Facilitation of evidence implementation within a clinical fellowship program: a mixed methods study.

BACKGROUND AND AIM: Facilitation is a multifaceted process for supporting and enabling individual or group of health practitioners to implement positive changes in clinical practice. Facilitation has never been explored within the context of an educational program that integrates a practical, evidence-based implementation component, such as a clinical fellowship program (CFP). The aim of this research was to identify features of facilitation as it occurs in the JBI (formerly known as Joanna Briggs Institute) CFP that promotes the use of evidence into clinical practice. METHODS: We used a mixed methods study design to address the objective of this study. An electronic survey was administered to clinicians of different clinical backgrounds who completed the CFP (i.e. clinical fellows). Purposively selected clinical fellows and assigned internal or external facilitators were interviewed. RESULTS: Forty-three clinical fellows completed the survey and 16 individual interviews and two focus groups were conducted. Findings from the survey and interviews demonstrated that facilitation within the context of a CFP is a collaborative effort between assigned facilitators and clinical fellows. Our study showed that both assigned facilitators and clinical fellows perform facilitation activities, with assigned internal and external facilitators providing support and assistance to clinical fellows, who in turn, support the evidence implementation project within their local organization. The study also suggests that external facilitation should be tailored to the individual clinical fellow's characteristics and their previous experiences. CONCLUSION: Facilitation in an evidence-based CFP involves a partnership between clinical fellows and assigned facilitators, indicating a collaborative effort that involves a set of internal and external facilitation activities. Our study findings can guide the delivery of CFPs, particularly in identifying suitable people for the facilitator's role, which can have important implications for evidence implementation. Future research should focus on evaluating the effectiveness of these programs in improving practice and health outcomes.

Prechemotherapy nursing assessment among adult cancer patients in a university cancer center in Shanghai, China: a best practice implementation project.

OBJECTIVE: The current implementation project aimed to promote evidence-based practice with prechemotherapy nursing assessment among adult cancer patients in a large university cancer center in Shanghai, China, over a 6-month timeframe. INTRODUCTION: Prechemotherapy nursing assessment is an essential element of cancer patient care, aiming to prevent or minimize potential problems from chemotherapy treatment. Regular comprehensive prechemotherapy assessment is not part of routine care currently in many clinical settings within China. METHODS: The project utilized the JBI approach to implementation, incorporating audit and feedback tools. Twelve evidence-based audit criteria were developed for use in the program. A baseline audit was conducted of prechemotherapy nursing assessment among adult cancer patients, with a sample size of 68 patients and 36 nursing staff. Following implementation of systematic strategies based on the analysis of three main barriers, a follow-up audit involving a similar sample as the first audit was conducted using the same audit criteria. RESULTS: The baseline audit indicated that for nursing assessment among adult cancer patients undergoing chemotherapy, the criteria (1, 10, 11 and 12) which related to nurse education, weight measurement, premedication and access device assessment had very high compliance (from 93 to 100%). Compliance for criteria (2, 6, 7, 9) related to medical history, previous exposure to chemotherapy, patients' or caregivers' comprehension of treatment and psychosocial assessment was 0%, while compliance with the other five criteria (3, 4, 5, 8) was low, ranging from 16 to 61%. There was improvement in all 12 criteria in the follow-up audit. Criteria 1, 11 and 12 maintained high compliance (100%). Criterion 2 (patients' medical history), criterion 3 (presence or absence of allergies), criterion 7 (previous exposure to chemotherapy) and criterion 9 (psychosocial elements) demonstrated a significant improvement in compliance. Although progress has been made, there were still some criteria that require further improvement. These included assessment of patients' current diagnosis and cancer status (criterion 4, from 61 to 66%), recent laboratory results (criterion 5, from 31 to 62%), patients' and/or caregivers' comprehension of information regarding the disease and treatment (criterion 6, from 0 to 34%), any previous exposure to chemotherapy agents (criterion 7, from 0 to 57%), and physical assessment of the patient (criterion 8, from 46 to 72%). CONCLUSION: The project achieved increased compliance with evidence-based best practice in all assessed audit criteria improving the practice of prechemotherapy assessment. Involvement of informatics technology is a great strategy to help overcome barriers, simplify the change process and assist in sustaining evidence-based practice change. Future plans and ideas are in place and have been discussed. Further audits will need to be carried out to improve the validity and quality of nursing assessment.

The ripple effect of evidence implementation: a descriptive evaluation of JBI's Evidence-based Clinical Fellowship Program.

