title: Planned change or emergent change implementation approach and nurses' professional clinical autonomy.
abstract: BACKGROUND
  Nurses' clinical autonomy is considered important for patients' outcome and influenced by the implementation approach of innovations. Emergent change approach with participation in the implementation process is thought to increase clinical autonomy. Planned change approach without this participation is thought not to increase clinical autonomy. Evidence of these effects on clinical autonomy is however limited.
  
  
  OBJECTIVE
  To examine the changes in clinical autonomy and in personal norms and values for a planned change and emergent change implementation of an innovation, e.g. intensive insulin therapy.
  
  
  METHODS
  Prospective comparative study with two geographically separated nurses' teams on one intensive care unit (ICU), randomly assigned to the experimental conditions.
  
  
  METHODS
  Data were collected from March 2008 to January 2009. Pre-existing differences in perception of team and innovation characteristics were excluded using instruments based on the innovation contingency model. The Nursing Activity Scale was used to measure clinical autonomy. The Personal Values and Norms instrument was used to assess orientation towards nursing activities and the Team Learning Processes instrument to assess learning as a team.
  
  
  RESULTS
  Pre-implementation the measurements did not differ. Post-implementation, clinical autonomy was increased in the emergent change team and decreased in the planned change team. The Personal Values and Norms instrument showed in the emergent change team a decreased hierarchic score and increased developmental and rational scores. In the planned change team the hierarchical and group scores were increased. Learning as a team did not differ between the teams.
  
  
  CONCLUSIONS
  In both teams there was a change in clinical autonomy and orientation towards nursing activities, in line with the experimental conditions. Emergent change implementation resulted in more clinical autonomy than planned change implementation.
  
  
  CONCLUSIONS
  If an innovation requires the nurses to make their own clinical decisions, an emergent change implementation should help to establish this clinical autonomy.
authors.affiliation: Intensive Care Unit, Sint Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Luiking
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Leon
authors.initials: L
authors.lastname: Aarts
authors.affiliation: Sint Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Leo
authors.initials: L
authors.lastname: Bras
authors.affiliation: University Medical Center Utrecht (NL), Ghent University (Belgium), University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Maria
authors.initials: M
authors.lastname: Grypdonck
authors.affiliation: University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Roland
authors.initials: R
authors.lastname: van Linge
mesh_terms: D000328:Adult; D000367:Age Factors; D001291:Attitude of Health Personnel; D003422:Critical Care / Q000379:methods; D064648:Critical Care Nursing / Q000458:organization & administration*; D004630:Emergencies / Q000451:nursing; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010347:Patient Care Planning; D017009:Professional Autonomy; D011446:Prospective Studies; D018570:Risk Assessment; D012737:Sex Factors
keywords: Autonomy; Emergent change; Implementation; Nursing; Planned change