Sustaining Best Practice Guidelines in Community Health Settings in Canada

Cindy E. Versteeg, RN, MScN¹, Barbara Davies, RN, PhD¹, Nancy Edwards, RN, PhD¹, and Jenny Ploeg, PhD². (1) Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada, (2) Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, ON, Canada

While many studies have focused on implementing best practice guidelines in hospital settings, few have examined implementation in community health and even fewer have assessed long-term sustainability. The two objectives for this mixed methods study were to: 1) describe the nature of sustained use of the Registered Nurses Association of Ontario (RNAO) Best Practice Guidelines in community settings (Public Health and Home Health Nursing); and 2) identify the key barriers and facilitators to sustained use. Data were collected through semi-structured telephone interviews with 11 nurses and 20 decision makers (educators, clinical nurse specialists and administrators). These participants worked in one of eight community sites that had implemented an RNAO guideline, two years prior to the interviews. Topics included breast-feeding, healthy adolescence, pain management, supporting and strengthening families, therapeutic relationships, and venous leg ulcer prevention. Data were also collected during site visits and through a review of agency documents. The results indicated that 4 of 8 sites sustained the recommendations in practice. Evidence of sustainability included BPG recommendations that were: embedded in documentation and assessment tools, included in staff orientations and implemented by multiple service partners and integrated into the curricula of educational institutions. The three main facilitators of sustainability were organizational support and commitment, teamwork and using a collaborative approach. The three main barriers were workload, resources for staff education, and funding for existing programs. The collaborative nature of community based practice has an impact on the sustainability of BPGs in those settings. Recommendations for the long term sustainability of BPGs in community health nursing settings include the use of multiple strategies targeted at the full range of barriers and increasing the capacity of facilitators to sustainability.

Learning Objective #1: Identify the key barriers and facilitators for implementing Best Practice Guidelines in a community setting.
Learning Objective #2: Describe the nature of sustained use of Best Practice Guidelines in a community setting.