1. Implementation Science: Translating Research into Practice
Pat Bruckenthal, PhD, APRN-BC, FAAN
Associate Dean for Research and Innovation
Stony Brook University School of Nursing
Implementation Science: Translating Research into Practice

2. Conflict of Interest
Pat Bruckenthal has no COI relative to this presentation

3. Compare and contrast implementation science to other scientific research methods
Discuss various implementation science models
Apply implementation strategies to real world practice
Objectives

4. “There are not two sciences
“There are not two sciences. There is science and the application of science, and these two are linked as the fruit is to the tree”
Louis Pasteur

5. Background for Implementation Science in Nursing
Purpose: to promote the systematic uptake of research findings and other EBP’s into routine practice to improve the quality, safety, and effectiveness of health services and care
Addresses challenges associated with the use of research to achieve more evidenced based practice
Uses robust theoretical underpinnings from psychology, sociology, and organizational theory (behavioral change within organizational systems)

6. Definitions
Basic Research: seeks to increase or advance knowledge through systematic investigation of a subject or phenomenon
Translational Research: transforms scientific findings or discoveries from basic laboratory, clinical, or population studies into new clinical tools, processes, or applications
Implementation Science: is the scientific study of the use of strategies to adapt and integrate evidence-based health interventions into clinical and community settings to improve patient outcomes and benefit population health
Evidence Based Practice: refers to integration of the best evidence with clinical expertise to ensure the best possible patient outcomes
Quality Improvement: Using data to monitor the outcomes of care processes and using improvement methods to design and test changes to continuously improve the quality and safety of health care systems” (QSEN, 2003)

7. Steps of EBP process

8. Implementation Theories, Models, and Frameworks
Go from more abstract to structured. They explain, describe, or structure phenomena
Aims in implementation science:
Describe or guide the process of translating research into practice
Understand or explain what influences implementation outcomes
Evaluation of implementation
5 types of theories, models, and frameworks used in implementation science
Process models
Determinant framework
Classic theories
Implementation theories
Evaluation frameworks
Implementation Theories, Models, and Frameworks

9. Basic Implementation Model

10. Specify steps in the process of translating research into practice including the implementation and use of research
K2A Framework
Stetler Model
ACE Star Model (Academic Center for Evidenced-Based Practice)
IOWA Model
Ottawa Model
Process Models

11. Knowledge to Action Cycle (Graham, et al., 2006)

14. Ottawa Model
(Logan and Graham, 1998, 2004)

15. Determinant Frameworks
Specify types of determinants and individual determinants which act as barriers and enablers that influence implementation outcomes
PARIHS (Promoting Action on Research Implementation and Health Sciences)
Ecological Framework
CFIR Framework
Determinant Frameworks

16. CFIR Framework (Damschroder, et al., 2009)

17. PARHIS Framework

18. Theories originating form fields external to implementation science which can be applied to provide understanding and/or explanation of aspects of implementation
Theory of Diffusion
Various organizational theories
Classic Theories

19. Rogers’ Theory for Diffusion of Innovations

20. Implementation Theories
Theories that have been developed from scratch or by combing theories
Implementation Climate
Organizational Readiness
COM-B
Implementation Theories

21. COM-B Model (Mitchie et al., 2011)

22. Evaluation Frameworks
Specify aspects of implementation that could be evaluated to determine implementation success
RE-AIM
PRECEDE-PROCEED
Evaluation Frameworks

23. RE-AIM Model (Glasgow et al., 1999)

24. PRECEDE-PROCEED MODEL (Green, et al., 2005)

25. Strategies to match facilitators and barriers to implementation
Facilitator/Barrier
Strategy
Knowledge
Active learning
Advanced organizers
Attitude
Shifting perspective
Anticipated regret
Self efficacy
Modeling
Planned coping responses
Social norms
Role modeling
leadership
Organization
Priority setting at organizational level
Financing
Financial incentives .
Bartholomew, et al. (2006)

26. Implementation of the Critical Care Pain Observation Tool increases the frequency of pain assessment for noncommunicative ICU patients (Phillips, ML., Kuruvilla, V., Bailey, M. 2018, Australian Critical Care)
Problem: the common practice in this ICU was informal observational assessment of noncommunicative patients, which was inconsistent with international guidelines.
EBP: The Behavioural Pain Scale (BPS) and the Critical Care Pain Observation Tool (CPOT) are both valid in critically ill patients and recommended in expert consensus clinical practice guidelines
Purpose: implement the CPOT in our routine ICU practice and evaluate the effects on pain assessment and management.
Framework: Powell et al (2013) Plan strategies (Gather information, assess for readiness and barriers), Education strategies (education principles of “develop materials”, “educate”, and “educate through peers”)
Outcomes: Improved frequency of assessments and pain management strategies.

27. Using Diffusion of Innovations Theory to Implement the Confusion Assessment Method for the Intensive Care Unit (Bowen,M., Stanton, M., Manno, M., (2012), Journal of Nursing Care Quality)
Problem: the common practice in this ICU was informal observational assessment of noncommunicative patients, which was inconsistent with international guidelines
EBP: Review of delirium assessment tools. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) reliable, valid and feasible
Purpose: to use the Diffusion of Innovations Theory as a guide for developing strategies to increase the frequency of assessments when implementing the CAM-ICU
Planning-Pilot: barriers to the use and successful implementation of the CAM-ICU,
1) low frequency of assessments( less than 10% )
2) Informal interviews revealed nurses perceptions on the usefulness of delirium assessments, time it took to perform the assessments, and availability of the CAM-ICU worksheets, which were not kept with their daily paperwork
3)results of the CAM-ICU were not ascertained by the physicians or residents or used for the development of the plan of care

28. Framework: Roger’s Diffusion of Innovation
Knowledge:
1-hour in-services, (double the length of the in-service from the original pilot)
A short video demonstrating time it took to perform the assessment
Poster boards placed them in the nurses’ lounge
Meeting with intensivist and key stakeholders to discuss implementing the CAM-ICU
Persuasion: Nurse managers identified as “CAM Champs”
Decision: poster boards and open access journal articles were used to provide weekly information and influence the nurses’ decision to continue to assess for delirium.
Implementation:
Assess delirium at the beginning of each shift, 8:00 am and 8:00 pm.
CAM-ICU worksheets were placed in the patients’ binders with the nurses’ daily paperwork
Placement of laminated CAM-ICU flow sheets in the patients’ binders
Continued support from the CAM Champs, nurse manager, and clinical educator
Confirmation
Continued feedback and support
Nurse manager and clinical educator informally discussed the potential for the development of a protocol for the management of delirium and possibility of performing research with the nurses
Evaluation
Data on the number of mechanically ventilated patients on each unit were collected on a daily basis
The frequency of CAM-ICU assessments was measured by determining how many assessments would be expected and how many were actually completed

29. Research is a “team sport”
Multidisciplinary: Coordination of research among scientists of different backgrounds and disciplines
Interdisciplinary: Cooperative effort of scientists on issues that fall between disciplinary boundaries
Transdisciplinary: Collaborative projects where information exchange, the modification of scientific approaches, and the integration of scientists and approaches from different disciplines advances research toward a common scientific goal

30. DNP vs PhD

31. Get Started Identify a problem Assemble your team
QI departments, decision support, etc…
Partner with DNP. PhD’s (others with experience and interest)
Plan the project out with a time line
Just do it
Celebrate your success

32. Thank you