effectiveness of a multifaceted approach to … of a multifaceted approach to implement a fall...

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Item type Presentation

Format Text-based Document

Title Effectiveness of a Multifaceted Approach to Implement aFall Prevention Guideline into Nursing Practice in aHospital Setting: Comparison of Before and In-BetweenAssessment

Authors Breimaier, Helga Elisabeth; Lohrmann, Christa Elisabeth

Downloaded 12-May-2018 14:48:33

Link to item http://hdl.handle.net/10755/243270

http://hdl.handle.net/10755/243270

Institute of Nursing Science

Effectiveness of a multifaceted approach to

implement a fall prevention guideline into nursing

practice in a hospital setting.

A before and in-between assessment

Helga E. Breimaier, MScN, BScN, RN, PhD cand.

Prof. Dr. Christa Lohrmann, MA, RN

Sigma Theta Tau International‘s 23rd International Nursing Research Congress

30th July - 3rd August 2012, Brisbane, Australia

Institute of Nursing Science Background

Increasing (inter-)national expectations for nurses to use

research findings

Use of research findings in daily nursing practice:

- as a basis for decisio-making

- to achieve evidence-based care

- to promote and to predict positive patient outcomes

- to save costs

Legal regulations:

- Health Care Quality Act, § 3 Scope of Applicability, Fed. Law Gaz I no. 179/2004

- Nursing Act, GuKG § 4 (1 & 2) Allgemeine Berufspflichten, BGBl. I Nr. 74/2011

(Nunnelee & Spaner 2002, Hart et al. 2008, Kirshbaum 2008, McCloskey 2008

GQG 2004, GuKG 2004) © Helga E. Breimaier, MScN, BScN, RN, PhD cand.

Institute of Nursing Science Cont‘d

Clinical practice guidelines (CPGs) ...

- help to meet certain standards

- provide recommendations

- guide towards the best behaviour in a particular area

© Helga E. Breimaier, MScN, BScN, RN, PhD cand.


Publication of CPGs does not ensure their use

The most effective means of implementing a CPG is still

unclear

Translating research remains a considerable challenge

Whole systems approaches and multifaceted strategies are

recommended


Campbell et al. 2007, Seers et al. 2012, Greenhalgh et al. 2004, Leykum et al. 2009, Arabi et al. 2007,

van der Wees et al. 2008

Institute of Nursing Science Aim

Assessing the effectiveness of a multifaceted approach

to implement a fall prevention clinical practice guideline

into nursing practice in a hospital setting



Design: participatory action research approach

including working-group meetings

Setting ophthalmologic hospital department

sample: nurses and nursing aides

Ethical approval: obtained from the university’s ethical

committee

informed consent obtained


Methods


Autumn

2010 Sept. – Dec.

2010

Jan.

2011

Autumn

2011

Febr.- March

2012

July

2011

Monthly working-

group meetings

Implementation phase

Comparison


Time frame


Elovainio 1999, Shortell et al. 2004, Schwarzer & Jerusalem 1999, Goh S. & Richards 1997 © Helga E. Breimaier, MScN, BScN, RN, PhD cand.

Data collection

T1 / T2: questionnaire T1: interviews (12) &

group discussions (4)

T1: interviews (11) &

group discussions (3)

demographic data

fall prevention

knowledge

attitudes towards

guidelines

organisational culture

self-efficacy

organisational learning

4-5-point

Likert-type

scales

perceived problems

participants‘ aims

measures undertaken

to prevent falls

measures used to

introduce sth. new

influencing factors

availability of necessary

devices

satisfaction with

obtained achievement

perceived differences in

daily nursing practice


Descriptive analysis: SPSS 18, IBM SPSS 19

Content analysis: MAXQDA

Consolidated Framework of Implementation Research (CFIR)

- intervention characteristics

- outer setting

- inner setting

- characteristics of individuals

- implementation process

Damschroder et al. 2009 © Helga E. Breimaier, MScN, BScN, RN, PhD cand.

Data analysis

Institute of Nursing Science Procedure

Results of first data collection period

Base for further action in working group meetings

8 representatives: 3 wards, outpatient department, surgery department

Defining underlying problem

Defining nurses’ aims & criteria to measure their achievement

Determining necessary devices

Development of information material

Determining appropriate implementation strategies:

internal lectures, internal written materials, opinion leaders, audit & feedback, changes in

patient record systems, acquisition of necessary devices



Participants 2010 / 2011: 69 (75.8%) / 81(93.1%)

Demographic data:

2010 2011 p

Female: 95.6% n=68

93.7% n=79

=.609

Nurses: 67.2% n=67

65.8% n=80

=.907

Work experience ≥

10 years:

67.2% n=64

48.1% n=78

=.096

Age: 41.6 y n=65

39.6 y n=71

=.268


Results


Knowledge regarding access to CPG:

p=.001 0%

20%

40%

60%

80%

baselinen=68

in-betweenn=78

yes

no



Knowledge:

*maximum 81

Attitudes: 4-point Likert-scale

*1 = I don’t agree, 4 = I agree

n mean* standard deviation p

baseline 69 52.6 7,13

in-between 81 54.0 7.81 .263

n mean* standard deviation p

baseline 48 3.015 .353

in-between 66 3.079 .411 . 387



Qualitative data:

Participants‘ raised awareness regarding fall prevention

Availability of new devices e.g. - “baby phone”

- additional walking aids

- material for safe patient transfer

Satisfaction with achievements

Compilation of supporting information material e.g.

Assessment

Patient information


Institute of Nursing Science Discussion

Positive effects

- of tailored interventions

- of multifaceted interventions

support/confirm existing literature


Baker et al. 2010, Grimshaw et al. 2004, Hutt et al. 2006, van der Wees et al.

2008

Limitation:

Time to conduct the project

Institute of Nursing Science Conclusion

Positive effects of multifaceted strategies within

a participatory action research approach



Helga E. Breimaier

Medical University of Graz


Email: [email protected]

Tel.: +43 316 385-72073

Financially supported

by:

In cooperation with:


Contact details

mailto:[email protected]

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