Marita G Titler

University of Michigan, Ann Arbor, Michigan, United States

Are you Marita G Titler?

Claim your profile

Publications (132)141.46 Total impact

  • Source
  • Source
    Dataset: iowa model
  • Source
  • Journal of Healthcare Leadership 06/2015; DOI:10.2147/JHL.S45077
  • [Show abstract] [Hide abstract]
    ABSTRACT: We respond to commentaries from the American Academy of Nursing, the American Association of Colleges of Nursing, and the National Institute of Nursing Research on our thoughts about integrating emerging areas of science into nursing PhD programs. We identify areas of agreement and focus our response on cross-cutting issues arising from cautions about the unique focus of nursing science and how best to proceed with incorporation of emerging areas of science into nursing PhD programs. Copyright © 2015 Elsevier Inc. All rights reserved.
    Nursing Outlook 05/2015; 63(4). DOI:10.1016/j.outlook.2015.05.003 · 1.83 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Council for the Advancement of Nursing Science aims to "facilitate and recognize life-long nursing science career development" as an important part of its mission. In light of fast-paced advances in science and technology that are inspiring new questions and methods of investigation in the health sciences, the Council for the Advancement of Nursing Science convened the Idea Festival for Nursing Science Education and appointed the Idea Festival Advisory Committee to stimulate dialogue about linking PhD education with a renewed vision for preparation of the next generation of nursing scientists. Building on the 2010 American Association of Colleges of Nursing Position Statement "The Research-Focused Doctoral Program in Nursing: Pathways to Excellence," Idea Festival Advisory Committee members focused on emerging areas of science and technology that impact the ability of research-focused doctoral programs to prepare graduates for competitive and sustained programs of nursing research using scientific advances in emerging areas of science and technology. The purpose of this article is to describe the educational and scientific contexts for the Idea Festival, which will serve as the foundation for recommendations for incorporating emerging areas of science and technology into research-focused doctoral programs in nursing. Copyright © 2015 Elsevier Inc. All rights reserved.
    Nursing Outlook 05/2015; 63(4). DOI:10.1016/j.outlook.2015.04.010 · 1.83 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In response to the passage of the Affordable Care Act in the United States, clinicians and researchers are critically evaluating methods to engage patients in implementing evidence-based care to improve health outcomes. However, most models on implementation only target clinicians or health systems as the adopters of evidence. Patients are largely ignored in these models. A new implementation model that captures the complex but important role of patients in the uptake of evidence may be a critical missing link. Through a process of theory evaluation and development, we explore patient-centered concepts (patient activation and shared decision making) within an implementation model by mapping qualitative data from an elective induction of labor study to assess the model's ability to capture these key concepts. The process demonstrated that a new, patient-centered model for implementation is needed. In response, the Evidence Informed Decision Making through Engagement Model is presented. We conclude that, by fully integrating women into an implementation model, outcomes that are important to both the clinician and patient will improve. In the interest of providing evidence-based care to women during pregnancy and childbirth, it is essential that care is patient centered. The inclusion of concepts discussed in this article has the potential to extend beyond maternity care and influence other clinical areas. Utilizing the newly developed Evidence Informed Decision Making through Engagement Model provides a framework for utilizing evidence and translating it into practice while acknowledging the important role that women have in the process. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
    Women s Health Issues 04/2015; 25(3). DOI:10.1016/j.whi.2015.02.002 · 1.61 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Council for the Advancement of Nursing Science aims to "facilitate and recognize life-long nursing science career development" as an important part of its mission. In light of fast-paced advances in science and technology that are inspiring new questions and methods of investigation in the health sciences, the Council for the Advancement of Nursing Science convened the Idea Festival for Nursing Science Education and appointed the Idea Festival Advisory Committee (IFAC) to stimulate dialogue about linking PhD education with a renewed vision for preparation of the next generation of nursing scientists. Building on the 2005 National Research Council report Advancing The Nation's Health Needs and the 2010 American Association of Colleges of Nursing Position Statement on the Research-Focused Doctorate Pathways to Excellence, the IFAC specifically addressed the capacity of PhD programs to prepare nursing scientists to conduct cutting-edge research in the following key emerging and priority areas of health sciences research: omics and the microbiome; health behavior, behavior change, and biobehavioral science; patient-reported outcomes; big data, e-science, and informatics; quantitative sciences; translation science; and health economics. The purpose of this article is to (a) describe IFAC activities, (b) summarize 2014 discussions hosted as part of the Idea Festival, and (c) present IFAC recommendations for incorporating these emerging areas of science and technology into research-focused doctoral programs committed to preparing graduates for lifelong, competitive careers in nursing science. The recommendations address clearer articulation of program focus areas; inclusion of foundational knowledge in emerging areas of science in core courses on nursing science and research methods; faculty composition; prerequisite student knowledge and skills; and in-depth, interdisciplinary training in supporting area of science content and methods. Copyright © 2015 Elsevier Inc. All rights reserved.
