The Clinical Scholar Program: A Fulbright collaboration in Northern Thailand

Background: The Complementing Alliance for Research and Evidence-Based Practice (CARE) project was initiated in 2006 in northern Thailand to develop regional capacity for emphasizing evidence-based practice (EBP) in international health; 5 projects were initiated. In 2009, Making Evidence and EBP Consultations Accessible to Practitioners (MEECAP) was added to accelerate the uptake of EBP using a nurse clinician-instructor model. The Fulbright Senior Specialist program, initiated in 2001, provides two to six week grants to qualified scholars to work with colleagues in smaller or isolated non-United States institutions where placing a traditional Fulbright scholar is not feasible. Approach: A Fulbright application submitted by the Director of Research at Boromrajonani College of Nursing Nakhon Lampang, Thailand utilizing the Clinical Scholar Program, a series of workshops for EB guideline development and implementation by nurse clinicians, requesting the program developer as the Fulbright Senior Specialist was approved. Based on the Clinical Scholar Model, three series of 6-day workshops were conducted in November-December, 2010. During the workshops, participants generated clinically relevant questions and searched for and evaluated primary quantitative and qualitative research studies, meta-analyses, and published guidelines. Scientific evidence was synthesized and recommendations were incorporated into clinical practice guidelines. Strategies for implementation, evaluation, and dissemination were presented and adapted to the local settings. During the final workshop, participants presented their work to colleagues. Outcomes: Ninety nurse clinicians and faculty from 24 healthcare facilities and colleges of nursing attended the workshops. Preliminary work was completed for 39 evidence-based clinical practice guidelines addressing nurse-sensitive quality indicators. A website, www.guidelinesforall.org, was developed for ongoing communication of guideline work and free dissemination of completed guidelines in Thai language to nurses and faculty throughout Thailand. Implications for Nursing: An update of the clinical projects in northern Thailand and the collaborative model used by the Fulbright Senior Specialist Program will be presented

Development of a campus-based clinic

Campus-based health centers that address chronic illnesses, minor injuries, and behavioral health support are an essential component of student success. Because our small, liberal arts college is not able to meet health care needs of our students, the goal of this leadership project was to develop a campus-based clinic

A global healthcare exchange: Building relationships to advance nursing excellence in education and practice

Authentic leadership skills were instrumental in building a relationship between a nursing program in an under resourced country, a Midwest university, and a global health business. Opportunities for faculty and students to participate as global partners have been created. A sense of renewal and purpose was experienced by STTI chapter

A realist review of interventions and strategies to promote evidence-informed healthcare: a focus on change agency

Background Change agency in its various forms is one intervention aimed at improving the effectiveness of the uptake of evidence. Facilitators, knowledge brokers and opinion leaders are examples of change agency strategies used to promote knowledge utilization. This review adopts a realist approach and addresses the following question: What change agency characteristics work, for whom do they work, in what circumstances and why?Methods The literature reviewed spanned the period 1997-2007. Change agency was operationalized as roles that are aimed at effecting successful change in individuals and organizations. A theoretical framework, developed through stakeholder consultation formed the basis for a search for relevant literature. Team members, working in sub groups, independently themed the data and developed chains of inference to form a series of hypotheses regarding change agency and the role of change agency in knowledge use.Results 24, 478 electronic references were initially returned from search strategies. Preliminary screening of the article titles reduced the list of potentially relevant papers to 196. A review of full document versions of potentially relevant papers resulted in a final list of 52 papers. The findings add to the knowledge of change agency as they raise issues pertaining to how change agents&rsquo; function, how individual change agent characteristics effect evidence-informed health care, the influence of interaction between the change agent and the setting and the overall effect of change agency on knowledge utilization. Particular issues are raised such as how accessibility of the change agent, their cultural compatibility and their attitude mediate overall effectiveness. Findings also indicate the importance of promoting reflection on practice and role modeling. The findings of this study are limited by the complexity and diversity of the change agency literature, poor indexing of literature and a lack of theory-driven approaches.Conclusion This is the first realist review of change agency. Though effectiveness evidence is weak, change agent roles are evolving, as is the literature, which requires more detailed description of interventions, outcomes measures, the context, intensity, and levels at which interventions are implemented in order to understand how change agent interventions effect evidence-informed health care.<br /

Admission assessment: Linking a standardized admission exam to nursing program outcomes

This article reports the results of an academic program evaluation in which standardized admission test scores are compared to intermediate and final program outcomes. We used two intermediate program measures of progress-first semester nursing grades and performance on a standardized exit exam prior to graduation. Program final outcomes compared are student attrition and graduate nurses’ performance on the NCLEX-RN. The analysis resulted in identifying statistically significant relationships between entrance exam scores and first semester grades. Statistically significant relationships were seen between entrance exam scores and performance on a pre-graduation exit exam. There was a statistically significant relationship between entrance exam scores and NCLEX-RN pass rates. These results indicate that admission testing is a viable option for use as part of an admission process for baccalaureate nursing programs

Realist synthesis : illustrating the method for implementation research

BackgroundRealist synthesis is an increasingly popular approach to the review and synthesis of evidence, which focuses on understanding the mechanisms by which an intervention works (or not). There are few published examples of realist synthesis. This paper therefore fills a gap by describing, in detail, the process used for a realist review and synthesis to answer the question \u27what interventions and strategies are effective in enabling evidence-informed healthcare?\u27 The strengths and challenges of conducting realist review are also considered. MethodsThe realist approach involves identifying underlying causal mechanisms and exploring how they work under what conditions. The stages of this review included: defining the scope of the review (concept mining and framework formulation); searching for and scrutinising the evidence; extracting and synthesising the evidence; and developing the narrative, including hypotheses. ResultsBased on key terms and concepts related to various interventions to promote evidenceinformed healthcare, we developed an outcome-focused theoretical framework. Questions were tailored for each of four theory/intervention areas within the theoretical framework and were used to guide development of a review and data extraction process. The search for literature within our first theory area, change agency, was executed and the screening procedure resulted in inclusion of 52 papers. Using the questions relevant to this theory area, data were extracted by one reviewer and validated by a second reviewer. Synthesis involved organisation of extracted data into evidence tables, theming and formulation of chains of inference, linking between the chains of inference, and hypothesis formulation. The narrative was developed around the hypotheses generated within the change agency theory area. ConclusionsRealist synthesis lends itself to the review of complex interventions because it accounts for context as well as outcomes in the process of systematically and transparently synthesising relevant literature. While realist synthesis demands flexible thinking and the ability to deal with complexity, the rewards include the potential for more pragmatic conclusions than alternative approaches to systematic reviewing. A separate publication will report the findings of the review. <br /

Using cross cultural communication to foster member engagement

Special Session presented on: Monday, November 18, 2013: The Globalization Task Force seeks to understand issues that may result in members from outside North America not achieving full potential within STTI. The symposium will focus on learning from the members issues, if any, that currently impede full membership, including cultural norms and expectations, and gender concerns. Of particular interest to the Task Force, is engaging non-North American members in society leadership positions. Strategies will include use of the ASKED (Awareness, Skills, Knowledge, Encounters, and Desires) model to frame the discussion; a representative panel will lead the discussions and be followed by working groups that will identify issues and solutions. Videos on understanding cross cultural communication and respecting differences will be used to assist in focusing the discussions

Engaging and retaining Sigma\u27s retired members

Retired Sigma members represent a valuable membership segment, with the knowledge and experience to lead, educate and mentor younger members. How can chapters help support and retain this important segment of career nurses? Attend this session, presented by Sigma’s Retired Member Taskforce, to learn more about engaging your retired members