Using a general theory of implementation to plan the introduction of delirium prevention for older people in hospital

Abstract

Aim To develop an implementation plan for delirium prevention. Background The use of non‐pharmacological interventions to prevent hospital‐acquired delirium is well established but their implementation has been notoriously difficult to achieve. Systematic analysis of context as part of implementation planning is critical. Methods Ethnographic study was conducted in a 24‐bed general medical ward. Eleven patients and family members and 15 health service staff participated through observations, individual interviews and document review. Inductive analysis was used to generate themes that described enablers and barriers. Results Enablers included a ward culture that embraced safety and placing the person at the centre of care. Barriers were in tension with the enablers and included limited staff knowledge, specialist forms exclusive to the nursing discipline, inflexible ward routines and frequent disruptions. Conclusions In addition to standard implementation strategies such as individual education and leadership, implementing delirium prevention requires consideration of team practices, review of policy document design and identification of outcomes data than can support collaborative reflexive practice. Implications for Nursing Management The use of a theory‐informed ethnographic approach exposed tensions that may be otherwise invisible. Understanding the tensions increases the likelihood of implementation success. Using a systematic assessment approach can create a comprehensive implementation plan.

Effect of Programmed Comprehensive Nursing for Postoperative Delirium in Intensive Care Unit Patients

“…Delirium is a frequent postoperative complication among ICU patients. Moreover, the long-term state of hypoperfusion in ICU patients after surgery and the reduced cardiac output may increase the incidence of delirium [ 12 – 15 ]. As one of the acute brain dysfunctions, delirium is characterized by clinical symptoms of fluctuating thinking disorder and disturbance of consciousness, such as delusion and hallucination.…”

Mapping research findings on change implementation in nursing practice: A scoping literature review

“…In terms of implementation strategies, a multifaceted approach with tailored interventions was identified as the most effective way to generate change (Abbott et al, 2014;Breimaier et al, 2015;Grealish et al, 2019;Kite, 1995;Koh et al, 2008;Lam et al, 2016;Lin et al, 2019;Munroe et al, 2018;Qin et al, 2020;Yagasaki & Komatsu, 2011) leadership approaches; participant involvement; organizational culture and support creation; the use of key actors as champions; role models and opinion leaders (Aitken et al, 2011;Grealish et al, 2019;Jansson et al, 2011;Katowa-Mukwato et al, 2021;Koh et al, 2008;Lam et al, 2016;Lin et al, 2019;Qin et al, 2020;Solomons & Spross, 2011;Wolak et al, 2020). Also, some specific interventions were related to contextual implementation such as partnering with patients and families (Grealish et al, 2019;Lin et al, 2019) and using reminder systems (Aitken et al, 2011;Barr, 2002;Colson et al, 2019;Katowa-Mukwato et al, 2021;Koh et al, 2008;Lin et al, 2019;Munroe et al, 2018;Solomons & Spross, 2011;Stewart & Bench, 2018).…”

“…In terms of implementation strategies, a multifaceted approach with tailored interventions was identified as the most effective way to generate change (Abbott et al, 2014;Breimaier et al, 2015;Grealish et al, 2019;Kite, 1995;Koh et al, 2008;Lam et al, 2016;Lin et al, 2019;Munroe et al, 2018;Qin et al, 2020;Yagasaki & Komatsu, 2011) leadership approaches; participant involvement; organizational culture and support creation; the use of key actors as champions; role models and opinion leaders (Aitken et al, 2011;Grealish et al, 2019;Jansson et al, 2011;Katowa-Mukwato et al, 2021;Koh et al, 2008;Lam et al, 2016;Lin et al, 2019;Qin et al, 2020;Solomons & Spross, 2011;Wolak et al, 2020). Also, some specific interventions were related to contextual implementation such as partnering with patients and families (Grealish et al, 2019;Lin et al, 2019) and using reminder systems (Aitken et al, 2011;Barr, 2002;Colson et al, 2019;Katowa-Mukwato et al, 2021;Koh et al, 2008;Lin et al, 2019;Munroe et al, 2018;Solomons & Spross, 2011;Stewart & Bench, 2018). These interventions confirmed the implementation strategies identified by Cochrane's Effective Practice and Organization of Care (EPOC) taxonomy guidelines (EPOC, 2015).…”

“…We identified also another type of factors related to activity level, but this was seen in fewer number of studies (20%), for example socio-material contexts were identified in only three studies (Allen, 2013;Grealish et al, 2019;May et al, 2014). Socio-materiality "arises from the interplay between particular configurations of not only material phenomena, but also material arrangements set up by individuals to discover these phenomena and the knowledge practices established in time" (Parmiggiani & Mikalsen, 2013).…”

“…The majority of studies used multifaceted approaches, which combined two or more strategies (Foy et al, 2005). In addition, tailored interventions target identified or perceived barriers to promote implementation (Abbott et al, 2014;Breimaier et al, 2015;Grealish et al, (Grealish et al, 2019;Lin et al, 2019), the use of role models or opinion leaders (Jansson et al, 2011;Kite, 1995;Munroe et al, 2018;Qin et al, 2020) and pilot schemes to test intended changes (Abbott et al, 2014;Aitken et al, 2011;Christensen & Christensen, 2007;Grealish et al, 2019;Kite, 1995;Stewart & Bench, 2018;Wolak et al, 2020). The use of an appropriate change model was also suggested by more than half of the studies (54%), either to guide an implementation process or as a tool to identify and understand what factors could influence a change practice implementation (Abbott et al, 2014;Aitken et al, 2011;Breimaier et al, 2015;Christensen & Christensen, 2007;Colson et al, 2019;Dulko, 2007;Grealish et al, 2019;Jansson et al, 2011;Katowa-Mukwato et al, 2021;Koh et al, 2008;Munroe et al, 2018;Qin et al, 2020;Stewart & Bench, 2018;Wolak et al, 2020).…”