Care Clinical Practice Research Articles

Appraisal of Clinical Care Practices for Child Obesity Treatment. Part I: Interventions.

The objective of this technical report is to provide clinicians with evidence-based, actionable information upon which to make assessment and treatment decisions for children and adolescents with obesity. In addition, this report will provide an evidence base to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) "What are clinically based, effective treatments for obesity?" and (KQ2) "What is the risk of comorbidities among children with obesity?" See Appendix 1 for the conceptual framework and a priori key questions.

Appraisal of Clinical Care Practices for Child Obesity Treatment. Part II: Comorbidities.

The objective of this technical report is to provide clinicians with actionable evidence-based information upon which to make treatment decisions. In addition, this report will provide an evidence base on which to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) "What are effective clinically based treatments for obesity?" and (KQ2) "What is the risk of comorbidities among children with obesity?" See Appendix 1 for the conceptual framework and a priori Key Questions.

How to improve interest for undergraduate nursing students working in primary health care.

To explore the association between the implementation of a new model of supervision and the impact of undergraduate nursing students' interest in working in primary health care. There is a need for more nurses in primary health care. To influence undergraduate nursing students to work in primary health care after graduation, the experience of their clinical practice in primary health care must be rewarding. In this study, we have implemented an alternative model of supervision for undergraduate nursing students in clinical practice, called 'strengthened supervision during clinical practice'. In this model, lectures from the university are responsible for giving support and tutoring the nurse supervisor in primary health care. Undergraduate nursing students in Norway (69) participated in an implementation of a new model for supervision in clinical practice. Thirty-one completed a questionnaire consisting of 15 questions. The questionnaire was analyzed using descriptive analyses. Undergraduate nursing students positively evaluated interactions with their fellow undergraduate nursing students in the primary health care setting. The undergraduate nursing students reported the nurse supervisor as most important for their perception of the practice site, followed by the work environment and their peers. When asked where they planned to work after graduation, very few undergraduate nursing students selected primary health care. It seems like aspects of the new model, 'strengthened supervision during clinical practice' are successful, but further research must be undertaken to explore whether this new model continues to be successful.

Application progress of dignity therapy in spiritual care of cancer patients

Through systematic literature review, this paper summarizes the current situation of spiritual care needs of cancer patients, clarifies the outline and evaluation tools of dignity therapy, and expounds the research and clinical practice of dignity therapy in spiritual care of cancer patients at home and abroad, the aim of the study is to provide a theoretical basis for the clinical practice of spiritual care in the Chinese mainland.

Best-practice recommendations to inform general practice nurses in the provision of dementia care: a Delphi study.

Worldwide, responsibility for dementia diagnosis and management is shifting to primary care, in particular to the general practitioner (GP). It has been acknowledged that primary care nurses, working collaboratively with GPs, have a role in dementia care by utilising their unique knowledge and skills. However, there are no best-practice guidelines or care pathways to inform nurses in general practice on what best-practice dementia care comprises and how to implement this into their practice. This study identified the recommendations in the Australian guidelines for dementia management most relevant to the role of the nurse working in general practice. Seventeen experts active in clinical practice and/or research in primary care nursing in general practice participated in an online three-round Delphi study. All 17 participants were female with a nursing qualification and experienced in general practice clinical nursing and/or general practice nursing research. Five recommendations were identified as the most relevant to the role of the nurse in general practice. These recommendations all contained elements of person-centred care: the delivery of individualised information, ongoing support, including the carer in decision-making, and they also align with the areas where GPs want support in dementia care provision. This novel study identified best-practice dementia care recommendations specific to nurses in general practice. These recommendations will inform a model of care for nurses in the provision of dementia care that supports GPs and better meets the needs of people living with dementia and their carer(s).

Step-Wise Management of Anemia in Patients With Chronic Kidney Disease in Primary Care: Qualitative Study.

