Abstract
The present study was part of an action research project that was performed to implement a clinical pathway for patients on mechanical ventilation and simultaneously explore the implementation process in a Swedish intensive care unit. The aim of this questionnaire study was to evaluate whether an action research methodology could affect the general prerequisites for evidence-based practice (EBP). Informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework, the study included registered nurses, assistant nurses and anesthesiologists in the unit at start of the project (n = 50) and at follow-up (n = 44). Data was collected with the Evaluation Before Implementation Questionnaire and the Attitudes towards Guidelines Scale.The results revealed that the general prerequisites for EBP in the setting improved. Compared to baseline measurements, the staff at follow-up conversed significantly more about the importance of the patients’ experiences, research utilization, context and facilitation, while changes with respect to clinical experiences were not significant. The attitudes towards guidelines were perceived as positive at baseline as well as at follow-up and did not significantly change.Longer professional experience was associated with a slightly lower probability of perceiving that the importance of research utilization was discussed and reflected upon, while belonging to a profession with longer education was associated with a higher probability of this perception. Compared to registered nurses and assistant nurses, the anesthesiologists perceived, to a greater extent, that the importance of clinical experience was discussed and reflected upon in the setting, while there was no significant association with the length of professional experience and/or specific professions regarding the other components.In conclusion, using action research to implement a clinical pathway methodology seems to set in motion various mechanisms that improve some but not all prerequisites that, according to the PARIHS framework, are advantageous for EBP.
Highlights
Patient care is intended to be reliable and provided according to evidence-based practice (EBP), which is based on integrated knowledge from a range of sources, including scientific research, clinical experience, contextual conditions, and patients’ preferences (Rycroft-Malone et al, 2004; Scott and McSherry, 2009)
Informed by the PARIHS framework (Rycroft-Malone, 2004), this questionnaire study evaluated the general prerequisites for EBP at baseline and at one-year follow-up after an action research project was performed that included the implementation of a clinical pathway for patients on mechanical ventilation
The results of the present study show that compared to baseline, a larger proportion of the staff at follow-up perceived that they discussed and reflected together on the importance of patients’ experiences, research utilization and conditions in the context. They scored higher on the associated Evaluation Before Implementation Questionnaire (EBIQ) subscales exploring perceptions of the conditions in the intensive care units (ICUs), indicating more advantageous prerequisites for EBP at follow-up compared to baseline, which is consistent with findings from a grounded theory study by Bjurling-Sjo€berg et al (2018) that was conducted within the same action research project
Summary
Patient care is intended to be reliable and provided according to evidence-based practice (EBP), which is based on integrated knowledge from a range of sources, including scientific research, clinical experience, contextual conditions, and patients’ preferences (Rycroft-Malone et al, 2004; Scott and McSherry, 2009). Further efforts are needed to increase reliability and EBP in care processes (Buchert and Butler, 2016), which is an issue of high relevance for all healthcare professionals. One of the strategies to implement EBP and increase reliability in care processes is to apply structured care methodologies, such as guidelines or clinical pathways. Clinical pathways have been increasingly used worldwide and have been acknowledged to be “the future of healthcare delivery” (p326, Buchert and Butler, 2016). A clinical pathway ( known as e.g., care pathway or critical pathway) is a complex intervention, a structured multidisciplinary care plan for a defined group of patients that translate current evidence into local contexts and coordinate roles and essential activities (Lawal et al, 2016; Vanhaecht et al, 2012)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
