• Laurie Grealish, Wendy Chaboyer, Alison Mudge, Toni Simpson, Margaret Cahill, Jo-Anne Todd, Tamara Ownsworth, Maree Krug, Andrew Teodorczuk, and Andrea P Marshall.
• Gold Coast Hospital and Health Service, Gold Coast, Qld, Australia.
• J Nurs Manag. 2019 Nov 1; 27 (8): 1631-1639.

AimTo develop an implementation plan for delirium prevention.BackgroundThe use of non-pharmacological interventions to prevent hospital-acquired delirium is well established but their implementation has been notoriously difficult to achieve. Systematic analysis of context as part of implementation planning is critical.MethodsEthnographic study was conducted in a 24-bed general medical ward. Eleven patients and family members and 15 health service staff participated through observations, individual interviews and document review. Inductive analysis was used to generate themes that described enablers and barriers.ResultsEnablers included a ward culture that embraced safety and placing the person at the centre of care. Barriers were in tension with the enablers and included limited staff knowledge, specialist forms exclusive to the nursing discipline, inflexible ward routines and frequent disruptions.ConclusionsIn addition to standard implementation strategies such as individual education and leadership, implementing delirium prevention requires consideration of team practices, review of policy document design and identification of outcomes data than can support collaborative reflexive practice.Implications For Nursing ManagementThe use of a theory-informed ethnographic approach exposed tensions that may be otherwise invisible. Understanding the tensions increases the likelihood of implementation success. Using a systematic assessment approach can create a comprehensive implementation plan.© 2019 John Wiley & Sons Ltd.

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