Dataset Information

Facilitators and barriers to implementing a specialized care unit for persons with cognitive impairment in an acute geriatric hospital: a process evaluation.

ABSTRACT:

Background

Implementing dementia care interventions in an acute hospital poses multiple challenges. To understand factors influencing the implementation, in-depth knowledge about specific facilitators and barriers is necessary. The aim of this study was to identify facilitators and barriers to implementing an interprofessional, multicomponent intervention of a specialized unit for persons with cognitive impairment in an acute geriatric hospital.

Methods

We conducted a process evaluation as part of a participatory action research study. For data collection, semi-structured individual interviews with fifteen professionals involved in the implementation of the specialized unit. We further conducted two focus groups with twelve professionals working on other units of the geriatric hospital. We performed a qualitative content analysis following Kuckartz's content-structuring analysis scheme.

Results

We identified the following barriers to implementing the specialized unit: uncontrollable contextual changes (e.g., COVID-19 pandemic), staff turnover in key functions, high fluctuation in the nursing team, traditional work culture, entrenched structures, inflexible and efficiency-oriented processes, monoprofessional attitude, neglect of project-related communication, and fragmentation of interprofessional cooperation. An established culture of interprofessionalism, an interprofessionally composed project group, cooperation with a research partner, as well as the project groups' motivation and competence of managing change facilitated the implementation.

Conclusions

The implementation faced numerous barriers that can be described using the key constructs of the i-PARIHS framework: context, recipients, innovation, and facilitation. Overcoming these barriers requires an organizational development approach, extended project duration and increased process orientation. Furthermore, strategically planned, precise and ongoing communication towards all persons involved seems crucial. Differences between the work cultures of the professions involved deserve particular attention with regard to project-related roles and processes.

SUBMITTER: Adlbrecht L

PROVIDER: S-EPMC10771665 | biostudies-literature | 2024 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Facilitators and barriers to implementing a specialized care unit for persons with cognitive impairment in an acute geriatric hospital: a process evaluation.

Adlbrecht Laura L Karrer Melanie M Helfenberger Nicole N Ziegler Eva E Zeller Adelheid A

BMC geriatrics 20240106 1

<h4>Background</h4>Implementing dementia care interventions in an acute hospital poses multiple challenges. To understand factors influencing the implementation, in-depth knowledge about specific facilitators and barriers is necessary. The aim of this study was to identify facilitators and barriers to implementing an interprofessional, multicomponent intervention of a specialized unit for persons with cognitive impairment in an acute geriatric hospital.<h4>Methods</h4>We conducted a process eval ...[more]

PMID: 38184542

Similar Datasets

Project description:BackgroundAvoidable hospital readmission is a major problem among health systems. Although there are effective peri-discharge interventions for reducing avoidable hospital readmission, successful implementation is challenging. This systematic review of qualitative studies aimed to identify barriers and facilitators to implementing peri-discharge interventions from providers' and service users' perspectives.MethodsWe searched four databases for potentially eligible qualitative studies from databases' inception to March 2020, and updated literature search for studies published between January 2020 to October 2021. Barriers and facilitators to implementing peri-discharge interventions were identified and mapped onto the Consolidated Framework for Implementation Research (CFIR) constructs. Inductive analysis of the CFIR constructs was performed to yield thematic areas that illustrated the relationship between various facilitators and barriers, generating practical insights to key implementation issues.ResultsThirteen qualitative studies were included in this systematic review. Key issues were clustered in the CFIR constructs of Design Quality and Complexity of the intervention, strength of Network and Communication, being responsive to Patient Needs with sufficient Resource support, and External Incentives. The three thematic areas were rationality of the interventions, readiness and effort of multidisciplinary implementation teams, and influence of external stakeholders. Common barriers included (i) limited resources, (ii) poor communication among team members, (iii) incompatibility between the new intervention and existing work routine, (iv) complicated implementation process, (v) low practicality of supporting instruments, and (vi) lack of understanding about the content and effectiveness of the new interventions. Common facilitators were (i) information sharing via regular meetings on implementation issues, (ii) organizational culture that values quality and accountability, (iii) financial penalties for hospitals with high avoidable readmissions rates, (iv) external support offered via quality improvement programs and community resources, and (v) senior leadership support.ConclusionThis study synthesized commonly-presenting barriers and facilitators to implementing peri-discharge interventions among different healthcare organizations. Findings may inform development of implementation strategies in different health systems after appropriate tailoring, based on a consensus-based formative research process.

