Barriers and facilitators for implementing a new screening tool in an emergency department: A qualitative study applying the Theoretical Domains Framework
Barriers and facilitators for implementing a new screening tool in an emergency department: A qualitative study applying the Theoretical Domains Framework
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DOI：
10.1111/jocn.13275
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发表时间：
2016-10-01
影响因子：
4.2
通讯作者：
Petersen, Helle V.
中科院分区：
文献类型：
--
作者：
Kirk, Jeanette W.;Sivertsen, Ditte M.;Petersen, Helle V.
瞄准。目的是确定在急诊科护士和老年团队中引入和打算使用新工具的促进者或障碍等最重要的因素。背景。年龄最大的患者和身体虚弱的患者在因急性疾病住院后功能衰退的发生率很高。在丹麦，急诊入院的老年内科患者中，超过35%在出院后90天内再次入院。开发了一种用于急诊科的新的筛查工具，旨在识别功能衰退和再次住院的特别高风险的患者。设计。定性研究基于对急诊科护士和老年团队的半结构化访谈以及与其管理人员的半结构化单一访谈。理论领域框架指导数据收集和分析。进行内容分析，描述每个领域中已经存在的新主题和主题。确定了六个主要领域：(1)专业角色和身份；(2)对结果的信念；(3)目标；(4)知识；(5)乐观；(6)环境背景和资源。内容分析确定了三个主题，每个主题包含两个分主题。主题是职业角色和身份认同、对结果的信念和成功实施的先决条件。在急诊科发现了两种不同的细菌。这些文化适用于不同的职业角色和身份、不同的行动和意义，并确定了与新的筛查工具有关的障碍和促进者是如何被感知的。
Aim. The aim was to identify the factors that were perceived as most important as facilitators or barriers to the introduction and intended use of a new tool in the emergency department among nurses and a geriatric team.Background. A high incidence of functional decline after hospitalisation for acute medical illness has been shown in the oldest patients and those who are physically frail. In Denmark, more than 35% of older medical patients acutely admitted to the emergency department are readmitted within 90 days after discharge. A new screening tool for use in the emergency department aiming to identify patients at particularly high risk of functional decline and readmission was developed.Design. Qualitative study based on semistructured interviews with nurses and a geriatric team in the emergency department and semistructured single interviews with their managers.Methods. The Theoretical Domains Framework guided data collection and analysis. Content analysis was performed whereby new themes and themes already existing within each domain were described.Results. Six predominant domains were identified: (1) professional role and identity; (2) beliefs about consequences; (3) goals; (4) knowledge; (5) optimism and (6) environmental context and resources. The content analysis identified three themes, each containing two subthemes. The themes were professional role and identity, beliefs about consequences and preconditions for a successful implementation.Conclusions. Two different cultures were identified in the emergency department. These cultures applied to different professional roles and identity, different actions and sense making and identified how barriers and facilitators linked to the new screening tool were perceived.