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

Maritz, Jacques Johannes (2018-03)

Thesis (MScPhysio)--Stellenbosch University, 2018.

Thesis

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 addressed through 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 acquisition of the perceptions and reflections of the target audience to assist in the development and 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 of ICU 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 the perception 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. All participants completed an audio-recorded, individual, semi-structured interview and a follow-up interview. The data was transcribed and thereafter analysed using deductive-inductive content analysis. Credibility and truth-value of the results was ensured through reflexivity, checking of transcriptions, member checking and peer review. Results: A total of nine papers were included in the scoping review. None of the included studies was conducted in developing countries or were specifically focused on physiotherapy. Through the scoping review, 24 factors affecting the perceptions of ICU 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 developed according to the objectives of the primary study. Ten sub-themes emerged from the data 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.

AFRIKAANSE OPSOMMING : Agtergrond: Daar is ‘n gaping op primêre en spesialis vlak tussen die beste beskikbare bewyse en kliniese praktyk in alle gesondheidsorg disiplines, in beide ontwikkelde en ontwikkelende lande. In die intensiewesorgeenheid (ISE) is die hoë koste van spesialis sorg, die beperkte hulpbronne en gedokumenteerde praktykvariasie kommerwekkend. Praktykvariasie kan aangespreek word deur die ontwikkeling en implementering van bewysgebaseerde intervensies. Verskillende raamwerke, modelle en teorieë is reeds ontwikkel om die implementering van hierdie intervensies te rig. Hierdie raamwerke beklemtoon dat die verkryging van die gebruikers se persepsies en refleksies belangrik is om die ontwikkeling en evaluering van implementeringsprosesse te fasiliteer. Die doel van hierdie tesis was om die persepsies van ISE personeel met betrekking tot die implementeringsprosesse van intervensies in ontwikkelende lande te verken, met spesifieke fokus op fisioterapie. Metodes: ‘n Literatuuroorsig is uitgevoer om die faktore wat die persepsie van ISE personeel met betrekking tot die implementeringsprosesse van intervensies in die ISE beïnvloed, te verken. Ses databasisse is deursoek. Die resultate is gebruik om ‘n besprekingskedule vir 'n kwalitatiewe primêre studie te rig. Die doel van die primêre studie was om die persepsie van fisioterapeute met betrekking tot die implementeringsproses van 'n bewysgesteunde fisioterapieprotokol vir die hantering van chirurgiese ISE pasiënte te verken en te beskryf. Deelnemers is gewerf met behulp van 'n volledige teikenpopulasie steekproefmetode. Alle deelnemers het ‘n stem-opgeneemde, individuele, semi-gestruktureerde onderhoud en opvolgonderhoud voltooi. Die data is getranskribeer en deduktiewe-induktiewe inhoudsanalise is gebruik om die data te analiseer. Geloofwaardigheid en waarheidswaarde van die resultate is deur refleksie, nagaan van transkripsies, lidkontrolering en portuuroorsig verseker. Resultate: Nege artikels is ingesluit in die literatuuroorsig. Geen van die insluitende studies is uitgevoer in ontwikkelende lande of is spesifiek gefokus op fisioterapie nie. Die literatuuroorsig het 24 faktore geidentifiseer wat die persepsies van ISE personeel met betrekking tot implementeringsprosesse beïnvloed. Hierdie 24 faktore is in vier kategorieë gekatagoriseer, naamlik: 1) intervensie; 2) organisasie; 3) eienskappe van die ISE personeel en 4) implementeringstrategieë. Twaalf fisioterapeute is gewerf vir deelname in die primêre studie. Vier temas is deduktief ontwikkel volgens die primêre studie se doelwitte. Tien subtemas het na vore gekom uit die dataanalise. Die persepsie van die fisioterapeute met betrekking tot die implementeringsproses is beïnvloed deur die vier kategorieë wat in die literatuuroorsig geidentifiseer is. Gevolgtrekking: Daar is unieke faktore wat die persepsie van personeel met betrekking tot die implementeringsprosesse van intervensies in die ISE beïnvloed. Ons data bevestig die faktore wat deur ander studies beskryf word. Die unieke fokus van ons studie, wat ‘n ontwikkelende land en die fisioterapie professie ingesluit het, het nie nuwe faktore geidentifiseer nie. Die geïmplementeerde intervensie, die struktuur en kultuur van die organisasie, die eienskappe van die individue wat betrokke is by die implementering en die eienskappe van die implementeringsproses, beïnvloed die persepsie van die personeel met betrekking tot implementeringsprosesse. Uniek tot ons bevindinge is dat die implementering van bewysgesteunde praktyk kontekstueel is. Veranderingsagente wat bewysgesteunde praktyk wil implementeer in die ISE omgewing moet die individuele konteks evalueer en in ag neem tydens die implementering van intervensies.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/103528
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