The use of psychiatry-focused simulation in undergraduate nursing education: A systematic search and review.

Evidence on the use of simulation to teach psychiatry and mental health (including addiction) content is emerging, yet no summary of the implementation processes or associated outcomes exists. The aim of this study was to systematically search and review empirical literature on the use of psychiatry-focused simulation in undergraduate nursing education. Objectives were to (i) assess the methodological quality of existing evidence on the use of simulation to teach mental health content to undergraduate nursing students, (ii) describe the operationalization of the simulations, and (iii) summarize the associated quantitative and qualitative outcomes. We conducted online database (MEDLINE, Embase, ERIC, CINAHL, PsycINFO from January 2004 to October 2015) and grey literature searches. Thirty-two simulation studies were identified describing and evaluating six types of simulations (standardized patients, audio simulations, high-fidelity simulators, virtual world, multimodal, and tabletop). Overall, 2724 participants were included in the studies. Studies reflected a limited number of intervention designs, and outcomes were evaluated with qualitative and quantitative methods incorporating a variety of tools. Results indicated that simulation was effective in reducing student anxiety and improving their knowledge, empathy, communication, and confidence. The summarized qualitative findings all supported the benefit of simulation; however, more research is needed to assess the comparative effectiveness of the types of simulations. Recommendations from the findings include the development of guidelines for educators to deliver each simulation component (briefing, active simulation, debriefing). Finally, consensus around appropriate training of facilitators is needed, as is consistent and agreed upon simulation terminology.

Systematic Review: Bridging the Gap in RPN-to-RN Transitions.

PURPOSE: To review the evidence examining the influences of successful education and professional role transition for registered practical nurses (RPNs) pursuing a baccalaureate degree in nursing (BScN) and registered nurse (RN) licensure through RPN-to-RN bridging programs. DESIGN: Systematic review of papers published between 1995 and 2014 that evaluated students' education and professional role transitions from RPN to RN. METHODS: Thirty-nine papers were selected that observed or studied the change or transition in designation from RPN to RN, or its equivalent, through bridging programs and analyzed thematically according to Meleis, Sawyer, Im, Hilfinger Messias, and Schumacher's transition model. FINDINGS: Personal, community, and social conditions related to preparation for entry, program enrolment, and postgraduate clinical integration influence successful education and professional role transitions for RPN-to-RN bridging students. CONCLUSIONS: Providing key transition supports may enhance the potential for successful student transition into and throughout a bridging program, but further research is necessary to enhance this understanding and to recommend best practices for optimizing students' success. CLINICAL RELEVANCE: The evidence from this review identifies facilitators and barriers to successful education and professional role transition for RPN-to-RN bridging students, and identifies important considerations for future research.

Promoting evidence-based care through nursing order sets / Promoviendo el cuidado basado en la evidencia a través de conjuntos de órdenes de Enfermería / Promover o cuidado da saúde baseada em evidências através de conjuntos de critérios de enfermagem

The use of best practice guidelines promotes evidence-based care and quality health outcomes. Traditionally, best practice guidelines were designed for use as a paper-based resource. More recently, best practice guidelines have been developed for use on mobile devices such as smartphones. Objective: This reflexive article seeks to document the features and perceived benefits of the RNAO nursing order sets and possible implementation strategies. Topic: With the increased use of electronic medical records and hospital information systems in health care, there is now a growing need for best practice guidelines to be seamlessly integrated within these electronic systems. The Registered Nurses’ Association of Ontario (RNAO) has recently developed nursing order sets as one strategy to address this need. Nursing order sets facilitate best practice guideline implementation in electronic environments by delineating clear, concise nursing interventions (derived from the best practice guidelines) that can be integrated with an electronic medical record or hospital information system, irrespective of the vendor. Conclusions: The integration of nursing order sets derived from RNAO’s Best Practice Guidelines within electronic or paper-based systems is one innovative solution to the growing need for evidence-informed decision-making at the point of care. Nursing order sets expedite the knowledge translation process and simplify BPG implementations in electronic environments.

