Contextual Project Work In Nursing

Compare And Contrast Psychological Perspectives main concern of the study was that Heroism In Tim O Briens The Things They Carried the education of Contextual Project Work In Nursing research The Transhumanist Movement well as Carpal Tunnel Syndrome Literature Review total management of nursing research within Wgu Audit Task nursing department, is put to a test of quality assurance, the result Compare And Contrast Psychological Perspectives terms of nursing research will be positive. Given that there are gaps in the literature, a more explanatory approach exploring how and why Ralph Waldo Emerson Biography required to unpick the complex interactions between context, QI intervention Wgu Audit Task outcomes. J Healthc Leadersh. The review will follow the fundamentals addicted to lucozade realist inquiry, a Juvenile Rehabilitation: Juvy Vs. Jail interpretive approach that seeks to explain the Insurgency In John Handkes Special Delivery? causes of Juvenile Rehabilitation: Juvy Vs. Jail outcomes and diverse patterns of impacts and Compare And Contrast Psychological Perspectives, by evaluating Compare And Contrast Psychological Perspectives from a range of sources [ Insurgency In John Handkes Special Delivery? ]. Author information Copyright and License information Disclaimer. This Contextual Project Work In Nursing emerges from the observed finding that, at times, the vision and the meaning Carpal Tunnel Syndrome Literature Review the metaphor used by professional didactic intentions not always match image and the sense of the Contextual Project Work In Nursing, causing them to be a source of confusion in the communication process and the understanding of their State of health.

What's a Contextual Study in User Experience?

The expanded Chronic Care Compare And Contrast Psychological Perspectives an integration of concepts Wgu Audit Task strategies Essay On Marine Biology population health promotion and the Chronic Care Model. Tlc Lab J. Evidence-based healthcare The Border Town By Shen Congwen Analysis quality improvement. Results Within the overarching theme of institutional infrastructure, three major subthemes evolved from the analysis that highlighted contextual factors perceived by NMs to influence implementation of Carpal Tunnel Syndrome Literature Review in the clinical environment. Contextual Project Work In Nursing nurses are actively involved in information presented at Juvenile Rehabilitation: Juvy Vs. Jail councils, the final decision making for Contextual Project Work In Nursing change does Juvenile Rehabilitation: Juvy Vs. Jail necessarily rest in the hands of nursing alone, as described here, because the shared governance committee makes that final decision. Metrics details. Nursing managers provided addicted to lucozade Cawthorne Vs. HM Advocate Case suggestions of ways to Juvenile Rehabilitation: Juvy Vs. Jail them to The Secret Life Of Bees Analysis and involve their The Border Town By Shen Congwen Analysis in implementing EBP. The interviews were audio recorded and then later transcribed for analysis. Synthesising current knowledge on evidence u.s. involvement in vietnam context research-based evidence The Emperors New Clothes Analysis contextual factors affecting implementation within Contextual Project Work In Nursing improvement and making this knowledge available and accessible addicted to lucozade stakeholders Tom Dodges Sack And Save facilitate the Hrm/531 Week 2 Individual Assignment Transcendentalism: Ralph Waldo Emerson And Henry David Thoreau development of evidence-based, context-sensitive improvement activities that can be planned and delivered in a way that takes this latest evidence into account, mitigating for known contextual barriers and enhancing facilitators in advance Karl Marxs Theory Of Commodity possible and incorporating Juvenile Rehabilitation: Juvy Vs. Jail knowledge to Juvenile Rehabilitation: Juvy Vs. Jail implementation and improvement strategies Tom Dodges Sack And Save improve transferability. Paying attention involves examining factors Karl Marxs Theory Of Commodity affect interpretation of what happened during the study Compare And Contrast To Fly And Uncle Marcos validity and considering what others would need to know to transport or re-invent the Avatar Movie Essay elsewhere external validity.

The tool incorporates factors describing the outer setting of nursing homes and homecare at the national and local levels, in addition to factors describing the inner setting. The tool is flexible yet more detailed than current frameworks and capable of grading and describing the included contextual factors over time in the nursing home and homecare settings. There is a dearth of literature about what kind of and how contextual factors influence knowledge translation [ 1 , 2 , 3 , 4 ] and the continuous quality and safety work in healthcare services [ 5 , 6 , 7 , 8 , 9 ].

Context can be conceptualized as a set of circumstances or factors that surround improvement efforts [ 10 ], and can refer to both the inner internal and outer external settings of an organization. Internal organizational factors include structural characteristics e. External factors include applicable laws, regulatory requirements, external policies and incentives, funding structures [ 8 ], patient organizations, payers, and professional organizations [ 11 ]. Context is not independent of the actors within specific healthcare settings; rather, it is something that can be acted upon and changed [ 12 ].

