Browsing by Subject "Implementation Science"
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Item Open Access An innovative DNP post-doctorate program to improve quality improvement and implementation science skills.(Journal of professional nursing : official journal of the American Association of Colleges of Nursing, 2021-01) Reynolds, Staci S; Howard, Valerie; Uzarski, Diane; Granger, Bradi B; Fuchs, Mary Ann; Mason, Leslie; Broome, Marion EBackground
Doctor of Nursing Practice programs prepare nurse leaders for unique roles to address healthcare needs across the quality spectrum. However, additional mentoring and training in implementation science and analytical skills is needed to effectively lead system-wide quality initiatives.Purpose
The purpose of this article is to describe the planning, implementation, and evaluation of an innovative post-doctoral DNP Quality Implementation Scholars Program developed through an academic-practice partnership to address this need.Project method
Throughout the one year post-doctoral program, we evaluated student experiences qualitatively using focus groups and quantitatively using standardized course and instructor surveys to assess overall programmatic goals. Program outcomes were evaluated from the perspective of the academic-practice partnership planning committee through a Qualtrics© survey.Findings
Strengths of the program included the in-depth mentoring by faculty and relationships built across the larger health system. Both scholars and the planning team noted that the system-wide project implemented by the scholars was relevant, timely, and quality-focused.Conclusions
This innovative DNP post-doctoral program leveraged the skill-sets of DNP-prepared nurse leaders to lead system-wide quality improvement initiatives tailored specifically to healthcare organizations.Item Open Access Evidence2Practice (E2P): Leveraging Implementation Science to Promote Careers in HIV Research Among Students From Historically Black Colleges and Universities.(Journal of acquired immune deficiency syndromes (1999), 2023-10) Okeke, Nwora Lance; Ware, Kenric B; Campbell, Russell; Taylor, Jamilah; Hung, Frances; Questell, Caroline; Brickler, Mildred P; Smith, Ukamaka D; Nawas, George T; Hanlen-Rosado, Emily; Chan, Cliburn; Bosworth, Hayden B; Aifah, Angela; Corneli, AmyBackground
The HIV research workforce is not representative of populations most affected by the epidemic. Innovative educational programs are needed to motivate diverse student populations to pursue careers in HIV research.Methods
The Duke University Center for AIDS Research Evidence2Practice (E2P) program is a 3-day interactive workshop that introduces students from Historically Black Colleges and Universities (HBCU) to HIV pre-exposure prophylaxis, implementation science, and human-centered design. Participants develop 1-page action plans to increase awareness and uptake of pre-exposure prophylaxis on their campus. The program was evaluated using a partially mixed-method concurrent equal status study design with pre-program and post-program surveys and in-depth interviews.Results
Among the 52 participating students, 44 completed the preworkshop survey, 45 completed the postworkshop survey, and 10 participated in an in-depth interview. Most participants identified as Black or African American and cisgender female. Participating in the E2P program was associated with: (1) an increase in median interest in pursuing a career in HIV research (P < 0.01) and (2) a decrease in median perceived difficulty in starting a career in HIV research (P < 0.01). Several students described that a lack of knowledge about initiating an HIV research career, a perceived lack of qualifications and knowledge about HIV science, and limited experience were major barriers to considering careers in HIV research.Conclusions
The E2P program enhanced HBCU students' interest in careers related to HIV research and improved their self-efficacy to pursue such careers. On-campus educational enrichment initiatives, led by active HIV researchers and clinicians, should be a critical part of diversifying the HIV workforce.Item Open Access ImPlementation REsearCh to DEvelop Interventions for People Living with HIV (the PRECluDE consortium): Combatting chronic disease comorbidities in HIV populations through implementation research.