The role of stroke nurse country coordinators in the Quality in Acute Stroke Care (QASC) Europe evidence translation project: results from a process evaluation.

Abstract

Introduction: A unique international collaboration between the Nursing Research Institute (NRI); Australian Catholic University; European Stroke Organisation and Angels Initiative evaluated the implementation of nurseinitiated evidence-based protocols for fever, hyperglycaemia (sugar) and swallowing (FeSS) in 64 European stroke services in 17 countries. As part of a qualitative process evaluation to identify factors influencing protocol facilitation, the role of nurse country co-ordinators in implementation was explored. Method(s): Focus groups and individual videoconference semi-structured interviews were audiotaped. Purposive sampling recruited: i) high-level project governance representatives (clinicians, researchers; industry executives); ii) Angels Initiative team leaders; iii) Angels Initiative consultants and iv) Stroke nurse country co-ordinators. Transcripts were thematically analysed. Result(s): Participant numbers were: n=12 interviews and n=5 in each of two focus groups. There were five themes: 1) negotiating expectations; 2) roles and responsibilities; 3) readiness for change; 4) communication systems and 5) tailoring and adapting implementation processes. These themes reflect that country-level nurses had to manage multi-level changes, relationships and processes in order to negotiate and facilitate practice changes. For many nurses this was the first time that a nurse, rather than medical staff, had led stroke practice change and been involved in a research project. Discussion(s): Participation in the project had positive impacts on nursing by: raising the profile of nursing in evidence translation within hospitals and countries where nurses had previously not been involved in leading evidence translation; boosting efforts to build country stroke nursing networks and to share knowledge with counterparts in other countries; and highlighting how care for patients with stroke can be improved by nurseled protocols.