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Factors and conditions that influence the implementation of standardized nursing care plans
Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
Faculty of Health and Society, Malmö University.
Gothenburg University,The Sahlgrenska Academy, Institute of Health and Care Sciences.
Gothenburg University,The Sahlgrenska Academy, Institute of Health and Care Sciences, and Department of Surgery, Sahlgrenska University Hospital.
2010 (English)In: Open Nursing Journal, ISSN 1874-4346, Vol. 4, 25-34 p.Article in journal (Refereed) Published
Abstract [en]

Rationale and aim: There is a lack of evidence about how to successfully implement standardized nursing care plans (SNCP) in various settings. 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 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 of Sweden 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 factors that had motivated the nurses to implement SNCPs were that they were easy to understand and follow as well as corresponding to organisational norms. The SNCPs were normally based on clinical experience, although research more frequently formed the basis of the SNCPs at the university hospital. Internal facilitators acted as important educators, who provided reminders to use the SNCP and feedback to the SNCP users. The patient experience was not considered valuable. Those who claimed that the implementation was successful were generally more positive in all measurable aspects. The use of SNCPs was rarely evaluated.

Conclusions: Clinical experience was considered important by the nurses, while they attributed little value to the patient experiences. Successful implementation of research based SNCPs requires internal facilitators with knowledge of evidence-based nursing.

Place, publisher, year, edition, pages
Hilversum: Bentham Science Publishers , 2010. Vol. 4, 25-34 p.
Keyword [en]
Implementation, standardized nursing care plans, PARIHS, questionnaire
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hh:diva-5611DOI: 10.2174/1874434601004010025PubMedID: 21283733OAI: oai:DiVA.org:hh-5611DiVA: diva2:349513
Available from: 2010-09-07 Created: 2010-09-07 Last updated: 2014-03-26Bibliographically 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. 67 p.
Keyword
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: 2012-11-06Bibliographically approved

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Citation style
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