Conectar
To: (i) examine Stroke Coordinators' perspectives of factors influencing sustained adherence to evidence-based protocols to manage Fever, Sugar (hyperglycaemia) and Swallow (FeSS) and (ii) compare findings between hospitals with consistently high FeSS Protocol adherence versus those with consistently low or variable adherence.
Qualitative descriptive process evaluation using in-depth, individual semi-structured interviews.
Hospitals that participated in ≥ 3 national stroke audit cycles were ranked by mean adherence to FeSS Protocols and stratified by consistently high, low and variable adherence. Three hospitals from each adherence strata were purposefully selected after further stratification by (i) previous participation in a FeSS Intervention study; and (ii) location (state, remoteness). Inductive thematic analysis was undertaken, with themes mapped to factors from the framework to compare findings by adherence level and contextualise the findings in relation to sustainability.
Analysis of 14 interviews identified two themes [and sub-themes]: (1) Stroke Coordinator as sustainability champions and boundary spanners [maintenance of implementation strategies; fostering working relationships, communication and influence] mapped to Workforce factors, organisational and Innovation-specific factors; and (2) Hospital executive and middle management respect of stroke specialty [designated area for stroke care; recognition of stroke specialist nursing skills; previous FeSS Intervention study participation] mapped to Workforce and Political factors. Key differences by adherence groupings related to the Stroke Coordinator model, workplace configuration, and the impact of interdepartmental relationships and competing organisational directives.
The Stroke Coordinator role was pivotal for sustained use of evidence-based FeSS Protocols for acute stroke care, driving multidisciplinary collaboration.
Internationally, many patients do not receive evidence-based acute stroke care. Despite the proven benefits of the FeSS Protocols, consistent implementation remains a challenge. This study recognises the critical importance of a dedicated Stroke Coordinator for all acute stroke hospitals. Their advocacy for the use of evidence-based interventions is key to improving stroke outcomes.
This study did not include patient or public involvement in its design, conduct, or reporting as it focused solely on the professional experiences of stroke care providers.
ACTRN 12623000445673. Registered 1 May 2023
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.
A qualitative descriptive study adhering to the COnsolidated criteria for REporting Qualitative research (COREQ) guidelines.
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.
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.
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.
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.
No Patient or Public Contribution.
To understand, from a nursing perspective, factors affecting the use of prophylactic dressings to prevent pressure injuries in acute hospitalised adults.
Pressure injury causes harm to patients and incurs significant costs to health services. Significant emphasis is placed on their prevention. Relatively recently, prophylactic dressings have been promoted to reduce pressure injury development. However, in the acute care setting, information about the clinical use of these dressing is lacking.
Qualitative, descriptive.
Nineteen medical and surgical nurses participated. Semi-structured interviews were conducted and transcribed verbatim. Thematic analysis was performed using an inductive approach using NVivo software.
Three themes were identified, reflecting factors that influenced and perpetuated indiscriminate use of prophylactic dressings: False sense of security; Convenience and task prioritisation; and Navigating challenges in evidence-based pressure injury prevention.
The findings indicate inconsistent prevention practices, with prophylactic dressings often applied without justification or referral to research-based evidence to guide clinical decision-making. There was a prevailing attitude of ‘job done’ when a prophylactic dressing was applied.
This study has identified several factors that perpetuate the inappropriate use of prophylactic dressings for pressure injury prevention that may be amenable to organisational change. The findings indicate that nurses often rely on these dressings as a shortcut due to time constraints, which led to missed skin assessments and low-value care. The research can be used to inform the development of clear guidelines on dressings within hospital settings which encourage assessment-based selection for their use, and process-based guidance for their application, skin surveillance, dressing inspection and removal.
The Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guideline was followed.
Neither patients nor the public were directly involved in this study.
To explore clinicians' and patients' perceptions of implementing evidence-based practice to improve clinical practice for preventing and managing surgical site infections within hospital acute care settings.
A convergent integrated mixed-methods systematic review using the Joanna Briggs Institute approach.
Included studies reported (i) acute care hospital clinicians' and patients' experiences and preferences for preventing and managing surgical site infections and (ii) barriers and facilitators to implementing surgical site infection prevention and management guidelines. The Mixed Methods Appraisal Tool and the Quality Improvement Minimum Quality Criteria Set were used for critical appraisal. Quantitative data was transformed into qualitised data, then thematically synthesised with qualitative data and coded all findings into themes. Clinicians' and patients' views were also compared.
English language peer-reviewed studies published from 2009 to March 2023 were identified from Medline, EMBASE, CINAHL, PsycINFO and Cochrane Central Library.
Thirty-seven studies (16 quantitative, 17 qualitative, 3 mixed-methods and 1 quality improvement) met the inclusion criteria. Five main themes represent key factors believed to influence the implementation of evidence-based surgical site infection prevention and management guidelines: (1) Intentional non-adherence to insufficiently detailed and outdated guidelines, (2) Knowledge deficits on evidence-based SSI care bring about inconsistent clinical practice, (3) Collaborative interdisciplinary and patient-provider relationship to enhance guideline uptake, (4) Infection surveillance to improve patient safety and quality of life and (5) Negative physical and psychological impacts on patients.
The five themes reflect a need for updated hospital guidelines as a medium to improve surgical site infection knowledge and ensure consistent and evidence-based clinical practice. This review also highlights the significance of interdisciplinary and patient-provider collaboration and infection surveillance to facilitate guideline uptake. The effectiveness of intervention bundles designed to improve these aspects of care will need to be evaluated in future research.
A future intervention bundle that includes (1) ensuring up-to-date hospital guidelines/policies; (2) fostering collaborative interdisciplinary teamwork culture between physicians, nurses, podiatrists, pharmacists and allied health professionals; (3) encouraging patient or carer involvement in shared decision-making and (4) implementing audit and feedback mechanism on infection surveillance is proposed to improve SSI prevention and management in acute care settings.
This paper followed the PRISMA 2020 checklist guideline for reporting systematic reviews.
This mixed-methods systematic review collates evidence of clinicians' and patients' experiences and preferences for preventing and managing surgical site infections. The inclusion of hospital patients' perspectives supports the development of patient-centred interventions.
Trial Registration: The review protocol is registered on the International Prospective Register of Systematic Reviews (PROSPERO 2021 CRD42021250885). Available at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021250885
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