Building the Ship While Sailing: A Qualitative Evidence Synthesis of the Implementation of Nursing Care Delivery Models in a Hospital Setting

AIM: To explore factors influencing the implementation of a nursing care delivery model in a hospital setting. DESIGN: A qualitative evidence synthesis with a thematic synthesis was conducted. METHODS: The search string consisted of four 'cluster topics': (1) nursing, (2) care delivery models, (3) hospital setting, (4) qualitative and mixed methods designs. Four electronic databases were searched from January 2000 until July 2024: MEDLINE (PubMed interface), Embase (embase.com interface), CINAHL (EBSCOhost interface) and Web of Science. A thematic synthesis was conducted consisting of the following steps; the 'line-by-line' coding of the text, the development and allocation of 'descriptive themes' and the generation of 'analytical themes'. RESULTS: In total, 3976 references were screened, of which 25 were included in the qualitative evidence synthesis. Eight analytical themes were generated that influence the implementation of a nursing care delivery model in a hospital setting: shared understanding of the care delivery model, ownership of the change, scope of practice and role clarity, collaboration, communication, responsibility, a double-loop process and aggregated recommendations. The themes were categorised on four different levels: vision, process, interactional factors and contextual factors. CONCLUSION: The eight themes identified in this qualitative evidence synthesis showed that during the implementation of a nursing care delivery model, a clear implementation strategy is often missing. It is advised that future implementation processes have a clear guide and goal. IMPACT: The analytical themes can guide the future implementation of a new nursing care delivery model in a hospital setting. This review can support nurses, researchers, hospital management and policymakers when implementing organisational alternatives to reorganise nursing care in a hospital setting. REPORTING METHOD: The qualitative evidence synthesis was reported according to the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) statement. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.