Barriers and facilitators in the management of preoperative thirst of the burned patient in the light of Knowledge Translation

Garcia, Aline Korki Arrabal; Conchon, Marilia Ferrari; Pierotti, Isadora; Zampar, Elisangela Flauzino; Fonseca, Lígia Fahl

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ARTIGO ORIGINAL • Rev. esc. enferm. USP 55 • 2021 • https://doi.org/10.1590/S1980-220X2020039803764 copy

Barriers and facilitators in the management of preoperative thirst of the burned patient in the light of Knowledge Translation^* * Extracted from the thesis: “Implantação do Modelo de Manejo da Sede Pré-operatória no Centro de Tratamento de Queimados: estudo de intervenção norteado pelo Knowledge Translation”, Programa de Pós-Graduação em Enfermagem, Universidade Estadual de Londrina, 2020.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To explore the perception of health care professionals about barriers and facilitators, and coping strategies for the implementation of the Thirst Management Model in the preoperative period of the burned patient.

Method

This is a qualitative study, anchored in the conceptual framework Knowledge Translation. The focus group technique was chosen for data collection, composed by eight key professionals, to identify barriers and facilitators in evidence implementation and to point out coping strategies for the critical nodes found. Thematic Content Analysis technique was used to evaluate the data.

Results

Five categories emerged: Physical structure, environment and supplies; Particularities of the burned patient; Human Resources; Team attitude; Team training and education. Coping strategies were raised for each barrier identified.

Conclusion

The main barriers identified were found in the Human Resources and Team Attitude categories. The main facilitators were Particularities of the burned patient and Team training and education. The identification allowed planning coping strategies for critical nodes, providing support for scientific evidence in clinical practice.

Evidence-Based Nursing; Translational Medical Research; Perioperative Nursing; Burns; Thirst

Categories	Facilitators	Barriers	Coping strategies
Physical structure, environment and supplies	Presence of a freezer in the sector to store the popsicles (A; S; PN; NM; P1; P2; NT1; NT2). Isolated sector allows engaged employees to collaborate with other colleagues (S; NM; NT 1). Feasibility of standardizing supplies applied as thirst management strategies (NM; S; P1; P2).	Difficulty in previous organization due to lack of a defined schedule (sequence) for anesthetic-surgical procedures (PN; NM; NT1; NT2).	Chief surgeon of the unit was responsible for defining the schedules of the first three patients every day (S).
Particularities of the burned patient	Professionals in the sector are aware of the intensity of the burned patient’s thirst, which leads to awareness raising (S; NM; NT 2).	-	-
Human Resources	Availability of a technical nursing professional for making the popsicles (NM; NT1; NT2).	Lack of time for the professionals to employ thirst management because they rely on the number of patients under their responsibility (PN; NT1; NT2).	At the end of training, the employees concluded that they can quickly manage thirst while they are providing basic care (PN; NT1; NT2).
Team attitude	Implementation of scientific evidence that is beneficial to the patient (A; S; PN; NM; P1; P2; NT1; NT2).	Resistance on the part of some team anesthetists regarding the possibility of reducing fasting time (A; S; PN; NM; P1; P2; NT1; NT2). Lack of interest by the perioperative team in learning and managing the preoperative thirst (PN; NM; NT1; NT2).	Meeting with the hospital charts of directors and head of anesthesiology to present the project, exposing the evidence on the benefit of managing thirst, reducing fasting and supporting the project (P1; P2; A; S; NM). Disclosure of the project and its objective through personalized strategies to the sector, which included professionals and patients (P1; P2; NM). Exposure of data from baseline collection to raise the awareness of professionals to the theme (P1; P2).
Team training and education	The willingness of the team implementing thirst management to train the entire team that provides care to the patient (S; NM; P1; P2).	Lack of knowledge of the team on management of preoperative thirst (A; S; PN; NM; P1; P2; NT1; NT2). Application of the protocol for children performed only by nurses, as it is more complex (PN; NM; NT1; NT2).	Training in the unit in the morning, afternoon and night, at different times, in order to contemplate the majority of the employees (PN; NM; S; A; NT1; NT2; P1; P2). Professional training for the use of the new perioperative form, which includes the record of thirst management (PN; NM; P1; P2). Individual training of all technicians and nurses on thirst management (P1; P2; NM). Development and dissemination of didactic video on the Adult and Pediatric Thirst Management Model (P1; P2).

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Aline Korki Arrabal Garcia. Rua Marcílio Dias, 125 CEP 86015-620 - Londrina, PR, Brazil alinekorki@yahoo.com.br