Improving stroke care: A process evaluation of factors influencing international implementation of nurse-led protocols (QASC Europe project).

Abstract

Background: The QASC Europe project is an international collaboration between the Nursing Research Institute (NRI); Australian Catholic University; European Stroke Organisation and Angels Initiative. The project evaluated implementation of nurse-initiated protocols for Fever, hyperglycaemia (Sugar) and Swallowing (FeSS) into stroke units in 64 European countries. Aim(s): A qualitative process evaluation was conducted to understand barriers and facilitators to nurseled protocol implementation from the viewpoint of stakeholders who were involved in promotion of protocol uptake. Method(s): Focus groups and individual face-to-face videoconference interviews were audiotaped. Purposive sampling was used to recruit: i) high-level project governance representatives (clinicians, researchers; industry executives); ii) Angels Initiative team leaders; iii) Angels Initiative consultants and iv) senior stroke nurse country co-ordinators. Transcripts were thematically analysed and mapped to barriers and facilitators. Result(s): Participant numbers were: n=12 interviews and n=5 in each of two focus groups. Barriers and facilitators that influenced facilitation were mapped to five themes: 1) negotiating expectations; 2) roles and responsibilities; 3) readiness for change; 4) communication systems and 5) tailoring and adapting implementation processes. Conclusion(s): A shared goal across stakeholders of improved stroke care was an overarching enabler to the implementation process. Barriers were: commencing the implementation process prior to the establishment of an agreed communication system, system readiness and uncertainty about some roles and responsibilities. Despite differences in perspectives and foci, implementing evidence-based clinical change within hospitals can be initiated outside of the healthcare system and facilitated by academic-industry partnerships.