title: A Bridge Over Turbulent Waters: Illustrating the Interaction Between Managerial Leaders and Facilitators When Implementing Research Evidence.
abstract: BACKGROUND
  Emerging evidence focuses on the importance of the role of leadership in successfully transferring research evidence into practice. However, little is known about the interaction between managerial leaders and clinical leaders acting as facilitators (internal facilitators [IFs]) in this implementation process.
  
  
  OBJECTIVE
  To describe the interaction between managerial leaders and IFs and how this enabled or hindered the facilitation process of implementing urinary incontinence guideline recommendations in a local context in settings that provide long-term care to older people.
  
  
  METHODS
  Semistructured interviews with 105 managers and 22 IFs, collected for a realist process evaluation across four European countries informed this study. An interpretive data analysis unpacks interactions between managerial leaders and IFs.
  
  
  RESULTS
  This study identified three themes that were important in the interactions between managerial leaders and IFs that could hinder or support the implementation process: "realising commitment"; "negotiating conditions"; and "encouragement to keep momentum going." The findings revealed that the continuous reciprocal relationships between IFs and managerial leaders influenced the progress of implementation, and could slow the process down or disrupt it. A metaphor of crossing a turbulent river by the "building of a bridge" emerged as one way of understanding the findings.
  
  
  CONCLUSIONS
  Our findings illuminate a neglected area, the effects of relationships between key staff on implementing evidence into practice. Relational aspects of managerial and clinical leadership roles need greater consideration when planning guideline implementation and practice change. In order to support implementation, staff assigned as IFs as well as stakeholders like managers at all levels of an organisation should be engaged in realising commitment, negotiating conditions, and keeping momentum going. Thus, communication is crucial between all involved.
authors.affiliation: Researcher and Lecturer, Fontys University of Applied Sciences, Faculty of Nursing, Eindhoven, The Netherlands.
authors.forename: Teatske Johanna
authors.initials: TJ
authors.lastname: van der Zijpp
authors.affiliation: Associate Professor, Fontys University of Applied Sciences, Faculty of Nursing, Eindhoven, The Netherlands.
authors.forename: Theo
authors.initials: T
authors.lastname: Niessen
authors.affiliation: Senior lecturer, School of Education, Health and Social Studies, Dalarna University, Falun, Sweden, and Researcher, Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ann Catrine
authors.initials: AC
authors.lastname: Eldh
authors.affiliation: Senior Research Fellow-Emergency Care, Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Hawkes
authors.affiliation: Research Fellow, Public Health, Institute of Applied Health Research, Murray Learning Centre, University of Birmingham, Birmingham, UK.
authors.forename: Christel
authors.initials: C
authors.lastname: McMullan
authors.affiliation: Senior Research Fellow, Royal College of Nursing Research Institute, Department of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Carole
authors.initials: C
authors.lastname: Mockford
authors.affiliation: Professor, School of Education, Health and Social Studies, Dalarna University, Falun, Sweden, and Associate Professor, Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Wallin
authors.affiliation: Head of the Division of Nursing, School of Health Sciences, Queen Margaret University, East Lothian, UK.
authors.forename: Brendan
authors.initials: B
authors.lastname: McCormack
authors.affiliation: Professor and Head of School, Bangor University, UK, and School of Healthcare Sciences, Bangor, UK.
authors.forename: Jo
authors.initials: J
authors.lastname: Rycroft-Malone
authors.affiliation: Director, RCN Research Institute and Professor of Health Research, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Seers
mesh_terms: D004739:England; D017408:Guidelines as Topic; D006801:Humans; D007400:Interprofessional Relations; D007494:Ireland; D007857:Leadership; D008134:Long-Term Care / Q000379:methods*; D009426:Netherlands; D009718:Nurse Administrators / Q000523:psychology*; D036301:Qualitative Research; D013548:Sweden; D014549:Urinary Incontinence / Q000628:therapy
keywords: evidence-based practice; long-term care; nursing practice; qualitative methodology; qualitative research; research methods; research utilisation; theory; work environment; working conditions