College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, South Australia, Australia; School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Queensland, Australia; School of Health, University of the Sunshine Coast, Queensland, Australia; Sunshine Coast Health Institute, Queensland, Australia.
Intensive Care Unit, Gold Coast University Hospital, Queensland Health, Queensland, Australia.
Intensive Crit Care Nurs. 2024 Feb;80:103553. doi: 10.1016/j.iccn.2023.103553. Epub 2023 Oct 1.
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.
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.
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.
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 integrated strategies, research evidence dissemination, audit, and feedback. However, there was a lack of consistency in practices such as audit, feedback, and patient participation.
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.
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.
有研究证据和临床实践指南可用于预防中心静脉相关血流感染。然而，对于基于证据的中心静脉置管护理的障碍和促进因素知之甚少。
本研究旨在调查成人重症监护病房中基于证据的中心静脉置管护理的促进因素和障碍。
这项探索性定性研究涉及焦点小组和访谈，对象是参与澳大利亚一家三级重症监护病房中心静脉置管插入和管理的注册护士和医生。采用目的抽样法招募具有不同临床经验和临床职位的工作人员（n=26）。共进行了 6 个焦点小组和 3 个单独的访谈。访谈内容进行了录音、逐字记录，并使用内容分析法进行了分析。
出现了三个总体类别：支持最佳绩效的工作结构；优化护理质量的流程，以及影响员工行为的因素。优化中心静脉置管护理的感知促进因素包括程序文件中使用明确的语言、工作系统综合策略、研究证据传播、审计和反馈。然而，在审计、反馈和患者参与等方面的做法缺乏一致性。
为了有效改善中心静脉置管护理，未来的干预措施应针对已确定的障碍进行调整，包括将审计和反馈纳入临床医生的工作流程。此外，还需要进一步研究患者及其家属在中心静脉置管护理中的作用。
在制定实践政策或程序手册时，使用明确的语言来确保向临床医生清晰传达基于证据的建议非常重要。整合到工作流程中的策略可以提高对基于证据的实践的依从性。教育资源有限的大型科室应探索在线教育等创新方法，以确保最佳的中心静脉置管护理。
