At this point, the practice change should be in process with multiple implementation strategies to increase evidence uptake. Leaders designate resources, such as information technology, to conduct and evaluate the change. The goal is to keep the change moving forward. In the case study, administrative support is observed with resource allocation. One nursing unit may pilot the practice change to routinely offer nonpharmacologic interventions to patients experiencing pain to augment pharmacologic strategies.
Implementation strategies: Multiple implementation strategies are purposefully selected to maintain the practice change momentum. Frequently measure outcomes such as pain ratings, opioid use, and nonpharmacologic interventions. Flexible selflearning modules and pocket reference cards can help staff gain confidence with the new practice. Electronic health record prompts, other types of remind — ers, and reports to leadership reinforce the new practice.
In addition, patient education and support help ensure success. This stage demands ongoing effort and resources to ensure the practice becomes hardwired and replaces the old practice. This may take weeks, months, and even years. In the case study, staff work to maintain their commitment to offering patients nonpharmacologic pain strategies.
Booster training may be needed for existing staff and a structured process created for onboarding new staff. Implementation strategies: Several implementation strategies can help maintain the practice change. Monitor data trends, report data to senior leaders, and encourage leadership rounds to ask about nonpharmacologic interventions. Project team members and unit leaders should continue to celebrate and recognize success and support champions with incentives and rewards.
Other strategies include rolling out the practice to other units, recognizing that drift back to the old practice can occur at any time, changing the reminder mechanisms, continuing to review literature and new evidence at regular intervals, setting new goals and objectives as needed, updating action plans, reporting to quality improvement teams, presenting project details and data through informal and formal presentations, and including project reports in annual reports.
If the practice is truly hardwired, no additional efforts are needed to sustain the change, and the implementation process can be terminated. This stage may not be reached for a long time and may not be appropriate for many practice changes. Implementation strategies: Specific implementation strategies at this stage begin with determining if terminating the team efforts is appropriate. In the case study, if termination can occur, team members will want to identify what indicators suggest that the nonpharmacologic interventions are consistently used and which focused implementation strategies are no longer needed.
Leadership will be responsible for ongoing monitoring of data trends and adherence to the practice change. If evidence of practice drift back is identified, the implementation project may need to be resumed or a new project created. Thank and celebrate all staff members, as a group and individually, and consider thank-you gifts for project team members. Termination interviews or focus groups can help the organization learn which implementation strategies were most effective.
Maintenance stage managing and preventing drift This stage demands ongoing effort and resources to ensure the practice becomes hardwired and replaces the old practice. Other strategies include rolling out the practice to other units, recognizing that drift back to the old practice can occur at any time, changing the reminder mech a ni — sms, continuing to review literature and new evidence at regular intervals, setting new goals and objectives as needed, updating action plans, reporting to quality improvement teams, presenting project details and data through informal and formal presentations, and including project reports in annual reports.
EBP uptake strategies A by-product of developing implementation models is identifying strategies for a successful EBP initiative. These strategies generally fall into seven categories: leadership, coaching, communication, reinforcement, recognition, measurement, and reporting. The following references were selected to highlight key implementation strategies that nurses can use in their EBP initiatives.
Keep in mind that a toolbox of strategies will improve success. A different strategy may be needed at each phase of the initiative, for use with barriers and facilitators, and in specific settings. These strategies can be used with each of the models described above. Grol and Grimshaw: Over 15 years ago, Grol and Grimshaw summarized 54 reviews about how to successfully change practice.
They focused on three areas: attributes of the practice, including its complexity and difference from usual practice; barriers and facilitators within the practice change setting and people involved; and the effectiveness of the most frequently used strategies for promoting change. Grol and Grimshaw found that education strategies, audit and feedback, and reminders and computers are important for successful change. They also recommended interactive small group meetings, mass media campaigns, and combined strategies.
