健康服务领域研究成果应用的行动促进框架应用性研究的文献范畴分析

目的探讨健康服务领域研究成果应用的行动促进框架(the promoting action on researchimplementation in health services framework,PARIHS)的应用现况,以期为后续的发展提供理论依据。方法 2016年3月,检索PubMed、Embase(Excerpt Medica Database)、EBSCO、JBI循证护理数据库、中国知网、万方、维普等数据库;中文检索词为"健康服务领域研究成果应用的行动促进框架"、"循证实践理论框架/模式"、"证据应用"、"组织变革";英文检索词为"PARIHS"/"parihs"、"evidence-basedpractice"、"implementation"、"evidenceutilization"。检索时限为建库以来至2015年12月31日。采用文献范畴分析的方法,重点分析PARIHS的应用性文献,即运用PARIHS指导循证实践活动。双人进行文献筛选和数据提取。结果共有33篇应用性文献纳入分析。根据PARIHS在不同研究中的作用分为两部分,即以PARIHS为理论框架的应用研究和以PARIHS指导研究设计的应用.研究。前者主要包括对循证实践中的影响因素的探讨、研究应用效果和循证实践实施的准备度/可行性的评估;后者包括基于PARIHS量表/问卷的构建及应用、以PARIHS指导实践策略的制定和以PARIHS为指导的结局资料的分析。结论 PARIHS全面阐释影响循证实践过程的多个元素,并分析了各元素相互作用、相互依存的关系。它可以直接地用于不同的实践项目、不同的环境及证据应用不同的阶段,对医疗机构循证实践的开展有较好的指导作用。     

PARIHS循证概念框架理论及应用现状分析与思考

将证据应用到临床实践具有复杂性与多变性,借助证据应用模式将有助于这一转化,健康服务领域研究成果应用的行动促进（promoting action on research implemrntation in health severice,PARIHS）循证概念框架,即证据应用模式的一种,其目前在我国鲜见报道与应用。笔者对 PARIHS循证概念框架的理论予以介绍,包括3大核心要素,即证据、证据应用组织环境及促进因素的协调;理论起源与发展的历程,突出 PARIHS框架内涵与思路不断清晰化的发展过程;还对目前应用于不同目的、不同领域临床实践与科研活动中的应用现状进行分析。最终得出 PARIHS框架研究与应用价值突出,最大化框架使用价值基础上清晰化理论内涵、促进框架应用方式与效果评价的标准化及研发恰当合适的应用工具是 PARIHS框架探索研究的重点。     

PARIHS 循证实践概念框架的应用研究进展

循证护理意为“遵循证据的护理学”,其含义为：慎重、准确和明智地应用当前所能获得的最佳研究证据,同时结合护理专业技能和多年临床经验,考虑患者的价值、愿望和实际情况,将两者完美地结合,制订完整的护理方案［1］。这一理念已经逐步被临床护理人员所认可和接受,并开始尝试循证实践活动,即在临床护理工作中运用循证护理的理念和方法解决护理问题。国外对循证实践模式已进行了较多探索性和发展性的研究,如澳大利亚循证卫生保健中心的“证据的临床应用模式”、Lowa 的循证实践模式、Ottawa 的证据转化模式（KT 模式）等,为循证护理实践提供了框架性的科学方法［1-3］。本文将对Kitson［4］发展的“健康服务领域研究成果应用的行动促进”（promoting action on research implementa-tion in health service,PARIHS）概念框架进行综合描述,以期为临床护理人员的循证实践活动提供科学、有效的指导。     

循证护理证据的获取、评价及应用

循证护理(EBN)作为新兴的临床护理模式,以持续改进护理质量为目的[1]。1996年,李幼平将EBN引入中国[2],它促进了中国护理的整体发展[1],有关EBN应用的文献不断增多。但是对于EBN证据应用过程的认识,目前尚存在一些不足。本文在阅读相关文献的基础上,从证据的搜索、评价及应用三方面对证据应用过程进行总结,现综述如下。EBN概念及EBN证据的含义1.EBN概念。参照循证医学创始人之一David Saekeu2000年“怎样实践和讲授循证医学”中的循证医学定义,国内比较认同的循证护理概念为:慎重、准确、明智地应用当前所能获得的最好研究依据,根…     

Johns Hopkins循证护理实践模式的研究进展

系统介绍了Johns Hopkins循证护理实践模式,包括3大关键要素,即实践、教育和研究;其核心是证据,分为研究型证据和非研究型证据;以及众多内因和外因。阐述了循证实践的3阶段流程即实践问题、证据生成和证据转化以及国内外应用进展,旨在为我国护理人员开展循证护理实践、教育和研究提供思路和方法指导。另一方面,在实践过程中加强该模式与其他循证护理实践模式的相互比较,并根据我国国情对该模式进行不断地测试和修订,加强该模式理解、应用和实践项目成效报道,并根据不同研究目的和临床情景来发展其概念框架是未来发展方向。     