Anemia is common in chronic kidney disease (CKD) and is associated with increased cardiovascular risk and reduced quality of life, but is often sub-optimally managed. Most patients are managed in primary care alongside other comorbidities. Interventions to improve the management of anemia in CKD in this setting are needed. We conducted a qualitative study to evaluate how an audit-based education (ABE) intervention might improve the management of anemia in CKD. We explored outcomes that would be relevant to practitioners and patients, that exposed variation of practice from National Institute for Health and Care Excellence (NICE) guidelines, and whether the intervention was feasible and acceptable. Practitioners (n = 5 groups) and patients (n = 7) from 4 London general practices participated in discussions. Practitioners welcomed the evidence-based step-wise intervention. However, prescribing erythropoiesis-stimulating agents (ESAs) was felt to be outside of their scope of practice. There was a gap between NICE guidance and clinical practice in primary care. Iron studies were not well understood and anemia management was often conservative or delayed. Patients were often unaware of having CKD, and were more concerned about their other comorbidities, but largely trusted their GPs to manage them appropriately. The first steps of the intervention were welcomed by practitioners, but they expressed concerns about independently prescribing ESAs. Renal physicians and GPs could develop shared care protocols for ESA use in primary care. There is scope to improve awareness of renal anemia, and enhance knowledge of guideline recommendations; and our intervention should be modified accordingly.

A Scoping Review of Highly Cited Published Articles in the Iranian Endodontic Journal: A Reflection of Trends in Endodontic Research.

Highly cited published articles play a critical role in shaping clinical practice, research directions, and advancements in a specific field of science. The current comprehensive scoping review aimed to provide an overview of highly cited articles published in the "Iranian Endodontic Journal" (IEJ), based on the IEJ's H-index (=29); highlighting their key findings and prominent implications in the field of endodontics. A systematic search was conducted in Scopus database to identify the top 29 highly cited published articles. The articles were selected based on their citation count (h-index); reflecting their impact and influence within the scientific community. Data extraction was performed to gather relevant information; including authors, titles, publication years, and the main topic(s) of each article. The selected highly cited published articles covered a broad range of endodontic topics; demonstrating the diversity and depth of research in the field. Key findings include significant contributions in vital pulp therapy, antimicrobial agents, root canal disinfection, regenerative techniques, cone-beam computed tomography applications, and intracanal medicaments. The distribution of research areas reflects the importance of evidence-based practice in clinical decision-making and patient care. These highly cited published articles have shown to have substantial impact on the field of endodontics. They have influenced clinical practice, guided research directions, and have improved patient care. The summary of key findings from each topic and the number of articles related to each area can provide readers with valuable insights into the distribution of research areas, and the significance of contributions made by the aforementioned highly cited published articles.

Application of Ultrasound in the Clinical Practice of Primary Health Care. Will Ultrasound Replace the Stethoscope?

Application of Ultrasound in the Clinical Practice of Primary Health Care. Will Ultrasound Replace the Stethoscope?

Effect of evidence-based care in continuous renal replacement therapy for severe pancreatitis and the effect on serum PCT, CRP levels, and CYP2C19 genotyping

