Knowledge, attitudes, beliefs and behaviour intentions for three bowel management practices in intensive care: effects of a targeted protocol implementation for nursing and medical staff.

Journal article


Knowles, Serena, Lam, Lawrence, McInnes, Elizabeth, Elliott, Doug, Hardy, Jennifer and Middleton, Sandy. (2015) Knowledge, attitudes, beliefs and behaviour intentions for three bowel management practices in intensive care: effects of a targeted protocol implementation for nursing and medical staff. BMC Nursing. 14(6), pp. 1 - 13. https://doi.org/10.1186/s12912-015-0056-z
AuthorsKnowles, Serena, Lam, Lawrence, McInnes, Elizabeth, Elliott, Doug, Hardy, Jennifer and Middleton, Sandy
Abstract

Background

Bowel management protocols have the potential to minimize complications for critically ill patients. Targeted implementation can increase the uptake of protocols by clinicians into practice. The theory of planned behaviour offers a framework in which to investigate clinicians’ intention to perform the behaviour of interest. This study aimed to evaluate the effect of implementing a bowel management protocol on intensive care nursing and medical staffs’ knowledge, attitude, subjective norms, perceived behavioural control, behaviour intentions, role perceptions and past behaviours in relation to three bowel management practices.

Methods

A descriptive before and after survey using a self-administered questionnaire sent to nursing and medical staff working within three intensive care units before and after implementation of our bowel management protocol (pre: May – June 2008; post: Feb – May 2009).

Results

Participants had significantly higher knowledge scores post-implementation of our protocol (pre mean score 17.6; post mean score 19.3; p = 0.004). Post-implementation there was a significant increase in: self-reported past behaviour (pre mean score 5.38; post mean score 7.11; p = 0.002) and subjective norms scores (pre mean score 3.62; post mean score 4.18; p = 0.016) for bowel assessment; and behaviour intention (pre mean score 5.22; post mean score 5.65; p = 0.048) for administration of enema.

Conclusion

This evaluation, informed by the theory of planned behaviour, has provided useful insights into factors that influence clinician intentions to perform evidence-based bowel management practices in intensive care. Addressing factors such as knowledge, attitudes and beliefs can assist in targeting implementation strategies to positively affect clinician behaviour change. Despite an increase in clinicians’ knowledge scores, our implementation strategy did not, however, significantly change clinician behaviour intentions for all three bowel management practices. Further research is required to explore the influence of opinion leaders and organizational culture on clinicians’ behaviour intentions related to bowel management for intensive care patients.

KeywordsBowel management; Intensive care; Nursing; Theory of planned behaviour; Questionnaire
Year2015
JournalBMC Nursing
Journal citation14 (6), pp. 1 - 13
Digital Object Identifier (DOI)https://doi.org/10.1186/s12912-015-0056-z
Scopus EID2-s2.0-84924292758
Open accessOpen access
Page range1 - 13
Research GroupNursing Research Institute
Publisher's version
Additional information

© 2015 Knowles et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the [http://creativecommons.org/licenses/by/2.0] Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The [http://creativecommons.org/publicdomain/zero/1.0/] Creative Commons Public Domain Dedication waiver applies to the data made available in this article, unless otherwise stated.

