Vaccinating healthcare workers: Level of implementation, barriers and proposal for evidence-based policies in Turkey

Abstract Translating evidence into complex health systems is an ongoing challenge. Building the capacity of healthcare workers in behavioral and implementation science methods may facilitate the use of evidence-based implementation approaches, leading to sustainable and effective translation. The aim was to describe the development, contents and evaluation of a training workshop aimed at upskilling hospital-embedded staff to deliver an evidence-based implementation approach. The Hide and Seek Project (HaSP) is a cluster randomized controlled trial testing two implementation approaches for improving hereditary cancer referral at eight Australian hospitals. Healthcare workers were recruited as “Implementation Leads” and trained via a one-day workshop—TRAining in evideNce-baSed ImpLementATion for hEalth (TRANSLATE). The purpose of TRANSLATE was to upskill Implementation Leads in the delivery of HaSP, as well as implementation science methods more broadly. Implementation Leads participated in semi-structured evaluation interviews, which were analyzed using inductive thematic analysis. Nine Implementation Leads from various professional backgrounds completed the training. Four key themes were identified: (i) training day reactions, (ii) learning, (iii) implementation barriers and facilitators, and (iv) building health system capacity for implementation. Participants reported high levels of satisfaction, and anticipated that the knowledge and skills may be useful in the future. We describe a novel training program focused on the delivery of evidence-based implementation within health systems. Guided by insights from this study, methods to deliver the training on a larger scale and across different contexts are being explored. The prolonged impact of TRANSLATE will be further evaluated at trial completion. Trial registration: ANZCTR, ACTRN12618001072202. Registered on June 27, 2018

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Barriers to infection prevention and control practice among Amhara region teaching hospitals in Ethiopia: Qualitative study

International Journal of Infection Control ◽

10.3396/ijic.v15i2.007.19 ◽

2019 ◽

Vol 15 (2) ◽

Author(s):

Walelegn Worku Yallew ◽

Abera Kumie ◽

Feleke Moges Yehuala

Keyword(s):

Healthcare Worker ◽

Prevention And Control ◽

Healthcare Workers ◽

Infection Prevention ◽

Teaching Hospitals ◽

Infection Prevention And Control ◽

Amhara Region ◽

Implementation Barriers ◽

Control Practice ◽

And Control

Healthcare workers have good perception towards infection prevention, but there has been a poor practice towards it. Therefore, the aim of this study was to explore barriers to practice of infection prevention and control practice in teaching hospitals in Amhara region. A phenomenological approach used to explore the lived experience of healthcare workers and management staffs towards infection prevention practice and control. The data was collected from ten in-depth interviews and 23 focus group discussion participants, by face to face interview using open ended interview performed in safe and quiet places. Data was managed using OpenCode software version 4.03 and contents were analyzed thematically. Totally ten different barriers were identified, such as availability of facilities, shortage of material supply, lack of maintenance of facilities and equipment, high patient flow, experience, emergency situation, healthcare worker behaviour and healthcare worker’s information about infection prevention, low awareness of patients and visitors and overflow of families and visitors to the hospital. For effective infection prevention practice implementation, barriers should be considered via identifying specific organizational, healthcare worker, patients and visitors as targets.

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Uncovering Burdens, Examining Needs, and Shedding Assumptions of Evidence-Based Social Support Programs for Mothers: A Descriptive Qualitative Study in a Remote Community

Global Qualitative Nursing Research ◽

10.1177/23333936211035747 ◽

2021 ◽

Vol 8 ◽

pp. 233339362110357

Author(s):

Johanna R. Jahnke ◽

Julee Waldrop ◽

Alasia Ledford ◽

Beatriz Martinez

Keyword(s):

Social Support ◽

Young Children ◽

Healthcare Workers ◽

Qualitative Interviews ◽

Well Being ◽

Evidence Based ◽

Community Stakeholders ◽

Significant Burden ◽

Many Sources ◽

Evidence Based Programs

Many studies have demonstrated a significant burden of maternal stress and depression for women living on the Galápagos Islands. Here, we aim to uncover burdens and needs of women with young children on San Cristóbal Island and then explore options for implementing evidence-based programs of social support to meet these needs. We conducted 17 semi-structured qualitative interviews with mothers of young children, healthcare workers, and community stakeholders. We then used Summary Oral Reflective Analysis (SORA), an interactive methodology, for qualitative analysis. Despite initial reports of a low-stress environment, women described many sources of stress and concerns for their own and their children’s health and well-being. We uncovered three broad areas of need for mothers of young children: (1) the need for information and services, (2) the need for trust, and (3) the need for space. In response to these concerns, mothers, healthcare workers, and community leaders overwhelmingly agreed that a social support program would be beneficial for the health of mothers and young children. Still, they expressed concern over the feasibility of such a program. To address these feasibility concerns, we propose that a web-based education and social support intervention led by nurses would best meet mothers’ needs. Women could learn about child health and development, develop strong, trusting friendships with other mothers, and have their own space to speak freely among experts and peers.

