|
1
|
Liu QY, You TY, Zhang DY, Wang J. Clinical application of multidisciplinary team- and evidence-based practice project in gynecological patients with perioperative hypothermia. World J Psychiatry 2023; 13:848-861. [DOI: 10.5498/wjp.v13.i11.848] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/04/2023] [Accepted: 09/27/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Perioperative hypothermia (PH) negatively affects the physical and mental health of patients to varying degrees. Currently, there is no effective multidisciplinary team (MDT) intervention for gynecological patients with PH.
AIM To apply the best evidence on the prevention and management of PH in gynecological patients, improve the quality of perioperative evidence-based care based on treatment by an MDT for gynecological patients and analyze the effect of MDT- and evidence-based practice (EBP) projects on the psychological status and cognitive function of gynecological patients with PH.
METHODS Under the guidance of knowledge translation and combined with the opinions of involved stakeholders and clinical experts, the best evidence for PH prevention and management in gynecological patients was selected and adjusted to suit the practice setting. Based on the evidence, the practice plan was developed, and the MDT intervention was carried out in the preoperative ward, the preoperative preparation room, the intraoperative operating room, the postanesthesia care unit, and the 24-hour postoperative gynecological ward through the EBP program. The incidence of hypothermia, the nurses’ awareness, the implementation rate of examination indicators, and the thermal comfort level, psychological status and cognitive function of patients were compared before and after the implementation of the program.
RESULTS The incidence of PH in gynecological patients decreased from 43.33% to 13.33% after the implementation of the scheme. The implementation rate of examination indicators 6-10, 12, 14, 16-18, 21, and 22 reached 100%, and that of other indicators was above 90%, except for examination indicators 5 and 13, which was 66.67%; the indices were significantly improved compared with the baseline (before evidence application) (P < 0.05). The score of nurses' awareness of PH prevention and management in gynecological patients increased from 60.96 ± 9.70 to 88.08 ± 8.96, and the difference was statistically significant (P < 0.001). The total score of the perioperative thermal comfort level of patients undergoing gynecological surgery was 27.97 ± 2.04, which was significantly increased compared with the score of 21.27 ± 1.57 observed by researchers at baseline (P < 0.001). The perioperative Hamilton Depression Scale and Hamilton Anxiety Scale scores of patients undergoing gynecological surgery decreased from 15.03 ± 3.16 and 13.93 ± 2.64 to 4.30 ± 1.15 and 3.53 ± 0.78, respectively, with statistically significant differences (P < 0.001). The perioperative Montreal Cognitive Assessment Scale score of the gynecological surgery patients increased from 23.17 ± 1.68 to 26.93 ± 1.11, also with statistical significance (P < 0.001).
CONCLUSION MDT-based EBP for PH prevention and management in gynecological patients during the perioperative period can standardize nursing operations, improve nurses' awareness and behavioral compliance with gynecological hypothermia management, and reduce the occurrence of PH in gynecological patients while playing a positive role in reducing patients’ negative emotions and enhancing their cognitive function.
Collapse
Affiliation(s)
- Qing-Yan Liu
- The Operating Room, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Tong-Yang You
- The Operating Room, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Dai-Ying Zhang
- The Operating Room, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Juan Wang
- The Operating Room, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| |
Collapse
|
|
2
|
Shafei I, Karnon J, Crotty M. Quality Improvement in Stroke Rehabilitation: A Scoping Review. J Multidiscip Healthc 2022; 15:2913-2931. [PMID: 36578360 PMCID: PMC9791932 DOI: 10.2147/jmdh.s389567] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Background Quality improvement interventions are used extensively in health care, aiming to improve delivery and promote best practice. The impact of quality improvement interventions implemented in stroke rehabilitation remains unclear. Objective The aim of this scoping review is to examine the different types of published quality improvement interventions in stroke rehabilitation and their impact on improving the quality of care. Materials and Methods A scoping review was performed in the PubMed, Embase and CINAHL databases. QI studies evaluating interventions for stroke rehabilitation patients that were published up to August 2020 were included. The review looked at the types of quality improvement interventions that have been evaluated as well as the improvements/impacts reported for quality improvement interventions for stroke patients in rehabilitation. Results We reviewed 1580 studies, twelve quality improvement interventions met inclusion criteria and were included in the current study. Six studies involved organizational change, three studies involved provider education and audit-feedback and three studies involved provider education. Of the twelve quality improvement interventions that have been included, >90% reported improvements (91.6%). In the majority of cases, improvements were noted through implementation of a myriad of interventions. Several facilitators and barriers were noted during implementation and contributed to success or failure of the intervention. Conclusion There is paucity of full-text peer-reviewed published research investigating quality improvement interventions for improving the quality of care in stroke rehabilitation. The current review offers value to healthcare providers in terms of key success factors, contextual factors, barriers and facilitators associated with improvements in stroke rehabilitation.
