Implementation in nursing and midwifery. A scoping review

Hintergrund: Evidenzbasiertes Wissen steht im Pflege- und Hebammenbereich zunehmend zur Verfügung, wird aber nicht automatisch in die Praxis umgesetzt. Implementationsforschung gewinnt daher immer grössere Bedeutung. Die international verfügbaren Forschungsergebnisse zu den Faktoren, die zum Gelingen einer Implementation beitragen, sind bislang noch nicht genügend aufbereitet worden. Gegenstand des Artikels: Im vorliegenden Scoping Review wird der Frage nachgegangen, welche Arbeiten zur gelungenen Vorbereitung, Durchführung und Aufrechterhaltung von Interventionen im Bereich der Pflege- und Hebammenarbeit vorliegen. Methode: In der für Scoping Reviews vorgesehenen, systematischen Vorgehensweise wurden einschlägige Datenbanken durchsucht, um Reviews und Studien zur Implementationsforschung im Bereich Pflege und Hebammenarbeit aufzufinden. Der Auswahlprozess, der zur Trefferliste führte, und die Charakteristika der eingeschlossenen Studien werden in Abbildungen und Tabellen strukturiert aufbereitet. Ergebnis: In vier Reviews und 38 Studien, die den Einschlusskriterien entsprechen, werden verschiedene Faktoren mit gelungener Implementation verbunden. Für die eingeschlossenen Studien werden folgende vier Kategorien aufgestellt: (1) Arbeitsplatzkultur mit 16 Nennungen, (2) Leitungskultur: 28 Nennungen, (3) Ressourcen: 4 Nennungen und (4) Training mit 22 Nennungen. Je nach Phase der Implementation (Vorbereitung, Durchführung oder Aufrechterhaltung) kommt ihnen eine etwas andere Bedeutung zu. Zusammenfassung: Das Review bietet eine Orientierung im Feld der Implementationsforschung und zeigt Design, Thema und Ergebnis der eingeschlossenen Studien auf. Nur wenige Studien berücksichtigen relevante Theorien und zeigen den Einfluss sowohl der Forschenden als auch der Zielgruppe auf den Implementationsprozess oder die genaue Beschreibung der Umstände, in denen die Implementation stattfindet, auf. Background: Evidence-based expertise in nursing and midwifery is growing but is not automatically turned into practice. The importance of implementation research is therefore increasing. International research results on factors facilitating implementation have not yet been sufficiently presented. Objective: This scoping review will explore the findings on successful preparation, realisation and maintenance of interventions in nursing and midwifery. Method: Based on an existing systematic approach, relevant data bases were accessed to identify original studies relating to implementation research in nursing and midwifery. The process of study selection and the characteristics of the included studies were charted. Findings: In the four reviews and 38 studies which met the inclusion criteria, various factors leading to successful implementation are identified. Based on the included studies, four facilitating factors can be pinpointed: (1) workplace culture (16 entries), (2) leadership culture (28 entries), (3) resources (4 entries), and (4) training (22 entries). Depending on the specific phase of the implementation process (preparation, realisation, or maintenance), these factors will vary in importance. Conclusion: This scoping review provides an orientation for the field of implementation research and it maps the design, themes and results of the studies included. It should be noted that few studies take into consideration the relevant theories, as well as the influence that the researchers and the target group may have on the implementation process, or provide an exact description of the setting in which the implementation takes place

Locating Citizen Participation

In recent years, citizens in many countries have been on the receiving end of a wave of interest from governments, NGOs, donors and lenders in ways of involving them more actively in shaping decisions that affect their lives. Innovative experiments in governance have opened up spaces for public involvement in deliberation over policies and a greater degree of control over certain kinds of resources (Fung and Wright 2000, Goetz and Gaventa 2001). Levering open arenas once closed off to citizen voice or public scrutiny, these moves have helped to widen political space for citizens to play more of a part in shaping some of the decisions that affect their lives. Forms of political participation associated with liberal democracy have come to be complemented with a new architecture of democratic practice, built on familiar foundations and offering ambiguous new political opportunities. Whether in budgeting, policy dialogue, planning, project appraisal, poverty assessment, monitoring or evaluation, ‘participatory ’ alternatives to expert-driven processes have gained ground.1 These moves have given rise to new interactions and institutions, blurring old boundaries and creating new configurations of power and resistance. Efforts to involve citizens more directly in processes of governance are inspired, an

