Positive Changes In Practice Research Articles

GrazingFutures: learnings from a contemporary collaborative extension program in rangeland communities of western Queensland, Australia

Producer reliance on drought subsidies instead of proactive planning and timely destocking in low rainfall years has prompted Queensland government investment in promoting business and drought resilience. GrazingFutures (AU$6 million budget, 2016–2022) is an extension project focussed on enhancing business management skills of extensive livestock producers in western Queensland, Australia. The region’s rangelands are in productivity decline, span 1 million km2 and are managed by graziers operating more than 2400 livestock businesses (beef, sheep and goats). The Queensland Department of Agriculture and Fisheries delivers GrazingFutures as a component of the Drought and Climate Adaptation Program, in partnership with regional natural resource management groups and other public and private organisations. Project delivery emphasised upskilling multi-agency staff and livestock producers to promote practice change within three whole of business themes: (1) grazing land management; (2) animal production; and (3) people-business. Three independent surveys (2018, 2019, 2020) indicated positive practice change was occurring in grazing businesses as a consequence of the project. Graziers instigated management changes even under major environmental challenges including extended drought (2013–2020), an extreme flood event in 2019 and the COVID-19 pandemic in 2020. This paper details the rationale, progress against the objectives, challenges and future direction of the GrazingFutures extension project.

Building entrepreneurial researcher capacity to increase positive changes in practice

Background: Over the past decade, research-based and evidence-informed decision-making have played increasingly important roles in influencing educational policy and impacting practices in education. The dissemination, implementation and sustainability of research-to-practice are thus fruitful topics for discussion. Even though, as Oliver and Cairney (2019) report, there is no shortage of literature on the topic, many academics struggle with where to start. This entrepreneurial concept is based on the current literature and the author’s experiences working with an Ontario Ministry of Education in Canada initiative designed to promote a systems approach to building research-practitioner partnerships so as to mobilise findings into practice. Aims and objectives: This practice paper is meant to offer such a starting place. It introduces the concept of the `entrepreneurial researcher’ and provides concrete strategies by which contemporary researchers can develop entrepreneurial skills to plan, promote and mobilise their research and findings. In doing so, the researchers may arrive at a better understanding of self-actualization opportunities and move beyond the institutional barriers (i.e. academic institutions), that underlie and incentivise much of scholarly publication, to broaden their research focus and dissemination (Best and Holmes 2010). Key conclusions: We suggest a revised research process that includes the importance and application of collaborative planning, networking, partnerships and knowledge mobilisation processes. Also, recognizing the goals of many research agendas to improve and impact practice, we provide a list of recommendations for researchers to support greater transfer of research into practice.

Pilot implementation of elder-friendly care practices in acute care setting: a mixed methods study

BackgroundFrail older patients are at risk of experiencing a decline in physical and cognitive function unrelated to the reason for admission. The Elder-Friendly Care (EFC) program was designed to improve the care, experiences, and outcomes of frail older adults. The project supported 8 Early Adoption Sites (EAS) in a large Canadian healthcare organization by providing multiple strategies, educational opportunities, and resources. The purpose of this study was to assess the usefulness of EFC educational materials and resources, staff practice changes and perceptions in pilot sites, and readiness for scale and spread.MethodsThe study was conducted from May 2017 to June 2018 using a mixed-methods approach incorporating the Kirkpatrick Model of Training/Evaluation. A total of 76 Direct Care Staff participated in the staff survey, which assessed their awareness of, satisfaction with, and utilization of EFC principles, resources, and practices. Additionally, 12 interviews were conducted with staff who were directly involved in site implementation of EFC.ResultsMost survey participants were aware (86%, n = 63) of the EFC program, and 85% (n = 41) indicated they or their site/unit had implemented EFC. Out of these 41 participants, the most common practice changes identified were: incorporating alternatives to restraint (81%, n = 33), decreased use of pharmacological restraint (78%, n = 32), and patient and family care planning (76%, n = 31). Participants that attended all 3 EFC Learning Workshops (LWs) were significantly more likely to recommend the EFC Toolkit to others (87% versus 40%; χ2 = 8.82, p < 0.01) compared to participants attending less than 3 EFC LWs. Interview participants indicated that the program was well structured and flexible as sites/units could adopt changes that suited their individual sites, needs, contexts, and challenges.ConclusionsThe educational materials and resources used for the EFC project are useful and appreciated by the Direct Care Staff. Further, participants perceive the EFC intervention as effective in creating positive practice change and useful in reducing hospital-related complications for older patients. Future implementation will investigate the impact of EFC on system-level outcomes in acute care.

