CARTER, JOAN KATHRYN; PHD
THE UNIVERSITY OF IOWA, 1995
HEALTH SCIENCES, NURSING (0569)
The purpose of this investigation was to study the implementation of the Nursing
Interventions
Classification (NIC) in five clinical sites. A prospective design was used to
(a) determine the strategies
used to introduce the Classification, (b) identify issues that emerged, and
(c) provide guidelines
facilitating smooth implementation in other agencies. Rogers' model of diffusion
of innovations in
organizations provided the conceptual framework for the conduction of the study.
Data collection
included recording participant interviews at each site, recording group meetings,
and analyzing all listserv
transactions. Key individuals in each setting were interviewed at the start
of the implementation process,
midway during the study, and immediately before the study was completed. These
key individuals
included: (a) the decision-maker for adopting NIC at each site, (b) the on-site
coordinator, (c) the college
liaison, and (d) four staff nurses, two selected for positive reaction to the
implementation and two
selected for negative reaction. Informed consent was obtained from the Institutional
Review Boards at
each site. In addition, consent forms were signed for each interview by each
interviewee. Ethnograph, a
computer program for the analysis of text based data, was used for coding and
organizing the data.
Inter-rater reliability was established by having two persons review 10% of
the interview and meeting
transcriptions. The inter-rater reliability was 86.5% and 93%. Intra-rater reliability
was 96%. The 86
interviews provided code words which were collapsed into 11 broad categories:
decision to adopt,
efficiency of nursing work, enhancing the work of nursing, planning strategies,
interactive strategies,
positive reaction, negative reaction, changing practice, documentation, information
dissemination, and
environmental influences. The findings show that the communications channels
used to process
information and leadership were key strategies for successful implementation.
The derived benefits of
using NIC showed a change (negative to positive) as nurses started using NIC.
Two major themes
emerged showing that the use of NIC increased efficiency and demonstrated effectiveness
of nursing
care. Documentation was the dominant issue for users. The guidelines developed
by the principal
investigators of the larger study were corroborated by this study.
Social
Systems Simulation Group
P.O. Box 6904 San Diego, CA 92166-0904 Roland Werner, Principal Phone/FAX (619) 660-1603 |