Contributions to the literature
Background
Methods
Evaluate framework usability
Participants
Procedures
Identify and specify strategies
Participants
Procedures
Identify strategy domains
Participants
Procedures
Revise and finalize framework
Participants
Procedures
Results
Evaluate framework usability
Characteristics | N (%) |
---|---|
Discipline | |
Nurse (includes nurse practitioner) | 125 (98.4) |
Physician | 1 (0.8) |
Others | 1 (0.8) |
Education | |
Doctoral | 70 (55.1) |
Masters | 50 (39.4) |
Bachelors | 6 (4.7) |
Others | 1 (0.8) |
Current role | |
Educator | 41 (32.3) |
Administrator | 21 (16.5) |
Clinician | 16 (12.6) |
Researcher | 12 (9.5) |
Student | 3 (2.4) |
Clinical nurse specialist/nurse leader | 20 (15.8) |
Others | 14 (11.0) |
Organization type | |
Hospital | 67 (52.3) |
College or university | 40 (31.3) |
Ambulatory clinic | 6 (4.7) |
Community | 3 (2.3) |
Long-term skilled care | 2 (1.6) |
Others | 10 (7.8) |
Type of hospital | |
Community | 31 (44.3) |
Academic medical center | 19 (27.1) |
Public (state or federal) | 12 (17.1) |
Critical access hospital | 2 (2.9) |
Others | 6 (8.6) |
Location | |
USA | 107 (84.3) |
Asia/Pacific Islands | 9 (7.1) |
North America (non-US) | 5 (3.9) |
Middle East | 4 (3.2) |
Africa | 1 (0.8) |
Europe | 1 (0.8) |
Purpose for using the implementation modela | |
Student paper or assignment | 38 (18.2) |
Organization EBP project | 38 (18.2) |
Unit/clinic EBP project | 34 (16.3) |
Classroom teaching | 30 (14.4) |
Research/grant | 18 (8.6) |
Publications/presentations | 15 (7.2) |
Magnet® submission | 10 (4.8) |
Others | 6 (2.9) |
Have not used | 20 (9.6) |
User rated experience with model | |
Expert—extensive experience, highly skilled, confident, able to hone in on solutions | 11(10.9) |
Proficient—skilled, experienced, confident, able to troubleshoot problems | 14 (13.9) |
Competent—building skill and experience but confident in use | 39 (38.6) |
Advanced beginner—just beginning, developing experience and confidence | 33 (32.7) |
Novice—lacking experience and confidence | 4 (4.0) |
Strategy number/name | Creating awareness and interest | Building knowledge and commitment | Promoting action and adoption | Pursuing integration and sustainability | p-value | |
---|---|---|---|---|---|---|
01 | Action plan | 32 (62.8) | 34 (66.7) § | 42 (82.4) § | 32 (62.8) | 0.034 |
02 | Actionable and timely data feedback | 19 (37.3) | 26 (51.0) | 34 (66.7) § | 32 (62.8) | 0.003 |
03 | Advisory boards | |||||
04 | Announcements and broadcasts | 42 (82.4) § | 25 (49.0) | 25 (49.0) | 22 (43.1) | < 0.0001 |
-- | Annual report | 23 (45.1) | 16 (31.4) | 16 (31.4) | 3 (64.7) § | 0.0008 |
05 | Audit and feedback | 21 (41.2) | 21 (41.2) | 31 (60.8) | 35 (68.6) § | 0.003 |
06 | Audit key indicators | 21 (41.2) | 22 (43.1) | 30 (58.8) § | 33 (64.7) | 0.015 |
07 | Benchmark data | 27 (52.9) | 24 (47.1) § | 30 (58.8) | 36 (70.6) | 0.034 |
08 | Case studies | 29 (56.9) | 31(60.8) § | 31 (60.8) | 21 (41.2) | 0.056 |
09 | Celebrate local unit progress | 23 (45.1) | 25 (49.0) | 30 (58.8) | 37 (72.6) § | 0.004 |
