Aloisio Laura D, Graham Nicole, Grinspun Doris, Naik Shanoja, Coughlin Mary, Medeiros Christina, McConnell Heather, Sales Anne, McNeill Susan, Santos Wilmer J, Squires Janet E
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
University of Ottawa, Faculty of Health Sciences, School of Nursing, Ottawa, ON, Canada.
Heliyon. 2023 Sep 9;9(9):e19983. doi: 10.1016/j.heliyon.2023.e19983. eCollection 2023 Sep.
The use of best practice guidelines (BPGs) has the potential to decrease the gap between best evidence and nursing and healthcare practices. We conducted an exploratory mixed method study to identify strategies, processes, and indicators relevant to the implementation and sustainability of two Registered Nurses' Association of Ontario (RNAO) BPGs at Best Practice Spotlight Organizations® (BPSOs).
Our study had four phases. In Phase 1, we triangulated two qualitative studies: a) secondary analysis of 126 narrative reports detailing implementation progress from 21 BPSOs spanning four sectors to identify strategies and processes used to support the implementation and sustainability of BPGs and b) interviews with 25 guideline implementers to identify additional strategies and processes. In Phase 2, we evaluated correlations between strategies and processes identified from the narrative reports and one process and one outcome indicator for each of the guideline. In Phase 3, the results from Phases 1 and 2 informed indicator development, led by an expert panel. In Phase 4, the indicators were assessed internally by RNAO staff and externally by Ontario Health Teams. A survey was used to validate proposed indicators to determine relevance, feasibility, readability, and usability with knowledge users and BPSO leaders.
Triangulation of the two qualitative studies revealed 46 codes of implementation and sustainability of BPGs, classified into eight overarching themes: Stakeholder Engagement, Practice Interventions, Capacity Building, Evidence-Based Culture, Leadership, Evaluation & Monitoring, Communication, and Governance. A total of 28 structure, process, or outcome indicators were developed. End users and BPSO leaders were agreeable with the indicators according to the validation survey.
Many processes and strategies can influence the implementation and sustainability of BPGs at BPSOs. We have developed indicators that can help BPSOs promote evidence-informed practice implementation of BPGs.
使用最佳实践指南（BPGs）有可能缩小最佳证据与护理及医疗实践之间的差距。我们开展了一项探索性混合方法研究，以确定与安大略省注册护士协会（RNAO）的两项最佳实践指南在最佳实践聚焦组织（BPSOs）中的实施和可持续性相关的策略、流程和指标。
我们的研究有四个阶段。在第一阶段，我们对两项定性研究进行了三角互证：a）对126份叙述性报告进行二次分析，这些报告详细说明了来自四个部门的21个BPSO的实施进展，以确定用于支持BPGs实施和可持续性的策略和流程；b）对25名指南实施者进行访谈，以确定其他策略和流程。在第二阶段，我们评估了从叙述性报告中确定的策略和流程与每个指南的一个流程指标和一个结果指标之间的相关性。在第三阶段，由一个专家小组根据第一阶段和第二阶段的结果进行指标开发。在第四阶段，RNAO工作人员在内部对指标进行评估，安大略省卫生团队在外部进行评估。通过一项调查来验证拟议的指标，以确定其与知识使用者和BPSO领导者的相关性、可行性、可读性和可用性。
两项定性研究的三角互证揭示了46条BPGs实施和可持续性的编码，分为八个总体主题：利益相关者参与、实践干预、能力建设、循证文化、领导力、评估与监测、沟通和治理。共制定了28个结构、流程或结果指标。根据验证调查，最终用户和BPSO领导者对这些指标表示认可。
许多流程和策略可以影响BPGs在BPSOs中的实施和可持续性。我们已经制定了一些指标，这些指标可以帮助BPSOs促进基于证据的BPGs实践实施。