(Progress in cardiovascular diseases, 2020-03) Gamble-George, Joyonna Carrie; Longenecker, Christopher T; Webel, Allison R; Au, David H; Brown, Arleen F; Bosworth, Hayden; Crothers, Kristina; Cunningham, William E; Fiscella, Kevin A; Hamilton, Alison B; Helfrich, Christian D; Ladapo, Joseph A; Luque, Amneris; Tobin, Jonathan N; Wyatt, Gail E; Implementation Research to Develop Interventions for People Living with HIV (PRECluDE) ConsortiumAntiretroviral therapy (ART) prevented premature mortality and improved the quality of life among people living with the human immunodeficiency virus (PLWH), such that now more than half of PLWH in the United States are 50 years of age and older. Increased longevity among PLWH has resulted in a significant rise in chronic, comorbid diseases. However, the implementation of guideline-based interventions for preventing, treating, and managing such age-related, chronic conditions among the HIV population is lacking. The PRECluDE consortium supported by the Center for Translation Research and Implementation Science at the National Heart, Lung, and Blood Institute catalyzes implementation research on proven-effective interventions for co-occurring heart, lung, blood, and sleep diseases and conditions among PLWH. These collaborative research studies use novel implementation frameworks with HIV, mental health, cardiovascular, and pulmonary care to advance comprehensive HIV and chronic disease healthcare in a variety of settings and among diverse populations.Item Open Access Implementation science in nursing education research: An exemplar.(Nurse education today, 2022-12) Reynolds, Staci S; Granger, Bradi B; Oermann, Marilyn HIntroduction
Using evidence-based teaching approaches can improve nursing students' learning. However, variation in how - or if - these approaches are implemented by faculty and nursing educators is prevalent. A thorough, applied understanding of how evidence-based teaching approaches can best be implemented in the educational setting is lacking.Objectives
The purpose of this project was to use an implementation science framework to implement and evaluate the quality of a doctor of nursing practice (DNP) course before and after implementing evidence-based revisions to course delivery and composition.Design
A pre/post design was used to evaluate course outcomes following implementation of evidence-based teaching approaches.Setting
A small, private university in the southeastern United States.Participants
Students who enrolled in a DNP healthcare quality improvement course.Methods
An implementation science framework for integrating evidence-based teaching approaches was used to guide this project. Revisions were made to a DNP course, with evidence-based teaching approaches implemented using strategies including a dedicated course facilitator, faculty education, interactive assistance to course faculty, and detailed rubrics to ensure consistency in grading between sections. Outcomes included course evaluation scores, qualitative student comments, and student engagement measured via the average number of discussion board posts authored and read.Results
After using the implementation science framework to translate evidence-based teaching approaches, there was a statistically significant improvement in three course evaluation questions and the overall course mean. Qualitative comments showed that students found the revisions beneficial to their learning. There was no change in student engagement.Conclusions
Using a structured implementation science framework and plan to translate and evaluate evidence-based teaching approaches resulted in significant improvements in course outcomes. Nurse educators should consider using an implementation framework to guide course revisions.Item Open Access Implementation Science Toolkit for Clinicians: Improving Adoption of Evidence in Practice.(Dimensions of critical care nursing : DCCN, 2023-01) Reynolds, Staci S; Granger, Bradi BBackground
Clinicians are often familiar with quality improvement (QI) and evidence-based practice (EBP) processes, which provides guidance into what evidence should be implemented; however, these processes do not address how to successfully implement evidence.Objective
Clinicians would benefit from a deeper understanding of implementation science, along with practical tools for how to use these principles in QI and EBP projects.Methods
We provide a brief background of the principles of implementation science, an overview of current implementation science models and a toolkit to facilitate choosing and using common implementation science strategies. In addition, the toolkit provides guidance for measuring the success of an implementation science project and a case study showing how implementation science strategies can be used successfully in clinical practice.Conclusions
Using an implementation science toolkit for designing, conducting, and evaluating a QI or EBP project improves the quality and generalizability of results.Item Open Access Implementation Strategies to Improve Evidence-Based Bathing Practices in a Neuro ICU.(Journal of nursing care quality, 2019-04) Reynolds, Staci Sue; Sova, Chris; McNalty, Bridget; Lambert, Suzanne; Granger, BradiBackground
