Barriers and facilitators to implement Function- Focused Care in hospitals: a mixed methods study

Abstract

Background: Stroke and geriatric patients are at high risk for functional decline during hospital admission. Functional decline is associated with prolonged hospitalization, reduced quality of life and increased morbidity and mortality. Function- Focused Care (FFC) is a promising approach of care in which nurses help patients engage in activities in daily living and physical activity, with the goal of preventing avoidable functional decline. Although there is existing knowledge of barriers, facilitators and influencing factors to implementation of FFC in the long- term setting, there is limited research in hospitals. Objective: The aim of the study was to identify barriers, facilitators and influencing factors to implementation of FFC in current daily nursing care in hospitals. Methods: A sequential, explanatory mixed methods design was adopted, using structured observations, questionnaires and focus groups. Results: Important barriers to implementation are knowledge and motivation, education, involvement and the lower priority nurses that nurses give to stimulating physical activity in patients. Increased job satisfaction is an important facilitator. Similarly, high levels of self-efficacy and outcome expectations positively influence the implementation. Factors such as patients’ wishes regarding physical activity and nurses’ estimation of patients’ capabilities could both positively and negatively influence the implementation. Conclusion: To enhance successful implementation of FFC in hospitals, implementation strategies should focus on increasing nurses’ motivation and knowledge about FFC and letting them feel more involved with the innovation. Further increase the levels of self-efficacy and outcome expectations will also positively affect the implementation. Recommendations: More research to the lower priority nurses give to stimulating physical activity in patients and what strategies can be applied to overcome this barrier is needed.