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

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