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  • Bergström, Anna, 1983-, et al. (författare)
  • The use of the PARIHS framework in implementation research and practice-a citation analysis of the literature
  • 2020
  • Ingår i: ; 15:1
  • Forskningsöversikt (refereegranskat)abstract
    • Background The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework. Methods This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail. Results The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated. Conclusions In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.
  • Ekdahl, A.W., et al. (författare)
  • Frailty and comprehensive geriatric assessment organized as CGA-ward or CGA-consult for older adult patients in the acute care setting: A systematic review and meta-analysis
  • Ingår i: European Geriatric Medicine. - : Springer. - 1878-7649 .- 1878-7657. ; 6:6, s. 523-540
  • Forskningsöversikt (refereegranskat)abstract
    • With worldwide population aging, increasing numbers of people need hospital care. Evidence suggests comprehensive geriatric assessment (CGA) is superior to usual care. To summarize the evidence for the effects of CGA in frail and moderately frail patients compared with usual care in acute care settings. CINAHL, PsycInfo, Cochrane Library, EMBASE, and PubMed were searched in October 2011, January 2013, and February 2015. Randomized controlled trials. CGA. Usual care. Change in housing, personal activities of daily living (PADL), instrumental activities of daily living (IADL), readmission, cognitive function, depression, quality-of-life care-giver burden, and mortality. The grading of recommendations assessment development and evaluation (GRADE) system to assess the quality of evidence and PRISMA-guidelines for meta-analyses and reviews. Continuous data were presented as standardized mean differences and dichotomous data were presented as risk differences. Twenty-nine articles based on 17 unique studies (6005 patients in total). CGA was categorized as CGA-ward or CGA-consult. In the frail group, CGA-ward was superior to usual care for change in housing, PADL, and depression. CGA-consult was superior to usual care for PADL and IADL in the moderately frail group. There was a stronger effect for frail older adults and CGA-ward compared with usual care. This highlights the importance of detecting frailty. However, the degree of evidence was limited.
  • Forberg, U., et al. (författare)
  • Effects of computer reminders on complications of peripheral venous catheters and nurses' adherence to a guideline in paediatric care-a cluster randomised study
  • 2016
  • Ingår i: Implementation Science. - 1748-5908. ; 11
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Reminder systems in electronic patient records (EPR) have proven to affect both health care professionals' behaviour and patient outcomes. The aim of this cluster randomised trial was to investigate the effects of implementing a clinical practice guideline (CPG) for peripheral venous catheters (PVCs) in paediatric care in the format of reminders integrated in the EPRs, on PVC-related complications, and on registered nurses' (RNs') self-reported adherence to the guideline. An additional aim was to study the relationship between contextual factors and the outcomes of the intervention. Methods: The study involved 12 inpatient units at a paediatric university hospital. The reminders included choice of PVC, hygiene, maintenance, and daily inspection of PVC site. Primary outcome was documented signs and symptoms of PVC-related complications at removal, retrieved from the EPR. Secondary outcome was RNs' adherence to a PVC guideline, collected through a questionnaire that also included RNs' perceived work context, as measured by the Alberta Context Tool. Units were allocated into two strata, based on occurrence of PVCs. A blinded simple draw of lots from each stratum randomised six units to the control and intervention groups, respectively. Units were not blinded. The intervention group included 626 PVCs at baseline and 618 post-intervention and the control group 724 PVCs at baseline and 674 post-intervention. RNs included at baseline were 212 (65.4 %) and 208 (71.5 %) post-intervention. Results: No significant effect was found for the computer reminders on PVC-related complications nor on RNs' adherence to the guideline recommendations. The complication rate at baseline and post-intervention was 40.6 % (95 % confidence interval (CI) 36.7-44.5) and 41.9 % (95 % CI 38.0-45.8), for the intervention group and 40.3 % (95 % CI 36.8-44.0) and 46.9 % (95 % CI 43.1-50.7) for the control. In general, RNs' self-rated work context varied from moderately low to moderately high, indicating that conditions for a successful implementation to occur were less optimal. Conclusions: The reminders might have benefitted from being accompanied by a tailored intervention that targeted specific barriers, such as the low frequency of recorded reasons for removal, the low adherence to daily inspection of PVC sites, and the lack of regular feedback to the RNs.