El uso de las guías de mejores prácticas promueve cuidado basado en la evidencia y calidad en los resultados sanitarios. Tradicionalmente, las guías de mejores prácticas fueron diseñadas para ser usadas como un recurso escrito de forma manual. Más recientemente, las guías de mejores prácticas han sido desarrolladas para el uso en aparatos móviles como teléfonos inteligentes. Objetivo: Este artículo reflexivo busca documentar las características y beneficios percibidos del conjunto de órdenes de enfermería de la RNAO y sus posibles estrategias de implementación. Tema de reflexión: Con el aumento del uso de registros médicos electrónicos y sistemas de información hospitalaria en el cuidado de salud, hay ahora una creciente necesidad para que las guías de mejores prácticas sean sin lugar a dudas integradas en los sistemas electrónicos. La Asociación de Enfermeras Profesionales de Ontario (RNAO) ha desarrollado recientemente un conjunto de órdenes de enfermería como una estrategia para cubrir esta necesidad. Los conjuntos de órdenes de enfermería facilitan la implementación de las guías de mejores prácticas en un ambiente electrónico delineando intervenciones de enfermería claras y concisas (derivadas de guías de mejores prácticas) que pueden ser integradas con un registro medico electrónico o un sistema de información hospitalario, sin importar el proveedor. Conclusiones: La integración de los conjuntos de órdenes de enfermería derivada de las guías de mejores prácticas de la RNAO en sistemas a papel o electrónicos, es una solución innovadora para la creciente necesidad de la toma de decisiones basadas en la evidencia al momento de tratar al paciente. Los conjuntos de órdenes de enfermería agilizan el proceso de traducción del conocimiento y simplifican las implementaciones de las guías de mejores prácticas en ambientes electrónicos.

O uso de guias sobre melhores práticas promove o cuidado baseado em evidências e qualidade nos resultados de saúde. Tradicionalmente, as guias de melhores práticas foram elaboradas como recurso a ser usado no papel. Mais recentemente, as diretrizes de melhores práticas foram desenvolvidas para uso em dispositivos móveis, como celulares smartphones. Objetivo: Este artigo de reflexão procura documentar as características e os benefícios percebidos no conjunto dos critérios da enfermagem RNAO e suas possíveis estratégias para colocá-las em prática. Temas: Com o uso cada vez mais frequente dos registros médicos eletrônicos e dos sistemas de informação hospitalar no cuidado da saúde, surge uma necessidade sempre crescente para que as guias sobre melhores práticas sejam incluídas nos sistemas eletrônicos. A Organização de Enfermeiras Profissionais de Ontario (RNAO) fez recentemente um conjunto de critérios de enfermagem como estratégia para atender a essa necessidade. O conjunto de critérios de enfermagem facilita a implementação de orientações sobre melhores práticas em um ambiente eletrônico delineando intervenções de enfermagem clara e concisa (derivado de guias de melhores práticas), que pode ser integrado com um prontuário eletrônico ou um sistema de informação hospitalar, independentemente do provedor. Conclusões: A integração do conjunto de critérios de enfermagem derivado das Guias sobre Melhores Práticas da RNAO, nos sistemas eletrônicos ou no papel, é uma solução inovadora para a crescente necessidade de tomada de decisões baseadas em evidências na hora de cuidar do paciente. O conjunto de critérios de enfermagem agiliza o processo de tradução do conhecimento e simplifica a implementação das guias sobre melhores práticas em ambientes eletrônicos.

Measuring the quality of evidence-based nursing care: NQuIRE - nursing quality indicators for reporting and evaluation data-system / Midiendo la calidad del cuidado de enfermería basado en la evidencia: NQuIRE: sistema de indicadores de calidad en enfermería para reportar y evaluar / Avaliando a qualidade dos cuidados de enfermagem baseada em evidências: NQuIRE: sistema de indicadores de qualidade na enfermagem para referenciar e avaliar

Nursing Quality Indicators for Reporting and Evaluation (NQuIRE) is an international quality improvement initiative to develop and sustain a data-system of nursing-sensitive quality indicators derived from recommendations within the Registered Nurses’ Association of Ontario’s evidence-based best practice guidelines. Objective: The purpose of this article is to provide an overview of the indicator database within the context of the Registered Nurses’ Association of Ontario’s best practice guideline program and Best Practice Spotlight Organization® Designation. Future directions for technical enhancements, quality indicator development and research within the database will also be discussed. Topic: Nursing Quality Indicators for Reporting and Evaluation consists of a database, a data dictionary, including a set of organization-level structural indicators, as well as a set of process and outcome indicators for each best practice guideline, and data collection and reporting processes. Conclusions: The data-system collects, analyzes and reports quality indicator data submitted by health-care service and academic organizations participating in the Registered Nurses’ Association of Ontario’s Best Practice Spotlight Organization® Designation.

