Christine E Cassidy1, Lauren MacEachern2, Shauna Best3, Laura Foley4, Mary Elizabeth Rowe5, Katherine Dugas6, Jessica L A Mills7. 1. IWK Health Centre, Halifax, Nova Scotia, Canada; Dalhousie University School of Nursing, Halifax, Nova Scotia, Canada. Electronic address: christine.cassidy@iwk.nshealth.ca. 2. IWK Health Centre, Halifax, Nova Scotia, Canada. Electronic address: lauren.macheachern@iwk.nshealth.ca. 3. IWK Health Centre, Halifax, Nova Scotia, Canada. Electronic address: shauna.best@iwk.nshealth.ca. 4. IWK Health Centre, Halifax, Nova Scotia, Canada. Electronic address: laura.foley@iwk.nshealth.ca. 5. IWK Health Centre, Halifax, Nova Scotia, Canada. Electronic address: mary.rowe@iwk.nshealth.ca. 6. IWK Health Centre, Halifax, Nova Scotia, Canada. Electronic address: katherine.dugas@iwk.nshealth.ca. 7. IWK Health Centre, Halifax, Nova Scotia, Canada; Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada. Electronic address: jessica.mills@iwk.nshealth.ca.
Abstract
PURPOSE: The purpose of this study was to identify and compare barriers and enablers to the implementation of the Children's Hospital Early Warning Score (CHEWS) on a pediatric inpatient unit pre- and post-implementation. DESIGN AND METHODS: A qualitative descriptive design, guided by the Theoretical Domains Framework, was used to conduct semi-structured focus groups and individual interviews with nurses on a pediatric inpatient unit to identify barriers and enablers in the pre- and post- CHEWS implementation phases. Data were analyzed using a directed content analysis approach followed by inductive thematic analysis. RESULTS: Two pre-implementation focus groups (N = 15) and 8 post-implementation individual interviews with nurses were conducted. We identified pre- and post- CHEWS implementation barriers related to clinical decision making, interprofessional relationships, the unit context, and negative emotions, and enablers related to quality of care and patient safety. The identified barriers and enablers to implementation were categorized within 13 TDF domains. CONCLUSIONS: Our findings illustrate a range of barriers and enablers to CHEWS implementation during the pre- and post-implementation phases. Tailored strategies are needed to overcome barriers related to nurses' perceptions of CHEWS impeding clinical decision-making and interprofessional collaboration. By addressing the identified barriers, we can leverage nurses' motivations for using CHEWS to improve the quality of patient care and enhance patient safety. PRACTICE IMPLICATIONS: The barriers and enablers identified in this study can be used to select implementation strategies to support the use of early warning systems in pediatric nursing practice.
PURPOSE: The purpose of this study was to identify and compare barriers and enablers to the implementation of the Children's Hospital Early Warning Score (CHEWS) on a pediatric inpatient unit pre- and post-implementation. DESIGN AND METHODS: A qualitative descriptive design, guided by the Theoretical Domains Framework, was used to conduct semi-structured focus groups and individual interviews with nurses on a pediatric inpatient unit to identify barriers and enablers in the pre- and post- CHEWS implementation phases. Data were analyzed using a directed content analysis approach followed by inductive thematic analysis. RESULTS: Two pre-implementation focus groups (N = 15) and 8 post-implementation individual interviews with nurses were conducted. We identified pre- and post- CHEWS implementation barriers related to clinical decision making, interprofessional relationships, the unit context, and negative emotions, and enablers related to quality of care and patient safety. The identified barriers and enablers to implementation were categorized within 13 TDF domains. CONCLUSIONS: Our findings illustrate a range of barriers and enablers to CHEWS implementation during the pre- and post-implementation phases. Tailored strategies are needed to overcome barriers related to nurses' perceptions of CHEWS impeding clinical decision-making and interprofessional collaboration. By addressing the identified barriers, we can leverage nurses' motivations for using CHEWS to improve the quality of patient care and enhance patient safety. PRACTICE IMPLICATIONS: The barriers and enablers identified in this study can be used to select implementation strategies to support the use of early warning systems in pediatric nursing practice.
Authors: Asya Agulnik; Gia Ferrara; Maria Puerto-Torres; Srinithya R Gillipelli; Paul Elish; Hilmarie Muniz-Talavera; Alejandra Gonzalez-Ruiz; Miriam Armenta; Camila Barra; Rosdali Diaz; Cinthia Hernandez; Susana Juárez Tobias; Jose de Jesus Loeza; Alejandra Mendez; Erika Montalvo; Eulalia Penafiel; Estuardo Pineda; Dylan E Graetz Journal: JAMA Netw Open Date: 2022-03-01
Authors: Dylan Graetz; Erica C Kaye; Marcela Garza; Gia Ferrara; Mario Rodriguez; Dora Judith Soberanis Vásquez; Alejandra Méndez Aceituno; Federico Antillon-Klussmann; Jami S Gattuso; Belinda N Mandrell; Justin N Baker; Carlos Rodriguez-Galindo; Jennifer W Mack; Asya Agulnik Journal: JCO Glob Oncol Date: 2020-07
Authors: Marcela Garza; Dylan E Graetz; Erica C Kaye; Gia Ferrara; Mario Rodriguez; Dora Judith Soberanis Vásquez; Alejandra Méndez Aceituno; Federico Antillon-Klussmann; Jami S Gattuso; Belinda N Mandrell; Justin N Baker; Carlos Rodriguez-Galindo; Asya Agulnik Journal: Front Oncol Date: 2021-06-23 Impact factor: 6.244