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Item Adoption and Implementation of Screening, Brief Intervention, and Referral to Treatment(2020-06) Thoele, Kelli Marie; Newhouse, Robin; Draucker, Claire Burke; Harle, Christopher; Fulton, JanetMore than 20 million people in the United States have a substance use disorder, resulting in negative individual and societal outcomes. An evidence-based intervention, Screening, Brief Intervention, and Referral to Treatment (SBIRT), involves screening patients to assess for substance use and then providing a brief intervention and referral to treatment when indicated. This evidence-based intervention is underutilized in healthcare settings. The purpose of this dissertation was to contribute to the body of evidence regarding the implementation of SBIRT in healthcare settings. Specifically, the aims of this dissertation were to 1) provide an overview of the evidence regarding the use of implementation strategies to facilitate the implementation of SBIRT, 2) describe implementation of SBIRT by nurses in acute care hospitals, and 3) examine individual and organizational characteristics associated with the intra-organizational adoption of SBIRT. To review the literature, a scoping review was completed on 18 articles that met the inclusion criteria. The review found that leaders often train and educate stakeholders to facilitate the implementation of SBIRT, but less attention has been given to adapting the intervention or engaging patients. Additionally, implementation efforts led to increases in screening, but the evidence regarding the effect on brief intervention is inconclusive, and evidence regarding referral to treatment is scarce. Eighteen nurses participated in a qualitative descriptive study of the implementation of SBIRT, and data were analyzed using content analysis. Participants identified barriers and facilitators associated with the nurses’ attitudes and beliefs about SBIRT, organizational factors, and patients’ response to the SBIRT process. Participants indicated that SBIRT was a useful intervention that was best implemented by providing a clear process and incorporating SBIRT into an established workflow. To examine factors related to intra-organizational adoption of a tool to screen patients for substance use, two hundred twenty-two nurses participated in a crosssectional study. Results of this study indicate that training and the perception of peer usage of the intervention were significantly related to individual nurses’ use of the intervention in practice. The findings of this dissertation can inform research and practice regarding the implementation of SBIRT in healthcare settings.Item Assessing public behavioral health services data: a mixed method analysis(BMC, 2020-11-11) Vaughn, Sierra X.; Maxey, Hannah L.; Keen, Alyson; Thoele, Kelli; Newhouse, Robin; Medicine, School of MedicineBackground Measuring behavioral health treatment accessibility requires timely, comprehensive and accurate data collection. Existing public sources of data have inconsistent metrics, delayed times to publication and do not measure all factors related to accessibility. This study seeks to capture this additional information and determine its importance for informing accessibility and care coordination. Methods The 2018 National Survey for Substance Abuse and Treatment Services (N-SSATS) data were used to identify behavioral health facilities in Indiana and gather baseline information. A telephone survey was administered to facilities with questions parallel to the N-SSATS and additional questions regarding capacity and patient intake. Quantitative analysis includes chi-square tests. A standard qualitative analysis was used for theming answers to open-ended questions. Results About 20% of behavioral health facilities responded to the study survey, and non-response bias was identified by geographic region. Among respondents, statistically significant differences were found in several questions asked in both the study survey and N-SSATS. Data gathered from the additional questions revealed many facilities to have wait times to intake longer than 2 weeks, inconsistency in intake assessment tools used, limited capacity for walk-ins and numerous requirements for engaging in treatment. Conclusion Despite the low response rate to this study survey, results demonstrate that multiple factors not currently captured in public data sources can influence coordination of care. The questions included in this study survey could serve as a framework for routinely gathering these data and can facilitate efforts for successful coordination of care and clinical decision-making.Item Building Evidence-Based Nursing Practice Capacity in a Large Statewide Health System(Wolters Kluwer, 2019-04) Storey, Susan; Wagnes, Lisa; LaMothe, Julie; Pittman, Joyce; Cohee, Andrea A.; Newhouse, Robin; School of NursingIntegration of evidence-based practice (EBP) into the culture of a healthcare organization is essential to provide safe patient care and promote a