Continuing professional development (CPD) system development, implementation, evaluation and sustainability for healthcare professionals in low- and lower-middle-income countries: a rapid scoping review.

BACKGROUND: Policymakers and program developers in low-and lower-middle-income countries (LLMICs) are increasingly seeking evidence-based information and guidance on how to successfully develop and implement continuing professional development (CPD) systems. We conducted a rapid scoping review to map and synthesize what is known regarding the development, implementation, evaluation and sustainability of CPD systems for healthcare professionals in LLMICs. METHODS: We searched MEDLINE, CINAHL and Web of Science. Reference lists were screened and a cited reference search of included articles was conducted. Supplementary information on the CPD systems identified in the articles was also identified via an online targeted grey literature search. English, French and Spanish literature published from 2011 to 2021 were considered. Data were extracted and combined and summarized according to country/region and healthcare profession via tables and narrative text. RESULTS: We included 15 articles and 23 grey literature sources. Africa was the region most represented followed by South and Southeast Asia and the Middle East. The literature most often referred to CPD systems for nurses and midwives; CPD systems for physicians were frequently referred to as well. Findings show that leadership and buy-in from key stakeholders, including government bodies and healthcare professional organizations, and a framework are essential for the development, implementation and sustainability of a CPD system in a LLMIC. The guiding framework should incorporate a regulatory perspective, as well as a conceptual lens (that informs CPD objectives and methods), and should consider contextual factors (support for CPD, healthcare context and population health needs). In terms of important steps to undertake, these include: a needs assessment; drafting of a policy, which details the regulations (laws/norms), the CPD requirements and an approach for monitoring, including an accreditation mechanism; a financing plan; identification and production of appropriate CPD materials and activities; a communication strategy; and an evaluation process. CONCLUSION: Leadership, a framework and a clearly delineated plan that is responsive to the needs and context of the setting, are essential for the development, implementation and sustainability of a CPD system for healthcare professionals in a LLMIC.

An Integrative Review of Organizational Factors Influencing Successful Large-Scale Changes in Healthcare.

OBJECTIVE: The aim of this study was to review organizational factors influencing successful large-scale change (LSC) in healthcare. BACKGROUND: LSC is necessary to achieve sustained and meaningful healthcare improvement. However, organizational readiness needs to be considered to promote successful LSC. METHODS: Four databases were searched for articles published between 2009 and 2018. Thematic analysis was used to identify enabling or hindering factors to LSC. RESULTS: Seven organizational factors were consistently described as facilitators of or barriers to successful LSC in healthcare: infrastructure support, organizational culture, leadership, change management approach, roles and responsibilities, networks, and measurement and feedback. CONCLUSION: The factors that emerged from this review are consistent with concepts of implementation but broadened and highlight learning organizations in successful LSC. The results of this review informed the development of a reflective tool on LSC for nurse leaders.

Using the Theoretical Domains Framework to Identify Barriers and Facilitators to Elder-Friendly Care Implementation Within a Multi-Site Academic Health Centre.

BACKGROUND: Societal demographic shifts are occurring globally. Within Quebec, Canada, the percentage of adults over 65 (older adults) is predicted to increase from 19.3% to >25.9% by the year 2036. Older adults (OAs) experience hospitalizations more frequently than persons aged 15-64 years old, and hospitalizations for OAs can be detrimental due to naturally occurring physiological changes. To address the needs of this population, the Quebec government mandated that all acute care hospitals implement OA-friendly care standards called AAPA ("l'Approche Adaptée à la Personne Âgée"). AIMS: To describe an approach for identifying barriers and facilitators (BFs) to AAPA implementation at the McGill University Health Centre, an academic healthcare centre in Montreal that provides tertiary and quaternary care. METHODS: Our approach included an organizational quality improvement (QI) model based on the Institute for Healthcare Improvement QI approach and the use of the Theoretical Domains Framework (TDF) to guide the assessment of BFs to AAPA implementation. To identify the BFs of AAPA implementation, themes were generated from the raw data. RESULTS: In total, 32 barriers and 88 facilitators were identified. Each BF was linked to one or more corresponding domain from the TDF. Seven of the most frequently occurring domains were: (1) knowledge, (2) beliefs about consequences, (3) social/professional role and identity, (4) social influences, (5) environmental context and resources, (6) intentions, and (7) goals. LINKING EVIDENCE TO ACTION: A theory-informed approach, such as the TDF, can be used to facilitate the implementation of evidence-based guidelines.

Having Therapeutic Conversations With Fathers Grieving the Death of a Child.

A child's death is a traumatic life experience for parents. Health-care professionals (HCPs) have sought guidance on how to intervene with grieving parents, particularly with fathers. Having therapeutic conversations is an effective way for HCPs to support grieving fathers. In our previous study, fathers identified core beliefs that influenced their experience of grief and coping. In this article, the Illness Beliefs Model was integrated with the findings to provide a framework for interventions to create open conversations, ease fathers' suffering, and thereby help their spouse and family suffering as well. This article will guide HCPs to engage in therapeutic conversations to support bereaved fathers.

