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To explore how coaching can facilitate the development of an Evidence-Based Quality Improvement (EBQI) learning culture within nursing teams in hospital and community care settings. This study also explores the specific contextual factors that influence effective outcomes.
Action research.
Nine teams, including 254 nurses were selected from four hospitals and two community care organisations to participate in the development of an EBQI-learning culture under the guidance of internal and external coaches. Data were gathered from 27 focus groups with 56 unique participants (of whom 31 participated multiple times) and six individual interviews with three external coaches. Transcripts of all interviews were subjected to abductive thematic analysis.
To promote an EBQI learning culture in nursing teams, it is essential that internal coaches effectively guide their team members. The internal coaches in this study focused on enhancing readiness for EBQI by providing support, encouraging involvement and motivating team members. They deepened innovation competencies including assessing daily care, implementing well-structured changes in care practices and embedding small steps in the change process in daily routines. It was found that barriers and facilitators within the team's context can influence the development of EBQI-learning culture and therefore need to be considered when seeking to make changes. The presence of external coaches served as a valuable resource and a motivator in supporting internal coaches to apply and improve their coaching skills.
To stimulate the development of an EBQI-learning culture, internal coaches need to focus on team readiness to work with EBQI. Priority needs to be given to enhancing the care change competencies of team members. Barriers to change must also be addressed. Internal coaches require external support and motivation to continually develop coaching skills.
The Standards for Reporting Qualitative Research.
No patient or public contribution.
To explore barriers and facilitators for reducing low-value home-based nursing care.
Qualitative exploratory study.
Seven focus group interviews and two individual interviews were conducted with homecare professionals, managers and quality improvement staff members within seven homecare organizations. Data were deductively analysed using the Tailored Implementation for Chronic Diseases checklist.
Barriers perceived by homecare professionals included lack of knowledge and skills, such as using care aids, interactions between healthcare professionals and general practitioners creating expectations among clients. Facilitators perceived included reflecting on provided care together with colleagues, clearly communicating agreements and expectations towards clients. Additionally, clients' and relatives' behaviour could potentially hinder reduction. In contrast, clients' motivation to be independent and involving relatives can promote reduction. Lastly, non-reimbursement and additional costs of care aids were perceived as barriers. Support from organization and management for the reduction of care was considered as facilitator.
Understanding barriers and facilitators experienced by homecare professionals in reducing low-value home-based nursing care is crucial. Enhancing knowledge and skills, fostering cross-professional collaboration, involving relatives and motivating clients' self-care can facilitate reduction of low-value home-based nursing care.
Implications for profession and patient care: De-implementing low-value home-based nursing care offers opportunities for more appropriate care and inclusion of clients on waitlists.
Addressing barriers with tailored strategies can successfully de-implement low-value home-based nursing care.
The Consolidated Criteria for Reporting Qualitative Research checklist was used.
No patient or public contribution.
To facilitate the delivery of appropriate care, the aim was to test if a tailored, multifaceted de-implementation strategy (RENEW) (1) would lead to less low-value nursing care and (2) was acceptable, implementable, cost effective and scalable in the home-based nursing care context.
A mixed-methods design.
The RENEW strategy with components on education, persuasion, enablement, incentives and training was introduced in seven teams from two organisations in the Netherlands. To estimate the effect size, data were collected at baseline (T0) and follow-up measurement (T1), on the volume of care in both frequency and time in minutes per week and independent samples t-tests were performed. A qualitative evaluation was conducted to understand feasibility aspects, see how the strategy works and identify influencing factors and used document analyses and semi-structured interviews. Deductive coding was used to analyse the results.
The time spent on low-value nursing care (mean, minutes per week per client) in seven teams for 210 clients in T1 compared to 222 clients in T0 reduced statistically significant. The difference between T0 and T1 equals 17.94%. The frequency of delivered low-value nursing care (mean per week) reduced but not statistically significant. From the transcripts of eight semi-structured interviews and documents, a list of 79 influencing factors were identified. Practical implementation tools, workplace coaching and sharing experiences within and between teams were considered as the most contributing elements.
The results showed that for the seven home-healthcare teams in this study, the RENEW strategy (1) leads to a reduction in low-value care and (2) is—conditional upon minor modifications—acceptable, implementable, cost effective and scalable.
Standards for Reporting Implementation Studies (StaRI) guidelines.
No Patient or Public Contribution.
Low-value care provides little or no benefit to patients, or its risk of harm outweighs the potential benefits. Non-nursing tasks refer to tasks performed by nurses below their scope of practice. With increasing pressure on the global nursing workforce, it is necessary to identify these concepts to deliver fundamental care.
To assess the prevalence, influencing factors and associations of low-value nursing care, and to identify non-nursing tasks and potential solutions in surgical hospital care settings.
The study followed a cross-sectional study design using a self-developed questionnaire.
A questionnaire on low-value care and non-nursing tasks was distributed to surgical wards in four hospitals in The Netherlands.
A total of 302 nurses responded to the survey. Five most prevalent low-value care practices were identified, including routine preoperative fasting (84.8%), taking over blood glucose monitoring (59.3%) and leaving in place any type of venous catheter (42.1%). These practices were mainly performed due to habitual practice, in accordance with an established protocol, or upon physicians' request. Most reported non-nursing tasks were administrative duties and cleaning patient rooms and equipment. Provided solutions included clearly defining responsibilities and taking personal responsibility.
Low-value care, provided by surgical nurses, is common in daily practice. This requires targeted de-implementation of each low-value care practice, based on influencing factors. Additionally, 85.8% of nurses perform non-nursing tasks daily or several times a day, underlining the need to re-organise nursing tasks.
De-implementing low-value care and reducing non-nursing tasks is necessary to ease pressure on the global nursing workforce and to improve fundamental care.
Low-value nursing care and non-nursing tasks persist when nurses lack leadership responsibility.
STROBE checklist.
No patient contribution.
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