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Developing Leadership Capacity for Guideline Use: A Pilot Cluster Randomized Control Trial

Authors

  • Wendy A. Gifford RN, PhD,

    Corresponding author
    1. Associate Researcher, Saint Elizabeth, Markham, Ontario, Canada
    • Assistant Professor, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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  • Barbara L. Davies RN, PhD,

    1. Professor, School of Nursing, Faculty of Health Sciences, and Co-Director, Nursing Best Practice Research Unit, University of Ottawa, Ottawa, Ontario, Canada
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  • Ian D. Graham PhD,

    1. Vice-President, Knowledge Translation, Canadian Institutes of Health Research, Ottawa, Ontario, Canada
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  • Ann Tourangeau RN, PhD,

    1. Associate Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, and Nursing Senior Career Researcher, Ontario Ministry of Health & Long-term Care, Toronto, Ontario, Canada
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  • A. Kirsten Woodend RN, PhD,

    1. Dean, Trent-Fleming School of Nursing, Peterborough, Ontario, Canada; all at Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
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  • Nancy Lefebre RN, MScN, FCCHL

    1. Senior Vice President, Chief Clinical Executive, Saint Elizabeth, Markham, Ontario, Canada
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Address correspondence to Wendy A. Gifford, Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada; wgifford@uottawa.ca

ABSTRACT

Significance

The importance of leadership to influence nurses’ use of clinical guidelines has been well documented. However, little is known about how to develop and evaluate leadership interventions for guideline use.

Purpose

The purpose of this study was to pilot a leadership intervention designed to influence nurses’ use of guideline recommendations when caring for patients with diabetic foot ulcers in home care nursing. This paper reports on the feasibility of implementing the study protocol, the trial findings related to nursing process outcomes, and leadership behaviors.

Methods

A mixed methods pilot study was conducted with a post-only cluster randomized controlled trial and descriptive qualitative interviews.

Four units were randomized to control or experimental groups. Clinical and management leadership teams participated in a 12-week leadership intervention (workshop, teleconferences). Participants received summarized chart audit data, identified goals for change, and created a team leadership action.

Criteria to assess feasibility of the protocol included: design, intervention, measures, and data collection procedures. For the trial, chart audits compared differences in nursing process outcomes. Primary outcome: 8-item nursing assessments score. Secondary outcome: 5-item score of nursing care based on goals for change identified by intervention participants. Qualitative interviews described leadership behaviors that influenced guideline use.

Results

Conducting this pilot showed some aspects of the study protocol were feasible, while others require further development. Trial findings observed no significant difference in the primary outcome. A significant increase was observed in the 5-item score chosen by intervention participants (p = 0.02). In the experimental group more relations-oriented leadership behaviors, audit and feedback and reminders were described as leadership strategies.

Conclusions

Findings suggest that a leadership intervention has the potential to influence nurses’ use of guideline recommendations, but further work is required to refine the intervention and outcome measures. A taxonomy of leadership behaviors is proposed to inform future research.

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