Abstract / Summary
The relationship between organizational context and nurses’ implementation of clinical practice guidelines (CPGs) has been highlighted in previous studies. Although this relationship may be culture-bound, its specific details within Japanese culture are still unclear, and little is known about the relationship between organizational context and patient outcomes. Examining this relationship may help leverage existing knowledge and guide culturally appropriate strategies to advance evidence-based practice in Japan. Hence, this study aimed to describe nurses’ awareness and implementation of CPGs, and examine their relationship with organizational context and patient outcomes (i.e., incidence rate of pressure ulcers and Methicillin-resistant Staphylococcus aureus infection). A cross-sectional survey was conducted in five acute care hospitals in Japan. Data were collected through a questionnaire on nurses’ awareness and implementation of recommendations on CPGs related to pressure ulcers and infection controls, their perceptions of the organizational context using the Alberta Context Tool (ACT), and characteristics of hospitals/units/respondents, and patient outcomes. Data from 508 staff nurses were analyzed. Approximately 40% of the respondents responded that they were unaware of CPGs. The percentage of those who said they “always” implemented the recommendation ranged from 15.0% to 48.2%, depending on the recommendation. Several concepts of the ACT—Culture, Structural/Electronic Resources, Evaluation, and Staff—were positively associated with the implementation of recommendations. Additionally, Evaluation, Leadership, Staff, and Time from the concept of ACT were significantly associated with patient outcomes. This study suggests that a supportive work culture, application of data for assessing team performance, and utilization of more resources was associated with implementing CPGs in Japan. Each recommendation was associated with a different organizational context, suggesting that varied implementation approaches may be required for each recommendation. A good organizational context could be associated with improved patient outcomes.