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Evidence-Based Practice Implementation: Case Report of the Evolution of a Quality Improvement Program in a Multicenter Physical Therapy Organization

Physical Therapy ◽

10.2522/ptj.20130541 ◽

2015 ◽

Vol 95 (4) ◽

pp. 588-599 ◽

Cited By ~ 8

Author(s):

Joel M. Stevans ◽

Christopher G. Bise ◽

John C. McGee ◽

Debora L. Miller ◽

Paul Rockar ◽

...

Keyword(s):

Quality Improvement ◽

Case Report ◽

Physical Therapy ◽

Care Quality ◽

Routine Practice ◽

Evidence Based ◽

Implementation Barriers ◽

Improvement Program ◽

Improvement Project ◽

Systems Perspective

Background and Purpose Our nation's suboptimal health care quality and unsustainable costs can be linked to the failure to implement evidence-based interventions. Implementation is the bridge between the decision to adopt a strategy and its sustained use in practice. The purpose of this case report is threefold: (1) to outline the historical implementation of an evidence-based quality improvement project, (2) to describe the program's future direction using a systems perspective to identify implementation barriers, and (3) to provide implications for the profession as it works toward closing the evidence-to-practice gap. Case Description The University of Pittsburgh Medical Center (UPMC) Centers for Rehab Services is a large, multicenter physical therapy organization. In 2005, they implemented a Low Back Initiative utilizing evidence-based protocols to guide clinical decision making. Outcomes The initial implementation strategy used a multifaceted approach. Formative evaluations were used repeatedly to identify barriers to implementation. Barriers may exist outside the organization, they can be created internally, they may result from personnel, or they may be a direct function of the research evidence. Since the program launch, 3 distinct improvement cycles have been utilized to address identified implementation barriers. Discussion Implementation is an iterative process requiring evaluation, measurement, and refinement. During this period, behavior change is actualized as clinicians become increasingly proficient and committed to their use of new evidence. Successfully incorporating evidence into routine practice requires a systems perspective to account for the complexity of the clinical setting. The value the profession provides can be enhanced by improving the implementation of evidence-based strategies. Achieving this outcome will require a concerted effort in all areas of the profession. New skills will be needed by leaders, researchers, managers, and clinicians.

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Promoting resilience in healthcare workers during the COVID-19 pandemic with a brief online intervention

10.1101/2021.07.28.21261304 ◽

2021 ◽

Author(s):

Nicole R DeTore ◽

Louisa Sylvia ◽

Elyse R Park ◽

Anne Burke ◽

Julie H Levison ◽

...

Keyword(s):

Emotional Distress ◽

Healthcare Workers ◽

Online Intervention ◽

Psychological Wellbeing ◽

Online Course ◽

Baseline Survey ◽

Evidence Based ◽

Emotional Resilience ◽

Self Compassion ◽

Resilience Training

Introduction: The psychological wellbeing of healthcare workers has been impacted by the high levels of stress many have experienced during the COVID-19 pandemic. This study aimed to examine the feasibility and acceptability of a brief online course focused on introducing skills that could increase resilience and decreases emotional distress in healthcare workers during the pandemic. Materials and Methods: Employees of a large healthcare system completed a survey at baseline, one month, and two months later. The online course, called Resilience Training for Healthcare Workers, consists of three 12-20 minute videos focused on evidence-based skills that support aspects of emotional resilience: mindfulness, mentalization, and self-compassion. Results: A total of 554 participants completed the baseline survey, endorsing moderate to high levels of emotional distress. Of those who completed all three assessments and participated in the course (n = 38), significant improvements in resilience and reductions in emotional distress were found across two months, in comparison to those who did not participate in the course. Discussion: These findings suggest that a brief, online intervention can improve the mental health of healthcare workers during a crisis such as the COVID-19 pandemic.

