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BMC Health Services Research
Published in: BMC Health Services Research 1/2008

Open Access 01-12-2008 | Research article

Nurses' perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals

Authors: Serena SL Koh, Elizabeth Manias, Alison M Hutchinson, Susan Donath, Linda Johnston

Published in: BMC Health Services Research | Issue 1/2008

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Abstract

Background

Theories of behavior change indicate that an analysis of barriers to change is helpful when trying to influence professional practice. The aim of this study was to assess the perceived barriers to practice change by eliciting nurses' opinions with regard to barriers to, and facilitators of, implementation of a Fall Prevention clinical practice guideline in five acute care hospitals in Singapore.

Methods

Nurses were surveyed to identify their perceptions regarding barriers to implementation of clinical practice guidelines in their practice setting. The validated questionnaire, 'Barriers and facilitators assessment instrument', was administered to nurses (n = 1830) working in the medical, surgical, geriatric units, at five acute care hospitals in Singapore.

Results

An 80.2% response rate was achieved. The greatest barriers to implementation of clinical practice guidelines reported included: knowledge and motivation, availability of support staff, access to facilities, health status of patients, and, education of staff and patients.

Conclusion

Numerous barriers to the use of the Fall Prevention Clinical Practice Guideline have been identified. This study has laid the foundation for further research into implementation of clinical practice guidelines in Singapore by identifying barriers to change in acute care settings.
Literature
1.
Buchan H, Sewell JR, Sweet M: Translating evidence into practice. The Medical Journal of Australia. 2004, 180: S43.PubMed
2.
Closs SJ, Cheater FM: Utilisation of Nursing Research: Culture, Interest and Support. Journal of Advanced Nursing. 1994, 19: 762-773. 10.1111/j.1365-2648.1994.tb01149.x.CrossRefPubMed
3.
Davies BL: Sources and models for moving research evidence into clinical practice. Journal of Obstetrics, Gynecologic, & Neonatal Nursing. 2002, 31: 558-562. 10.1111/j.1552-6909.2002.tb00081.x.CrossRef
4.
Hutchinson AM, Johnston L: Bridging the divide: a survey of nurses' opinions regarding barriers to, and facilitators of, research utilization in the practice setting. Journal of Clinical Nursing. 2004, 13: 304-315. 10.1046/j.1365-2702.2003.00865.x.CrossRefPubMed
5.
Funk SG, Champagne MT, Wiese RA, Tornquist EM: Barriers to Using Research Findings in Practice: The Clinician's Perspective. Applied Nursing Research. 1991, 4: 90-95.CrossRefPubMed
6.
Hunt J: Barriers to research utilization. Journal of Advanced Nursing. 1996, 23: 423-425. 10.1111/j.1365-2648.1996.tb00001.x.CrossRefPubMed
7.
Bryar RM, Closs SJ, Baum G, Cooke J, Griffiths J, Hostick T, Kelly S, Knight S, Marshall K, Thompson DR: The Yorkshire BARRIERS project: diagnostic analysis of barriers to research utilisation. International Journal of Nursing Studies. 2003, 40: 73-84. 10.1016/S0020-7489(02)00039-1.CrossRefPubMed
8.
Slutsky J: Using Evidence-Based Practice Guidelines: Tools for Improving Practice. Evidence-Based Practice in Nursing & Healthcare A guide to best practice. Edited by: Melnyk BM, Fineout-Overholt E. 2005, Philadelphia: Lippincott Williams & Wilkins
9.
Institute of Medicine: Guidelines for clinical practice. From development to use. Edited by: Field MJ, Lohr KN. 1992, Washington: National Academy Press
10.
Eccles M, Grimshaw J: Selecting, presenting and delivering clinical guidelines: Are there any "magic bullets"?. The Medical Journal of Australia. 2004, 180: S52-54.PubMed
