Handling a challenging context: experiences of facilitating evidence-based elderly care.

AIM To explore improvement facilitators' experiences of handling their commission to implement evidence-based practice in elderly care for frail older persons. BACKGROUND Improvement facilitators were put in place across Sweden in a time-limited project by the government, with one part of the project being to evaluate the model before establishing this facilitation of evidence-based practice in elderly care. METHOD Two focus groups were interviewed twice. Each group comprised three respondents. The interviews were analysed using qualitative content analysis. FINDINGS A main theme, 'Moving forward by adjusting to the circumstances', described how the improvement facilitators handle their commitment. Five subthemes emerged: identifying barriers, keeping focus, maintaining motivation, building bridges and finding balance. CONCLUSION The improvement facilitators' commitment is ambiguous because of unclear leadership of, and responsibility for the national investment. They have to handle leaders' different approaches and justify the need for evidence-based practice. The improvement facilitators did not reflect on the impact of programme adaptations on evidence-based practice. IMPLICATIONS FOR NURSING MANAGEMENT The findings emphasise the need for collaboration between the improvement facilitator and the nurse manager. To fully implement evidence-based practice, negotiations with current practitioners for adaptation to local conditions are necessary. Furthermore, the value of improving organisational performance needs to be rigorously communicated throughout the organisation.