Implementation leadership: A concept analysis.

AIM: To analyse the concept of implementation leadership (IL) in health care and nursing literature. BACKGROUND: Implementation leadership has emerged as a type of leadership that is lacking but required for the successful implementation of evidence-based practices (EBPs). A concept analysis of IL can help identify, clarify and apply this concept to inform strategies for nursing leadership development. METHOD: A concept analysis using Rodger's evolutionary method identified attributes of IL, and the context in which it is expressed including antecedents, consequences, references and surrogate terms. Forty-two articles were analysed following a Boolean search of MEDLINE and CINAHL databases. RESULTS: Implementation leadership is a specific and strategic approach to leadership characterized by a set of influencing behaviours leading to positive outcomes for the implementation of EBPs. CONCLUSION: The concept analysis describes an evolving term that requires further clarification. This analysis contributes to an expanding knowledge base for capacity-building strategies for EBP implementation in nursing and health care. IMPLICATIONS FOR NURSING MANAGEMENT: Effective IL, specifically in nurse managers, may be key in facilitating the implementation process for future successes. Nursing managers can build on a foundation of general leadership practices and consider the role of other members of the nurse leadership team in IL.

Vinca alkaloids and analogues as anti-cancer agents: Looking back, peering ahead.

Cancer still represents a "nightmare" worldwide, causing annually millions of victims. Several antiproliferative molecules are currently used as drugs market and offer a pharmaceutical opportunity for attenuating and treating tumor manifestations. In this context, natural sources have a relevant role, since they provide the 60% of currently-used anticancer agents. Among the numerous natural products, acting via different mechanisms of action, microtubule-targeting agents (MTAs) have a high therapeutic potential, since they disrupt the abnormal cancer cell growth, interfering with the continuous mitotic division. Vinca alkaloids (VAs) are the earliest developed MTAs and approved for clinical use (Vincristine, Vinblastine, Vinorelbine, Vindesine, and Vinflunine) as agents in the treatment of hematological and lymphatic neoplasms. Here, we review the state-of-art of VAs, discussing their mechanism of action and pharmacokinetic properties and highlighting their therapeutic relevance and toxicological profile. Additionally, we briefly disclosed the technological approaches faced so far to ameliorate the pharmacological properties, as well as to avoid the drug resistance. Lastly, we introduced the recent advances in the discovery of new derivatives.

Exploring Shared Implementation Leadership of Point of Care Nursing Leadership Teams on Inpatient Hospital Units: Protocol for a Collective Case Study.

BACKGROUND: Nursing leadership teams at the point of care (POC), consisting of both formal and informal leaders, are regularly called upon to support the implementation of evidence-based practices (EBPs) in hospital units. However, current conceptualizations of effective leadership for successful implementation typically focus on the behaviors of individual leaders in managerial roles. Little is known about how multiple nursing leaders in formal and informal roles share implementation leadership (IL), representing an important knowledge gap. OBJECTIVE: This study aims to explore shared IL among formal and informal nursing leaders in inpatient hospital units. The central research question is as follows: How is IL shared among members of POC nursing leadership teams on inpatient hospital units? The subquestions are as follows: (1) What IL behaviors are enacted and shared by formal and informal leaders? (2) What social processes enable shared IL by formal and informal leaders? and (3) What factors influence shared IL in nursing leadership teams? METHODS: We will use a collective case study approach to describe and generate an in-depth understanding of shared IL in nursing. We will select nursing leadership teams on 2 inpatient hospital units that have successfully implemented an EBP as instrumental cases. We will construct data through focus groups and individual interviews with key informants (leaders, unit staff, and senior nurse leaders), review of organizational documents, and researcher-generated field notes. We have developed a conceptual framework of shared IL to guide data analysis, which describes effective IL behaviors, formal and informal nursing leaders' roles at the POC, and social processes generating shared leadership and influencing contextual factors. We will use the Framework Method to systematically generate data matrices from deductive and inductive thematic analysis of each case. We will then generate assertions about shared IL following a cross-case analysis. RESULTS: The study protocol received research ethics approval (2022-8408) on February 24, 2022. Data collection began in June 2022, and we have recruited 2 inpatient hospital units and 25 participants. Data collection was completed in December 2023, and data analysis is ongoing. We anticipate findings to be published in a peer-reviewed journal by late 2024. CONCLUSIONS: The anticipated results will shed light on how multiple and diverse members of the POC nursing leadership team enact and share IL. This study addresses calls to advance knowledge in promoting effective implementation of EBPs to ensure high-quality health care delivery by further developing the concept of shared IL in a nursing context. We will identify strategies to strengthen shared IL in nursing leadership teams at the POC, informing future intervention studies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/54681.

Effects of implementation strategies on nursing practice and patient outcomes: a comprehensive systematic review and meta-analysis.

