Implementation science: describing implementation methods used by pediatric intensive care units in a national collaborative.

BACKGROUND: In 2001, the Committee on Quality in Health Care in America found it took 17 years for evidence from randomized controlled trials to be applied to practice, with little improvement over the last decade. Even abbreviated and summarized evidence fails to be consistently implemented at the bedside. More emphasis needs to be placed on understanding which Implementation Methods are most effective in successfully implementing evidence-based practice at the bedside. PURPOSE: The purpose of the study was to explore the use of 20 Implementation Methods by 57 Pediatric Intensive Care Units (PICUs) participating in the National Association of Children's Hospitals and Related Institutions (NACHRI, 2011) collaborative to eliminate central line associated blood stream infections (CLABSI) in critically ill children. METHODS: This descriptive research study was conducted using a Likert survey to determine the intensity of use of 20 Implementation Methods by PICUs. PICUs were also asked to identify any additional Implementation Methods that were used, but not included in the survey. RESULTS: Most Implementation Methods had high or very high use across the 57 PICUs. CONCLUSIONS: The 20 Implementation Methods identified as part of this study, represented the vast majority of Implementation Methods used by PICUs.

Translational research: why nursing's interdisciplinary collaboration is essential.

The heightened demand for benefit from scientific contributions has driven scientific initiatives such as the NIH Roadmap, the recently established Clinical Translational Science Awards, and requests for applications for funding by the National Institutes of Health (NIH) and Agency for Health Research and Quality (AHRQ) to support studies of translational efforts. Our article focuses on a rapidly developing area--translational research--and the value, if not necessity, of nursing's contributions to interdisciplinary efforts. Our objectives are to: 1. Relate the changing nature of research (and clinical practice) to the need for interdisciplinary efforts in translational research; 2. Delineate the skills necessary for translation of research to clinical and community-based practice; 3. Review nursing's contributions to national interdisciplinary initiatives; 4. Identify critical areas for nursing leadership in translational research and consequences of our absence from these efforts; and 5. Propose a translational research agenda for nursing.

Advancing practice inquiry: research foundations of the practice doctorate in nursing.

The University of Washington Doctor of Nursing Practice program entails 3 curricular dimensions: advanced practice, leadership, and practice inquiry. In this article, the practice inquiry dimension is discussed and defined as a type of clinical investigation that closely aligns with the realities and complexities of everyday practice by advanced practice nurses (APNs). The advancement of APNs' practice inquiry competencies is timely for its interfaces with the national scientific agenda's emphasis on translating science to clinical practice, health care delivery systems and policy. A framework for conceptualizing a practice inquiry curriculum and competencies is proposed. In addition, the divergent and convergent comparisons with Doctor of Philosophy (PhD) nursing programs are discussed, with emphasis placed on potential collaborative clinical research endeavors.

A decision tree and clinical paths for the assessment and management of children with ADHD.

Attention Deficit/Hyperactivity Disorder (ADHD) is a common neurobehavioral disorder. Children with ADHD are disproportionately represented in pediatric populations characterized by school failure, criminal behavior, and substance abuse. Many children who present with ADHD symptomatology do not receive systematic assessments nor comprehensive treatment that is well coordinated across home and school environments. And yet, evidence suggests that early detection and appropriate treatment can alter the probability of a negative developmental trajectory. The Decision Tree and Clinical Paths for Assessment and Management of ADHD identify the critical components of care through a stepwise decision-making process involving the assessment, diagnosis, treatment, and outcome evaluation of children who present with ADHD symptomatology. Preliminary field testing supports the clinical utility and validity of the ADHD Decision Tree/Paths. In addition, cross-validation comparisons indicate consistency between the ADHD Decision Tree/Paths and recently released ADHD clinical guidelines issued by several national professional organizations.

Positive mental health: a turn of the century perspective.

Within the last decade, a national prevention research, training, and practice agenda on mental health has been established to address the epidemiological increases in mental disorders and associated emotional and financial costs to individuals, families, and communities. In this article, the author reviews theoretical, empirical, and public policy support in favor of prevention science that inherently includes a broad positive mental health orientation with an emphasis on mental health promotion processes. Prevention within the mental health field needs to include not only minimizing mental disorders, but also enhancing positive qualities of daily functioning. The socioeconomic and cultural context of positive mental health is emphasized with particular attention given to the interrelatedness of individual, family, and community "collective sense of well being." Nursing and interdisciplinary contributions are reviewed, noting implications for future public policy and service system changes. Innovative ways to enhance mental health will require study of system integration across primary and mental health services as well as incorporating services within societal institutions such as schools and the workplace.