University of Ottawa, Faculty of Health Sciences, School of Nursing, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
Implement Sci. 2008 Dec 10;3:51. doi: 10.1186/1748-5908-3-51.
Foot ulcers are a significant problem for people with diabetes. Comprehensive assessments of risk factors associated with diabetic foot ulcer are recommended in clinical guidelines to decrease complications such as prolonged healing, gangrene and amputations, and to promote effective management. However, the translation of clinical guidelines into nursing practice remains fragmented and inconsistent, and a recent homecare chart audit showed less than half the recommended risk factors for diabetic foot ulcers were assessed, and peripheral neuropathy (the most significant predictor of complications) was not assessed at all. Strong leadership is consistently described as significant to successfully transfer guidelines into practice. Limited research exists however regarding which leadership behaviours facilitate and support implementation in nursing. The purpose of this pilot study is to evaluate the impact of a leadership intervention in community nursing on implementing recommendations from a clinical guideline on the nursing assessment and management of diabetic foot ulcers.
Two phase mixed methods design is proposed (ISRCTN 12345678). Phase I: Descriptive qualitative to understand barriers to implementing the guideline recommendations, and to inform the intervention. Phase II: Matched pair cluster randomized controlled trial (n = 4 centers) will evaluate differences in outcomes between two implementation strategies.
Nursing assessments of client risk factors, a composite score of 8 items based on Diabetes/Foot Ulcer guideline recommendations.
In addition to the organization's 'usual' implementation strategy, a 12 week leadership strategy will be offered to managerial and clinical leaders consisting of: a) printed materials, b) one day interactive workshop to develop a leadership action plan tailored to barriers to support implementation; c) three post-workshop teleconferences.
This study will provide vital information on which leadership strategies are well received to facilitate and support guideline implementation. The anticipated outcomes will provide information to assist with effective management of foot ulcers for people with diabetes. By tracking clinical outcomes associated with guideline implementation, health care administrators will be better informed to influence organizational and policy decision-making to support evidence-based quality care. Findings will be useful to inform the design of future multi-centered trials on various clinical topics to enhance knowledge translation for positive outcomes.
足部溃疡是糖尿病患者的一个严重问题。临床指南建议全面评估与糖尿病足溃疡相关的危险因素，以减少愈合时间延长、坏疽和截肢等并发症，并促进有效的管理。然而，临床指南向护理实践的转化仍然是零散和不一致的，最近的家庭护理图表审核显示，评估的糖尿病足溃疡危险因素不足推荐的一半，而且根本没有评估周围神经病变（并发症的最重要预测因素）。一致认为，强有力的领导力对于成功地将指南转化为实践具有重要意义。然而，关于哪些领导行为有助于和支持护理实施的研究有限。本研究旨在评估社区护理领导力干预对实施糖尿病足溃疡护理评估和管理临床指南建议的影响。
拟采用两阶段混合方法设计（ISRCTN 12345678）。第一阶段：描述性定性研究，以了解实施指南建议的障碍，并为干预提供信息。第二阶段：配对簇随机对照试验（n=4 个中心）将评估两种实施策略之间结果的差异。
根据糖尿病/足部溃疡指南建议，对客户风险因素进行护理评估，为 8 项指标的综合评分。
除了组织的“常规”实施策略外，还将为管理和临床领导者提供为期 12 周的领导力策略，包括：a）印刷材料，b）为期一天的互动研讨会，以制定针对支持实施的障碍的领导力行动计划；c）三次研讨会后的电话会议。
本研究将提供有关哪些领导策略受到欢迎以促进和支持指南实施的重要信息。预期结果将为帮助管理糖尿病患者的足部溃疡提供信息。通过跟踪与指南实施相关的临床结果，医疗保健管理人员将更好地了解影响组织和政策决策以支持循证质量护理的信息。研究结果将有助于为未来各种临床主题的多中心试验提供信息，以增强知识转化，实现积极的结果。
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