Objectives Even though guidelines are available to guide dysphagia identification and management practice,there is still a gap between evidence and practice,which requires improvement.The purpose of this study was to ...Objectives Even though guidelines are available to guide dysphagia identification and management practice,there is still a gap between evidence and practice,which requires improvement.The purpose of this study was to determine the effect of using tailored,multifaceted strategies to improve evidence-based post-stroke dysphagia identification and management practice in a community hospital.Methods Guided by the Knowledge to Action framework,the tailored,multifaceted strategies were developed and implemented for 5 months in a community hospital using a before-and-after study design.These strategies consisted of training intervention,policy intervention,and audit and feedback intervention.Nurses’level of knowledge and adherence,were collected in March 2019 and again in January 2020.Patients’quality of life and satisfaction were evaluated during the pre-intervention period(between February 2019 and April 2019)and the post-intervention period(between November 2019 and January 2020).Results A total of 55 patients with post-stroke dysphagia(28 in the pre-intervention period and 27 in the post-intervention period)and 17 registered nurses were recruited.Following implementation,there were statistically significant improvements in patients’outcomes(quality of life and satisfaction)and nurses’outcomes(level of knowledge and adherence).Conclusions This study assists in closing the research-practice gap by using tailored,multifaceted strategies to increase the use of evidence-based nursing care for dysphagia identification and management practices.展开更多
Objectives:A framework for the advanced practice nurse(APN)role was developed in our Canadian Tertiary Care Centre,delineating five domains of advanced nursing practice:clinical practice,consultation,research,educatio...Objectives:A framework for the advanced practice nurse(APN)role was developed in our Canadian Tertiary Care Centre,delineating five domains of advanced nursing practice:clinical practice,consultation,research,education and leadership.The goal of this study was to evaluate perceptions of the effectiveness of the implementation of an innovative APN role on an in-patient Neurosurgery unit.Methods:A pre-and-post implementation design,incorporating both qualitative and quantitative data,was utilized.An innovative APN role was implemented within the Neurosurgery program focusing on the clinical domain and required the successful candidates to be NP prepared.This APN role was designed to improve patient flow,documentation,communication and patient and staff satisfaction.Three primary outcomes were measured:pre-implementation questionnaire(nurses),post-implementation questionnaire(nurses and residents)and number of pages to the on-call resident.Results:Survey scores by nurses and residents indicated improvement across all aspects studied.Average scores increased from 1.1 to 2.6,reflecting an overall statistically significant increase.The number of pages to the on-call resident also showed a decrease.Conclusion:Perceptions of patient care delivery and professional collaboration improved following implementation of the APN role.Responses indicated that APNs significantly impacted patient care and improved nurses and residents'job satisfaction.展开更多
International collaboration on the prediabetes and cardiovascular complications study started in 2013.In 2017,a reflection was reported.Incompleteness of documentation and screening of antenatal cases for gestational ...International collaboration on the prediabetes and cardiovascular complications study started in 2013.In 2017,a reflection was reported.Incompleteness of documentation and screening of antenatal cases for gestational diabetes mellitus(GDM)was concerning.Hence,further observations have been made that warrant an update.The objective of this review is to highlight gaps between clinical knowledge and practice in GDM,diabetes self-management and primary health care(PHC)for rural dwellers.We followed a descriptive field notes method.Antenatal records of patients screened for GDM with incomplete documentation were examined to determine incompleteness of data in those that also met the criteria for GDM risk assessment.Experiences on development of a diabetes register and education and notes on behavioural change wheel were also reviewed.Other data included cross-sectional evaluation of activities of daily living at two private hospitals.Up to 29%had high GDM risk factors,which fulfilled selection criteria for laboratory screening.Demographic data was complete in all women;however,incomplete documentation was observed with as much as 98%of basic data.High levels of physical activity were found in the population,and health lectures proved effective in food choices.The workforce need for diabetes care seems underestimated,but this may be better understood with reactivation of PHC services.The observations highlight behavioural change wheel issues on GDM and PHC services that need concerted focus.Two proposals are to advance the use of a‘risk assessment and screening sheet’for GDM screening and enlightenment of stakeholders on the central hub role of PHC in diabetes management.展开更多
基金This work was supported by the Postgraduate Independent Project of Beijing University of Chinese Medicine(No.2017-JYB-XS-085).
