Perception of the implementation process of a physiotherapy protocol in a surgical ICU : the physiotherapists' perspectives

[摘要] ENGLISH SUMMARY : Background: There is a gap at primary and specialty level between best available evidence and clinical practice in all health care disciplines, in both developed and developing countries. The high costs, limited resources and existing evidence of practice variation are a concern in intensive care. Practice variation can be addressedthrough the development and implementation of evidence-based interventions. Different frameworks, models and theories have been developed to guide the implementation of these interventions. These frameworks emphasise the acquisitionof the perceptions and reflections of the target audience to assist in the developmentand evaluation of the implementation process. The aim of this thesis was to explore the perceptions of intensive care unit (ICU) staff regarding implementation processes of interventions in developing countries, specifically with regard to physiotherapy.Methods: A scoping review was performed to explore the factors affecting the perception ofICU staff regarding implementation processes of interventions in the ICU setting. Six databases were searched. The results informed the discussion schedule of a qualitative primary study. The primary study aimed to explore and describe theperception of physiotherapists regarding the implementation process of a validated,evidence-based physiotherapy protocol for the management of surgical ICU patients.Participants were recruited using a complete target population sampling method. Allparticipants completed an audio-recorded, individual, semi-structured interview and afollow-up interview. The data was transcribed and thereafter analysed usingdeductive-inductive content analysis. Credibility and truth-value of the results wasensured through reflexivity, checking of transcriptions, member checking and peerreview.Results: A total of nine papers were included in the scoping review. None of the includedstudies was conducted in developing countries or were specifically focused onphysiotherapy. Through the scoping review, 24 factors affecting the perceptions ofICU staff regarding implementation processes were identified and categorised. Four categories emerged, namely: 1) intervention; 2) organisation; 3) characteristics of the ICU staff, and 4) implementation strategies. Twelve physiotherapists were recruited to participate in the primary study. Four themes were deductively developedaccording to the objectives of the primary study. Ten sub-themes emerged from thedata analysis. The perception of the physiotherapists regarding the implementation process was influenced by the four categories identified in the scoping review.Conclusion: There are unique factors affecting the perceptions of staff regarding the implementation of interventions specifically in the ICU setting. Our data confirms the factors that are described by other studies. The unique focus of our study, which included a developing country and a specific profession, namely physiotherapy, did not identify new factors. The intervention being implemented, the structure and culture of the organisation, the characteristics of the individuals involved in the implementation, and the characteristics of the implementation process, all influence the perception of staff regarding implementation processes. An aspect unique to our findings is that the implementation of evidence-based practice is contextual. Change agents who want to implement evidence-based practice in the ICU environment must evaluate and take the individual context into account during the implementation of interventions.

[发布机构] Stellenbosch University