Nadalin Penno Letitia, Graham Ian D, Backman Chantal, Davies Barbara, Squires Janet
Faculty of Environment and Health Sciences, Canadore College, North Bay, ON, Canada.
School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
Front Health Serv. 2023 Jun 8;3:1102428. doi: 10.3389/frhs.2023.1102428. eCollection 2023.
To date, little attention has focused on what the determinants are and how evidence-based practices (EBPs) are sustained in tertiary settings (i.e., acute care hospitals). Current literature reveals several frameworks designed for implementation of EBPs (0-2 years), yet fewer exist for the sustainment of EBPs (>2 years) in clinical practice. Frameworks containing both phases generally list few determinants for the sustained use phase, but rather state ongoing monitoring or evaluation is necessary. Notably, a recent review identified six constructs and related strategies that facilitate sustainment, however, the pairing of determinants and how best to sustain EBPs in tertiary settings over time remains unclear. The aim of this paper is to present an evidence-informed framework, which incorporates constructs, determinants, and knowledge translation interventions (KTIs) to guide implementation practitioners and researchers in the ongoing use of EBPs over time.
We combined the results of a systematic review and theory analysis of known sustainability frameworks/models/theories (F/M/Ts) with those from a case study using mixed methods that examined the ongoing use of an organization-wide pain EBP in a tertiary care center (hospital) in Canada. Data sources included peer-reviewed sustainability frameworks ( = 8) related to acute care, semi-structured interviews with nurses at the department ( = 3) and unit ( = 16) level, chart audits ( = 200), and document review ( = 29). We then compared unique framework components to the evolving literature and present main observations.
We present the Sustaining Innovations in Tertiary Settings (SITS) framework which consists of 7 unique constructs, 49 determinants, and 29 related KTIs that influence the sustainability of EBPs in tertiary settings. Three determinants and 8 KTIs had a continuous influence during implementation and sustained use phases. Attention to the level of application and changing conditions over time affecting determinants is required for sustainment. Use of a participatory approach to engage users in designing remedial plans and linking KTIs to target behaviors that incrementally address low adherence rates promotes sustainability.
The SITS framework provides a novel resource to support future practice and research aimed at sustaining EBPs in tertiary settings and improving patient outcomes. Findings confirm the concept of sustainability is a "dynamic ongoing phase".
迄今为止，很少有人关注在三级医疗机构（即急症护理医院）中，循证实践（EBP）的决定因素是什么以及如何维持这些实践。当前文献揭示了一些为循证实践的实施（0 - 2年）设计的框架，但在临床实践中用于维持循证实践（超过2年）的框架较少。包含两个阶段的框架通常为持续使用阶段列出的决定因素很少，而是指出持续监测或评估是必要的。值得注意的是，最近的一项综述确定了六种促进维持的构建和相关策略，然而，决定因素的配对以及如何随着时间的推移在三级医疗机构中最好地维持循证实践仍不清楚。本文的目的是提出一个基于证据的框架，该框架纳入构建、决定因素和知识转化干预措施（KTI），以指导实施从业者和研究人员随着时间的推移持续使用循证实践。
我们将对已知的可持续性框架/模型/理论（F/M/Ts）的系统评价和理论分析结果与来自一个案例研究的结果相结合，该案例研究采用混合方法，考察了加拿大一家三级护理中心（医院）中一项全组织范围的疼痛循证实践的持续使用情况。数据来源包括与急症护理相关的同行评审的可持续性框架（n = 8）、对科室（n = 3）和病房（n = 16）层面护士的半结构化访谈、图表审核（n = 200）以及文件审查（n = 29）。然后，我们将独特的框架组件与不断发展的文献进行比较，并呈现主要观察结果。
我们提出了三级医疗机构持续创新（SITS）框架，该框架由7个独特的构建、49个决定因素和29个相关的知识转化干预措施组成，这些因素影响着循证实践在三级医疗机构中的可持续性。三个决定因素和8个知识转化干预措施在实施和持续使用阶段具有持续影响。维持需要关注应用水平以及随着时间推移影响决定因素的不断变化的情况。采用参与式方法让用户参与设计补救计划，并将知识转化干预措施与逐步解决低依从率问题的目标行为相联系，可促进可持续性。
SITS框架提供了一种新颖的资源，以支持未来旨在维持三级医疗机构中循证实践并改善患者结局的实践和研究。研究结果证实了可持续性的概念是一个“动态的持续阶段”。
