Exemplars Illustrating De-implementation of Tradition-Based Practices

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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What hinders and facilitates the implementation of nurse-led interventions in dementia care? A scoping review

10.21203/rs.2.20304/v2 ◽

2020 ◽

Author(s):

Melanie Karrer ◽

Julian Hirt ◽

Adelheid Zeller ◽

Susi Saxer

Keyword(s):

Scoping Review ◽

Implementation Process ◽

Dementia Care ◽

Barriers And Facilitators ◽

Successful Implementation ◽

Evidence Based ◽

Management Support ◽

Implementation Processes ◽

Culture Of Care ◽

People With Dementia

Abstract Background The implementation of evidence-based interventions for people with dementia is complex and challenging. However, successful implementation might be a key element to ensure evidence-based practice and high quality of care. There is a need to improve implementation processes in dementia care by better understanding the arising challenges. Thus, the aim of this study was to identify recent knowledge concerning barriers and facilitators to implementing nurse-led interventions in dementia care. Methods We performed a scoping review using the methodological framework of Arksey and O’Malley. Studies explicitly reporting on the implementation process and factors influencing the implementation of a nurse-led intervention in dementia care in all settings were included. We searched eight databases from January 2015 until January 2019. Two authors independently selected the studies. For data analysis, we used an inductive approach to build domains and categories. Results We included 26 studies in the review and identified barriers as well as facilitators in five domains: policy (e.g. financing issues, health insurance), organisation (e.g. organisational culture and vision, resources, management support), intervention/implementation (e.g. complexity of the intervention, perceived value of the intervention), staff (e.g. knowledge, experience and skills, attitude towards the intervention), and person with dementia/family (e.g. nature and stage of dementia, response of persons with dementia and their families). Conclusions Besides general influencing factors for implementing nursing interventions, we identified dementia-specific factors reaching beyond already known barriers and facilitators. A pre-existing person-centred culture of care as well as consistent team cultures and attitudes have a facilitating effect on implementation processes. Furthermore, there is a need for interventions that are highly flexible and sensitive to patients’ condition, needs and behaviour.

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Applying an intersectionality lens to the Theoretical Domains Framework: a tool for thinking about how intersecting social identities and structures of power influence behaviour

10.21203/rs.2.23235/v4 ◽

2020 ◽

Author(s):

Nicole Etherington ◽

Isabel Braganca Rodrigues ◽

Lora Giangregorio ◽

Ian D. Graham ◽

Alison M Hoens ◽

...

Keyword(s):

Theoretical Domains Framework ◽

Implementation Process ◽

Barriers And Facilitators ◽

Implementation Barriers ◽

Modified Delphi ◽

Delphi Approach ◽

Effective Interventions ◽

Novel Approach ◽

Interdisciplinary Framework ◽

Context Shapes

Abstract Background: A key component of the implementation process is identifying potential barriers and facilitators that need to be addressed. The Theoretical Domains Framework (TDF) is one of the most commonly used frameworks for this purpose. When applying the TDF, it is critical to understand the context in which behaviours occur. Intersectionality, which accounts for the interface between social identity factors (e.g. age, gender) and structures of power (e.g. ageism, sexism), offers a novel approach to understanding how context shapes individual decision-making and behaviour. We aimed to develop a tool to be used alongside applications of the TDF to incorporate an intersectionality lens when identifying implementation barriers and enablers. Methods: An interdisciplinary Framework Committee (n=17) prioritized the TDF as one of three models, theories, and frameworks (MTFs) to enhance with an intersectional lens through a modified Delphi approach. In collaboration with the wider Framework Committee, a subgroup considered all 14 TDF domains and iteratively developed recommendations for incorporating intersectionality considerations within the TDF and its domains. An iterative approach aimed at building consensus was used to finalize recommendations.Results: Consensus on how to apply an intersectionality lens to the TDF was achieved after 12 rounds of revision. Two overarching considerations for using the intersectionality alongside the TDF were developed by the group as well as two to four prompts for each TDF domain to guide interview topic guides. Considerations and prompts were designed to assist users to reflect on how individual identities and structures of power may play a role in barriers and facilitators to behaviour change and subsequent intervention implementation. Conclusions: Through an expert-consensus approach, we developed a tool for applying an intersectionality lens alongside the TDF. Considering the role of intersecting social factors when identifying barriers and facilitators to implementing research evidence may result in more targeted and effective interventions that better reflect the realities of those involved.

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Applying an intersectionality lens to the Theoretical Domains Framework: a tool for thinking about how intersecting social identities and structures of power influence behaviour

10.21203/rs.2.23235/v3 ◽

2020 ◽

Author(s):

Nicole Etherington ◽

Isabel Braganca Rodrigues ◽

Lora Giangregorio ◽

Ian D. Graham ◽

Alison M Hoens ◽

...

