Implementation science has progressed towards increased use of theoretical approaches to provide better understanding and explanation of how and why implementation succeeds or fails. The aim of this article is to propose a taxonomy that distinguishes between different categories of theories, models and frameworks in implementation science, to facilitate appropriate selection and application of relevant approaches in implementation research and practice and to foster cross-disciplinary dialogue among implementation researchers. Theoretical approaches used in implementation science have three overarching aims: describing and/or guiding the process of translating research into practice (process models); understanding and/or explaining what influences implementation outcomes (determinant frameworks, classic theories, implementation theories); and evaluating implementation (evaluation frameworks). This article proposes five categories of theoretical approaches to achieve three overarching aims. These categories are not always recognized as separate types of approaches in the literature. While there is overlap between some of the theories, models and frameworks, awareness of the differences is important to facilitate the selection of relevant approaches. Most determinant frameworks provide limited “how-to” support for carrying out implementation endeavours since the determinants usually are too generic to provide sufficient detail for guiding an implementation process. And while the relevance of addressing barriers and enablers to translating research into practice is mentioned in many process models, these models do not identify or systematically structure specific determinants associated with implementation success. Furthermore, process models recognize a temporal sequence of implementation endeavours, whereas determinant frameworks do not explicitly take a process perspective of implementation.

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Making sense of implementation theories, models and frameworks

Implementation science is a quickly growing discipline. Lessons learned from business and medical settings are being applied but it is unclear how well they translate to settings with different historical origins and customs (e.g., public mental health, social service, alcohol/drug sectors). The purpose of this paper is to propose a multi-level, four phase model of the implementation process (i.e., Exploration, Adoption/Preparation, Implementation, Sustainment), derived from extant literature, and apply it to public sector services. We highlight features of the model likely to be particularly important in each phase, while considering the outer and inner contexts (i.e., levels) of public sector service systems.

https://link.springer.com/content/pdf/10.1007%2Fs10488-010-0327-7.pdf

Advancing a conceptual model of evidence-based practice implementation in public service sectors.

https://qsen.org/wp-content/uploads/2016/02/QSENArticle.pdf

Quality and Safety Education for Nurses.

Medical scientists and public health policy makers are increasingly concerned that the scientific discoveries of the past generation are failing to be translated efficiently into tangible human benefit. This concern has generated several initiatives, including the Clinical Research Roundtable at the Institute of Medicine, which first convened in June 2000. Representatives from a diverse group of stakeholders in the nation’s clinical research enterprise have collaborated to address the issues it faces. The context of clinical research is increasingly encumbered by high costs, slow results, lack of funding, regulatory burdens, fragmented infrastructure, incompatible databases, and a shortage of qualified investigators and willing participants. These factors have contributed to 2 major obstacles, or translational blocks: impeding the translation of basic science discoveries into clinical studies and of clinical studies into medical practice and health decision making in systems of care. Considering data from across the entire health care system, it has become clear that these 2 translational blocks can be removed only by the collaborative efforts of multiple system stakeholders. The goal of this article is to articulate the 4 central challenges facing clinical research at present—public participation, information systems, workforce training, and funding; to make recommendations about how they might be addressed by particular stakeholders; and to invite a broader, participatory dialogue with a viewtoimprovingtheoverallperformanceoftheUSclinicalresearchenterprise.

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=JAMA&articleId=196150&pdfFileName=jsc20303.pdf

Central challenges facing the national clinical research enterprise.