This paper presents an in-depth study and analysis of evidence-based care in continuous renal replacement therapy for severe pancreatitis and examines the effects of serum procalcitonin (PCT), C-reactive protein (CRP) levels, and CYP2C19 genotyping. Eighty patients with severe pancreatitis who met the inclusion criteria were randomly assigned to the medium metabolic group and the slow metabolic group according to their CYP2C19 gene test results, and then the two groups were randomly divided into the control group and the observation group according to the different treatment regimens. Group 1 was CYP2C19 gene intermediate metabolism and was given to the control group; group 2 was CYP2C19 gene intermediate metabolism and was given to the observation group; group 3 was CYP2C19 gene slow metabolism and was given to the control group; group 4 was CYP2C19 gene slow metabolism and was given to the observation group. The number of cases in each group was 20, and follow-up was taken, but enteral nutrition also has some complications, such as feeding intolerance, if clinicians and nursing staff actively give effective care, it can significantly reduce the incidence of complications, and improve the value of enteral nutrition, shorten the hospitalization time, and improve the clinical prognosis. The relationship between serum CRP and PCT levels and Spatially Oriented Format for Acoustics (SOFA) score and the type of Virtual Access Point (VAP) pathogens and prognosis was investigated by Spearman correlation analysis. Finally, Pearson correlation analysis was used to investigate the relationship between serum CRP and PCT levels and SOFA scores in VAP patients. Based on the above analysis, the clinical value of CRP, PCT levels, and SOFA scores in VAP was evaluated. Several evidence-based guidelines were developed to provide clear recommendations and guidance for the preventive management of enteral nutrition feeding intolerance, but there is a gap between clinical care practice and the best evidence, so the best evidence was introduced. We compare the analysis of the test results with previously reported similar tests, and our results show good accuracy and higher efficiency.

Critical perspectives on rehabilitation education, practice and process: northern Honduras case study

BackgroundRehabilitation services are an integral part of patient care, but in many developing countries, they are not prioritized and either unavailable or easily accessible to those who need them. Although the need for rehabilitation services is increasing in Honduras, rehabilitation workers are not included in the health care model that guides the care provided to communities, particularly in rural and remote areas. To understand the need for providing impactful rehabilitation services in disadvantaged communities, we explored the education and perception of the community relating to rehabilitation, investigated training available for rehabilitation workers, and examined the rehabilitation processes and practices in Northern Honduras from stakeholders’ experiences.MethodsWe utilized a qualitative descriptive and interpretive approach grounded in case study methodology to understand rehabilitation education, process, and practice in Northern Honduras. Three rehabilitation centres were purposefully selected as the cases, and participants consisted of rehabilitation workers and managers from these centres. We collected data via interviews and focus group sessions. We analyzed the data via thematic analysis using NVivo version 12.ResultsIn Northern Honduras, rehabilitation workers' limited training and continuing education, along with awareness about rehabilitation by community members and other health providers influence rehabilitation care. Although policies and initiatives to support people with disabilities and the broader community in need of rehabilitation exist, most policies are not applied in practice. The sustainability of rehabilitation services, which is rooted in charity, is challenged by the small range of funding opportunities strongly affecting rehabilitation care processes and clinical practices. The lack of trust and awareness from the medical profession towards rehabilitation workers sets a major barrier to referrals, interdisciplinary work, and quality of life for individuals in need of rehabilitation.ConclusionThis study advances knowledge of the need to increase understanding of rehabilitation care among community members and health providers, improve care processes and resources, and foster interprofessional practice, to enhance the quality of care and promote equitable care delivery, especially in rural and remote communities.

1216. An Outbreak Investigation of Pulmonary Infections Caused by Mycobacterium abscessus in a Cardiothoracic Transplant Population

