6th UK and Ireland Implementation Science Research Conference 2023
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PRESENter
authors
Biography
Selena joined the National Suicide Research Foundation and School of Public Health, UCC in 2021. She initially worked across three projects with a focus on developing suicide bereavement supports. She now works on the PRISM project led by Dr Eve Griffin. Within this project, she is the primary researcher on a work package which aims to identify the determinants contributing to the implementation of the National Clinical Programme for self-harm and suicide-related ideation across Irish hospitals. As a postdoctoral researcher, she also previously worked on mySupport Study: a cross-case analysis of the implementation of an intervention to facilitate family involvement in decision-making regarding end-of-life care for people with dementia; and with the Health Implementation Science and Technology (HIST) Cluster in University of Limerick across a number of projects involving implementation science.
background
A national clinical programme (NCP) was first introduced in Ireland in 2014 to standardise the assessment, care planning and follow-up of people presenting to the emergency department (ED) with self-harm or suicidal ideation. This study aimed to explore the determinants of implementation of the NCP.
MEthod
The Consolidated Framework for Implementation Research (CFIR) and documentary analysis were used to inform the interview topic guide. Semi-structured interviews (n=30) were conducted with staff involved in delivering the programme, primarily Clinical Nurse Specialists, Consultant Leads, Nursing Management and Emergency Medicine representatives. Participants were asked about the factors affecting implementation in early years (approx. 2015-2017) and in later years (2019-2022). Thematic analysis was used with primarily deductive coding based on CFIR and additional codes developed inductively. A second researcher independently coded 20% of transcripts. Findings were reviewed by the research team and are in the process of being finalised following review and feedback by NCP staff.
results
All five CFIR domains were influential. Prominent factors were the perceived relative advantage of the NCP and clarity of key pillars of the programme as delivered in ED (innovation); links with community and primary care providers, financing and national-level governance (outer setting); relationships between members of the implementation team, availability of resources and infrastructure within the ED (inner setting); and processes of recording data and feeding back to sites (implementation process).
Conclusion
This study highlights the range of factors influencing a programme rolled out at a national level across ED’s. The context of existing services within hospitals strongly influenced the process of implementing the programme. Strategies that facilitated implementation included audit and feedback, promoting networking between sites, as well as supporting staff through regular meetings, training and career progression.