El sistema de indicadores de calidad en enfermería para reportar y evaluar (NQuIRE) es una iniciativa internacional de mejoramiento de la calidad para desarrollar y sostener un sistema de datos de indicadores de calidad de enfermería derivados de las recomendaciones de guías de buenas prácticas basadas en la evidencia de la Asociación de Enfermeras Profesionales de Ontario. Objetivo: El propósito de este artículo es ofrecer un panorama de la base de datos de indicadores dentro del contexto del programa de guías de buenas prácticas de enfermería de la Asociación de Enfermeras Profesionales de Ontario y el programa de centros comprometidos con la Excelencia en Cuidados. Futuras directrices para el mejoramiento técnico, desarrollo e investigación de los indicadores de calidad en la base de datos también serán discutidos. Desarrollo del tema: El Sistema de Indicadores de Calidad en Enfermería para Reportar y Evaluar consta de una base de datos, un diccionario de datos que incluye un conjunto de indicadores estructurales a nivel de la organización, además de un conjunto de indicadores de procesos y resultados para cada guía de mejores prácticas, y procesos de recopilación y reporte de datos. Conclusiones: El sistema de datos recopila, analiza e informa los datos sobre indicadores de calidad presentados por las organizaciones académicas y de servicio de atención médica que participan en el programa de designación como Centro Comprometido con la Excelencia en Cuidados de la Organización de Enfermeras Profesionales de Ontario.

O Sistema de Indicadores da Avaliação de Qualidade na Enfermagem é uma iniciativa internacional de melhoria na qualidade para promover e manter um sistema de dados de indicadores de qualidade na enfermagem decorrentes das recomendações de diretrizes de melhores práticas baseadas em evidências da Associação das Enfermeiras Profissionais de Ontario, no Canadá*. Objetivo: O objetivo deste artigo é fornecer uma visão geral do banco de dados de indicadores no contexto do Programa das Guias* de Boas Práticas na Enfermagem da Associação de Enfermeiras Profissionais de Ontario e o Programa dos Centros Comprometidos com a Excelência nos Cuidados. Orientações futuras para o aprimoramento técnico, pesquisa e desenvolvimento de indicadores de qualidade no banco de dados, também serão discutidos. Temas: O sistema de indicadores de Qualidade na Enfermagem para o Relatório e Avaliação conta com um banco de dados, um dicionário de dados que inclui um conjunto de indicadores estruturais próprio da organização, juntamente com um conjunto de indicadores de processos e resultados para cada guia de melhores práticas, e processos recopilados e dados relatados. Conclusões: O sistema de dados recolhe, analisa e informa os indicadores de qualidade apresentados pelas organizações acadêmicas e os serviços médicos escolhidos como Centros Comprometidos com a Excelência nos Cuidados da Organização de Enfermeiras Profissionais de Ontario.

Leading quality improvement through best practice guideline development, implementation, and measurement science / Liderando mejoras de qualidad el desarrollo, implementación, y medición de las guias de buenas práticas de enfermeria / Liderando com melhor qualidade por meio da elaboraçãp, implementação e avaliação de guias de boas práticas na enfermagem

The quest for evidence-based practice has spurred action by a number of groups worldwide to develop knowledge tools. However, the uptake of knowledge and implementation of clinical practice guidelines in any practice setting requires more than just the awareness and distribution of rigorously developed guidelines. Objective: The objective of this article is to share successful implementation strategies developed by the Best Practice Guideline Program of the Registered Nurses’ Association of Ontario (RNAO), that ensure practitioners are fully aware of the best available knowledge and have adequate supports to translate clinical practice guideline recommendations into their day to day practice. Topics: Details of RNAO’s seven stage process of sound guideline development are provided and RNAO’s Best Practice Spotlight Organization Designation is highlighted as a top implementation strategy that enables organizations to partner with RNAO to implement multiple RNAO Best Practice Guidelines using a systematic planned approach and full participation of staff, with a focus on quality improvement and evaluation. The BPSO Designation is informed by implementation science and is rapidly gaining international acclaim for its effectiveness in creating high levels of nurse and other health provider engagement in quality care, evidence-based practice cultures, and improved health outcomes. Conclusions: Through its leading work in rigorous guideline development, implementation and evaluation, RNAO is successfully transforming nursing practice thorough knowledge on a global scale. (au)

