Facilitators and barriers to nurses’ adherence to traumatic brain injury management guidelines at the accident and emergency unit in a national referral hospital in Uganda: a qualitative study

Abstract

Objective This study explored the facilitators and barriers to adherence to traumatic brain injury management guidelines among nurses at the accident and emergency unit in a national referral hospital in Uganda. Design An exploratory qualitative study was conducted among nurses. Data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR). Setting The study was conducted in the Accident and Emergency unit at the Mulago National Referral Hospital in Kampala, Uganda. Participants The participants included nurses working at the Accident and Emergency unit of Mulago National Referral Hospital. Results 15 nurses were enrolled in the study, but transcripts for 13 of them were analysed as two audio recordings were corrupted before transcription. The facilitators of TBI management guidelines included the perceived simplicity of stepwise assessment, nurses’ motivation, experience and knowledge of TBI care, supportive peer relationships and nurses’ ability to adapt during emergencies. Conversely, barriers to TBI management guidelines included inaccessible or outdated protocols, severe understaffing, inadequate in- service training, shortages of equipment, sundries and medicines, delays in imaging fee- waiver processes, limited dissemination of TBI guidelines, external pressure from political actors and family members, overcrowding, unpredictable patient surges and difficulty maintaining monitoring fidelity. Conclusion Nurses’ adherence to TBI management guidelines was shaped by the interaction between individual commitment, guideline accessibility and the wider emergency care environment.