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Barriers and facilitators to implementing pressure injury prevention and management guidelines in acute care : A mixed-methods systematic review
Wan, Ching Shan Cheng, Heilok Musgrave-Takeda, Mika Liu, Mark Tobiano, Georgia McMahon, Jake McInnes, Elizabeth Catherine
Wan, Ching Shan
Cheng, Heilok
Musgrave-Takeda, Mika
Liu, Mark
Tobiano, Georgia
McMahon, Jake
McInnes, Elizabeth Catherine
Abstract
Background: Evidence-based pressure injury prevention and management is a global health service priority. Low uptake of pressure injury guidelines leads to compromised patient outcomes. Understanding clinicians' and patients' views on the barriers and facilitators to implementing guidelines and mapping the identified barriers and facilitators to the Theoretical Domains Framework and behaviour change techniques will inform an end-user and theoretically informed intervention to improve guideline uptake in the acute care setting.
Objectives: To synthesise quantitative and qualitative evidence on i) hospital clinicians' and inpatients' perceptions and experiences of evidence-based pressure injury practices and ii) barriers and facilitators to implementing guidelines.
Design: A convergent integrated mixed-methods systematic review was conducted using the JBI approach.
Data source: English language peer-reviewed studies published from 2009 to August 2022 were identified from MEDLINE, EMBASE, CINAHL, PsycINFO and Cochrane Central Library.
Review methods: Included studies reported: i) acute care hospital clinicians' and patients' perceptions and experiences of evidence-based pressure injury practices and ii) barriers and facilitators to implementing guidelines. The Mixed Methods Appraisal Tool was used for critical appraisal. Quantitative data was transformed into qualitised data, then thematically synthesised with qualitative data, comparing clinicians' and patients' views. Barriers and facilitators associated with each main theme were mapped to the Theoretical Domains Framework and allocated to relevant behaviour change techniques.
Results: Fifty-five out of 14,488 studies of variable quality (29 quantitative, 22 qualitative, 4 mixed-methods) met the inclusion criteria. Four main themes represent factors thought to influence the implementation of evidence-based guidelines: 1) nurse-led multidisciplinary care, 2) patient participation in care, 3) practicability of implementation and 4) attitudes towards pressure injury prevention and management. Most barriers identified by clinicians were related to the third theme, whilst for patients, there were multiple barriers under theme 2. Barriers were mainly mapped to the Knowledge domain and Environmental Context and Resources domain and were matched to the behaviour change techniques of “instruction on how to perform a behaviour” and “restructuring the physical environment”. Most facilitators mentioned by clinicians and patients were related to themes 1 and 2, respectively, and mapped to the Environmental Context and Resources domain. All patient-related attitudes in theme 4 were facilitators.
Conclusions: These review findings highlight the most influential factors related to implementing evidence-based pressure injury care from clinicians' and patients' views and mapping these factors to the Theoretical Domains Framework and behaviour change techniques has contributed to developing a stakeholder-tailored implementation intervention in acute care settings.
PROSPERO registration: CRD42021250885.
Keywords
Evidence-based practice, Inpatients, Patient care, Pressure ulcer, Systematic review
Date
2023
Type
Journal article
Journal
Book
Volume
145
Issue
Page Range
1-16
Article Number
ACU Department
Nursing Research Institute
Faculty of Health Sciences
School of Nursing, Midwifery and Paramedicine
Faculty of Health Sciences
School of Nursing, Midwifery and Paramedicine
Relation URI
Event URL
Open Access Status
Published as ‘gold’ (paid) open access
License
CC BY-NC-ND 4.0
File Access
Open
Notes
©2023TheAuthor(s).
Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ).
PROSPERO registration: CRD42021250885.
Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ).
PROSPERO registration: CRD42021250885.