La busqueda de prácticas basadas en la evidencia ha estimulado acciones por parte de un número de grupos a nivel mundial para desarrollar herramientas de conocimiento. Sin embargo, la absorción de conocimiento y la implementación de guias de practica clinica en cualquier ambiente clínico requieren más que la concientización y distribución de guias desarrolladas rigurosamente. Objetivo: El objetivo de este artículo es compartir la implementación de estrategias exitosas desarrolladas por el Programa de Guas de Buenas Practicas en Enfermeria de la Asociación de Enfermeras Profesionales de Ontario (RNAO, por sus siglas en ingles), la cual asegura que sus practicantes estén completamente consientes del mejor conocimiento disponible y que tengan el adecuado soporte para transferir las recomendaciones de guías de buenas prácticas clínicas a su práctica diaria. Temas de reflexión: Los detalles del proceso de siete etapas de la RNAO de desarrollo de la guía y el Programa de Directrices sobre las Mejores Prácticas de la RNAO son proporcionadas y resaltadas como estrategias de implementación que permite a las organizaciones asociarse con la RNAO para implementar múltiples guías de buenas prácticas usando un método sistemático planeado y una activa participación del personal, con énfasis en mejoras de calidad y evaluación. El Programa de Directrices sobre las Mejores Prácticas es informado por la ciencia de implementación y esta rápidamente ganando aclamación internacional por su eficiencia en crear altos niveles de cuidado de enfermeria y calidad en el cuidado que las instituciones sanitarias ofrecen, así como mejoramiento y mejores resultados en las practicas basadas en la evidencia. Conclusiones: A través de su labor de liderazgo en el desarrollo, la implementación y la evaluación rigurosa de las guías, la RNAO esta exitosamente transformando las prácticas de enfermería mediante el conocimiento a escala mundial.

O movimento de praticas baseadas na evidência, associado à enfermagem, tem estimulado ações em nível mundial para desenvolver ferramentas de conhecimento. Contudo, assimilar o conhecimento e implementar as diretrizes na pratica clيnica em qualquer ambiente clيnico requer mais do que conscientização e distribuição de guias de orientação desenvolvidas com rigor. Objetivo: O objetivo deste artigo é partilhar a implementação de estratégias bem-sucedidas desenvolvidas pelo Programa de Guias para a Boa Pratica na Enfermagem, da Associação de Enfermeiras de Ontario, (Canada) (RNAO, segundo sua sigla em Inglês), que assegura aos praticantes maior consciência sobre os melhores conhecimentos disponíveis fazendo-os realidade em sua pratica cotidiana, jل que as guias ou manuais de boas praticas baseadas em evidências constituem uma abordagem que possibilita melhorias da qualidade da assistência à saúde. Tَpicos: Os detalhes do processo das sete etapas do desenvolvimento RNAO de Orientação e Diretrizes do Programa de Melhores Praticas RNAO são oferecidas e destacadas como estratégias de implementação que permitem às organizações associadas com RNAO implementar diversas guias ou manuais de boas praticas através de um planejamento sistemático e da participação ativa, com ênfase na avaliação e melhoria da qualidade e da assistência à saْde permanentemente. O Programa das Diretrizes de Melhores Praticas é informado pela ciência da implementação e esta ganhando rápido reconhecimento internacional pela sua eficiência na criação de alto nível nos cuidados da enfermagem e da qualidade nos cuidados que as instituições de saúde oferecem, igualmente pela sua melhoria continua e aprimoramento dos resultados das praticas baseadas em evidências. Conclusões: através do seu protagonismo e liderança no desenvolvimento, implementação e avaliação rigorosa das guias, o RNAO esta transformando exitosamente a pratica da enfermagem, através do seu conhecimento e divulgação mundial. (au)

Spreading and sustaining best practices for home care of older adults: a grounded theory study.