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New graduate nurses' experiences of interactions in the critical care unit
Saghafi, Farida, Hardy, Jennifer and Hillege, Sharon. (2012) New graduate nurses' experiences of interactions in the critical care unit. Contemporary Nurse: Health care across the lifespan. 42(1), pp. 20 - 27. https://doi.org/10.5172/conu.2012.42.1.20
Preventing pressure ulcers-are pressure-redistributiong support surfaces effective?: A Cochrane systematic review and meta-analysis
McInnes, Elizabeth, Jammali-Blasi, Asmara, Bell-Syer, Sally, Dumville, Jo and Cullum, Nicky. (2012) Preventing pressure ulcers-are pressure-redistributiong support surfaces effective?: A Cochrane systematic review and meta-analysis. International Journal of Nursing Studies. 49(3), pp. 345 - 359. https://doi.org/10.1016/j.ijnurstu.2011.10.014
A qualitative study of stakeholder views of the conditions for and outcomes of successful clinical networks
McInnes, Elizabeth, Middleton, Sandy, Gardner, Glenn, Haines, Mary, Haertsch, Maggie, Paul, Christine L. and Castaldi, Peter. (2012) A qualitative study of stakeholder views of the conditions for and outcomes of successful clinical networks. BMC Health Services Research. 12(1), pp. 1 - 12. https://doi.org/10.1186/1472-6963-12-49
Determinants of successful clinical networks: the conceptual framework and study protocol
Haines, Mary, Brown, Bernadette, Craig, Jonathan, D'Este, Catherine, Elliott, Elizabeth, Klineberg, Emily, McInnes, Elizabeth, Middleton, Sandy, Paul, Christine and Redman, Sally. (2012) Determinants of successful clinical networks: the conceptual framework and study protocol. Implementation Science. 7(16), pp. 1 - 10. https://doi.org/10.1186/1748-5908-7-16
Peri-operative nurses' knowledge and reported practice of pressure injury risk assessment and prevention: A before-after intervention study
Sutherland-Fraser, Sally, McInnes, Elizabeth, Maher, Elisabeth and Middleton, Sandy. (2012) Peri-operative nurses' knowledge and reported practice of pressure injury risk assessment and prevention: A before-after intervention study. BMC Nursing. 11(25), pp. 1 - 10. https://doi.org/10.1186/1472-6955-11-25
Preventing pressure ulcers -- Are pressure-redistributing support surfaces effective? A Cochrane systematic review and meta-analysis
McInnes, Elizabeth, Jammali-Blasi, Asmara, Bell-Syer, Sally, Dumville, Jo and Cullum, Nicky. (2012) Preventing pressure ulcers -- Are pressure-redistributing support surfaces effective? A Cochrane systematic review and meta-analysis. International Journal of Nursing Studies. 49(3), pp. 345 - 359. https://doi.org/10.1016/j.ijnurstu.2011.10.014
The use of morphine to treat cancer related pain: a worked example of critical interpretive synthesis
Flemmings, Kate and McInnes, Elizabeth. (2012) The use of morphine to treat cancer related pain: a worked example of critical interpretive synthesis. In In K. Haines and C. Lockwood (Ed.). Choosing the right approach pp. 59 - 82 John Wiley & Sons. https://doi.org/10.1002/9781119959847.ch4
Repositioning for pressure ulcer prevention in adults (Protocol)
Gillespie, Brigid, Chaboyer, Wendy, McInnes, Elizabeth, Kent, Bridie and Whitty, Jennifer. (2012) Repositioning for pressure ulcer prevention in adults (Protocol). Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD009958
End-of-life care in the intensive care unit: A systematic review of qualitative studies investigating the experiences and perceptions of the patient's families
Coventry, Alysia, McInnes, Elizabeth and Rosenberg, John. (2012) End-of-life care in the intensive care unit: A systematic review of qualitative studies investigating the experiences and perceptions of the patient's families. JBI Database of Systematic Reviews and Implementation Reports. 10, pp. 95 - 106. https://doi.org/10.11124/jbisrir-2012-177
Older people's views in relation to risk of falling and need for intervention: A meta-ethnography
McInnes, Elizabeth, Seers, Kate and Tutton, Liz. (2011) Older people's views in relation to risk of falling and need for intervention: A meta-ethnography. Journal of Advanced Nursing. 67(12), pp. 2525 - 2536. https://doi.org/10.1111/j.1365-2648.2011.05707.x
Support surfaces for pressure ulcer prevention (Review)
McInnes, Elizabeth, Jammali-Blasi, Asmara, Bell-Syer, Sally E. M., Dumville, Jo C. and Cullum, Nicky. (2011) Support surfaces for pressure ulcer prevention (Review). Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD001735.pub4
A study of 90-day outcomes for a cohort of patients admitted to an Australian metropolitan acute stroke unit
