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Lee SJS, Tan MP, Mat S, Singh DKA, Saedon N, Aravindhan K, Xu XJ, Ramasamy K, Majeed ABA, Khor HM. Predictive value of the World falls guidelines algorithm within the AGELESS-MELoR cohort. Arch Gerontol Geriatr 2024; 125:105523. [PMID: 38878671 DOI: 10.1016/j.archger.2024.105523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 05/21/2024] [Accepted: 06/05/2024] [Indexed: 07/13/2024]
Abstract
AIM The World Falls Guidelines (WFG) Task Force published a falls risk stratification algorithm in 2022. However, its adaptability is uncertain in low- and middle-income settings such as Malaysia due to different risk factors and limited resources. We evaluated the effectiveness of the WFG risk stratification algorithm in predicting falls among community-dwelling older adults in Malaysia. METHODS Data from the Malaysian Elders Longitudinal Research subset of the Transforming Cognitive Frailty into Later-Life Self-Sufficiency cohort study was utilized. From 2013-2015, participants aged ≥55 years were selected from the electoral rolls of three parliamentary constituencies in Klang Valley. Risk categorisation was performed using baseline data. Falls prediction values were determined using follow-up data from wave 2 (2015-2016), wave 3 (2019) and wave 4 (2020-2022). RESULTS Of 1,548 individuals recruited, 737 were interviewed at wave 2, 858 at wave 3, and 742 at wave 4. Falls were reported by 13.4 %, 29.8 % and 42.9 % of the low-, intermediate- and high-risk groups at wave 2, 19.4 %, 25.5 % and 32.8 % at wave 3, and 25.8 %, 27.7 % and 27.0 % at wave 4, respectively. At wave 2, the algorithm generated a sensitivity of 51.3 % (95 %CI, 43.1-59.2) and specificity of 80.1 % (95 %CI, 76.6-83.2). At wave 3, sensitivity was 29.4 % (95 %CI, 23.1-36.6) and specificity was 81.6 % (95 %CI, 78.5-84.5). At wave 4, sensitivity was 26.0 % (95 %CI, 20.2-32.8) and specificity was 78.4 % (95 %CI, 74.7-81.8). CONCLUSION The algorithm has high specificity and low sensitivity in predicting falls, with decreasing sensitivity over time. Therefore, regular reassessments should be made to identify individuals at risk of falling.
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Affiliation(s)
- Soo Jin Sherry Lee
- Department of Medicine, Faculty of Medicine, University of Malaya 50603 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya 50603 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia; Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Bandar Sunway 47500 Petaling Jaya, Selangor, Malaysia
| | - Sumaiyah Mat
- Centre for Healthy Ageing & Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia 50300 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Devinder Kaur Ajit Singh
- Centre for Healthy Ageing & Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia 50300 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Nor'Izzati Saedon
- Department of Medicine, Faculty of Medicine, University of Malaya 50603 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Kiirtaara Aravindhan
- Department of Medicine, Faculty of Medicine, University of Malaya 50603 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Xiang Jiang Xu
- Department of Medicine, Faculty of Medicine, University of Malaya 50603 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Kalavathy Ramasamy
- Faculty of Pharmacy, Universiti Teknologi MARA(UiTM) Cawangan Selangor, Kampus Puncak Alam 42300 Bandar Puncak Alam, Selangor Darul Ehsan, Malaysia
| | - Abu Bakar Abdul Majeed
- Faculty of Pharmacy, Universiti Teknologi MARA(UiTM) Cawangan Selangor, Kampus Puncak Alam 42300 Bandar Puncak Alam, Selangor Darul Ehsan, Malaysia
| | - Hui Min Khor
- Department of Medicine, Faculty of Medicine, University of Malaya 50603 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia.
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Randell R, McVey L, Wright J, Zaman H, Cheong VL, Woodcock DM, Healey F, Dowding D, Gardner P, Hardiker NR, Lynch A, Todd C, Davey C, Alvarado N. Practices of falls risk assessment and prevention in acute hospital settings: a realist investigation. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-194. [PMID: 38511977 DOI: 10.3310/jwqc5771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Background Falls are the most common safety incident reported by acute hospitals. The National Institute of Health and Care Excellence recommends multifactorial falls risk assessment and tailored interventions, but implementation is variable. Aim To determine how and in what contexts multifactorial falls risk assessment and tailored interventions are used in acute National Health Service hospitals in England. Design Realist review and multisite case study. (1) Systematic searches to identify stakeholders' theories, tested using empirical data from primary studies. Review of falls prevention policies of acute Trusts. (2) Theory testing and refinement through observation, staff interviews (n = 50), patient and carer interviews (n = 31) and record review (n = 60). Setting Three Trusts, one orthopaedic and one older person ward in each. Results Seventy-eight studies were used for theory construction and 50 for theory testing. Four theories were explored. (1) Leadership: wards had falls link practitioners but authority to allocate resources for falls prevention resided with senior nurses. (2) Shared responsibility: a key falls prevention strategy was patient supervision. This fell to nursing staff, constraining the extent to which responsibility for falls prevention could be shared. (3) Facilitation: assessments were consistently documented but workload pressures could reduce this to a tick-box exercise. Assessment items varied. While individual patient risk factors were identified, patients were categorised as high or low risk to determine who should receive supervision. (4) Patient participation: nursing staff lacked time to explain to patients their falls risks or how to prevent themselves from falling, although other staff could do so. Sensitive communication could prevent patients taking actions that increase their risk of falling. Limitations Within the realist review, we completed synthesis for only two theories. We could not access patient records before observations, preventing assessment of whether care plans were enacted. Conclusions (1) Leadership: There should be a clear distinction between senior nurses' roles and falls link practitioners in relation to falls prevention; (2) shared responsibility: Trusts should consider how processes and systems, including the electronic health record, can be revised to better support a multidisciplinary approach, and alternatives to patient supervision should be considered; (3) facilitation: Trusts should consider how to reduce documentation burden and avoid tick-box responses, and ensure items included in the falls risk assessment tools align with guidance. Falls risk assessment tools and falls care plans should be presented as tools to support practice, rather than something to be audited; (4) patient participation: Trusts should consider how they can ensure patients receive individualised information about risks and preventing falls and provide staff with guidance on brief but sensitive ways to talk with patients to reduce the likelihood of actions that increase their risk of falling. Future work (1) Development and evaluation of interventions to support multidisciplinary teams to undertake, and involve patients in, multifactorial falls risk assessment and selection and delivery of tailored interventions; (2) mixed method and economic evaluations of patient supervision; (3) evaluation of engagement support workers, volunteers and/or carers to support falls prevention. Research should include those with cognitive impairment and patients who do not speak English. Study registration This study is registered as PROSPERO CRD42020184458. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129488) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 5. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Rebecca Randell
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Lynn McVey
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Hadar Zaman
- Faculty of Life Sciences, University of Bradford, Bradford, UK
| | | | | | | | - Dawn Dowding
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Peter Gardner
- Wolfson Centre for Applied Health Research, Bradford, UK
- Faculty of Life Sciences, University of Bradford, Bradford, UK
| | - Nicholas R Hardiker
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Alison Lynch
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Chris Todd
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | | | - Natasha Alvarado
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
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Alvarado N, McVey L, Wright J, Healey F, Dowding D, Cheong VL, Gardner P, Hardiker N, Lynch A, Zaman H, Smith H, Randell R. Exploring variation in implementation of multifactorial falls risk assessment and tailored interventions: a realist review. BMC Geriatr 2023; 23:381. [PMID: 37344760 DOI: 10.1186/s12877-023-04045-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/16/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Falls are the most common safety incident reported by acute hospitals. In England national guidance recommends delivery of a multifactorial falls risk assessment (MFRA) and interventions tailored to address individual falls risk factors. However, there is variation in how these practices are implemented. This study aimed to explore the variation by examining what supports or constrains delivery of MFRAs and tailored interventions in acute hospitals. METHODS A realist review of literature was conducted with searches completed in three stages: (1) to construct hypotheses in the form of Context, Mechanism, Outcome configurations (CMOc) about how MFRAs and interventions are delivered, (2) to scope the breadth and depth of evidence available in Embase to test the CMOcs, and (3) following prioritisation of CMOcs, to refine search strategies for use in multiple databases. Citations were managed in EndNote; titles, abstracts, and full texts were screened, with 10% independently screened by two reviewers. RESULTS Two CMOcs were prioritised for testing labelled: Facilitation via MFRA tools, and Patient Participation in interventions. Analysis indicated that MFRA tools can prompt action, but the number and type of falls risk factors included in tools differ across organisations leading to variation in practice. Furthermore, the extent to which tools work as prompts is influenced by complex ward conditions such as changes in patient condition, bed swaps, and availability of falls prevention interventions. Patient participation in falls prevention interventions is more likely where patient directed messaging takes individual circumstances into account, e.g., not wanting to disturb nurses by using the call bell. However, interactions that elicit individual circumstances can be resource intensive and patients with cognitive impairment may not be able to participate despite appropriately directed messaging. CONCLUSIONS Organisations should consider how tools can be developed in ways that better support consistent and comprehensive identification of patients' individual falls risk factors and the complex ward conditions that can disrupt how tools work as facilitators. Ward staff should be supported to deliver patient directed messaging that is informed by their individual circumstances to encourage participation in falls prevention interventions, where appropriate. TRIAL REGISTRATION PROSPERO: CRD42020184458.
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Affiliation(s)
- Natasha Alvarado
- Wolfson Centre for Applied Health Research, Bradford, UK.
