Article type
Year
Abstract
Background: BPG s are touted as one of the most promising and effective tools for improving the quality of heath care. Despite the large number of BPG s produced, there has been little evaluation of impact, particularly long-term. It is not known which strategies are the most effective for guideline implementation. The purpose of this study is to understand the process and policies required for successfully sustaining evidence-based changes in practice.
Methods: A panel study design is being used to evaluate sustainability since these guidelines were developed and implemented in three consecutive cohorts or cycles. Topics include both humanistic (e.g. client centered care, supporting families, therapeutic relationships) and management aspects (e.g. asthma, smoking cessation, pressure ulcers). Sustained use is assessed using criteria developed by an international expert panel. An institutional ethnographic approach is being used to describe sustained use and expanded use. Data collection methods include semi-structured interviews of administrators and nurses, document review (policy, clinical protocols, and patient education materials) and site visits. Organizational processes in place to track patient indicators are identified. Organizations include acute, long-term, community and home-based nursing care. Cluster debriefing sessions and co-investigator meetings with active participation by our partner the Registered Nurses Association of Ontario (RNAO) are used to identify patterns and trends. Co-investigators are from two universities and the Office of Nursing Policy,
Health Canada.
Results: To date, participation has been good with 29/33 (88%) organizations, 40/45 (88%) administrators or advanced practice nurses and 25/28 (89%) staff
nurses volunteering for the study. Site visits have been conducted for six BPG topics with one refusal. Site visits are scheduled after the majority of interviews are conducted and the organization has sent policy documents about the specific BPG topic. The site visit teams include researchers and guideline developers. Triangulation of data from multiple sources is valuable to explain different patterns of research use. In some facilities, either sustained use or no use of the BPG recommendations in current practice is found 24 months after the initiation. However, in many institutions, partial sustainability is observed. For example, BPG guidelines may be embedded in practice on one unit within an organization but not on other units. Expanded use of the BPG recommendations on additional units, by other disciplines and with other referral or community agencies has occurred.
Conclusion: This project has developed methodology to determine factors influencing sustained use of research evidence in a multi-site study. Multiple methods of data collection and triangulation are essential for understanding the process of successful strategies for research utilzation. This study shows that active partnership between researchers and guideline developers facilitates an increased understanding of the research utilization process and provides useful information for future guideline development and knowledge transfer.
Methods: A panel study design is being used to evaluate sustainability since these guidelines were developed and implemented in three consecutive cohorts or cycles. Topics include both humanistic (e.g. client centered care, supporting families, therapeutic relationships) and management aspects (e.g. asthma, smoking cessation, pressure ulcers). Sustained use is assessed using criteria developed by an international expert panel. An institutional ethnographic approach is being used to describe sustained use and expanded use. Data collection methods include semi-structured interviews of administrators and nurses, document review (policy, clinical protocols, and patient education materials) and site visits. Organizational processes in place to track patient indicators are identified. Organizations include acute, long-term, community and home-based nursing care. Cluster debriefing sessions and co-investigator meetings with active participation by our partner the Registered Nurses Association of Ontario (RNAO) are used to identify patterns and trends. Co-investigators are from two universities and the Office of Nursing Policy,
Health Canada.
Results: To date, participation has been good with 29/33 (88%) organizations, 40/45 (88%) administrators or advanced practice nurses and 25/28 (89%) staff
nurses volunteering for the study. Site visits have been conducted for six BPG topics with one refusal. Site visits are scheduled after the majority of interviews are conducted and the organization has sent policy documents about the specific BPG topic. The site visit teams include researchers and guideline developers. Triangulation of data from multiple sources is valuable to explain different patterns of research use. In some facilities, either sustained use or no use of the BPG recommendations in current practice is found 24 months after the initiation. However, in many institutions, partial sustainability is observed. For example, BPG guidelines may be embedded in practice on one unit within an organization but not on other units. Expanded use of the BPG recommendations on additional units, by other disciplines and with other referral or community agencies has occurred.
Conclusion: This project has developed methodology to determine factors influencing sustained use of research evidence in a multi-site study. Multiple methods of data collection and triangulation are essential for understanding the process of successful strategies for research utilzation. This study shows that active partnership between researchers and guideline developers facilitates an increased understanding of the research utilization process and provides useful information for future guideline development and knowledge transfer.