Implementation of evidence-based practice guidelines to prevent urinary retention in hospitals: A process evaluation in orthopaedic care
8 affiliations
- 1Department of Orthopaedics and School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- 2University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- 3Department of Clinical Science and Education and Department of Perioperative Care and Intensive Care, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- 4Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- 5Department of Care Science, Malmö University, Malmö, Sweden
- 6The Clinical Gerontology Division, National Ageing Research Institute, Parkville, Victoria, Australia
- 7The Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
- 8Health and Innovation Transformation Centre, Federation University, Ballarat, Victoria, Australia
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.
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BibTeX
@article{hallebergnyman2026implementation,
title = {{Implementation of evidence-based practice guidelines to prevent urinary retention in hospitals: A process evaluation in orthopaedic care}},
author = {Maria Hälleberg-Nyman and Erika Fjordkvist and Eva Joelsson-Alm and Madeleine Winberg and Ami Hommel and Joan Ostaszkiewicz and Lars Wallin and Ann Catrine Eldh},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0338755},
url = {https://doi.org/10.1371/journal.pone.0338755},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Implementation of evidence-based practice guidelines to prevent urinary retention in hospitals: A process evaluation in orthopaedic care
AU - Maria Hälleberg-Nyman
AU - Erika Fjordkvist
AU - Eva Joelsson-Alm
AU - Madeleine Winberg
AU - Ami Hommel
AU - Joan Ostaszkiewicz
AU - Lars Wallin
AU - Ann Catrine Eldh
PY - 2026
DA - 2026/09/23
JO - PLOS One
DO - 10.1371/journal.pone.0338755
UR - https://doi.org/10.1371/journal.pone.0338755
AB - 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.
SN - 1932-6203
ER -