Rationale and developmental methodology for the SIMPLE approach: A Systematised, Interdisciplinary Malnutrition Pathway for impLementation and Evaluation in hospitals

Bell, Jack J.; Young, Adrienne; Hill, J.; Banks, Merrilyn; Comans, Tracy; Barnes, Rhiannon; Keller, Heather

doi:10.1111/1747-0080.12406

Cited by 38 publications

(93 citation statements)

References 32 publications

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“…Consequently, there have been ongoing calls for greater healthcare team engagement and collaboration in nutrition care (Bell et al, 2018;Stone, 2013). Efforts to achieve this have included novel models of care addressing organizational culture (Tappenden et al, 2013) and interventions, such as protected mealtimes (Porter, Ottrey, & Huggins, 2017).…”

mentioning

confidence: 99%

Ward culture and staff relationships at hospital mealtimes in Australia: An ethnographic account

Ottrey

Porter

Huggins

et al. 2018

Nursing & Health Sciences

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Nutrition care is a fundamental component of quality health care provided to patients in hospital, yet little is known about the staff who deliver this care and their interrelationships, and how this impacts nutrition care. In this ethnographic study on two subacute wards, 67 h of fieldwork was conducted over 3 months to explore the relationships, roles, and responsibilities of those involved at mealtimes, and the influence on meal provision. Data were analyzed inductively and thematically. Three themes describing ward culture and staff relationships emerged: (i) defining mealtime roles and maintaining boundaries; (ii) balancing the need for teamwork and having time and space; and (iii) effective communication supports role completion and problem solving. Lack of appreciation of workflow enablers and barriers degraded working relationships between staff with and without central roles at mealtimes. The present study informs health-care organizations on building a culture that supports interprofessional collaboration in nutrition care in the subacute setting. All staff need to be aware of their and others' mealtime roles and responsibilities to support a coordinated approach.

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mentioning

confidence: 99%

Ward culture and staff relationships at hospital mealtimes in Australia: An ethnographic account

Ottrey

Porter

Huggins

et al. 2018

Nursing & Health Sciences

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“…These projects include: BHIP: Behavioural Health Interdisciplinary Program [13] CHERISH: Collaboration for Hospitalised Elders Reducing the Impact of Stays in Hospital [14]. The SIMPLE Approach: A Systematised, Interdisciplinary Malnutrition Pathway for impLementation and Evaluation in hospitals [15]. REACH: The Researching Effective Approaches to Cleaning Hospitals study [16] The following case summaries explore how each implementation project utilised and operationalised the i-PARIHS framework.…”

Section: Resultsmentioning

confidence: 99%

Experiences of using the i-PARIHS framework: a co-designed case study of four multi-site implementation projects

Hunter

Kim

Mudge

et al. 2020

BMC Health Serv Res

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Background: The integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework is an implementation framework that has been developed and refined over the last 20 years. Its underlying philosophy is that implementing research into healthcare practice is complex, unpredictable and nonlinear which therefore requires a flexible and responsive approach to implementation. Facilitation is recognized as the central ingredient of this approach, and i-PARIHS now provides a Facilitation Guide with associated tools. This multiple case study of four implementation projects explored how the i-PARIHS framework has been practically operationalized by diverse implementation project teams. Methods: A co-design approach was used to elicit the experiences of four implementation project teams who used the i-PARIHS framework to guide their implementation approach. We conducted the established co-design steps of (i) setting up for success, (ii) gathering the experience, and (iii) understanding the experience. In particular we explored teams' approaches to setting up their projects; why and how they used the i-PARIHS framework and what they learnt from the experience. Results: We found both commonalities and differences in the use of i-PARIHS across the four implementation projects: (i) all the projects used the Facilitation Checklist that accompanies i-PARIHS as a starting point, (ii) the projects differed in how facilitation was carried out, (iii) existing tools were adapted for distinct phases: preimplementation, during implementation, and post-implementation stages; and (iv) project-specific tools were often developed for monitoring implementation activities and fidelity. Conclusions: We have provided a detailed overview of how current users of i-PARIHS are operationalising the framework, which existing tools they are using or adapting to use, and where they have needed to develop new tools to best utilise the framework. Importantly, this study highlights the value of existing tools from the published i-PARIHS Facilitation Guide and provides a starting point to further refine and add to these tools within a future Mobilising Implementation of i-PARIHS (or "Mi-PARIHS") suite of resources. Specifically, Mi-PARIHS might include more explicit guidance and/or tools for developing a structured implementation plan and monitoring fidelity to the implementation plan, including recording how strategies are tailored to an evolving context.