Project description:ObjectiveThe aim of this research was to study the facilitators and barriers to implementation of sustainable oral health care in Dutch dental practices using a qualitative research design.MethodsA conceptual framework was developed and based on 2 theories for implementation in dental practices. The framework covered 4 levels: structural, dental practice, oral health care practitioner, and method and product level. Semi-structured interviews were conducted to collect guided and in-depth data. Fourteen key stakeholders were interviewed: dentists, dental hygienists, dental assistants, managers and owners of dental practices, and suppliers of dental goods. Data were analysed using both a thematic analysis approach and open coding.ResultsParticipants were aware of the compromised planetary health and, in part, of their contribution to it. However, turning this awareness into action proved to be challenging. Barriers that were identified included limited knowledge and awareness of the largest sources of planetary burden in oral health care. Also, information and availability of sustainable products and methods cannot yet meet the requirements of current performance standards, costs, and infection control guidelines. Facilitators that were observed included a growing awareness to contribute to planetary health and to implement sustainability outside oral health care, especially in women and younger people. Overviews and guides of existing sustainable methods are available, but additional methods and products should be developed as well.ConclusionsMany participants considered infection control guidelines as the most prominent barrier to sustainable oral health care. Women felt more involved with planetary health compared to men, which is in line with the concept of ecofeminism. It is essential for stakeholders to collaborate to reach the next levels of implementation. Action is required on all levels to secure both oral and planetary health. Now is the time to act.

Project description:BackgroundMyDispense is a simulation software developed by Monash University that has been utilized by over 200 institutions worldwide to educate pharmacy students. However, little is known about the processes by which it is used to teach dispensing skills to students and how they use it to facilitate critical thinking in an authentic environment. This study aimed to understand and investigate how simulations are used to teach dispensing skills in pharmacy programs globally, and to determine the opinions, attitudes and experiences of pharmacy educators towards MyDispense and other simulation software within their pharmacy program.MethodsPurposive sampling was used to identify pharmacy institutions for the study. A total of 57 educators were contacted, 18 responded to the study invitation, 12 were MyDispense users and 6 were non-users. Two investigators conducted an inductive thematic analysis to generate key themes and subthemes to provide insight into the opinions, attitudes and experiences towards MyDispense and other simulation software used specifically for dispensing within pharmacy programs.Results26 pharmacy educators were interviewed, of which 14 were individual interviews and four were group interviews. Intercoder reliability was investigated and a Kappa coefficient of 0.72 indicated substantial agreement between both coders. Five main themes were identified: "dispensing and counseling", which encompassed discussions about how dispensing techniques were taught, the time allocated for students to practice their skills and the use of software other than MyDispense; "description of MyDispense use" includes discussions about the setup of the software, how dispensing skills were taught prior to using MyDispense as well as its use in student assessments; "barriers to MyDispense use", covers discussions about the obstacles users have faced; "facilitators to use MyDispense", includes discussion about the various motivators to using MyDispense and lastly "future use and suggested improvements" of MyDispense are covered by the interviewees.ConclusionThe initial outcomes of this project evaluated the awareness and utilization of MyDispense and other dispensing simulations by pharmacy programs globally. By addressing the barriers of use, promotion of the sharing of MyDispense cases can assist in creating more authentic assessments, as well as improving staff workload management. The outcomes of this research will also facilitate the development of a framework for MyDispense implementation, thus streamlining and improving the uptake of MyDispense by pharmacy institutions globally.

Project description:BackgroundThe uptake of family involvement in health care services for patients with psychotic disorders is poor, despite a clear evidence base, socio-economic and moral justifications, policy, and guideline recommendations. To respond to this knowledge-practice gap, we established the cluster randomised controlled trial: Implementation of guidelines on Family Involvement for persons with Psychotic disorders in community mental health centres (IFIP). Nested in the IFIP trial, this sub-study aims to explore what organisational and clinical barriers and facilitators local implementation teams and clinicians experience when implementing family involvement in mental health care for persons with psychotic disorders.MethodsWe performed 21 semi-structured focus groups, including 75 participants in total. Implementation team members were interviewed at the initial and middle phases of the intervention period, while clinicians who were not in the implementation team were interviewed in the late phase. A purposive sampling approach was used to recruit participants with various engagement in the implementation process. Data were analysed using manifest content analysis.ResultsOrganisational barriers to involvement included: 1) Lack of shared knowledge, perceptions, and practice 2) Lack of routines 3) Lack of resources and logistics. Clinical barriers included: 4) Patient-related factors 5) Relative-related factors 6) Provider-related factors. Organisational facilitators for involvement included: 1) Whole-ward approach 2) Appointed and dedicated roles 3) Standardisation and routines. Clinical facilitators included: 4) External implementation support 5) Understanding, skills, and self-efficacy among mental health professionals 6) Awareness and attitudes among mental health professionals.ConclusionsImplementing family involvement in health care services for persons with psychotic disorders is possible through a whole-ward and multi-level approach, ensured by organisational- and leadership commitment. Providing training in family psychoeducation to all staff, establishing routines to offer a basic level of family involvement to all patients, and ensuring that clinicians get experience with family involvement, reduce or dissolve core barriers. Having access to external implementation support appears decisive to initiate, promote and evaluate implementation. Our findings also point to future policy, practice and implementation developments to offer adequate treatment and support to all patients with severe mental illness and their families.Trial registrationClinicalTrials.gov Identifier NCT03869177. Registered 11.03.19.