Systemwide Practice Change Program to Combat Hospital-Acquired Pressure Injuries

Considerable evidence exists on how to prevent hospital-acquired pressure injuries (HAPIs). However, processes employed to implement evidence play a significant role in influencing outcomes. One Australian health district experienced a substantial increase in HAPIs over a 5-year period (by almost 60%) that required a systemwide practice change. This article reports on the people, processes, and learnings from using the Promoting Action on Research Implementation in Health Services (PARiHS) framework taking into account the evidence, context, and facilitation to address HAPIs. Applying this approach resulted in a significant decrease in pressure injuries and positive practice change, leading to improved patient outcomes in a shorter time frame than previous strategies. Processes guided by the PARiHS enhanced the effectiveness of translating evidence into practice and positively assisted clinicians to promote optimal patient care. This approach is transferrable to other health care settings.

Oncology practice changes during a multistep Oncology Care Model practice transformation project.

88 Background: Treatment of lung cancer has seen a paradigm shift in recent years. While the availability of newer treatment options such as targeted therapy and immunotherapy have provided new hope for better outcomes, this has added to the cost of care. Participation in the Center for Medicare Services’ Oncology Care Model (OCM) provides opportunities for oncology practices to identify practice transformation (PT) change strategies that result in improved quality of care (QOL) and cost savings. Methods: A lung cancer PT team convened to facilitate changes that improve patient outcomes and decrease costs at an OCM organization. The year-long project included clinical treatment updates, quantitative and qualitative assessments, and data sharing. Practice changes focused on biomarker driven treatment selection, nurse navigation to better manage symptoms and decrease emergency department (ED) visits and hospitalizations, and earlier advanced care planning (ACP) discussions. Surveys were completed by oncology physicians and nurse practitioners at baseline (n = 9) and end of the project (n = 7). Results: After education, there were more correct responses in 3 of 6 knowledge questions and providers noted less concern about performance status or co-morbidities when prescribing immunotherapy. Providers noted fewer barriers with biomarker documentation; self-reported confidence in 4 questions of biomarker selection was unchanged. Providers reported increased participation of nurse navigators to impact ED visits and hospitalizations over time. Documentation of ACP discussions increased, 42% (8/19) to 56% (13/23), but did not reach statistical significance due to sample size. Although providers reported changes toward earlier ACP discussions, 1 in 3 still wait until performance status declines to initiate discussion. Conclusions: Systematic PT can improve quality of patients care and measures used in value-based care reimbursement models. Providers need ongoing education, practice feedback, and organizational support to effect positive practice changes. In addition, new strategies to increase provider ability to initiate end of life discussions need to be explored.

Sustainable Aquaculture Futures

Sustainable Aquaculture Futures

HSR19-098: Opportunities and Challenges of Managing Breakthrough Cancer Pain (BTCP): An Educational Exercise

