Table 3 Suggestions to enhance sustainability by overcoming barriers to nurses providing values-sensitive decision support
| Most frequently identified barriers | Suggestions to enhance sustainability | |
|---|---|---|
| Innovation: Decision Support | Patient decision aids are hard to use with patients over telephone | - Decision aids need more point form and auto-charting |
| No structured process for preparing callers for shared decision making | - Resolved with use of Decision support protocol. | |
| Decision support protocol is not integrated with charting | - Integrate protocol in computer database with auto-charting ability | |
| Potential Adopters: Nurses | Inadequate decision support knowledge | - Resolved by providing nurses with access to an autotutorial |
| Inadequate skills in providing decision support |
- Partially resolved with nurses participation in skill building workshop - Mentoring from supervisors to further develop nurses' skills - Revise call audit tool to include key decision support elements - Continuing education to reinforce learning - Encourage nurses to self-assess their performance | |
| Low confidence in ability to provide decision support | - Nurse supervisors could give positive feedback on quality of decision support provided | |
| Practice Environment: Call Centre | Unclear program direction to provide decision support |
- Determine impact of decision support calls on program services - Establish clear direction |
| Limited orientation of new staff to decision support resources |
- Use feedback to revise implementation intervention - Extend training to all nurses and in-particular nurse supervisors - Revise call audit tool to include elements of quality decision support | |
| Pressures to minimize call length |
- Revise call classification to collect decision support calls statistics - Establish call length guidelines tailored to types of calls - Revise patient decision aids for easier use by telephone - Integrate decision support protocol into the database | |
| Low caller awareness that call centre nurses provide decision support | - Market decision support services to public & other health services | |