Tailored implementation with the guideline 'Education CVA patients and caregivers', an effect study.

Abstract

Title: Tailored implementation with the guideline ´Education CVA patients and caregivers´, an effect study. Background: Implementation of nursing innovations is often not achieved, which can lead to suboptimal care for many patients. Tailored implementation strategies seem to be promising for the implementation effectiveness, however empirical studies are missing. Aims and Research Question: This study was accomplished, to obtain insight into tailoring and how to implement nursing innovations into clinical practice. An effective implementation strategy will lead to more nursing compliance to evidence based guidelines, thereby providing optimal care to patients. The research question was: What is the effect of a tailored implementation strategy with the guideline ´Education CVA patients and caregivers´ on the Neurology ward on (I) organizational characteristics, (II) team learning and (III) nurses’ attitude? Methods: A prospective quasi-experimental study with a one group pretest-posttest design was used. All Registered Nurses from a Neurology ward were included. Results: Organizational outcomes improved, however the change was not significant. One aspect of team learning, ‘storage and retrieval of production oriented information’, decreased significantly (p=0.001). For nurses’ attitude, a significant improvement was found for ‘complexity of the innovation’ (p = 0.061). No significant change was found on the remaining aspects of team learning and nurses’ attitude. Conclusion: This study shows that the tailored implementation strategy for the guideline education CVA patients and caregivers was partially successful. Recommendations: Further research should focus on patients’ outcomes as well as cost-effectiveness of tailored implementation strategies. Furthermore, a longer follow- up period and a time-series design or RCT are recommended to measure implementation effectiveness and reduce the risk of bias. To increase the understanding of effect mechanisms and practice behavior change, quantitative effect studies need to be accompanied by qualitative studies.