Planned change or emergent change implementation approach and nurses' professional clinical autonomy

Luiking, Marie-Louise; Aarts, Leon; Bras, Leo; Grypdonck, Maria; Linge, Roland van

doi:10.1111/nicc.12135

Cited by 11 publications

(13 citation statements)

References 25 publications

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“…Importantly, a common aspect across many of the works cited above is a call for more research, including prospective study designs, to evaluate ways to overcome physician resistance to innovation implementation and identify strategies based upon the evidence. 46,47 As such, similar to the calls (noted earlier), among organizational-level retrospective studies on innovation implementation, the clinician-level studies have also called for prospective research to understand how successful behavior change and innovation implementation occur at the clinician level.…”

Section: Lessons Learned On Factors Driving Innovation Implementationmentioning

confidence: 89%

Innovation Implementation in the Context of Hospital QI-Lessons Learned and Strategies for Success

Rangachari¹

2018

Proceedings

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In 1999, the Institute of Medicine (IOM) reported that 98,000 people die each year due to medical errors. In the following years, the focus on hospital quality was intensified nationally, with policymakers providing evidence-based practice guidelines for improving health care quality. However, these innovations (evidence-based guidelines) that were being produced at policy levels were not translating to clinical practice at the hospital organizational level easily, and stark variations continued to persist, in the quality of health care. Circa 2009, nearly a decade after the release of the IOM report, the health care organizational literature began referring to this challenge as "innovation implementation failure" in health care organizations (HCOs), ie, failure to implement an evidence-based practice that is new to a HCO. This stream of literature drew upon management research to explain why innovation implementation failure occurs in HCOs and what could be done to prevent it. This paper conducts an integrative review of the literature on "innovation implementation" in hospitals and health systems over the last decade, since the spotlight was cast on "innovation implementation failure" in HCOs. The review reveals that while some studies have retrospectively sought to identify the key drivers of innovation implementation, through surveys and interviews of practitioners (the "what"), other studies have prospectively sought to understand how innovation implementation occurs in hospitals and health systems (the "how"). Both make distinctive contributions to identifying strategies for success in innovation implementation. While retrospective studies have helped identify the key drivers of innovation implementation, prospective studies have shed light on how these drivers could be attained, thereby helping to develop context-sensitive management strategies for success. The literature has called for more prospective research on the implementation and sustainability of health care innovations. This paper summarizes the lessons learned from the literature, discusses the relevance of management research on innovation implementation in HCOs, and identifies future research avenues.

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Section: Lessons Learned On Factors Driving Innovation Implementationmentioning

confidence: 89%

Innovation Implementation in the Context of Hospital QI-Lessons Learned and Strategies for Success

Rangachari¹

2018

Proceedings

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“…In the context of nursing, professional autonomy is a great challenge, characterized by a considerable complexity. Professional autonomy is defined in nursing literature as the autonomy to make decisions in each one’s professional area and to act according to it 1 . It is also related to the ability to make autonomous decisions based on comprehensive understanding about the human being and on knowledge supported by scientific evidence 1 .…”

Section: Introductionmentioning

confidence: 99%

“…Professional autonomy is defined in nursing literature as the autonomy to make decisions in each one’s professional area and to act according to it 1 . It is also related to the ability to make autonomous decisions based on comprehensive understanding about the human being and on knowledge supported by scientific evidence 1 . At the same time, professional autonomy can be defined as independence or self-determination in the professional practice, with legal support to allow the implementation of the decisions regarding nursing actions 2 .…”

Section: Introductionmentioning

confidence: 99%

Comparative study of representations of professional autonomy produced by first and last-period undergraduate nursing students

Santos

Gomes

Marques

et al. 2017

Rev. Latino-Am. Enfermagem

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Objective:to compare the social representations of professional nurse autonomy produced by first and last-period undergraduate nursing students. Method:qualitative, descriptive and exploratory study, based on the structural approach of social representations, the Central Core Theory, carried out with 171 students from three federal public universities, using the free association technique on the object “professional nurse autonomy”. The data were submitted to EVOC 2005 software and to similarity analysis. Results:care was the central core of the representational structure identified among the students of the first period. Among last-period students, knowledge stood out as a core element. The term responsibility was identified as common to both central cores. Conclusion:regarding professional autonomy, the results point to an overlapping process of the reified and consensual universes during the undergraduate course. However, responsibility, inherent in the profession, remains cross-sectional. For the first period students, autonomy is resignified in a practical and attitudinal way, whereas for the last period students, the knowledge acquired stimulates them to assign meaning to professional autonomy with a cognitive and attitudinal representation. The data can support the use of innovative teaching practices in nursing undergraduate courses.