    Nursing Outlook 04/2015; 63(4). DOI:10.1016/j.outlook.2015.04.007 · 1.83 Impact Factor
  • Rhonda R. Schoville · Marita G. Titler
    [Show abstract] [Hide abstract]
    ABSTRACT: Healthcare technology is used to improve delivery of safe patient care by providing tools for early diagnosis, ongoing monitoring, and treatment of patients. This technology includes bedside physiologic monitors, pulse oximetry devices, electrocardiogram machines, bedside telemetry, infusion pumps, ventilators, and electronic health records. Healthcare costs are a challenge for society, and hospitals are pushed to lower costs by discharging patients sooner. Healthcare technology is being used to facilitate these early discharges. There is little understanding of how healthcare facilities purchase, implement, and adopt technology. There are two areas of theories and models currently used when investigating technology: technology adoption and implementation science. Technology adoption focuses mainly on how the end users adopt technology, whereas implementation science describes methods, interventions, and variables that promote the use of evidence-based practice. These two approaches are not well informed by each other. In addition, amplifying the knowledge gap is the limited conceptualization of healthcare technology implementation frameworks. To bridge this gap, an all-encompassing model is needed. To understand the key technology implementation factors utilized by leading healthcare facilities, the prevailing technology adoption and implementation science theories and models were reviewed. From this review, an integrated technology implementation model will be set forth.
    CIN Computers Informatics Nursing 03/2015; 33(3). DOI:10.1097/CIN.0000000000000130 · 0.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Although the US Department of Veterans Affairs (VA) has promoted adherence to smoking cessation guidelines since 1997, hospitalized smokers do not consistently receive assistance in quitting. In a pre-post guideline implementation trial on the inpatient medicine units of four VA hospitals, the effectiveness of a multimodal intervention (enhanced academic detailing, modification of the nursing admission template, patient education materials and quitline referral, practice facilitation and staff feedback) changing practice behavior was evaluated. Peridischarge interviews were conducted with 824 patients to assess receipt of nurses' and physicians' delivery of the 5A's (Ask, Advise, Assess, Assist, Arrange) in hospitalized smokers. Subjects were significantly more likely to have received each of the 5A's from a nurse during the postimplementation period (except for "advise to quit"). More patients were assisted in quitting (75% versus 56%, adjusted odds ratio [OR] = 2.3, 95% confidence interval [CI] = 1.6, 3.1) and had follow-up arranged (23% versus 18%, adjusted OR = 1.5, 95% CI = 1.0, 2.2) by a nurse during the postimplementation period. However, unadjusted results showed no improvement in seven-day point prevalence abstinence at six-month follow-up (13.5% versus 13.9%). Nurses' self-efficacy in cessation counseling, as measured in a survey of 166 unit nurses, improved following guideline implementation. A multifaceted intervention including enhanced academic detailing is an effective strategy for improving the delivery of smoking cessation services in medical inpatients. To promote long-term cessation, more intensive interventions are needed to ensure that motivated smokers receive guideline-recommended treatment (including pharmacotherapy and referral to outpatient cessation counseling).
