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Developing leadership capacity for guideline use: a pilot cluster randomized control trial.

https://arctichealth.org/en/permalink/ahliterature123925
Source
Worldviews Evid Based Nurs. 2013 Feb;10(1):51-65
Publication Type
Article
Date
Feb-2013
Author
Wendy A Gifford
Barbara L Davies
Ian D Graham
Ann Tourangeau
A Kirsten Woodend
Nancy Lefebre
Author Affiliation
School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada. wgifford@uottawa.ca
Source
Worldviews Evid Based Nurs. 2013 Feb;10(1):51-65
Date
Feb-2013
Language
English
Publication Type
Article
Keywords
Diabetic Foot - therapy
Feasibility Studies
Home Nursing - education - methods - standards
Humans
Leadership
Nursing Process - organization & administration
Ontario
Pilot Projects
Practice Guidelines as Topic
Qualitative Research
Abstract
The importance of leadership to influence nurses' use of clinical guidelines has been well documented. However, little is known about how to develop and evaluate leadership interventions for guideline use.
The purpose of this study was to pilot a leadership intervention designed to influence nurses' use of guideline recommendations when caring for patients with diabetic foot ulcers in home care nursing. This paper reports on the feasibility of implementing the study protocol, the trial findings related to nursing process outcomes, and leadership behaviors.
A mixed methods pilot study was conducted with a post-only cluster randomized controlled trial and descriptive qualitative interviews. Four units were randomized to control or experimental groups. Clinical and management leadership teams participated in a 12-week leadership intervention (workshop, teleconferences). Participants received summarized chart audit data, identified goals for change, and created a team leadership action. Criteria to assess feasibility of the protocol included: design, intervention, measures, and data collection procedures. For the trial, chart audits compared differences in nursing process outcomes.
8-item nursing assessments score. Secondary outcome: 5-item score of nursing care based on goals for change identified by intervention participants. Qualitative interviews described leadership behaviors that influenced guideline use.
Conducting this pilot showed some aspects of the study protocol were feasible, while others require further development. Trial findings observed no significant difference in the primary outcome. A significant increase was observed in the 5-item score chosen by intervention participants (p = 0.02). In the experimental group more relations-oriented leadership behaviors, audit and feedback and reminders were described as leadership strategies.
Findings suggest that a leadership intervention has the potential to influence nurses' use of guideline recommendations, but further work is required to refine the intervention and outcome measures. A taxonomy of leadership behaviors is proposed to inform future research.
PubMed ID
22647197 View in PubMed
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Evaluation of a multiple component intervention to support the implementation of a 'Therapeutic Relationships' best practice guideline on nurses' communication skills.

https://arctichealth.org/en/permalink/ahliterature167725
Source
Patient Educ Couns. 2006 Oct;63(1-2):3-11
Publication Type
Article
Date
Oct-2006
Author
Nancy Edwards
Wendy E Peterson
Barbara L Davies
Author Affiliation
School of Nursing, Faculty of Health Sciences, University of Ottawa, Canada.
Source
Patient Educ Couns. 2006 Oct;63(1-2):3-11
Date
Oct-2006
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Benchmarking - organization & administration
Clinical Competence - standards
Communication
Education, Nursing, Continuing - organization & administration
Female
Health Knowledge, Attitudes, Practice
Health services needs and demand
Humans
Inservice Training - organization & administration
Matched-Pair Analysis
Maternal-Child Nursing - education - standards
Nurse Clinicians - organization & administration
Nurse's Role - psychology
Nurse-Patient Relations
Nursing Education Research
Nursing Evaluation Research
Nursing Staff - education - psychology
Ontario
Postnatal Care - psychology - standards
Practice Guidelines as Topic
Program Development
Program Evaluation
Abstract
To determine if there was an improvement in nurses' communication skills 5 months after a multiple component intervention to implement the Registered Nurses' Association of Ontario best practice guideline 'Establishing Therapeutic Relationships'.
A matched pair, before and after design was used. Eight client scenarios with corresponding client comments were read aloud to nurses who were asked to respond verbally, as though they were interacting with the client. Responses were audio-taped and transcribed. The frequency and quality of nurses' active listening, initiating and assertiveness skills were measured pre- and post-implementation of the guideline.
Twenty-two nurses responded at both time points. Active listening skills were most frequently used. There was a statistically significant decrease in the number of active listening skills used, but a statistically significant improvement in the quality of active listening and initiating statements and frequency of initiating skills.
Nurses demonstrated improvements in selected communication skills following the implementation of a multiple component intervention that included a best practice guideline.
A combination of strategies that support the implementation of a best practice guideline is described. Results indicate some improvement in communication skills that are essential to the establishment of therapeutic nurse-client relationships.
PubMed ID
16935459 View in PubMed
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Facilitating the use of evidence in practice: evaluating and adapting clinical practice guidelines for local use by health care organizations.

