Dogherty Elizabeth J, Harrison Margaret, Graham Ian, Keeping-Burke Lisa
1Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada 2School of Nursing, Queen's University, Kingston, Ontario, Canada 3Centre for Practice-Changing Research, The Ottawa Hospital Research Institute, and School of Nursing, University of Ottawa, Ottawa, Ontario, Canada 4Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada.
Int J Evid Based Healthc. 2014 Jun;12(2):105-27. doi: 10.1097/XEB.0000000000000008.
Facilitation is a mechanism for implementing practice guidelines in nursing. Facilitation aims to prepare clinicians and organisations for implementation and to provide support and help in problem-solving as implementation progresses. However, any evidence supporting its effectiveness is limited due to a lack of empirical testing.
: To examine the presence and role of facilitation in studies included in an existing systematic review of guideline dissemination and implementation in nursing.
Using a descriptive, exploratory approach, we examined 28 studies for elements of facilitation that were included in a review of the effectiveness of interventions to increase the use of practice guidelines in nursing. We conducted a content analysis of a subset of studies that included facilitation activity to gather descriptions of study interventions, characteristics and skills required, use of theory, and effectiveness. Extracted data were analysed using a previously developed taxonomy containing 53 activities related to facilitation.
Ten of the 28 studies exhibited evidence of facilitation process and activity. Only two of the 10 studies explicitly referred to 'facilitators,' with just one indicating that facilitators were a part of the implementation intervention being tested. We identified facilitation processes in the eight remaining studies even though the authors did not report it as such. All studies used facilitation activities in combination with other interventions, the most common being educational meetings or distribution of educational materials. We found evidence related to facilitation for 37 of the 53 facilitation activities (70%) in the taxonomy in at least one study or across studies. An additional three novel facilitation-related activities were identified. Most studies exhibited evidence of external facilitation activity whereby researchers outside of the setting assisted nurses to implement guidelines. Theory informed the development or selection of implementation interventions in 60% (n = 6) of the studies. Drawing conclusions regarding effectiveness of interventions involving facilitation was difficult due to the small number of studies that were included. Furthermore, the included studies varied in the detail provided about the intervention or combination of interventions tested and how interventions were delivered.
Using an existing systematic review for the purpose of gaining insight into additional research questions was valuable. Although facilitation process and activities are used in interventions to enhance guideline uptake in nursing, these were not conceptualized or referred to by researchers as 'facilitation.' As such, facilitation may be a broader intervention that includes organizing and delivering other interventions. Further research is required to evaluate the relationship between facilitation and other guideline implementation interventions in nursing. The facilitation uncovered within included studies was located primarily in the context of research as it was the researchers who performed most of the facilitation activities. Future inquiries must explore non-researcher-initiated and delivered facilitation intervention activities by following local groups naturally within clinical contexts.
促进是护理领域实施实践指南的一种机制。促进旨在使临床医生和组织为实施做好准备，并在实施过程中提供支持和解决问题的帮助。然而，由于缺乏实证检验，支持其有效性的证据有限。
考察促进在一项现有的关于护理领域指南传播与实施的系统评价所纳入研究中的存在情况及作用。
采用描述性、探索性方法，我们在一项关于提高护理实践指南使用率的干预措施有效性评价中，对28项研究进行考察，以寻找促进要素。我们对一部分包含促进活动的研究进行了内容分析，以收集有关研究干预措施、所需特征和技能、理论应用及有效性的描述。使用先前开发的包含53项与促进相关活动的分类法对提取的数据进行分析。
28项研究中有10项显示出促进过程和活动的证据。10项研究中只有2项明确提及“促进者”，其中只有1项表明促进者是正在测试的实施干预措施的一部分。我们在其余8项研究中也识别出了促进过程，尽管作者并未如此报告。所有研究都将促进活动与其他干预措施结合使用，最常见的是教育会议或分发教育材料。我们在分类法中的53项促进活动中，至少在一项研究或多项研究中发现了与37项活动（70%）相关的促进证据。另外还识别出了三项与促进相关的新活动。大多数研究显示出外部促进活动的证据，即机构外部的研究人员协助护士实施指南。60%（n = 6）的研究中，理论为实施干预措施的开发或选择提供了依据。由于纳入的研究数量较少，难以就涉及促进的干预措施的有效性得出结论。此外，纳入的研究在提供的关于所测试的干预措施或干预措施组合的细节以及干预措施的实施方式方面存在差异。
利用现有的系统评价来深入了解其他研究问题很有价值。尽管促进过程和活动在干预措施中用于提高护理领域对指南的采纳率，但研究人员并未将其概念化或称为“促进”。因此，促进可能是一种更广泛的干预措施，包括组织和实施其他干预措施。需要进一步研究来评估促进与护理领域其他指南实施干预措施之间的关系。纳入研究中发现的促进主要存在于研究背景中，因为大多数促进活动是由研究人员进行的。未来的研究必须通过在临床环境中自然跟踪当地群体，探索非研究人员发起和实施的促进干预活动。