Project description:BackgroundEnd-of-life (EoL) care volunteers in hospitals are a novel approach to support patients and their close ones. The iLIVE Volunteer Study supported hospital volunteer coordinators from five European countries to design and implement an EoL care volunteer service on general wards in their hospitals. This study aimed to identify and explore barriers and facilitators to the implementation of EoL care volunteer services in the five hospitals.MethodsVolunteer coordinators (VCs) from the Netherlands (NL), Norway (NO), Slovenia (SI), Spain (ES) and United Kingdom (UK) participated in a focus group interview and subsequent in-depth one-to-one interviews. A theory-inspired framework based on the five domains of the Consolidated Framework for Implementation Research (CFIR) was used for data collection and analysis. Results from the focus group were depicted in radar charts per hospital.ResultsBarriers across all hospitals were the COVID-19 pandemic delaying the implementation process, and the lack of recognition of the added value of EoL care volunteers by hospital staff. Site-specific barriers were struggles with promoting the service in a highly structured setting with many stakeholders (NL), negative views among nurses on hospital volunteering (NL, NO), a lack of support from healthcare professionals and the management (SI, ES), and uncertainty about their role in implementation among VCs (ES). Site-specific facilitators were training of volunteers (NO, SI, NL), involving volunteers in promoting the service (NO), and education and awareness for healthcare professionals about the role and boundaries of volunteers (UK).ConclusionEstablishing a comprehensive EoL care volunteer service for patients in non-specialist palliative care wards involves multiple considerations including training, creating awareness and ensuring management support. Implementation requires involvement of stakeholders in a way that enables medical EoL care and volunteering to co-exist. Further research is needed to explore how trust and equal partnerships between volunteers and professional staff can be built and sustained.Trial registrationNCT04678310. Registered 21/12/2020.

Project description:Background: COVID-19 has brought to the fore an urgent need for secure information and communication technology (ICT) supported healthcare delivery, as the pertinence of infection control and social distancing continues. Telemedicine for paediatric care warrants special consideration around logistics, consent and assent, child welfare and communication that may differ to adult services. There is no systematic evidence synthesis available that outlines the implementation issues for incorporating telemedicine to paediatric services generally, or how users perceive these issues. Methods: We conducted a rapid mixed-methods evidence synthesis to identify barriers, facilitators, and documented stakeholder experiences of implementing paediatric telemedicine, to inform the pandemic response. A systematic search was undertaken by a research librarian in MEDLINE for relevant studies. All identified records were blind double-screened by two reviewers. Implementation-related data were extracted, and studies quality appraised using the Mixed-Methods Appraisal Tool. Qualitative findings were analysed thematically and then mapped to the Consolidated Framework for Implementation Research. Quantitative findings about barriers and facilitators for implementation were narratively synthesised. Results: We identified 27 eligible studies (19 quantitative; 5 mixed-methods, 3 qualitative). Important challenges highlighted from the perspective of the healthcare providers included issues with ICT proficiency, lack of confidence in the quality/reliability of the technology, connectivity issues, concerns around legal issues, increased administrative burden and/or fear of inability to conduct thorough examinations with reliance on subjective descriptions. Facilitators included clear dissemination of the aims of ICT services, involvement of staff throughout planning and implementation, sufficient training, and cultivation of telemedicine champions. Families often expressed preference for in-person visits but those who had tried tele-consultations, lived far from clinics, or perceived increased convenience with technology considered telemedicine more favourably. Concerns from parents included the responsibility of describing their child's condition in the absence of an in-person examination. Discussion: Healthcare providers and families who have experienced tele-consultations generally report high satisfaction and usability for such services. The use of ICT to facilitate paediatric healthcare consultations is feasible for certain clinical encounters and can work well with appropriate planning and quality facilities in place.

Dataset Information

Facilitators and barriers to implementing a specialized care unit for persons with cognitive impairment in an acute geriatric hospital: a process evaluation.

Background

Methods

Results

Conclusions

Publications

Facilitators and barriers to implementing a specialized care unit for persons with cognitive impairment in an acute geriatric hospital: a process evaluation.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets