scholarly journals Protocol for Implementation of an Evidence Based Parentally Administered Intervention for Preterm Infants

2020 ◽  
Author(s):  
Rosemary C White-Traut ◽  
Debra Brandon ◽  
Karen Kavanaugh ◽  
Karen Gralton ◽  
Wei Pan ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Behavioral Interventions ◽  
Neonatal Intensive Care ◽  
Developmental Trajectories ◽  
Implementation Process ◽  
Routine Care ◽  
Individual Characteristics ◽  
Successful Implementation ◽  
Evidence Based ◽  
Facilitators And Barriers

Abstract BackgroundMulti-sensory behavioral interventions for preterm infants have the potential to accelerate feeding, growth, and optimize developmental trajectories and increase parents’ interactive engagement with their infants. However, few neonatal intensive care units (NICUs) provide evidence-based standardized early behavioral interventions as routine care. Lack of implementation is a major gap between research and clinical practice. H-HOPE, is a standardized behavioral intervention with an infant- directed component (Massage+) and a parent-directed component (four participatory guidance sessions that focus on preterm infants’ behaviors and appropriate responses). H-HOPE has well documented efficacy. The purpose of this implementation study is to establish H-HOPE as the standard of care in 5 NICUs. MethodsThe study employs a Type 3 Hybrid design to simultaneously examine the implementation process and effectiveness in five NICUs. To stagger implementation across the clinical sites, we use an incomplete stepped wedge design. The five participating NICUs were purposively selected to represent different acuity levels, number of beds, locations and populations served. Our implementation strategy integrates our experience conducting H-HOPE and a well-established implementation model, the Consolidated Framework for Implementation Research (CFIR). The CFIR identifies influences (facilitators and barriers) that affect successful implementation within five domains: intervention characteristics, outer setting (the hospital and external events and stakeholders), inner setting (NICU), implementers’ individual characteristics, and the implementation process. NICUs will use the CFIR process, which includes three phases: Planning and Engaging, Executing, and Reflecting and Evaluating. Because sustaining is a critical goal of implementation, we modify the CFIR implementation process by adding a final phase of Sustaining.DiscussionThis study builds on the CFIR, adding Sustaining H-HOPE to observe what happens when sites begin to maintain implementation without outside support, and extends its use to the NICU acute care setting. Our mixed methods analysis systematically identifies key facilitators and barriers of implementation success and effectiveness across the five domains of the CFIR. Long term benefits have not yet been studied but may include substantial health and developmental outcome for infants, more optimal parent-child relationships, reduced stress and costs for families, and substantial indirect societal benefits including reduced health care and special education costs.Trial registrationClinicalTrials.gov registration number NCT04555590, Registered on 8/19/2020

scholarly journals Protocol for implementation of an evidence based parentally administered intervention for preterm infants

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rosemary White-Traut ◽  
Debra Brandon ◽  
Karen Kavanaugh ◽  
Karen Gralton ◽  
Wei Pan ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Behavioral Interventions ◽  
Neonatal Intensive Care ◽  
Developmental Trajectories ◽  
Implementation Process ◽  
Routine Care ◽  
Individual Characteristics ◽  
Successful Implementation ◽  
Evidence Based ◽  
Facilitators And Barriers

