Pub Date : 2023-12-01DOI: 10.1097/XEB.0000000000000371
Victoria M Gholar, Robin Christian
Objective: The objective of this project was to promote evidence-based practice and identify how to best implement nutrition education interventions for adults living in rural and/or low-income communities.
Introduction: Adults living in rural and/or low-income communities are at increased risk for poor nutrition and chronic health conditions. Patients are referred to the EversCare Clinic (ECC), an ambulatory clinic at an academic medical center in Mississippi, USA, to receive assistance with social needs. In addition to living in rural and/or low-income communities, over 90% of the patients seen at the ECC are food-insecure, yet nutrition education is inconsistently provided.
Methods: The JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) audit and feedback tools were used. The ECC team conducted a baseline audit of 30 patient electronic health records, designed and implemented best-practice nutrition education strategies, and completed a follow-up audit of 30 patient electronic health records. Four evidence-based criteria for nutrition education in adults living in rural and/or low-income communities were audited, and various interventions were used to address multiple levels.
Results: The baseline audit revealed patients were not receiving recommended nutrition education interventions. Following the implementation, there was a 64.2% improvement in compliance with all four best practice criteria. Involving nursing students proved to be an effective method of improving compliance.
Conclusion: Adherence to best practices regarding implementing nutrition education interventions was satisfactory, with 80% of patients receiving interventions at individual, interpersonal, community, and societal levels. Future audits are planned to ensure sustainability.
目的:该项目的目的是促进循证实践,并确定如何最好地实施农村和/或低收入社区成年人的营养教育干预措施。导言:生活在农村和/或低收入社区的成年人患营养不良和慢性疾病的风险增加。患者被转介到EversCare诊所(ECC),这是美国密西西比州一家学术医疗中心的门诊诊所,以接受社会需求方面的援助。除了生活在农村和/或低收入社区之外,在ECC就诊的90%以上的患者都是粮食不安全的,但营养教育却没有得到持续的提供。方法:采用JBI临床证据系统(pace)的实际应用和get Research into Practice (GRiP)的审核和反馈工具。ECC小组对30名患者电子健康记录进行了基线审计,设计和实施了最佳做法营养教育战略,并完成了对30名患者电子健康记录的后续审计。对农村和/或低收入社区成人营养教育的四项循证标准进行了审核,并采用了多种干预措施来解决多个层面的问题。结果:基线审计显示患者没有接受推荐的营养教育干预。在实施之后,在遵守所有四个最佳实践标准方面有64.2%的改进。让护生参与是提高依从性的有效方法。结论:实施营养教育干预的最佳实践的依从性是令人满意的,80%的患者在个人、人际、社区和社会层面接受了干预。计划未来的审计以确保可持续性。
{"title":"Effectiveness of implementation strategies to improve nutrition education interventions in adults living in rural and/or low-income communities.","authors":"Victoria M Gholar, Robin Christian","doi":"10.1097/XEB.0000000000000371","DOIUrl":"10.1097/XEB.0000000000000371","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this project was to promote evidence-based practice and identify how to best implement nutrition education interventions for adults living in rural and/or low-income communities.</p><p><strong>Introduction: </strong>Adults living in rural and/or low-income communities are at increased risk for poor nutrition and chronic health conditions. Patients are referred to the EversCare Clinic (ECC), an ambulatory clinic at an academic medical center in Mississippi, USA, to receive assistance with social needs. In addition to living in rural and/or low-income communities, over 90% of the patients seen at the ECC are food-insecure, yet nutrition education is inconsistently provided.</p><p><strong>Methods: </strong>The JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) audit and feedback tools were used. The ECC team conducted a baseline audit of 30 patient electronic health records, designed and implemented best-practice nutrition education strategies, and completed a follow-up audit of 30 patient electronic health records. Four evidence-based criteria for nutrition education in adults living in rural and/or low-income communities were audited, and various interventions were used to address multiple levels.</p><p><strong>Results: </strong>The baseline audit revealed patients were not receiving recommended nutrition education interventions. Following the implementation, there was a 64.2% improvement in compliance with all four best practice criteria. Involving nursing students proved to be an effective method of improving compliance.</p><p><strong>Conclusion: </strong>Adherence to best practices regarding implementing nutrition education interventions was satisfactory, with 80% of patients receiving interventions at individual, interpersonal, community, and societal levels. Future audits are planned to ensure sustainability.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":"374-385"},"PeriodicalIF":2.3,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9768986","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}
Pub Date : 2023-12-01DOI: 10.1097/XEB.0000000000000388
Lucia Kantorová, Andrea Poloková, Michal Sýkora, Tereza Vrbová, Miloslav Klugar, Jitka Klugarová
Objectives: The aim of this implementation project was to improve breastfeeding support, and more specifically, to increase compliance with the Baby-Friendly Hospital Initiative (BFHI) and the requirements of the International Code of Marketing of Breastmilk Substitutes (the Code).