Background: Cancer pain is one of the most feared symptoms of cancer and is usually moderate to severe in intensity, particularly in later stages. Opioids are the mainstay maintenance treatment of chronic cancer-related pain. However, between one third and two thirds of cancer patients treated with opioids still experience episodes of severe and debilitating pain known as breakthrough cancer pain (BTCP). Given the number of available treatment approaches for BTCP, healthcare professionals (HCPs) need guidance in selecting the treatment that best meets their patient’s needs and provide the best opportunity for a positive outcome. Aim: Describe the pathophysiology and characteristics of BTCP, its prevalence, and the negative impact on patients. Discuss the characteristics of ideal BTCP treatments and available options. Evaluate the concepts of dependence, addiction, and diversion; ways to minimize risk in cancer patients using opioids; and strategies to address issues. Apply shared decision-making resources to improve collaboration with clinician and patient for optimal BTCP management outcomes by providing best standard of care. Methods: 12 live expert faculty meetings held in oncology/hematology departments in community hospitals, regional cancer centers, and academic centers nationwide from November 17, 2017–June 01, 2018 (Table 1). Target audience of hematologists/oncologists, oncology nurses, physician assistants (PAs), nurse practitioners (NPs), palliative care physicians, pain management specialists, pharmacists, and other HCPs involved in the treatment of patients with BTCP. Results: Overall participation: 321 (anticipated 265; 186 CME completers); 193 oncology MDs; 61 oncology nurses/NP; 17 pharmacists; 22 PAs; 28 other HCPs interested in BTCP. Pre/post-test and 90-day follow-up surveys assessed. 0% commercial bias. Satisfaction of program rated 97%–100%; 96% intend to apply what they acquired to their practice; 97% have a strategy to combat BTCP; 99% are better able to describe BTCP and its negative impact on patients; 98% can better evaluate dependence, addiction, and diversion and to minimize risk of using opioids. +35% average pre- to post-test change with 4 of 5 questions achieving a P≤.0001 at 90-day follow-up. 72% of participants implemented practice changes by 90-day follow-up. Conclusion: Results suggest that participation in this activity is associated with increased competence and positive practice changes for BTCP.

The Impact of Professional Development on Library Faculty Attitudes, Practices, and Knowledge of Student Learning Assessment

In order to align with university-wide assessment initiatives and to promote a systematic approach to one-shot assessment within our library, a team of five librarians participated in a campus-wide professional development program about student learning assessment. We then implemented library-specific professional development about student learning assessment for one-shot instruction. We provide an overview of the professional development program and discuss our study that explored the impact of the program on librarians’ knowledge, skills, and attitudes about student learning assessment. Our findings indicate that faculty participants had a positive change in practice, knowledge, and attitude after participating in the professional development program.

CPD and revalidation: Theory, practice and lessons from teachers

As part of the revalidation process, midwives are required to undertake 35 hours of continuing professional development (CPD), of which 20 must be ‘participatory’. Participatory learning includes any learning activity that involves interaction with other people, providing the opportunity to learn with and from each other. Participation can take place face-to-face such as attendance at a study day or conference; or virtually, such as an online discussion group using a social media platform. As oposed to a didactic methods, a participatory approach to ongoing professional development is more likely to lead to positive changes in practice and thus better levels of care. This article will look at the theory of CPD and compare CPD activities of midwives and teachers to consider how ‘teacher research’ might be adopted by midwives, with the potential for service improvement and better quality of care as a consequence.

MP19: Interprofessional airway microskill checklists facilitate the deliberate practice of direct intubation with a bougie and airway manikins

Introduction: Deliberate practice (DP) is the evolution of practice using continually challenging and focused practice on a particular task. DP involves immediate feedback, time for problem-solving and evaluation, and opportunities for repeated performance. Mircroskills training breaks down larger tasks into multiple smaller subtasks and then adds opportunities for feedback and adjustment for each subtask. Microskills training is routinely used to achieve excellence in competitive sports, martial arts, military operations, and music. Endotracheal intubation is a complex task with a clinically significant complication and failure rate. Methods: Two doctors and three nurses developed stepwise team microskills checklist from case review, simulations and published evidence. The checklist was tested, evaluated and developed during four days of simulation faculty team training. The final 36 item checklist was used to facilitate skills training for doctors, nurses, respiratory therapists and ACPs in one level 2, and two level 3 trauma centers from April 2017 to October 2017. The microskills checklist was used in four phases: 1. Group discussion of each microskill step 2. Groups of three team members; operator, assistant and microskill facilitator (using the checklist) to enable the deliberate analysis of the teams current performance. Each subtask is performed with immediate peer and where necessary faculty feedback. Changes are recorded. 3. Total task run though without interruption. Changes are recorded. 4. Repetition and feedback using different team members, manikins, including time pressure. User satisfaction surveys were collected after the skills training session Results: Results. Teams were composed of Registered Nurses (8), Physicians (9), and Respiratory Therapists (2). All of the teams experienced a change in practice. The median number of microskills changed for MDs 13/30, RNs 7/16. The commonest changes in practice were patient positioning (all teams). All professions agreed strongly that the approach produces a positive change in practice (median score 4.8/5). Conclusion: Microskills checklist facilitate endotracheal intubation with a bougie skill development in interprofessional teams in this provisional analysis.

