Table 7 |
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Participants' perceptions of most important barriers to implementation |
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|
Asthma |
Breastfeeding |
Delirium, Dementia, Depression |
Diabetes Foot Care |
Smoking Cessation |
Venous Leg Ulcers |
|
|
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|
Lack of time to work with patients in emergency department |
Staff resistance |
Workload and competing demands |
Time and workload pressure for nurses |
Client resistance to smoking cessation |
Time and workload pressures |
|
Too few asthma patients on in-patient units (not peak asthma season) |
Public Health Nurses' limited access to CRN and lactation consultant |
Limited time spent with patient, patient stay too short |
Difficulty getting support and buy- in from all levels of organization (managers, nurses, physicians) |
Time and workload pressures, and competing demands |
SARS outbreak created delay in education and implementation |
|
Timing of project, timing of launch, lost momentum |
Workload and limited availability of CRN‡in hospital |
Complexity of skills required for RPNs§ |
Patient issues: cost of taking action, patient motivation, communication, follow-up |
Challenges of administration and coordination across four sites |
Lack of physicians willingness to order high compression bandaging |
|
Change in management in two key units |
Lack of communication between hospital and public health |
Lack of buy-in from nurse managers at unit level and some nurses |
Lack of CRN‡ for a period of time, delay in appointing new CRN |
Attitudes re clients, past experience led to belief clients can't quit smoking |
Format of education manual |
|
Lack of physician and administrative support in emergency; physicians in a hurry to send patients home |
Lack of management support |
Changes in senior personnel and lack of consistent champion |
Organizational change, reorganization |
Documentation not changed for staff to record assessment of smoking cessation |
Lack of educational material for clients |
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|
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† APNs or Advanced Practice Nurses ‡ CRN or Clinical Resource Nurse § RPN or Registered Practical Nurses |
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Davies et al. BMC Health Services Research 2008 8:29 doi:10.1186/1472-6963-8-29 |
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