Amanda Digel Vandyk

Turning Knowledge Into Action at the Point‐of‐Care: The Collective Experience of Nurses Facilitating the Implementation of Evidence‐Based Practice

Background: Facilitation is considered a way of enabling clinicians to implement evidence into practice by problem solving and providing support. Practice development is a well-established movement in the United Kingdom that incorporates the use of facilitators, but in Canada, the role is more obtuse. Few investigations have observed the process of facilitation as described by individuals experienced in guideline implementation in North America. AimTo describe the tacit knowledge regarding facilitation embedded in the experiences of nurses implementing evidence into practice. Methods: Twenty nurses from across Canada were purposively selected to attend an interactive knowledge translation symposium to examine what has worked and what has not in implementing evidence in practice. This study is an additional in-depth analysis of data collected at the symposium that focuses on facilitation as an intervention to enhance evidence uptake. Critical incident technique was used to elicit examples to examine the nurses’ facilitation experiences. Participants shared their experiences with one another and completed initial data analysis and coding collaboratively. The data were further thematically analyzed using the qualitative inductive approach of constant comparison. Results: A number of factors emerged at various levels associated with the successes and failures of participants’ efforts to facilitate evidence-based practice. Successful implementation related to: (a) focus on a priority issue, (b) relevant evidence, (c) development of strategic partnerships, (d) the use of multiple strategies to effect change, and (e) facilitator characteristics and approach. Negative factors influencing the process were: (a) poor engagement or ownership, (b) resource deficits, (c) conflict, (d) contextual issues, and (e) lack of evaluation and sustainability. Conclusions: Factors at the individual, environmental, organizational, and cultural level influence facilitation of evidence-based practice in real situations at the point-of-care. With a greater understanding of factors contributing to successful or unsuccessful facilitation, future research should focus on analyzing facilitation interventions tailored to address barriers and enhance facilitators of evidence uptake.

Frequent emergency department use by individuals seeking mental healthcare: a systematic search and review.

OBJECTIVE The aim of this study was to compare research on individuals who frequently use the ED for mental health complaints including parameters used to identify the population, as well as socio-demographic, clinical, and service use factors. METHODS Systematic search and review of Medline, Cinahl, PsycInfo, and HealthStar (1980 to 2011). Double-data extraction ensured accuracy. Descriptive statistics were reported. RESULTS Thirteen studies were included. Median sample size was 100. Parameters varied across studies. Profile: young, unemployed males living in transient accommodations, diagnosis of a psychotic disorder, self-referral to the ED for symptoms/unmet needs, and discharge to community resources. CONCLUSIONS Consistently used, meaningful definitions/parameters are needed.

Qualitative descriptive study exploring schizophrenia and the everyday effect of medication-induced weight gain.

Weight gain and obesity are serious side effects of the medications used to manage psychotic disorders and successful, long-term weight loss interventions are not yet available. One reason for this may be that current interventions are designed without consideration of the patients perspective. The purpose of this study was to explore the subjective experience of weight and lifestyle from the perspective of people with schizophrenia. A qualitative, constructivist research design was used and conversational interviews were conducted with 18 purposefully recruited participants from an outpatient clinic at a psychiatric hospital in Eastern Ontario. Data were analysed according to the method of constant comparison and three central themes emerged: a life altering diagnosis, weight management as complex, and todays experiences shape tomorrows outcomes. Weight management was seen as difficult yet important to the participants. The findings of this study provide insight into the views and opinions of the participants regarding weight and lifestyle and may be used to support the design of tailored heath initiatives for persons with mental illness.

Profiling Frequent Presenters to the Emergency Department for Mental Health Complaints: Socio-Demographic, Clinical, and Service Use Characteristics

BACKGROUND A small subset of individuals makes a disproportionate number of ED visits for mental health complaints. STUDY OBJECTIVES To explore the population profile and associated socio-demographic, clinical, and service use factors of individuals who make frequent visits (5+ annually) to hospital EDs for mental health complaints. METHODS Case-control study using electronic health record data. RESULTS Frequent presenters represented 3% of mental health ED patients and accounted for 18% of visits. Several factors were significantly associated with frequent ED use, including limited social support, documented personality disorder/traits, regular antipsychotic use, self-reported alcohol use, and having multiple referral sources.

Towards a conceptual consensus of continuity in mental healthcare: focused literature search and theory analysis

AIM While continuity of care is an important component in the provision of mental health services, a universally accepted definition is missing. There is a need to identify areas of consensus and discrepancy in continuity theory and provide a foundation for advancing measurement capabilities. The purpose of this study was to systematically identify and examine scholarship on continuity in mental healthcare. METHODS Using a focused literature review modelled on the Joanna Briggs Methodology for systematic reviews, MEDLINE, CINAHL, Embase, PsycINFO and Health STAR were searched from 1950 to 2011 for articles on the theoretical nature of continuity in mental healthcare. Included conceptualisations were subject to a theory analysis to critically examine similarities and differences. Next, a content analysis on the extracted data was used to identify a global understanding and set of theoretically defined concepts for the whole. Finally, the identified global concepts were compared with the original documents and to items identified on existing quantitative measurement tools to assess areas of consensus and discrepancy. RESULTS Seven documents describing the conceptualisation of continuity in mental healthcare were identified. From these, a deductive theoretical summary is proposed and theoretical consensus exists to support nine global concepts of continuity in mental healthcare. These global concepts include Longitudinality, Input & Individuality, Comprehensiveness, Flexible Consistency, Stability & Relationship, Accessibility, Information & Sharing, Realities, and Responsibility/Accountability. The original theories proposed by Dr Bachrach and colleagues and Dr Joyce and colleagues, as well as the ACSS-MH measurement tool, provide the best coverage of the proposed concepts. CONCLUSIONS Consensus exists across conceptualisations of continuity in mental healthcare, yet it is obscured by inconsistent use of language. Existing tools capture many of the associated concepts and elements, but none do so entirely. Further tool development and psychometric testing is needed. This study provides the foundational work required to advance research priorities in this area.

