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Knowledge Utilisation in Swedish Neonatal Nursing: Studies on Guideline Implementation, Change Processes and Contextual Factors
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to study the implementation of guidelines, change processes and contextual variables from the perspective of improvements and neonatal nursing care’s endeavours to be more evidenced-based. Because health care is exposed to extensive change pressure and because the impact of effectiveness research on clinical practice is limited, it becomes urgent to understand how knowledge utilisation initiatives can be facilitated.

Three studies involved managers and nurses at all neonatal units in Sweden. Two of these studies also included nurses from other healthcare organisations. The fourth study included all staff at four neonatal units. The study designs used were cross-sectional, comparative and prospective longitudinal surveys; questionnaires were used as data collection tools in all four studies.

Evaluation of the utilisation of the neonatal nursing guidelines showed that the guidelines were known to the nurse managers and used at most of the units, though to varying degrees and in different ways. Fifteen months after guideline dissemination, 8 of 35 units had changed practice, of which 2 units had completed the implementation process of a guideline. Involvement in the preceding guideline project facilitated the completion of improvement projects compared with participation in training courses for quality improvement (QI) only. There was no difference between these two groups on long-standing involvement in improvement work. Nurses who continued QI work over a 4-year period were more active in seeking research and implementing research findings in clinical practice than those who ceased the improvement work. The QI-sustainable nurses reported better contextual support for research-related activities. In a separate study staff perceptions of organisational factors appeared stable over the course of one year at the aggregated level. Improvements in skills development and participatory management predicted higher overall organisational and staff well-being.

The findings emphasize the importance of including both individual and organisational factors in the strategic planning for evidence-based nursing. Plans have to be long-term and consider that change is a slow process. Leadership commitment is essential and there are clear benefits in developing a learning and professional supportive environment as well as of involving staff in organisational decision making.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2003. , p. 68
Series
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1272
Keywords [en]
Pediatrics, neonatal nursing, knowledge utilisation, quality improvement, change processes, clinical practice guidelines, evidence-based nursing, contextual factors, research utilisation
Keywords [sv]
Pediatrik
National Category
Pediatrics
Identifiers
URN: urn:nbn:se:uu:diva-3426ISBN: 91-554-5658-8 (print)OAI: oai:DiVA.org:uu-3426DiVA, id: diva2:162764
Public defence
2003-06-05, Grönvallsalen, ingång 70, Akademiska sjukhuset, Uppsala, 13:15
Opponent
Supervisors
Available from: 2003-05-08 Created: 2003-05-08Bibliographically approved

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CiteExportLink to record
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Citation style
  • apa
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  • Other style
More styles
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  • de-DE
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  • nn-NB
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  • Other locale
More languages
Output format
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