CONTEXT\nHospital computerized physician order entry (CPOE) systems are widely regarded as the technical solution to medication ordering errors, the largest identified source of preventable hospital medical error. Published studies report that CPOE reduces medication errors up to 81%. Few researchers, however, have focused on the existence or types of medication errors facilitated by CPOE.\n\n\nOBJECTIVE\nTo identify and quantify the role of CPOE in facilitating prescription error risks.\n\n\nDESIGN, SETTING, AND PARTICIPANTS\nWe performed a qualitative and quantitative study of house staff interaction with a CPOE system at a tertiary-care teaching hospital (2002-2004). We surveyed house staff (N = 261; 88% of CPOE users); conducted 5 focus groups and 32 intensive one-on-one interviews with house staff, information technology leaders, pharmacy leaders, attending physicians, and nurses; shadowed house staff and nurses; and observed them using CPOE. Participants included house staff, nurses, and hospital leaders.\n\n\nMAIN OUTCOME MEASURE\nExamples of medication errors caused or exacerbated by the CPOE system.\n\n\nRESULTS\nWe found that a widely used CPOE system facilitated 22 types of medication error risks. Examples include fragmented CPOE displays that prevent a coherent view of patients' medications, pharmacy inventory displays mistaken for dosage guidelines, ignored antibiotic renewal notices placed on paper charts rather than in the CPOE system, separation of functions that facilitate double dosing and incompatible orders, and inflexible ordering formats generating wrong orders. Three quarters of the house staff reported observing each of these error risks, indicating that they occur weekly or more often. Use of multiple qualitative and survey methods identified and quantified error risks not previously considered, offering many opportunities for error reduction.\n\n\nCONCLUSIONS\nIn this study, we found that a leading CPOE system often facilitated medication error risks, with many reported to occur frequently. As CPOE systems are implemented, clinicians and hospitals must attend to errors that these systems cause in addition to errors that they prevent.

Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors

Unit 1 Steps Zero, One, Two: Getting Started Chapter 1 Making the Case for Evidence-Based Practice and Cultivating a Spirit of Inquiry Chapter 2 Asking Compelling, Clinical Questions Chapter 3 Finding Relevant Evidence to Answer Clinical Questions Unit 1 Making EBP Real: A Success Story. Using Evidence-Based Practice to Reduce Catheter-Associated Urinary Tract Infections in a Long- Term Acute Care Facility Unit 2: Step Three: Critically Appraising Evidence Chapter 4 Critically Appraising Knowledge for Clinical Decision Making Chapter 5 Critically Appraising Quantitative Evidence for Clinical Decision Making Chapter 6 Critically Appraising Qualitative Evidence for Clinical Decision Making Unit 2 Making Ebp Real: A Success Story. Making EBP a Reality by Reducing Patient Falls Through Transdisciplinary Teamwork Unit 3: Steps Four and Five: Moving From Evidence to Sustainable Practice Change Chapter 7 Integration of Patient Preferences and Values and Clinician Expertise Into Evidence-Based Decision Making Chapter 8 Advancing Optimal Care With Rigorously Developed Clinical Practice Guidelines and Evidence-Based Recommendations Chapter 9 Implementing Evidence in Clinical Settings Chapter 10 The Role of Outcomes and Quality Improvement in Enhancing and Evaluating Practice Changes Chapter 11 Leadership Strategies and Evidence-Based Practice Competencies to Sustain a Culture and Environment That Supports Best Practice Unit 3 Making EBP Real: A Success Story. Improving Outcomes for Depressed Adolescents with the Brief Cognitive Behavioral COPE Intervention Delivered in 30-Minute Outpatient Visits Unit 4: Creating and Sustaining a Culture and Environment for Evidence-Based Practice Chapter 12 Innovation and Evidence: A Partnership in Advancing Best Practice and High Quality Care Chapter 13 Models to Guide Implementation and Sustainability of Evidence-Based Practice Chapter 14 Creating a Vision and Motivating a Change to Evidence-Based Practice in Individuals, Teams, and Organizations Chapter 15 Teaching Evidence-Based Practice in Academic Settings Chapter 16 Teaching Evidence-Based Practice in Clinical Settings Chapter 17 ARCC Evidence-Based Practice Mentors: The Key to Sustaining Evidence-Based Practice Unit 4 Making EBP Real: A Success Story. Mercy Heart Failure Pathway Unit 5: Step Six: Disseminating Evidence and Evidence-Based Practice Implementation Outcomes Chapter 18 Disseminating Evidence Through Publications, Presentations, Health Policy Briefs, and the Media Unit 5 Making EBP Real: A Success Story. Faculty Research Projects Receive Worldwide Coverage Unit 6: Next Steps: Generating External Evidence and Writing Successful Funding Proposals Chapter 19 Generating Evidence Through Quantitative Research Chapter 20 Generating Evidence Through Qualitative Research Chapter 21 Writing a Successful Grant Proposal to Fund Research and Evidence-Based Practice Implementation Projects Chapter 22 Ethical Considerations for Evidence Implementation and Evidence Generation Unit 6 Making EBP Real: Selected Excerpts From a Funded Grant Application. COPE/Healthy Lifestyles for Teens: A School-Based RCT Appendix A Templates for Asking Clinical Questions Appendix B Rapid Critical Appraisal Checklists Appendix C Evaluation and Synthesis Tables Templates for Critical Appraisal Appendix D Walking the Walk and Talking the Talk: An Appraisal Guide for Qualitative Evidence Appendix E Example of a Health Policy Brief Appendix F Example of a Press Release Appendix G An Example of a Successful Media Dissemination Effort: Patient-Directed Music Intervention to Reduce Anxiety and Sedative Exposure in Critically Ill Patients Receiving Mechanical Ventilatory Support Appendix H Approved Consent Form for a Study Appendix I System-Wide ARCC Evidence-Based Practice Mentor Role Description 587 Appendix J ARCC Timeline for an EBP Implementation Project Appendix K Sample Instruments to Evaluate Organizational Culture and Readiness for Integration of EBP, EBP Beliefs, and EBP Implementation in Clinical and Academic Settings Glossary Index

