Evidence-based practice (EBP) is important for positive health outcomes. Nursing leadership is critical for implementing evidence-based practice however limited evidence exists on how best to develop leadership for evidence-based practice. There is high-quality evidence for pediatric pain management, however utilization of effective recommended pain management strategies varies greatly.
Purpose
To develop, deliver and evaluate the feasibility, acceptability and usefulness of a leadership intervention in mainland China, for implementing evidence-based pain management in infants and children.
Methods
Participants were fourteen senior frontline nurse leaders and three physicians from four pediatric units within a large specialist hospital in mainland China. Participants received a two-month leadership intervention that included four weekly-workshops and eight bi-weekly coaching. We utilized mixed methods with quantitative surveys and qualitative interview. Five data sources were used: process log, Implementation Leadership Scale (ILS), a validated 12-item questionnaire, a 14-item questionnaire based on ChildKind International principals, and individual and focus group semi-structured interviews. Descriptive content analysis was used to analyze interview data and survey data were described as frequencies and proportions, and summarized using descriptive statistics as appropriate for the distribution of the data.
Results
Fourteen nurse leaders and 3 physicians participated in the pre-intervention data collection. The participation rate of nurse leaders were 71%~86% in four workshops and 75%~83% in eight group coaching sessions and no physicians participated in the intervention.
Acceptability and Usefulness: The highest rated components of the intervention, rated on a Likert scale of 1-10 were the workshops (8.4±1.8); goal setting (8.3±1.7) and development of action plans (8.5±1.6).
Behaviour Change Impact: The ILS scores post-intervention (37.1±8.6) were higher than baseline (34.7±8.0). The qualitative interview results showed the intervention was perceived to positively influence leadership behaviors, such as reminding nurses about the importance of pain assessment, supporting nurses to implement best pain management evidence, and role modeling. ChildKind surveys showed an increase from baseline to post intervention on protocols for pain management and auditing practices. Qualitative results showed that one unit perceived they implemented their pain management goal successfully, while the other three units failed to achieve the goal they had set. Four main factors affected implementation for evidence-based pain management in infants and children: i) Culture of unit; ii) human resources and workload; iii) perceived effectiveness of the evidence; iv) Interdisciplinary support and family engagement.
Conclusions
The findings in this study showed that the leadership intervention for implementing evidence-based pain management in infants and children was acceptable to participants and feasible to deliver. We also found the intervention had positive effects on developing leadership behaviors for the nursing leaders. Further research is needed to determine impact on pediatric pain management as well as other clinical practices.