Keyword(s):

Theoretical Domains Framework ◽

Implementation Process ◽

Barriers And Facilitators ◽

Implementation Barriers ◽

Modified Delphi ◽

Delphi Approach ◽

Effective Interventions ◽

Novel Approach ◽

Interdisciplinary Framework ◽

Context Shapes

Abstract Background A key component of the implementation process is identifying potential barriers and facilitators that need to be addressed. The Theoretical Domains Framework (TDF) is one of the most commonly used frameworks for this purpose. When applying the TDF, it is critical to understand the context in which behaviours occur. Intersectionality, which accounts for the interface between social identity factors (e.g. age, gender) and structures of power (e.g. ageism, sexism), offers a novel approach to understanding how context shapes individual decision-making and behaviour. We aimed to develop a tool to be used alongside applications of the TDF to incorporate an intersectionality lens when identifying implementation barriers and enablers. Methods An interdisciplinary Framework Committee (n=17) prioritized the TDF as one of three models, theories, and frameworks (MTFs) to enhance with an intersectional lens through a modified Delphi approach. In collaboration with the wider Framework Committee, a subgroup considered all 14 TDF domains and iteratively developed recommendations for incorporating intersectionality considerations within the and its domains TDF. An iterative approach aimed at building consensus was used to finalize recommendations. Results Consensus on how to apply an intersectionality lens to the TDF was achieved after 12 rounds of revision. Two overarching considerations for using the intersectionality-enhanced TDF were developed by the group as well as two to four prompts for each TDF domain to guide interview topic guides. Considerations and prompts were designed to assist users to reflect on how individual identities and structures of power may play a role in barriers and facilitators to behaviour change and subsequent intervention implementation. Conclusions Through an expert-consensus approach, we developed a tool for applying an intersectionality lens alongside the TDF. Considering the role of intersecting social factors when identifying barriers and facilitators to implementing research evidence may result in more targeted and effective interventions that better reflect the realities of those involved.

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Evidence-Based Interventions in Schools: Developers’ Views of Implementation Barriers and Facilitators

School Mental Health ◽

10.1007/s12310-008-9002-5 ◽

2008 ◽

Vol 1 (1) ◽

pp. 26-36 ◽

Cited By ~ 205

Author(s):

Susan G. Forman ◽

S. Serene Olin ◽

Kimberly Eaton Hoagwood ◽

Maura Crowe ◽

Noa Saka

Keyword(s):

Barriers And Facilitators ◽

Evidence Based ◽

Implementation Barriers

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Implementing an Evidence-Based Exercise Program for Breast Cancer Survivors

10.1093/med/9780190647421.003.0026 ◽

2018 ◽

Author(s):

Kathryn H. Schmitz ◽

Rinad Beidas

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Exercise Program ◽

Implementation Process ◽

Future Research ◽

Successful Implementation ◽

Evidence Based ◽

Referral Process ◽

Implementation Barriers

Multiple persistent adverse effects of breast cancer treatment are improved with regular exercise. This case study describes a safe and effective exercise program for breast cancer survivors that was adapted into an evidence-based intervention offered through physical therapy (Strength After Breast Cancer). The program was successfully translated and implemented, and it showed equal safety and efficacy as the parent program with regard to lymphedema symptoms, muscular strength, quality of life, and body image. Evaluation of the implementation process revealed multiple facilitators and barriers to implementation. Barriers included the intervention characteristics and challenges with the referral process from oncology. Facilitators included getting the program covered by insurance, a champion in the outpatient clinic, and adaptations to the program and referral process that resulted in successful implementation. Future research is needed to further the goal of ensuring all breast cancer survivors are connected to safe and effective exercise programming.

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What an Internist Needs to Know about Statistics

Canadian Journal of General Internal Medicine ◽

10.22374/cjgim.v7i3.136 ◽

2016 ◽

Vol 7 (3) ◽

Author(s):

Dale Gardiner MBBS MBioEth ◽

Caroline Hird MBChB MPH

Keyword(s):

Critical Care ◽

Clinical Practice ◽

Medical School ◽

Sensitivity And Specificity ◽

Diagnostic Tests ◽

Building Blocks ◽

Descriptive Statistics ◽

P Value ◽

Evidence Based ◽

Therapeutic Trials

The basics of medical statistics can be readily understood but are often approached by clinicians as if mysterious or forbidding. This may be because statistics was poorly taught at medical school or due to a tendency for articles on statistics to rapidly overcomplicate concepts. It is our hope that this series will be enlightening and provide a solid grounding in the building blocks to all evidence-based medicine.This series is divided into the three main statistical areas: descriptive statistics as may be used commonly in audit projects, inferential statistics as may be used in therapeutic trials, and diagnostic tests in which sensitivity and specificity are important. Statistical concepts are illustrated with examples predominantly from the critical care literature. The choice of examples, however, should be regarded as non-significant when compared with any personal clinical practice. (There is no p value for this statement.)

