Department of Partnerships, Professional Education and Practice, School of Nursing, University of Maryland, Baltimore, Maryland.
Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan.
Nurs Forum. 2020 Apr;55(2):182-189. doi: 10.1111/nuf.12414. Epub 2019 Nov 19.
The cesarean birth rate for low-risk pregnant individuals in the United States exceeds the recommended Healthy People 2020 rate. One recommended strategy to reduce cesarean in this population is delaying hospital admission until active labor commences. A quality improvement program was implemented at a community hospital using the early labor lounge (ELL) to promote admission in active labor. This study focuses on identifying the barriers and facilitators from the clinician perspective to implementing the ELL.
Interviews were conducted with a purposive sample of clinicians. Interview transcripts were open coded and themes identified inductively. A framework analysis was then conducted using the Consolidated Framework for Implementation Research (CFIR).
Twenty-five staff members participated. Barriers and facilitators were identified in four of the CFIR domains. Facilitators included the strength of the evidence and the ELL itself, including the tools it contained for supporting women in latent labor. Barriers to implementation included clinician self-efficacy and perceived low usage of the ELL.
This analysis using, CFIR identified several barriers and facilitators to the implementation of the ELL. The context of the individual woman presenting in triage and the acceptability and self-efficacy of the individual clinicians represented important factors for implementation.
在美国，低风险孕妇的剖宫产率超过了“健康人民 2020”目标推荐的剖宫产率。为降低这一人群的剖宫产率，推荐的策略之一是延迟至产妇进入活跃期后再入院。一家社区医院采用早期分娩休息室（ELL）来推行活跃期入院，实施了一项质量改进计划。本研究主要从临床医生的角度出发，确定实施 ELL 的障碍和促进因素。
采用目的抽样法对临床医生进行访谈。对访谈记录进行开放性编码，并进行归纳主题。然后使用实施研究整合框架（CFIR）进行框架分析。
共有 25 名工作人员参与。在 CFIR 的四个领域中确定了障碍和促进因素。促进因素包括证据的强度和 ELL 本身，包括其为处于潜伏期的产妇提供支持的工具。实施的障碍包括临床医生的自我效能感和对 ELL 的低使用率。
本研究使用 CFIR 对 ELL 的实施进行了分析，确定了实施 ELL 的几个障碍和促进因素。每位进入分诊的产妇的具体情况以及每位临床医生对 ELL 的接受度和自我效能感是实施的重要因素。