- University of Bradford, Bradford, UK.
| | - Lynn McVey
- Wolfson Centre for Applied Health Research, Bradford, UK
- University of Bradford, Bradford, UK
| | - Judy Wright
- University of Leeds, Leeds, West Yorkshire, UK
| | | | | | | | - Peter Gardner
- Wolfson Centre for Applied Health Research, Bradford, UK
- University of Bradford, Bradford, UK
| | | | - Alison Lynch
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Heather Smith
- Leeds Office of NHS West Yorkshire Integrated Care, Leeds, UK
| | - Rebecca Randell
- Wolfson Centre for Applied Health Research, Bradford, UK
- University of Bradford, Bradford, UK
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Kuş B, Büyükyılmaz F, Ardıç A. Comparison of three fall risk assessment tools in older hospitalized patients in Turkey: analysis of sensitivity and specificity. Aging Clin Exp Res 2023; 35:1033-1041. [PMID: 36859749 DOI: 10.1007/s40520-023-02369-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/15/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND As a result of falls, older patients experience injury and loss of function, and their length of hospital stay and care costs increase. AIM This study was conducted to determine fall risks and compare the sensitivity and specificity of three fall risk assessment tools. METHODS Older patients' fall risk levels were determined according to the Itaki, Hendrich-II, and Morse tools within 2 h following their admission to the wards. A methodological design was used in the study, which included 388 hospitalized elderly patients. The mean age of the patients was 72.29 ± 5.6 years, and 57.7% were female. RESULTS According to the ROC curve values of Sensitivity and 1-Specificity, the cut-off points for the Hendrich-II, Itaki, and Morse fall tools were accepted as 27.5, 8.5, and 6.5, respectively. According to the analysis results, the ratios of the areas under the ROC curve for the Itaki, Morse, and Hendrich-II fall tools were 0.794, 0.773, and 0.724, respectively, which were found to be statistically significant for all three tools (p ≤ 0.001). CONCLUSIONS The Itaki Fall Risk Tool was found to be the most sensitive one among the three instruments in assessing the fall risk of older hospitalized patients. The Itaki Fall Risk Tool was followed by the Morse and Hendrich-II tools, respectively, in terms of sensitivity.
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Affiliation(s)
- Betül Kuş
- Department of Nursing, Health Sciences Faculty, Yozgat Bozok University, Yozgat, Turkey.
| | - Funda Büyükyılmaz
- Department of Fundamentals of Nursing, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Aysun Ardıç
- Department of Public Health Nursing, Florence Nightingale Faculty of Nursing, Istanbul-Cerrahpaşa University, Istanbul, Turkey
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Salma I, Waelli M. Mapping research findings on change implementation in nursing practice: A scoping literature review. Nurs Open 2022; 10:450-468. [PMID: 36112719 PMCID: PMC9834520 DOI: 10.1002/nop2.1369] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/20/2022] [Accepted: 08/30/2022] [Indexed: 01/16/2023] Open
Abstract
AIMS The aim of this study was to map the diverse factors impacting change implementation in nursing practices and investigate different implementation strategies. DESIGN Scoping literature review following PRISMA-ScR extension. METHODS Data were collected from PubMed, Ebsco, Scopus and ScienceDirect databases from 1990 onwards. Only English peer-reviewed studies reporting an implementation of change in nursing practice were included. Of 9,954 studies, 425 abstracts were scanned and 98 full-text articles were screened. Finally, 28 studies were selected. RESULTS A multifaceted approach, with a tailored intervention, was the most effective implementation strategy. Most identified factors were considered systematic, for example resource availability, leadership and knowledge. However, others related to local social and material context were identified in fewer number of studies. These seem to be operational elements for implementation processes. Both types of factors are essential and must be considered for successful implementation. CONCLUSION We advocate the development of framework including systematic factors and which capture the local context flexibility.
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Affiliation(s)
- Israa Salma
- École des Hautes Etudes en Santé PubliqueInserm U 1309‐RSMS, CNRS UMR 6051 ‐ ARENESRennesFrance
| | - Mathias Waelli
- École des Hautes Etudes en Santé PubliqueInserm U 1309‐RSMS, CNRS UMR 6051 ‐ ARENESRennesFrance,Global Health InstituteGeneva UniversityGeneveSwitzerland
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6
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Sattar S, Haase KR, Milisen K, Campbell D, Kim SJ, Chalchal H, Kenis C. Oncology clinic nurses' attitudes and perceptions regarding implementation of routine fall assessment and fall risk screening: A survey study. Can Oncol Nurs J 2021; 31:367-375. [PMID: 34786454 PMCID: PMC8565430 DOI: 10.5737/23688076314367375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Falls in older adults with cancer are often under-recognized and under-reported. The objective of this study was to explore oncology clinic nurses' willingness and perceived barriers to implement routine falls assessment and falls screening in their practice. Nurses working in outpatient oncology clinics were invited to complete an online survey. Data were analyzed using descriptive statistics and sorted into thematic categories. The majority of respondents indicated willingness to routinely ask older patients about falls (85.7%) and screen for fall risks (73.5%). The main reasons for unwillingness included: belief that patients report falls on their own, lack of time, and lack of support staff. Findings from this study show many oncology nurses believe in the importance of routine fall assessment and screening and are willing to implement them routinely, although falls are not routinely asked about or assessed. Future work should explore strategies to address barriers nurses face given the implications of falls amongst this vulnerable population.
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Affiliation(s)
| | - Kristen R Haase
- School of Nursing, University of British Columbia, Vancouver, BC
| | - Koen Milisen
- Department of Geriatrics, University Hospitals Leuven, Leuven, Belgium & Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Diane Campbell
- College of Nursing, University of Saskatchewan, Saskatoon, SK
| | - Soo Jung Kim
- Geriatrics Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Haji Chalchal
- College of Medicine, University of Saskatchewan; Saskatchewan Cancer Agency, Regina, SK
| | - Cindy Kenis
- University Hospitals Leuven, Leuven, Belgium
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Sattar S, Haase KR, Milisen K, Campbell D, Kim SJ, Chalchal H, Kenis C. Évaluation systématique des chutes et du risque de chutes : Sondage sur l’attitude et les perceptions des infirmières cliniques en oncologie. Can Oncol Nurs J 2021; 31:376-385. [PMID: 34786455 PMCID: PMC8565442 DOI: 10.5737/23688076314376385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Chez les personnes âgées atteintes de cancer, les chutes sont un problème souvent sous-estimé et peu rapporté. La présente étude visait à explorer la volonté des infirmières cliniques en oncologie à évaluer et à dépister systématiquement les chutes dans leur pratique; l’étude examinait également les obstacles perçus à l’évaluation et au dépistage systématique. Les infirmières ont donc été invitées à remplir un sondage en ligne. Les données ont été analysées à l’aide de statistiques descriptives. La majorité des infirmières ayant répondu ont dit qu’elles accepteraient de poser systématiquement des questions sur les chutes (85,7 %) et de dépister les risques de chutes (73,5 %) chez les personnes âgées. Voici les principales raisons des réticences : conviction que les patients signalent les chutes d’euxmêmes, manque de temps, pénurie de personnel de soutien. Selon les résultats de l’étude, beaucoup d’infirmières en oncologie trouvent important d’évaluer et de dépister systématiquement les chutes, et sont d’accord pour l’intégrer à leur pratique bien que, d’habitude, les chutes ne fassent pas automatiquement l’objet de questions ou d’une évaluation. Étant donné les conséquences des chutes sur ces patients vulnérables, la recherche à venir devra explorer les stratégies permettant de surmonter les obstacles auxquels se butent les infirmières.
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Affiliation(s)
- Schroder Sattar
- Collège des sciences infirmières, Université de la Saskatchewan, Regina, SK
| | - Kristen R Haase
- École des sciences infirmières, Université de la Colombie-Britannique, Vancouver, BC
| | - Koen Milisen
- Département de gériatrie, Hôpital universitaire de Louvain, Louvain, Belgique, et Département de santé publique et de soins primaires, Centre universitaire de sciences infirmières et de pratique sagefemme, KU Leuven, Louvain, Belgique
| | - Diane Campbell
- Collège des sciences infirmières, Université de la Saskatchewan, Regina, SK
| | - Soo Jung Kim
- Service de gériatrie, Centre de cancérologie Memorial Sloan Kettering, New York, États-Unis
| | - Haji Chalchal
- Collège de médecine, Université de la Saskatchewan, Agence du cancer de la Saskatchewan, Regina, SK
| | - Cindy Kenis
- Hôpital universitaire de Louvain, Louvain, Belgique
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Thatphet P, Kayarian FB, Ouchi K, Hogan T, Schumacher JG, Kennedy M, Liu SW. Lessons Learned From Emergency Department Fall Assessment and Prevention Programs. Cureus 2021; 13:e16526. [PMID: 34430136 PMCID: PMC8377387 DOI: 10.7759/cureus.16526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives This research describes the experiences of emergency departments (EDs) with geriatric fall programs and qualitatively synthesizes lessons learned to inform other EDs planning new fall program implementation. Methods By using grounded theory, we conducted semi-structured, open-ended telephone/skype interviews of emergency physicians and geriatric providers recruited from a purposeful sampling technique. The interviews were transcribed and reviewed by two investigators. The codes were generated and listed, and common concepts emerged. Lastly, the final codes were organized into concepts and themes with the aim to create a strong coding structure. Result The main lessons learned are: (1) understand the hospital’s existing local environment and resources, (2) utilize champions and interdisciplinary teams, (3) acknowledge that specific fall assessment tools and interventions vary widely between institutions, (4) engage in routine plan-do-study-act (PDSA) cycles to improve the quality of fall initiatives, and (5) operate under the principle that falls are a syndrome, which must be incorporated within the multifactorial medical needs of geriatric fall patients. Conclusion Based on the lessons learned from our ED fall implementation pioneers, implementing an effective geriatric fall protocol in an ED setting is complicated. Understanding a hospital’s resources, assigning champions, working as an interdisciplinary team, choosing proper fall assessment tools/interventions, and completing regular PDSA cycles are important lessons for ED programs planning to implement their own ED fall programs.