P048: Interprofessional airway microskill checklists facilitate the deliberate practice of surgical cricothyrotomy with 3-D printed surgical airway trainers

Introduction: Deliberate practice (DP) is the evolution of practice using continually challenging and focused practice on a particular task. DP involves immediate feedback, time for problem-solving and evaluation, and opportunities for repeated performance. Microskills training breaks down larger tasks into multiple smaller subtasks and then adds opportunities for feedback and adjustment for each subtask. Microskills training is routinely used to achieve excellence in competitive sports, martial arts, military operations, and music. Surgical cricothyrotomy is a rarely performed safety critical task. Methods: Two doctors and three nurses developed stepwise team microskills checklists from case review, simulations and published evidence. The checklist was tested, evaluated and developed during four days of simulation faculty team training. The final 30 item checklist was used to facilitate skills training for doctors, nurses, respiratory therapists and ACPs in one level 2, and two level 3 trauma centers from April 2017 to October 2017. Commonly available airway trainers were retrofitted with the 3-D printed larynx. The microskills checklist was used in four phases: 1. Group discussion of each microskill step; 2. Groups of three team members; operator, assistant and microskill facilitator (using the checklist) to enable the deliberate analysis of the teams current performance. Each subtask is performed with immediate peer and where necessary faculty feedback - changes are recorded; 3. Total task run through without interruption - changes are recorded; 4. Repetition and feedback using different team members, manikins, including time pressure. User satisfaction surveys were collected after the skills training session Results: Teams were composed of Registered Nurses (8), Physicians (9), and Respiratory Therapists (2). All of the teams experienced a change in practice. The median number of microskills changed for MDs 12/21, RNs 6/12. The commonest changes in practice were equipment preparation (all teams). All professions agreed strongly that the approach produces a positive change in practice (median score 5/5). Conclusion: Microskills checklists facilitate cricothyrotomy skill development in interprofessional teams in this provisional analysis.

2.10-P16How coordinated actions between a federal authority and cantonal health care institutions can generate positive practice changes relevant to the health of forced migrants: barriers and facilitators, based on the Swiss Hospitals for Equity Network in Switzerland

2.10-P16How coordinated actions between a federal authority and cantonal health care institutions can generate positive practice changes relevant to the health of forced migrants: barriers and facilitators, based on the Swiss Hospitals for Equity Network in Switzerland

Validation of Multisource Feedback in Assessing Medical Performance: A Systematic Review.

Over the past 10 years, a number of systematic reviews have evaluated the validity of multisource feedback (MSF) to assess and quality-assure medical practice. The purpose of this study is to synthesize the results from existing reviews to provide a holistic overview of the validity evidence. This review identified eight systematic reviews evaluating the validity of MSF published between January 2006 and October 2016. Using a standardized data extraction form, two independent reviewers extracted study characteristics. A framework of validation developed by the American Psychological Association was used to appraise the validity evidence within each systematic review. In terms of validity evidence, each of the eight reviews demonstrated evidence across at least one domain of the American Psychological Association's validity framework. Evidence of assessment validity within the domains of "internal structure" and "relationship to other variables" has been well established. However, the domains of content validity (ie, ensuring that MSF tools measure what they are intended to measure); consequential validity (ie, evidence of the intended or unintended consequences MSF assessments may have on participants or wider society), and response process validity (ie, the process of standardization and quality control in the delivery and completion of assessments) remain limited. Evidence for the validity of MSF has, across a number of domains, been well established. However, the size and quality of the existing evidence remains variable. To determine the extent to which MSF is considered a valid instrument to assess medical performance, future research is required to determine the following: (1) how best to design and deliver MSF assessments that address the identified limitations of existing tools and (2) how to ensure that involvement within MSF supports positive changes in practice. Such research is integral if MSF is to continue to inform medical performance and subsequent improvements in the quality and safety of patient care.