BACKGROUND: Across healthcare there are acknowledged gaps in the translation of evidence into clinical practice. Undertaking a structured implementation program may assist clinicians to achieve this in their clinical practice setting. AIMS/METHODS: The current study descriptively evaluates and analyzes the impact of JBI's (formerly known as the Joanna Briggs Institute) Evidence-based Clinical Fellowship program, since its inception in 2005. RESULTS: Since its inception the JBI Evidence-based Clinical Fellowship Program has trained over 560 Clinical Fellows. The program consists of two 1-week intensive training workshops at JBI, collaborating with a JBI Research Fellow facilitator, with each participant then conducting a workplace evidence implementation project over the intervening 6 months in their own clinical setting. A 'train-the-trainer' program was established to provide accredited trainers to run the program through established JBI Collaborating Entities. CONCLUSION: Implementation of research evidence into the clinical setting is challenging for health professionals. A pragmatic approach adopted through the JBI Evidence-based Clinical Fellowship Program ensures that the Clinical Fellow remains central as the program leader, but has direction and support from their team of various stakeholders, and ongoing collaboration with a JBI facilitator. This ensures increased capacity for engagement and ongoing sustainability of future implementation programs.

Characteristics of Indigenous primary health care service delivery models: a systematic scoping review.

BACKGROUND: Indigenous populations have poorer health outcomes compared to their non-Indigenous counterparts. The evolution of Indigenous primary health care services arose from mainstream health services being unable to adequately meet the needs of Indigenous communities and Indigenous peoples often being excluded and marginalised from mainstream health services. Part of the solution has been to establish Indigenous specific primary health care services, for and managed by Indigenous peoples. There are a number of reasons why Indigenous primary health care services are more likely than mainstream services to improve the health of Indigenous communities. Their success is partly due to the fact that they often provide comprehensive programs that incorporate treatment and management, prevention and health promotion, as well as addressing the social determinants of health. However, there are gaps in the evidence base including the characteristics that contribute to the success of Indigenous primary health care services in providing comprehensive primary health care. This systematic scoping review aims to identify the characteristics of Indigenous primary health care service delivery models. METHOD: This systematic scoping review was led by an Aboriginal researcher, using the Joanna Briggs Institute Scoping Review Methodology. All published peer-reviewed and grey literature indexed in PubMed, EBSCO CINAHL, Embase, Informit, Mednar, and Trove databases from September 1978 to May 2015 were reviewed for inclusion. Studies were included if they describe the characteristics of service delivery models implemented within an Indigenous primary health care service. Sixty-two studies met the inclusion criteria. Data were extracted and then thematically analysed to identify the characteristics of Indigenous PHC service delivery models. RESULTS: Culture was the most prominent characteristic underpinning all of the other seven characteristics which were identified - accessible health services, community participation, continuous quality improvement, culturally appropriate and skilled workforce, flexible approach to care, holistic health care, and self-determination and empowerment. CONCLUSION: While the eight characteristics were clearly distinguishable within the review, the interdependence between each characteristic was also evident. These findings were used to develop a new Indigenous PHC Service Delivery Model, which clearly demonstrates some of the unique characteristics of Indigenous specific models.

Strategies for Effective Facilitation as a Component of an Evidence-Based Clinical Fellowship Program.

Clinical fellowships are a common means to provide health practitioners with professional development and education, including training for research and evidence-based practice. The Joanna Briggs Institute offers a clinical fellowship program as part of its strategy to promote evidence-based health care. A key aspect of the Joanna Briggs Institute clinical fellowship program is facilitation. This article aims to outline some practical tips for effective facilitation as it is applied in a clinical fellowship program aimed to promote evidence implementation. A set of practical strategies, based on the authors' experiences and which are supported by evidence from the literature, are proposed to maximize the learning experiences of clinicians and provide an opportunity to engage with health service researchers within a supportive and individualized program. J Contin Educ Nurs. 2017;48(10):458-463.

Access to primary health care services for Indigenous peoples: A framework synthesis.

BACKGROUND: Indigenous peoples often find it difficult to access appropriate mainstream primary health care services. Securing access to primary health care services requires more than just services that are situated within easy reach. Ensuring the accessibility of health care for Indigenous peoples who are often faced with a vast array of additional barriers including experiences of discrimination and racism, can be complex. This framework synthesis aimed to identify issues that hindered Indigenous peoples from accessing primary health care and then explore how, if at all, these were addressed by Indigenous health care services. METHODS: To be included in this framework synthesis papers must have presented findings focused on access to (factors relating to Indigenous peoples, their families and their communities) or accessibility of Indigenous primary health care services. Findings were imported into NVivo and a framework analysis undertaken whereby findings were coded to and then thematically analysed using Levesque and colleague's accessibility framework. RESULTS: Issues relating to the cultural and social determinants of health such as unemployment and low levels of education influenced whether Indigenous patients, their families and communities were able to access health care. Indigenous health care services addressed these issues in a number of ways including the provision of transport to and from appointments, a reduction in health care costs for people on low incomes and close consultation with, if not the direct involvement of, community members in identifying and then addressing health care needs. CONCLUSIONS: Indigenous health care services appear to be best placed to overcome both the social and cultural determinants of health which hamper Indigenous peoples from accessing health care. Findings of this synthesis also suggest that Levesque and colleague's accessibility framework should be broadened to include factors related to the health care system such as funding.

