Implementing seating guidelines into clinical practice and policy: A critical reflection and novel theory

Abstract

Introduction: A significant proportion of healthcare that is delivered is wasteful, harmful and not evidence based. There are many wound care related guidelines, but their implementation in practice is variable. The Society of Tissue Viability (SoTV) published updated seating guidelines in 2017, but there is a lack of theoretical and conceptual clarity about how these guidelines are being utilised to inform clinical practice. Therefore, the aim of this paper is to generate a theory that can be used to incorporate the SoTV seating guidelines into policy and clinical practice. Methods: We critically reflected on data from an evaluation study utilising systems-thinking approach, informed by implementation and safety science using wider literature as well as our expertise to generate a guideline implementation theory. Discussion: Factors that facilitate or hinder the incorporation of the SoTV guidelines into policy and practice were characterised. We conceptualised the implementation of these guidelines into policy and practice into a Translation or Implementation into Policy or Practice (TIPP) theory with distinct stages, that we called liminal spaces. Knowledge of the guidelines, and the agency or authority to effect change, are key factors in the translation of these guidelines into clinical practice. Conclusion: Our theory is that there are liminal spaces in the implementation trajectory of these guidelines into practice, which have their own characteristics. This theory provides a framework that can be used to underpin guidelines strategies to embed skin and wound care guidelines into policy and clinical practice in order to improve patient care.