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Measured and perceived effects of audit and feedback on nursing performance: a mixed methods systematic review protocol.

ABSTRACT: BACKGROUND:The use of audit and feedback (A&F) interventions in health care has been demonstrated to generally be effective on medical teams. However, literature suggests that the response of nurses to this type of intervention may differ from that of other types of health professionals, in relation to their roles, power, and to the configuration of nursing care activities. To our knowledge, no review has been conducted on A&F interventions with nurses. The objective of this systematic review is to examine the evidence of measured and perceived effects of A&F interventions on nurses' performance. METHODS:A mixed methods systematic review design with thematic and narrative synthesis is used. Studies reporting quantitative and qualitative data on the effects of A&F interventions specific to nursing care are considered for inclusion. Studies will be appraised for quality using the Mixed Methods Appraisal Tool. Quantitative and qualitative data will be summarized in narrative and tabular form and will be synthetized using a segregated methodologies approach. DISCUSSION:Results will describe the characteristics of A&F with nurses, as well as the measured and perceived effects specific to nursing care. The associations between the characteristics and the effects as well as the concordance between measured and perceived effects will be presented. We anticipate that combining the evidence from qualitative and quantitative studies will allow us to provide relevant insight that can inform the design of better suited A&F interventions for nurses. Audit and feedback interventions demonstrate potential for improving the performance of nursing care. As their effectiveness varies greatly depending on the context and the professionals involved, a better understanding of the associations between its characteristics and the measured and perceived effects is valuable for improving the effectiveness of A&F. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42018104973.

SUBMITTER: Dufour E

PROVIDER: S-EPMC6357419 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Measured and perceived effects of audit and feedback on nursing performance: a mixed methods systematic review protocol.

Dufour Émilie É Duhoux Arnaud A Bolduc Jolianne J

Systematic reviews 20190201 1

<h4>Background</h4>The use of audit and feedback (A&F) interventions in health care has been demonstrated to generally be effective on medical teams. However, literature suggests that the response of nurses to this type of intervention may differ from that of other types of health professionals, in relation to their roles, power, and to the configuration of nursing care activities. To our knowledge, no review has been conducted on A&F interventions with nurses. The objective of this systematic r ...[more]

PMID: 30709416

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Project description:IntroductionDespite the abundance of existing literature on evidence-based nursing practice, knowledge regarding evidence-based leadership, that is, leadership supported by an evidence-based approach, is lacking. Our aim is to conduct a mixed-methods systematic review with qualitative and quantitative studies to examine how evidence is used to solve leadership problems and to describe the measured and perceived effects of evidence-based leadership on nurses and nurse leaders and their performance as well as on organisational and clinical outcomes.Methods and analysisWe will search the following databases with no year limit or language restrictions: CINAHL (EBSCO), Cochrane Library, Embase (Elsevier), PsycINFO (EBSCO), PubMed (MEDLINE), Scopus (Elsevier) and Web of Science. In addition, the databases for prospectively registered trials and other systematic reviews will be screened. We will include articles using any type of research design as long as the study includes a component of an evidence-based leadership approach. Three reviewers will independently screen all titles, abstracts and full-text articles and two reviewers will extract the data according to the appropriate checklists. The quality of each study will be appraised using specific appraisal tool fitting in study design used in each study. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) grid, PRISMA Protocols, Synthesis Without Meta-analysis and ENTREQ will guide the study process and reporting. Outcomes related to individual or group performance of nurses or nurse managers regarding leadership skills (e.g., communication skills), organisational outcomes (e.g., work environment, costs) and clinical outcomes (e.g., patient quality of life, treatment satisfaction) will be extracted and synthesised.Ethics and disseminationThis systematic review will not include empirical data, and therefore, ethics approval will not be sought. The results of the review will be disseminated in a peer-reviewed scientific journal and in a conference presentation.Prospero registration numberCRD42021259624.

