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Table 3 Suggestions to enhance sustainability by overcoming barriers to nurses providing values-sensitive decision support

From: Adoption and sustainability of decision support for patients facing health decisions: an implementation case study in nursing

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