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Factors and Conditions That Have an Impact in Relation to the Successful Implementation and Maintenance of Individual Care Plans
Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
Göteborgs universitet, Sahlgrenska akademin.
Göteborgs universitet, Sahlgrenska akademin.
2011 (English)In: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 8, no 2, p. 66-75Article in journal (Refereed) Published
Abstract [en]

Background: The gap between what is stated in legislation about written individualized nursing care plans (ICP) and how they are used in practice is still too wide. Aim: To explore attitudes and experiences among nurses and managers in order to capture which factors and conditions impact on the successful implementation of individual care plans within hospital care, as well as the strategies that were adopted to ensure continued use. Method: The study was carried out through directed content analysis guided by the Promoting Action on Research Implementation in Health Services framework. Interviews were conducted with 15 informants on different operational and decision levels at a hospital that is well known in Sweden for its work in the ICP area. Findings: Important factors for implementation on the wards were clear instructions from the hospital management at the start of implementation as well as clear roles and mandates for those involved. The work of internal facilitators was crucial for the continuation of the process. Clinical experience was important as the long-term driving force. Implications: On the basis of the findings of this study, we argue that it is important for hospital managers to recruit leaders that focus on individual nursing care and can highlight needs and instigate change. It seems also important that the organization takes advantage of the potential of skilled facilitators.

Place, publisher, year, edition, pages
Oxford: Blackwell Publishing, 2011. Vol. 8, no 2, p. 66-75
Keywords [en]
Individual care plans, Implementation, In-patient, Interview, PARIHS framework
National Category
Nursing
Identifiers
URN: urn:nbn:se:hh:diva-5610DOI: 10.1111/j.1741-6787.2010.00195.xISI: 000292292200003PubMedID: 20604910Scopus ID: 2-s2.0-79958774083OAI: oai:DiVA.org:hh-5610DiVA, id: diva2:349504
Available from: 2010-09-07 Created: 2010-09-07 Last updated: 2018-03-23Bibliographically approved
In thesis
1. Planerad processorienterad omvårdnad - nytta och implementering
Open this publication in new window or tab >>Planerad processorienterad omvårdnad - nytta och implementering
2010 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

To ensure the provision of good and safe nursing care in the ward, the nursing needs of each patient should be established and clearly documented in the form of care plans in his/her medical record. There is a lack of scientific evidence of the benefits of this method of working as well as why this part of the nursing process is not always successful. The main aim of this thesis was to describe the assessment and decision-making process pertaining to nursing needs performed by nurses, to evaluate the consequences of planned, process oriented nursing care and to identify the factors and conditions that have had an impact on the implementation of individual care plans (ICP) and standardized care plans (SCP).

 

In studies I and III, qualitative methods were used. In study I, data collection and analysis were carried out by means of Grounded theory. Study III was conducted by means of directed content analysis and guided by “The Promoting Action on Research Implementation in Health Services framework”. In studies II and IV, quantitative methods were employed.

 

The benefits of a planned, process oriented method of working involving documentation of care plans have been investigated from the perspective of both the patient and the nurse. Nurses who applied the process oriented method adopted a nursing perspective in the assessment of and decision making pertaining to the patient’s nursing needs, which was not the case with nurses who did not work in this way and who instead exhibited a more medical approach (I). Patients cared for in wards where care plans were documented reported being more involved and that the care was more tailored to their individual needs compared to those not cared for in this manner (II). Leadership that prioritises the development of nursing care is essential for the implementation and continued use of ICPs and SCPs. Another important factor was the presence of internal facilitators in the ward in the form of nurses with a clear mandate to work with these issues. The nurses reported that they did not discuss scientific evidence as a basis for performing planned process oriented nursing care and that they did not listen to patient experiences to any great extent (III, IV).

 

The conclusion is that structured, process oriented nursing care based on written care plans probably promotes the nursing perspective and enables patient participation. Leadership as well as facilitators with a clear role and mandate are important factors in the implementation of this method of working and scientific evidence is of less importance.

Place, publisher, year, edition, pages
Göteborg: Göteborgs Universitet, 2010. p. 67
Keywords
Nursing process, assessment, judgment, individual care plans, standardized care plans, implementation, PARIHS framework
National Category
Nursing
Identifiers
urn:nbn:se:hh:diva-5612 (URN)978-91-628-8043-9 (ISBN)
Public defence
2010-05-07, Göteborg, 13:00 (Swedish)
Supervisors
Available from: 2010-09-07 Created: 2010-09-07 Last updated: 2018-03-23Bibliographically approved

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