Patient-oriented research competencies in health (PORCH) for researchers, patients, healthcare providers, and decision-makers: results of a scoping review.

PLAIN ENGLISH SUMMARY: Background The Canadian Institutes of Health Research funded a program, "patient-oriented research" (POR), to change the way health research is done. POR involves patients and their families/caregivers as equal partners on research teams with researchers, healthcare providers and decision-makers. The authors of this paper work through a unit in British Columbia, Canada that functions to help research teams learn how to do patient-oriented research. We felt that we could not train people if we didn't first understand what others had learned about what competencies (knowledge, skills and attitudes) were helpful for members of these research teams. Method We used a method called a scoping review to search literature on patient-involved research. Our search included papers in academic journals as well as information on websites, training manuals, conference proceedings, governmental documents and statements from health organizations. Findings Writers reported the usefulness of many competencies for researchers and patients, with fewer competencies for healthcare providers or decision-makers. The main competencies for researchers had to do with participation, communication and conflict management; for patients they had to do with research knowledge and skills, cultural competence and participation. It was helpful that all team members want to work as part of a group for the public good. Conclusions We worked with an advisory group of people representing patients and their families/caregivers, researchers, healthcare providers and decision-makers to review our findings. We concluded that our competency statements are helpful for people to determine what they need to know or learn as they join research teams. ABSTRACT: Background The Canadian Institutes of Health Research (CIHR) launched an initiative called the Strategy for Patient-Oriented Research (SPOR) encouraging patient-oriented research (POR) that engages patients as equal partners in research teams alongside researchers, healthcare providers and health system decision-makers. Other countries have launched similar initiatives (POR-related work) yet there has never been full review of the competencies needed by individuals engaging in this work. Purpose and methods Our purpose was to summarize existing knowledge on POR and POR-related competencies by conducting a scoping review of peer-reviewed and grey literature. Our objectives were to systematically explore literature, articulate competencies necessary for research team members, identify research gaps and provide recommendations for further research. Using standard health databases and search methods, a total of 2036 sources was retrieved. Data were extracted from 35 peer-reviewed papers and 38 grey literature sources. We used an iterative process to reach consensus on competency statements. Findings and conclusions The main competencies for researchers were in categories of participation, communication and teamwork and conflict/tension management; for patients the main competencies were in research knowledge and skills, cultural competence/context and participation. While fewer competencies were documented for the other stakeholder groups, the need for understanding patient involvement in research and knowledge of the needs that research partners have are noted as competencies for healthcare providers and decision-makers. Attitudes demonstrating inclination to conduct the work were noted for all. The competencies can be used to consider learning needs of research team members and for team members wishing to assess their own readiness to serve on a POR or POR-related research team. Incidentally, we noted the lack of a common vocabulary used to describe patient-involved research, a situation making research and literature review/retrieval quite challenging. Recommendations for future research and for achieving consistency in language are addressed.

What's in a Definition? Holistic Nursing, Integrative Health Care, and Integrative Nursing: Report of an Integrated Literature Review.

Background: Nurses and others have used various terms to describe our caring/healing approach to practice. Because terms used can influence our image of ourselves and the image others have of us, we sought to clarify their meanings. Questions: How are the terms holistic nursing, integrative health care, and integrative nursing defined or described? Do we identify with these definitions/descriptions? Are the various terms the same or are they distinct? Method: We conducted an integrated review of peer-reviewed literature following the process described by Whittemore and Knafl. Using standard search methods, we reviewed full texts of 94 published papers and extracted data from 58 articles. Findings: Holistic describes "whole person care" often acknowledging body-mind-spirit. Holistic nursing defines a disciplinary practice specialty. The term integrative refers to practice that includes two or more disciplines or distinct approaches to care. Both terms, integrative and holistic, are associated with alternative/complementary modalities and have similar philosophical and/or theoretical underpinnings. Conclusions: There is considerable overlap between holistic nursing and integrative nursing. The relationship of integrative nursing to integrative health care is unclear based solely on definitions. Consideration of terms used provides opportunities for reflection, collaboration, and growth.

Nursing perspectives on Integral Theory in nursing practice and education: An interpretive descriptive study.