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“…Essa dimensão conceitual corrobora com a literatura que aponta a autonomia como a "capacidade de se governar pelos próprios meios" 2 , sendo este um termo introduzido por Kant, que afirmava tratar-se da capacidade de reger-se conforme uma lei própria, da independência de vontade em relação a qualquer desejo ou objeto de desejo. No contexto da enfermagem, entende-se autonomia como a liberdade de tomar decisões no domínio profissional de cada um e agir conforme esse domínio 10 .De outra parte, a autonomia relaciona-se à habilidade de tomar decisões autônomas baseadas em noções holísticas a respeito do ser humano, fundamentadas em conhecimento amparado por evidências científicas10 . Desse modo, ter autonomia representa para os enfermeiros ter competência profissional em realizar, com liberdade e poder de decisão, suas atividades baseadas em conhecimento técnico-científicos, significando, assim, sua emancipação e independência.…”

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Representaciones sociales de la autonomía profesional de los (as) enfermeros (as) en el quirófano

et al. 2020

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Introducción: La autonomía profesional en enfermería se presenta como un tema complejo y de poca visibilidad, especialmente en sectores que demandan acciones de gran complejidad como en el quirófano. Objetivo: Analizar las representaciones sociales elaboradas por las enfermeras sobre su autonomía profesional en el quirófano. Materiales y Métodos: Estudio descriptivo y exploratorio de enfoque cualitativo, desarrollado con el apoyo teórico de la Teoría de las Representaciones Sociales. Nueve enfermeros que trabajan en la sala de operaciones de un hospital universitario en el estado de Río de Janeiro participaron en el estudio. La recopilación de datos tuvo lugar entre junio y octubre de 2017 a través de una entrevista semiestructurada. Los datos fueron sometidos a análisis temáticos. Resultados: Del análisis de datos surgieron las siguientes categorías: la autonomía profesional de la enfermera del quirófano: conocimiento, libertad de acción y poder de decisión; los límites para la autonomía profesional de la enfermera en sala de cirugía: relaciones jerárquicas y de poder, y conocimiento. Discusión: La autonomía profesional de las enfermeras en el quirófano es un objeto de representación con diferentes dimensiones, una cognitiva y una práctica, la primera de las cuales se basa esencialmente en el conocimiento técnico-científico, y la segunda en la libertad de acción y el poder de decisión necesario para el pleno ejercicio de autonomía. Conclusiones: La autonomía profesional de las enfermeras es un objeto de representación social, ya que es un cuerpo generador de conocimiento, saberes, reflexión e identidad profesional capaz de despertar actitudes y prácticas. Como citar este artigo: Milosky JP, Silva ACSS, Gomes AMT, Góes FGB, Knupp VMAO, Silva MVG. Representações sociais da autonomia profissional do enfermeiro no centro cirúrgico. Rev Cuid. 2020; 11(1): e849. http://dx.doi.org/10.15649/cuidarte.849

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Planned change or emergent change implementation approach and nurses' professional clinical autonomy

Abstract: If an innovation requires the nurses to make their own clinical decisions, an emergent change implementation should help to establish this clinical autonomy.

Cited by 11 publications

References 25 publications

Innovation Implementation in the Context of Hospital QI-Lessons Learned and Strategies for Success

Innovation Implementation in the Context of Hospital QI-Lessons Learned and Strategies for Success

Comparative study of representations of professional autonomy produced by first and last-period undergraduate nursing students

Representaciones sociales de la autonomía profesional de los (as) enfermeros (as) en el quirófano

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