McNett Molly, Tucker Sharon, Zadvinskis Inga, Tolles Diana, Thomas Bindu, Gorsuch Penelope, Gallagher-Ford Lynn
Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare, The Ohio State University, 1585 Neil Ave, Columbus, OH 43210 USA.
College of Nursing, The Ohio State University, 1585 Neil Avenue, Columbus, OH 43210 USA.
Glob Implement Res Appl. 2022;2(3):195-208. doi: 10.1007/s43477-022-00051-6. Epub 2022 Aug 12.
Research has identified facilitators and barriers to implementation of evidence-based practices (EBPs). Few studies have evaluated which factors persist among healthcare clinicians with extensive education and training on EBP implementation. Therefore, the purpose of this study was to examine facilitators and barriers to EBP implementation across a national sample of specialty-prepared EBP mentors in healthcare settings. Healthcare clinicians participating in an immersive 5-day EBP knowledge and skill building program were invited to complete a follow-up survey 12 months later to report on implementation experiences. The Consolidated Framework for Implementation Research (CFIR) guided content analysis of responses. A force field analysis using Lewin's change theory was used to assign numerical 'weights' to factors. Eighty-four individuals reported facilitators and barriers to implementation. The majority occurred within the inner setting of the CFIR model. Facilitators were strong leadership engagement ( = 15), positive EBP culture ( = 9), and resources ( = 4). Barriers included lack of resources ( = 21), poor leadership engagement ( = 19), implementation climate ( = 17), lack of relative priority ( = 12), and organizational characteristics ( = 9). Respondents also identified simultaneous facilitators and barriers within the process domain of the CFIR model. The construct of stakeholder engagement was a barrier when absent from the implementation process ( = 23), yet was a strong facilitator when present ( = 23). Implementation in healthcare settings appears most effective when conducted by an interprofessional team with strong leadership, resources, stakeholder engagement, and positive EBP culture. When these same factors are absent, they remain persistent barriers to implementation, even among specialty-trained healthcare clinicians.
The online version of this article (10.1007/s43477-022-00051-6) contains supplementary material, which is available to authorized users.
研究已确定了基于证据的实践（EBP）实施的促进因素和障碍。很少有研究评估在接受过广泛的EBP实施教育和培训的医疗保健临床医生中，哪些因素仍然存在。因此，本研究的目的是在全国范围内的医疗保健环境中，对专业准备的EBP导师样本进行调查，以检查EBP实施的促进因素和障碍。参加为期5天的沉浸式EBP知识和技能培养计划的医疗保健临床医生被邀请在12个月后完成一项后续调查，以报告实施经验。实施研究的综合框架（CFIR）指导了对回复的内容分析。使用Lewin变革理论进行的力场分析用于为因素赋予数值“权重”。84人报告了实施的促进因素和障碍。大多数因素出现在CFIR模型的内部环境中。促进因素包括强有力的领导参与（=15）、积极的EBP文化（=9）和资源（=4）。障碍包括资源缺乏（=21）、领导参与度低（=19）、实施氛围（=17）、缺乏相对优先级（=12）和组织特征（=9）。受访者还在CFIR模型的过程领域中确定了同时存在的促进因素和障碍。利益相关者参与这一构念在实施过程中缺失时是一个障碍（=23），而在存在时则是一个强有力的促进因素（=23）。当由具有强有力的领导、资源、利益相关者参与和积极的EBP文化的跨专业团队进行时，医疗保健环境中的实施似乎最有效。当这些相同的因素不存在时，它们仍然是实施的持续障碍，即使在经过专业培训的医疗保健临床医生中也是如此。
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