Evidence-based practice in nursing & healthcare : a guide to best practice

Guyatt G, Rennie D, editors and The Evidence-Based Medicine Working Group. Users' guides to the medical literature. A manual for evidence-based clinical practice. Chicago: AMA Press, 2002



The JAMA series on how to use the medical literature has been expanded and put into book and CD-ROM format. The Evidence-Based Medicine Working Group along with editors Gordon Guyatt and Drummond Rennie have provided practitioners with a valuable resource for evaluating evidence relevant to their practice. The authors of this “how to” book have made certain that it includes challenges to all levels of users of evidence, from beginners to experts. The material is presented in 3 formats: a 700 page manual for evidence-based practice (EBP) (Manual) that is thorough and comprehensive; a 440 page pocket version of the essentials of EBP (Essentials) that provides an indepth discussion of the basics; and a hyperlinked CD-ROM that contains the contents of the Manual and is included with both hardcopy versions. The Essentials book is small enough to keep in a large pocket, although the print is small and may be difficult for really tired eyes to read. The Manual …

https://ebn.bmj.com/content/ebnurs/5/1/8.full.pdf

Users' Guides to the Medical Literature

Unit 1: Steps Zero, One, Two: Getting Started Chapter 1: Making the Case for Evidence-Based Practice and Cultivating a Spirit of Inquiry Chapter 2: Thoroughly Revised! Asking Compelling, Clinical Questions Chapter 3: Thoroughly Revised! Finding Relevant Evidence to Answer Clinical Questions Unit 2: Step Three: Critically Appraising Evidence Chapter 4: Critically Appraising Knowledge for Clinical Decision Making Chapter 5: Thoroughly Revised! Critically Appraising Quantitative Evidence for Clinical Decision Making Chapter 6: Critically Appraising Qualitative Evidence for Clinical Decision Making Unit 3: Steps Four and Five: Moving from Evidence to Action Chapter 7: Patient Concerns, Choices, and Clinical Judgment in Evidence-Based Practice Chapter 8: Advancing Optimal Care with Clinical Practice Guidelines Chapter 9: NEW! Implementing Evidence in Clinical Settings Chapter 10: Thoroughly Revised! The Role of Outcomes in Evaluating Practice Change Unit 4: Creating and Sustaining a Culture for Evidence-Based Practice Chapter 11: NEW! Models to Guide Implementation of Evidence-Based Practice Chapter 12: Creating a Vision and Motivating a Change to Evidence-Based Practice in Individuals, Teams, and Organizations Chapter 13: Teaching Evidence-Based Practice in Academic Settings Chapter 14: NEW! Teaching Evidence-Based Practice in Clinical Settings Chapter 15: NEW! ARCC Evidence-Based Practice Mentors: The Key to Sustaining Evidence-Based Practice Unit 5: Step Six: Disseminating Evidence and Evidence-Based Practice Implementation Outcomes Chapter 16: Disseminating Evidence Through Publications, Presentations, Health Policy Briefs, and the Media Unit 6: Next Steps: Generating External Evidence Chapter 17: Generating Evidence Through Quantitative Research Chapter 18: Generating Evidence Through Qualitative Research Chapter 19: Writing a Successful Grant Proposal to Fund Research and Evidence-Based Practice Implementation Projects Chapter 20: NEW! Ethical Considerations for Evidence Implementation and Evidence Generation Appendices Appendix A: Case Examples: Evidence-Based Care and Outcomes in Adult Depression and in Critically Ill Children Appendix B: Template for Asking PICOT Questions Appendix C: Walking the Walk and Talking the Talk: An Appraisal Guide for Qualitative Evidence