Effectiveness of multifaceted and tailored strategies to implement a fall-prevention guideline into acute care nursing practice: a before-and-after, mixed-method study using a participatory action research approach

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.

Evaluation of a Systems Analysis and Improvement Approach to Optimize Prevention of Mother-To-Child Transmission of HIV Using the Consolidated Framework for Implementation Research

“…28 PMTCT services in Kenya are provided through public and private not-for-profit health facilities. High volume facilities typically offer option B+, whereas lower volume facilities offer option B or A.…”

Implementation in nursing and midwifery. A scoping review / Implementationsprojekte in der Pflege und Hebammenarbeit. Scoping review

“…Seit einigen Jahren stehen zunehmend Studienergebnisse zur Verfügung, die Informationen für eine gezielte Implementationsstrategie bieten. Unter "Implementation" wird im Gegensatz zur "Diffusion" eine bewusste Umsetzung der Erkenntnisse verstanden, während eine "Dissemination" lediglich die Verbreitung der Erkenntnisse betrifft (Rabin und Brownson, 2012, pp.25-26 (Breimaier et al, 2015;Williamson et al, 2005;Masso et al, 2014;Helmink et al, 2010) und in vier weiteren weniger intensiv (Jewell et al, 2007;Friesen-Storms, 2015;Chan et al, 2013;Gupta et al, 2015) In Tabelle 1 werden die 38 eingeschlossenen Studien mit Erscheinungsjahr, Land, Thema, Design sowie Aussagen zu den einzelnen Implementationsphasen aufgelistet (nähere Erläuterungen zu den Aspekten des Gelingens siehe auch weiter unten). Die Treffer werden nach Fachgebiet sowie danach kategorisiert, ob sie Forschungsergebnisse zur Implementation allgemein bieten (bezeichnet als "nicht eine spezielle Intervention betreffend") oder "einfache Interventionen", "komplexe Interventionen" bzw.…”

“…In 22 Studien wurde sie offensichtlich nicht angestrebt, obwohl sie sinnvoll erscheint. In vier Studien wird sie intensiv (Breimaier et al, 2015;Williamson et al, 2005;Masso et al, 2014;Helmink et al, 2010) und in vier weiteren weniger intensiv (Jewell et al, 2007;Friesen-Storms, 2015;Chan et al, 2013;Gupta et al, 2015) (Brobeck et al, 2013). Eine schlechte Rücklaufquote kann die Tendenz der Antworten verfälschen (Frost et al, 2003).…”

“…Leitlinien sollten zunächst durch Gruppengespräch und Interaktion kennengelernt werden (Ploeg et al, 2007). Breimaier et al (2015) betonen, dass verschiedene Strategien für die Implementierung zugeschnitten auf die Bedürfnisse der jeweiligen Abteilung kreiert werden sollten. Jewell et al (2007) erkennen, dass ein Schritt zur Autonomie wesentlich ist: Es war den Beteiligten wichtig, die Anweisung zur praktischen Umsetzung der Leitlinie interdisziplinär festzulegen.…”

Unpacking action research and implementation science: Implications for nursing

“…Some authors describe the integration of participatory action research (PAR) approaches into implementation science projects (Bailie, Matthews, Brands, & Schierhout, 2013;Goodyear-Smith, Jackson, & Greenhaigh, 2015). Others take an action research approach but draw on theoretical frameworks from the implementation science field (Breimaier, Halfens, & Lohrmann, 2015;Brown & McCormack, 2011;Heyrani et al, 2012;Murphy, 2015). As highlighted earlier, action research is not a single approach but a family of approaches, yet in the implementation science literature, participatory action research (PAR) appears to be the only form of action research drawn on (Leykum, Pugh, Lanham, Harmon, & McDaniel, 2009).…”