Project description:BackgroundWith the accumulation of evidence regarding potential harms of cancer screening in recent years, researchers, policy-makers, and the public are becoming more critical of population-based cancer screening. Consequently, a high-quality cancer screening program should consider individuals’ values and preferences when determining recommendations. In cervical cancer screening, offering women autonomy is considered a “person-centered” approach to health care services; however, it may impact the effectiveness of the program should women choose to not participate. As part of a larger project to investigate women’s cervical screening preferences and correlates of these preferences, this systematic review will capture quantitative and qualitative investigations of women’s cervical screening preferences and the methods used to elicit them.Design and methodsThis mixed methods synthesis will use a thematic analysis approach to synthesize qualitative, quantitative, and mixed methods evidence. This protocol describes the methods that will be used in this investigation. A search strategy has been developed with a health librarian and peer reviewed using PRESS. Based on this strategy, five databases and the gray literature will be searched for studies that meet the inclusion criteria. The quality of the included individual studies will be examined using the Mixed Methods Appraisal Tool. Three reviewers will extract data from the primary studies on the tools or instruments used to elicit women’s preferences regarding cervical cancer screening, theoretical frameworks used, outcomes measured, the outstanding themes from quantitative and qualitative evidence, and the identified preferences for cervical cancer screening. We will describe the relationships between study results and the study population, “intervention” (e.g., tool or instrument), and context. We will follow the PRISMA reporting guideline. We will compare findings across studies and between study methods (e.g., qualitative versus quantitative study designs). The strength of the synthesized findings will be assessed using the validated GRADE and CERQual tool.DiscussionThis review will inform the development of a tool to elicit women’s cervical screening preferences. Understanding the methods used to elicit women’s preferences and what is known about women’s cervical screening preferences will be useful for guideline developers who wish to incorporate a woman-centered approach specifically for cervical screening guidelines.Systematic review registrationPROSPERO CRD42016035737Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0310-9) contains supplementary material, which is available to authorized users.

Project description:BackgroundAcademic success has been the primary criterion for admission to many nursing programs. However, academic success as an admission criterion may have limited predictive value for success in noncognitive skills. Adding situational judgment tests, such as Casper, to admissions procedures may be one strategy to strengthen decisions and address the limited predictive value of academic admission criteria. In 2021, admissions processes were modified to include Casper based on concerns identified with noncognitive skills.ObjectiveThis study aims to (1) assess the incremental validity of Casper scores in predicting nursing student performance at years 1, 2, 3, and 4 and on the National Council Licensing Examination (NCLEX) performance; and (2) examine faculty members' perceptions of student performance and influences related to communication, professionalism, empathy, and problem-solving.MethodsWe will use a multistage evaluation mixed methods design with 5 phases. At the end of each year, students will complete questionnaires related to empathy and professionalism and have their performance assessed for communication and problem-solving in psychomotor laboratory sessions. The final phase will assess graduate performance on the NCLEX. Each phase also includes qualitative data collection (ie, focus groups with faculty members). The goal of the focus groups is to help explain the quantitative findings (explanatory phase) as well as inform data collection (eg, focus group questions) in the subsequent phase (exploratory sequence). All students enrolled in the first year of the nursing program in 2021 were asked to participate (n=290). Faculty will be asked to participate in the focus groups at the end of each year of the program. Hierarchical multiple regression will be conducted for each outcome of interest (eg, communication, professionalism, empathy, and problem-solving) to determine the extent to which scores on Casper with admission grades, compared to admission grades alone, predict nursing student performance at years 1-4 of the program and success on the national exam. Thematic analysis of focus group transcripts will be conducted using interpretive description. The quantitative and qualitative data will be integrated after each phase is complete and at the end of the study.ResultsThis study was funded in September 2021, and data collection began in March 2022. Year 1 data collection and analysis are complete. Year 2 data collection is complete, and data analysis is in progress.ConclusionsAt the end of the study, we will provide the results of a comprehensive analysis to determine the extent to which the addition of scores on Casper compared to admission grades alone predicts nursing student performance at years 1-4 of the program and on the NCLEX exam.International registered report identifier (irrid)RR1-10.2196/48672.

Project description:BackgroundLong length of stays (LOS) in emergency departments (ED) negatively affect quality of care. Ordering of inappropriate diagnostic tests contributes to long LOS and reduces quality of care. One strategy to change practice patterns is to use performance feedback dashboards for physicians. While this strategy has proven to be successful in multiple settings, the most effective ways to deliver such interventions remain unknown. Involving end-users in the process is likely important for a successful design and implementation of a performance dashboard within a specific workplace culture. This mixed methods study aimed to develop design requirements for an ED performance dashboard and to understand the role of culture and social networks in the adoption process.MethodsWe performed 13 semi-structured interviews with attending physicians in different roles within a single public ED in the U.S. to get an in-depth understanding of physicians' needs and concerns. Principles of human-centered design were used to translate these interviews into design requirements and to iteratively develop a front-end performance feedback dashboard. Pre- and post- surveys were used to evaluate the effect of the dashboard on physicians' motivation and to measure their perception of the usefulness of the dashboard. Data on the ED culture and underlying social network were collected. Outcomes were compared between physicians involved in the human-centered design process, those with exposure to the design process through the ED social network, and those with limited exposure.ResultsKey design requirements obtained from the interviews were ease of access, drilldown functionality, customization, and a visual data display including monthly time-trends and blinded peer-comparisons. Identified barriers included concerns about unintended consequences and the veracity of underlying data. The surveys revealed that the ED culture and social network are associated with reported usefulness of the dashboard. Additionally, physicians' motivation was differentially affected by the dashboard based on their position in the social network.ConclusionsThis study demonstrates the feasibility of designing a performance feedback dashboard using a human-centered design approach in the ED setting. Additionally, we show preliminary evidence that the culture and underlying social network are of key importance for successful adoption of a dashboard.

