Table 4 Implementation components of included studies

Impetus for implementation

To redress the traditional student-teacher power imbalance and to help students and teacher re-consider and re-vision nursing

To make sense of the field of the use of telehealth technology in heart failure management

To make sense of disparate literature on what integrated care is, how it is experienced and how it is conceptualized

To improve care for patients with regard to pain and pain assessment

To understand nurses’ clinical reasoning about psychosocial interventions in order to improve the implementation of family interventions

To address cross cultural communication between residents and staff, one of the most challenging aspects of care in aged care homes

Implementation actions

Students and teacher agreed on mutual expectations and principles through approach taken in weekly discussions of novels, poetry, art, music, paintings, photographs. Specifically focused discussions and essays

Searched the literature using hermeneutic approach. Extracted key data, arguments and explanations.

Crafted a narrative synthesis of relevant key questions, theories, methods, findings and scholarly arguments. Surfaced tensions in the literature;

identified unanswered questions about implementing telehealth for heart failure

Conducted a hermeneutic literature review. Extracted “story lines” from each of the included papers, including the key questions, theories, arguments, and methods. Identified four perspectives, identified how integration must be understood as emerging from particular as well as common contexts

During focus group sessions, participants made a plan for treating patients in pain, made a decision about a pain assessment form. In the last two sessions participants evaluated the pain assessment form and further developed their work related to pain. All sessions started with feedback from actions from the previous session and participants decided together on way forward

No specific implementation actions

No specific implementation actions

Components influencing implementation

Mutually developed expectations and principles

Hermeneutic approach to searching literature and synthesizing

key questions, theories, methods, findings and scholarly arguments

Hermeneutic approach to searching and synthesizing literature on patient experience, concepts, strategies and contextual factors, and lines of argument

Participants’ joint action, reflection, and decision-making about the content and process of the change to be implemented

Nurses’ clinical reasoning processes

Organizational and structural conditions for change

Implementation steps

Specifically focused discussions, activities, and assignments

Informed implementation steps

Informed implementation steps

Working together, and collectively reflecting, participants planned, implemented and evaluated clinical actions and decisions

Informed implementation steps

Informed implementation steps

What are the main findings about implementation that were illuminated by the hermeneutic approach?

The hermeneutic approach fostered interpretive and critical understandings and new insights into previously taken-for-granted issues

The hermeneutic approach to the literature review allowed five tensions in the literature to be surfaced: heart failure as isolated condition vs one within multi-morbidities; intensive monitoring telehealth vs basic support; active self-managing patient of theory vs actual patients of experiential descriptions; biomedically focused practice vs patient experience practice; fixed vs agile telehealth programs. The tensions were key to explaining variation in uptake and sustainability of telehealth services

The hermeneutic approach to the literature review revealed tensions and gaps, including misalignment of professional and organizational efforts with patient experiences/expectations; mis-match between conceptual models and strategies to integrate care. Integrated care is also subject to political economy of health care and power relations. Integrated care can be better understood as an emergent set of practices shaped by the context than as an intervention that will achieve a pre-determined set of outcomes.

The hermeneutic approach worked to transfer knowledge into action. Participation and reflection improved professionals’ understanding of patients’ experiences, and changed attitudes and clinical actions, while creating a tool for further action.

Participants changed their understanding of their own professional identity and the group’s confidence and relationships changed in a positive manner

The hermeneutic approach of attending to context and to the patients story helped nurses to overcome attribution bias and improve clinical reasoning.

The critical hermeneutics approach enhanced understanding about social conditions. It illuminated cross cultural care and effective communication. It identified a key concept for addressing issues of structural power imbalance, cultural humility.

Implementation knowledge/outcome

Conceptual knowledge

Professional reorientation

Conceptual knowledge

Instrumental knowledge (hermeneutic approach to literature review)

Implementation knowledge

Conceptual knowledge

Instrumental knowledge (hermeneutic approach to literature review)

Implementation knowledge

Conceptual knowledge

Instrumental knowledge

Professional reorientation

Conceptual knowledge

Instrumental knowledge for subsequent practice

Professional reorientation

Conceptual knowledge

Knowledge for subsequent implementation