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Table 7 Participants' perceptions of most important barriers to implementation

From: Insights about the process and impact of implementing nursing guidelines on delivery of care in hospitals and community settings

Asthma Breastfeeding Delirium, Dementia, Depression Diabetes Foot Care Smoking Cessation Venous Leg Ulcers
Lack of time to work with patients in emergency department Staff resistance Workload and competing demands Time and workload pressure for nurses Client resistance to smoking cessation Time and workload pressures
Too few asthma patients on in-patient units (not peak asthma season) Public Health Nurses' limited access to CRN and lactation consultant Limited time spent with patient, patient stay too short Difficulty getting support and buy- in from all levels of organization (managers, nurses, physicians) Time and workload pressures, and competing demands SARS outbreak created delay in education and implementation
Timing of project, timing of launch, lost momentum Workload and limited availability of CRN‡in hospital Complexity of skills required for RPNs§ Patient issues: cost of taking action, patient motivation, communication, follow-up Challenges of administration and coordination across four sites Lack of physicians willingness to order high compression bandaging
Change in management in two key units Lack of communication between hospital and public health Lack of buy-in from nurse managers at unit level and some nurses Lack of CRN‡ for a period of time, delay in appointing new CRN Attitudes re clients, past experience led to belief clients can't quit smoking Format of education manual
Lack of physician and administrative support in emergency; physicians in a hurry to send patients home Lack of management support Changes in senior personnel and lack of consistent champion Organizational change, reorganization Documentation not changed for staff to record assessment of smoking cessation Lack of educational material for clients
  1. † APNs or Advanced Practice Nurses
  2. ‡ CRN or Clinical Resource Nurse
  3. § RPN or Registered Practical Nurses