Abstract Background Nontuberculous mycobacteria (NTM) are environmental organisms that can form biofilms in municipal water systems and as such are difficult to eliminate. Mycobacterium abscessus is a rapid-growing NTM that can cause skin and soft tissue, disseminated, and pulmonary infections. M. abscessus is difficult to treat, often requiring prolonged therapy with several antibiotics due to its intrinsic drug resistance. In 2021, our institution identified a significant increase in pulmonary infections caused by M. abscessus in the cardiothoracic transplant population. Methods All M. abscessus cases among inpatients at our institution were extracted from the electronic medical record (EMR) between January 2019 and September 2021. Clinical characteristics were determined through EMR review and included demographics, transplant status, specimen type, COVID-19 history, and patient care practices involving water. A multidisciplinary team conducted an investigation to identify possible variations in practice related to the source of water used for clinical care activities in this identified population. Results Between January 2021 and September 2021, there were 12 cases of M. abscessus among inpatients at our institution compared to 6 cases in 2019 and 5 in 2020 (Figure 1). Between 2019 and 2020, post-heart and pre-/post-lung transplant patients comprised 9% of cases, 55% of cases were pulmonary infections, and none had a history of COVID-19 infection. In 2021, post-heart and pre-/post-lung transplant patients comprised 58% of cases, 83% of cases were pulmonary infections, and 33% of cases had a history of COVID-19 infection. There were varying sources of water utilized for the clinical care activities in this identified population (Table 1). Figure 1Mycobacterium abscessus epidemic curveTable 1Patient Care Practices Involving Water Conclusion To investigate the potential outbreak, we are actively collecting water samples and swabs from water fixtures in both patient and nourishment rooms for water culturing. To mitigate a potential water-borne source, we will use sterile water for all clinical care practices involving water and for all patient water drinking needs in the post-heart and pre-/post-lung transplant population impacted by the outbreak. The only use of tap water is hand hygiene and patient bathing. Disclosures Asra Salim, MPH, CPH, FAPIC, IRhythym Technologies Inc: Stocks/Bonds Valentina Stosor, MD, DiaSorin: Advisor/Consultant|Eli Lilly and Company: Grant/Research Support|Med Learning Group: Honoraria Michael P. Angarone, DO, Abbvie: Advisor/Consultant Michael G. Ison, MD MS, GlaxoSmithKlein: Grant/Research Support|Pulmocide: Grant/Research Support|Viracor Eurfins: Advisor/Consultant Janna L. Williams, MD, Abbvie: COVID19 Infection Prevention Consultant.

Second-year undergraduate nursing students’ experiences with clinical simulation training in mental health clinical practice: A focus group study

AimThe aim of this focus group study was to investigate second-year undergraduate nursing students’ experiences with clinical simulation training as part of their clinical practice in acute mental health care. BackgroundThe quality of bachelor programmes in nursing has been criticised for lacking theoretical and experiential learning in the mental health modules. Novice nurses feel unprepared to care for patients with mental health challenges and graduate nurses are reported to lack the necessary knowledge and skills to manage patients with mental health issues confidently and competently. Clinical simulation training can facilitate the teaching of clinical and non-clinical skills simultaneously and is a highly suitable method within mental health care for addressing gaps in knowledge and skills in communicating with patients. Clinical simulation training may enhance nursing students' competence and thereby reduce the risk of adverse events and increase safety. However, we know little about undergraduate nursing students’ experiences with clinical simulation training as an integrated part of nursing students’ clinical practice in acute mental health wards. DesignExplorative qualitative focus group study. MethodThree focus group interviews were conducted using a semi-structured interview guide with second-year undergraduate nursing students from a university in Norway during spring 2020. In total, 14 students who had experienced clinical simulation training as part of their mental health clinical practice participated in the study. The collected data were analysed using systematic text condensation. ResultsClinical simulation training as part of the clinical practice increased the students’ preparedness, coping and self-awareness. Most of the participants had positive perceptions of the use of high-fidelity simulation-based learning. Furthermore, they highlighted three elements that increased the value of the training. First, the simulation felt authentic and increased their professional skills. Second, the standardised patient had clinical qualifications, which made the simulation feel authentic and close to realistic situations. Third, not having a former relationship with the person acting as the standardised patient enhanced authenticity. ConclusionClinical simulation training as part of clinical practice contributed to increasing the students’ self-awareness and in-depth reflection and to broadening their nursing competence. The present study lays the groundwork for future studies on clinical simulation training in mental health clinical practice for nursing students.

Sleep Disturbance, Psychological Distress and Perceived Burden in Female Family Caregivers of Dependent Patients with Dementia: A Case-Control Study.

