EXploring practice gaps to improve PERIperativE Nutrition CarE (EXPERIENCE Study): a qualitative analysis of barriers to implementation of evidence-based practice guidelines
EXploring practice gaps to improve PERIperativE Nutrition CarE (EXPERIENCE Study): a qualitative analysis of barriers to implementation of evidence-based practice guidelines
复制标题
DOI：
10.1038/s41430-018-0276-x
复制
发表时间：
2019-01-01
影响因子：
4.7
通讯作者：
Bauer, Judy
中科院分区：
文献类型：
--
作者：
Byrnes, Angela;Young, Adrienne;Bauer, Judy
背景/目的将护理与最佳实践相结合--如术后增强恢复（ERAS）指南--可能会改善患者的预后。然而，将研究转化为实践是具有挑战性的，实施科学文献强调了解当地环境和临床医生特有的障碍和推动因素的重要性。本研究的目的是探讨工作人员的看法的障碍和推动因素，以实践改变与营养相关的建议，从ERAS guidelines.Subjects/Methods使用最大变异抽样方法的定性研究。临床医生参与护理的病人承认两个普通外科病房同意参加半结构化的采访。框架分析是利用综合促进行动在卫生服务的研究实施框架，以确定先验和紧急的主题。（两名外科顾问、一名登记员、一名实习生;一名麻醉师;两名护士单位管理员、一名外科护士协调员、三名护士;两名营养师），确定了三个主要主题：（a）背景的复杂性（例如，手术时间不可预测，需要灵活性和大量多学科工作人员）;（B）决策等级森严，加上初级和非手术工作人员缺乏实施变革的知识、信心或权威;以及（c）沟通和团队合作不力（学科内和学科间）。这些障碍最终在实践中默认的行为习惯，并认为，实现临床共识是challenging.Conclusions本研究强调的必要性，一个多方面的实施方法，简化了过程中，besides的权力差异，促进沟通和团队合作。其他设施在实施类似的做法改变干预措施时可能会考虑这些调查结果。
Background/Objectives Aligning care with best practice-such as Enhanced Recovery After Surgery (ERAS) guidelines-may improve patient outcomes. However, translating research into practice is challenging and implementation science literature emphasises the importance of understanding barriers and enablers specific to the local context and clinicians. This study aimed to explore staff perceptions about barriers and enablers to practice change aligning with nutrition-related recommendations from ERAS guidelines.Subjects/Methods A qualitative study using a maximum variation sampling method. Clinicians involved in care of patients admitted to two general surgical wards consented to participate in semi-structured interviews. Framework analysis was undertaken using the integrated Promoting Action on Research Implementation in Health Services framework to identify a priori and emergent themes.Results From interviews with 13 clinicians (two surgical consultants, one registrar, one intern; one anaesthetist; two nurse unit managers, one surgical nurse coordinator, three nurses; two dietitians), three major themes were identified: (a) complexity of the context (e.g., unpredictable theatre times, requirement for flexibility and large, multidisciplinary workforce); (b) strong decision-making hierarchy, combined with lack of knowledge, confidence or authority of junior and non-surgical staff to implement change; and (c) poor communication and teamwork (within and between disciplines). These barriers culminate in practice where default behaviours are habit, and the view that achieving clinical consensus is challenging.Conclusions This study highlights the necessity for a multifaceted implementation approach that simplifies the process, flattens the power differential and facilitates communication and teamwork. Other facilities may consider these findings when implementing similar practice change interventions.