An evaluation of a dissemination intervention to enhance registered nurses' use of clinical practice guidelines related to tobacco reduction

摘要

Clinical practice guidelines (CPGs) have been developed to support knowledge transfer in health care settings. Rigorous evaluations assessing the effectiveness of methods to disseminate and implement CPGs into nursing practice are scarce. A quasi experimental, pretest, post-test design was conducted to examine the effect of a dissemination intervention on nurse adherence to CPGs on tobacco reduction and self-efficacy in treating tobacco use and dependence. A sample of 138 hospital-based registered nurses who provided routine pregnancy and postpartum care was recruited from two hospitals in one urban Regional Health Authority in mid-western Canada. Following randomisation of hospitals, the dissemination intervention consisting of academic detailing visits supplemented with a self-study package of print materials, a video, and a Smoking Cessation Interventions Record form, was administered to nurses in one hospital. Data were collected from self-administered, baseline and follow-up questionnaires and nurse documentation of their use of the CPGs during the 10-week intervention period. At three weeks post intervention, quantitative results indicated the dissemination intervention positively and significantly enhanced nurse adherence to the CPGs and boosted self-efficacy beliefs in treating tobacco use and dependence. Although nurses' perceptions of autonomy modified the effect of the dissemination intervention on change in beliefs in treating tobacco use and dependence, the intervention group demonstrated significantly improved self-efficacy scores in comparison to the control group. Multiple regression analyses revealed three significant predictors of nurse adherence to CPGs: receiving the intervention (p<0.001); baseline perceptions about using CPGs (p=0.05); and resource adequacy (p=0.04) and three significant predictors of self-efficacy: receiving the intervention (p<0.001); working full-time (p=0.01); and own value of research (p=0.05). This study demonstrated the efficacy of a multifaceted intervention on enhancing nurses' use of the CPGs in a hospital-based maternal child practice setting. Receiving the intervention was clearly the strongest predictor of self-efficacy beliefs in treating tobacco use and dependence and nurse adherence to the CPGs on tobacco reduction. The findings broaden our understanding of how to support hospital-based nurses in using the CPGs on tobacco reduction and provide direction for improving future dissemination strategies.