title: Handling a challenging context: experiences of facilitating evidence-based elderly care.
abstract: OBJECTIVE
  To explore improvement facilitators' experiences of handling their commission to implement evidence-based practice in elderly care for frail older persons.
  
  
  BACKGROUND
  Improvement facilitators were put in place across Sweden in a time-limited project by the government, with one part of the project being to evaluate the model before establishing this facilitation of evidence-based practice in elderly care.
  
  
  METHODS
  Two focus groups were interviewed twice. Each group comprised three respondents. The interviews were analysed using qualitative content analysis.
  
  
  RESULTS
  A main theme, 'Moving forward by adjusting to the circumstances', described how the improvement facilitators handle their commitment. Five subthemes emerged: identifying barriers, keeping focus, maintaining motivation, building bridges and finding balance.
  
  
  CONCLUSIONS
  The improvement facilitators' commitment is ambiguous because of unclear leadership of, and responsibility for the national investment. They have to handle leaders' different approaches and justify the need for evidence-based practice. The improvement facilitators did not reflect on the impact of programme adaptations on evidence-based practice.
  
  
  CONCLUSIONS
  The findings emphasise the need for collaboration between the improvement facilitator and the nurse manager. To fully implement evidence-based practice, negotiations with current practitioners for adaptation to local conditions are necessary. Furthermore, the value of improving organisational performance needs to be rigorously communicated throughout the organisation.
authors.affiliation: Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping, Sweden.
authors.forename: Annette
authors.initials: A
authors.lastname: Nygårdh
authors.affiliation: Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
authors.forename: Gerd
authors.initials: G
authors.lastname: Ahlström
authors.affiliation: Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.
authors.forename: Christine
authors.initials: C
authors.lastname: Wann-Hansson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055317:Evidence-Based Practice / Q000458:organization & administration*; D005260:Female; D017144:Focus Groups; D016330:Frail Elderly; D006299:Health Services for the Aged / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007857:Leadership; D008297:Male; D008875:Middle Aged; D009745:Nursing, Supervisory / Q000458:organization & administration; D036301:Qualitative Research; D058996:Quality Improvement / Q000458:organization & administration*; D013548:Sweden
keywords: elderly care; evidence-based practice; facilitators; nurse management; quality register