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Suggestions to enhance sustainability by overcoming barriers to nurses providing values-sensitive decision support |
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| Most frequently identified barriers |
Suggestions to enhance sustainability |
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| Innovation: Decision Support |
Patient decision aids are hard to use with patients over telephone |
- Decision aids need more point form and auto-charting |
| No structured process for preparing callers for shared decision making |
- Resolved with use of Decision support protocol. |
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| Decision support protocol is not integrated with charting |
- Integrate protocol in computer database with auto-charting ability |
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| Potential Adopters: Nurses |
Inadequate decision support knowledge |
- Resolved by providing nurses with access to an autotutorial |
| Inadequate skills in providing decision support |
- Partially resolved with nurses participation in skill building workshop - Mentoring from supervisors to further develop nurses' skills - Revise call audit tool to include key decision support elements - Continuing education to reinforce learning - Encourage nurses to self-assess their performance |
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| Low confidence in ability to provide decision support |
- Nurse supervisors could give positive feedback on quality of decision support provided |
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| Practice Environment: Call Centre |
Unclear program direction to provide decision support |
- Determine impact of decision support calls on program services - Establish clear direction |
| Limited orientation of new staff to decision support resources |
- Use feedback to revise implementation intervention - Extend training to all nurses and in-particular nurse supervisors - Revise call audit tool to include elements of quality decision support |
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| Pressures to minimize call length |
- Revise call classification to collect decision support calls statistics - Establish call length guidelines tailored to types of calls - Revise patient decision aids for easier use by telephone - Integrate decision support protocol into the database |
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| Low caller awareness that call centre nurses provide decision support |
- Market decision support services to public & other health services |
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Stacey et al. Implementation Science 2006 1:17 doi:10.1186/1748-5908-1-17 |
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