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Logo of bmchsrBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Health Services Research
 
From:
Published online 2008 February 2. doi: 10.1186/1472-6963-8-29

Table 7

Participants' perceptions of most important barriers to implementation

AsthmaBreastfeedingDelirium, Dementia, DepressionDiabetes Foot CareSmoking CessationVenous Leg Ulcers
Lack of time to work with patients in emergency departmentStaff resistanceWorkload and competing demandsTime and workload pressure for nursesClient resistance to smoking cessationTime and workload pressures
Too few asthma patients on in-patient units (not peak asthma season)Public Health Nurses' limited access to CRN and lactation consultantLimited time spent with patient, patient stay too shortDifficulty getting support and buy- in from all levels of organization (managers, nurses, physicians)Time and workload pressures, and competing demandsSARS outbreak created delay in education and implementation
Timing of project, timing of launch, lost momentumWorkload and limited availability of CRN‡in hospitalComplexity of skills required for RPNs§Patient issues: cost of taking action, patient motivation, communication, follow-upChallenges of administration and coordination across four sitesLack of physicians willingness to order high compression bandaging
Change in management in two key unitsLack of communication between hospital and public healthLack of buy-in from nurse managers at unit level and some nursesLack of CRN‡ for a period of time, delay in appointing new CRNAttitudes re clients, past experience led to belief clients can't quit smokingFormat of education manual
Lack of physician and administrative support in emergency; physicians in a hurry to send patients homeLack of management supportChanges in senior personnel and lack of consistent championOrganizational change, reorganizationDocumentation not changed for staff to record assessment of smoking cessationLack of educational material for clients

† APNs or Advanced Practice Nurses

‡ CRN or Clinical Resource Nurse

§ RPN or Registered Practical Nurses