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Sustaining a nursing best practice guideline in an acute care setting over 10 years: A mixed methods case study

BACKGROUND: To improve patient outcomes many healthcare organizations have undertaken a number of steps to enhance the quality of care, including the use of evidence-based practices (EBPs) such as clinical practice guidelines. However, there is little empirical understanding of the longer-term use o...

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Autores principales: Nadalin Penno, Letitia, Graham, Ian D., Backman, Chantal, Fuentes-Plough, Jessica, Davies, Barbara, Squires, Janet
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10012662/
https://www.ncbi.nlm.nih.gov/pubmed/36925887
http://dx.doi.org/10.3389/frhs.2022.940936
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author Nadalin Penno, Letitia
Graham, Ian D.
Backman, Chantal
Fuentes-Plough, Jessica
Davies, Barbara
Squires, Janet
author_facet Nadalin Penno, Letitia
Graham, Ian D.
Backman, Chantal
Fuentes-Plough, Jessica
Davies, Barbara
Squires, Janet
author_sort Nadalin Penno, Letitia
collection PubMed
description BACKGROUND: To improve patient outcomes many healthcare organizations have undertaken a number of steps to enhance the quality of care, including the use of evidence-based practices (EBPs) such as clinical practice guidelines. However, there is little empirical understanding of the longer-term use of guideline-based practices and how to ensure their ongoing use. The aim of this study was to identify the determinants and knowledge translation interventions (KTIs) influencing ongoing use of selected recommendations of an institutional pain policy and protocol over time from an organizational perspective and 10 years post implementation on two units within an acute care setting. METHODS: We conducted a mixed methods case study guided by the Dynamic Sustainability Framework of an EBP 10 years post implementation. We examined protocol sustainability at the nursing department and unit levels of a multi-site tertiary center in Canada. Data sources included document review (n = 29), chart audits (n = 200), and semi-structured interviews with nurses at the department (n = 3) and unit (n = 16) level. RESULTS: We identified 32 sustainability determinants and 29 KTIs influencing ongoing use of an EBP in acute care. Three determinants and eight KTIs had a continuous influence in all three time periods: implementation phase (0–2 yrs), sustained phase (>2–10 yrs.), and at the 10-year mark. Implementation of KTIs evolved with the level of application (e.g., department vs. unit) to fit the EBP within the context highlighting the need to focus on determinants influencing ongoing use. Sustainability was associated with continual efforts of monitoring and providing timely feedback regarding adherence to recommendations. KTIs used to embed recommendations into routine practices/processes positively influenced high adherence rates. Use of a participatory approach for implementation and sustainment and linking KTIs designed to incrementally address low adherence rates facilitated sustainment. CONCLUSION: This research provides insight into the relationship between implementation and sustainability determinants and related KTIs during implementation and sustained use phases. Unique determinants identified by department and unit nurses reflect their different perspectives toward the innovation based on their respective roles and responsibilities. KTIs fostered changed behaviors and facilitated EBP sustainment in acute care. Findings confirm the concept of sustainability is a dynamic “ongoing process.”
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spelling pubmed-100126622023-03-15 Sustaining a nursing best practice guideline in an acute care setting over 10 years: A mixed methods case study Nadalin Penno, Letitia Graham, Ian D. Backman, Chantal Fuentes-Plough, Jessica Davies, Barbara Squires, Janet Front Health Serv Health Services BACKGROUND: To improve patient outcomes many healthcare organizations have undertaken a number of steps to enhance the quality of care, including the use of evidence-based practices (EBPs) such as clinical practice guidelines. However, there is little empirical understanding of the longer-term use of guideline-based practices and how to ensure their ongoing use. The aim of this study was to identify the determinants and knowledge translation interventions (KTIs) influencing ongoing use of selected recommendations of an institutional pain policy and protocol over time from an organizational perspective and 10 years post implementation on two units within an acute care setting. METHODS: We conducted a mixed methods case study guided by the Dynamic Sustainability Framework of an EBP 10 years post implementation. We examined protocol sustainability at the nursing department and unit levels of a multi-site tertiary center in Canada. Data sources included document review (n = 29), chart audits (n = 200), and semi-structured interviews with nurses at the department (n = 3) and unit (n = 16) level. RESULTS: We identified 32 sustainability determinants and 29 KTIs influencing ongoing use of an EBP in acute care. Three determinants and eight KTIs had a continuous influence in all three time periods: implementation phase (0–2 yrs), sustained phase (>2–10 yrs.), and at the 10-year mark. Implementation of KTIs evolved with the level of application (e.g., department vs. unit) to fit the EBP within the context highlighting the need to focus on determinants influencing ongoing use. Sustainability was associated with continual efforts of monitoring and providing timely feedback regarding adherence to recommendations. KTIs used to embed recommendations into routine practices/processes positively influenced high adherence rates. Use of a participatory approach for implementation and sustainment and linking KTIs designed to incrementally address low adherence rates facilitated sustainment. CONCLUSION: This research provides insight into the relationship between implementation and sustainability determinants and related KTIs during implementation and sustained use phases. Unique determinants identified by department and unit nurses reflect their different perspectives toward the innovation based on their respective roles and responsibilities. KTIs fostered changed behaviors and facilitated EBP sustainment in acute care. Findings confirm the concept of sustainability is a dynamic “ongoing process.” Frontiers Media S.A. 2022-08-30 /pmc/articles/PMC10012662/ /pubmed/36925887 http://dx.doi.org/10.3389/frhs.2022.940936 Text en Copyright © 2022 Nadalin Penno, Graham, Backman, Fuentes-Plough, Davies and Squires. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Health Services
Nadalin Penno, Letitia
Graham, Ian D.
Backman, Chantal
Fuentes-Plough, Jessica
Davies, Barbara
Squires, Janet
Sustaining a nursing best practice guideline in an acute care setting over 10 years: A mixed methods case study
title Sustaining a nursing best practice guideline in an acute care setting over 10 years: A mixed methods case study
title_full Sustaining a nursing best practice guideline in an acute care setting over 10 years: A mixed methods case study
title_fullStr Sustaining a nursing best practice guideline in an acute care setting over 10 years: A mixed methods case study
title_full_unstemmed Sustaining a nursing best practice guideline in an acute care setting over 10 years: A mixed methods case study
title_short Sustaining a nursing best practice guideline in an acute care setting over 10 years: A mixed methods case study
title_sort sustaining a nursing best practice guideline in an acute care setting over 10 years: a mixed methods case study
topic Health Services
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10012662/
https://www.ncbi.nlm.nih.gov/pubmed/36925887
http://dx.doi.org/10.3389/frhs.2022.940936
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