Sydney Nursing School, University of Sydney, Sydney, Australia.
Emergency Department, Westmead Hospital, Hawkesbury Road, Westmead, NSW, 2145, Australia.
Implement Sci. 2019 Apr 29;14(1):43. doi: 10.1186/s13012-019-0890-6.
Major trauma patients-such as patients who have experienced road injury, high-impact falls or violence-require complex, intense and rapid resuscitation from a multidisciplinary team of clinicians. These 'flash teams' must form quickly and function effectively, often having never met before. There is evidence that multidisciplinary teamwork training improves the performance of the trauma team in simulation. However, the translation of learnt resuscitation teamwork skills from simulation into clinical practice has had modest and variable effects. This paper outlines a method for developing an intervention designed to translate the teaching from a simulated training environment into clinical practice using the theoretical domains framework, behaviour change wheel and behaviour change techniques as the theoretical and empirical basis for the process.
The data used to inform the intervention development process were collected during an implementation evaluation study of the trauma team training programme at the busiest level 1 trauma centre in Sydney, Australia. A detailed barrier and enabler assessment were conducted using qualitative and quantitative data. The theoretical domains framework was used to integrate the results. Implementation interventions were selected using the behaviour change wheel.
Twenty-three facilitators and 19 barriers were identified to influence the implementation of trauma team training in the clinical setting. The facilitators and barriers corresponded to all 14 domains of the theoretical domains framework. Seven intervention functions and four policy categories of the behavioural change wheel were selected to address the target behaviours, and a multimodal relaunch of the revised trauma team training programme was developed.
This study offers a framework for deductively employing the theoretical domains framework, behaviour change wheel and behaviour change techniques to assess and develop intervention strategies to improve the functioning of trauma resuscitation teams.
严重创伤患者，如经历道路伤害、高冲击坠落或暴力的患者，需要多学科临床医生团队进行复杂、强烈和快速的复苏。这些“闪光团队”必须迅速组建并有效运作，通常以前从未见过面。有证据表明，多学科团队合作培训可以提高模拟创伤团队的表现。然而，从模拟到临床实践中学习的复苏团队技能的转化效果有限且各不相同。本文概述了一种方法，用于开发一项干预措施，该措施旨在使用理论领域框架、行为改变轮和行为改变技术将模拟培训环境中的教学转化为临床实践，作为该过程的理论和经验基础。
用于告知干预措施开发过程的数据是在澳大利亚悉尼最繁忙的一级创伤中心进行的创伤团队培训计划实施评估研究中收集的。使用定性和定量数据进行了详细的障碍和促进因素评估。理论领域框架用于整合结果。使用行为改变轮选择实施干预措施。
确定了 23 个促进因素和 19 个障碍来影响创伤团队培训在临床环境中的实施。促进因素和障碍与理论领域框架的所有 14 个领域相对应。选择了行为改变轮的七个干预功能和四个政策类别来解决目标行为，并开发了修订后的创伤团队培训计划的多模式重新启动。
本研究提供了一种框架，用于演绎地运用理论领域框架、行为改变轮和行为改变技术来评估和制定干预策略，以提高创伤复苏团队的功能。
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