NURS 836 Week 5 Discussion Board Forum 5 on Selecting Implementation Strategies Example

Discussion Board Forum 5: A Strategy for Each Barrier

NURS 836 Translational Research in Health Care, Discussion Board Forum 5

Thread by [Student Name]

The hospital and the classmates replied to are composites written for a model discussion; the textbook and studies cited are real.

My first plan for introducing prophylactic dressings in our long surgeries was an in-service and a laminated card on the supply cart. This week's chapters made me see that I had chosen a strategy before I knew what problem it was meant to solve. Brownson et al. (2018) describe implementation strategies as the methods used to enhance the adoption, implementation and sustainability of a practice, and they are most useful when chosen to fit the barriers a setting actually has.

The Expert Recommendations for Implementing Change project produced a compilation of 73 discrete strategies with standard names and definitions, grouped through expert consensus (Powell et al., 2015). Education is one of them, but so are revising professional roles, changing record systems, conducting local consensus discussions, using audit and feedback and altering incentive structures. Having names and definitions forces precision: "engage staff" is not a strategy, but "conduct local consensus discussions" is.

For our operating rooms, I identified four barriers, similar to those twelve operating room nurses described in a qualitative study, which included too few supplies, guidance that did not fit how operating rooms actually run and weak communication across departments (Gao et al., 2026).

Notice that education appears in none of these rows. Staff already know pressure injuries are harmful. What they lack is a clear role, a prompt, an agreement with surgeons and a budget that does not penalize the department doing the prevention. An in-service answers a question no one in our operating room is asking.

Choosing strategies remains a matter of judgment. In a study asking 169 implementation researchers and practitioners to match strategies to barriers defined by the Consolidated Framework for Implementation Research, an average of 47 different strategies was endorsed for each barrier, and the authors built a tool to prioritize options while noting the wide disagreement (Waltz et al., 2019). That variation argues for treating my table as a hypothesis to test, with fidelity and adoption measures telling me which strategies work. If, after six weeks, the checklist item is completed but dressings are still not applied, the problem is not the prompt but something later in the workflow, and I will return to the staff to find it. Each strategy also has an owner: the perioperative director for the role change, the informatics nurse for the checklist, the chief of surgery for the consensus meeting and the chief financial officer for the budget change, each with a date by which the strategy should be in place.

Reply to Brianna

Brianna, your plan for improving chlorhexidine bathing relies mostly on education, but you also mentioned that bathing rates drop on weekends when float staff cover. That sounds like a workflow and feedback problem more than a knowledge problem. Audit and feedback is one of the named strategies in the ERIC compilation (Powell et al., 2015), and it fits a barrier where staff believe they are complying more than they are. Brownson et al. (2018) also emphasize that strategies should be matched to the specific determinants they are meant to change. Posting weekend bathing rates by unit, compared with weekdays, might change practice faster than another in-service. Which barrier do you think is strongest on weekends?

Reply to Owen

Owen, you chose a champion for your delirium screening project, which fits your barrier of nurses not knowing how to use the tool. My concern is what happens when the champion leaves. Waltz et al. (2019) found that experts endorsed many different strategies for the same barrier, which suggests building in more than one rather than relying on a single person. The ERIC compilation includes strategies such as developing educational materials that remain after the champion leaves and building the tool into the record system (Powell et al., 2015). Pairing your champion with a record prompt might sustain screening after the project. Is your champion's time protected, and for how long? Knowing that will tell you how soon the record prompt needs to be in place.

References

Brownson, R. C., Colditz, G. A., & Proctor, E. K. (Eds.). (2018). Dissemination and implementation research in health: Translating science to practice (2nd ed.). Oxford University Press.

Gao, Y., Chen, J., Guang, W., Xu, W., Wei, Z., & Yang, H. (2026). A qualitative study of facilitators and barriers to intraoperative acquired pressure injury prevention implementation in operating room nurses based on the CFIR framework. Frontiers in Health Services, 6, Article 1877556. https://doi.org/10.3389/frhs.2026.1877556

Powell, B. J., Waltz, T. J., Chinman, M. J., Damschroder, L. J., Smith, J. L., Matthieu, M. M., Proctor, E. K., & Kirchner, J. E. (2015). A refined compilation of implementation strategies: Results from the Expert Recommendations for Implementing Change (ERIC) project. Implementation Science, 10(1), Article 21. https://doi.org/10.1186/s13012-015-0209-1

Waltz, T. J., Powell, B. J., Fernández, M. E., Abadie, B., & Damschroder, L. J. (2019). Choosing implementation strategies to address contextual barriers: Diversity in recommendations and future directions. Implementation Science, 14(1), Article 42. https://doi.org/10.1186/s13012-019-0892-4