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Affiliation(s)
- Phraewa Thatphet
- Department of Emergency Medicine, Massachusetts General Hospital, Massachusetts, USA.,Emergency Medicine, Khon Kaen University, Khon Kaen, THA
| | - Fae B Kayarian
- Department of Emergency Medicine, Massachusetts General Hospital, Massachusetts, USA
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, Massachusetts, USA
| | - Teresita Hogan
- Department of Emergency Medicine, University of Chicago Medicine, Illinois, USA
| | - John G Schumacher
- Epidemiology and Public Health, University of Maryland, Maryland, USA
| | - Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, Massachusetts, USA
| | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Massachusetts, USA
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Hakvoort L, Dikken J, van der Wel M, Derks C, Schuurmans M. Minimizing the knowledge-to-action gap; identification of interventions to change nurses' behavior regarding fall prevention, a mixed method study. BMC Nurs 2021; 20:80. [PMID: 34016106 PMCID: PMC8139083 DOI: 10.1186/s12912-021-00598-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/04/2021] [Indexed: 01/21/2023] Open
Abstract
Background The need for effective continuing education is especially high in in-hospital geriatric care, as older patients have a higher risk of complications, such as falls. It is important that nurses are able to prevent them. However, it remains unknown which interventions change the behavior of nurses. Therefore, the aim of this study is to identify intervention options to change the behavior of hospital nurses regarding fall prevention among older hospitalized patients. Methods This study used a mixed method design. The Behavior Change Wheel (BCW) was used to identify intervention functions and policy categories to change the behavior of nurses regarding fall prevention. This study followed the eight steps of the BCW and two methods of data collection were used: five focus groups and three Delphi rounds. The focus groups were held with hospital nurses (n=26). Geriatric experts (n=11), managers (n=13) and educators (n=13) were included in the Delphi rounds. All data were collected within ten tertiary teaching hospitals in the Netherlands. All participants were included based on predefined in- and exclusion criteria and availability. Results In Geriatric experts opinions interventions targeting behavior change of nurses regarding fall prevention should aim at after-care, estimating fall risk and providing information. However, in nurses opinions it should target; providing information, fall prevention and multifactorial fall risk assessment. Nurses experience a diversity of limitations relating to capability, opportunity and motivation to prevent fall incidents among older patients. Based on these limitations educational experts identified three intervention functions: Incentivisation, modelling and enablement. Managers selected the following policy categories; communication/marketing, regulation and environmental/social planning. Conclusions The results of this study show there is a discrepancy in opinions of nurses, geriatric experts, managers and educators. Further insight in the role and collaboration of managers, educators and nurses is necessary for the development of education programs strengthening change at the workplace that enable excellence in nursing practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00598-z.
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Affiliation(s)
| | - Jeroen Dikken
- De Haagse Hogeschool, Faculteit Gezondheid, Voeding & Sport, Johanna Westerdijkplein 75, 2521 EN, The Hague, The Netherlands
| | - Maaike van der Wel
- Sint Franciscus Gasthuis en Vlietland, Kleiweg 500, 3004 BA, Rotterdam, The Netherlands
| | - Christel Derks
- Elisabeth Tweesteden Ziekenhuis, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands
| | - Marieke Schuurmans
- Onderwijscentrum, UMC Utrecht, Heijmans van den Berghgebouw, 3508 GA, Utrecht, The Netherlands
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10
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Ahmad Ainuddin H, Romli MH, Hamid TA, SF Salim M, Mackenzie L. An Exploratory Qualitative Study With Older Malaysian Stroke Survivors, Caregivers, and Healthcare Practitioners About Falls and Rehabilitation for Falls After Stroke. Front Public Health 2021; 9:611814. [PMID: 33987161 PMCID: PMC8110702 DOI: 10.3389/fpubh.2021.611814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Studies on rehabilitation for falls after a stroke remain limited despite its impact being profound. This scenario justifies a deeper understanding of why falls in stroke rehabilitation received less attention. Current investigations on the perception of falls and stroke also proved inadequate. Therefore, this study aims to explore the perceptions and experiences of older Malaysian stroke survivors, spousal caregivers, and healthcare practitioners on falls in stroke rehabilitation. Method: A qualitative study of three focus groups with 18 individuals from one community-based stroke rehabilitation center was conducted. The discussions were audio-recorded, video-recorded, transcribed, summarized, and analyzed using thematic analysis. Results: Three themes emerged from the analysis: (i) perceived factors and consequences of falls after stroke, (ii) physical-based interventions predominate in rehabilitation for falls after stroke, and (iii) the role of home hazards in fall prevention is taken for granted. Although, awareness of falls is high, they are regarded as a peripheral issue in stroke. Rehabilitation interventions such as improved functionality are believed to be adequate and can indirectly prevent falls. Other interventions for fall prevention such as home hazards management are relatively less known. Conclusion: There is a need for more attention regarding home environment risk assessment and intervention among healthcare professionals, and more education for clients and caregivers is required. Although, other stroke interventions may also benefit stroke survivors, falls prevention should be a central component in stroke rehabilitation. As this study focused on a specific population, the findings should be validated with larger populations, and in diverse settings.
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Affiliation(s)
- Husna Ahmad Ainuddin
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
- Centre of Occupational Therapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Selangor, Malaysia
| | - Muhammad Hibatullah Romli
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Selangor, Malaysia
| | - Tengku Aizan Hamid
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Selangor, Malaysia
| | - Mazatulfazura SF Salim
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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11
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Seo Y, Kim K, Kim JS. Trends of Nursing Research on Accidental Falls: A Topic Modeling Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3963. [PMID: 33918730 PMCID: PMC8068873 DOI: 10.3390/ijerph18083963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 11/16/2022]
Abstract
This descriptive study analyzed 1849 international and 212 Korean studies to explore the main topics of nursing research on accidental falls. We extracted only nouns from each abstract, and four topics were identified through topic modeling, which were divided into aspects of fall prevention and its consequences. "Fall prevention program and scale" is popular among studies on the validity of fall risk assessment tools and the development of exercise and education programs. "Nursing strategy for fall prevention" is common in studies on nurse education programs and practice guidelines to improve the quality of patient safety care. "Hospitalization by fall injury" is used in studies about delayed discharge, increased costs, and deaths of subjects with fall risk factors hospitalized at medical institutions due to fall-related injuries. "Long-term care facility falls" is popular in studies about interventions to prevent fall injuries that occur in conjunction with dementia in long-term care facilities. It is necessary to establish a system and policy for fall prevention in Korean medical institutions. This study confirms the trends in domestic and international fall-related research, suggesting the need for studies to address insufficient fall-related policies and systems and translational research to be applied in clinical trials.
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Affiliation(s)
| | | | - Ji-Su Kim
- Department of Nursing, Chung-Ang University, 84 Heukseok-Ro Dongjak-Gu, Seoul 06974, Korea; (Y.S.); (K.K.)
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Singh H, Collins K, Flett HM, Jaglal SB, Musselman KE. Therapists' perspectives on fall prevention in spinal cord injury rehabilitation: a qualitative study. Disabil Rehabil 2021; 44:4351-4360. [PMID: 33789064 DOI: 10.1080/09638288.2021.1904013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Therapists play a key role in delivering fall prevention/management education to individuals with spinal cord injury/disease, yet their perspectives on this topic remain understudied. Here, we described the perspectives of physical and occupational therapists who routinely provided rehabilitation to patients with spinal cord injury/disease on: (1) how fall risk was assessed, (2) what fall prevention education, interventions or strategies were provided, and (3) opportunities to improve fall risk assessment and the delivery of fall prevention education, strategies and interventions. MATERIALS AND METHODS Twenty-one therapists completed an individual interview or focus group that was analyzed using an inductive thematic analysis. RESULTS Four main themes were identified: (1) policy and procedures impact practice (i.e., policy and procedures positively and negatively impact practice), (2) assessing and managing fall risk/falls in patients with spinal cord injury/disease (i.e., discipline-specific roles in fall risk assessments and fall management processes in rehabilitation), (3) fall prevention and management education (i.e., helicopter therapists and challenges with fall prevention and management education), (4) building insight into fall risk and management (e.g., building insight into fall risk for patients and therapists). CONCLUSIONS This study revealed opportunities to improve the delivery of fall prevention education and training to individuals with spinal cord injury/disease.IMPLICATIONS FOR REHABILITATIONFall prevention education should be initiated in spinal cord injury rehabilitation and then reinforced in community rehabilitation.Barriers and challenges faced by therapists when delivering fall prevention and management education/training in spinal cord injury rehabilitation include their perceptions of a patient's readiness to receive fall prevention education, short length of stay in rehabilitation, organization's expectations of zero falls and a lack of spinal cord injury-specific fall prevention resources.Therapists who work in spinal cord injury rehabilitation may benefit from information about fall risk factors encountered by individuals with spinal cord injury/disease in the community.
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Affiliation(s)
- Hardeep Singh
- KITE, Toronto Rehab-University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Kyla Collins
- KITE, Toronto Rehab-University Health Network, Toronto, Canada.,School of Rehabilitation Sciences, University of Saskatchewan, Saskatoon, Canada
| | - Heather M Flett
- KITE, Toronto Rehab-University Health Network, Toronto, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Susan B Jaglal
- KITE, Toronto Rehab-University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
| | - Kristin E Musselman
- KITE, Toronto Rehab-University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,School of Rehabilitation Sciences, University of Saskatchewan, Saskatoon, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
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13
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Ch FA, Babur MN, Rashid S, Liaqat M. Interprofessioal collaboration among Speech Language Pathologists and Nurses in Acute Care in Pakistan. Pak J Med Sci 2021; 37:489-493. [PMID: 33679937 PMCID: PMC7931301 DOI: 10.12669/pjms.37.2.3545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/15/2020] [Accepted: 11/05/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To find out inter-professional collaboration among speech-language pathologists and nurses in acute care in Pakistan. METHODS This was a cross sectional study which was conducted in all government and private hospitals of Islamabad and Rawalpindi having facility of ICUs after taking consent from authorities. The duration of study was six months from October 2018 to February 2019. A total number of 350 participants (200 nurses, 150 speech language pathologists) working in ICU of different private and government hospitals of Pakistan were included in the study. Standardized questionnaire of ": assessment of inter-professioal collaboration scale": (AITCS) was circulated to nurses and speech language pathologists (SLPS) working in ICU with its subscale's partnership, coordination, cooperation and shared decision making on a 5-point likert scale. Data was analyzed using SPSS version 21.Measure of mean was obtained by independent sample t-test. P- Value less than 0.05 was considered as significant. RESULTS Statistical analysis showed measures of mean differences obtained by t-test revealed significant differences at p<0.001 level between partnership scores of SLPS and nurses. This reveals good partnership between two disciplines. Measures of mean differences obtained by t-test revealed significant differences at p<0.001 level between partnership scores of SLPS and nurses. Both do not value each other in cooperation. Measures of mean differences obtained by t-test showed significant differences at p<0.001 level amongst coordination scores of SLPS and nurses. Both have good coordination. Measures of mean differences obtained by t-test revealed significant differences at p<0.001 level amongst shared decision-making scores of SLPS and nurses. Both are involved in shared decision making. CONCLUSION Results show significant difference in partnership, coordination, and shared decision making. There is no significant difference in cooperation.
