School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Glob Health Action. 2024 Dec 31;17(1):2328894. doi: 10.1080/16549716.2024.2328894. Epub 2024 Apr 5.
Globally, every year, approximately 1 million foetal deaths take place during the intrapartum period, fetal heart monitoring (FHRM) and timely intervention can reduce these deaths.
This study evaluates the implementation barriers and facilitators of a device, Moyo for FHRM.
The study adopted a qualitative study design in four hospitals in Nepal where Moyo was implemented for HRM. The study participants were labour room nurses and convenience sampling was used to select them. A total of 20 interviews were done to reach the data saturation. The interview transcripts were translated to English, and qualitative content analysis using deductive approach was applied.
Using the deductive approach, the data were organised into three categories i) changes in practice of FHRM, ii) barriers to implementing Moyo and iii) facilitators of implementing Moyo. Moyo improved adherence to intermittent FHRM as the device could handle higher caseloads compared to the previous devices. The implementation of Moyo was hindered by difficulty to organise training ondevice during non-working hours, technical issue of the device, nurse mistrust towards the device and previous experience of poor implementation to similar innovations. Facilitators for implementation included effective training on how to use Moyo, improvement in intrapartum foetal monitoring and improvement in staff morale, ease of using the device, Plan Do Study Act (PDSA) meetings to improve use of Moyo and supportive leadership.
The change in FHRM practice suggests that the implementation of innovative solution such as Moyo was successful with adequate facilitation, supportive staff attitude and leadership.
在全球范围内，每年大约有 100 万胎儿死亡发生在分娩期间，胎儿心率监测（FHRM）和及时干预可以减少这些死亡。
本研究评估了一种设备 Moyo 在胎儿心率监测中的实施障碍和促进因素。
该研究采用了在尼泊尔的四家医院进行的定性研究设计，Moyo 用于 FHRM。研究参与者是产房护士，采用便利抽样法选择他们。共进行了 20 次访谈，以达到数据饱和。访谈记录被翻译成英文，并采用演绎法进行定性内容分析。
使用演绎法，数据被组织成三个类别：i）FHRM 实践的变化，ii）实施 Moyo 的障碍，iii）实施 Moyo 的促进因素。Moyo 改善了间歇性 FHRM 的依从性，因为该设备可以处理比以前设备更高的病例量。Moyo 的实施受到一些障碍的阻碍，例如在非工作时间组织设备培训困难、设备技术问题、护士对设备的不信任以及之前类似创新实施经验不佳。实施的促进因素包括如何使用 Moyo 的有效培训、分娩期间胎儿监测的改善以及员工士气的提高、设备使用的便利性、通过 PDSA 会议提高 Moyo 的使用以及得到支持的领导力。
FHRM 实践的改变表明，通过充分的促进、支持性的员工态度和领导力，实施创新解决方案，如 Moyo，是成功的。