    Joint Commission journal on quality and patient safety / Joint Commission Resources 11/2014; 40(11).
  • Source
    Christine A Anderson · Marita G Titler
    [Show abstract] [Hide abstract]
    ABSTRACT: Background The use of opinion leaders is a strategy used to speed the process of translating research into practice. Much is still unknown about opinion leader attributes and activities and the context in which they are most effective. Agent-based modeling is a methodological tool that enables demonstration of the interactive and dynamic effects of individuals and their behaviors on other individuals in the environment. The purpose of this study was to develop and test an agent-based model of opinion leadership. The details of the design and verification of the model are presented.Methods The agent-based model was developed by using a software development platform to translate an underlying conceptual model of opinion leadership into a computer model. Individual agent attributes (for example, motives and credibility) and behaviors (seeking or providing an opinion) were specified as variables in the model in the context of a fictitious patient care unit. The verification process was designed to test whether or not the agent-based model was capable of reproducing the conditions of the preliminary conceptual model. The verification methods included iterative programmatic testing (`debugging¿) and exploratory analysis of simulated data obtained from execution of the model. The simulation tests included a parameter sweep, in which the model input variables were adjusted systematically followed by an individual time series experiment.ResultsStatistical analysis of model output for the 288 possible simulation scenarios in the parameter sweep revealed that the agent-based model was performing, consistent with the posited relationships in the underlying model. Nurse opinion leaders act on the strength of their beliefs and as a result, become an opinion resource for their uncertain colleagues, depending on their perceived credibility. Over time, some nurses consistently act as this type of resource and have the potential to emerge as opinion leaders in a context where uncertainty exists.Conclusions The development and testing of agent-based models is an iterative process. The opinion leader model presented here provides a basic structure for continued model development, ongoing verification, and the establishment of validation procedures, including empirical data collection.
    Implementation Science 09/2014; 9(1):136. DOI:10.1186/s13012-014-0136-6 · 3.47 Impact Factor
  • Source
    Okeoma Mmeje · Marita G. Titler · Vanessa K. Dalton
    International Journal of Gynecology & Obstetrics 09/2014; 128(1). DOI:10.1016/j.ijgo.2014.07.034 · 1.56 Impact Factor
  • Michelle Aebersold · Marita G. Titler
    [Show abstract] [Hide abstract]
    ABSTRACT: Simulation has become a necessary and integral part of education for prelicensure and ongoing education of health care practitioners. To guide this process, the Simulation Model for Improving Learner and Health Outcomes (SMILHO) model provides a framework to design the experience from a science of learning approach and links it to learner and health outcomes to add to the knowledge base. Much work has been done in this area, and the SMILHO model will support the future work needed to continue to create effective simulation-based learning experiences and move research from knowledge and skill evaluation to learner and health outcomes.
    Nursing Clinics of North America 09/2014; 49(3):431–439. DOI:10.1016/j.cnur.2014.05.011 · 0.59 Impact Factor
  • Marita G. Titler
    [Show abstract] [Hide abstract]
    ABSTRACT: Evidence-based practice and translation science are not interchangeable terms; EBP is the application of evidence in practice (the doing of EBP), whereas translation science is the study of implementation interventions, factors, and contextual variables that affect knowledge uptake and use in practices and communities. The use of collaborative networks such as the National Nursing Practice Network maximizes sharing of resources and knowledge about EBPs, an infrastructure for conducting multi-site translation studies, and a venue for large scale-up of EBP projects across multiple healthcare settings.