BACKGROUND: Implementation strategies targeting individual healthcare professionals and teams, such as audit and feedback, educational meetings, opinion leaders, and reminders, have demonstrated potential in promoting evidence-based nursing practice. This systematic review examined the effects of the 19 Cochrane Effective Practice and Organization Care (EPOC) healthcare professional-level implementation strategies on nursing practice and patient outcomes. METHODS: A systematic review was conducted following the Cochrane Handbook, with six databases searched up to February 2023 for randomized studies and non-randomized controlled studies evaluating the effects of EPOC implementation strategies on nursing practice. Study selection and data extraction were performed in Covidence. Random-effects meta-analyses were conducted in RevMan, while studies not eligible for meta-analysis were synthesized narratively based on the direction of effects. The quality of evidence was assessed using GRADE. RESULTS: Out of 21,571 unique records, 204 studies (152 randomized, 52 controlled, non-randomized) enrolling 36,544 nurses and 340,320 patients were included. Common strategies (> 10% of studies) were educational meetings, educational materials, guidelines, reminders, audit and feedback, tailored interventions, educational outreach, and opinion leaders. Implementation strategies as a whole improved clinical practice outcomes compared to no active intervention, despite high heterogeneity. Group and individual education, patient-mediated interventions, reminders, tailored interventions and opinion leaders had statistically significant effects on clinical practice outcomes. Individual education improved nurses' attitude, knowledge, perceived control, and skills, while group education also influenced perceived social norms. Although meta-analyses indicate a small, non-statistically significant effect of multifaceted versus single strategies on clinical practice, the narrative synthesis of non-meta-analyzed studies shows favorable outcomes in all studies comparing multifaceted versus single strategies. Group and individual education, as well as tailored interventions, had statistically significant effects on patient outcomes. CONCLUSIONS: Multiple types of implementation strategies may enhance evidence-based nursing practice, though effects vary due to strategy complexity, contextual factors, and variability in outcome measurement. Some evidence suggests that multifaceted strategies are more effective than single component strategies. Effects on patient outcomes are modest. Healthcare organizations and implementation practitioners may consider employing multifaceted, tailored strategies to address local barriers, expand the use of underutilized strategies, and assess the long-term impact of strategies on nursing practice and patient outcomes. TRIAL REGISTRATION: PROSPERO CRD42019130446.

Implementation Leadership in the Point of Care Nursing Context: A Systematic Review Comparing Two Measurement Tools.

Introduction: Implementation leadership (IL) are effective point of care (POC) nursing leadership behaviors that facilitate contexts conducive to the successful implementation of evidence-based practices (EBPs). However, no systematic evaluation of IL tools validated for the nursing context existed. Aims: The purpose of this systematic review was to compare iterations of two IL measurement tools, the Implementation Leadership Scale (ILS) and the iLEAD, for application in a nursing context; and to critically appraise and summarize the methodological quality of studies assessing their psychometric properties. Methods: A comprehensive search was conducted in four databases. Two reviewers independently screened titles and abstracts, reviewed full-text articles, and performed extraction into data tables. Statisticians appraised the quality control aspects. Findings were narratively summarized. Results: A total of 247 records were included, where 10 for the ILS (including different versions) and one for the iLEAD met the inclusion criteria. Three studies evaluated the psychometric properties of the ILS in nursing, and its translations into Chinese and Greek. Content validity was deemed to be doubtful for both tools, but the ILS had adequate rating for comprehensiveness; methodological quality was very good for structural validity, internal consistency, hypothesis testing, and responsiveness where applicable for both scales, with the exception of cross-cultural validity which had ratings of adequate and inadequate for versions of the scales. Several study findings met the criteria for good measurement properties. No studies for either tool formally assessed feasibility. Conclusion: Applying validated and contextually relevant tools to evaluate the capacity of nursing leadership to engage in IL in real-world contexts are needed. The ILS shows promise but requires further validation for contexts with diverse and multiple nursing leaders at the POC. Feasibility needs to be further studied.

Follow-up phone calls after pediatric ambulatory surgery for tonsillectomy: what can we learn from families?

The purpose of this quality improvement study was to describe families' responses regarding the adequacy of the preoperative preparation provided in the Preoperative Assessment Clinic, and the necessity of two follow-up phone calls after pediatric ambulatory surgery for tonsillectomy with or without adenoidectomy (T+/-A). Using a questionnaire developed for the study, 90 families were contacted by phone on the first postoperative day and, of them, 73 were contacted a second time between the ninth and twelfth postoperative days. Families' responses were reported in four categories: (1) concerns, (2) use of resources, (3) adequacy of the preoperative teaching, and (4) necessity of the two postoperative phone calls. Results showed that, at the first phone call, a sore throat was reported as the most important concern followed by a decreased oral intake (ie, fluid, food, medicine), vomiting, and fever or "perceived fever." During the second phone call, a sore throat remained the most important concern followed by a decreased intake. Earache was the third highest concern and vomiting was then reported of concern by a minority of families. The most frequently consulted resource person for concerns was the physician on call for the otolaryngology service. Eighty-seven percent of families felt the preoperative preparation was adequate. For reasons of instructional and/or emotional support, 94% of families who responded reported that the first phone call was necessary and 68% reported that the second call was as well.