Evidence supports daily bathing using chlorhexidine gluconate (CHG) cloths to decrease preventable hospital-acquired central line-associated bloodstream infections (CLABSIs). However, implementation of this practice is inconsistent. Using multifaceted strategies to promote implementation is supported in the literature, yet there is a gap in knowing which strategies are most successful.Purpose
Using the Grol and Wensing Model of Implementation as a guide, the purpose of this study was to determine whether using tailored, multifaceted strategies would improve implementation of daily CHG bathing and decrease CLABSIs in a large neuro ICU.Methods
An observational pre-/postdesign was used.Results
Following implementation, infection rates decreased (P = .031). Statistically significant improvements were also seen across all process measures: bathing documentation, nursing knowledge, and perceived importance of CHG bathing.Conclusions
This study assists in closing the research-practice gap by using tailored, multifaceted implementation strategies to increase use of evidence-based nursing care for infection prevention practices.Item Open Access Improving acute myocardial infarction care in northern Tanzania: barrier identification and implementation strategy mapping.(BMC health services research, 2024-03) Hertz, Julian T; Sakita, Francis M; Prattipati, Sainikitha; Coaxum, Lauren; Tarimo, Tumsifu G; Kweka, Godfrey L; Mlangi, Jerome J; Stark, Kristen; Thielman, Nathan M; Bosworth, Hayden B; Bettger, Janet PBackground
Evidence-based care for acute myocardial infarction (AMI) reduces morbidity and mortality. Prior studies in Tanzania identified substantial gaps in the uptake of evidence-based AMI care. Implementation science has been used to improve uptake of evidence-based AMI care in high-income settings, but interventions to improve quality of AMI care have not been studied in sub-Saharan Africa.Methods
Purposive sampling was used to recruit participants from key stakeholder groups (patients, providers, and healthcare administrators) in northern Tanzania. Semi-structured in-depth interviews were conducted using a guide informed by the Consolidated Framework for Implementation Research (CFIR). Interview transcripts were coded to identify barriers to AMI care, using the 39 CFIR constructs. Barriers relevant to emergency department (ED) AMI care were retained, and the Expert Recommendations for Implementing Change (ERIC) tool was used to match barriers with Level 1 recommendations for targeted implementation strategies.Results
Thirty key stakeholders, including 10 patients, 10 providers, and 10 healthcare administrators were enrolled. Thematic analysis identified 11 barriers to ED-based AMI care: complexity of AMI care, cost of high-quality AMI care, local hospital culture, insufficient diagnostic and therapeutic resources, inadequate provider training, limited patient knowledge of AMI, need for formal implementation leaders, need for dedicated champions, failure to provide high-quality care, poor provider-patient communication, and inefficient ED systems. Seven of these barriers had 5 strong ERIC recommendations: access new funding, identify and prepare champions, conduct educational meetings, develop educational materials, and distribute educational materials.Conclusions
Multiple barriers across several domains limit the uptake of evidence-based AMI care in northern Tanzania. The CFIR-ERIC mapping approach identified several targeted implementation strategies for addressing these barriers. A multi-component intervention is planned to improve uptake of evidence-based AMI care in Tanzania.Item Open Access Measuring and Evaluating Clinical Context in Implementation Science Research.(AACN advanced critical care, 2022-03) Woltz, Patricia C; Granger, Bradi B; Reynolds, Staci SItem Open Access Moving from the Trial to the Real World: Improving Medication Adherence Using Insights of Implementation Science.