推动证据向临床转化 (二)如何选择知识转化理论模式

本文作为证据临床转化方法学系列文章的第二篇,旨在详细阐述如何选择合适的知识转化理论模式,以指导和促进证据向临床的转化。本文分析了理论、模式和概念框架的内涵,并介绍了5个知识转化领域最常用的理论模式,包括KTA知识转化框架、渥太华研究应用模式、PARIHS框架、复旦循证护理路径图和基于证据的持续质量改进模式图。在此基础上,分析了在推动证据临床转化的过程中,选择合适的知识转化理论模式的重要性、依据及应注意的问题。     

Rosswurm和Larrabee循证实践变革模式及其在护理实践中的应用

系统阐述了Rosswurm和Larrabee循证实践变革模式的6个步骤及其在护理实践中的应用。该模式通过评估现状及需求以明确变革问题,检索文献以获取证据,并根据具体的实践环境设计变革方案,以促进实践变革并维持证据的持续应用。该模式为实践者开展循证实践变革提供了一个清晰、流畅的指导性框架,引导实践者明确问题,获取证据,促进证据向实践的转化和应用。     

循证实践证据在临床护理高质量转化中应用的管理策略

循证护理证据的应用能够有效改善临床护理质量。在循证实践过程中, 管理者带领护理团队在针对特定的临床护理问题寻找证据并进行证据转化和评估, 构建循证实践项目, 利用一切可以利用的资源, 以多学科协作模式, 推动循证实践证据转换, 给护理工作带来改变。在此过程中, 管理者的管理策略至关重要, 管理者在开发、推动及持续应用循证实践方案时, 应以卓越的领导力推动证据在临床护理转化中的顺利实施并得以维持, 使工作得以改进, 患者和临床护士均可受益。本文基于循证实践现状, 探索如何在卓越管理模式下, 推动循证实践证据在临床护理实践中进行高质量转化, 进而深化护理专业内涵, 促进循证护理实践和临床护理专业的发展。     

循证护理在护理实践中的运用

循证护理就是慎重、准确和明智地应用当前所能获得的最好的研究证据，同时结合护理专业技能和多年临床经验，考虑患者的价值和愿望，将三者完美地结合，制定护理措施。循证护理实践是依据科学证据基础的临床实践，是指整合患者主客观资料与科学证据为最佳状态，它既是服务对象的需求，又是护理学发展的必然，它证明了护士自身价值，使护理活动更加科学化、专业化、为护理学科提高权威性、独立性，促进学科的发展提供了机遇。本文对循证护理的概念与产生背景，循证护理促进独立学科体系的形成，循证护理方法的认识及应用方面存在的一些误区进行分析，认为循证护理是一种模式或工作形式，同时循证护理在护理实践运用中护理问题期待研究证据，整个过程进行系统评价，以及护理实践所面临的新使命及合理运用，着重阐述了循证护理必须从问题出发，重视证据、重视整体观，注重个体化差异，只有这样，才能切实推进循证护理在我国护理实践中的运用。     

中国循证护理的发展研究检索分析

目的通过对近10年发表在核心期刊的循证护理文献进行统计分析,描述中国循证护理的研究特征,为今后循证护理研究提出建议。方法检索中国期刊网数据库1996～2007年的核心期刊,对循证护理文献进行描述性统计分析。结果（1）循证护理研究文献的数量呈递增趋势;（2）循证护理的发展存在地域不均衡性,华东地区发展比较快,西北地区发展比较缓慢;（3）循证护理的研究质量偏低,体现在：权威护理杂志发表的文章较少;研究类文献中,51．94％没有说明证据来源;92．21％未说明研究证据的质量等级;运用SR及RCT研究结果或公认问卷指导实践的仅占7．79％;49．35彤术提及循证护理的效果评价。结论中国护士需要进一步加强循证实践的知识与技能学习,积极开展合作研究,以促进临床护理实践的发展。     

不同类型综述的方法学分析

文献综述是护理研究中必不可少的环节。系统、严谨的文献综述可以使已有的初级研究转化为有效指导护理实践的证据,进而促进护理专业化的发展。本文通过介绍系统评价、Meta分析、系统评价再评价、Meta整合、范围综述、整合综述等常见的综述类型,区别不同类型综述的异同点,分析其优点及局限性,以期提高护理实践的科学性和专业化水平,促进循证和护理学科的发展。     