文摘Objectives Even though guidelines are available to guide dysphagia identification and management practice,there is still a gap between evidence and practice,which requires improvement.The purpose of this study was to determine the effect of using tailored,multifaceted strategies to improve evidence-based post-stroke dysphagia identification and management practice in a community hospital.Methods Guided by the Knowledge to Action framework,the tailored,multifaceted strategies were developed and implemented for 5 months in a community hospital using a before-and-after study design.These strategies consisted of training intervention,policy intervention,and audit and feedback intervention.Nurses’level of knowledge and adherence,were collected in March 2019 and again in January 2020.Patients’quality of life and satisfaction were evaluated during the pre-intervention period(between February 2019 and April 2019)and the post-intervention period(between November 2019 and January 2020).Results A total of 55 patients with post-stroke dysphagia(28 in the pre-intervention period and 27 in the post-intervention period)and 17 registered nurses were recruited.Following implementation,there were statistically significant improvements in patients’outcomes(quality of life and satisfaction)and nurses’outcomes(level of knowledge and adherence).Conclusions This study assists in closing the research-practice gap by using tailored,multifaceted strategies to increase the use of evidence-based nursing care for dysphagia identification and management practices.
文摘Objectives:A framework for the advanced practice nurse(APN)role was developed in our Canadian Tertiary Care Centre,delineating five domains of advanced nursing practice:clinical practice,consultation,research,education and leadership.The goal of this study was to evaluate perceptions of the effectiveness of the implementation of an innovative APN role on an in-patient Neurosurgery unit.Methods:A pre-and-post implementation design,incorporating both qualitative and quantitative data,was utilized.An innovative APN role was implemented within the Neurosurgery program focusing on the clinical domain and required the successful candidates to be NP prepared.This APN role was designed to improve patient flow,documentation,communication and patient and staff satisfaction.Three primary outcomes were measured:pre-implementation questionnaire(nurses),post-implementation questionnaire(nurses and residents)and number of pages to the on-call resident.Results:Survey scores by nurses and residents indicated improvement across all aspects studied.Average scores increased from 1.1 to 2.6,reflecting an overall statistically significant increase.The number of pages to the on-call resident also showed a decrease.Conclusion:Perceptions of patient care delivery and professional collaboration improved following implementation of the APN role.Responses indicated that APNs significantly impacted patient care and improved nurses and residents'job satisfaction.
文摘International collaboration on the prediabetes and cardiovascular complications study started in 2013.In 2017,a reflection was reported.Incompleteness of documentation and screening of antenatal cases for gestational diabetes mellitus(GDM)was concerning.Hence,further observations have been made that warrant an update.The objective of this review is to highlight gaps between clinical knowledge and practice in GDM,diabetes self-management and primary health care(PHC)for rural dwellers.We followed a descriptive field notes method.Antenatal records of patients screened for GDM with incomplete documentation were examined to determine incompleteness of data in those that also met the criteria for GDM risk assessment.Experiences on development of a diabetes register and education and notes on behavioural change wheel were also reviewed.Other data included cross-sectional evaluation of activities of daily living at two private hospitals.Up to 29%had high GDM risk factors,which fulfilled selection criteria for laboratory screening.Demographic data was complete in all women;however,incomplete documentation was observed with as much as 98%of basic data.High levels of physical activity were found in the population,and health lectures proved effective in food choices.The workforce need for diabetes care seems underestimated,but this may be better understood with reactivation of PHC services.The observations highlight behavioural change wheel issues on GDM and PHC services that need concerted focus.Two proposals are to advance the use of a‘risk assessment and screening sheet’for GDM screening and enlightenment of stakeholders on the central hub role of PHC in diabetes management.
