Article type
Abstract
Background: Neonatal intensive care unit (NICU) newborns are a high-risk population for peripheral intravenous infusion (PIV) extravasation. Our research team has previously summarized the evidence for preventing PIV extravasation in NICU newborns and obtained ethical approval for clinical practice in a tertiary hospital in China.
Objective: This study aims to explore the facilitators and barriers to the clinical application of the best evidence for preventing PIV extravasation in NICU newborns based on the i-PARIHS framework. The findings will provide a basis for developing strategies to implement change in clinical practice.
Methods: From September to October 2023, a sample of 24 nurses with low, medium, and high levels of experience in the NICU of a tertiary hospital in China were selected for focus group interviews. The interviews were guided by the i-PARIHS framework, and a content analysis was conducted.
Results: During the implementation of the best evidence for preventing PIV extravasation in NICU newborns, barriers were identified in the "innovation" dimension, including inadequacies in the applicability, accessibility, and operability of the evidence, as well as significant differences between some evidence and existing nursing procedures. In the “recipients” dimension, barriers included nurses' lack of awareness, confidence, and information about the evidence, as well as limited authority for certain aspects of change. In the “context” dimension, challenges included outdated nursing standards and procedures, the need for equipment optimization and procurement, and the necessity for enhanced collaboration between medical and nursing staff. Facilitators included nurses' strong acceptance and learning abilities, past incidents of extravasation in the department prompting a desire for change, the presence of specialized subgroups and learning systems, departmental experience and culture supporting change, and leadership support and continuous optimization of information systems at various levels of the hospital.
Conclusion: Factors influencing the clinical implementation of evidence for preventing PIV extravasation in NICU newborns are diverse. Addressing identified barriers involves enhancing the local accessibility of evidence, increasing practitioners' knowledge and beliefs, optimizing operational processes, fostering collaboration between medical and nursing staff, and improving equipment. These measures aim to promote the clinical application of the best evidence.
Objective: This study aims to explore the facilitators and barriers to the clinical application of the best evidence for preventing PIV extravasation in NICU newborns based on the i-PARIHS framework. The findings will provide a basis for developing strategies to implement change in clinical practice.
Methods: From September to October 2023, a sample of 24 nurses with low, medium, and high levels of experience in the NICU of a tertiary hospital in China were selected for focus group interviews. The interviews were guided by the i-PARIHS framework, and a content analysis was conducted.
Results: During the implementation of the best evidence for preventing PIV extravasation in NICU newborns, barriers were identified in the "innovation" dimension, including inadequacies in the applicability, accessibility, and operability of the evidence, as well as significant differences between some evidence and existing nursing procedures. In the “recipients” dimension, barriers included nurses' lack of awareness, confidence, and information about the evidence, as well as limited authority for certain aspects of change. In the “context” dimension, challenges included outdated nursing standards and procedures, the need for equipment optimization and procurement, and the necessity for enhanced collaboration between medical and nursing staff. Facilitators included nurses' strong acceptance and learning abilities, past incidents of extravasation in the department prompting a desire for change, the presence of specialized subgroups and learning systems, departmental experience and culture supporting change, and leadership support and continuous optimization of information systems at various levels of the hospital.
Conclusion: Factors influencing the clinical implementation of evidence for preventing PIV extravasation in NICU newborns are diverse. Addressing identified barriers involves enhancing the local accessibility of evidence, increasing practitioners' knowledge and beliefs, optimizing operational processes, fostering collaboration between medical and nursing staff, and improving equipment. These measures aim to promote the clinical application of the best evidence.