Duan Yinfei, Wang Jing, Lanham Holly J, Berta Whitney, Chamberlain Stephanie A, Hoben Matthias, Choroschun Katharina, Iaconi Alba, Song Yuting, Perez Janelle Santos, Shrestha Shovana, Beeber Anna, Anderson Ruth A, Hayduk Leslie, Cummings Greta G, Norton Peter G, Estabrooks Carole A
Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada.
Nursing Department, College of Health and Human Services, University of New Hampshire, Durham, NH, USA.
Implement Sci Commun. 2024 Jun 7;5(1):63. doi: 10.1186/s43058-024-00600-0.
Context (work environment) plays a crucial role in implementing evidence-based best practices within health care settings. Context is multi-faceted and its complex relationship with best practice use by care aides in long-term care (LTC) homes are understudied. This study used an innovative approach to investigate how context elements interrelate and influence best practice use by LTC care aides.
In this secondary analysis study, we combined coincidence analysis (a configurational comparative method) and qualitative analysis to examine data collected through the Translating Research in Elder Care (TREC) program. Coincidence analysis of clinical microsystem (care unit)-level data aggregated from a survey of 1,506 care aides across 36 Canadian LTC homes identified configurations (paths) of context elements linked consistently to care aides' best practices use, measured with a scale of conceptual research use (CRU). Qualitative analysis of ethnographic case study data from 3 LTC homes (co-occurring with the survey) further informed interpretation of the configurations.
Three paths led to very high CRU at the care unit level: very high leadership; frequent use of educational materials; or a combination of very high social capital (teamwork) and frequent communication between care aides and clinical educators or specialists. Conversely, 2 paths led to very low CRU, consisting of 3 context elements related to unfavorable conditions in relationships, resources, and formal learning opportunities. Our qualitative analysis provided insights into how specific context elements served as facilitators or barriers for best practices. This qualitative exploration was especially helpful in understanding 2 of the paths, illustrating the pivotal role of leadership and the function of teamwork in mitigating the negative impact of time constraints.
Our study deepens understanding of the complex interrelationships between context elements and their impact on the implementation of best practices in LTC homes. The findings underscore that there is no singular, universal bundle of context-related elements that enhance or hinder best practice use in LTC homes.
环境（工作环境）在医疗保健机构中实施循证最佳实践方面起着至关重要的作用。环境具有多面性，而其与长期护理（LTC）机构中护理助手使用最佳实践之间的复杂关系尚未得到充分研究。本研究采用创新方法来探究环境因素如何相互关联并影响LTC护理助手对最佳实践的使用。
在这项二次分析研究中，我们将一致性分析（一种构型比较方法）和定性分析相结合，以检查通过老年护理研究转化（TREC）项目收集的数据。对来自加拿大36所LTC机构的1506名护理助手的调查汇总的临床微观系统（护理单元）层面的数据进行一致性分析，确定了与护理助手最佳实践使用始终相关的环境因素构型（路径），使用概念性研究应用（CRU）量表进行测量。对来自3所LTC机构（与调查同时进行）的人种学案例研究数据进行定性分析，进一步为构型的解释提供了信息。
三条路径在护理单元层面导致了非常高的CRU：非常高的领导力；频繁使用教育材料；或非常高的社会资本（团队合作）以及护理助手与临床教育工作者或专家之间频繁沟通的组合。相反，两条路径导致了非常低的CRU，由与关系、资源和正式学习机会中的不利条件相关的3个环境因素组成。我们的定性分析提供了关于特定环境因素如何作为最佳实践的促进因素或障碍的见解。这种定性探索在理解其中两条路径方面特别有帮助，说明了领导力的关键作用以及团队合作在减轻时间限制负面影响方面的作用。
我们的研究加深了对环境因素之间复杂相互关系及其对LTC机构中最佳实践实施影响的理解。研究结果强调，不存在单一的、普遍的与环境相关的因素组合会增强或阻碍LTC机构中最佳实践的使用。