Training and Mentoring End-of-Life Nursing Education Consortium (ELNEC) Educators in India

India is the world's most populous nation with an estimated 1 million new cases of cancer a year, yet less than 1% has access to palliative care. There are excellent centers offering palliative care but not enough to meet the need for education and care. Nurses outnumber physicians in India and are essential in building a strong national palliative care program. This pilot project has aimed to use a culturally adapted version of End-of-Life Nursing Education Consortium train-the-trainer and distance mentoring to enable trainees to educate nurses in their institution. A secondary goal was to evaluate the training on nurses' knowledge and attitudes to pediatric palliative care and pain management. The 2-day train-the-trainer End-of-Life Nursing Education Consortium seminars, with online mentoring between the sessions, provided palliative care education for 26 nurse trainers from across India. A pretest and posttest showed an increase in knowledge and a positive change in practice. Because of lack of reliable computer access for the nurses, mentoring was conducted online via Facebook. There were good results including multiple trainings across India and important lessons learned from this pilot project to help international training and mentoring projects.

Experiences of and support for nurses as second victims of adverse nursing errors: a qualitative systematic review.

Second victims are clinicians who have made adverse errors and feel traumatized by the experience. The current published literature on second victims is mainly representative of doctors, hence nurses' experiences are not fully depicted. This systematic review was necessary to understand the second victim experience for nurses, explore the support provided, and recommend appropriate support systems for nurses. To synthesize the best available evidence on nurses' experiences as second victims, and explore their experiences of the support they receive and the support they need. Participants were registered nurses who made adverse errors. The review included studies that described nurses' experiences as second victims and/or the support they received after making adverse errors. All studies conducted in any health care settings worldwide. The qualitative studies included were grounded theory, discourse analysis and phenomenology. A structured search strategy was used to locate all unpublished and published qualitative studies, but was limited to the English language, and published between 1980 and February 2017. The references of studies selected for eligibility screening were hand-searched for additional literature. Eligible studies were assessed by two independent reviewers for methodological quality using a standardized critical appraisal instrument from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI QARI). Themes and narrative statements were extracted from papers included in the review using the standardized data extraction tool from JBI QARI. Data synthesis was conducted using the Joanna Briggs Institute meta-aggregation approach. There were nine qualitative studies included in the review. The narratives of 284 nurses generated a total of 43 findings, which formed 15 categories based on similarity of meaning. Four synthesized findings were generated from the categories: (i) The error brings a considerable emotional burden to the nurse that can last for a long time. In some cases, the error can alter nurses' perspectives and disrupt workplace relations; (ii) The type of support received influences how the nurse will feel about the error. Often nurses choose to speak with colleagues who have had similar experiences. Strategies need to focus on helping them to overcome the negative emotions associated with being a second victim; (iii) After the error, nurses are confronted with the dilemma of disclosure. Disclosure is determined by the following factors: how nurses feel about the error, harm to the patient, the support available to the nurse, and how errors are dealt with in the past; and (iv) Reconciliation is every nurse's endeavor. Predominantly, this is achieved by accepting fallibility, followed by acts of restitution, such as making positive changes in practice and disclosure to attain closure (see "Summary of findings"). Adverse errors were distressing for nurses, but they did not always receive the support they needed from colleagues. The lack of support had a significant impact on nurses' decisions on whether to disclose the error and his/her recovery process. Therefore, a good support system is imperative in alleviating the emotional burden, promoting the disclosure process, and assisting nurses with reconciliation. This review also highlighted research gaps that encompass the characteristics of the support system preferred by nurses, and the scarcity of studies worldwide.

Policy Delivery Strategies for Education Reform: A Formative Research and Development

Thailand education reform in the first decade (1999-2009) seemed to be unsuccessful, partly because of the predominant use of top-down policy delivery strategies. This report aims to develop new delivery strategies for education reform policy for practitioners, especially teachers. Using concepts of assessment-based education reform and university-and-school collaboration, the present study employed a formative research and development methodology to develop and examine policy delivery strategies during 2011-2013. All strategies proposed here were the synthesized results from subprojects of the study. Findings of the study lead to several policy recommendations. It is highly recommended for Thailand education reform to establish policy delivery units. Results also suggest concepts and activities for empowering teachers. After using such strategies in the participated schools, positive changes in practice of school teachers and students were noticeable.

American society for parenteral and enteral nutrition (a.s.p.e.N.) standards of practice for nutrition support pharmacists.

