Graham Ian D, Logan Jo, Davies Barbara, Nimrod Carl
School of Nursing, Faculty of Health Sciences, University of Ottawa, Ontario, Canada.
Birth. 2004 Dec;31(4):293-301. doi: 10.1111/j.0730-7659.2004.00322.x.
Decreasing the use of continuous electronic fetal monitoring and increasing professional labor support for low-risk pregnancies are recommended by the Society of Obstetricians and Gynecologists of Canada. This study explored factors influencing the successful (and unsuccessful) introduction of an evidence-based fetal health surveillance guideline.
This qualitative case study was conducted at two tertiary and one community hospital. Data were collected in 14 clinician focus groups (51 nurses), followed by 8 interviews with nurse administrators and educators. Analysis of verbatim transcripts and unit records included coding and categorizing data to form profiles that were compared across hospitals.
Implementation of the guideline recommendations in the hospital settings was affected by many different factors originating in the practice environment, with the potential adopters, and related to the characteristics of the guideline. The influences of these diverse factors interacted sometimes to magnify or counteract each other's effect. The physical setting, adopter concerns, and the medicolegal issues surrounding the guideline played critical roles in uptake. In addition, changes preceding the introduction of the recommendations, the institution's agenda, and nursing and medical leadership influenced the uptake of guideline recommendations. The number and experience of nurses in each setting and availability of equipment also affected guideline acceptance and use.
When implementing best practice, it is important to identify organizational barriers to the change that will need managing by the appropriate level of administration in the organization. Careful tailoring of implementation interventions to the barriers originating with the potential adopters is also necessary. Be prepared for unanticipated effects.
加拿大妇产科学会建议减少连续电子胎儿监护的使用，并增加对低风险妊娠的专业分娩支持。本研究探讨了影响循证胎儿健康监测指南成功（及未成功）引入的因素。
本定性案例研究在两家三级医院和一家社区医院开展。在14个临床医生焦点小组（51名护士）中收集数据，随后对护士管理人员和教育工作者进行了8次访谈。对逐字记录和科室记录进行分析，包括对数据进行编码和分类以形成概况，并在各医院之间进行比较。
医院环境中指南建议的实施受到许多不同因素的影响，这些因素源于实践环境、潜在采用者，并与指南的特征有关。这些不同因素的影响有时相互作用，放大或抵消彼此的效果。物理环境、采用者的担忧以及围绕该指南的法医学问题在采用过程中起关键作用。此外，建议引入之前的变化、机构议程以及护理和医疗领导也影响了指南建议的采用。每个环境中护士的数量和经验以及设备的可用性也影响了指南的接受和使用。
在实施最佳实践时，识别组织变革的障碍很重要，这些障碍需要由组织中适当层级的管理层进行管理。还需要针对潜在采用者产生的障碍仔细调整实施干预措施。要对意外影响做好准备。
