Organizational knowledge translation strategies for allied health professionals in traumatology settings: realist review protocol.

BACKGROUND: Knowledge translation (KT) is an important means of improving the health service quality. Most research on the effectiveness of KT strategies has focused on individual strategies, i.e., those directly targeting the modification of allied health professionals' knowledge, attitudes, and behaviors, for example. In general, these strategies are moderately effective in changing practices (maximum 10% change). Effecting change in organizational contexts (e.g., change readiness, general and specific organizational capacity, organizational routines) is part of a promising new avenue to service quality improvement through the implementation of evidence-based practices. The objective of this study will be to identify why, how, and under what conditions organizational KT strategies have been shown to be effective or ineffective in changing the (a) knowledge, (b) attitudes, and (c) clinical behaviors of allied health professionals in traumatology settings. METHODS: This is a realist review protocol involving four iterative steps: (1) Initial theory formulation, (2) search for Evidence search, (3) knowledge extraction and synthesis, and (4) recommendations. We will search electronic databases such as PubMed, Embase, CINHAL, Cochrane Library, and Conference Proceedings Citation Index - Science. The studies included will be those relating to the use of organizational KT strategies in trauma settings, regardless of study designs, published between January 1990 and October 2020, and presenting objective measures that demonstrate change in allied health professionals' knowledge, attitudes, and clinical behaviors. Two independent reviewers will select, screen, and extract the data related to all relevant sources in order to refine or refute the context-mechanism-outcome (CMO) configurations developed in the initial theory and identify new CMO configurations. DISCUSSION: Using a systematic and rigorous method, this review will help guide decision-makers and researchers in choosing the best organizational strategies to optimize the implementation of evidence-based practices. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020216105.

Early Mobilization in People With Acute Cardiovascular Disease.

BACKGROUND: Early mobilization (EM) is recommended in critical care units. However, there is little known about EM in people with acute cardiovascular disease. METHODS: Consecutive admissions to a tertiary-care cardiovascular intensive care unit (CICU) before and after implementation of an EM program were reviewed. The Level of Function (LOF) Mobility Scale, which ranges from 0 (bed immobile) to 5 (able to walk >20 m), was used to measure and guide mobility. The primary outcome was discharge home. RESULTS: There were 1489 patients included in the analysis (preintervention, N = 637; intervention, N = 852). There were no differences in age, sex, or admission for ischemic heart disease (age 68.1 ± 16.1 years; 39.3% female). In the intervention cohort, one-quarter (N = 222; 26.1%) had at least mildly impaired prehospital functional status. The LOF was 4.6 ± 0.7 prehospital, 3.2 ± 1.4 on admission, and 4.2 ± 0.9 on CICU discharge. Half of patients (51.6%) increased their LOF by ≥1 during CICU admission. Nearly all mobility opportunities had a mobility activity (97.0%). The adverse event rate was 0.3% with no life-threatening events, falls, line dislodgements, or health care personnel injuries. The intervention group, compared with the preintervention group, was more likely to be discharged home (83.9% vs 78.3%, P < 0.007) and had a lower rate of in-hospital death (4.2% vs 6.8%; P = 0.04). When adjusted for age, sex, and comorbid illness, admission LOF was a predictor of discharge to health care facility (odds ratio = 0.72; P < 0.001). CONCLUSIONS: EM is safe and feasible in the CICU and effective at increasing discharge home.

Level of function mobility scale for nurse-driven early mobilisation in people with acute cardiovascular disease.

BACKGROUND: There are currently no validated tools that are reliable and easy to use for nurses to assess mobility in people with acute cardiovascular disease in the Cardiovascular Intensive Care Unit (CICU). METHODS: A multidisciplinary team at an academic tertiary care centre developed the Level of Function (LOF) Mobility Scale for use in a nurse-driven early progressive mobilisation in the CICU. To determine inter-rater reliability, the prehospital and admission LOF were assessed independently by two CICU nurses. Pairwise comparisons between raters were evaluated using Cohen's kappa statistic. To determine convergence validity, the LOF and Activity Measure for Post-Acute Care 6-Clicks score upon admission were compared with Spearman's correlation. To determine feasibility, a 9-item mobility scale questionnaire was distributed to CICU nurses with and without experience using the LOF Mobility Scale. The STROBE reporting guidelines were used. RESULTS: The LOF Mobility Scale had good inter-rater reliability for assessment of LOF prior to hospitalisation (N = 131, kappa = 0.66, p < .001) and at the time of CICU admission (N = 131, kappa = 0.71, p < .001). There was a moderate correlation (N = 79 observations; correlation coefficient = 0.525; p < .01) between the bedside nurses LOF and the 6-Clicks score. All nurses surveyed (N = 54; 100%) thought that the LOF Mobility Scale was clear and unambiguous, the LOFs were well-defined and the scale was an appropriate length. Nearly all of the nurses with experience using the scale (N = 22/24; 92%) felt that the scale took less than one minute to complete, compared with about half (N = 14/30; 47%) in the group of nurses without experience using the scale. CONCLUSION: The LOF Mobility Scale is reliable and feasible for mobility assessment in a nurse-driven early progressive mobilisation programme in patients with acute cardiovascular disease in the CICU. RELEVANCE TO CLINICAL PRACTICE: A nurse-driven EM programme can be implemented in the CICU.

Factors influencing the adoption of a healthy eating campaign by federal cross-sector partners: a qualitative study.

BACKGROUND: The Eat Well Campaign (EWC) was a social marketing campaign developed by Health Canada and disseminated to the public with the help of cross-sector partners. The purpose of this study was to describe factors that influenced cross-sector partners' decision to adopt the EWC. METHODS: Thematic content analysis, based primarily on an a priori codebook of constructs from Roger's diffusion of innovations decision process model, was conducted on hour-long semi-structured telephone interviews with Health Canada's cross-sector partners (n = 18). RESULTS: Dominant themes influencing cross-sector partners' decision to adopt the EWC were: high compatibility with the organization's values; being associated with Health Canada; and low perceived complexity of activities. Several adopters indicated that social norms (e.g., knowing that other organizations in their network were involved in the collaboration) played a strong role in their decision to participate, particularly for food retailers and small organizations. The opportunity itself to work in partnership with Health Canada and other organizations was seen as a prominent relative advantage by many organizations. Adopters were characterized as having high social participation and positive attitudes towards health, new ideas and Health Canada. The lack of exposure to the mass media channels used to diffuse the campaign and reserved attitudes towards Health Canada were prominent obstacles identified by a minority of health organizations, which challenged the decision to adopt the EWC. Most other barriers were considered as minor challenges and did not appear to impede the adoption process. CONCLUSIONS: Understanding factors that influence cross-sector adoption of nutrition initiatives can help decision makers target the most appropriate partners to advance public health objectives. Government health agencies are likely to find strong partners in organizations that share the same values as the initiative, have positive attitudes towards health, are extremely implicated in social causes and value the notion of partnership.