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Affiliation(s)
- Fariha Ambreen Ch
- Fariha Ambreen Ch, M.Phil. (Rehab Sci) Visiting Faculty Member, ISRA University, Islamabad Campus, Islamabad, Pakistan
| | - Muhammad Naveed Babur
- Prof. Dr. Muhammad Naveed Babur, PhD (Rehab Sciences) Principal, ISRA Institute of Rehabilitation Sciences, ISRA University, Islamabad Campus, Islamabad, Pakistan
| | - Sajid Rashid
- Prof. Dr. Sajid Rashid Ch Multan Medical & Dental College, Multan, Pakistan
| | - Maria Liaqat
- Maria Liaqat, PP-DPT Assistant Professor, ISRA University, Islamabad Campus, Islamabad, Pakistan
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Makhado L, Davhana-Maselesele M, Lebese RT, Maputle SM. Factors facilitating trained NIMART nurses' adherence to treatment guidelines: a vital matter in the management of TB/HIV treatment in South Africa. BMC Nurs 2020; 19:77. [PMID: 32821244 PMCID: PMC7429774 DOI: 10.1186/s12912-020-00470-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 08/06/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Globally, the burden of tuberculosis or human immunodeficiency virus (TB/HIV) is at 24% and this alarming rate compelled the World Health Organization (WHO) to declare the African region as a critical workforce shortage area. To facilitate adherence to treatment guidelines, WHO recommended a strategy of task shifting for countries with high health workforce shortages. The strategy aimed at the redistribution of health care tasks to available workers. The study aimed to determine the factors facilitating nurse-initiated management of antiretroviral therapy (NIMART) trained nurses' adherence to TB/HIV treatment guidelines. METHODS The study employed an exploratory-descriptive design. The study was conducted in Ugu and Ngaka Modiri Molema Districts of KwaZulu-Natal (KZN) and North West (NW) Provinces of South Africa. The population comprised of 24 participants who were purposively selected. The in-depth focus group discussions were conducted and ATLAS T.I. was used for data analysis following the basic steps of notice-collect-think (NCT) analysis. Trustworthiness and adherence to ethics were ensured. RESULTS The singular theme of factors facilitating NIMART trained nurses' adherence to treatment guidelines which included positive attitudinal needs and positive behavioural change emerged from raw data. CONCLUSION Continuous training, support supervision, and improved relationships with colleagues need to be enhanced to enable NIMART trained nurses to adhere to treatment guidelines.
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Affiliation(s)
- Lufuno Makhado
- Department of Public Health, School of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Mashudu Davhana-Maselesele
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Tshwane, South Africa
| | - Rachel Tsakani Lebese
- Research office, School of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Sonto Maria Maputle
- Department of Advanced Nursing Science, School of Health Sciences, University of Venda, Thohoyandou, South Africa
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Anderson K, Bradford N, Edwards R, Nicholson J, Lockwood L, Clark J. Addressing the barriers to optimal management of febrile neutropenia in children with cancer. Eur J Oncol Nurs 2020; 45:101719. [DOI: 10.1016/j.ejon.2019.101719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 10/15/2019] [Accepted: 12/23/2019] [Indexed: 12/25/2022]
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Barriers and Facilitators for Screening Older Adults on Fall Risk in a Hospital Setting: Perspectives from Patients and Healthcare Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051461. [PMID: 32106465 PMCID: PMC7084218 DOI: 10.3390/ijerph17051461] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/1970] [Revised: 02/22/2020] [Accepted: 02/23/2020] [Indexed: 01/22/2023]
Abstract
We aimed to gain insight into the barriers and facilitators to fall risk screening of older adults visiting the hospital as experienced by patients and healthcare professionals, and to examine the differences between chronic- and acute-care patients. We invited patients (≥ 70 years) attending the nephrology and emergency department to participate in the screening. Patients and their healthcare professionals were asked to complete a self-administered questionnaire based on the "Barriers and Facilitators Assessment Instrument". Differences in barriers and facilitators between acute- and chronic-care patients were examined with chi-square tests. A total of 216 patients were screened, and 103 completed the questionnaire. They considered many factors as facilitators, and none as barriers. Acute-care patients were more positive than chronic-care patients about healthcare worker characteristics, such as knowledge and skills. After screening, patients were more open to receiving advice regarding fall prevention. The 36 healthcare professionals considered program characteristics to be facilitators and mainly factors regarding healthcare worker characteristics as barriers to implementation. For patients, the outpatient setting seemed to be a good place to be screened for fall risk. Healthcare professionals also suggested that program characteristics could enhance implementation. However, healthcare professionals' mindsets and the changing of routines are barriers that have to be addressed first.
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17
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Park BM, Ryu HS, Kwon KE, Lee CY. [Development and Effect of a Fall Prevention Program Based on the King's Goal Attainment Theory for Fall High-Risk Elderly Patients in Long-Term Care Hospital]. J Korean Acad Nurs 2019; 49:203-214. [PMID: 31064973 DOI: 10.4040/jkan.2019.49.2.203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study to develop a fringed fall prevention program based on King's goal attainment theory and education. This study is applied to the personal, interpersonal, and social systems of fall high-risk patients to test its effects. METHODS This study was a nonequivalent control group pre- and post-test design. There were 52 fall high-risk patients in the experimental group and 45 in the control group. The experimental group received six sessions, with the group sessions lasting 60 minutes and the individual sessions lasting 20~30 minutes. Data were analyzed using descriptive statistics, an χ²-test, a paired sample t-test, and a Wilcoxon signed-ranks test utilizing IBM SPSS software. RESULTS For the 3-month intervention period, the fall prevention program was found to be particularly effective for patients in the experimental group (from 3.38 to 1.69 per 1000 patient days; p=.044), as opposed to the control group (from 1.94 to 1.49 per 1000 patient days; p=.300). For the 6-month follow up period, the fall prevention program was again found to be effective for patients in the experimental group (from 3.26 to 0.76 per 1000 patient days; p=.049) compared to the control group (from 1.98 to 1.01 per 1000 patient days; p=.368). CONCLUSION These results indicate that the fringed fall prevention program is very effective in reducing falls, not only during the intervention period, but also after the intervention period has ended. We can therefore recommend this program for use concerning fall high-risk patients in long-term care hospitals.
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Affiliation(s)
- Bom Mi Park
- Department of Nursing, Gangnam-gu Haengbok Convalescene Hospital, Seoul, Korea
| | - Ho Sihn Ryu
- College of Nursing, Korea University, Seoul, Korea.
| | - Kyeung Eun Kwon
- Department of Nursing, Gangnam-gu Haengbok Convalescene Hospital, Seoul, Korea
| | - Chun Young Lee
- Department of Nursing, Gangnam-gu Haengbok Convalescene Hospital, Seoul, Korea
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18
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Kalu ME, Vlachantoni A, Norman KE. Knowledge about risk factors for falls and practice about fall prevention in older adults among physiotherapists in Nigeria. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 24:e1742. [PMID: 30280457 DOI: 10.1002/pri.1742] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 06/11/2018] [Accepted: 07/27/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Falling is a major health concern that has contributed significantly to older people's injury and loss of life worldwide, warranting the development of fall-prevention strategies, the success of which has been attributed to the levels of knowledge and practice about fall prevention among physiotherapists and other health professionals. The objective of this study was to determine the self-reported levels of knowledge on risk factors of fall and practices about fall prevention in older adults among physiotherapists in Nigeria. METHODS Physiotherapists (N = 237) recruited from the six geopolitical zones of Nigeria completed a three-part structured questionnaire that asked questions about risk factors for fall and common practices for fall prevention using a 5-point-rated Likert scale. Data were analysed using descriptive analysis, chi-square, and Kruskal-Wallis tests. RESULTS Among physiotherapists in Nigeria, 89% rated their level of knowledge about preventing falls among older adults as high, and 64% of them rated their level of practice on this topic as high. Among the individual items that measured knowledge, 40% of the participants reported a moderate level of knowledge about multiple medications as a risk factor for falls. Fifty percent of the participants reported a low level of practice of referral to other health care professionals, whereas 40% and 41% reported a moderate level of practice on documenting risk factors and treatment plans, respectively. There was no association between age, gender, or years of practice with levels of knowledge or practice. CONCLUSION This study suggests that physiotherapists in Nigeria have adequate knowledge and practice for fall prevention in older adults. However, there are potential gaps in knowledge of risk factors, documentation, and referrals to other professions that may be addressed through developing context-specific fall-prevention clinical guidelines for practice in Nigeria.
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Affiliation(s)
- Michael E Kalu
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Athina Vlachantoni
- Centre for Research on Ageing and ERSC Centre for Population Change, Faculty of Social, Human and Mathematical Science, University of Southampton, Southampton, UK
| | - Kathleen E Norman
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
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19
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Jansson MM, Syrjälä HP, Talman K, Meriläinen MH, Ala-Kokko TI. Critical care nurses' knowledge of, adherence to, and barriers toward institution-specific ventilator bundle. Am J Infect Control 2018; 46:1051-1056. [PMID: 29573832 DOI: 10.1016/j.ajic.2018.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 02/05/2018] [Accepted: 02/05/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although evidence-based practices are known to improve the quality of care, making it cost-efficient and improving clinical results, barriers to transferring research into clinical practice have hindered this process. AIMS To evaluate critical care nurses' knowledge of, adherence to, and barriers toward institution-specific ventilator bundle. MATERIAL AND METHODS In 2015, we conducted an institution-specific, cross-sectional study in a 26-bed adult mixed medical-surgical intensive care unit (ICU) in Finland using quantitative survey of knowledge and self-reported adherence with qualitative gathering of barrier data. A pre-validated multiple-choice Ventilator Bundle Questionnaire was distributed to all registered nurses who were direct care providers (n = 155). RESULTS The final response rate was 55.5% (n = 86), and 47.2% (n = 34) of respondents had more than 10 years of ICU experience. The levels of knowledge and self-reported adherence were 71.1% and 65.8% of the total score, respectively. The level of knowledge was higher among respondents who had received in-service education about ventilator bundle compared with respondents who had not received in-service education (27.0 vs 24.0 [P = .012]). Less experienced nurses reported significantly higher adherence than nurses with more ICU experience (29.0 vs 25.0 [P = .034]). The correlation between knowledge and adherence scores was low (ρ 0.48 [P <.001]). The most well-known and adhered-to guidelines described patient positioning, daily chlorhexidine-based oral care, and strict hand hygiene. The least-known guidelines and those least adhered to described respiratory equipment, management of sedation and analgesia, and practices prior to and during endotracheal suctioning. The main barriers were related to the nurse respondents (e.g., lack of education [25.9%]), environment (e.g., role ambiguities [36.4%] and inadequate resources [21.1%]), and patients (e.g., patient discomfort [4.8%] and fear of adverse effects [4.6%]). CONCLUSIONS Self-reported adherence did not correlate with knowledge and was not related to work experience. Most of the barriers toward evidence-based guidelines indicated a need for changes that are beyond the control of individual nurses.