Introduction: The Ten Steps to Successful Breastfeeding of the BFHI have been shown to improve breastfeeding outcomes at target hospitals. The Code is a minimum standard for the regulation of marketing practices related to breastfeeding support.
Methods: We used the JBI evidence implementation model to identify a group of stakeholders in a hospital in the Czech Republic and carried out a best practice implementation project from January 2021 to May 2022. After conducting a baseline audit, the clinical team and external breastfeeding experts discussed challenges and devised an implementation plan using the JBI Getting Research into Practice framework. Follow-up audits were undertaken from January to December 2021 and in May 2022.
Results: Compliance improved across all audited criteria, namely, to fully comply with the Code (0% to 100%); to have a written infant feeding policy (0% to 100%); to ensure staff have skills to support breastfeeding (0% to 100%); to discuss breastfeeding with pregnant women (0% to 100%); to facilitate skin-to-skin contact (67.86% to 83.58%); to support and provide help with breastfeeding (67.86% to 82.09%); to not provide fluids other than breast milk (50% to 58.21%); to practice rooming-in (57.14% to 61.19%); to respond to infant cues (50% to 64.18%); to provide information about community support services (32.14% to 62.69%); and to coordinate discharge and ongoing care (0% to 100%).
Conclusions: Breastfeeding support requires a sustained long-term effort before it can become fully established. The involvement of national-level policy makers is needed.
{"title":"Breastfeeding support and avoiding inappropriate breast milk substitute marketing in a neonatal ward in the Czech Republic: a best practice implementation project.","authors":"Lucia Kantorová, Andrea Poloková, Michal Sýkora, Tereza Vrbová, Miloslav Klugar, Jitka Klugarová","doi":"10.1097/XEB.0000000000000388","DOIUrl":"10.1097/XEB.0000000000000388","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this implementation project was to improve breastfeeding support, and more specifically, to increase compliance with the Baby-Friendly Hospital Initiative (BFHI) and the requirements of the International Code of Marketing of Breastmilk Substitutes (the Code).</p><p><strong>Introduction: </strong>The Ten Steps to Successful Breastfeeding of the BFHI have been shown to improve breastfeeding outcomes at target hospitals. The Code is a minimum standard for the regulation of marketing practices related to breastfeeding support.</p><p><strong>Methods: </strong>We used the JBI evidence implementation model to identify a group of stakeholders in a hospital in the Czech Republic and carried out a best practice implementation project from January 2021 to May 2022. After conducting a baseline audit, the clinical team and external breastfeeding experts discussed challenges and devised an implementation plan using the JBI Getting Research into Practice framework. Follow-up audits were undertaken from January to December 2021 and in May 2022.</p><p><strong>Results: </strong>Compliance improved across all audited criteria, namely, to fully comply with the Code (0% to 100%); to have a written infant feeding policy (0% to 100%); to ensure staff have skills to support breastfeeding (0% to 100%); to discuss breastfeeding with pregnant women (0% to 100%); to facilitate skin-to-skin contact (67.86% to 83.58%); to support and provide help with breastfeeding (67.86% to 82.09%); to not provide fluids other than breast milk (50% to 58.21%); to practice rooming-in (57.14% to 61.19%); to respond to infant cues (50% to 64.18%); to provide information about community support services (32.14% to 62.69%); and to coordinate discharge and ongoing care (0% to 100%).</p><p><strong>Conclusions: </strong>Breastfeeding support requires a sustained long-term effort before it can become fully established. The involvement of national-level policy makers is needed.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":"21 S1","pages":"S47-S56"},"PeriodicalIF":2.3,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138463735","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}
Pub Date : 2023-12-01DOI: 10.1097/XEB.0000000000000387
Leticia Bernués-Caudillo, Laura Albornos-Muñoz, M Paz Fernández Rodrigo, Marta Álvarez García, Marta De Rioja Benito, María Jesús Ruano Serrano, Paloma García Navarro, Patricia Ledesma Pérez, Sonia González Sotelo, M Teresa Moreno-Casbas, Tereza Vrbová, Miloslav Klugar, Jitka Klugarová, Esther Gonzalez-María
Objectives: This project aimed to improve compliance with evidence-based practice in pain assessment and management in a gynecology ward.
