scholarly journals A qualitative examination of the perceived impact of bureaucratic managerialism on evidence-based practice implementation in Nigeria: a collective case study

2019 ◽  
Vol 24 (8) ◽  
pp. 635-646
Author(s):  
Jude N Ominyi ◽  
David A Agom ◽  
Chidiebere Valentine Ekuma
Keyword(s):  
Acute Care ◽  
Nurse Managers ◽  
Evidence Based Practice ◽  
Care Quality ◽  
Healthcare Management ◽  
Successful Implementation ◽  
Evidence Based ◽  
Case Study Methodology ◽  
The Impact

Background Evidence-based practice (EBP) is widely recognised as an essential aspect of contemporary healthcare delivery. However, the rise in cost containment and quest for profitability in healthcare management is found to be compromising implementation of evidence-based initiatives aimed at improving care quality. Aims The aim of this work was to examine perspectives of nurses regarding the impact of bureaucratic managerialism on EBP implementation in the Nigerian acute care setting. Methods A qualitative case study methodology was utilised to gather data from two large acute care settings. Drawing on semi-structured interviews, 12 staff nurses, 21 ward managers and 2 nurse managers were interviewed. Data were inductively analysed and themes generated. Results The managerial practice in this context is founded on bureaucratic managerialism, which in turn generated hierarchical constraints that denied nurses the opportunity to self-govern. Implementation of evidence-based initiatives was consequently opposed by the managerial desire to maximise throughput. Conclusions There is need for nurse managers to have greater managerial influence, which would allow opportunities for implementing EBPs to be created. Managerial autonomy for nurse managers would allow them to create enabling environments capable of facilitating successful implementation.

scholarly journals How nurse manager’s position in the hospital hierarchy influences evidence-based practice implementation in nursing: A qualitative case study of the Nigerian acute care setting

2019 ◽  
Vol 9 (6) ◽  
pp. 14 ◽  
Author(s):  
Jude Ominyi ◽  
Chinwe Florence Samantha Ezeruigbo
Keyword(s):  
Acute Care ◽  
Nurse Managers ◽  
Evidence Based Practice ◽  
Qualitative Case Study ◽  
Healthcare Delivery ◽  
Successful Implementation ◽  
Evidence Based ◽  
Case Study Methodology ◽  
Objective Evidence

Background and objective: Evidence-based practice (EBP) is widely acknowledged as an essential aspect of healthcare delivery. Nurse managers are expected to contribute to the development of organisational cultures promoting EBP. However, there are indications that nurse managers are not necessarily empowered to drive implementation due to hierarchical constraints. This study explores how nurse manager’s position in the hospital hierarchy influences EBP implementation in nursing, in the Nigerian acute care settings.Methods: A qualitative case study methodology is utilised to gather data from two large acute care settings in Nigeria. Drawing on semi-structured interview, twenty-one ward managers and two nurse managers were interviewed. Data were transcribed and inductively analysed to generate four overarching themes.Results: Nurse managers were hugely constrained by lack of autonomy to mobilise resources for EBP related activities. The hierarchical structure of the settings promoted top-down decision-making processes which in turn, limited nurse manager’s visibility in the boardroom. Consequently, nurse managers were excluded from key strategic planning within the organisation and could not drive EBP implementation.Conclusions: Findings highlight need for nurse managers to have greater visibility and managerial influence to enable them create opportunities for implementation of EBP in nursing. Implications for nursing management: Administratively, there is need for nurses to have greater involvement in management. Adequate authority and leadership visibility as well as managerial influence would enable nurse managers create opportunities for successful implementation.

scholarly journals Experiences of nurses implementing evidence-based practice in an acute care setting in Nigeria: A qualitative study

2019 ◽  
Vol 7 (4) ◽  
pp. 54
Author(s):  
Jude N. Ominyi ◽  
David A. Agom ◽  
Chukwuma N. Anyigor ◽  
Aaron B. Nwedu ◽  
Simon N. Onwe
Keyword(s):  
Acute Care ◽  
Care Setting ◽  
Nurse Managers ◽  
Evidence Based Practice ◽  
Staff Nurses ◽  
Evidence Based ◽  
Acute Care Setting ◽  
Face To Face ◽  
Implementation Processes ◽  
Ebp Implementation

