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Nursing Implementation Science: How Evidence-Based Nursing Requires Evidence-Based Implementation

Authors

  • Theo Van Achterberg,

    1. Theo van Achterberg, RN, PhD, FEANS, Rho Chi, Professor of Nursing Science, IQ healthcare; Lisette Schoonhoven, RN, PhD, FEANS, Rho Chi, Associate Professor of Nursing Science, IQ healthcare; Richard Grol, PhD Professor of Quality of Care and Implementation Science, Director of IQ healthcare; all at Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. Correspondence to Dr. van Achterberg, IQ healthcare 114, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. E-mail: t.vanachterberg@iq.umcn.nl
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  • Lisette Schoonhoven,

    1. Theo van Achterberg, RN, PhD, FEANS, Rho Chi, Professor of Nursing Science, IQ healthcare; Lisette Schoonhoven, RN, PhD, FEANS, Rho Chi, Associate Professor of Nursing Science, IQ healthcare; Richard Grol, PhD Professor of Quality of Care and Implementation Science, Director of IQ healthcare; all at Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. Correspondence to Dr. van Achterberg, IQ healthcare 114, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. E-mail: t.vanachterberg@iq.umcn.nl
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  • Richard Grol

    1. Theo van Achterberg, RN, PhD, FEANS, Rho Chi, Professor of Nursing Science, IQ healthcare; Lisette Schoonhoven, RN, PhD, FEANS, Rho Chi, Associate Professor of Nursing Science, IQ healthcare; Richard Grol, PhD Professor of Quality of Care and Implementation Science, Director of IQ healthcare; all at Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. Correspondence to Dr. van Achterberg, IQ healthcare 114, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. E-mail: t.vanachterberg@iq.umcn.nl
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Abstract

Purpose: Evidence is not always used in practice, and many examples of problematic implementation of research into practice exist. The aim of this paper is to provide an introduction and overview of current developments in implementation science and to apply these to nursing.

Methods: We discuss a framework for implementation, describe common implementation determinants, and provide a rationale for choosing implementation strategies using the available evidence from nursing research and general health services research.

Findings: Common determinants for implementation relate to knowledge, cognitions, attitudes, routines, social influence, organization, and resources. Determinants are often specific for innovation, context, and target groups. Strategies focused on individual professionals and voluntary approaches currently dominate implementation research. Strategies such as reminders, decision support, use of information and communication technology (ICT), rewards, and combined strategies are often effective in encouraging implementation of evidence and innovations. Linking determinants to theory-based strategies, however, can facilitate optimal implementation plans.

Conclusions: An analytical, deliberate process of clarifying implementation determinants and choosing strategies is needed to improve situations where suboptimal care exists. Use of theory and evidence from implementation science can facilitate evidence-based implementation. More research, especially in the area of nursing, is needed. This research should be focused on the effectiveness of innovative strategies directed to patients, individual professionals, teams, healthcare organizations, and finances.

Clinical Relevance: Implementation of evidence-based interventions is crucial to professional nursing and the quality and safety of patient care.

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