Evaluation of a leadership intervention for implementing recommendations for nursing care for people with diabetes and foot ulcers in community nursing practice

INTERVENTION: In addition to ?usual? implementation strategy, a 12 week strategy will be offered to mangers, supervisors, resource nurses, and two preceptor staff from each centre consisting of: 1. Mailed package of printed materials: study purpose; summary of recommendations, models of leadership and planned change; literature article; four questions related to assessing barriers to practice change. Review time: approx 15 ‐ 30 minutes. 2. Interactive workshop (7.5 hours) at SEHC Corporate Office. Content and structure will be tailored to results of phase one, tentatively planned to include: 2.1. Evidence and theory on leadership and implementing practice change 2.2. Focus group discussions about barriers to implementing change based on recommendations 2.3. Case study discussions 2.4. Role playing exercises 2.5. Games 2.6. Development of implementation plan for each centre tailored to identified barriers. Workshop will be facilitated by Co‐PI (WG); SEHC senior administrator (NL); and administrative/clinical staff from SEHC to be determined. 3. Post‐workshop teleconferences: (2, 6, and 10 weeks after workshop) to provide a forum for questions, discussions and networking amongst participants CONDITION: Diabetes/foot ulcers/knowledge translation ; Nutritional, Metabolic, Endocrine ; Unspecified diabetes mellitus PRIMARY OUTCOME: Nursing Assessments of Client Risk Factors Scores (NACRF), a composite score of 8 items based on recommendations from the Diabetes/Foot Ulcer guidelines. ; ; Timepoints for primary and secondary outcomes: 12 weeks following completion of the intervention, chart audits will be conducted on all patients being treated for diabetic foot ulcers. To understand the leadership and management behaviours that influenced nursing practice, semi structured qualitative interviews will be conducted 12 weeks following intervention strategy with managers, supervisors, resource nurses and staff nurses at control and experimental centres. SECONDARY OUTCOME: 1. Proportion of people with healed ulcers at 12 weeks (defined as complete wound closure); 2. Healing time, in number of weeks; 3. Types of treatments used (e.g., hydrogel dressings, sharp debridement, offloading devices); 4. Referral rates to specialists services; 5. Documented patient education; 6. Proportion clients assessed for all items in the NACRF scale (all‐or‐none measure); 7. Nursing participant satisfaction and perceived utility of elements of the intervention; ; Timepoints for primary and secondary outcomes: 12 weeks following completion of the intervention, chart audits will be conducted on all patients being treated for diabetic foot ulcers. To understand the leadership and management behaviours that influenced nursing practice, semi structured qualitative interviews will be conducted 12 weeks following intervention strategy with managers, supervisors, resource nurses and staff nurses at control and experimental centres. INCLUSION CRITERIA: 1. Service delivery centres with minimum number of clients with diabetes being treated for foot ulcers to satisfy sample size calculations 2. Chart audit: all adult clients (18 years or older) diagnosed with type 1 or type 2 diabetes that have been treated for a first or recurring foot ulcer(s) in the previous 6 months 3. Intervention: managers, supervisors, resource nurses and two staff nurses from each intervention site