Introduction: Effective pain control is important to prevent the negative consequences of pain that is poorly managed. However, it remains undervalued and inadequately treated. Applying evidence-based practices to correctly evaluate and manage pain is essential to improve pain relief.
Methods: This project followed the JBI Evidence Implementation Framework. A baseline audit of 41 women admitted to the gynecology ward was conducted and measured against 5 best practice criteria, along with a patient satisfaction questionnaire. Targeted strategies were then implemented and a follow-up audit was conducted using the same criteria, methods, and sample size as the baseline audit.
Results: The baseline audit revealed gaps between current and best practice. Barriers to implementation were identified and strategies to resolve the barriers were designed and implemented (nurse education, informative materials, electronic patient records system improvements). Comprehensive pain assessment, including dynamic and static pain assessment, use of a validated tool, and education provided to patients and carers, improved in the follow-up audit. There was no change in patient satisfaction levels; however, the discrepancy between pain measured by nurses and pain measured by patients was reduced.
Conclusions: The JBI methodology was useful in improving compliance with evidence-based practice criteria. It also facilitated adaptation to new barriers, such as the COVID-19 pandemic. Improving nurses' knowledge of pain assessment can lead to more accurate assessment. Inadequate records systems also made it difficult to record the care that was provided. Subsequent audits will assess sustainability and the project will be escalated to other wards.
{"title":"Pain assessment and management among adult patients in a gynecology ward: a best practice implementation project.","authors":"Leticia Bernués-Caudillo, Laura Albornos-Muñoz, M Paz Fernández Rodrigo, Marta Álvarez García, Marta De Rioja Benito, María Jesús Ruano Serrano, Paloma García Navarro, Patricia Ledesma Pérez, Sonia González Sotelo, M Teresa Moreno-Casbas, Tereza Vrbová, Miloslav Klugar, Jitka Klugarová, Esther Gonzalez-María","doi":"10.1097/XEB.0000000000000387","DOIUrl":"10.1097/XEB.0000000000000387","url":null,"abstract":"<p><strong>Objectives: </strong>This project aimed to improve compliance with evidence-based practice in pain assessment and management in a gynecology ward.</p><p><strong>Introduction: </strong>Effective pain control is important to prevent the negative consequences of pain that is poorly managed. However, it remains undervalued and inadequately treated. Applying evidence-based practices to correctly evaluate and manage pain is essential to improve pain relief.</p><p><strong>Methods: </strong>This project followed the JBI Evidence Implementation Framework. A baseline audit of 41 women admitted to the gynecology ward was conducted and measured against 5 best practice criteria, along with a patient satisfaction questionnaire. Targeted strategies were then implemented and a follow-up audit was conducted using the same criteria, methods, and sample size as the baseline audit.</p><p><strong>Results: </strong>The baseline audit revealed gaps between current and best practice. Barriers to implementation were identified and strategies to resolve the barriers were designed and implemented (nurse education, informative materials, electronic patient records system improvements). Comprehensive pain assessment, including dynamic and static pain assessment, use of a validated tool, and education provided to patients and carers, improved in the follow-up audit. There was no change in patient satisfaction levels; however, the discrepancy between pain measured by nurses and pain measured by patients was reduced.</p><p><strong>Conclusions: </strong>The JBI methodology was useful in improving compliance with evidence-based practice criteria. It also facilitated adaptation to new barriers, such as the COVID-19 pandemic. Improving nurses' knowledge of pain assessment can lead to more accurate assessment. Inadequate records systems also made it difficult to record the care that was provided. Subsequent audits will assess sustainability and the project will be escalated to other wards.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":"21 S1","pages":"S1-S8"},"PeriodicalIF":2.3,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138463738","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}
Pub Date : 2023-12-01DOI: 10.1097/XEB.0000000000000380
Pedro Sousa, Daniela Cardoso, Tereza Vrbová, João Apóstolo, Margarida Santos, Gracinda Manso, Daniel Mourão, Goreti Ferreira, Manuela Monteiro, Jacinta Manata, Alexandre Vaz, Jitka Klugarová, Miloslav Klugar
Objectives: To improve postdischarge telephone follow-up in the context of chronic disease management (peripheral artery disease), in a vascular surgery service.
Introduction: Patients with chronic diseases, such as peripheral artery disease, present a higher risk of complications and greater constraints regarding their adherence to treatment, leading to an increasing mortality rate and decreased functional capacity. Comprehensive discharge planning plus postdischarge telephone follow-up may reduce 30-day re-hospitalization rates.
