title: Assessing the Spread and Uptake of a Framework for Introducing and Evaluating Advanced Practice Nursing Roles.
abstract: BACKGROUND
  Health system researchers must ensure that the products of their work meet the needs of various stakeholder groups (e.g., patients, practitioners, and policy makers). Evidence-based frameworks can support the uptake and spread of research evidence; however, their existence as knowledge translation tools does not ensure their uptake and it is difficult to ascertain their spread into research, practice, and policy using existing methods.
  
  
  OBJECTIVE
  The purpose of this article is to report results of a study on the spread and uptake of an evidence-based framework (i.e., the participatory, evidence-based, patient-focused process for advanced practice nursing [PEPPA] framework) into research, practice, and policies relevant to the introduction and evaluation of advanced practice nursing roles. We also reflect on the utility of using a modified citation methodology to evaluate knowledge translation efforts.
  
  
  METHODS
  We searched four databases for literature published between 2004 and 2014 citing the original paper in which the PEPPA framework was published, and carried out an Internet search for grey literature using keywords. Relevant data were extracted from sources and organized using NVivo software. We analysed results descriptively.
  
  
  RESULTS
  Our search yielded 164 unique sources of which 69.5% were from published literature and the majority (83.4%) of these were published in nursing journals. Most frequently (71.5%), the framework was used by researchers and students in research studies. A smaller number of citations (11.3%) reflected use of the PEPPA framework in practice settings with a focus on role development, implementation, evaluation, or a combination of these.
  
  
  CONCLUSIONS
  This study demonstrates that the PEPPA framework has been used to varying degrees as intended, and provides guidance on how to evaluate the spread and uptake of research outputs (e.g., theoretical frameworks). Further research is needed about ways to determine whether evidence-informed research tools such as frameworks have been taken up successfully into practice and policy contexts.
authors.affiliation: Postdoctoral Fellow, Faculty of Health Sciences and Faculty of Information & Media Studies, Western University, London, ON, Canada.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Boyko
authors.affiliation: Assistant Professor, School of Nursing, Affiliate, Canadian Centre for Advanced Practice Nursing Research, McMaster University, Hamilton, ON, Canada.
authors.forename: Nancy
authors.initials: N
authors.lastname: Carter
authors.affiliation: Associate Professor, School of Nursing and Department of Oncology, Co-Director, Canadian Centre for Advanced Practice Nursing Research, McMaster University Hamilton, ON, Canada.
authors.forename: Denise
authors.initials: D
authors.lastname: Bryant-Lukosius
mesh_terms: D057179:Advanced Practice Nursing / Q000592:standards*; D005069:Evaluation Studies as Topic; D006801:Humans; D024802:Nurse's Role; D009936:Organizational Innovation; D018802:Patient-Centered Care / Q000379:methods*; D013997:Time Factors
keywords: PEPPA; advanced practice nursing; knowledge translation; modified citation analysis; theoretical framework