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The implementation of evidence-based guidelines for the prevention and appropriate management of postpartum hemorrhage significantly decreases maternal morbidity and mortality. However, postpartum hemorrhage evidence-based guidelines are not optimally adhered to. This study aimed to examine individual- and organizational-level factors and the interaction effects that explain the implementation of evidence-based practice for PPH management among nurse-midwives. A multi-stage sampling technique was used in this cross-sectional study to recruit 298 nurse-midwives from 50 delivery rooms of community hospitals in Thailand between March to June 2019. Data were collected through seven self-administered questionnaires including a Demographic questionnaire, Evidence-Based Practice Implementation Activity for Postpartum Hemorrhage Management scale, Organizational Support scale, Implementation Climate Scale, Individual Innovativeness scale, Perceived Characteristics of Guidelines scale, and BARRIERS Scale. Descriptive statistics and multilevel modeling analysis were carried out to analyze the data.
The results revealed the factors that significantly influenced the implementation of evidence-based practice at the level of an individual nurse-midwife were years of experience, personal innovativeness, perceived barriers, and perceived characteristics of guidelines, and the organizational level factors were being a large community hospital and organizational climate. Individual nurse level factors significantly accounted for 68%of the variance in the implementation of evidence-based practice while organizational level factors accounted for 32% of the variance. There was an interactive effect between individual- and organization-level variables. The results of this study suggest that nurse administrators should develop a strategy to promote the adherence of evidence-based practice guidelines among nurse-midwives by decreasing their perceived barriers and establishing an organizational climate of evidence-based implementation.
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