thriving culture for the nurses within the healthcare organization. Collaboration and utilization of both clinical and academic experts facilitate the removal of barriers to EBP. This article describes the successful partnership between a healthcare system and school of nursing in executing a 3-phased multimodal approach to an EBP training program.Item Building Research Infrastructure in Magnet® Hospitals: Current Status and Future Directions(Lippincott, Williams, and Wilkins, 2017-04) Johantgen, Meg; Weiss, Marianne; Lundmark, Vicki; Newhouse, Robin; Haller, Karen; Unruh, Lynn; Shirey, Maria; School of NursingOBJECTIVE: The aim of this study was to describe the infrastructures supporting research in Magnet® hospitals. BACKGROUND: Hospitals undertaking the journey toward Magnet designation must build research and evidence-based practice (EBP) infrastructures that support the infusion of research and EBP into clinical practice. METHODS: An electronic survey was developed and distributed to the chief nursing officer or Magnet coordinator of all Magnet hospitals between June 10, 2015, and July 8, 2015. RESULTS: Of the 418 Magnet hospitals invited, 249 responses (60%) were received. Resources dedicated to nursing research were difficult to isolate from those for EBP. Supporting clinical nurses’ time away from the bedside remains a challenge. Nearly half (44%) indicated that research is conducted within the nurses’ usual clinical hours, and 40% indicated that nurses participate on their own time. CONCLUSIONS: Hospitals use a variety of resources and mentor arrangements to support research and EBP, often the same resources. More targeted resources are needed to fully integrate research into clinical practice.Item Development and assessment of the usability of a web-based referral to treatment tool for persons with substance use disorders(Springer Nature, 2021-09-08) Thoele, Kelli; Yu, Mengmeng; Dhillon, Mandeep; Comer, Robert; Maxey, Hannah L.; Newhouse, Robin; Oruche, Ukamaka M.; School of NursingBackground: Hospitalized people with unhealthy substance use should be referred to treatment. Although inpatient referral resources are often available, clinicians report that outpatient referral networks are not well-established. The purpose of this manuscript is to describe the development and usability testing of a web-based Referral to Treatment Tool (RTT © 2020 Trustees of Indiana University, all rights reserved) designed to identify treatment centers for people with unhealthy substance use. Results: The RTT was conceptualized, developed, and then populated with public use and local survey data of treatment centers from 14 market ZIP codes of hospitals participating in an SBIRT implementation study. The tool underwent initial heuristic testing, followed by usability testing at three hospitals within a large healthcare system in the Midwest region of the United States. Administrative (n = 6) and provider (n = 12) users of the RTT completed a list of tasks and provided feedback through Think-Aloud Tests, the System Usability Scale, and in-person interviews. Patients (n = 4) assessed multiple versions of a take-home printout of referral sites that met their specifications and completed in-person interviews to provide feedback. Each administrative task was completed in less than 3 min, and providers took an average of 4 min and 3 s to identify appropriate referral sites for a patient and print a referral list for the patient. The mean System Usability Scale score (M = 77.22, SD = 15.57, p = 0.03) was significantly higher than the passable score of 70, indicating favorable perceptions of the usability of the RTT. Administrative and provider users felt that the RTT was useful and easy to use, but the settings and search features could be refined. Patients indicated that the printouts contained useful information and that it was helpful to include multiple referral sites on the printout. Conclusion: The web-based referral tool has the potential to facilitate voluntary outpatient referral to treatment for patients with unhealthy substance use. The RTT can be customized for a variety of health care settings and patient needs. Additional revisions based on usability testing results are needed to prepare for a broader multi-site clinical evaluationItem Development and use of a toolkit to facilitate implementation of an evidence-based intervention: a descriptive case study(BMC, 2020-10-06) Thoele, Kelli; Ferren, Melora; Moffat, Laura; Keen, Alyson; Newhouse, Robin; School of NursingBackground Implementation of evidence-based clinical interventions in real-world settings becomes a futile effort when effective strategies to foster adoption are not used. A toolkit, or a collection of adaptable documents to inform and facilitate implementation, can increase the use of evidence-based interventions. Most available toolkits provide resources about the intervention but lack guidance for adaptation to different contexts or strategies to support implementation. This paper describes the development