This study aimed at establishing the enablers and barriers of guideline implementation in a primary healthcare setting. The Promoting Action on Research Implementation in Health Services (PARIHS) framework acted as “a template for data analysis and interpretation” (McKillop, Crisp and Walsh, 2012). The researchers intended to undertake a qualitative study to clarify the process of implementing the Assessment and Management of Cardiovascular Risk (AMCVR) guideline by getting a detailed description of practical realities in primary healthcare environments.
Participants and contributors of data
For the success of this study, there was a need for intensive research. The main sources of data were the indigenous New-Zealand People- the Maori and the Non-Maori population in New Zealand. Researchers recruited participants from primary healthcare settings in one region of New Zealand to gain their perspectives of using the Assessment and Management of Cardiovascular Risk (AMCVR) guideline in everyday practice. The participants included primary health care nurses, general practitioners, primary health care managers, and planners.
Method of data collection
Researchers used focus groups and interviews as methods of obtaining data. Researchers used loosely structured Focus groups and interviews with open-ended questions aimed at obtaining diverse data that reflected the perspectives and experiences of participants. Data collection techniques widely focused on the nature of information used to implement the AMCVR and the usefulness of AMCVR applications.
Main findings
The research established that the Maori people had overall worse health status than the non-Maori population and that cardiovascular disease disproportionately affected them, leaving them with lower life expectancy.
Participants attributed this to a highly complex range of contextual influences of the Maori’s culture on cardiovascular disease and deaths. Most nurses attributed values and beliefs to workplace settings, which result into health inequity in Maori.
Findings showed that the number of nurses available was inefficient. The participants acknowledged the need to increase qualified nurses for proper handling of cardiovascular cases.
Researchers discovered that leadership organization was essential for dealing with cardiovascular disease and deaths. Clinician groups described the model of health care for general practices as effective in handling patients attending the clinics. However, they criticized the healthcare of poor organization in regard to out-reach, cardiovascular screening, and health promotion.
Findings revealed the importance of a clinical experience. Participants attributed efficient handling of cardiovascular disease patients to experience of nurses.
Another aspect that was evident in handling cardiovascular disease was the relationship between practitioners and clients. Nurse focus groups acknowledged the importance of respectful, individualized interaction with clients.
Participants noted difficulties in gaining access to feedback on the progress of implementation. They blamed this on reliance on a narrow range of clinical indicator such as fasting blood lipids.
Conclusion
The increasing number of healthcare issues, limited resources, and the discovery of new insights for interventions require applications of proven methods in order to enhance healthcare provisions. Therefore, healthcare providers must implement evidence-based approaches to meet healthcare goals (Brown, 2012).
In the US, we use various strategies such as policy tracking, systematic reviews, and evidence-based guidelines. Such approaches have facilitated effective implementation of evidenced-based practices. This differs with practices in New Zealand where factors like culture, high costs of healthcare services, and shortages of nurses affect implementation of evidence-based practices. This implies that New Zealand must develop and evaluate its healthcare practices in order to accommodate research findings.
References
Brown, S. J. (2012). Evidence-Based Nursing: The Research-Practice Connection (2nd ed.). Burlington, MA: Jones & Bartlett Learning.
McKillop, A., Crisp, J., and Walsh, K. (2012). Barriers and enablers to implementation of a New Zealand-wide guideline for assessment and management of cardiovascular risk in primary health care: a template analysis. Worldviews on Evidence-Based Nursing, 9(3), 159-171. Web.