Abstract
Background: A stroke is a devastating disease. Despite the advancement in technology and medicine, the burden of stroke in New Zealand is projected to increase (Ranta, 2018). In an effort to provide organised stroke care, acute stroke units (ASU) have been established. Within an ASU, clinical practice guidelines (CPG) have been instrumental towards the improvement in patient outcomes (Hubbard et al., 2012). Nurses are crucial to the successful implementation of CPG as they provide 24-hour bedside care. In New Zealand, the experiences of nurses working with CPG in an ASU is yet to be established.
Aim: To identify nurse perspectives on barriers and facilitators of implementing the nationally endorsed stroke guidelines in a New Zealand ASU.
Methods: A qualitative descriptive design underpinned the research project. Thematic analysis was used to identify the perspectives of the nurses from the focus group discussion. Four nurses working in the ASU in a single hospital contributed to one focus group, which was guided by semi-structured questions.
Findings: The findings from the research showed that there were many factors which influenced the nurses use of the nationally endorsed stroke guidelines. Four main themes arose from the discussion. Theme one described how nurses engaged with the guidelines as informed by their experience and clinical judgement. Theme two described the accessibility of the guidelines, which was primarily influenced by its location and the format. Theme three depicted how the multidisciplinary team (MDT) collaboration informed guideline use. Finally, the ward environment also influenced the nurse's role and engagement with the guidelines.
Conclusion: The findings of this research contributed to an understanding of the challenges and successes for nurses of using CPG in an ASU. Barriers to use of stroke guidelines included the pressure and lack of resources within the ward, lack of accessibility of the guidelines, and a lack of nursing knowledge of the guidelines. Interestingly, a wealth of nursing knowledge could also be a barrier towards implementation of the guidelines. Facilitators included a stroke nurse champion, nursing specific guidelines and good communication within the MDT. The clinical implications and recommendations for future research were considered.