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ignificance The importance of leadership to influence nurses’ use of clinical guidelines has been well documented. However, little is known about how to develop and evaluate leadership interventions for guideline use. Purpose The purpose of this study was to pilot a leadership intervention designed to influence nurses’ use of guideline recommendations when caring for patients with diabetic foot ulcers in home care nursing. This paper reports on the feasibility of implementing the study protocol, the trial findings related to nursing process outcomes, and leadership behaviors. Methods A mixed methods pilot study was conducted with a post-only cluster randomized controlled trial and descriptive qualitative interviews. Four units were randomized to control or experimental groups. Clinical and management leadership teams participated in a 12-week leadership intervention (workshop, teleconferences). Participants received summarized chart audit data, identified goals for change, and created a team leadership action. Criteria to assess feasibility of the protocol included: design, intervention, measures, and data collection procedures. For the trial, chart audits compared differences in nursing process outcomes. Primary outcome: 8-item nursing assessments score. Secondary outcome: 5-item score of nursing care based on goals for change identified by intervention participants. Qualitative interviews described leadership behaviors that influenced guideline use. Results Conducting this pilot showed some aspects of the study protocol were feasible, while others require further development. Trial findings observed no significant difference in the primary outcome. A significant increase was observed in the 5-item score chosen by intervention participants (p = 0.02). In the experimental group more relations-oriented leadership behaviors, audit and feedback and reminders were described as leadership strategies. Conclusions Findings suggest that a leadership intervention has the potential to influence nurses’ use of guideline recommendations, but further work is required to refine the intervention and outcome measures. A taxonomy of leadership behaviors is proposed to inform future research.

Background: Clinical practice guidelines are promising tools for closing the research evidence-practice gap, yet effective and timely implementation of guidelines into practice remains fragmented and inconsistent. Factors influencing effective guideline implementation remain poorly understood, particularly in nursing. A sound understanding of barriers and facilitators is critical for development of effective and targeted guideline implementation strategies. Aim: This paper reports the perceptions of administrators, staff, and project leaders about factors influencing implementation of nursing best practice guidelines. Methods: Twenty-two organizations, in clusters of two to five, implemented one of seven guidelines in acute, community and long-term care settings. The topics were client centered care, crisis intervention, healthy adolescent development, pain assessment, pressure ulcers, supporting and strengthening families and therapeutic relationships. Fifty-nine administrators, 58 staff and 8 project leaders participated in post implementation semi-structured telephone interviews. Qualitative thematic analysis was conducted. Findings: Factors at individual, organizational and environmental levels were identified as influencing guideline implementation. Facilitators included learning about the guideline through group interaction, positive staff attitudes and beliefs, leadership support, champions, teamwork and collaboration, professional association support, and inter-organizational collaboration and networks. Barriers included negative staff attitudes and beliefs, limited integration of guideline recommendations into organizational structures and processes, time and resource constraints, and organizational and system level change. Similarities and differences in perceptions of these factors were found among staff, project leaders and administrators. Implications/Conclusions: Best practice guideline implementation strategies should address barriers related to the individual practitioner, social context, and organizational and environmental context, and should be tailored to different groups of stakeholders (i.e., nursing staff, project leaders and administrators). Health care administrators need to recognize the “real” costs and complexity associated with successful implementation of guidelines and the need to ensure corporate commitment at the onset.

Background Integration of research evidence into clinical nursing practice is essential for the delivery of high-quality nursing care. Leadership behaviours of nurse managers and administrators have been identified as important to support research use and evidence-based practice. Yet minimal evidence exists indicating what constitutes effective nursing leadership for this purpose, or what kinds of interventions help leaders to successfully influence research-based care. Aims (1) To describe leadership activities of nurse managers that influence nurses' use of research evidence; and (2) to identify interventions aimed at supporting nurse managers to influence research use in clinical nursing practice. Methods A search of electronic databases was conducted for studies on behaviours or activities of nurse managers/administrators and the use of research evidence by nurses. Sifting, screening, and quality assessments were done by two reviewers. Results were synthesized by study type (quantitative and qualitative) and reported. Results Twelve studies met inclusion criteria (eight quantitative, four qualitative). Three activities were found in quantitative studies that influenced nurses' use of research: managerial support, policy revisions, and auditing. Qualitative studies showed organizational issues as barriers to managers' abilities to affect research use, while role modeling and valuing research facilitated research use. Four studies, one of which was experimental, included an intervention to support managers, but all had insufficient information about leadership development. Conclusions To date, important descriptive work highlights the strategic role managers have in research transfer. Both facilitative and regulatory activities appear to be necessary for managers to influence research use. These findings have important implications for evolving theoretical models describing factors that affect the process of research utilization. It is time to move the science forward and test a hypothesis linking leadership to outcomes. Qualitative methods are essential for understanding the process of leadership for research transfer.

The delivery of efficient and high quality nursing care in today's health care environment requires that nurses utilize research evidence to guide their decision-making in clinical practice. Best Practice Guidelines (BPGs) are an accessible link to research evidence and an effective tool for improving quality health care. Despite reported benefits and dissemination strategies, the transfer and uptake of guidelines does not always occur, and sustainability over time is seldom evaluated. Emerging evidence indicates that leadership plays a fundamental role in the transfer and sustained use of BPGs in clinical decision-making. However, a clear understanding of effective nursing leadership to sustain knowledge transfer remains unclear and research is limited. Objective: To describe the evolving development of a conceptual framework for sustaining knowledge transfer of BPGs into nursing practice in Canadian health care settings. Methods: A critical review of the literature has been conducted. A model was developed to direct an inquiry about leadership characteristics and activities in 10 organizations that either sustained, partially sustained, or did not sustain practice guidelines 2 years after a pilot implementation initiative administrated by the Registered Nurses Association of Ontario Best Practice Guideline (RNAO-BPG) Project. Findings: A conceptual framework has been developed to represent the key components of leadership and how these components are operationalized for knowledge transfer of BPGs into clinical practice. The model is an assimilation of the United Kingdom and North American literature and includes a pathway for personal attributes, defined skills, and knowledge repertoires that emerge from two domains of influence: cultural/clinical and political/organizational. Although the literature shows many similarities between leadership paradigms, some differences in discourse and approach were found. Implications: To create successful strategies to sustain practice innovations, we need to better understand how nursing leaders operate effectively within both clinical and organizational environments. This framework is the groundwork for conceptualizing nursing leadership as a vehicle to influence, shape, and sustain evidence-based nursing practice.