Abstract Background Multi-sensory behavioral interventions for preterm infants have the potential to accelerate feeding, growth, and optimize developmental trajectories and increase parents’ interactive engagement with their infants. However, few neonatal intensive care units (NICUs) provide evidence-based standardized early behavioral interventions as routine care. Lack of implementation is a major gap between research and clinical practice. H-HOPE, is a standardized behavioral intervention with an infant- directed component (Massage+) and a parent-directed component (four participatory guidance sessions that focus on preterm infants’ behaviors and appropriate responses). H-HOPE has well documented efficacy. The purpose of this implementation study is to establish H-HOPE as the standard of care in 5 NICUs. Methods The study employs a Type 3 Hybrid design to simultaneously examine the implementation process and effectiveness in five NICUs. To stagger implementation across the clinical sites, we use an incomplete stepped wedge design. The five participating NICUs were purposively selected to represent different acuity levels, number of beds, locations and populations served. Our implementation strategy integrates our experience conducting H-HOPE and a well-established implementation model, the Consolidated Framework for Implementation Research (CFIR). The CFIR identifies influences (facilitators and barriers) that affect successful implementation within five domains: intervention characteristics, outer setting (the hospital and external events and stakeholders), inner setting (NICU), implementers’ individual characteristics, and the implementation process. NICUs will use the CFIR process, which includes three phases: Planning and Engaging, Executing, and Reflecting and Evaluating. Because sustaining is a critical goal of implementation, we modify the CFIR implementation process by adding a final phase of Sustaining. Discussion This study builds on the CFIR, adding Sustaining H-HOPE to observe what happens when sites begin to maintain implementation without outside support, and extends its use to the NICU acute care setting. Our mixed methods analysis systematically identifies key facilitators and barriers of implementation success and effectiveness across the five domains of the CFIR. Long term benefits have not yet been studied but may include substantial health and developmental outcomes for infants, more optimal parent-child relationships, reduced stress and costs for families, and substantial indirect societal benefits including reduced health care and special education costs. Trial registration ClinicalTrials.gov registration number NCT04555590, Registered on 8/19/2020.

Staff Training Aimed at Reducing Rearrest: Probation officer attitudes and experiences

2020 ◽  
Vol 12 (3) ◽  
pp. 238-264
Author(s):  
Jill Viglione ◽  
Lucas M Alward ◽  
DeCarlos L Sheppard
Keyword(s):  
Staff Training ◽  
Implementation Process ◽  
Probation Officer ◽  
Community Supervision ◽  
Successful Implementation ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Facilitators And Barriers ◽  
Training Programmes ◽  
Officer Attitudes

Community correction organisations have recognised the importance of implementing evidence-based practices to improve probation practice and reduce recidivism rates. Research finds when probation agencies implement evidence-based practices in line with the Risk, Need, Responsivity model with fidelity, reductions in recidivism are possible. However, challenges of implementation persist. To assist in the translation of evidence-based practices to real-world practice, researchers and practitioners developed community supervision officer training programmes. Using qualitative interview data of trained federal probation officers, this study examined the implementation of the Staff Training Aimed at Reducing Rearrest. This study explored (1) probation officer attitudes and perceptions of Staff Training Aimed at Reducing Rearrest, training and implementation process; (2) how users and coaches implement key components of Staff Training Aimed at Reducing Rearrest; and (3) the organisational facilitators and barriers associated with Staff Training Aimed at Reducing Rearrest implementation. Findings suggest positive attitudes towards Staff Training Aimed at Reducing Rearrest for improving supervision process and highlight key facilitators and barriers that can be addressed to support successful implementation efforts.

Evidence-based eHealth interventions for caregivers of people with dementia (Myinlife and Partner in Balance): Evaluation of implementations in municipality contexts (Preprint)

2020 ◽  
Author(s):  
Hannah Liane Christie ◽  
Lizzy Mitzy Maria Boots ◽  
Huibert Johannes Tange ◽  
Frans Rochus Josef Verhey ◽  
Marjolein Elizabeth de Vugt
Keyword(s):  
Self Efficacy ◽  
Measurement Instrument ◽  
Implementation Process ◽  
Successful Implementation ◽  
Evidence Based ◽  
Multiple Sources ◽  
Target Groups ◽  
Face To Face ◽  
People With Dementia ◽  
Implementation Context

BACKGROUND Very few evidence-based eHealth interventions for caregivers of people with dementia are implemented into practice. Municipalities are one promising context to implement these interventions, due to their available policy and innovation incentives regarding (dementia) caregiving and prevention. In this study, two evidence-based eHealth interventions for caregivers of people with dementia (Partner in Balance and Myinlife) were implemented in eight municipalities in the Euregion Meuse-Rhine. OBJECTIVE This study’s objectives were to (1.) evaluate this implementation and (2.) investigate determinants of successful implementation. METHODS This study collected eHealth usage data, Partner in Balance coach evaluation questionnaires, and information on implementation determinants. This was done by conducting interviews with the municipality officials, based on the Measurement Instrument for Determinants of Implementation (MIDI). This data from multiple sources and perspectives was integrated and analysed to form a total picture of the municipality implementation process. RESULTS The municipality implementation of Partner in Balance and Myinlife showed varying levels of success. In the end, three municipalities planned to continue the implementation of Partner in Balance, while none planned to continue the implementation of Myinlife. The two Partner in Balance municipalities that did not consider the implementation to be successful, viewed the implementation as an external project. For Myinlife, it was clear that more face-to-face contact was needed to engage the implementing municipality and the target groups. Successful implementations were linked to implementer self-efficacy CONCLUSIONS The experiences of implementing these interventions suggested that this implementation context was feasible regarding the required budget and infrastructure. The need to foster sense of ownership and self-efficacy in implementers will be integrated into future implementation protocols, as part of standard implementation materials for municipalities and organisations implementing Myinlife and Partner in Balance.

