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Table 6 Reflexive monitoring-supporting quotes

From: Implementation of grip strength measurement in medicine for older people wards as part of routine admission assessment: identifying facilitators and barriers using a theory-led intervention

Reflexive monitoring

Supporting quotes

Performance appraisal

It’s because I constantly look at the board because that’s part of my job and I see grip strength stickers up there, think gotta do that. (Nurse 1)

I mean, we’re pretty good as a team at looking at the white boards, if somebody’s has got a, um, one of the fists on the whiteboards I’ll go in them and sort of make sure they’ve got their exercise programme (Therapist 4)

There was one time I put a sticker in, and the same time the doctor wanted the folder and then she looked at it and said ah I’d better prescribe some Fortisips for this patient’….. And there was a physio, he was a Band 7 and said that we’re the only ward consistently doing it. It makes me feel happy (Nurse 4).

Monitoring results

I’m not so much happy about the results because all my patient is like high risk….. Sometimes I tell. You need to ‘don’t worry but exercise’ and eat some more healthy, because we need to make you more strong’ (Nurse 3)

Sometimes we saw the patient is really strong, he’s eighty years, but he is really strong but in the tests…He scored low. so I am surprised about this, yes, and sometimes the family are surprised too because ‘oh really only this’? (Nurse 6)

I had a woman yesterday, I thought she won’t do more than 10, but she was doing like 24, 25 (Nurse 5)

Occasionally you are surprised by people, particularly men that they do better than you imagine they’re going to do. It’s interesting.(Consultant 1)

I’ve seen it in the notes and things, but a lot of my patients, I would say like 85% have got the little grip strength (Therapist 2)

Normalisation

it’s like your routine and doing all we really need to do, we know this is important for patient, important for family, important for us, they start to do it (Nurse 3)

I don’t know why it’s, I don’t know why people act any differently towards that, than they would the weighing chair, I don’t know why they’re treating that any different, (Nurse 4)

Yes. I think all of us now; we know that’s other job that we have to do yeah (Nurse 6)

I think, and they’ve sort of maintained that they still do the grip. They’ve sort of, they’ve got it as part of, it’s all integrated into part of their working practice, I’m not sure if all wards have done that, you know what I mean. That’s what I see, but not all wards are quite there yet (Consultant 1)