Barriers and carriers: a multicenter survey of nurses’ barriers and facilitators to monitoring of nurse-sensitive outcomes in intensive care units

Abstract

AimTo identify nurses’ barriers and facilitators to monitoring of nurse‐sensitive outcomes in intensive care units (ICUs), and to explore influential nurse characteristics and work environment factors.DesignA cross‐sectional survey in three Dutch ICUs between October 2013 ‐ June 2014.MethodsA questionnaire with questions regarding facilitators and three types of barriers: knowledge, attitude and behaviour. The Dutch Essentials of Magnetism II was used to examine work environments.ResultsAll 126 responding nurses identified pressure ulcers and patient satisfaction as outcomes that are nurse‐sensitive and nurses’ full responsibility. Lack of time (behaviour) was perceived as the most prominent barrier, followed by unfamiliarity with mandatory indicators (knowledge), and unreliability of indicators as benchmark data (attitude). Education and clear policies were relevant facilitators. Of nurse characteristics, only regularity of shifts was related to perceived attitude related barriers. The work environment factor “clinical autonomy” was potentially associated with behaviour related barriers.

How do nurse managers describe clinical nurses' work arrangements? A qualitative study

“…Recent studies indicate that the resources—such as time—that nurses have, nurses' work experience and nurse‐to‐patient ratios affect the extent to which nurses complete patient care tasks such as the monitoring of patients' fluid intake (Litchfield, Magill, & Flint, ) and the taking of patients' vital signs (Recio‐Saucedo et al, ). The delivery and monitoring of these tasks are important because they are within nurses' scope of practice and they directly affect patients' health outcomes (Stalpers, De Vos, Van Der Linden, Kaljouw, & Schuurmans, ). Such nuances in nurses' work, nurses' qualifications and motivations as well as the challenges that nurses confront daily highlight salient factors that facilities must constantly evaluate as they ascertain and manage the staffing mix appropriate for their respective circumstances.…”

A Rapid Realist Review of Quality Care Process Metrics Implementation in Nursing and Midwifery Practice

“…Clinical sites that are outward-facing and well-networked are adept at introducing and implementing external strategies (including policy, regulation, guidelines, and QCP-M) and using available resources to spread the intervention. Nurses and midwives in these sites engage with provided resources (such as champions and materials), resulting in an increased chance of intervention success [33,36,[38][39][40].…”

“…Where interventions are supported at a national level [38] by an implementation framework [40] and organizations are externally facing, then there is a more standardized approach to implementation [33], leading to successful adoption of the intervention. Clinical sites that show readiness for QCP-M implementation have strong internal networks and communication systems that facilitate a practice culture compatible with the introduction of quality interventions and a learning climate supportive of nurses and midwives who are implementing the QCP-M, resulting in an increased chance of the intervention becoming embedded in practice [34,36,[38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57].…”

“…Clinical sites that have effective internal networks and communication systems [34,41,44,46,50] and an organizational commitment to, and readiness for change implementation [40,[42][43][44][45]48,52,53,55,57] evidence practice cultures that are supportive of staff [32,38,[40][41][42][43]47,50,53] and compatible with quality interventions [38][39][40][41]44,47,48,57] in a supportive learning climate [36,[41][42][43]45,46,48,49,[54][55][56][57] leading to the successful adoption and integration of the QCP-M into clinical practice. The implementation of QCP-M in clinical sites is influenced by nurses and midwives, whose local knowledge, values, beliefs, and individual characteristics determine their interaction with the intervention.…”

Prevention of pressure ulcers in patients undergoing subacute rehabilitation after severe brain injury: An observational study

“…Thus, a survey on nurses’ attitudes to PU prevention (Unver, Findik, Ozkan, & Surucu, ) found that previous PU care education significantly affected nurses’ attitudes. A multicentre survey aimed at identifying barriers and facilitators to the monitoring of nurse‐sensitive outcomes in intensive care units found that education and clear management policy were important facilitators (Stalpers, De Vos, Van Der Linden, Kaljouw, & Schuurmans, ). In this study, nurses identified PUs and patient satisfaction as outcomes falling squarely within nurses’ responsibility.…”