Peer Responses

Responding to Tiffany Taylor

Hello,

Thank you for sharing your post about the application of the Consolidated Framework of Implementation Research (CFIR) in managing sepsis. You have done a good job arguing that the CFIR framework is adaptable and can be used to inform multi-domain interventions. In addition, I would recommend adding the Theoretical Domains Framework (TDF) as an additional framework to your practice: Peer Responses.

Notably, the TDF concentrates on behavioral determinants that affect the behavior and way of interacting with new practices, which would give an in-depth look into the attitudes and behaviors of healthcare staff that may be involved in the process of implementation (McGowan et al., 2020). As an example, in case of resistance to implementing the new sepsis protocol, the TDF could be useful in helping to determine the psychological and social reasons that can render change needs, which may be perceptions of their work or role clarity and self-perceptions of their abilities.

Practically, applying specific interventions that deal with these behavioral aspects may increase staff buy-in and create a more welcoming culture that embraces change. Indeed, your plan to utilize the holistic perspective of the setting provided by the CFIR is excellent, and the addition of the Theoretical Domains Framework can make your project even more successful as it will allow you to consider the human aspect of the implementation as well. This integrated strategy would determine the management of sepsis to be more sustainable and has the possibility of succeeding in the long-term perspective (O’Donovan et al., 2023). Great work!

References

McGowan, L. J., Powell, R., & French, D. P. (2020). How can use of the theoretical domains framework be optimized in qualitative research? A rapid systematic review. British Journal of Health Psychology, 25(3), 677–694. https://bpspsychub.onlinelibrary.wiley.com/doi/abs/10.1111/bjhp.12437

O’Donovan, B., Kirke, C., Pate, M., McHugh, S., Bennett, K., & Cahir, C. (2023). Mapping the theoretical domain framework to the consolidated framework for implementation research: Do multiple frameworks add value? Implementation Science Communications, 4(1). https://doi.org/10.1186/s43058-023-00466-8

Responding to Judeith L James

Hello,

Great work. This is an informative post about how the Iowa Model can be applied to better serve the early identification and management of patients who are at risk of psychiatric decompensation. I fully concur with the fact that the Iowa Model is important in mental care, particularly in communities, due to the correlation between the idea of collaboration and flexibility. To add on, I would recommend taking into account the RE-AIM framework in addition to the Iowa Model.

RE-AIM is based on five important elements, including Reach, Effectiveness, Adoption, Implementation, and Maintenance, that can be used to establish the wider effects of interventions (Hodgson et al., 2023). Tracking these elements would allow you to determine not only whether your intervention is effective but also how rapidly it is spreading, to what degree it influences patient outcomes, and whether or not it can be sustained moving forward.

With regard to your project, RE-AIM can assist you in determining the extent to which your integrated care management platform is effective in identifying and mitigating the risk factors among the home care population. It can also give a great indication of the successful adoption of intervention amongst various stakeholders such as care managers, social workers, and family members (Cullen et al., 2022). Additionally, introducing the platform locally, with a smaller group of patients, to test its reach and effectiveness, and then trying it on a larger scale would be valuable.

This would enable you to perfect the intervention and deal with the challenges that might be encountered in real-world settings. Your project will be able to make a huge difference in the area of care coordination, and with the RE-AIM framework included, it may get even more effective.

References

Cullen, L., Hanrahan, K., Edmonds, S. W., Reisinger, H. S., & Wagner, M. (2022). Iowa implementation for sustainability framework. Implementation Science, 17(1), 1–20. https://doi.org/10.1186/s13012-021-01157-5

Hodgson, W., Kirk, A., Lennon, M., Janssen, X., Russell, E., Wani, C., & Eskandarani, D. (2023). RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) evaluation of the use of activity trackers in the clinical care of adults diagnosed with a chronic disease: Integrative systematic review. Journal of Medical Internet Research, 25(1), e44919. https://doi.org/10.2196/44919

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By Day 6 of Week 5

• Respond to at least two of your colleagues, on different days, who selected translation frameworks or models different than you did, by suggesting an additional framework or model that they might consider and explaining why you think it might be a good fit for their EBP, IS, and QI Assignment.

Note: Your responses to colleagues should be substantial (250 words minimum), supported with scholarly evidence from your research and/or the Learning Resources, and properly cited using APA Style. Personal anecdotes are acceptable as part of a meaningful response but cannot stand alone as a response. Your responses should enrich the initial post by supporting and/or adding a fresh viewpoint and be constructive, enhancing the learning experience for all students.

 Topic: Week 5: Discussion

Week 5- Discussion Post

Jennifer Kolowinski

Walden University

NURS 8114- Theoretical and Scientific Foundations of Nursing

Professor Ramirez

June 23 , 2025

The Evidence-based practice, implementation science, and quality improvement chosen focused on addressing, identifying, and managing post-partum depression. Transformational, authentic, and servant leadership are related interdisciplinary theories used as the framework for this specific practice issue.

Translation framework selected for your EBP, IS, and QI Assignment
Post-partum depression is the continuous depressed state of mind in mother’s following child birth. It can consist of intense feelings of sadness, fatigue, withdrawal, anxiety, and lack of emotional and physical bonding with the newborn baby (Pajai, S. 2022). When addressing the frameworks selected, each is uniquely helpful and can be worked together to bring the best possible care to patients.

Transformational leadership motivates employees to go beyond basic job duties and work towards productive changes within their workplace setting/organization (McEwen. 2022). Authentic leadership, as it sounds, inspires personnel to provide care in an authentic, genuine, and empathetic way (McEwen. 2022). Finally, servant leadership focuses on encouraging the greater good and well-being of others (McEwen. 2022).