This case-control study analyzed the sleep disturbance, psychological distress and perceived burden in female family caregivers of dependent people with dementia (n = 74) compared with female family caregivers of dependent people without dementia (n = 74) and with age-matched non-caregiver control females (n = 74). Participants completed the Pittsburgh Sleep Quality Index (PSQI), the 12-item General Health Questionnaire (GHQ-12), the Caregiver Burden Inventory (CBI) and an ad hoc questionnaire to collect sociodemographic data. There were significant differences between the groups in PSQI total (F = 24.93; p < 0.001), psychological distress (F = 26.71; p < 0.001) and in all sleep domains assessed: subjective sleep quality (F = 16.19; p < 0.001), sleep latency (F = 9.5; p< 0.001), sleep duration (F = 18.57; p < 0.001), habitual sleep efficiency (F = 19.77; p < 0.001), sleep disturbances (F = 9.22; p < 0.001), use of sleep medications (F = 4.24; p< 0.01) and daytime dysfunction (F = 5.57; p < 0.01). In all measures, the female family caregivers of dependent people with dementia showed the significantly higher mean scores. Regarding the two groups of female caregivers, statistically significant differences were found in daily hours of care (t = -2.45; p < 0.05) and perceived burden (t = -3.65; p < 0.001), as well as in the following dimensions of caregiver burden: time-dependence burden (t = -5.09; p < 0.001), developmental burden (t = -2.42; p < 0.05) and physical burden (t = -2.89; p < 0.01). These findings suggest that female family caregivers of dependent patients with dementia should be subject to psychopathological screening and preventive cognitive-behavioral interventions in clinical practice in primary health care.

Dyadic associations between perceived social support and psychological well-being in caregivers and older care recipients.

Caregiving can be burdensome for both family caregivers and older care recipients (i.e., adults 75 years or older with care needs). This study aimed to determine dyadic associations between caregivers' and care recipients' perceived social support from others (e.g., family and friends) and psychological well-being as a dyad. Caregivers and care recipients (N = 215 dyads) in this cross-sectional study were recruited by pensioner trade unions in Italy. Both members of the dyad completed the World Health Organization-Five Well-Being Index (WHO-5). Social support was measured with the Carers of Older People in Europe Index for caregivers and the Oslo-3 Scale for care recipients. Dyadic data were analyzed with the actor-partner interdependence model. Caregivers' and care recipients' well-being was moderately correlated (r = 0.41, p < .01), with care recipients reporting significant lower well-being (MCR = 30.95 vs. MCG = 46.45). Social support perceived by the caregivers was positively associated with their own well-being (actor effect; β = 3.31, p < .001) and with the care recipients' well-being (partner effect; β = 0.58, p < .001). No significant care recipient actor and partner effects were detected. This study provided evidence on crossover effects between social support and well-being in caregiving dyads. Findings have implications for research and clinical practice in familial aged care. Family interventions targeted at the caregivers' broader social environment might enhance both dyad members' well-being. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PP27 Reusing And Adapting Health Technology Assessments (HTAs): An Example From The COVID-19 Time

IntroductionHealth technology assessment (HTA) reports are complex technical documents that address multiple aspects of the incorporation of a technology into the health care system applying complicated methodologies coming from different disciplines. The purpose of HTA is to support decision-makers and these should have an adequate level of training to fully understand these assessments. However, most HTA education programs and courses are intended for HTA doers and there is a lack of practical guidance training aimed at preparing health managers or policy makers in HTA. The objective is to describe an HTA training program developed for decision-makers of the three levels (health care administration, hospital management and clinical practice).MethodsRolling Collaborative Review (RCR) 01 of convalescent plasma was identified and selected because it complied with our Population Intervention Comparator Outcome Design Question. The EUnetHTA HTA adaptation Toolkit was used to check the relevance (about research question); reliability (quality of the report) and transferability (application of information to the target setting). Additional considerations regarding the local context were examined. A panel of four professionals and one patient was formed to rate the importance of the outcomes and to carry out the external reviewResultsAccording to the toolkit, information on RCR01 Convalescent Plasma could be adopted for the safety and effectiveness domains. The technical characteristics and current use domains were adapted and extended. It was considered of interest to include the domains of organization and ethics. The organizational aspects were answered through the information retrieved in a search for systematic reviews and guides, and with the collaboration of experts. The ethics domain was answered through a specific literature search on ethical issues related to COVID-19 and transfusions.ConclusionsThe use of the EUnetHTA Toolkit has been helpful in supporting the adaptation process. The adoption of the effectiveness and safety domains from already developed HTA assessments is an efficient way to provide useful information for the decision-making process. However, contextual elements should be included in the adaptation process to ensure a complete framework for the decision.