While for decades nursing has advocated for theory-informed practice, more recent attention has tended to focus on mid-range theory rather than the earlier focus on developing grand theory to encompass all of nursing practice. However, there has been continued interest in the holistic nursing community on grand theory and, in particular, on Integral Theory. Although Integral Theory's four-quadrant (AQAL) perspective is familiar in nursing, little is known about how it is being used by nurses in direct practice. The purpose of this interpretive descriptive study was to provide a practice-based perspective on Ken Wilber's Integral Theory in professional nursing practice. The following research question was investigated: How does Integral Theory assist nurses in describing and understanding their professional work? Nurses participating in this study used Integral Theory as a map or heuristic that gave structure to an inquiry process in professional nursing practice and in nursing education in a manner that was holonic, multiperspectival, and self-reflective. Challenges constraining nurses' use of Integral Theory included its intricacy, as well as contextual factors in practice environments. Implications for nursing practice and education for the use of Integral Theory's meta-framework are described.

Research Competencies Assessment Instrument for Nurses: Preliminary Psychometric Properties.

BACKGROUND AND PURPOSE: Clinician research competencies influence research use for evidence-based practice (EBP). We aimed to develop, refine, and psychometrically assess the Research Competencies Assessment Instrument for Nurses (RCAIN) to measure registered nurse research competencies (i.e., knowledge, skills, attitudes) focused on EBP-related domains: research process, knowledge synthesis, and knowledge translation activities. METHODS: The preliminary psychometrics (face, content, construct/criterion validity) were evaluated based on 63 completed surveys. RESULTS: The Cronbach's α coefficients were .871, .813, and .946 for each domain, respectively; interitem correlations ranged from .472 to .833 (explained variance: 68.5%). Three components/factors revealed: comprehension of and skills required in research process and application of knowledge and skills. The revised RCAIN consists of 19 five-point Likert-type questions. CONCLUSIONS: The RCAIN assesses modifiable characteristics and explains variance in practice, health system, and patient outcomes. Further assessments are underway.

Patient-Oriented Research Competencies in Health (PORCH) for patients, healthcare providers, decision-makers and researchers: protocol of a scoping review.

BACKGROUND: Patient-Oriented Research (POR) is a Canadian initiative for health research that refers to research processes informed by full and active patient involvement in all aspects of the research. Ideally, POR results in a wide dissemination of the research findings and the uptake of such findings in both clinical practice and health policy. The Canadian Institute for Health Research (CIHR) identifies four stakeholder groups that are involved in POR who are envisioned to take on a collaborative role in enacting this approach to research. Those stakeholder groups are patients, researchers, health care providers and healthcare decision-makers. To achieve collaboration among stakeholders in POR, tools, resources, education/training and capacity building are required for each stakeholder group engaged in this work. Therefore, this review focuses on understanding and articulating competencies needed by participants to engage in POR. The aim is to summarize existing knowledge on discrete POR competencies for the four stakeholder groups; to support collaboration among them for uptake and strengthening of POR; and to inform policy, education and future research. Accordingly, our research question is 'What are the POR core competencies needed by patients, researchers, healthcare providers, and decision-makers?' The main objectives are to (1) systematically explore the academic and grey literature on competencies needed for these stakeholder groups to engage in POR; (2) map the eligible publications and research gaps in this area; (3) gain knowledge to support collaboration among stakeholders; and (4) provide recommendations for further research to use competencies that emerge in developing stakeholder groups' readiness to conduct POR. METHODS/DESIGN: We will use a methodologically rigorous scoping review approach including formulation of the research question and development of the protocol; screening and identification of the literature; selection of relevant studies; data extraction; and collation, summary and report of the results. Our eligibility criteria include elements of population (patients, researchers, healthcare providers and decision-makers); concept (competencies: knowledge, skills, attitudes; and POR); context (level of involvement in research, settings, funding sources); study design (sample, stakeholder group, methodology, grey literature, theoretical framework); outcomes (primary: relevant to decision-making/policy and practice; and secondary: relevant to education and research); language (English, French); and timing (1990-2017). Registration with PROSPERO is not eligible for scoping reviews; so, it has not been registered. DISCUSSION: Research on core competencies required to enact POR is in its infancy. In this review, we can articulate what is known and thought about competencies (knowledge, skills and attitudes) needed by individuals on POR research teams and ultimately provide knowledge that could impact research, practice, education and policy. Identification of competencies can contribute to design of healthcare professionals' basic and ongoing educational programmes, patient training in research, and professional development activities for health care providers and decision-makers. In addition, knowledge of core competencies can permit individuals to evaluate their own readiness to enter POR research teams.

Core knowledge translation competencies: a scoping review.

