Hypertension guideline implementation: experiences of Finnish primary care nurses.
OBJECTIVE
Evidence-based guidelines on hypertension have been developed in many western countries. Yet, there is little evidence of their impact on the clinical practices of primary care nurses.


METHODS
We assessed the style of implementation and adoption of the national Hypertension Guideline (HT Guideline) in 32 Finnish health centres classified in a previous study as 'disseminators' (n = 13) or 'implementers' (n = 19). A postal questionnaire was sent to all nurses (n = 409) working in the outpatient services in these health centres. Additionally, senior nursing officers were telephoned to enquire if the implementation of the HT Guideline had led to a new division of labour between nurses and doctors.


RESULTS
Questionnaires were returned from 327 nurses (80.0%), while all senior nursing officers (n = 32) were contacted. The majority of nurses were of the opinion that the HT Guideline has been adopted into clinical practice. The recommendations in the HT Guideline were adopted in clinical practice with varying success, and slightly more often in implementer health centres than in disseminator health centres. Nurses in implementer health centres more often agreed that multiple channels had been used in the implementation (P < 0.001). According to senior nursing officers the implementation of the HT Guideline had led to a new division of labour between nurses and doctors in about a half of the health centres, clearly more often in implementer health centres (P < 0.001).


CONCLUSIONS
The HT Guideline was well adopted into clinical practice in Finland. The implementation of the HT Guideline had an impact on clinical practices, and on creating a new division of labour between nurses and doctors.
Alanen
Seija
S
Tampere University Hospital, Tampere, Finland. seija.alanen@pshp.fi
Ijäs
Jarja
J
Kaila
Minna
M
Mäkelä
Marjukka
M
Välimäki
Maritta
M
D000553:Ambulatory Care / Q000458:organization & administration; D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D004059:Diffusion of Innovation; D055317:Evidence-Based Practice / Q000193:education / Q000458:organization & administration; D005260:Female; D005387:Finland; D006801:Humans; D006973:Hypertension / Q000517:prevention & control*; D033181:Information Dissemination; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role / Q000523:psychology; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000193:education / Q000458:organization & administration / Q000523:psychology*; D009936:Organizational Innovation; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D016526:Workload / Q000523:psychology