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Implementation evaluation and refinement of an intervention to improve blunt chest injury management - a mixed methods study

Curtis, K; Van, C; Lam, M; Asha, S; Unsworth, A; Clements, A; Atkins, L; (2017) Implementation evaluation and refinement of an intervention to improve blunt chest injury management - a mixed methods study. Journal of Clinical Nursing , 26 (23-24) pp. 4506-4518. 10.1111/jocn.13782. Green open access

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Abstract

AIMS AND OBJECTIVES: To investigate uptake of a Chest Injury Protocol (ChIP), examine factors influencing its implementation and identify interventions for promoting its use. BACKGROUND: Failure to treat blunt chest injuries in a timely manner with sufficient analgesia, physiotherapy and respiratory support, can lead to complications such as pneumonia and respiratory failure and/or death. DESIGN: This is a mixed methods implementation evaluation study. METHODS: Two methods were used: 1) identification and review of the characteristics of all patients eligible for the ChIP protocol, and 2) survey of hospital staff opinions mapped to the Theoretical Domains Framework (TDF) to identify barriers and facilitators to implementation. The characteristics and treatment received between the groups were compared using the chi-square test or Fischer's exact test for proportions, and the Mann-Whitney U-test for continuous data. Quantitative survey data were analysed using descriptive statistics. Qualitative data was coded in NVivo 10 using a coding guide based on the TDF and Behaviour Change Wheel (BCW). Identification of interventions to change target behaviours was sourced from the Behaviour Change Technique Taxonomy Version 1 in consultation with stakeholders. RESULTS: Only 68.4% of eligible patients received ChIP. Fifteen facilitators and 10 barriers were identified to influence the implementation of ChIP in the clinical setting. These themes were mapped to 10 of the 14 TDF domains and corresponded with all nine intervention functions in the BCW. Seven of these intervention functions were selected to address the target behaviours. CONCLUSIONS: This study demonstrated how the BCW may be used to revise and improve a clinical protocol in the ED context. RELEVANCE TO CLINICAL PRACTICE: Newly implemented clinical protocols should incorporate clinician behaviour change assessment, strategy and interventions. Enhancing the self-efficacy of emergency nurses when performing assessments has the potential to improve patient outcomes and should be included in implementation strategy. This article is protected by copyright. All rights reserved.

Type: Article
Title: Implementation evaluation and refinement of an intervention to improve blunt chest injury management - a mixed methods study
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/jocn.13782
Publisher version: http://dx.doi.org/10.1111/jocn.13782
Language: English
Additional information: This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Keywords: Chest injury, behaviour change, behaviour change wheel, implementation evaluation, nursing, theoretical domains framework
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences > Clinical, Edu and Hlth Psychology
URI: http://discovery.ucl.ac.uk/id/eprint/1545076
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