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      Describing the implementation of an innovative intervention and evaluating its effectiveness in increasing research capacity of advanced clinical nurses: using the consolidated framework for implementation research

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          Abstract

          Background

          Despite advanced nursing roles having a research competency, participation in research is low. There are many barriers to participation in research and few interventions have been developed to address these. This paper aims to describe the implementation of an intervention to increase research participation in advanced clinical nursing roles and evaluate its effectiveness.

          Methods

          The implementation of the intervention was carried out within one hospital site. The evaluation utilised a mixed methods design and a implementation science framework. All staff in advanced nursing roles were invited to take part, all those who were interested and had a project in mind could volunteer to participate in the intervention. The intervention consisted of the development of small research groups working on projects developed by the nurse participant/s and supported by an academic and a research fellow. The main evaluation was through focus groups. Output was analysed using thematic analysis. In addition, a survey questionnaire was circulated to all participants to ascertain their self-reported research skills before and after the intervention. The results of the survey were analysed using descriptive statistics. Finally an inventory of research outputs was collated.

          Results

          In the first year, twelve new clinical nurse-led research projects were conducted and reported in six peer reviewed papers, two non-peer reviewed papers and 20 conference presentations. The main strengths of the intervention were its promptness to complete research, to publish and to showcase clinical innovations. Main barriers identified were time, appropriate support from academics and from peers. The majority of participants had increased experience at scientific writing and data analysis.

          Conclusion

          This study shows that an intervention, with minor financial resources; a top down approach; support of a hands on research fellow; peer collaboration with academics; strong clinical ownership by the clinical nurse researcher; experiential learning opportunities; focused and with needs based educational sessions, is an intervention that can both increase research outputs and capacity of clinically based nurses. Interventions to further enhance nursing research and their evaluation are crucial if we are to address the deficit of nurse-led patient-centred research in the literature.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12912-017-0214-6) contains supplementary material, which is available to authorized users.

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          Most cited references37

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          Analysing and presenting qualitative data.

          This paper provides a pragmatic approach to analysing qualitative data, using actual data from a qualitative dental public health study for demonstration purposes. The paper also critically explores how computers can be used to facilitate this process, the debate about the verification (validation) of qualitative analyses and how to write up and present qualitative research studies.
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            The Consolidated Framework for Implementation Research (CFIR): a useful theoretical framework for guiding and evaluating a guideline implementation process in a hospital-based nursing practice

            Background Implementing clinical practice guidelines (CPGs) in healthcare settings is a complex intervention involving both independent and interdependent components. Although the Consolidated Framework for Implementation Research (CFIR) has never been evaluated in a practical context, it appeared to be a suitable theoretical framework to guide an implementation process. The aim of this study was to evaluate the comprehensiveness, applicability and usefulness of the CFIR in the implementation of a fall-prevention CPG in nursing practice to improve patient care in an Austrian university teaching hospital setting. Methods The evaluation of the CFIR was based on (1) team-meeting minutes, (2) the main investigator’s research diary, containing a record of a before-and-after, mixed-methods study design embedded in a participatory action research (PAR) approach for guideline implementation, and (3) an analysis of qualitative and quantitative data collected from graduate and assistant nurses in two Austrian university teaching hospital departments. The CFIR was used to organise data per and across time point(s) and assess their influence on the implementation process, resulting in implementation and service outcomes. Results Overall, the CFIR could be demonstrated to be a comprehensive framework for the implementation of a guideline into a hospital-based nursing practice. However, the CFIR did not account for some crucial factors during the planning phase of an implementation process, such as consideration of stakeholder aims and wishes/needs when implementing an innovation, pre-established measures related to the intended innovation and pre-established strategies for implementing an innovation. For the CFIR constructs reflecting & evaluating and engaging, a more specific definition is recommended. The framework and its supplements could easily be used by researchers, and their scope was appropriate for the complexity of a prospective CPG-implementation project. The CFIR facilitated qualitative data analysis and provided a structure that allowed project results to be organised and viewed in a broader context to explain the main findings. Conclusions The CFIR was a valuable and helpful framework for (1) the assessment of the baseline, process and final state of the implementation process and influential factors, (2) the content analysis of qualitative data collected throughout the implementation process, and (3) explaining the main findings. Electronic supplementary material The online version of this article (doi:10.1186/s12912-015-0088-4) contains supplementary material, which is available to authorized users.
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              Advanced practice nurse outcomes 1990-2008: a systematic review.

              Advanced practice registered nurses have assumed an increasing role as providers in the health care system, particularly for underserved populations. The aim of this systematic review was to answer the following question: Compared to other providers (physicians or teams without APRNs) are APRN patient outcomes of care similar? This systematic review of published literature between 1990 and 2008 on care provided by APRNs indicates patient outcomes of care provided by nurse practitioners and certified nurse midwives in collaboration with physicians are similar to and in some ways better than care provided by physicians alone for the populations and in the settings included. Use of clinical nurse specialists in acute care settings can reduce length of stay and cost of care for hospitalized patients. These results extend what is known about APRN outcomes from previous reviews by assessing all types of APRNs over a span of 18 years, using a systematic process with intentionally broad inclusion of outcomes, patient populations, and settings. The results indicate APRNs provide effective and high-quality patient care, have an important role in improving the quality of patient care in the United States, and could help to address concerns about whether care provided by APRNs can safely augment the physician supply to support reform efforts aimed at expanding access to care.
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                Author and article information

                Contributors
                00353 1 8962779 , gmckee@tcd.ie
                mcodd@STJAMES.ie
                O.Demspey@yahoo.ie
                PGallagher@STJAMES.IE
                ccomiske@tcd.ie
                Journal
                BMC Nurs
                BMC Nurs
                BMC Nursing
                BioMed Central (London )
                1472-6955
                2 May 2017
                2 May 2017
                2017
                : 16
                : 21
                Affiliations
                [1 ]ISNI 0000 0004 1936 9705, GRID grid.8217.c, , School of Nursing and Midwifery, Trinity College Dublin, ; 24 D’Olier St, Dublin, Ireland
                [2 ]ISNI 0000 0004 0617 8280, GRID grid.416409.e, , St James Hospital , ; Dublin, Ireland
                [3 ]ISNI 0000 0004 1936 9705, GRID grid.8217.c, Post-Doctoral Fellow and Quantitative Healthcare Lead, Centre for Practice and Healthcare and Innovation, , School of Nursing and Midwifery, Trinity College Dublin, ; Dublin, Ireland
                Author information
                http://orcid.org/0000-0003-0211-5330
                Article
                214
                10.1186/s12912-017-0214-6
                5414169
                28469530
                5a2ac386-e0ee-4a8c-b12a-a0aec542c730
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 27 July 2016
                : 14 April 2017
                Funding
                Funded by: National Council of Nursing and Midwifery
                Award ID: CEERHA 0503
                Award Recipient :
                Funded by: The Royal City of Dublin Hospital Trust
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Nursing
                research capacity building,clinician researcher,nurse role,nursing research,programme evaluation,research participation

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