Collapse
Affiliation(s)
- Ingy Shafei
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- College of Business, Government and Law, Flinders University, Adelaide, South Australia, Australia
| | - Jonathan Karnon
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| |
Collapse
|
|
3
|
Hreha K, Barrett AM, Gillen RW, Gonzalez-Snyder C, Masmela J, Chen P. The Implementation Process of Two Evidence-Based Protocols: A Spatial Neglect Network Initiative. FRONTIERS IN HEALTH SERVICES 2022; 2:839517. [PMID: 36925858 PMCID: PMC10012810 DOI: 10.3389/frhs.2022.839517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/23/2022] [Indexed: 11/13/2022]
Abstract
Introduction Spatial neglect, a neurocognitive disorder of lateralized spatial attention, is prevalent among stroke survivors especially in inpatient rehabilitation facilities (IRFs). The ultimate goal of the project was to improve spatial neglect care in inpatient rehabilitation and trained as many OTs as possible using both tools in their regular practices as the means to achieve our overall objective. Therefore, we conducted a project aimed at implementing two evidence-based protocols, one for assessment (KF-NAP®) and the other for treatment (KF-PAT®), and share the implementation process, which included barriers and facilitators identified during and after the process, and implementation outcomes. Methods Sixteen IRFs were involved. The Knowledge-To-Action Cycle was used to describe the process of knowledge inquiry (training), translating knowledge (implementation) and evaluating the use of knowledge in clinical practice (outcomes). Barriers and strategies were reported using the Consolidated Framework for Implementation Research and identified through a survey, after the study concluded. Results Thirty-two therapists at the participating sites were trained to some level of the KF-NAP and KF-PAT. Throughout the project and also once after it finished, different barriers were identified by researchers and clinicians, who then determined together actions to eliminate or minimize the barriers. For example, multiple sites reported: "not having time to train other staff at their hospital due to high patient volume and other responsibilities." Discussion The project shared our implementation process which demonstrated the importance of using implementation methods and incorporating a researcher-clinician partnership, not only for knowledge generation but also knowledge translation. Frequent communications and exchanging information with stakeholders at different levels, may be determinant to the success of each implementation phase. Further research is needed.