https://arctichealth.org/en/permalink/ahliterature188364
Source
J Obstet Gynecol Neonatal Nurs. 2002 Sep-Oct;31(5):599-611
Publication Type
Article
Author
Ian D Graham
Margaret B Harrison
Melissa Brouwers
Barbara L Davies
Sandra Dunn
Author Affiliation
Ottawa Health Research Institute, Ottawa Hospital, Ontario, Canada. igraham@ohri.ca
Source
J Obstet Gynecol Neonatal Nurs. 2002 Sep-Oct;31(5):599-611
Language
English
Publication Type
Article
Keywords
Benchmarking - organization & administration
Breast Feeding
Diffusion of Innovation
Evidence-Based Medicine - organization & administration
Health Facility Administration
Humans
Maternal-Child Nursing - education - standards
Models, organizational
Ontario
Practice Guidelines as Topic - standards
Research Design - standards
Abstract
This article describes a framework for evaluating and adapting existing practice guidelines for local use by health care organizations and groups. The framework presents the major issues related to guideline adaptation and breaks them down into manageable steps. Many steps of the framework are illustrated using the process used by the Registered Nurses Association of Ontario to develop best practice guidelines for breastfeeding.
Notes
Comment In: J Obstet Gynecol Neonatal Nurs. 2003 Jan-Feb;32(1):1012570175
Comment In: J Obstet Gynecol Neonatal Nurs. 2003 Jan-Feb;32(1):10-112570176
PubMed ID
12353740 View in PubMed
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Impacting Canadian public health nurses' job satisfaction.

https://arctichealth.org/en/permalink/ahliterature128877
Source
Can J Public Health. 2011 Nov-Dec;102(6):427-31
Publication Type
Article
Author
Karen R Graham
Barbara L Davies
A Kirsten Woodend
Jane Simpson
Shannon L Mantha
Author Affiliation
Vaccine Preventable Diseases Program, North Bay Parry Sound District Health Unit, 681 Commercial Street, North Bay, ON P1B 4E7. karen.graham@nbpsdhu.ca
Source
Can J Public Health. 2011 Nov-Dec;102(6):427-31
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Attitude of Health Personnel
Canada
Cross-Sectional Studies
Humans
Intergenerational Relations
Internal-External Control
Job Satisfaction
Logistic Models
Middle Aged
Professional Autonomy
Public Health Nursing - manpower - standards
Workload - psychology - statistics & numerical data
Abstract
Workforce recruitment and retention challenges are being experienced in public health as in other Canadian health sectors. While there are many nurses working in public health, little research has been done about their job satisfaction. Job satisfaction is linked to recruitment, retention and positive client outcomes. The purpose of this research was to examine the relationships between three modifiable work environment factors (autonomy, control-over-practice, and workload) and Canadian public health nurses' (PHNs) job satisfaction.
Data were from the 2005 National Survey of the Work and Health of Nurses (response rate, 79.7%; 18,676 nurses). Bivariate and multivariate logistic regression analyses were used for this secondary analysis. Findings were discussed with practicing PHNs, policy-makers and researchers from across Canada at a knowledge translation (KT) 'Think-Tank'.
Among the 271 PHNs, 53.5% reported being 'very satisfied' with their jobs. The interaction between autonomy and workload was a significant predictor of PHNs' job satisfaction, (OR 0.97, 95% CI 0.96-0.99, p
PubMed ID
22164552 View in PubMed
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Implementation of clinical guidelines for adults with asthma and diabetes: a three-year follow-up evaluation of nursing care.

