Background
Blunt chest injury can lead to significant morbidity and mortality if not treated appropriately. A
blunt chest injury care bundle
was to be implemented at two sites to guide care.
Aim
To identify facilitators and barriers to the implementation of a
blunt chest injury care bundle
and design strategies tailored to promote future implementation.
Methods
1) A mixed-method survey based on the theoretical domains framework (TDF) was used to identify barriers and facilitators to the implementation of a
blunt chest injury care bundle.
This survey was distributed to 441 staff from 12 departments across two hospitals. Quantitative data were analysed using SPSS and qualitative using inductive content analysis.
2) The quantitative and qualitative results from the survey were integrated and mapped to each of the TDF domains.
3) The facilitators and barriers were evaluated using the Behaviour Change Wheel to extract specific intervention functions, policies, behaviour change techniques and implementation strategies. Each phase was assessed against the Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Side-effects or safety and Equity (APEASE) criteria.
Results
One hundred ninety eight staff completed the survey. All departments surveyed were represented. Nine facilitators and six barriers were identified from eight domains of the TDF. Facilitators (
TDF domains
) were: understanding evidence-informed patient care and understanding risk factors (
Knowledge
); patient assessment skills and blunt chest injury management skills (
Physical skills
); identification with professional role (
Professional role and identity
); belief of consequences of care bundle
(Belief about consequences
); provision of training and protocol design (
Environmental context and resources
); and social supports (
Social influences
). Barriers were: not understanding the term ‘care bundle’ (
Knowledge
); lacking regional analgesia skills (
Physical skills
); not remembering to follow protocol (
Memory, attention, and decision processes
); negative emotions relating to new protocols (
Emotions
); equipment and protocol access (
Environmental context and resources
). Implementation strategies were videos, education sessions, visual prompt for electronic medical records and change champions.
Conclusions
Multiple facilitators and barriers were identified that may affect the implementation of a
blunt chest injury care bundle.
Implement...
Please cite this article as: Kourouche S et al., Implementation of a hospital-wide multidisciplinary blunt chest injury care bundle (ChIP): Fidelity of delivery evaluation, Australian Critical Care,
The majority of trauma nursing education is focused on the emergency phases of care. We describe the development and evaluation of a trauma eLearning module for the ward environment. The module was developed using adult learning principles and implemented in 2 surgical wards. There were 3 phases of evaluation: (1) self-efficacy of nurses; (2) relevance and usability of the module and; (3) application of knowledge learnt. The majority indicated they had applied new knowledge, particularly when performing a physical assessment (85.7%), communicating (91.4%), and identifying risk of serious illness (90.4%). Self-efficacy relating to confidence in caring for patients, communication, and escalating clinical deterioration improved (p = .023). An eLearning trauma patient assessment module for ward nursing staff improves nursing knowledge and self-efficacy.
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