scholarly journals 584. Use of Multi-Disciplinary Prevention Rounds to Reduce Central Line-Associated Bloodstream Infections in a Neonatal Intensive Care Unit

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S275-S276
Author(s):  
Matthew Linam ◽  
Jessica Wright ◽  
Kum Kim ◽  
Cara Van Treek ◽  
Patrick Spafford
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Central Venous Line ◽  
Patient Specific ◽  
Successful Implementation ◽  
Evidence Based ◽  
Clabsi Rate

Abstract Background Despite successful implementation of evidence-based prevention bundles, central line-associated bloodstream infections (CLABSIs) continue to occur in neonatal intensive care units (NICUs). We hypothesized that multi-disciplinary prevention rounds may be able to further reduce CLABSIs. Methods We implemented bedside rounds in a 39-bed tertiary NICU in November 2018 with the focus of reducing CLABSIs. Standardized rounds for all patients with a central venous line (CVL) occurred 2–3 times/week on weekdays during either the day or evening shifts. Rounds included NICU nursing leadership, the Hospital Epidemiologist and the patient’s nurse. Questions focused on the CVL maintenance bundle, reducing line access, and patient-specific CLABSI risk factors. Best practices were reinforced and solutions for identified risk factors were developed. Recommendations were communicated to the physician, as appropriate. Prevention rounds data were collected. Nurses and providers in the NICU were surveyed about their perceptions of the rounds. CLABSIs were identified by Infection Prevention using standard definitions. Results The average daily NICU census was 35.6, with an average of 14 patients with CVLs/day. The average duration of rounds was 45 minutes. Recommendations to physicians, such as changing medications from intravenous to oral or line removal, were accepted 85% of the time. 74.5% of nurses and 87.5% of providers thought that prevention rounds had at least some impact on CLABSI prevention. Nurse and provider responses to the perceived impact of CLABSI prevention rounds are in Tables 1 and 2, respectively. In the 12 months prior to starting prevention rounds, the CLABSI rate was 1.53 /1000 line days and the CLABSI rate for the 6 months after starting rounds was 0.99/1,000 line days, a 65% decrease. Conclusion CLABSI prevention rounds helped reinforce evidence-based prevention practices, identified patient-specific risk factors and improved physician-nurse communication. CLABSIs in NICU were reduced. Disclosures All authors: No reported disclosures.

scholarly journals What hinders and facilitates the implementation of nurse-led interventions in dementia care? A scoping review

2020 ◽  
Author(s):  
Melanie Karrer ◽  
Julian Hirt ◽  
Adelheid Zeller ◽  
Susi Saxer
Keyword(s):  
Scoping Review ◽  
Implementation Process ◽  
Dementia Care ◽  
Barriers And Facilitators ◽  
Successful Implementation ◽  
Evidence Based ◽  
Management Support ◽  
Implementation Processes ◽  
Culture Of Care ◽  
People With Dementia

Abstract Background The implementation of evidence-based interventions for people with dementia is complex and challenging. However, successful implementation might be a key element to ensure evidence-based practice and high quality of care. There is a need to improve implementation processes in dementia care by better understanding the arising challenges. Thus, the aim of this study was to identify recent knowledge concerning barriers and facilitators to implementing nurse-led interventions in dementia care. Methods We performed a scoping review using the methodological framework of Arksey and O’Malley. Studies explicitly reporting on the implementation process and factors influencing the implementation of a nurse-led intervention in dementia care in all settings were included. We searched eight databases from January 2015 until January 2019. Two authors independently selected the studies. For data analysis, we used an inductive approach to build domains and categories. Results We included 26 studies in the review and identified barriers as well as facilitators in five domains: policy (e.g. financing issues, health insurance), organisation (e.g. organisational culture and vision, resources, management support), intervention/implementation (e.g. complexity of the intervention, perceived value of the intervention), staff (e.g. knowledge, experience and skills, attitude towards the intervention), and person with dementia/family (e.g. nature and stage of dementia, response of persons with dementia and their families). Conclusions Besides general influencing factors for implementing nursing interventions, we identified dementia-specific factors reaching beyond already known barriers and facilitators. A pre-existing person-centred culture of care as well as consistent team cultures and attitudes have a facilitating effect on implementation processes. Furthermore, there is a need for interventions that are highly flexible and sensitive to patients’ condition, needs and behaviour.

scholarly journals Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: a systematic mixed-studies review and qualitative synthesis

2018 ◽  
Vol 20 ◽  
Author(s):  
Amy Mathieson ◽  
Gunn Grande ◽  
Karen Luker
Keyword(s):  
Evidence Based Practice ◽  
Grey Literature ◽  
Empirical Literature ◽  
Successful Implementation ◽  
Evidence Based ◽  
Community Nursing ◽  
Health And Social Care ◽  
Mixed Studies Review ◽  
Facilitators And Barriers ◽  
Systematic Mixed Studies Review

AbstractAimTo appraise and synthesize empirical literature on implementation of evidence within community nursing. To explore the use of implementation theory and identify the strategies required for, and the barriers and facilitators to, successful implementation within this context.BackgroundThere is an international consensus that evidence-based practice can improve outcomes for people using health and social care services. However, these practices are not always translated into care delivery. Community nursing is a relatively understudied area; little is known about how innovations in practice are implemented within this setting.MethodsSystematic mixed-studies review, synthesizing quantitative and qualitative research. The electronic databases AMED, PsycINFO, Ovid Medline, CINAHL Plus, ASSIA, British Nursing Index and EMBASE were used. Two grey literature databases were also searched: OpenGrey and EThOS. English language, peer-reviewed papers published between January 2010 and July 2017 were considered. Criteria included implementation of an innovation and change to practice within adult community nursing. An approach called Critical Interpretive Synthesis was used to integrate the evidence from across the studies into a comprehensible theoretical framework.ResultsIn total, 22 papers were reviewed. Few studies discussed the use of theory when planning, guiding and evaluating the implementation of the innovation (n=6). A number of implementation strategies, facilitators and barriers were identified across the included studies, highlighting the interplay of both service context and individual factors in successful implementation.ConclusionImplementation is an expanding area of research; yet is challenged by a lack of consistency in terminology and limited use of theory. Implementation within community nursing is a complex process, requiring both individual and organizational adoption, and managerial support. Successful adoption of evidence-based practice however, is only possible if community nurses themselves deem it useful and there is evidence that it could have a positive impact on the patient and/or their primary carer.

Stem cell-based therapies in neonatology: a new hope

2018 ◽  
Vol 103 (6) ◽  
pp. F583-F588 ◽  
Author(s):  
Bernard Thébaud
Keyword(s):  
Stem Cell ◽  
Preterm Infants ◽  
Stromal Cells ◽  
Neonatal Intensive Care ◽  
Organ Damage ◽  
Evidence Based ◽  
Preclinical Studies ◽  
Cell Therapies ◽  
Early Phase Clinical Trials ◽  
Made In

Despite progress made in neonatal intensive care, complications of extreme preterm birth still contribute as the main cause of death to children below 5 years of age. Stem cell-based therapies—mesenchymal stromal cells in particular—offer a new hope in preventing and/or restoring organ damage in extreme preterm infants. Early phase clinical trials, fueled by promising preclinical studies on lung and brain injury, have begun. While the enthusiasm in the neonatal community is palpable, much more needs to be learnt about cell-based therapies. Maintaining the balance between temptation and a cautious, evidence-based approach will be critical for cell therapies to fulfil their promise in substantially improving the outcome of extreme preterm infants.

