Designing strategies to implement a blunt chest injury care bundle using the behaviour change wheel: a multi-site mixed methods study
Abstract Background Blunt chest injury can lead to significant morbidity and mortality if not treated appropriately. A blunt chest injury care bundle was to be implemented at two sites to guide care. Aim To identify facilitators and barriers to the implementation of a blunt chest injury care bundle...
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| Format: | Article |
| Language: | English |
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BMC
2019-07-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-019-4177-z |
| _version_ | 1818506254190903296 |
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| author | Sarah Kourouche Tom Buckley Connie Van Belinda Munroe Kate Curtis |
| author_facet | Sarah Kourouche Tom Buckley Connie Van Belinda Munroe Kate Curtis |
| author_sort | Sarah Kourouche |
| collection | DOAJ |
| description | Abstract Background Blunt chest injury can lead to significant morbidity and mortality if not treated appropriately. A blunt chest injury care bundle was to be implemented at two sites to guide care. Aim To identify facilitators and barriers to the implementation of a blunt chest injury care bundle and design strategies tailored to promote future implementation. Methods 1) A mixed-method survey based on the theoretical domains framework (TDF) was used to identify barriers and facilitators to the implementation of a blunt chest injury care bundle. This survey was distributed to 441 staff from 12 departments across two hospitals. Quantitative data were analysed using SPSS and qualitative using inductive content analysis. 2) The quantitative and qualitative results from the survey were integrated and mapped to each of the TDF domains. 3) The facilitators and barriers were evaluated using the Behaviour Change Wheel to extract specific intervention functions, policies, behaviour change techniques and implementation strategies. Each phase was assessed against the Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Side-effects or safety and Equity (APEASE) criteria. Results One hundred ninety eight staff completed the survey. All departments surveyed were represented. Nine facilitators and six barriers were identified from eight domains of the TDF. Facilitators (TDF domains) were: understanding evidence-informed patient care and understanding risk factors (Knowledge); patient assessment skills and blunt chest injury management skills (Physical skills); identification with professional role (Professional role and identity); belief of consequences of care bundle (Belief about consequences); provision of training and protocol design (Environmental context and resources); and social supports (Social influences). Barriers were: not understanding the term ‘care bundle’ (Knowledge); lacking regional analgesia skills (Physical skills); not remembering to follow protocol (Memory, attention, and decision processes); negative emotions relating to new protocols (Emotions); equipment and protocol access (Environmental context and resources). Implementation strategies were videos, education sessions, visual prompt for electronic medical records and change champions. Conclusions Multiple facilitators and barriers were identified that may affect the implementation of a blunt chest injury care bundle. Implementation strategies developed through this process have been included in a plan for implementation in the emergency departments of two hospitals. Evaluation of the implementation is underway. |
| first_indexed | 2024-12-10T22:02:05Z |
| format | Article |
| id | doaj.art-44f30204caf94d71875e422b5448f942 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-10T22:02:05Z |
| publishDate | 2019-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-44f30204caf94d71875e422b5448f9422022-12-22T01:31:52ZengBMCBMC Health Services Research1472-69632019-07-0119111710.1186/s12913-019-4177-zDesigning strategies to implement a blunt chest injury care bundle using the behaviour change wheel: a multi-site mixed methods studySarah Kourouche0Tom Buckley1Connie Van2Belinda Munroe3Kate Curtis4Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and MidwiferyFaculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and MidwiferyFaculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and MidwiferyFaculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and MidwiferyFaculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and MidwiferyAbstract Background Blunt chest injury can lead to significant morbidity and mortality if not treated appropriately. A blunt chest injury care bundle was to be implemented at two sites to guide care. Aim To identify facilitators and barriers to the implementation of a blunt chest injury care bundle and design strategies tailored to promote future implementation. Methods 1) A mixed-method survey based on the theoretical domains framework (TDF) was used to identify barriers and facilitators to the implementation of a blunt chest injury care bundle. This survey was distributed to 441 staff from 12 departments across two hospitals. Quantitative data were analysed using SPSS and qualitative using inductive content analysis. 2) The quantitative and qualitative results from the survey were integrated and mapped to each of the TDF domains. 3) The facilitators and barriers were evaluated using the Behaviour Change Wheel to extract specific intervention functions, policies, behaviour change techniques and implementation strategies. Each phase was assessed against the Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Side-effects or safety and Equity (APEASE) criteria. Results One hundred ninety eight staff completed the survey. All departments surveyed were represented. Nine facilitators and six barriers were identified from eight domains of the TDF. Facilitators (TDF domains) were: understanding evidence-informed patient care and understanding risk factors (Knowledge); patient assessment skills and blunt chest injury management skills (Physical skills); identification with professional role (Professional role and identity); belief of consequences of care bundle (Belief about consequences); provision of training and protocol design (Environmental context and resources); and social supports (Social influences). Barriers were: not understanding the term ‘care bundle’ (Knowledge); lacking regional analgesia skills (Physical skills); not remembering to follow protocol (Memory, attention, and decision processes); negative emotions relating to new protocols (Emotions); equipment and protocol access (Environmental context and resources). Implementation strategies were videos, education sessions, visual prompt for electronic medical records and change champions. Conclusions Multiple facilitators and barriers were identified that may affect the implementation of a blunt chest injury care bundle. Implementation strategies developed through this process have been included in a plan for implementation in the emergency departments of two hospitals. Evaluation of the implementation is underway.http://link.springer.com/article/10.1186/s12913-019-4177-zHealth plan implementationNursingEmergencyOrganisationsThoracic injuriesThoracic wall |
| spellingShingle | Sarah Kourouche Tom Buckley Connie Van Belinda Munroe Kate Curtis Designing strategies to implement a blunt chest injury care bundle using the behaviour change wheel: a multi-site mixed methods study BMC Health Services Research Health plan implementation Nursing Emergency Organisations Thoracic injuries Thoracic wall |
| title | Designing strategies to implement a blunt chest injury care bundle using the behaviour change wheel: a multi-site mixed methods study |
| title_full | Designing strategies to implement a blunt chest injury care bundle using the behaviour change wheel: a multi-site mixed methods study |
| title_fullStr | Designing strategies to implement a blunt chest injury care bundle using the behaviour change wheel: a multi-site mixed methods study |
| title_full_unstemmed | Designing strategies to implement a blunt chest injury care bundle using the behaviour change wheel: a multi-site mixed methods study |
| title_short | Designing strategies to implement a blunt chest injury care bundle using the behaviour change wheel: a multi-site mixed methods study |
| title_sort | designing strategies to implement a blunt chest injury care bundle using the behaviour change wheel a multi site mixed methods study |
| topic | Health plan implementation Nursing Emergency Organisations Thoracic injuries Thoracic wall |
| url | http://link.springer.com/article/10.1186/s12913-019-4177-z |
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