Bridging the gap between practice and research: Evidence-based practice after aquired brain injury in a sub-acute rehabilitation setting

Publikation: KonferencebidragKonferenceabstrakt til konferenceFormidling

1) Please declare any conflicts of interest below
The authors have no conflicts of interest to declare. No funding was obtained.

2) Ethics Approval:
All participating clinical staff received written and verbal information about the study and gave their verbal and written consent to participate. The quality development study was conducted in accordance with Danish legislation on research ethics.


3) Context:
The project took place at a sub-acute rehabilitation ward at Hammel Neurorehabilitation Center and University Research Clinic.
Management, researchers and health professionals responsible for clinical development collaborated.
Patients are admitted shortly after injury for in-hospital rehabilitation following severe acquired brain injury. Disturbances in consciousness and cognition are frequent in these patients.

4) Problem:
In early rehabilitation, a large proportion of patients with severe brain injury show only weak signs of contact. The results of a previous research project conducted at the previously mentioned rehabilitation ward showed that promoting active participation of patients with reduced consciousness in therapeutic interventions and everyday activities is difficult, but also possible. Staff at the same ward contributed to further research clarifying that specific staff competencies were of significant importance when promoting early participation for patients with severe acquired brain injury. However, there was no systematic education and implementation plan to ensure that these competencies were present in each individual within the staff.

5) Assessment of problem and analysis of its causes:
Individual competence levels did not warrant a systematic approach to promote early participation in patients with severe acquired brain injury. A systematic education and implementation plan was needed.



6) Intervention:
Management, researchers and health professionals responsible for clinical development collaborated closely to strategically develop and implement a plan to promote the growth of relevant competencies among all employees during 2019 outlined in the 5 steps below:

1) Individual competencies from clinical staff was observed by researchers (empirical data)
• High quality clinical practice
• Individual competencies
• Observations of early participation
2) Empirical studies
• Research projects
• Clinical setting described
• Interdisciplinary strategies observed and systematized
3) Systematic results
• New approach developed
• Strategies to promote early participation
4) Implementation
• Systematic approach
• Educational training
• Peer feedback
• Using a theoretical model as a framework to promote early participation
5) Evaluation
• Effect and experience
• Evaluation on two levels; organisational and patient related
• Qualitative and quantitative outcome meassures

7) Strategy for change:
The strategy for change was a feedback loop between researchers, managers, and clinical staff ensuring a systematic approach based on the individual competencies in the clinical staff.

Step 1,2 and 3 took place in 2015-2017
Step 4 took place in 2019.
Step 5 – evaluation – will take place in 2020
Management and interdisciplinary health professionals were facilitators of the new systematic approach.
All staff were involved in educational training and peer feedback on the strategies implemented.

8) Measurement of improvement:
Preliminary results: Staff responded by questionnaires after each teaching course. Further, focus group interviews have been conducted after educational training 2. Early Functional Ability scores from patients have been registered.
All findings will be presented as descriptive data.

9) Effects of changes:
Staff will report their experience of the systematic approach in focus group interviews.
It will also be interesting to see if
● staff report changed level of perceived competencies
● average early functional ability of the patients have changed post implementation


10) Lessons learnt:
Facilitation of patient participation among patients with severe disturbances in consciousness and cognition involves several professional and often tacit competencies. A ward with a highly skilled multidisciplinary staff and 24 hour rehabilitation service requires that development and implementation of capacity building programs are based on values, customized to the specific staff, systematic and closely monitored.

11) Messages for others:
Final analysis of implementation evaluation will be ready in March 2020.

12) Please describe how you have involved patients, carers or family members in the project:
The whole implementation project has derived from empirical data gathered from observational studies in the clinic. This means that knowledge and actions from the clinical staff were systematized and given back to the clinical staff as a systematic approach. Part of the evaluation of the implementation was based on questionnaire and focus group assessments of clinical staff regarding their learning experience and perceived level of competence.
Bidragets oversatte titelBrobygning mellem klinisk praksis og forskning: Evidensbaseret praksis efter erhvervet hjerneskade på et subakut rehabiliteringscenter
OriginalsprogEngelsk
Udgivelsesår28 apr. 2020
StatusUdgivet - 28 apr. 2020
BegivenhedInternational Forum on Quality and Safety in Healthcare 2020 - Bella Center, Copenhagen, Danmark
Varighed: 28 apr. 202030 apr. 2020
https://internationalforum.bmj.com/copenhagen/

Konference

KonferenceInternational Forum on Quality and Safety in Healthcare 2020
LokationBella Center
LandDanmark
ByCopenhagen
Periode28/04/202030/04/2020
Internetadresse

    Forskningsområder

  • Implementation, Evidence-based practice

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