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Clinical Nurse Leader Knowledge Production to Quality Improvement in a Seamless Trajectory: A Participatory Research Approach.

ABSTRACT: BACKGROUND:Health systems are actively implementing Clinical Nurse Leader (CNL)-integrated care delivery across the United States. PROBLEM:However, the CNL model is a complex health care intervention, making it difficult to generate evidence of effectiveness using traditional research frameworks. APPROACH:Participatory research is a growing alternative to traditional research frameworks, emphasizing partnership with target community members in all phases of research activities. This article describes a system-based participatory study that leveraged academic and practice knowledge to conduct research that was feasible and relevant, and which produced findings that were easily translated into systematic action by the health system. OUTCOMES:Study data were used to produce improvements in the health system's CNL onboarding process, role differentiation, performance, recruitment, and growth plus development. CONCLUSIONS:A participatory approach can be used in future CNL studies, providing a framework for research efforts and potentially speeding up CNL evidence generation and utilization in practice.

SUBMITTER: Bender M

PROVIDER: S-EPMC6710131 | biostudies-literature | 2019 Oct/Dec

REPOSITORIES: biostudies-literature

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Clinical Nurse Leader Knowledge Production to Quality Improvement in a Seamless Trajectory: A Participatory Research Approach.

Bender Miriam M Spiva LeeAnna L Patrick Sara S Meffert Sarah S Moton Lonnie L Clarke Sharee S Mathis Kendra K Leclerc Lucy L Knotts Kimberly K Mount April A

Journal of nursing care quality 20191001 4

<h4>Background</h4>Health systems are actively implementing Clinical Nurse Leader (CNL)-integrated care delivery across the United States.<h4>Problem</h4>However, the CNL model is a complex health care intervention, making it difficult to generate evidence of effectiveness using traditional research frameworks.<h4>Approach</h4>Participatory research is a growing alternative to traditional research frameworks, emphasizing partnership with target community members in all phases of research activit ...[more]

PMID: 30839410

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Project description:Indigenous communities in Latin America and elsewhere have complex bodies of knowledge, but Western health services generally approach them as vulnerable people in need of external solutions. Intercultural dialogue recognises the validity and value of Indigenous standpoints, and participatory research promotes reciprocal respect for stakeholder input in knowledge creation.As part of their decades-long community-based work in Mexico's Guerrero State, researchers at the Centro de Investigación de Enfermedades Tropicales responded to the request from Indigenous communities to help them address poor maternal health. We present the experience from this participatory research in which both parties contributed to finding solutions for a shared concern. The aim was to open an intercultural dialogue by respecting Indigenous skills and customs, recognising the needs of health service stakeholders for scientific evidence.Three steps summarise the opening of intercultural dialogue. Trust building and partnership based on mutual respect and principles of cultural safety. This focused on understanding traditional midwifery and the cultural conflicts in healthcare for Indigenous women. A pilot randomised controlled trial was an opportunity to listen and to adjust the lexicon identifying and testing culturally coherent responses for maternal health led by traditional midwives. Codesign, evaluation and discussion happened during a full cluster randomised trial to identify benefits of supporting traditional midwifery on maternal outcomes. A narrative mid-term evaluation and cognitive mapping of traditional knowledge offered additional evidence to discuss with other stakeholders the benefits of intercultural dialogue. These steps are not mechanistic or invariable. Other contexts might require additional steps. In Guerrero, intercultural dialogue included recovering traditional midwifery and producing high-level epidemiological evidence of the value of traditional midwives, allowing service providers to draw on the strengths of different cultures.

Project description:IntroductionInternational policy recommends continuous, cost-effective monitoring of health data to enable health services to identify and respond to health inequities as experienced by different ethnic groups. However, there is a lack of routinely collected ethnicity data, particularly in primary care, and very little implementation research internationally to understand how ethnic identifiers are introduced, embedded and used in healthcare settings. This paper describes a protocol for a novel participatory health research project with the objective of building the evidence base on ethnic minority health in Ireland. Findings on the participatory appraisal of ethnic identifiers as an intervention to generate useful data about minority and majority ethnic groups will have relevance in other settings and countries.Methods and analysisThis multidisciplinary project is designed as a participatory health research study where all stakeholders, including ethnic minority communities, participate in co-design of the research protocol, project governance, collaborative data interpretation and disseminating findings. A national catalogue of all routinely collected health data repositories will be electronically searched for any repositories that contain information on ethnicity. A secondary quantitative analysis of a population-representative cohort study, Growing Up in Ireland, will be carried out to compare the health of ethnic minority and majority groups. A qualitative case study informed by normalisation process theory will be carried out at three primary care sites to monitor the implementation of an ethnic identifier and identify barriers and levers to implementation.Ethics and disseminationEthical approval for the qualitative case study has been granted by the Irish Council for General Practitioners (06/09/17). Permission to access data from Growing Up in Ireland has been granted by the Director General of the Central Statistics Office. Dissemination will be carried out at community events and academic conferences, in peer-reviewed journal publications, and through academic and healthcare provider networks.

Project description:ObjectivesThough multidisciplinary research networks support the practice and effectiveness of continuous quality improvement (CQI) programmes, their characteristics and development are poorly understood. In this study, we examine publication outputs from a research network in Australian Indigenous primary healthcare (PHC) to assess to what extent the research network changed over time.SettingAustralian CQI research network in Indigenous PHC from 2002 to 2019.ParticipantsAuthors from peer-reviewed journal articles and books published by the network.DesignCoauthor networks across four phases of the network (2002-2004; 2005-2009; 2010-2014; 2015-2019) were constructed based on author affiliations and examined using social network analysis methods. Descriptive characteristics included organisation types, Indigenous representation, gender, student authorship and thematic research trends.ResultsWe identified 128 publications written by 308 individual authors from 79 different organisations. Publications increased in number and diversity over each funding phase. During the final phase, publication outputs accelerated for organisations, students, project officers, Indigenous and female authors. Over time there was also a shift in research themes to encompass new clinical areas and social, environmental or behavioural determinants of health. Average degree (8.1), clustering (0.81) and diameter (3) indicated a well-connected network, with a core-periphery structure in each phase (p≤0.03) rather than a single central organisation (degree centralisation=0.55-0.65). Academic organisations dominated the core structure in all funding phases.ConclusionCollaboration in publications increased with network consolidation and expansion. Increased productivity was associated with increased authorship diversity and a decentralised network, suggesting these may be important factors in enhancing research impact and advancing the knowledge and practice of CQI in PHC. Publication diversity and growth occurred mainly in the fourth phase, suggesting long-term relationship building among diverse partners is required to facilitate participatory research in CQI. Despite improvements, further work is needed to address inequities in female authorship and Indigenous authorship.

Dataset Information

Clinical Nurse Leader Knowledge Production to Quality Improvement in a Seamless Trajectory: A Participatory Research Approach.

Publications

Clinical Nurse Leader Knowledge Production to Quality Improvement in a Seamless Trajectory: A Participatory Research Approach.

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