Summary: The aim of this study was to use the “Promotion Action on Research Implementation in Health Services framework” (PARIHS) to explore important factors and conditions at hospital wards that had implemented Standardized Nursing Care Plans (SNCPs). Outcome was measured by means of a questionnaire based on the PARIHS-model.
Rationale: There is a lack of evidence about how to successfully implement standardized nursing care plans (SNCP), in various settings. SNCP is described as a printed general action plan that outlines the nursing care. The plan includes nursing diagnosis, goal and planned interventions. Implementing SNCP as an everyday and clinically useful tool in a hospital ward might, as with all kinds of implementation, be problematic. Important factors and prerequisites for the use of research results as well as changes in practical working methods in clinical practice can be described on the basis of the Promoting Action on Research Implementation in Health Services (PARIHS) theoretical framework. According to PARIHS, successful change is based on the interaction between evidence, context and facilitation.
Aim: The aim of this study was to use the PARIHS framework to explore important factors and conditions at hospital wards that had implemented SNCPs.
Method. We employed a retrospective, cross-sectional design and recruited nurses from four units at a rural hospital and seven units at a university hospital in the western and southern region ofSweden where SNCPs had been implemented. Outcome was measured by means of a questionnaire based on the PARIHS-model.
Result: In total, 137 nurses participated in the study. The main results of this study were that the basis of SNCPs mainly involved clinical experience and research, while patient experience was rarely included. Research was more frequently mentioned by the respondents from the university hospital. The strengths of SNCPs were that they were easy to understand and follow as well as being based on the relevant clinical standards and experience. The most common implementation strategies were: reminders to apply the new method after implementation and an internal facilitator. Only 21 % of the respondents stated that the SNCP had been evaluated. The most common form of evaluation was based on the clinical experience of the staff as well as on patient records, which were employed to a greater degree in the rural hospital. The value of clinical experience was discussed more frequently than the value of patient experience.
Conclusions: Our study demonstrates that in order for SNCPs to be implemented in clinical practice, they need to be easy for the nurses to assimilate, thus enabling their use as a tool in clinical practice. Successful implementation of research based SNCPs requires internal facilitators with knowledge of evidence-based nursing. It takes time and knowledge to develop an SNCP. Therefore such work should be prioritised and co-ordinated to avoid every hospital or unit carrying out duplicate work.
More research is required to explore the reason why patient experience is not considered and how this situation can be improved. We also require more knowledge about why research appears to be of no interest to practising clinical nurses, as well as how their attitude can be changed.
Dublin: ACENDIO , 2011. 40-46 p.