Study within a review (SWAR).

Study within a review (SWAR).

PP69 Supporting Decision Making: A Health Technology Assessment Training Proposal for Decision Makers

IntroductionHealth technology assessment (HTA) reports are complex technical documents that address multiple aspects of the incorporation of a technology into the healthcare system applying complicated methodologies coming from different disciplines. The purpose of HTA is to support decision makers, who should have an adequate level of training to fully understand these assessments. However, most HTA education programs and courses are intended for HTA doers and there is a lack of practical guidance training aimed at preparing health managers or policy makers in HTA. The objective is to describe an HTA training program developed for decision makers of the three levels (health care administration, hospital management and clinical practice).MethodsThe education program has been designed through a collaboration between the Public Health Department of the Faculty of Medicine of the University of Santiago de Compostela (USC) and the Galician Health Technology Assessment Agency that belongs to the Spanish HTA Bodies Network. The duration of the course is 200 hours and the methodology will be distance learning, through the virtual classroom of the USC. The teaching collaborators come from the academic field and the HTA area.ResultsThe course will cover the legal, clinical and organizational framework in which the HTA is developed in Spain and in Europe; and will approach the methodology used in HTA. The course is structured in six modules: (i) Research, development and regulation of health technologies; (ii) Role of HTA as a decision support tool; (iii) HTA Methodology; (iv) Health information systems (including use of real world data); (v) Incorporation of HTA into society (stakeholders); (vi) Future challenges (personalized medicine and e-health).ConclusionsA specific training about HTA from a practical approach not theoretical could be of interest for different stakeholders involved in the decision-making process across the health systems. This type of educational program will allow decision makers to have a good understanding of the wide range of information they handle.

Applying / Adapting the Rehabilitation Treatment Specification System for Documenting Standard Clinical Care

<h3>Research Objectives</h3> To describe methods for applying/adapting the Rehabilitation Treatment Specification System (RTSS) to specifying standard care clinical practice, as well as the challenges encountered and solutions. <h3>Design</h3> Iterative qualitative interviews. One coder produced RTSS specifications per videotaped voice and/or upper airway treatment session. This specification was sent to the treating speech-language pathologist (SLP) and two RTSS experts for feedback and iterative revisions until consensus was reached. <h3>Setting</h3> Outpatient voice centers in the United States: Massachusetts General Hospital, Emory University, New York University, University of Connecticut, and University of Wisconsin-Madison. <h3>Participants</h3> Five clinicians and two RTSS and voice rehabilitation experts watched a single videotaped treatment session for fifty-nine patients diagnosed with a voice and/or upper airway disorder(s). One non-SLP and RTSS expert read through the specifications. <h3>Interventions</h3> Standard care treatment for voice and/or upper airway disorder(s). <h3>Main Outcome Measures</h3> Consensus for each specification, where the clinicians reported no critical treatment aspects were missing, redundant, or incorrect and the RTSS experts reported correct use of the RTSS framework. <h3>Results</h3> Decision rules were developed to help specify Representations and Skills and Habits treatment components. Organ Functions treatment components were rarely identified in vocal rehabilitation. Two Representations specification difficulties were commonly encountered: (1) When did volition ingredients have their own targets versus added ingredients to a Skills and Habits target? and (2) When was information considered a volition versus feedback ingredient? For Skills and Habits, the most common difficulty was deciding which modified patient functions were mechanisms of action, the singular target, and/or aims of treatment. Also, commonly encountered, theory-driven variations in volition, feedback, and practice ingredients will be discussed. <h3>Conclusions</h3> An iterative process identified and addressed commonly encountered difficulties with creating RTSS specifications for standard care clinical practice. Broader implications for implementation into clinical practice will be discussed as well as next steps needed to further bridge the gap between theory and practice. <h3>Author(s) Disclosures</h3> No conflicts of interest to report.