American society for parenteral and enteral nutrition (a.s.p.e.N.) standards of practice for nutrition support pharmacists.

Anesthesia report card - a customizable tool for performance improvement.

Measuring and providing performance feedback to physicians has gained momentum not only as a way to comply with regulatory requirements, but also as a way to improve patient care. Measurement of structural, process, and outcome metrics in a reliable, evidence-based, specialty-specific manner maximizes the probability of improving physician performance. The manner in which feedback is provided influences whether the measurement tool will be successful in changing behavior. We created an innovative reporting tool template for anesthesiology practitioners designed to provide detailed, continuous feedback covering many aspects of clinical practice. The literature regarding quality metric measurement and feedback strategies was examined to design a reporting tool that could provide high quality information and result in improved performance of clinical and academic tasks. A committee of department leaders and information technology professionals was tasked with determining the measurement criteria and infrastructure needed to generate these reports. Data was collected in a systematic, unbiased manner, and reports were populated with information from multiple databases and software systems. Feedback would be based on frequently updated information and allow for analysis of historical performance as well as comparison amongst peers. A template for an anesthesia report card was created. Categories included compliance, credentialing and qualifications, education, clinical and operating room responsibilities, and academic achievements. Physicians were able to choose to be evaluated in some of the categories and had to meet a minimum number of criteria within each category. This allowed for customization to each practitioner's practice. Criteria were derived from the measures of academic and clinical proficiency, as well as quality metrics. Criteria were objective measures and data gathering was often automated. Reports could be generated that were updated daily and provided historical information, and information about peers in the department and within each subspecialty group. We demonstrate the creation of an online anesthesia report card that incorporates metrics most likely to engender positive changes in practice and academic responsibilities. This tool provides timely and customized information for each anesthesia practitioner, designed to be easily modifiable to improve the quantity, quality, and substance of metrics being measured. Finally, our tool could serve as a template for a performance measuring tool that can be customizable to a wide variety of practice settings, and upon which both monetary and non-monetary incentives might be based in the future.

Reversing the Telescope: Evaluating NGO Peer Regulation Initiatives

AbstractThis article investigates perceptions of the extent to which non‐governmental organization (NGO) peer regulation initiatives have been effective in enhancing accountability in the humanitarian sector. It is based upon semi‐structured interviews with individuals with responsibility for accountability policy from leading NGOs and focuses on two of the best‐known initiatives: Humanitarian Accountability Partnership and Sphere. It finds that the initiatives have prompted positive changes in practice, but there are significant concerns about their deleterious impacts. Participants describe a host of challenges, including the tendency of peer regulation to become excessively bureaucratic and labour intensive. They cast some doubt on the potential of the initiatives to assist NGOs to be more accountable to affected communities. Copyright © 2014 John Wiley &amp; Sons, Ltd.

Progress made towards enhancement of rheumatology education and practice in Zambia: review of an ILAR-supported project.

The burden of non-communicable diseases such as musculoskeletal diseases in the developing world is often overshadowed by the more prevalent infectious diseases. Generally, there is gross underestimation of the burden of rheumatologic disease in the backdrop of scanty or indeed non-existent rheumatology services in these countries. Local studies conducted in the last two decades in Zambia have documented the increasing burden of rheumatologic conditions in the country. There are unfortunately negligible rheumatology services in the country both at tertiary or primary health-care facility levels. There is thus an urgent need to build capacity for these services so as to improve the care and management of rheumatic conditions. Here, we review progress made by an International League of Associations for Rheumatology (ILAR)-supported project that has run for the past 2 years (2012–2013) with the objective of enhancing paediatric and adult rheumatology education and practice so as to stimulate positive change in practice and related care services in Zambia. During this short time of the project, substantial progress has been made in the areas of paediatric and adult rheumatology services enhancement at the University Teaching Hospital, Lusaka: streamlining of referrals and follow-ups of rheumatology patients, laying foundations for short- and long-term medical education in rheumatology and raising public awareness of rheumatic diseases. The progress made by this grant underscores the suitability of the ILAR mission statement “think global, act local” demonstrating that even with minimum resources and networking, improvement of rheumatology care in developing countries is attainable.