Evidence implementation: diving into the world of research

‘Why did I agree to this?’ was the first thing I thought as I boarded the plane to the Czech Republic. I was newly in post as a lecturer following a clinical career in primary care nursing, and here I was stepping into the world of research with a colleague whom I didn’t know, and with little experience in research and implementation projects. At this point it was either sink or swim. I was embarking on a journey that involved learning about implementation projects with other like-minded people from around Europe.
The anxiety and self-doubt that absorbed me that day soon melted away. I quickly recalled the reason why I was here: implementation projects in the world of research are crucial in bringing about quality improvement. The approach is grounded in audit and feedback processes, providing the best available evidence to drive and improve health outcomes. 
 

My particular implementation project concerned the implementation of clinical supervision. Within the nursing profession, the dramatic change in power, responsibility and professionalism is substantial, and it, ultimately, carries a high emotional cost in relation to the roles and responsibilities it holds. Therefore, the need for clinical support is essential. The work carried out by David Snowdon and his colleagues found that clinical supervision is a way in which this can be addressed, and this is what I wanted to implement in practice. Clinical supervision within healthcare is important as it provides a sanctuary for clinical staff to uncover their own personal emotions, reflect on practice and receive feedback.
 

Training program: collaborating and learning from like-minded colleagues
I attended the JBI Evidence implementation training program in November 2019. Due to the COVID-19 pandemic, the second part of the training program ended up being online and did not run until April 2021. The training took place over the course of five days in November and April; 12 participants were trained in implementation projects from around Europe and mentored by facilitators. Implementation topics other than clinical supervision included multidisciplinary ward rounds in Malawi, enhancing the use of pain assessment in the emergency department, communication in a medical laboratory, and many more. This program not only provided the necessary training and education on evidence implementation, but also provided an opportunity to collaborate with other healthcare professionals, discussing challenges, topics and what was going well with their projects, which was invaluable to my experience and knowledge gain.
 

Implementation project: teamwork, facilitation, stakeholder engagement
My evidence implementation project used the JBI Evidence Implementation Framework, the JBI Practical Appliance of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) audit feedback tool. My project team consisted of five members: myself, one primary care senior nurse, one team manager and two team leaders of a district nursing team. In order to start my project and establish a project team, I first had to engage with the health board and promote my project idea. This prompted ongoing discussions with and support from the host district nursing team, and it also allowed the senior nurse to act as a facilitator, bridging the gap between myself and the team. The importance of teamwork was high on my agenda; collaborating with clinical colleagues during this process was vital to make sure I established a productive project team and found an even balance between academia and clinical practice. This provided the project with stability and ensured that we communicated any difficulties, challenges and positive steps between us.
 

Sixteen registered nurses were recruited onto the project from one district nursing team that accounted for 302 patients across four general practice surgeries. I conducted a baseline audit before implementation in order to assess the use of clinical supervision in practice and identify any gaps. This consisted of audit questions being answered by participants. The results showed a very low compliance to all audit questions; for example, compliance to clinical supervision training was at 25% and knowledge of any activities associated with clinical supervision within practice was at 19%. It was clear that the uptake of clinical supervision was low. After meeting with the project team, we decided to deliver educational lectures on clinical supervision to all participants. Following this, clinical supervision sessions were carried out within the team over a period of five months, which allowed all participants to actively engage in clinical supervision at a time and place that was convenient to them. A follow-up audit using the same audit questions was completed five months after the last educational session. The results showed a significant improvement in all the audit questions, with some rising to 100% compliance.
 

However, this was not a straightforward process. I hit many barriers and challenges along the way. Firstly, my project started right at the beginning of the COVID-19 pandemic, healthcare systems were in emergency overdrive, staff were concentrating on how best to manage the pandemic, and time was a great issue. Yet the project team and participants remained optimistic, educational sessions were converted to online delivery and, even though the process took longer than originally thought, the clinical supervision sessions proved valuable to the participants during this time thanks to the professional and emotional support provided through the clinical supervision sessions. Communication was also a fundamental challenge, alongside available documentation and paperwork specific to clinical supervision. But again, with time, these were overcome.
 

Lessons learned
There have been many lessons learned from the first day of the training program to the success of the implementation project. Making strong relationships and collaborating with other healthcare professionals from around Europe provides a comprehensive approach to evidence implementation. Not only that, but as an academic, it brings me back to the ‘front line’, updating my own knowledge of the current state of clinical practice both within my local area and within Europe. Building strong relationships with the project team also contributed to the success of the project and showed that challenges can be overcome. For example, implementing clinical supervision within primary care can be difficult due to the setting/environment, and the variety of teams and staff members working within that setting, yet we successfully implemented clinical supervision within one team within primary care. Subsequently, all project team members learned that careful planning, consideration and working within a team environment helps to overcome challenges and aids in the successful implementation of change that can ultimately benefit those involved.
 

Secondly, I have helped healthcare professionals attend a clinical supervision session that benefited not only their personal health but their work ethos and ethic. And lastly, barriers and challenges always happen, whether you are carrying out an implementation project or leading a big research proposal, but they can always be overcome. Whether this is through your passion, determination, organisational skills or flexibility, if you believe in yourself, you can overcome any obstacle.
 

Key messages

• Evidence-based implementation projects are crucial in bringing about quality improvement.
• The importance of clinical supervision within healthcare is highly emphasised.
• Collaborating provides a comprehensive approach to evidence implementation.
• If you believe in yourself, you can overcome any obstacle.
   

Disclaimer
The views expressed in this World EBHC Day Blog, as well as any errors or omissions, are the sole responsibility of the author and do not represent the views of the World EBHC Day Steering Committee, Official Partners or Sponsors; nor does it imply endorsement by the aforementioned parties.