Abstract
BackgroundResearch- and/or evidence-based knowledge are not routinely adopted in healthcare and nursing practice. It is also unclear which implementation strategies are effective in nursing practice and what expenditures of time and money are required for the successful implementation of clinical practice guidelines (CPGs). The aim in this study was to assess the effectiveness and required time investment of multifaceted and tailored strategies for implementing an evidence-based fall-prevention guideline (Falls CPG) into nursing practice in an acute care hospital setting.MethodsA before-and-after, mixed-method design was used within a participatory action research approach (PAR). The study was carried out in two departments of an Austrian university teaching hospital and included all graduate and assistant nurses. Data were collected through a questionnaire, group discussions and semi-structured interviews. Qualitative data were content-analysed using a template based on the Consolidated Framework for Implementation Research (CFIR), which also served as a theoretical framework for the study. Quantitative data were descriptively analysed using appropriate tests for independent groups.ResultsBy applying multifaceted and tailored implementation strategies, the graduate and assistant nurses’ knowledge on fall prevention, how to access the Falls CPG and the guideline itself increased significantly between baseline and final assessment (p ≤ .001). Qualitative data also revealed an increase in participant awareness of fall prevention. A baseline positive attitude towards guidelines improved significantly towards the end of the project (p = .001). Required fall prevention equipment like baby monitors or one-way glide sheets were available for use and any required environmental adaptations, e.g. a handrail in the corridor, were made. Hospital nursing personnel (approximately 150) invested a total of 1192 hours of working time over the course of the project.ConclusionsMultifaceted strategies tailored to the specific setting within a PAR approach and guided by the CFIR enabled the effective implementation of a CPG into acute care nursing practice. Nursing managers now have sound knowledge of the time resources required for CPG implementation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12912-015-0064-z) contains supplementary material, which is available to authorized users.
Highlights
Research- and/or evidence-based knowledge are not routinely adopted in healthcare and nursing practice
Aim As it was unclear which implementation strategies are effective in nursing and what resources are required to implement a Clinical practice guideline (CPG), this study aimed to assess the effectiveness of multifaceted and tailored strategies in implementing an evidence-based fall-prevention guideline into nursing practice in an acute care hospital setting
Demographics Approximately two thirds of the participating nursing personnel worked in the Ophthalmic Department (OD) (t1: 65.1%, n = 106; t3: 68.2%, n = 110)
Summary
Research- and/or evidence-based knowledge are not routinely adopted in healthcare and nursing practice. The implementation of evidencebased care into healthcare systems is not typically the norm [1] This applies to nursing, despite the increasing expectation, and in some countries even a legal obligation, to work according to research-based standards/knowledge [2,3] in order to promote positive patient outcomes [4,5]. After nearly four decades of work implementing researchand evidence-based knowledge into healthcare and nursing, there is still a notorious mismatch between target and current conditions [6,7,8] This mismatch threatens the safety and quality of patient care [8] as it may lead to unnecessary suffering [9]
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