Girard Ariane, Roberge Pasquale, Ellefsen Dith, Bernard-Hamel Jolle, Carrier Jean-Daniel, Hudon Catherine
Facult de mdecine et de sciences de la sant, cole des sciences infirmires, Universit de Sherbrooke, Qubec, Canada.
Facult de mdecine et des sciences de la sant, Dpartement de mdecine de famille et de mdecine durgence, Universit de Sherbrooke, Qubec, Canada; Centre de recherche du centre hospitalier universitaire de Sherbrooke, Canada.
Int J Integr Care. 2021 May 19;21(2):20. doi: 10.5334/ijic.5556.
Primary care nurses are well-suited to provide care management for common mental disorders, but their practices depend on context. Various strategies can be considered to improve the adoption of nursing care manager activities, but data from implementation studies rarely address strategy formulation.
To analyze the influence of contextual factors on strategy formulation to improve the adoption of care manager activities by primary care nurses.
A qualitative multiple case study in three primary care clinics was carried out. Data were collected through individual interviews (n = 32) and observations (n = 7), working group meetings, and relevant documents. Thematic analysis was conducted.
Contextual factors influenced strategy formulation through organizational readiness for change, which resulted from tension for change and perceived organizational ability to implement change. Tension for change was generated through the perceived gap between patient needs and service availability, perceived compatibility with the nurses work environment, and their assessment of their capacity to perform care manager activities or acquire the necessary skills.
Future studies should give sufficient attention to implementation strategy formulation and consider the dynamic role of organizational readiness for change when facilitating the adoption of evidence-based practices for common mental disorders in primary care.
基层医疗护士非常适合为常见精神障碍提供护理管理，但他们的做法取决于具体情况。可以考虑采用各种策略来提高护理管理活动的采用率，但实施研究的数据很少涉及策略制定。
分析背景因素对策略制定的影响，以提高基层医疗护士对护理管理活动的采用率。
在三家基层医疗诊所开展了一项定性多案例研究。通过个人访谈（n = 32）、观察（n = 7）、工作组会议和相关文件收集数据。进行了主题分析。
背景因素通过组织变革准备度影响策略制定，组织变革准备度源于变革压力和对组织实施变革能力的认知。变革压力通过患者需求与服务可及性之间的感知差距、与护士工作环境的感知兼容性以及他们对执行护理管理活动或获取必要技能能力的评估而产生。
未来的研究应充分关注实施策略的制定，并在促进基层医疗中常见精神障碍的循证实践采用时，考虑组织变革准备度的动态作用。