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Applying an intersectionality lens to the Theoretical Domains Framework: a tool for thinking about how intersecting social identities and structures of power influence behaviour

10.21203/rs.2.23235/v2 ◽

2020 ◽

Author(s):

Nicole Etherington ◽

Isabel Braganca Rodrigues ◽

Lora Giangregorio ◽

Ian D. Graham ◽

Alison M Hoens ◽

...

Keyword(s):

Theoretical Domains Framework ◽

Implementation Process ◽

Barriers And Facilitators ◽

Implementation Barriers ◽

Modified Delphi ◽

Delphi Approach ◽

Effective Interventions ◽

Novel Approach ◽

Interdisciplinary Framework ◽

Context Shapes

Abstract Background: A key component of the implementation process is identifying potential barriers and facilitators that need to be addressed. The Theoretical Domains Framework (TDF) is one of the most commonly used frameworks for this purpose. When applying the TDF, it is critical to understand the context in which behaviours occur. Intersectionality, which accounts for the interface between social identity factors (e.g. age, gender) and structures of power (e.g. ageism, sexism), offers a novel approach to understanding how context shapes individual decision-making and behaviour. We aimed to develop a tool to be used alongside applications of the TDF to incorporate an intersectionality lens when identifying implementation barriers and enablers. Methods: An interdisciplinary Framework Committee (n=17) prioritized the TDF as one of three models, theories, and frameworks (MTFs) to enhance with an intersectional lens through a modified Delphi approach. In collaboration with the wider Framework Committee, a subgroup considered all 14 TDF domains and iteratively developed recommendations for incorporating intersectionality considerations within the and its domains TDF. An iterative approach aimed at building consensus was used to finalize recommendations.Results: Consensus on how to apply an intersectionality lens to the TDF was achieved after 12 rounds of revision. Two overarching considerations for using the intersectionality-enhanced TDF were developed by the group as well as two to four prompts for each TDF domain to guide interview topic guides. Considerations and prompts were designed to assist users to reflect on how individual identities and structures of power may play a role in barriers and facilitators to behaviour change and subsequent intervention implementation. Conclusions: Through an expert-consensus approach, we developed a tool for applying an intersectionality lens alongside the TDF. Considering the role of intersecting social factors when identifying barriers and facilitators to implementing research evidence may result in more targeted and effective interventions that better reflect the realities of those involved.

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Dyspnea

AACN Advanced Critical Care ◽

10.4037/15597768-2007-1006 ◽

2007 ◽

Vol 18 (1) ◽

pp. 45-60 ◽

Cited By ~ 2

Author(s):

Nancy Spector ◽

Maria A. Connolly ◽

Karen K. Carlson

Keyword(s):

Palliative Care ◽

Critical Care ◽

Clinical Practice ◽

Critical Illness ◽

Length Of Stay ◽

Critical Care Nurses ◽

Evidence Based ◽

Common Symptom ◽

Chronic Critical Illness ◽

Planning Intervention

Dyspnea is a common symptom in patients with acute and chronic critical illness as well as in patients receiving palliative care. While dyspnea can be found in a variety of clinical arenas and across many specialties, the mechanisms that cause dyspnea are similar. Although not often the cause for admission to critical care, it may complicate and extend length of stay. This article defines and describes dyspnea and its pathophysiology. Critical care nurses should strive to implement interventions supported by evidence whenever possible. An evidence-based plan of care for the assessment, planning, intervention, and evaluation of the patient with dyspnea is outlined, using levels of recommendation based on the strength of available evidence. Two case studies are presented to illustrate its application to clinical practice.

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Implementation Challenges With Evidence-Based Practice Within Inpatient Rehabilitation to Incorporate Task-Specific Training

American Journal of Occupational Therapy ◽

10.5014/ajot.2021.75s2-rp266 ◽

2021 ◽

Vol 75 (Supplement_2) ◽

pp. 7512510266p1-7512510266p1

Author(s):

Eron Bozec ◽

Namrata Grampurohit ◽

Jaime Gorska

Keyword(s):

Implementation Research ◽

Inpatient Rehabilitation ◽

Barriers And Facilitators ◽

Training Manual ◽

Evidence Based ◽

Specific Training ◽

Implementation Barriers ◽

Study Objective ◽

Implementation Challenges ◽

Primary Author

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The study objective was to examine the implementation barriers and facilitators after a year of training and use of a task-specific training manual in inpatient rehabilitation. The Consolidated Framework for Implementation Research provided structure for the survey of OTs. Stakeholders reported confidence in evidence incorporation, and the barriers related to ease of selection and use of this intervention need to be addressed. Primary Author and Speaker: Eron Bozec Additional Authors and Speakers: Namrata Grampurohit Contributing Authors: Namrata Grampurohit, Jaime Gorska

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