NURS 836 Week 2 Discussion Board Forum 2 on Choosing Implementation Frameworks Example

Discussion Board Forum 2: Determinants Versus Evaluation Frameworks

NURS 836 Translational Research in Health Care, Discussion Board Forum 2

Thread by [Student Name]

The hospital and the classmates replied to are composites written for a model discussion; the textbook and studies cited are real.

When I first opened this week's chapters, the number of frameworks felt overwhelming. Brownson et al. (2018) describe a field with many theories, models and frameworks, and a student could spend a term comparing them. What helped me was a simpler question: what job do I need a framework to do? For my perioperative dressing project, I need two jobs done. I need to understand why the practice is not happening, and I need to know, later, whether my plan worked. Those are different jobs, and they call for different frameworks.

For the first job, I chose CFIR in its 2022 revision, which sorts determinants into five domains covering the dressing practice itself, the policy and market forces beyond the hospital, the hospital's own culture and structure, the people involved and the process of carrying the change out (Damschroder et al., 2022). Applied to our operating rooms, the innovation domain includes the dressing's cost and surgeons' concern that it shifts during prep; the outer setting includes national pressure injury reporting and supply contracts; the inner setting includes a checklist that does not mention the dressing and a supply budget that bears the cost; the individuals include circulating nurses, anesthesia staff and surgeons; and the process includes who leads, how staff are engaged and how progress is reflected back. The framework has already been used in exactly this setting. In a 2026 qualitative study, twelve operating room nurses interviewed with a CFIR 2.0 guide described six barriers, among them a mismatch between guidelines and operating room realities, insufficient supplies, poor interdepartmental communication and uneven competence, and eight facilitators, including manager support and accessible training (Gao et al., 2026). A determinant framework turns "they just don't do it" into a list of reasons someone can act on.

For the second job, I chose RE-AIM, whose five letters stand for how many intended people are reached, whether the intervention works, how many settings take it up, the fidelity of its delivery and its staying power (Glasgow et al., 2019). For our project, the reach measure is the share of eligible surgeries of three hours or more in which the dressing is applied; effectiveness is the rate of perioperative pressure injury; adoption is the number of surgical services and teams using it; implementation is whether it is applied correctly to sacrum and heels before positioning; and maintenance is whether use holds a year later.

Reply to Hannah

Hannah, you were deciding between CFIR and RE-AIM for your venous thromboembolism prophylaxis project and leaning toward CFIR because it is more detailed. I would suggest you may need both, for the reason I gave in my thread: CFIR tells you what to fix before you start, while RE-AIM tells you what to count afterward. Glasgow et al. (2019), reviewing twenty years of RE-AIM, describe how the framework has been adapted for planning as well as evaluation, and for pragmatic use in which teams select the dimensions most relevant to them rather than measuring every one. For prophylaxis, reach (the share of eligible patients with an order) and implementation (whether doses are actually given) may matter most. Brownson et al. (2018) encourage choosing frameworks deliberately for the purpose at hand, which a pairing does. Which dimension would your unit's leaders care most about?

Reply to Marcus

Marcus, you wrote that once you choose a framework your plan is basically written. I see it differently: a framework organizes thinking but does not choose your strategies or your timeline. CFIR, for example, helps identify barriers, but its authors present it as a determinant framework and describe how users should link determinants to strategies rather than treat the framework as the plan (Damschroder et al., 2022). The textbook makes a similar distinction between frameworks that explain and the strategies that act (Brownson et al., 2018). In your fall prevention project, CFIR might reveal that night staffing is the main barrier, but the plan still has to decide what to do about it. Have you started matching your barriers to specific strategies?

References

Brownson, R. C., Colditz, G. A., & Proctor, E. K. (Eds.). (2018). Dissemination and implementation research in health: Translating science to practice (2nd ed.). Oxford University Press.

Damschroder, L. J., Reardon, C. M., Widerquist, M. A. O., & Lowery, J. (2022). The updated Consolidated Framework for Implementation Research based on user feedback. Implementation Science, 17(1), Article 75. https://doi.org/10.1186/s13012-022-01245-0

Gao, Y., Chen, J., Guang, W., Xu, W., Wei, Z., & Yang, H. (2026). A qualitative study of facilitators and barriers to intraoperative acquired pressure injury prevention implementation in operating room nurses based on the CFIR framework. Frontiers in Health Services, 6, Article 1877556. https://doi.org/10.3389/frhs.2026.1877556

Glasgow, R. E., Harden, S. M., Gaglio, B., Rabin, B., Smith, M. L., Porter, G. C., Ory, M. G., & Estabrooks, P. A. (2019). RE-AIM planning and evaluation framework: Adapting to new science and practice with a 20-year review. Frontiers in Public Health, 7, Article 64. https://doi.org/10.3389/fpubh.2019.00064