The influence of history on nutrition practice in intensive care, V1.0

• Research type

  Research Study

• Full title

  An ethnographic investigation into how historical organisational context influences implementation of nutrition practice in three intensive care units

• IRAS ID

  288082

• Contact name

  Sue Brierley-Hobson

• Contact email

  hsp248@bangor.ac.uk

• Sponsor organisation

  Bangor University

• Clinicaltrials.gov Identifier

  288082, I have confirmed that Betsi Cadwaladr Health Board will use the IRAS reference number for this study

• Duration of Study in the UK

  2 years, 0 months, 1 days

• Research summary

  Critically ill patients on the Intensive Care Unit (ICU) need good nutrition to help them recover. Unfortunately, patients typically only meet around 40-60% of the nutrition they are prescribed. Researchers trying to improve nutritional care in the ICU, have attempted to use contextually tailored strategies to improve implementation of nutrition protocols. These strategies include for example, trying to overcome local practical challenges, yet this approach is commonly unsuccessful.
  
  Little is known about how contextual situations influence behaviour in complex care systems like the ICU. Some suggest ‘history matters’ to what happens in practice today. If context-related behaviour can be better understood, theories can be developed to support successful implementation: which is essential to improve ICU patient outcomes.

  This study asks: how does historical organisational context influence implementation of nutrition practice in the ICU?

  The study aims to gain an in-depth understanding of how historical organisational context influences behaviour and action related to the implementation of nutrition practice in the ICU; and:

  To develop an explanatory theory or theories of how historical events influence current implementation behaviours within the context of path dependency (PD). PD is a theory of organisational history which proposes past events and decisions influence current ways of working in a manner people struggle to change.

  To answer the question, the study uses an ethnographic design with complementary comparative historical analysis.

  Data collection and analysis will be undertaken over a period of 24 months, in three ICUs from the same Health Board, in three phases:
  1: Documentary analysis
  2: Staff individual interviews
  3: Focus group interviews

  Analysis of the data will be undertaken throughout data collection, using a method of identifying sequences of events and common themes to understand the effect of historical events on current behaviour.

  Participants will include:
  - ICU Staff involved in bedside implementation of nutrition practice
  - Those who influence (or have influenced) how decisions are made, agreed or prioritised on the ICU
  - Those who influence (or have influenced) staff structures & resources.

• REC name

  N/A

• REC reference

  N/A