Lyng Hilda Bø, Strømme Torunn, Ree Eline, Johannessen Terese, Wiig Siri
SHARE-Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
Department of Health and Nursing Sciences, Faculty of Health and Sports Science, University of Agder, Kristiansand, Norway.
Front Health Serv. 2024 Jun 11;4:1294299. doi: 10.3389/frhs.2024.1294299. eCollection 2024.
Implementation and adoption of quality improvement interventions have proved difficult, even in situations where all participants recognise the relevance and benefits of the intervention. One way to describe difficulties in implementing new quality improvement interventions is to explore different types of knowledge boundaries, more specifically the syntactic, semantic and pragmatic boundaries, influencing the implementation process. As such, this study aims to identify and understand knowledge boundaries for implementation processes in nursing homes and homecare services.
An exploratory qualitative methodology was used for this study. The empirical data, including individual interviews ( = 10) and focus group interviews ( = 10) with leaders and development nurses, stem from an externally driven leadership intervention and a supplementary tracer project entailing an internally driven intervention. Both implementations took place in Norwegian nursing homes and homecare services. The empirical data was inductively analysed in accordance with grounded theory.
The findings showed that the syntactic boundary included boundaries like the lack of meeting arenas, and lack of knowledge transfer and continuity in learning. Furthermore, the syntactic boundary was mostly related to the dissemination and training of staff across the organisation. The semantic boundary consisted of boundaries such as ambiguity, lack of perceived impact for practice and lack of appropriate knowledge. This boundary mostly related to uncertainty of the facilitator role. The pragmatic boundary included boundaries related to a lack of ownership, resistance, feeling unsecure, workload, different perspectives and a lack of support and focus, reflecting a change of practices.
This study provides potential solutions for traversing different knowledge boundaries and a framework for understanding knowledge boundaries related to the implementation of quality interventions.
事实证明，即使在所有参与者都认识到质量改进干预措施的相关性和益处的情况下，实施和采用这些措施也很困难。描述实施新的质量改进干预措施时所遇到困难的一种方法是探索不同类型的知识边界，更具体地说是句法、语义和语用边界，这些边界会影响实施过程。因此，本研究旨在识别和理解养老院及家庭护理服务中实施过程的知识边界。
本研究采用探索性定性方法。实证数据包括对领导人和发展护士进行的个人访谈（10次）和焦点小组访谈（10次），这些数据来自一项外部驱动的领导力干预以及一个涉及内部驱动干预的补充追踪项目。这两项实施均在挪威的养老院和家庭护理服务机构中进行。根据扎根理论对实证数据进行归纳分析。
研究结果表明，句法边界包括诸如缺乏会议场所、缺乏知识转移以及学习缺乏连续性等边界。此外，句法边界大多与整个组织内员工的传播和培训有关。语义边界包括诸如模糊性、对实践缺乏感知到的影响以及缺乏适当知识等边界。这个边界大多与促进者角色的不确定性有关。语用边界包括与缺乏主人翁意识、抵触情绪、不安全感、工作量、不同观点以及缺乏支持和重点相关的边界，反映了实践的变化。
本研究为跨越不同知识边界提供了潜在解决方案，以及一个用于理解与质量干预实施相关的知识边界的框架。