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Affiliation(s)
- Miia M Jansson
- Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Research Group of Surgery, Anesthesiology and Intensive Care, Medical Research Center Oulu, Oulu, Finland.
| | - Hannu P Syrjälä
- Department of Infection Control, Oulu University Hospital, Oulu, Finland
| | - Kirsi Talman
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Merja H Meriläinen
- Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Research Group of Surgery, Anesthesiology and Intensive Care, Medical Research Center Oulu, Oulu, Finland
| | - Tero I Ala-Kokko
- Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Research Group of Surgery, Anesthesiology and Intensive Care, Medical Research Center Oulu, Oulu, Finland
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Ghanbari A, Rahmatpour P, Jafaraghaee F, Kazemnejad E, Khalili M. Quality assessment of diabetic foot ulcer clinical practice guidelines. J Evid Based Med 2018; 11:200-207. [PMID: 29882311 DOI: 10.1111/jebm.12304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 05/17/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Nurses play an effective role in diabetic foot care and they should know the best evidence. In this way, implementations according evidence-based clinical practice guidelines have positive effects on nurses' practice and patient outcomes. The objective of this study was quality assessment of diabetic foot ulcer clinical practice guidelines. METHODS Evidence about nursing care in diabetic foot ulcer in last 5 years was searched and categorized based on nursing diagnosis (ND) and evidence levels and was finally designed as a guideline. Quality appraisal of guideline was evaluated with AGREEII tool by an expert panel. AGREEII consists of 23 items, grouped in six domains: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence. Applicability of the guideline in clinical was assessed with a checklist by the nursing group. Data analysis was carried out with SPSS v.18 (descriptive statistics and binomial test). RESULTS Of the 114 studies, evidence of 19 studies was selected. The guidelines had three parts: introduction, nursing recommendation, and appendix. Evidence was categorized according to 8 NDs. According to AGREEII, the guideline had the highest score in the "scope and purpose" (92.7%) and the lowest in "applicability" (76.2%) domains. Also, nurses reported the positive effect of implementation of guideline recommendations and lack of needed equipment for its implementation. CONCLUSIONS Guidelines received acceptable scores in all the domains of AGREEII. Based on nurses' opinion, recommendations of guidelines will play an effective role in prevention, treatment, reduction of complication among diabetic foot patients. Therefore, adaptation, implementation, and evaluation of the guidelines were recommended.
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Affiliation(s)
- Atefeh Ghanbari
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Pardis Rahmatpour
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Fateme Jafaraghaee
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnejad
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Malahat Khalili
- School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
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McEwan H, Baker R, Armstrong N, Banerjee J. A qualitative study of the determinants of adherence to NICE falls guideline in managing older fallers attending an emergency department. Int J Emerg Med 2018; 11:33. [PMID: 30022394 PMCID: PMC6051952 DOI: 10.1186/s12245-018-0192-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 06/25/2018] [Indexed: 11/25/2022] Open
Abstract
Background The National Institute for Health and Care Excellence (NICE) 2004 Falls guideline was developed to improve the assessment and management of falls and prevention of future falls. However, adherence to the guideline can be poor. As emergency departments (EDs) are usually consulted by older adults (aged 65 and over) who experience a fall, they provide a setting in which assessments can be conducted or referrals made to more appropriate settings. The objective of this study was to investigate how falls are managed in EDs, reasons why guideline recommendations are not always followed, and what happens instead. Methods The study involved two EDs. We undertook 27 episodes of observation of healthcare professional interactions with patients aged 65 or over presenting with a fall, supported by review of the clinical records of these interactions, and subsequently, 30 interviews with healthcare professionals. The qualitative analysis used the framework approach. Results Various barriers and enablers (i.e. determinants of practice) influenced adherence at both EDs, including the following: support from senior staff; education; cross-boundary care; definition of falls; communication; organisational factors; and staffing. Conclusions A variety of factors influence adherence to the Falls guideline within an ED, and it may be difficult to address all of them simultaneously. Simple interventions such as education and pro-formas are unlikely to have substantial effects alone. However, taking advantage of the influence of senior staff on juniors could enhance adherence. In addition, collaborative care with other NHS services offers a potential approach for emergency practitioners to play a part in managing and preventing falls.
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Affiliation(s)
- Helen McEwan
- Department of Psychology, Faculty of Business, Law and Social Sciences, Birmingham City University, C303 Curzon Building, 4 Cardigan Street, Birmingham, B4 7BD, England.
| | - Richard Baker
- Department of Health Sciences, Centre for Medicine, University of Leicester, Leicester, England
| | - Natalie Armstrong
- Department of Health Sciences, Centre for Medicine, University of Leicester, Leicester, England
| | - Jay Banerjee
- Department of Emergency Medicine, University Hospitals of Leicester NHS Trust, Leicester, England
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Khanuja K, Joki J, Bachmann G, Cuccurullo S. Gait and balance in the aging population: Fall prevention using innovation and technology. Maturitas 2018; 110:51-56. [DOI: 10.1016/j.maturitas.2018.01.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 01/20/2018] [Accepted: 01/23/2018] [Indexed: 12/27/2022]
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Sharma S, Pandit A, Tabassum F. Potential facilitators and barriers to adopting standard treatment guidelines in clinical practice. Int J Health Care Qual Assur 2017; 30:285-298. [PMID: 28350223 DOI: 10.1108/ijhcqa-10-2016-0148] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to assess medicines information sources accessed by clinicians, if sources differed in theory and practice and to find out the barriers and facilitators to effective guideline adoption. Design/methodology/approach In all, 183 doctors were surveyed. Barriers and facilitators were classified as: communication; potential adopters; innovation; organization characteristics and environmental/social/economic context. Findings Most of the clinicians accessed multiple information sources including standard treatment guidelines, but also consulted seniors/colleagues in practice. The top three factors influencing clinical practice guideline adoption were innovation characteristics, environmental context and individual characteristics. The respondents differed in the following areas: concerns about flexibility offered by the guideline; denying patients' individuality; professional autonomy; insights into gaps in current practice and evidence-based practice; changing practices with little or no benefit. Barriers included negative staff attitudes/beliefs, guideline integration into organizational structures/processes, time/resource constraints. Fearing third parties (government and insurance companies) restricting medicines reimbursement and poor liability protection offered by the guidelines emerged as the barriers. Facilitators include aligning organizational structures/processes with the innovation; providing leadership support to guide diffusion; increasing awareness and enabling early innovation during pre/in-service training, with regular feedback on outcomes and use. Practical implications Guideline adoption in clinical practice is partly within doctors' control. There are other key prevailing factors in the local context such as environmental, social context, professional and organizational culture affecting its adoption. Organizational policy and accreditation standards necessitating adherence can serve as a driver. Originality/value This survey among clinicians, despite limitations, gives helpful insights. While favourable attitudes may be helpful, clinical adoption could be improved more effectively by targeting barriers.
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Affiliation(s)
- Sangeeta Sharma
- Department of Neuropsychopharmacology, Institute of Human Behaviour and Allied Sciences, Delhi, India
| | - Ajay Pandit
- Faculty of Management Studies, University of Delhi , Delhi, India
| | - Fauzia Tabassum
- Department of Pharmacology, Institute of Human Behaviour and Allied Sciences, New Delhi, India
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Kang Y, Moyle W, Cooke M, O'Dwyer S. Qualitative evaluation of a delirium prevention and management programme. J Clin Nurs 2017; 26:4574-4582. [DOI: 10.1111/jocn.13799] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Yun Kang
- School of Nursing and Midwifery; Griffith University; Nathan, Brisbane Qld Australia
- Menzies Health Institute Queensland; Griffith University; Nathan, Brisbane Qld Australia
| | - Wendy Moyle
- School of Nursing and Midwifery; Griffith University; Nathan, Brisbane Qld Australia
- Menzies Health Institute Queensland; Griffith University; Nathan, Brisbane Qld Australia
| | - Marie Cooke
- School of Nursing and Midwifery; Griffith University; Nathan, Brisbane Qld Australia
- Menzies Health Institute Queensland; Griffith University; Nathan, Brisbane Qld Australia
| | - Siobhan O'Dwyer
- Menzies Health Institute Queensland; Griffith University; Nathan, Brisbane Qld Australia
- University of Exeter; Exeter UK
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Ayton DR, Barker AL, Morello RT, Brand CA, Talevski J, Landgren FS, Melhem MM, Bian E, Brauer SG, Hill KD, Livingston PM, Botti M. Barriers and enablers to the implementation of the 6-PACK falls prevention program: A pre-implementation study in hospitals participating in a cluster randomised controlled trial. PLoS One 2017; 12:e0171932. [PMID: 28207841 PMCID: PMC5313144 DOI: 10.1371/journal.pone.0171932] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 01/27/2017] [Indexed: 11/18/2022] Open
Abstract
Evidence for effective falls prevention interventions in acute wards is limited. One reason for this may be suboptimal program implementation. This study aimed to identify perceived barriers and enablers of the implementation of the 6-PACK falls prevention program to inform the implementation in a randomised controlled trial. Strategies to optimise successful implementation of 6-PACK were also sought. A mixed-methods approach was applied in 24 acute wards from 6 Australian hospitals. Participants were nurses working on participating wards and senior hospital staff including Nurse Unit Managers; senior physicians; Directors of Nursing; and senior personnel involved in quality and safety or falls prevention. Information on barriers and enablers of 6-PACK implementation was obtained through surveys, focus groups and interviews. Questions reflected the COM-B framework that includes three behaviour change constructs of: capability, opportunity and motivation. Focus group and interview data were analysed thematically, and survey data descriptively. The survey response rate was 60% (420/702), and 12 focus groups (n = 96 nurses) and 24 interviews with senior staff were conducted. Capability barriers included beliefs that falls could not be prevented; and limited knowledge on falls prevention in patients with complex care needs (e.g. cognitive impairment). Capability enablers included education and training, particularly face to face case study based approaches. Lack of resources was identified as an opportunity barrier. Leadership, champions and using data to drive practice change were recognised as opportunity enablers. Motivation barriers included complacency and lack of ownership in falls prevention efforts. Motivation enablers included senior staff articulating clear goals and a commitment to falls prevention; and use of reminders, audits and feedback. The information gained from this study suggests that regular practical face-to-face education and training for nurses; provision of equipment; audit, reminders and feedback; leadership and champions; and the provision of falls data is key to successful falls prevention program implementation in acute hospitals.
