Changing the Use of Electronic Fetal Monitoring and Labor Support: A Case Study of Barriers and Facilitators

Graham, Ian D.; Logan, Jo; Davies, Barbara; Nimrod, Carl

doi:10.1111/j.0730-7659.2004.00322.x

Cited by 47 publications

(63 citation statements)

References 11 publications

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“…Analysis of transcripts was planned according to Graham 2004. 18 The tapes were transcribed, and their accuracy was verified.…”

Section: Discussionmentioning

confidence: 99%

“…18 The tapes were transcribed, and their accuracy was verified. Analysing the data from one hospital at a time, two researchers (NC, ED) jointly coded and categorized ideas into broader themes through consensus until all the transcripts were reviewed.…”

Section: Discussionmentioning

confidence: 99%

“…The identification of specific barriers and facilitators represents a new approach for identifying the determinants of guidelines use by health professionals. 7,[15][16][17][18] This study's premise is that strategies to implement guidelines and reduce caesarean section rates should take into account physicians' perceptions in order to identify different forces and variables influencing their behaviour. Consequently, we carried out an exploratory study to investigate obstetricians' perceptions of SOGC guidelines, and to identify barriers to, facilitators of and obstetricians' solutions for their implementation.…”

Section: Introductionmentioning

confidence: 99%

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Identifying barriers and facilitators towards implementing guidelines to reduce caesarean section rates in Quebec

Chaillet¹

2007

Bull World Health Organ

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Objective To investigate obstetricians' perceptions of clinical practice guidelines targeting management of labour and vaginal birth after previous caesarean birth, and to identify the barriers to, facilitators of and obstetricians' solutions for implementing these guidelines in practice. Methods This qualitative study was conducted in three hospitals in Montreal that represent around 10% of births in Quebec. Data was collected from 10 focus groups, followed by six semi-structured interviews. Two researchers jointly analysed the verbatim transcripts according to A manual for the use of focus groups. Findings The identified barriers to and facilitators of the implementation of guidelines can be classified into four categories: 1) the hospital level, including management and hospital policies; 2) the departmental level, including local policies, leadership, organizational factors, economic incentive, and availability of equipment and staff; 3) the health professionals' motivations and attitudes, including medico-legal concerns, skill levels, acceptance of guidelines and strategies used to implement recommendations; and 4) patients' motivations. Conclusion Identifying the barriers to and facilitators of the adoption of recommendations is an important way to guide the development of efficient strategies. The findings of this study suggest that the adoption of guidelines may be improved if local health professionals' perceptions are considered to make recommendations more acceptable and useful. Our findings also support the assumption that obstetricians seek to implement best practices, but require evidence tools and support to assess their practices and enhance their performance. In addition, peer review activities championed by opinion leaders have been identified by obstetricians as the most suitable strategy to improve the use of the guidelines in their practices.

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“…Analysis of transcripts was planned according to Graham 2004. 18 The tapes were transcribed, and their accuracy was verified.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Identifying barriers and facilitators towards implementing guidelines to reduce caesarean section rates in Quebec

Chaillet¹

2007

Bull World Health Organ

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“…Many barriers exist preventing nurses from implementing IA during the intrapartum period (Graham, Logan, Davies, & Nimrod, 2004;Lewis & Rowe, 2004;Rattray, Flowers, Miles, & Clarke, 2011;Regan & Liaschenko, 2007;Sleutel, Schultz, & Wyble, 2007). The purpose of this article is to review the history of fetal monitoring; address factors influencing the fetal heart rate during labor; report on the different types of fetal monitoring available; discuss barriers identified in the literature inhibiting the implementation of fetal monitoring choice in childbirth; and provide suggestions to incorporate evidence-based material into childbirth classes.…”

Section: Different Types Of Fetal Monitoringmentioning

confidence: 99%

“…A facility culture that supports implementing evidence-based change is more likely to institute IA policies for healthy women with uncomplicated pregnancies than one that doesn't (Graham et al, 2004;Sleutel et al, 2007). Although change can occur from administration, change is more likely to be implemented if nursing staff have input into creating and supporting the change prior to the initiation of the new policy (Graham et al, 2004).…”

Section: Institutional Barriersmentioning

confidence: 99%

Fetal Monitoring: Creating a Culture of Safety With Informed Choice

Heelan¹

2013

J Perinat Educ

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The dominant culture in labor and birth is the medical model, not the midwifery model of woman-centered care. Consensus among professional and governmental groups is that, based on the evidence, intermittent auscultation is safer to use in healthy women with uncomplicated pregnancies than electronic fetal monitoring (EFM). Barriers impact the laboring woman's ability to give informed choice regarding fetal monitoring. Lack of informed choice denies a woman her right to be in control of her birth experience, and is in opposition to a woman's right to autonomy and self-determination.

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