目的:调查护士在实施临床实践指南中的工作动态。
方法:混合:用于确定临床指南实施的定性研究的系统评价技术;理论主导和文本数据的结构化分析。
方法:CINAHL,CSAIllumina,EMBASE,MEDLINE,PsycINFO,和社会学文摘。
方法:对临床实践指南实施的定性研究进行系统评价,使用定向内容分析进行分析,并根据归一化过程理论进行解释。
结果:7项研究符合本综述的纳入标准。这些表明,临床实践指南在以下情况下倾向于正常化:(a)它们与从业者可以在实践中可行的活动相关联,和从业者能够将其集成到他们的集体工作流程中。(b)当其支持者将其与现有临床实践区分开来时,以及当差异化主张被其潜在用户视为合法时。(c)当他们与新兴的实践社区有联系时,以及当该实践社区的成员相互注册到指定其参与的小组流程时。(d)当它们与用户集体知识的改进有关时,当用户能够将这些知识的应用集成到他们个人的工作流程中时。And,(e)当护士可以最大程度地减少对行为规范和商定的专业角色的干扰时,并以跨越专业界限建立共同承诺的方式调动结构和认知资源。
结论:本综述证明了以理论为主导的护理实践研究综述的可行性和益处。并提出了实施的动态模型。规范化过程理论支持护理工作的分析。它表征了使工作连贯和有意义的机制,是围绕一系列关系承诺形成的,被颁布和语境化,并进行了评估和重新配置。它从护理知识和实践本身的框架内促进了这种分析。
OBJECTIVE: To investigate the dynamics of nurses\' work in implementing Clinical Practice
Guidelines.
METHODS: Hybrid: systematic review techniques used to identify qualitative studies of clinical
guideline implementation; theory-led and structured analysis of textual data.
METHODS: CINAHL, CSA Illumina, EMBASE, MEDLINE, PsycINFO, and Sociological Abstracts.
METHODS: Systematic review of qualitative studies of the implementation of Clinical Practice
Guidelines, analysed using Directed Content Analysis, and interpreted in the light of Normalisation Process Theory.
RESULTS: Seven studies met the inclusion criteria of the review. These revealed that clinical practice
guidelines are disposed to normalisation when: (a) They are associated with activities that practitioners can make workable in practice, and practitioners are able to integrate it into their collective workflow. (b) When they are differentiated from existing clinical practice by its proponents, and when claims of differentiation are regarded as legitimate by their potential users. (c) When they are associated with an emergent community of practice, and when members of that community of practice enrol each other into group processes that specify their engagement with it. (d) When they are associated with improvements in the collective knowledge of its users, and when users are able to integrate the application of that knowledge into their individual workflow. And, (e) when nurses can minimise disruption to behaviour norms and agreed professional roles, and mobilise structural and cognitive resources in ways that build shared commitments across professional boundaries.
CONCLUSIONS: This review demonstrates the feasibility and benefits of theory-led review of studies of nursing practice, and proposes a dynamic model of implementation. Normalisation Process Theory supports the analysis of nursing work. It characterises mechanisms by which work is made coherent and meaningful, is formed around sets of relational commitments, is enacted and contextualised, and is appraised and reconfigured. It facilitates such analysis from within the frame of nursing knowledge and practice itself.