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Table 7 Description of the differences in implementation across the five wards

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

Wards

Factors affecting implementation of grip strength measurement

Ward 1

Highly motivated ward champion (a nurse)

Buy-in from the ward manager

High shared commitment from other staff

Engagement strategies included incorporating grip strength test in handover, adding the care plan to admission booklet, and using the grip strength magnets on the board. The ward champion was awarded the employee of the month award for excellence.

Grip strength test was normalised in this ward.

Ward 2

Initially there was high turnover in ward champions and ward managers.

Then two nominated keen champions (2 nurses) led the implementation process with the support of a new ward manager.

Little shared commitment from other staff

Ward 3

Initially there was lack of buy in form the ward manager and lack of perceived responsibility.

Then 2 highly motivated ward champions (Healthcare assistant and Associate practitioner) were nominated to lead implementation.

Supportive new ward manager

No shared commitment from other staff was achieved.

Engagement strategies included using the grip strength magnets on the board to monitor performance, include the grip test in the bays checklist, adding the care plan to the admission booklet, allocating certain time during the day to perform the grip test. The ward champions were awarded the employee of the month award for extraordinary efforts.

Ward 4

Highly motivated ward champion (a healthcare assistant). Engagement strategies included placing visual reminders in each bay. The ward champion was awarded the employee of the month award.

Unsupportive ward manager

No shared commitment from other staff

Ward 5

Highly motivated ward champion (a senior nurse)

Supportive ward manager

Low shared commitment from other staff

Engagement strategies included using the grip strength magnets on the board, allocating the mission to measure grip strength to other staff