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Table 2 Implementation strategies

From: Insights about the process and impact of implementing nursing guidelines on delivery of care in hospitals and community settings

Bolded columns indicate guideline implementation that resulted in no change in > 80% of indicators
Strategies Asthma Breastfeeding Delirium, Dementia, Depression (DDD) Diabetes Foot Care Smoking Cessation Venous Leg Ulcers (VLU)
Educational strategies for nurses Paid time 2 core sessions of 2 hours each for separate groups of nurses-inpatient and emergency Pre-learning package Articles about the project in internal newsletters Placebos to practice skills Paid time Core 4-hour training session off site Written material team teaching, non-didactic, focus on attitudes, beliefs and values, use of stories by mother/baby dyads Additional short in-services held Paid time 2–3.5 hours Powerpoint slides, facilitator guide, handouts, case studies, a game to review materials, standardized assessment tools Paid time Hospital: 1 session 30 to 60 minutes, as a lunch and learn, handouts, self-learning package Visiting nurses: 6 sessions for 1.5 hours each, practice sessions, word game, refresher training Paid time 2 hours, Powerpoint slides, informal and interactive, stages of change theory Use of case scenarios depending on group e. g. in- patient, outpatient, long term care Paid time Manual (basic wound and VLU care) and CD for self-directed learning, individual 2-hour session with quiz, demonstration and bandaging practice by nurses Discussion of newsletters (not mailed) hospital nurses had demonstrations on bandaging and products
Champions (Local opinion leaders) Encouraged stronger nurses to sign up early to be advocates and mentors   Champions on each unit, part of the steering committee with role to raise issues in day to day rounds and to encourage the nurses to use the recommended assessment tools   A senior leader physician champion Several clinical resource nurses with one on each unit Resource people trained in both community and hospital settings Mentoring by consultants at client's home
Reminder systems Logo, mugs, posters, name tags for nurses who completed the training   Posters, binders, pocket cards listing symptoms of DDD Project logo, posters, articles in newsletters, voicemail messages, special flyer Buttons, posters, laminated pocket cards summarizing the steps of ask, advise, and assist strategy  
Policy Review yes Yes Yes Yes Yes Smoking room policy changes yes
Creation of new documentation Flow sheets Patient pathways Newborn critical pathways chart New charting tools and discharge sheets Trigger questions added to initial pt assessment forms to help nurses maintain an index of suspicion New assessment tool   
Multi-disciplinary involvement Respirologists very supportive but emergency physicians reluctant due to concern for nurses' workload "Little involvement of other disciplines" Conflict with dieticians in public health unit about 6 months excusive breast feeding   Steering group formed with both hospital and community reps but did not have an active ongoing role Strong senior physician champion 'interdisciplinary work was amazing...the camaraderie between the disciplines and meeting everyone else from the different sites was one of the major benefits" Steering committee Community physician support
Patient Education Patient education toolkits with placebos, teaching booklets and laminated cards on all units    Patient education and referral resources   Patient education brochure initiated but not completed