Mismatches in the production of a scoping review: Highlighting the interplay of (in)formalities

The move towards evidence‐based medicine has generated rapid growth in reviews of research literature. The scoping review is one of the new literature reviews that has emerged from traditional systematic reviews. A scoping review aims to map the literature on a particular topic or research area. As scoping reviews become more popular, methods for conducting scoping reviews are rapidly increasing. In light of these recent developments, this paper investigates how complex scoping reviews are conducted. As an analytical framework, we draw on previous work about (in)formalities (ie, the interplay of formalities and informal judgments in scientific research). We show how the process of constructing a population, intervention, comparison, and outcome (PICO), searching and selecting relevant literature, requires informal deliberations, judgments, and choices that are not considered in the formal methodology used when conducting scoping reviews. This paper asks the following questions: What could be learned from this empirical case of conducting a scoping review by applying theoretical insights about (in)formalities? What are the possible implications for future development of scoping reviews? We provide three suggestions. First, PICO served as a starting point for the review process, supported decisions continuously during the process, and served as an image of the end product of the scoping review. We suggest that these three roles need to be considered to a larger extent in the future development of scoping review methods. Second, the contextual constraints of scoping reviews such as time, resources, and the jurisdiction of the commissioning agency need to be made explicit in the reporting of scoping reviews. Third, the findings in this paper indicate that the evolving emphasis on formalization in both the methods the reporting practices of scoping reviews could benefit if complemented with a more pronounced role for informalities. In addition, highlighting the informalities in scoping review methods may serve to create more realistic expectations of the methods, the validity, and the potentials of scoping reviews.     

Teaching strategies of clinical reasoning in advanced nursing clinical practice: A scoping review

Aim/objectiveTo report and synthesize the main strategies for teaching clinical reasoning described in the literature in the context of advanced clinical practice and promote new areas of research to improve the pedagogical approach to clinical reasoning in Advanced Practice Nursing.BackgroundClinical reasoning and clinical thinking are essential elements in the advanced nursing clinical practice decision-making process. The quality improvement of care is related to the development of those skills. Therefore, it is crucial to optimize teaching strategies that can enhance the role of clinical reasoning in advanced clinical practice.DesignA scoping review was conducted using the framework developed by Arksey and O’Malley as a research strategy. Consistent with the nature of scoping reviews, a study protocol has been established.MethodsThe studies included and analyzed in this scoping review cover from January 2016 to June 2022. Primary studies and secondary revision studies, published in biomedical databases, were selected, including qualitative ones. Electronic databases used were: CINAHL, PubMed, Cochrane Library, Scopus, and OVID. Three authors independently evaluated the articles for titles, abstracts, and full text.Results1433 articles were examined, applying the eligibility and exclusion criteria 73 studies were assessed for eligibility, and 27 were included in the scoping review. The results that emerged from the review were interpreted and grouped into three macro strategies (simulations-based education, art and visual thinking, and other learning approaches) and nineteen educational interventions.ConclusionsAmong the different strategies, the simulations are the most used. Despite this, our scoping review reveals that is necessary to use different teaching strategies to stimulate critical thinking, improve diagnostic reasoning, refine clinical judgment, and strengthen decision-making. However, it is not possible to demonstrate which methodology is more effective in obtaining the learning outcomes necessary to acquire an adequate level of judgment and critical thinking. Therefore, it will be necessary to relate teaching methodologies with the skills developed.     

Mentorship in nursing in Canada – A scoping review

AimTo review the literature on mentoring of nursing students in Canada.BackgroundMentorship in nursing has been in existence for a long time. Supportive, nurturing guidance by an experienced individual in the profession has been found to have many benefits both to the giver and the receiver. However, there is no uniformity in the length, model, delivery method and evaluation of mentorship programs' impact. The purpose of this scoping review is to appraise the available literature and synthesize knowledge on mentorship in nursing in Canada.DesignScoping ReviewMethodsThe scoping review was guided by the methodological framework developed by Hilary Arksey & Lisa O'Malley and the findings are reported using PRISMA ScR guidelines. A systematic search of MEDLINE, CINAHL, EMBASE and ERIC databases was conducted to identify articles describing nursing mentorship in Canada.ResultsAfter the initial screening, a total of 125 articles were included for a full-text review. Of the 48 items included, 28 were research articles and 20 were other forms of literature. Forty-eight items were included for data extraction.ConclusionThe scoping review revealed several benefits of mentorship. While synthesizing the evidence, it was noted that the components of the mentorship programs, such as the length, models, mode of delivery and the impact, vary with every nursing field.Implications for PracticeBased on the results of the scoping review, it is recommended to consider the unique needs, strengths and challenges of the group for whom the mentorship is planned. One size may not fit all.     