and use of a toolkit to guide the implementation of an evidence-based intervention to identify and intervene for people with risky substance use. Methods A descriptive case study describes the development and use of a toolkit throughout a two-year study. Investigators and site coordinators from 14 acute care hospitals developed tools and engaged external stakeholders as they prepared for implementation, integrated the clinical intervention into practice, and reflected on implementation. Results The final toolkit included 54 different tools selected or created to define the intervention, engage and communicate with stakeholders, assess for readiness and plan for implementation, train clinical nurses and other stakeholders, evaluate training and implementation effectiveness, create policies and procedures for different contexts, and identify opportunities for reimbursement. Each tool corresponds to one or more implementation strategies. Conclusion The approach used to develop this implementation toolkit may be used to create resources for the implementation of other evidence-based interventions.Item Evidence-Based Practive Sustainability and Nursing Professional Governance(2021-10) Ferren, Melora Darlene; Newhouse, Robin; Von Ah, Diane; Ellis, Rebecca J. Bartlett; Menachemi, NirPatient care that is not based on evidence-based practice (EBP) could be considered malpractice, and it threatens patient safety, quality, and fiscal performance. EBP implementation is complex, and sustainment of these practices is such a persistent challenge that up to 70% of organizational change fails to be sustained. Sustainment of EBP decreases healthcare costs and improves patient outcomes. Professional attributes that influence sustainability are not well understood. Nursing professional governance (PG) is a framework of professional attributes that includes accountability, professional obligation, collateral relationships, and decision-making. This framework includes attributes that are necessary for professionals to effectively govern their profession and influence outcomes. Healthcare professionals are an important component of sustainability frameworks; however, the professional attributes that influence sustainability have not been validated by research. The purpose of this dissertation was to examine the influence of professional attributes on the sustainability of EBP and patient outcomes. This was accomplished through 1) an ethnographic qualitative study, 2) a cross-sectional study, and 3) a scoping review. The researcher used a qualitative study to described cultural characteristics, nurse values, and beliefs that influenced the sustainability of an EBP in the acute care setting. This was accomplished through a focused ethnographic approach with semi-structured interviews and observations. The study setting was a community hospital and the sample included registered nurses. In this study, nurses’ described experiences, beliefs, and values of an EBP intervention that influenced sustainability. The purpose of the cross-sectional study was to examine associations between professional governance attributes and unit-level central line-associated bloodstream infection outcomes. Secondary cross-sectional data were analyzed with independent-sample t-test, point-biserial correlation, and univariate logistic regression. The study setting included ninety-one inpatient units within eight acute care hospitals. In this study, results revealed possible connections between professional governance attributes and patient outcomes. Finally, a scoping review included 31 articles to provide an overview of evidence about sustainability and EBP champion responsibilities. The scoping review summarized literature on EBP champion responsibilities that influenced EBP sustainability. The findings of this dissertation can inform research, practice, and policy regarding professional attributes that enhanced or hindered EBP sustainability.Item Exploring the Demographic and Professional Characteristics of Physicians and Nurse Practitioners Associated With Providing Medication-Assisted Treatment: A Retrospective Observational Study(Sage, 2024) Maxey, Hannah L.; Vaughn, Sierra X.; Dickinson, Analise; Newhouse, Robin; Medicine, School of MedicineIntegration of medication-assisted treatment (MAT) for opioid use disorder in primary care settings is an emerging health care delivery model that supports increased access to specialized care but requires primary care provider engagement. Examining the characteristics of providers who provide this service is key to informing targeted recruitment. Using administrative and supplemental data collected during license renewal, this study aimed to identify the characteristics of primary care physicians and nurse practitioners (NPs) associated with greater odds of providing MAT in their practice. A retrospective observational study was conducted using a descriptive correlational design. The analysis included 5259 physicians and 3486 NPs who renewed their licenses electronically