No tension, no change? - Use and influencing factors of a Dutch nursing guideline on Activities of Daily Living (ADL) – a pilot implementation study

Abstract

Abstract Background Care for activities of daily living (ADL) performed by nursing professionals is poorly informed by scientific evidence. To address the nursing professionals’ need for guidance, we developed a clinical practice guideline on ADL care. This guideline comprises key recommendations (KRs) on involving care receivers and informal caregivers in ADL care, identifying ADL care needs, and effective ADL interventions. With the actual guideline use depending on different factors, insight into these influencing factors is necessary prior to the actual implementation. In a pilot implementation, we aimed to measure the use of KRs in various relevant care settings and to identify and explore these influencing factors. Methods In a pilot implementation study, mixed methods were applied where (1) nursing professionals weekly and retrospectively registered the frequency of the used key recommendations in a three-week period; (2) a survey was used to identify impeding and facilitating factors; and (3) focus groups were conducted to explore additional factors and how they influence KR use. Descriptive analysis was performed on registration and survey data, while focus group data was analyzed deductively. Results Seven nursing care teams participated from the hospital (n = 1), rehabilitation (n = 2), home-care (n = 1), and long-term care (n = 3). The use of KRs varied between KRs and across care settings, with the most frequently used KRs being on involving care receivers in ADL related care choices. KRs were least applied to assessing ADL functioning. The survey on factors influencing the implementation showed how the majority of factors across domains and care settings were generally perceived as facilitating, including the inner setting, the innovation itself, and individuals. Impeding factors mainly related to low tension for change and limited personal benefits. Additional constructs addressed in six focus group sessions included innovation characteristics (e.g. procedural clarity) and cooperation with care receivers. Conclusions The KRs generally appear implementable across care settings, with limited factors hindering the KR use. Despite the impression that the KRs are generally perceived as highly compatible with current norms and workflows, low tension for change raises questions on the awareness of current opportunities for improvement in ADL nursing care.