|
| 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) |
|
