Supporting the Uptake of Nursing Guidelines: What You Really Need to Know to Move Nursing Guidelines into Practice
Dr. Ploeg is a ministry of Health and Long-Term Care Nursing Mid-Career Research Award recipient. Dr. Jack holds a New Investigator Personnel Award from the Canadian Institutes of Health—Research. Dr. Matthew-Maich was awarded a Registered Nurses Association of Ontario Best Practice Guideline Doctoral Fellowship funded by the Ontario (Canada) Ministry of Health and Long Term Care, which funded the study.
Address correspondence to Dr. Nancy Matthew-Maich, School of Nursing, Faculty of Health Sciences, Mohawk College, McMaster-Mohawk Institute for Applied Health Sciences, Room 350, 1400 Main Street West, Hamilton, Ontario, Canada L8S 1C7; firstname.lastname@example.org
There is a current push to use best practice guidelines (BPGs) in health care to enhance client care and outcomes. Even though intensive resources have been invested internationally to develop BPGs, a gap in knowledge exists about how to consistently and efficiently move them into practice.
Constructivist grounded theory was used to explore the complex processes of a breastfeeding BPG implementation and uptake in three acute care hospitals. Interviews (n = 120) with 112 participants representing clients, nurses, lactation consultants, midwives, physicians, managers, administrators, and nurse educators as well as document and field note analysis informed this study. Data were analyzed using constant comparison and coding steps outlined by Charmaz: initial coding, selective (focused) coding, then theoretical coding. Triangulation of data types and sources were used as well as theoretical sampling. Data were collected from 2009 to 2010.
Two sites showed BPG uptake while one did not. Factors present in the uptake sites included, ongoing passionate frontline leaders, the use of multifaceted strategies, and processes that occurred at organizational, leadership, individual and social levels. Particularly noteworthy was the transformation of individual nurses to believing in and using the BPG. Impacts occurred at client, nurse, unit, inter-professional, organizational and system levels.
A conceptual framework: Supporting the Uptake of Nursing Guidelines, was developed that reveals essential processes used to facilitate BPG uptake into nursing practice and a process of nurse transformation to believing in and using the BPG.