Collapse
Affiliation(s)
- Kimberly Hreha
- Division of Occupational Therapy Doctorate, Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, NC, United States
| | - A M Barrett
- Atlanta VA Health Care System, U.S. Department of Veterans Affairs, Center for Visual and Neurocognitive Rehabilitation, Decatur, GA, United States.,Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Robert W Gillen
- Neuropsychology Department, Sunnyview Rehabilitation Hospital, Schenectady, NY, United States
| | - Chris Gonzalez-Snyder
- Division of In-Patient Rehabilitation, Select Medical, Mechanicsburg, PA, United States
| | - Jenny Masmela
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ, United States
| | - Peii Chen
- Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ, United States.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, United States
| |
Collapse
|
|
4
|
Roy N, Daburger A, Goodfellow N, Herr D, Schramm M, Eng JJ, Louie DR. Mirror Therapy for Lower-Extremity Hemiparesis: A Knowledge Translation Study Using an Educational Module to Change Physiotherapists' Perceptions. Physiother Can 2021; 73:218-225. [PMID: 34456438 DOI: 10.3138/ptc-2020-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: Despite growing evidence that mirror therapy (MT) is effective for improving lower-extremity (LE) function in patients with stroke, it is not commonly used by physiotherapists. The purpose of this study was to determine whether change would occur in physiotherapists' knowledge of, confidence in performing, and willingness to use MT for LE stroke rehabilitation after participating in a 1-hour educational module. Method: A convenience sample of physiotherapists working in neurorehabilitation was recruited for a single-group quasi-experimental pre-post study. Participants attended a 1-hour educational module on MT. Therapists' perceptions of the use of MT were assessed by questionnaire before and after they participated in the module. A follow-up telephone survey was conducted after 3 months to determine how many participants had actually used MT in their practice. Results: Nine physiotherapists participated in this study. Statistically significant increases were found in their perceived knowledge of, confidence in, and willingness to use MT. At the 3-month follow-up, three participants had used MT with patients with LE hemiparesis. Conclusions: Therapists' knowledge of and attitudes toward MT for LE stroke rehabilitation changed favourably after participating in a 1-hour educational module. The module also led some therapists to make a change in practice at 3 months.
Collapse
Affiliation(s)
- Noel Roy
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anna Daburger
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Natalie Goodfellow
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Herr
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michelle Schramm
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janice J Eng
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Dennis R Louie
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| |
Collapse
|
|
5
|
Xu Y, Li S, Zhao P, Zhao J. Using the knowledge-to-action framework with joint arthroplasty patients to improve the quality of care transition: a quasi-experimental study. J Orthop Surg Res 2020; 15:31. [PMID: 31996244 PMCID: PMC6988266 DOI: 10.1186/s13018-020-1561-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Total joint arthroplasty is a mature and effective treatment for end-stage osteoarthritis. Assisting patients in completing the transition of the perioperative period and improving their satisfaction are important aspects of quality of care. This study aimed to investigate an intervention to improve the quality of care transition for joint arthroplasty patients informed by the knowledge-to-action (KTA) framework. METHODS In this quasi-experimental study, a total of 160 patients who underwent joint arthroplasty at a tertiary hospital from September to November 2018 and January to March 2019 were selected as participants using convenience sampling. The control group received routine medical care, while the observation group received medical care based on the KTA framework. Transitional care quality was assessed by the Care Transition Measure (CTM), with follow-up 1 week after discharge. RESULTS The observation group fared significantly better than the control group on general self-care preparation and written plan dimensions, as well as the quality of care transition. There was no significant difference in doctor-patient communication or health monitoring. CONCLUSIONS The KTA framework provides a logical, valuable tool for clinical work. Using the KTA framework for joint arthroplasty patients helps to improve the quality of care transition, which is worth promoting.
Collapse
Affiliation(s)
- Yaping Xu
- Department of Orthopedics, China-Japan Friendship Hospital, Beijing, China. .,Bone Necrosis and Joint Preservation Reconstruction Center, China-Japan Friendship Hospital, Beijing, China. .,Department of Bone and Joint Surgery, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Hepingli, Chaoyang District, Beijing, 100029, China.
