Barriers and enablers of recognition and response to deteriorating patients in the acute hospital setting: A theory‐driven interview study using the Theoretical Domains Framework

Abstract

Aim To explore barriers and enablers of recognition and response to signs of patient deterioration by nursing staff in an acute hospital. Design A theory‐driven interview study underpinned by the Theoretical Domains Framework of behaviour change. Methods Between 07/01/2019 and 18/12/2019 a purposive sample of registered nurses and healthcare assistants was recruited to participate in a semi‐structured (audio‐recorded) interview, to explore the determinants of seven specified behaviours of the afferent limb. Anonymised transcripts were deductively coded (using the 14 Theoretical Domains Framework domains as coding categories) and then extracts within each domain were inductively analysed to synthesise belief statements and themes. Prioritisation criteria from published literature were applied. Results Thirty‐two semi‐structured interviews were conducted. From 1,888 quotes, 184 belief statements and 66 themes were synthesised. One hundred and forty‐six belief statements, represented by 58 themes, met prioritisation criteria. Nine domains of the Theoretical Domains Framework were of high importance: Knowledge; Social, Professional Role and Identity; Beliefs about Consequences; Reinforcement; Intentions; Goals; Memory, Attention and Decision Processes; Environment, Context and Resources and Social Influences. Conclusions Barriers and enablers most likely to impact on nursing staff afferent limb behaviour were identified in nine domains of the Theoretical Domains Framework.

Selecting intervention content to target barriers and enablers of recognition and response to deteriorating patients: an online nominal group study

“…There was overlap in the TDF domains that represented important barriers and enablers to the target behaviours for both RNs and HCAs [58]. Similar overlap in the determinants of behaviour change, between different healthcare practitioners, has been reported in other work [59].…”

“…In a previous publication from this programme of work [58], the TDF domain Knowledge was identified as representing important barriers and enablers to the target behaviours. Despite this, none of the specific BCTs mapped from this domain were considered suitable for inclusion in this intervention.…”

“…Whilst educational approaches alone are unlikely to be sufficient to drive behaviour change [66,67], possession of knowledge is often a pre-requisite to the decisions individuals make and the behaviours they enact [67]. Consequently, despite the lack of appropriate BCTs, we opted to include a training component to our intervention that will address specific knowledge-related barriers identified from earlier empirical work [58,68]. The importance of this is underscored by the wider literature where knowledge deficits have been reported as antecedents to afferent limb failure [21,69,70].…”

Health professionals’ initial experiences and perceptions of the acceptability of a whole-hospital, pro-active electronic paediatric early warning system (the DETECT study): a qualitative interview study

“…2 ). The DETECT system aimed to resolve the key barriers that impact on identifying the deteriorating child, including incomplete documentation [ 29 ], data input not being in real time [ 30 ], incorrect calculation of scores [ 31 ], lack of/over-confidence [ 32 ], poor communication and/or delayed/non response to alerts [ 33 , 34 ].

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“…HPs talked about how an effective whole system approach [ 38 ] such as DETECT e-PEWS can improve situation awareness (SA) (through alerts, raising concern, response to concerns) on both an individual level and at an organisational level (a culture of “everyone taking deterioration more seriously’), as seen in other studies [ 39 , 40 ]. However, even confident HPs who expressed a clear understanding of benefits for children sometimes circumvented the system, deliberately choosing to revert to ‘paper towel’ (e.g., writing observations on paper towels and later transcribing into the device) techniques; other studies reveal adoption can be inhibited by persistence of paper-based approaches [ 34 , 41 ].…”