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Nurses’ experiences of guideline implementation: a focus group study

Authors

  • Seija Alanen,

    1. Authors: Seija Alanen, MNSc, Head Nurse, Tampere University Hospital, Pirkanmaa Hospital District, Tampere, Finland; Maritta Välimäki, PhD, Professor, Senior Nursing Officer, Department of Nursing Science, University of Turku and The Hospital District of Southwest Finland, Turku, Finland; Minna Kaila, MD, PhD, Senior Medical Officer, Finnish Office for Health Technology Assessment at STAKES Tampere Satellite Office, Tampere and Department of Paediatrics, Tampere University Hospital, Tampere, Finland
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  • Maritta Välimäki,

    1. Authors: Seija Alanen, MNSc, Head Nurse, Tampere University Hospital, Pirkanmaa Hospital District, Tampere, Finland; Maritta Välimäki, PhD, Professor, Senior Nursing Officer, Department of Nursing Science, University of Turku and The Hospital District of Southwest Finland, Turku, Finland; Minna Kaila, MD, PhD, Senior Medical Officer, Finnish Office for Health Technology Assessment at STAKES Tampere Satellite Office, Tampere and Department of Paediatrics, Tampere University Hospital, Tampere, Finland
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  • Minna Kaila,

    1. Authors: Seija Alanen, MNSc, Head Nurse, Tampere University Hospital, Pirkanmaa Hospital District, Tampere, Finland; Maritta Välimäki, PhD, Professor, Senior Nursing Officer, Department of Nursing Science, University of Turku and The Hospital District of Southwest Finland, Turku, Finland; Minna Kaila, MD, PhD, Senior Medical Officer, Finnish Office for Health Technology Assessment at STAKES Tampere Satellite Office, Tampere and Department of Paediatrics, Tampere University Hospital, Tampere, Finland
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  • for the ECCE Study Group

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    • *

      ECCE Study Group: Maaret Castren, Jarja Ijäs, Riitta Johannala-Kemppainen, Pekka Jousilahti, Matti Klockars, Marjukka Mäkelä, Taina Mäntyranta, Marita Poskiparta, Risto P Roine, Ilkka Tikkanen, Timo Tolska, Juha-Pekka Turunen and Liisa-Maria Voipio-Pulkki.


Seija Alanen, Head Nurse, Tampere University Hospital, Pirkanmaa Hospital District, PL 2000, 33521 Tampere, Finland. Telephone: +358-3-311 63334.
E-mail: seija.alanen@pshp.fi

Abstract

Aims.  The aim of the study was to address the following questions: What kind of experiences do primary care nurses have of guideline implementation? What do nurses think are the most important factors affecting the adoption of guidelines?

Background.  The implementation of clinical guidelines seems to be dependent on multiple context-specific factors. This study sets out to explore the experiences of primary care nurses concerning guideline implementation.

Design.  Qualitative interview.

Methods.  Data were generated by four focus group interviews involving nurses working in out-patient services in primary health centres in Finland. Purposive sampling was used to select health centres. Inductive content analysis was used to identify themes emerging from the data.

Results.  Four main groups of factors were identified from the analysis of data: (i) factors related to the organisation, (ii) factors related to nurses, (iii) factors related to the anticipated consequences and (iv) factors related to the patient group. Nurses’ awareness and acceptance of guidelines and the anticipated positive consequences facilitate the implementation of guidelines. Organisational support, especially the adapting of guidelines to local circumstances, seems to be crucial for successful implementation.

Conclusions.  Clinical guidelines can be promising tools in enhancing evidence-based nursing practice, as nurses see them as practical work tools in patient care and so are willing to adopt them. However, support from management and physicians is needed to ensure the successful implementation of guidelines into nursing practices.

Relevance to clinical practice.  Based on the findings of this study and previous knowledge of guideline implementation some practical recommendations are suggested. Select the most relevant guidelines to clinical practice, organise the adaptation of guidelines to local circumstances, inform all practitioners involved in treatment and give clear instructions for the adoption of the guidelines.

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