Integrating the transitional relationship model into clinical practice.

BACKGROUND: The challenge of facilitating knowledge translation in clinical practice includes enabling practitioners and agencies to implement a common set of best practices, such as the Transitional Relationship Model (TRM). In 1992, a participatory action project implemented the TRM on a long-term psychiatric hospital ward in Ontario, Canada. All participants were successfully "bridged" to the community. Despite positive outcomes associated with the TRM, implementation of any best practice is difficult because it involves changing processes. OBJECTIVE: It was hypothesized that using multiple implementation strategies developed by wards that had already implemented the model would result in improved TRM implementation. METHOD: This study compared three groups of hospital wards; Group A wards had already adopted the TRM, Group B wards implemented the TRM in Year 1, and Group C wards implemented the TRM in Year 2. An iterative process was used in which strategies suggested by the A wards were used to enhance implementation on the B and C wards, respectively. These included enhancing staff participation, creating/maintaining supportive ward milieus, meeting specific educational needs, and supporting managers throughout the implementation process. The degree of actual implementation on each ward served as the primary outcome measure. RESULTS: Group C implemented the TRM model significantly quicker than the other groups. Sustainability in the initial A wards required the implementation of additional strategies used by the later wards.

Integrating an evidenced-based research intervention in the discharge of mental health clients.

The purpose of this Canadian qualitative study was to explore the experiences of clinical staff who implemented a research intervention: the Transitional Discharge Model (TDM). The TDM provided mental health clients who were hospitalized with peer support and an inpatient staff member to bridge the therapeutic transitioning from hospital staff to the community care provider. Staff from three tertiary care mental health facilities in Canada identified their learning needs in regard to providing the intervention. An educational program was developed and delivered to the clinical staff to support and facilitate the implementation of the new TDM. The extent of the utilization of knowledge and implementation of the TDM varied across the three tertiary care mental health facilities. Focus groups (N=49) with clinical staff were conducted to explore various factors related to the training process as well as the challenges and benefits of implementing the TDM. Data were analyzed using Leininger's Phases of Ethnonursing Qualitative Data Analysis [Leininger, M. (2002). The theory of culture care and the ethnonursing research method. In M. Leininger & M. McFarland (eds.), Transcultural nursing: Concepts, theories, research, and practice (3rd ed.). New York: McGraw-Hill]. Findings revealed that clinical staff experienced challenges in roles and responsibilities, relationships with others, values and beliefs of clients, staff and community, resources, and the processes of care. From the findings, strategies were identified to support the integration of knowledge about the TDM into practice and to increase clinical staff's skills in implementing research interventions. These included support from others, as well as support of practice, policy, and education.