Abstract
This study aimed to explore an evidence-based nursing practice model of CRF management in hospitalized adult patients using the PARIHS evidence-implementation framework as the theoretical structure to provide guidance for similar nursing practices. The implementation of guideline evidence into clinical practice was conducted on the oncology and radiotherapy wards of a university-affiliated hospital. The process of integrating the guideline into the symptom management system of cancer patients was described. The impact of the evidence implementation was evaluated from three aspects: organizational innovations and outcome measures associated with nurses and with patients pre- and post-evidence implementation. During the implementation of evidence into practice on the wards, a nursing process, health education, a quality control sheet and CRF training courses were established. Through this implementation, compliance with evidence related to CRF increased significantly on the two wards, with that of ward B being higher than that of ward A. Regarding nursing outcomes, nursing knowledge, attitude and behavior scores with respect to CRF nursing care increased substantially after its application on the two wards, and the ward B nurses’ scoring was higher than that of the ward A nurses. Qualitative analysis concerning the nurses suggested that leadership, patient concern about CRF management, and the need for professional development were the main motivators of the application, whereas the shortage and mobility of nursing human resources and insufficient communication between doctors and nurses were the main barriers. Additionally, most nurses felt more professional and confident about their work. Regarding patient outcomes, patient knowledge, attitude and behavior scores regarding CRF self-management increased significantly. Patients’ post-implementation CRF was alleviated compared with the pre-implementation treatment cycle. The PARIHS framework may provide instructive guidance for the incorporation of evidence into practice, and the process-oriented framework might provide greater operational utility of the application.
Highlights
Cancer-related fatigue (CRF) has been reportedly experienced by 80%-90% of cancer patients undergoing chemotherapy or/and radiotherapy [1] and is considered more distressing to patients than either pain or nausea and vomiting [2]
Considering the differences in internal and external cultures and clinical situations [3,4,5,6] along with abundant indigenous evidence resources, we developed the “Clinical Practice Guideline: Nursing Care of Cancer-Related Fatigue in Adults with Cancers” under the guidance of SIGN 50 issued by the Scottish Intercollegiate Guidelines Network (SIGN) [7]
We evaluated the impact of evidence implementation from three aspects: organizational innovations, and outcome measures related to nurses and patients pre- and post-implementation of the interventions
Summary
Cancer-related fatigue (CRF) has been reportedly experienced by 80%-90% of cancer patients undergoing chemotherapy or/and radiotherapy [1] and is considered more distressing to patients than either pain or nausea and vomiting [2]. Considering the differences in internal and external cultures and clinical situations [3,4,5,6] along with abundant indigenous evidence resources, we developed the “Clinical Practice Guideline: Nursing Care of Cancer-Related Fatigue in Adults with Cancers” under the guidance of SIGN 50 (a guideline developer’s handbook) issued by the Scottish Intercollegiate Guidelines Network (SIGN) [7]. Implementation of evidence into practice is an iterative and gradual process that includes actively and systematically integrating information into place, defining the barriers to the innovation, resolving these barriers by effective communication, and improving the effects of the innovation using management or educational strategies [8]. It outlines the factors that require attention before, during, and after the implementation process, which may guarantee the successful application of the evidence [11]. We adopted the PARIHS framework to guide the implementation process
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