Center for Nursing Research & Quality Outcomes

In 2002, the Center for Nursing Research and Quality Outcomes (CNRQO) was established within the Department of Nursing to promote quality patient care and patient-centered outcomes. This innovative approach provided full-time, on-site scholarly support for all nursing staff to integrate scientific evidence and research into their nursing practice. The success of this hospital-based service was quickly recognized and expanded to include support to a diverse group of health care professionals, such as physical therapists, speech and language pathologists, dietitians and other clinicians. Today, the CNRQO fosters a culture of evidence-based practice at MMC by supporting Patient Care Services’ staff with all aspects of their research studies and quality improvement projects.

The core mission of the CNRQO is to promote excellence in clinical care and improvement of patient outcomes through the generation of new scientific knowledge and the translation, synthesis, and implementation of existing evidence into practice.

We are dedicated to improvements in evidence-based patient care and professional practice through the advancement of the art and science of Nursing. We aim to promote quality patient care and outcomes; generate, analyze, disseminate and translate findings and outcomes to foster collaborative interprofessional partnerships through research and education for the communities we serve. The CNRQO also provides consultative services on evidence-based practice, quantitative and qualitative research and other topics to a variety of institutions across the country and are available upon request.

The Center regularly celebrates the outstanding scholarly work accomplished by Patient Care Services’ clinicians through the annual Research Excellence Award, the biennial Book of Abstracts, the Nursing Annual Report, the Patient Care Services’ Research poster display, the Interprofessional Research and Innovation Council updates, the electronic Knowledge Bank, the annual Clinical Scholar Program poster and podium presentations, and other means of Patient Care Services’ recognition.

The Collaborative Model of Evidence Translation (CoMET©)

The Collaborative Model of Evidence Translation (CoMET©) was developed and tested at Maine Medical Center (Lancaster et al. 2014). The model utilized the Promoting Action on Research Implementation in Health Services or PARIHS framework (Kitson,1998) for evidence translation, which posits three core concepts:

(1) Evidence: the strength and nature of the evidence as perceived by multiple stakeholders (Rycroft-Malone et al., 2004)

(2) Context: the quality of the context or environment in which the research is implemented (Kitson et al., 1998)

(3) Facilitation: the process of helping and enabling the implementation of evidence into practice (Harvey et al., 2002)

The CoMET© provides a framework to guide implementation of evidence-based practice initiatives to improve healthcare outcomes. The CoMET©  defines a standardized process for reviewing, communicating, implementing & monitoring the outcomes of evidence-based patient care policies, practice guidelines and standards of care. When used by the Practice, Research, & Quality Councils, their collaborative efforts determine the strength of the evidence, education content, and the implementation and facilitation process for a practice initiative with the goal of improving practice uptake, sustainability and improving outcomes.

Essentially, councils collaborate to:

  • Identify the practice change/initiative
  • Critically appraise the evidence
  • Determine appropriateness of practice initiative
  • Plan: education, facilitation process, & data collection
  • Customize the implementation
  • Facilitate the Practice Initiative
  • Monitor, report, and evaluate the outcomes

The collaboration is guided by: (a) the CoMET algorithm ©, (b) the CoMET Pathway © and supported by (c) the Toolbox.  The algorithm describes the collaborative process and the pathway demonstrates the systematic process for using the algorithm. The algorithm, the pathway and the toolbox were developed to ensure:

  • Consistent understanding of the process

  • Ensures steps are followed by everyone

  • Lead Sponsor identification and commitment to a practice initiative

By using CoMET© and following its standardized processes, practice initiatives are more likely to be sustainable, leading to less variation in practice and improved outcomes.


Harvey, G., Loftus-Hills, A., Rycroft-Malone, J., Titchen, A., Kitson, A., McCormack, B., &  Seers, K. (2002). 

Getting evidence into practice: the role and function of facilitation. Journal of Advanced Nursing, 37(6), 577-588.

Kitson, A., Harvey, G., & McCormack, B. (1998). Enabling the implementation of evidence-based practice:  a conceptual framework. Quality in Healthcare, 7(1), 149-158.

Lancaster, K. Hyrkas, K., Michaud D., & Kent G. (2014). Promoting evidence-based practice and

improving outcomes through council collaboration using a model of evidence translation. 2014 ANCC National Magnet Conference, Dallas, TX: Kay Bailey Hutchison Convention Center. October 8-10, 2014 (Podium)

Rycroft-Malone, J., Harvey, G., Seers, K., Kitson, A., McCormack, B., & Titchen, A. (2004). An exploration of  the factors that influence the implementation of evidence into practice. Journal of Clinical Nursing, 13(1), 913-924.


The Center for Nursing Research and Quality Outcomes supports the internal and external dissemination of evidence-based practice and quality improvement projects, research studies and other scholarly manuscripts. A list of articles authored by MMC clinicians published in peer-reviewed scientific journals since 2014 is included here.

Babine, R.L, Honess, C., Wierman, H.R., & Hallen, S. (2016). The role of clinical nurse specialists in the implementation and sustainability of a practice change. Journal of Nursing Management. Jan;24(1):39-49. doi: 10.1111/jonm.12269.

