Emergency Department, Children's Hospital of Fudan University, Shanghai, China.
Nursing Department, ShenZhen Children's Hospital, Guangdong, China.
JBI Evid Implement. 2024 May 1;22(2):195-204. doi: 10.1097/XEB.0000000000000418.
Evidence-based nursing practice can reduce complications associated with central venous catheters (CVCs). In this project, the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework was considered an ideal theoretical instrument to identify facilitators and barriers to implementing evidence-based practice.
The project was conducted in pediatric intensive care units in six Chinese tertiary children's hospitals. Twenty-two audit criteria were obtained from best practice recommendations, and a baseline audit was conducted to assess current practice against best practice. Next, the i-PARIHS framework was used to identify facilitators and barriers to best practice and develop improvement strategies. A follow-up audit was then conducted to measure changes in compliance with best practices.
Facilitators and barriers were identified at the innovation, recipient, and context levels. A comprehensive CVC maintenance strategy was then developed to apply the best evidence to nurses' clinical work. Of the 22 audit criteria, 17 showed significant improvement compared with the baseline audit.
The i-PARIHS framework is an effective tool for developing targeted, evidence-based improvement strategies and applying these to the clinical setting. The quality of the nurses' clinical practice improved during CVC maintenance. However, there is no certainty that these positive results can be maintained, and long-term data are needed to verify this.
循证护理实践可以减少与中心静脉导管（CVC）相关的并发症。在这个项目中，综合促进卫生服务研究实施行动（i-PARIHS）框架被认为是识别实施循证实践的促进因素和障碍的理想理论工具。
该项目在六家中国三级儿童医院的儿科重症监护病房进行。从最佳实践建议中获得了 22 项审核标准，并进行了基线审核，以评估当前实践与最佳实践的差距。然后，使用 i-PARIHS 框架来识别最佳实践的促进因素和障碍，并制定改进策略。随后进行了后续审核，以衡量对最佳实践的遵守情况的变化。
在创新、接受者和环境层面确定了促进因素和障碍。然后制定了一项全面的 CVC 维护策略，将最佳证据应用于护士的临床工作中。在 22 项审核标准中，有 17 项与基线审核相比有显著改善。
i-PARIHS 框架是制定有针对性的循证改进策略并将其应用于临床环境的有效工具。在 CVC 维护过程中，护士临床实践的质量得到了提高。然而，不能确定这些积极的结果能否持续，需要长期数据来验证这一点。