    Nursing Clinics of North America 09/2014; 49(3). DOI:10.1016/j.cnur.2014.05.001 · 0.59 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Patient preferences and clinician practices are possible causative factors to explain the increase in induction of labor, but scientific studies that demonstrate this link are limited. The purpose of this study is to identify factors that influence inductions from the perspective of women.MethodsA qualitative investigation using grounded theory methodology was conducted. Women were interviewed preinduction and postinduction. Analysis of the interviews was conducted using constant comparison to identify codes, categories, and themes. Through this process the complex intersection between women, their clinician, and the application of evidence-based care in clinical practice was explored.ResultsFive major themes from the preinduction interview were identified; safety of baby, women's trust in their clinician, relief of discomfort and/or anxiety, diminish potential or actual risk, and lack of informed decision making. Five major themes were identified from the postinduction interview; lack of informed decision making, induction as part of a checklist, women's trust in their clinician, happy with induction, and opportunities to improve the experience.Conclusions Lack of informed decision making was cited as a barrier to optimal care. This study has important implications for patient-centered research and clinical care, requiring the inclusion of women and the salient concepts of care that they identify.
    Birth 04/2014; 41(2). DOI:10.1111/birt.12080 · 2.05 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The US Public Health Service smoking cessation practice guideline specifically recommends that physicians and nurses strongly advise their patients who use tobacco to quit, but the best approach for attaining this goal in the emergency department (ED) remains unknown. The aim of this study was to characterize emergency physicians' (EPs) and nurses' (ENs) perceptions of cessation counseling and to identify barriers and facilitators to implementation of the 5 A's framework (Ask-Advise-Assess-Assist-Arrange) in the ED. We conducted semi-structured, face-to-face interviews of 11 EPs and 19 ENs following a pre-post implementation trial of smoking cessation guidelines in two study EDs. We used purposeful sampling to target EPs and ENs with different attitudes toward cessation counseling, based on their responses to a written survey (Decisional Balance Questionnaire). Conventional content analysis was used to inductively characterize the issues raised by study participants and to construct a coding structure, which was then applied to study transcripts. The main findings of this study converged upon three overarching domains: 1) reactions to the intervention; 2) perceptions of patients' receptivity to cessation counseling; and 3) perspectives on ED cessation counseling and preventive care. ED staff expressed ambivalence toward the implementation of smoking cessation guidelines. Both ENs and EPs agreed that the delivery of smoking cessation counseling is important, but that it is not always practical in the ED on account of time constraints, the competing demands of acute care, and resistance from patients. Participants also called attention to the need for improved role clarity and teamwork when implementing the 5 A's in the ED. There are numerous challenges to the implementation of smoking cessation guidelines in the ED. ENs are generally willing to take the lead in offering brief cessation counseling, but their efforts need to be reinforced by EPs. ED systems need to address workflow, teamwork, and practice policies that facilitate prescription of smoking cessation medication, referral for cessation counseling, and follow-up in primary care. The results of this qualitative evaluation can be used to guide the design of future ED intervention studies.Trial registration: ClinicalTrials.gov registration number NCT00756704.
    Addiction science & clinical practice 01/2014; 9(1):1. DOI:10.1186/1940-0640-9-1
  • [Show abstract] [Hide abstract]
    ABSTRACT: Change agency in its various forms is one intervention aimed at improving the effectiveness of the uptake of evidence. Facilitators, knowledge brokers and opinion leaders are examples of change agency strategies used to promote knowledge utilization. This review adopts a realist approach and addresses the following question: What change agency characteristics work, for whom do they work, in what circumstances and why? The literature reviewed spanned the period 1997-2007. Change agency was operationalized as roles that are aimed at effecting successful change in individuals and organizations. A theoretical framework, developed through stakeholder consultation formed the basis for a search for relevant literature. Team members, working in sub groups, independently themed the data and developed chains of inference to form a series of hypotheses regarding change agency and the role of change agency in knowledge use. 24, 478 electronic references were initially returned from search strategies. Preliminary screening of the article titles reduced the list of potentially relevant papers to 196. A review of full document versions of potentially relevant papers resulted in a final list of 52 papers. The findings add to the knowledge of change agency as they raise issues pertaining to how change agents' function, how individual change agent characteristics effect evidence-informed health care, the influence of interaction between the change agent and the setting and the overall effect of change agency on knowledge utilization. Particular issues are raised such as how accessibility of the change agent, their cultural compatibility and their attitude mediate overall effectiveness. Findings also indicate the importance of promoting reflection on practice and role modeling. The findings of this study are limited by the complexity and diversity of the change agency literature, poor indexing of literature and a lack of theory-driven approaches. This is the first realist review of change agency. Though effectiveness evidence is weak, change agent roles are evolving, as is the literature, which requires more detailed description of interventions, outcomes measures, the context, intensity, and levels at which interventions are implemented in order to understand how change agent interventions effect evidence-informed health care.
