Exploring barriers and facilitators to the implementation of non-pharmacological preventive nursing interventions for postoperative delirium in elderly adults with hip fracture based on the consolidated framework for implementation research: A qualitative study.

Abstract

Non-pharmacological prevention of postoperative delirium in elderly hip fracture patients shortens hospital stay and improves rehabilitation quality, but its implementation faces multiple challenges. This study aimed to identify barriers and facilitators to implementing non-pharmacological preventive measures in Chinese healthcare settings, providing a basis for culturally appropriate nursing strategies. A descriptive qualitative study was conducted with 21 healthcare professionals from a tertiary Grade A hospital in Shanghai. Semi-structured interviews were performed using an interview guide developed based on the updated Consolidated Framework for Implementation Research, which was also used for deductive analysis of interview data. Four primary themes and sixteen secondary themes of the Consolidated Framework for Implementation Research were identified, including intervention characteristics, outer setting, inner setting, and individual characteristics. A total of 11 barriers and 8 facilitators. Key barriers include the complexity of interventions, a lack of awareness of delirium amongst family members, structural constraints within orthopaedic care workflows, and knowledge gaps amongst healthcare providers. To address these challenges, nursing-led optimization strategies are required, including the integration of delirium risk assessment into existing electronic health records, the use of a consultation-liaison model to access specialist support, and the provision of training to enhance nurses' clinical judgement. These context-specific adaptations are designed to improve the feasibility and accuracy of non-pharmacological preventive measures and to enhance cognitive function in older patients.