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806 Barriers to screening and diagnosis of obstructive sleep apnea during inpatient traumatic brain injury rehabilitation

SLEEP ◽

10.1093/sleep/zsab072.803 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A314-A315

Author(s):

Bridget Cotner ◽

Risa Nakase-Richardson ◽

Becky Gius ◽

Lauren Fournier ◽

Alexa Watach ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Obstructive Sleep Apnea ◽

Brain Injury ◽

Sleep Apnea ◽

Inpatient Rehabilitation ◽

Screening Tools ◽

Diagnostic Tools ◽

Evidence Based ◽

Implementation Barriers ◽

Obstructive Sleep

Abstract Introduction Obstructive Sleep Apnea (OSA) is prevalent after moderate to severe traumatic brain injury (TBI) and may diminish recovery when left untreated. Despite the demonstrated importance of treating OSA following TBI, assessment for OSA during or soon after inpatient rehabilitation for TBI is limited. Little is known about barriers to implementing OSA screening and early diagnosis during inpatient rehabilitation thus hindering the translation of evidence-based OSA assessment procedures into clinical practice and potentially delaying necessary OSA treatment. The current analysis explored facilitators and barriers to implementing OSA screening tools in an inpatient rehabilitation setting from the perspectives of end user stakeholders. Methods Patients, families, industry, clinical providers and administrators participated in a two-day meeting following completion of a diagnostic clinical trial of OSA screening and diagnostic tools during inpatient rehabilitation. Stakeholders were provided with open ended questions generated by study investigators and given the opportunity to respond on paper or a “graffiti wall” (i.e., white board). Example questions include “What are the greatest needs of the healthcare system related to sleep apnea and TBI?” and “What are the key things we need to consider to move results into real-world practice?” Qualitative content analyses using a rapid matrix approach were conducted from stakeholder feedback obtained during the two-day meeting, which included a guided review of emerging OSA research and discussion of potential implementation barriers of OSA assessment during inpatient rehabilitation. Results Improved screening and treatment practices for OSA were the greatest needs identified. To meet these needs, stakeholders identified the importance of improving patient, family, and staff understanding of OSA (e.g., health literacy) and other sleep disorders through education; inpatient rehabilitation access to resources (technology; sleep providers); and reimbursement for additional inpatient procedures. Conclusion Although treatment of OSA is crucial for recovery during inpatient rehabilitation following TBI, barriers to earlier recognition, diagnosis, and treatment of OSA exists across several different domains, including education, resources, and funding policies. Findings support future implementation efforts to translate evidence-based care into practice to improve patient outcomes. Support (if any) PCORI-NCT03033901

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The effectiveness of leadership: meta-analysis of trial, cross-sectional, and before after studies

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.654 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

V Restivo ◽

M Gaeta ◽

A Odone ◽

C Trucchi ◽

A Battaglini ◽

...

Keyword(s):

Healthcare Workers ◽

Evidence Based Practice ◽

Meta Analysis ◽

Healthcare Setting ◽

Risk Difference ◽

Audit And Feedback ◽

Evidence Based ◽

Cross Sectional ◽

Cross Sectional Studies ◽

Private Setting

Abstract Background The clinical and surgical procedures are often based on scientifical evidence but 30-40% of patients do not receive treatment according to evidence based medicine. The main aim of this review and meta-analysis is to assess the effectiveness of leadership in healthcare setting. Methods It was conducted a literature research on MEDLINE, Pubmed and Scopus with publication year between 2015 and 2019. The inclusion criteria were studies involving healthcare workers that evaluated effectiveness of opinion leaders in improving behaviour of healthcare workers, according to clinical or patient related outcomes. The quality of studies were assesed with the NHLBI for before after studies and the NOS for other study designs. The effect of leadership was assessed as risk difference for all studies with the exception of cross sectional studies. For the last it was evaluated correlation between leadership level and outcome measurment. Results A total of 3,155 articles were screened and 284 were fully assessed including 22 of them in the final database: 1 randomized trial, 9 cross sectional and 12 before after studies. For the cross-sectional studies there was a correlation of 0.22 (95% CI 0.15-0.28) between leadership level and outcome measurment. In the metaregression analysis the only factor that increased the correlation was private setting (meta regression coefficent =0.52, p = 0.022). The pooled efficacy was 24% (95% CI 10%-17%) for before after studies. Furthermore, a higher effectiveness was revealed in studies conducted on multi professional (24%) than single professional (9%) healthcare workers. Conclusions According to results, the guidelines adherence and task performance increased in a setting with leadership implementation. The leadership effectiveness appears comparable to other strategies as audit and feedback used to implement evidence-based practice in worldwide healthcare. Key messages The translation of evidence into clinical practice is often difficult but this study suggests that leaderhip can had higher effectiveness in multiprofessional healthcare workers and private setting. The effectiveness of leadership in this review suggests that it can be of help in order to make aware healthcare professionals about effectiveness of comply with evidence-based practice.