Appendix D: Rapid Critical Appraisal Checklists Appendix E: Templates for Evaluation and Synthesis Tables for Conducting an Evidence Review Appendix F: Example of a Slide Show for a 20-Minute Paper Presentation Appendix G: Example of a Health Policy Brief Appendix H: Example of a Press Release Appendix I: Example of a Successful Media Dissemination Effort: When Rocking Chairs in Nursing Homes Make the News Appendix J: Example of an Approved Consent Form for a Study Appendix K: A Data and Safety Monitoring Plan for an Intervention Study Appendix L: System-Wide ARCC Evidence-Based Practice Mentor Role Description Appendix M: Timeline for an EBP Implementation Project Appendix N: Instruments to Evaluate Organizational Culture and Readiness for System-Wide Integration of EBP, EBP Beliefs, and EBP Implementation and Psychometrics Glossary

Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice

Evidence-based practice in nursing and healthcare , Evidence-based practice in nursing and healthcare , کتابخانه دانشگاه علوم پزشکی و خدمات بهداشتی درمانی کرمان

Evidence-Based Practice in Nursing and Healthcare

Background
Although it is widely known that evidence-based practice (EBP) improves healthcare quality, reliability, and patient outcomes as well as reduces variations in care and costs, it is still not the standard of care delivered by practicing clinicians across the globe. Adoption of specific EBP competencies for nurses and advanced practice nurses (APNs) who practice in real-world healthcare settings can assist institutions in achieving high-value, low-cost evidence-based health care.

Aim
The aim of this study was to develop a set of clear EBP competencies for both practicing registered nurses and APNs in clinical settings that can be used by healthcare institutions in their quest to achieve high performing systems that consistently implement and sustain EBP.

Methods
Seven national EBP leaders developed an initial set of competencies for practicing registered nurses and APNs through a consensus building process. Next, a Delphi survey was conducted with 80 EBP mentors across the United States to determine consensus and clarity around the competencies.

Findings
Two rounds of the Delphi survey resulted in total consensus by the EBP mentors, resulting in a final set of 13 competencies for practicing registered nurses and 11 additional competencies for APNs.

Linking Evidence to Action
Incorporation of these competencies into healthcare system expectations, orientations, job descriptions, performance appraisals, and clinical ladder promotion processes could drive higher quality, reliability, and consistency of healthcare as well as reduce costs. Research is now needed to develop valid and reliable tools for assessing these competencies as well as linking them to clinician and patient outcomes.

https://sigmapubs.onlinelibrary.wiley.com/doi/epdf/10.1111/wvn.12021

The Establishment of Evidence-Based Practice Competencies for Practicing Registered Nurses and Advanced Practice Nurses in Real-World Clinical Settings: Proficiencies to Improve Healthcare Quality, Reliability, Patient Outcomes, and Costs

Ellen Fineout-Overholt

Papers

Evidence-based practice in nursing & healthcare : a guide to best practice

Users' Guides to the Medical Literature

Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice

Evidence-Based Practice in Nursing and Healthcare

The Establishment of Evidence-Based Practice Competencies for Practicing Registered Nurses and Advanced Practice Nurses in Real-World Clinical Settings: Proficiencies to Improve Healthcare Quality, Reliability, Patient Outcomes, and Costs