11.
Grimshaw J, Russell I: Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993, 342: 1317-1322. 10.1016/0140-6736(93)92244-N.CrossRefPubMed
12.
Grimshaw J, Freemantle N, Wallace S, Russell I, Hurwitz B, Watt I, Long A, Sheldon T: Developing and implementing clinical practice guidelines. Quality in Health Care. 1995, 4: 55-64.CrossRefPubMedPubMedCentral
13.
Grol R: Successes and Failures in the Implementation of Evidence-Based Guidelines for Clinical Practice. Medical Care. 2001, 39: II–46-II–54. 10.1097/00005650-200108002-00003.CrossRef
14.
Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J: Clinical guidelines: Potential benefits, limitations, and harms of clinical guidelines. British Medical Journal. 1999, 318: 527-530.CrossRefPubMedPubMedCentral
15.
Lomas J, Anderson GM, Domnick-Pierre K, Vayda E, Enkin MW, Hannah WJ: Do practice guidelines guide practice? The effect of a consensus statement on the practice of physicians. New England Journal of Medicine. 1989, 321: 1306-1311.CrossRefPubMed
16.
Kanouse DE, Winkler JD, Kosecoff Jea: Changing medical practice through technology assessment: An evaluation of the NIH consensus development program. 1989, Santa Monica, Calif: RAND
17.
Woolf SH: Practice guidelines: A new reality in medicine, III: impact on patient care. Archives of Internal Medicine. 1993, 153: 2646-2655. 10.1001/archinte.153.23.2646.CrossRefPubMed
18.
19.
Grimshaw J, Thomas R, MacLennan G, Fraser C, Ramsay C, Vale L, Whitty P, Eccles M, Matowe L, Shirran L, et al: Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technology Assessment. 2004, 8: iii-iv. 1–72.CrossRefPubMed
20.
Thomas L, Cullum N, McColl E, Rousseau N, Soutter J, Steen N: Guidelines in professions allied to medicine. The Cochrane Library. 2004, Chichester, UK: John Wiley & Sons, Ltd, 3
21.
Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA: Getting research findings into practice: Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. British Medical Journal. 1998, 317: 465-468.CrossRefPubMedPubMedCentral
22.
Grimshaw J, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L, Grilli R, Harvey E, Oxman A, O'Brien M: Changing Provider Behavior: An Overview of Systematic Reviews of Interventions. Med Care. 2001, 39 (8 suppl 2): II2-45. 10.1097/00005650-200108002-00002.PubMed
23.
Oxman AD, Thomson MA, Davis DA, Haynes B: No magic bullets: A systematic review of 102 trials of interventions to improve professional practice. CMAJ. 1995, 153 (10): 423-431.
24.
Foxcroft DR, Cole N: Organisational Infrastructures to Promote Evidence Based Nursing Practice (Cochrane Review). The Cochrane Library. The Cochrane Database of Systematic Reviews. 2005, Chichester, UK: John Wiley & Sons, Ltd, 2007: 4
25.
Cheater FM, Closs SJ: The Effectiveness of Methods of Dissemination and Implementation of Clinical Guidelines for Nursing Practice: A Selective Review. Clinical Effectiveness in Nursing. 1997, 1: 4-15. 10.1016/S1361-9004(97)80022-2.CrossRef
26.
27.
Wensing M, Laurant M, Hulscher M, Grol R: Methods for identifying barriers and facilitators for implementation. Changing Professional Practice Theory and Practice of Clinical Guidelines Implementation. Edited by: Thorsen T, Makela M. 1999, Copenhagen: DSI, 119-132.
28.
McCormack B, Kitson A, Harvey G, Rycroft-Malone J, Titchen A, Seers K: Getting evidence into practice: the meaning of 'context'. Journal of Advanced Nursing. 2002, 38: 94-104. 10.1046/j.1365-2648.2002.02150.x.CrossRefPubMed
29.
Rycroft-Malone J, Seers K, Titchen A, Harvey G, Kitson A, McCormack B: What counts as evidence in evidence-based practice?. Journal of Advanced Nursing. 2004, 47: 81-90. 10.1111/j.1365-2648.2004.03068.x.CrossRefPubMed
30.