Methods: The project used the JBI audit and feedback methodological approach to implement the best available evidence into practice. Two audit criteria were used: existence of comprehensive discharge planning and timely telephone follow-up. A baseline audit was conducted, followed by analysis of barriers, which led to the implementation of several strategies, namely, a targeted training program, the development of educational resources and standardized procedures for the discharge process, and postdischarge telephone follow-up.
Results: Results from the baseline and first follow-up audits showed improvement for both criteria. Compliance for criterion 1 (comprehensive discharge planning, including postdischarge telephone follow-up) increased from 0% to 40.7%, and for criterion 2 (patient is followed up by telephone within 2 weeks of discharge) increased from 0% to 44.4%. These two criteria sustained improvements in the second follow-up audit: compliance increased to 45% (criterion 1) and 60% (criterion 2).
Conclusions: This implementation project contributed to the optimization of the chronic disease management, including improved compliance with discharge planning and early postdischarge telephone follow-up.
{"title":"Postdischarge telephone follow-up among chronic disease patients discharged from a vascular surgery service: a best practice implementation project.","authors":"Pedro Sousa, Daniela Cardoso, Tereza Vrbová, João Apóstolo, Margarida Santos, Gracinda Manso, Daniel Mourão, Goreti Ferreira, Manuela Monteiro, Jacinta Manata, Alexandre Vaz, Jitka Klugarová, Miloslav Klugar","doi":"10.1097/XEB.0000000000000380","DOIUrl":"10.1097/XEB.0000000000000380","url":null,"abstract":"<p><strong>Objectives: </strong>To improve postdischarge telephone follow-up in the context of chronic disease management (peripheral artery disease), in a vascular surgery service.</p><p><strong>Introduction: </strong>Patients with chronic diseases, such as peripheral artery disease, present a higher risk of complications and greater constraints regarding their adherence to treatment, leading to an increasing mortality rate and decreased functional capacity. Comprehensive discharge planning plus postdischarge telephone follow-up may reduce 30-day re-hospitalization rates.</p><p><strong>Methods: </strong>The project used the JBI audit and feedback methodological approach to implement the best available evidence into practice. Two audit criteria were used: existence of comprehensive discharge planning and timely telephone follow-up. A baseline audit was conducted, followed by analysis of barriers, which led to the implementation of several strategies, namely, a targeted training program, the development of educational resources and standardized procedures for the discharge process, and postdischarge telephone follow-up.</p><p><strong>Results: </strong>Results from the baseline and first follow-up audits showed improvement for both criteria. Compliance for criterion 1 (comprehensive discharge planning, including postdischarge telephone follow-up) increased from 0% to 40.7%, and for criterion 2 (patient is followed up by telephone within 2 weeks of discharge) increased from 0% to 44.4%. These two criteria sustained improvements in the second follow-up audit: compliance increased to 45% (criterion 1) and 60% (criterion 2).</p><p><strong>Conclusions: </strong>This implementation project contributed to the optimization of the chronic disease management, including improved compliance with discharge planning and early postdischarge telephone follow-up.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":"21 S1","pages":"S19-S27"},"PeriodicalIF":2.3,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138463740","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}
Introduction: Facilitation is a key element of evidence implementation. Although quantitative systematic reviews have been undertaken to examine its components and effectiveness, no attempt has been made to synthesize qualitative evidence examining the experiences of facilitators on how facilitation is operationalized, the challenges associated with it, and the factors that can influence its perceived effectiveness.
Methods: A systematic review of qualitative studies was conducted using the JBI methodology.
Results: A total of 36 qualitative studies was included in the systematic review, with the majority being assessed as high quality following critical appraisal. The findings were extracted and further synthesized, highlighting that facilitation involves providing technical and non-technical support to health professionals, as well as high-intensity collaborations and relationship building. Determinants of perceived effectiveness of facilitation include facilitators' access to resources and learning support; their skills, traits/attitudes, and approach to facilitation; and the context of the organization where the implementation occurs. Work demands, emotional stress, and lack of clarity in roles and career development can pose challenges for facilitators.
Conclusion: To maximize the outcomes of facilitation in evidence implementation, the team of facilitators should be carefully selected to ensure they have the right skills, traits/attitudes, and approach to facilitation. They should also be provided with dedicated time to conduct the facilitation and have access to resources, training, and mentoring support. Future research should aim to examine the perspectives of the "implementers" who received support from facilitators to gain a better understanding of which facilitation strategies have an impact on clinical practice behavior.