Perspectives from Academic Leaders of the Nursing Faculty Shortage in Canada

Abstract There is a world-wide shortage of nursing faculty, which is complicated by the need for French, English, and bilingual professors in Canada. The purpose of this qualitative study was to explore the current status and effects of the nursing faculty shortage on Canadian Schools of Nursing (SON) from a leadership perspective. We conducted semi-structured interviews with 12 Deans and Directors of Canadian Schools of Nursing. The participants spoke about the faculty shortage in terms of demand, supply, and strategies employed. The participants were concerned about the ramifications of some of the decisions deemed necessary for continued viability of their programs, such as over-assigning teaching workloads. In light of mass upcoming retirements, shortening the time to completion for PhD studies and making graduate education more accessible are important priorities.

Exploring the Experiences of Persons Who Frequently Visit the Emergency Department for Mental Health-Related Reasons:

In this qualitative study, the experiences of persons who frequently visit the emergency department (ED) for mental health-related reasons were explored. Interpretive Description guided the design, and data were collected through interviews with 10 adults who made 12+ ED visits within a 1-year time frame (2015). Thematic analysis was used to analyze data inductively. The participants’ experiences were described with the help of three themes emerging from the data: The Experience, The Providers, and Protective Factors. The participants felt compelled to come to hospital. For them, every visit was necessary, and dismissal of their needs by staff was interpreted as disrespect and prejudice. We noted differences in ED utilization patterns according to psychiatric diagnosis, and more research is needed to explore the phenomenon of frequent use by particular patient populations. Furthermore, health care providers implementing interventions designed to improve emergency care should consider tailored approaches rather than a one-size-fits-all strategy.

Using Facebook and LinkedIn to Recruit Nurses for an Online Survey

Social media is an emerging tool used by researchers; however, limited information is available on its use for participant recruitment specifically. The purpose of this article is to describe the use of Facebook and LinkedIn social media sites in the recruitment of nurses for an online survey, using a 5-week modified online Dillman approach. Within 3 weeks, we exceeded our target sample size (n = 170) and within 5 weeks recruited 267 English-speaking nurses (n = 172, Facebook; n = 95, LinkedIn). Advantages included speed of recruitment, cost-efficiency, snowballing effects, and accessibility of the researcher to potential participants. However, an analysis of the recruited participants revealed significant differences when comparing the sociodemographics of participants recruited through Facebook and LinkedIn, specifically relating to the characteristics of sex, age, and level of education. Differences between Facebook and LinkedIn as recruitment platforms should be considered when incorporating these strategies.

Critical care nurses’ experiences of withdrawal of treatment: A systematic review of qualitative evidence

BACKGROUND Death and dying is a reality of the clinical context of the intensive care unit. Death often follows a decision to withdraw life-sustaining treatments. Critical care nurses, are the primary care providers to patients and families at the end-of-life in the intensive care unit. OBJECTIVE To synthesize qualitative evidence on the experiences of critical care nurses who have cared for patients and families throughout the process of withdrawal of life-sustaining treatment. METHODS This was a systematic review and qualitative evidence synthesis modeled on the Joanna Briggs Methodology. Pre-defined keywords were searched for in Medline, CINAHL, PsycInfo, and Web of Science to locate studies published in the English, French, and Greek languages in any year. Two reviewers independently screened articles for congruence with eligibility criteria, engaged in data extraction, and assessed quality of the included studies. Meta-aggregation was performed to synthesize the findings. A protocol was developed by two members of the review team prior to initiation of the study. RESULTS Thirteen studies were included in the review, 12 qualitative and one mixed-methods. Four key themes were identified from the original research: Navigating Complexity and Conflict; Focusing on the Patient; Working with Families; and Dealing with Emotions Related to Treatment Withdrawal. Critical care nurses provide care to patients and families during the process of withdrawal of life-sustaining treatment which is described as complex and challenging. Despite the inherent challenges, nurses strive towards doing their utmost for patients and families.

Exploring the Experiences of Parent Caregivers of Adult Children With Schizophrenia: A Systematic Review

Abstract This is a qualitative evidence synthesis on the experiences of parents caring for their adult child with schizophrenia. The Joanna Briggs Methodology for systematic reviews guided the study and standard systematic review procedures were followed. Content analysis was used to synthesize findings from the five studies included into the following categories: ‘Resources,’ ‘Loss,’ ‘Psychological Distress,’ ‘Effects on Family,’ and ‘Framing the Experience.’ Findings suggest that parent caregivers struggle to navigate services and need greater support to protect their mental and physical health. From a research perspective, factors influencing parents’ abilities to stay engaged in caregiving warrant further exploration. HighlightsParent caregivers of adult children with schizophrenia experience significant losses related to their child and themselves.Navigating the mental health care system presents significant challenges to parent caregivers.Framing experiences in positive or meaningful ways can be helpful in coping with their care giving role.Parent caregivers ultimately require support in protecting their own mental and physical health.