| | - Shuang Li
- Department of Orthopedics, China-Japan Friendship Hospital, Beijing, China.,Bone Necrosis and Joint Preservation Reconstruction Center, China-Japan Friendship Hospital, Beijing, China
| | - Peiyu Zhao
- Department of Nursing, China-Japan Friendship Hospital, Beijing, China
| | - Jing Zhao
- Department of Nursing, China-Japan Friendship Hospital, Beijing, China
| |
Collapse
|
|
6
|
McEwen SE, Donald M, Jutzi K, Allen KA, Avery L, Dawson DR, Egan M, Dittmann K, Hunt A, Hutter J, Quant S, Rios J, Linkewich E. Implementing a function-based cognitive strategy intervention within inter-professional stroke rehabilitation teams: Changes in provider knowledge, self-efficacy and practice. PLoS One 2019; 14:e0212988. [PMID: 30856191 PMCID: PMC6411258 DOI: 10.1371/journal.pone.0212988] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/13/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The Cognitive Orientation to daily Occupational Performance (CO-OP) approach is a complex rehabilitation intervention in which clients are taught to use problem-solving cognitive strategies to acquire personally-meaningful functional skills, and health care providers are required to shift control regarding treatment goals and intervention strategies to their clients. A multi-faceted, supported, knowledge translation (KT) initiative was targeted at the implementation of CO-OP in inpatient stroke rehabilitation teams at five freestanding rehabilitation hospitals. The study objective was to estimate changes in rehabilitation clinicians' knowledge, self-efficacy, and practice related to implementing CO-OP. METHODS A single arm pre-post and 6-month follow up study was conducted. CO-OP KT consisted of a 2-day workshop, 4 months of implementation support, a consolidation session, and infrastructure support. In addition, a sustainability plan was implemented. Consistent with CO-OP principles, teams were given control over specific implementation goals and strategies. Multiple choice questions (MCQ) were used to assess knowledge. A self-efficacy questionnaire with 3 subscales (Promoting Cognitive Strategy Use, PCSU; Client-Focused Therapy, CFT; Top-Down Assessment and Treatment, TDAT) was developed for the study. Medical record audits were used to investigate practice change. Data analysis for knowledge and self-efficacy utilized mixed effects models. Medical record audits were analyzed with frequency counts and chi-squares. RESULTS Sixty-five health care providers consisting mainly of occupational and physical therapists entered the study. Mixed effects models revealed intervention effects for MCQs, CFT, and PCSU at post intervention and follow-up, but no effect on TDAT. No charts showed any evidence of CO-OP use at baseline, compared to 8/40 (20%) post intervention. Post intervention there was a trend towards reduction in impairment goals and significantly more component goals were set (z = 2.7, p = .007).
Collapse
Affiliation(s)
- Sara E. McEwen
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Donald
- North & East GTA Stroke Network, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Katelyn Jutzi
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Kay-Ann Allen
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Lisa Avery
- Avery Information Services Ltd., Orillia, Ontario, Canada
| | - Deirdre R. Dawson
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department & Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- Rotman Research Institute, Baycrest, Toronto, Ontario, Canada
| | - Mary Egan
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Katherine Dittmann
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Anne Hunt
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department & Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Jennifer Hutter
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Sylvia Quant
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- North & East GTA Stroke Network, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jorge Rios
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Elizabeth Linkewich
- North & East GTA Stroke Network, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department & Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- Practice-Based Research, Sunnybrook Research Institute, Toronto, Ontario, Canada
| |
Collapse
|
|
7
|
MacKenzie HM, Rice D, Teasell R, Macaluso S. Screening Adherence for Depression Post Stroke: Evaluation of Outpatients, a London Experience (SAD PEOPLE). Top Stroke Rehabil 2018; 26:6-17. [PMID: 30346909 DOI: 10.1080/10749357.2018.1536096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Post stroke depression (PSD) is common, and the transition home following discharge may be especially challenging for stroke survivors. OBJECTIVES This study aimed to determine how well specific Canadian Best Practice Recommendations for PSD screening were adopted within a stroke rehabilitation outpatient clinic before and after the utilization of a standardized clinical form. METHODS Practices were evaluated through retrospective chart review before and after the implementation of the standardized form which cued physicians to administer the Patient Health Questionnaire 9 (PHQ-9) at the first outpatient visit. Participants included those aged ≥18 years with a primary diagnosis of stroke. RESULTS One hundred thirty-five subjects' charts were reviewed. Form implementation was associated with increased rates of PSD screening (93.8% versus 0%) and charting regarding mood (55.4% versus 15.7%). CONCLUSION This study highlights the frequency of depressive symptoms in an outpatient cohort and demonstrates how screening rates can be improved by using a standardized form. Routine PHQ-9 completion at the first outpatient visit was associated with more physician-patient discussion and documentation regarding mood.
Collapse
|