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Affiliation(s)
- Darshini R. Ayton
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- * E-mail:
| | - Anna L. Barker
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Renata T. Morello
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Caroline A. Brand
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jason Talevski
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Mayer M. Melhem
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Evelyn Bian
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sandra G. Brauer
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Keith D. Hill
- School of Physiotherapy and Exercise Science, Curtin University, Western Australia, Australia
| | - Patricia M. Livingston
- Epworth/Deakin Centre for Clinical Nursing Research, Deakin University, Victoria, Australia
| | - Mari Botti
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
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Barker AL, Morello RT, Ayton DR, Hill KD, Brand CA, Livingston PM, Botti M. Acceptability of the 6-PACK falls prevention program: A pre-implementation study in hospitals participating in a cluster randomized controlled trial. PLoS One 2017; 12:e0172005. [PMID: 28199376 PMCID: PMC5310900 DOI: 10.1371/journal.pone.0172005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 01/30/2017] [Indexed: 11/25/2022] Open
Abstract
There is limited evidence to support the effectiveness of falls prevention interventions in the acute hospital setting. The 6-PACK falls prevention program includes a fall-risk tool; ‘falls alert’ signs; supervision of patients in the bathroom; ensuring patients’ walking aids are within reach; toileting regimes; low-low beds; and bed/chair alarms. This study explored the acceptability of the 6-PACK program from the perspective of nurses and senior staff prior to its implementation in a randomised controlled trial. A mixed-methods approach was applied involving 24 acute wards from six Australian hospitals. Participants were nurses working on participating wards and senior hospital staff including: Nurse Unit Managers; senior physicians; Directors of Nursing; and senior personnel involved in quality and safety or falls prevention. Information on program acceptability (suitability, practicality and benefits) was obtained by surveys, focus groups and interviews. Survey data were analysed descriptively, and focus group and interview data thematically. The survey response rate was 60%. Twelve focus groups (n = 96 nurses) and 24 interviews with senior staff were conducted. Falls were identified as a priority patient safety issue and nurses as key players in falls prevention. The 6-PACK program was perceived to offer practical benefits compared to current practice. Nurses agreed fall-risk tools, low-low beds and alert signs were useful for preventing falls (>70%). Views were mixed regarding positioning patients’ walking aid within reach. Practical issues raised included access to equipment; and risk of staff injury with low-low bed use. Bathroom supervision was seen to be beneficial, however not always practical. Views on the program appropriateness and benefits were consistent across nurses and senior staff. Staff perceived the 6-PACK program as suitable, practical and beneficial, and were open to adopting the program. Some practical concerns were raised highlighting issues to be addressed by the implementation plan.
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Affiliation(s)
- Anna L. Barker
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- * E-mail:
| | - Renata T. Morello
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Darshini R. Ayton
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Keith D. Hill
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia, Australia
| | - Caroline A. Brand
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Patricia M. Livingston
- Epworth/Deakin Centre for Clinical Nursing Research, Deakin University, Richmond, Victoria, Australia
| | - Mari Botti
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
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Haghighi MJ, Shahdadi H, Moghadam MP, Balouchi A. The Impact of Evidence-Based Practices on Postoperative Pain in Patients undergoing Gastrointestinal Surgery in Amiralmomenin Hospital in Zabol During 2014-2015. J Clin Diagn Res 2016; 10:IC01-IC04. [PMID: 27630865 DOI: 10.7860/jcdr/2016/20961.8119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 05/14/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The Evidence-Based Practices (EBP), have gained considerable ground in treatment and care, increases the quality of nurses' clinical care. Yet EBP is less frequently employed despite its efficiency and importance. Pain management is an important component of nursing care and sufficient pain control has still remained as a challenge despite routine nursing practices that are already provided. AIM The present study intended to define the impact of evidence-based nursing practices on postoperative pain in patients undergoing gastrointestinal surgery. MATERIALS AND METHODS The present study was a single group quasi-experimental study with before/after design. The study was conducted in the General Surgery Departments of the Amiralmomenin Hospital in Zabol during 2014-2015. A purposive sampling method was used to study 55 patients undergoing abdominal surgery. The data collection tool was a questionnaire. The patients pain severity was defined before and after implementing evidence-based practices. The collected data were analysed in SPSS using descriptive statistics and inferential statistics. RESULTS The results showed that 61.8% of patients experienced severe postoperative pain. The mean perceived pain ratings in women and men were 7.88±1.78 and 9.42±0.81, respectively. The mean pain intensity was 8.48±1.66 before the intervention and reached 7.16±1.71 after the intervention, which was significant based on Kruskal-Wallis test (p=0.003). The mean postoperative pain experienced by the patients (p<0.01) and pain-relief following the intervention (p=0.002) was significant for gender. CONCLUSION This study suggests that a high percentage of patients experienced acute postoperative pain despite routine nursing care, while evidence-based nursing practices could significantly alleviate pain.
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Affiliation(s)
- Maryam Jahantigh Haghighi
- Student, Student Research Committee, Faculty of Nursing and Midwifery, Zabol University of Medical Sciences , Zabol, Iran
| | - Hossein Shahdadi
- Lecturer, Department of Nursing, School of Nursing and Midwifery, Zabol University of Medical Sciences , Zabol, Iran
| | - Mahdieh Poodineh Moghadam
- Lecturer, Department of Nursing, School of Nursing and Midwifery, Zabol University of Medical Sciences , Zabol, Iran
| | - Abbas Balouchi
- Student, Student Research Committee, Faculty of Nursing and Midwifery, Zabol University of Medical Sciences , Zabol, Iran
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Cloete I, Daniels L, Jordaan J, Derbyshire C, Volmink L, Schubl C. Knowledge and perceptions of nursing staff on the new Road to Health Booklet growth charts in primary healthcare clinics in the Tygerberg subdistrict of the Cape Town metropole district. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2016. [DOI: 10.1080/16070658.2013.11734458] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Jun J, Kovner CT, Stimpfel AW. Barriers and facilitators of nurses' use of clinical practice guidelines: An integrative review. Int J Nurs Stud 2016; 60:54-68. [PMID: 27297368 DOI: 10.1016/j.ijnurstu.2016.03.006] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 03/06/2016] [Accepted: 03/08/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Preventable harm continues to be one of the leading causes of patient death. Each year about 400,000 patients die from sepsis, hospital acquired infections, venous thromboembolism, and pulmonary embolism. However, as shown in the recent reduction in hospital acquired infections, the number of deaths could be reduced if healthcare providers used evidence-based therapies, which are often included in clinical practice guidelines (CPGs). PURPOSE The purpose of this integrative review is to appraise and synthesize the current literature on barriers to and facilitators in the use of clinical practice guidelines (CPGs) by registered nurses. DESIGN Whittemore and Knafl integrative review methodology was used. Primary quantitative and qualitative studies about the nurses' use of CPGs and published in peer-reviewed journals between January 2000 and August 2015 were included. METHODS The Critical Skills Appraisal Program (CASP) was used to critically appraise the quality of sixteen selected quantitative and qualitative studies. RESULTS Internal factors were attitudes, perceptions, and knowledge whereas format and usability of CPGs, resources, leadership, and organizational culture were external factors influencing CPG use. CONCLUSION Given each barrier and facilitator, interventions and policies can be designed to increase nurses' use of CPGs to deliver more evidence based therapy. In order to improve the use of CPGs and to ensure high quality care for all patients, nurses must actively participate in development, implementation, and maintenance of CPGs.
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Affiliation(s)
- Jin Jun
- New York University, College of Nursing, United States.
| | - Christine T Kovner
- Mathy Mezey Professor of Geriatric Nursing, New York University, College of Nursing, United States.
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Voogdt-Pruis HR, Beusmans GHMI, Gorgels APM, van Ree JW. Experiences of doctors and nurses implementing nurse-delivered cardiovascular prevention in primary care: a qualitative study. J Adv Nurs 2016; 67:1758-66. [PMID: 21545701 DOI: 10.1111/j.1365-2648.2011.05627.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIM This paper reports on a study of the experiences of general practitioners and practice nurses implementing nurse-delivered cardiovascular prevention to high risk patients in primary care. BACKGROUND Difficulties may arise when innovations are introduced into routine daily practice. Whether or not implementation is successful is determined by different factors related to caregivers, patients, type of innovation and context. METHODS A qualitative study nested in a randomized trial (2006-2008) to evaluate the effectiveness of nurse-delivered cardiovascular prevention. Six primary health care centres in the Netherlands (25 general practitioners, 6 practice nurses) participated in the trial. Interviews were held on two occasions: at 3 and at 18 months after commencement of consultation. The first occasion was a group interview with six practice nurses. The second consisted of semi-structured interviews with one general practitioner and one practice nurse from each centre. FINDINGS Main barriers to the implementation included: lack of knowledge about the guideline, attitudes towards treatment targets, lack of communication, insufficient coaching by doctors, content of life style advice. At the start of the consultation project, practice nurses expressed concern of losing nursing tasks. Other barriers were related to patients (lack of motivation), the guideline (target population) and organizational issues (insufficient patient recording and computer systems). CONCLUSIONS Both general practitioners and practice nurses were positive about nurse-delivered cardiovascular prevention in primary care. Nurses could play an important role in successive removal of barriers to implementation of cardiovascular prevention. Mutual confidence between care providers in the healthcare team is necessary.