Jammali-Blasi, Asmara, McInnes, Elizabeth, Markus, Romesh, Faux, Steven, O'Loughlin, Grainne, Dale, Simeon and Middleton, Sandy. (2011) A study of 90-day outcomes for a cohort of patients admitted to an Australian metropolitan acute stroke unit. Journal of Vascular Nursing. 29(1), pp. 3 - 10. https://doi.org/10.1016/j.jvn.2010.11.004
Support surfaces for treating pressure ulcers (Review)
McInnes, Elizabeth, Dumville, Jo C., Jammali-Blasi, Asmara and Bell-Syer, Sally E. M.. (2011) Support surfaces for treating pressure ulcers (Review). Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD009490
Support surfaces for pressure ulcer prevention (Review)
McInnes, Elizabeth, Jammali-Blasi, Asmara, Bell-Syer, Sally, Dumville, Jo and Cullum, Nicky. (2011) Support surfaces for pressure ulcer prevention (Review). Cochrane Database of Systematic Reviews. 21(21-22), pp. 3195 - 3198. https://doi.org/10.1002/14651858.CD001735.pub4
Who to turn to? Knowing the 'ropes' in an underbounded health care system
Chiarella, Mary and McInnes, Elizabeth. (2010) Who to turn to? Knowing the 'ropes' in an underbounded health care system. Contemporary Nurse. 36(February), pp. 10 - 20. https://doi.org/10.5172/conu.2010.36.1-2.010
Testing the effect of a targeted intervention on nurses' compliance with 'best practice' mechanical venous thromboembolism prevention
Li, Francesca, Walker, Kim, McInnes, Elizabeth and Duff, Jed. (2010) Testing the effect of a targeted intervention on nurses' compliance with 'best practice' mechanical venous thromboembolism prevention. Journal of Vascular Nursing. 28(3), pp. 92 - 96. https://doi.org/10.1016/j.jvn.2010.06.002
Patient care guidelines: A telephone survey of intensive care practices in New South Wales
Serena, Knowles,, Rolls, Kaye, Elliott, Doug, Hardy, Jenni and Middleton, Sandy. (2010) Patient care guidelines: A telephone survey of intensive care practices in New South Wales. Australian Critical Care. 23(1), pp. 21 - 29. https://doi.org/10.1016/j.aucc.2009.10.001
Celebrating connecting with communities: Coproduction in global primary health care
Chiarella, Mary, Savage, Jane and McInnes, Elizabeth. (2010) Celebrating connecting with communities: Coproduction in global primary health care. Primary Health Care Research and Development. 11(2), pp. 108 - 122.
In their own words: Support surfaces to prevent pressure ulcers
McInnes, Elizabeth. (2010) In their own words: Support surfaces to prevent pressure ulcers. Journal of Evidence-Based Medicine. 3(2), pp. 132 - 132. https://doi.org/10.1111/j.1756-5391.2010.01081.x
Letter: Evidence-based wound care in the UK: A response to David Leaper's Editorial in International Wound Journal April 2009 6(2)
Bell-Syer, Sally, Brady, Marian, Bruce, Julie, Cullum, Nicky A., Foxlee, Ruth, Jull, Andrew, Margolis, David, McInnes, Elizabeth, Nelson, Andre, O'Meara, Susan and Ubbink, Dirk. (2009) Letter: Evidence-based wound care in the UK: A response to David Leaper's Editorial in International Wound Journal April 2009 6(2). International Wound Journal. 6(4), pp. 306 - 309. https://doi.org/10.1111/j.1742-481X.2009.00620_1.x
Support surfaces for pressure ulcer prevention
McInnes, Elizabeth, Cullum, Nicky A., Bell-Syer, Sally, Dumville, Jo C. and Jammali-Blasi, Asmara. (2008) Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD001735.pub3
Implementing technology-based care and management, systems for effective aged care outcomes: Issues and recommendations
McDonald, Tracey Therese Anne, Hardy, Jennifer Lynette, Lee, Carolyn and Kwok, C.. (2008) Implementing technology-based care and management, systems for effective aged care outcomes: Issues and recommendations. In Heather Grain (Ed.). Health Informatics Society of Australia, HISA 2008 'The person in the centre'. Melbourne, Australia: Health Informatics Society of Australia. pp. 1 - 6
Support surfaces for pressure ulcer prevention
McInnes, Elizabeth, Cullum, Nicky, Bell-Syer, Sally and Legood, Rosa. (2008) Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD001735.pub2
An overview of the competency movement in nursing and midwifery
Tho, Debra, Chiarella, Mary, McInnes, Elizabeth and Lau, Cecilia. (2008) An overview of the competency movement in nursing and midwifery. Collegian. 15(2), pp. 45 - 53. https://doi.org/10.1016/j.colegn.2008.02.001
Using the qualitative assessment and review instrument (QARI) software to synthesise studies on older people's views and experiences of falls prevention
McInnes, Elizabeth and Wimpenny, Peter. (2008) Using the qualitative assessment and review instrument (QARI) software to synthesise studies on older people's views and experiences of falls prevention. International Journal of Evidence-Based Healthcare. 6(3), pp. 337 - 344.
A case study on implementing Portfolios and ePortfolios :more than a learning curve
