Author Affiliations: Department of Pediatrics, Boston Medical Center, Boston, Massachusetts (Dr Cordova-Ramos and Ms Burke); Department of Medicine, Evans Center for Implementation and Improvement Sciences (Drs Cordova-Ramos and Drainoni), Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts (Mss Sileo, McGean, and Mantri); Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York (Dr Torrice); Department of Pediatrics, UMass Memorial Medical Center, Worcester, Massachusetts (Dr Parker); Section of Infectious Diseases, Department of Medicine, Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts (Dr Drainoni); and Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston, Massachusetts (Dr Drainoni).
J Perinat Neonatal Nurs. 2024;38(3):271-279. doi: 10.1097/JPN.0000000000000766. Epub 2024 Jul 29.
Low uptake of social determinants of health (SDH) screening and referral interventions within neonatal intensive care units (NICUs) is partly due to limited understanding of the best procedures to integrate this practice into routine clinical workflows.
To examine the feasibility and acceptability of an SDH screening and referral intervention in the NICU from the perspective of neonatal nurses; and to identify factors affecting implementation outcomes.
We conducted 25 semistructured interviews with NICU nurses. We used the Promoting Action on Research Implementation in Health Services (PARiHS) framework to guide interview questions and codebook development for directed content analysis. Themes were mapped onto the 3 PARiHS domains of context, evidence, and facilitation.
Analysis yielded 8 themes. Context : Nurses felt that stressors experienced by NICU families are magnified in a safety net environment. Nurses shared varying viewpoints of the roles and responsibilities for social care in the NICU, and feared that scarcity of community resources would make it difficult to address families' needs. Evidence : The intervention was perceived to increase identification of adverse SDH and provision of resources; and to potentially jump-start better caregiver and infant health trajectories. Facilitation : Procedures that improved acceptability included dynamic training and champion support, regular feedback on intervention outcomes, and strategies to reduce stigma and bias.
We identified contextual factors, concrete messaging, and training procedures that may inform implementation of SDH screening and referral in NICU settings.
新生儿重症监护病房（NICU）中社会决定因素健康（SDH）筛查和转介干预措施的采用率较低，部分原因是对将这一实践融入常规临床工作流程的最佳程序缺乏了解。
从新生儿护士的角度考察 NICU 中 SDH 筛查和转介干预措施的可行性和可接受性；并确定影响实施结果的因素。
我们对 25 名新生儿护士进行了半结构化访谈。我们使用促进健康服务研究实施行动（PARiHS）框架来指导访谈问题和定向内容分析的编码手册开发。主题被映射到 PARiHS 的 3 个领域，即背景、证据和促进。
分析产生了 8 个主题。背景：护士们认为，安全网环境中 NICU 家庭所经历的压力因素被放大了。护士们对 NICU 中社会护理的角色和责任有不同的看法，并担心社区资源的匮乏会使满足家庭需求变得困难。证据：该干预措施被认为可以增加对不利 SDH 的识别和资源提供；并可能为更好的护理人员和婴儿健康轨迹奠定基础。促进：提高可接受性的程序包括动态培训和拥护者支持、对干预结果的定期反馈，以及减少污名化和偏见的策略。
我们确定了可能为 NICU 环境中 SDH 筛查和转介实施提供信息的背景因素、具体信息和培训程序。
