title: Knowledge, attitudes, beliefs and behaviour intentions for three bowel management practices in intensive care: effects of a targeted protocol implementation for nursing and medical staff.
abstract: BACKGROUND
  Bowel management protocols have the potential to minimize complications for critically ill patients. Targeted implementation can increase the uptake of protocols by clinicians into practice. The theory of planned behaviour offers a framework in which to investigate clinicians' intention to perform the behaviour of interest. This study aimed to evaluate the effect of implementing a bowel management protocol on intensive care nursing and medical staffs' knowledge, attitude, subjective norms, perceived behavioural control, behaviour intentions, role perceptions and past behaviours in relation to three bowel management practices.
  
  
  METHODS
  A descriptive before and after survey using a self-administered questionnaire sent to nursing and medical staff working within three intensive care units before and after implementation of our bowel management protocol (pre: May - June 2008; post: Feb - May 2009).
  
  
  RESULTS
  Participants had significantly higher knowledge scores post-implementation of our protocol (pre mean score 17.6; post mean score 19.3; p = 0.004). Post-implementation there was a significant increase in: self-reported past behaviour (pre mean score 5.38; post mean score 7.11; p = 0.002) and subjective norms scores (pre mean score 3.62; post mean score 4.18; p = 0.016) for bowel assessment; and behaviour intention (pre mean score 5.22; post mean score 5.65; p = 0.048) for administration of enema.
  
  
  CONCLUSIONS
  This evaluation, informed by the theory of planned behaviour, has provided useful insights into factors that influence clinician intentions to perform evidence-based bowel management practices in intensive care. Addressing factors such as knowledge, attitudes and beliefs can assist in targeting implementation strategies to positively affect clinician behaviour change. Despite an increase in clinicians' knowledge scores, our implementation strategy did not, however, significantly change clinician behaviour intentions for all three bowel management practices. Further research is required to explore the influence of opinion leaders and organizational culture on clinicians' behaviour intentions related to bowel management for intensive care patients.
authors: School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Australia, and Clinical Nurse Specialist, Intensive Care Service, St. Vincent's Hospital, Sydney, Australia.
authors: Serena
authors: S
authors: Knowles
authors: Department of Health and Physical Education, The Hong Kong Institute of Education, Hong Kong, Hong Kong.
authors: Lawrence T
authors: LT
authors: Lam
authors: Nursing Research Institute, St Vincent's Health Australia (Syd) and Australian Catholic University, Sydney, NSW Australia.
authors: Elizabeth
authors: E
authors: McInnes
authors: Faculty of Health, University of Technology, Sydney, Australia.
authors: Doug
authors: D
authors: Elliott
authors: Sydney Nursing School, University of Sydney, Sydney, Australia.
authors: Jennifer
authors: J
authors: Hardy
authors: Nursing Research Institute, St Vincent's Health Australia (Syd) and Australian Catholic University, Executive Suite, Level 5, deLacy Building, St. Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW Australia.
authors: Sandy
authors: S
authors: Middleton
keywords: Bowel management; Intensive care; Nursing; Questionnaire; Theory of planned behaviour