Babine, R., Hyrkas, K., Baschand, D., Chapman, J., Fuller, V., Honess, C. & Wierman, H. (2016) Falls in A tertiary Care Hospital – Association With Delirium: A Replication Study. Psychosomatics, May-Jun;57(3):273-82. doi: 10.1016/j.psym.2016.01.003

Bowden, K. & Goodman, D. (2014). Barriers to recovery in postpartum addicted women.  Work: A Journal of Prevention, Assessment and Rehabilitation, 16:6. Special Issue: Parenting. DOI: 10.3233/WOR-141951

Campbell, J. (2015) Education and simulation training for PICU RNs. Critical Care Nurse Vol 35, No 3, June 2015 (pp. 76 – 81). doi: 10.4037/ccn2015312

Glisic EK, Gardiner L, Josti L, Dermanelian E, Ridel S, Dziodzio J, McCrum B, Enos B, Lerwick P, Fraser GL, Muscat P, Riker RR, Ecker R, Florman J, Seder DB. (2016 Mar). Inadequacy of Headache Management after Subarachnoid Hemorrhage. American Journal of Critical Care, 25(2), 136-143. doi: 10.4037/ajcc2016486.

Hyrkas, K., Linscott, D., & Rhudy, J. (2014). Evaluating preceptors’ and preceptees’ satisfaction concerning preceptorship and the preceptor-preceptee relationship. Journal of Nursing Education and Practice, 4(4), 120-133. Published online 11 February 2014. doi: 10.5430/jnep.v4n4p120

Hyrkas, K. & Wiggins, M. (2014). A comparison of usual care, patient-centered education and motivational interviewing to improve medication adherence and readmissions. Journal of Nursing Management, 22(3), 350-361. doi: 10.1111/jonm.12221

Inman, C. (2015) Promoting Positive Patients' Perception of Quietness on a Telemetry Unit: A Quality Improvement Study supporting Sustainable Practice Changes. Nursing 2015 Sep;45(9):14-7. doi: 10.1097/01.NURSE.0000470423.32557.f0.

Macken, L. & Hyrkas, K. (2014)   Editorial: Work climate, communication and culture - workforce issues and staff retention. Journal of Nursing Management, 22(8), 951-952. doi: 10.1111/jonm.12275.

Macken, L. & Hyrkas, K. (2014). Editorial: Retention, fatigue, burnout and job satisfaction: New aspects and challenges. Journal of Nursing Management, 22(5), 541-542. Doi: 10.1111/jonm.12254.

Macken, L., Yates, B., Meza, J., Norman, J., Barnason, S., and Pozehl, B. (2014).  Health-related quality of life outcomes in coronary artery bypass patients and partners. Journal of Cardiopulmonary Rehabilitation, 34(2), 130-137doi: 10.1097/HCR.0b013e3182a528ba

McCormick, S. & Hildebrand, A. (2015) A qualitative study of patient and family perceptions of chaplain presence during post-trauma.  Journal of Health Care Chaplaincy, 21(2):60-75. doi: 10.1080/08854726.2015.1016317

Phillips K, Keane K, Wolfe BE. Peripheral brain derived neurotrophic factor (BDNF) in bulimia nervosa: a systematic review . Archives of Psychiatric Nursing. 2014 Apr;28(2):108-13. doi: 10.1016/j.apnu.2013.11.006. Epub 2013 Nov 23.

Rhudy, Jr., J., Bakitas, M., Hyrkas, K., Jablonski, R., Pryor, E., Wang, H. & Alexandrov, A. (2015) Effectiveness of Regionalized Systems for Stroke and Myocardial Infarction. Brain and Behavior, 5:10, October 2015. DOI: 10.1002/brb3.398

Thompson, P. &Hyrkas, K. (2014). Editorial: Global nursing leadership. Journal of Nursing Management, 22, 1-3. doi: 10.1111/jonm.12215.

Quality & Research

Evidence-based Practice & Interprofessional Research

The Center for Nursing Research and Quality Outcomes provides consultation and assistance to clinical staff for evidence-based practice, quality improvement and research projects. This includes: development of clinically important questions, crystallization of project/study designs, Institutional Review Board (IRB) proposal and application writing, implementation of project/research plans, data collection, data entry and analysis, interpretation and utilization of the findings and extensive support for the dissemination at inter-professional conferences and publication in peer-reviewed journals, as well as internal reporting mechanisms.  In 2015, more than 200 quality projects and 30 clinically-based research studies were actively tracked through the Center for Nursing Research and Quality Outcomes.

