A qualitative study of a primary-care based intervention to improve the management of patients with heart failure: the dynamic relationship between facilitation and context.
A qualitative study of a primary-care based intervention to improve the management of patients with heart failure: the dynamic relationship between facilitation and context.
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一项基于初级护理的干预措施的定性研究，以改善心力衰竭患者的管理：促进与情境之间的动态关系。
DOI：
10.1186/1471-2296-15-153
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发表时间：
2014-09-18
影响因子：
2.9
通讯作者：
Deaton C
中科院分区：
文献类型：
--
作者：
Tierney S;Kislov R;Deaton C
目前，初级保健越来越重视为特定疾病提供循证服务，例如心力衰竭(HF)，这传统上被视为专家领域的一部分。虽然与初级保健改善相关的背景挑战以前已经被记录在案，但我们仍然相对较少地知道，在这种保健环境中，有意识的、理论知情的循证变革是如何由背景因素塑造的。因此，进行了一项定性研究，以解决这个问题：促进循证实践的过程如何受到初级保健的影响？数据收集是在英格兰西北部的一般做法中进行的，作为大曼彻斯特心力衰竭调查工具(GM-HFIT)过程评估的一部分，该工具是一项旨在改善初级保健中心力衰竭管理的工作计划。对刻意选择的GM-HFIT团队成员(n = 9)和初级保健从业者(n = 7)进行的半结构化访谈补充了观察数据和反映促进活动的三个月日记。使用框架分析来管理和解释数据。我们描述了促进和背景之间复杂和动态的相互作用，重点放在三个主要主题上：(1)处理宏观和微观议程；(2)组成促进单位；(3)保持势头。我们表明，HF专科护士(HFSN)具有很高的职业可信度，这使得他们能够在为改善患者护理提出建议方面发挥关键作用。同时，我们认为，背景因素，如最高层的认可，遵守绩效评估系统的必要性，以及实习护士的不同参与，都会产生紧张，对促进过程既有促进作用，也有制约作用。在促进证据转让时，背景是在宏观和微观层面上需要考虑的一个重要方面；这些层面之间可能存在复杂的相互作用，这可能会限制或使修正实践的努力成为可能。那些参与促进初级保健改革的人必须处理这些不同背景力量相互作用所产生的紧张局势，以最大限度地减少它们对根据最佳证据改变做法的努力的影响。
There is currently a growing emphasis in primary care on upscaling the provision of evidence-based services for specific conditions, such as heart failure (HF), which have traditionally been seen as part of a specialist’s domain. While contextual challenges associated with improvement in primary care have been documented previously, we still know relatively little about how the intentional, theory-informed facilitation of evidence-based change is shaped by contextual factors within this healthcare setting. Hence, a qualitative study was conducted to address the question: How is the process of facilitating evidence-based practice affected by the context of primary care? Data collection took place across general practices in northwest England as part of a process evaluation of the Greater Manchester HF Investigation Tool (GM-HFIT) - a programme of work aiming to improve the management of HF in primary care. Semi-structured interviews, with purposefully selected GM-HFIT team members (n = 9) and primary care practitioners (n = 7), were supplemented by observational data and a three-month diary reflecting on facilitation activities. Framework analysis was used to manage and interpret data. We describe a complex and dynamic interplay between facilitation and context, focusing on three major themes: (1) Addressing macro and micro agendas; (2) Forming a facilitative unit; (3) Maintaining momentum. We show that HF specialist nurses (HFSNs) have a high level of professional credibility, which allows them to play a key role in making recommendations to practices for improving patient care. At the same time, we argue that contextual factors, such as top-level endorsement, the necessity to comply with a performance measurement system, and the varying involvement of practice nurses produce tensions that can have both an enabling and constraining effect on the process of facilitation. When facilitating the transfer of evidence, context is an important aspect to consider at a macro and micro level; a complex interplay can exist between these levels, which may constrain or enable efforts to amend practice. Those involved in facilitating change within primary care have to manage tensions arising from the interplay of these different contextual forces to minimise their impact on efforts to alter practice based on best evidence.
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影响因子：
2
作者：
Sandelowski, Margarete
通讯作者：
Sandelowski, Margarete
影响因子：
168.9
作者：
Cleland, JGF;Cohen-Solal, A;Widimsky, J
通讯作者：
Widimsky, J
影响因子：
4.2
作者：
Rycroft-Malone, J;Harvey, G;Titchen, A
通讯作者：
Titchen, A
影响因子：
39.3
作者：
McMurray, John J. V.;Adamopoulos, Stamatis;Ponikowski, Piotr
通讯作者：
Ponikowski, Piotr
影响因子：
3.8
作者：
Harvey, G;Loftus-Hills, A;Seers, K
通讯作者：
Seers, K