Fjordkvist Erika, Hälleberg Nyman Maria, Winberg Madeleine, Joelsson-Alm Eva, Eldh Ann Catrine
Faculty of Medicine and Health, School of Health Sciences, Örebro University, 701 82, Örebro, Sweden.
Department of Orthopaedics, Faculty of Medicine and Health, Örebro University, 701 82, Örebro, Sweden.
BMC Health Serv Res. 2024 Jul 31;24(1):871. doi: 10.1186/s12913-024-11353-w.
First-line managers have a unique role and potential in encouraging the use of evidence-based clinical practice guidelines (CPGs) and thus serve the provision of safe patient care. In acute and planned hospital care, effective yet safeguarded nursing procedures are a necessity. Little is currently known about how first-line managers engage in supporting the adoption of evidence-based nursing care and about what barriers and enablers there are for implementation of CPGs in the orthopaedic care context.
To investigate first-line managers' experience of clinical practice guideline implementation in orthopaedic care.
This qualitative interview study included 30 first-line nursing and rehabilitation managers in 17 orthopaedic units in Sweden. A deductive content analysis, with the Ottawa Model of Implementation Leadership as a guide, was employed.
To the first-line managers, any guideline implementation required them to balance contexts, including their outer context (signified by the upper-level management and decision-makers) and their inner context, including staff and patients in their unit(s). Acting in response to these contexts, the managers described navigating the organization and its terms and conditions; using relations-, change-, and task-oriented leadership, such as involving the staff; motivating the change by emphasizing the patient benefits; and procuring resources, such as time and training. Even though they knew from past experience what worked when implementing CPGs, the first-line managers often encountered barriers within the contexts that hampered successful implementation.
Although first-line managers know how to effectively implement CPGs, an organization's terms and conditions can limit their opportunities to fully do so. Organizational awareness of what supports and hinders first-line managers to offer implementation leadership can enhance opportunities to alter behaviours and conditions for the benefit of CPG implementation.
The study was registered as NCT04700969 with the U.S. National Institutes of Health Clinical Trials Registry on 8 January 2021.
一线管理人员在鼓励使用循证临床实践指南（CPG）方面具有独特作用和潜力，从而有助于提供安全的患者护理。在急性和计划性医院护理中，有效且有保障的护理程序是必要的。目前对于一线管理人员如何支持循证护理的采用，以及在骨科护理环境中实施CPG存在哪些障碍和促进因素知之甚少。
调查一线管理人员在骨科护理中实施临床实践指南的经验。
这项定性访谈研究包括瑞典17个骨科单元的30名一线护理和康复管理人员。采用以渥太华实施领导力模型为指导的演绎性内容分析。
对于一线管理人员而言，任何指南的实施都要求他们在各种环境之间取得平衡，包括外部环境（以上级管理层和决策者为代表）和内部环境，包括其所在科室的 staff 和患者。针对这些环境采取行动时，管理人员描述了在组织及其条款和条件中进行导航；运用关系导向、变革导向和任务导向的领导方式，例如让 staff 参与进来；通过强调患者受益来推动变革；以及获取资源，如时间和培训。尽管一线管理人员从过去的经验中知道在实施CPG时哪些方法有效，但他们在这些环境中经常遇到阻碍成功实施的障碍。
尽管一线管理人员知道如何有效实施CPG，但组织的条款和条件可能会限制他们充分这样做的机会。组织了解哪些因素支持和阻碍一线管理人员提供实施领导力，可以增加改变行为和条件以促进CPG实施的机会。
该研究于2021年1月8日在美国国立卫生研究院临床试验注册中心注册为NCT04700969。
