Eva Joelsson-Alm

Aim(s) To explore first‐line managers' experience of guideline implementation in orthopaedic care during the COVID‐19 pandemic. Design A descriptive, qualitative study. Methods Semi‐structured interviews with 30 first‐line nursing and rehabilitation managers in orthopaedic healthcare at university, regional and local hospitals. The interviews were analysed by thematic analysis. Results First‐line managers described the implementation of guidelines related to the pandemic as different from everyday knowledge translation, with a swifter uptake and time freed from routine meetings in order to support staff in adoption and adherence. The urgent need to address the crisis facilitated guideline implementation, even though there were specific pandemic‐related barriers such as staffing and communication issues. An overarching theme, Hanging on to guidelines for dear life , is substantiated by three themes: Adapting to facilitate change , Anchoring safety through guidelines and Embracing COVID guidelines . Conclusion A health crisis such as the COVID‐19 pandemic can generate enabling elements for guideline implementation in healthcare, despite prevailing or new hindering components. The experience of guideline implementation during the COVID‐19 pandemic can improve understanding of context aspects that can benefit organizations in everyday translation of evidence into practice. Implications for the Profession and/or Patient Care Recognizing what enabled guideline implementation in a health crisis can help first‐line managers to identify local enabling context elements and processes. This can facilitate future guideline implementation. Impact During the COVID‐19 pandemic, the healthcare context and staff's motivation for guideline recognition and adoption changed. Resources and ways to bridge barriers in guideline implementation emerged, although specific challenges arose. Nursing managers can draw on experiences from the COVID‐19 pandemic to support implementation of new evidence‐based practices in the future. Reporting Method This study adheres to the EQUATOR guidelines by using Standards for Reporting Qualitative Research (SRQR). No Patient or Public Contribution.