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Affiliation(s)
- Helene R Voogdt-Pruis
- Researcher Department of Integrated Health Care, Maastricht University Medical Centre/CAPHRI, The Netherlands
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A 10-year journey in sustaining fall reduction in an academic medical center in Singapore. INT J EVID-BASED HEA 2016; 14:24-33. [DOI: 10.1097/xeb.0000000000000066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Loganathan A, Ng CJ, Tan MP, Low WY. Barriers faced by healthcare professionals when managing falls in older people in Kuala Lumpur, Malaysia: a qualitative study. BMJ Open 2015; 5:e008460. [PMID: 26546140 PMCID: PMC4636608 DOI: 10.1136/bmjopen-2015-008460] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 08/26/2015] [Accepted: 09/02/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore the barriers faced by healthcare professionals (HCPs) in managing falls among older people (aged above 60 years) who have a high risk of falling. RESEARCH DESIGN The study used a qualitative methodology, comprising 10 in-depth interviews and two focus group discussions. A semistructured topic guide was used to facilitate the interviews, which were audio recorded, transcribed verbatim and checked for accuracy. Data were analysed thematically using WeftQDA software. PARTICIPANTS 20 HCPs who managed falls in older people. SETTING This study was conducted at the Primary Care Clinic in the University Malaya Medical Centre (UMMC), Malaysia. RESULTS Four categories of barriers emerged-these were related to perceived barriers for older people, HCPs' barriers, lack of caregiver support and healthcare system barriers. HCPs perceived that older people normalised falls, felt stigmatised, were fatalistic, as well as in denial regarding falls-related advice. HCPs themselves trivialised falls and lacked the skills to manage falls. Rehabilitation was impeded by premature decisions to admit older people to nursing homes. Lastly, there was a lack of healthcare providers as well as a dearth of fall education and training on fall prevention for HCPs. CONCLUSIONS This study identified barriers that explain poor fall management in older people with a high risk of falls. The lack of structured fall prevention guidelines and insufficient training in fall management made HCPs unable to advise patients on how to prevent falls. The findings of this study warrant evidence-based structured fall prevention intervention targeted to patients as well as to HCPs.
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Affiliation(s)
- Annaletchumy Loganathan
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wah Yun Low
- Faculty of Medicine, Dean's Office, University of Malaya, Kuala Lumpur, Malaysia
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Nursing Home Registered Nurses' and Licensed Practical Nurses' Knowledge of Causes of Falls. J Nurs Care Qual 2015; 31:153-60. [PMID: 26421775 DOI: 10.1097/ncq.0000000000000157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Reducing falls in nursing homes requires a knowledgeable nursing workforce. To test knowledge, 8 validated vignettes representing multifactorial fall causes were administered to 47 nurses from 3 nursing homes. Although licensed practical nurses scored higher than registered nurses in individual categories of falls, when we computed the average score of all 8 categories between groups of registered nurses and licensed practical nurses, registered nurses scored higher (F = 4.106; P < .05) in identifying 8 causal reasons for older adults to fall.
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Damkliang J, Considine J, Kent B, Street M. Nurses' perceptions of using an evidence-based care bundle for initial emergency nursing management of patients with severe traumatic brain injury: A qualitative study. Int Emerg Nurs 2015; 23:299-305. [PMID: 26049810 DOI: 10.1016/j.ienj.2015.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 04/13/2015] [Accepted: 04/27/2015] [Indexed: 11/19/2022]
Abstract
Evidence to guide initial emergency nursing care of patients with severe traumatic brain injury (TBI) in Thailand is currently not available in a useable form. A care bundle was used to summarise an evidence-based approach to the initial emergency nursing management of patients with severe TBI and was implemented in one Thai emergency department. The aim of this study was to describe Thai emergency nurses' perceptions of care bundle use. A descriptive qualitative study was used to describe emergency nurses' perceptions of care bundle use during the implementation phase (Phase-One) and then post-implementation (Phase-Two). Ten emergency nurses participated in Phase-One, while 12 nurses participated in Phase-Two. In Phase-One, there were five important factors identified in relation to use of the care bundle including quality of care, competing priorities, inadequate equipment, agitated patients, and teamwork. In Phase Two, participants perceived that using the care bundle helped them to improve quality of care, increased nurses' knowledge, skills, and confidence. Care bundles are one strategy to increase integration of research evidence into clinical practice and facilitate healthcare providers to deliver optimal patient care in busy environments with limited resources.
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Affiliation(s)
- Jintana Damkliang
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia; Faculty of Nursing, Prince of Songkla University, Songkhla, Thailand.
| | - Julie Considine
- Eastern Health, Midwifery Research Centre, Centre for Quality and Patient Safety Research, Deakin University Nursing, Burwood, Victoria, Australia
| | - Bridie Kent
- School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
| | - Maryann Street
- Eastern Health, Midwifery Research Centre, Centre for Quality and Patient Safety Research, Deakin University Nursing, Burwood, Victoria, Australia
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Farokhzadian J, Nayeri ND, Borhani F, Zare MR. Nurse leaders' Attitudes, Self-Efficacy and training Needs for Implementing Evidence-Based Practice: Is It Time for a Change toward Safe Care? ACTA ACUST UNITED AC 2015; 7:662-671. [PMID: 26877975 PMCID: PMC4751982 DOI: 10.9734/bjmmr/2015/16487] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Introduction Evidence-based practice (EBP) has been recognized as the gold standard for safe and high quality care. Nurse leaders have a strategic position in terms of initiating changes in clinical settings for successfully implementing EBP. Therefore, the factors that influence implementing EBP must be measured. Aims To examine nurse leaders' attitudes, self-efficacy, and training needs for implementing evidence-based practice. Place and Duration of Study Four teaching hospitals affiliated to Kerman University of Medical Sciences in the southeast of Iran from January to April 2014. Methods A cross-sectional study was conducted on 70 nurse leaders from four teaching hospitals. After using a modified forward/backward translation procedure to create a Persian version of “perceptions of nurses of evidence-based practice questionnaire”, data were collected from the participants and analyzed using SPSS (version 20), descriptive statistics, Student's t-test, analysis of variance (ANOVA), and Pearson's correlation. Results Most (82.86%) of the participants had not attended any specific training course on the implementation of EBP and 80% had not been involved in any research activities. Nurse leaders' attitudes toward EBP were unfavorable (mean=2.55±0.88), their levels of self-efficacy in EBP skills were weak (mean=2.64±1.31), and their demand for training in all of the EBP areas was moderate (3.89±.97). Conclusion Current practice of nurse leaders is not evidence-based, which is worrisome and can result in serious deficiencies in the quality and safety of nursing care. Nurse leaders must attempt to equip themselves with the attitudes and skills required to change in practice using EBP.
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Affiliation(s)
- Jamileh Farokhzadian
- Department of Community Health Nursing, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Nahid Dehghan Nayeri
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Borhani
- Department of Nursing Ethics, Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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van de Steeg L, Langelaan M, Ijkema R, Nugus P, Wagner C. Improving delirium care for hospitalized older patients. A qualitative study identifying barriers to guideline adherence. J Eval Clin Pract 2014; 20:813-9. [PMID: 25081423 DOI: 10.1111/jep.12229] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2014] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Guidelines are intended as a means of getting research evidence into practice and ensuring provided care is of sufficient quality. However, the effect of guidelines is hindered by limited guideline adherence. The aim of this study is to identify and classify barriers to adherence by nurses to a guideline on delirium care. METHODS Open-ended interviews were conducted with a purposive sample of 63 research participants. The sample included 28 nurses, 18 doctors and 17 policy advisors working in 19 hospitals in the Netherlands. The interviews were conducted between June and September 2011. The data were analysed using thematic analysis. RESULTS Barriers to guideline adherence that were identified could be grouped into four themes: motivation and goals, knowledge and skills, professional role and identity, and context and resources. While the interviews with nurses, doctors and policy advisors produced similar views of the current situation, doctors and policy advisors placed a higher importance on education as a means of stimulating adherence. CONCLUSIONS This study illustrates that individual, social and organizational factors play a role in nurse's adherence to a delirium guideline. The potential benefits of following a guideline, both for patients and for nursing staff, need to be highlighted in order to motivate nurses. When formulating new guidelines, nurses' perceptions of their professional role and patient care need to be taken into account to ensure that policy makers and managers are realistic about guideline adherence and engage with nurses from a position of mutual respect and trust.
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Affiliation(s)
- Lotte van de Steeg
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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Walker B, Stomski N, Hebert J, French S. Evidence-based practice in chiropractic practice: A survey of chiropractors’ knowledge, skills, use of research literature and barriers to the use of research evidence. Complement Ther Med 2014; 22:286-95. [DOI: 10.1016/j.ctim.2014.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 02/28/2014] [Indexed: 11/15/2022] Open
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Ersek M, Jablonski A. A mixed-methods approach to investigating the adoption of evidence-based pain practices in nursing homes. J Gerontol Nurs 2014; 40:52-60. [PMID: 24640959 DOI: 10.3928/00989134-20140311-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 12/18/2013] [Indexed: 11/20/2022]
Abstract
This mixed methods study examined perceived facilitators and obstacles to adopting evidence-based pain management protocols vis-a-vis documented practice changes that were measured using a chart audit tool. This analysis used data from a subgroup of four nursing homes that participated in a clinical trial. Focus group interviews with staff yielded qualitative data about perceived factors that affected their willingness and ability to use the protocols. Chart audits determined whether pain assessment and management practices changed over time in light of these reported facilitators and barriers. Reported facilitators included administrative support, staff consistency, and policy and procedure changes. Barriers were staff attitudes, regulatory issues, and provider mistrust of nurses' judgment. Overall, staff reported improvements in pain practices. These reports were corroborated by modest but significant increases in adherence to recommended practices. Change in clinical practice is complex and requires attention to both structural and process aspects of care.
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Bunting RF. Healthcare innovation barriers: results of a survey of certified professional healthcare risk managers. J Healthc Risk Manag 2014; 31:3-16. [PMID: 22528399 DOI: 10.1002/jhrm.20099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Medical errors cause significant patient injuries, including deaths. Innovations designed to improve quality and reduce risk are numerous, as are the barriers that prevent innovation implementation. The purpose of this research was to analyze the relationships, if any, between the independent variables of hospital bed size and organizational structure, and the dependent variable barriers to three innovations: implementing a surgical safety checklist, preventing catheter-associated urinary tract infections, and adopting patient- and family-centered care. The findings strengthen and expand existing research and serve as the foundation for understanding barriers to implementation of three healthcare innovations. Future research should focus on organizational culture instead of innovation-specific barriers and should incorporate other independent variables, such as organizational profitability.
