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To explore factors influencing the implementation of a nursing care delivery model in a hospital setting.
A qualitative evidence synthesis with a thematic synthesis was conducted.
The search string consisted of four ‘cluster topics’: (1) nursing, (2) care delivery models, (3) hospital setting, (4) qualitative and mixed methods designs. Four electronic databases were searched from January 2000 until July 2024: MEDLINE (PubMed interface), Embase (embase.com interface), CINAHL (EBSCOhost interface) and Web of Science. A thematic synthesis was conducted consisting of the following steps; the ‘line-by-line’ coding of the text, the development and allocation of ‘descriptive themes’ and the generation of ‘analytical themes’.
In total, 3976 references were screened, of which 25 were included in the qualitative evidence synthesis. Eight analytical themes were generated that influence the implementation of a nursing care delivery model in a hospital setting: shared understanding of the care delivery model, ownership of the change, scope of practice and role clarity, collaboration, communication, responsibility, a double-loop process and aggregated recommendations. The themes were categorised on four different levels: vision, process, interactional factors and contextual factors.
The eight themes identified in this qualitative evidence synthesis showed that during the implementation of a nursing care delivery model, a clear implementation strategy is often missing. It is advised that future implementation processes have a clear guide and goal.
The analytical themes can guide the future implementation of a new nursing care delivery model in a hospital setting. This review can support nurses, researchers, hospital management and policymakers when implementing organisational alternatives to reorganise nursing care in a hospital setting.
The qualitative evidence synthesis was reported according to the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) statement.
No patient or public contribution.
Reducing sedentary behaviour (SB) in older adults is a promising strategy to promote healthy ageing. However, to develop more effective interventions, more in-depth information is needed on how existing interventions work. The present realist review aims to identify the working mechanisms and contextual preconditions to guide the development of future interventions.
A realist review was conducted following the iterative process of Pawson and Tilley and reported following the RAMESES publication standards.
Evidence was searched in four databases: EMBASE, PubMed, Web of Science and Scopus, and in the grey literature.
All study types and designs were included. Studies conducted in older adults with a mean age of 60 years or older, providing information on the context, mechanisms and/or outcomes of interventions aimed at the reduction of SB were eligible for inclusion and appraised for relevance and rigour.
All data were coded by two independent reviewers. Sections that contained relevant information to refine, refute or confirm the initial programme theory were given a code. Based on these codes, context-mechanism-outcome configurations were made, and a final programme theory was developed.
In total, 58 studies, from 61 articles, were eligible. The review revealed three important contexts for changes in SB: the (1) motivation, (2) opportunities and (3) capabilities of older adults. Depending on the context, other behaviour change techniques should be used to trigger specific mechanisms and, in turn, reduce SB. Especially, the impact of the underlying automatic processes of SB on the effectiveness of SB interventions became clear. Existing interventions primarily focus on the reflective processes guiding SB, without taking into account that SB is often an automatic response that occurs unconsciously, with little reasoning.
The effectiveness of SB interventions in older adults highly depends on the context in which the interventions occur. In particular, the context of automatic motivation should receive more attention to break the ingrained habit of SB in older adults.
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