Maine Medical Center

Center for Nursing Research & Quality Outcomes

In 2002, the Center for Nursing Research and Quality Outcomes (CNRQO) was established within the MaineHealth Maine Medical Center (MHMMC) Portland Department of Nursing to promote quality patient care and patient-centered outcomes. The CNRQO provides 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 expanded in 2009 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 MHMMC Portland by supporting care team members 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 patient care findings and outcomes
  • 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 CNRQO regularly celebrates the outstanding scholarly work accomplished by clinicians through the:

  • Annual Research Excellence Award
  • Biennial Book of Abstracts
  • Nursing Annual Report
  • Patient Care Services Research Poster Display
  • Interprofessional Research and Innovation Council Updates
  • Annual Clinical Scholar Program Poster and Podium Presentations
  • Other Patient Care Services Recognition

The Collaborative Model of Evidence Translation (CoMET©) was developed and tested at MHMMCP (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.

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. 

The Abstract Book

The Abstract Book is a biennial publication showcasing MHMMC Portland clinicians’ evidence-based practice, quality improvement and research projects in abstract format. It highlights the continued commitment of MHMMC Portland clinical staff to a culture of evidence-based practice. Abstracts are authored by bedside nurses and other front-line clinicians for conference presentations. 

Many of the abstracts are based on nurse-led and clinician-driven projects and reflect a robust culture of inquiry at MHMMC Portland. Nurses and other healthcare colleagues are supported and empowered to ask important clinical questions, seek evidence-based answers, and share their findings within MHMMC Portland and at many professional local, regional and national conferences. 

The Qualitative Research Interest Group

The Qualitative Research Interest Group (QRIG) is one of six interprofessional research-focused groups that were 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). This group is open to the public. Please contact Kristiina Hyrkas, RN, MNSc, LicNSc, PhD for more information.


The MHMMC Portland Clinical Scholar Program (CSP) is an educational opportunity offered to all clinicians. The program is designed to support evidence-based practice (EBP), quality improvement (QI) and research.

The first CSP was offered in 2003/2004. In 2014, the program was revised to provide:

  • Basic EBP information including critical appraisal of the literature in the first two EBP classes
  • Project development, data collection and dissemination in the last three CSP classes

Participants may choose to enroll in either the EBP or both the EBP/CSP classes which are offered once each year. The Center for Nursing Research and Quality Outcomes in collaboration with interprofessional experts in the field of EBP present the five workshops between February and May. Scholars who elect to complete an EBP, QI or research project as part of the CSP will develop a clinical question, collect and analyze data, and present their results in October. Experienced mentors are assigned to support each CSP participant.


Eira Kristiina Hyrkäs, PhD, LicNSc, MNSc, RN 
Director for CNRQO

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.

The MHMMC Portland Department of Nursing, was accepted as the first practice site of the Sigma Theta Tau International (STTI) on June 21st, 2017. The chartering ceremony took place in September 16th, at MHMMC Portland and chapter recognition occurred at the Sigma Theta Tau International’s 44th Biennial Convention, October 28 - 1 November 2017. 

The STTI Honor Society of Nursing is the second-largest nursing organization in the world with approximately 135,000 active members in more than 90 countries and territories. The 431 chapters are located on 515 college and university campuses.

We received the STTI’s Chapter Key Award in 2019 and this was recognized at the Sigma’s Biennium Conference in Washington, DC. November 2019. The Chapter Key Award, established in 1991, honors Sigma chapters that excel in chapter-related activities such as:

  • Membership recruitment and retention
  • Publicity and programming
  • Professional and leadership development
  • Local, national, and international collaboration