in 2021 and specialized in primary care or psychiatry. Chi-square and logistic regression analyses were conducted to identify the demographic and clinical characteristics of physicians and NPs associated with MAT participation in their practice. Physicians had a higher odds ratio (OR) of providing MAT if they were younger than 35 years (OR = 1.334; P = .0443), practiced in a federally qualified health center (OR = 3.101, P < .0001), and offered a sliding fee scale in their practice (OR = 2.046; P < .0001). Likewise, NPs had higher odds of providing MAT if they practiced in a public or community health center (OR = 3.866; P < .0001). The results of this study highlight the personal and professional characteristics of physicians and NPs associated with higher odds of providing MAT. These findings may have implications for the recruitment and sustainability of MAT integration in primary care.Item Implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) by Nurses on Acute Care Units: A Qualitative Descriptive Study(Taylor & Francis, 2020) Thoele, Kelli; Burke Draucker, Claire; Newhouse, Robin; School of NursingBackground Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based intervention for patients with substance use disorders, but this intervention is under-utilized. Little is known about the implementation of SBIRT in acute care facilities. The purpose of this study is to describe implementation of SBIRT by nurses in acute care hospitals. Methods: A qualitative descriptive design was used for this study. Registered nurses who agreed to participate in the study completed a 1:1 interview using a semi-structured interview guide. Interviews were audio recorded and transcribed and then data were analyzed using qualitative content analysis. Results: When implementing SBIRT in an acute care setting, participants identified several factors that affect implementation. Some nurses felt that it is “one more thing to do” but other nurses feel that it was a “good, simple” screening tool that does not take long to do and can “plant the seeds of change” for patients. Additionally, participants mentioned barriers and facilitators related to the patients’ responses to SBIRT and organizational factors. Conclusions: This study identified several barriers and facilitators to SBIRT implementation related to the nurses, patients, and organization. By understanding the factors that influence implementation, healthcare providers can develop strategies to support effective implementation of SBIRT.Item Leadership Characteristics of Nurse Managers Associated with Implementation of Evidence-Based Practice(2021-12) Noth-Matchett, Amanda Ann; Newhouse, Robin; Von Ah, Diane; Ellis, Rebecca Bartlett; Menachemi, NirThe implementation of evidence into practice is a complex process. Estimates indicate that it takes seventeen years on average for research to be translated into practice. Delay in implementation of evidence-based practice (EBP) results in poor patient outcomes and negative impacts to healthcare systems. While many factors contribute to delayed implementation of evidence, organizational characteristics of healthcare institutions have a significant impact on implementation. Leaders play a critical role by influencing these organizational characteristics to support evidence-based practice implementation. A key leadership role within acute care healthcare organizations is that of the front-line nurse manager (NM). Front-line nurse managers have responsibility for nursing unit operations and clinical nurses who deliver patient care under the nurse managers supervision. The relationship between NM leadership competencies and implementation of EBP is not well understood. Therefore, there is a critical need to identify how NM leadership behaviors influence the implementation of EBP. This dissertation examined the relationship between NM leadership behaviors and implementation of EBP. Results link the role of the NM to evidence-based clinical practice, and describe competencies and education needed for NM development. With an understanding of the NM leadership behaviors associated with implementation of EBP, healthcare leaders can develop education, processes, and interventions to increase competencies on NM leadership behaviors. Better implementation support by NMs will result in an improvement in use of EBPs. To examine the NM leadership behaviors that are associated with implementation of EBP, the following activities were completed: (1) an integrative review of the literature related to NM competencies associated with implementation, (2) identification and description of nurse manager competencies associated with EBP implementation using the Delphi method, and (3) examination of NM leadership behaviors associated with implementation of EBP during the COVID-19 pandemic response through a multi-site descriptive correlational survey of NMs and their nursing staff. Results of these studies demonstrate the importance of NM leadership characteristics and behaviors on EBP implementation.