https://arctichealth.org/en/permalink/ahliterature135288
Source
J Clin Nurs. 2011 May;20(9-10):1329-38
Publication Type
Article
Date
May-2011
Author
Kathryn Smith Higuchi
Barbara L Davies
Nancy Edwards
Jenny Ploeg
Tazim Virani
Author Affiliation
School of Nursing, University of Ottawa, Ottawa, ON, Canada. khiguchi@uottawa.ca
Source
J Clin Nurs. 2011 May;20(9-10):1329-38
Date
May-2011
Language
English
Publication Type
Article
Keywords
Asthma - nursing
Diabetes Mellitus - nursing
Follow-Up Studies
Humans
Ontario
Practice Guidelines as Topic
Abstract
To report on a three-year follow-up evaluation in Canada of nursing care indicators following the implementation of the Adult Asthma Care Best Practice Guideline and the Reducing Foot Complications for People with Diabetes Best Practice Guideline and to describe the contextual changes in the clinical settings.
The Registered Nurses' Association of Ontario in Canada has developed and published more than 42 guidelines related to clinical nursing practice and healthy work environments. To date, evaluation has involved one-year studies of the impact of guideline implementation on the delivery of care in hospital and community settings, but little is known about whether changes in practice that were made during the initial implementation period have been sustained.
Longitudinal follow-up study.
Site observations and interviews were conducted with key informants at two hospitals. Indicators of nursing care changes identified six months post-implementation were compared with indicators found during a retrospective chart audit at the same sites three years later. Fisher exact tests were used to compare outcomes for the two time periods.
Three out of 12 indicators related to asthma care remained consistently high (= 84% of audited charts) and four indicators declined significantly (p
Notes
Comment In: Evid Based Nurs. 2012 Jan;15(1):5-622039204
PubMed ID
21492279 View in PubMed
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Knowledge to action: implementing a guideline for second stage labor.

https://arctichealth.org/en/permalink/ahliterature157415
Source
MCN Am J Matern Child Nurs. 2008 May-Jun;33(3):179-86; quiz 187-8
Publication Type
Article
Author
Ann E Sprague
Lawrence Oppenheimer
Linda McCabe
Ian D Graham
Barbara L Davies
Author Affiliation
Perinatal Partnership Program of Eastern and Southeastern Ontario, Canada. asprague@ottawahospital.on.ca
Source
MCN Am J Matern Child Nurs. 2008 May-Jun;33(3):179-86; quiz 187-8
Language
English
Publication Type
Article
Keywords
Anesthesia, Epidural - nursing
Anesthesia, Obstetrical - nursing
Chi-Square Distribution
Delivery, Obstetric - education - methods - nursing
Diffusion of Innovation
Evidence-Based Medicine
Feasibility Studies
Female
Guideline Adherence
Health Knowledge, Attitudes, Practice
Humans
Labor Stage, Second
Nursing Assessment
Nursing Audit
Nursing Evaluation Research
Nursing Records
Nursing Staff, Hospital - education - organization & administration - psychology
Obstetric Nursing - education - methods
Ontario
Parity
Practice Guidelines as Topic
Pregnancy
Pregnancy outcome
Time Factors
Abstract
To quantify practice changes associated with implementing a clinical practice guideline for the second stage of labor in term nulliparous women with epidural anesthesia and to describe the lessons learned about knowledge translation. The main clinical practice guideline recommendation was waiting up to 2 hours before pushing after full dilatation.
Pre- and post-evaluation of clinical outcomes and knowledge translation strategies associated with implementing the second stage of labor clinical practice guideline at two birthing units within a large teaching hospital.
The implementation of the clinical practice guideline resulted in a significant increase in median waiting time before pushing of 33 minutes at Site 1. This change was also reflected in the twofold increase in the proportion of women waiting longer than 120 minutes before pushing at this site. There was no change in waiting time at Site 2. The duration of the second stage did not change significantly at either site. The median pushing time decreased at both sites but was only statistically significant at Site 1.
Bringing about practice change in obstetrics is complex. The measured change in this study was less than we expected. Greater success might have been achieved by enhancing feedback to care providers and more frequent audits of practice. We need to better understand the subtle influences in attitude and culture that prevented successful implementation in one site. For units considering a similar process, we recommend a commensurately greater level of presence in the units to encourage compliance with the clinical practice guideline in order to achieve the desired level of practice change.
PubMed ID
18453908 View in PubMed
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Labor support: nurses' self-efficacy and views about factors influencing implementation.

