Quality in acute stroke care (QASC) Europe - factors influencing international upscale of nurse-led stroke protocols in 64 european hospitals: a qualitative study.

Abstract

Background and aims: QASC Europe was a collaboration between academics, the European Stroke Organisation and the Angels Initiative. A before-after study evaluated the effect of nurse-led implementation of evidence-based stroke protocols on patient care in 64 European hospitals from 17 countries. A qualitative process evaluation sought to identify factors that influenced protocol implementation from multiple stakeholders' perspectives. Method(s): Focus groups and individual face-to-face videoconference interviews using a semi-structured interview guide. Purposive sampling to recruit interviewees from four stakeholder groups: 1) high-level project governance (senior project team and steering committee members); 2) Angels team leaders; 3) Angels consultants and 4) Stroke Nurse Country Co-ordinators. Interview transcripts were thematically analysed. Result(s): All 22 approached, consented and participated. Participant numbers: n=13 interviews (groups 1 and 2); n=9 across three focus groups (groups 3 and 4). Four themes represent factors that influenced protocol implementation: 1) negotiating expectations; 2) role clarity; 3) optimal communication and 4) ability to tailor and adapt processes. These themes underpin a cascading facilitation model that reflects the sequence of processes and support required for multi-country nurse-led protocol implementation. Stakeholders reported the following benefits: expanded skillsets in implementation science and clinical quality monitoring; nurse leadership in evidence translation; and progressing of national stroke nurse networks. Conclusion(s): A multi-layered collaborative partnership model of cascading facilitation enabled European stroke nurses to develop capability in leading and negotiating practice change at the hospital level. This model has potential for future international scale-up of other evidence translation initiatives.