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Analysis of certain factors in the deffusion of innovations in nursing practice in the public general hospitals of the province of British Columbia Du Gas, Beverly Witter

Abstract

Literature on continuing education for members of the health professions has stressed that understanding of the diffusion process is fundamental to the development of sound educational programs. A review of the literature on diffusion suggests that the theoretical framework that has evolved concerning the transmission of information about new ideas and practices in other disciplines may be applied to nursing. The present study analyzes the process of diffusion as it functions in regard to changes in nursing practice in a selected segment of Canadian hospitals. Three aspects of diffusion are investigated: (1) the flow of new information in nursing through a network of hospitals; (2) factors affecting the adoption of new nursing practices; and (3) factors influencing delay in the adoption process, rejection of innovations, or their discontinuance following adoption. The population consisted of eighty-five public general hospitals in the province of British Columbia. An analytical survey method was used and the structured interview technique employed to gather data from the Director of Nursing of each hospital. Data relative to the flow of information were analyzed by calculating frequency and percentage distributions to assess the relative importance of sources of information used by the Directors of Nursing, and flow charts developed to illustrate the transmission of information through the network of hospitals. Characteristics of the hospitals, of the Directors of Nursing, of the hospital administrators, and of the nursing staffs, with emphasis on the first two, were studied relative to the adoption of nine new practices in nursing. The hospitals were divided into four categories, according to size. An adoption score for each hospital was computed, based on the stage in the adoption process reached by the nurses for each of the nine innovations. Using these scores, the hospitals were divided into four adopter categories and characteristics of the population related to these. Frequency and percentage distributions were again used to analyze factors influencing delay, rejection and discontinuance of innovations. Significant findings in regard to the sources of information used by nurses were (1) the importance of interpersonal communication with colleagues; (2) the high ranking of continuing education programs as an initial source of new knowledge; (3) the role of the hospital supply house salesman in disseminating information to nurses, and (4) the decreasing importance of impersonal sources in later stages of the adoption process. Two cycles of influence were shown to be operating in the flow of information to nurses in the province; the first deriving from the major teaching and research centers in Vancouver; the second, from the larger centrally located hospitals in districts of the province. Four sequential steps were identified in the transmission of information to nurses in British Columbia. The specific characteristics of the population which showed a relationship to adoption included: 1. Size , teaching status, geographic location, and accreditation of the hospital, 2. Age of the Director of Nursing, her marital status, academic preparation, professional nursing experience, extent of attendance at educational meetings, participation in professional nursing organizations, and subscription to nursing journals. 3. Professional preparation and prestige of the hospital administrator, 4. Relative age of the nursing staff. Factors influencing delay, rejection or discontinuance were shown to be related both to characteristics of the new practice and to characteristics of the individuals involved in making the decision to adopt innovations. From the findings of this study, it is evident that there is a serious problem in the communication of new information to nurses employed in public general hospitals in British Columbia. The problem is particularly acute in regard to the nurses in small hospitals. It is suggested that a step towards resolution of this problem might be the development of a 'systems' approach to continuing education for nurses. This approach could effectively utilize resources and facilities throughout the province and provide for coordination of all educational activities for nurses. An integral part of the system would be the development of information retrieval centers in nursing to supplement continuing education programs in the communication of scientific information to nursing practitioners. Areas suggested for further research include: an investigation of the flow of information through the social network of nurses within a hospital; an analysis of the in-service aspects of continuing education for nurses; a study of the role of change agents in nursing; the extent of the commercial salesman's influence on the adoption of nursing innovations; and research into various aspects of continuing education programs for nurses, such as an analysis of participants, the effectiveness of the short, continuing education course, and the design of effective methods of instruction.

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