The Large Imaging Spectrometer for Solar Accelerated Nuclei (LISSAN): A Next-Generation Solar γ-ray Spectroscopic Imaging Instrument Concept

Models of particle acceleration in solar eruptive events suggest that roughly equal energy may go into accelerating electrons and ions. However, while previous solar X-ray spectroscopic imagers have transformed our understanding of electron acceleration, only one resolved image of γ-ray emission from solar accelerated ions has ever been produced. This paper outlines a new satellite instrument concept—the large imaging spectrometer for solar accelerated nuclei (LISSAN)—with the capability not only to observe hundreds of events over its lifetime, but also to capture multiple images per event, thereby imaging the dynamics of solar accelerated ions for the first time. LISSAN provides spectroscopic imaging at photon energies of 40 keV–100 MeV on timescales of ≲10 s with greater sensitivity and imaging capability than its predecessors. This is achieved by deploying high-resolution scintillator detectors and indirect Fourier imaging techniques. LISSAN is suitable for inclusion in a multi-instrument platform such as an ESA M-class mission or as a smaller standalone mission. Without the observations that LISSAN can provide, our understanding of solar particle acceleration, and hence the space weather events with which it is often associated, cannot be complete

Fluctuation-Driven Neural Dynamics Reproduce Drosophila Locomotor Patterns.

The neural mechanisms determining the timing of even simple actions, such as when to walk or rest, are largely mysterious. One intriguing, but untested, hypothesis posits a role for ongoing activity fluctuations in neurons of central action selection circuits that drive animal behavior from moment to moment. To examine how fluctuating activity can contribute to action timing, we paired high-resolution measurements of freely walking Drosophila melanogaster with data-driven neural network modeling and dynamical systems analysis. We generated fluctuation-driven network models whose outputs-locomotor bouts-matched those measured from sensory-deprived Drosophila. From these models, we identified those that could also reproduce a second, unrelated dataset: the complex time-course of odor-evoked walking for genetically diverse Drosophila strains. Dynamical models that best reproduced both Drosophila basal and odor-evoked locomotor patterns exhibited specific characteristics. First, ongoing fluctuations were required. In a stochastic resonance-like manner, these fluctuations allowed neural activity to escape stable equilibria and to exceed a threshold for locomotion. Second, odor-induced shifts of equilibria in these models caused a depression in locomotor frequency following olfactory stimulation. Our models predict that activity fluctuations in action selection circuits cause behavioral output to more closely match sensory drive and may therefore enhance navigation in complex sensory environments. Together these data reveal how simple neural dynamics, when coupled with activity fluctuations, can give rise to complex patterns of animal behavior

The Large Imaging Spectrometer for Solar Accelerated Nuclei (LISSAN): A next-generation solar γ-ray spectroscopic imaging instrument concept

Models of particle acceleration in solar eruptive events suggest that roughly equal energy may go into accelerating electrons and ions. However, while previous solar X-ray spectroscopic imagers have transformed our understanding of electron acceleration, only one resolved image of γ-ray emission from solar accelerated ions has ever been produced. This paper outlines a new satellite instrument concept—the large imaging spectrometer for solar accelerated nuclei (LISSAN)—with the capability not only to observe hundreds of events over its lifetime, but also to capture multiple images per event, thereby imaging the dynamics of solar accelerated ions for the first time. LISSAN provides spectroscopic imaging at photon energies of 40 keV–100 MeV on timescales of ≲10 s with greater sensitivity and imaging capability than its predecessors. This is achieved by deploying high-resolution scintillator detectors and indirect Fourier imaging techniques. LISSAN is suitable for inclusion in a multi-instrument platform such as an ESA M-class mission or as a smaller standalone mission. Without the observations that LISSAN can provide, our understanding of solar particle acceleration, and hence the space weather events with which it is often associated, cannot be complete