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Barriers and enablers to the implementation of evidence-based practice in pressure ulcer prevention and management in an integrated community care setting: a qualitative study informed by the Theoretical Domains Framework

Taylor, C., Mulligan, K. ORCID: 0000-0002-6003-3029 and McGraw, C. ORCID: 0000-0001-6661-9808 (2021). Barriers and enablers to the implementation of evidence-based practice in pressure ulcer prevention and management in an integrated community care setting: a qualitative study informed by the Theoretical Domains Framework. Health and Social Care in the Community, 29(3), pp. 766-779. doi: 10.1111/hsc.13322

Abstract

Pressure ulcer reduction is a healthcare priority. Good clinical guidelines have the potential to transform pressure ulcer prevention and management practices. However, evidence suggests these guidelines are inconsistently utilised. The aim of this study was to explore health practitioners’ perceived barriers and enablers to the implementation of evidence-based pressure ulcer prevention and management recommendations in an integrated community care setting. The study used a qualitative exploratory design. It took place in a community Trust in London, England. Semi-structured interviews were conducted with a purposive sample of registered nurses and allied healthcare professionals (AHPs). The Theoretical Domains Framework (TDF) informed both data collection and data analysis. Analysis followed a five-step process including deductive coding of the transcripts and inductive generation of specific belief statements. Nine nurses and four AHPs took part in the study. Six TDF domains were identified as most relevant to the implementation of best practice in pressure ulcer prevention and management: Goals, Knowledge, Skills, Beliefs about capabilities, Environmental context and resources and Social influences. All participants felt it was important to prevent pressure ulcers and were motivated to do so. Key enablers to the implementation of evidence-based practice included high levels of self-reported pressure ulcer knowledge and skills (nurses), responsive community equipment provision, the introduction of novel Pressure Ulcer Implementation Facilitator roles and integrated team working. Barriers included self-reported deficits in knowledge and skills (AHPs), worries about inspecting intimate anatomical locations (AHPs), difficulties initiating conversations with patients about risk and behaviour change, high workloads and clutter in the home. Family members and mobile working solutions were identified as both enablers and barriers. Potential routes to addressing implementation challenges are identified and recommendations made for future research.

Publication Type: Article
Additional Information: This is the peer reviewed version of the following article: Taylor, C., Mulligan, K. and Mcgraw, C. (2021). Barriers and enablers to the implementation of evidence-based practice in pressure ulcer prevention and management in an integrated community care setting: a qualitative study informed by the Theoretical Domains Framework. Health and Social Care in the Community, published in final form at https://doi.org/10.1111/hsc.13322. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Publisher Keywords: Pressure ulcer; Evidence based practice; Theoretical Domains Framework; Integrated care; Community nursing; Allied healthcare professionals
Subjects: R Medicine > RC Internal medicine
R Medicine > RT Nursing
Departments: School of Health Sciences > Healthcare Services Research & Management
Date available in CRO: 08 Feb 2021 16:26
Date deposited: 8 February 2021
Date of acceptance: 26 January 2021
Date of first online publication: 4 March 2021
URI: https://openaccess.city.ac.uk/id/eprint/25627
[img] Text - Accepted Version
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