https://arctichealth.org/en/permalink/ahliterature191535
Source
J Obstet Gynecol Neonatal Nurs. 2002 Jan-Feb;31(1):48-56
Publication Type
Article
Author
Barbara L Davies
Ellen Hodnett
Author Affiliation
University of Ottawa School of Nursing, Ontario, Canada. bdavies@uottawa.ca
Source
J Obstet Gynecol Neonatal Nurs. 2002 Jan-Feb;31(1):48-56
Language
English
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Female
Humans
Labor, Obstetric
Neonatal Nursing
Nurses - psychology
Ontario
Practice Guidelines as Topic
Pregnancy
Questionnaires
Self Efficacy
Abstract
To develop and evaluate a questionnaire assessing nurses' self-efficacy for labor support and to describe nurses' perceptions of factors assisting and preventing the provision of labor support.
Two surveys completed by participants.
Five Canadian hospitals.
For Phase 1, 81% (55/68) of maternity nurses at one hospital participated; for Phase 2, 88% (152/173) of labor and delivery (L&D) nurses at four hospitals participated.
Phase 1, psychometric properties of a new scale; Phase 2, nurses' self-efficacy for labor support and content analysis of nurses' comments.
Phase 1: The Cronbach's alpha coefficient of the self-efficacy scale was .98, with a test-retest correlation of r(s) = .93. Higher (more positive) self-efficacy scores were found for L&D nurses compared with postpartum nurses, p
PubMed ID
11843019 View in PubMed
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Multidisciplinary collaborative maternity care in Canada: easier said than done.

https://arctichealth.org/en/permalink/ahliterature160507
Source
J Obstet Gynaecol Can. 2007 Nov;29(11):880-6
Publication Type
Article
Date
Nov-2007
Author
Wendy E Peterson
Jennifer M Medves
Barbara L Davies
Ian D Graham
Author Affiliation
School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
Source
J Obstet Gynaecol Can. 2007 Nov;29(11):880-6
Date
Nov-2007
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Canada
Cooperative Behavior
Female
Health Care Surveys
Health services needs and demand
Humans
Interdisciplinary Communication
Male
Maternal Health Services - organization & administration - standards
Models, organizational
Patient care team
Pregnancy
Professional Autonomy
Quality Assurance, Health Care
Abstract
To describe care provider attitudes towards multidisciplinary collaborative maternity care in Canada and the factors influencing such care from the perspective of members of national professional associations of care providers.
A qualitative descriptive approach was used. Leaders of national associations nominated key members, who were invited to participate in semi-structured telephone interviews.
Twenty-five participants from six national care provider associations (family physicians, obstetricians, registered midwives, registered nurses, nurse practitioners, and rural physicians) were interviewed. Participants described at least one of two main benefits of collaborative maternity care: a partial solution to the human resources shortage in maternity care, and improved maternity care for women. Despite their belief that collaboration is needed, participants expressed concern about the effects of collaboration on their practice. In particular, some participants were concerned about how collaborative models could support woman-centred care or respond to local community needs and promote continuity of care. Significant barriers to collaboration include structural factors (fee structure, liability issues) and interdisciplinary rivalry between groups of providers (turf protection, lack of mutual respect). Strategies to promote collaboration that were supported by the participants include strong national leadership and interdisciplinary education.
Representatives of professional associations of care providers believe that multidisciplinary collaborative maternity care is needed to sustain the availability of care providers and to improve access and women's choices for maternity care in Canada. However, they perceive that strong leadership and education are needed to address significant structural and relational barriers to collaborative practice.
PubMed ID
17977491 View in PubMed
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8 records – page 1 of 1.