当前位置： SCI文献检索 > Implementation Science期刊下所有文献 > Implementation of clinical practice changes in the PICU: a qualitative study using and refining the iPARIHS framework.

Implementation of clinical practice changes in the PICU: a qualitative study using and refining the iPARIHS framework.

Abstract：

BACKGROUND:Like in many settings, implementation of evidence-based practices often fall short in pediatric intensive care units (PICU). Very few prior studies have applied implementation science frameworks to understand how best to improve practices in this unique environment. We used the relatively new integrated Promoting Action on Research Implementation in Health Services (iPARIHS) framework to assess practice improvement in the PICU and to explore the utility of the framework itself for that purpose. METHODS:We used the iPARIHS framework to guide development of a semi-structured interview tool to examine barriers, facilitators, and the process of change in the PICU. A framework approach to qualitative analysis, developed around iPARIHS constructs and subconstructs, helped identify patterns and themes in provider interviews. We assessed the utility of iPARIHS to inform PICU practice change. RESULTS:Fifty multi-professional providers working in 8 U.S. PICUs completed interviews. iPARIHS constructs shaped the development of a process model for change that consisted of phases that include planning, a decision to adopt change, implementation and facilitation, and sustainability; the PICU environment shaped each phase. Large, complex multi-professional teams, and high-stakes work at near-capacity impaired receptivity to change. While the unit leaders made decisions to pursue change, providers' willingness to accept change was based on the evidence for the change, and provider's experiences, beliefs, and capacity to integrate change into a demanding workflow. Limited analytic structures and resources frustrated attempts to monitor changes' impacts. Variable provider engagement, time allocated to work on changes, and limited collaboration impacted facilitation. iPARIHS constructs were useful in exploring implementation; however, we identified inter-relation of subconstructs, unique concepts not captured by the framework, and a need for subconstructs to further describe facilitation. CONCLUSIONS:The PICU environment significantly shaped the implementation. The described process model for implementation may be useful to guide efforts to integrate changes and select implementation strategies. iPARIHS was adequate to identify barriers and facilitators of change; however, further elaboration of subconstructs for facilitation would be helpful to operationalize the framework. TRIAL REGISTRATION:Not applicable, as no health care intervention was performed.

journal_name

Implement Sci

journal_title

Implementation science : IS

authors

Steffen KM,Holdsworth LM,Ford MA,Lee GM,Asch SM,Proctor EK

doi

10.1186/s13012-021-01080-9

subject

Has Abstract

pub_date

2021-01-28 00:00:00

pages

issue

issn

1748-5908

pii

10.1186/s13012-021-01080-9

journal_volume

pub_type

杂志文章

在线工具

Implementation of clinical practice changes in the PICU: a qualitative study using and refining the iPARIHS framework.