BACKGROUND: Improving health care quality requires effective and timely spread of innovations that support evidence-based practices. However, there is limited rigorous research on the process of spread, factors influencing spread, and models of spread. It is particularly important to study spread within the home care sector given the aging of the population, expansion of home care services internationally, the high proportion of older adult users of home care services, and the vulnerability of this group who are frail and live with multiple chronic conditions. The purpose of this study was to understand how best practices related to older adults are spread within home care organizations. METHODS: Four home care organizations in Ontario, Canada that had implemented best practices related to older adults (falls prevention, pain management, management of venous leg ulcers) participated. Using a qualitative grounded theory design, interviews were conducted with frontline providers, managers, and directors at baseline (n = 44) and 1 year later (n = 40). Open, axial, and selective coding and constant comparison analysis were used. RESULTS: A model of the process of spread of best practices within home care organizations was developed. The phases of spread included (1) committing to change, (2) implementing on a small scale, (3) adapting locally, (4) spreading internally to multiple users and sites, and (5) disseminating externally. Factors that facilitated progression through these phases were (1) leading with passion and commitment, (2) sustaining strategies, and (3) seeing the benefits. Project leads, champions, managers, and steering committees played vital roles in leading the spread process. Strategies such as educating/coaching and evaluating and feedback were key to sustaining the change. Spread occurred within the home care context of high staff and manager turnover and time and resource constraints. CONCLUSIONS: Spread of best practices is optimized through the application of the phases of spread, allocation of resources to support spread, and implementing strategies for ongoing sustainability that address potential barriers. Further research will help to understand how best practices are spread externally to other organizations.

Using the NHS sustainability framework to understand the activities and resource implications of Canadian nursing guideline early adopters.

AIMS AND OBJECTIVES: To examine the activities and resource implications for the initial cohort of healthcare organisations involved in the introduction of multiple nursing guidelines. BACKGROUND: The Best Practice Spotlight Organization initiative was launched in 2003 as part of the Registered Nurses' Association of Ontario's Best Practice Guidelines programme. While previous research has evaluated improvements in patient care and outcomes, there has been limited research from an organisational perspective on the activities conducted to introduce nursing guidelines. DESIGN: Secondary analysis of retrospective narrative data. METHODS: We conducted a content analysis of the 2004-2006 annual reports from the seven participating sites. We used both deductive and inductive approaches to categorise the guideline implementation activities and their resource implications. RESULTS: All sites reported implementing multiple guidelines (four to nine guidelines per site) and used a wide range of implementation activities that clearly addressed nine of the 10 NHS Sustainability dimensions. The dimension not reported was benefits beyond helping patients. All sites established steering committees that involved staff and senior leaders, reviewed selected guidelines and recommendations, reviewed existing policies and procedures and developed new policies and procedures, recruited champions or peer mentors, applied for additional external funding to support activities, developed relationships with external clinical partners, included guideline implementation in orientation, developed intra-agency web-based and print communications for the project, and evaluated practice changes. For each of these activities, the sites reported expenditures and resource usage. CONCLUSIONS: The organisational processes used for the introduction of new nursing guidelines in Canada are remarkably consistent with factors identified by leaders and change agents in the UK who developed the NHS Sustainability Model. RELEVANCE TO CLINICAL PRACTICE: A multidimensional framework for sustainability is useful for planning successful guideline implementation across an organisation. Examples of specific activities and resource implications for organisational change are provided.

Moving knowledge to action: a qualitative study of the Registered Nurses' Association of Ontario Advanced Clinical Practice Fellowship program.

UNLABELLED: With funding from the Ontario Ministry of Health and Long-Term Care, the Registered Nurses' Association of Ontario (RNAO) established the Advanced Clinical Practice Fellowship (ACPF) program in 2000 to improve patient care and outcomes through advanced nursing knowledge and skills. This paper describes the perceptions of ACPF fellows regarding their influence on quality of care and patient outcomes, specifically, the types of practice change activities initiated, successful implementation and influence on outcomes, barriers encountered and strategies used to address them and influence change. METHODS: Thirty telephone interviews were conducted with ACPF fellows after completing their fellowship. Interviews were analyzed using descriptive content analysis. RESULTS: Fifty-one practice change activities were identified. Ratings for successful implementation (1 = not successful, 10 = extremely successful) were 7.2/10; ratings for successful influence on outcomes were 7.4/10. Barriers identified were (a) resistant attitudes, (b) time and workload, (c) lack of administrative support and (d) lack of mentor's involvement. Strategies proposed were (a) building a knowledge base, (b) negotiation and dialogue and (c) self-reliance and persistence. IMPLICATIONS: The ACPF program is an innovative and highly utilized initiative. While this program supports strategic directions of government and nursing professional groups, further research will validate and expand on the specific ways in which the initiative influences professional development, healthcare delivery and patient outcomes.

Building positive relationships in healthcare: evaluation of the Teams of Interprofessional Staff interprofessional education program.