BACKGROUND: Knowledge translation (KT) is the broad range of activities aimed at supporting the use of research findings leading to evidence-based practice (EBP) and policy. Recommendations have been made that capacity building efforts be established to support individuals to enact KT. In this study, we summarized existing knowledge on KT competencies to provide a foundation for such capacity building efforts and to inform policy and research. Our research questions were "What are the core KT competencies needed in the health sector?" and "What are the interventions and strategies to teach and reinforce those competencies?" METHODS: We used a scoping review approach and an integrated KT process by involving an Advisory Group of diverse stakeholders. We searched seven health and interdisciplinary electronic databases and grey literature sources for materials published from 2003 to 2017 in English language only. Empirical and theoretical publications in health that examined KT competencies were retrieved, reviewed, and synthesized. RESULTS: Overall, 1171 publications were retrieved; 137 were fully reviewed; and 15 empirical and six conceptual academic, and 52 grey literature publications were included and synthesized in this scoping review. From both the academic and grey literature, we categorized 19 KT core competencies into knowledge, skills, or attitudes; and identified commonly used interventions and strategies to enhance KT competencies such as education, organizational support and hands-on training. CONCLUSIONS: These initial core KT competencies for individuals provide implications for education, policy, knowledge brokering, and future research, and on the need for future evaluation of the KT competencies presented. We also discuss the essential role of organizational support and culture for successful KT activities/practice.

Holistic Nurses' Use of Energy-Based Caring Modalities.

As part of a study of a larger study of self-identified holistic nurses, researchers asked nurses to describe practice situations where energy-based modalities (EBMs) were used. Four hundred and twenty-four nurses responded by writing free-text responses on an online survey tool. The participants were highly educated and very experienced with 42% holding graduate degrees and 77% having over 21 years of practice. Conventional content analysis revealed four themes: EMBs are 1) caring modalities used to treat a wide range of identified nursing concerns; 2) implemented across the life span and to facilitate life transitions; 3) support care for the treatment of specific medical conditions; and 4) Use of EBMs transcend labels of 'conditions' and are used within a holistic framework. The fourth theme reveals a shared vision of nursing work such that the modality becomes secondary and the need to address the 'whole' at an energetic level emerges as the primary focus of holistic nursing.

Protocol of a scoping review on knowledge translation competencies.

BACKGROUND: Knowledge translation (KT) activities can reduce the gap between "what is known" and "what is done". Several factors hinder or facilitate KT activities including individual characteristics and organizational attributes; we will focus on individual healthcare professional modifiable characteristics. The purpose of this scoping review is to summarize knowledge on KT competencies for knowledge users, knowledge brokers, and knowledge producers/researchers to support evidence-based practice (EBP) and inform policy and research in health. Our objectives are to explore the relevant theoretical and empirical literature; map the publications for key themes and research gaps of KT competencies, and interventions for enhancing KT competencies; summarize and disseminate findings; produce an action plan and research agenda; and develop self-assessment tools (the KT Pathways) for professional development for our three target audiences. METHODS: The scoping review method will guide our study by following six stages: formulating the research question; identifying relevant studies; selecting the literature; charting the data; collating, summarizing, and reporting the results; and developing a KT plan and consulting stakeholders involved in the fields of KT, EBP, evidence-informed policy-making, and/or research. We will include empirical and theoretical/conceptual peer-reviewed and grey literature in health that examine knowledge user, knowledge broker and knowledge producer KT competencies. Publications written in the English language and published after 2003 only will be considered. Our multidisciplinary research team will collaborate using technology (i.e., WebEx for discussions and a Web 2.0 website for storing documents). Our KT plan consists of an Advisory Group and dissemination plan of the findings. DISCUSSION: We expect the identified KT competencies to contribute to the KT science by providing positive outcomes in practice, policy, education, and future research. Incorporation of the core KT competencies may enhance safety, effectiveness of clinical care, and quality of health outcomes; contribute to and facilitate collaboration among practitioners, knowledge users, knowledge brokers, researchers, employers, and educators; improve education of healthcare professionals and inform policy-making process; benefit practitioners by guiding their KT professional development to become effective at moving evidence into practice and policy; guide suitable interventions and strategies to enhance KT activities in the health sector; and direct future research.

Expanding the Reach of Continuing Educational Offerings Through a Web-Based Virtual Network: The Experience of InspireNet.

Virtual platforms using webinars, e-posters, e-newsletters, wikis and blogs connect people who have common interests in new ways. When those individuals are healthcare providers, a professional network that operates on a virtual platform can support their needs for learning, professional development and information currency. The practice of e-learning for continuing professional development is emerging , particularly in nursing where shift work shift inhibits their ability to attend conferences and classes. This article reports the experience of the InspireNet network that provided e-learning models to: 1) provide opportunities for healthcare providers to organize themselves into learning communities through development of electronic communities of practice; 2) support learning on demand; and 3) dramatically increase the reach of educational offerings.

Developing Effective Case Scenarios for Interprofessional Electronic Health Record Research.

