De-Implementation: A Concept Analysis

Aim: The purpose of this concept analysis is to explore the meaning of de-implementation and provide a definition that can be used by researchers and clinicians to facilitate evidence-based practice. Background: De-implementation is a relatively unknown process overshadowed by the novelty of introducing new ideas and techniques into practice. Few studies have addressed the challenge of de-implementation and the cognitive processes involved when terminating harmful or unnecessary practices. Also, confusion exists regarding the myriad of terms used to describe de-implementation processes. Design: Walker and Avant\u27s method (2011) for describing concepts was used to clarify de-implementation. Data source: A database search limited to academic journals yielded 281 publications representing basic research, study protocols, and editorials/commentaries from implementation science experts. After applying exclusion criterion of English language only and eliminating overlap between databases, 41 articles were selected for review. Review methods: Literature review and synthesis provided a concept analysis and a distinct definition of de-implementation. Results: De-implementation was defined as the process of identifying and removing harmful, non–cost-effective, or ineffective practices based on tradition and without adequate scientific support. Conclusions: The analysis provided further refinement of de-implementation as a significant concept for ongoing theory development in implementation science and clinical practice

Revising A Conceptual Model Of Partnership And Sustainability In Global Health

Objectives: Models to guide global health partnerships are rare in the nursing literature. The Conceptual Model for Partnership and Sustainability in Global Health while significant was based on Western perspectives. The purpose of this study was to revise the model to include the voice of nurses from low- and middle-resource countries. Design and Sample: Grounded theory was used to maintain fidelity with the design in the original model. A purposive sample of 15 participants from a variety of countries in Africa, the Caribbean, and Southeast Asia and having extensive experience in global health partnerships were interviewed. Measures: Skype recordings and in-person interviews were audiotaped using the same questions as the original study. Theoretical coding and a comparison of results with the original study was completed independently by the researchers. Results: The process of global health partnerships was expanded from the original model to include engagement processes and processes for ongoing partnership development. New concepts of Transparency, Expanded World View, and Accompaniment were included as well as three broad themes: Geopolitical Influence, Power differential/Inequities, and Collegial Friendships. Conclusion: The revised conceptual model embodies a more comprehensive model of global health partnerships with representation of nurses from low- and middle-resource countries

Capacity development for community health nurses in Pakistan: the assistant manager role.

Background:Community health nurses (CHNs), as leaders in developing countries, can promote successful outcomes in meeting the targets of the Millennium Development Goals. A community-based organization in Pakistan is striving to achieve the goals of maternal and child health through the development of the assistant manager role for community health nursing. Purpose: The Purpose of this study was to assess the perception of the role of the CHN assistant manager, with the goal of strengthening that role. Methods: This interpretive, qualitative study included 13 participants already familiar with CHNs in Pakistan. Interviewing was utilized to explore perceptions of the assistant manager role and to uncover challenges currently existing within this new role. FINDINGS: Content analysis revealed the following themes: \u27role perceptions\u27, \u27expectations of the role\u27 and \u27collaboration with other community healthcare providers\u27. Conclusion: Changes to the role are necessary including increased education of the assistant manager CHNs and preparing administration to work with the assistant mangers for effective leadership

Using Gemba Boards To Facilitate Evidence-Based Practice In Critical Care

Background Tradition-based practices lack supporting research evidence and may be harmful or ineffective. Engagement of key stakeholders is a critical step toward facilitating evidence-based practice change. Gemba, derived from Japanese, refers to the real place where work is done. Gemba boards (visual management tools) appear to be an innovative method to engage stakeholders and facilitate evidence-based practice. Objectives To explore the use of gemba boards and gemba huddles to facilitate practice change. Methods Twenty-two critical care nurses participated in interviews in this qualitative, descriptive study. Thematic analysis was used to code and categorize interview data. Two researchers reached consensus on coding and derived themes. Data were managed with qualitative analysis software. Results The code gemba occurred most frequently; a secondary analysis was performed to explore its impact on practice change. Four themes were derived from the gemba code: (1) facilitation of staff, leadership, and interdisciplinary communication, (2) transparency of outcome data, (3) solicitation of staff ideas and feedback, and (4) dissemination of practice changes. Gemba boards and gemba huddles became part of the organizational culture for promoting and disseminating evidence-based practices. Conclusions Unit-based, publicly located gemba boards and huddles have become key components of evidence-based practice culture. Gemba is both a tool and a process to engage team members and the public to generate clinical questions and to plan, implement, and evaluate practice changes. Future research on the effectiveness of gemba boards to facilitate evidence-based practice is warranted

A Teaching Strategy to Facilitate Nursing Students’ Translation of Global Health Learning From Classroom to the Community

Integrating global health concepts in nursing curricula is important for a competent contemporary global nursing workforce. This article describes a teaching strategy that facilitates students’ translation of global health content from classroom to the community. A community–academic partnership and a train-the-trainers’ approach to support community capacity for working with refugees was implemented. The Community-As-A Partner model was used as the guiding framework. Additionally, the DEAL model was used to support students’ reflections on their clinical experiences. A quiz, reflections, participant evaluations, and student peer evaluations were used to assess students’ clinical learning experiences. Key lessons learned are also presented

Private thoughts in public spheres : issues in reflection and reflective practices in nursing

Private thoughts in public spheres: issues in reflection and reflective practices in nursing: Aim. This paper aims to problematize the notions of reflection and reflective practice, particularly as they relate to private thoughts in public spheres and the constitution of personal and professional subjectivities. Background/rationale. Reflection and reflective practice, through the technologies of power and technologies of the self, permit the previously private thoughts of nurses to enter the public sphere where they are subject to surveillance, assessment, classification and control. Instead of raising serious concerns and debate about such practices, the plethora of literature, whilst using a bewildering array of ambiguous, diverse interpretations of reflection and reflective practice, has been united in claiming them as good for nurses and nursing. Approach. The paper draws on Foucauldian concepts of power-knowledge and discourse to interrogate radically the conceptualizations of reflection and reflective practice in contemporary nursing literature. Conclusions. The paper challenges the hegemonic discourse of reflection in nursing. It argues that new conceptualizations of reflection that acknowledge and value a diversity of perspectives, contexts and dimensions are needed