Implementation of evidence-based nursing care for hospital patients with community-acquired pneumonia

Sammanfattning: Insufficient nursing care is a major threat to a patient’s safety. Despite the development of evidence-based guidelines (EBGs) guiding the delivery of high-quality and effective nursing care, research presents an inadequate implementation of EBGs in clinical practice. Patients who appear to receive insufficient nursing care are older patients (≥65 years) with community-acquired pneumonia (CAP), a disease that is a significant cause of morbidity and in-hospital mortality. Optimised nursing care will benefit CAP patients’ safety and clinical practice.The overall aim of the thesis was to determine a tailored theory- and research-based strategy to implement EBGs for nursing care of older patients admitted with CAP in a hospital setting. A descriptive cross-sectional study (Study I) identified gaps between current practice and EBG recommendations for the diagnostics, treatment, and care of CAP. An ethnographic study (Study II) explored determinants influencing registered nurses’ (RNs) adherence to EBGs. In Studies III and IV, a tailored theory- and research-based strategy for implementing evidence-based nursing care (EBNC) was designed, developed, and evaluated. Study I shows a few potentially serious gaps in diagnostic procedures and medical treatment, but several gaps in nursing care. In Study II, RNs’ adherence to EBGs was heavily influenced by the RNs’ professional identity and contextual barriers, such as the dominance of the biomedical model, the team-related hierarchy, and the organisational structures. The nurse manager was a key facilitator for mediating a changed hierarchical culture and the performance of EBNC. The developed strategy (Study III) consisted of multiple interventions targeting individual, team, and environmental determinants, and a structured programme for implementation. The strategy was found to be acceptable, appropriate, and feasible for implementing EBNC (Study IV). However, the lack of timely resources, and competing organisational tasks challenged fidelity and sustainability. In conclusion, the tailored theory- and research-based strategy appeared feasible for changing determinants influencing nursing practice and improving patient care.