La Trobe University, Melbourne, Victoria, Australia
La Trobe University, Melbourne, Victoria, Australia.
BMJ Open. 2024 Feb 13;14(2):e075896. doi: 10.1136/bmjopen-2023-075896.
Worldwide, neonatal jaundice accounts for considerable morbidity and mortality. Although severe adverse outcomes, such as hyperbilirubinaemia and kernicterus, are uncommon in high-income countries, these outcomes do occur, have enormous lifelong personal, health and social costs, and may be preventable. Evidence-based practice commonly relies on clinical guidelines; however, their implementation can be difficult. Implementation of neonatal jaundice care has been adversely affected by issues with professional boundaries, competing professional priorities and poor understanding of neonatal jaundice. This paper focuses on the perceptions and experiences of Australian health professionals involved in the management of neonatal jaundice.
Using a qualitative descriptive approach, semistructured interviews were undertaken to gain understanding of the experiences of health professionals in Australia across the scope of care for jaundiced newborns through an interpretivist approach and to identify possible gaps in the delivery of evidence-based care. Health professionals from a range of disciplines and care settings were recruited by purposive maximum variation sampling. Interviews were conducted face-to-face or by telephone with detailed notes taken and a field journal maintained. Interview scripts were verified by participants and imported into NVivo software. Data were analysed for major themes according to type and contexts of practice.
Forty-one health professionals from six broad discipline areas were interviewed. Two major themes and explanatory subthemes were found. The first theme, , highlighted gaps in evidence-based care, as described by four explanatory subthemes: professional boundaries, blindness to possibility of adverse outcomes, competing professional development priorities and unintended consequences.The second major theme, described participant perceptions that it was known what was required to improve care but how to achieve such changes was unclear. The two subthemes are: improvements in education and training, and standardised policies and protocols.
Multiple barriers to the provision of evidence-based care related to neonatal jaundice management are experienced by health professionals in Australia. Clinical guidelines are not sufficient to support health professionals deliver evidence-based care in the complex contexts in which they work. Implementation strategies for evidence-based practice need to take account of the experiences of health professionals and the challenges they face. Such strategies need to focus on improving collaboration between different disciplines for the well-being of those needing care. In the case of neonatal jaundice management, consideration is also needed in how to raise awareness of the importance of avoiding severe adverse outcomes, even when they might be rare, and how this might be done. Addressing issues that lead to disjointed care or poor knowledge of neonatal jaundice among health professionals is essential.
在全球范围内，新生儿黄疸会导致相当大的发病率和死亡率。尽管在高收入国家，严重的不良后果，如高胆红素血症和核黄疸，并不常见，但这些后果确实存在，会给个人带来巨大的终身健康和社会成本，而且可能是可以预防的。循证实践通常依赖于临床指南；然而，实施起来可能很困难。新生儿黄疸护理的实施受到专业界限、竞争专业优先级和对新生儿黄疸理解不佳等问题的影响。本文重点介绍澳大利亚参与管理新生儿黄疸的卫生专业人员的看法和经验。
使用定性描述方法，通过解释主义方法，对澳大利亚各护理领域的卫生专业人员进行半结构化访谈，以了解他们在管理黄疸新生儿方面的经验，并确定在提供循证护理方面可能存在的差距。通过目的性最大变异抽样，从各种学科和护理环境中招募卫生专业人员。面对面或通过电话进行访谈，详细记录笔记并保持现场日记。访谈脚本由参与者验证并导入 NVivo 软件。根据实践的类型和背景，对主要主题进行数据分析。
对来自六个广泛学科领域的 41 名卫生专业人员进行了访谈。发现了两个主要主题和解释性子主题。第一个主题，“专业界限和知识差距”，强调了循证护理中的差距，由四个解释性子主题描述：专业界限、对不良后果可能性的盲目性、竞争专业发展优先级和意外后果。第二个主要主题，“实施证据的挑战”，描述了参与者的看法，即知道需要改进护理，但如何实现这些变化尚不清楚。两个子主题是：教育和培训的改进，以及标准化的政策和协议。
澳大利亚卫生专业人员在提供新生儿黄疸管理循证护理方面面临多种障碍。临床指南不足以支持卫生专业人员在其工作的复杂环境中提供循证护理。实施循证实践的策略需要考虑卫生专业人员的经验和他们面临的挑战。此类策略需要专注于改善不同学科之间的合作，以造福需要护理的人。就新生儿黄疸管理而言，还需要考虑如何提高对避免严重不良后果的重要性的认识，即使这些后果可能很少见，以及如何做到这一点。解决导致卫生专业人员护理不连贯或对新生儿黄疸知识不足的问题至关重要。
