Nurses' perceptions of working according to standardized care plans: a questionnaire study

MSc, RN Jenny Jakobsson; Wann-Hansson, RN Christine

doi:10.1111/scs.12009

Cited by 8 publications

(8 citation statements)

References 12 publications

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“…Questionnaires were distributed to all staff when the pathway had been implemented for approximately 1 year. The composition of the questionnaire was based on a previously used questionnaire [ 28 ] with additional questions inspired by previous studies [ 15 , 23 , 29 ], and it encompassed the following: the general impression of the pathway, utilization, patient/family involvement, usability, documentation, care quality, and the implementation process. Additional file 2 provides the questions included in the questionnaire.…”

Section: Methodsmentioning

confidence: 99%

Struggling for a feasible tool – the process of implementing a clinical pathway in intensive care: a grounded theory study

Bjurling-Sjöberg

Wadensten

Pöder

et al. 2018

BMC Health Serv Res

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BackgroundClinical pathways can enhance care quality, promote patient safety and optimize resource utilization. However, they are infrequently utilized in intensive care. This study aimed to explain the implementation process of a clinical pathway based on a bottom-up approach in an intensive care context.MethodsThe setting was an 11-bed general intensive care unit in Sweden. An action research project was conducted to implement a clinical pathway for patients on mechanical ventilation. The project was managed by a local interprofessional core group and was externally facilitated by two researchers. Grounded theory was used by the researchers to explain the implementation process. The sampling in the study was purposeful and theoretical and included registered nurses (n31), assistant nurses (n26), anesthesiologists (n11), a physiotherapist (n1), first- and second-line managers (n2), and health records from patients on mechanical ventilation (n136). Data were collected from 2011 to 2016 through questionnaires, repeated focus groups, individual interviews, logbooks/field notes and health records. Constant comparative analysis was conducted, including both qualitative data and descriptive statistics from the quantitative data.ResultsA conceptual model of the clinical pathway implementation process emerged, and a central phenomenon, which was conceptualized as ‘Struggling for a feasible tool,’ was the core category that linked all categories. The phenomenon evolved from the ‘Triggers’ (‘Perceiving suboptimal practice’ and ‘Receiving external inspiration and support’), pervaded the ‘Implementation process’ (‘Contextual circumstances,’ ‘Processual circumstances’ and ‘Negotiating to achieve progress’), and led to the process ‘Output’ (‘Varying utilization’ and ‘Improvements in understanding and practice’). The categories included both facilitating and impeding factors that made the implementation process tentative and prolonged but also educational.ConclusionsThe findings provide a novel understanding of a bottom-up implementation of a clinical pathway in an intensive care context. Despite resonating well with existing implementation frameworks/theories, the conceptual model further illuminates the complex interaction between different circumstances and negotiations and how this interplay has consequences for the implementation process and output. The findings advocate a bottom-up approach but also emphasize the need for strategic priority, interprofessional participation, skilled facilitators and further collaboration.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3629-1) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Struggling for a feasible tool – the process of implementing a clinical pathway in intensive care: a grounded theory study

Bjurling-Sjöberg

Wadensten

Pöder

et al. 2018

BMC Health Serv Res

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“…Dunn, 2012) and affirm that in decision-making, they prioritise their experience on the content of the plans (Jakobsson & Wann-Hansson, 2013;Svensson et al, 2012). Finally, lack of interest could influence negatively the individualisation process (Baraki et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, nurses acknowledge that they do not use the CP as an instrument of communication between them. Because they do not comment on their content, especially if there are discrepancies (Estrada & Dunn, ) and affirm that in decision‐making, they prioritise their experience on the content of the plans (Jakobsson & Wann‐Hansson, ; Svensson et al, ). Finally, lack of interest could influence negatively the individualisation process (Baraki et al, ).…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators involved in standardised care plan individualisation process in acute hospitalisation wards: A grounded theory approach

Castellà-Creus

Delgado‐Hito

Casanovas-Cuellar

et al. 2019

Journal of Clinical Nursing

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Objective To identify and classify the barriers and facilitators of the individualisation process of the standardised care plan in hospitalisation wards. Background The administration of individualised care is one of the features of the nursing process. Care plans are the structured record of the diagnosis, planning and evaluation stages of the nursing process. Although the creation of standardised care plan has made recording easier, it is still necessary to record the individualisation of the care. It is important to study the elements that influence the individualisation process from the nurses' perspective. Design Qualitative study with the grounded theory approach developed by Strauss and Corbin. Methods Thirty‐nine nurses from three hospitals participated by way of theoretical sampling. In‐depth interviews were conducted, as well as participant observation, document analysis and focus group discussion. The analysis consisted of open, axial and selective coding until data saturation was reached. EQUATOR guidelines for qualitative research (COREQ) were applied. Results For both barriers and facilitators, three thematic categories emerged related to organisational, professional and individual aspects. The identified barriers included routines acquired in the wards, the tradition of narrative records, lack of knowledge and limited interest in individualisation. The identified facilitators included holding clinical care sessions, use of standardised care plan and an interface terminology, the nurse's expertise and willingness to individualise. Conclusion The individualisation process of the standardised care plan involves multiple barriers and facilitators, which influence its degree of accuracy. Relevance to clinical practice Implementing strategies at an organisational level, professional level and individual level to improve the way the process is carried out would encourage individualising the standardised care plan in a manner that is consistent with the needs of the patient and family; it would improve the quality of care and patient satisfaction.

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“…, Bjurling‐Sjöberg et al . , Jakobsson & Wann‐Hansson ). SCPs may also help staff improve patient outcomes, reduce length of hospital stays, and enhance teamwork and record keeping (Rycroft‐Malone et al .…”

Section: Introductionmentioning

confidence: 97%

“…Studies have shown that hospital staff believe SCPs increase their ability to provide high-quality patient care (Lee 2005, 2006, Dahm & Wadensten 2008, P€ oder et al 2011, Svensson et al 2012, Bjurling-Sj€ oberg et al 2013, Jakobsson & Wann-Hansson 2013. SCPs may also help staff improve patient outcomes, reduce length of hospital stays, and enhance teamwork and record keeping (Rycroft-Malone et al 2004, Deneckere et al 2013, Deng et al 2014.…”

Section: Introductionmentioning

confidence: 99%

Standardised care plans for in hospital stroke care improve documentation of health care assessments

Pöder

Dahm

Karlsson

et al. 2015

Journal of Clinical Nursing

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Nurses' perceptions of working according to standardized care plans: a questionnaire study

Abstract: The nurses had overall positive perceptions of working according to an SCP mainly in terms of usability, documentation and quality of care. The implementation process was not optimal and it was doubtful whether the SCP rendered any positive side effects.

Cited by 8 publications

References 12 publications

Struggling for a feasible tool – the process of implementing a clinical pathway in intensive care: a grounded theory study

Struggling for a feasible tool – the process of implementing a clinical pathway in intensive care: a grounded theory study

Barriers and facilitators involved in standardised care plan individualisation process in acute hospitalisation wards: A grounded theory approach

Standardised care plans for in hospital stroke care improve documentation of health care assessments

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