Devi R, Martin GP, Banerjee J, Gladman JR, Dening T, Barat A, et al.
BMJ quality & safety. 2022 Mar;
INTRODUCTION: Inadequate and varied quality of care in care homes has led to a proliferation of quality improvement (QI) projects. This study examined the sustainability of interventions initiated by such projects. METHOD: This qualitative study explored the sustainability of seven interventions initiated by three QI projects between 2016 and 2018 in UK care homes and explored the perceived influences to the sustainability of interventions. QI projects were followed up in 2019. Staff leading QI projects (n=9) and care home (n=21, from 13 care homes) and healthcare (n=2) staff took part in semi-structured interviews. Interventions were classified as sustained if the intervention was continued at the point of the study. Thematic analysis of interview data was performed, drawing on the Consolidated Framework for Sustainability (CFS), a 40-construct model of sustainability of interventions. RESULTS: Three interventions were sustained and four interventions were not. Seven themes described perceptions around what influenced sustainability: monitoring outcomes and regular check-in; access to replacement intervention materials; staff willingness to dedicate time and effort towards interventions; continuity of staff and thorough handover/inductions in place for new staff; ongoing communication and awareness raising; perceived effectiveness; and addressing care home priorities. All study themes fell within 18 of the 40 CFS constructs. DISCUSSION: Our findings resonate with the CFS and are also consistent with implementation theories, suggesting sustainability is best addressed during implementation rather than treated as a separate process which follows implementation. Commissioning and funding QI projects should address these considerations early on, during implementation.
Palubiski LM, Tulsieram KL, Archibald D, Conklin J, Elliott J, Hsu A, et al.
Journal of the American Medical Directors Association. 2022 Feb.
This rapid review aimed to identify the strategies used to (re)integrate essential caregivers (ECs) into the LTC setting, particularly pertaining to principles of equity, diversity, and inclusion. In addition, this rapid review aimed to identify the strategies used during prior infectious disease threats, when similar blanket visitor restrictions were implemented in LTC homes. The review was part of a larger effort to support LTC homes in Ontario. Design A rapid review was conducted in accordance with principles from the Canadian National Collaborating Centre for Methods and Tools. Setting and Participants ECs, residents, staff, and policy decision makers in long-term care home settings. Methods Five electronic databases were searched for academic and gray literature using predefined search terms. Selected documents met inclusion criteria if they included policy guidance or an intervention to (re)integrate ECs into LTC homes at the local, national, and/or international level. Results In total, 15 documents met the inclusion and exclusion criteria. All documents retrieved focused on the context of COVID-19. Documents were either policy guidance (n = 13) or primary research studies (n = 2). Documents differed in these notable ways: Definition of EC; the degree to which an EC is recognized for her or his role in the care of the resident; the degree to which ECs are (re)integrated into the LTC setting is prioritized; response to community spread of COVID-19; visitation during an outbreak or if a resident is symptomatic; the reliance on equity, diversity, and inclusion principles; and lastly, monitoring and improving the process. Conclusions and Implications Using an equity, diversity, and inclusion lens, we posit promising practices for (re)integration. It is clear from the rapid review that more research is needed to understand the efficacy of policies and guidelines to (re)integrate ECs into the LTC setting. Until such evidence is available, expert opinion will drive best care practices.
AIMS: To investigate nursing and allied health professional perceptions of the interrelationship between avoidable hospital readmissions and fundamental care delivery. DESIGN: A qualitative, exploratory study using a critical realist approach. METHOD: One-to-one semi-structured interviews with 14 nursing and allied health professionals conducted between May and September 2019. RESULTS: Several tensions and contradictions were identified in the data, which demonstrated clinicians’ perceptions about the priority of both fundamental care and two avoidable readmission conditions (aspiration pneumonia and constipation). These tensions are illustrated in two major themes: Avoidable versus inevitable; and everyone versus no one. The first theme demonstrates clinicians’ perceptions that readmissions for aspiration pneumonia and constipation are not common, despite acknowledging that they generally lacked knowledge on readmission rates; and that these conditions may not be preventable in acute settings. The second theme demonstrates clinicians’ perception that preventing readmissions is everyone’s responsibility, however, this was coupled with a lack of articulation around how this multidisciplinary approach could be achieved, leading to a distinct lack of agency for care delivery. CONCLUSION: Articulating the tensions described in the results provides vital knowledge for understanding how clinicians may respond to initiatives designed to reduce avoidable readmissions. Avoidable hospital readmissions may be usefully understood as a wicked problem: one that is complex and requires adaptive, not linear, solutions. Wicked problems pose a challenge for leaders and managers in healthcare because top-down, hierarchical strategies are unlikely to be successful. Effective prevention of avoidable readmissions requires leaders to enable facilitator-led change through relational leadership strategies. IMPACT: Avoidable hospital readmissions are a global problem increasingly addressed via funding changes and the introduction of penalties to hospitals. This study provides insights on clinicians’ perspectives of avoidable hospital readmissions and their prevention, demonstrating the complexity of this challenge and the need for healthcare leaders to enable individual and organizational readiness for change.
Brooks SP, Zimmermann GL, Lang M, Scott SD, Thomson D, Wilkes G, et al.
Implementation science communications. 2022 Mar;3(1):35.
