Conectar
To evaluate the implementation process of a novel program focused on improving interactive (dialogic) feedback between clinicians and students during placement.
Quantitative cross-sectional hybrid type 3 effectiveness–implementation study driven by a federated model of social learning theory and implementation theory.
From June to November 2018, feedback approaches supported by socio-constructive learning theory and Normalisation Process Theory were enacted in four clinical units of a healthcare facility in southeast Queensland, Australia. The study involved 16 clinical instructors/supervisors, 94 bedside nurses, and 85 final-year nursing students. Engagement was evaluated using the Normalisation Measure Development survey. Situated learning encounters were constructed based on the needs of each group.
Survey results of the four Normalisation Process Theory constructs identified variable adoption by participant groups. Engagement in situated learning encounters that facilitate dialogic feedback was greatest in clinical instructors/supervisors, followed by students. Bedside registered nurses, while indicating they understood purposeful feedback behaviours, did not demonstrate them in practice.
The extent to which each group practiced dialogic feedback depended on their perceptions of their influence, whether they saw it as part of their role, and the effort and time required, regardless of the activity's importance, role statements, and codes of conduct.
Understanding the norms that shape communication, engagement, and nurses' role priorities is crucial for guiding practice and ongoing engagement with feedback.
The research provides valuable insights for leaders aiming to enhance the integration of evidence into practice. It guides leaders to understand that participants prioritise the reach, relevance, and resources of evidence over formal role descriptions, responsibilities, policies, and codes of conduct. This research encourages leaders to scrutinise existing beliefs, norms, and routines when implementing evidence-based practices.
Standards for Reporting Implementation Studies (StaRI) reporting guidelines were used.
None.
To identify and understand the different approaches to local consensus discussions that have been used to implement perioperative pathways for common elective surgeries.
Systematic review.
Five databases (MEDLINE, CINAHL, EMBASE, Web of Science and the Cochrane Library) were searched electronically for literature published between 1 January 2000 and 6 April 2023.
Two reviewers independently screened studies for inclusion and assessed quality. Data were extracted using a structured extraction tool. A narrative synthesis was undertaken to identify and categorise the core elements of local consensus discussions reported. Data were synthesised into process models for undertaking local consensus discussions.
The initial search returned 1159 articles after duplicates were removed. Following title and abstract screening, 135 articles underwent full-text review. A total of 63 articles met the inclusion criteria. Reporting of local consensus discussions varied substantially across the included studies. Four elements were consistently reported, which together define a structured process for undertaking local consensus discussions.
Local consensus discussions are a common implementation strategy used to reduce unwarranted clinical variation in surgical care. Several models for undertaking local consensus discussions and their implementation are presented.
Advancing our understanding of consensus building processes in perioperative pathway development could be significantly improved by refining reporting standards to include criteria for achieving consensus and assessing implementation fidelity, alongside advocating for a systematic approach to employing consensus discussions in hospitals.
These findings contribute to recognised gaps in the literature, including how decisions are commonly made in the design and implementation of perioperative pathways, furthering our understanding of the meaning of consensus processes that can be used by clinicians undertaking improvement initiatives.
This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.
No patient or public contribution.
Trial Registration: CRD42023413817
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