The Abstract Book

The Abstract Book is a biennial publication showcasing MMC clinicians’ evidence-based practice, quality improvement and research projects in abstract format. The sixth edition of the Book of Research, Quality Project and Magnet Conference Abstracts was made available in May 2016. It highlights the continued commitment of MMC clinical staff to a culture of evidence-based practice.  Many of the quality improvement and research abstracts in the most recent (2014-2015) Book are authored by bedside nurses and other front-line clinicians. These nurse-led and clinician-driven projects reflect a robust culture of inquiry at MMC. Nurses and other healthcare colleagues are supported and empowered to ask important clinical questions, seek evidence-based answers, and share their findings within the MMC family and outside the organization at many professional local, regional and national conferences

 The Knowledge Bank

The Knowledge Bank is an electronic database for research, quality improvement and evidence-based practice projects originating within the organization by nurses and other health care clinicians. The aim of the Knowledge Bank is to increase visibility, accessibility and utilization of the results and outcomes of internal research, quality improvement and evidence-based projects. Today the Knowledge Bank is a depository and a publishing site for an extensive amount of completed and current projects. The information, available in a structured abstract format, has been organized under 60 categories. MMC users have access to the Knowledge Bank from unit work stations; and they can do searches within the database using key words.

 The Qualitative Research Interest Group

The Qualitative Research Interest Group(QRIG) is one of six interprofessional research-focused groups that formed in 2014 to promote collegiality and learning among clinicians and researchers at MMC. Through a partnership between the Center for Nursing Research and Quality Outcomes and the Center for Outcomes Research and Evaluation (CORE), members discuss topics of interest related to qualitative research methods. The group meets every two months (January, March, May, July, September and November). For anyone interested in this group, it is open to the public. Please contact Kristiina Hyrkas, RN, MNSc, LicNSc, PhD  for more information.

Nursing Informatics

Nursing Informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice (American Nurses Association, 2008).

The Clinical Informatics’ team works in collaboration with multidisciplinary patient care teams to optimize the design and functionality of the electronic health record, promoting standardized, evidenced based, efficient and safe clinical care processes.

We coordinate and facilitate educational activities associated with the EHR, including orientation, refresher classes, system upgrade preparations and new technological device implementations.

As liaisons between Patient Care Services and Information Services, we are able to translate essential clinical processes into technological tools resulting in optimized workflows and improved quality of patient care.

Contact Us

Michelle Duval BSN, RN
Senior Director of Nursing Informatics
(207) 662-4266

Sally Prokey BSN, RN
Manager of Clinical Informatics PCS
(207) 662-5945

Diane Vachon BSN, RN
Clinical Informatics’ Specialist
(207) 662-4176

Erin Pappal BSN, RN, CMSRN
Clinical Informatics’ Specialist
(207) 662-2901

Tammy Whitney MSN/MHA, RN
Clinical Informatics’ Specialist

Katherine Sargent BSN, RN
Clinical Informatics’ Specialist

Anne McIntire MS, BSN, RN-BC
Clinical Informatics’ Specialist


Eira Kristiina Hyrkäs, PhD, LicNSc, MNSc, R.N. 
Director for CNRQO
Phone: (207) 662-2460

Dr. Hyrkas graduated in 1982 and specialized in surgical nursing in 1984. She worked as a staff nurse in the Intensive Care Unit of Turku University Hospital and in the ER of Loimaa District Hospital from 1982-1987. She began teaching in 1988 at Pirkanmaa College of Nursing and also became a full time lecturer. Dr. Hyrkas completed her Master's degree in 1992; her Licentiate Degree (a post-graduate degree in the Finnish education system. The credits required for this degree are equal to a Doctor of Nursing Practice [DNP] degree) in 1997 and her Doctoral Degree in 2002. Her academic teaching career started in 1994 at the University of Tampere. She worked first as a Planning Officer, and after that as a Senior Lecturer and Senior Assistant Professor in the Department of Nursing Science. During 1997 to 2002 she worked as a full time researcher at the University of Tampere, Department of Nursing Science.

In 2002, she moved to Canada and started to work as an Assistant Professor at the University of Alberta, Faculty of Nursing. Later on she became an Associate Professor at the University of Northern British Columbia. The focuses of her research projects are (a) quality and quality related issues in health care, (b) patient satisfaction, (c) clinical supervision, (d) teaching and learning nursing. Methodological expertise: Dr. Hyrkas has applied both quantitative and qualitative methods in her studies and triangulation. She has applied action research -approach in many of the research projects in clinical settings. Dr. Hyrkas reviews manuscripts for twelve academic journals. She has published several articles, chapters and three books and has written her publications in English and Finnish. She is also an Adjunct Professor at the University of Southern Maine School of Nursing.

Lynda Macken, R.N., PhD
Research Nurse Specialist
Phone: (207) 662-1576

Dr. Lynda (Lynn) Macken is a Research Nurse Specialist in the Center for Nursing Research and Quality Outcomes (CNRQO) at Maine Medical Center. Her clinical background is in nursing management, critical care, cardiopulmonary rehabilitation and corporate and community health promotion. She has master’s degrees in Nursing and Health Education. She completed her PhD in Nursing at the University of Nebraska Medical Center. Her research interests have focused on patients with cardiovascular disease and their partners, cardiac rehabilitation, and health-related quality of life. She is co-principal investigator with a team of clinical researchers who received a grant in 2015 from the MMC Cardiovascular Services to study the health-related quality of life in patients with atrial fibrillation. At the CNRQO she provides evidence-based practice and research expertise to support nursing and other Patient Care Services’ clinicians conducting quality improvement and research projects. This support includes project consultation, design, data analysis, education and dissemination through presentation and manuscript development.