Engaging national and regional partners to accelerate broad-scale implementation of nurse-developed interventions

Only a small proportion of research-tested interventions translate into broad-scale implementation in real world practice, and when they do, it often takes many years. Partnering with national and regional organizations is one strategies that researchers may apply to speed the translation of interventions into real-world practice. Through these partnerships, researchers can promote and distribute interventions to the audiences they want their interventions to reach. In this paper, we describe five nurse scientists’ programs of research and their partnerships with networks of national, regional, and local organizations, including their initial formative work, activities to engage multi-level network partners, and lessons learned about partnership approaches to speeding broad-scale implementation.     

Applying theories to better understand socio-political challenges in implementing evidence-based work disability prevention strategies

Purpose: This article explores and applies theories for analyzing socio-political aspects of implementation of work disability prevention (WDP) strategies.

Method: For the analysis, theories from political science are explained and discussed in relation to case examples from three jurisdictions (Sweden, Brazil and Québec).

Results: Implementation of WDP strategies may be studied through a conceptual framework that targets: (1) the institutional system in which policy-makers and other stakeholders reside; (2) the ambiguity and conflicts regarding what to do and how to do it; (3) the bounded rationality, path dependency and social systems of different stakeholders; and (4) coalitions formed by different stakeholders and power relations between them. In the case examples, the design of social insurance systems, the access to and infrastructure of healthcare systems, labor market policies, employers’ level of responsibility, the regulatory environment, and the general knowledge of WDP issues among stakeholders played different roles in the implementation of policies based on scientific evidence.

Conclusions: Future research may involve participatory approaches focusing on building coalitions and communities of practice with policy-makers and stakeholders, in order to build trust, facilitate cooperation, and to better promote evidence utilization.

• Implications for Rehabilitation

• Implementation of work disability prevention policies are subject to contextual influences from the socio-political setting and from relationships between stakeholders

• Stakeholders involved in implementing strategies are bound to act based on their interests and previous courses of action

• To promote research uptake on the policy level, stakeholders and researchers need to engage in collaboration and translational activities

• Political stakeholders at the government and community levels need to be more directly involved as partners in the production and utilization of evidence

     

推动证据临床转化(一)促进健康照护领域科学决策

阐述在知识转化模式和实施性科学框架下循证实践领域证据临床转化的背景、意义以及实施方法。分析证据临床转化的关键要素、与持续护理质量改进之间的关系。     

基于渥太华研究应用模式的妊娠期糖尿病临床护理实践指南应用方案的构建

目的构建妊娠期糖尿病临床护理实践指南应用方案。方法以渥太华研究应用模式为指导,建立指南应用方案构建小组和咨询小组,采用专家咨询法,根据前期确定的障碍因素,从证据、采纳者及实践环境三面面构建指南应用方案。结果在证据方面,制定了针对护理人员的“妊娠期糖尿病护理管理最佳实践手册”;在实践者方面,构建了护理人员培训方案;在患者方面,构建了“妊娠期糖尿病孕妇自我管理手册”、体验门诊、基于微信平台的健康教育;在实践环境方面,构建了护理操作规范和管理流程、患者血糖管理档案、以妊娠期糖尿病专科护士为主导、病区责任护士参与的专科护理团队、多途径、多形式的妊娠期糖尿病健康教育方案、GDM专科护士与医生的双向转诊流程。结论在渥太华研究应用模式的指导下,本研究构建了基于指南的可操作性强的综合干预策略,获取领导力支持、推动干预策略的实施,是下一步研究的重点。     

推动证据向临床转化(三)研究的选题和问题构建

开展证据向临床转化相关研究的起点是选择合适的主题、构建循证问题。确定研究的纳入排除标准,也是构建系统性文献检索策略的基础。本文将详细介绍证据临床转化研究的选题原则、选题流程和构建结构化的研究问题的PIPOST模型,为研究者进一步梳理证据实施临床转化中所包含的重要元素,开展后续应用环节提供依据。     

昆山市卫生监督职能项目开展落实情况研究

目的:了解昆山市卫生监督职能项目落实情况。方法:采用问卷调查方法,对昆山市市级、乡镇两级卫生监督机构展开调查,对机构各职能、项目的开展、落实情况进行分析。结果:(1)昆山卫生监督机构对于课题组界定的应由本级机构开展项目的认同率达98.41%;(2)昆山市卫生监督机构各项职能平均开展率、完成率和落实率分别为:91.73%、90.74%、83.24%;(3)昆山市卫生监督机构各项业务职能项目平均开展率、完成率和落实率分别为:89.00%、92.00%、81.65%。结论:总体来说,昆山市卫生监督体系各项职能已经基本落实到位,但部分职能落实还存在一定差距,需要进一步建设完善。     