10 | Change agents (e.g., change champion, core group, opinion leader, thought leader, etc.) | 32 (62.8) | 35 (68.6) § | 34 (66.7) § | 28 (54.9) | 0.241 |
11 | Checklist | 19 (37.3) | 22 (43.1) | 37 (72.6) § | 25 (49.0) | 0.0002 |
12 | Clinician input | 27 (52.9) | 35 (68.6) § | 32 (62.8) | 29 (56.9) | 0.102 |
13 | Cultural broker | |||||
-- | Competency metric for discontinuing training | 16 (31.4) | 20 (39.2) | 18 (35.3) | 24 (47.1) § | 0.313 |
-- | Continuing education programs | 20 (39.2) § | 36 (70.6) | 26 (51.0) | 28 (54.9) | 0.002 |
14 | Data collection by clinicians | 19 (37.3) | 24 (47.1) | 31 (60.8) § | 28 (54.9) | 0.032 |
15 | Decision algorithm | |||||
16 | Demonstrate workflow or decision algorithm | 18 (35.3) | 29 (56.9) | 34 (66.7) § | 30 (58.8) | 0.002 |
17 | Disincentives | |||||
18 | Disseminate credible evidence with clear implications for practice | 25 (49.0) | 22 (43.1) § | 28 (54.9) | 32 (62.8) | 0.10 |
19 | Distribute key evidence | 22 (43.1) § | 26 (51.0) | 25 (49.0) | 29 (56.9) | 0.419 |
20 | Documentation | 15 (29.4) | 17 (33.3) | 25 (49.0) § | 26 (51.0) | 0.014 |
21 | Education (e.g., live, virtual, or computer-based) | 27 (52.9) | 35 (68.6) § | 28 (54.9) | 22 (43.1) | 0.004 |
22 | Educational outreach or academic detailing | 23 (45.1) | 31 (60.8) § | 25 (49.0) § | 22 (43.1) | 0.116 |
23 | “Elevator speech” | 29 (56.9) | 26 (51.0) | 20 (39.2) § | 15 (29.4) | 0.001 |
-- | Financial incentives | 16 (31.4) | 13 (25.5) | 22 (43.1) | 25 (49.0) § | 0.017 |
24 | Focus groups for planning change | 23 (45.1) | 23 (45.1) § | 28 (54.9) | 22 (43.1) | 0.477 |
25 | Gaming | |||||
26 | Gap assessment/gap analysis | 27 (52.9) | 26 (51.0) § | 25 (49.0) | 18 (35.3) | 0.135 |
27 | Give evaluation results to colleagues | 18 (35.3) | 19 (37.3) | 28 (54.9) § | 31 (60.8) | 0.002 |
28 | Highlight advantages or anticipated impact | 27 (52.9) § | 27 (52.9) | 26 (51.0) | 25 (49.0) | 0.939 |
29 | Highlight compatibility | 16 (31.4) § | 21 (41.2) | 23 (45.1) | 18 (35.3) | 0.332 |
30 | Incentives | 21 (41.2) | 20 (39.2) | 28 (54.9) § | 25 (49.0) | 0.215 |
31 | Individual performance evaluation | 15 (29.4) | 17 (33.3) | 31 (60.8) § | 25 (49.0) | 0.0006 |
32 | Individualize data feedback | 15 (29.4) | 16 (31.4) | 29 (56.9) | 25 (49.0) § | 0.0016 |
33 | Inform organizational leaders | 21 (41.2) | 21 (41.2) § | 25 (49.0) | 24 (47.1) | 0.692 |
34 | Integrate practice change with other EBP protocols | 13 (25.5) | 20 (39.2) § | 29 (56.9) | 30 (58.8) | 0.0003 |
35 | Interprofessional discussion and troubleshooting | |||||
36 | Journal club | 27 (52.9) § | 32 (62.8) | 21 (41.2) | 12 (23.5) | < .0001 |
37 | Knowledge broker(s) | 26 (51.0) § | 30 (58.8) | 22 (43.1) | 14 (27.5) | 0.001 |
38 | Learning collaborative | |||||
39 | Link practice change and power holder/stakeholder priorities | 22 (43.1) | 28 (54.9) § | 28 (54.9) | 25 (49.0) | 0.373 |
40 | Link to patient/family needs and organizational priorities | 23 (45.1) | 23 (45.1) | 28 (54.9) § | 25 (49.0) | 0.521 |
41 | Local adaptation and simplify | 14 (27.5) | 16 (31.4) § | 28 (54.9) | 25 (49.0) | 0.0006 |