    Implementation Science 09/2013; 8(1):107. DOI:10.1186/1748-5908-8-107 · 3.47 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: A minority of hospitalized smokers actually receives assistance in quitting during hospitalization or cessation counseling following discharge. This study aims to determine the impact of a guideline-based intervention on 1) nurses' delivery of the 5A's (Ask-Advise-Assess-Assist-Arrange follow-up) in hospitalized smokers, and 2) nurses' attitudes toward the intervention. METHODS: We conducted a pre-post guideline implementation trial involving 205 hospitalized smokers on the inpatient medicine units at one US Department of Veterans Affairs (VA) medical center. The intervention included: 1) academic detailing of nurses on delivery of brief cessation counseling, 2) modification of the admission form to facilitate 5A's documentation, and 3) referral of motivated inpatients to receive proactive telephone counseling. Based on subject interviews, we calculated a nursing 5A's composite score for each patient (ranging from 0 to 9). We used linear regression with generalized estimating equations to compare the 5A's composite score (and logistic regression to compare individual A's) across periods. We compared 29 nurses' ratings of their self-efficacy and decisional balance ("pros" and "cons") with regard to cessation counseling before and after guideline implementation. Following implementation, we also interviewed a purposeful sample of nurses to assess their attitudes toward the intervention. RESULTS: Of 193 smokers who completed the pre-discharge interview, the mean nursing 5A's composite score was higher after guideline implementation (3.9 vs. 3.1, adjusted difference 1.0, 95 % CI 0.5-1.6). More patients were advised to quit (62 vs. 48 %, adjusted OR = 2.1, 95 % CI = 1.2-3.5) and were assisted in quitting (70 vs. 45 %, adjusted OR = 2.9, 95 % CI = 1.6-5.3) by a nurse during the post-implementation period. Nurses' attitudes toward cessation counseling improved following guideline implementation (35.3 vs. 32.7 on "pros" subscale, p = 0.01), without significant change on the "cons" subscale. CONCLUSIONS: A multifaceted intervention including academic detailing and adaptation of the nursing admission template is an effective strategy for improving nurses' delivery of brief cessation counseling in medical inpatients.
    Journal of General Internal Medicine 05/2013; 28(11). DOI:10.1007/s11606-013-2464-7 · 3.42 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Application of research evidence in care delivery improves patient outcomes. Large gaps still exist, however, between recommended care and that used in practice. To increase the understanding of implementation studies, and dissemination of research findings, we present the perspective of investigators from seven Interdisciplinary Nursing Quality Research Initiative (INQRI)-funded studies. Objective: To describe implementation strategies, challenges, and lessons learned from conducting 5 INQRI-funded implementation studies, and present 2 case examples of other INQRI studies to illustrate dissemination strategies. Potential impact of study findings are set forth. Research Design: Qualitative descriptive methods were used for the implementation studies. Case examples were set forth by investigators using reflection questions. Results: Four of the 5 implementation studies focused on clinical topics and 1 on professional development of nurse managers, 4 were multisite studies. Common implementation strategies used across studies addressed education, ongoing interaction with sites, use of implementation tools, and visibility of the projects on the study units. Major challenges were the Institutional Review Board approval process and the short length of time allocated for implementation. Successes and lessons learned included creating excitement about research, packaging of study tools and resources for use by other organizations, and understanding the importance of context when conducting this type of research. Case examples revealed that study findings have been disseminated to study sites and to the health care community through publications and presentations. The potential impact of all 7 studies is far reaching. Conclusions: This study captures several nuanced perspectives from 5 Principal Investigators, who were completing INQRI-funded implementation studies. These nuanced perspectives are important lessons for other scientists embarking on implementation studies. The INQRI case examples illustrate important dissemination strategies and impact of findings on quality of care.
