期刊
INTENSIVE AND CRITICAL CARE NURSING
卷 80, 期 -, 页码 -出版社
ELSEVIER SCI LTD
DOI: 10.1016/j.iccn.2023.103553
关键词
Central venous access device; Infection; Prevention; Barriers; Facilitators; Clinical practice guidelines
类别
This study investigated the facilitators and barriers to evidence-based central venous access device care in the adult intensive care setting. The results identified work structures, processes to optimize care quality, and factors influencing staff behavior as the key factors. Facilitators to optimal care included explicit language use, work system integration, research evidence dissemination, audit, and feedback. However, there was inconsistency in practices such as audit, feedback, and patient participation.
Introduction: Research evidence and clinical practice guidelines exist on preventing central line-associated bloodstream infections. However, there is limited knowledge about the barriers and facilitators to evidence -based central venous access device care. Aim: The aim of this study was to investigate the facilitators and barriers to evidence-based central venous access device care in the adult intensive care setting.Method: This exploratory qualitative study involved focus groups and interviews with registered nurses and physicians involved in central venous access device insertion and management in a tertiary Australian intensive care unit. Purposive sampling was used to recruit staff (n = 26) with varying years of clinical experience and clinical positions. Six focus groups and three individual interviews were conducted. Interviews were audio recorded, transcribed verbatim and analysed using content analysis.Results: Three overarching categories emerged: work structures to support optimal performance; processes to optimise quality of care, and factors influencing staff members' behaviour. Perceived facilitators to optimal central venous access device care included explicit language use in procedure documents, work-system inte-grated strategies, research evidence dissemination, audit, and feedback. However, there was a lack of consistency in practices such as audit, feedback, and patient participation.Conclusion: To bring about effective improvement in central venous access device care, future interventions should be tailored to address identified barriers, including integrating audit and feedback into clinicians' work processes. Additionally, future research is needed to explore the role of patients and their families in central venous access device care.Implications for clinical practice: When developing practice policies or procedure manuals, it is important to use explicit language to ensure clear communication of evidence-based recommendations to clinicians. Strategies integrated into work processes can enhance adherence to evidence-based practice. Large departments with limited educators should explore innovative methods like online education to ensure optimal central venous access device care.
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