Exploring implementation of clinical practice guidelines in burn care among nurses in emergency and critical care departments: a mixed methods study

Abstract

Background: Clinical Practice Guidelines (CPGs) are essential in standardising care and improving patient outcomes, especially in managing complex conditions like burn care where early intervention is crucial. Despite their benefits, CPGs are often underutilised, particularly among nurses in high-pressure environments such as Emergency Departments (ED) and Critical Care Units (CCU). Aims: This study explored nurses' knowledge of, and motivation to use, burn care CPGs in these settings, and identified barriers and facilitators to their implementation. Method: Using an explanatory mixed-methods approach. Results: The study surveyed ED and CCU nurses across two hospitals in Saudi Arabia. In the quantitative phase, 171 nurses responded to a questionnaire testing knowledge of burn care guideline content, motivation to use them, and influencing factors, guided by the Theory of Planned Behaviour (TPB). The findings revealed low knowledge of guideline content, with ED nurses scoring significantly lower than CCU nurses. However, prior training, whether during studies or at work, was positively associated with better knowledge. Nurses displayed moderate levels of motivation and perceived behavioural control regarding CPG use, with no significant difference between ED and CCU groups. In the qualitative phase, 25 nurses participated in interviews, which revealed three major themes influencing CPG implementation: ‘Nurses’ attitudes that impact the implementation of burn care guidelines’, ‘Key relationships’, and ‘External factors. Finally, data from both phases were integrated and aligned with the overarching theoretical framework of TPB. The analysis of qualitative data almost supported and expanded upon the findings from the quantitative phase. Conclusion: Overall, the study underscores a gap between positive perceptions of burn care CPGs and actual knowledge. Addressing barriers like training deficits and access issues while leveraging facilitators such as team support and positive attitudes could significantly improve the uptake of CPGs, ultimately enhancing patient care in ED and CCU settings.