{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T18:24:38Z","timestamp":1787336678285,"version":"build-2736575974"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ester \u00c5sberg Lindbergs Foundation"},{"name":"Centre for Clinical Research in Dalarna"},{"name":"Magtarmfonden"},{"DOI":"10.13039\/501100007051","name":"Uppsala Universitet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007051","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To explore aspects of implementing a nurse-based outpatient follow-up intervention for patients with liver cirrhosis by means of experiences reported by registered nurses, physicians and managers employed at six study clinics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This explorative, qualitative and deductive study involved interviews with 29 healthcare professionals and managers about the implementation of the intervention. Repeated interviews were performed from 2018 to 2022. Directed content analysis was performed, based on a coding scheme from the PARiHS conceptual framework. Reporting followed the COREQ guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The analysis revealed 23 different factors that influenced implementation of the nurse-based intervention, which covered all PARiHS elements. Eleven factors reduced the likelihood of successful implementation, e.g., the randomised study design became a moral dilemma, lack of clarity, resources and supportive leaders in the organisation, unclear roles, and a fragile mandate for nurses to implement the intervention. Twelve factors improved the probability for implementation success. The intervention was deemed safe, relevant and in line with clinical goals. Managers could facilitate the nurses\u2019 role in the team, which supported the nurses\u2019 mandate and professional growth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In conclusion, implementation of nurse-based interventions is facilitated by simple procedures that can be performed independently by RNs but also by the fact that the interventions are considered valuable for the clinic concerned. Staff shortage is a barrier to clinical research, and a moral dilemma might be experienced when not all patients in need of extensive care can be randomized to the intervention. An adequate number of benefits are needed to drive the success of an implementation. The PARiHS conceptual framework includes relevant perspectives required to implement evidence-based nursing practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0356782","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T17:25:56Z","timestamp":1787333156000},"page":"e0356782","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Aspects of implementing a nurse-based follow-up of patients with liver cirrhosis: A qualitative study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0264-9992","authenticated-orcid":true,"given":"Maria","family":"Hjorth","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Forsberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"issue":"10308","key":"pone.0356782.ref001","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1016\/S0140-6736(21)01374-X","article-title":"Liver cirrhosis","volume":"398","author":"P Gines","year":"2021","journal-title":"Lancet"},{"issue":"9","key":"pone.0356782.ref002","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1007\/s10654-023-01028-x","article-title":"Incidence, prevalence and mortality of chronic liver diseases in Sweden between 2005 and 2019","volume":"38","author":"P Nasr","year":"2023","journal-title":"Eur J Epidemiol"},{"issue":"4","key":"pone.0356782.ref003","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0283611","article-title":"Feeling safe or falling through the cracks-Patients\u2019 experiences of healthcare in cirrhosis illness: A qualitative study","volume":"18","author":"M Hjorth","year":"2023","journal-title":"PLoS One"},{"issue":"5","key":"pone.0356782.ref004","doi-asserted-by":"crossref","first-page":"1983","DOI":"10.1002\/hep.25915","article-title":"New therapeutic paradigm for patients with cirrhosis","volume":"56","author":"EA Tsochatzis","year":"2012","journal-title":"Hepatology"},{"issue":"10","key":"pone.0356782.ref005","doi-asserted-by":"crossref","first-page":"4104","DOI":"10.1111\/jan.14930","article-title":"Secondary prevention of coronary heart disease: The effect of a nursing intervention using Cox\u2019s interaction model of client health behaviour","volume":"77","author":"Q Shen","year":"2021","journal-title":"J Adv Nurs"},{"issue":"8","key":"pone.0356782.ref006","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1177\/1474515118779732","article-title":"Effectiveness of interventions involving nurses in secondary stroke prevention: A systematic review and meta-analysis","volume":"17","author":"BP Parappilly","year":"2018","journal-title":"Eur J Cardiovasc Nurs"},{"key":"pone.0356782.ref007","doi-asserted-by":"crossref","first-page":"3625","DOI":"10.1111\/jocn.15416","article-title":"Self-management programmes for cirrhosis: A systematic review","volume":"29","author":"S Boudreault","year":"2020","journal-title":"J Clin Nurs"},{"issue":"7","key":"pone.0356782.ref008","article-title":"Efficacy of a chronic disease management model for patients with chronic liver failure","volume":"11","author":"AJ Wigg","year":"2013","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"1","key":"pone.0356782.ref009","doi-asserted-by":"crossref","first-page":"38","DOI":"10.3138\/canlivj-2020-0017","article-title":"Impact of specialized multidisciplinary care on cirrhosis outcomes and acute care utilization","volume":"4","author":"M Carbonneau","year":"2021","journal-title":"Can Liver J"},{"issue":"5","key":"pone.0356782.ref010","doi-asserted-by":"crossref","DOI":"10.1097\/HC9.0000000000000418","article-title":"A randomized controlled trial of a postdischarge nursing intervention for patients with decompensated cirrhosis","volume":"8","author":"M Barfod O\u2019Connell","year":"2024","journal-title":"Hepatol Commun"},{"issue":"3","key":"pone.0356782.ref011","first-page":"199","article-title":"Nurse-led clinics as an effective service for cardiac patients: results from a systematic review","volume":"9","author":"V Schadewaldt","year":"2011","journal-title":"Int J Evid Based 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