Table 6 Enablers and barriers of implementation at the nursing home level
Categories | Enablers | Barriers |
|---|---|---|
Personal factors | • Social relationships (F) - Respect and social support of facilitators by the nursing team (F) | • Social relationships (F) - Therapists perceive PECAN as an interference in their responsibilities (F) - Conflicting opinions and challenges within the interprofessional team regarding the care of residents with joint contractures (F, T) |
• Motives and motivation (F, SW, R) - Differing priorities of management and nursing team (F) - Poor motivation or little interest of the different stakeholders, i.e., nurses (F), physicians (F), therapists (F), social workers (SW) or residents (R) - Lack of interprofessional attitude among physicians (F) - Uncertainty and fear among relatives (e.g., additional costs, overburdening) (F) | ||
Organisational factors | • Clear commitment of the entire nursing home (F) - Active leadership to support changes (e.g., regularly occurring agreements and exchange, adoption of organisational tasks, approved time slots for meetings, provision of technical and medical aids) (F) - Open-mindedness to changes in the nursing team (e.g., review of residents’ care plans, implementation of measures to support participation, initiation of case conferences) (F) - Clear responsibilities within the interprofessional team (e.g., in collaboration with social workers, therapists and physicians) (F) | • Lack of impact on organisational conditions and routines (F, SW, T, R) - Unclear and unspecified responsibilities (F, SW) - Lack of interprofessional collaboration (e.g., little exchange, strict separation of working areas) (F, SW, T, R) - No established culture of contact and exchange between relatives and nursing staff (R) - No interprofessional case conferences (SW, T) |
• Respect for the expertise of different healthcare professionals and relatives (F, SW, T, R) - Respect for involved healthcare professionals (F, SW, T, R) - Recognition of various expertise and resources (T, SW, R) | • Lack of time and staff competences (F, R, T) - Staff shortage and high workload for nurses (F, R, T) and therapists (F, T) - No time slots for unscheduled tasks (F) - Skills shortage in the nursing staff (F, R, T) - Language barriers of the nursing staff (R) |