Describing a programme of implementation-effectiveness research on the organization and implementation of frontline nursing care delivery into diverse heath systems.

ABSTRACT

AIMS: The longitudinal programme of research described in this paper seeks to generate knowledge about factors influencing the implementation of a system-level intervention, the clinical nurse leader care model, involving nurses as leaders at the frontlines of care and the outcomes achievable with successful implementation. The research programme has the following aims, (a) to clarify clinical nurse leader practice, (b) develop and empirically validate a translational model of frontline care delivery that includes clinical nurse leader practice and (c) delineate the patterns of and critical outcomes of successful implementation of the clinical nurse leader care model. DESIGN: This programme of research follows a knowledge-building trajectory involving multiple study designs in both qualitative (grounded theory, case study) and quantitative (descriptive, correlational and quasi-experimental) traditions. METHODS: Multiple mixed methods within a system-based participatory framework were used to conduct this programme of implementation-effectiveness research. RESULTS: Findings are demonstrating how the clinical nurse leader care model, as a complex system-level intervention, can be implemented in diverse healthcare contexts to make a difference to patient care quality and safety. Findings also contribute to implementation science, helping to better understand the dynamic interdependencies between implementation, the interventions implemented and the contexts in which they are implemented. CONCLUSION: Findings translate into sets of evidence-informed implementation 'recipes' that health systems can match to their specific contexts and needs. This allows health systems to take on strategies that both maximize resource impact within their existing structures and support achieving intended outcomes. IMPLICATION This programme of research is producing actionable implementation and outcome evidence about ways to organize nursing knowledge and practice into care models that can be successfully adopted within real-world healthcare settings to achieve safer and higher quality patient care.