First-line managers' experience of guideline implementation in orthopaedic nursing and rehabilitation: a qualitative study.

BACKGROUND: First-line managers have a unique role and potential in encouraging the use of evidence-based clinical practice guidelines (CPGs) and thus serve the provision of safe patient care. In acute and planned hospital care, effective yet safeguarded nursing procedures are a necessity. Little is currently known about how first-line managers engage in supporting the adoption of evidence-based nursing care and about what barriers and enablers there are for implementation of CPGs in the orthopaedic care context. PURPOSE: To investigate first-line managers' experience of clinical practice guideline implementation in orthopaedic care. METHODS: This qualitative interview study included 30 first-line nursing and rehabilitation managers in 17 orthopaedic units in Sweden. A deductive content analysis, with the Ottawa Model of Implementation Leadership as a guide, was employed. RESULTS: To the first-line managers, any guideline implementation required them to balance contexts, including their outer context (signified by the upper-level management and decision-makers) and their inner context, including staff and patients in their unit(s). Acting in response to these contexts, the managers described navigating the organization and its terms and conditions; using relations-, change-, and task-oriented leadership, such as involving the staff; motivating the change by emphasizing the patient benefits; and procuring resources, such as time and training. Even though they knew from past experience what worked when implementing CPGs, the first-line managers often encountered barriers within the contexts that hampered successful implementation. CONCLUSIONS: Although first-line managers know how to effectively implement CPGs, an organization's terms and conditions can limit their opportunities to fully do so. Organizational awareness of what supports and hinders first-line managers to offer implementation leadership can enhance opportunities to alter behaviours and conditions for the benefit of CPG implementation. TRIAL REGISTRATION: The study was registered as NCT04700969 with the U.S. National Institutes of Health Clinical Trials Registry on 8 January 2021.

Adherence to evidence-based guidelines for prevention of urinary retention in hip surgery patients: a multicentre observational study.

Urinary retention is a healthcare complication putting patients at risk of unnecessary suffering and harm. Orthopaedic patients are known to face an increased such risk, calling for evidence-based preoperative assessment and corresponding measures to prevent bladder problems. The aim of this study was to evaluate healthcare professionals' adherence to risk assessment guidelines for urinary retention in hip surgery patients. This was an observational study from January 2021 to April 2021 with a descriptive and comparative design, triangulating three data sources: (I) Medical records for 1382 hip surgery patients across 17 hospitals in Sweden were reviewed for preoperative risk assessments for urinary retention and voiding-related variables at discharge; (II) The patients completed a survey regarding postoperative lower urinary tract symptoms, and; (III) data were extracted from a national quality registry regarding type of surgery, preoperative physical status, and perioperative urinary complications. Group differences were analysed with Chi-square/Fisher's exact test, t-test, Wilcoxon rank-sum test, or Mann-Whitney U-test. Logistic regression was used to analyse variables associated with completed risk assessments for urinary retention. Of all study participants, 23.4% (n = 323) had a preoperative documented risk assessment of urinary retention. Whether a risk assessment was performed was significantly associated with acute surgery [odds ratio (OR) 3.56, 95% confidence interval (CI) 2.48-5.12] and undergoing surgery at an academic hospital (OR 4.59, 95% CI 2.68-7.85). Acute patients were more often affected by urinary retention and had bladder issues and/or an indwelling catheter at discharge. More than every tenth patient (11. 9%, n = 53) completing the survey experienced intensified bladder problems after their hip surgery. The study shows a lack of adherence to risk assessment for urinary retention according to evidence-based guidelines, which negatively affects quality of care and patient safety.

First-line managers' experience of guideline implementation during the COVID-19 pandemic.

AIM(S): To explore first-line managers' experience of guideline implementation in orthopaedic care during the COVID-19 pandemic. DESIGN: A descriptive, qualitative study. METHODS: Semi-structured interviews with 30 first-line nursing and rehabilitation managers in orthopaedic healthcare at university, regional and local hospitals. The interviews were analysed by thematic analysis. RESULTS: First-line managers described the implementation of guidelines related to the pandemic as different from everyday knowledge translation, with a swifter uptake and time freed from routine meetings in order to support staff in adoption and adherence. The urgent need to address the crisis facilitated guideline implementation, even though there were specific pandemic-related barriers such as staffing and communication issues. An overarching theme, Hanging on to guidelines for dear life, is substantiated by three themes: Adapting to facilitate change, Anchoring safety through guidelines and Embracing COVID guidelines. CONCLUSION: A health crisis such as the COVID-19 pandemic can generate enabling elements for guideline implementation in healthcare, despite prevailing or new hindering components. The experience of guideline implementation during the COVID-19 pandemic can improve understanding of context aspects that can benefit organizations in everyday translation of evidence into practice. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Recognizing what enabled guideline implementation in a health crisis can help first-line managers to identify local enabling context elements and processes. This can facilitate future guideline implementation. IMPACT: During the COVID-19 pandemic, the healthcare context and staff's motivation for guideline recognition and adoption changed. Resources and ways to bridge barriers in guideline implementation emerged, although specific challenges arose. Nursing managers can draw on experiences from the COVID-19 pandemic to support implementation of new evidence-based practices in the future. REPORTING METHOD: This study adheres to the EQUATOR guidelines by using Standards for Reporting Qualitative Research (SRQR). No Patient or Public Contribution.

Patients' experiences of urinary retention and bladder care - A qualitative study in orthopaedic care.

BACKGROUND: Urinary retention is a common complication associated with hip surgery. There are easily available, evidence-based clinical practice guidelines prescribing how to prevent both urinary retention and other voiding issues, by means of bladder monitoring and risk assessments. A detected lack of adherence to such guidelines increases risks for unnecessary suffering among patients but a greater understanding of patients' experiences can benefit tailored interventions to address quality and safety gaps in orthopaedic nursing and rehabilitation. PURPOSE: The aim was to describe patients' experiences of urinary retention, bladder issues, and bladder care in orthopaedic care due to hip surgery. METHOD: This was a qualitative study with a descriptive design: content analysis with an inductive approach was applied to interviews (n = 32) and survey free-text responses (n = 122) across 17 orthopaedic units in Sweden. RESULTS: The patients had received no or limited details for the recurrent bladder care interventions (such as bladder scans and prompted voiding) while at the hospital. They relied on the staff for safe procedures but were left to themselves to manage and comprehend prevailing bladder issues. Despite the patients' experiences of bladder issues or the risk of urinary retention postoperatively, the link to hip surgery remained unknown to the patients, leaving them searching for self-management strategies and further care. CONCLUSIONS: Patients' perspectives on bladder care, urinary retention and bladder issues can serve as a means for increased understanding of procedures and issues, reinforcing improved implementation of guidelines, including person-centred information. Safer bladder procedures imply further patient engagement, highlighted in guidelines.

Struggling to be seen and understood as a person - Chronic back pain patients' experiences of encounters in health care: An interview study.

AIM: The aim of this study was to describe how patients with chronic back pain experience encounters with health care. Persons with chronic back pain are a stigmatized group often treated based on stereotypes, which may lead to misunderstandings and create frustrated patients and healthcare personnel. Few studies have examined the generic aspects of quality of care in this context. DESIGN: A descriptive design with a qualitative approach was used. METHODS: Nine individual interviews were conducted with chronic back pain patients after admission to an orthopaedic hospital ward. Data were analysed using content analysis. RESULTS: The patients' experiences of healthcare encounters can be described by the theme "Struggling to be seen and understood as a person," comprising the categories "Lack of access and trust to care," "A desire to be taken care of and listened to" and "Own strength to handle healthcare situations."