Oxman AD, Flottorp S: An overview of strategies to promote implementation of evidence based health care. Evidence-based practice in primary care. Edited by: Silagy C, Haines A. 2001, London: BMJ Books, 91-109.
31.
NHS Centre for Reviews and Dissemination: Getting evidence into practice. Effective Health Care. 1999, 5: 1-15.
32.
Rycroft-Malone J: The PARIHS Framework – A Framework for Guiding the Implementation of Evidence-based Practice. Journal of Nursing Care Quality. 2004, 19: 297-304.CrossRefPubMed
33.
Kitson A, Harvey G, McCormack B: Enabling the implementation of evidence-based practice: A conceptual framework. Quality in Health Care. 1998, 7: 149-158.CrossRefPubMedPubMedCentral
34.
Rycroft-Malone J, Kitson A, Harvey G, McCormack B, Seers K, Titchen A, Estabrooks C: Ingredients for change: Revisiting a conceptual framework. Qual Saf Health Care. 2002, 11 (2): 174-180. 10.1136/qhc.11.2.174.CrossRefPubMedPubMedCentral
35.
Rycroft-Malone J, Harvey G, Kitson A, McCormack B, Seers K, Titchen A: Getting evidence into practice: Ingredients for change. Nursing Standard. 2002, 16: 38-43.CrossRefPubMed
36.
Harvey G, Loftus-Hills A, Rycroft-Malone J, Titchen A, Kitson A, McCormack B, Seers K: Getting evidence into practice: the role and function of facilitation. Journal of Advanced Nursing. 2002, 37: 577-588. 10.1046/j.1365-2648.2002.02126.x.CrossRefPubMed
37.
Rycroft-Malone J, Harvey G, Seers K, Kitson A, McCormack B, Titchen A: An exploration of the factors that influence the implementation of evidence into practice. Journal of Clinical Nursing. 2004, 13: 913-924. 10.1111/j.1365-2702.2004.01007.x.CrossRefPubMed
38.
Grol R, Grimshaw J: Evidence-based implementation of evidence-based medicine. Joint Commission Journal on Quality Improvement. 1999, 25: 503-513.PubMed
39.
Grol R, Wensing M: What drives change? Barriers to and incentives for achieving evidence-based practice. The Medical Journal of Australia. 2004, 180: S57-60.PubMed
40.
Grol R, Grimshaw J: From best evidence to best practice: effective implementation of change in patients' care. Lancet. 2003, 362: 1225-1230. 10.1016/S0140-6736(03)14546-1.CrossRefPubMed
41.
Fonda D, Cook J, Sandler V, Bailey M: Sustained Reduction in Serious Fall-Related Injuries in Older People in Hospital. The Medical Journal of Australia. 2006, 184: 379-382.PubMed
42.
Helm van der J, Goossens A, Bossuyt P: When Implementation Fails: The Case of a Nursing Guideline for Fall Prevention. Jt Comm J Qual Patient Saf. 2006, 32 (3): 152-160.PubMed
43.
Semin-Goossens A, Helm Van der JMJ, Bossuyt PMM: A failed model-based attempt to implement an evidence-based nursing guideline for fall prevention. Journal of Nursing Care Quality. 2003, 18: 217-225.CrossRefPubMed
44.
Koh SSL, Manias E, Hutchinson A, Johnston L: Fall incidence and fall prevention practices at acute care hospitals in Singapore: a retrospective audit. Journal of Evaluation in Clinical Practice. 2007, 13: 722-727. 10.1111/j.1365-2753.2006.00743.x.CrossRefPubMed
45.
Lane AJ: Evaluation of the fall prevention program in an acute care setting. Orthopaedic Nursing. 1999, 18: 37-43. 10.1097/00006416-199911000-00008.CrossRefPubMed
46.
Poe S, Cvach M, Gartrell D, Radzik B, Joy T: An Evidence-based Approach to Fall Risk Assessment, Prevention, and Management: Lessons Learned. Journal of Nursing Care Quality. 2005, 20: 107-116.CrossRefPubMed
47.
Morse JM: Preventing patient falls. 1996, London: Sage publications
48.
Gryfe C, Amies A, Ashley M: A longitudinal study on falls in an elderly population. Incidence and morbidity. Age and Ageing. 1977, 6: 201-210. 10.1093/ageing/6.4.201.CrossRefPubMed
49.
Robertson MC, Campbell AJ: Preventing falls and fall-related injuries in the elderly: A literature review. 1993, Dunedin, New Zealand: Fall Prevention Research Group
50.
Chen YC, Lin LH, Jeng SF: The impacting factors of hospitalised patient injurious falls and the correlation with the consumption of medical resources. Tzu Chi Nursing Journal. 2002, 1: 66-76.