(Annual review of pharmacology and toxicology, 2019-01) Zullig, Leah L; Deschodt, Mieke; Liska, Jan; Bosworth, Hayden B; De Geest, SabinaMedication nonadherence is a serious public health concern. Although there are promising interventions that improve medication adherence, most interventions are developed and tested in tightly controlled research environments that are dissimilar from the real-world settings where the majority of patients receive health care. Implementation science methods have the potential to facilitate and accelerate the translation shift from the trial world to the real world. We demonstrate their potential by reviewing published, high-quality medication adherence studies that could potentially be translated into clinical practice yet lack essential implementation science building blocks. We further illustrate this point by describing an adherence study that demonstrates how implementation science creates a junction between research and real-world settings. This article is a call to action for researchers, clinicians, policy makers, pharmaceutical companies, and others involved in the delivery of care to adopt the implementation science paradigm in the scale-up of adherence (research) programs.Item Embargo Opening the Implementation Blackbox for Non-Pharmacologic Pain Interventions(2024) Ballengee, Lindsay AMusculoskeletal pain remains a pervasive public health challenge affecting over 80% of Americans with substantial economic costs1,2. Non-pharmacologic interventions such as physical therapy and cognitive-behavioral therapy are recommended as first-line treatments for musculoskeletal pain but face significant implementation barriers in clinical practice3,4. This dissertation investigated strategies to optimize the implementation of non-pharmacologic pain interventions in real-world settings.The first project explored the relationship between intervention complexity and adaptations across 24 pragmatic trials using the Intervention Complexity Tool for Embedded Pragmatic Clinical Trials (ICT-ePCT)5 and a survey analysis. Our findings suggest that intervention delivery complexity may be higher for pragmatic trials that are investigating non-pharmacologic pain interventions versus non-pain trials but only in very specific areas. Additionally, changes in workflow was an important consideration for intervention delivery for all trials in our study. Future research should capture detailed, real-time information about the nature of intervention delivery complexity, adaptions, and implementation success to help improve delivery of non-pharmacologic pain interventions. These findings underscore the importance of understanding and systematically documenting adaptations to enhance intervention fit within diverse healthcare environments. The second project investigated clinically relevant contextual factors influencing patient enrollment in multimodal LBP interventions across different healthcare centers. Using the Basel Approach for Contextual Analysis (BANANA), we quantitatively and qualitatively analyzed clinically relevant contextual factors such as number of referring providers and institutional characteristics6. This contextual analysis provided key insights into the influence of contextual factors on referral processes for low back pain care. While both pathways achieved their enrollment goals within a similar timeframe, there were several differences in relationships of contextual factors between the two pathways, highlighting the importance of using tailored implementation strategies in future studies. Our qualitative findings emphasize the significance of ongoing provider engagement and communication in enhancing referral processes. Additionally, beliefs about program effectiveness and referral priorities underscore the need for targeted educational interventions and provider training to optimize program adoption. The third project evaluated the feasibility of implementing an evidence-based pain cognitive-behavioral therapy (CBT) protocol among oncology nurses. Surveys and qualitative interviews explored nurses’ perceptions and barriers to implementing pain-CBT and revealed important insights into feasibility and acceptability within oncology settings. The study findings highlight specific opportunities for future research focused on the design and evaluation of interventions that use a nurse-specialist model of pain coping skills training for patients with cancer. Future studies should use a hybrid effectiveness-implementation design to (1) evaluate the impact of the nurse-specialist model on clinical pain outcomes and (2) test strategies for the initial training and ongoing support of nurse-specialists delivering the intervention. This project contributes valuable data on strategies to support effective implementation of behavioral pain management strategies. This dissertation contributes to bridging the gap between evidence and practice in non-pharmacologic pain interventions by systematically examining intervention complexity, contextual factors, and implementation outcomes. By elucidating the adaptation process and identifying facilitators of successful implementation, this research informs efforts to enhance the availability and effectiveness of recommended non-pharmacologic pain treatments in routine clinical care.
