Using a general theory of implementation to plan the introduction of delirium prevention for older people in hospital
Author(s)
Grealish, Laurie
Chaboyer, Wendy
Mudge, Alison
Simpson, Toni
Cahill, Margaret
Todd, Jo-Anne
Ownsworth, Tamara
Krug, Maree
Teodorczuk, Andrew
Marshall, Andrea P
Griffith University Author(s)
Year published
2019
Metadata
Show full item recordAbstract
Aim:
Develop an implementation plan for delirium prevention.
Background:
The use of non‐pharmacological interventions to prevent hospital‐acquired delirium is well established but their implementation has been notoriously difficult to achieve. Systematic analysis of context as part of implementation planning is critical.
Methods:
Ethnographic study conducted in a 24 bed general medical ward. Eleven patients and family members and 15 health service staff participated through observations, individual interviews, and document review. Inductive analysis was used to generate themes that described enablers and barriers.
Results: ...
View more >Aim: Develop an implementation plan for delirium prevention. Background: The use of non‐pharmacological interventions to prevent hospital‐acquired delirium is well established but their implementation has been notoriously difficult to achieve. Systematic analysis of context as part of implementation planning is critical. Methods: Ethnographic study conducted in a 24 bed general medical ward. Eleven patients and family members and 15 health service staff participated through observations, individual interviews, and document review. Inductive analysis was used to generate themes that described enablers and barriers. Results: Enablers included a ward culture that embraced safety and placing the person at the centre of care. Barriers were in tension with the enablers and included limited staff knowledge, specialist forms exclusive to the nursing discipline, inflexible ward routines, and frequent disruptions. Conclusions: In addition to standard implementation strategies such as individual education and leadership, implementing delirium prevention requires consideration of team practices, review of policy document design, and identification of outcomes data than can support collaborative reflexive practice. Implications for nursing management: The use of a theory‐informed ethnographic approach exposed tensions that may be otherwise invisible. Understanding the tensions increases the likelihood of implementation success. Using a systematic assessment approach can create a comprehensive implementation plan.
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View more >Aim: Develop an implementation plan for delirium prevention. Background: The use of non‐pharmacological interventions to prevent hospital‐acquired delirium is well established but their implementation has been notoriously difficult to achieve. Systematic analysis of context as part of implementation planning is critical. Methods: Ethnographic study conducted in a 24 bed general medical ward. Eleven patients and family members and 15 health service staff participated through observations, individual interviews, and document review. Inductive analysis was used to generate themes that described enablers and barriers. Results: Enablers included a ward culture that embraced safety and placing the person at the centre of care. Barriers were in tension with the enablers and included limited staff knowledge, specialist forms exclusive to the nursing discipline, inflexible ward routines, and frequent disruptions. Conclusions: In addition to standard implementation strategies such as individual education and leadership, implementing delirium prevention requires consideration of team practices, review of policy document design, and identification of outcomes data than can support collaborative reflexive practice. Implications for nursing management: The use of a theory‐informed ethnographic approach exposed tensions that may be otherwise invisible. Understanding the tensions increases the likelihood of implementation success. Using a systematic assessment approach can create a comprehensive implementation plan.
View less >
Journal Title
Journal of Nursing Management
Note
This publication has been entered into Griffith Research Online as an Advanced Online Version.
Subject
Mental Health Nursing
Nursing
General theory of implementation
acute confusion
delirium
ethnography
older people