Design, Evaluation, and Translation of

Nurse-led intervention research is a core component of the global initiative to improve quality of care. Though research in this area has already contributed much to the advancement of patient care, future strides depend on the dissemination practical, how-to instruction on this important area of research. Design, Evaluation, and Translation of Nursing Interventions aids in this endeavor by presenting both general approaches and specific methods for developing nursing interventions. Logically organized to facilitate ease of use, the book is partitioned into four sections. The introduction provides a firm grounding in intervention science by situating it within the broader topics of evidence-based practice, client-centered care, and quality of care redefined. Section two describes each step of intervention design including correct identification of the health issue or problem, clarification of the elements comprising an intervention, and application of theory. Section three centers on implementation, highlighting such topics as development of the intervention manual, training interventionists, and intervention fidelity. The book concludes with methods to evaluate interventions enacted and suggestions for their translation into practice. Design, Evaluation, and Translation of Nursing Interventions distills the authors' years of expertise in intervention research into comprehensive, easy-to-follow chapters. It is a must-have resource for students, researchers and healthcare professionals wishing to impact the future of patient care. Key Features: Provides a thorough foundation in nursing intervention research and its impact on improving standards of care Segments the multifaceted process of intervention development into easy-to-follow, step-by-step chapters Presents methods for the evaluation of interventions developed Written by experts in the field

Souraya Sidani, Ph.D. is Professor and Canada Research Chair at the School of Nursing, Ryerson University. She has served as an investigator on over 20 funded grants and has numerous publications in peer-reviewed journals and books. Dr. Sidani’s research focuses on evaluating interventions and advanced practice roles, examining patient preferences for treatments, and refining research methods and measures for determining the clinical effectiveness of interventions.

Carrie Jo Braden, Ph.D. is Associate Dean for Research and Hugh Roy Cullen Professor of Nursing at the University of Texas Health Sciences Center at San Antonio. Dr. Braden is a Fellow of both the American Academy of Nursing and the Western Academy of Nursing. Her research focuses on learned response to chronic illness, mechanisms enhancing scholarly achievement (interprofessional research mentoring), and support resources for health disparities research. She has served as an investigator on 23 funded grants. She is a recipient of the Nurse of the Year Award for Excellence in Nursing Research and has authored or co-authored three books and numerous articles for refereed journals.