{"title":"Facilitation in evidence implementation - experiences, challenges, and determinants of perceived effectiveness: a qualitative systematic review.","authors":"Lucylynn Lizarondo, Alexa McArthur, Demetrius Porche, Marleen Corremans, Beatrice Perrenoud, Rogério Rodrigues, Craig Lockwood","doi":"10.1097/XEB.0000000000000399","DOIUrl":"10.1097/XEB.0000000000000399","url":null,"abstract":"<p><strong>Introduction: </strong>Facilitation is a key element of evidence implementation. Although quantitative systematic reviews have been undertaken to examine its components and effectiveness, no attempt has been made to synthesize qualitative evidence examining the experiences of facilitators on how facilitation is operationalized, the challenges associated with it, and the factors that can influence its perceived effectiveness.</p><p><strong>Methods: </strong>A systematic review of qualitative studies was conducted using the JBI methodology.</p><p><strong>Results: </strong>A total of 36 qualitative studies was included in the systematic review, with the majority being assessed as high quality following critical appraisal. The findings were extracted and further synthesized, highlighting that facilitation involves providing technical and non-technical support to health professionals, as well as high-intensity collaborations and relationship building. Determinants of perceived effectiveness of facilitation include facilitators' access to resources and learning support; their skills, traits/attitudes, and approach to facilitation; and the context of the organization where the implementation occurs. Work demands, emotional stress, and lack of clarity in roles and career development can pose challenges for facilitators.</p><p><strong>Conclusion: </strong>To maximize the outcomes of facilitation in evidence implementation, the team of facilitators should be carefully selected to ensure they have the right skills, traits/attitudes, and approach to facilitation. They should also be provided with dedicated time to conduct the facilitation and have access to resources, training, and mentoring support. Future research should aim to examine the perspectives of the \"implementers\" who received support from facilitators to gain a better understanding of which facilitation strategies have an impact on clinical practice behavior.</p><p><strong>Review registration number: </strong>PROSPERO CRD42023402496.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":"409-431"},"PeriodicalIF":2.3,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136399865","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}
Pub Date : 2023-12-01DOI: 10.1097/XEB.0000000000000373
Philip Garcia, Hannah Jang Kim, Susan Barbour, Adam S Cooper
Introduction and objective: Advance care planning (ACP) communication and documentation are often inadequate, leading to care that is inconsistent with patients' preferences and moral dilemmas for family members. Nurses are patient advocates optimally positioned to initiate ACP but many feel that they lack the training and skills to navigate these conversations. The objective of this project was to increase nurses' capacity to engage in ACP.
Methods: This project used the JBI audit and feedback method to implement evidence into practice. The JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit tools were used to incorporate ACP into nursing workflow. Eight audit criteria were created based on a JBI evidence summary. Compliance was measured by reviewing ACP notes from electronic health records and online survey responses. A baseline audit was followed by educational presentations and development of posted materials. Three follow-up audits examined sustainability.
Results: Compliance with the best practice recommendation for nurses to engage in ACP discussions increased from 55% to 80%. There was improvement from zero ACP notes at baseline (0% compliance) to 12 ACP notes in the final audit. Of these notes, 42% included all best practice elements and 92% included patients' treatment preferences.
Conclusions: Development of an integrative nursing education plan for ACP empowers nurses to engage in vital conversations. Informing nurses of their scope of practice, defining terms and expectations, and encouraging them to attempt and document conversations will benefit patients. Future initiatives would benefit from incorporating practical opportunities without real-life implications and providing continued support to cohorts.