42 | Make impact observable | 19 (37.3) | 21 (41.2) § | 26 (51.0) | 29 (56.9) | 0.044 |
43 | Match practice change with resources and equipment | 12 (23.5) | 16 (31.4) § | 27 (52.9) | 27 (52.9) | 0.0001 |
44 | Mobile “show on the road” | 23 (45.1) § | 20 (39.2) | 21 (41.2) | 22 (43.1) | 0.861 |
-- | Multidisciplinary discussion and troubleshooting | 16 (31.4) | 25 (49.0) | 30 (58.8) § | 27 (52.9) | 0.001 |
45 | Non-punitive discussion of results | 13 (25.5) | 15 (29.4) | 25 (49.0) § | 26 (51.0) | 0.001 |
46 | Patient decision aids | 16 (31.4) | 23 (45.1) | 28 (54.9) § | 22 (43.1) | 0.032 |
47 | Patient reminders | 13 (25.5) | 16 (31.4) | 26 (51.0) § | 21 (41.2) | 0.005 |
-- | Peer influence | 24 (47.1) | 24 (47.1) | 26 (51.0) | 22 (43.1) § | 0.738 |
48 | Personalize the messages to staff (e.g., reduces work, reduces infection exposure, etc.) based on actual improvement data | 27 (52.9) | 27 (52.9) | 23 (45.1) | 20 (39.2) § | 0.322 |
49 | Pocket guides | 19 (37.3) | 22 (43.1) § | 29 (56.9) | 24 (47.1) | 0.047 |
50 | Positive deviance | |||||
51 | Posters and postings/fliers | 23 (45.1) § | 25 (49.0) | 24 (47.1) | 23 (45.1) | 0.943 |
-- | Present in educational programs | 25 (49.0) | 30 (58.8) | 28 (54.9) | 18 (35.3) § | 0.008 |
52 | Project responsibility in unit or organizational committee | 14 (27.5) | 23 (45.1) | 27 (52.9) | 26 (51.0) § | 0.004 |
53 | Provide recognition at the point of care | 15 (29.4) | 20 (39.2) | 25 (49.0) § | 26 (51.0) | 0.016 |
54 | Public recognition | 18 (35.3) | 16 (31.4) | 22 (43.1) | 27 (52.9) § | 0.013 |
55 | Publicize new equipment | 18 (35.3) § | 16 (31.4) | 27 (52.9) | 24 (47.1) | 0.010 |
56 | Reminders or practice prompts | 16 (31.4) | 20 (39.2) | 29 (56.9) § | 26 (51.0) | 0.004 |
57 | Report into quality improvement program | 11 (21.6) | 15 (29.4) | 24 (47.1) § | 25 (49.0) § | 0.0007 |
58 | Report progress and updates | 12 (23.5) | 14 (27.5) | 25 (49.0) § | 28 (54.9) | < .0001 |
59 | Report to senior leaders | 11 (21.6) | 12 (23.5) § | 22 (43.1) § | 27 (52.9) § | 0.0002 |
60 | Report within organizational infrastructure | 14 (27.5) | 18 (35.3) § | 23 (45.1) | 28 (54.9) | 0.005 |
60 | Resource manual or materials (i.e., electronic or hard copy) | 15 (29.4) | 24 (47.1) § | 28 (54.9) | 24 (47.1) | 0.011 |
61 | Resource materials and quick reference guides | 17 (33.3) | 25 (49.0) | 30 (58.8) § | 25 (49.0) | 0.010 |
62 | Quick reference guide | |||||
63 | Revise policy, procedure, or protocol | 11 (21.6) | 15 (29.4) | 24 (47.1) | 28 (54.9) § | < .0001 |
64 | Revise professional roles | |||||
65 | Role model | 18 (35.3) | 23 (45.1) | 29 (56.9) § | 27 (52.9) | 0.008 |
66 | Rounding by unit and organizational leadership | 23 (45.1) | 21 (41.2) | 29 (56.9) § | 25 (49.0) | 0.154 |
67 | Self-learning | |||||
68 | Senior executives’ announcements | 19 (37.3) § | 14 (27.5) | 21 (41.2) | 22 (43.1) | 0.207 |
69 | Share protocol revisions with clinician that are based on feedback from clinicians, patient, or family | 13 (25.5) | 19 (37.3) | 27 (52.9) | 22 (43.1) § | 0.009 |
70 | Simplify | |||||
71 | Skill competence | 11 (21.6) | 23 (45.1) | 30 (58.8) § | 20 (39.2) | < .0001 |
