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Managing flail chest, a condition characterized by a segment of the chest wall moving independently from the rest of the thoracic cage, requires a comprehensive approach. It includes a thorough assessment of the patient's condition, a diagnostic evaluation to determine the extent of the injury, and the implementation of appropriate medical interventions tailored to the individual's needs.
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Nursing Assessment:Nursing management of acute coronary syndrome (ACS) involves taking the patient's history, focusing on primary complaints such as chest pain, dyspnea, and excessive sweating (diaphoresis), as well as other symptoms like back or jaw pain, nausea, vomiting, palpitations, dizziness, and fatigue. The nurse also reviews the patient's history of cardiac events, risk factors such as hypertension, diabetes, smoking, family history, and current medications.In the objective assessment,...
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Observational Study Protocol for Repeated Clinical Examination and Critical Care Ultrasonography Within the Simple Intensive Care Studies
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Implementation strategy fidelity evaluation for a multidisciplinary Chest Injury Protocol (ChIP).

Sarah Kourouche1, Kate Curtis2,3,4, Belinda Munroe2,5

  • 1Faculty of Medicine and Health, Sydney Nursing School, The University of Sydney Susan Wakil School of Nursing and Midwifery, 88 Mallet St, Camperdown, NSW, Australia. Sarah.Kourouche@sydney.edu.au.

Implementation Science Communications
|August 11, 2021
PubMed
Summary

High fidelity was achieved in implementing a Chest Injury Protocol (ChIP) using behavior change techniques. This systematic approach to care for blunt chest wall injuries demonstrates successful strategy implementation.

Keywords:
Behaviour changeBlunt chest wall injuryCare bundleEmergencyImplementation strategyInjuryIntervention fidelityProcess evaluationnursing

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Area of Science:

  • Healthcare Quality Improvement
  • Clinical Protocol Implementation
  • Evidence-Based Practice

Background:

  • Blunt chest wall injuries pose significant risks without timely intervention.
  • A Chest Injury Protocol (ChIP) was developed to standardize evidence-based emergency department care.
  • Implementation strategy fidelity measures adherence to the planned intervention delivery.

Purpose of the Study:

  • To evaluate the fidelity of strategies used in the implementation plan for the Chest Injury Protocol (ChIP).

Main Methods:

  • Retrospective evaluation of behavior change techniques (BCTs) used in the ChIP implementation plan.
  • Scoring of BCT implementation (0=not, 1=partially, 2=fully) and adaptation (1=many changes, 4=as planned).
  • Collection of free-text explanations and supporting documentation.

Main Results:

  • Overall implementation fidelity for BCTs was high at 97.6% (fully or partially implemented).
  • 76.2% of BCTs were fully implemented; 21.4% were partially implemented.
  • Lower implementation or higher adaptation was noted for clinical champions and audit/feedback modes.

Conclusions:

  • The study demonstrates high implementation strategy fidelity in an acute care setting.
  • Systematic use of the Behavior Change Wheel facilitated a successful implementation plan.
  • A developed fidelity checklist can aid implementers in assessing adherence to protocols.