Utilising Practice Development and the PARIHS Framework to Implement the Liverpool Care Pathway

The LCP is an evidence-based integrated care pathway that provides guidance to generic health care professionals to deliver best practice end-of-life care. My role as the LCP Project Coordinator in a District Health Board in New Zealand is central to the exploration of this process of implementing practice change. Working with clinicians to advance effective care and management of patients during the process of dying in an acute hospital setting requires not only knowledge and understanding of the clinical pathway and evidence supporting best practice, but also careful working with cultural and contextual change. This paper descriptively addresses the bases of both components, and provides a case example of the development. Working with health care professionals to bring about practice change is complex and challenging. Successful implementation of evidence in practice is dependant not only on the strength and nature of the evidence, but also the context and models of facilitation. Practice development (PD) methodology informs the realities and complexities of practice change and of achieving sustainable development. The 'Promoting Action in Research Implementation in Health Services' (PARIHS) framework identifies the interplay and interdependence of factors that resonate with the reality of the complexity of practice change in relation to the evidence and best practice for particular clinical contexts. Highlighting PD processes and the relevance of the PARIHS framework alongside real-time practice change will continue to stimulate recognition of change and development complexities and bring consideration of these as robust methods for working between the theory and implementation of evidence in practice.