Stakeholder Participants | Comments: Barriers & Facilitators |
---|---|
Organizational Readiness for Change | |
 HCAs | • Making environment elder friendly with mirrors & intercoms • Environmental barriers: unsuitable unit layout & insufficient space |
 LPNs | • Environmental barriers: slippery floors, low toilet seats & absence of railings |
 RNs | • Staff shortages |
 Nurse Managers | • Policy on admission assessment - basic information needs |
 Surgeons | • Staff shortages • Staff and Physician education • Too many overlapping research projects |
Individual Acceptance of New Roles and Duties | |
 HCAs | Staff-to-staff level  • Inappropriate care culture like passing on care work from one health worker to another  • Negative staff relationships: HCAs perceive heavy tasks assigned to them by RNs and LPNs Staff-to-family-level  • Involvement of family in patient care  • Improving communication with family using story boards Staff-to-patient level  • Offering choice in care: e.g. bathing, clothing, meals  • Patient language and culture barriers |
 LPNs | Staff-to-staff level  • Effective communication strategies: problem boards  • Improving teamwork Staff-to-family-level  • Involvement of family in patient care Staff-to-patient level  • Comorbidities: lead to difficulty predicting discharge date  • Comorbidities: lead to more work |
 RNs | Staff-to-staff level  • Effective communication strategies: communication book, report, whiteboard, clipboard etc.  • Insufficient communication due to casual staff  • Improving teamwork  • Negative staff relationships: conflict with HCAs regarding delegation of work Staff-to-family-level  • Lack of family involvement in patient care Staff-to-patient level  • Improving communication strategies with patients about their progress  • Educating patients about interventions  • Comorbidities: involve more work and time requirements |
 Nurse Managers | Staff-to-patient level  • Improving communication strategies with patients about their progress and treatment options |
 Surgeons | Staff-to-staff level  • Improving teamwork  • Insufficient communication among interdisciplinary professionals  • Inappropriate care culture: unfocused geriatric consultations Staff-to-family-level  • Improving communication with family through consistently scheduled health care professional rounds |