BACKGROUND: Stories can be a powerful tool to increase uptake of health information, a key goal of knowledge translation (KT). Systematic reviews demonstrate that storytelling (i.e. sharing stories) can be effective in changing health-promoting behaviours. Though an attractive KT strategy, storytelling is a complex approach requiring careful planning and consideration of multiple factors. We sought to develop a framework to assist KT researchers and practitioners in health contexts to consider and develop effective KT interventions that include stories or storytelling. METHODS: We conducted a broad search of the literature to identify studies that used storytelling as a KT intervention across different disciplines: health research, education, policy development, anthropology, organizational development, technology research, and media. We extracted purposes, theories, models, mechanisms, and outcomes and then mapped the theoretical and practical considerations from the literature onto the Medical Research Council guidance for complex interventions. The theoretical and practical considerations uncovered comprised the basis of the storytelling framework development. Through discussion and consensus, methodological experts refined and revised the framework for completeness, accuracy, nuance, and usability. RESULTS: We used a complex intervention lens paired with existing behaviour change techniques to guide appropriate theory-based intervention planning and practical choices. An intentional approach to the development of story-based KT interventions should involve three phases. The theory phase specifies the goal of the intervention, mechanisms of action, and behaviour change techniques that will achieve the intended effects. The modelling phase involves development and testing using an iterative approach, multiple methods and engagement of end-users. Finally, formal evaluation using multiple methods helps determine whether the intervention is having its intended effects and value added. CONCLUSIONS: This framework provides practical guidance for designing story-based KT interventions. The framework was designed to make explicit the requisite considerations when determining the appropriateness and/or feasibility of storytelling KT, clarify intervention goals and audience, and subsequently, support the development and testing of storytelling interventions. The framework presents considerations as opposed to being prescriptive. The framework also offers an opportunity to further develop theory and the KT community’s understanding of effectiveness and mechanisms of action in storytelling interventions.
Elliott SA, Wright KS, Scott SD, Hartling L.
JMIR formative research. 2022 Mar;6(3):e33156.
BACKGROUND: A number of evidence-based knowledge translation (KT) tools for parents of children with acute health conditions have been developed. These tools were created and tested with parental input and disseminated to groups proficient in English. Therefore, it is unclear whether they are useful for populations that are more diverse. To enhance the reach of our current and future KT tools, language translation and cultural adaptations may promote relevance for previously underserved knowledge users. OBJECTIVE: This study aims to explore and understand considerations for the cultural and linguistic adaptation of a KT tool in French and Filipino communities. METHODS: A KT tool (whiteboard animation video) describing the signs and symptoms of croup was originally developed in English to provide parents with evidence-based information couched within a narrative reflecting parents’ experiences with the condition. This KT tool was adapted (linguistics and imagery) for French- and Tagalog-speaking parents and caregivers through feedback from key stakeholders. The videos were presented to the respective language speakers for usability testing and discussion. Participants were asked to view the KT tool, complete a usability survey, and participate in semistructured interviews. Audio recordings from the interviews were transcribed verbatim, translated into English, and analyzed for relevant themes by using thematic analysis. RESULTS: French- (n=13) and Tagalog-speaking (n=13) parents completed the usability survey and were interviewed. Although analyzed separately, both data sets produced similar findings, with key themes relating to understanding, relatability, and accessibility. Both the French and Tagalog groups reported that the video and other KT tools were useful in their adapted forms. Participants in both groups cautioned against using verbatim vocabulary and suggested that cultural competency and understanding of health languages were essential for high-quality translations. Parents also discussed their preference for videos with diverse visual representations of families, home environments, and health care workers, as such videos represent their communities more broadly. CONCLUSIONS: French and Filipino parents appreciated having KT tools in their first language; however, they were also supportive of the use of English KT products. Their suggestions for improving the relatability and communication of health messages are important considerations for the development and adaptation of future KT products. Understanding the needs of the intended end users is a crucial first step in producing relevant tools for health evidence dissemination.
Park CS-Y, Kabak M, Kim H, Lee S, Cummings GG.
Contemporary nurse. 2022 Mar;1–23.
OBJECTIVE: This paper aims to spur thought-provoking practical debates on current nurse workforce staffing and scheduling systems in relation to a critical review of Ang and colleagues’ (2018) article entitled “Nurse workforce scheduling in the emergency department: A sequential decision support system considering multiple objectives.” DESIGN: Discussion paper on a practical discourse in connection with the aforementioned published article. DISCUSSION: Mathematical Programming (optimization) (MP)-based nursing research has been published for nearly thirty years almost exclusively in industrial engineering or health business administration journals, demonstrating a widening gap between nursing research and practice. Nurse scientists’ knowledge and skill of MP is insufficient, as are their interdisciplinary collaborations, setting back the advancement of nursing science. Above all, nurse scientists skilled in decision science are desperately needed for that analytic intellection which is rooted in the ‘intrinsic nature and value of nursing care.’ It is imperative that nurse scientists be well-prepared for the new age of the Fourth Industrial Revolution through both an education in MP and interdisciplinary collaboration with decision science experts in order to prevent potential stereotyped MP-based algorithm-driven destructive influences. CONCLUSIONS: The current global nursing shortage makes optimal nursing workforce staffing and scheduling more important. MP helps nurse executives and leaders to ensure the most efficient number of nurses with the most effective composition of nurse staffing at the right time for a reasonable cost. Nurse scientists urgently need to produce a new nursing knowledge base that is directly implementable in nursing practice.