Abstract:
The implementation of evidence-based clinical practice guidelines in primary health care can substantially improve health outcomes. However, the implementation of evidence into practice is so complex and unpredictable, it is said to occur in a ,black box,. The aim of this study is to explore the ,black box, of guideline implementation in primary health care nursing by focussing on the use of a guideline for reducing cardiovascular risk. There are two components to the study, both using qualitative methods. The first is a qualitative description utilising focus groups and interviews to explore the use of the guideline. The second component uses template analysis based on the Promoting Action on Research Implementation in Health Services (PARiHS) framework to expose enablers and barriers to guideline implementation. Qualitative description revealed four themes depicting the realities of guideline implementation: self-managing client, everyday nursing practice, developing new relationships in the health team, and impact on health care delivery. Template analysis exposed significant enablers and barriers affecting the implementation of the guideline. Overall, this study found that guideline implementation to improve cardiovascular health overall and to address health inequity mandates sustained effort and mobilisation of required resources. This is achievable by employing practice development methodology.