Project description:BackgroundAudit and feedback (A&F) is more effective if it facilitates action planning, but little is known about how best to do this. We developed an electronic A&F intervention with an action implementation toolbox to improve pain management in intensive care units (ICUs); the toolbox contained suggested actions for improvement. A head-to-head randomised trial demonstrated that the toolbox moderately increased the intervention's effectiveness when compared with A&F only.ObjectiveTo understand the mechanisms through which A&F with action implementation toolbox facilitates action planning by ICUs to increase A&F effectiveness.MethodsWe extracted all individual actions from action plans developed by ICUs that received A&F with (n = 10) and without (n = 11) toolbox for 6 months and classified them using Clinical Performance Feedback Intervention Theory. We held semi-structured interviews with participants during the trial. We compared the number and type of planned and completed actions between study groups and explored barriers and facilitators to effective action planning.ResultsICUs with toolbox planned more actions directly aimed at improving practice (p = 0.037) and targeted a wider range of practice determinants compared to ICUs without toolbox. ICUs with toolbox also completed more actions during the study period, but not significantly (p = 0.142). ICUs without toolbox reported more difficulties in identifying what actions they could take. Regardless of the toolbox, all ICUs still experienced barriers relating to the feedback (low controllability, accuracy) and organisational context (competing priorities, resources, cost).ConclusionsThe toolbox helped health professionals to broaden their mindset about actions they could take to change clinical practice. Without the toolbox, professionals tended to focus more on feedback verification and exploring solutions without developing intentions for actual change. All feedback recipients experienced organisational barriers that inhibited eventual completion of actions.Trial registrationClinicalTrials.gov, NCT02922101 . Registered on 26 September 2016.

Project description:Audit and feedback is effective in improving the quality of care. However, methods and results of international studies are heterogeneous, and studies have been criticized for a lack of systematic use of theory. In TREC (Translating Research in Elder Care), a longitudinal health services research program, we collect comprehensive data from care providers and residents in Canadian nursing homes to improve quality of care and life of residents, and quality of worklife of caregivers. The study aims are to a) systematically feed back TREC research data to nursing home care units, and b) compare the effectiveness of three different theory-based feedback strategies in improving performance within care units.INFORM (Improving Nursing Home Care through Feedback On PerfoRMance Data) is a 3.5-year pragmatic, three-arm, parallel, cluster-randomized trial. We will randomize 67 Western Canadian nursing homes with 203 care units to the three study arms, a standard feedback strategy and two assisted and goal-directed feedback strategies. Interventions will target care unit managerial teams. They are based on theory and evidence related to audit and feedback, goal setting, complex adaptive systems, and empirical work on feeding back research results. The primary outcome is the increased number of formal interactions (e.g., resident rounds or family conferences) involving care aides - non-registered caregivers providing up to 80% of direct care. Secondary outcomes are a) other modifiable features of care unit context (improved feedback, social capital, slack time) b) care aides' quality of worklife (improved psychological empowerment, job satisfaction), c) more use of best practices, and d) resident outcomes based on the Resident Assessment Instrument - Minimum Data Set 2.0. Outcomes will be assessed at baseline, immediately after the 12-month intervention period, and 18 months post intervention.INFORM is the first study to systematically assess the effectiveness of different strategies to feed back research data to nursing home care units in order to improve their performance. Results of this study will enable development of a practical, sustainable, effective, and cost-effective feedback strategy for routine use by managers, policy makers and researchers. The results may also be generalizable to care settings other than nursing homes.ClinicalTrials.gov Identifier: NCT02695836 . Date of registration: 24 February 2016.

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Measured and perceived effects of audit and feedback on nursing performance: a mixed methods systematic review protocol.

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Measured and perceived effects of audit and feedback on nursing performance: a mixed methods systematic review protocol.

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