Developing guideline-based quality indicators: assessing gaps in pain management practice.

Aim: In this article, the authors discuss a multiphase approach for developing quality indicators based on pain practice guidelines, and the challenges associated with the process. The presentation is based on previously published reporting standards for guideline-based quality indicators.

Methods: The following steps of the indicator development process were undertaken: topic selection; guideline selection; extraction of recommendations; quality indicator selection and practice test.

Ottawa Model of Implementation Leadership and Implementation Leadership Scale: mapping concepts for developing and evaluating theory-based leadership interventions.

Purpose: Leadership in health care is instrumental to creating a supportive organizational environment and positive staff attitudes for implementing evidence-based practices to improve patient care and outcomes. The purpose of this study is to demonstrate the alignment of the Ottawa Model of Implementation Leadership (O-MILe), a theoretical model for developing implementation leadership, with the Implementation Leadership Scale (ILS), an empirically validated tool for measuring implementation leadership. A secondary objective is to describe the methodological process for aligning concepts of a theoretical model with an independently established measurement tool for evaluating theory-based interventions.

Evidence-Based Practice in Clinical Nursing Education: A Scoping Review.

Background: Nursing students require education that integrates evidence-based practice (EBP) knowledge across classroom and clinical settings. This study was conducted to identify and examine the literature related to nursing students' use of evidence in clinical education and to identify associated research gaps.

Method: A scoping review describing the extent, range, and nature of the research activity focused on students' use of evidence in clinical education.

Multi-level barriers analysis to promote guideline based nursing care: a leadership strategy from home health care.

Background: Understanding the types of barriers that exist when implementing change can assist healthcare managers to tailor implementation strategies for optimal patient outcomes.

Aim: The aim of this paper is to present an organising framework, the Barriers Assessment Taxonomy, for understanding barriers to nurses' use of clinical practice guideline recommendations. Barriers to recommendations are illustrated using the Barriers Assessment Taxonomy and insights discussed.

Moving knowledge to action: a qualitative study of the Registered Nurses' Association of Ontario Advanced Clinical Practice Fellowship program.

Unlabelled: With funding from the Ontario Ministry of Health and Long-Term Care, the Registered Nurses' Association of Ontario (RNAO) established the Advanced Clinical Practice Fellowship (ACPF) program in 2000 to improve patient care and outcomes through advanced nursing knowledge and skills. This paper describes the perceptions of ACPF fellows regarding their influence on quality of care and patient outcomes, specifically, the types of practice change activities initiated, successful implementation and influence on outcomes, barriers encountered and strategies used to address them and influence change.

Methods: Thirty telephone interviews were conducted with ACPF fellows after completing their fellowship.

Developing leadership capacity for guideline use: a pilot cluster randomized control trial.

Significance: The importance of leadership to influence nurses' use of clinical guidelines has been well documented. However, little is known about how to develop and evaluate leadership interventions for guideline use.

Purpose: The purpose of this study was to pilot a leadership intervention designed to influence nurses' use of guideline recommendations when caring for patients with diabetic foot ulcers in home care nursing.

Impacting Canadian public health nurses' job satisfaction.

Objective: Workforce recruitment and retention challenges are being experienced in public health as in other Canadian health sectors. While there are many nurses working in public health, little research has been done about their job satisfaction. Job satisfaction is linked to recruitment, retention and positive client outcomes.

Implementation of clinical guidelines for adults with asthma and diabetes: a three-year follow-up evaluation of nursing care.

Aims And Objectives: To report on a three-year follow-up evaluation in Canada of nursing care indicators following the implementation of the Adult Asthma Care Best Practice Guideline and the Reducing Foot Complications for People with Diabetes Best Practice Guideline and to describe the contextual changes in the clinical settings.

Background: The Registered Nurses' Association of Ontario in Canada has developed and published more than 42 guidelines related to clinical nursing practice and healthy work environments. To date, evaluation has involved one-year studies of the impact of guideline implementation on the delivery of care in hospital and community settings, but little is known about whether changes in practice that were made during the initial implementation period have been sustained.

Knowledge to action: implementing a guideline for second stage labor.

Purpose: To quantify practice changes associated with implementing a clinical practice guideline for the second stage of labor in term nulliparous women with epidural anesthesia and to describe the lessons learned about knowledge translation. The main clinical practice guideline recommendation was waiting up to 2 hours before pushing after full dilatation.

Design And Methods: Pre- and post-evaluation of clinical outcomes and knowledge translation strategies associated with implementing the second stage of labor clinical practice guideline at two birthing units within a large teaching hospital.

Multidisciplinary collaborative maternity care in Canada: easier said than done.

Objective: To describe care provider attitudes towards multidisciplinary collaborative maternity care in Canada and the factors influencing such care from the perspective of members of national professional associations of care providers.

Methods: A qualitative descriptive approach was used. Leaders of national associations nominated key members, who were invited to participate in semi-structured telephone interviews.

Evaluation of a multiple component intervention to support the implementation of a 'Therapeutic Relationships' best practice guideline on nurses' communication skills.

Objective: To determine if there was an improvement in nurses' communication skills 5 months after a multiple component intervention to implement the Registered Nurses' Association of Ontario best practice guideline 'Establishing Therapeutic Relationships'.

Methods: A matched pair, before and after design was used. Eight client scenarios with corresponding client comments were read aloud to nurses who were asked to respond verbally, as though they were interacting with the client.

Sustaining rural maternity care--don't forget the RNs.

Introduction: Registered nurses provide intrapartum care to women who choose to have their babies in hospital. Considering the current national shortage of nurses, the ability of registered nurses to continue to care for women, especially in small rural hospitals, is a critical concern.

Purposes: The purposes of the study were 1) to conduct a systematic review of the maternal-child-nursing literature in rural locations; and 2) to identify one rural Ontario hospital where nurses and physicians deliver care to women with low-risk pregnancies, and then conduct an institutional ethnography to understand the enablers and barriers to low-risk rural maternity care.

Facilitating the use of evidence in practice: evaluating and adapting clinical practice guidelines for local use by health care organizations.

This article describes a framework for evaluating and adapting existing practice guidelines for local use by health care organizations and groups. The framework presents the major issues related to guideline adaptation and breaks them down into manageable steps. Many steps of the framework are illustrated using the process used by the Registered Nurses Association of Ontario to develop best practice guidelines for breastfeeding.

Sources and models for moving research evidence into clinical practice.

High quality research evidence for nursing practice is available from the Cochrane Library and in clinical practice guidelines produced by professional associations. The transfer of research evidence into practice is a complex process, and changing provider behavior is a challenge, even when the relative advantages are strong. An active approach with multifaceted interventions based on the assessment of barriers has been found most effective.

Labor support: nurses' self-efficacy and views about factors influencing implementation.

Objective: To develop and evaluate a questionnaire assessing nurses' self-efficacy for labor support and to describe nurses' perceptions of factors assisting and preventing the provision of labor support.

Design: Two surveys completed by participants.

Setting: Five Canadian hospitals.