Item Open Access Program Evaluation of Implementation Science Outcomes From an Intervention to Improve Compliance With Chlorhexidine Gluconate Bathing: A Qualitative Study.(Dimensions of critical care nursing : DCCN, 2022-07) Reynolds, Staci S; Woltz, Patricia; Keating, Edward; Neff, Janice; Elliott, Jennifer; Granger, Bradi BBackground and objectives
Evaluation of implementation science research is warranted to better understand and determine the success of translating evidence-based infection prevention practices at the bedside. The purpose of this program evaluation was to evaluate implementation outcomes from the perspectives of nurses and nursing leaders regarding a previously conducted chlorhexidine gluconate (CHG) bathing implementation science study among 14 critical care units.Methods
Focus groups and interviews, using semistructured interview questions, were conducted to examine the perceptions of nurses who participated in a CHG bathing implementation science study. A deductive qualitative analysis using Proctor and colleagues' implementation outcomes framework was used. Transcripts were analyzed and categorized using the framework as a predetermined code list to structure the implementation outcomes of acceptability, appropriateness, adoption, feasibility, and sustainability.Findings
A total of 19 nurses and nurse leaders participated in a focus group or interview. Participants noted that both implementation strategies used in the initial study (educational outreach and audit and feedback) were acceptable and appropriate and expressed that the evidence-based CHG bathing practice was feasible to integrate into practice and was being adopted.Discussion
The program evaluation identified strengths and opportunities for improvement related to the implementation strategies and evidence-based CHG bathing protocol. Findings can inform future studies that seek to implement CHG bathing protocols in the critical care setting using audit and feedback and educational outreach strategies.Item Open Access Relevant Journals for Identifying Implementation Science Articles: Results of an International Implementation Science Expert Survey.(Frontiers in public health, 2021-01) Mielke, Juliane; Brunkert, Thekla; Zullig, Leah L; Bosworth, Hayden B; Deschodt, Mieke; Simon, Michael; De Geest, SabinaIn implementation science (IS), conducting well-targeted and reproducible literature searches is challenging due to non-specific and varying terminology that is fragmented over multiple disciplines. A list of journals that publish IS-relevant content for use in search strings can support this process. We conducted a cross-sectional online survey of 56 Australian, European, and North American IS experts to identify and prioritize relevant journals that publish IS articles. Journals' relevance was assessed by providing each with a list of 12 journals, to which they were encouraged to add additional journal names and comments as free text. We also assessed which journals had published special IS-focused issues-identified via PubMed and Google searches-over the last 20 years. Data were analyzed descriptively. Between February 28 and March 15, 2020, a purposive sample of 34/56 experts participated in the survey (response rate: 60.7%). Implementation Science and BMC Health Services Research were perceived as relevant by 97.1% of participants; other journals' relevance varied internationally. Experts proposed 50 additional journals from various clinical fields and health science disciplines. We identified 12 calls and 53 special issues on IS published within various journals and research fields. Experts' comments confirmed the described challenges in identifying IS literature. This report presents experts' ratings of IS journals, which can be included in strategies supporting searches of IS evidence. However, challenges in identifying IS evidence remain geographically and interdisciplinary. Further investment is needed to develop reproducible search strings to capture IS evidence as an important step in improving IS research quality.Item Open Access The Importance of Considering Clinical Inertia and Implementation Science When Addressing Medication Adherence.(JAMA network open, 2020-10) Bosworth, Hayden BItem Open Access Using an implementation science framework to advance the science of nursing education.(Journal of professional nursing : official journal of the American Association of Colleges of Nursing, 2022-03) Oermann, Marilyn H; Reynolds, Staci S; Granger, Bradi BBackground
The process of adopting evidence-based educational practices and teaching methods has not been examined in nursing education.Purpose
This article provides a framework for adopting educational evidence and designing studies in nursing education using an implementation science (IS) framework.Method
The three phases for implementing evidence-based practices (development, translation, and sustainment) are used for this framework.Results
Preparatory activities are needed before implementing a new educational practice or method, followed by identification of implementation strategies (e.g., training and support of faculty, strategies for communication and tips to remove barriers, guides for deciding on timing), assessing process and outcome measures, and plans for sustaining the new practice. A process map, examples of implementation processes, and sample research questions guide nurse educators in planning and conducting studies using an IS framework.Conclusions
Research has not examined the processes and strategies for applying evidence-based educational practices in nursing. Studies using an IS framework are needed to provide knowledge about how to move evidence into routine educational practices and implement more effective teaching methods. This article provides guidance for nurse educators to begin this research and suggests possible research questions.