{"title":"Empowering nurses to increase engagement in advance care planning in a medicine transitional care unit: a best practice implementation project.","authors":"Philip Garcia, Hannah Jang Kim, Susan Barbour, Adam S Cooper","doi":"10.1097/XEB.0000000000000373","DOIUrl":"10.1097/XEB.0000000000000373","url":null,"abstract":"<p><strong>Introduction and objective: </strong>Advance care planning (ACP) communication and documentation are often inadequate, leading to care that is inconsistent with patients' preferences and moral dilemmas for family members. Nurses are patient advocates optimally positioned to initiate ACP but many feel that they lack the training and skills to navigate these conversations. The objective of this project was to increase nurses' capacity to engage in ACP.</p><p><strong>Methods: </strong>This project used the JBI audit and feedback method to implement evidence into practice. The JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit tools were used to incorporate ACP into nursing workflow. Eight audit criteria were created based on a JBI evidence summary. Compliance was measured by reviewing ACP notes from electronic health records and online survey responses. A baseline audit was followed by educational presentations and development of posted materials. Three follow-up audits examined sustainability.</p><p><strong>Results: </strong>Compliance with the best practice recommendation for nurses to engage in ACP discussions increased from 55% to 80%. There was improvement from zero ACP notes at baseline (0% compliance) to 12 ACP notes in the final audit. Of these notes, 42% included all best practice elements and 92% included patients' treatment preferences.</p><p><strong>Conclusions: </strong>Development of an integrative nursing education plan for ACP empowers nurses to engage in vital conversations. Informing nurses of their scope of practice, defining terms and expectations, and encouraging them to attempt and document conversations will benefit patients. Future initiatives would benefit from incorporating practical opportunities without real-life implications and providing continued support to cohorts.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":"310-324"},"PeriodicalIF":2.3,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9619418","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}
Pub Date : 2023-12-01DOI: 10.1097/XEB.0000000000000400
Michal Hájek, Dittmar Chmelař, Miroslav Rozložník, Alexandra Lochmanová, Jakub Tlapák, Tereza Vrbová, Miloslav Klugar, Jitka Klugarová
Objective: This implementation project compared standard operating procedures, accepted preventive measures, and disinfection procedures between the initial stage of the COVID-19 pandemic (first wave: March 15 to May 31, 2020) and the later stages of the pandemic (second and third waves: September 1, 2020 to January 31, 2021).
Introduction: This project sought to improve compliance with international evidence-based guidelines and clinical standards for the prevention and control of COVID-19 infection during hyperbaric oxygen therapy taking into account the conditions of the local hospital.
Methods: Guided by the JBI evidence implementation framework, seven evidence-based audit criteria were developed for the prevention and control of COVID-19 infection during hyperbaric oxygen therapy. A questionnaire was used to measure compliance in baseline and follow-up audits.
Results: Differences between the baseline and follow-up audits were noted for criteria 6 and 7. Criterion 6 increased from 0% to 100% as the hyperbaric facility was equipped with certified ultraviolet-C radiation for air disinfection during the later period, but this equipment was not available in the initial period of the pandemic. Criterion 7 dropped from 100% in the baseline audit to 0% in the follow-up audit because of a significant increase in the operational burden of the treatment capacity of the facility, which made it impossible to comply with the recommended distancing between patients.
Conclusions: Differences were found in preventive measures, disinfection procedures, work organization, and approach to care strategy. The project objectives were met and the implementation strategies proved effective. Larger sample sizes would need be needed to confirm the reproducibility of the results.
{"title":"COVID-19 infection prevention and control management during hyperbaric oxygen therapy: a best practice implementation project.","authors":"Michal Hájek, Dittmar Chmelař, Miroslav Rozložník, Alexandra Lochmanová, Jakub Tlapák, Tereza Vrbová, Miloslav Klugar, Jitka Klugarová","doi":"10.1097/XEB.0000000000000400","DOIUrl":"10.1097/XEB.0000000000000400","url":null,"abstract":"<p><strong>Objective: </strong>This implementation project compared standard operating procedures, accepted preventive measures, and disinfection procedures between the initial stage of the COVID-19 pandemic (first wave: March 15 to May 31, 2020) and the later stages of the pandemic (second and third waves: September 1, 2020 to January 31, 2021).</p><p><strong>Introduction: </strong>This project sought to improve compliance with international evidence-based guidelines and clinical standards for the prevention and control of COVID-19 infection during hyperbaric oxygen therapy taking into account the conditions of the local hospital.</p><p><strong>Methods: </strong>Guided by the JBI evidence implementation framework, seven evidence-based audit criteria were developed for the prevention and control of COVID-19 infection during hyperbaric oxygen therapy. A questionnaire was used to measure compliance in baseline and follow-up audits.</p><p><strong>Results: </strong>Differences between the baseline and follow-up audits were noted for criteria 6 and 7. Criterion 6 increased from 0% to 100% as the hyperbaric facility was equipped with certified ultraviolet-C radiation for air disinfection during the later period, but this equipment was not available in the initial period of the pandemic. Criterion 7 dropped from 100% in the baseline audit to 0% in the follow-up audit because of a significant increase in the operational burden of the treatment capacity of the facility, which made it impossible to comply with the recommended distancing between patients.</p><p><strong>Conclusions: </strong>Differences were found in preventive measures, disinfection procedures, work organization, and approach to care strategy. The project objectives were met and the implementation strategies proved effective. Larger sample sizes would need be needed to confirm the reproducibility of the results.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":"21 S1","pages":"S57-S63"},"PeriodicalIF":2.3,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138463736","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}
Pub Date : 2023-12-01DOI: 10.1097/XEB.0000000000000386
Jiří Kantor, Anna Neuwirthová, Barbora Hořejší, Jan Koucun, Lucia Kantorová, Tereza Vrbová, Zachary Munn, Jitka Klugarová, Miloslav Klugar
Introduction and aims: Czech music therapists lacked the skills and knowledge to adapt their practice to virtual music therapy (VMT) at the beginning of the COVID-19 pandemic, when physical contact was restricted. The aims of this project were to implement the best evidence-based recommendations concerning VMT in the practice of Czech music therapists and increase the number of therapists using VMT.
