자연주의적 탐구조사(Naturalistic Inquiry)

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

Committee for assessing progress on implementing the recommendations of the institute of medicine report the future of nursing: leading change, advancing health

Much contemporary dialogue has centered on the difficulty of establishing validity criteria in qualitative research. Developing validity standards in qualitative research is challenging because of the necessity to incorporate rigor and subjectivity as well as creativity into the scientific process. This article explores the extant issues related to the science and art of qualitative research and proposes a synthesis of contemporary viewpoints. A distinction between primary and secondary validity criteria in qualitative research is made with credibility, authenticity, criticality, and integrity identified as primary validity criteria and explicitness, vividness, creativity, thoroughness, congruence, and sensitivity identified as secondary validity criteria.

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Validity in Qualitative Research

One of the most consistent findings from clinical and health services research is the failure to translate research into practice and policy. As a result of these evidence-practice and policy gaps, patients fail to benefit optimally from advances in healthcare and are exposed to unnecessary risks of iatrogenic harms, and healthcare systems are exposed to unnecessary expenditure resulting in significant opportunity costs. Over the last decade, there has been increasing international policy and research attention on how to reduce the evidence-practice and policy gap. In this paper, we summarise the current concepts and evidence to guide knowledge translation activities, defined as T2 research (the translation of new clinical knowledge into improved health). We structure the article around five key questions: what should be transferred; to whom should research knowledge be transferred; by whom should research knowledge be transferred; how should research knowledge be transferred; and, with what effect should research knowledge be transferred? We suggest that the basic unit of knowledge translation should usually be up-to-date systematic reviews or other syntheses of research findings. Knowledge translators need to identify the key messages for different target audiences and to fashion these in language and knowledge translation products that are easily assimilated by different audiences. The relative importance of knowledge translation to different target audiences will vary by the type of research and appropriate endpoints of knowledge translation may vary across different stakeholder groups. There are a large number of planned knowledge translation models, derived from different disciplinary, contextual (i.e., setting), and target audience viewpoints. Most of these suggest that planned knowledge translation for healthcare professionals and consumers is more likely to be successful if the choice of knowledge translation strategy is informed by an assessment of the likely barriers and facilitators. Although our evidence on the likely effectiveness of different strategies to overcome specific barriers remains incomplete, there is a range of informative systematic reviews of interventions aimed at healthcare professionals and consumers (i.e., patients, family members, and informal carers) and of factors important to research use by policy makers. There is a substantial (if incomplete) evidence base to guide choice of knowledge translation activities targeting healthcare professionals and consumers. The evidence base on the effects of different knowledge translation approaches targeting healthcare policy makers and senior managers is much weaker but there are a profusion of innovative approaches that warrant further evaluation.

https://link.springer.com/content/pdf/10.1186%2F1748-5908-7-50.pdf

Knowledge translation of research findings

Emotional intelligence and nursing: An integrative literature review

Background. Critical thinking is essential to nursing practice; therefore, knowledge and understanding of nursing students’ critical thinking skills (CTS) and related dispositions are important to nurse educators. This paper presents the results of a non-experimental study conducted in spring 1998, identifies implications for nurse educators, and offers recommendations for future research.

Aim. The aim of the study was to investigate the CTS and critical thinking dispositions (CTD) of students enrolled in a 4-year baccalaureate programme at a university in Western Canada.

Methods. The study used a cross-sectional design. Data collection occurred during regularly scheduled classes. A volunteer sample of 228 students from all 4 years of the baccalaureate programme completed a background/demographic questionnaire, the California Critical Thinking Skills Test, and the California Critical Thinking Disposition Inventory. The reliability of the test and inventory were established using the Kuder Richardson 20 and Cronbach Alpha respectively. Both descriptive and inferential statistical analyses were carried out.

Findings. Critical thinking mean scores increased from years 1 to 4 with the exception of year 3. However, there was no statistically significant difference among the four student groups. Although differences in critical thinking disposition scores were not statistically significant, students’ scores differed significantly on the systematicity subscale. There was a significant relationship between students’ overall CTS and CTD scores.

Conclusions. Approximately 38% of the students in the current study had adequate levels of CTS and 85·5% of the students had adequate levels of CTD. Results indicate a need for students’ continued development in these areas. Dispositions are crucial to critical thinking; without them critical thinking does not happen or may be substandard.

The relationship of critical thinking skills and critical thinking dispositions of baccalaureate nursing students

cowden t.,cummings g. & profetto-mcgrath j (2011) Journal of Nursing Management19, 461–477
Leadership practices and staff nurses’ intent to stay: a systematic review

Aim  The aim of the present study was to describe the findings of a systematic review of the literature that examined the relationship between managers’ leadership practices and staff nurses’ intent to stay in their current position.

Background  The nursing shortage demands that managers focus on the retention of staff nurses. Understanding the relationship between leadership practices and nurses’ intent to stay is fundamental to retaining nurses in the workforce.

Methods  Published English language articles on leadership practices and staff nurses’ intent to stay were retrieved from computerized databases and a manual search. Data extraction and quality assessments were completed for the final 23 research articles.

Results  Relational leadership practices influence staff nurses’ intentions to remain in their current position.

Conclusion  This study supports a positive relationship between transformational leadership, supportive work environments and staff nurses’ intentions to remain in their current positions. Incorporating relational leadership theory into management practices will influence nurse retention. Advancing current conceptual models will increase knowledge of intent to stay. Clarifying the distinction between the concepts intent to stay and intent to leave is needed to establish a clear theoretical foundation for further intent to stay research.

Implications for Nurse Managers  Nurse managers and leaders who practice relational leadership and ensure quality workplace environments are more likely to retain their staff. The findings of the present study support the claim that leadership practices influence staff nurse retention and builds on intent to stay knowledge.

Leadership practices and staff nurses' intent to stay: a systematic review.

Several studies have been published listing sources of practice knowledge used by nurses. However, the authors located no studies that asked clinicians to describe comprehensively and categorize the kinds of knowledge needed to practice or in which the researchers attempted to understand how clinicians privilege various knowledge sources. In this article, the authors report findings from two large ethnographic case studies in which sources of practice knowledge was a subsidiary theme. They draw on data from individual and card sort interviews, as well as participant observations, to identify nurses' sources of practice knowledge. Their findings demonstrate that nurses categorize their sources of practice knowledge into four broad groupings: social interactions, experiential knowledge, documents, and a priori knowledge. The insights gained add new understanding about sources of knowledge used by nurses and challenge the disproportionate weight that proponents of the evidence-based movement ascribe to research knowledge.

Joanne Profetto-McGrath

Papers

Emotional intelligence and nursing: An integrative literature review

The relationship of critical thinking skills and critical thinking dispositions of baccalaureate nursing students

Leadership practices and staff nurses' intent to stay: a systematic review.

Sources of Practice Knowledge Among Nurses

Critical Thinking and Evidence-Based Practice