Organizational factors influencing the modification of policies and procedures: Towards the implementation of best practices

Background. Several theoretical models now suggest the need to promote an organizational approach to practice change for nursing. Objectives. To examine organizational factors that influence revisions and modifications to policies and procedures in health care agencies that participated in a pilot implementation and evaluation of six clinical practice guidelines developed by the Registered Nurses Association of Ontario. To describe the nature and extent of changes to policies and procedures from the perspective of nursing administrators, clinical resource nurses and nursing staff. Conclusion. Organizational support in the form of perceived support by top management, sufficient time and training to learn how to use the clinical guideline, adequate number of qualified staff and sufficient equipment and supplies to implement the clinical guideline is important and can influence nurses' awareness of evidence-based modification of policies and procedures. Further research is needed to compare nurses' actual practice with current policies and procedures. In addition, research is needed to determine whether organizations that modified or internalized their policies and procedures sustained the implementation of the clinical guidelines recommendations better over time. (Abstract shortened by UMI.)