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Understanding practice: the factors that influence management of mild traumatic brain injury in the emergency department - a qualitative study using the Theoretical Domains Framework

Tavender, EJ; Bosch, M; Gruen, RL; Green, SE; Knott, J; Francis, JJ; Michie, S; (2014) Understanding practice: the factors that influence management of mild traumatic brain injury in the emergency department - a qualitative study using the Theoretical Domains Framework. Implementation Science , 9 , Article 8. 10.1186/1748-5908-9-8. Green open access

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Abstract

Background: Mild traumatic brain injury is a frequent cause of presentation to emergency departments. Despite the availability of clinical practice guidelines in this area, there is variation in practice. One of the aims of the Neurotrauma Evidence Translation program is to develop and evaluate a targeted, theory- and evidence-informed intervention to improve the management of mild traumatic brain injury in Australian emergency departments. This study is the first step in the intervention development process and uses the Theoretical Domains Framework to explore the factors perceived to influence the uptake of four key evidence-based recommended practices for managing mild traumatic brain injury. / Methods: Semi-structured interviews were conducted with emergency staff in the Australian state of Victoria. The interview guide was developed using the Theoretical Domains Framework to explore current practice and to identify the factors perceived to influence practice. Two researchers coded the interview transcripts using thematic content analysis. / Results: A total of 42 participants (9 Directors, 20 doctors and 13 nurses) were interviewed over a seven-month period. The results suggested that (i) the prospective assessment of post-traumatic amnesia was influenced by: knowledge; beliefs about consequences; environmental context and resources; skills; social/professional role and identity; and beliefs about capabilities; (ii) the use of guideline-developed criteria or decision rules to inform the appropriate use of a CT scan was influenced by: knowledge; beliefs about consequences; environmental context and resources; memory, attention and decision processes; beliefs about capabilities; social influences; skills and behavioral regulation; (iii) providing verbal and written patient information on discharge was influenced by: beliefs about consequences; environmental context and resources; memory, attention and decision processes; social/professional role and identity; and knowledge; (iv) the practice of providing brief, routine follow-up on discharge was influenced by: environmental context and resources; social/professional role and identity; knowledge; beliefs about consequences; and motivation and goals. Conclusions: Using the Theoretical Domains Framework, factors thought to influence the management of mild traumatic brain injury in the emergency department were identified. These factors present theoretically based targets for a future intervention.

Type: Article
Title: Understanding practice: the factors that influence management of mild traumatic brain injury in the emergency department - a qualitative study using the Theoretical Domains Framework
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1186/1748-5908-9-8
Publisher version: http://dx.doi.org/10.1186/1748-5908-9-8
Language: English
Additional information: Copyright © 2014 Tavender et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Brain Injuries, Clinical Competence, Communication, Emergency Service, Hospital, Environment, Evidence-Based Medicine, Health Knowledge, Attitudes, Practice, Humans, Patient Education as Topic, Personnel, Hospital, Physician's Practice Patterns, Practice Guidelines as Topic, Professional Role, Qualitative Research, Victoria
UCL classification: UCL
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: https://discovery.ucl.ac.uk/id/eprint/1419669
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