Preface xi

Acknowledgment xiii

SECTION 1 INTRODUCTION

1 Introduction to Intervention Research 3

1.1 Overview of paradigm shift 4

1.1.1 Evidence-based practice: a review 5

1.1.2 Client-centered care 7

1.1.3 High-quality care redefined 9

1.2 Process for designing, evaluating, and translating interventions 11

1.2.1 Design of interventions 11

1.2.2 Evaluation of interventions 12

1.2.3 Translation of interventions 13

1.3 Overview of the book 14

SECTION 2 DESIGNING INTERVENTIONS

2 Overview of Designing Interventions 17

2.1 Nursing interventions defined 17

2.1.1 Definition of interventions 17

2.1.2 Characteristics of interventions 19

2.2 Presenting problems 21

2.2.1 Definition of problem 21

2.2.2 Characteristics of problems 21

2.3 Design of interventions 23

3 Understanding the Problem 27

3.1 Theoretical approach for understanding the problem 27

3.2 Empirical approach for understanding the problem 31

3.3 Experiential approach for understanding the problem 35

3.4 Combined approach for understanding the problem 40

3.5 Theory of the problem 42

4 Clarifying Elements of the Intervention 43

4.1 Theory-based approach for designing interventions 43

4.2 Empirical approach for designing interventions 49

4.3 Experiential approach for designing interventions 53

4.3.1 Focus group 53

4.3.2 Concept mapping 54

4.3.3 Assessment of treatment preferences 54

4.4 Specification of interventions 56

4.4.1 Intervention goals 56

4.4.2 Intervention components and activities 56

4.4.3 Intervention mode of delivery 57

4.4.4 Intervention dose 59

5 Intervention Theory 61

5.1 Delineation of intervention outcomes 61

5.2 Intervention theory 64

5.2.1 Structure 64

5.2.2 Process 68

5.2.3 Outcome 68

5.3 Utility of intervention theory 71

6 Tailored Intervention 73

6.1 Design of tailored interventions 74

6.1.1 Intervention theory 74

6.1.2 Identification of client characteristics for tailoring 75

6.1.3 Assessment of client characteristics 76

6.1.4 Construction of a list of intervention strategies 76

6.1.5 Development of algorithm 78

6.2 Effectiveness of tailored interventions 81

6.3 Mechanisms underlying effects of tailored interventions 82

SECTION 3 IMPLEMENTATION OF INTERVENTIONS

7 Overview of Implementation of Interventions 85

7.1 Variations in intervention implementation 85

7.2 Consequences of variations in intervention implementation 90

7.3 Strategies to enhance intervention implementation 91

8 Development of Intervention Manual 93

8.1 Procedure for developing the intervention manual 93

8.1.1 Contextual characteristics 94

8.1.2 Process 94

8.2 Content of the intervention manual 95

8.2.1 Section 1: overview of the intervention 95

8.2.2 Section 2: human and material resources 97

8.2.3 Section 3: procedure 100

8.3 Use of the intervention manual 108

9 Selecting, Training, and Addressing the Influence of Interventionists 111

9.1 Traditional perspective on interventionist influence 112

9.2 Interventionist influence: the evidence 113

9.3 Selection of interventionists 116

9.4 Training of interventionists 119

9.5 Methodological features of studies aimed at investigating interventionist effects 123

10 Intervention Fidelity 125

10.1 Definition of fidelity 125

10.2 Methods for monitoring fidelity 129

10.2.1 Theoretical fidelity 130

10.2.2 Operational fidelity 133

10.3 Importance of monitoring fidelity of intervention implementation 143

SECTION 4 EVALUATION OF INTERVENTIONS

11 Overview of Evaluation of Interventions 149

11.1 Criteria for inferring causality 149

11.2 Phases for intervention evaluation 154

11.2.1 Phase 1 154

11.2.2 Phase 2 155

11.2.3 Phase 3 158

11.2.4 Phase 4 160

11.3 Role of intervention theory 161

12 Testing the Acceptability and Feasibility of Interventions 163

12.1 Acceptability of interventions 164

12.1.1 Conceptualization of intervention acceptability 165

12.1.2 Operationalization of intervention acceptability 167

12.2 Feasibility of interventions 180

12.2.1 Definition of feasibility 180

12.2.2 Indicators of feasibility 181

12.3 Feasibility of research methods 185

12.3.1 Recruitment procedures 186

12.3.2 Screening 188

12.3.3 Randomization 189

12.3.4 Retention 191

12.3.5 Data collection 192

12.4 Design of pilot study 193

13 Examining the Efficacy of Interventions 197

13.1 Factors affecting the causal relationship between intervention and outcomes 198

13.1.1 Conceptual factors 198

13.1.2 Methodological factors 200

13.1.3 Addressing conceptual and methodological factors 201

13.2 Design features of an efficacy study 201

13.2.1 Careful selection of participants 219

13.2.2 Control of experimental condition 222

13.2.3 Selection of comparison group 223

13.2.4 Allocation of participants to groups 228

13.2.5 Standardized treatment implementation 230

13.2.6 Outcome measurement 231

13.2.7 Outcome data analysis 231

14 Determining the Effectiveness of Interventions 233

14.1 Efficacy versus effectiveness: A brief review 234

14.2 Limitations of the RCT design in effectiveness research 235

14.2.1 Unrepresentativeness of the sample 235

14.2.2 Highly select setting 236

14.2.3 Limited applicability of interventions 237

14.2.4 Irrelevance of comparison treatment 238

14.2.5 Limited utility of randomization 239

14.2.6 Limited relevance of findings 240

14.3 Alternative designs for evaluating effectiveness 241

14.3.1 Overall function or goal 241

14.3.2 Broad representative sample 241

14.3.3 Selection of different settings 242

14.3.4 Comparison of clinically relevant alternative treatments 242

14.3.5 Assessment of relevant health outcomes at follow-up 243

14.3.6 Allocation to treatment 243

14.3.7 Additional features 245

15 Preferences for Treatment 251

15.1 Conceptualization of treatment preferences 251

15.1.1 Factors influencing treatment preferences 252

15.1.2 Consequences of treatment preferences 253

15.2 Mechanisms underlying influence of treatment preferences in intervention research 254

15.2.1 Influence of treatment preferences on external validity 254

15.2.2 Influence of treatment preferences on internal validity 256

15.2.3 Research designs accounting for treatment preferences 258

SECTION 5 TRANSLATION OF INTERVENTIONS

16 Translation of Interventions 263

16.1 Systematic review of evidence 264

16.2 Translation of evidence 265

16.3 Transfer of guideline to practice 268

16.3.1 Adaptation of guideline 268

16.3.2 Dissemination and implementation of guideline 270

References 271

Index 295

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Design, Evaluation, and Translation of Nursing Interventions

Summary

Author Biography

Table of Contents

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