The Teams of Interprofessional Staff (TIPS) project consisted of five healthcare teams from across Ontario, participating in three, two-day face-to-face interprofessional educational (IPE) sessions over an 8-month period. The purpose of TIPS was to explore whether interprofessional team development for practicing healthcare professionals, makes a difference in team functioning, team member satisfaction, ability to work effectively both individually and as a team, and improved patient well-being. A comprehensive formative and summative evaluation revealed that all teams perceived they benefitted from and engaged in successful team development. Success meant different things to each team reflecting the continuum of team development from building a safe, trusted group to becoming leaders of team development for other interprofessional teams. Effective teamwork is crucial to nurses who often take on the role of coordinator of care on a day-to-day basis, or are in managerial roles in interprofessional clinics or clinical program teams.

Measuring outcomes of nursing care, improving the health of Canadians: NNQR (C), C-HOBIC and NQuiRE.

The purpose of this paper is to inform the nursing community of the extraordinary progress that the Canadian National Nursing Quality Report (NNQR(C)), the Canadian Health Outcomes for Better Information and Care (C-HOBIC) and the Nursing Quality Indicators for Reporting and Evaluation (NQuiRE) have made to date, and to share our commitment to continue working together to build a strong nursing profession that, armed with evidence, will contribute to healthier Canadians.

The role of organizational context and individual nurse characteristics in explaining variation in use of information technologies in evidence based practice.

BACKGROUND: There is growing awareness of the role of information technology in evidence-based practice. The purpose of this study was to investigate the role of organizational context and nurse characteristics in explaining variation in nurses' use of personal digital assistants (PDAs) and mobile Tablet PCs for accessing evidence-based information. The Promoting Action on Research Implementation in Health Services (PARIHS) model provided the framework for studying the impact of providing nurses with PDA-supported, evidence-based practice resources, and for studying the organizational, technological, and human resource variables that impact nurses' use patterns. METHODS: A survey design was used, involving baseline and follow-up questionnaires. The setting included 24 organizations representing three sectors: hospitals, long-term care (LTC) facilities, and community organizations (home care and public health). The sample consisted of 710 participants (response rate 58%) at Time 1, and 469 for whom both Time 1 and Time 2 follow-up data were obtained (response rate 66%). A hierarchical regression model (HLM) was used to evaluate the effect of predictors from all levels simultaneously. RESULTS: The Chi square result indicated PDA users reported using their device more frequently than Tablet PC users (p = 0.001). Frequency of device use was explained by 'breadth of device functions' and PDA versus Tablet PC. Frequency of Best Practice Guideline use was explained by 'willingness to implement research,' 'structural and electronic resources,' 'organizational slack time,' 'breadth of device functions' (positive effects), and 'slack staff' (negative effect). Frequency of Nursing Plus database use was explained by 'culture,' 'structural and electronic resources,' and 'breadth of device functions' (positive effects), and 'slack staff' (negative). 'Organizational culture' (positive), 'breadth of device functions' (positive), and 'slack staff '(negative) were associated with frequency of Lexi/PEPID drug dictionary use. CONCLUSION: Access to PDAs and Tablet PCs supported nurses' self-reported use of information resources. Several of the organizational context variables and one individual nurse variable explained variation in the frequency of information resource use.

The role of nursing best practice champions in diffusing practice guidelines: a mixed methods study.

BACKGROUND: While the importance of nursing best practice champions has been widely promoted in the diffusion of evidence-based practice, there has been little research about their role. By learning more about what champions do in guideline diffusion, the nursing profession can more proactively manage and facilitate the role of champions while capitalizing on their potential to be effective leaders of the health care system. AIM: To determine how nursing best practice champions influence the diffusion of Best Practice Guideline recommendations. METHODS: A mixed method sequential triangulation design was used involving two phases: (1) key informant interviews with 23 champions between February and July 2006 and (2) a survey of champions (N= 191) and administrators (N= 41) from September to October 2007. Qualitative findings informed the development of surveys and were used in interpreting quantitative information collected in phase 2. RESULTS: Most interview and survey participants were female, employed full-time, and had worked in practice for over 20 years. Qualitative and quantitative findings suggest that champions influence the use of Best Practice Guideline recommendations most readily through: (1) dissemination of information about clinical practice guidelines, specifically through education and mentoring; (2) being persuasive practice leaders at interdisciplinary committees; and (3) tailoring the guideline implementation strategies to the organizational context. CONCLUSIONS AND IMPLICATIONS: Our research suggests that nursing best practice champions have a multidimensional role that is well suited to navigating the complexities of a dynamic health system to create positive change. Understanding of this role can help service organizations and the nursing profession more fully capitalize on the potential of champions to influence and implement evidence-based practices to advance positive patient, organizational, and system outcomes.