Background: Evidence-based practice (EBP) is widely recognised as being relevant in improving nursing care. However, its implementation in nursing practice has been difficult for nurses, particularly in the developing countries. Existing evidence suggests that bureaucracy in organisational governance impacts implementation processes, however, the nature of this effect is not yet explored. Objective: The study examined experiences of nursing staff implementing EBP in a bureaucratic acute care setting in Nigeria.Methods: A qualitative exploratory design was adopted. A purposive sample of 11 ward managers and 12 staff nurses from a large acute care setting in Nigeria participated in the in-depth, face-to-face interviews. Data was analysed using the thematic analysis approach.Results: Four key themes emerged: (1) top down managerial approach; (2) nurse and nurse manager relations; (3) managerial prerogatives; (4) managerial autonomy.Conclusions and implications for practice: The Nigerian bureaucracy limits professional and managerial autonomy that nurses require in driving EBP implementation. Nurse Managers require greater leadership visibility and structural empowerment to create enabling environment for EBP implementation in nursing.

Modernisation of Higher Education – Willful Action or Wishful Thinking? The Case of Bulgaria

2020 ◽  
Vol 8 (3) ◽  
pp. 3-17
Author(s):  
Elena Blagoeva
Keyword(s):  
Higher Education ◽  
Economic Crisis ◽  
Negative Impact ◽  
National Level ◽  
Sustainable Growth ◽  
Research Approach ◽  
Case Study Methodology ◽  
The Impact ◽  
The Eu

The impact of the last global economic crisis (2008) on the European economy put a strain on higher education (HE), yet it also pushed the sector towards intensive reforms and improvements. This paper focuses on the “Strategy for the Development of Higher Education in the Republic of Bulgaria 2014-2020”. With a case study methodology, we explore the strategic endeavours of the Bulgarian government to comply with the European directions and to secure sustainable growth for the HE sector. Our research question is ‘How capable is the Bulgarian HE Strategy to overcome the economic and systemic restraints of Bulgarian higher education?’. Because the development of strategies for HE within the EU is highly contextual, a single qualitative case study was chosen as the research approach. HE institutions are not ivory towers, but subjects to a variety of external and internal forces. Within the EU, this is obviated by the fact that Universities obtain their funds from institutions such as governments, students and their families, donors, as well as EU-level programmes. Therefore, to explore how these pressures interact to affect strategic action on national level, the case method is well suited as it enabled us to study the phenomena thoroughly and deeply. The paper suggests the actions proposed within the Strategy have the potential to overcome the delay, the regional isolation and the negative impact of the economic crisis on the country. Nevertheless, the key elements on which the success or failure of this Strategy hinges are the control mechanisms and the approach to implementation. Shortcomings in these two aspects of strategic actions in HE seem to mark the difference between gaining long-term benefits and merely saving face in front of international institutions.

scholarly journals Older and Wiser? The Need to Reexamine the Impact of Health Professionals Age and Experience on Competency-Based Practices

2021 ◽  
Vol 7 ◽  
pp. 237796082110290
Author(s):  
Jing Xu ◽  
Kristen Hicks-Roof ◽  
Chloe E. Bailey ◽  
Hanadi Y. Hamadi
Keyword(s):  
Health Professionals ◽  
Online Survey ◽  
Evidence Based Practice ◽  
Core Competencies ◽  
Healthcare Services ◽  
Interdisciplinary Teams ◽  
Evidence Based ◽  
Health Providers ◽  
Cross Sectional ◽  
The Impact

Introduction Delivery of healthcare services makes up a complex system and it requires providers to be competent and to be able to integrate each of the institute of medicine’s (IOM) 5 core competencies into practice. However, healthcare providers are challenged with the task to be able to understand and apply the IOM core competencies into practice. Objective The purpose of the study was to examine the factors that influence health professional’s likelihood of accomplishing the IOM core competencies. Methods A cross-sectional study design was used to administer a validated online survey to health providers. This survey was distributed to physicians, nursing professionals, specialists, and allied healthcare professionals. The final sample included 3,940 participants who completed the survey. Results The study findings show that younger health professionals more consistently practice daily competencies than their older counterparts, especially in the use of evidence-based practice, informatics, and working in interdisciplinary teams. Less experienced health professionals more consistently applied quality improvement methods but less consistently used evidence-based practice compared to their more experienced counterparts. Conclusion There is a need to understand how health professionals’ age and experience impact their engagement with IOM’s core competencies. This study highlights the need for educational resources on the competencies to be tailored to health providers’ age and experience.