责任组长竞聘上岗方法及实施体会

目的探讨责任组长竞聘上岗在优质护理示范病房中的作用,从而提高护理质量和护理管理水平。方法参照2010年“优质护理服务示范工程”、“优质护理示范病房”的活动方案和评价标准,制定新的护理模式和岗位职责,并分析我科开展优质护理服务以来,责任组长在其中的作用。结果责任组长竞聘上岗体现了护士的分层级使用理念,激发了护理人员的工作积极性,护理质控检查平均得分达到99．7分,患者及家属、医生、院领导的满意度达到98．6％。结论责任组长竞聘上岗在优质护理示范病房的设立,能充分发挥其潜力,在护理工作中起到传、帮、带的作用,大大提高了科室整体护理水平,值得临床进一步推广应用。     

Multifaceted interventions are likely to be more effective to increase adherence to the ventilator care bundle: A systematic review of strategies to improve care bundle compliance

BackgroundThe implementation of ventilator care bundles has remained suboptimal. However, it is unclear whether improving adherence has a positive relationship with patient outcomes.ObjectivesTo identify the most effective implementation strategies to improve adherence to ventilator bundles and to investigate the relationship between adherence to ventilator bundles and patient outcomes.MethodsA systematic review followed the PRISMA guidelines. A systematic literature search from the inception of ventilator care bundles 2001 to January 2021 of relevant databases, screening and data extraction according to Cochrane methodology.ResultsIn total, 6035 records were screened, and 24 studies met the eligibility criteria. The implementation strategies were provider-level interventions (n = 15), included educational activities, checklist, and audit/feedback. Organizational-level interventions include (n = 8) included change of medical record system and multidisciplinary team. System-level intervention (n = 1) had motivation and reward. The most common strategies were education, checklists, audit feedback, which are probably effective in improving adherence. We could not perform a meta-analysis due to heterogeneity of the strategies and types of adherence measurement. Most studies (n = 7) had a high risk of bias. There were some conflicting results in determining the associations between adherence and patient outcomes because of the poor quality of the studies.ConclusionMultifaceted interventions are likely to be effective for consistent improvement in adherence. It remains uncertain whether improvements in adherence have positive outcomes on patients due to limited evidence of low to moderate uncertainty. We recommend the need for robust research methodology to assess the effectiveness of implementation strategies on improving adherence and patient outcomes.     

Implementation of a successful electronic wound documentation system in rural Victoria,Australia: a subject of collaboration and community engagement

To describe the steps needed for a successful implementation of an e‐health programme (the Mobile Wound Care system) in rural Victoria, Australia and to provide recommendations for future e‐health initiatives. Wound care is a major burden on the health care system. Optimal wound care was found to be impeded by issues that included the limited access to health care providers, incomplete and inconsistent documentation and limited access to expert review. This study trialled the use of a shared electronic wound reporting and imaging system in combination with an expert remote wound consultation service for the management of patients with chronic and acute wounds in Gippsland. The trial sites included four rural Home and Community Health Care providers. Considerable effort was put into designing a best practice e‐health care programme. There was support from managers and clinicians at regional and local levels to address an area of health care considered a priority. Various issues contributing to the successful implementation of the wound care project were identified: the training model, quality of data collected, demands associated with multiple sites across a vast geographic region, computer access, hardware and computer literacy.     

沈阳市5家非政府办基层医疗卫生机构实施国家基本药物制度后机构运行现状调查

目的：促进国家基本药物制度在沈阳市的继续深入推进和实施.方法：随机抽取沈阳市5家非政府办基层医疗卫生机构进行调查.结果：沈阳市5家非政府办基层医疗卫生机构收入、就诊人次、医务人员收入均逐年增加,就诊患者人均药品费用低于全国水平,基本药物基本得到合理使用.但仍存在一些问题,非政府办基层医疗卫生机构执行基本药物制度的积极性不高、基本药物配置率低、对医务人员的培训不能满足推进基本药物制度需求等.结论：应当通过鼓励非政府办基层医疗卫生机构积极实施基本药物制度、加强培训和教育进一步促进合理使用基本药物等措施,推动国家基本药物制度在沈阳市的实施.