Dementia Care

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Vol 5 No 5 October/November 2016 Australian Journal of Dementia Care 61
Difficulties with suggesting
or implementing change
Organisational management,
structure and culture
Consistent with the work of
others (Cooke et al 2014;
Phillipson et al 2016),
participants reported that a
lack of support from
management and/or senior
staff was a key barrier to their
ability to suggest and trial
changes. Management were
often viewed as not interested
in, or not in agreement with,
suggestions from direct care
staff. A lack of effective
consultation, follow up and
feedback where suggestions
were made was also reported.
One participant noted: “… I
wrote a letter recommending
changes in a secure unit and I
knew there was funding
available. There was no reply
frommanagement and nothing
happened.”
In some cases an
organisational culture which
lacked flexibility in practice and
approach to dementia care,
existing policies and
procedures and the hierarchical
structure within organisations
were seen as discouraging of
suggestions regarding different
ways of approaching BPSD
management.
The shifting nature of the
dementia care workforce was
raised as being inconsistent
with implementing changes
systematically. Specifically,
variable shift structure, high
staff turnover, rigid care
routines, staff fatigue/burnout
and frequent rotation of staff
from one area of the workplace
to another (daily in some cases)
reportedly limit motivation to
suggest and implement
changes. As a result care staff
may not be invested in
changing practice.
Direct care staff factors
Staff attitude was often seen as
resistant toward change.
Change in practice was
sometimes perceived as too
difficult to implement or not
worth the effort. Fear of change
and wanting to “stay in their
comfort zone” was reported.
Staff members who had been
working in an organisation for
an extended period were
thought to be “set in their
ways”. The potential for “long-
term staff to instil ‘old ways’ in
new staff” was seen as
problematic in that resistance to
trialling new approaches to
BPSDmanagement persisted.
Participants also indicated that
bullying of newer staff
sometimes occurred where they
were set up to fail when
attending to the most “difficult”
residents.
Difficulties around
communication within the
workplace and relevant
information not being passed
on were repeatedly raised as
barriers. Specifically,
communication breakdown was
linked to:
• not reading resident/client
notes and/or care plans
• information not recorded
• insufficient information
provided at staff handover
• communication limitations
due to language and cultural
differences between staff
members as well as between
staff and people with
dementia
Participants noted issues with
identifying BPSD
management strategies as such,
and thus not passing the
information on to others (eg
providing a light breakfast at
6am calmed a resident who
would otherwise call out
DCRC SPEC I AL I SSUE : THE B I G P I CTURE I N DEMENT I A RESEARCH
Figure 1: A summary of participant feedback on the barriers and enablers
to implementing evidence-based interventions for BPSDmanagement
Barriers and enablers to KT in health care
In our review of the academic literature* we identified the following barriers and enablers to knowledge
translation (KT) in health care.
Barriers
The four main categories of barriers to successful KT in health care are:
• accessibility of research findings
• anticipated outcomes of using research
• organisational support to use research
• support from others to use research (Retsas 2000).
A lack of authority and limited time to implement change as well as a lack of organisational support are
often reported by health professionals as the greatest barriers to KT (Phillipson et al 2016; Retsas 2000;
Carlson et al 2008; Malik et al 2015; Chau et al 2008; Atkinson et al 2008).
Evidence-based practice is not always seen as a core component of clinical care (Harding et al 2014).
A lack of awareness of the current research and a lack of confidence to evaluate the quality of research
outcomes are also ranked high on the list of barriers (Retsas 2000; Atkinson et al 2008; McKenna et al
2005; Draper et al 2009; Grant et al 2012).
The BPSD Guide provides access to synthesised evidence with all research outcomes rated for quality
of the evidence.
Enablers
The literature also outlines enablers for evidence-based practice. These include:
• Providing integrated, multimodal education that meets the goals of the organisation (Nayton et al
2014; Chesney et al 2011).
• Initiating discussion among colleagues to reach consensus around changes to practice (Berland et
al 2012).
• Providing ready access to research outcomes (Atkinson et al 2008) and KT strategies tailored to
specific barriers in a specific participant group and setting (Grimshaw et al 2012; Nayton et al 2014;
Baker et al 2010).
• KT strategies are more likely to be successful where the approach is informed by an understanding
of the probable barriers and enablers specific to the context (Grimshaw et al 2012; Rosen et al 2002;
Low et al 2015; Baker et al 2015; Grol & Grimshaw 2003).
* Details of the literature review are available on request by emailing Kim Burns at