Faculty of Health Sciences, University of Southampton, Building 67 (Nightingale), University Road, Highfield, Southampton SO17 1BJ, UK.
Faculty of Health Sciences, University of Southampton, Building 67 (Nightingale), University Road, Highfield, Southampton SO17 1BJ, UK.
Int J Nurs Stud. 2014 Feb;51(2):289-99. doi: 10.1016/j.ijnurstu.2013.06.019. Epub 2013 Jul 30.
To investigate the dynamics of nurses' work in implementing Clinical Practice Guidelines.
Hybrid: systematic review techniques used to identify qualitative studies of clinical guideline implementation; theory-led and structured analysis of textual data.
CINAHL, CSA Illumina, EMBASE, MEDLINE, PsycINFO, and Sociological Abstracts.
Systematic review of qualitative studies of the implementation of Clinical Practice Guidelines, analysed using Directed Content Analysis, and interpreted in the light of Normalisation Process Theory.
Seven studies met the inclusion criteria of the review. These revealed that clinical practice guidelines are disposed to normalisation when: (a) They are associated with activities that practitioners can make workable in practice, and practitioners are able to integrate it into their collective workflow. (b) When they are differentiated from existing clinical practice by its proponents, and when claims of differentiation are regarded as legitimate by their potential users. (c) When they are associated with an emergent community of practice, and when members of that community of practice enrol each other into group processes that specify their engagement with it. (d) When they are associated with improvements in the collective knowledge of its users, and when users are able to integrate the application of that knowledge into their individual workflow. And, (e) when nurses can minimise disruption to behaviour norms and agreed professional roles, and mobilise structural and cognitive resources in ways that build shared commitments across professional boundaries.
This review demonstrates the feasibility and benefits of theory-led review of studies of nursing practice, and proposes a dynamic model of implementation. Normalisation Process Theory supports the analysis of nursing work. It characterises mechanisms by which work is made coherent and meaningful, is formed around sets of relational commitments, is enacted and contextualised, and is appraised and reconfigured. It facilitates such analysis from within the frame of nursing knowledge and practice itself.
调查护士在实施临床实践指南方面的工作动态。
混合方法：系统评价技术用于确定临床指南实施的定性研究；理论导向和文本数据的结构化分析。
CINAHL、CSA Illumina、EMBASE、MEDLINE、PsycINFO 和 Sociological Abstracts。
对临床实践指南实施的定性研究进行系统评价，使用定向内容分析进行分析，并根据规范化进程理论进行解释。
有 7 项研究符合本研究的纳入标准。这些研究表明，临床实践指南倾向于规范化，当：(a) 它们与从业者在实践中能够使之可行的活动相关联，并且从业者能够将其纳入他们的集体工作流程中。(b) 当它们由其支持者与现有的临床实践区分开来，并且当潜在用户认为这种区分是合法的时。(c) 当它们与一个新兴的实践共同体相关联时，并且当该共同体的成员将彼此纳入规定其参与的团体过程中时。(d) 当它们与用户集体知识的提高相关联，并且当用户能够将该知识的应用纳入他们的个人工作流程中时。并且，(e) 当护士能够最小化对行为规范和商定的专业角色的干扰，并以在专业边界内建立共同承诺的方式调动结构和认知资源时。
本综述证明了理论指导的护理实践研究审查的可行性和益处，并提出了一个实施的动态模型。规范化进程理论支持对护理工作的分析。它描述了使工作连贯和有意义的机制，围绕一系列关系承诺形成，被执行和上下文化，并被评估和重新配置。它从护理知识和实践本身的框架内促进了这种分析。
