title: Effectiveness of multifaceted and tailored strategies to implement a fall-prevention guideline into acute care nursing practice: a before-and-after, mixed-method study using a participatory action research approach.
abstract: BACKGROUND
  Research- and/or evidence-based knowledge are not routinely adopted in healthcare and nursing practice. It is also unclear which implementation strategies are effective in nursing practice and what expenditures of time and money are required for the successful implementation of clinical practice guidelines (CPGs). The aim in this study was to assess the effectiveness and required time investment of multifaceted and tailored strategies for implementing an evidence-based fall-prevention guideline (Falls CPG) into nursing practice in an acute care hospital setting.
  
  
  METHODS
  A before-and-after, mixed-method design was used within a participatory action research approach (PAR). The study was carried out in two departments of an Austrian university teaching hospital and included all graduate and assistant nurses. Data were collected through a questionnaire, group discussions and semi-structured interviews. Qualitative data were content-analysed using a template based on the Consolidated Framework for Implementation Research (CFIR), which also served as a theoretical framework for the study. Quantitative data were descriptively analysed using appropriate tests for independent groups.
  
  
  RESULTS
  By applying multifaceted and tailored implementation strategies, the graduate and assistant nurses' knowledge on fall prevention, how to access the Falls CPG and the guideline itself increased significantly between baseline and final assessment (p ≤ .001). Qualitative data also revealed an increase in participant awareness of fall prevention. A baseline positive attitude towards guidelines improved significantly towards the end of the project (p = .001). Required fall prevention equipment like baby monitors or one-way glide sheets were available for use and any required environmental adaptations, e.g. a handrail in the corridor, were made. Hospital nursing personnel (approximately 150) invested a total of 1192 hours of working time over the course of the project.
  
  
  CONCLUSIONS
  Multifaceted strategies tailored to the specific setting within a PAR approach and guided by the CFIR enabled the effective implementation of a CPG into acute care nursing practice. Nursing managers now have sound knowledge of the time resources required for CPG implementation.
authors: Institute of Nursing Science, Medical University of Graz, Billrothgasse 6, 8010 Graz, Austria.
authors: Helga E
authors: HE
authors: Breimaier
authors: Department of Health Services Research, CAPHRI, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, The Netherlands.
authors: Ruud Jg
authors: RJ
authors: Halfens
authors: Institute of Nursing Science, Medical University of Graz, Billrothgasse 6, 8010 Graz, Austria.
authors: Christa
authors: C
authors: Lohrmann
keywords: Before-and-after design; Effectiveness; Fall prevention; Guidelines; Implementation strategies; Nursing; Participatory action research