title: Nurses' perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals.
abstract: BACKGROUND
  Theories of behavior change indicate that an analysis of barriers to change is helpful when trying to influence professional practice. The aim of this study was to assess the perceived barriers to practice change by eliciting nurses' opinions with regard to barriers to, and facilitators of, implementation of a Fall Prevention clinical practice guideline in five acute care hospitals in Singapore.
  
  
  METHODS
  Nurses were surveyed to identify their perceptions regarding barriers to implementation of clinical practice guidelines in their practice setting. The validated questionnaire, 'Barriers and facilitators assessment instrument', was administered to nurses (n = 1830) working in the medical, surgical, geriatric units, at five acute care hospitals in Singapore.
  
  
  RESULTS
  An 80.2% response rate was achieved. The greatest barriers to implementation of clinical practice guidelines reported included: knowledge and motivation, availability of support staff, access to facilities, health status of patients, and, education of staff and patients.
  
  
  CONCLUSIONS
  Numerous barriers to the use of the Fall Prevention Clinical Practice Guideline have been identified. This study has laid the foundation for further research into implementation of clinical practice guidelines in Singapore by identifying barriers to change in acute care settings.
authors.affiliation: School of Nursing, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia. Serena.Koh.SL@kkh.com.sg
authors.forename: Serena S L
authors.initials: SS
authors.lastname: Koh
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Manias
authors.forename: Alison M
authors.initials: AM
authors.lastname: Hutchinson
authors.forename: Susan
authors.initials: S
authors.lastname: Donath
authors.forename: Linda
authors.initials: L
authors.lastname: Johnston
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D001291:Attitude of Health Personnel; D003625:Data Collection; D019983:Guideline Adherence; D006284:Health Plan Implementation; D006761:Hospitals; D006801:Humans; D009729:Nursing; D017410:Practice Guidelines as Topic; D012846:Singapore