Laurie Grealish1,2, Wendy Chaboyer2, Alison Mudge3,4, Toni Simpson1, Margaret Cahill3, Jo-Anne Todd2, Tamara Ownsworth5, Maree Krug6, Andrew Teodorczuk7, Andrea P Marshall1,2. 1. Gold Coast Hospital and Health Service, Gold Coast, Qld, Australia. 2. School of Nursing & Midwifery and Menzies Health Institute Queensland, Griffith University, Gold Coast, Qld, Australia. 3. Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Herston, Qld, Australia. 4. School of Clinical Medicine, University of Queensland, Brisbane, Qld, Australia. 5. School of Applied Psychology, Griffith University, Mt Gravatt, Qld, Australia. 6. Specialist Medical Unit, Robina Hospital, Robina, Qld, Australia. 7. School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Qld, Australia.
Abstract
AIM: To 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 was 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.
AIM: To 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 was 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.