{
  "abstract": "Background and objectives: National clinical practice guidelines promote evidence-based practice, though are hardly implemented without local facilitation. While further research is needed as for what facilitation strategies work, in what context, and with what outcomes, the Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation (OPTION) trialled a tailored implementation intervention for evidence-based clinical practice guidelines in orthopaedic care. Informed by the principles of realism, this paper describes the evaluation of the context, mechanisms, and outcomes triad of locally assembled teams of nursing and rehabilitation staff and their managers offered monthly guideline implementation support for one year. Methods: A process evaluation incorporating group interviews with designated teams across seven intervention sites, at the end of their programme and 12 months later. Individual facilitator logs, photos and educational material from the intervention, and external facilitators’ notes were added. The data was thematically analysed, describing and contrasting the initial hypotheses with a refined understanding of the theoretical and practical features of the process and outcomes. Results: With increased knowledge of the content and purpose of the guidelines and further recognition of their local context and implementation essentials, the intervention facilitated the local, designated teams to practise concurrent quality improvement procedures and skills. Having both staff and managers on the teams authorised modifications of their local context in favour of guideline implementation. The one-year support programme enabled primary implementation steps, though a comprehension of what could work and why required that the teams saw the intervention through. Conclusion: Learning about the implementation of a clinical practice guideline is a local effort. This requires dedicated teams with sustained roles, resources, and mandate, with external implementation and clinical support. Nevertheless, this is a slow process that requires repeated or prolonged follow-up to identify long-term implementation intervention outcomes. Trial Registration: US National Institutes of Health Clinical Trials Registry: NCT04700969. Registered 8 January 2021. https://clinicaltrials.gov/study/NCT04700969.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Orthopaedics and School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden",
    "University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden",
    "Department of Clinical Science and Education and Department of Perioperative Care and Intensive Care, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden",
    "Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden",
    "Department of Care Science, Malmö University, Malmö, Sweden",
    "The Clinical Gerontology Division, National Ageing Research Institute, Parkville, Victoria, Australia",
    "The Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia",
    "Health and Innovation Transformation Centre, Federation University, Ballarat, Victoria, Australia"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 8,
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      "name": "Maria Hälleberg-Nyman"
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      "name": "Erika Fjordkvist"
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      "name": "Eva Joelsson-Alm"
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    {
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      "name": "Madeleine Winberg"
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    {
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      "name": "Ami Hommel"
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    {
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      "name": "Joan Ostaszkiewicz"
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    {
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        6
      ],
      "name": "Lars Wallin"
    },
    {
      "affs": [
        7
      ],
      "name": "Ann Catrine Eldh"
    }
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  "doi": "10.1371/journal.pone.0338755",
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  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
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  "pmcid": null,
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  "published": "2026-09-23",
  "publisher": "Public Library of Science",
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  "title": "Implementation of evidence-based practice guidelines to prevent urinary retention in hospitals: A process evaluation in orthopaedic care",
  "title_text": "Implementation of evidence-based practice guidelines to prevent urinary retention in hospitals: A process evaluation in orthopaedic care",
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