The authors concluded that change generally requires comprehensive approaches at different levels and for different interventions, and that a one-size-fits-all approach is unlikely to be successful. Grimshaw and colleagues: Grimshaw and colleagues suggested that successfully translating research into practice requires asking five key questions:. The authors stressed that a critical first step is assessing organizational barriers and facilitators specific to the proposed practice change. This assessment can guide implementation strategy selection. They also reviewed the latest evidence on various implementation strategies and highlighted the most effective: Holding educational meetings and providing learning materials, leveraging the influence of local opinion leaders, auditing clinician documentation and providing specific feedback, and building computerized reminders.
In addition, they noted patient strategies— such as patient decision aids, interactive health communication apps, and communication before consultations to introduce recommended health behavior— that can help facilitate health behavior change.
For each of 63 implementation strategies, the authors provide a definition, benefits, procedure, case example, and support references. Powell and colleagues: Similar to the work led by the UIHC nursing team, Powell and colleagues used an expert panel to compile a list of 73 implementation strategies for example, accessing funding, audit and feedback, centralizing technical assistance, developing an implementation glossary, distributing education materials, facilitating, and using advisory boards and data experts for the mental health sector.
The panel was selected based on expertise in implementation science and clinical practice, and members participated in three rounds of a survey using a Delphi process research design. The first two rounds involved a web-based survey; the third round used a web-based live polling and consensus process. Although these strategies are specific to mental health, they cross disciplines, specialties, and settings.
Li and colleagues: A systematic review by Li and colleagues focused on organizational contextual features that influence EBP implementation across healthcare settings. They reviewed and rated the quality of 36 studies published between January and June Using a standardized rating tool, they scored five studies as high quality, 22 as moderately high quality, and eight as moderate quality. Factors identified as important to implementation included organizational culture, networks and communication, leadership, resources financial, staffing and workload, time, and education and training , evaluation, monitoring and feedback, and champions.
The authors noted that leadership influences all other factors and should be a priority in implementation initiatives and that combined factors are more influential than a single factor, pointing to the importance of a multistrategy toolkit.
These combined resources provide nurses with multiple strategies to consider when embarking on EBP changes. Tucker and colleagues from the Ohio State University developed a scale that includes a list of implementation strategies clinicians can rate their confidence in using. Many implementation models promote EBP, and a toolbox of strategies is your surest path to success. Iowa model of evidence-based practice: Revisions and validation. Worldviews Evid Based Nurs.
Cullen L, Adams SL. Planning for implementation of evidence-based practice. J Nurs Adm. A guiding framework and approach for implementation research in substance use disorders treatment. Psychol Addict Behav. Am J Public Health. Knowledge translation of research findings. Implement Sci. Grol R, Grimshaw J. Organizational contextual features that influence the implementation of evidence-based practices across healthcare settings: A systematic integrative review.
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Reporting requirements for Victorian public mental health services and an overview of government-funded mental health research. A hard copy of a publication can be ordered online by filling out this form - we do not ship outside of Australia. Some items are available in limited quantities only. This webpage links to more information from the Victorian Government about policy, research and legislation for the alcohol and other drug sector.
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This section provides information about funding models for alcohol and other drug service providers and details about the reporting requirements. The Victorian Government supports older Victorians to live independently in the community through a range of support programs. Supported residential services provide accommodation and support services for Victorians who need help with everyday activities. They are regulated by the Victorian Government. Residential aged care is for older people who can no longer live at home. These services are funded and regulated by the Commonwealth Government and can be operated by not-for-profit, private or state government providers.
Assessment services help older people and their carers to identify care that best meets their needs and access Commonwealth Government services for older people.
Implementation: The linchpin of evidence-based practice changes - American Nurse Today
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Evidence - based practice EBP is an approach to care that integrates the best available research evidence with clinical expertise and patient values. Implementing clinical knowledge, and introducing new interventions and therapies, is an important way to minimise functional decline in older people.
Implementing evidence-based practice is a key part of improving outcomes for older people in hospital. When considering current best practice in the areas of nutrition, cognition, continence, medication, skin integrity, and mobility and self-care, a good first reference is the Older people in hospital website. The National Safety and Quality Health Service Standards outlines the standards for providing best evidence care for older people in hospital.