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Affiliation(s)
- Robert F Bunting
- Walden University, College of Health Sciences, School of Health Sciences, USA
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Doran DM, Reid-Haughian C, Chilcote A, Bai YQ. A formative evaluation of nurses' use of electronic devices in a home care setting. Can J Nurs Res 2013; 45:54-73. [PMID: 23789527 DOI: 10.1177/084456211304500106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to evaluate the implementation of a clinical information system (CIS) in a community setting. The researchers used a mixed-method design involving interviews, focus groups, and surveys. An independent cross-sectional sample of nurses was surveyed. At time 1 a total of 118 nurses responded and at time 2 a total of 81. Respondents were moderately satisfied with features of the CIS. User satisfaction was positively associated with access to structural and electronic resources and social capital and negatively associated with nurses' age at time 1. Social capital was positively associated with user satisfaction at time 2. Younger age was associated with overall research use at both time 1 and time 2. Research use was negatively associated with evaluation and feedback but positively associated with formal interactions. This evaluation identified the importance of educational support, user-centred design, and responsiveness to successful implementation of CISs in a community setting.
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Affiliation(s)
- Diane M Doran
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada
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D’Avolio DA, Strumpf NE, Feldman J, Mitchell P, Rebholz CM. Barriers to Primary Care. Clin Nurs Res 2013; 22:416-31. [DOI: 10.1177/1054773813485597] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This purpose of this mixed methods study was to understand access to primary care among older adults who present to an inner city emergency department (ED) for nonurgent care. Questionnaires ( N = 62) included demographic, illness characteristics, and health care utilization. Qualitative interviews ( N = 20) were conducted. Data was analyzed using descriptive statistics, and qualitative methodology. More than half of the participants were female (60%), African American (57%) and pain was the presenting symptoms among 48% of the participants. Nearly all participants reported barriers to primary care; difficulty with phone systems and staff, and lack of available appointments resulting in an ED visit. Older adults face barriers accessing primary care and as a result, can turn to the ED for their primary care needs. Interventions to improve access for vulnerable older adults might have benefits not only for patient outcomes but also for health policy issues related to cost effective care and overcrowded EDs.
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Affiliation(s)
| | | | | | | | - Casey M. Rebholz
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Milisen K, Coussement J, Arnout H, Vanlerberghe V, De Paepe L, Schoevaerdts D, Lambert M, Van Den Noortgate N, Delbaere K, Boonen S, Dejaeger E. Feasibility of implementing a practice guideline for fall prevention on geriatric wards: A multicentre study. Int J Nurs Stud 2013; 50:495-507. [DOI: 10.1016/j.ijnurstu.2012.09.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 09/18/2012] [Accepted: 09/30/2012] [Indexed: 11/16/2022]
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Hutchinson AM, Batra-Garga N, Cranley L, Bostrom AM, Cummings G, Norton P, Estabrooks CA. Feedback reporting of survey data to healthcare aides. Implement Sci 2012; 7:89. [PMID: 22974485 PMCID: PMC3495892 DOI: 10.1186/1748-5908-7-89] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 07/26/2012] [Indexed: 11/23/2022] Open
Abstract
Background This project occurred during the course of the Translating Research in Elder Care (TREC) program of research. TREC is a multilevel and longitudinal research program being conducted in the three Canadian Prairie Provinces of Alberta, Saskatchewan, and Manitoba. The main purpose of TREC is to increase understanding about the role of organizational context in influencing knowledge use in residential long-term care settings. The purpose of this study was to evaluate healthcare aides’ (HCAs) perceptions of a one-page poster designed to feed back aggregated data (including demographic information and perceptions about influences on best practice) from the TREC survey they had recently completed. Methods A convenience sample of 7 of the 15 nursing homes participating in the TREC research program in Alberta were invited to participate. Specific facility-level summary data were provided to each facility in the form of a one-page poster report. Two weeks following delivery of the report, a convenience sample of HCAs was surveyed using one-to-one structured interviews. Results One hundred twenty-three HCAs responded to the evaluation survey. Overall, HCAs’ opinions about presentation of the feedback report and the understandability, usability, and usefulness of the content were positive. For each report, analysis of data and production and inspection of the report took up to one hour. Information sessions to introduce and explain the reports averaged 18 minutes. Two feedback reports (minimum) were supplied to each facility at a cost of CAN$2.39 per report, for printing and laminating. Conclusions This study highlights not only the feasibility of producing understandable, usable, and useful feedback reports of survey data but also the value and importance of providing feedback to survey respondents. More broadly, the findings suggest that modest strategies may have a positive and desirable effect in participating sites.
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Affiliation(s)
- Alison M Hutchinson
- School of Nursing and Midwifery, Deakin University, Melbourne, Victoria, Australia.
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Tzeng HM. Nurses' caring attitude: fall prevention program implementation as an example of its importance. Nurs Forum 2011; 46:137-45. [PMID: 21806622 DOI: 10.1111/j.1744-6198.2011.00222.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED BACKGROUND OF THE PROBLEM: Fall prevention programs are universally multidisciplinary, but nursing care plays the central role. Since October 2008, Medicare has no longer reimbursed acute care hospitals for the costs of additional care required due to hospital-acquired injuries (e.g., injurious falls). PROBLEM However, fall prevention programs for hospitalized patients have had limited success, and multifaceted strategies for implementing fall prevention programs cannot guarantee success. It is possible that cultivating and sustaining a caring attitude among clinicians is often overlooked as an intervention strategy. METHOD This article discusses the barriers to implementing fall prevention programs in acute care hospitals. The attributional theory of success and failure is used to analyze these barriers. In addition, the author discusses whether a lack of knowledge and/or a lack of caring attitude play a role as the underlying barriers to implementing a successful fall prevention program. A patient's story illustrates patients' expectations for the care environment to center on their needs. Possible educational strategies as interventions for fall prevention programs are discussed. FINDINGS It is suggested that education goals for nurses need to not only promote their professional knowledge and skills in implementing a fall prevention program but also cultivate their caring attitudes.
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Affiliation(s)
- Huey-Ming Tzeng
- Department of Nursing, School of Health Professions and Studies, The University of Michigan-Flint, Flint, MI 48502-1950, USA.
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Haines TP, Waldron NG. Translation of falls prevention knowledge into action in hospitals: what should be translated and how should it be done? JOURNAL OF SAFETY RESEARCH 2011; 42:431-442. [PMID: 22152261 DOI: 10.1016/j.jsr.2011.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 08/31/2011] [Accepted: 10/04/2011] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Falls prevention evidence has changed and evolved over time with positive and negative studies revealing that a "one-size fits all" approach is not the solution. Care must be taken to critically appraise the evidence and the potential applicability of that evidence to the specific hospital setting. METHOD A narrative account of the evolution of research evidence in this field is first presented. How this evidence should be applied in clinical practice is challenging, with a lack of translational evidence for the hospital setting we draw on broader theory of translating knowledge to action. CONCLUSIONS The journey should begin with formation of a management and engagement committee. A review of existing practices and the difference between existing practice and evidence-based practice should be undertaken to identify the "evidence-practice gap." Engagement with staff is recommended to inform a plan for practice change. Plans for resourcing, targeting, and evaluating these strategies should also be undertaken. IMPACT ON INDUSTRY This paper will assist hospitals to identify and implement evidence based falls prevention strategies leading to an improvement in patient safety.
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Affiliation(s)
- Terry P Haines
- Allied Health Research Unit, Southern Health, Kingston Centre, Kingston Rd, Cheltenham, Victoria, Australia, 3192.
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van Harten-Krouwel D, Schuurmans M, Emmelot-Vonk M, Pel-Littel R. Development and feasibility of falls prevention advice. J Clin Nurs 2011; 20:2761-76. [DOI: 10.1111/j.1365-2702.2011.03801.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Black AA, Brauer SG, Bell RAR, Economidis AJ, Haines TP. Insights into the climate of safety towards the prevention of falls among hospital staff. J Clin Nurs 2011; 20:2924-30. [DOI: 10.1111/j.1365-2702.2010.03535.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sustainable practice change: professionals' experiences with a multisectoral child health promotion programme in Sweden. BMC Health Serv Res 2011; 11:61. [PMID: 21426583 PMCID: PMC3077331 DOI: 10.1186/1472-6963-11-61] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Accepted: 03/22/2011] [Indexed: 01/08/2023] Open
Abstract
Background New methods for prevention and health promotion and are constantly evolving; however, positive outcomes will only emerge if these methods are fully adopted and sustainable in practice. To date, limited attention has been given to sustainability of health promotion efforts. This study aimed to explore facilitators, barriers, and requirements for sustainability as experienced by professionals two years after finalizing the development and implementation of a multisectoral child health promotion programme in Sweden (the Salut programme). Initiated in 2005, the programme uses a 'Salutogenesis' approach to support health-promoting activities in health care, social services, and schools. Methods All professionals involved in the Salut Programme's pilot areas were interviewed between May and September 2009, approximately two years after the intervention package was established and implemented. Participants (n = 23) were midwives, child health nurses, dental hygienists/dental nurses, and pre-school teachers. Transcribed data underwent qualitative content analysis to illuminate perceived facilitators, barriers, and requirements for programme sustainability. Results The programme was described as sustainable at most sites, except in child health care. The perception of facilitators, barriers, and requirements were largely shared across sectors. Facilitators included being actively involved in intervention development and small-scale testing, personal values corresponding to programme intentions, regular meetings, working close with collaborators, using manuals and a clear programme branding. Existing or potential barriers included insufficient managerial involvement and support and perceived constraints regarding time and resources. In dental health care, barriers also included conflicting incentives for performance. Many facilitators and barriers identified by participants also reflected their perceptions of more general and forthcoming requirements for programme sustainability. Conclusions These results contribute to the knowledge of processes involved in achieving sustainability in health promotion initiatives. Facilitating factors include involving front-line professionals in intervention development and using small scale testing; however, the success of a programme requires paying attention to the role of managerial support and an overall supportive system. In summary, these results emphasise the importance for both practitioners and researchers to pay attention to parallel processes at different levels in multidisciplinary improvement efforts intended to ensure sustainable practice change.
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Abstract
This ethnographic study examines the experiences of health care providers (HCPs) and advocates implementing intimate partner violence (IPV) screening and interventions in their health care organizations. Numerous policies and protocols have been developed to improve the response of HCPs to survivors of IPV. Typically studies have focused on HCPs with little attention to the role of organizations in providing care. The findings from this study highlight that even with IPV programs in place the organizational environment can contribute to suboptimal outcomes. Identified challenges included time constraints, organizational expectations for increased productivity, and dwindling organizational support and services for IPV. With the continuing debate regarding universal screening, this study illuminates the need for clinicians to have a supportive clinical environment and resources for IPV screening and intervention.
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