Paper
Wednesday, July 13, 2005
2 Building Capacity for Evidence-Based Practice Change Using External Coaches and Internal Linkers to Reduce Hospital Falls: Analysis of Intervention Processes and Content
Dana N. Rutledge, PhD, RN1, Nancy E. Donaldson, RN, DNSc, FAAN2, Jeffrey Ashley, RN, MS, PhD(c)2, Kristin Geiser, PhD3, and Joanne S. Kingsbury, RN, MBA, CNA4. (1) Department of Nursing, California State University, Fullerton, Fullerton, CA, USA, (2) Center for Research & Innovation in Patient Care, UCSF School of Nursing, San Francisco, CA, USA, (3) Consultant, Menlo Park, CA, USA, (4) Association of California Nurse Leaders, Sacramento, CA, USA
Aim. This paper examines preliminary patterns in external coach and internal linkers contact content intended to build organizational capacity for falls related performance improvement in acute care hospitals. Methods. Adapting Havelock's Linkage Model (1986), the CalNOC Partners to Reduce Patient Falls Project uses external coaches to assist site-based linkers to reduce patient falls in 92 medical surgical units drawn from 33 hospitals participating in the ongoing California Nursing Outcomes Coalition Project (CalNOC). The standardized, yet individualized coaching process was guided by organizational and unit-level self assessments, and a drill down analysis of each hospital's CalNOC data. Each coach from the team of 6 advanced practice nurses forged a partnership with designated “linkers” to identify goals/priorities for improvement, develop a systematic plan for attaining those goals and execute the plan successfully. Regional networking across sites and web-based information resources, plus dissemination of emerging “best practices” supplemented the coaching contacts. Procedure. The coaching process was adopted from the field of education with customized actions and content documented using tools adapted from Donaldson (1987). Foci of monthly, predominately telephone-based coaching interactions included, (1) evidence-based content falls reduction, (2) process evaluation and strategic planning, (3) building relationships with linkers, and (4) understanding organizational context and barriers. Coaches strengthen linker capacity to plan, implement, and evaluate efforts to reduce patient falls. Linkers literally connect research findings to practice. Important linker qualifications were status as an “expert” nurse within the NSO, and excellent verbal, written, and computer skills. Preferred qualifications include advanced practice role with minimum education at the baccalaureate level and multiple years of clinical experience. Findings. This presentation will examine qualitative data gleaned from the Coaching Documentation Record, analyzing themes and patterns across sites. Implications for research translation and related evidence-based practice change efforts and generalizability of this method will be discussed.