Methods: The project used the JBI Evidence Implementation Framework to promote change in the practice of participants. A baseline audit of 26 practitioners was conducted using questionnaires and interviews. The audit criteria consisted of 8 best practice recommendations, followed by the implementation of targeted strategies and a follow-up audit.
Results: Of the 26 music therapists, 18 began practicing VMT following the rollout of the implementation strategies. Strategies included educational workshops, instructional materials, technological support, individual counseling, and interactive training sessions. There was an increase in compliance with all audit criteria. The most critical barriers were lack of knowledge about VMT and lack of technical skills; lack of resources; technological challenges; low confidence of music therapists to provide VMT; and reduced need for VMT after the lockdown restrictions were relaxed.
Conclusions: The implementation project helped to overcome temporary pandemic restrictions, increase the quality of VMT practice, develop strategies for VMT training, and identify reasons for using VMT during the pandemic and beyond.
{"title":"Implementation of virtual music therapy in the practice of Czech music therapists: a best practice implementation project.","authors":"Jiří Kantor, Anna Neuwirthová, Barbora Hořejší, Jan Koucun, Lucia Kantorová, Tereza Vrbová, Zachary Munn, Jitka Klugarová, Miloslav Klugar","doi":"10.1097/XEB.0000000000000386","DOIUrl":"10.1097/XEB.0000000000000386","url":null,"abstract":"<p><strong>Introduction and aims: </strong>Czech music therapists lacked the skills and knowledge to adapt their practice to virtual music therapy (VMT) at the beginning of the COVID-19 pandemic, when physical contact was restricted. The aims of this project were to implement the best evidence-based recommendations concerning VMT in the practice of Czech music therapists and increase the number of therapists using VMT.</p><p><strong>Methods: </strong>The project used the JBI Evidence Implementation Framework to promote change in the practice of participants. A baseline audit of 26 practitioners was conducted using questionnaires and interviews. The audit criteria consisted of 8 best practice recommendations, followed by the implementation of targeted strategies and a follow-up audit.</p><p><strong>Results: </strong>Of the 26 music therapists, 18 began practicing VMT following the rollout of the implementation strategies. Strategies included educational workshops, instructional materials, technological support, individual counseling, and interactive training sessions. There was an increase in compliance with all audit criteria. The most critical barriers were lack of knowledge about VMT and lack of technical skills; lack of resources; technological challenges; low confidence of music therapists to provide VMT; and reduced need for VMT after the lockdown restrictions were relaxed.</p><p><strong>Conclusions: </strong>The implementation project helped to overcome temporary pandemic restrictions, increase the quality of VMT practice, develop strategies for VMT training, and identify reasons for using VMT during the pandemic and beyond.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":"21 S1","pages":"S64-S71"},"PeriodicalIF":2.3,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138463737","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}
Pub Date : 2023-12-01DOI: 10.1097/XEB.0000000000000397
Zachary Munn, Alexa McArthur, Miloslav Klugar, Daphne Stannard, Adam S Cooper, Yeetey Enuameh, Kylie Porritt
Abstract: There are many theories, models, and frameworks that have been proposed in the field of implementation science. Despite this, many evidence implementation or practice improvement projects do not consider these theories, models, or frameworks in their improvement efforts. The JBI approach is one example of an implementation theory, model, or framework. This approach has been developed particularly with health care professionals in mind and is designed to clearly guide pragmatic evidence implementation efforts based on the best available evidence. In this paper, we discuss how the JBI approach to evidence implementation can interact with and support theory-informed, pragmatic evidence implementation projects.
