CARTER, JOAN KATHRYN; PHD

                         THE UNIVERSITY OF IOWA, 1995
                         HEALTH SCIENCES, NURSING (0569)

                         The purpose of this investigation was to study the implementation of the Nursing Interventions
                         Classification (NIC) in five clinical sites. A prospective design was used to (a) determine the strategies
                         used to introduce the Classification, (b) identify issues that emerged, and (c) provide guidelines
                         facilitating smooth implementation in other agencies. Rogers' model of diffusion of innovations in
                         organizations provided the conceptual framework for the conduction of the study. Data collection
                         included recording participant interviews at each site, recording group meetings, and analyzing all listserv
                         transactions. Key individuals in each setting were interviewed at the start of the implementation process,
                         midway during the study, and immediately before the study was completed. These key individuals
                         included: (a) the decision-maker for adopting NIC at each site, (b) the on-site coordinator, (c) the college
                         liaison, and (d) four staff nurses, two selected for positive reaction to the implementation and two
                         selected for negative reaction. Informed consent was obtained from the Institutional Review Boards at
                         each site. In addition, consent forms were signed for each interview by each interviewee. Ethnograph, a
                         computer program for the analysis of text based data, was used for coding and organizing the data.
                         Inter-rater reliability was established by having two persons review 10% of the interview and meeting
                         transcriptions. The inter-rater reliability was 86.5% and 93%. Intra-rater reliability was 96%. The 86
                         interviews provided code words which were collapsed into 11 broad categories: decision to adopt,
                         efficiency of nursing work, enhancing the work of nursing, planning strategies, interactive strategies,
                         positive reaction, negative reaction, changing practice, documentation, information dissemination, and
                         environmental influences. The findings show that the communications channels used to process
                         information and leadership were key strategies for successful implementation. The derived benefits of
                         using NIC showed a change (negative to positive) as nurses started using NIC. Two major themes
                         emerged showing that the use of NIC increased efficiency and demonstrated effectiveness of nursing
                         care. Documentation was the dominant issue for users. The guidelines developed by the principal
                         investigators of the larger study were corroborated by this study.


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