Development of a clinical implementation framework for evidence-based practice guidelines in settings featuring...

This study aimed to develop a systematic framework for the clinical transformation and application of Best Practice Guidelines (BPGs) in Chinese healthcare contexts, thus providing a reference for the implementation of evidence-based nursing reform and practice.

From October to December 2024, a preliminary framework was developed based on a knowledge translation model, a systematic literature review, and 10 years of implementation experience as a Best Practice Spotlight Organization® (BPSO®) at Dongzhimen Hospital, Beijing University of Chinese Medicine. The preliminary framework was then refined through qualitative interviews with 12 multidisciplinary experts. Subsequently, from January to April 2025, the content validity of the preliminary framework was evaluated by 15 multidisciplinary experts using the Content Validity Index (CVI). Following this, the framework was revised and finalized through a focus group discussion involving 13 experts. In April 2025, this framework was implemented in the Department of Orthopedics at Dongzhimen Hospital, Beijing University of Chinese Medicine, taking pain management as the clinical application scenario. A total of 12 participants, including clinical physicians, nursing staff and methodological experts, were recruited to evaluate its clinical applicability and implementation feasibility.

The expert consultation results indicated good content validity of the framework, with an overall CVI of 0.88. The final framework comprises three concentric rings. The inner ring comprises three types of products derived from integrating Chinese and Western medical evidence-namely, evidence-based nursing protocols, locally adapted patient guidelines, and patient decision aids. The middle ring represents a seven-step, full-cycle implementation pathway that covers problem identification, evidence localization, barrier/facilitator assessment, intervention selection/adaptation/implementation, process monitoring, outcome evaluation, and sustainability maintenance. The outer ring comprises nine targeted intervention functions, including education, persuasion, incentivization, coercion, training, restriction, environmental restructuring, modeling, and enablement. In the preliminary application to orthopedic pain management, qualitative interviews revealed three themes: the three-ring structure provided clear guidance; the selection criteria for evidence products in the inner ring need further clarification; the intervention functions of the outer ring require more targeted practical guidance for implementation.

The framework developed in this study demonstrates strong scientific rigor and practical feasibility for BPG transformation in settings featuring integrative medicine, while preserving both evidence-based standards and the characteristics of traditional Chinese medicine (TCM). This framework can serve as both a theoretical and practical reference for healthcare institutions and researchers seeking to efficiently adapt international guidelines and promote standardized, evidence-based nursing practice.