These findings offer a better understanding of the processes used by health professionals' in their decision-making in wound care. Such an understanding may inform the development of evidence-based interventions that lead to better patient outcomes.
Aims
To identify the facilitators of and barriers to nurses’ adherence to evidence‐based wound care clinical practice guidelines (CPGs) in preventing surgical site infections (SSIs) in an Australian tertiary hospital.
Background
Current research suggests that up to 50% of nurses are unaware of the evidence‐based recommendations to prevent SSIs and that adherence to evidence‐based CPGs is suboptimal. However, little is known regarding the facilitators and barriers to adherence to evidence‐based CPGs.
Design
A qualitative study incorporating ethnographic data collection techniques.
Methods
Data collection included semi‐structured individual interviews and focus groups (N = 20), and examination of existing hospital policy and procedure documents. Thematic analysis using inductive and deductive approaches was conducted. This manuscript adheres to the COnsolidated criteria for REporting Qualitative research (COREQ) guidelines.
Findings
Data analysis revealed four themes: adhering to aseptic technique, knowledge and information seeking, documenting wound care and educating and involving patients in wound care. Facilitators and barriers within each theme were identified. Facilitators included participants’ active information‐seeking behaviour, a clear understanding of the importance of aseptic technique, and patient participation in wound care. Barriers included participants’ knowledge and skills deficits regarding application of aseptic technique principles in practice, the availability of the hospital's wound care procedure document, suboptimal wound care documentation and the timing of patient education.
Conclusions
There is a need to develop interventions to improve nurses’ adherence to recommended CPGs including following aseptic technique principles, hand hygiene, documentation and patient education. Hospital procedure documents that outline wound care need to reflect current recommended CPGs.
Relevance to clinical practice
Adhering to evidence‐based CPGs has been found to be effective in reducing and preventing SSIs. Our study provides an in‐depth understanding of the barriers and facilitators to nurses’ adherence to recommended CPGs. The findings may inform future practice improvements in wound care.
Insurance fraud is a serious and growing problem, and there is widespread recognition that traditional approaches to tackling fraud are inadequate. Studies of insurance fraud have typically focused upon identifying characteristics of fraudulent claims and claimants, and this focus is apparent in the current wave of forensic and data-mining technologies for fraud detection. An alternative approach is to understand and then optimize existing practices in the detection of fraud. We report an ethnographic study that explored the nature of motor insurance fraud-detection practices in two leading insurance companies. The results of the study suggest that an occupational focus on the practices of fraud detection can complement and enhance forensic and data-mining approaches to the detection of potentially fraudulent claims
These results suggest that postoperative wound care practices are not consistent with evidence-based guidelines. Consequently, it is important to involve clinicians in identifying possible challenges within the clinical environment that may curtail guideline use.
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