Perceptions of racism in a children's psychiatric inpatient unit: A qualitative study of entrenching and uprooting factors.

We describe a systematic and orderly way to identify factors that contribute to entrenching racism as the status quo or that help to uproot it. By incorporating a racial equity lens, we can better understand daily racism and inform the optimal antiracist actions most relevant to an inpatient psychiatric setting. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Our two-domain/six-theme model may serve as a rubric for individuals to engage in structured self-reflection, for organizations in auditing or programmatic evaluation, or as scaffolding for difficult but frequently elided conversations. The unique strengths of a mental health environment can be harnessed toward the elimination of racism and racist practices in clinical care and in the workplace ABSTRACT: INTRODUCTION: It is well documented that racism plays a role in health care access and outcomes. However, discussions about racism in the inpatient psychiatric workplace are generally avoided. To address this gap, we incorporated a racial equity perspective into a qualitative study to better understand daily racism, its impact on patients and staff, and to inform optimal antiracist actions most relevant to inpatient psychiatric settings. We sought to identify factors that may contribute to or deter from racism to inform interventions to sustain a psychologically supportive environment for patients and staff. We conducted semistructured interviews using a purposive sample of 22 individuals in an acute child psychiatric inpatient service. We analysed transcripts using thematic analysis guided by a constructivist grounded theory conceptual framework. We identified two countervailing processes: (1) Entrenching-factors that sustain or increase racism: Predisposing, Precipitating, and Perpetuating and (2) Uprooting-factors that rectify or reduce racism: Preventing, Punctuating, and Prohibiting. We organized each of the elements into a '6P' model along a temporal sequence around sentinel racist events. For each of the six components we describe: Contributing Factors, Emotional Reactions, and Behavioural Responses as reported by participants. Identifying factors that entrench or uproot racism can inform specific steps to improve the care of all children and families on an inpatient child psychiatry unit. The two-domain/six-theme model we developed can serve as a rubric for individuals or milieu-based inpatient settings serving patients of any age to engage in structured self-reflection, auditing, program evaluation, or as scaffolding for difficult but frequently elided conversations.

From Evidence-Based Practice to Knowledge Translation: What Is the Difference? What Are the Roles of Nurse Leaders?

ObjectivesNurses, as the largest healthcare workforce, are well-positioned to apply knowledge translation. The role of nursing leadership in facilitating evidence-based practice has been extensively discussed in the literature, but this is not the case for knowledge translation. The objective of this study was to examine the potential role of nurse leaders in applying knowledge translation across health settings. Data SourcesWe reviewed the existing literature for evidence-based practice as best practice in clinical care; examined how a complex systems approach to knowledge translation may extend beyond evidence-based practice, and considered nursing leadership approaches including transformational leadership. ConclusionIn this discursive article, we discuss the differences between evidence-based practice and knowledge translation, highlight the promise of transformational leadership in facilitating knowledge translation through a complex systems lens, and argue for the importance of nurse leaders in facilitating and supporting complex knowledge translation across healthcare settings. Implications for Nursing PracticeAlthough future research is needed to test our ideas, we argue that the advanced conceptual understanding generated in this article should inform a roadmap toward a future in which nurse leaders initiate, participate and advocate for complex knowledge translation across healthcare settings.