title: Improving delirium care for hospitalized older patients. A qualitative study identifying barriers to guideline adherence.
abstract: OBJECTIVE
  Guidelines are intended as a means of getting research evidence into practice and ensuring provided care is of sufficient quality. However, the effect of guidelines is hindered by limited guideline adherence. The aim of this study is to identify and classify barriers to adherence by nurses to a guideline on delirium care.
  
  
  METHODS
  Open-ended interviews were conducted with a purposive sample of 63 research participants. The sample included 28 nurses, 18 doctors and 17 policy advisors working in 19 hospitals in the Netherlands. The interviews were conducted between June and September 2011. The data were analysed using thematic analysis.
  
  
  RESULTS
  Barriers to guideline adherence that were identified could be grouped into four themes: motivation and goals, knowledge and skills, professional role and identity, and context and resources. While the interviews with nurses, doctors and policy advisors produced similar views of the current situation, doctors and policy advisors placed a higher importance on education as a means of stimulating adherence.
  
  
  CONCLUSIONS
  This study illustrates that individual, social and organizational factors play a role in nurse's adherence to a delirium guideline. The potential benefits of following a guideline, both for patients and for nursing staff, need to be highlighted in order to motivate nurses. When formulating new guidelines, nurses' perceptions of their professional role and patient care need to be taken into account to ensure that policy makers and managers are realistic about guideline adherence and engage with nurses from a position of mutual respect and trust.
authors: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors: Lotte
authors: L
authors: van de Steeg
authors: Maaike
authors: M
authors: Langelaan
authors: Roelie
authors: R
authors: Ijkema
authors: Peter
authors: P
authors: Nugus
authors: Cordula
authors: C
authors: Wagner
mesh_terms: D000367:Age Factors; D000368:Aged; D003693:Delirium / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009426:Netherlands; D024802:Nurse's Role; D010348:Patient Care Team / Q000458:organization & administration*; D010819:Physician's Role; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D058996:Quality Improvement; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: clinical guidelines; delirium; evaluation; nursing; older people; quality