Learning programme for on-the-job reflection on guideline use in district nursing practice: a protocol for an action research study

INTRODUCTION: The rising global demand for district nursing care necessitates effective strategies to support evidence-based decision-making. Despite the extensive development of nursing guidelines, adherence by district nursing teams remains suboptimal, revealing a gap between guideline development and daily practice. The Learning And Reflection for Nurses (LEARN) programme aims to bridge this gap by enhancing guideline use and fostering a learning attitude among district nursing teams. This protocol outlines the programme's development, components and evaluation approach.

METHODS AND ANALYSIS: An action research approach will be used to develop, adjust and evaluate the LEARN programme. The programme includes two interventions: a team-learning intervention focusing on guideline use and collective learning, and a leadership training intervention for district nurses to enhance their impact and role in adopting new knowledge. The team learning intervention will be sequentially deployed and evaluated in four district nursing teams across three care organisations, each lasting approximately 5 months. The leadership training will be conducted and evaluated in two cohorts, each lasting about 5 months. Participation in the team learning intervention requires at least one district nurse to participate in the leadership training. Each intervention will follow an action spiral structure, with learning outcomes from previous interventions carried over to the next. Data will be collected through observations, written reflections, focus groups and questionnaires via a mobile application. Data analysis will occur in two steps: parallel data collection and analysis during the intervention, followed by a longitudinal qualitative approach to identify learning processes over time and evaluate the intervention's impact.

ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Ethical Committee Research of the HU University of Applied Sciences Utrecht (reference numbers 165-001-2022 and 157-001-2022). Findings will be disseminated continuously throughout the research via workshops, presentations and summary documents for district nurses and their teams, care organisations, strategic policymakers and the academic community.