A RANDOMIZED TRIAL TO MEASURE THE OPTIMAL ROLE OF THE PHARMACIST IN PROMOTING EVIDENCE-BASED ANTIBIOTIC USE IN ACUTE CARE HOSPITALS

2001 ◽  
Vol 17 (2) ◽  
pp. 171-180 ◽  
Author(s):  
George Dranitsaris ◽  
Diana Spizzirri ◽  
Monique Pitre ◽  
Allison McGeer
Keyword(s):  
Acute Care ◽  
Broad Spectrum ◽  
Randomized Clinical Trials ◽  
Intervention Group ◽  
Hospital Setting ◽  
Control Group ◽  
Evidence Based ◽  
Care Hospital ◽  
Broad Spectrum Antibiotics ◽  
The Impact

Background: There is a considerable gap between randomized clinical trials and implementing the results into practice. This is particularly relevant in the use of broad-spectrum antibiotics in hospitals. Hospital pharmacists can be effective vehicles for bridging this gap and promoting evidence-based medicine. To determine the most effective way of using the pharmacist in this role, a prospective cefotaxime intervention study was conducted with randomization incorporated into the design as well as patient-related therapeutic outcomes.Methods: A total of 323 patients who were prescribed cefotaxime were randomized into an intervention or nonintervention group where only the former was challenged by pharmacists for inappropriate cefotaxime usage relative to hospital guidelines. The primary outcome was the appropriateness of cefotaxime prescribing between groups. Logistic regression analysis was then used to identify factors that were associated with successful clinical response.Results: Overall, 94% of orders in the intervention group met cefotaxime dosage criteria compared with 86% in the control group (p = .018). However, there was no impact with respect to promoting cefotaxime use for an appropriate indication (81% vs. 80%; p = .67). There was a trend for improved clinical outcomes in patients who received cefotaxime within hospital guidelines (OR = 1.73; p = .31).Conclusions: The pharmacist as a vehicle for promoting the appropriate use of broad-spectrum antibiotics in the acute care hospital setting can improve the dosing of such agents. However, several barriers to optimizing the impact of the pharmacist were implied by the data. Removing these barriers could increase the pharmacists' utility as an agent for improved patient care.

scholarly journals Apprehensions of nurse managers on evidence-based practice

2017 ◽  
Vol 22 (1) ◽  
Author(s):  
Fernanda Carolina Camargo ◽  
Mayla Borges Goulart ◽  
Helena Hemiko Iwamoto ◽  
Maria Rizoneide Negreiros de Araújo ◽  
Divanice Contim
Keyword(s):  
Teaching Hospital ◽  
Diffusion Of Innovations ◽  
Nurse Managers ◽  
Evidence Based Practice ◽  
Scientific Production ◽  
Evidence Based ◽  
Semantic Categories ◽  
Timely Access ◽  
The Subject ◽  
Textual Records

Abstract Objective: To analyze the apprehensions of nurse managers in the implementation of the Evidence Based Practice in a Teaching Hospital of Triângulo Mineiro. Method: Qualitative research guided by the Theory of the Diffusion of Innovations. Five workshops were conducted per focal group (n = 18 participants), conducted by hermeneutic-dialectic interactions between August and September/2016. Textual records resulting from each workshop were analyzed by semantic categories. Results: Aspects conditioning to the implementation of the Evidence Based Practice permeate from elements related to the fragmentation of the care network to the necessary expansion of the governability of the nurse managers to put changes into practice in their sectors. Most importantly, timely access to the results of research conducted at the teaching hospital was mentioned as crucial to guide better practices. Final considerations: The approach allowed the recognition of contextual conditions for the implementation of the Evidence-Based Practice, which may coincide with similar scenarios, as well as increase the national scientific production on the subject, which is still scarce.

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