72 | Slogans and logos | 25 (49.0) § | 19 (37.3) | 21 (41.2) | 16 (31.4) | 0.138 |
73 | Social media influencer | |||||
74 | Sound bites | 26 (51.0) § | 16 (31.4) | 20 (39.2) | 16 (31.4) | 0.036 |
75 | Staff meetings | 25 (49.0) § | 24 (47.1) | 26 (51.0) | 23 (45.1) | 0.842 |
76 | Standing orders | 9 (17.7) | 13 (25.5) | 27 (52.9) § | 26 (51.0) | < .0001 |
-- | Strategic plan | 14 (27.5) | 15 (29.4) | 24 (47.1) | 26 (51.0) § | 0.004 |
77 | Teamwork | 26 (51.0) | 29 (56.9) § | 31 (60.8) | 29 (56.9) | 0.459 |
78 | Trend results | 16 (31.4) | 18 (35.3) | 27 (52.9) | 24 (47.1) § | 0.025 |
79 | Troubleshoot use/application | 9 (17.7) | 21 (41.2) § | 28 (54.9) | 24 (47.1) | < .0001 |
80 | Troubleshooting at the point of care/bedside | 8 (15.7) | 17 (33.3) | 27 (52.9) § | 26 (51.0) | < .0001 |
81 | Try the practice change | 11 (21.6) | 17 (33.3) | 31 (60.8) § | 21 (41.2) | < .0001 |
82 | Unit inservices | 22 (43.1) § | 27 (52.9) | 29 (56.9) | 23 (45.1) | 0.174 |
83 | Unit newsletter | 25 (49.0) § | 27 (52.9) | 25 (49.0) | 26 (51.0) | 0.932 |
84 | Unit orientation | 22 (43.1) | 24 (47.1) | 24 (47.1) § | 20 (39.2) | 0.619 |
-- | Update practice reminders | 18 (35.3) | 21 (41.2) | 24 (47.1) | 28 (54.9) § | 0.033 |
85 | Visit other sites |
Identify and specify strategies
Implementation Strategy Specifications (Related Theory) | ||
---|---|---|
Name | ||
Addresses what to call each implementation strategy to be able to identify and communicate those selected. | ||
Addresses when to use each implementation strategy(ies). | ||
➭ Create Awareness & Interest | ➭Promote Action & Adoption | |
➭ Build Knowledge & Commitment | ➭Pursue Integration & Sustained Use | |
Additional phases | ||
Addresses additional options for when to use each implementation strategy(gies): | ||
Adds guidance for which implementation strategy(ies) to include. | ||
▪ Marketing | ▪ Information | ▪ Learning |
▪ Commitment | ▪ Change Agents | ▪ Decision Support |
▪ Adaptation | ▪ Data | ▪ Organizational Infrastructure |
▪ Reinforcement | ||
Definition | ||
Provides detail for what each implementation strategy is addressing. It is not an operational definition (see action). | ||
Function(s) (43) | ||
Describes why the implementation strategy may work. | ||
▪ Education | ▪ Modeling | ▪ Coercion |
▪ Enablement | ▪ Incentivization | ▪ Training |
▪ Persuasion | ▪ Restrictions | ▪ Environmental restructuring |
Actor (30) | ||
Identifies who could best provide this implementation strategy. | ||
▪ Payer | ▪ Community stakeholders | ▪ Outside consultants |
▪ Clinicians | ▪ Administrators | ▪ Implementers (within organization) |
▪ Intervention developers | ▪ Patient | |
Target (42) | ||
Describes where each implementation strategy will impact. | ||
▪ Intervention/localized protocol | ▪ Characteristics of individuals | ▪ Outer setting |
▪ Process | ▪ Inner setting | |
Action procedure | ||
Provides directions for how to do each implementation strategy to improve their effectiveness. | ||
Considerations | ||
Addresses additional details for how to use each implementation strategy. |