Hreha Kimberly, Barrett A M, Gillen Robert W, Gonzalez-Snyder Chris, Masmela Jenny, Chen Peii
Division of Occupational Therapy Doctorate, Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, NC, United States.
Atlanta VA Health Care System, U.S. Department of Veterans Affairs, Center for Visual and Neurocognitive Rehabilitation, Decatur, GA, United States.
Front Health Serv. 2022 Jun 23;2:839517. doi: 10.3389/frhs.2022.839517. eCollection 2022.
Spatial neglect, a neurocognitive disorder of lateralized spatial attention, is prevalent among stroke survivors especially in inpatient rehabilitation facilities (IRFs). The ultimate goal of the project was to improve spatial neglect care in inpatient rehabilitation and trained as many OTs as possible using both tools in their regular practices as the means to achieve our overall objective. Therefore, we conducted a project aimed at implementing two evidence-based protocols, one for assessment (KF-NAP®) and the other for treatment (KF-PAT®), and share the implementation process, which included barriers and facilitators identified during and after the process, and implementation outcomes.
Sixteen IRFs were involved. The Knowledge-To-Action Cycle was used to describe the process of knowledge inquiry (training), translating knowledge (implementation) and evaluating the use of knowledge in clinical practice (outcomes). Barriers and strategies were reported using the Consolidated Framework for Implementation Research and identified through a survey, after the study concluded.
Thirty-two therapists at the participating sites were trained to some level of the KF-NAP and KF-PAT. Throughout the project and also once after it finished, different barriers were identified by researchers and clinicians, who then determined together actions to eliminate or minimize the barriers. For example, multiple sites reported: "not having time to train other staff at their hospital due to high patient volume and other responsibilities."
The project shared our implementation process which demonstrated the importance of using implementation methods and incorporating a researcher-clinician partnership, not only for knowledge generation but also knowledge translation. Frequent communications and exchanging information with stakeholders at different levels, may be determinant to the success of each implementation phase. Further research is needed.
空间忽视是一种偏侧化空间注意力的神经认知障碍，在中风幸存者中很常见，尤其是在住院康复机构（IRF）中。该项目的最终目标是改善住院康复中的空间忽视护理，并在常规实践中使用这两种工具培训尽可能多的职业治疗师，以此作为实现我们总体目标的手段。因此，我们开展了一个项目，旨在实施两项循证方案，一项用于评估（KF-NAP®），另一项用于治疗（KF-PAT®），并分享实施过程，其中包括在此过程中和之后识别出的障碍和促进因素以及实施结果。
16个住院康复机构参与其中。知识转化行动循环用于描述知识探究（培训）、知识转化（实施）以及评估知识在临床实践中的应用（结果）的过程。研究结束后，使用实施研究综合框架报告障碍和策略，并通过一项调查加以识别。
参与项目的机构中有32名治疗师接受了一定程度的KF-NAP和KF-PAT培训。在整个项目过程中以及项目结束后，研究人员和临床医生识别出了不同的障碍，然后共同确定消除或最小化这些障碍的行动。例如，多个机构报告称：“由于患者数量多和其他职责，没有时间在本院培训其他工作人员。”
该项目分享了我们的实施过程，这表明使用实施方法并建立研究人员与临床医生的合作关系不仅对知识生成而且对知识转化都很重要。与不同层面的利益相关者频繁沟通和交流信息，可能是每个实施阶段取得成功的决定性因素。还需要进一步的研究。
