Psychometric Testing of the Smoking Cessation Counseling Scale among Magnet® Hospital Nurses

Psychometrics of the Smoking Cessation Counseling Scale, which measures adherence to evidence-based smoking cessation counseling practice, were originally estimated among rural hospital nurses. The purpose of this study was to estimate the scale’s reliability, convergent validity, and factor structure among 289 nurses from 27 acute care Magnet® hospitals. The scale demonstrated acceptable estimates for internal consistency (Cronbach’s α = .95, 95% CI = [0.94, 0.96]). Convergent validity was supported by the association with comfort in conducting smoking cessation counseling (coefficient = 3.58, 95% CI = [2.80, 4.37]) and shared vision (coefficient = 0.72, 95% CI = [0.02, 1.42]). A four-factor structure (standard care, basic counseling, advanced counseling, and referral to services) was identified. Findings supported the scale’s reliability and convergent validity among Magnet® hospital nurses. Further testing is needed to confirm the four-factor structure and accumulate psychometric evidence among different nursing providers and health care settings to expand the use of the instrument

Shared Vision Among Acute Care Magnet® Hospital Nurses

Psychometric testing of the Shared Vision (SV) scale that measures team efforts toward common patient-centered goals was initially estimated among rural hospital nurse executives. The purpose of this study was to estimate the scale’s reliability (internal consistency), convergent validity (Pearson correlation with Practice Environment Scale), and structural validity (ordinal confirmatory factor analysis) among acute care Magnet® hospital nurses. The study sample included 289 nurses from 27 acute care Magnet® hospitals. The scale demonstrated acceptable estimates for internal consistency (Cronbach’s α = .902, 95% confidence interval [CI] = [0.883, 0.919]), convergent validity (r = .720, p < .001), and structural validity with a one-factor structure. The findings of this study supported the reliability and validity of the SV scale as a unidimensional construct in measuring SV among nurses in acute care Magnet® hospitals. Further testing among different nursing providers and health care settings is needed to accumulate evidence and expand use of the instrument

Methodology Issues in Implementation Science

Background: Putting evidence into practice at the point of care delivery requires an understanding of implementation strategies that work, in what context and how. Objective: To identify methodological issues in implementation science using 4 studies as cases and make recommendations for further methods development. Research Design: Four cases are presented and methodological issues identified. For each issue raised, evidence on the state of the science is described. Results: Issues in implementation science identified include diverse conceptual frameworks, potential weaknesses in pragmatic study designs, and the paucity of standard concepts and measurement. Conclusions: Recommendations to advance methods in implementation include developing a core set of implementation concepts and metrics, generating standards for implementation methods including pragmatic trials, mixed methods designs, complex interventions and measurement, and endorsing reporting standards for implementation studies

Building Evidence-Based Nursing Practice Capacity in a Large Statewide Health System

Integration of evidence-based practice (EBP) into the culture of a healthcare organization is essential to provide safe patient care and promote a thriving culture for the nurses within the healthcare organization. Collaboration and utilization of both clinical and academic experts facilitate the removal of barriers to EBP. This article describes the successful partnership between a healthcare system and school of nursing in executing a 3-phased multimodal approach to an EBP training program

Implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) by Nurses on Acute Care Units: A Qualitative Descriptive Study

Background Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based intervention for patients with substance use disorders, but this intervention is under-utilized. Little is known about the implementation of SBIRT in acute care facilities. The purpose of this study is to describe implementation of SBIRT by nurses in acute care hospitals. Methods: A qualitative descriptive design was used for this study. Registered nurses who agreed to participate in the study completed a 1:1 interview using a semi-structured interview guide. Interviews were audio recorded and transcribed and then data were analyzed using qualitative content analysis. Results: When implementing SBIRT in an acute care setting, participants identified several factors that affect implementation. Some nurses felt that it is “one more thing to do” but other nurses feel that it was a “good, simple” screening tool that does not take long to do and can “plant the seeds of change” for patients. Additionally, participants mentioned barriers and facilitators related to the patients’ responses to SBIRT and organizational factors. Conclusions: This study identified several barriers and facilitators to SBIRT implementation related to the nurses, patients, and organization. By understanding the factors that influence implementation, healthcare providers can develop strategies to support effective implementation of SBIRT

Engaging Patients with Heart Failure into the Design of Health System Interventions: Impact on Research Methods