In the last decade, there have been numerous calls for research in interprofessional communication and documentation. Some of the limitations of research in this area have been proprietary user interfaces that may not be generalizable and impact varying adoption rates of electronic documentation among different health disciplines. In order to address these concerns, researchers need to create standardized case scenarios as research instruments. This paper outlines the process for developing a case scenario instrument for use in interprofessional electronic documentation research.

Human Energy Field: A Concept Analysis.

The human energy field (HEF) as a phenomenon of interest across disciplines has gained increased attention over the 20th and 21st centuries. However, a concern has arisen that there is a lack of evidence to support the concept of the HEF as a phenomenon of interest to professional nurses and nursing practice. Using Chinn and Kramer's method of creating conceptual meaning, a concept analysis was conducted for the purpose of developing a conceptual definition of HEF. A systematic review of the literature using the CINAHL database yielded a total of 81 articles and text sources that were determined to be relevant to the concept analysis. The HEF is defined as a luminous field of energy that comprises a person, extends beyond the physical body, and is in a continuous mutual process with the environmental energy field. It is a vital energy that is a continuous whole and is recognized by its unique pattern; it is dynamic, creative, nonlinear, unpredictable, and flows in lower and higher frequencies. The balanced HEF is characterized by flow, rhythm, symmetry, and gentle vibration.

Wilber's Integral Theory and Dossey's Theory of Integral Nursing: An Examination of Two Integral Approaches in Nursing Scholarship.

The purpose of this article is to examine Dossey's theory of integral nursing in relation to its major theoretical source, Wilber's integral theory. Although several nursing scholars have written about integral theory in relation to nursing scholarship and practice, Dossey's theory of integral nursing may be influencing how nurses take up integral theory in a significant way due to an extensive outreach in the holistic nursing community. Despite this wide circulation, the theory of integral nursing has yet to be reviewed in the nursing literature. This article (a) compares Dossey's theory of integral nursing with Wilber's integral theory and (b) contrasts Dossey's integral approach with another integral approach used by other scholars of integral theory.

Integration of electronic health records into nursing education: issues, challenges and limitations.

In this paper we describe our integration of teaching about the use of electronic health records into a fourth year undergraduate nursing course. We report on our method of integration and issues, challenges and limitations of the approach. We present our findings using a case study approach that includes a description of the context and EHR software used.

Nursing Handover using an Electronic Application for Community Nurses.

Handover from one healthcare professional is an essential component of patient care. This can be a challenge in the community setting where care occurs in the patient's home and clinicians do not have the benefit of face-to-face interactions with colleagues. The purpose of this study was to explore the nurses' perceptions of handover and their views on using an electronic application as opposed to their current email system. Nurses completed two surveys, one prior to viewing the application and the second after reviewing the application. Both surveys were analyzed by educational preparation and age to explore whether either factor influenced opinions of handover or the electronic application. Nurses reported that handover was important and standardization of reporting improved their knowledge of their patients' care plan.

Readiness of nurse executives and leaders to advocate for health information systems supporting nursing.

Literature suggests that nurses at all levels remain unprepared to make use of full use of technologies required for current practice. Specifically, nurses lack sufficient background to engage with information systems, electronic records, and unit-level and aggregated data that could support understanding of the contributions of nursing services to care and the development of best practice guidelines. Given that nursing leadership is needed in this area, the authors conducted a review of graduate nursing curricula preparing nurses to take on leadership, management and executive roles. Findings revealed that only 12 out of 36 graduate nursing programs on the west coast of the US and Canada required any content in informatics, and five more offered elective opportunities. Implications for education and practice are discussed.

Application of integral theory in holistic nursing practice.

This study explores the utility of Integral Theory's metatheoretical framework in supporting holistic nursing practice. A case example is provided to illustrate how integral theory allows for the organization, integration, and application of nursing knowledge generated from multiple perspectives in complex nursing contexts.

Developing entry-to-practice nursing informatics competencies for registered nurses.

Information and communication technologies (ICT) have brought about significant changes to the processes of health care delivery and changed how nurses perform in clinical, administrative, academic, and research settings. Because the potential benefits of ICT are significant, it is critical that new nurses have the knowledge and skills in informatics to provide safe and effective care. Despite the prevalence of technology in our day to day lives, and the potential significant benefits to patients, new nurses may not be prepared to work in this evolving reality. An important step in addressing this need for ICT preparation is to ensure that new graduates are entering the work force ready for technology-enabled care environments. In this paper, we describe the process and outcomes of developing informatics entry-to-practice competencies for adoption by Canadian Schools of Nursing.