Chicoine Gabrielle, Côté José, Pepin Jacinthe, Pluye Pierre, Jutras-Aswad Didier
Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, ON,Toronto, Canada.
Université de Montréal Hospital Research Center, Montreal, QC, Canada.
Int J Nurs Stud Adv. 2023 Sep 7;5:100153. doi: 10.1016/j.ijnsa.2023.100153. eCollection 2023 Dec.
People with concurrent mental health and substance use disorders have complex biopsychosocial problems but risk not having their healthcare needs met. Nurses are positioned to meet these needs but often lack training in concurrent disorder management. Extension for Community Healthcare Outcomes (ECHO®, University of New Mexico Health Sciences Center, 2003) is a promising technology-enabled collaborative learning model used to implement evidence-based practice and build capacity among healthcare professionals in managing complex, chronic, health conditions.
To understand how an ECHO program for concurrent disorder management impacts nurses' competency development and clinical practice and uncover key conditions for successful uptake and implementation.
A convergent mixed-methods design comprising a quantitative, uncontrolled before-and-after study and a qualitative study using interpretive description methodology.
An ECHO program for concurrent disorder management was implemented in 2018 at a quaternary academic hospital centre in metropolitan Western Canada. All 65 nurses who registered in the program between 2018 and 2020 were invited to participate in the study.
Online surveys completed by the participating nurses ( = 28) were administered at baseline and six and 12 months following entry-to-program to measure changes in nurse-related outcomes. The survey data were analyzed using descriptive statistics and repeated measures analysis. Semi-structured interviews were conducted with a nurse subgroup ( = 10) to explore how they developed and implemented competencies and what factors influenced this process. Interview transcripts were analyzed using inductive thematic analysis. Using the Pillar Integration Process, we analyzed results from both methods to provide a richer understanding of the phenomena.
We identified six interrelated key conditions for successful uptake and implementation of evidence-based practice in concurrent disorder nursing care with ECHO: (1) Practice and validation opportunities; (2) Reciprocal and trusting relationships in an interprofessional education context; (3) Peer-to-peer experience sharing; (4) Collaboration with experts; (5) Reinforcement of positive attitudes towards one's professional role; and (6) Organizational support.
Outcome measures, perspectives, and experiences collected over 12 months indicated that ECHO contributed to nurses' competency development and, under some conditions, to effective nursing practice changes. Given the challenges in implementing clinical guidelines in concurrent disorder nursing care, our results highlight the importance of understanding the key conditions for successful uptake and implementation. This informs approaches to optimally adapt implementation strategies to the needs and specificities of nurses to obtain impactful and sustainable results.
患有心理健康和物质使用障碍的人群存在复杂的生物心理社会问题，但他们的医疗保健需求可能无法得到满足。护士有能力满足这些需求，但在并发疾病管理方面往往缺乏培训。社区医疗保健成果扩展项目（ECHO®，新墨西哥大学健康科学中心，2003年）是一种很有前景的技术支持的协作学习模式，用于实施循证实践，并培养医疗保健专业人员管理复杂慢性健康状况的能力。
了解一个针对并发疾病管理的ECHO项目如何影响护士的能力发展和临床实践，并揭示成功采用和实施该项目的关键条件。
采用收敛性混合方法设计，包括一项定量的、非对照的前后研究以及一项使用解释性描述方法的定性研究。
2018年，在加拿大西部大都市的一家四级学术医院中心实施了一个针对并发疾病管理的ECHO项目。邀请了2018年至2020年期间注册参加该项目的所有65名护士参与研究。
参与研究的护士（n = 28）在基线、进入项目后的6个月和12个月时完成在线调查，以测量与护士相关的结果变化。调查数据采用描述性统计和重复测量分析。对一个护士亚组（n = 10）进行半结构化访谈，以探讨他们如何培养和实施能力，以及哪些因素影响了这一过程。访谈记录采用归纳主题分析。使用支柱整合过程，我们分析了两种方法的结果，以更深入地理解这些现象。
我们确定了在使用ECHO进行并发疾病护理中成功采用和实施循证实践的六个相互关联的关键条件：（1）实践和验证机会；（2）跨专业教育背景下的相互信任关系；（3）同行间的经验分享；（4）与专家的合作；（5）强化对自身专业角色的积极态度；（6）组织支持。
在12个月内收集的结果指标、观点和经验表明，ECHO有助于护士的能力发展，并且在某些条件下有助于实现有效的护理实践变革。鉴于在并发疾病护理中实施临床指南存在挑战，我们的结果凸显了理解成功采用和实施的关键条件的重要性。这为优化实施策略以满足护士的需求和特殊性从而获得有影响力和可持续的结果提供了指导。
