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Lessons learned from a failed implementation: Effective communication with patients in transmission-based precautions

Juskevicius, Luize F.; Luz, Reginaldo Adalberto; Felix, Adriana Maria da Silva; Timmons, Stephen; Padoveze, Maria Clara

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Luize F. Juskevicius

Reginaldo Adalberto Luz

Adriana Maria da Silva Felix

Professor of Health Services Management

Maria Clara Padoveze


Background: Patient engagement with transmission-based precautions can be an important strategy to prevent adverse events related to isolation. Most patient education is still highly prescriptive and is thus unlikely to help. Effective communication requires behavior change, leading to a meaningful dialog between the parties involved. Objective: evaluate implementation process of a protocol for effective communication with patients in transmission-based precautions (Com-Efe). Methods: Implementation research using qualitative methods in 4 sequential phases: (1) nonparticipant observation in inpatient wards; (2) design of the intervention for implementation; (3) adaptation of the Com-Efe through workshops with nurses; (4) final assessment of the implementation results through interviews with nurses. Study was performed in a public, secondary, teaching hospital. Consolidated Framework for Implementation Research was used as the reference for interview design and data analysis, aiming to identify barriers and enablers of the implementation process. Results: Main factors that could have facilitated adherence were beliefs and perceived advantages in using the Com-Efe by nurses. Main barriers that may have contributed to the failure were the unfavorable climate for implementation, insufficient individual and leadership commitment, and the lack of understanding of the concepts underpinning effective communication. Conclusions: Despite using a systematic approach, the Com-Efe protocol was not fully implemented. The lessons learned in this study allowed us to propose suggestions for future protocol implementations in similar contexts.

Journal Article Type Article
Acceptance Date Sep 28, 2022
Online Publication Date Oct 7, 2022
Publication Date 2023-06
Deposit Date Sep 29, 2022
Publicly Available Date Oct 8, 2023
Journal American Journal of Infection Control
Print ISSN 0196-6553
Electronic ISSN 1527-3296
Publisher Elsevier BV
Peer Reviewed Peer Reviewed
Volume 51
Issue 6
Pages 687-693
Keywords Infectious Diseases; Public Health, Environmental and Occupational Health; Health Policy; Epidemiology
Public URL
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