Abstract
BackgroundBowel management protocols have the potential to minimize complications for critically ill patients. Targeted implementation can increase the uptake of protocols by clinicians into practice. The theory of planned behaviour offers a framework in which to investigate clinicians’ intention to perform the behaviour of interest. This study aimed to evaluate the effect of implementing a bowel management protocol on intensive care nursing and medical staffs’ knowledge, attitude, subjective norms, perceived behavioural control, behaviour intentions, role perceptions and past behaviours in relation to three bowel management practices.MethodsA descriptive before and after survey using a self-administered questionnaire sent to nursing and medical staff working within three intensive care units before and after implementation of our bowel management protocol (pre: May – June 2008; post: Feb – May 2009).ResultsParticipants had significantly higher knowledge scores post-implementation of our protocol (pre mean score 17.6; post mean score 19.3; p = 0.004). Post-implementation there was a significant increase in: self-reported past behaviour (pre mean score 5.38; post mean score 7.11; p = 0.002) and subjective norms scores (pre mean score 3.62; post mean score 4.18; p = 0.016) for bowel assessment; and behaviour intention (pre mean score 5.22; post mean score 5.65; p = 0.048) for administration of enema.ConclusionThis evaluation, informed by the theory of planned behaviour, has provided useful insights into factors that influence clinician intentions to perform evidence-based bowel management practices in intensive care. Addressing factors such as knowledge, attitudes and beliefs can assist in targeting implementation strategies to positively affect clinician behaviour change. Despite an increase in clinicians’ knowledge scores, our implementation strategy did not, however, significantly change clinician behaviour intentions for all three bowel management practices. Further research is required to explore the influence of opinion leaders and organizational culture on clinicians’ behaviour intentions related to bowel management for intensive care patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12912-015-0056-z) contains supplementary material, which is available to authorized users.
Highlights
Bowel management protocols have the potential to minimize complications for critically ill patients
Questionnaire We developed a questionnaire comprising 98 items divided into six sections; demographics (10 items), knowledge (31 items), three behaviours assessed by Theory of Planned Behaviour (TPB) constructs (15 items repeated for three behaviour sections), and perceptions of roles and responsibilities (12 items) (Additional file 1)
The post-implementation group scored significantly higher for knowledge of medications that cause diarrhoea (t = −2.350, df = 148.2, p = 0.02) and knowledge of general bowel management (t = − 2.499, df = 152, p = 0.014) than the pre-implementation group
Summary
Bowel management protocols have the potential to minimize complications for critically ill patients. This study aimed to evaluate the effect of implementing a bowel management protocol on intensive care nursing and medical staffs’ knowledge, attitude, subjective norms, perceived behavioural control, behaviour intentions, role perceptions and past behaviours in relation to three bowel management practices. Bowel management in intensive care Maintenance of normal bowel function for a critically ill patient, often viewed as a low care priority in the highly technical intensive care unit (ICU) environment, is imperative to avoid complications that can delay discharge [1,2,3,4]. Bowel management protocols (BMPs) have been developed for specific use with ICU patients, with initial evaluations demonstrating a reduction in constipation and diarrhoea [10,11,12,13,14,15]. Most evaluations of BMP have only assessed impact on patient outcomes and clinician practices within single site studies; e.g. [15]
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