%0 Journal Article
%T First-line managers' experience of guideline implementation in orthopaedic nursing and rehabilitation: a qualitative study.
%A Fjordkvist E
%A Hälleberg Nyman M
%A Winberg M
%A Joelsson-Alm E
%A Eldh AC
%J BMC Health Serv Res
%V 24
%N 1
%D 2024 Jul 31
%M 39085940
%F 2.908
%R 10.1186/s12913-024-11353-w
%X <B>BACKGROUND: </B>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.<BR><B>OBJECTIVE: </B>To investigate first-line managers' experience of clinical practice guideline implementation in orthopaedic care.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>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.<BR><B>BACKGROUND: </B>The study was registered as NCT04700969 with the U.S. National Institutes of Health Clinical Trials Registry on 8 January 2021.