Barriers and facilitators to sustainable operating theatres: a systematic review using the Theoretical Domains Framework.
Barriers and facilitators to sustainable operating theatres: a systematic review using the Theoretical Domains Framework.
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DOI：
10.1097/js9.0000000000000829
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发表时间：
2024-01-01
影响因子：
15.3
通讯作者：
Judah, Gaby
中科院分区：
文献类型：
--
作者：
Almukhtar, Aws;Batcup, Carys;Bowman, Miranda;Winter-Beatty, Jasmine;Leff, Daniel;Demirel, Pelin;Porat, Talya;Judah, Gaby
关键词：
卫生部门对气候危机有重大贡献。特别是手术室（OT）是温室气体排放和废物的主要贡献者，虽然有几个基于证据的指导方针来减少这种影响，但这些指导方针往往没有得到遵守。作者系统地回顾了文献，以确定OT中可持续行为的障碍和促进因素，并使用理论领域框架（TDF）对这些进行分类。检索Medline、Embase、PsychInfo和Global Health数据库中2000年1月至2023年6月期间发表的文章，使用的概念包括：障碍和促进因素、可持续性和手术。两名评审员筛选已确定研究的摘要，评估质量并提取数据。确定的决定因素被映射到TDF领域，并根据需要进一步的主题。根据PRISMA（系统性综述和荟萃分析的首选报告项目）和AMSTAR（评估系统性综述的测量工具）指南报告结果。选择了21项研究进行分析和评估（17项调查和4项访谈研究），包括8286名参与者，包括外科医生，护士和麻醉师。确定了跨10个TDF领域的18个主题。在运营商中采用绿色行为的最常见障碍是：“知识”（N=18），例如可持续实践的知识;“环境背景和资源”（N=16），例如人员短缺和工作量以及回收设施不足;“社会影响”（N=9），例如缺乏领导/组织授权或支持;“对后果的信念”（N=9），例如对安全性的担忧。意图是最常见的促进因素，有11项研究引用了它。尽管意图在OT中采用可持续的实践，但这项审查确定了这样做的几个障碍。干预措施应侧重于缓解这些问题，特别是通过提高工作人员对可持续性做法的了解，并在环境背景和时间压力下开展工作。此外，还需要制定制度变革计划和政策，以优先考虑医院和信托层面的可持续发展。还应使用行为框架进行额外的定性工作，以更全面地调查OTs脱碳的障碍和决定因素。
The health sector contributes significantly to the climate crisis. Operating theatres (OTs) in particular are a major contributor of greenhouse gas emissions and waste, and while there are several evidence-based guidelines to reduce this impact, these are often not followed. The authors systematically reviewed the literature to identify barriers and facilitators of sustainable behaviour in OTs, categorising these using the Theoretical Domains Framework (TDF). Medline, Embase, PsychInfo, and Global Health databases were searched for articles published between January 2000 and June 2023, using the concepts: barriers and facilitators, sustainability, and surgery. Two reviewers screened abstracts from identified studies, evaluated quality, and extracted data. Identified determinants were mapped to TDF domains and further themes as required. The results were reported in line with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) and AMSTAR (A MeaSurement Tool to Assess Systematic Reviews) guidelines. Twenty-one studies were selected for analysis and assessment (17 surveys and four interview studies) comprising 8286 participants, including surgeons, nurses, and anaesthetists. Eighteen themes across 10 TDF domains were identified. The most common barriers to adoption of green behaviours in OTs were in domains of: ‘knowledge’ (N=18), for example knowledge of sustainable practices; ‘environmental context and resources’ (N=16) for example personnel shortage and workload and inadequate recycling facilities; ‘social influences’ (N=9) for example lack of leadership/organisational mandate or support; ‘beliefs about consequences’ (N=9) for example concerns regarding safety. Intention was the most common facilitator, with 11 studies citing it. Despite intentions to adopt sustainable practices in OTs, this review identified several barriers to doing so. Interventions should focus on mitigating these, especially by improving staff’s knowledge of sustainability practices and working within the environmental context and time pressures. Furthermore, institutional change programmes and policies are needed to prioritise sustainability at the hospital and trust level. Additional qualitative work should also be conducted using behavioural frameworks, to more comprehensively investigate barriers and determinants to decarbonise OTs.
影响因子：
1.5
作者：
Hathi, Kalpesh;Fowler, James;Zahabi, Sarah;Dzioba, Agnieszka;Madou, Edward;Gunz, Anna C.;Sowerby, Leigh J.;Nichols, Anthony C.;Strychowsky, Julie E.
通讯作者：
Strychowsky, Julie E.