{"title":"Providing a scaffold for considering theoretical frameworks in evidence implementation projects: the JBI approach to evidence implementation.","authors":"Zachary Munn, Alexa McArthur, Miloslav Klugar, Daphne Stannard, Adam S Cooper, Yeetey Enuameh, Kylie Porritt","doi":"10.1097/XEB.0000000000000397","DOIUrl":"10.1097/XEB.0000000000000397","url":null,"abstract":"<p><strong>Abstract: </strong>There are many theories, models, and frameworks that have been proposed in the field of implementation science. Despite this, many evidence implementation or practice improvement projects do not consider these theories, models, or frameworks in their improvement efforts. The JBI approach is one example of an implementation theory, model, or framework. This approach has been developed particularly with health care professionals in mind and is designed to clearly guide pragmatic evidence implementation efforts based on the best available evidence. In this paper, we discuss how the JBI approach to evidence implementation can interact with and support theory-informed, pragmatic evidence implementation projects.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":"386-393"},"PeriodicalIF":2.3,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92157046","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}
Pub Date : 2023-12-01DOI: 10.1097/XEB.0000000000000391
Iina Ryhtä, Anna Axelin, Heidi Parisod, Arja Holopainen, Lotta Hamari
Introduction and aims: Dysfunction related to pelvic floor muscles (PFM) is common among pregnant and postpartum women and can cause symptoms such as urinary incontinence or pelvic organ prolapse (POP). As part of developing a nationwide clinical practice guideline for nursing in Finland, the aim of this umbrella review is to summarize the existing evidence about the effectiveness of exercise interventions on urinary incontinence and POP in pregnant and postpartum women. To promote knowledge translation, recommendations for health care professionals are presented.
Methods: We conducted an umbrella review to summarize the existing evidence. The JBI methodology for umbrella reviews was used to guide the review. The level of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, and recommendations based on the evidence were formulated by a clinical guideline working group.
Results: Altogether, 9 systematic reviews, reporting findings from 89 original studies, were included. The methodological quality of the reviews was evaluated using JBI's checklist. The highest level of evidence was found for preventing the symptoms of postpartum urinary incontinence through exercise and pelvic floor muscle training (PFMT) during pregnancy. Moderate-level evidence showed that exercise and PFMT are likely to reduce the symptoms and severity of urinary incontinence, but the level of evidence was low on PFMT reducing the symptoms of POP.
Conclusion: We recommend encouraging and guiding pregnant and postpartum women to exercise and train PFM. We also recommend identifying pregnant and postpartum women with symptoms of PFM dysfunction and directing them to a physiotherapist or other health care professional specializing in pelvic floor function.
{"title":"Effectiveness of exercise interventions on urinary incontinence and pelvic organ prolapse in pregnant and postpartum women: umbrella review and clinical guideline development.","authors":"Iina Ryhtä, Anna Axelin, Heidi Parisod, Arja Holopainen, Lotta Hamari","doi":"10.1097/XEB.0000000000000391","DOIUrl":"10.1097/XEB.0000000000000391","url":null,"abstract":"<p><strong>Introduction and aims: </strong>Dysfunction related to pelvic floor muscles (PFM) is common among pregnant and postpartum women and can cause symptoms such as urinary incontinence or pelvic organ prolapse (POP). As part of developing a nationwide clinical practice guideline for nursing in Finland, the aim of this umbrella review is to summarize the existing evidence about the effectiveness of exercise interventions on urinary incontinence and POP in pregnant and postpartum women. To promote knowledge translation, recommendations for health care professionals are presented.</p><p><strong>Methods: </strong>We conducted an umbrella review to summarize the existing evidence. The JBI methodology for umbrella reviews was used to guide the review. The level of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, and recommendations based on the evidence were formulated by a clinical guideline working group.</p><p><strong>Results: </strong>Altogether, 9 systematic reviews, reporting findings from 89 original studies, were included. The methodological quality of the reviews was evaluated using JBI's checklist. The highest level of evidence was found for preventing the symptoms of postpartum urinary incontinence through exercise and pelvic floor muscle training (PFMT) during pregnancy. Moderate-level evidence showed that exercise and PFMT are likely to reduce the symptoms and severity of urinary incontinence, but the level of evidence was low on PFMT reducing the symptoms of POP.</p><p><strong>Conclusion: </strong>We recommend encouraging and guiding pregnant and postpartum women to exercise and train PFM. We also recommend identifying pregnant and postpartum women with symptoms of PFM dysfunction and directing them to a physiotherapist or other health care professional specializing in pelvic floor function.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":"394-408"},"PeriodicalIF":2.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10715701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41240001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}