The Consolidated Framework for Implementation Research (CFIR): a useful theoretical framework for guiding and evaluating a guideline implementation process in a hospital-based nursing practice

BMC Nursing

Christa Lohrmann¹  Ruud J. G. Halfens²  Birgit Heckemann²  Helga E. Breimaier¹ 

[1] Institute of Nursing Science, Medical University of Graz, Billrothgasse 6, Graz, 8010, Austria;Department of Health Services Research, CAPHRI, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands

关键词: Nursing;    Guideline implementation;    Evaluation;    Consolidated Framework of Implementation Research (CFIR);   

Others  :  1222367
DOI  :  10.1186/s12912-015-0088-4

 received in 2014-03-03, accepted in 2015-07-13,  发布年份 2015

【 摘 要 】

Background

Implementing clinical practice guidelines (CPGs) in healthcare settings is a complex intervention involving both independent and interdependent components. Although the Consolidated Framework for Implementation Research (CFIR) has never been evaluated in a practical context, it appeared to be a suitable theoretical framework to guide an implementation process. The aim of this study was to evaluate the comprehensiveness, applicability and usefulness of the CFIR in the implementation of a fall-prevention CPG in nursing practice to improve patient care in an Austrian university teaching hospital setting.

Methods

The evaluation of the CFIR was based on (1) team-meeting minutes, (2) the main investigator’s research diary, containing a record of a before-and-after, mixed-methods study design embedded in a participatory action research (PAR) approach for guideline implementation, and (3) an analysis of qualitative and quantitative data collected from graduate and assistant nurses in two Austrian university teaching hospital departments. The CFIR was used to organise data per and across time point(s) and assess their influence on the implementation process, resulting in implementation and service outcomes.

Results

Overall, the CFIR could be demonstrated to be a comprehensive framework for the implementation of a guideline into a hospital-based nursing practice. However, the CFIR did not account for some crucial factors during the planning phase of an implementation process, such as consideration of stakeholder aims and wishes/needs when implementing an innovation, pre-established measures related to the intended innovation and pre-established strategies for implementing an innovation. For the CFIR constructs reflecting & evaluating and engaging, a more specific definition is recommended. The framework and its supplements could easily be used by researchers, and their scope was appropriate for the complexity of a prospective CPG-implementation project. The CFIR facilitated qualitative data analysis and provided a structure that allowed project results to be organised and viewed in a broader context to explain the main findings.

Conclusions

The CFIR was a valuable and helpful framework for (1) the assessment of the baseline, process and final state of the implementation process and influential factors, (2) the content analysis of qualitative data collected throughout the implementation process, and (3) explaining the main findings.

【 授权许可】

   
2015 Breimaier et al.

【 图 表 】

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