A pilot study of an electronic interprofessional evidence-based care planning tool for clients with mental health problems and addictions.

BACKGROUND: The health system must develop effective solutions to the growing challenges it faces with respect to individuals who suffer with mental health disorders and addictions. The purpose of this study was to evaluate the usability and potential impact on outcomes of a knowledge translation system aimed at improving client-centered, evidence-based care for hospitalized individuals with schizophrenia. METHODOLOGY: A pre-posttest design was used. The e-Volution-TREAT system was implemented on two inpatient units at a large mental health facility. Thirty-seven nurses, allied health workers, and physicians participated from two units. Data collection involved questionnaires, semistructured interviews, and observations. Thirty-eight consenting clients' outcome data were collected from organizational records. RESULTS: Overall, staff participants were very satisfied with the functions of the e-Volution-TREAT system. Barriers to using the system were identified by participants related to the work environment, to understaffing, equipment problems, discomfort with technology, and a focus on short-term rather than long-term goals. There was moderate uptake of guidelines related to social issues, and low uptake of guidelines related to family support and addictions. There were significant improvements in four client outcomes over time, specifically aggressive behavior, depression, withdrawal, and psychosis. CONCLUSIONS: In conclusion, users were overall satisfied with the e-Volution-TREAT system, although expressed challenges related to workload that interfered with time to utilize the system. It would be premature to conclude the change in client outcomes was related to the e-Volution-TREAT system without a randomized controlled trial with outcomes compared to a control group. Future research needs to incorporate strategies for modifying the context and engage clinicians who are in a position of influence to model change.

Integrating evidence-based interventions into client care plans.

Within the mental health care system, there is an opportunity to improve patient safety and the overall quality of care by integrating clinical practice guidelines with the care planning process through the use of information technology. Electronic assessment tools such as the Resident Assessment Inventory - Mental Health (RAI-MH) are widely used to identify the health care needs and outcomes of clients. In this knowledge translation initiative, an electronic care planning tool was enhanced to include evidence-based clinical interventions from schizophrenia guidelines. This paper describes the development of a mental health decision support prototype, a field test by clinicians, and user experiences with the application.

A collaborative curricular model for implementing evidence-based nursing in a critical care setting.

This article discusses how a curricular model for introducing nurses to the Registered Nurses' Association of Ontario Best Practice Guideline Risk Assessment and Prevention of Pressure Ulcers was used to reduce pressure ulcer prevalence in the critical care setting. This curricular model is particularly relevant to hospitals that are on the Magnet Journey or are involved in other quality improvement efforts to develop an evidence-based nursing practice culture.

Systematic review on embracing cultural diversity for developing and sustaining a healthy work environment in healthcare.

Objectives The objective of this review was to evaluate evidence on the structures and processes that support development of effective culturally competent practices and a healthy work environment. Culturally competent practices are a congruent set of workforce behaviours, management practices and institutional policies within a practice setting resulting in an organisational environment that is inclusive of cultural and other forms of diversity. Inclusion criteria This review included quantitative and qualitative evidence, with a particular emphasis on identifying systematic reviews and randomised controlled trials. For quantitative evidence, other controlled, and descriptive designs were also included. For qualitative evidence, all methodologies were considered. Participants were staff, patients, and systems or policies that were involved or affected by concepts of cultural competence in the nursing workforce in a healthcare environment. Types of interventions included any strategy that had a cultural competence component, which influenced the work environment, and/or patient and nursing staff in the environment. The types of outcomes of interest to this review included nursing staff outcomes, patient outcomes, organisational outcomes and systems level outcomes. Search strategy The search sought both published and unpublished literature written in the English language. A comprehensive three-step search strategy was used, first to identify appropriate key words, second to combine all optimal key words into a comprehensive search strategy for each database and finally to review the reference lists of all included reviews and research reports. The databases searched were CINAHL, Medline, Current Contents, the Database of Abstracts of Reviews of Effectiveness, The Cochrane Library, PsycINFO, Embase, Sociological Abstracts, Econ lit, ABI/Inform, ERIC and PubMed. The search for unpublished literature used Dissertation Abstracts International. Methodological quality Methodological quality was independently established by two reviewers, using standardised techniques from the Joanna Briggs Institute (JBI) System for the Unified Management, Assessment and Review of Information (SUMARI) package. Discussion with a third reviewer was initiated where a low level of agreement was identified for a particular paper. Following inclusion, data extraction was conducted using standardised data extraction tools from the JBI SUMARI suite for quantitative and qualitative research. Data synthesis was performed using the JBI Qualitative Assessment and Review Instrument and JBI Narrative, Opinion and Text Assessment and Review Instrument software to aggregate findings by identifying commonalities across texts. Quantitative data were presented in narrative summary, as statistical pooling was not appropriate with the included studies. Results Of the 659 identified papers, 45 were selected for full paper retrieval, and 19 were considered to meet the inclusion criteria for this review. The results identified a number of processes that would contribute to the development of a culturally competent workforce. Appropriate and competent linguistic services, and intercultural staff training and education, were identified as key findings in this review. Conclusions The review recommends that health provider agencies establish links with organisations that can address needs of culturally diverse groups of patients, include cultural competence in decision support systems and staff education as well as embed them in patient brochures and educational materials. The review also concluded that staff in-service programs consider the skills needed to foster a culturally competent workforce, and recruitment strategies that also explicitly address this need.

