Selecting intervention content to target barriers and enablers of recognition and response to deteriorating patients: an online nominal group study

Smith, Duncan and Cartwright, Martin and Dyson, Judith and Hartin, Jillian and Aitken, Leanne (2022) Selecting intervention content to target barriers and enablers of recognition and response to deteriorating patients: an online nominal group study. BMC Health Services Research, 22. p. 766. ISSN 1472-6963

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Abstract

Background
Patients who deteriorate in hospital wards without appropriate recognition and/or response are at risk of increased morbidity and mortality. Track-and-trigger tools have been implemented internationally prompting healthcare practitioners (typically nursing staff) to recognise physiological changes (e.g. changes in blood pressure, heart rate) consistent with patient deterioration, and then to contact a practitioner with expertise in management of acute/critical illness. Despite some evidence these tools improve patient outcomes, their translation into clinical practice is inconsistent internationally. To drive greater guideline adherence in the use of the National Early Warning Score tool (a track-and-trigger tool used widely in the United Kingdom and parts of Europe), a theoretically informed implementation intervention was developed (targeting nursing staff) using the Theoretical Domains Framework (TDF) version 2 and a taxonomy of Behaviour Change Techniques (BCTs).

Methods
A three-stage process was followed: 1. TDF domains representing important barriers and enablers to target behaviours derived from earlier published empirical work were mapped to appropriate BCTs; 2. BCTs were shortlisted using consensus approaches within the research team; 3. shortlisted BCTs were presented to relevant stakeholders in two online group discussions where nominal group techniques were applied. Nominal group participants were healthcare leaders, senior clinicians, and ward-based nursing staff. Stakeholders individually generated concrete strategies for operationalising shortlisted BCTs (‘applications’) and privately ranked them according to acceptability and feasibility. Ranking data were used to drive decision-making about intervention content.

Results
Fifty BCTs (mapped in stage 1) were shortlisted to 14 (stage 2) and presented to stakeholders in nominal groups (stage 3) alongside example applications. Informed by ranking data from nominal groups, the intervention was populated with 12 BCTs that will be delivered face-to-face, to individuals and groups of nursing staff, through 18 applications.

Conclusions
A description of a theory-based behaviour change intervention is reported, populated with BCTs and applications generated and/or prioritised by stakeholders using replicable consensus methods. The feasibility of the proposed intervention should be tested in a clinical setting and the content of the intervention elaborated further to permit replication and evaluation.

Item Type: Article
Identification Number: https://doi.org/10.1186/s12913-022-08128-6
Dates:
DateEvent
23 May 2022Accepted
10 June 2022Published Online
Uncontrolled Keywords: Clinical deterioration; Critical care; Vital signs; Behavioural Research; Group processes; Consensus; Nursing
Subjects: CAH02 - subjects allied to medicine > CAH02-04 - nursing and midwifery > CAH02-04-01 - nursing (non-specific)
CAH02 - subjects allied to medicine > CAH02-04 - nursing and midwifery > CAH02-04-02 - adult nursing
Divisions: Faculty of Health, Education and Life Sciences > Centre for Social Care, Health and Related Research (C-SHARR)
Depositing User: Judith Dyson
Date Deposited: 06 Jun 2022 16:09
Last Modified: 17 Jun 2022 14:48
URI: http://www.open-access.bcu.ac.uk/id/eprint/13272

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