Multi-level barriers analysis to promote guideline based nursing care: a leadership strategy from home health care
Article first published online: 18 JUL 2013
© 2013 John Wiley & Sons Ltd
Journal of Nursing Management
Special Issue: This issue: Nursing leadership and patient outcomes Issue editor: Greta G. Cummings
Volume 21, Issue 5, pages 762–770, July 2013
How to Cite
2013) Journal of Nursing Management 21, 762–770. Multi-level barriers analysis to promote guideline based nursing care: a leadership strategy from home health care, & (
- Issue published online: 18 JUL 2013
- Article first published online: 18 JUL 2013
- Manuscript Accepted: 24 MAY 2013
- Ministry of Health and Long Term Care
- Canadian Nurses Foundation
- Ministry of Health and Long Term Care of Ontario
- Registered Nurses' Association of Ontario
- barriers assessment;
- clinical practice guidelines;
- implementing change;
Understanding the types of barriers that exist when implementing change can assist healthcare managers to tailor implementation strategies for optimal patient outcomes.
The aim of this paper is to present an organising framework, the Barriers Assessment Taxonomy, for understanding barriers to nurses' use of clinical practice guideline recommendations. Barriers to recommendations are illustrated using the Barriers Assessment Taxonomy and insights discussed.
As part of a pilot implementation study, semi-structured interviews (n = 26) were conducted to understand barriers to nurses' use of nine guideline recommendations for diabetic foot ulcers. Content analysis of verbatim transcripts included thematic coding and categorising barriers using the Barriers Assessment Taxonomy.
Nineteen barriers were associated with nine recommendations, crossing five levels of the health care delivery system. The Barriers Assessment Taxonomy revealed that all recommendations had individual and organisational level barriers, with one recommendation having barriers at all levels. Individual level barriers were most frequent and lack of knowledge and skills was the only barrier that crossed all recommendations.
Implications for nursing management
The Barriers Assessment Taxonomy provides a framework for nursing managers to understand the complexity of barriers that exist, and can assist in choosing intervention strategies to support improved quality care and patient outcomes.