Relevant and applicable translation framework to use for your EBP, IS, and QI
Transformational leadership can be applied to the issue of post-partum depression because it is the theory that that motivates employees to go beyond expectation and advocate for patients and their safety. Transformational leadership will empower employees to make change within their organization.

Servant leadership focuses on the promotion of the greater good and well-being of individuals and communities. Authentic leadership is a leadership style that focusses on being genuine, having an increased level of self-awareness, and leading with transparency and dignity.

Example
An example of Transformational leadership when treating post-partum depressions is Nurses can advocate for more patient education, screenings, resources, and treatment for their patients (Ystaas et. al. 2023). Many women and families are not aware of the statics regarding post-partum depression and what early warning signs may be or what social determinants of health may put them at an increased risk.

Improved patient advocacy for screenings, resources and education would be greatly beneficial. This can also incorporate the three different levels of prevention; primary, secondary, and tertiary (Kisling. 2023).

An example of Servant leadership when treating post-partum depression is staff and organizations can work towards finding a systematic approach to caring for expectant mom and new moms who are at risk or experiencing post-partum depression (Canavessi. 2021). This can be identifying what resources are available to the mother once she leaves the hospital.

Does she have a pediatrician? Will a spouse or family members be able to help her and the baby? This theory addresses can we not only help mothers when they are receiving prenatal care and delivery their baby, but also continuing the care once they leave the hospital.

An example of Authentic leadership when treating post-partum depression is nurse’s and health care staff developing honest, genuine, and trustworthy relationships with their patients. It values being honest with our patients and having a strong sense of self and how we value treating our patients.

Building a positive and trustworthy rapport with patients has been shown to increase patient outcomes and increase patient satisfaction (Butt. 2021). This is not only important to the topic of post-partum depression, but all patients we encounter.

References
Butt, M. (2021). Approaches to building rapport with patients. NIH: National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC8806294/

Canavessi, A. (2021). Servant Leadership: A Systematic Literature Review and Network Analysis. NIH: National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC8476984/

Kisling, L. (2023). Prevention Strategies. NIH: National Library of Medicine.https://www.ncbi.nlm.nih.gov/books/NBK537222/

McEwen, M., & Wills, E. M. (2022). Theoretical basis for nursing (6th ed.). Wolters Kluwer. https://mbsdirect.vitalsource.com/reader/books/9781975175672/epubcfi/6/54[%3Bvnd.vst.idref%3DMcEwen9781975175658-
ch016]!/4/2/140[McEwen-ch016-para056]/1:315[nce%2C%20of ]

Pajai, Sandhya. December 20th, 2022. A Comprehensive Review on Postpartum Depression. NIH: National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC9851410/ .

Ystass, L., Nikitara, M., Ghobrial, S. (2023). The Impact of Transformational Leadership in the Nursing Work Environment and Patients’ Outcomes: A Systematic Review. NIH: National Library of
Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC10537672/

TT Tiffany Taylor

For the Evidence-Based Practice (EBP), Implementation Science (IS), and Quality Improvement (QI) assignment focused on managing sepsis in a hospital setting, I selected the Consolidated Framework for Implementation Research (CFIR) as the framework for translation.

Description of CFIR

The CFIR is a comprehensive framework that identifies five major domains that influence the implementation of interventions:
1. Intervention Characteristics: This domain examines the features of the intervention itself, such as its complexity, adaptability, and evidence strength.
For managing sepsis, the intervention might include standardized protocols for early identification and treatment, which should be simple enough for staff to follow yet flexible to adapt to individual patient needs.

2. Outer Setting: This domain examines the external influences on implementation, including patient needs and resources, as well as external policies and incentives. For instance, understanding the local epidemiology of sepsis can guide the development of tailored protocols that meet the specific needs of the patient population.

3. Inner Setting: This refers to the characteristics of the organization where the implementation occurs, including its culture, climate, and available resources. A supportive organizational culture that prioritizes patient safety and quality improvement will facilitate the adoption of sepsis management protocols.

4. Characteristics of Individuals: This domain considers the knowledge, beliefs, and attitudes of those involved in the implementation. Training healthcare staff on the importance of recognizing and managing sepsis early can enhance their willingness to adopt new protocols.

5. Process: This domain focuses on the steps taken to implement the intervention, including planning, engagement, and evaluation. A structured implementation plan with continuous feedback loops can help refine the sepsis management protocol based on real-world outcomes.

Relevance and Applicability

The CFIR framework is particularly relevant and applicable for several reasons:

• Comprehensive Approach: CFIR provides a holistic view of the factors influencing implementation, making it suitable for the complex nature of sepsis management, which involves multiple stakeholders, including physicians, nurses, and administrative staff.
• Flexibility: The framework enables adaptation to diverse contexts within the hospital setting. For example, different departments may require tailored approaches based on their specific workflows and patient demographics.
• Focus on Evaluation: CFIR emphasizes the importance of evaluating the implementation process and outcomes, which is crucial for continuous quality improvement in sepsis management. Using this framework, we can systematically assess the effectiveness of the standardized protocol and make necessary adjustments.
• Facilitating Communication: By using a common framework, all stakeholders can engage in meaningful discussions about the implementation process, barriers, and facilitators, thereby enhancing collaboration and buy-in for the sepsis management protocol.

Example
For instance, when implementing a standardized sepsis protocol, the characteristics of the intervention may include clear guidelines for early recognition and treatment, based on the latest evidence. The outer setting could involve collaboration with emergency services to ensure that patients are screened for sepsis before arriving at the hospital. Within the inner setting, fostering a culture that values rapid response to sepsis can be reinforced through leadership support and training programs.

Overall, the CFIR framework not only guides the implementation of the sepsis management protocol but also ensures that the process is evaluated and refined over time, leading to improved patient outcomes and adherence to best practices in sepsis care.