Implementation science: issues of fidelity to consider in community nursing

Programme implementation is a complex process, and literature around the area of implementation science is growing, particularly with respect to programme fidelity (Dusenbury et al, 2003; Carroll et al, 2007). This paper draws on the findings from an evaluation in one area involving restructuring of the Public Health Nursing service from a generalist, geographically based service, to a team-based specialist approach. From this evaluation, it is clear that careful consideration must be given to a number of key issues that could arise in moving from a pilot project to a more mainstream or widescale implementation. These issues could relate to workforce planning; the role of the team leader; formation, maintenance, and development of teams; expertise and knowledge, including knowledge of local communities; active caseload management; continuity across a range of areas; alignment with primary care teams; co-location; and the need for support, particularly in the IT infrastructure.