  • Harvey, G., et al. (författare)
  • Mobilising evidence to improve nursing practice: A qualitative study of leadership roles and processes in four countries
  • 2019
  • Ingår i: International Journal of Nursing Studies. - 0020-7489 .- 1873-491X. ; 90, s. 21-30
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The approach and style of leaders is known to be an important factor influencing the translation of research evidence into nursing practice. However, questions remain as to what types of roles are most effective and the specific mechanisms through which influence is achieved. Objectives: The aim of the study was to enhance understanding of the mechanisms by which key nursing roles lead the implementation of evidence-based practice across different care settings and countries and the contextual factors that influence them. Design: The study employed a qualitative descriptive approach. Settings: Data collection was undertaken in acute care and primary/community health care settings in Australia, Canada, England and Sweden. Participants: 55 individuals representing different levels of the nursing leadership structure (executive to frontline), roles (managers and facilitators), sectors (acute and primary/community) and countries. Methods: Individual semi-structured interviews were conducted with all participants exploring their roles and experiences of leading evidence-based practice. Data were analysed through a process of qualitative content analysis. Results: Different countries had varying structural arrangements and roles to support evidence-based nursing practice. At a cross-country level, three main themes were identified relating to different mechanisms for enacting evidence-based practice, contextual influences at a policy, organisational and service delivery level and challenges of leading evidence-based practice. Conclusions: National policies around quality and performance shape priorities for evidence-based practice, which in turn influences the roles and mechanisms for implementation that are given prominence. There is a need to maintain a balance between the mechanisms of managing and monitoring performance and facilitating critical questioning and reflection in and on practice. This requires a careful blending of managerial and facilitative leadership. The findings have implications for theory, practice, education and research relating to implementation and evidence-based practice. © 2018 Elsevier Ltd
  • Koistinen, Susanne, et al. (författare)
  • Oral health and oral care in short-term care : prevalence, related factors, and coherence between older peoples and professionals assessments
  • 2019
  • Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 33:3, s. 712-722
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Oral health is important for well-being and overall health. Older peoples oral health is well described in the residential care context, but remains understudied in short-term care.Objective: The aim of this study was to describe oral health, daily oral care and related factors among older people in short-term care and to compare self-perceived oral health with professional assessment.Materials and methods: This cross-sectional study included 391 older people in 36 short-term units in 19 Swedish municipalities. Oral health was assessed professionally by clinical oral assessment and the Revised Oral Assessment Guide (ROAG). The older peoples’ perceptions of their own oral health were measured with a global question on self-perceived oral health. Self-care ability was assessed with Katz Index of Activities of Daily Living (Katz-ADL).Results: Mean age was 82.9 years, 19% of participants were totally edentulous, and 43% had ≥20 teeth. Almost 60% had coating or food debris on their teeth, but only 19% received help with daily oral care. Those who were dependent on help with self-care had around a sixfold higher risk of having oral problems. There was a low level of agreement between the clinical assessment based on ROAG and self-perceived oral health.Conclusion: Professionals’ assessments of oral health differed considerably from the older peoples own assessments. A higher risk of oral problems and more occurrence of coating or food debris or broken teeth were seen among those dependent on help with self-care (ADL). This study indicates that in order to improve older peoples oral health and oral care we need to provide person-centred oral care and to develop a close collaboration between nursing and dental staff.
  • Koistinen, Susanne, et al. (författare)
  • Oral health-related quality of life and associated factors among older people in short-term care.
  • 2019
  • Ingår i: International Journal of Dental Hygiene. - : Blackwell Publishing. - 1601-5029 .- 1601-5037.
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: It is well known that oral health status is associated with oral health-related quality of life (OHRQoL) in the general population. The aim of this study was to describe and analyze OHRQoL among older people in short-term care and its associated factors.MATERIALS AND METHODS: This cross-sectional study included 391 older people in 36 short-term care units. Data were collected via clinical oral assessments, questions about self-perceived oral and general health, Katz Index of Activities of Daily Living (Katz-ADL) and the Revised Oral Assessment Guide (ROAG). OHRQoL was measured using the Oral Health Impact Profile (OHIP-14). Multivariate logistic regression models were applied in the analysis.RESULTS: Poor OHRQoL was reported by 34% of the older people. Associated factors were swallowing problems according to ROAG; quite poor/poor self-perceived physical, psychological, and oral health; and being a woman.CONCLUSIONS: There is an association between OHRQoL and older people's self-perceived health according to the OHIP-14. This indicates the importance of early detection of oral health problems in frail older people and to assess both oral health and swallowing problems among older people in short-term care.
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