The Connected Learning Model for disseminating evidence-based care practices in clinical settings

Lekan, Deborah; Hendrix, Cristina C.; McConnell, Eleanor S.; White, Heidi K.

doi:10.1016/j.nepr.2009.11.013

Cited by 11 publications

(16 citation statements)

References 37 publications

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“…A breadth of observations described situations where context was an active modifier in implementation. For example, a "top down" organizational culture was described as inhibiting uptake in nurses, however the same paper described "top down" support as necessary to launch and sustain implementation initiatives and therefore essential for uptake [72]. These findings suggest that leadership culture can be facilitative and inhibitive.…”

Section: Processmentioning

confidence: 97%

Context, complexity and process in the implementation of evidence-based innovation: a realist informed review

Dryden-Palmer

Parshuram

Berta

2020

BMC Health Serv Res

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Background: This review of scholarly work in health care knowledge translation advances understanding of implementation components that support the complete and timely integration of new knowledge. We adopt a realist approach to investigate what is known from the current literature about the impact of, and the potential relationships between, context, complexity and implementation process. Methods: Informed by two distinct pathways, knowledge utilization and knowledge translation, we utilize Rogers' Diffusion of Innovations theory (DOI) and Harvey and Kitson's integrated-Promoting Action on Research Implementation in Health Service framework (PARIHS) to ground this review. Articles from 5 databases; Medline, Scopus, PsycInfo, Web of Science, and Google Scholar and a search of authors were retrieved. Themes and patterns related to these implementation components were extracted. Literature was selected for inclusion by consensus. Data extraction was iterative and was moderated by the authors. Results: A total of 67 articles were included in the review. Context was a central component to implementation. It was not clear how and to what extent context impacted implementation. Complexity was found to be a characteristic of context, implementation process, innovations and a product of the relationship between these three elements. Social processes in particular were reported as influential however; descriptions of how these social process impact were limited. Multiple theoretical and operational models were found to ground implementation processes. We offer an emerging conceptual model to illustrate the key discoveries. Conclusions: The review findings indicate there are dynamic relationship between context, complexity and implementation process for enhancing uptake of evidence-based knowledge in hospital settings. These are represented in a conceptual model. Limited empiric evidence was found to explain the nature of the relationships.

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Section: Processmentioning

confidence: 97%

Context, complexity and process in the implementation of evidence-based innovation: a realist informed review

Dryden-Palmer

Parshuram

Berta

2020

BMC Health Serv Res

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“…Drawing on models such as the Gold Standards Framework in Care Homes (GFSCH)36 in the UK, and the residential aged care integration programme (RACIP)37 study (involving gerontology ARC outreach) in New Zealand, as well as results from the present study, the new model includes clinical coaching, and role modelling of both elements are shown to be successful in sustaining knowledge transfer 38. Staff in the current study indicated difficulty identifying when a palliative approach should be initiated.…”

Section: Discussionmentioning

confidence: 88%

Necessary but not yet sufficient: a survey of aged residential care staff perceptions of palliative care communication, education and delivery

Frey

Boyd

Foster

et al. 2016

BMJ Support Palliat Care

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“…As APNs are prepared to practice beyond medical care management to lead implementation of evidence-based practice programs (Lekan et al, 2010), our finding suggests a missed opportunity for increasing capacity to improve care. Future work should explore this in more depth, including giving consideration to differences in having APNs directly employed by the home versus providing care as external care providers.…”

Section: Discussionmentioning

confidence: 93%

“…For example, higher levels of educational preparation and specialty knowledge in nursing homes have been related to more effective RN leadership and supervisory skills (Fleming & Kayser-Jones, 2008; Siegel, Young, Mitchell, & Shannon, 2008). Nursing home use of advanced practice nurses (APNs) has been related to better resident quality of care outcomes (Kane, Keckhafer, Flood, Bershadsky, & Siadaty, 2003; Lekan, Hendrix, McConnell, & White, 2010; Mezey et al, 2005). A higher proportion of RNs among nursing home staff, as well as having overall higher RN staffing levels, have been linked to better quality of care (Akinci & Krolikowski, 2005; Anderson, Hsieh, & Su, 1998; Bostick, 2004; Castle, 2002; Horn et al, 2005; Weech-Maldonado, Meret-Hanke, Neff, & Mor, 2004).…”

mentioning

confidence: 99%

Jurisdiction Over Nursing Care Systems in Nursing Homes

et al. 2012

Self Cite

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Background In the context of declining registered nurse (RN) staffing levels in nursing homes, professional nursing jurisdiction over nursing care systems may erode. Objectives The purpose of this study is to develop a typology of professional nursing jurisdiction in nursing homes in relation to characteristics of RN staffing, drawing upon Abbott's (1988) tasks and jurisdictions framework. Method The study was a cross-sectional, observational study using the 2004 National Nursing Home Survey (N=1,120 nursing homes). Latent class analysis tested whether RN staffing indicators differentiated facilities in a typology of RN jurisdiction, and compared classes on key organizational environment characteristics. Multiple logistic regression analysis related the emergent classes to presence or absence of specialty care programs in 8 clinical areas. Results Three classes of capacity for jurisdiction were identified, including ‘low capacity’ (41% of homes) with low probabilities of having any indicators of RN jurisdiction, ‘mixed capacity’ (26% of homes) with moderate to high probabilities of having higher RN education and staffing levels, and ‘high capacity’ (32% of homes) with moderate to high probabilities of having almost all indicators of RN jurisdiction. ‘High capacity’ homes were more likely to have specialty care programs relative to ‘low capacity’ homes; such homes were less likely to be chain-owned, and more likely to be larger, provide higher technical levels of patient care, have unionized nursing assistants, have a lower ratio of LPNs to RNs, and a higher education level of the administrator. Discussion Findings provide preliminary support for the theoretical framework as a starting point to move beyond extensive reliance on staffing levels and mix as indicators of quality. Further, findings indicate the importance of RN specialty certification.

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The Connected Learning Model for disseminating evidence-based care practices in clinical settings

Cited by 11 publications

References 37 publications

Context, complexity and process in the implementation of evidence-based innovation: a realist informed review

Context, complexity and process in the implementation of evidence-based innovation: a realist informed review

Necessary but not yet sufficient: a survey of aged residential care staff perceptions of palliative care communication, education and delivery

Jurisdiction Over Nursing Care Systems in Nursing Homes

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