51.
Peters MAJ, Harmsen M, Laurant MGH, Wensing M: Barriers to and facilitators for improvement of patient care. 2002, Nijmegen, the Netherlands: Centre for Quality of Care (WOK), Radboud University Nijmegen Medical Centre
52.
Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud P-AC, Rubin HR: Why Don't Physicians Follow Clinical Practice Guidelines?: A Framework for Improvement. Journal of the American Medical Association. 1999, 282: 1458-1465. 10.1001/jama.282.15.1458.CrossRefPubMed
53.
Lomas J: Retailing research: Increasing the role of evidence in clinical services for childbirth. The Milbank Quarterly. 1993, 71: 439-475. 10.2307/3350410.CrossRefPubMed
54.
Stross JK, Harlan WR: The dissemination of new medical information. Journal of the American Medical Association. 1979, 241: 2622-2624. 10.1001/jama.241.24.2622.CrossRefPubMed
55.
Solberg LI, Brekke ML, Kottke TE: How important are clinician and nurse attitudes to the delivery of clinical preventive services?. Journal of Family Practice. 1997, 44: 451-461.PubMed
56.
Resnicow KA, Schorow M, Bloom HG, Massad R: Obstacles to family practitioners use of screening tests: Determinants of practice?. Preventive Medicine. 1989, 18: 101-112. 10.1016/0091-7435(89)90057-1.CrossRefPubMed
57.
Kosecoff J, Kanouse DE, Rogers WH, McCloskey L, Winslow CA, Brook RH: Effects of the National Institutes of Health Consensus Development Program on Physician Practice. Journal of the American Medical Association. 1987, 258: 2709-2713.
58.
Dijkstra R, Braspenning J, Uilers E, van Ballegooie E, Grol R: Perceived barriers to the implementation of diabetes guidelines in hospitals in the Netherlands. The Netherlands Journal of Medicine. 2000, 56: 80-85. 10.1016/S0300-2977(99)00123-0.CrossRefPubMed
59.
Skinner B: The behaviour of organisms: an experimental analysis. 1938, New York: Appleton-Century
60.
Petrie JC, Grimshaw JM, Bryson A: The Scottish intercollegiate guidelines network initiative: SIGN – getting validated guidelines into practice. Health Bulletin. 1995, 53: 345-348.PubMed
61.
Mittman BS, Tonesk X, Jacobson PD: Implementing clinical practice guidelines: social influence strategies and practitioner behavior change. Quality Review Bulletin. 1992, 18: 413-422.PubMed
62.
Lomas J, Enkin M, Anderson G, Vayda E, Hannah W, Singer J: Opinion leaders vs audit and feedback to implement practice guidelines. Delivery after previous cesarean section. Journal of the American Medical Association. 1991, 265: 2202-2207. 10.1001/jama.265.17.2202.CrossRefPubMed
63.
Soumerai SB, Avorn J: Principles of educational outreach ('academic detailing') to improve clinical decision making. Journal of the American Medical Association. 1990, 263: 549-556. 10.1001/jama.263.4.549.CrossRefPubMed
64.
Thomson MA, Oxman AD, Haynes RB: Outreach visits to improve health care professional practice and health care outcomes (Cochrane Review). The Cochrane Library. 1998, Oxford, UK.: Update Software, 2
65.
Thomson MA, Oxman AD, Haynes RB: Local opinion leaders to improve health professional practice and health care outcomes (Cochrane Review). The Cochrane Library. 1999, Oxford, UK: Update Software, 2
66.
Wensing M, Grol R: Single and Combined Strategies for Implementing Changes in Primary Care: A Literature Review. International Journal for Quality in Health Care. 1994, 6: 115-132.CrossRefPubMed
Metadata
Title
Nurses' perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals
Authors
Serena SL Koh
Elizabeth Manias
Alison M Hutchinson
Susan Donath
Linda Johnston
Publication date
01-12-2008
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2008
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-8-105

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