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“…Chapple et al , recently reported that 71.5% of a dietitians workload in a neurosurgical setting is spent managing EN. With an increasing focus on high‐value health care and demand for dietetic services, the use of a nurse‐led feeding protocol has the potential to further reduce OOS for the ward dietitian and hence save time to facilitate the delivery of full scope or extended specialised nutrition care . Once fully embedded into ward nursing care this TFP has the potential to do the above.…”

Section: Discussionmentioning

confidence: 99%

“…An increased understanding of TF practices has the potential to improve patients’ nutrition outcomes and work efficiency of dietitians. With increasing focus on high‐value health care and reducing low‐value activities, the use of feeding protocols led by non‐dietetic staff presents an opportunity for systematised and interdisciplinary nutrition care, releasing time for dietitians to deliver full scope or extended specialised nutrition care . The aim of this pragmatic study was to evaluate the impact of a newly developed and implemented nurse‐led TFP on patients’ nutrition outcomes, dietetic efficiency, and nurses’ attitudes, practices and knowledge on nutrition support.…”

Section: Introductionmentioning

confidence: 99%

Improving nutrition care for neurosurgery patients through a nurse‐led transition feeding protocol

Dux

Lim

Jeffree

et al. 2019

Nutrition & Dietetics

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Aim Neurosurgical patients often transition from enteral nutrition (EN) to oral nutrition (ON) as they recover. Implementing a nurse‐led feeding protocol to guide this transition may improve consistency of nutrition care and dietitian workload efficiency. This pragmatic study aimed to evaluate the effect of such a protocol on these outcomes and on nurses’ nutrition care attitudes, practices and knowledge. Methods Data were collected retrospectively for 1 year pre‐ and prospectively for 1 year post‐implementation of the transition feeding protocol (TFP). Participants who transitioned from EN to ON were included in the study. Post‐implementation nurses in the neurosurgery ward were invited to complete a self‐administered questionnaire to investigate attitudes, practices and knowledge. Results One hundred and thirteen participants, 55 pre‐ and 58 post‐implementation, took part in the study. Significantly more patients received transition feeding (TF) post‐implementation (58% vs 93%, P < 0.001), there was a statistically significant improvement in the commencement of TF (0 vs 1 day after ON clearance; P = 0.029), and all patients consumed adequate oral intake 1‐week post‐EN cessation (92.3% vs 100%, P = 0.078). There was no difference in dietetic occasions of service post‐implementation (2 vs 1.5; P = 0.204). A 38% survey response rate from nursing staff (n = 15) was achieved. More nurses were found to be initiating TF (P < 0.001) and a majority reported a perceived increase in knowledge and confidence in providing nutrition support. Conclusions A TFP can optimise the transition from EN to ON by improving consistency and commencement of TF and nurses’ confidence and knowledge in overall nutrition care.

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Rationale and developmental methodology for the SIMPLE approach: A Systematised, Interdisciplinary Malnutrition Pathway for impLementation and Evaluation in hospitals

Cited by 38 publications

References 32 publications

Ward culture and staff relationships at hospital mealtimes in Australia: An ethnographic account

Ward culture and staff relationships at hospital mealtimes in Australia: An ethnographic account

Experiences of using the i-PARIHS framework: a co-designed case study of four multi-site implementation projects

Improving nutrition care for neurosurgery patients through a nurse‐led transition feeding protocol

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