Barriers and Facilitators to Implementing Pressure Injury Guidelines for Nutrition Assessment and Alternating Pressure Air Mattress Allocation: A Qualitative Study

ABSTRACT

Aims

To investigate clinicians' views on barriers and facilitators to implementing pressure injury prevention guideline recommendations for nutrition assessment and treatment, and de-implementing inappropriate alternating pressure air mattress allocation.

Design

A qualitative descriptive study adhering to the COnsolidated criteria for REporting Qualitative research (COREQ) guidelines.

Methods

We conducted face-to-face or videoconference focus groups and semi-structured individual interviews with clinicians recruited from a metropolitan tertiary hospital. Participants were purposively sampled according to their years of clinical practice. Interview transcripts were thematically analysed inductively to derive barriers and facilitators to guideline uptake. These were then mapped to the Theoretical Domains Framework and behaviour change techniques to inform an evidence-based implementation intervention development to improve guideline uptake.

Results

Thirteen nurses, four occupational therapists and three dietitians were interviewed. Six themes illustrate three guideline-specific barriers and three common facilitators influencing nutrition- and mattress-related guideline uptake. The three barriers were: (1) nurses devalue the use of validated tools in nutrition screening; (2) nurses prioritise vital-sign-related nursing duties over feeding assistance according to clinical urgency; and (3) nurses consider air mattresses a preventative strategy irrespective of patient PI risks. Facilitators to improve guideline uptake were: (1) nurse-led interdisciplinary collaboration, (2) carer involvement and (3) easily accessible updated guidelines. Different Theoretical Domains Framework domains and behaviour change techniques were mapped to the identified nutrition- and mattress-related barriers.

Conclusion

The findings highlight three key nurses' attitudinal barriers to nutrition- and mattress-related guideline uptake, which inform the development of theory- and end-user-informed implementation interventions in pressure injury prevention.

Implications

An implementation strategical plan that addresses attitudinal barriers to improving guideline uptake for nutrition assessment and treatment and reducing air mattress overprescription appears critical in developing an intervention to enhance value-based practice, which will need to be evaluated in future trials.

Patient or Public Contribution

No Patient or Public Contribution.