Dennis, Christine, Hardy, Jennifer Lynette and Matejka, Des. (2008) A case study on implementing Portfolios and ePortfolios :more than a learning curve. In Joseph Luca and Edgar R. Weippl (Ed.). Proceedings of ED-MEDIA 2008. Chesapeake, USA: Association for the Advancement of Computing in Education. pp. 755 - 760
Legality, morality and reality - the role of the nurse in maintaining standards of care
Chiarella, Mary and McInnes, Elizabeth. (2008) Legality, morality and reality - the role of the nurse in maintaining standards of care. Australian Journal of Advanced Nursing. 26(1), pp. 77 - 83.
A systematic review of older people's perceptions of facilitators and barriers to participation in falls-prevention interventions
Bunn, Frances, Dickinson, Angela, Barnett-Page, Elaine, McInnes, Elizabeth and Horton, Khim. (2008) A systematic review of older people's perceptions of facilitators and barriers to participation in falls-prevention interventions. Ageing and Society. 28(4), pp. 449 - 472. https://doi.org/10.1017/S0144686X07006861
Trialing collaborative nursing models of care: The impact of change.
Fowler, Joanna, Hardy, Jenni and Howarth, Teresa. (2006) Trialing collaborative nursing models of care: The impact of change. Australian Journal of Advanced Nursing. 23(4), pp. 40 - 46.
Development of a model to advance the uptake of e-portfolios for undergraduates in teacher education and registered nurse preparation :An exemplar of best practice
White, Paul, Hardy, Jennifer Lynette and Dennis, Christine. (2006) Development of a model to advance the uptake of e-portfolios for undergraduates in teacher education and registered nurse preparation :An exemplar of best practice. In Elaine Pearson and Paul Bohman (Ed.). Proceedings of Ed-Media 2006: World Conference on Educational multimedia; hypermedia and telecommunications. Norfold,USA: Association for the Advancement of Computing in Education. pp. 248 - 253
Using e-learning principles in an undergraduate nursing course
Drury, Peta, Hardy, Jennifer Lynette and Frotjold, Astrid Jann. (2005) Using e-learning principles in an undergraduate nursing course. In E-Learn (Ed.). Proceedings of World Conference on E-Learning in Corporate, Government, Healthcare, and Higher Education; 2005. Montreal, Canada: Association for the Advancement of Computing in Education. pp. 276 - 281
Clinical practice guidelines for the assessment and prevention of falls in older people
McInnes, Elizabeth, Gibbons, Elizabeth and Chandler-Oatts, Jacqueline. (2005) Clinical practice guidelines for the assessment and prevention of falls in older people. Worldviews on Evidence-Based Nursing. 2(1), pp. 33 - 36. https://doi.org/10.1111/j.1524-475X.2005.04094.x
Developing a guideline on the use of pressure-relieving
Legood, Rosa and McInnes, Elizabeth. (2005) Developing a guideline on the use of pressure-relieving. Journal of Advanced Nursing. 50(3), pp. 307 - 314. https://doi.org/10.1111/j.1365-2648.2005.03394.x
The prevention of pressure ulcers
Rycroft-Malone, Jo and McInnes, Elizabeth. (2004) The prevention of pressure ulcers. Worldviews on Evidence-Based Nursing. 1(2), pp. 146 - 149. https://doi.org/10.1111/j.1741-6787.2004.04032.x
Leadership in health informatics: Roles and responsibilities
Hardy, Jennifer Lynette. (2004) Leadership in health informatics: Roles and responsibilities. In In J. Daly, S. Speedy and D. Jackson (Ed.). Nursing Leadership pp. 261 - 272 Churchill Livingstone.
Evidence review on older people's views and experiences of falls prevention strategies
McInnes, Elizabeth and Askie, Lisa. (2004) Evidence review on older people's views and experiences of falls prevention strategies. Worldviews on Evidence-Based Nursing. 1(1), pp. 20 - 37. https://doi.org/10.1111/j.1741-6787.2004.04013.x
Developing national clinical practice guidelines :the NICE experience
McInnes, Elizabeth. (2004) Developing national clinical practice guidelines :the NICE experience. Implementing evidence based practice in nursing and midwifery. Adelaide, Australia: The Joanna Briggs Institute. pp. 73 - 76
The use of pressure-relieving devices (beds, mattresses and overlays) for the prevention of pressure ulcers in primary and secondary care
McInnes, Elizabeth. (2004) The use of pressure-relieving devices (beds, mattresses and overlays) for the prevention of pressure ulcers in primary and secondary care. Journal of Tissue Viability. 14(1), pp. 4 - 23.
Evidence-based practice
Richens, Yana, Loftus-Hills, Alison and McInnes, Elizabeth Catherine. (2003) Evidence-based practice. In In S. Hinchliff, S. Norman and J. Schober (Ed.). Nursing practice and health care pp. 149 - 176 Hodder Arnold.