    Medical Care 04/2013; 51:S41-S46. DOI:10.1097/MLR.0b013e3182802fb5 · 2.94 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Application of research evidence in care delivery improves patient outcomes. Large gaps still exist, however, between recommended care and that used in practice. To increase the understanding of implementation studies, and dissemination of research findings, we present the perspective of investigators from seven Interdisciplinary Nursing Quality Research Initiative (INQRI)-funded studies. Objective: To describe implementation strategies, challenges, and lessons learned from conducting 5 INQRI-funded implementation studies, and present 2 case examples of other INQRI studies to illustrate dissemination strategies. Potential impact of study findings are set forth. Research Design: Qualitative descriptive methods were used for the implementation studies. Case examples were set forth by in-vestigators using reflection questions. Results: Four of the 5 implementation studies focused on clinical topics and 1 on professional development of nurse managers, 4 were multisite studies. Common implementation strategies used across studies addressed education, ongoing interaction with sites, use of implementation tools, and visibility of the projects on the study units. Major challenges were the Institutional Review Board ap-proval process and the short length of time allocated for im-plementation. Successes and lessons learned included creating excitement about research, packaging of study tools and resources for use by other organizations, and understanding the importance of context when conducting this type of research. Case examples re-vealed that study findings have been disseminated to study sites and to the health care community through publications and presentations. The potential impact of all 7 studies is far reaching. Conclusions: This study captures several nuanced perspectives from 5 Principal Investigators, who were completing INQRI-funded implementation studies. These nuanced perspectives are important lessons for other scientists embarking on implementation studies. The INQRI case examples illustrate important dissemination strat-egies and impact of findings on quality of care. U se of research evidence to guide practice improves pa-tient outcomes. Large gaps still exist, however, between recommended, evidence-based (EB) care and what is applied in care of patients and populations. 1,2 The objectives of this study were to describe, as perceived by the Principal In-vestigators (PIs), the implementation strategies, challenges, successes, and lessons learned from conducting 5 im-plementation studies funded by the Interdisciplinary Nursing Quality Research Initiative (INQRI), and to present 2 case examples of other INQRI studies to illustrate dissemination strategies. Potential impact of study findings are set forth.
    Medical Care 04/2013; 51(4):S41. · 2.94 Impact Factor

Publication Stats

2k Citations
141.46 Total Impact Points

Institutions

  • 2009–2015
    • University of Michigan
      • School of Nursing
      Ann Arbor, Michigan, United States
    • Florida International University
      • College of Nursing and Health Sciences
      Miami, FL, United States
  • 2010–2014
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
  • 2012
    • University of Medicine and Health Sciences St Kitts
      New York, New York, United States
  • 1991–2010
    • University of Iowa
      • College of Nursing
      Iowa City, IA, United States
  • 1991–2009
    • University of Iowa Children's Hospital
      Iowa City, Iowa, United States
  • 2008
    • Emporia State University
      Kansas, United States
  • 2006
    • University of Texas at Austin
      • School of Nursing
      Texas City, TX, United States
  • 2004
    • University of Utah
      • School of Medicine
      Salt Lake City, Utah, United States
  • 2001
    • University of Arkansas at Little Rock
      Little Rock, Arkansas, United States