Educational programs and teaching strategies for health professionals responding to women with complex perinatal mental health and psychosocial concerns: A scoping review

BackgroundMental health and psychosocial concerns such as domestic violence in pregnancy and after birth are significant issues. Maternal health, social and environmental contexts have a direct influence on child development and long-term health. However, midwives, nurses and other health professionals lack confidence and skills in assessing, supporting and referring women with perinatal psychosocial concerns.Aim and objectivesThe aim of the scoping review is to review educational innovations and teaching strategies used to build skills and knowledge in health professionals and students to address psychosocial concerns including perinatal mental health, domestic violence and drug and alcohol misuse.DesignA scoping review was undertaken to help identify the breadth of papers reporting educational innovations and strategies particularly to address psychosocial concerns.MethodFour databases CINAHL, PsychoInfo, PubMed, OvidMedline and the grey literature were searched using a diverse range of terms for papers published in English between January 2009 and December 2020. This yielded 2509 papers and after review, 34 papers were included in the scoping review.ResultsThe 34 papers in this review found a diversity of educational initiatives and strategies delivered either face-to-face, online or in a blended mode addressing the learning needs of health professionals working with women with complex psychosocial concerns. The following characteristics in the papers were examined; focus of education, design and development, length, target audience including interprofessional focus, self-care, sensitive topics, debriefing, involving lived experience consumers and evaluation measures.ParticipantsIn the studies indicated that they benefited from hearing about the individuals’ lived experiences, opportunities for simulated practice and valued interprofessional learning experiences for both content and teamwork. The emergence of virtual modes offered some innovative and engaging ways to create a safe space for psychosocial education. However, the research does not provide guidance as to the best mode of delivery or length of programConclusionThis scoping review provides a broad overview of innovative and diverse educational methods and strategies being used in the nursing, midwifery and health disciplines to engage students and practitioners in learning in the areas of perinatal mental health and psychosocial care. Involvement of lived experience consumers in the design and delivery of education programs can positively impact learners’ knowledge and understandings of sensitive psychosocial topics. These diverse approaches could be used to shape the development and evaluation of future education programs.     

再生疗法和康复治疗的联合应用对神经疾病运动功能的康复效果：Scoping综述

目的 综述再生疗法和康复治疗联合应用于神经疾病运动功能的康复效果。方法 检索建库至2021年4月1日PubMed、Web of Science、中国知网、万方数据库中有关再生疗法和康复治疗相结合作用于神经疾病的相关研究,提取文献内容并进行Scoping综述。结果 共检索文献2567篇,最终纳入26篇,其中3篇为人类临床研究,23篇为动物基础研究。研究设计主要为随机或非随机对照试验、病例系列研究。研究主要涉及再生疗法和康复治疗的联合干预对脑卒中、脊髓损伤、脑性瘫痪等神经疾病运动功能的治疗效果。结论 本文从范畴上界定了再生康复在神经疾病的相关研究和应用,发现再生疗法和康复治疗的结合对于神经疾病运动功能的恢复具有一定的协同效应。未来需要更多的科研工作来支持其临床实践。     

Academic-practice partnerships in evidence-based nursing education: Protocol of a theory-guided scoping review

AimThis theory-guided scoping review aims to provide an overview of existing literature about academic-practice partnerships in evidence-based nursing education.BackgroundAcademic-practice partnership is an approach to improve evidence-based nursing education, to promote evidence-based nursing practice which could reduce the nursing care discrepancy, improve the nursing care quality and patient safety, reduce healthcare costs and promote nursing professional development. However, the related research is limited and there is a lack of systematic review of related literature.DesignA scoping review guided by the theories of the Practice-Academic Partnership Logic Model and the JBI Model of Evidence-Based Healthcare.MethodsThe researchers will use JBI guidelines for scoping reviews and related theories to guide this theory-guided scoping review. The researchers will systematically search Cochrane Library, PubMed, Web of Science, CINAHL, EMBASE, SCOPUS and Educational Resource Information Centre (ERIC) using major search concepts including academic-practice partnership, evidence-based nursing practice and education. Two reviewers will be responsible for independent literature screening and data extraction. Discrepancies would be solved by a third reviewer.Expected resultsThis scoping review will identify related research gaps to provide implications for researchers and identify specific information to provide implications for developing interventions of academic-practice partnerships in evidence-based nursing education.Registration numberThis scoping review had been registered on Open Science Framework (https://osf.io/83rfj).