National Trauma Research Institute, The Alfred Hospital/Department of Surgery, Monash University, Melbourne, Australia.
Implement Sci. 2014 Jan 13;9:8. doi: 10.1186/1748-5908-9-8.
Mild traumatic brain injury is a frequent cause of presentation to emergency departments. Despite the availability of clinical practice guidelines in this area, there is variation in practice. One of the aims of the Neurotrauma Evidence Translation program is to develop and evaluate a targeted, theory- and evidence-informed intervention to improve the management of mild traumatic brain injury in Australian emergency departments. This study is the first step in the intervention development process and uses the Theoretical Domains Framework to explore the factors perceived to influence the uptake of four key evidence-based recommended practices for managing mild traumatic brain injury.
Semi-structured interviews were conducted with emergency staff in the Australian state of Victoria. The interview guide was developed using the Theoretical Domains Framework to explore current practice and to identify the factors perceived to influence practice. Two researchers coded the interview transcripts using thematic content analysis.
A total of 42 participants (9 Directors, 20 doctors and 13 nurses) were interviewed over a seven-month period. The results suggested that (i) the prospective assessment of post-traumatic amnesia was influenced by: knowledge; beliefs about consequences; environmental context and resources; skills; social/professional role and identity; and beliefs about capabilities; (ii) the use of guideline-developed criteria or decision rules to inform the appropriate use of a CT scan was influenced by: knowledge; beliefs about consequences; environmental context and resources; memory, attention and decision processes; beliefs about capabilities; social influences; skills and behavioral regulation; (iii) providing verbal and written patient information on discharge was influenced by: beliefs about consequences; environmental context and resources; memory, attention and decision processes; social/professional role and identity; and knowledge; (iv) the practice of providing brief, routine follow-up on discharge was influenced by: environmental context and resources; social/professional role and identity; knowledge; beliefs about consequences; and motivation and goals.
Using the Theoretical Domains Framework, factors thought to influence the management of mild traumatic brain injury in the emergency department were identified. These factors present theoretically based targets for a future intervention.
轻度创伤性脑损伤是急诊科就诊的常见原因。尽管该领域有临床实践指南，但实践仍存在差异。神经创伤证据转化计划的目的之一是制定和评估有针对性的、基于理论和证据的干预措施，以改善澳大利亚急诊科轻度创伤性脑损伤的管理。本研究是干预措施开发过程的第一步，使用理论领域框架来探讨影响采用四项关键循证推荐的管理轻度创伤性脑损伤的实践的因素。
在澳大利亚维多利亚州对急诊工作人员进行了半结构化访谈。访谈指南是使用理论领域框架制定的，以探讨当前的实践，并确定影响实践的因素。两位研究人员使用主题内容分析对访谈记录进行编码。
在七个月的时间里，共对 42 名参与者（9 名主任、20 名医生和 13 名护士）进行了访谈。结果表明：（i）前瞻性评估创伤后遗忘症受到：知识；对后果的信念；环境背景和资源；技能；社会/职业角色和身份；以及对能力的信念的影响；（ii）使用指南制定的标准或决策规则来告知适当使用 CT 扫描受到：知识；对后果的信念；环境背景和资源；记忆、注意力和决策过程；对能力的信念；社会影响；技能和行为调节；（iii）在出院时提供口头和书面患者信息受到：对后果的信念；环境背景和资源；记忆、注意力和决策过程；社会/职业角色和身份；以及知识的影响；（iv）在出院时进行简短、常规随访的实践受到：环境背景和资源；社会/职业角色和身份；知识；对后果的信念；以及动机和目标的影响。
使用理论领域框架确定了影响急诊科轻度创伤性脑损伤管理的因素。这些因素为未来的干预提供了基于理论的目标。