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There were no significant changes in social support, obtaining respite services, or positive aspects of caregiving Table 2. The effects for depression, burden, bother, and self-efficacy were maintained at 12 months. At 12 months, CGs also reported higher overall social support and higher self-efficacy obtaining respite. There was a significant increase in use of respite services from baseline to the month follow-up. Note : Mean change scores are reported for each time interval; positive numbers indicate improvement.
A Means for burden at each time and B Means for Bother at each time. The CGs also found the online support groups valuable. All of the CGs indicated they would recommend the program to others. Overall, the program was effective. Caregivers who participated in the program reported a significant improvement in depression; burden; less bother with care recipient behavior and memory problems; and greater CG self-efficacy. Participation in the program also resulted in a decrease in the number of CGs at risk for clinical depression.
Importantly, treatment effects were maintained at the month post randomization assessment, which indicates that a relatively short-term 6 months, 12 sessions intervention can have lasting effects. Interestingly, CGs reported an increase in social support and self-efficacy with respect to obtaining respite at the month follow-up. The increase in self-efficacy in obtaining respite at the month post randomization assessment may be due to the fact that there was also an increase in use of these services.
Thus, CGs had more confidence in obtaining and using these services. The increase in social support at the 12 month post randomization assessment may be related to the fact that the CGs learned skills related to asking for support and receiving support in the intervention and support groups sessions and translated the skills they learned beyond the intervention period to others once the interventionist and formal support groups were no longer available.
Caregivers also found the program to be beneficial and indicated that the program increased their ability to provide care, which is consistent with the reported increase in caregiving self-efficacy. They were especially enthusiastic about the support groups, which may in part be due to the fact that they could participate in the groups from the comfort of their own home.
Like REACH VA, this study demonstrates that it is feasible to implement evidence-based programs into community settings and that these programs can be effective when delivered by organizational staff. The care recipients in our sample were also considerably more impaired. An important next step would be to examine if a shorter, less intense version of the intervention would be effective. If so, this would enhance the feasibility of broad scale implementation of the program. Nichols and colleagues Nichols et al.
Importantly, the community organization was involved in tailoring the intervention so that it could be implemented within the constraints of the organization. The number of sessions delivered in the home was reduced, behavioral strategies were provided, and the assessment battery was shortened.
Having organizational buy-in and input was an essential component of the implementation process Czaja et al. This study addresses an important gap in the intervention literature, the implementation of evidence-based interventions in practice. Although there has been an enormous investment in the development and evaluation of CG interventions, relatively few intervention programs have been implemented in clinical and community settings especially with minority CGs. The recent report by the National Academies of Engineering Science and Medicine on family caregiving, noted that to increase the number of CGs who benefit from proven interventions, these interventions need to undergo a translational phase where the program is adapted to fit within an agency or clinic and evaluated within that setting.
Challenges encountered included missing data on some of the assessment instruments such as the program evaluation.
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This is less likely to occur in RCTs, as there is greater control of study protocols. An additional challenge was participant retention. Further, many CGs were unreachable at follow-up; which may have been due to staff having insufficient time and resources to locate these participants. Also, as noted, health of the CG was a significant predictor of drop out at 12 months. Finally, it is difficult as with most community programs, to evaluate the longer-term sustainability of the intervention. Due to changes within the organization and resource constraints, the entire Community REACH intervention is not currently being implemented.
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However, UHCS staff are still using several components of the intervention, such as the skill building modules and resources guide with their CG clients. The current limited implementation of the program underscores the importance of evaluating the feasibility of interventions with respect to available community resources and constraints.
Optimally, this should be done at the front end of intervention development. In order to impact health care practices, understanding how to best design interventions so that they can be implemented in community and clinical settings is an imperative Gitlin and Czaja, Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.
Sign In or Create an Account. Sign In. Advanced Search. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents. Conflict of Interest. Address correspondence to: Sara J. E-mail: sczaja med. Oxford Academic. Google Scholar. Dolores Perdomo, PhD. David Loewenstein, PhD. Neurobehavioral Associates, Doral, Florida.
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