|
Author (year) | Reported barriers |
|
Anekwe et al. [81] (2017) | Perceived patient level barriers |
(i) Medical instability |
(ii) Risk of dislodgement |
(iii) Excessive sedation |
(iv) Endotracheal intubation |
(v) Cognitive impairment |
(vi) Inadequate analgesia |
Perceived institutional level barriers |
(i) Orders required |
(ii) Lack of equipment |
Perceived provider level barriers |
(i) Limited staff |
(ii) Communication among providers |
(iii) Inadequate training |
(iv) Not a priority |
(v) Safety concerns |
|
Costa et al. [82] (2017) | Patient related |
(i) Lack of patient’s cooperation |
(ii) Patient’s instability and safety concerns |
(iii) Patient status issues (fatigue, diarrhea, leaking wound, weight size, confusion, agitation, and death) |
Clinician related |
(i) Lack of awareness and knowledge about the protocol |
(ii) Lack of conceptual agreement with guidelines |
(iii) Lack of self-efficacy and confidence in protocol implementation |
(iv) Staff and patient safety concerns |
(v) The perception that rest equals healing |
(vi) Reluctance to follow protocol (due to previous adverse outcomes) |
(vii) Lack of confidence |
(viii) Perceived workload |
(ix) Safety of tubes, wires, and catheters |
Protocol related |
(i) Unavailability of protocol |
(ii) Unclear protocol criteria |
(iii) Protocol development cost (money and time) |
(iv) Learning curve (possibility for the clinician to test guideline and observe other clinicians using the guideline easily) |
(v) Lack of clarity as to who is responsible, steps needed to take, and expected standards for protocol implementation |
(vi) Lack of confidence in evidence supporting protocol and guideline developer |
(vii) Lack of confidence in the reliability of screening tools |
ICU contextual barriers culture |
(i) Interprofessional team care coordination, communication, and collaboration barriers |
(ii) Lack of leadership/management |
(iii) Interprofessional clinician staffing, workload, and time |
(iv) Physical environment, equipment, and resources |
(v) Staff turnover |
(vi) Low prioritization and perceived importance |
(vii) Scheduling conflicts (i- + -e, patient off, at dialysis, and procedure) |
|