Implementation Design of a Complex Nursing Intervention in Dutch Hospitals: A Methods Paper

Implementing complex nursing interventions can be challenging. The degree of fit between context and the intervention is essential in explaining whether the implementation succeeds or fails, how and to what extent the intervention achieves impact and whether interventions can be sustained or successfully translated from one context to another. We provide a comprehensive description of the design of the implementation of a complex nursing intervention, which is implemented in 12 cardiac surgery centres in the Netherlands. With this, we aim to enhance transparency and replicability about the method of the implementation and reflect on methodological choices. We follow general steps of implementation including (1) adapting evidence, (2) identifying barriers and facilitators, (3) tailoring implementation activities and (4) monitoring and evaluating. We chose a general predefined approach for support, measurements and feedback and combined this with a local tailored approach to enhance the fit between the intervention and its implementation context. For monitoring, we measured three implementation outcomes: barriers and facilitators, behaviours of involved professionals, which was guided by the COM-B model, and the fidelity of executing the intervention. Feedback based on the results of the measurements were returned to local project leaders to enhance the implementation strategy in each setting continuously. We made a clear distinction between implementation strategies at the general program level and the local project level. Through various measurements, in which behaviour change of professionals was central, feedback and mutual learning, we facilitated the implementation of a complex nursing intervention. We discuss methodological challenges about tailoring the implementation approach and providing feedback on the behaviour of professionals.