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Implementation Strategies

10.1093/med/9780190647421.003.0007 ◽

2018 ◽

Cited By ~ 1

Author(s):

Byron J. Powell ◽

Krystal G. Garcia ◽

Maria E. Fernandez

Keyword(s):

Scale Up ◽

Research Priorities ◽

Cancer Control ◽

Implementation Strategies ◽

Routine Care ◽

The State ◽

Evidence Based ◽

Implementation Barriers ◽

Research And Practice ◽

Effective Strategies

Implementation strategies are methods or techniques that can be used to enhance the adoption, implementation, scale-up, and sustainment of evidence-based cancer control practices into routine care. This chapter defines implementation strategies, presents several taxonomies of implementation strategies that can be used to address multilevel implementation barriers, describes guidelines for reporting and specifying implementation strategies to ensure the efficient generation of knowledge and the replication of effective strategies in research and practice, briefly overviews the state of evidence for strategies, and suggests ways in which they can be carefully developed and applied to address the needs of specific contexts. The chapter concludes by presenting several research priorities related to implementation strategies.

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Protecting healthcare workers from SARS-CoV-2 infection: practical indications

European Respiratory Review ◽

10.1183/16000617.0068-2020 ◽

2020 ◽

Vol 29 (155) ◽

pp. 200068 ◽

Cited By ~ 123

Author(s):

Martina Ferioli ◽

Cecilia Cisternino ◽

Valentina Leo ◽

Lara Pisani ◽

Paolo Palange ◽

...

Keyword(s):

High Risk ◽

Severe Acute Respiratory Syndrome ◽

World Health Organization ◽

Noninvasive Ventilation ◽

Healthcare Workers ◽

World Health ◽

Evidence Based ◽

The World ◽

Health Organization ◽

Respiratory Devices

The World Health Organization has recently defined the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection a pandemic. The infection, that may cause a potentially very severe respiratory disease, now called coronavirus disease 2019 (COVID-19), has airborne transmission via droplets. The rate of transmission is quite high, higher than common influenza. Healthcare workers are at high risk of contracting the infection particularly when applying respiratory devices such as oxygen cannulas or noninvasive ventilation. The aim of this article is to provide evidence-based recommendations for the correct use of “respiratory devices” in the COVID-19 emergency and protect healthcare workers from contracting the SARS-CoV-2 infection.

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Exemplars Illustrating De-implementation of Tradition-Based Practices

Critical Care Nurse ◽

10.4037/ccn2019534 ◽

2019 ◽

Vol 39 (6) ◽

pp. 64-69 ◽

Cited By ~ 1

Author(s):

Michele J. Upvall ◽

Annette M. Bourgault ◽

Cody Pigon ◽

Christine A. Swartzman

Keyword(s):

Internal Medicine ◽

Critical Care ◽

Clinical Practice ◽

Cognitive Dissonance ◽

Implementation Process ◽

Barriers And Facilitators ◽

Evidence Based ◽

Implementation Barriers ◽

Complex Process ◽

Psychological Bias

Clinical practice must be based on evidence. When evidence suggests that a certain practice may be ineffective or even harmful, that practice should be discontinued. The Choosing Wisely campaign, an initiative of the ABIM (American Board of Internal Medicine) Foundation, is intended to bring attention to tradition-based practices, or “sacred cows,” which lack evidence to support their ongoing use. The complex process of discontinuing or reducing the use of tradition-based practices is known as “de-implementation.” Recognizing the importance of de-implementation is necessary to fully understand evidence-based practice. This article explores the de-implementation process, examining its barriers and facilitators. Three critical care exemplars of tradition-based practices are presented and examined through the lens of de-implementation. Barriers and facilitators related to de-implementing these tradition-based practices are described, with an emphasis on the roles of various stakeholders and the need to overcome cognitive dissonance and psychological bias.

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