the implementation period. In the post-implementation analysis, there were notable improvements in compliance with strategies related to nurses; however, reduced compliance was observed related to patients. Key barriers to implementation included patients still disturbing nurses despite the nurses wearing the medication vests and patients forgetting instructions not to disturb nurses during medication administration. Strategies to improve compliance included ensuring coverage in each cubicle during insulin preparation and administration, tending to patients' needs prior to insulin administration, and use of posters as reminders.

Conclusions: There was an overall increase in compliance with best practice to reduce interruptions and distractions and no insulin omission incidences related to interruptions and distractions during the implementation phase.

Spanish abstract: http://links.lww.com/IJEBH/A219.

导言和目标:胰岛素是一种高警戒药物,也是当地报告错误率最高的药物之一,漏用胰岛素可能导致严重的高血糖,如不及时治疗,可能导致昏迷或死亡。本研究旨在确定、评估和实施相关策略,以减少需要使用胰岛素的成年糖尿病患者发生胰岛素漏服错误:该项目遵循 JBI 证据实施框架,根据循证质量指标进行背景分析、策略实施和结果评估。JBI PACES 和 JBI GRiP 情境分析工具用于支持数据收集和实施规划。共有一个循证标准和五个次级标准,样本量为 22 名患者:从基线审计(50%)到后续审计 1(45.4%)和审计 2(31.8%),患者对减少干扰和分心的最佳实践的遵从度有所提高,在实施期间没有发生胰岛素遗漏事件。在实施后的分析中,护士对相关策略的依从性有了明显改善;但观察到患者对相关策略的依从性有所降低。实施过程中遇到的主要障碍包括:尽管护士穿上了服药背心,但患者仍会打扰护士;患者忘记了在服药过程中不要打扰护士的指示。提高依从性的策略包括确保在胰岛素准备和给药过程中每个隔间都有人值班、在给药前照顾病人的需要以及使用海报作为提醒:西班牙文摘要:http://links.lww.com/IJEBH/A219。
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引用次数: 0
Preventing functional decline in hospitalized older adults in medical ward: a best practice implementation project. 预防内科病房住院老年人功能衰退:最佳实践实施项目。
IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1097/XEB.0000000000000411
Chia-Te Chen, Heng-Hsin Tung, Chi-Wen Chen, Yea-Ru Yang, Jiun-Ling Wang, Chia-Ming Chang, Yen-Chin Chen, Shih-Hsin Liang, Chia-Hao Fan

Introduction and objectives: Functional decline frequently occurs in older adults in hospitals. The aim of this project was to promote evidence-based strategies for physical activity to prevent functional decline in hospitalized older adults in a medical center in southern Taiwan.

Methods: This project was guided by the JBI Evidence Implementation Framework. Seven audit criteria were derived from a JBI evidence summary and a baseline audit involving 25 nurses and 30 hospitalized older adults was conducted to compare current practice with best practice recommendations. The JBI Getting Research into Practice (GRiP) approach was used to identify barriers to implementation, and strategies were developed to overcome those barriers. A follow-up audit was conducted to measure any changes in compliance.

Results: After implementing the strategies, the pass rate of nursing staff improved in the physical activity knowledge test, rising from 56% to 88%. Compliance of nursing staff with providing physical activity instructions using evidence-based guidelines to hospitalized older adults reached 80%. The incidence of functional decline among hospitalized older adults decreased from 36.7% to 20%.

Conclusions: The results of this best practice implementation project suggest that initiating physical activity as early as possible for hospitalized older adults once their medical condition has stabilized can help prevent functional decline.

Spanish abstract: http://links.lww.com/IJEBH/A171.

导言和目标:住院老年人经常出现功能衰退。本项目旨在台湾南部的一家医疗中心推广以证据为基础的体育锻炼策略,以预防住院老年人的功能衰退:本项目以 JBI 证据实施框架为指导。方法:该项目以JBI证据实施框架为指导,从JBI证据摘要中提取了七项审核标准,并对25名护士和30名住院老年人进行了基线审核,以比较当前实践与最佳实践建议。利用 JBI 将研究付诸实践(GRiP)工具来确定实施障碍,并制定了克服这些障碍的策略。此外,还进行了一次后续审计,以衡量遵守情况的变化:结果:实施这些策略后,护理人员在体育锻炼知识测试中的通过率有所提高,从 56% 提高到 88%。护理人员使用循证指南为住院老年人提供体育锻炼指导的依从性达到了 80%。住院老年人功能衰退的发生率从 36.7% 降至 20%:这一最佳实践实施项目的结果表明,一旦住院老年人的病情稳定,尽早为他们开展体育锻炼有助于预防功能衰退。西班牙文摘要:http://links.lww.com/IJEBH/A171。
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引用次数: 0
Building an implementation strategy for community-based rehabilitation for mental health in Colombia. 在哥伦比亚制定以社区为基础的心理健康康复实施战略。
IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1097/XEB.0000000000000431
Felipe Agudelo-Hernández, Rodrigo Rojas-Andrade, Ana Belén Giraldo Alvarez

Introduction: Scientific evidence indicates that the community-based rehabilitation (CBR) model is recommended for recovery from mental disorders. However, this approach encounters barriers and often lacks implementation strategies.