Characteristics of Indigenous primary health care models of service delivery: a scoping review protocol.

REVIEW OBJECTIVE: The objective of the scoping review is to identify and describe within the existing literature the characteristics (values, principles, components and suggest practical applications) of primary health care models of service delivery for Indigenous people. More specifically, the review question is:What are the characteristics (values, principles, components and suggested practical applications) of primary health care models of service delivery for Indigenous people?Findings from this scoping review will inform two systematic reviews. One of these will explore the acceptability and the other the effectiveness of identified characteristics. METHODOLOGY: The scoping review will follow the JBI Scoping Review methodology as outlined in the 2015 Joanna Briggs Institute Reviewers' Manual. BACKGROUND: Indigenous populations in colonized countries experience worse health outcomes relative to their non-Indigenous counterparts. In Australia, in the period 2010 to 2012 the estimated gap in life expectancy between Aboriginal and Torres Strait Islander Australians compared to non-Indigenous Australians was 10 years Similar gaps in life expectancy between Indigenous and non-Indigenous have been demonstrated in other countries, such as New Zealand, Canada and the United StatesThe gap in life expectancy and the health disadvantage experienced by Indigenous people is in part the result of mainstream health services not adequately meeting the health needs of Indigenous people and Indigenous people's inability to access mainstream services Part of the solution has been the establishment of primary health care services for and in many cases run by Indigenous people. Indigenous primary health services have been developed to provide culturally appropriate services that meet the needs of local Indigenous communities.In Australia, the first Aboriginal medical service was established in 1971 in Redfern, New South Wales, by "community activists in response to ongoing discrimination against Aboriginal people within mainstream health services to address the poor health and premature deaths of Aboriginal people, and to provide a culturally appropriate system of health care". There are now over 150 Aboriginal Community Controlled Health Services in Australia. Aboriginal Community Controlled Health Services are underpinned by common values such as culture, cultural respect, integrity, inclusion, self-determination, community control, sovereignty and leadership.Similar models of Indigenous health services exist in other countries, such as Maori health providers in New Zealand, First Nations and Inuit Health Authorities in Canada, and the Indian Health Services in the US. In New Zealand, Maori health providers deliver health and disability services to Maori and non-Maori clients. The difference between Maori health providers and mainstream services in New Zealand is that Maori health services are based on kaupapa, a plan or set of principles and ideas that informs behavior and customs, and the delivery framework which is distinctively Maori. First Nations and Inuit Health Authorities in Canada coordinate and integrate health programs and services to achieve better health outcomes for First Nations people. These community-based services largely focus on health promotion and prevention. First Nations and Inuit Health Authorities work under a unique health governance structure that includes local First Nations' leadership, based on the philosophy of self-governance and self-determination, which represent and address the health needs of First Nation communities. The Indian Health Service (IHS) in the US is responsible for providing comprehensive health services to American Indians and Alaska Natives. The IHS aims to raise the physical, mental, social and spiritual health of American Indians and Alaska Natives to the highest level, and its goal is "to ensure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and Alaska Native people". The IHS "grew out of a special government-to-government relationship between the federal government and Indian Tribes".Evidence suggests that "a strong primary health care sector is essential to the health and wellbeing of a population, and that a strong primary health care sector is associated with better population health, reduced costs of health care provision, and greater efficiency within the system". A study of Aboriginal Canadians shows that poor access and ineffective primary health care services were directly related to increased avoidable hospital admissions. In addition, a recent study in Australia focusing on the costs and the health outcomes associated with primary care use by Indigenous people with diabetes in remote communities in the Northern Territory demonstrates that improved access to primary health care which is responsive to the needs of Aboriginal and Torres Strait Islander people is both cost-effective and associated with better health outcomes.Given the strong link between primary health care and health outcomes and the significant contribution Indigenous health services make towards reducing the health disadvantage experienced by Indigenous people, it is important to understand the characteristics that support the delivery of health provided by Indigenous health services and their unique models. While there is not a clear definition in the literature about what a model of care or model of service delivery is, for the purpose of this review, it will encompass all factors involved in the delivery of care including but not limited to the vision, values and strategies that underpin the delivery of care, healthcare services and programs, governance and leadership, workforce, organization and supply, and infrastructure and other resources.The aim of this scoping review is to determine the characteristics of Indigenous primary health care models of service delivery by drawing on existing literature that look at the way in which services are delivered in this setting.An initial search of literature was conducted to establish whether there are studies with findings available to answer the review question, and whether there is a systematic or scoping review addressing the knowledge gap currently underway or published. There are no systematic or scoping reviews published or underway that address the question proposed by this review.