Aspects of implementing a nurse-based follow-up of patients with liver cirrhosis: A qualitative study

To explore aspects of implementing a nurse-based outpatient follow-up intervention for patients with liver cirrhosis by means of experiences reported by registered nurses, physicians and managers employed at six study clinics.

This explorative, qualitative and deductive study involved interviews with 29 healthcare professionals and managers about the implementation of the intervention. Repeated interviews were performed from 2018 to 2022. Directed content analysis was performed, based on a coding scheme from the PARiHS conceptual framework. Reporting followed the COREQ guidelines.

The analysis revealed 23 different factors that influenced implementation of the nurse-based intervention, which covered all PARiHS elements. Eleven factors reduced the likelihood of successful implementation, e.g., the randomised study design became a moral dilemma, lack of clarity, resources and supportive leaders in the organisation, unclear roles, and a fragile mandate for nurses to implement the intervention. Twelve factors improved the probability for implementation success. The intervention was deemed safe, relevant and in line with clinical goals. Managers could facilitate the nurses' role in the team, which supported the nurses' mandate and professional growth.

In conclusion, implementation of nurse-based interventions is facilitated by simple procedures that can be performed independently by RNs but also by the fact that the interventions are considered valuable for the clinic concerned. Staff shortage is a barrier to clinical research, and a moral dilemma might be experienced when not all patients in need of extensive care can be randomized to the intervention. An adequate number of benefits are needed to drive the success of an implementation. The PARiHS conceptual framework includes relevant perspectives required to implement evidence-based nursing practice.