University of Wollongong
Browse

Mechanisms which help explain implementation of evidence-based practice in residential aged care facilities: a grounded theory study

Download (358.84 kB)
journal contribution
posted on 2024-11-14, 20:18 authored by Malcolm MassoMalcolm Masso, Grace McCarthyGrace McCarthy, Alison Kitson
BACKGROUND: The context for the study was a nation-wide programme in Australia to implement evidence-based practice in residential aged care, in nine areas of practice, using a wide range of implementation strategies and involving 108 facilities. The study drew on the experiences of those involved in the programme to answer the question: what mechanisms influence the implementation of evidence-based practice in residential aged care and how do those mechanisms interact? METHODS: The methodology used grounded theory from a critical realist perspective, informed by a conceptual framework that differentiates between the context, process and content of change. People were purposively sampled and invited to participate in semi-structured interviews, resulting in 44 interviews involving 51 people during 2009 and 2010. Participants had direct experience of implementation in 87 facilities, across nine areas of practice, in diverse locations. Sampling continued until data saturation was reached. The quality of the research was assessed using four criteria for judging trustworthiness: credibility, transferability, dependability and confirmability. RESULTS: Data analysis resulted in the identification of four mechanisms that accounted for what took place and participants' experiences. The core category that provided the greatest understanding of the data was the mechanism On Common Ground, comprising several constructs that formed a 'common ground' for change to occur. The mechanism Learning by Connecting recognised the ability to connect new knowledge with existing practice and knowledge, and make connections between actions and outcomes. Reconciling Competing Priorities was an ongoing mechanism whereby new practices had to compete with an existing set of constantly shifting priorities. Strategies for reconciling priorities ranged from structured approaches such as care planning to more informal arrangements such as conversations during daily work. The mechanism Exercising Agency bridged the gap between agency and action. It was the human dimension of change, both individually and collectively, that made things happen. CONCLUSIONS: The findings are consistent with the findings of others, but fit together in a novel way and add to current knowledge about how to improve practices in residential aged care. Each of the four mechanisms is necessary but none are sufficient for implementation to occur.

History

Citation

M. Masso, G. McCarthy & A. Kitson, "Mechanisms which help explain implementation of evidence-based practice in residential aged care facilities: a grounded theory study", International Journal of Nursing Studies 51 7 (2014) 1014-1026.

Journal title

International Journal of Nursing Studies

Volume

51

Issue

7

Pagination

1014-1026

Language

English

RIS ID

88438

Usage metrics

    Categories

    Exports

    RefWorks
    BibTeX
    Ref. manager
    Endnote
    DataCite
    NLM
    DC