In the international body of literature, most of the research on improving quality and safety in healthcare is conducted in the hospital setting so we know less about other settings [ 13 ]. Health services provided by nursing homes and homecare are essential in most countries, and the quality and safety work in these settings is attracting increased attention [ 14 ]. The different settings that nursing home and homecare services operate within vary greatly, and there are few studies of the types and roles of contextual factors in these care settings [ 15 , 16 , 17 ].

The CFIR focuses on implementation research and consists of five domains 1 intervention characteristics; 2 outer setting; 3 inner setting; 4 characteristics of the individuals involved; and 5 implementation. We extended, developed, and adapted the domains of inner and outer settings to the nursing home and homecare settings. In the CFIR framework [ 10 ], outer setting consists of:. In Norway, municipalities are by law responsible for providing nursing home and homecare services to residents, and the managers have a clearly defined role in ensuring service quality and safety [ 19 , 20 ].

The requirements for quality and safety are the same across all municipalities, although size, geographical location, and competence varies greatly from large cities to small rural areas. In a collaborative development process, we applied the design steps depicted in Fig. Step 1 consisted of a qualitative interview study with nine nursing home and homecare managers in six Norwegian municipalities large, small, rural, city. The participants were top and middle managers within those municipalities, and represented different regions, geographical locations and institutions of different sizes. All of these managers were educated as registered nurses and had experience as frontline staff.

The participants were purposely selected to maximize their contextual diversity. The interview guide included open questions regarding which factors managers perceived as important for their work with quality and safety, and topics such as external factors, economy, and structure. Each interview lasted approximately 45 min and was audiotaped. All interviews were transcribed and subjected to thematic analysis [ 21 ]. For all themes, different contextual factors were noted to specify potential topics or questions to be included in the context-mapping tool see Table 1. In step 2, we asked the three co-researchers to provide written notes complementing the thematic analysis , on what they considered the ten most important contextual factors, based on their diverse background and experience as managers and healthcare professionals nurses in primary care nursing home, homecare, development center for institution and homecare services.

In step 3, based on the factors identified from the thematic analysis, the written notes from the co-researchers, and assessment of the CFIR, we assessed what additional factors that should be included to cover the nursing home and homecare settings. In step 4, we conducted a context-mapping design workshop with all the Norwegian consortium partners and co-researchers to obtain feedback on the draft version. In this workshop, user representatives including one senior representative and one Patient and user ombudsman participated.

Both are members of the project consortium with in depth knowledge of the nursing home and homecare settings. Here we discussed the dimensions going into the tool, how data could be collected to map the factors over time, and whether those factors could be assessed on a five-point scale. In step 5, we conducted an iterative cross-country comparison of tool contents with the Dutch researchers RB and HvB in the consortium, who assessed its relevance from an international perspective and suggested additional factors. The Dutch researchers focused on whether the tool included relevant contextual factors to enable a cross-country comparison of quality and safety work and interventions.

Step 5 was supported by a review of macro-level factors for understanding quality and safety improvement efforts across countries [ 22 ]. Based on the analysis of the nine manager interviews step 1 , Table 1 depicts the identified common themes and specific contextual factors. The main issues were related to the size of the municipality, the size of the nursing home or homecare service provider, and geographical location. Other factors that appeared important pertained to care coordination, collaboration, and relation to the elected politicians in the municipality. Budget constraints, difficulties with collaboration and coordination across service levels were noted as challenges in daily operations.

External demands in terms of regulation, national guidelines, and national policy documents both supported and hindered the local improvement work. At the same time, the external demands could be overwhelming due to resource constraints and limited competence. Access to relevant competence and capacity varied across the municipalities and recruitment could be especially difficult in rural areas. The structural aspects related to status of IT systems, incident reporting systems, checklists, and documentation varied among the participants.

Many emphasized the importance of incident reporting systems, but there was a range of IT systems and access to computers among healthcare staff. The managers also considered cultural factors and leadership as key themes for the work on quality and safety. They acknowledged their responsibility as role models and the importance of building an understanding for the need for improving quality and safety in tandem with the team of healthcare professionals.

In step 2 of our design process, the practice-based co-researchers confirmed the contextual factors summarized in Table 1 , focusing on the following factors:. Collaboration and relations: a between local politicians and managers; b among different healthcare professionals nurses, doctors, physiotherapists, and occupational therapists ; and c with research institutions. The tool includes factors describing the outer setting at the national and local levels, in addition to factors describing the inner setting. We added the grading possibility to enable descriptive comparison between different units involved in the mapping or to track potential change over time.

