Semester

Fall

Date of Graduation

2009

Document Type

Dissertation

Degree Type

PhD

College

School of Nursing

Department

Adult Health

Committee Chair

June H Larrabee

Abstract

Background. Mixed evidence exists regarding the effective use of the use of the four translation strategies of educational materials, educational meetings, reminders, and audit and feedback on the adoption and implementation of interventions by nurses. Many clinical practice guidelines for the care of the stroke patient advocate for bladder training, but evidence-based bladder protocols for the stroke patient are not available. The best available bladder protocol identified was a prompted voiding algorithm from the Registered Nurses' Association of Ontario. Review of the literature reported 32--79% of hospitalized stroke patients suffer from urinary incontinence. Strong support for prompted voiding demonstrated the reduction of urinary incontinence in patients with cognitive and physical deficits. There was no evidence relevant to nurses' attitudes toward using and participating in research and their influences on the implementation of the stroke clinical practice guidelines. Additionally, there was no study located that investigated the effective use of the four translation strategies on nurses' adoption of a bladder protocol when providing care to stroke patients.;Purpose. The primary purpose of this study was to examine the effects of an intervention consisting of the four translation strategies of educational materials (clinical practice guideline), educational meetings, reminders, and audit and feedback on nurses' adoption of an evidence-based bladder program for stroke patients in an acute care setting. The second purpose was to evaluate the difference in incontinence episodes of stroke patients before and after nurses received the intervention. The third purpose of the protocol was to evaluate the influence of nurses' attitudes and the demographic characteristics on the adoption and the use of the evidence-based bladder program after receiving the intervention.;Methodology. A time-series design, using 8 one-week time points before the intervention and 16 one-week time points after the intervention, was used to obtain the required sample, n = 29. The nurse and medical record samples were convenience samples from a 40-bed neuroscience acute care unit affiliated with a 695-bed academic medical center. To meet the design requirements, data were collected over an extended period of time and an intervention was introduced during the time period. The intervention consisted of the use of the four translation strategies of educational materials (prompted voiding algorithm), educational meetings (staff education), reminders (e-mail messages and bulletin board updates), audit (chart review form data) and feedback (e-mail messages and bulletin board updates). The purpose of the intervention was to teach and encourage nurses to adopt a prompted voiding algorithm for stroke patients. The Research Utilization Survey was used to evaluate the influence of nurses' attitudes and demographic characteristics on the adoption and the use of the evidence-based bladder program after receiving the intervention.;Results. Data supported the degree of change as a two-fold increase in the nurses' adoption of an evidence-based bladder protocol, but there was no statistical difference in the incontinence episodes pre- and post-intervention. The increased research utilization and attitude scores were not statistically significant. Nurses' level of basic nursing education was positively associated with the adoption and the use of the evidence-based bladder protocol.;Conclusions. This study was the first to provide empirical support for the influence of the combination of these four translation strategies and nurses' attitudes toward research on adoption of evidence-based practice in a time-series design study; thus, the combined use of the four translation strategies did have an impact on nurses' adoption of evidence-based practice.

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