Systematic review on embracing cultural diversity for developing and sustaining a healthy work environment in healthcare.

OBJECTIVES: The objective of this review was to evaluate evidence on the structures and processes that support development of effective culturally competent practices and a healthy work environment. Culturally competent practices are a congruent set of workforce behaviours, management practices and institutional policies within a practice setting resulting in an organisational environment that is inclusive of cultural and other forms of diversity. INCLUSION CRITERIA: This review included quantitative and qualitative evidence, with a particular emphasis on identifying systematic reviews and randomised controlled trials. For quantitative evidence, other controlled, and descriptive designs were also included. For qualitative evidence, all methodologies were considered. Participants were staff, patients, and systems or policies that were involved or affected by concepts of cultural competence in the nursing workforce in a healthcare environment. Types of interventions included any strategy that had a cultural competence component, which influenced the work environment, and/or patient and nursing staff in the environment. The types of outcomes of interest to this review included nursing staff outcomes, patient outcomes, organisational outcomes and systems level outcomes. SEARCH STRATEGY: The search sought both published and unpublished literature written in the English language. A comprehensive three-step search strategy was used, first to identify appropriate key words, second to combine all optimal key words into a comprehensive search strategy for each database and finally to review the reference lists of all included reviews and research reports. The databases searched were CINAHL, Medline, Current Contents, the Database of Abstracts of Reviews of Effectiveness, The Cochrane Library, PsycINFO, Embase, Sociological Abstracts, Econ lit, ABI/Inform, ERIC and PubMed. The search for unpublished literature used Dissertation Abstracts International. METHODOLOGICAL QUALITY: Methodological quality was independently established by two reviewers, using standardised techniques from the Joanna Briggs Institute (JBI) System for the Unified Management, Assessment and Review of Information (SUMARI) package. Discussion with a third reviewer was initiated where a low level of agreement was identified for a particular paper. Following inclusion, data extraction was conducted using standardised data extraction tools from the JBI SUMARI suite for quantitative and qualitative research. Data synthesis was performed using the JBI Qualitative Assessment and Review Instrument and JBI Narrative, Opinion and Text Assessment and Review Instrument software to aggregate findings by identifying commonalities across texts. Quantitative data were presented in narrative summary, as statistical pooling was not appropriate with the included studies. RESULTS: Of the 659 identified papers, 45 were selected for full paper retrieval, and 19 were considered to meet the inclusion criteria for this review. The results identified a number of processes that would contribute to the development of a culturally competent workforce. Appropriate and competent linguistic services, and intercultural staff training and education, were identified as key findings in this review. CONCLUSIONS: The review recommends that health provider agencies establish links with organisations that can address needs of culturally diverse groups of patients, include cultural competence in decision support systems and staff education as well as embed them in patient brochures and educational materials. The review also concluded that staff in-service programs consider the skills needed to foster a culturally competent workforce, and recruitment strategies that also explicitly address this need.

A toolkit to facilitate the implementation of clinical practice guidelines in healthcare settings.

In the early stages of development and pilot implementation of the guidelines, it became apparent that organizations were struggling to identify ways to introduce and implement the guidelines. The majority of the pilot sites were providing education sessions to facilitate CPG utilization with little attention to other implementation strategies. Those charged with introducing the CPG into the clinical setting were soon faced with a myriad of implementation challenges for which they needed a solution. It became clear that a planned systematic approach to facilitate implementation of CPGs was needed.