Aim: The aim of this study was to create a strategy for the implementation of CBR for mental health in Colombia through the identification of barriers and facilitators, together with the expected outcomes, from the perspective of mental health decision-makers in Colombia.

Methods: This study adopts a qualitative descriptive approach, using focus group data collection methods and thematic analysis to code and analyze the data.

Results: A total of 208 individuals participated in the study, including mental health decision-makers and health care professionals. Intersectoral collaboration, contextualization, financial resources, and community commitment and autonomy were identified as barriers and facilitators. The element that was considered a priority for successful implementation was the contextualization of strategies.

Conclusions: CBR needs to be strengthened through implementation science if these strategies are to be successfully developed and implemented in various contexts.

Spanish abstract: http://links.lww.com/IJEBH/A210.

导言:科学证据表明,以社区为基础的康复(CBR)模式被推荐用于精神障碍患者的康复。目的:本研究旨在从哥伦比亚精神健康决策者的角度出发,通过识别障碍和促进因素以及预期成果,为哥伦比亚精神健康社区康复的实施制定战略:本研究采用定性描述法,使用焦点小组数据收集方法和主题分析法对数据进行编码和分析:共有 208 人参与了研究,其中包括心理健康决策者和医疗保健专业人员。跨部门合作、情境化、财政资源、社区承诺和自治被认为是障碍和促进因素。被认为是成功实施的优先要素是战略的因地制宜:如果要在各种情况下成功制定和实施这些战略,就需要通过实施科学来加强社区康复。西班牙文摘要:http://links.lww.com/IJEBH/A210。
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引用次数: 0
Promoting running as the best treatment for lower back pain in physiotherapy practice: a best practice implementation project. 在物理治疗实践中推广跑步作为治疗腰背痛的最佳疗法:最佳实践实施项目。
IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1097/XEB.0000000000000441
Christina Jaster, Jitka Klugarová, Aleksandra Królikowska, Anna Kołcz, Tina Poklepović Peričić, Małgorzata M Bała, Tereza Vrbová, Roland Becker, Robert Prill

Objectives: This project aimed to promote running as the best treatment for lower back pain (LBP) in an outpatient setting.

Introduction: LBP is one of the most prevalent conditions worldwide. Sixty-two percent of all Germans experience episodes of non-specific back pain at least once a year, with one-fifth developing chronic conditions. Intervertebral disc (IVD) degeneration is a natural process, contributing to periods of acute LBP. However, the scientific literature and guidelines partially overlook the significance of water management in IVD. This implementation project sought to address this gap by educating patients about this process. Running and/or walking were chosen as general approaches for treatment rather than specific disease-related approaches.

Methods: This implementation project was conducted in an outpatient physiotherapy clinic in Brandenburg, Germany, utilizing the JBI Evidence Implementation Framework. An evidence-informed clinical audit and feedback strategy was used to measure compliance with ten audit criteria. Five physiotherapists and 20 patients took part in the audits.

Results: At baseline, only 20% of participating physiotherapists screened for yellow flags regarding psychological issues. However, after project implementation, this criterion scored 100% compliance. Some patients performed exercises independently, but confusion persisted regarding the choice of beneficial exercises. Patients continued running, but those who took a break due to pain expressed uncertainty about resuming.

Conclusions: The project highlighted the effectiveness of collaborative efforts between patients and therapists to address the issue. The project team's conviction in action and solution strategies serves as the foundation for this collaboration. This implementation strategy provided "running" patients with the confidence to either resume or reintegrate running after an extended break.

Spanish abstract: http://links.lww.com/IJEBH/A222.

目标:该项目旨在门诊环境中推广跑步作为治疗腰背痛(LBP)的最佳方法:该项目旨在推广跑步作为门诊治疗下背痛的最佳方法:简介:腰背痛是全球最常见的疾病之一。62%的德国人每年至少经历一次非特异性腰痛,其中五分之一的人发展为慢性病。椎间盘 (IVD) 退化是一个自然过程,会导致急性腰背痛。然而,科学文献和指南部分忽视了椎间盘水管理的重要性。本实施项目旨在通过向患者宣传这一过程来弥补这一不足。跑步和/或步行被选为治疗的一般方法,而不是与疾病相关的特定方法:该实施项目在德国勃兰登堡的一家物理治疗门诊进行,采用了 JBI 证据实施框架。采用循证临床审核和反馈策略来衡量十项审核标准的合规性。5名物理治疗师和20名患者参加了审核:结果:在基线阶段,只有 20% 的参与理疗师筛查出了心理问题黄旗。但在项目实施后,这一标准的符合率达到了 100%。一些患者独立进行了锻炼,但在有益锻炼的选择上仍然存在困惑。患者继续跑步,但那些因疼痛而暂停跑步的患者对恢复跑步表示不确定:该项目强调了患者和治疗师合作解决问题的有效性。项目团队对行动和解决策略的信念是这种合作的基础。这一实施策略为 "跑步 "患者提供了信心,使他们在长期休息后恢复或重新参与跑步。西班牙文摘要:http://links.lww.com/IJEBH/A222。
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引用次数: 0
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Jbi Evidence Implementation
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