Purpose: To engage patients with heart failure (HF) to assess if changes are needed in a research study design, methods and outcomes when transferring interventions used in urban/community hospitals to rural hospital settings. Design: A qualitative structured interview was conducted. Method: Eight patients from two rural hospitals participated in an interview prior to discharge. Results: Patients validated the study design, measures and outcomes, but identified one area that should be added to the study protocol, symptom experience. Conclusion: Patient interviews validated that the intervention, methods and outcomes were important, but modifications to the study protocol resulted. Patient engagement in the conceptualization of patient centered outcome research is essential to guide the investigator approach to studies

The Patient-Centered Outcomes Research Institute (PCORI): Information for academic nursing

AbstractAs part of the Patient Protection and Affordable Care Act of 2010, the U.S. Congress created the Patient-Centered Outcomes Research Institute (PCORI). Its goal is to fund research that will assist patients, caregivers, clinicians, and others in making informed health decisions. Because nurses play a critical role in engaging patients in health care, they are valued participants in setting the institute's agenda and carrying out its programs. In this article, we provide an overview of PCORI and describe how nurses can participate in institute activities and apply for research grants

Strategies to promote the implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) in healthcare settings: a scoping review

Background: Screening, brief intervention, and referral to treatment (SBIRT), is an approach for the prevention and treatment of substance use disorders, but is often underutilized in healthcare settings. Although the implementation of SBIRT is challenging, the use of multi-faceted and higher intensity strategies are more likely to result in the successful incorporation of SBIRT into practice in primary care settings. SBIRT may be used in different healthcare settings, and the context for implementation and types of strategies used to support implementation may vary by setting. The purpose of this scoping review is to provide an overview regarding the use of strategies to support implementation of SBIRT in all healthcare settings and describe the associated outcomes. Methods: A scoping review was conducted using CINAHL Complete, HealthBusiness FullTEXT, PsycINFO, PubMed, and Embase to search for articles published in English prior to September 2019. The search returned 462 citations, with 18 articles included in the review. Two independent reviewers extracted data from each article regarding the theory, design, timeline, location, setting, patient population, substance type, provider, sample size and type, implementation strategies, and implementation outcomes. The reviewers entered all extracted data entered into a table and then summarized the results. Results: Most of the studies were conducted in the United States in primary care or emergency department settings, and the majority of studies focused on SBIRT to address alcohol use in adults. The most commonly used strategies to support implementation included training and educating stakeholders or developing stakeholder interrelationships. In contrast, only a few studies engaged patients or consumers in the implementation process. Efforts to support implementation often resulted in an increase in screening, but the evidence regarding the brief intervention is less clear, and most studies did not assess the reach or adoption of the referral to treatment. Discussion: In addition to summarizing the strategies used to increase reach and adoption of SBIRT in healthcare settings, this scoping review identified multiple gaps in the literature. Two major gaps include implementation of SBIRT in acute care settings and the application of implementation theories to inform healthcare efforts to enable use of SBIRT

911 Calls for Emergency Medical Services in Heart Failure: A Descriptive Qualitative Study

Background Heart failure (HF) is a common condition leading to activation of emergency medical services (EMS). Objective The aim of this study was to describe reasons given by persons with HF, family members, or other caregivers for requesting EMS activation during 911 calls. Methods In this descriptive qualitative study, a content analysis was performed on transcribed audio files of 383 EMS requests involving 383 persons with HF in the community. Results One hundred forty-seven calls (38.4%) were placed by the family members, 75 (19.6%) were placed by the patients, 56 (14.6%) were placed by healthcare workers or personnel from living facilities, and the remaining calls (n = 105, 27.4%) were placed by others (eg, friends, neighbors, officers). Three broad categories of symptoms, signs, and events were identified as the reasons for an EMS request. Frequently reported symptoms were breathing problems (55.4%), chest pain (18.3%), and other pain (eg, head, extremities) (16.7%). Signs included decreased consciousness (15.4%), swelling (5.7%), and bleeding (5.0%). The reported events involved falls (8.1%), heart attack (6.3%), hypoxic episodes (6.0%), stroke (5.2%), and post–hospital-discharge complications (4.7%). In most calls (74.9%), multiple reasons were reported and a combination of symptoms, signs, and events were identified. Heart failure diagnosis was mentioned in fewer than 10% of the calls. Conclusions Overall, symptoms and signs of HF exacerbation were common reasons to activate 911 calls. Falls were frequently reported. Under the duress of the emergent situations surrounding the 911 call, callers rarely mentioned the existence of HF. Interventions are needed to guide patients with HF and their family members to promote the management of HF to reduce EMS activation as well as to activate EMS quickly for acute changes in HF conditions