Tags

Type your tag names separated by a space and hit enter

Using a general theory of implementation to plan the introduction of delirium prevention for older people in hospital.

Abstract

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.

Authors+Show Affiliations

Menzies Health Institute Queensland, Griffith University And Gold Coast Hospital and Health Service, 2.05c, G01, Gold Coast Campus, Griffith University, Southport, Queensland.School of Nursing & Midwifery and Menzies Health Institute Queensland, Griffith University, GOLD COAST Qld.Clinical Director Research and Education, Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, HERSTON Qld, And Professor, School of Clinical Medicine, University of Queensland, Brisbane, Qld.Nurse Practitioner - Ageing, Gold Coast Hospital and Health Service, GOLD COAST Qld.Clinical Nurse Consultant - Eat Walk Engage, Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, HERSTON Qld.School of Nursing & Midwifery, Griffith University, GOLD COAST Qld.School of Applied Psychology, Griffith University, Mt GRAVATT, Qld.Nursing Unit Manager, Specialist Medical Unit, Robina Hospital, ROBINA, Qld.School of Medicine and Menzies Health Institute Queensland, Griffith University, GOLD COAST Qld.Acute and Complex Care Nursing, Menzies Health Institute Queensland & School of Nursing and Midwifery, Griffith University And Gold Coast Hospital and Health Service Griffith University, GOLD COAST Qld.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31444812

Citation

Grealish, Laurie, et al. "Using a General Theory of Implementation to Plan the Introduction of Delirium Prevention for Older People in Hospital." Journal of Nursing Management, 2019.
Grealish L, Chaboyer W, Mudge A, et al. Using a general theory of implementation to plan the introduction of delirium prevention for older people in hospital. J Nurs Manag. 2019.
Grealish, L., Chaboyer, W., Mudge, A., Simpson, T., Cahill, M., Todd, J. A., ... Marshall, A. P. (2019). Using a general theory of implementation to plan the introduction of delirium prevention for older people in hospital. Journal of Nursing Management, doi:10.1111/jonm.12849.
Grealish L, et al. Using a General Theory of Implementation to Plan the Introduction of Delirium Prevention for Older People in Hospital. J Nurs Manag. 2019 Aug 24; PubMed PMID: 31444812.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Using a general theory of implementation to plan the introduction of delirium prevention for older people in hospital. AU - Grealish,Laurie, AU - Chaboyer,Wendy, AU - Mudge,Alison, AU - Simpson,Toni, AU - Cahill,Margaret, AU - Todd,Jo-Anne, AU - Ownsworth,Tamara, AU - Krug,Maree, AU - Teodorczuk,Andrew, AU - Marshall,Andrea P, Y1 - 2019/08/24/ PY - 2019/8/25/entrez KW - General theory of implementation KW - acute confusion KW - delirium KW - ethnography KW - older people JF - Journal of nursing management JO - J Nurs Manag N2 - 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. SN - 1365-2834 UR - https://www.unboundmedicine.com/medline/citation/31444812/Using_a_general_theory_of_implementation_to_plan_the_introduction_of_delirium_prevention_for_older_people_in_hospital L2 - https://doi.org/10.1111/jonm.12849 DB - PRIME DP - Unbound Medicine ER -