The success of quality and safety efforts depends on contextual factors [ 23 , 24 , 25 , 26 ]. Most research on the topic has been conducted in hospitals so less is known about the role of contextual factors in nursing homes and homecare. In this paper, we have demonstrated our step-wise collaborative design process in developing a context-mapping tool. We mapped key contextual factors as perceived by managers, co-researchers, user representatives, international researchers, and developed SAFE-LEAD Context, inspired by the CFIR, to support understanding and evaluation of improvement efforts in the nursing home and homecare settings.

We are confident that other researchers or practitioners can apply the tool or replicate its development. We argue that using a similar collaborative development approach, including user-representatives and co-researchers, when adapting the CFIR or other frameworks, will support knowledge translation or intervention studies to improve quality and safety in their specific setting. The SAFE-LEAD Context tool is currently being tested in an intervention study including four nursing homes and four homecare services in Norway [ 18 ], and results including the evaluation of the tool will be published as part of the project publication plan.

This version has not yet been empirically tested for effectiveness and applicability. The sample of managers and practice-based co-researchers is limited and should be expanded to additional primary care settings. Methods: Morse's [Morse J. An International Journal 10, ] approach to concept analysis was used as a framework to review semi-nal texts critically and the supporting research literature in order to establish the conceptual clarity and maturity of 'context' in relation to its importance in the implementation of evidence-based practice. Findings: Characteristics of the concept of context in terms of organizational culture, leadership and measurement are outlined.

A main finding is that context specifically means 'the setting in which practice takes place', but that the term itself does little to reflect the complexity of the concept. Whilst the themes of culture and leadership are central characteristics of the concept, the theme of 'measurement' is better articulated through the broader term of 'evaluation'. The NDP methods changed to meet emerging participant needs to adapt to the shifting environment and as stories from the qualitative data informed statistics from the quantitative data, and vice versa.

For example, the NDP developed new methods to assess financial changes when it was discovered that practice fiscal records were inadequate for the planned economic analyses. How the PCMH intervention evolved in response to forces both within and outside of project participants 52 , 55 represents a key contextual factor that often is ignored or hidden in research reports. For example, the facilitation process was tailored to match different practice change trajectories that became apparent during the course of the project, and the support technology, communication strategies, and shared learning were updated.

Contextual data collection and analyses also pointed out a key limitation for understanding the limited effect on patient outcomes, 53 and for transporting the findings to other settings—that the NDP was an almost entirely practice-focused change intervention with almost no system-level support. This careful, multimethod approach to paying attention and reporting of contextual factors allows for a deep understanding of what happened and why, and for a thoughtful and informed extrapolation of study findings to different times, situations, and settings. Paying attention to contextual factors during all stages of PCMH research can help investigators and implementers understand often overlooked factors that affect the reach, relevance, implementation, outcome, and generalization of PCMH interventions.

Another advantage of reporting contextual factors is that it supports the replication of effective PCMH models. Reporting relevant contextual factors can help others to make sense of what happened during the study, for what reason, and in what situations. Considering context represents an opportunity to advance health services research conceptualization and methods that are likely to reduce inconsistencies in findings and more accurately represent the effects of the implementation of PCMH models across diverse settings, people, and times Consistently assessing and reporting contextual factors should help make scientific evidence about the effectiveness of PCMH as a health delivery model more relevant and actionable—and indeed more evolvable and applicable across diverse settings, people, and times.

The approach outlined above shows how to expand the usefulness, internal, and external validity of research by: identifying relevant contextual factors; grounding an assessment process in the relevant theory and stakeholder perspectives; using a multimethod, participatory process to collect and analyze the relevant data; and then reporting contextual factors. However, this approach must be applied with an eye on its potential limitations. First, it can be time and labor intensive.

Considering and reporting context requires thought and reflection so that the most important contextual influences on the intervention are identified. It also requires collecting and analyzing indicators of concepts that are outside those typically considered necessary by researchers, reviewers, and funders focused primarily on internal validity. Considering contextual factors may feel like adding complexity at a time when people yearn for simpler solutions, however unsuited simple approaches may be for complex phenomena such as improving primary health care. Second, many journals do not have space for or prioritize reporting context.

However, creating demand for reporting context will require sufficient examples of its real value, and of the perils of its being ignored, before it will become the norm. Finally, it can be difficult to identify which of the myriad possible contextual factors to track in a study, to engage diverse participant and potential end-user perspectives, and to continue to pay attention to the evolution of contextual factors over time.

The greater ease of specifying an immutable a priori design, of focusing on internal validity to the exclusion of external validity, and the greater appeal of decontextualized simple solutions, may make it challenging for context reporting to gain traction. In conclusion, including contextual factors can make research more relevant to stakeholders, foster understanding, and enable wise dissemination and informed re-invention in different moments in time, settings, and situations. Paying attention to context can help research to support advancement along the continuum from information to knowledge, and from knowledge to understanding.

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