Music Therapy Research in the NICU: An Updated Meta-Analysis

2012 ◽  
Vol 31 (5) ◽  
pp. 311-316 ◽  
Author(s):  
Jayne Standley
Keyword(s):  
Music Therapy ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Best Practice ◽  
Meta Analysis ◽  
Evidence Based ◽  
Music Listening ◽  
Positive Direction ◽  
Medical Benefits ◽  
Postmenstrual Age

Purpose: To provide an overview of developmental and medical benefits of music therapy for preterm infants.Design: Meta-analysis.Sample: Empirical music studies with preterm infants in the neonatal intensive care unit (NICU).Main Outcome: Evidence-based NICU music therapy (NICU-MT) was highly beneficial with an overall large significant effect size (Cohen’s d = 0.82). Effects because of music were consistently in a positive direction.Results: Results of the current analysis replicated findings of a prior meta-analysis and included extended use of music.1 Benefits were greatest for live music therapy (MT) and for use early in the infant’s NICU stay (birth weight <1,000 g, birth postmenstrual age <28 weeks). Results justify strong consideration for the inclusion of the following evidence-based NICU-MT protocols in best practice standards for NICU treatment of preterm infants: music listening for pacification, music reinforcement of sucking, and music pacification as the basis for multilayered, multimodal stimulation.

Implementing an Evidence-Based Exercise Program for Breast Cancer Survivors

2018 ◽  
Author(s):  
Kathryn H. Schmitz ◽  
Rinad Beidas
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Exercise Program ◽  
Implementation Process ◽  
Future Research ◽  
Successful Implementation ◽  
Evidence Based ◽  
Referral Process ◽  
Implementation Barriers

Multiple persistent adverse effects of breast cancer treatment are improved with regular exercise. This case study describes a safe and effective exercise program for breast cancer survivors that was adapted into an evidence-based intervention offered through physical therapy (Strength After Breast Cancer). The program was successfully translated and implemented, and it showed equal safety and efficacy as the parent program with regard to lymphedema symptoms, muscular strength, quality of life, and body image. Evaluation of the implementation process revealed multiple facilitators and barriers to implementation. Barriers included the intervention characteristics and challenges with the referral process from oncology. Facilitators included getting the program covered by insurance, a champion in the outpatient clinic, and adaptations to the program and referral process that resulted in successful implementation. Future research is needed to further the goal of ensuring all breast cancer survivors are connected to safe and effective exercise programming.

scholarly journals Preterm Infant Neurodevelopmental Care Training Program and Mother-Infant Attachment

2019 ◽  
Vol 8 (2) ◽  
pp. 192-197
Author(s):  
Fatemeh Fallah Rostami ◽  
Farin Soleimani ◽  
Mehdi Norouzi ◽  
Nikta Hatamizadeh ◽  
Jamileh Mokhtarinouri ◽  
...  
Keyword(s):  
Preterm Infant ◽  
Training Program ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Intervention Group ◽  
Routine Care ◽  
Control Group ◽  
Infant Attachment ◽  
Significant Difference ◽  
Care Training

Objectives: Preterm birth and admission to the neonatal intensive care unit (NICU) would disrupt mother-infant attachment. Neurodevelopmental care training and support of family programs are essential for the family of such infants. The purpose of this study was to investigate the effect of neurodevelopmental care training program for mothers with preterm infants on mother-infant attachment at one month’s age. Materials and Methods: Study population included all the mothers of preterm infants born in the hospitals of Tehran in 2018. The research was designed as a multicenter cluster clinical trial and four hospitals were randomly selected and divided into intervention and control groups. Before the intervention, the mother-infant attachment was measured by the Maternal-Postnatal Attachment Scale (MPAS). The mothers in the intervention group received a 12-session preterm infant neurodevelopmental care training program while the control group only received the routine care in the unit. Finally, the mother-infant attachment was re-measured in both groups at the one month corrected age. Results: No significant difference was observed in the attachment score before and after the intervention in the control group but the mother-infant attachment score was significantly different in the intervention group (57.75±11.09 vs. 78.27±4.54). Conclusions: The neurodevelopmental care training program was effective and increased the mother-infant attachment rate.

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